Brain magnetic resonance imaging without contrast significantly increased serum levels of IL-6, but not IL-10, IL-17A and TGF-ß.

Introduction: Magnetic Resonance Imaging (MRI) is a non-invasive imaging modality. However, the effects of MRI on the immune system in the in vivo conditions are yet to be clarified. In this study we explored the effects of routine brain MRI on the protein and mRNA peripheral blood levels of interleukin-6 (IL-6), IL-10, IL-17A and transforming growth factor-beta (TGF-ß).Material and methods: 40 subjects, who referred for brain MRI, were entered for evaluating effects of routine brain MRI on the protein and mRNA peripheral blood levels of IL-6, IL-10, IL-17A and TGF-ß. Accordingly, peripheral blood were collected before and 3 hours after MRI from the participants. Protein levels of the cytokines were evaluated using ELISA. Also, mRNA levels were analyzed using Real-Time PCR techniques.Results: Brain MRI without contrast led to an increase in protein levels of IL-6 in the peripheral serum, but did not change protein and mRNA levels of IL-10, IL-17A and TGF-ß. IL-6 mRNA levels after MRI were higher in the participants with mild anxiety compared to those without anxiety.Conclusion: brain MRI without contrast can induce secretion of IL-6 and may be associated with its functions, such as development of plasma cells or induction of inflammation.

PATIENT DOSE SURVEY BASED ON SIZE-SPECIFIC DOSE ESTIMATE AND ACCEPTABLE QUALITY DOSE IN CHEST AND ABDOMEN/PELVIS CT EXAMINATIONS.

The practical aspects of two recently developed patient dose optimization methods in computed tomography (CT) examinations, size-specific dose estimate (SSDE) and acceptable quality dose (AQD), were verified for the chest and abdomen/pelvis examinations. A dose survey was performed in a CT institute by considering patients lateral diameter, weight and body mass index (BMI). The AQD tables for weight and BMI groups and SSDE threshold curves were obtained. The mean of volume CT dose index and dose length product for standard-size patients were compared with the national diagnostic reference levels (NDRLs) of Iran. The results show that patient doses are below the NDRLs. It is more reliable to report the AQDs based on SSDE and for BMI groups which can well take into account patient size in the dose optimization process. The SSDE threshold curves can be determined with more precision by including dose data of all possible sizes in the curves.

Statistical analysis for obtaining optimum number of CT scanners in patient dose surveys for determining national diagnostic reference levels.

OBJECTIVES: To statistically determine an 'optimum number of CT scanners' for obtaining 'diagnostic reference levels' (DRLs) in CT examinations as close as possible to 'ideal DRLs' when all available CT scanners are considered. METHODS: First, six 'ideal DRLs' (CTDIVol and DLP) were determined for head, chest and abdomen/pelvis examinations by using patient-dose survey data of 100 CT scanners of different models in Tehran. Then, a 'random sampling method' was applied to different percent fractions of patient dose data of 100 CT scanners. The percent differences (PD) of the DRLs obtained from 'ideal DRLs' and their coefficients of variation (CVs) were calculated. The 'optimum number of CT scanners' determined met those of 'ideal DRL' criteria; i.e. precision (CV ≤ 10%) and accuracy (PD ≤ 10%). RESULTS: 'Optimum number of CT scanners' for determining DRLs as close as possible to 'ideal DRLs', fulfilling the stated criteria, is 43 instead of using 100. CONCLUSION: 'Optimum number of CT scanners' for obtaining DRLs as close as possible to 'ideal DRLs' was determined. This optimum number can be effectively applied in patient-dose survey situations with limited resources in a time- and cost-effective manner. KEY POINTS: • Ideal DRLs were determined by a CT patient-dose survey applied to available scanners. • 'Optimum number of CT scanners' statistically determined for DRLs is 43%. • Optimum number can be used for DRLs as if 'ideal DRLs' were determined by all scanners.

A New Dual-purpose Quality Control Dosimetry Protocol for Diagnostic Reference-level Determination in Computed Tomography.

A diagnostic reference level is an advisory dose level set by a regulatory authority in a country as an efficient criterion for protection of patients from unwanted medical exposure. In computed tomography, the direct dose measurement and data collection methods are commonly applied for determination of diagnostic reference levels. Recently, a new quality-control-based dose survey method was proposed by the authors to simplify the diagnostic reference-level determination using a retrospective quality control database usually available at a regulatory authority in a country. In line with such a development, a prospective dual-purpose quality control dosimetry protocol is proposed for determination of diagnostic reference levels in a country, which can be simply applied by quality control service providers. This new proposed method was applied to five computed tomography scanners in Shiraz, Iran, and diagnostic reference levels for head, abdomen/pelvis, sinus, chest, and lumbar spine examinations were determined. The results were compared to those obtained by the data collection and quality-control-based dose survey methods, carried out in parallel in this study, and were found to agree well within approximately 6%. This is highly acceptable for quality-control-based methods according to International Atomic Energy Agency tolerance levels (±20%).

Determination of Examination-Specific Diagnostic Reference Level in Computed Tomography by A New Quality Control-Based Dose Survey Method.

A new "quality-control-based (QC-based) dose survey method" has been developed for determination of diagnostic reference levels (DRL) in Computed Tomography (CT) examinations. The "QC-based dose survey method" is based on the use of retrospective data in the QC documents and reports, which are typically available from the National Regulatory Authority database. The method was applied to 70 CT scanners in Tehran, Iran, by using the available QC reports from the database. The commonly used "data collection method" was also applied by filling each questionnaire on-site to validate the new method. Using the new QC-based and data collection methods, the DRLs of four common CT examinations: head, sinus, chest, and abdomen/pelvis were determined and compared. The DRLs determined by the "QC-based method" for head, sinus, chest, and abdomen/pelvis are 59, 29, 10, and 13 mGy, respectively, for the volume computed tomography dose index (CTDIVol) and 834, 235, 233, and 522 mGy-cm for the dose length product (DLP), respectively. The difference between the DRLs obtained by the two methods is on the average 6.7 ± 5.7%, which is within the acceptance tolerance level of the IAEA for QC dosimetry tests. The "QC-based dose survey method" is believed to be an effective alternative method to the other commonly used "data collection" and "direct dose measurement method" for determination of CT examination DRLs. This new method has unique characteristics such as simplicity, time and cost effectiveness, highly reduced clinical interruptions and collaborations, and potential for large-scale surveys with capability for more frequent review of national DRL values.

DETERMINATION OF NATIONAL DIAGNOSTIC REFERENCE LEVELS IN COMPUTED TOMOGRAPHY EXAMINATIONS OF IRAN BY A NEW QUALITY CONTROL-BASED DOSE SURVEY METHOD.

National diagnostic reference levels (NDRLs) of Iran were determined for the four most common CT examinations including head, sinus, chest and abdomen/pelvis. A new 'quality control (QC)-based dose survey method', as developed by us, was applied to 157 CT scanners in Iran (2014-15) with different slice classes, models and geographic spread across the country. The NDRLs for head, sinus, chest and abdomen/pelvis examinations are 58, 29, 12 and 14 mGy for CTDIVol and 750, 300, 300 and 650 mGy.cm for DLP, respectively. The 'QC-based dose survey method' was further proven that it is a simple, accurate and practical method for a time and cost-effective NDRLs determination. One effective approach for optimization of the CT examination protocols at the national level is the provision of an adequate standardized training of the radiologists, technicians and medical physicists on the patient radiation protection principles and implementation of the DRL concept in clinical practices.

A "quality-control-based correction method" for displayed dose indices on CT scanner consoles in patient dose surveys.

PURPOSE: A new quality-control-based (QC-based) method is introduced to obtain correction factors to be applied to displayed patient dose indices (CTDIVol and DLP) on CT scanner consoles to verify improvement of dose surveys for diagnostic reference levels (DRLs) determination. METHOD: An available data-base of QC documents and reports of 57 CT scanners in Tehran, Iran was used to estimate CTDIVol, DLP and relevant correction factors for three CT examination types including head, chest and abdomen/pelvis. The correction factor is the ratio of QC-based estimated dose to displayed dose. A dose survey was performed by applying on-site "data collection method" and correction factors obtained in order to select CT scanners in three modes for determination of CT DRLs by inclusion of: (a) all CT scanners before displayed dose indices were corrected (57), (b) only CT scanners calibrated by QC experts (41) and (c) all CT scanners after displayed dose indices were corrected (57). RESULTS: For the 41 CT scanners, correction factors of three examination types obtained in this study are within the acceptance tolerance of IAEA HHS-19. The correction factors range from 0.45 to 1.7 (average of 3 examinations) which is due to the change in the calibrated value of CTDIVol over extended time. The DRL differences in three modes are within ±1.0% for CTDIVol and ±12.4% for DLP. CONCLUSIONS: The "QC-based correction method" applied to mode (c) has improved the DRLs obtained by other two modes. This method is a strong alternative to "direct dose measurement" with simplicity and cost effectiveness.

GANTRY ANGULATION EFFECTS ON CT DOSE ALONG THE Z-AXIS DIRECTION IN HEAD EXAMINATIONS.

The purpose of this study was to evaluate the effects of the gantry angulation on dose profiles along the z-axis, the CTDIW value and the CTDIW efficiency in the head examinations. A Monte Carlo simulation model of a GE LightSpeed 16-slice CT scanner was developed by a GATE toolkit. The CTDI100 in air at the isocenter and in a head dosimetry phantom were measured using a pencil ion chamber. Dose profiles were studied in the central and peripheral holes of the head phantom using thermoluminescence LiF disc dosemeters for gantry angulations of 0°, 10° and 20°. Results show a small shift for only the peripheral dose profiles with increasing the gantry angulation (maximum shift of 24 mm at 20°). The peak amplitude of the dose profiles was reduced for both of the central and peripheral holes by ~5%, while the CTDIW values and the CTDIW efficiencies did not change significantly.