Simulation of H p (10) and effective dose received by the medical staff in interventional radiology procedures.

Interventional radiology and cardiology are widespread employed techniques for diagnosis and treatment of several pathologies because they avoid the majority of the side-effects associated with surgical treatments, but are known to increase the radiation exposure to patient and operators. In recent years many studies treated the exposure of the operators performing cardiological procedures. The aim of this work is to study the exposure condition of the medical staff in some selected interventional radiology procedures. The Monte Carlo simulations have been employed with anthropomorphic mathematical phantoms reproducing the irradiation scenario of the medical staff with two operators and the patient. A personal dosemeter, put on apron, was modelled for comparison with measurements performed in hospitals, done with electronic dosemeters, in a reduced number of interventional radiology practices. Within the limits associated to the use of numerical anthropomorphic models to mimic a complex interventional procedure, the personal dose equivalent, H p (10), was evaluated and normalised to the simulated Kerma-Area Product, KAP, value, indeed the effective dose has been calculated. The H p (10)/KAPvalue of the first operator is about 10 µSv/Gy.cm2, when ceiling shielding is not used. This value is calculated on the trunk and it varies of +/-30% moving the dosemeter to the waist or to the neck. The effective dose, normalised to the KAP value, varies between 0.03 and 0.4 µSv/Gy.cm2. Considering all the unavoidable approximation of this kind of investigations, the comparisons with hospital measurement and literature data showed a good agreement allowing to use of the present results for dosimetric characterisation of interventional radiology procedures.

The Ukrainian-American study of leukemia and related disorders among Chornobyl cleanup workers from Ukraine: I. Study methods.

There are relatively few data on the risk of leukemia among those exposed to external radiation during cleanup operations after the Chornobyl nuclear accident, and results have not been consistent. To investigate this further, we assembled a cohort of 110,645 male cleanup workers from Ukraine and identified cases of leukemia occurring during the period 1986 to 2000. Detailed interviews were conducted and individual bone marrow doses estimated using a new time-and-motion method known as RADRUE described in companion paper II. For the initial analyses we used a nested case-control approach with a minimum of five controls per case, matched for year of birth, oblast (region) of registration, and residence. All identified cases were reviewed by an international panel of experts; 87 of 111 were confirmed. The dose-response analysis and results are given in companion paper III. As background, we describe herein the design, procedures, outcome of case finding and confirmation, control selection, dose estimation and interviewing of subjects.

Dosimetry for a study of low-dose radiation cataracts among Chernobyl clean-up workers.

A cohort of 8,607 Ukrainian Chernobyl clean-up workers during 1986-1987 was formed to study cataract formation after ionizing radiation exposure. Study eligibility required the availability of sufficient exposure information to permit the reconstruction of doses to the lens of the eye. Eligible groups included civilian workers, such as those who built the "sarcophagus" over the reactor, Chernobyl Nuclear Power Plant Workers, and military reservists who were conscripted for clean-up work. Many of the official doses for workers were estimates, because only a minority wore radiation badges. For 106 military workers, electron paramagnetic resonance (EPR) measurements of extracted teeth were compared with the recorded doses as the basis to adjust the recorded gamma-ray doses and provide estimates of uncertainties. Beta-particle doses to the lens were estimated with an algorithm devised to take into account the nature and location of Chernobyl work, time since the accident, and protective measures taken. A Monte Carlo routine generated 500 random estimates for each individual from the uncertainty distributions of the gamma-ray dose and of the ratio of beta-particle to gamma-ray doses. The geometric mean of the 500 combined beta-particle and gamma-ray dose estimates for each individual was used in the data analyses. The median estimated lens dose for the cohort was 123 mGy, while 4.4% received >500 mGy.

Cataracts among Chernobyl clean-up workers: implications regarding permissible eye exposures.

The eyes of a prospective cohort of 8,607 Chernobyl clean-up workers (liquidators) were assessed for cataract at 12 and 14 years after exposure. The prevalence of strictly age-related cataracts was low, as expected (only 3.9% had nuclear cataracts at either examination), since 90% of the cohort was younger than 55 years of age at first examination. However, posterior subcapsular or cortical cataracts characteristic of radiation exposure were present in 25% of the subjects. The data for Stage 1 cataracts, and specifically for posterior subcapsular cataracts, revealed a significant dose response. When various cataract end points were analyzed for dose thresholds, the confidence intervals all excluded values greater than 700 mGy. Linear-quadratic dose-response models yielded mostly linear associations, with weak evidence of upward curvature. The findings do not support the ICRP 60 risk guideline assumption of a 5-Gy threshold for "detectable opacities" from protracted exposures but rather point to a dose-effect threshold of under 1 Gy. Thus, given that cataract is the dose-limiting ocular pathology in current eye risk guidelines, revision of the allowable exposure of the human visual system to ionizing radiation should be considered.

A Review of Radiation Protection Requirements and Dose Estimation for Staff and Patients in CT Fluoroscopy.

The combination of fluoroscopically guided interventional procedures with computed tomography (CTF) has become widespread around the world. The benefits of CTF include the ability to obtain a real-time visualization of the entire body, increased target accuracy and improved visualization of biopsy needles. Modern CTF units work with variable frame rates for image selection, and therefore the dose distributions for patients and staff can considerably vary, creating growing concern in terms of the occupational exposure of interventionists and the drawback of a higher exposure of the patient. A literature review of the latest CTF publications is summarized in this article. A wide range of CTF studies reveal different treatment methods used in clinical practice, and therefore the differences in the exposures between them; as well as in the radiation protection tools and dose monitoring. Further optimization of radiation protection methods, harmonization of exposure patterns as well as training and education of CTF staff on the basis of the information in the survey, are strongly recommended.

STUDY OF DOSES TO HIPPOCAMPUS OF INTERVENTIONAL CARDIOLOGISTS AND THEIR IMPLICATION FOR DOSIMETRIC MONITORING.

Dosimetric monitoring and protection of the personnel involved into interventional procedures is one of the key issues nowadays, yet doses received by their brains were left without rigorous consideration so far. The paper is the fast track of the results of the pilot study of possible magnitude of operator's doses with particular focus on difference between doses in left and right hippocampi and their relation to effective doses of personnel using protective aprons. Monte Carlo simulation of irradiation in a typical interventional cardiology (IC) operation room shows that for standard C-arm angulations difference in doses between left and right hippocampi can be as large as 5-fold (depending on energy and projection), under certain conditions dose to left (most exposed) hippocampus can be up to two times higher than effective dose estimated by a common double dosimetry algorithm. This finding calls for closer attention to possible manifestations of health detriment associated with occupational irradiation of left hippocampus in course of IC practice.

Incidence of multiple myeloma among cleanup workers of the Chornobyl accident and their survival.

The study presents the updated data on the multiple myeloma (MM) incidence in Ukrainian cleanup workers after the Chornobyl accident and their survival. The epidemiological analysis is based on the extended follow-up period to identify new MM cases for higher statistical power and to collect additional data on the disease course and outcome for the survival analysis. The objective of the study was to analyze the MM incidence and survival in Chornobyl cleanup workers in 1996-2013 in comparison with the national MM statistical data. MATERIALS AND METHODS: A study cohort consisted of 152,520 male cleanup workers resided in one of 6 regions of Ukraine or Kyiv city and registered in the Ukrainian State Chornobyl Registry (SChR). The Cohort Database was linked to the Ukrainian National Cancer Registry (NCR) Database to identify MM cases and to analyze MM incidence in 1996-2013. Standardized incidence ratios (SIR) for MM over the period 1996-2013 were calculated as compared to the general population of Ukraine. A 10-year lag period (when incident cases are not considered radiation-related) was applied. One-year and 5-year cause-specific survival of MM cases were calculated as percentage of those who were alive correspondingly for 1 or 5 years after diagnosis among overall diagnosed. By the moment, the 5-year survival rate either for the sub-period 2008-2013 or for the whole study period 1996-2013 cannot be determined. Vital status data were updated according to the recent SChR and NCR information. RESULTS: 75 MM cases diagnosed in 1986-2013 were identified in the studied cohort. 69 of them were included to the incidence analysis considering a 10-year lag period. While the incidence over 15 years after the accident did not differ significantly from the corresponding rate in general population of Ukraine, a tendency to increase was seen in the period from 16 to 21 years after the accident, and significantly increased SIR estimate was revealed for 2008-2013 (SIR 1.86, 95% confidence interval (CI) 1.27-2.44). The highest incidence was detected in 2008-2013 among cohort members diagnosed over the age of 50 years mostly due to the significant excess among those aged 60-69 (SIR 2.46, 95% CI 1.32-3.59). Survival rates in cleanup workers were shown to be higher than in the general population of Ukraine (73.9% and up to 65.0%, respectively). CONCLUSIONS: SIR for the 2008-2013 period, 22-27 years after the accident, demonstrated the significant excess of MM incidence among male cleanup workers. Survival of MM cases is higher in cleanup workers in comparison with that in general population. This article is a part of a Special Issue entitled "The Chornobyl Nuclear Accident: Thirty Years After".

High precision EPR dosimetry as a reference tool for validation of other techniques.

We present here a particular application area for EPR dosimetry with teeth--use as a source of reference dose values for validation/verification of other retrospective dosimetry techniques and existing dose records. The conditions of application of EPR dosimetry in this role as well as practical design of such studies are shown. Particular attention is given to the requirements to the techniques in terms of precision and throughput, as well as to the issue of availability of samples for analysis and practical solution of this problem. Practical application of this approach is illustrated by several examples of completed validation sub-studies, which were performed in the framework of large-scale post-Chernobyl epidemiological studies.

Problems following hippocampal irradiation in interventional radiologists - doses and potential effects: a Monte Carlo simulation. / PROBLEMY VNASLIDOK OPROMINENNIa GIPOKAMPA INTERVENTsIYNYKh RADIOLOGIV - DOZOVI NAVANTAZhENNIa TA YMOVIRNI EFEKTY: MODELIuVANNIa METODOM MONTE KARLO.

OBJECTIVE: This study aimed at investigating radiation exposure of hippocampus in interventional medical profes sionals irradiated in the operating room, and to compare doses in the hippocampus with the effective dose (protec tion quantity), as well as with the doses measured by individual dosimeter, in order to estimate probability of reach ing levels of radiation induced cognitive and other neuropsychiatric alterations during their working career, through a Monte Carlo simulation. MATERIALS AND METHODS: A Monte Carlo simulation of hippocampal exposure was used by means of a hybrid voxel mathematical phantom of a doctor irradiated in typical angiographic projections and energy spectra inherent to interventional cardiology procedures. RESULTS: The results showed that cranial irradiation was very heterogeneous and depended on the projection: doses of left and right hippocampi may be different up to a factor of 2.5; under certain conditions, the dose of the left hippocampus may be twice the effective dose, estimated by conventional double dosimetry algorithm. CONCLUSIONS: The professional span doses of the irradiated hippocampus may overcome the threshold able to pro voke possible cognitive and emotional behavioral impairment. Therefore, in depth studies of the effects of brain irradiation in occupationally exposed interventional medical personnel appear urgently needed and crucial.

Relationship between protection and operational quantities in dosimetry of photon external exposure-deficiencies of Hp(10).

It is commonly assumed that, for a variety of conditions, the E/Hp(10) conversion coefficient is below unity, i.e., Hp(10) can be used as a conservative surrogate of effective dose. The validity of this assumption was checked by Monte Carlo simulation of E and Hp(10) as determined by a practical dosemeter. The calculations concerned irradiation by parallel photon beams with directions varying within a 4pi solid angle and energy ranging from 50 keV to 1 MeV. Observed dependences of conversion coefficients on irradiation geometry, photon energy and dosemeter position demonstrate that in strongly anisotropic radiation fields straightforward application of Hp(10) for assessment of effective dose may lead to significant underestimation of the latter. For photon energy of 80 keV this underestimation may be up to 16-fold. For simulation of real life situations, irradiation by photons coming within broad cones (with solid angle pi) was considered. It was found that even for this irradiation geometry, E/Hp(10) may be as high as 4.3. At the same time, for radiation coming from the frontal hemisphere, the values of the conversion coefficient for a typically positioned (i.e., the left chest pocket) personal dosemeter do not exceed unity. The conclusion was reached that prior to application of Hp(10) as a surrogate of effective dose, the information regarding angular distribution of radiation fields must be taken into account.

Passive TLD based system for characterisation of spectral and angular properties of high dose rate workplace fields.

In order to address the problem of characterisation of high dose rate workplace fields, unique techniques and devices have been developed and tested. The kit of devices comprises a passive spectrometric system and six-vector collimator with thermoluminiscent detectors (TLDs) inside, allowing determination of the anisotropy of the radiation field, both horizontal and vertical. The passive spectrometric system makes use of simultaneous exposure of several TLDs placed inside spherical attenuators. Deconvolution of gamma spectra is performed by solving a system of simultaneous linear equations. The problem of solving ill-defined systems of simultaneous equations was addressed by a system regularisation method. The energy resolution of the system is not high (seven to ten energy bins can be distinguished), yet is sufficient for practical needs. After several benchmark tests, the discussed experimental set-up was extensively tested in various locations within Object 'Shelter'. Results of both energy spectrum and exposure geometry characterisation demonstrated the feasibility of the proposed approach.

Multiple myeloma among Chornobyl accident clean-up workers - state and perspectives of analytical study.

UNLABELLED: The objective of the study was to analyze the Multiple Myeloma (MM) incidence in clean-up workers preparing the information background for consequent analytical study with a dose-dependent risk estimates. MATERIALS AND METHODS: The Cohort Database was linked to the Ukrainian National Cancer Registry to identify the MM cases in a cohort of 152 520 male clean-up workers. RESULTS: The 64 MM cases were identified in the studied Cohort for the 1987-2012 period. Fifty-eight of them were included to the preliminary incidence analysis accounting for the 10-years lag-period. According to the preliminary data analysis the MM incidence rate in studied clean-up workers Cohort did not exceed the corresponding rate in general population of Ukraine along the 21 years after the catastrophe. CONCLUSIONS: Standardized incidence ratio for the 2008-2012 period, that is 22-26 years after the accident, demonstrated the significant excess of MM incidence among male clean-up workers in comparison with general population of Ukraine of corresponding age and gender (SIR 1.61, 95% CI 1.01;2.21).

Determination of angular distributions of workplace photon fields in a context of effective dose estimation.

Estimating the effective dose E with dosemeters calibrated in terms of the personal dose equivalent H(p)(10), one should take into account that the ratio of these two values, i.e. the conversion coefficient C(k), depends essentially on angular and energy parameters of the incident radiation field and is not always close to unity. Introducing the parameter that expresses the degree of anisotropy of the photon field, the paper proposes workplace categorisation and presents methods of workplace monitoring used for more accurate estimation of E at two operating nuclear power plants (NPPs) and Object Shelter in Ukraine.

Review of retrospective dosimetry techniques for external ionising radiation exposures.

The current focus on networking and mutual assistance in the management of radiation accidents or incidents has demonstrated the importance of a joined-up approach in physical and biological dosimetry. To this end, the European Radiation Dosimetry Working Group 10 on 'Retrospective Dosimetry' has been set up by individuals from a wide range of disciplines across Europe. Here, established and emerging dosimetry methods are reviewed, which can be used immediately and retrospectively following external ionising radiation exposure. Endpoints and assays include dicentrics, translocations, premature chromosome condensation, micronuclei, somatic mutations, gene expression, electron paramagnetic resonance, thermoluminescence, optically stimulated luminescence, neutron activation, haematology, protein biomarkers and analytical dose reconstruction. Individual characteristics of these techniques, their limitations and potential for further development are reviewed, and their usefulness in specific exposure scenarios is discussed. Whilst no single technique fulfils the criteria of an ideal dosemeter, an integrated approach using multiple techniques tailored to the exposure scenario can cover most requirements.