Support for the "Vancouver call for action to strengthen expertise in radiological protection worldwide": the position of organisations in formal relations with the International Commission on Radiological Protection (ICRP).

The International Commission on Radiological Protection (ICRP), recently expressed concern that "a shortage of investment in training, education, research, and infrastructure seen in many sectors and countries may compromise society's ability to properly manage radiation risks" and in 2022 announced the "Vancouver call for action to strengthen expertise in radiological protection worldwide". As representatives of organisations in formal relations with ICRP, we decided to promote this position paper to declare and emphasise that strengthening the expertise in radiological protection is a collective priority for all of us.

Cone beam CT doses in radiotherapy patient positioning in Finland-prostate treatments.

Imaging parameters, frequencies and resulting patient organ doses in treatments of prostate cancer were assessed in Finnish radiotherapy centres. Based on a questionnaire to the clinics, Monte Carlo method was used to estimate organ doses in International Commission on Radiological Protection standard phantom for prostate, bladder, rectum and femoral head. The results show that doses from cone beam computed tomography imaging have reduced compared to earlier studies and are between 3.6 and 34.5 mGy per image for the above-mentioned organs and for normal sized patients. There still is room for further optimization of the patient exposure, as many centres use the default imaging parameters, and the length of the imaged region may not be optimal for the purpose.

Optimization of contrast and dose in x-ray phase-contrast tomography with a Talbot-Lau interferometer.

X-ray phase-contrast imaging has become a valuable tool for biomedical research due to its improved contrast abilities over regular attenuation-based imaging. The recently emerged Talbot-Lau interferometer can provide quantitative attenuation, phase-contrast and dark-field image data, even with low-brilliance x-ray tube sources. Thus, it has become a valid option for clinical environments. In this study, we analyze the effects of x-ray tube voltage and total number of images on the contrast-to-noise ratio (CNR) and dose-weighted CNR (CNRD) calculated from tomographic transmission and phase-contrast data of a phantom sample. Constant counting statistics regardless of the voltage was ensured by adjusting the image exposure time for each voltage setting. The results indicate that the x-ray tube voltage has a clear effect on both image contrast and noise. This effect is amplified in the case of phase-contrast images, which is explained by the polychromatic x-ray spectrum and the dependence of interferometer visibility on the spectrum. CNRD is additionally affected by the total imaging time. While submerging the sample into a water container effectively reduces image artefacts and improves the CNR, the additional attenuation of the water must be compensated with a longer exposure time. This reduces dose efficiency. Both the CNR and CNRD are higher in the phase-contrast images compared to transmission images. For transmission images, and phase-contrast images without the water container, CNRD can be increased by using higher tube voltages (in combination with a lower exposure time). For phase-contrast images with the water container, CNRD is increased with lower tube voltages. In general, the CNRD does not strongly depend on the number of tomographic angles or phase steps used.

Metrology supporting the European regulation for radiation protection.

The European Association of National Metrology Institutes (EURAMET) within its research programme European Metrology Programme for Innovation and Research (EMPIR) funded project EMPIR 19NET03 supportBSS that contributes to the establishment of a European Metrology Network (EMN) for Radiation Protection (RP). The EMN-RP was established in September 2021 with the intent to work as a meeting point for the metrology community and all stakeholders in the field of ionising radiation regulation, thus providing quality assurance for measurements in each of the exposure situations contemplated in the European Legislation. Within project EMPIR 19NET03, work package 3 aims at the preparation of a Strategic Research Agenda (SRA) by identifying the metrology needs to support the European legislation and regulation in Radiation Protection and of two Roadmaps for metrology services, one under the European Council Directive 2013/59/EURATOM and the other under the EURATOM Treaty. Following a Gaps Workshop held in September 2020 and a second internal workshop that took place in April 2022, a questionnaire was prepared for distribution to the stakeholders, e.g. RP platforms and authorities, academia, industry, among other, together with an accompanying paper. In this paper, the authors present the state of the art of European legislation in RP, address the importance of metrology, the practices and activities that need metrology to meet the requirements set in the regulations, emphasise the need for quality assured measurements in all fields, highlight the stakeholders contributions in their specific area and show their vision of the EMN-RP.

Construction of a radiation beam scanner and investigation of volume averaging correction factor effects on beam-profile.

In radiation beam-profile measurements, an accurate positioning of the detector with high position resolution is essential. For this purpose, we built a scanning device capable of moving a detector in three dimensions (3D) using mainly parts from a commercial 3D-printer. The accuracy and repeatability of movement was tested with caliper, laser displacement sensor and repeated 60Co beam-profile measurements in a water phantom. The results from the caliper and the sensor showed position accuracy for the scanner to be better than $\pm$150 µm. The standard deviation of the error in position from laser sensor measurements was approximately 30 µm, and the beam profile scans showed a maximum deviation from the mean position of 50 µm. The effect of volume averaging correction factors on 60Co beam-profile was investigated with two different sized ionization chambers. The differences in the profiles were reduced significantly after applying the correction factors.

Current status of diagnostic reference levels in interventional cardiology.

Interventional cardiology provides indisputable benefits for patients but uses a substantial amount of ionising radiation. The diagnostic reference level (DRL) is the tool recommended by the International Commission on Radiological Protection to optimise imaging procedures. In this work, a review of studies dealing with radiation dose or recommending DRL values for interventional cardiology since 2010 is presented, providing quantitative and qualitative results. There are many published papers on coronary angiography (CA) and percutaneous coronary intervention. The DRL values compiled for different continental regions are different: the DRL for CA is about 35 Gy cm2for Europe and 83 Gy cm2for North America. These differences emphasise the need to establish national DRLs considering different social and/or economic factors and the harmonisation of the survey methodology. Surveys with a large amount of data collected with the help of dose management systems provide more reliable information with less chance of statistical bias than those with a small amount of data. The complexity of procedures and improvements in technology are important factors that affect the radiation dose delivered to patients. There is a need for additional data on structural and electrophysiological procedures. The analysis of paediatric procedures is especially difficult because some studies present results split into age bands and others into weight bands. Diagnostic procedures are better described, but there is a great variety of therapeutic procedures with different DRL values (up to a factor of nine) and these require a dedicated review.

Staff eye lens dose in interventional radiology and cardiology in Finland.

PURPOSE: The aim of this study was to investigate the eye lens and whole-body radiation doses to interventional radiology and cardiology staff in two Finnish hospitals. METHODS: Simultaneous measurements of personal dose equivalent quantities Hp(3) and Hp(10) were conducted in clinical conditions during different radiological and cardiological interventional procedures. In order to study the feasibility to estimate eye lens dose with Hp(10) measured over the protective apron or thyroid shield, the ratio between measured Hp(3) and Hp(10) was investigated. RESULTS AND CONCLUSIONS: Applying the obtained ratio on Hp(10) records from national dose register showed that only a small number of interventional radiologists and cardiologists in Finland may exceed eye lens equivalent dose levels of 20 mSv per year or 100 mSv in five consecutive years, but likely do not exceed 50 mSv in a single year. For the most Finnish interventionalists, the eye lens dose is well below 10 mSv per year. Nurses and radiographers assisting in interventions are, on average, less exposed than interventionalists, and will not exceed 20 mSv per year. Based on our results, Hp(10) measured over the protective apron or thyroid shield provides a conservative estimate of the eye lens dose for interventional radiologists and cardiologists, provided that appropriate protective glasses are used.

Dental cone beam CT: An updated review.

Cone beam computed tomography (CBCT) is a diverse 3D x-ray imaging technique that has gained significant popularity in dental radiology in the last two decades. CBCT overcomes the limitations of traditional two-dimensional dental imaging and enables accurate depiction of multiplanar details of maxillofacial bony structures and surrounding soft tissues. In this review article, we provide an updated status on dental CBCT imaging and summarise the technical features of currently used CBCT scanner models, extending to recent developments in scanner technology, clinical aspects, and regulatory perspectives on dose optimisation, dosimetry, and diagnostic reference levels. We also consider the outlook of potential techniques along with issues that should be resolved in providing clinically more effective CBCT examinations that are optimised for the benefit of the patient.

A European perspective on dental cone beam computed tomography systems with a focus on optimisation utilising diagnostic reference levels.

Cone beam computed tomography (CBCT) has been available since the late 1990s for use in dentistry. European legislation requires optimisation of protection and the use of diagnostic reference levels (DRLs) as well as regular quality control (QC) of the imaging devices, which is well outlined in existing international recommendations. Nevertheless, the level of application is not known. Earlier studies have indicated that few European countries have established DRLs and that patient doses (exposure parameters) have not been properly optimised. The EURADOS Working Group 12-Dosimetry in Medical Imaging undertook a survey to identify existing practices in Member States. Questionnaires were developed to identify equipment types, clinical procedures performed, and exposure settings used. The surveys were circulated to 22 countries resulting in 28 responses from 13 countries. Variations were identified in the exposure factors and in the doses delivered to patients for similar clinical indicators. Results confirm that patient doses are still not properly optimised and DRLs are largely not established. There is a need to promote the importance of performing QC testing of dental CBCT equipment and to further optimise patient exposure by establishment and use of DRLs as a part of a continuous optimisation process.

CONTEMPORARY RADIATION DOSES IN INTERVENTIONAL CARDIOLOGY: A NATIONWIDE STUDY OF PATIENT SKIN DOSES IN FINLAND.

In contemporary interventional cardiology, for typical elderly patients, the most severe radiation-related harm to patients can be considered to come from skin exposures. In this paper, maximum local skin doses in cardiological procedures are explored with Gafchromic film dosimetry. Film and reader calibrations and reading were performed at the Secondary Standards Dosimetry Laboratory of the Radiation and Nuclear Safety Authority (STUK), and data were gathered from seven hospitals in Finland. As alert levels for early transient erythema, 200 Gycm2 kerma area product (KAP) and 2000 mGy air kerma levels for transcatheter aortic valve implantations (TAVI) procedures are proposed. The largest doses were measured in TAVI (4158.8 mGy) and percutaneous coronary interventions (PCI) (941.68 mGy). Accuracies of the GE DoseWatch and Siemens CareMonitor skin dose estimates were reasonable, but more results are needed to reliably assess and validate the tools' capabilities and reliabilities. Uncertainty of the Gafchromic dosimetry was estimated as 9.1% for a calibration with seven data points and 19.3% for a calibration with five data points.

CONTEMPORARY RADIATION DOSES IN INTERVENTIONAL CARDIOLOGY: A NATIONWIDE STUDY OF PATIENT DOSES IN FINLAND.

The amount of interventional procedures such as percutaneous coronary intervention (PCI), transcatheter aortic valve implantation (TAVI), pacemaker implantation (PI) and ablations has increased within the previous decade. Simultaneously, novel fluoroscopy mainframes enable lower radiation doses for patients and operators. Therefore, there is a need to update the existing diagnostic reference levels (DRLs) and propose new ones for common or recently introduced procedures. We sought to assess patient radiation doses in interventional cardiology in a large sample from seven hospitals across Finland between 2014 and 2016. Data were used to set updated national DRLs for coronary angiographies (kerma-air product (KAP) 30 Gycm2) and PCIs (KAP 75 cm2), and novel levels for PIs (KAP 3.5 Gycm2), atrial fibrillation ablation procedures (KAP 25 Gycm2) and TAVI (KAP 90 Gycm2). Tentative KAP values were set for implantations of cardiac resynchronization therapy devices (CRT, KAP 22 Gycm2), electrophysiological treatment of atrioventricular nodal re-entry tachycardia (6 Gycm2) and atrial flutter procedures (KAP 16 Gycm2). The values for TAVI and CRT device implantation are published for the first time on national level. Dose from image acquisition (cine) constitutes the major part of the total dose in coronary and atrial fibrillation ablation procedures. For TAVI, patient weight is a good predictor of patient dose.

Potential occupational exposures in diagnostic and interventional radiology: statistical modeling based on Finnish national dose registry data.

BACKGROUND: Radiation worker categorization and exposure monitoring practices must be proportional to the current working environment. PURPOSE: To analyze exposure data of Finnish radiological workers and to estimate the magnitude and frequency of their potential occupational radiation exposure, and to propose appropriate radiation worker categorization. MATERIAL AND METHODS: Estimates of the probabilities of annual effective doses exceeding certain levels were obtained by calculating the survival function of a lognormal probability density function (PDF) fitted in the measured occupational exposure data. RESULTS: The estimated probabilities of exceeding annual effective dose limits of 1 mSv, 6 mSv, and 20 mSv were in the order of 1:200, 1:10,000, and 1:500,000 per person, respectively. CONCLUSION: It is very unlikely that the Category B annual effective dose limit of 6 mSv could even potentially be exceeded using modern equipment and appropriate working methods. Therefore, in terms of estimated effective dose, workers in diagnostic and interventional radiology could be placed into Category B in Finland. Current national personal monitoring practice could be replaced or supplemented using active personal dosimeters, which offer more effective means for optimizing working methods.

Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures.

PURPOSE: The feasibility of setting-up generic, hospital-independent dose alert levels to initiate vigilance on possible skin injuries in interventional procedures was studied for three high-dose procedures (chemoembolization (TACE) of the liver, neuro-embolization (NE) and percutaneous coronary intervention (PCI)) in 9 European countries. METHODS: Gafchromic® films and thermoluminescent dosimeters (TLD) were used to determine the Maximum Skin Dose (MSD). Correlation of the online dose indicators (fluoroscopy time, kerma- or dose-area product (KAP or DAP) and cumulative air kerma at interventional reference point (Ka,r)) with MSD was evaluated and used to establish the alert levels corresponding to a MSD of 2 Gy and 5 Gy. The uncertainties of alert levels in terms of DAP and Ka,r, and uncertainty of MSD were calculated. RESULTS: About 20-30% of all MSD values exceeded 2 Gy while only 2-6% exceeded 5 Gy. The correlations suggest that both DAP and Ka,r can be used as a dose indicator for alert levels (Pearson correlation coefficient p mostly >0.8), while fluoroscopy time is not suitable (p mostly <0.6). Generic alert levels based on DAP (Gy cm2) were suggested for MSD of both 2 Gy and 5 Gy (for 5 Gy: TACE 750, PCI 250 and NE 400). The suggested levels are close to the lowest values published in several other studies. The uncertainty of the MSD was estimated to be around 10-15% and of hospital-specific skin dose alert levels about 20-30% (with coverage factor k = 1). CONCLUSIONS: The generic alert levels are feasible for some cases but should be used with caution, only as the first approximation, while hospital-specific alert levels are preferred as the final approach.

NEUTRON FIELD CHARACTERISTICS AT RADIATION METROLOGY LABORATORY OF STUK.

Radiation metrology laboratory at Radiation and Nuclear Safety Authority (STUK) is Finnish national laboratory for ionizing radiation. In order to establish personal dose equivalent available for neutron calibration service, a project was started to evaluate the neutron reference fields in the present facility. The irradiation room conditions were characterized in order to establish reference conditions for personal dose equivalent. To verify the validity of the calculations, ambient dose equivalent rates and room return were measured and calculated for 241AmBe and 252Cf sources. First results of Monte Carlo calculations and measurements are presented in this article.

Imaging practices and radiation doses from imaging in radiotherapy.

Modern radiotherapy treatments require frequent imaging for accurate patient positioning relative to the therapeutic radiation beam. Imaging practices in five Finnish radiotherapy clinics were assessed and discussed from the patient dose optimization point of view. The results show that imaging strategies are not jointly established and variations exist. The organ absorbed doses depend on imaging technique and imaging frequency. In particular, organ doses from the cone beam computed tomography can have very large variations (a factor of 10-50 in breast imaging and factor of 5 in prostate imaging). The cumulative imaging organ dose from the treatment can vary by a factor of ten or more for the same treatment, depending on the chosen technique and imaging frequency. Awareness and optimization of the imaging dose in image-guided radiotherapy should be strengthened.

Actual and Potential Radiation Exposures in Digital Radiology: Analysis of Cumulative Data, Implications to Worker Classification and Occupational Exposure Monitoring.

Radiation worker categorization and exposure monitoring are principal functions of occupational radiation safety. The aim of this study was to use the actual occupational exposure data in a large university hospital to estimate the frequency and magnitude of potential exposures in radiology. The additional aim was to propose a revised categorization and exposure monitoring practice based on the potential exposures. The cumulative probability distribution was calculated from the normalized integral of the probability density function fitted to the exposure data. Conformity of the probabilistic model was checked against 16 years of national monitoring data. The estimated probabilities to exceed annual effective dose limits of 1 mSv, 6 mSv and 20 mSv were 1:1000, 1:20 000 and 1:200 000, respectively. Thus, it is very unlikely that the class A categorization limit of 6 mSv could be exceeded, even in interventional procedures, with modern equipment and appropriate working methods. Therefore, all workers in diagnostic and interventional radiology could be systematically categorized into class B. Furthermore, current personal monitoring practice could be replaced by use of active personal dosemeters that offer more effective and flexible means to optimize working methods.

Novel Equipment for In Situ Alpha Spectrometry with Good Energy Resolution.

An approach for in situ alpha spectrometry that allows one to measure the spectra with good energy resolution at ambient air pressure has been developed recently. Here, novel equipment is introduced for in situ measurements. Neither vacuum pumps nor radiochemical sample processing are necessary. Flat and smooth surfaces are ideal sources provided that the radionuclide contamination represents a thin layer on the surface. Other sources, such as air filters or evaporation residues, are also possible. Alpha particle collimation is used to obtain good energy resolution, but the equipment can also be used without collimation. An estimation of the detection efficiency with and without collimation is given using an extended area source containing 241Am.

Accuracy of the electron transport in mcnp5 and its suitability for ionization chamber response simulations: A comparison with the egsnrc and penelope codes.

PURPOSE: In this work, accuracy of the mcnp5 code in the electron transport calculations and its suitability for ionization chamber (IC) response simulations in photon beams are studied in comparison to egsnrc and penelope codes. METHODS: The electron transport is studied by comparing the depth dose distributions in a water phantom subdivided into thin layers using incident energies (0.05, 0.1, 1, and 10 MeV) for the broad parallel electron beams. The IC response simulations are studied in water phantom in three dosimetric gas materials (air, argon, and methane based tissue equivalent gas) for photon beams ((60)Co source, 6 MV linear medical accelerator, and mono-energetic 2 MeV photon source). Two optional electron transport models of mcnp5 are evaluated: the ITS-based electron energy indexing (mcnp5(ITS)) and the new detailed electron energy-loss straggling logic (mcnp5(new)). The electron substep length (ESTEP parameter) dependency in mcnp5 is investigated as well. RESULTS: For the electron beam studies, large discrepancies (>3%) are observed between the MCNP5 dose distributions and the reference codes at 1 MeV and lower energies. The discrepancy is especially notable for 0.1 and 0.05 MeV electron beams. The boundary crossing artifacts, which are well known for the mcnp5(ITS), are observed for the mcnp5(new) only at 0.1 and 0.05 MeV beam energies. If the excessive boundary crossing is eliminated by using single scoring cells, the mcnp5(ITS) provides dose distributions that agree better with the reference codes than mcnp5(new). The mcnp5 dose estimates for the gas cavity agree within 1% with the reference codes, if the mcnp5(ITS) is applied or electron substep length is set adequately for the gas in the cavity using the mcnp5(new). The mcnp5(new) results are found highly dependent on the chosen electron substep length and might lead up to 15% underestimation of the absorbed dose. CONCLUSIONS: Since the mcnp5 electron transport calculations are not accurate at all energies and in every medium by general clinical standards, caution is needed, if mcnp5 is used with the current electron transport models for dosimetric applications.

Simulated and measured spectral characteristics of 137Cs reference radiation beams.

137Cs sources are widely used in calibrations of radiation protection dosimeters and doserate meters. In these calibrations, conversion coefficients from the air kerma to various dose equivalent quantities are needed. These conversion quantities are functions of photon energy. In this work, Monte Carlo simulations and measurements are used for quantifying the energy distributions of the photon fluence from two 137Cs sources used for calibration purposes. The results indicate that the standard set of conversion coefficients, obtained from a monoenergetic spectrum, do not sufficiently take into account the scattered radiation (most of which is scattered by the source itself): For the large (14x15.6 mm) and small (3.5x3 mm) 137Cs sources, the simulated values for the conversion coefficients H'(0.07)/Ka and H*(10)/Ka (which were nearly equal for the both quantities) showed around 1.0 and 1.5% deviations from the ISO standard value 1.20 (for the large and small sources, respectively). Similarly, the conversion coefficient Hp(10)/Ka showed around 1.5 and 2.5% deviations from the ISO standard value 1.21 for the large and small 137Cs sources, respectively, whereas Hp(0.07)/Ka had the values 1.22 and 1.23. The amplitude of the variation of the conversion coefficients due to varying 137Cs source size did not exceed 1%. Thus, the overall uncertainty (with coverage factor k=2) due to varying source size for the average values of the conversion coefficients can be estimated as low as 0.6%.

Design, spectrum measurements and simulations for a 238Pu alpha-particle irradiator for bystander effect and genomic instability experiments.

Design, spectrum measurements and simulations for an alpha-particle irradiator for bystander effect and genomic instability experiments are presented. Measured alpha-particle energy spectra were used to confirm the characteristics of the source of the irradiator specified by the manufacturer of the source. The spectra were measured in vacuum with a high-resolution spectrometer and simulated with an AASI Monte Carlo code. As a next step, we simulated alpha-particle energy spectra at the target plane of the irradiator for three different source-to-target distances. In these simulations, helium was used as the medium between the source and the exit window of the irradiator; its pressure and temperature corresponded to those of the ambient air. Mean energies and full-widths at half-maximum (FWHM) were calculated for the three different helium gas tracks.