The ICRU Proposal for New Operational Quantities for External Radiation.

Report Committee 26 of the ICRU proposes a set of operational quantities for radiation protection for external radiation, directly based on effective dose and for an extended range of particles and energies. It is accompanied by quantities for estimating deterministic effects to the eye lens and the local skin. The operational quantities are designed to overcome the conceptual and technical shortcomings of those presently in use. This paper describes the proposed operational quantities, and highlights the improvements with respect to the present, legal monitoring quantities.

The role of active immunization therapy as preoperative treatment for chronic osteomyelitis.

BACKGROUND: This retrospective study was performed to assess the effectiveness of active immunostimulation therapy with bacterial immunotherapy (BIT) in treatment for chronic osteomyelitis (COM). MATERIALS AND METHODS: We analyze 154 patients affected by COM and treated with BIT from 1995 to 2009 at our Institution. Using Cierny and Mader classification, patients were divided according to their clinical status and anatomic nature of septic process. The data were analyzed considering several confounding factors, such as antibiotic therapy and hyperbaric oxygen therapy combined with the administration of BIT. According to clinical and radiographic parameters, patients were considered as unchanged, improved, or healed. RESULTS: After a mean follow-up of 40.4 months (median 38 months), healing was achieved in 41.6 % of cases. Multivariate statistical analysis showed that patient's clinical status is the most important prognostic factor of responding (p < 0.0005) and healing (p = 0.008) after therapy. The best healing rate (62 % of cases) was achieved in patients with a normal clinical condition (Cierny-Mader group A); it was worse (20 % of cases) in those patients with a compromised clinical status (Cierny-Mader group B). There was no healing case in group C. CONCLUSIONS: The results show the effectiveness of BIT in treatment of patients affected by COM with uncompromised clinical status. The use of this therapy must be assessed critically in patients with alterations in clinical conditions.

Monte Carlo variance reduction techniques: an overview with some practical examples.

Since the first developments of Monte Carlo radiation transport codes, the importance of solving deep penetration problems in the phase space was pointed out. Whilst natural Monte Carlo radiation transport models are rather easy and straightforward to be implemented, apart from geometry extreme complexities that could limit the modelling capabilities of the user, the possibility to obtain results with high precision and reasonable CPU time, when the scored events contributing to the response of interest are characterised by a low probability of occurrence, can be guaranteed only through biased games for which the user needs a robust expertise. The present paper wanted to present in a concise way the main aspects of the variance reduction techniques and some practical application to help the users in becoming more familiar with such a necessary tool.

Principles for the design and calibration of radiation protection dosemeters for operational and protection quantities for eye lens dosimetry.

The work package two of the ORAMED project--Collaborative Project (2008-2011) supported by the European Commission within its seventh Framework Programme--is devoted to the study of the eye lens dosimetry. A first approach is to implement the use of H(p)(3) by providing new sets of conversion coefficients and well suited calibration and type test procedures. This approach is presented in other papers in the proceedings of this conference. Taking into account that the eye lens is an organ close to the surface of the body, another approach would be to directly estimate the absorbed dose to the eye lens, D(lens,est) through a special calibration procedure although this quantity is not directly measurable. This paper is a methodological paper that tries to identify the critical aspects of a dosimetry in terms of D(lens).

Eye lens dosimetry: task 2 within the ORAMED project.

The ORAMED (Optimization of RAdiation protection for MEDical staff) project is funded by EU-EURATOM within the 7° Framework Programme. Task 2 of the project is devoted to study the dose to the eye lens. The study was subdivided into various topics, starting from a critical revision of the operational quantity H(p)(3), with the corresponding proposal of a cylindrical phantom simulating as best as possible the head in which the eyes are located, the production of a complete set of air kerma to dose equivalent conversion coefficients for photons from 10 keV to 10 MeV, and finally, the optimisation of the design of a personal dosemeter well suited to respond in terms of H(p)(3). The paper presents some preliminary results.

Extremity exposure in nuclear medicine: preliminary results of a European study.

The Work Package 4 of the ORAMED project, a collaborative project (2008-11) supported by the European Commission within its seventh Framework Programme, is concerned with the optimisation of the extremity dosimetry of medical staff in nuclear medicine. To evaluate the extremity doses and dose distributions across the hands of medical staff working in nuclear medicine departments, an extensive measurement programme has been started in 32 nuclear medicine departments in Europe. This was done using a standard protocol recording all relevant information for radiation exposure, i.e. radiation protection devices and tools. This study shows the preliminary results obtained for this measurement campaign. For diagnostic purposes, the two most-used radionuclides were considered: (99m)Tc and (18)F. For therapeutic treatments, Zevalin(®) and DOTATOC (both labelled with (90)Y) were chosen. Large variations of doses were observed across the hands depending on different parameters. Furthermore, this study highlights the importance of the positioning of the extremity dosemeter for a correct estimate of the maximum skin doses.

Knee arthrodesis with the Ilizarov external fixator as treatment for septic failure of knee arthroplasty.

BACKGROUND: The authors report the results of femoral-tibial fusion with an Ilizarov circular external fixator following septic loosening of knee prosthesis. MATERIALS AND METHODS: The series included 17 patients with a mean age of 62.9 years, treated from 1990 to 2007 with femoral-tibial fusion. The Cierny-Mader classification was used for clinical and anatomopathological evaluation; the Engh classification was used to assess the bone defect. Surgical treatment differed according to these criteria. RESULTS: Healing was achieved in 13 out of 17 patients at the first surgical attempt in a mean time of 9.3 months. Mean follow-up was 30 months. Of the four complications, two patients had an intolerance to the external fixator that led to its early removal, and the other two had a septic intraarticular nonunion. CONCLUSIONS: The Ilizarov circular external fixator is a very reliable fixation system due to its low cost, versatility, stability under load, and low risk of septic dissemination. Nevertheless, an appropriate patient selection and a good surgeon's experience are necessary.

Chronic recurrent multifocal and aspecific osteomyelitis: a case report.

Chronic recurrent multifocal and unspecific osteomyelitis (CRMUO) is a severe form of chronic nonbacterial osteomyelitis. Lesions can be found anywhere in the skeleton, in young patients, such as children or adolescents, chronic nonbacterial osteomyelitis often affects the metaphyses of the long bones. Furthermore, other organs like skin, eyes and gastrointestinal tract can also be affected. Because of symptoms and course of disease vary in significant way, a clinical diagnosis is often difficult. The radiographic appearance suggests subacute or chronic osteomyelitis. CRMUO may mimic acute hematogenous osteomyelitis, but bacterial culture are usually negative and nonspecific histopathological and laboratory findings are present. This kind of osteomyelitis is often diagnosed by exclusion of the two main differential diagnoses-bacterial infections and tumor-by assessing for a characteristic course and the findings by conventional radiography, if necessary supplemented by scintigraphy and magnetic resonance imaging (MRI). The MRI appearance of CRMUO lesions in tubular bones and the spine is often rather characteristic and can support the diagnosis. It is important to diagnose CRMUO to avoid unnecessary diagnostic procedures or therapy, and initiate an appropriate one. We present a case report of a 44-year-old woman diagnosed with CRMUO involving both femurs.

Analysis of the CONRAD computational problems expressing only stochastic uncertainties: neutrons and protons.

Within the scope of CONRAD (A Coordinated Action for Radiation Dosimetry) Work Package 4 on Computational Dosimetry jointly collaborated with the other research actions on internal dosimetry, complex mixed radiation fields at workplaces and medical staff dosimetry. Besides these collaborative actions, WP4 promoted an international comparison on eight problems with their associated experimental data. A first set of three problems, the results of which are herewith summarised, dealt only with the expression of the stochastic uncertainties of the results: the analysis of the response function of a proton recoil telescope detector, the study of a Bonner sphere neutron spectrometer and the analysis of the neutron spectrum and dosimetric quantity H(p)(10) in a thermal neutron facility operated by IRSN Cadarache (the SIGMA facility). A second paper will summarise the results of the other five problems which dealt with the full uncertainty budget estimate. A third paper will present the results of a comparison on in vivo measurements of the (241)Am bone-seeker nuclide distributed in the knee. All the detailed papers will be presented in the WP4 Final Workshop Proceedings.

Analysis of a computational problem involving complex voxel geometries.

This communication briefly summarises the results obtained from the 'International comparison on MC modeling for in vivo measurement of Americium in a knee phantom' organised within the EU Coordination Action CONRAD (Coordinated Network for Radiation Dosimetry) as a joint initiative of EURADOS working groups 6 (computational dosimetry) and 7 (internal dosimetry). Monte Carlo simulations using the knee voxel phantom proved to be a viable approach to provide the calibration factor needed for in vivo measurements.

Preliminary evaluations of the undesirable patient dose from a BNCT treatment at the ENEA-TAPIRO reactor.

Boron neutron capture therapy (BNCT) is an experimental technique for the treatment of certain kinds of tumors. Research in BNCT is performed utilizing both thermal and epithermal neutron beams. Epithermal neutrons (0.4 eV-10 keV) penetrate more deeply into tissue and are thus used in non-superficial clinical applications such as the brain glioma. In the last few years, the fast reactor TAPIRO (ENEA-Casaccia Rome) has been employed as a neutron source for research into BNCT applications. Recently, an 'epithermal therapeutic column' has been designed and its construction has been completed. The Monte Carlo code MCNPX was employed to optimize the design of the column and to evaluate the dose profiles and the therapeutic parameters in the cranium of the anthropomorphic phantom ADAM. In the same context, some preliminary evaluations of the undesirable doses to the patient were performed with MCNPX. A hermaphrodite phantom derived from ADAM and EVA was employed to evaluate the energy deposition in some organs during a standard BNCT treatment. The total dose consists of the contributions from the primary neutron beam, the neutron interactions with boron and the neutron induced photons generated in the epithermal column structures and in the patient's tissues. The paper summarizes the computational procedure and provides a general dosimetric framework of the patient radiological protection aspects related to a BNCT treatment scenario at the TAPIRO reactor.

Monte Carlo evaluated parameters for internal dosimetry.

The radiation doses received by individuals from radionuclides which enter the human body cannot be measured directly but must be inferred. In these calculations, several measurable quantities (such as the internal whole body burden or urine daily excretion) and quantities derived from models are employed. The Radiation Protection Quantities for internal dosimetry are, in principle, the same as for external dosimetry with the addition of quantities taking into account that the doses in the body are protracted. Other parameters are also necessary for the dose assessment, such as the SAFs (Specific Absorbed Fractions). All these quantities are calculated using Monte Carlo codes and complex anthropomorphic phantoms. Monte Carlo codes are also widely employed as useful tools during the calibration procedure for in vivo measurements. This paper summarises the role played by Monte Carlo modelling in these fields.

MCNPX internal dosimetry studies based on the NORMAN-05 voxel model.

Anthropomorphic computational models coupled with radiation transport codes are valuable tools in radiation protection dosimetry. In particular, they are very reliable for the estimate of the energy absorbed by different organs due to an incorporated radionuclide. MIRD-based stylised analytical models are widely accepted as standards but the recent generation of voxel phantoms, developed on real anatomical data derived from tomographic images, can represent a valid alternative for radiation protection and dosimetry purposes. Specific absorbed fraction evaluation and patient-specific dose estimate in nuclear medicine and radiotherapy could be considered as the optimal area for their implementation and use. On the other hand, the accuracy of organ and body structure representation guarantees an improved dose evaluation system also for radiation protection purposes in the workplace in case of accidental internal contamination. In the present work the voxel model NORMAN-05, a modified version of NORMAN (HPA, UK) model, has been employed with the Monte Carlo code MCNPX. Some preliminary investigations were carried out to evaluate the absorbed fractions for a series of source-target organ couples in case of gamma emitters and the organ absorbed doses in case of 90Sr incorporation. The paper summarises the main preliminary outcomes of such studies.

Monte Carlo modeling for individual monitoring.

Thanks to the continuously increasing computer power, Monte Carlo techniques are progressively playing a key role in radiation dosimetry, in the field of dose assessment from internal and external exposures. Internal dosimetry aspects are presented in a separate paper in the same issue. For external exposure, individual monitoring techniques provide suitable tools to estimate the personal dose equivalent Hp(d), that should be a conservative estimate of the effective dose. Personal dosemeters should be designed and type tested in terms of Hp(d) and also irradiations facilities should be characterised in terms of the same operational quantity. This paper provides a concise overview on the role played by monte Carlo techniques in the field.

Personal dosimetry in terms of HP(3): Monte Carlo and experimental studies.

Hp(3) has been defined as the operational quantity for eye lens dosimetry. Hp(3)/ka conversion coefficients were evaluated at the GSF (Germany) in a 30x30x15 cm3 4-elements ICRU slab phantom for various energies and incident angles through Monte Carlo. The ISO report 12,794 suggests to employ a PMMA water filled phantom, of the same dimensions, for dosemeter calibration in terms of Hp(3). The present paper briefly summarises the main aspects of a study carried out at ENEA-Radiation Protection Institute (Bologna, Italy) to provide practical procedures for the calibration of dosemeters in terms of Hp(3). Tabulations of a new set conversion coefficients and air kerma backscatter factors are provided as a function of energy and incident angle. The paper demonstrates that a more accurate approach to the dosimetric assessment in terms of Hp(3) could be rather simply introduced employing a reduced phantom.

Treating voxel geometries in radiation protection dosimetry with a patched version of the Monte Carlo codes MCNP and MCNPX.

The question of Monte Carlo simulation of radiation transport in voxel geometries is addressed. Patched versions of the MCNP and MCNPX codes are developed aimed at transporting radiation both in the standard geometry mode and in the voxel geometry treatment. The patched code reads an unformatted FORTRAN file derived from DICOM format data and uses special subroutines to handle voxel-to-voxel radiation transport. The various phases of the development of the methodology are discussed together with the new input options. Examples are given of employment of the code in internal and external dosimetry and comparisons with results from other groups are reported.

Pitfalls and modelling inconsistencies in computational radiation dosimetry: lessons learnt from the QUADOS intercomparison. Part I: Neutrons and uncertainties.

The QUADOS EU cost shared action conducted an intercomparison on the usage of numerical methods in radiation protection and dosimetry. The eight problems proposed were intended to test the usage of Monte Carlo and deterministic methods by assessing the accuracy with which the codes are applied and also the methods used to evaluate uncertainty in the answer gained through these methods. The overall objective was to spread good practice through the community and give users information on how to assess the uncertainties associated with their calculated results.

Pitfalls and modelling inconsistencies in computational radiation dosimetry: lessons learnt from the QUADOS intercomparison. Part II: Photons, electrons and protons.

'QUADOS', a concerted action of the European Commission, has promoted an intercomparison aimed at evaluating the use of computational codes for dosimetry in radiation protection and medical physics. This intercomparison was open to all users of radiation transport codes. Eight problems were selected for their relevance to the radiation dosimetry community, five of which involved photon and proton transport. This paper focuses on a discussion of lessons learned from the participation in solving the photon and charged particle problems. The lessons learned from the participation in solving the neutron problems are presented in a companion paper (in this issue).

Two miniaturised TEPCS in a single detector for BNCT microdosimetry.

Microdosimetry with tissue-equivalent proportional counters (TEPC) has proven to be an ideal dosimetry technique for mixed radiation fields as those ones used in boron neutron capture therapy (BNCT). A new counter, composed of two twin cylindrical mini TEPCs inserted in a slim titanium sleeve of 2.7 mm external diameter, has been constructed. The detector has been designed to perform dosimetry and microdosimetry in intense radiation fields. The two mini TEPCs work in gas flow mode. They have right cylinder sensitive volumes of 0.9 mm. In spite of gas line tiny sizes, the gas pressure inside the two counters is well established with <1% of uncertainty. The counter has been calibrated in a secondary standard photon fields. The mean of the effective sensitive volume sizes has been measured to be 0.86 mm. The twin TEPC acquisition system processes properly the signals up to about 30 kHz of counting rate. Therefore, twin TEPC can perform dosimetric measurements in photon field with intensities of some tens of Gy h(-1).

An improved MCNP version of the NORMAN voxel phantom for dosimetry studies.

In recent years voxel phantoms have been developed on the basis of tomographic data of real individuals allowing new sets of conversion coefficients to be calculated for effective dose. Progress in radiation studies brought ICRP to revise its recommendations and a new report, already circulated in draft form, is expected to change the actual effective dose evaluation method. In the present paper the voxel phantom NORMAN developed at HPA, formerly NRPB, was employed with MCNP Monte Carlo code. A modified version of the phantom, NORMAN-05, was developed to take into account the new set of tissues and weighting factors proposed in the cited ICRP draft. Air kerma to organ equivalent dose and effective dose conversion coefficients for antero-posterior and postero-anterior parallel photon beam irradiations, from 20 keV to 10 MeV, have been calculated and compared with data obtained in other laboratories using different numerical phantoms. Obtained results are in good agreement with published data with some differences for the effective dose calculated employing the proposed new tissue weighting factors set in comparison with previous evaluations based on the ICRP 60 report.