Development and validation of a GEANT4 radiation transport code for CT dosimetry.

The authors have created a radiation transport code using the GEANT4 Monte Carlo toolkit to simulate pediatric patients undergoing CT examinations. The focus of this paper is to validate their simulation with real-world physical dosimetry measurements using two independent techniques. Exposure measurements were made with a standard 100-mm CT pencil ionization chamber, and absorbed doses were also measured using optically stimulated luminescent (OSL) dosimeters. Measurements were made in air with a standard 16-cm acrylic head phantom and with a standard 32-cm acrylic body phantom. Physical dose measurements determined from the ionization chamber in air for 100 and 120 kVp beam energies were used to derive photon-fluence calibration factors. Both ion chamber and OSL measurement results provide useful comparisons in the validation of the Monte Carlo simulations. It was found that simulated and measured CTDI values were within an overall average of 6% of each other.

Comparison of measured and calculated dose rates near nuclear medicine patients.

Widely used release criteria for patients receiving radiopharmaceuticals (NUREG-1556, Vol. 9, Rev.1, Appendix U) are known to be overly conservative. The authors measured external exposure rates near patients treated with I, Tc, and F and compared the measurements to calculated values using point and line source models. The external exposure dose rates for 231, 11, and 52 patients scanned or treated with I, Tc, and F, respectively, were measured at 0.3 m and 1.0 m shortly after radiopharmaceutical administration. Calculated values were always higher than measured values and suggested the application of "self-shielding factors," as suggested by Siegel et al. in 2002. The self-shielding factors of point and line source models for I at 1 m were 0.60 ± 0.16 and 0.73 ± 0.20, respectively. For Tc patients, the self-shielding factors for point and line source models were 0.44 ± 0.19 and 0.55 ± 0.23, and the values were 0.50 ± 0.09 and 0.60 ± 0.12, respectively, for F (all FDG) patients. Treating patients as unshielded point sources of radiation is clearly inappropriate. In reality, they are volume sources, but treatment of their exposures using a line source model with appropriate self-shielding factors produces a more realistic, but still conservative, approach for managing patient release.

Realistic reference adult and paediatric phantom series for internal and external dosimetry.

A new generation of realistic, image-based anthropomorphic phantoms has been developed based on the reference masses and organ definitions given in the International Commission on Radiological Protection Publication 89. Specific absorbed fractions for internal radiation sources have been calculated for photon and electron sources for many body organs. Values are similar to those from the previous generation of 'stylized' (mathematical equation-based) models, but some differences are seen, particularly at low particle or photon energies, due to the more realistic organ geometries, with organs generally being closer together, and with some touching and overlapping. Extension of this work, to use these phantoms in Monte Carlo radiation transport simulation codes with external radiation sources, is an important area of investigation that should be undertaken.

Image quantification for radiation dose calculations--limitations and uncertainties.

Radiation dose calculations in nuclear medicine depend on quantification of activity via planar and/or tomographic imaging methods. However, both methods have inherent limitations, and the accuracy of activity estimates varies with object size, background levels, and other variables. The goal of this study was to evaluate the limitations of quantitative imaging with planar and single photon emission computed tomography (SPECT) approaches, with a focus on activity quantification for use in calculating absorbed dose estimates for normal organs and tumors. To do this we studied a series of phantoms of varying complexity of geometry, with three radionuclides whose decay schemes varied from simple to complex. Four aqueous concentrations of 99mTc, ¹³¹I, and ¹¹¹In (74, 185, 370, and 740 kBq mL⁻¹) were placed in spheres of four different sizes in a water-filled phantom, with three different levels of activity in the surrounding water. Planar and SPECT images of the phantoms were obtained on a modern SPECT/computed tomography (CT) system. These radionuclides and concentration/background studies were repeated using a cardiac phantom and a modified torso phantom with liver and "tumor" regions containing the radionuclide concentrations and with the same varying background levels. Planar quantification was performed using the geometric mean approach, with attenuation correction (AC), and with and without scatter corrections (SC and NSC). SPECT images were reconstructed using attenuation maps (AM) for AC; scatter windows were used to perform SC during image reconstruction. For spherical sources with corrected data, good accuracy was observed (generally within ±10% of known values) for the largest sphere (11.5 mL) and for both planar and SPECT methods with 99mTc and ¹³¹I, but were poorest and deviated from known values for smaller objects, most notably for ¹¹¹In. SPECT quantification was affected by the partial volume effect in smaller objects and generally showed larger errors than the planar results in these cases for all radionuclides. For the cardiac phantom, results were the most accurate of all of the experiments for all radionuclides. Background subtraction was an important factor influencing these results. The contribution of scattered photons was important in quantification with ¹³¹I; if scatter was not accounted for, activity tended to be overestimated using planar quantification methods. For the torso phantom experiments, results show a clear underestimation of activity when compared to previous experiment with spherical sources for all radionuclides. Despite some variations that were observed as the level of background increased, the SPECT results were more consistent across different activity concentrations. Planar or SPECT quantification on state-of-the-art gamma cameras with appropriate quantitative processing can provide accuracies of better than 10% for large objects and modest target-to-background concentrations; however when smaller objects are used, in the presence of higher background, and for nuclides with more complex decay schemes, SPECT quantification methods generally produce better results.

Influence of total-body mass on the scaling of S-factors for patient-specific, blood-based red-marrow dosimetry.

To perform patient-specific, blood-based red-marrow dosimetry, dose conversion factors (the S factors in the MIRD formalism) have to be scaled by patients' organ masses. The dose to red marrow includes both self-dose and cross-irradiation contributions. Linear mass scaling for the self-irradiation term only is usually applied as a first approximation, whereas the cross-irradiation term is considered to be mass independent. Recently, the need of a mass scaling correction on both terms, not necessarily linear and dependent on the radionuclide, has been highlighted in the literature. S-factors taking into account different mass adjustments of organs are available in the OLINDA/EXM code. In this paper, a general algorithm able to fit the mass-dependent factors S(rm<--tb) and S(rm<--rm) is suggested and included in a more general equation for red-marrow dose calculation. Moreover, parameters to be considered specifically for therapeutic radionuclides such as (131)I, (90)Y and 177Lu are reported. The red-marrow doses calculated by the traditional and new algorithms are compared for (131)I in ablation therapy (14 pts), 177Lu- (13 pts) and (90)Y- (11 pts) peptide therapy for neuroendocrine tumours, and (90)Y-Zevalin therapy for NHL (21 pts). The range of differences observed is as follows: -36% to -10% for (131)I ablation, -22% to 5% for 177Lu-DOTATATE, -9% to 11% for (90)Y-DOTATOC and -8% to 6% for (90)Y-Zevalin. All differences are mostly due to the activity in the remainder of the body contributing to cross-irradiation. This paper quantifies the influence of mass scaling adjustment on usually applied therapies and shows how to derive the appropriate parameters for other radionuclides and radiopharmaceuticals.

Specific absorbed fractions for internal photon emitters calculated for a tomographic model of a pregnant woman.

Specific absorbed fractions are essential for calculation of radiation dose from internal emitters. Existing specific absorbed fractions for pregnant women were calculated using the stylized models; in this work, a partial-body tomographic model for a pregnant woman was constructed from a rare set of CT images. Based on this tomographic model, the Monte Carlo code, EGS4-VLSI, was used to derive specific absorbed fractions. Monoenergetic, isotropic photon emitters from 15 keV to 4 MeV were distributed in different source organs, and doses were calculated to many target regions in the body. Even though the results showed general agreement with previous studies for higher energies, significant differences were also found, especially for lower energies. The main reasons for the differences are due to the variation of mass, geometry, and organ distances, and they demonstrate the influence of more realistic body models on dose calculations.

Developments in the internal dosimetry of radiopharmaceuticals.

Various radionuclides are used in nuclear medicine in different diagnostic and therapeutic procedures. Recently, interest has grown in therapeutic agents for some interesting applications in nuclear medicine. Internal dose models and methods in use for many years are well established, and can give radiation doses to stylised models representing reference individuals. Kinetic analyses need to be carefully planned, and dose conversion factors that are most similar to the subject in question should be chosen, which can then be tailored somewhat to be more patient-specific. Internal dose calculations, however, are currently not relevant in patient management in internal emitter therapy, as they are not sufficiently accurate or detailed to guide clinical decision-making, and as calculated doses have historically not been well correlated with observed effects on tissues. Great strides are being made at many centres regarding the use of patient image data to construct individualised voxel-based models for more detailed and patient-specific dose calculations, and new findings are encouraging regarding improvement of internal dose models to provide better correlations of dose and effect. These recent advances make it likely that the relevance will soon change to be more similar to that of external beam treatment planning.

Evolution and status of bone and marrow dose models.

Investigations at the University of Leeds under the direction of F.W. Spiers in the early 1960s through the late 1970s established the first comprehensive assessment of marrow dose conversion factors (DCFs) for beta-emitting radionuclides within the volume or on the surface of trabecular bone. These DCFs were subsequently used in deriving radionuclide S values for skeletal tissues published in MIRD Pamphlet No. 11. Eckerman re-evaluated this work and extended the methods of Spiers to radionuclides within the marrow to provide DCFs for fifteen skeletal regions in computational models representing individuals of six different ages. These results were used in the MIRDOSE3 software. Bouchet et al. used updated information on regional bone and marrow masses, as well as 3D electron transport techniques, to derive radionuclide S values in skeletal regions of the adult. Although these two efforts are similar in most regards, the models differ in three respects in: (1) the definition of the red marrow region, (2) the definition of a surface source of activity, and (3) the assumption applied in transporting electrons through the trabecular endosteum. In this study, a review of chord-based skeletal models is given, followed by a description of the differences in the Eckerman and Bouchet et al. transport models. Finally, new data from NMR microscopy and radiation transport in trabecular bone is applied to address item (1) above. Dose conversion factors from MIRD 11, the Eckerman model, the Bouchet et al. model, and a revised model are compared for several radionuclides important to internal emitter therapy.

A voxel-based head-and-neck phantom built from tomographic colored images.

Recent progress in computer speed and medical imaging has made possible the development of a new family of anthropomorphic models, based on a volume elements (voxels) approach to phantom design. Such phantoms can represent details of the anatomical structures of the human body more realistically. Tomographic images (CT or MRI) contain the basic information for the construction of voxel-based phantoms. Use of voxel-based phantoms has its most significant application in the planning of individual patients therapy. To be implemented, results must be obtained in a reasonably short period of time. The segmentation of organs and tissues is a critical step in this process. This article presents a new approach in the construction of voxel-based phantoms that was implemented to simplify the segmentation process of organs and tissues, reducing the time used in this procedure. A voxel-based head and neck phantom, called MCvoxEL, was built using this new approach. The volumes and masses of the segmented organs and tissues were compared with data published by other investigators.