Dose constraints and guidance for exposure of individuals knowingly and willingly helping in the support and comfort of individuals undergoing medical exposure.

The council of the European Union (EU) has adopted directive 97/43/EURATOM that states that Member States shall ensure that dose constraints are established for exposure of those individuals (voluntary helpers) knowingly and willingly helping patients undergoing medical diagnosis or treatment. This study investigates for which medical diagnoses and treatments voluntary helpers are active. It provides a rough estimation of the effective dose to the voluntary helper for various applications. It summarises the dose constraints established in various EU Member States. Voluntary helpers are especially active in paediatric radiology and in nuclear medicine for both diagnostic and for therapeutic purposes. No voluntary helpers are active during radiotherapy. Voluntary helpers are commonly one of the parents, relatives or friends of the patient. In The Netherlands, the highest effective dose to voluntary helpers of approximately 2.3 mSv is found for therapy of patients younger than 1 y with metaiodobenzylguanidine labelled with 131I. Effective doses to voluntary helpers in paediatric radiology are, generally, quite small, i.e. lower than several tens of microSv at maximum without wearing protective clothing.

Survey of posteroanterior chest radiography in The Netherlands: patient dose and image quality.

Council Directive 97/43/Euratom (Medical Exposure Directive) states that member States of the European Union shall promote the establishment and use of diagnostic reference levels for radio-diagnostic examinations. Dose surveys can form the basis for the establishment of diagnostic reference levels. In view of the implementation of the Medical Exposure Directive in the Netherlands, a survey of dose and image quality has been performed for posteroanterior (PA) chest radiography in 2001. In this survey, 25 participants were selected from a list of 175 Dutch hospitals, whereas in a previous PA chest survey (about 10 years ago) participation was voluntary and participants came predominantly from the south-western part of the Netherlands. For conventional screen-film PA chest radiography, the present results for patient dose and image quality are quite similar to those results from the previous survey. The fraction of conventional X-ray systems utilizing lung compensation filters has remained approximately the same. For dedicated digital chest radiography systems, image quality is better than for conventional systems, but doses vary and can assume relatively high values. The results indicate that there are still possibilities for dose reduction, without loss of image quality. The 75 percentile value of the entrance surface dose distribution is approximately 0.13 mGy.

The effect of equipment set up on patient radiation dose in conventional and CT angiography of the renal arteries.

Patient radiation dose in angiography of the renal arteries was assessed and optimized after installing new radiological equipment. In three separate studies (n=50, 25 and 20) patient exposure was monitored in detail. For the first study default factory settings were used, for the second the number of digital subtraction angiography (DSA) images was halved and the X-ray beam filtering during fluoroscopy was increased, and for the third study filtering during DSA was increased as well. Standard projections were derived and used in Monte Carlo simulations to derive dose conversion coefficients to calculate effective dose from the dose-area product (DAP). Dose conversion coefficients were also calculated for CT angiography (CTA). Using default factory settings on the new angiography system, DAP, number of images and effective dose were much higher than on the replaced unit. For the studies given above, DAP was reduced from 144 Gy cm(2) to 65 Gy cm(2) to 32 Gy cm(2), and effective dose from 22 mSv to 11 mSv to 9.1 mSv, respectively. Effective dose due to CTA was 5.2 mSv. It is concluded that modern angiography systems, resulting in high customer satisfaction, may readily cause much higher patient exposure than older systems. These doses may also be much higher than necessary. Optimization before putting such systems into use is absolutely essential. Internationally accepted recommendations for image quality and technique factors in angiography would be of great help.

A Monte Carlo analysis of possible cell dose enhancement effects by uranium microparticles in photon fields.

Uranium microparticles (radii: 50 nm-1.25 µm) were modelled surrounded by tissue and exposed to natural background radiation, in order to investigate potential dose enhancements from photon interactions. Generally, the results depended on the microparticle size. For a 0.5 µm radius microparticle in an isotropic field, it was found that the combined photon/electron doses deposited in 1 and 10 µm radii shells around it were raised by factors of ∼3.8 and ∼1.1, respectively; for a typical background photon fluence rate, these would correspond to increased energy depositions of a few 10s and a few 100s of eV y(-1), which are far less than the likely deposition rate resulting from the radioactive decay of a (238)U microparticle. The health hazard from uranium microparticle interactions with background photons was concluded to be negligible.