Assessment of radio-activation using spectroscopy in medical linear accelerators.

In radiotherapy, when photon energy exceeding 8 MV is utilized, photoneutrons can activate the components within the gantry of the linear accelerator (linac). At the end of the linac's lifecycle, radiation workers are tasked with its dismantling and disposal, potentially exposing them to unintentional radiation. This study aims to identify and measure the radioisotopes generated by this activation through spectroscopy, and to evaluate the effective dose rate. We selected nine medical linacs, considering various factors such as manufacturer (Siemens, Varian, and Elekta), model, energy, period of operation, and workload. We identified the radionuclides in the linac head by employing an in situ high-purity germanium (HPGe) detector. Spectroscopy and dose-rate measurements were conducted post-shutdown. We also measured the dose rates at the beam-exit window following irradiation with 10 MV and 15 MV photon beams. As a result of the spectroscopy, we identified approximately 20 nuclides including those with half-lives of 100 days or longer, such as 54Mn, 60Co, 65Zn, 122Sb, and 198Au. The dose rate measurements after 10 MV irradiation decreased to the background level in 10 min. By contrast, on 15 MV irradiation, the dose rate was 628 nSv/h after 10 min and decreased to 268 nSv/h after 1.5 hours. It was confirmed that the difference in the level of radiation and the type of nuclide depends on the period of use, energy, and workload. However, the type of nuclide does not differ significantly between the linacs. It is necessary to propose appropriate guidelines for the safety of workers, and disposal/move-install should be planned while taking into consideration the equipment's energy usage rate.

Body-size-dependent phantom library constructed from ICRP mesh-type reference computational phantoms.

Recently, ICRP Task Group 103 developed new mesh-type reference computational phantoms (MRCPs) for the adult male and female by converting the current voxel-type reference computational phantoms (VRCPs) of ICRP Publication 110 into a high-quality/fidelity mesh format. Utilizing the great deformability/flexibility of the MRCPs compared with the VRCPs, in the present study, we established a body-size-dependent phantom library by modifying the MRCPs. The established library includes 108 adult male and 104 adult female phantoms in different standing heights and body weights, covering most body sizes representative of Caucasian and Asian populations. Ten secondary anthropometric parameters with respect to standing height and body weight were derived from various anthropometric databases and applied in the construction of the phantom library. An in-house program for automatic phantom adjustment was developed and applied for practical construction of such a large number of phantoms in the library with minimized human intervention. Organ/tissue doses calculated with three male phantoms in different standing heights (165, 175, and 190 cm) with a fixed body weight of 80 kg for external exposures to broad parallel photon beams from 0.01 to 104 MeV were compared, observing there are significant dose differences particularly for the photon energies <0.1 MeV in which the organ/tissue doses tended to increase with increasing standing height. In addition, the organ/tissue doses of three female phantoms in different body weights (45, 65, and 140 kg) with a fixed standing height of 165 cm were compared, showing a significant decreasing tendency with increasing body weight for the photon energies <10 MeV. For the higher energies, the opposite trend, interestingly, was observed; that is, the organ/tissue doses tended to increase with increasing body weight. The results, despite the limited number of exposure cases, suggest that the use of the body-size-dependent phantom library can improve the accuracy of individual dose estimates for many retrospective dosimetry studies by taking the body size of individuals into account.

Efficacy of Systemic Steroid Use Given One Day After Total Knee Arthroplasty for Pain and Nausea: A Randomized Controlled Study.

BACKGROUND: Systemic steroid has been used to control pain and nausea in total knee arthroplasty (TKA), but most studies recommend a single dose administration prior to, or during, surgery. This study aimed to determine the efficacy of administration on 1 day postoperatively. METHODS: Patients who were scheduled to undergo TKA were randomly assigned to the following groups: control group, receiving normal saline injection; group 1, receiving 10 mg dexamethasone intravenously (IV) 1 hour before surgery; group 2, receiving 0.1 mg/kg dexamethasone (IV) 24 hours after surgery; or group 3, receiving 0.2 mg/kg dexamethasone (IV) 24 hours after surgery (n = 44-46 per group). Primary outcomes were pain and nausea visual analogue scale (VAS). Secondary outcomes were analgesic administration, rescue antiemetic administration, C-reactive protein, range of motion, and complications. RESULTS: Postoperative pain and nausea remained high for 48 hours post-TKA. Group 1 had lower pain and nausea VAS scores than did the control group (P < .01) for only 24 hours post-TKA. Groups 2 and 3 had lower pain and nausea VAS scores than did the control group and group 1 (P < .01) 48 hours post-TKA. Analgesic and antiemetic administration were significantly lower in groups 2 and 3 than in the control group during 48 hours after TKA. There were no differences in C-reactive protein level and range of motion, and complications were not detected. CONCLUSION: The effect of preoperative and postoperative administration of dexamethasone for controlling pain and nausea was observed only for 24 hours. Considering that severe pain and nausea persisted for more than 48 hours after TKA, additional administration of dexamethasone at 1 day postoperatively is suggested. LEVEL OF EVIDENCE: Level I.

Do the increment of femoral condyle curvature and the change of tibia shape improve clinical outcome in total knee arthroplasty? A propensity score matching analysis.

PURPOSE: Recently, the Persona total knee arthroplasty (TKA) system with more anatomical features and a similarly high flexion to the previous version, LPS-Flex, was introduced and is widely used. This study aimed to compare the early outcomes obtained using Persona versus an LPS-Flex fixed PS implant. METHODS: A total of 784 knees that underwent primary TKAs (162: Persona group and 622: LPS-Flex group) were included. After 1:2 propensity score matching, there were 143 and 286 knees in Persona and LPS-Flex groups, respectively. Range of motion at the 2-year follow-up was the primary variable. Secondary variables were functional score, ability to perform activities requiring deep knee flexion, patient satisfaction, and radiographic measurements, including radiolucent line (RLL). RESULTS: The average postoperative maximal flexion measured by goniometer at 2 years after TKA was 126.1° ± 10.8° (range 95°-140°) for the Persona group and 132.7° ± 11.7° (range 103°-145°) for the LPS-Flex group (P < 0.05). This significant difference was observed from 1 year postoperatively (P < 0.05). The two groups did not show a significant difference in functional score, postoperative ability in high flexion activities, and satisfaction at the 2-year follow-up. The rate of RLL was significantly lower in the Persona group (P < 0.05). CONCLUSION: At the 2-year follow-up, the Persona group had less maximal flexion; however, the difference in flexion did not seem to affect clinical outcomes. According to the radiological results, the Persona system shows less RLL than does the LPS-Flex system. LEVEL OF EVIDENCE: III.

Mesh-type reference Korean phantoms (MRKPs) for adult male and female for use in radiation protection dosimetry.

In the present study, to overcome the dosimetric limitations of the previous voxel-type reference Korean computational phantoms due to their limited voxel resolutions (i.e. on the order of millimeters) and the nature of voxel geometry, a pair of new reference Korean phantoms, called mesh-type reference Korean phantoms (MRKPs), were developed for the adult male and female in a high-quality/fidelity mesh format. The developed phantoms include all target and source regions required for effective dose calculation, even micrometer-scale target and source regions of the respiratory and alimentary tract organs, skin, urinary bladder, and eye lens. The developed phantoms, which are in either the polygon-mesh (PM) format or the tetrahedral-mesh (TM) format as necessary, can be directly used in several general-purpose Monte Carlo codes (e.g. Geant4, MCNP6, and PHITS) without voxelization. In order to understand the dosimetric impact of the new phantoms, the dose coefficients (=fluence-to-effective dose conversion coefficients) were calculated for photons and electrons with energies ranging from 10 keV to 10 GeV for the anterior-posterior (AP) irradiation geometry and compared with those of the previous voxel-type reference Korean phantoms. The results demonstrate that the effective dose coefficients of the MRKPs were generally similar to those of the previous voxel-type reference phantoms for photons; however, for electrons, significant differences were observed at energies lower than 1 MeV that were mainly due to the explicit definition of the 50 µm-thick radiosensitive target layer in the skin of the new mesh phantoms.

Percentile-specific computational phantoms constructed from ICRP mesh-type reference computational phantoms (MRCPs).

Recently, the Task Group 103 of the International Commission on Radiological Protection (ICRP) has developed new mesh-type reference computational phantoms (MRCPs) for adult male and female. When compared to the current voxel-type reference computational phantoms in ICRP Publication 110, the MRCPs have several advantages, including deformability which makes it possible to create phantoms in different body sizes or postures. In the present study, the MRCPs were deformed to produce a set of percentile-specific phantoms representing the 10th, 50th and 90th percentiles of standing height and body weight in Caucasian population. For this, anthropometric parameters for the percentile-specific phantoms were first derived from the anthropometric software and survey data. Then, the MRCPs were modified to match the derived anthropometric parameters. For this, first, the MRCPs were scaled in the axial direction to match the head height, torso length, and leg length. Then, the head, torso, and legs were scaled in the transversal directions to match the lean body mass for the percentile-specific phantoms. Finally, the scaled phantoms were manually adjusted to match the body weight and the remaining anthropometric parameters (upper arm, waist, buttock, thigh, and calf circumferences and sagittal abdominal diameter). The constructed percentile-specific phantoms and the MRCPs were implemented into the Geant4 Monte Carlo code to calculate organ doses for a cesium-137 contaminated floor. The results showed that organ doses of the 50th percentile (both standing height and body weight) phantoms are very close to those of the MRCPs. There were noticeable differences in organ doses, however, for the 10th and 90th percentile phantoms when compared with those of the MRCPs. The results of the present study confirm the general intuition that a small person receives higher doses than a large person when exposed to a static radiation field, and organs closer to the source receive higher doses.