Gonad dose assessment in paediatric kidney nuclear medicine test using Monte Carlo simulation.

In this study, we evaluated the effect of radiation dose on gonads during paediatric kidney nuclear medicine tests. Using Monte Carlo simulations, the distribution and effects of radiation were physically evaluated by displaying the distribution path of the source in the human body over time. In particular, the evaluation of doses in children, who are sensitive to radiation during nuclear medicine tests that use internal exposure among several types of medical exposures, was conducted to obtain data for the management of medical exposures. Our results indicated that under normal kidney function, the dose received by the target kidney was 0.430 mGy/mCi, which is ~6% higher than the dose suggested by the International Commission on Radiation Protection (ICRP). Furthermore, when kidney function was compromised, the dose estimated was 0.726 mGy/mCi, which is ~2% lower than the dose suggested by the ICRP. In the male and female gonads, namely the testicles and ovaries, the doses received were 0.359 mGy/mCi and 0.394 mGy/mCi, respectively, under normal kidney function. Similarly, under abnormal kidney function, the doses ranged from 0.187 to 0.353 mGy/mCi and 0.238 to 0.388 mGy/mCi in the male and female gonads, respectively.

Simple variance reduction in Monte Carlo calculations of specific absorbed fractions: Russian roulette and splitting at the source organ.

PURPOSE: To investigate the capabilities of several variance reduction techniques in the calculation of specific absorbed fractions in cases where the source and the target organs are far away and/or the target organs have a small volume. METHODS: The specific absorbed fractions have been calculated by using the Monte Carlo code PENELOPE and by assuming the thyroid gland as the source organ and the testicles, the urinary bladder, the uterus, and the ovaries as the target ones. A mathematical anthropomorphic phantom, similar to the MIRD-type phantoms, has been considered. Photons with initial energies of 50, 100 and 500 keV were emitted isotropically from the volume of the source organ. Simulations have been carried out by implementing the variance reduction techniques of splitting and Russian roulette at the source organ only and the interaction forcing at the target organs. The influence of the implementation details of those techniques have been investigated and optimal parameters have been determined. All simulations were run with a CPU time of 1.5 · 105 s. RESULTS: Specific absorbed fractions with relative uncertainties well below 10% have been obtained in most cases, agreeing with those used as reference. The best value for the factor defining the application of the Russian roulette technique was r = 0.3. The best value for the splitting number was between s = 3 and s = 10, depending on the specific energies and target organs. CONCLUSIONS: The proposed strategy provides an effective method for computing specific absorbed fractions for the most unfavorable situations, with a computing effort that is considerably reduced with respect to other methodologies.

Assessment of testicular dose during preoperative radiotherapy for rectal cancer.

BACKGROUND: Radiotherapy (RT) for rectal cancer can have adverse effects on testicular function resulting in azoospermia and low testosterone levels. Variability of testicular dose (TD) due to differences in position of testes has been assessed with scrotal dosimeters and resulted in substantial variability of delivered TD. The aim of this study was to estimate planned and delivered TD using a treatment planning system (TPS). METHODS: In 101 men treated with RT for rectal cancer the cumulative mean TD (mTD) was calculated by TPS based on plan-computed tomography (CT) to evaluate the effect of different predictors on planned TD. The delivered TD was estimated by TPS based on repeated cone-beam CTs in 32 of 101 men to assess within-person variability of planned and delivered TD in a longitudinal analysis. RESULTS: The median planned mTD for short course RT was 0.57 Gy (range 0.06-14.37 Gy) and 0.81 Gy (range 0.36-10.80 Gy) for long course RT. The median planned mTD was similar to the median delivered mTD in the 32 men analysed over the entire course of RT (p=0.84). The mTD did not change significantly over time of planning and delivering RT. The variation in proximity between testes and planning target volume (PTV) was related to within-person variability of mTD in men on the 50th and 75th percentile of mTD and as expected the absolute difference between planned and delivered mTD increased with higher mTD. CONCLUSION: Testicular doses calculated based on plan-CT are an accurate estimation of delivered TD based on repeated cone beam (CB)CT. The within-person variability of TD is related to variation in proximity between testes and PTV in men with moderate to high TD.

Assessment of concomitant testicular dose with radiochromic film.

To assess the suitability of EBT2 and XRQA2 Gafchromic film for measuring low doses in the periphery of treatment fields, and to measure the accumulative concomitant dose to the contralateral testis resulting from CT imaging, pre-treatment imaging (CBCT) and seminoma radiotherapy with and without gonadal shielding. Superficial peripheral dose measurements made using EBT2 Gafchromic film on the surface of water equivalent material were compared to measurements made with an ionisation chamber in a water phantom to evaluate the suitability and accuracy of the film dosimeter for such measurements. Similarly, XRQA2 was used to measure surface doses within a kilovoltage beam and compared with ionisation chamber measurements. Gafchromic film was used to measure CT, CBCT and seminoma treatment related testicular doses on an anthropomorphic phantom. Doses were assessed for two clinical plans, both with and without gonadal shielding. Testicular doses resulting from the treatment of up to 0.83 ± 0.17 Gy were measured per treatment. Additional doses of up to 0.49 ± 0.01 and 2.35 ± 0.05 cGy were measured per CBCT and CT image, respectively. Reductions in the testicular dose in the order of 10, 36 and 78% were observed when gonadal shielding was fitted for treatment, CT and CBCT imaging, respectively. Gafchromic film was found to be suitable for measuring dose in the periphery of treatment fields. The dose to the testis should be limited to minimise the risk of radiation related side effects. This can be achieved by using appropriate gonadal shielding, irrespective of the treatment fields employed.

Establishing the radiation risk from fluoroscopic-assisted arthroscopic surgery of the hip.

PURPOSE: The purpose of the study was to quantify patient exposure to ionising radiation during fluoroscopic-assisted arthroscopic surgery of the hip, establish a risk profile of this exposure, and reassure patients of radiation safety during the procedure. METHODS: We retrospectively analysed the dose area products for 50 consecutive patients undergoing arthroscopic hip surgery by an experienced hip arthroscopic surgeon. The effective dose and organ dose were derived using a Monte Carlo program. RESULTS: The mean total fluoroscopy time was 1.10 minutes and the mean dose area product value was 297.2 cGycm(2). We calculated the entrance skin dose to be 52 mGy to the area where the beam was targeted (81 cm(2)). The mean effective dose for intra-operative fluoroscopy was 0.33 mSv, with a SD of 0.90 Sv. CONCLUSION: This study confirms that fluoroscopic-assisted arthroscopic surgery of the hip is safe with a low maximum radiation dose and supports its continued use in preference to alternative imaging modalities.

Kilovoltage imaging doses in the radiotherapy of pediatric cancer patients.

PURPOSE: To investigate doses induced by kilovoltage cone-beam computed tomography (kVCBCT) to pediatric cancer patients undergoing radiotherapy, as well as strategies for dose reduction. METHODS AND MATERIALS: An EGS4 Monte Carlo code was used to calculate three-dimensional dose deposition due to kVCBCT on 4 pediatric cancer patients. Absorbed doses to various organs were analyzed for both half-fan and full-fan modes. Clinical conditions, such as distance from organ at risk (OAR) to CBCT field border, kV peak energy, and testicular shielding, were studied. RESULTS: The mean doses induced by one CBCT scan operated at 125 kV in half-fan mode to testes, liver, kidneys, femoral heads, spinal cord, brain, eyes, lens, and optical nerves were 2.9, 4.7, 7.7, 10.5, 8.8, 7.6, 7.7, 7.8, and 7.2 cGy, respectively. Increasing the distances from OARs to CBCT field border greatly reduced the doses to OARs, ranging from 33% reduction for spinal cord to 2300% reduction for testes. As photon beam energy increased from 60 to 125 kV, the dose increase due to kVCBCT ranged from 170% for lens to 460% for brain and spinal cord. A testicular shielding made of 1-cm cerrobend could reduce CBCT doses down to 31%, 51%, 68%, and 82%, respectively, for 60, 80, 100, and 125 kV when the testes lay within the CBCT field. CONCLUSIONS: Generally speaking, kVCBCT deposits much larger doses to critical structures in children than in adults, usually by a factor of 2 to 3. Increasing the distances from OARs to CBCT field border greatly reduces doses to OARs. Depending on OARs, kVCBCT-induced doses increase linearly or exponentially with photon beam energy. Testicular shielding works more efficiently at lower kV energies. On the basis of our study, it is essential to choose an appropriate scanning protocol when kVCBCT is applied to pediatric cancer patients routinely.

Testicular doses in image-guided radiotherapy of prostate cancer.

PURPOSE: To investigate testicular doses contributed by kilovoltage cone-beam computed tomography (kVCBCT) during image-guided radiotherapy (IGRT) of prostate cancer. METHODS AND MATERIALS: An EGS4 Monte Carlo code was used to calculate three-dimensional dose distributions from kVCBCT on 3 prostate cancer patients. Absorbed doses to various organs were compared between intensity-modulated radiotherapy (IMRT) treatments and kVCBCT scans. The impact of CBCT scanning mode, kilovoltage peak energy (kVp), and CBCT field span on dose deposition to testes and other organs was investigated. RESULTS: In comparison with one 10-MV IMRT treatment, a 125-kV half-fan CBCT scan delivered 3.4, 3.8, 4.1, and 5.7 cGy to the prostate, rectum, bladder, and femoral heads, respectively, accounting for 1.7%, 3.2%, 3.2%, and 8.4% of megavoltage photon dose contributions. However, the testes received 2.9 cGy from the same CBCT scan, a threefold increase as compared with 0.7 cGy received during IMRT. With the same kVp, full-fan mode deposited much less dose to organs than half-fan mode, ranging from 9% less for prostate to 69% less for testes, except for rectum, where full-fan mode delivered 34% more dose. As photon beam energy increased from 60 to 125 kV, kVCBCT-contributed doses increased exponentially for all organs, irrespective of scanning mode. Reducing CBCT field span from 30 to 10 cm in the superior-inferior direction cut testicular doses from 5.7 to 0.2 cGy in half-fan mode and from 1.5 to 0.1 cGy in full-fan mode. CONCLUSIONS: Compared with IMRT, kVCBCT-contributed doses to the prostate, rectum, bladder, and femoral heads are clinically insignificant, whereas dose to the testes is threefold more. Full-fan CBCT usually deposits much less dose to organs (except for rectum) than half-fan mode in prostate patients. Kilovoltage CBCT-contributed doses increase exponentially with photon beam energy. Reducing CBCT field significantly cuts doses to testes and other organs.

Uncertainty analysis of doses from ingestion of plutonium and americium.

Uncertainty analyses have been performed on the biokinetic model for americium currently used by the International Commission on Radiological Protection (ICRP), and the model for plutonium recently derived by Leggett, considering acute intakes by ingestion by adult members of the public. The analyses calculated distributions of doses per unit intake. Those parameters having the greatest impact on prospective doses were identified by sensitivity analysis; the most important were the fraction absorbed from the alimentary tract, f(1), and rates of uptake from blood to bone surfaces. Probability distributions were selected based on the observed distribution of plutonium and americium in human subjects where possible; the distributions for f(1) reflected uncertainty on the average value of this parameter for non-specified plutonium and americium compounds ingested by adult members of the public. The calculated distributions of effective doses for ingested (239)Pu and (241)Am were well described by log-normal distributions, with doses varying by around a factor of 3 above and below the central values; the distributions contain the current ICRP Publication 67 dose coefficients for ingestion of (239)Pu and (241)Am by adult members of the public. Uncertainty on f(1) values had the greatest impact on doses, particularly effective dose. It is concluded that: (1) more precise data on f(1) values would have a greater effect in reducing uncertainties on doses from ingested (239)Pu and (241)Am, than reducing uncertainty on other model parameter values and (2) the results support the dose coefficients (Sv Bq(-1) intake) derived by ICRP for ingestion of (239)Pu and (241)Am by adult members of the public.

Weighting of secondary radiations in organ dose calculations.

The current system of dose quantities in radiological protection is based, in addition to the absorbed dose, on the concepts of equivalent dose and effective dose. This system has been developed mainly with uniform whole-body exposures in mind. Conceptual and practical problems arise when the system is applied to more general exposure situations where the radiation quality is altered within the human body. In this article these problems are discussed, using proton beam radiotherapy as a specific example, and a proposition is made that dose equivalent quantities should be used instead of equivalent doses when organ doses are of interest. The calculations of out-of-field organ doses in proton therapy show that the International Commission on Radiological Protection-prescribed use of the proton weighting factor generally leads to an underestimation of the stochastic risks, while the use of neutron weighting factors in the way as practised in the literature leads to a significant overestimation of these risks.

[Preliminary results of reproductive system function assessment in young men after Hodgkin's disease therapy]. / Wstepne wyniki oceny czynnosci ukladu rozrodczego mlodych mezczyzn z zakonczonym leczeniem choroby Hodgkina.

The introduction of modern methods of combined therapy: chemotherapy and radiotherapy, allows the cure more than 90% of children and adolescents with Hodgkin's disease (HD). However, the intensive treatment carries the risk of early and late complications. One of the late effects is gonadal dysfunction which may develop in men as well as in women. In this report preliminary results of testicular function assessment in young men after HD therapy. Testicular function was evaluated in 24 young men (age: 10.6-18.2 years, median 14.6 years at the beginning of treatment, and 18.5-24.6 years, median 21.4 years at the end of therapy) treated between January 1, 1999 and December 31, 2009. in Department of Pediatric Oncology and Hematology PAIP JU-CM in Kraków, according to PGP-HD-97 protocol. Multidrug chemotherapy combined with low-dose involved-field radiotherapy (15-25 Gy) was used in treatment in 21 men, and 3 other men were treated with chemotherapy only. Therapy was completed in all analyzed patients. Physical examination and Tanner stages of pubic hair and genital development were recorded as well as the plasma levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (TST) were measured in all patients. Testicular volumes were measured in 14 men. The study was conducted between January 1, 2009 and December 31, 2009. All men reached Tanner stages of pubic hair and genital development appropriate for their age. One hundred and fourteen measurements of hormones levels were performed in all of patients. At least one abnormal result of measurements was found in 16/24 (66.7%) of men. The most frequent abnormality was the increased level of FSH (in 15 patients, 60.5% of FSH measurements). Abnormal results of measurements were found in 14/20 (70%) patients who received 6 chemotherapy cycles and in 2/4 patients treated with 3-4 cycles. Within the group of patients with abnormal results eight men previously received subdiaphragmatic region radiotherapy. Semen analysis was performed in one man and revealed azoospermia. Initial results of reproductive system assessment indicate the impairment of testicular function depending on intensity of treatment. Further observation and repeated gonadal function tests (including semen analysis) are needed in young men with completed HD treatment. These studies are essential especially for young people who intend to have children.

Assessment of DNA damage in multiple organs from mice exposed to X-rays or acrylamide or a combination of both using the comet assay.

BACKGROUND: X-rays and acrylamide (AA) are present in the general environment and workplace and are potential hazards for human health. Combined exposure to both agents is possible, especially at low doses. MATERIALS AND METHODS: The induction of DNA damage after single or combined exposure to X-rays and/or AA was measured in multiple mice organs using a comet assay. RESULTS: X-rays and AA alone induced generally dose-dependent increases in DNA damage of somatic and germ cells. Combined exposure to 0.10 Gy + 50 mg/kg bw AA induced higher DNA damage than each agent alone in the spleen, kidneys, lungs and testes. In bone marrow lymphocytes there was clear increase in DNA damage compared to that produced by X-rays only. Significant DNA damage was observed in liver cells only after combined exposure to 0.25 Gy + 50 mg/kg bw AA. CONCLUSION: Combined exposure to X-rays and AA enhanced DNA damage after single exposure to each agent.

Applicability of dose conversion coefficients of ICRP 74 to Asian adult males: Monte Carlo simulation study.

International Commission on Radiological Protection (ICRP) reported comprehensive dose conversion coefficients for adult population, which is exposed to external photon sources in the Publication 74. However, those quantities were calculated from so-called stylized (or mathematical) phantoms composed of simplified mathematical surface equations so that the discrepancy between the phantoms and real human anatomy has been investigated by several authors using Caucasian-based voxel phantoms. To address anatomical and racial limitations of the stylized phantoms, several Asian-based voxel phantoms have been developed by Korean and Japanese investigators, independently. In the current study, photon dose conversion coefficients of ICRP 74 were compared with those from a total of five Asian-based male voxel phantoms, whose body dimensions were almost identical. Those of representative radio-sensitive organs (testes, red bone marrow, colon, lungs, and stomach), and effective dose conversion coefficients were obtained for comparison. Even though organ doses for testes, colon and lungs, and effective doses from ICRP 74 agreed well with those from Asian voxel phantoms within 10%, absorbed doses for red bone marrow and stomach showed significant discrepancies up to 30% which was mainly attributed to difference of phantom description between stylized and voxel phantoms. This study showed that the ICRP 74 dosimetry data, which have been reported to be unrealistic compared to those from Caucasian-based voxel phantoms, are also not appropriate for Asian population.

Human radiation experiments: what price informed consent?

In 1992 a system of public access was established to more than three million pages of files in government depositories related to radiation experiments on US citizens, including children, pregnant women, and convicts, studying the effects of radioactive isotopes and testicular irradiation. The background to some of these studies is described; many were considered by Ethics Committees and the results published in the open literature after peer review.

Long-term irradiation of a marine fish, the plaice Pleuronectes platessa: an assessment of the effects on size and composition of the testes and of possible genotoxic changes in peripheral erythrocytes.

PURPOSE: Previous investigation showed the very significant effects of chronic gamma-radiation on plaice testes at mean absorbed dose rates as low as 1.3 mGy h(-1) given over a period of 168 days (accumulated dose 4.7 Gy). The present paper examines the effects on the testes of exposure to even lower dose rates of gamma-radiation given over periods of 73 days or 197 days. In addition, the use of micronucleus counts and flow-cytometric measurement of nuclear DNA content in samples of peripheral blood for monitoring genotoxic effects has been assessed. MATERIALS AND METHODS: In Experiment 1, adult male plaice were exposed at mean absorbed dose rates of 0.25, 0.5 or 1.2 mGy h(-1) for 73 days (mean accumulated doses of 0.43, 0.85 and 2.03 Gy, respectively) and in Experiment 2 to 0.24, 0.5 or 1.0 mGy h(-1) for 197 days (mean accumulated doses of 1.07, 2.24 and 4.57 Gy, respectively). At termination the testes were removed, weighed and sections were prepared and examined histometrically. In addition, in Experiment 2, blood samples were taken during exposure and at termination. Blood smears were scored for micronuclei and samples processed and examined for nuclear DNA content by flow cytometry. RESULTS: Significant reductions in testis weight were seen in all radiation groups after 197 days of exposure, which were predominantly due to decreased amounts of sperm. In plaice killed after 73 days (at an earlier stage of spermatogenesis), there were no significant differences in weight compared with controls but amounts of spermatogonia were significantly reduced in irradiated fish. CONCLUSIONS: Exposure to dose rates as low as 0.24 mGy h(-1) of gamma-radiation given over a period of 197 days significantly reduced the weights of plaice testes, this being consequent on reductions in the amounts of sperm. Although there was some evidence of radiation affecting the numbers of spermatogonia it was not possible to determine the primary target for radiation damage which eventually caused the sperm reductions. Along with the related work described by Greenwood and Knowles (1996) this is the first investigation of a marine fish and it indicates that plaice testes are probably more radiosensitive than those previously described in tropical fish and of a similar radiosensitivity to mammalian testes. Although significant effects were observed after the lowest dose rate used of 0.24 mGy h(-1), this is still a factor of about 400 times greater than the estimated absorbed dose rate to plaice testes in the north-east Irish Sea off Sellafield at the present time. Micronucleus counts and flow-cytometric analysis of blood DNA both failed to show any evidence of genotoxic damage.

Assessment of testicular function after acute and chronic irradiation: further evidence for an influence of late spermatids on Sertoli cell function in the adult rat.

To study cell to cell communications within the testis of adult Sprague-Dawley rats, we used acute whole body neutron plus gamma-irradiation (0.99 Gray of neutron and 0.24 Gray of gamma-rays, 3 min; Exp A) over 7-121 days postirradiation and chronic whole body gamma-irradiation (7 cGy/day 60Co gamma-rays; Exp B) over 14-84 days of irradiation and 7-86 days postirradiation. Neither irradiation protocol had an effect on the body weight of the animals. Neutron plus gamma-rays induced dramatic damages to spermatogonia, preleptotene spermatocytes, spermatozoa, and, to a lesser extent, pachytene spermatocytes. In contrast, gamma-rays induced a selective destruction of spermatogonia. Subsequently, in both experiments a maturation-depletion process led to a marked decrease in all germ cell types. A complete or near complete recovery of the different germ cell types and spermatozoa took place during the two postirradiation periods. Under both irradiation protocols Sertoli cells number was unchanged. Androgen-binding protein and FSH levels were normal in spite of the disappearance of most germ cells from spermatogonia to early spermatids. However, the decline of androgen-binding protein as well as the rise of FSH and their subsequent recovery were highly correlated to the number of late spermatids and spermatozoa. Moreover, it appeared that spermatocytes may also interfere with the production of inhibin (Exp B). With neither irradiation was Leydig cell function altered, except in Exp B in which elevated LH levels were temporarily observed. Correlation analysis suggested a relationship between preleptotene spermatocytes and Leydig cell function. In conclusion, this study establishes that chronic gamma-irradiation is particularly useful in the study of intratesticular paracrine regulation in vivo and provides further support to the concept that late spermatids play a major role in controlling some aspects of Sertoli cell function in the adult rat.

Simplifying radiological examinations. The urogram as a model.

The diagnostic yield of one and three film urograms was compared with that of complete examinations to determine whether a moderately complex examination could be simplified without loss of important diagnostic information. Although sensitivity was high (88-93%) and was not altered by increasing the complexity of the examination, the definitive disease diagnoses were more accurate with the three film rather than the one film studies. Specificity increased from 69% to 77-80% with the more complex examinations. A strategy based on terminating the examination if the single film urogram is normal with a three-film examination in positive cases might effect considerable savings, both economic and in terms of gonadal radiation dose, without serious diagnostic loss.