Feasibility study of computational occupational dosimetry: evaluating a proof-of-concept in an endovascular and interventional cardiology setting.

Individual monitoring of radiation workers is essential to ensure compliance with legal dose limits and to ensure that doses are As Low As Reasonably Achievable. However, large uncertainties still exist in personal dosimetry and there are issues with compliance and incorrect wearing of dosimeters. The objective of the PODIUM (Personal Online Dosimetry Using Computational Methods) project was to improve personal dosimetry by an innovative approach: the development of an online dosimetry application based on computer simulations without the use of physical dosimeters. Occupational doses were calculated based on the use of camera tracking devices, flexible individualised phantoms and data from the radiation source. When combined with fast Monte Carlo simulation codes, the aim was to perform personal dosimetry in real-time. A key component of the PODIUM project was to assess and validate the methodology in interventional radiology workplaces where improvements in dosimetry are needed. This paper describes the feasibility of implementing the PODIUM approach in a clinical setting. Validation was carried out using dosimeters worn by Vascular Surgeons and Interventional Cardiologists during patient procedures at a hospital in Ireland. Our preliminary results from this feasibility study show acceptable differences of the order of 40% between calculated and measured staff doses, in terms of the personal dose equivalent quantity Hp(10), however there is a greater deviation for more complex cases and improvements are needed. The challenges of using the system in busy interventional rooms have informed the future needs and applicability of PODIUM. The availability of an online personal dosimetry application has the potential to overcome problems that arise from the use of current dosimeters. In addition, it should increase awareness of radiation protection among staff. Some limitations remain and a second phase of development would be required to bring the PODIUM method into operation in a hospital setting. However, an early prototype system has been tested in a clinical setting and the results from this two-year proof-of-concept PODIUM project are very promising for future development.

Report of Task Group on the implications of the implementation of the ICRP recommendations for a revised dose limit to the lens of the eye.

This report was commissioned by the IRPA President to provide an assessment of the impact on members of IRPA Associate Societies of the introduction of ICRP recommendations for a reduced dose limit for the lens of the eye. The report summarises current practice and considers possible changes that may be required. Recommendations for further collaboration, clarification and changes to working practices are suggested.

Dose assesment with fast Monte Carlo codes in interventional radiology.

This study presents the performance of two fast Monte Carlo codes, PENELOPE/penEasyIR and MCGPU-IR in order to assess operator doses in interventional radiology. In particular, it aims to validate the calculations when workers are protected with shielding located between the patient and the operator. The experiments are performed in a calibration laboratory and measurements are gathered using Thermo EPD and Mirion DMC personal active dosemeters. Calculation efficiency of the fast Monte Carlo codes is approximately four orders of magnitude greater than for a standard Monte Carlo code. Satisfactory agreement between measurements and calculations is shown.

PERSONAL DOSIMETRY USING MONTE-CARLO SIMULATIONS FOR OCCUPATIONAL DOSE MONITORING IN INTERVENTIONAL RADIOLOGY: THE RESULTS OF A PROOF OF CONCEPT IN A CLINICAL SETTING.

Exposure levels to staff in interventional radiology (IR) may be significant and appropriate assessment of radiation doses is needed. Issues regarding measurements using physical dosemeters in the clinical environment still exist. The objective of this work was to explore the prerequisites for assessing staff radiation dose, based on simulations only. Personal dose equivalent, Hp(10), was assessed using simulations based on Monte Carlo methods. The position of the operator was defined using a 3D motion tracking system. X-ray system exposure parameters were extracted from the x-ray equipment. The methodology was investigated and the simulations compared to measurements during IR procedures. The results indicate that the differences between simulated and measured staff radiation doses, in terms of the personal dose equivalent quantity Hp(10), are in the order of 30-70 %. The results are promising but some issues remain to be solved, e.g. an automated tracking of movable parts such as the ceiling-mounted protection shield.

Fast Monte Carlo codes for occupational dosimetry in interventional radiology.

PURPOSE: Interventional radiology techniques cause radiation exposure both to patient and personnel. The radiation dose to the operator is usually measured with dosimeters located at specific points above or below the lead aprons. The aim of this study is to develop and validate two fast Monte Carlo (MC) codes for radiation transport in order to improve the assessment of individual doses in interventional radiology. The proposed methodology reduces the number of required dosemeters and provides immediate dose results. METHODS: Two fast MC simulation codes, PENELOPE/penEasyIR and MCGPU-IR, have been developed. Both codes have been validated by comparing fast MC calculations with the multipurpose PENELOPE MC code and with measurements during a realistic interventional procedure. RESULTS: The new codes were tested with a computation time of about 120 s to estimate operator doses while a standard simulation needs several days to obtain similar uncertainties. When compared with the standard calculation in simple set-ups, MCGPU-IR tends to underestimate doses (up to 5%), while PENELOPE/penEasyIR overestimates them (up to 18%). When comparing both fast MC codes with experimental values in realistic set-ups, differences are within 25%. These differences are within accepted uncertainties in individual monitoring. CONCLUSION: The study highlights the fact that computational dosimetry based on the use of fast MC codes can provide good estimates of the personal dose equivalent and overcome some of the limitations of occupational monitoring in interventional radiology. Notably, MCGPU-IR calculates both organ doses and effective dose, providing a better estimate of radiation risk.

Recommendations for the use of active personal dosemeters (APDs) in interventional workplaces in hospitals.

Occupational radiation doses from interventional procedures have the potential to be relatively high. The requirement to optimise these doses encourages the use of electronic or active personal dosimeters (APDs) which are now increasingly used in hospitals. They are typically used in tandem with a routine passive dosimetry monitoring programme, with APDs used for real-time readings, for training purposes and when new imaging technology is introduced. However, there are limitations when using APDs. A survey in hospitals to identify issues related to the use of APDs was recently completed, along with an extensive series of APD tests by the EURADOS Working Group 12 on Dosimetry for Medical Imaging. The aim of this review paper is to summarise the state of the art regarding the use of APDs. We also used the results of our survey and our tests to develop a set of recommendations for the use of APDs in the clinical interventional radiology/cardiology settings, and draw attention to some of the current challenges.

THE USE OF ACTIVE PERSONAL DOSEMETERS IN INTERVENTIONAL WORKPLACES IN HOSPITALS: COMPARISON BETWEEN ACTIVE AND PASSIVE DOSEMETERS WORN SIMULTANEOUSLY BY MEDICAL STAFF.

Medical staff in interventional procedures are among the professionals with the highest occupational doses. Active personal dosemeters (APDs) can help in optimizing the exposure during interventional procedures. However, there can be problems when using APDs during interventional procedures, due to the specific energy and angular distribution of the radiation field and because of the pulsed nature of the radiation. Many parameters like the type of interventional procedure, personal habits and working techniques, protection tools used and X-ray field characteristics influence the occupational exposure and the scattered radiation around the patient. In this paper, we compare the results from three types of APDs with a passive personal dosimetry system while being used in real clinical environment by the interventional staff. The results show that there is a large spread in the ratios of the passive and active devices.

HOW TO ESTABLISH AN ADEQUATE SYSTEM FOR EYE LENS DOSE MONITORING: A PROPOSAL FOR TYPICAL WORKPLACES.

For years, the dose limit of 150 mSv for occupational exposure of the lens of the eye to ionising radiation was rarely exceeded, and the dose to the eye was only monitored occasionally. With the national implementation of the European Basic Safety Standards in 2018, this dose limit was reduced to 20 mSv and the Member States are expected to implement an adequate system for the monitoring of category A workers. Where the system for monitoring the whole body dose is settled in most countries, this is not the situation for the lens of the eye. This article presents a system for eye lens dose monitoring, based on the particle type, energy, angle of incidence and geometry of the radiation field and the use of protective measures. The system provides recommendations for the adequate operational quantity and dosemeter position for some of the most relevant workplaces.

An overview on extremity dosimetry in medical applications.

Some activities of EURADOS Working Group 9 (WG9) are presently funded by the European Commission (CONRAD project). The objective of WG9 is to promote and co-ordinate research activities for the assessment of occupational exposures to staff at workplaces in interventional radiology (IR) and nuclear medicine. For some of these applications, the skin of the fingers is the limiting organ for individual monitoring of external radiation. Therefore, sub-group 1 of WG9 deals with the use of extremity dosemeters in medical radiation fields. The wide variety of radiation field characteristics present in a medical environment together with the difficulties in measuring a local dose that is representative for the maximum skin dose, usually with one single detector, makes it difficult to perform accurate extremity dosimetry. Sub-group 1 worked out a thorough literature review on extremity dosimetry issues in diagnostic and therapeutic nuclear medicine and positron emission tomography, interventional radiology and interventional cardiology and brachytherapy. Some studies showed that the annual dose limits could be exceeded if the required protection measures are not taken, especially in nuclear medicine. The continuous progress in new applications and techniques requires an important effort in radiation protection and training.

An overview of the use of extremity dosemeters in some European countries for medical applications.

Some medical applications are associated with high doses to the extremities of the staff exposed to ionising radiation. At workplaces in nuclear medicine, interventional radiology, interventional cardiology and brachytherapy, extremities can be the limiting organs as far as regulatory dose limits for workers are concerned. However, although the need for routine extremity monitoring is clear for these applications, no data about the status of routine extremity monitoring reported by different countries was collected and analysed so far, at least at a European level. In this article, data collected from seven European countries are presented. They are compared with extremity doses extracted from dedicated studies published in the literature which were reviewed in a previous publication. The analysis shows that dedicated studies lead to extremity doses significantly higher than the reported doses, suggesting that either the most exposed workers are not monitored, or the dosemeters are not routinely worn or not worn at appropriate positions.

Extremity ring dosimetry intercomparison in reference and workplace fields.

An intercomparison of ring dosemeters has been organised with the aim of assessing the technical capabilities of available extremity dosemeters and focusing on their performance at clinical workplaces with potentially high extremity doses. Twenty-four services from 16 countries participated in the intercomparison. The dosemeters were exposed to reference photon ((137)Cs) and beta ((147)Pm, (85)Kr and (90)Sr/(90)Y) fields together with fields representing realistic exposure situations in interventional radiology (direct and scattered radiation) and nuclear medicine ((99 m)Tc and (18)F). It has been found that most dosemeters provided satisfactory measurements of H(p)(0.07) for photon radiation, both in reference and realistic fields. However, only four dosemeters fulfilled the established requirements for all radiation qualities. The main difficulties were found for the measurement of low-energy beta radiation. Finally, the results also showed a general under-response of detectors to (18)F, which was attributed to the difficulties of the dosimetric systems to measure the positron contribution to the dose.

EURADOS 2016 INTERCOMPARISON EXERCISE OF EYE LENS DOSEMETERS.

In the context of a new annual eye lens dose limit for occupational exposure equal to 20 mSv, European Radiation Dosimetry Group (EURADOS) organized an intercomparison dedicated to eye lens dosemeters, including photon and beta radiations. The objective was to complete the first intercomparison recently organized by EURADOS for photons and to update the overview of eye lens dosemeters available in Europe. The dosemeters provided by the 22 participants coming from 12 countries were all composed of thermoluminescent detectors. The dosemeters were irradiated with photon and beta fields defined in relevant standards. The results, provided by participants in terms of Hp(3), were compared to the reference delivered doses. Results are globally satisfactory for photons since 90% of the data are in accordance to the ISO 14146 standard requirements. The respective values for betas stress the fact that dosemeters designed for Hp(0.07) are not suitable to monitor the eye lens dose in case of betas.

Comparison of dose calculation algorithms in slab phantoms with cortical bone equivalent heterogeneities.

To evaluate the dose values predicted by several calculation algorithms in two treatment planning systems, Monte Carlo (MC) simulations and measurements by means of various detectors were performed in heterogeneous layer phantoms with water- and bone-equivalent materials. Percentage depth doses (PDDs) were measured with thermoluminescent dosimeters (TLDs), metal-oxide semiconductor field-effect transistors (MOSFETs), plane parallel and cylindrical ionization chambers, and beam profiles with films. The MC code used for the simulations was the PENELOPE code. Three different field sizes (10 x 10, 5 x 5, and 2 x 2 cm2) were studied in two phantom configurations and a bone equivalent material. These two phantom configurations contained heterogeneities of 5 and 2 cm of bone, respectively. We analyzed the performance of four correction-based algorithms and one based on convolution superposition. The correction-based algorithms were the Batho, the Modified Batho, the Equivalent TAR implemented in the Cadplan (Varian) treatment planning system (TPS), and the Helax-TMS Pencil Beam from the Helax-TMS (Nucletron) TPS. The convolution-superposition algorithm was the Collapsed Cone implemented in the Helax-TMS. All the correction-based calculation algorithms underestimated the dose inside the bone-equivalent material for 18 MV compared to MC simulations. The maximum underestimation, in terms of root-mean-square (RMS), was about 15% for the Helax-TMS Pencil Beam (Helax-TMS PB) for a 2 x 2 cm2 field inside the bone-equivalent material. In contrast, the Collapsed Cone algorithm yielded values around 3%. A more complex behavior was found for 6 MV where the Collapsed Cone performed less well, overestimating the dose inside the heterogeneity in 3%-5%. The rebuildup in the interface bone-water and the penumbra shrinking in high-density media were not predicted by any of the calculation algorithms except the Collapsed Cone, and only the MC simulations matched the experimental values within the estimated uncertainties. The TLD and MOSFET detectors were suitable for dose measurement inside bone-equivalent materials, while parallel ionization chambers, applying the same calibration and correction factors as in water, systematically underestimated dose by 3%-5%.

Improvements in extremity dose assessment for ionising radiation medical applications.

This study aims at testing the INTE ring dosemeter based on MCP-Ns and TLD-100 detectors on users from the field of medical applications, namely radiopharmacists, personnel at a cyclotron facility with corresponding FDG synthesis cells, interventional radiology technologists and radiologists. These users were chosen due to the fact that they have a significantly high risk of exposure to their hands. Following previous results, MCP-Ns TL thin material was used for radiology measurements, whereas TLD-100 was preferred for other applications. The dosemeters were tested to make sure that they were waterproof and that they could be sterilised properly prior to use. Results confirm the need to implement finger dosimetry, mainly for interventional radiologists as finger dose can be >50 times higher than whole-body dose and 3 times higher than wrist dose.

Overview of active personal dosemeters for individual monitoring in the European Union.

In 2001, the European Radiation Dosimetry Group, EURADOS, started a working group on 'Harmonisation of Individual Monitoring in Europe and the Dissemination of Information on New Techniques in this Field'. Within this group, one of the projects consisted of analysing the status of active personal dosemeters (APDs) in Europe. This paper reviews the regulatory requirements for APDs in 15 EU member states and summarises the main characteristics of commercial and new developments in this field. In particular, it focuses on the comparison of APD performance and standard passive dosimetry systems. Based on this information, an evaluation is initiated to establish why several countries are reluctant to accept APDs for dose records.

Comparison of two extremity dosemeters based on LiF:Mg,Cu,P thin detectors for mixed beta-gamma fields.

Two types of thin LiF:Mg,Cu,P detectors, GR-200F and MCP-Ns, have been characterised for use in the design of an extremity dosemeter for mixed beta-photon radiation fields. Both detectors consist of an extremely thin layer of sensitive material with effective thicknesses of 5 and 8 mg cm(-2), respectively, held in a 5 mg cm(-2) PVC ring holder. Dosimetric performance was analysed according to the ISO 12794 standard and compared with 240 mg cm(-2) TLD-100 measurements. In particular, the energy response was obtained for ISO narrow X-ray spectra, (137)Cs, (60)Co, (204)Tl and (90)Sr/(90)Y. From these measurements a mean calibration factor was calculated to estimate H(p)(0.07). Subsequently, the performance of the dosemeters was checked for a set of 10 different mixed photon and beta-photon fields. The study shows that the proposed dosemeters can estimate H(p)(0.07) in a wide range of mixed beta-photon fields with a maximum deviation from the given dose of 30% and an overall uncertainty of the order of 25% (k = 1). However, the results also highlight a large variability among the different thin detectors and, thus, the standard TLD-100 material is recommended whenever the workplace does not include low-energy beta radiation.

Dose evaluation in lung-equivalent media in high-energy photon external radiotherapy.

In high-energy photon external radiotherapy treatment planning systems (TPSs) are used to calculate the dose to the target volume and the dose distribution around it. Commonly used TPSs include algorithms based on measurements in water and often fail in the estimate of dose in the presence of heterogeneities. In this study TL detectors were used to study the reliability of the Cadplan (Varian) TPS in the presence of low-density heterogeneities such as the lung for 6 and 18 MV photon beams at different field sizes. TL measurements were compared with TPS calculations and Monte Carlo simulations performed with the PENELOPE MC code. In a phantom with lung heterogeneity, TL measurements and MC simulations agreed, with an average deviation inside the lung of 2%. In contrast, TPS results overestimated the dose inside the lung, with a maximum deviation of 39% for the 18 MV photon beam and a field size of 2 x 2 cm(2).

Aspects of harmonisation of individual monitoring for external radiation in Europe: conclusions of a EURADOS action.

Following the publication of the EU Council Directive 96/29, EURADOS coordinated two working groups (WGs) for promoting the process of harmonisation on individual monitoring of occupationally exposed persons in Europe. An overview of the major findings of the second WG is presented. Information on the technical and quality standards and on the accreditation and approval procedures has been compiled. The catalogue of dosimetric services has been updated and extended. An overview of national regulations and standards for protection from radon and other natural sources in workplaces has been made, attempting to combine the results from individual monitoring for external, internal and workplace monitoring. A first status description of the active personal dosemeters, including legislative and technical information, and their implementation has been made. The importance of practical factors on the uncertainty in the dose measurement has been estimated. Even if a big progress has been made towards harmonisation, there is still work to be done.

A PRACTICAL APPROACH TO PERFORM THE ISOTROPY TEST FOR EXTREMITY DOSEMETERS.

The requirements for determining extremity dosemeter performance have evolved over the past decade. In 2010, the Spanish Nuclear Safety Council (CSN) adopted a national protocol with performance requirements based on ISO 12794. Because of the lack of symmetry of ISO 4037-3 calibration phantoms, the isotropy test set up in the sagittal plane presented several challenges both for individual monitoring services and for calibration labs. This article proposes and validates a practical approach to reduce the number of irradiations. Results show that wrist and ring dosemeters in this study meet the ISO 12794 requirements for the isotropy test. However, additional studies would be needed to verify the newer IEC 62387 Standard.

AIR KERMA TO Hp(3) CONVERSION COEFFICIENTS FOR IEC 61267 RQR X-RAY RADIATION QUALITIES: APPLICATION TO DOSE MONITORING OF THE LENS OF THE EYE IN MEDICAL DIAGNOSTICS.

Recent studies highlight the fact that the new eye lens dose limit can be exceeded in interventional radiology procedures and that eye lens monitoring could be required for these workers. The recommended operational quantity for monitoring of eye lens exposure is the personal dose equivalent at 3 mm depth Hp(3) (ICRU 51). However, there are no available conversion coefficients in international standards, while in the literature coefficients have only been calculated for monoenergetic beams and for ISO 4037-1 X-ray qualities. The aim of this article is to provide air kerma to Hp(3) conversion coefficients for a cylindrical phantom made of ICRU-4 elements tissue-equivalent material for RQR radiation qualities (IEC-61267) from 40 to 120 kV and for angles of incidence from 0 to 180°, which are characteristic of medical workplace. Analytic calculations using interpolation techniques and Monte Carlo modelling have been compared.