The European intercomparison of in-vivo monitoring laboratories: the EIVIC-2020 project.

The EIVIC project was launched in 2020, and the main goal was the organisation of a European intercomparison of in-vivo monitoring laboratories dealing with direct measurements of gamma-emitting radionuclides incorporated into the body of exposed workers. This project was organised jointly by members of EURADOS Working Group 7 on internal dosimetry (WG7), the Federal Office for Radiation Protection (BfS, Germany) and the Radioprotection and Nuclear Safety Institute (IRSN, France). The objective was to assess the implementation of individual-monitoring requirements in EU Member States on the basis of in-vivo measurements and to gain insight into the performance of in-vivo measurements using whole-body counters. In this context, a total of 41 in-vivo monitoring laboratories from 21 countries, together with JRC (EC) and IAEA participated. The results were submitted in terms of activity (Bq) of the radionuclides identified inside phantoms that were circulated to all participants. The measured data were compared with reference activity values to evaluate the corresponding bias according to the standards ISO 28218 and ISO 13528. In general, the results of the different exercises are good, and most facilities are in conformity with the criteria for the bias and z-scores in the ISO standards. Furthermore, information about technical and organisational characteristics of the participating laboratories was collected to test if they had a significant influence on the reported results.

Patient-specific biokinetics and hybrid 2D/3D approach integration in OEDIPE software: Application to radioiodine therapy.

BACKGROUND: The progression of targeted radionuclide therapy requires the development of dosimetry software accounting for patient-specific biokinetics. New functionalities were thus developed in the OEDIPE software, to deal with multiple 3D images or multiple planar images and a SPECT image. MATERIEL & METHOD: Methods were implemented to recover patient biokinetics in volumes of interest. If several 3D SPECT images are available, they are registered to a reference CT scan. When several planar images and a single SPECT are available, the planar images are registered to the SPECT and counts of the planar images converted to activity. To validate these developments, six SPECT/CT and planar images of a Jaszczak phantom containing I-131 were acquired at different dates. Cumulated activity was estimated in each sphere using the SPECT/CT images only or the planar series associated to one SPECT/CT. Biokinetics and doses in lesions and in the lungs of a patient treated with I-131 for differentiated thyroid cancer were then estimated using four planar images and a SPECT/CT scan. Whole-body retention data were used to compare the biokinetics obtained from the planar and SPECT data. RESULTS: Activities and cumulated activities estimated using OEDIPE in the phantom spheres agreed well with the reference values for both approaches. Results obtained for the patient compared well with those derived from whole-body retention data. CONCLUSION: The implemented features allow automatic evaluation of patient-specific biokinetics from different series of patient images, enabling patient-specific dosimetry without the need for external software to estimate the cumulated activities in different VOIs.

Novel transforaminal approach allows surgical decompression of an atlantoaxial band in dogs: a cadaveric study and clinical cases.

OBJECTIVES: To describe a novel transforaminal approach for surgical excision of the atlantoaxial (AA) band and examine its feasibility, safety, and mechanical advantages in an ex vivo study and clinical cases. SAMPLES: 26 canine cadavers and 2 canine patients with AA bands. PROCEDURES: The transforaminal approach via the first intervertebral foramen was designed to avoid damaging the dorsal AA ligament (DAAL) and dorsal laminas to maintain joint stability. The cadaveric study started on December 2020 and lasted 3 months. The ligamentum flavum (LF) was removed using a novel approach; then, gross examination was conducted to verify the potential damage to the spinal cord and associated structures and the adequacy of LF removal. Subsequently, the ex vivo tension test of the DAAL was conducted to establish whether the approach induced mechanical damage to the ligaments. Finally, 2 dogs diagnosed with an AA band were surgically treated with the transforaminal approach. RESULTS: In the cadaveric study, postsurgical evaluation verified the subtotal removal of LF without damage to the dura mater. There were no significant differences in the mechanical properties of the DAAL, including the ultimate strength (P = .645) and displacement (P = .855), between the surgical and intact groups during the ex vivo tension test. In clinical cases, clinical signs and neurologic grades improved until the final follow-up. CLINICAL RELEVANCE: The described surgical procedure using a transforaminal approach appears to sufficiently permit the removal of an AA band while reducing damage to the DAAL and spinal cord. Our study highlights the feasibility of the transforaminal approach.

Using radial distribution functions to calculate cellular cross-absorbed dose forßemitters: comparison with reference methods and application for18F-FDG cell labeling.

To further improve the understanding ofin vitrobiological effects of incorporated radionuclides, it is essential to accurately determine cellular absorbed doses. In the case ofßemitters, the cross-dose is a major contribution, and can involve up to millions of cells. Realistic and efficient computational models are needed for that purpose. Conventionally, distances between each cell are calculated and the related dose contributions are cumulated to get the total cross-dose (standard method). In this work, we developed a novel approach for the calculation of the cross-absorbed dose, based on the use of the radial distribution function (rdf)) that describes the spatial properties of the cellular model considered. The dynamic molecular tool LAMMPS was used to create 3D cellular models and computerdfsfor various conditions of cell density, volume size, and configuration type (lattice and randomized geometry). The novel method is suitable for any radionuclide of nuclear medicine. Here, the model was applied for the labeling of cells with18F-FDG used for PET imaging, and first validated by comparison with other reference methods. MeanScrossvalues calculated with the novel approach versus the standard method agreed very well (relative differences less that 0.1%). Implementation of therdf-based approach with LAMMPS allowed to achieved results considerably faster than with the standard method, the computing time decreasing from hours to seconds for 106cells. Therdf-based approach was also faster and easier to accommodate more complex cellular models than the standard and other published methods. Finally, a comparative study of the meanScrossfor different types of configuration was carried out, as a function of the cell density and the volume size, allowing to better understand the impact of the configuration on the cross-absorbed dose.

EURADOS work on internal dosimetry.

European Radiation Dosimetry Group (EURADOS) Working Group 7 is a network on internal dosimetry that brings together researchers from more than 60 institutions in 21 countries. The work of the group is organised into task groups that focus on different aspects, such as development and implementation of biokinetic models (e.g. for diethylenetriamine penta-acetic acid decorporation therapy), individual monitoring and the dose assessment process, Monte Carlo simulations for internal dosimetry, uncertainties in internal dosimetry, and internal microdosimetry. Several intercomparison exercises and training courses have been organised. The IDEAS guidelines, which describe - based on the International Commission on Radiological Protection's (ICRP) biokinetic models and dose coefficients - a structured approach to the assessment of internal doses from monitoring data, are maintained and updated by the group. In addition, Technical Recommendations for Monitoring Individuals for Occupational Intakes of Radionuclides have been elaborated on behalf of the European Commission, DG-ENER (TECHREC Project, 2014-2016, coordinated by EURADOS). Quality assurance of the ICRP biokinetic models by calculation of retention and excretion functions for different scenarios has been performed and feedback was provided to ICRP. An uncertainty study of the recent caesium biokinetic model quantified the overall uncertainties, and identified the sensitive parameters of the model. A report with guidance on the application of ICRP biokinetic models and dose coefficients is being drafted at present. These and other examples of the group's activities, which complement the work of ICRP, are presented.

LESSONS LEARNED FROM THE EURADOS SURVEY ON INDIVIDUAL MONITORING DATA AND INTERNAL DOSE ASSESSMENTS OF FOREIGNERS EXPOSED IN JAPAN FOLLOWING THE FUKUSHIMA DAIICHI NPP ACCIDENT.

European Radiation Dosimetry Group e.V. (EURADOS) survey on individual monitoring data and dose assessment has been carried out for 550 foreigners returning home after being exposed in Japan to intakes of radionuclides (mainly (131)I, (132)I, (132)Te, (134)Cs and (137)Cs) as a consequence of the Fukushima Daiichi NPP accident. In vivo and in vitro measurements were performed in their respective countries at an early stage after that accident. Intakes of radionuclides were detected in 208 persons from Europe and Canada, but the committed effective dose E(50) was below the annual dose limit for the public (<1 mSv) in all the cases. Lessons learned from this EURADOS survey are presented here regarding not only internal dosimetry issues, but also the management of the emergency situation, the perception of the risk of health effects due to radiation and the communication with exposed persons who showed anxiety and lack of trust in monitoring data and dose assessments.

TECHNICAL RECOMMENDATIONS FOR MONITORING INDIVIDUALS FOR OCCUPATIONAL INTAKES OF RADIONUCLIDES.

The TECHREC project, funded by the European Commission, will provide Technical Recommendations for Monitoring Individuals for Occupational Intakes of Radionuclides It is expected that the document will be published by the European Commission as a report in its Radiation Protection Series during 2016. The project is coordinated by the European Radiation Dosimetry Group (EURADOS) and is being carried out by members of EURADOS Working Group 7 (Internal Dosimetry). This paper describes the aims and purpose of the Technical Recommendations, and explains how the project is organised.

Focusing on Plates: Controlling Guided Waves using Negative Refraction.

Elastic waves are guided along finite structures such as cylinders, plates, or rods through reflection, refraction, and mode conversion at the interfaces. Such wave propagation is ubiquitous in the world around us, and studies of elastic waveguides first emerged in the later part of the 19(th) century. Early work on elastic waveguides revealed the presence of backward propagating waves, in which the phase velocity and group velocity are anti-parallel. While backward wave propagation exists naturally in very simple finite elastic media, there has been remarkably little attention paid to this phenomenon. Here we report the development of a tunable acoustic lens in an isotropic elastic plate showing negative refraction over a finite acoustic frequency bandwidth. As compared to engineered acoustic materials such as phononic crystals and metamaterials, the design of the acoustic lens is very simple, with negative refraction obtained through thickness changes rather than internal periodicity or sub-wavelength resonant structures. A new class of acoustic devices, including resonators, filters, lenses, and cloaks, may be possible through topography optimization of elastic waveguide structures to exploit the unique properties of backward waves.

Uncertainty induced by chest wall thickness assessment methods on lung activity estimation for plutonium and americium: a large population-based study.

In vivo lung counting aims at assessing the retained activity in the lungs. The calibration factor relating the measured counts to the worker's specific retained lung activity can be obtained by several means and strongly depends on the chest wall thickness. Here we compare, for 374 male nuclear workers, the activity assessed with a reference protocol, where the material equivalent chest wall thickness is known from ultrasound measurements, with two other protocols. The counting system is an array of four germanium detectors.It is found that non site-specific equations for the assessment of the chest wall thickness induce large biases in the assessment of activity. For plutonium isotopes or (241)Am the proportion of workers for whom the retained activity is within ± 10% of the reference one is smaller than 10%.The use of site-specific equations raises this proportion to 20% and 58% for plutonium and (241)Am, respectively.Finally, for the studied population, when site-specific equations are used for the chest wall thickness, the standard uncertainties for the lung activity are 42% and 12.5%, for plutonium and (241)Am, respectively. Due to the relatively large size of the studied population, these values are a relatively robust estimate of the uncertainties due to the assessment of the chest wall thickness for the current practice at this site.

Energy dependent chest wall thickness equations for male lung monitoring with germanium detectors.

The thickness and fat fraction of the chest wall are important parameters for in vivo lung monitoring. They have been measured from ultrasonic images on 374 male workers of the French nuclear industry using four measurement locations, as dictated by the size and position of the germanium detectors used for monitoring. The plastic muscle equivalent chest wall thickness (PMECWT) and the plastic 50% muscle-50% adipose equivalent chest wall thickness (X5050) have been calculated for each worker at 17, 59.5, and 185.7 keV, respectively. Multi-linear regression models have been tested to predict PMECWT and X5050 as a function of anthropometric measurements. Finally, it was considered whether the average chest wall thickness could be used instead of the material equivalent chest wall thickness. It was found that the mean chest wall thickness was (27 ± 5) mm and the mean fat fraction was (25 ± 8)%. The best and more convenient model for material equivalent chest wall thickness is a linear function of the body mass index. Depending on the energy, the standard errors of estimate for this model range between 3.2-3.4 mm for PMECWT and between 3.2-3.7 mm for X5050. At 59.5 and 185.7 keV, it was determined, to an excellent approximation, that the fat fraction and consideration of an equivalent material are unnecessary, contrary to the case at 17 keV.

Clinical results of an EPID-based in-vivo dosimetry method for pelvic cancers treated by intensity-modulated radiation therapy.

The purpose of our work was to investigate the feasibility of using an EPID-based in-vivo dosimetry method initially designed for conformal fields on pelvic dynamic IMRT fields. The method enables a point dose delivered to the patient to be calculated from the transit signal acquired with an electronic portal imaging device (EPID). After defining a set of correction factors allowing EPID pixel values to be converted into absolute doses, several tests on homogeneous water-equivalent phantoms were performed to estimate the validity of the method in reference conditions. The effects of different treatment parameters, such as delivered dose, field size dependence and patient thickness were also studied. The model was first evaluated on a group of 53 patients treated by 3D conformal radiotherapy (3DCRT) and then on 92 patients treated by IMRT, both for pelvic cancers. For each measurement, the dose was reconstructed at the isocenter (DREC) and compared with the dose calculated by our treatment planning system (DTPS). Excellent agreement was found between DREC and DTPS for both techniques. For 3DCRT treatments, the mean deviation between DREC and DTPS for the 211 in-vivo dose verifications was equal to -1.0  ±  2.2% (1SD). Concerning IMRT treatments, the averaged deviation for the 418 fields verified was equal to -0.3 ± 2.6% (1SD) proving that the method is able to reconstruct a dose for dynamic IMRT pelvic fields. Based on these results, tolerance criteria and action levels were established before its implementation in clinical routine.

Comparison of organs' shapes with geometric and Zernike 3D moments.

The morphological similarity of organs is studied with feature vectors based on geometric and Zernike 3D moments. It is particularly investigated if outliers and average models can be identified. For this purpose, the relative proximity to the mean feature vector is defined, principal coordinate and clustering analyses are also performed. To study the consistency and usefulness of this approach, 17 livers and 76 hearts voxel models from several sources are considered. In the liver case, models with similar morphological feature are identified. For the limited amount of studied cases, the liver of the ICRP male voxel model is identified as a better surrogate than the female one. For hearts, the clustering analysis shows that three heart shapes represent about 80% of the morphological variations. The relative proximity and clustering analysis rather consistently identify outliers and average models. For the two cases, identification of outliers and surrogate of average models is rather robust. However, deeper classification of morphological feature is subject to caution and can only be performed after cross analysis of at least two kinds of feature vectors. Finally, the Zernike moments contain all the information needed to re-construct the studied objects and thus appear as a promising tool to derive statistical organ shapes.

Analysis of the time reversal operator for a scatterer undergoing small displacements.

The method of the time reversal operator decomposition is usually employed to detect and characterize static targets using the invariants of the time reversal operator. This paper presents a theoretical and experimental investigation into the impact of small displacements of the target on these invariants. To find these invariants, the time reversal operator is built from the multistatic response matrix and then diagonalized. Two methods of recording the multistatic response matrix while the target is moving are studied: Acquisition either element by element or column by column. It is demonstrated that the target displacement generates new significant eigenvalues. Using a perturbation theory, the analytical expressions of the eigenvalues of the time-reversal operator for both acquisition methods are derived. We show that the distribution of the new eigenvalues strongly depends on these two methods. It is also found that for the column by column acquisition, the second eigenvector is simply linked to the scatterer displacements. At last, the implications on the Maximum Likelihood and Multiple Signal Classification detection are also discussed. The theoretical results are in good agreement with numerical and 3.4 MHz ultrasonic experiments.

Adjuvant radiotherapy in the management of axillary node negative invasive breast cancer: a qualitative systematic review.

PURPOSE: To actualize and to detail guidelines used in technical radiotherapy and indications for innovative radiation technologies in early axillary node negative breast cancer (BC). METHODS: Dosimetric and treatment planning studies, phase II and III trials, systematic reviews and retrospective studies were all searched (Medline(®) database). Their quality and clinical relevance were also checked against validated checklists. A level of evidence was associated for each result. RESULTS: A total of 75 references were included. Adjuvant BC radiotherapy (50Gy/25 fractions/5 weeks followed by a tumor boost of 16Gy/8 fractions) is still the standard of care. Overall treatment time could be shortened for patients who present with low local relapse risk BC by using either hypofractionated whole breast irradiation; or accelerated partial breast irradiation. BC IMRT is not used in current practice. CONCLUSION: Our group aimed to provide guidelines for technical and clinical applications of innovative BC radiation technologies.

Development of two mobile laboratories for a routine and accident monitoring of internal contamination.

To provide medical surveillance of workers exposed to risk of internal contamination, IRSN (French Institute for Radiological Protection and Nuclear Safety) has developed two mobile laboratories for on-site monitoring. The laboratories are unique in Europe. They meet the new radiation protection requirements for nuclear medicine departments and radiological emergency response. Details of the design, calibration procedures and performance characteristics of these systems in measurements of various types of organs (thyroid, lung and whole body) are described. The sensitivity of the measurements is very close to that achieved in a heavily shielded stationary laboratory.

Microdosimetry of alpha particles for simple and 3D voxelised geometries using MCNPX and Geant4 Monte Carlo codes.

Microdosimetry using Monte Carlo simulation is a suitable technique to describe the stochastic nature of energy deposition by alpha particle at cellular level. Because of its short range, the energy imparted by this particle to the targets is highly non-uniform. Thus, to achieve accurate dosimetric results, the modelling of the geometry should be as realistic as possible. The objectives of the present study were to validate the use of the MCNPX and Geant4 Monte Carlo codes for microdosimetric studies using simple and three-dimensional voxelised geometry and to study their limit of validity in this last case. To that aim, the specific energy (z) deposited in the cell nucleus, the single-hit density of specific energy f(1)(z) and the mean-specific energy were calculated. Results show a good agreement when compared with the literature using simple geometry. The maximum percentage difference found is <6 %. For voxelised phantom, the study of the voxel size highlighted that the shape of the curve f(1)(z) obtained with MCNPX for <1 µm voxel size presents a significant difference with the shape of non-voxelised geometry. When using Geant4, little differences are observed whatever the voxel size is. Below 1 µm, the use of Geant4 is required. However, the calculation time is 10 times higher with Geant4 than MCNPX code in the same conditions.

Construction of an extended library of adult male 3D models: rationale and results.

In order to best cover the possible extent of heights and weights of male adults the construction of 25 whole body 3D models has been undertaken. Such a library is thought to be useful to specify the uncertainties and relevance of dosimetry calculations carried out with models representing individuals of average body heights and weights. Representative 3D models of Caucasian body types are selected in a commercial database according to their height and weight, and 3D models of the skeleton and internal organs are designed using another commercial dataset. A review of the literature enabled one to fix volume or mass target values for the skeleton, soft organs, skin and fat content of the selected individuals. The composition of the remainder tissue is fixed so that the weight of the voxel models equals the weight of the selected individuals. After mesh and NURBS modelling, volume adjustment of the selected body shapes and additional voxel-based work, 25 voxel models with 109 identified organs or tissue are obtained. Radiation transport calculations are carried out with some of the developed models to illustrate potential uses. The following points are discussed throughout this paper: justification of the fixed or obtained models' features regarding available and relevant literature data; workflow and strategy for major modelling steps; advantages and drawbacks of the obtained library as compared with other works. The construction hypotheses are explained and justified in detail since future calculation results obtained with this library will depend on them.

EURADOS coordinated action on research, quality assurance and training of internal dose assessments.

EURADOS working group on 'Internal Dosimetry (WG7)' represents a frame to develop activities in the field of internal exposures as coordinated actions on quality assurance (QA), research and training. The main tasks to carry out are the update of the IDEAS Guidelines as a reference document for the internal dosimetry community, the implementation and QA of new ICRP biokinetic models, the assessment of uncertainties related to internal dosimetry models and their application, the development of physiology-based models for biokinetics of radionuclides, stable isotope studies, biokinetic modelling of diethylene triamine pentaacetic acid decorporation therapy and Monte-Carlo applications to in vivo assessment of intakes. The working group is entirely supported by EURADOS; links are established with institutions such as IAEA, US Transuranium and Uranium Registries (USA) and CEA (France) for joint collaboration actions.