Estimation of occupational radiation doses in neuroendovascular procedures.

To estimate the mean effective dose per procedure with multiple dosimetry, to calculate the annual effective dose to personnel working in neuroendovascular procedures and compared with methods reported in the literature and with national and international limits. The radiation dose to personnel was monitored in 20 procedures classified as diagnostic or therapeutic. During each procedure, the equivalent dose to eyes, thyroid, under and over the lead apron at chest level, hands, gonads and knees was measured with lithium fluoride thermoluminescent dosimeter chips (TLD-100). Estimations of the annual effective dose from different methods found in literature that use one or two dosimeters and from this work were compared. Also, a comparison was made with the safety limits recommended in national and international regulations. Radiation exposure to eyes, thyroid, gonads and knees is relevant to the effective dose, and therefore to the annual effective dose estimations. Personnel position is important, as the performing physician, who is closer to the patient, received the highest dose measured. In particular, this was observed in the equivalent dose received over the apron. However, the equivalent dose to the right eye was higher for neuroanaesthesiologists than for performing physicians due to their position relative to the patient. In general, effective doses estimated using one- and two-dosimeter methods found in the literature were, respectively, lower and higher than those obtained with the ten-dosimeter method in this work. The annual effective doses to personnel estimated with the multiple dosimetry algorithm ranged from 1.3 to 1.5 mSv y-1and are within the national and international limits.

Comparing different methods for estimating radiation dose to the conceptus.

PURPOSE: To compare different methods available in the literature for estimating radiation dose to the conceptus (Dconceptus) against a patient-specific Monte Carlo (MC) simulation and a commercial software package (CSP). METHOD: Eight voxel models from abdominopelvic CT exams of pregnant patients were generated. Dconceptus was calculated with an MC framework including patient-specific longitudinal tube current modulation (TCM). For the same patients, dose to the uterus, Duterus, was calculated as an alternative for Dconceptus, with a CSP that uses a standard-size, non-pregnant phantom and a generic TCM curve. The percentage error between Duterus and Dconceptus was studied. Dose to the conceptus and percent error with respect to Dconceptus was also estimated for three methods in the literature. RESULTS: The percentage error ranged from -15.9% to 40.0% when comparing MC to CSP. When comparing the TCM profiles with the generic TCM profile from the CSP, differences were observed due to patient habitus and conceptus position. For the other methods, the percentage error ranged from -30.1% to 13.5% but applicability was limited. CONCLUSIONS: Estimating an accurate Dconceptus requires a patient-specific approach that the CSP investigated cannot provide. Available methods in the literature can provide a better estimation if applicable to patient-specific cases. KEY POINTS: • A patient's internal anatomy affects the dose to the conceptus. • Conceptus position has an influence on its dose estimation. • Patient anatomy and specific TCM must be considered for accurate conceptus dosimetry. • D uterus to a standard-size phantom should not be used as D conceptus .

Clinical indications and radiation doses to the conceptus associated with CT imaging in pregnancy: a retrospective study.

OBJECTIVE: To perform an internal audit at a university hospital with the aim of evaluating the number, clinical indication and operating procedure of computed tomography (CT) performed on pregnant patients and of estimating the radiation doses to the conceptus. METHODS: A retrospective review was conducted of all CT examinations performed in a single centre on pregnant patients between January 2008 and July 2013. The radiation doses to the conceptus were estimated. The results were compared with published data. RESULTS: The number of CT examinations during pregnancy increased from 3-4 per year in 2008-2011 to 11 per year in 2012. The mean estimated conceptus radiation dose was considered negligible for CT of the head and cervical spine, being less than 0.01 mGy, and for CT of the chest, less than 0.1 mGy. The estimated conceptus radiation dose from abdominopelvic CT was on average 28.7 mGy (range 6.7-60.5 mGy). CONCLUSIONS: The number of CT scans of pregnant patients increased threefold during the last few years. Most clinical indications and doses were in line with good clinical practice and literature; only in two cases the dose to the conceptus was higher than 50 mGy. KEY POINTS: • An increase in CT imaging of pregnant patients is of concern. • Clinical indications were in line with good practice. • Estimated conceptus doses were lower or similar to published data. • Internal guidelines for appropriate use of imaging during pregnancy should be established.

Effective dose and organ doses estimation taking tube current modulation into account with a commercial software package.

PURPOSE: To evaluate the effect of including tube current modulation (TCM) versus using the average mAs in estimating organ and effective dose (E) using commercial software. METHOD: Forty adult patients (24 females, 16 males) with normal BMI underwent chest/abdomen computed tomography (CT) performed with TCM at 120 kVp, reference mAs of 110 (chest) and 200 (abdomen). Doses to fully irradiated organs (breasts, lungs, stomach, liver and ovaries) and E were calculated using two versions of a dosimetry software: v.2.0, which uses the average mAs, and v.2.2, which accounts for TCM by implementing a gender-specific mAs profile. Student's t-test was used to assess statistically significant differences between organ doses calculated with the two versions. RESULTS: A statistically significant difference (p < 0.001) was found for E on chest and abdomen CT, with E being lower by 4.2% when TCM is considered. Similarly, organ doses were also significantly lower (p < 0.001): 13.7% for breasts, 7.3% for lungs, 9.1% for the liver and 8.5% for the stomach. Only the dose to the ovaries was higher with TCM (11.5%). CONCLUSION: When TCM is used, for the stylized phantom, the doses to lungs, breasts, stomach and liver decreased while the dose to the ovaries increased. KEY POINTS: • Estimated dose to the ovaries increased with TCM. • Estimated dose to lungs, breasts, stomach and liver decreased with TCM. • A unique but gender-specific mAs profile resulted in a radiation dose shift. • Even for normal size patients there is a variety in mAs profiles.

Peak skin and eye lens radiation dose from brain perfusion CT: CTDIvol and Monte Carlo based estimations.

PURPOSE: To quantify the eye lens, peak skin and brain doses associated with head CT perfusion exam by means of thermoluminescent dosimeters (TLDs) measurements in a cadaver and compare them to Monte Carlo (MC) dose estimations as well as to the CTDIvol. METHOD: 18 TLDs were inserted in the brain, skin, and eye lenses of a female cadaver head, who underwent a CT brain perfusion scan using a Siemens Definition Flash. The table-toggling protocol used 80 kVp, 200 mAs, 32 × 1.2 mm collimation and 30 sequences. From the CT images, a voxel model was created. Doses were calculated with a MC framework (EGSnrc) and compared to TLD measurements. TLD measurements were also compared to the displayed CTDIvol. RESULTS: The average measured doses were: 185 mGy for the eyes lenses, 107 mGy for the skin, 172 mGy for the brain and 273 mGy for the peak skin. The reported CTDIvol of 259 mGy overestimated the averaged organ doses but not the peak skin dose. MC estimated organ doses were 147 mGy for the eyes (average), 104 mGy for the skin and 178 mGy for the brain (-20 %, -3% and 4% difference respect to the TLDs measurements, respectively). CONCLUSIONS: CTDIvol remains a conservative metric for average brain, skin and eyes lenses doses. For accurate eye lens and skin dose estimates MC simulations can be used. CTDIvol should be used with caution as it was of the same order of magnitude as the peak skin dose for this protocol and this particular CT scanner.

CUSTOMISATION OF A MONTE CARLO DOSIMETRY TOOL FOR DENTAL CONE-BEAM CT SYSTEMS.

A versatile EGSnrc Monte Carlo (MC) framework, initially designed to explicitly simulate X-ray tubes and record the output data into phase space data files, was modified towards dental cone-beam computed tomography (CBCT) dosimetric applications by introducing equivalent sources. Half value layer (HVL) measurements were conducted to specify protocol-specific energy spectra. Air kerma measurements were carried out with an ionisation chamber positioned against the X-ray tube to obtain the total filtration attenuation characteristics. The framework is applicable to bowtie and non-bowtie inherent filtrations, and it accounts for the anode heel effect and the total filtration of the tube housing. The code was adjusted to the Promax 3D Max (Planmeca, Helsinki, Finland) dental CBCT scanner. For each clinical protocol, calibration factors were produced to allow absolute MC dose calculations. The framework was validated by comparing MC calculated doses and measured doses in a cylindrical water phantom. Validation results demonstrate the reliability of the framework for dental CBCT dosimetry purposes.