NCRP Report no.180-management of exposure to ionizing radiation: NCRP radiation protection guidance for the United States.

NCRP Report No. 180, 'Management of Exposure to Ionizing Radiation: Radiation Protection Guidance for the United States (2018)' was developed by Council Committee 1. The report builds and expands upon previous recommendations of NCRP and ICRP, covering exposure to radiation and radioactive materials for five exposure categories: occupational, public, medical, emergency workers, and nonhuman biota. Actions to add, increase, reduce or remove a source of exposure to humans require justification. Optimisation of protection universally applies, taking into account societal, economic, and environmental factors; addressing all hazards, and striving for continuous improvement when it is reasonable to do so. Numeric protection criteria for management of dose to an individual for a given exposure situation are provided, and differ in some respects from ICRP. A specific numeric criterion is suitable to be designated as a regulatory dose limit only when the source of exposure is stable, characterised, and the responsible organisation has established an appropriate radiation control program in advance of source introduction. Medical exposure includes patients, comforters and caregivers of a patient, and voluntary participants in biomedical research. Emergency workers are a new exposure category; their exposure is treated separately from occupational, public or medical exposure, and numeric criteria are provided for deterministic and stochastic effects. For nonhuman biota, the focus is on population maintenance of the affected species, and a guideline is provided for when additional assessment may be necessary. In addition, the recommendations emphasise that: ethical principles support decision-making; stakeholder engagement is necessary in deciding suitable management of their radiation exposure; and a strong safety culture is intrinsic to effective radiation protection programs.

Design and dosimetric properties of an intraoperative radiation therapy system using an orthovoltage X ray unit.

A 300 kVp orthovoltage therapy machine has been installed in an operating room for intraoperative radiation therapy (IORT). A description is presented of the physical aspects of the treatment system including applicator design, radiation field data, dosimetry, and radiation shielding of the operating room.

Measurements of dose from secondary radiation outside a treatment field: effects of wedges and blocks.

Radiation dose outside the radiotherapy treatment field can be significant and therefore is of clinical interest in estimating organ doses. In a previous paper we reported the results of measurements made using unmodified radiation fields. We have extended this study to include the effects of wedge filters and blocks. For a given dose on the central axis of a radiation field, wedges can cause a factor of 2 to 4 increase in dose at any point outside the field compared with the dose when no wedge is used. Adding blocks to a treatment field can cause an increase in dose at points outside the field, but the effect is much smaller than the effect of a wedge, and generally less than a factor of 2. From the results of these measurements, doses to selected organs outside the field for specified treatment geometries were estimated, and the potential for reducing these organ doses by additional shielding was assessed.

Electron beam modifications for the treatment of superficial malignancies.

For the treatment of superficial tumors, the surface dose should be high; unfortunately, because of pronounced dose buildup in low energy electron beams, their efficacy for such treatment is reduced. Electron beams can be modified by placing a low atomic number material called a beam spoiler in the beam. In general, the surface dose is a function of electron energy, source to surface distance, field size, thickness of beam spoiler, distance of beam spoiler from surface, atomic number of beam spoiler, and angle of the beam. The effects of these parameters are evaluated with respect to surface dose, bremsstrahlung dose, and field size changes for small fields at standard SSD and electron energies from 6 to 17 MeV. It was found that the use of a beam spoiler can generally increase the surface dose to values exceeding 90% of the maximum buildup value while maintaining a bremsstrahlung dose less than 3%. Changes in field size related to the placement of the beam spoiler were considerable in some cases.

Tolerances in setup and dosimetric errors in the radiation treatment of breast cancer.

PURPOSE: Treatment failure in radiation therapy, as well as unexpected complications, can be associated with set up changes or variations that can cause deviations from the prescribed radiation dose distribution both inside and outside the target volume. The effect of various deviations from the planned setup on the delivery of the prescribed radiation dose to the desired treatment volume was studied. METHODS AND MATERIALS: Adding a second simulation was investigated as means of minimizing setup changes on treatment. The first simulation was used for planning the treatment and the second simulation was essentially a mock treatment. Dosimetric evaluations based on dose volume histograms were analyzed for each deviation in the setup. RESULTS: In 95% of the patients, the frequency of the changes in the setup parameters between the second simulation and the treatment setup were reduced significantly from the changes that occurred between the first simulation and the second simulation. The changes in isocenter coordinates up to +/- 1.0 cm have minimal effects (+/- 2%) on the dose distributions. Gantry angle variations up to +/- 4 degrees produce a change of less than +/- 5% in the dose distribution within the target volume. However, this angular variation resulted in additional tissue irradiation outside of the desired treatment field (about 10 cm3 for a large patient). A gantry angle variation of +/- 6 degrees can change the volume of tissue that receives the prescribed dose by at least +/- 10%. In addition, such a change can increase the volume of tissue outside the desired treatment field that is irradiated. CONCLUSION: It is concluded that individually, deviations in one of the parameters from the planned setup of +/- 1.0 cm in isocenter position and +/- 4 degrees in gantry angle do not produce significant deviations from the planned dose distribution. However, a significant change in dose distribution is observed if the setup parameters are concurrently changed. A second simulation may minimize the deviations of the treatment setup from the planned setup and maximize the precision in dose delivery to the target volume.

Measurements of dose from secondary radiation outside a treatment field.

Radiation dose to organs outside the radiotherapy treatment field can be significant and therefore is of clinical interest. We have made measurements of dose at distances up to 70 cm from the central axes of 5 X 5, 15 X 15 and 25 X 25 cm radiation fields of 300 kVp, 4 MV and 8 MV X rays, and 60Co gamma rays, at the surface and at depths in water of 5 and 10 cm. Contributions to the total secondary radiation dose from water scatter, machine (collimator) scatter and leakage radiation have been separated. We have found that the component of dose from water scatter can be described by a simple exponential function of distance from the central axis of the radiation field for all energies and field sizes. Machine scatter contributes 20 to 40% of the total secondary dose depending on machine, field size and distance from the field. Leakage radiation contributes very little dose, but becomes the dominant component at distances beyond 60 cm from the central axis. Estimates of the risk of second tumors in long term survivors indicate a small incremental increase above the natural incidence rate based on information from the 1980 BEIR Committee report.

Orthovoltage intraoperative radiotherapy: a new look at an old idea.

A 300 kvp orthovoltage machine has been permanently installed in an operating room for delivering intraoperative radiation therapy (IORT). A historical review of orthovoltage IORT and our present approach are described. The preliminary experience with 38 patients treated with orthovoltage IORT indicates that this technique is feasible, has low acute morbidity, and can be useful for palliation. "Radical" radiation therapy consisting of IORT "boost" treatment combined with external beam was used in 24 patients with primary or recurrent cancer. Local failure in 27 patients treated with IORT +/- external beam radiation therapy was 56%, but varied from 11% (1/9) for patients with resected disease to 78% (14/18) for patients with unresected disease. Complications occurred in nine patients (24%) and have been acceptable. There are 17 patients alive and six are NED, with follow-up of 4-18 months. There appears to be a role for orthovoltage IORT especially when combined with surgical resection for local control of advanced cancer arising in the abdomen where the use of high doses of external radiation therapy are hazardous.

Study of dose perturbation parameters for eye shielding in megavoltage photon beam therapy.

Shielding blocks are frequently used to minimize dose and shield sensitive organs in radiation therapy. The blocks, which are made of high atomic number materials, produce significant dose perturbations in megavoltage photon beams. The effects of these perturbations are studied with special interest in the eye shielding in the treatment of head and neck malignancies. Optimum parameters for the treatment are suggested.

Patient biodistribution of intraperitoneally administered yttrium-90-labeled antibody.

Although 90Y is one of the best radionuclides for radioimmunotherapeutic applications, the lack of gamma rays in its decay complicates the estimation of radiation dose since its biodistribution cannot be accurately determined by external imaging. A limited clinical trial has been conducted with tracer doses (1 mCi) of 90Y in five patients who then received second-look surgery such that tissue samples were obtained for accurate radioactivity quantitation by in vitro counting. The anti-ovarian antibody OC-125 as the F(ab')2 fragment was coupled with diethylenetriaminepentaacetic acid, radiolabeled with 90Y and administered intraperitoneally to patients with suspected or documented ovarian cancer. Size exclusion and ion exchange high performance liquid chromatography analysis of patient ascitic fluid and serum samples showed no evidence of radiolabel instability although a high molecular weight species (presumably immune complex) was observed in three patients. Total urinary excretion of radioactivity prior to surgery averaged 7% of the administered radioactivity while at surgery the mean organ accumulation was 8% of the administered radioactivity in serum, 10% in liver, 7% in bone marrow, and 19% in bone with large patient to patient variation. The mean tumor/normal tissue radioactivity ratio varied between 3 and 25. On the assumption that the above radioactivity levels were achieved immediately following administration, that the radioactivity remained in situ until decayed and that the dimensions of tumor were sufficient to completely attenuate the emissions of 90Y, the dose to tumor for a 1-mCi administration would be approximately 50 rad with normal tissues receiving approximately 8 rad.

The v-src oncogene may not be responsible for the increased radioresistance of hematopoietic progenitor cells expressing v-src.

Infection of the IL-3-dependent, myeloid progenitor cell line 32D cl 3 with murine retroviruses that contain either the wild-type or a temperature-sensitive mutant v-src can render these cells growth-factor independent. These cells also became resistant to gamma irradiation administered at the low-dose rate of 0.05 Gy/min, which is used clinically. The v-src-dependent nature of resistance to gamma irradiation was examined by studying four clones of 32D cl 3 cells that had been infected with a retrovirus carrying the tsLA31A mutant of v-src. The tyrosine-specific kinase activity of this mutant is dramatically reduced at the nonpermissive temperature of 39 degrees C. Cells transformed by v-src and grown at either 34 or 39 degrees C, in the presence or absence of IL-3, demonstrated a significantly higher D0 compared to parental cells examined under identical conditions. In addition, expression of v-src abrogated the synergistic killing effect of heat and gamma irradiation. The D0 of parental 32D cl 3 cells kept at 39 degrees C after gamma irradiation was reduced significantly compared to the D0 of these cells kept at 34 degrees C. This contrasts with data from 32D cl 3 cells infected with either the wild-type v-src or the temperature-sensitive mutant, neither exhibited a synergistic effect in the D0 at either 34 or 39 degrees C. Therefore, while continuous expression of a v-src gene product is required for maintenance of the growth-factor-independent state, v-src does not appear to be responsible for the increased gamma-radiation resistance of these cells at low dose rate.

Measurement of replacement factors for a parallel-plate chamber.

We have measured the replacement correction factors (Prepl) for a PTW/Markus parallel plate chamber at mean incident electron energies of 3.1, 4.4, 8.9, 13.0, 16.3, and 18.8 MeV. The factors are significantly different from unity at low energies.

Head scatter data for several linear accelerators (4-18 MV).

Measurements were made in air on the central axis of radiation beams from linear accelerators operating in the energy range from 4 to 18 MV, to determine the magnitude and source of head scattered radiation. Machines of several manufacturers were studied. The data indicate that, except for one unique collimator design, head scatter originates primarily in the flattening filter and is relatively independent of energy and machine.

Higher energy: is it necessary, is it worth the cost for radiation oncology?

The physical characteristics of the interactions of megavoltage photons and electrons with matter provide distinct advantages, relative to low-energy (orthovoltage) x rays, that lead to better radiation dose distributions in patients. Use of these high-energy radiations has resulted in better patient care, which has been reflected in improved radiation treatment outcome in recent years. But, as the desire for higher energy radiation beams increases, it becomes important to determine whether the physical characteristics that make megavoltage beams beneficial continue to provide a net advantage. It is demonstrated that, in fact, there is an energy range from 4 to 15 MV for photons and 4 to 20 MeV for electrons that is optimally suited for the treatment of cancer in humans. Radiation beams that exceed these maximum energies were found to add no advantage. This is because the costs (price of unit, installation, maintenance, shielding for neutron and photons) are not justified by either improved physical characteristics of the radiation (penetration, skin sparing, dose distribution) or treatment outcome. In fact, for photon beams some physical characteristics result in less desirable dose distributions, less accurate dosimetry, and increased safety problems as the energy increases for example, increasingly diffuse beam edges, loss of electron equilibrium, uncertainty in dose perturbations at interfaces, increased neutron contamination, and potential for higher personnel dose. The special features that make electron beams useful at lower energies, for example, skin sparing and small penetration, are lost at high energies. These physical factors are analyzed together with the economic factors related to radiation therapy patient care using megavoltage beams.

Determination of primary dose in 60Co gamma beam using a small attenuator.

A measurement technique previously proposed for determining dose from primary radiation has been tested using 60Co gamma rays. It is shown that the dose from primary radiation is reliably determined for field sizes of 10 X 10 and 20 X 20 cm2 at depths of 0.5, 5, and 10 cm in water. With further development this technique may be useful for verifying dose from primary radiation that may be calculated using a variety of methods.

Replacement correction factors for photon and electron dose measurements.

A "gradient correction factor" and an "electron fluence correction factor" are used in the AAPM Task Group 21 dosimetry protocol, the product of the two being the "replacement correction factor." The separation of two physical processes, implied by the concepts, is theoretically unfounded. The proof of this statement rests on Fano's theorem, the conditions for which constitute a case without variations in fluence or its directional and energy distributions. Deviations from these conditions represent gradients in the radiation field, affect the response of a measurement cavity, and do so by perturbing the fluence of electrons that deposit energy in the cavity. Thus, in beams of both electrons and photons, corrections are required when fluence variations exist in the vicinity of the cavity. The rationale for an electron fluence correction based on "in-scattering" and "obliquity" is weak, since the effects only occur when gradients are present. The choice of values for the two correction factors at the depth of maximum dose are particularly inconsistent with the actual characteristics of the radiation field.

Reconstruction of diagnostic x-ray spectra by numerical analysis of transmission data.

Numerical reconstruction of x-ray spectra from narrow-beam transmission data was tested with published spectra in the range from 45 to 100 kVp. Transmission curves were calculated from the spectra to simulate measured data. Spectra were reconstructed from these transmission curves with use of an iterative numerical analysis. Comparison of the calculated spectra with the original spectra shows good agreement, including the tungsten characteristic x rays. This demonstrates the potential usefulness of measured transmission data for deducing x-ray spectra in the diagnostic energy range.

Reconstruction of 4-MV bremsstrahlung spectra from measured transmission data.

Transmission data for 4-MV bremsstrahlung beams have been measured with a combination of lead and aluminum attenuators. From these data, the original energy spectra have been reconstructed using an iterative least-squares technique, previously evaluated by simulation studies. The spectra on the central axis for three similar 4-MV linear accelerators indicated no significant differences. When studying the spectra at 5 degrees and 9 degrees off the central axis, that at 9 degrees showed the expected increase of low-energy photons. All these spectra showed a maximum photon energy of 4.5 +/- 0.2 MeV. When the magnetron power was reduced, the spectrum on the central axis shifted to lower energies and the maximum photon energy decreased to 3.5 +/- 0.2 MeV. The result of this experimental study confirms the conclusions from the previous stimulation, that the numerical technique for analysis of transmission data can accurately represent 4-MV bremsstrahlung spectra and detect differences in energy distribution with changes in machine tuning and position in the radiation field for a 4-MV bremsstrahlung beam.

Simulation studies of 4-MV x-ray spectral reconstruction by numerical analysis of transmission data.

The use of transmission measurements with combinations of attenuating materials has been investigated as a method of determining the x-ray energy spectrum from a 4-MV linear accelerator. Simulation studies have been made with three 4-MV x-ray spectra of slightly different shapes. From each of these spectra, the narrow beam transmission curve was calculated, using lead to attenuate the beam for the first several points. Aluminum was then added to attenuate the beam to 0.001 of its initial intensity. A computer program using an iterative least-squares technique has been developed to analyze the transmission data and determine the spectrum by applying some physically reasonable sensible constraints. The calculated transmission values agreed with the simulated data within the estimated experimental uncertainties, and it is concluded that the technique is reliable for the spectral reconstruction and is sensitive to small spectral changes.

Comparisons of electron beam dose measurements in water and polystyrene using various dosimeters.

A comparison has been made of central axis percent depth dose and absorbed dose in electron beams of 7.8 and 10.2 MeV, measured with devices of differing geometry and construction. Flat and cylindrical ionization chambers have been used as well as thin thermoluminescent dosimeters. The ionization chambers had walls of air equivalent or tissue equivalent plastic. Results indicate that central axis depth dose measurements are independent of measuring device. No significant difference was found among the various ionization chambers with air equivalent walls in the determination of absorbed dose. The dose determined by the tissue-equivalent wall chamber was about 3% higher than the dose determined by the other ionization chambers. Dose maximum on the central axis in water is about 4% greater than when this same quantity is calculated from data measured in polystyrene.

Spectral characterization of 4 MV Bremsstrahlung by attenuation analysis.

The "quality of radiation" for a high energy x-ray beam can be specified by its attenuation curve in a selected material. The inverse Laplace transform of the attenuation curve can be used as an approximate indication of the energy spectrum of the beam. Existing mathematical procedures for this purpose have been evaluated and were found to poorly represent measured transmission data for 4 MV x-rays from a linear accelerator. The transmission data between 1 and 0.002 could be fitted within the experimental uncertainty by expressing the logarithmic transmission as a second order polynomial of attenuator thickness. The inverse Laplace transform them becomes a Gaussian function of the attenuation coefficient. This new version of "attenuation analysis" provides a practical method for specification of the quality of the radiation in this energy range.