A survey of radiation oncologists regarding their radiation physics instruction.

The American Association of Physicists in Medicine, Committee on Training of Radiologists conducted a survey of radiation oncologists requesting information regarding their radiation oncology physics training. General questions were asked of the oncologist regarding their radiation oncology practice such as number of oncologists, number of new patients treated, and the size and type of facility in which the practice is located. The oncologist also responded to questions regarding their educational background. The survey requested the radiation oncologists to answer questions regarding the adequacy and importance of their training in specific areas of radiation physics. The responders indicated that the importance of most physics topics in their clinical practice corresponded to the level of their understanding. The survey indicated that for most radiation oncologists their physics instruction was an important and interesting part of their residency program.

Dosimetry of several DTPA radiopharmaceuticals in cisternography.

Previously published biologic distribution and clearance data for 169Yb-DTPA in cisternography were utilized to obtain effective spinal segment clearance data for six other easily dhelated radionuclides: 99mTc, 113mIn, 111In, 67Ga, 51Cr, and 203Pb. Absorbed radiation doses to the spinal cord and nerve roots were calculated for each radioactive DTPA compound, employing appropriate cylindrical geometry and reduction coeffients for the dose contributions from the electrons of each radionuclide. Doses are maximal at the surface and decrease rapidly with distance from the surface. The relative useful photon flux from each DTPA radiopharmaceutical for approximately the same average absorbed radiation dose to the spinal cord was determined. The results indicate that 111In and 203Pb should be considered as possible radionuclide tags for DTPA cisternographic imaging.

Aerosol penetration ratio: a new index of ventilation.

Superimposition of nuclear medicine scintigrams and standard radiographs provides a unique opportunity for merging functional information intrinsic to nuclear medicine images with the high resolution anatomic detail of radiographs. A newly developed image processing system allows the merging of two separate films of greatly varying sizes to form a single composite image. Subsequent quantitative analysis of the composite image may be performed. Using the superimposition technique, [99mTc]DTPA aerosol ventilation scans (4.5 X 4.5 cm) were superimposed upon chest radiographs (35.6 X 43.2 cm) in 17 cystic fibrosis (CF) patients. Subsequent quantification of the area of nuclear scan ventilation and the radiographic lung area was then performed. A new quantitative radiologic index of ventilation, the aerosol penetration ratio (APR), was defined. Linear correlation of aerosol penetration ratio with residual volume (RV) as percent of total lung capacity (TLC) measured by body plethysmography was good. We conclude that the APR has validity as a physiologic parameter which localized regional excessive residual volume and correlates well with RV/TLC, the "gold standard" pulmonary function index of obstructive airway disease.

Comparison of dual-energy x-ray absorptiometry and dual photon absorptiometry for bone mineral measurements of the lumbar spine.

A new x-ray-based (dual-energy x-ray absorptiometry [DEXA]) instrument for measurement of bone mineral in the spine and hips (QDR-1000, Hologic, Inc.) was compared with a commercial dual photon absorptiometry (DPA) instrument that uses a 153Gd source (DP3, Lunar Radiation Corporation). Measurements were made on phantoms and lumbar spines of patients to study accuracy, precision, limitations, and compatibility of results between instruments. Both instruments measure bone mineral of integral bone in terms of area bone density with an entrance exposure of less than 5 mR. For spinal bone mineral measurements, the DEXA instrument had a shorter scanning time and higher resolution images than the DPA system. The DEXA instrument also showed better precision in a spine phantom and reduced influence of thickness for patient measurement. For bone mineral content, accuracy was about equal for both instruments; for measurements of the area of the region of interest, accuracy was better with the DEXA instrument. With both instruments, fat had little effect on bone mineral density in bone phantom studies. Measurements on both instruments were influenced by the location of a bone phantom within the photon beam. Results in patients showed good correlation (r = 0.988) for bone mineral density. Measurements of bone mineral density in patients were consistently lower with the DEXA instrument because of better accuracy in area measurements. The new x-ray-based instrument is a major advance in bone mineral absorptiometry and provides improved, yet less expensive, measurements in research and clinical applications.

Routine quality control tests for film-screen mammographic systems with automatic exposure control.

Quality control of the contrast and density of mammograms is of extreme importance not only because of patient dose considerations but also because of the need to monitor changes in the breast over extended periods of time. A phantom and test technique has been developed and used at two institutions for monitoring the ability of mammographic generators and phototiming systems to provide consistent contrast and density. The phantom consists of a solid acrylic block and an embedded aluminum step wedge designed specially for low kVp use. Optical densities of various portions of the phantom are used to determine constancy of density and contrast. By minimizing fluctuations due to processing and film handling, normal variations were reduced enough to determine changes in contrast and density due to generator and phototimer changes equivalent to those monitored in processor quality control programs. The data have been correlated with changes in processor function. Changes in density and contrast values have also been related to phototimer malfunction and reduced image quality.

Performance testing of a dedicated magnetic resonance peripheral blood flow scanner.

This work presents a novel investigation of an NMR device to measure blood flow. Continuous-wave magnetic resonance scanners are now available for noninvasive peripheral blood flow measurements. The appearance of dedicated peripheral blood flow scanners in the clinical setting requires analysis of system performance. No reports were found that explore methods or results of clinical MR blood flow scanner performance evaluation. This work was undertaken to identify the testing procedures and characteristics of a clinical, dedicated NMR blood flow scanner. The dependence of flow measurement on tubing size, material, offset from isocenter, and angulation was examined. In addition, the precision and accuracy of the scanner were investigated. The results demonstrate a strong dependence between the measured blood flow and both the tube size and flow rate. The tube offset results exhibited a region of weak dependence in the center of the bore, which becomes stronger near the edge. The measured flow rate was found to be relatively insensitive to tube angles less than 30 degrees to 55 degrees. The repeatability was typically better than 5% and the table positioning was found to be highly accurate.

Dose calibrator response to brachytherapy sources: A Monte Carlo and analytic evaluation.

It is well known that the dose calibrator response/unit exposure rate depends significantly upon source energy. However, investigation of 137Cs, 192Ir, and 226Ra brachytherapy sources by empirical, analytical, and Monte Carlo techniques shows that source filtration significantly affects the calibrator reading to exposure rate conversion factor. The results demonstrate that for each clinically used filtration thickness an exposure calibrated standard source is required to establish the response of the well chamber. An interesting consequence of this analysis is that the Sievert point dose algorithm for clinical sources overestimates the dose on the order of 3% at distances of approximately 3.5 cm from the source.

Monte Carlo advice.

The generation of long, high quality random number sequences for Monte Carlo simulations using minicomputers is considered. The importance of the thorough testing of Monte Carlo random number generators is emphasized. A recommendation is given to authors of Monte Carlo papers to specify their random number generator and to describe the randomness testing which that generator has undergone.

The technical design and performance of ultrafast computed tomography.

The ultrafast radiograph CT scanner utilizes a scanning electron beam and semicircular tungsten targets to produce a moving radiograph source about the patient, thus eliminating mechanical motion within the gantry. This design allows scan times as short as 50 or 100 ms, as well as two levels of image resolution. The short scan time reduces the effects of motion blurring and artifacts and provides the ability to obtain high-quality images of dynamic processes and rapidly moving organs. When utilized in the SS (high-resolution) mode, the UFCT scanner provides contiguous image acquisition through a patient volume at rapid speeds, yet maintains image quality comparable with conventional CT scanners. This technology provides extremely short exposure times, rapid acquisition of multiple slices, continuous scanning without concern for anode heat storage and dissipation, and the ability to image moving organs or flowing contrast media. Many clinical applications exist that exploit these unique features.

Monte Carlo evaluation of the Sievert integral for brachytherapy dosimetry.

The Sievert integral, widely used to compute dose distributions about filtered line sources, assumes that the emitted energy fluence is exponentially attenuated by the filter thickness traversed by the primary photons. To evaluate this approximation, a Monte Carlo simulation was performed realistically modelling the diffusion and energy degradation of primary photons due to coherent, incoherent and photoelectric interactions in the source filter. Estimates of the exposure rate at points near the source were obtained using analytical averaging. Comparison of the two models shows that for 226Ra and 192Ir sources, the Sievert algorithm consistently overestimates the exposure rate per unit activity. However, such errors may be significantly reduced if source intensity is expressed in terms of exposure rate. Computed exposure rate distributions based on exposure rate calibrations are also less sensitive to uncertainties in available spectroscopic data.

Electron dose reduction coefficients for seven radionuclides and cylindrical geometry.

In determining internal radiation absorbed dose it is frequently not possible to assume a uniform distribution of radionuclide in an infinite, homogeneous, absorbing material. When the source-target geometry is such that the target is source-free, special considerations must be given to the dose contributions from electrons, since the conventional assumption of 100% absorption of non-penetrating radiations leads to overestimation of the absorbed dose. The absorbed dose from electrons determined at a point within the source-free region depends upon the depth within it. Electron dose reduction coefficients determined at appropriate distances from the source surface are multiplied by the electron doses determined from the general absorbed dose equation. This method of correcting for source-free regions has been applied to cylindrical and planar geometry, for spinal cord and nerve root dosimetry in cisternography. Utilising published scaled point kernels for mono-energetic electrons, electron dose reduction coefficients have been determined as a function of depth from the source surface for cylindrical source-free regions of radii 0.5, 0.05 cm and infinity, and seven gamma-ray-emitting radionuclides: 51Cr, 67Ga, 99Tcm, 111In, 113Inm, 169Yb and 203Pb. These values may be used in other internal radiation absorbed dose situations, and similar techniques applied to other source-target geometries.

The significance of electron binding corrections in Monte Carlo photon transport calculations.

Many Monte Carlo simulations ignore coherent scattering events and utilise the Klein-Nishina free electron distribution, rather than the incoherent differential cross-section, for choosing the trajectories of incoherently scattered photons. We assess the accuracy of this model by comparing its results with those of the complete bound electron model (form factor approach), which simulates coherent scattering events, and uses the appropriate bound electron angular scattering distributions. Both analytic and Monte Carlo calculations demonstrate that use of the free electron scattering distributions significantly underestimates the angular distribution of scattered photon energy resulting from low and medium energy photons incident upon carbon, iron, and platinum barriers. In using the free electron approximations to calculate barrier transmission, significant errors occur only for primary photon energies below 100 keV. Implementation of the complete bound electron model reduces the computational efficiency of our Monte Carlo code by only 10-25%.

Patient doses in bone mineral densitometry.

Procedures were developed to compute effective dose equivalent (H(E)) values for patients undergoing bone mineral densitometry (BMD) measurements such as dual energy X-ray absorptiometry (DEXA) and quantitative computed tomography (QCT). Representative values of H(E) were determined for patients undergoing each type of BMD procedure. Typical DEXA measurements are associated with an H(E) of about 2.5 microSv. For QCT, the values of H(E) are 300 microSv for single energy techniques and 1 mSv for dual energy techniques, respectively. By comparison, a single well collimated abdominal X-ray examination often taken in conjunction with DEXA studies results in an H(E) of about 100 microSv. BMD patient doses are at the lower end of the exposure range encountered in diagnostic radiology. As a result, radiation dose is not a primary factor in choosing the method for BMD determination.

Effect of titanium endoprostheses on bone mineral density measurements, using quantitative computed tomography.

Quantitative computed tomography has been used extensively to measure bone mineral density; particularly in the vertebral column and in the proximal portion of the femur in human beings with osteoporosis. Other potential applications of this technique include evaluation of bone adjacent to metallic endoprostheses and evaluation of fractures as they heal. Unfortunately, metal causes severe image degradation, principally seen as starburst streaking. One method used to decrease these artifacts is by imaging less-attenuating materials, such as titanium alloy. Titanium decreases image degradation sufficiently to allow accurate determination of the geometric properties of cadaveric bone. In our study, the effect of a titanium segmental endoprosthesis on bone mineral density measurement was determined by use of bone specimens from dogs and calibration standards. Titanium decreased the bone mineral density of calibration solutions from 6.8 (500 mg/cm3) to 17.7% (250 mg/cm3), and increased bone mineral density of cortical bone by 5.3%. Titanium did not affect the repeatability of these scans, indicating that the error caused by titanium was systematic and can be corrected. Our data were suggestive that quantitative computed tomography can be used to measure bone mineral density of cortical bone adjacent to titanium endoprostheses, with a predictable increase in density measurement.

Multiplanar quantitative computed tomography for bone mineral analysis in dogs.

The purpose of this study was to determine the precision and accuracy of quantitative computed tomography bone mineral analysis in dogs in coronally reconstructed images. Nonhomogeneous tissues, such as bones with fractures or deformities, may be better analyzed if multiplanar reconstruction of the transaxial data could be performed without degradation of information. Our analysis demonstrated that coronal reconstruction of quantitative-computed tomography data was precise (1.2 to 4.7%) and accurate (1.3 to 7.5%) in vitro. The technique displays high-quality images, which can be analyzed at any location within the volume scanned. Quantitative computed tomography of canine osteotomy healing in vivo accurately determined bone mineral density of selected regions of interest. Bone mineral density correlated highly with calcium content of the tissue (R2 = 0.76, P less than 0.0001).

Hand dose measurements in interventional radiology.

Measurements of radiation dose to the hand were conducted using TLD ring badges for individual interventional radiology cases. Results from over 30 examinations (including transhepatic cholangiograms and biliary and nephrostomy procedures) conducted by four radiologists using identical equipment show an average hand dose of 1.5 mGy (150 mrad) per procedure. Hand dose varied inversely with distance from the patient. Due to variable hand positions during clinical examinations, fluoroscopic time was not found to be a good indicator of hand dose.