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.

A study to establish international diagnostic reference levels for paediatric computed tomography.

The article reports results from the largest international dose survey in paediatric computed tomography (CT) in 32 countries and proposes international diagnostic reference levels (DRLs) in terms of computed tomography dose index (CTDI vol) and dose length product (DLP). It also assesses whether mean or median values of individual facilities should be used. A total of 6115 individual patient data were recorded among four age groups: <1 y, >1-5 y, >5-10 y and >10-15 y. CTDIw, CTDI vol and DLP from the CT console were recorded in dedicated forms together with patient data and technical parameters. Statistical analysis was performed, and international DRLs were established at rounded 75th percentile values of distribution of median values from all CT facilities. The study presents evidence in favour of using median rather than mean of patient dose indices as the representative of typical local dose in a facility, and for establishing DRLs as third quartile of median values. International DRLs were established for paediatric CT examinations for routine head, chest and abdomen in the four age groups. DRLs for CTDI vol are similar to the reference values from other published reports, with some differences for chest and abdomen CT. Higher variations were observed between DLP values, based on a survey of whole multi-phase exams. It may be noted that other studies in literature were based on single phase only. DRLs reported in this article can be used in countries without sufficient medical physics support to identify non-optimised practice. Recommendations to improve the accuracy and importance of future surveys are provided.

Dose reduction using bismuth shielding during paediatric CT examinations in Slovakia.

Considering the massive increase of computer tomography (CT) examinations in Slovakia during the last 10 y, it can be expected that a higher radiation load may be observed in the Slovak population. Since child population is more sensitive to radiation than adult population, a monitoring has started to see how high the radiation dose is for paediatric patients during CT examinations in chosen departments in Slovakia. The CT examination of the head is one of the most frequently done examinations in Slovakian departments and that is why measurements were done to clarify how usage of bismuth shields for eyes and thyroid can affect the eye and thyroid doses. For simulation, 215 thermoluminescent dosimeters were exposed on anthropomorphic phantom of a child with and without usage of bismuth shields. The result was that only two of the three chosen departments confirmed a reduction. On the other hand, one of the departments confirmed that the reduction can be up to 56-65 %, which is significant.

Extremity and eye lens doses in interventional radiology and cardiology procedures: first results of the ORAMED project.

The main objective of WP1 of the ORAMED (Optimization of RAdiation protection for MEDical staff) project is to obtain a set of standardised data on extremity and eye lens doses for staff in interventional radiology (IR) and cardiology (IC) and to optimise staff protection. A coordinated measurement program in different hospitals in Europe will help towards this direction. This study aims at analysing the first results of the measurement campaign performed in IR and IC procedures in 34 European hospitals. The highest doses were found for pacemakers, renal angioplasties and embolisations. Left finger and wrist seem to receive the highest extremity doses, while the highest eye lens doses are measured during embolisations. Finally, it was concluded that it is difficult to find a general correlation between kerma area product and extremity or eye lens doses.

Comparison of double dosimetry algorithms for estimating the effective dose in occupational dosimetry of interventional radiology staff.

'Double dosimetry' i.e. measurement with two dosemeters, one located above the protective apron and one under has been recommended in interventional radiology (IR) to determine the effective dose to staff. Several algorithms have been developed to calculate the effective dose from the readings of the two dosemeters, but there is no international consensus on what is the best algorithm. In this work, a few of the most recently developed algorithms have been tested in typical IR conditions. The effective dose and personnel dosemeter readings were obtained experimentally by using thermoluminescent dosemeters in and on a Rando-Alderson phantom provided with a lead apron. In addition, the effective dose and personnel dosemeter readings were calculated by the Monte Carlo method for the same irradiation geometry. The results suggest that most of the algorithms overestimate effective dose in the selected IR conditions, but there is also a risk of underestimation by using the least conservative algorithms. Two of the algorithms seem to comply best with the chosen criteria of performance, i.e. no underestimation, minimum overestimation and close estimation of effective dose in typical IR conditions. However, it might not be justified to generalise the results. It is recommended that whenever personnel doses approach or exceed the dose limit, IR conditions should be further investigated and the possibility of over- or under-estimation of effective dose by the algorithm used should be considered.

Overview of double dosimetry procedures for the determination of the effective dose to the interventional radiology staff.

In interventional radiology, for an accurate determination of effective dose to the staff, measurements with two dosemeters have been recommended, one located above and one under the protective apron. Such 'double dosimetry' practices and the algorithms used for the determination of effective dose were reviewed in this study by circulating a questionnaire and by an extensive literature search. The results indicated that regulations for double dosimetry almost do not exist and there is no firm consensus on the most suitable calculation algorithms. The calculation of effective dose is mainly based on the single dosemeter measurements, in which either personal dose equivalent, directly, (dosemeter below the apron) or a fraction of personal dose equivalent (dosemeter above the apron) is taken as an assessment of effective dose. The most recent studies suggest that there might not be just one double dosimetry algorithm that would be optimum for all interventional radiology procedures. Further investigations in several critical configurations of interventional radiology procedures are needed to assess the suitability of the proposed algorithms.

Patient doses and image quality in digital chest radiology.

Chest X-ray examination is one of the most frequently required procedures used in clinical practice. For studying the image quality of different X-ray digital systems and for the control of patient doses during chest radiological examinations, the standard anthropomorphic lung/chest phantom RSD 330 has been used and exposed in different digital modalities available in Slovakia. To compare different techniques of chest examination, a special software has been developed that enables researchers to compare digital imaging and communications in medicine header images from different digital modalities, using a special viewer. In this paper, this special software has been used for an anonymous correspondent audit for testing image quality evaluation by comparing various parameters of chest imaging, evaluated by 84 Slovak radiologists. The results of the comparison have shown that the majority of the participating radiologists felt that the highest image quality is reached with a flat panel, assessed by the entrance surface dose value, which is approximately 75% lower than the diagnostic reference level of chest examination given in the Slovak legislation. Besides the results of the audit, the possibilities of using the software for optimisation, education and training of medical students, radiological assistants, physicists and radiologists in the field of digital radiology will be described.

Patient dose in interventional radiology: a European survey.

Patient doses for a few common fluoroscopy-guided procedures in interventional radiology (IR) (excluding cardiology) were collected from a few radiological departments in 13 European countries. The major aim was to evaluate patient doses for the basis of the reference levels. In total, data for 20 procedures for about 1300 patients were collected. There were many-fold variations in the number of IR equipment and procedures per population, in the entrance dose rates, and in the patient dose data (total dose area product or DAP, fluoroscopy time and number of frames). There was no clear correlation between the total DAP and entrance dose rate, or between the total DAP and fluoroscopy time, indicating that a number of parameters affect the differences. Because of the limited number of patients, preliminary reference levels were proposed only for a few procedures. There is a need to improve the optimisation of IR procedures and their definitions and grouping, in order to account for their different complexities.

Implementation of QA and QC standards in radiology in Slovakia.

The Slovak government organizes the radiation protection policy through its regulatory authorities within the Ministry of Health, on a central level. The health protection regulations are compatible with international standards and recommendations of the ICRP and the EC. The general requirements on quality assurance (QA) and quality control (QC) (acceptance, constancy and routine tests), the guidance levels for various types of radiological examinations and the instructions for optimisation procedures are supported by Slovak technical standards, compatible with European standards. But the QA/QC process, as well as the training of the staff, needs improvement. The Slovak Medical University participates in the QA implementation through organising and managing national audits for control of the QA programme. In this paper, we present results of patient dose measurement studies carried out in the Slovak Republic, in the framework of activities of the Slovak Commission of QA established by the Slovak Ministry of Health.

Use of various microdosimetric models for the prediction of radon induced damage in human lungs.

Exposure to radon and radon decay products in some residential areas and at workplaces constitutes one of the greatest risks from natural sources of ionising radiation. Recently, increasing attention has been paid to the precise estimations of this health risk by numerous models. The compartmental model published in ICRP Publication 66 (HRTM) has been used for calculating alpha activity concentration in human lung. Energy deposition in the tissue was calculated by the Bethe-Bloch equation. The aim of this study was to check the performance and to compare the reliability of the microdosimetric models. In this work different thicknesses of mucus in the cases of non-smokers and smokers has been considered. Transformed cells were considered as the radiation risk parameters. The radiation risk evaluation for different exposure levels was based on homogeneous and heterogeneous distributions of target cells. The results of application of these procedures were compared with the epidemiological study of Czechoslovakian uranium miners.

Monte Carlo simulation of 252CF dose distribution brachytherapy.

The calculation of absorbed dose rate of photons and neutrons for the linear source of 252Cf with the active length of 2 cm is presented. Monte Carlo code and neutron cross-section data processed from ENDF/B-6 library were used. The achieved values of the absorbed dose rates are in good agreement with those published by other authors. The results of the calculation are applied to the gynecological configuration used in brachytherapy.

Effect of small doses of 252Cf on the tumour regression in cervix uteri during combined radiotherapy.

The results of a randomized study on the regression rate of the cervix uteri tumour for a group of 56 patients, investigated during and after radiotherapy with 2 Gy dose of the 252Cf neutron component applied by means of intracavitary therapy at the beginning of the therapeutic cure are presented and compared with the conventional 226Ra therapy. It was found that the tumour regression curve after 252Cf irradiation is significantly steeper than the curve of the control group. The quantitative evaluation of the results regarding the time required for a 50% regression of the original tumour shows that a group of patients treated by 252Cf needs a 27 days' cure in comparison with 40 days' cure for patients treated only by gamma radiation. The regression rate of the irradiated tumours shows a difference of approximately 30% for the treatment using small doses of 252Cf.