Relationship between kerma and treatment volume in intracavitary radiation therapy

Data on 200 patients with carcinoma of the uterine cervix irradiated with afterloading brachytherapy using various high dose rate source configurations have been evaluated with respect to the total reference air kerma and the treatment volume as well as other volumes of interest. The experimental results showed good correlation between kerma and volume, and have also been discussed theoretically for the single-source, double-source and triple-source configurations. The possibility of using the demonstrated kerma-volume relationships for simple estimation of volumes enables us to select the appropriate treatment plan for the individual patient and to evaluate the results of the treatment.

Dynamic quantitative bone scintigraphy in patients with prostatic carcinoma treated by orchiectomy

Dynamic quantitative bone scintigraphy was performed on 31 men with prostatic carcinoma before orchiectomy as well as 2 weeks, 2 and 6 months postoperatively. After injection of technetium methylene diphosphonate Tc 99m (99mTc-MDP) the count rate was recorded as serial images over the lower thoracic and all the lumbar vertebrae from 1 to 240 min post-injection. Thirteen men had normal bone scintigrams with no changes in 99mTc-MDP content at the four different investigation times. Eighteen men had skeletal metastases. Throughout the study half of the abnormal vertebrae in these patients showed an abnormal count rate after only 6 min post-injection. After 1 h it was possible in almost all abnormal vertebrae to predict abnormal bone uptake. In response to therapy a "flare phenomenon" with an increase in count rate was seen 2 weeks after orchiectomy followed by a decrease 2 months postoperatively in most of the abnormal vertebrae. The count rate decreased even below the pre-operative level after 6 months. Also, the normal vertebrae in the patients with skeletal metastases showed a tendency towards the flare phenomenon, which was not seen in patients with normal bone scintigrams.

In vivo measurements of bone lead--a comparison of two x-ray fluorescence techniques used at three different bone sites

In vivo bone lead measurements have been made on a group of about 120 people, most of whom were lead exposed workers. Two different x-ray fluorescence (XRF) techniques were used to make measurements at three bone sites. Finger lead was measured using 57Co sources, and lead measurements were made in both tibia and calcaneus with a technique based on 109Cd sources. The results of the bone lead measurements correlated strongly with each other and with the index of cumulative exposure, thus confirming the value and reliability of these in vivo measurements as a tool in the study of chronic lead exposure. Measurement precision, +/- 1 standard deviation, was highest for tibia +/- 7.4 micrograms (g bone mineral)-1, +/- 16.6 micrograms (g bone mineral)-1 for the calcaneus and lowest for phalangeal lead +/- 25.0 micrograms (g bone mineral)-1. Maximum absorbed doses to the skin were comparable for all three measurements (1-3 mGy). The mean whole body dose equivalents were all low, but that for the finger measurement, 0.1 microSv, was significantly less than for the calcaneus and tibia measurements 3-5 microSv.

Digital chest radiography with a large image intensifier. An ROC study with an anthropomorphic phantom

The diagnostic performance of two systems for chest radiography was studied. One system was based on a large image intensifier, the other was a conventional film-screen system. The images from the image intensifier were studied either on a digital TV screen or on 100 mm photofluorograms. Receiver operating characteristic curve analysis was performed on images of an anthropomorphic chest phantom. Low-contrast MMAP (methyl methacrylate polymer) nodules and simulated vessels were positioned over the parenchymal and the mediastinal region of the phantom. Five observers assessed the digital monitor images, photofluorograms, and conventional full-size radiograms. The results showed a significantly superior detectability for the full-size radiograms over the digital monitor images both in the parenchyma and in the mediastinum. No significant difference was found between photofluorograms and digital images.

Digital chest radiography with a large image intensifier. Evaluation of diagnostic performance and patient exposure

A digital system for chest radiography based on a large image intensifier was compared with a conventional film-screen system. The diagnostic performance was evaluated with special reference to the digital monitor images with a modified version of receiver operating characteristic (ROC) analysis--free response ROC (FROC) analysis--on a chest equivalent phantom. Measurements of spatial resolution and energy imparted were also performed. The detectability of low-contrast objects as well as spatial resolution was better for the full-size film-screen radiographs than for both the digital monitor images and the 100 mm photofluorograms. The image-intensifier system has a potential for considerable dose savings in relation to the conventional technique provided that fluoroscopy is excluded in the positioning of the patients.

Radiation dose to patients and personnel during fluoroscopy at percutaneous renal stone extraction

The radiation dose to patients and personnel was estimated during 11 percutaneous renal stone extractions. For the patients the energy imparted, the mean absorbed dose to various organs, and the effective dose equivalent were estimated. For different personnel categories some organ doses and the effective dose equivalent were also estimated. Large differences in the radiation dose between patients were observed. The mean effective dose equivalent to the patient was 4.2 (range 0.6-8.3) mSv, and the energy imparted 285 (range 50-500) mJ. These figures are comparable to those reported for routine colon examination and urography. For the personnel there were also large differences between individuals and categories. The highest radiation dose was received by the radiologist. It was estimated that a radiologist who performs 150 percutaneous renal stone extractions per year will receive a yearly contribution to his/her effective dose equivalent of 2.4 mSv. Even when the contribution from other diagnostic and interventional radiologic procedures is added, the total effective dose equivalent hardly exceeds 5 mSv or 1/10 of the present dose limit for persons engaged in radiologic work. For the hands of the radiologist there is a risk of doses closer to the present limit for single organs or tissues of 500 mSv/year.

Kinetics of radioiodinated monoclonal antibodies in the rat. Influence of tumour growth and reticuloendothelial system host modulation

This experimental study in rats examines the influence of tumour growth and RES function modulation on the kinetics of iodinated MAb IgG1 C241. The study was designed to investigate unspecific accumulation in liver and blood. C241 is raised against human colon adenocarcinoma COLO 205 and reacts with SiLea tumour-associated antigen, also known as tumour-associated antigen 19-9. In 26 rats, 2 micrograms 125I MAb C241 (lodobead labelling method) was given i.v. Blood, organ and tumour content was measured at 0.5, 24, 72 and 144 h. In 61 rats, 10 micrograms 131I MAb C241 (lodogen labelling method) was given i.v. The rats were divided into a non-tumour and a tumour-bearing group and subjected to RES function modulation with Zymosan stimulation or methyl palmitate depression. A syngeneic nitrosoguanidine-induced colonic carcinoma--mean 11 g--was growing in back subcutaneous tissue and hind leg musculature. Serum content of tumour-associated antigen was not found on IRMA testing and tumour content of SiLea ganglioside antigen was found only on lipid binding phase assay. The half-time in blood of iodinated MAb C241 was three days. In-vivo release of iodine was tested by plasma separation on a gel column. More than 90% of the iodine was in the IgG fraction. The activity distribution was almost in equilibrium after 24 h. A tumour/blood activity concentration ratio of 0.5 and liver/blood ratio of 0.3 remained at 72 h and 144 h. Radionuclide accumulation was equally low in the macrophage-rich liver and the kidneys. Tumour-bearing animals had significantly lower blood content (0.37 versus 0.99% g-1) and liver content (0.09 versus 0.31% g-1) at 144 h than non-tumour-bearing rats. The whole body content at 144 h was also lower (24% versus 35% of administered activity) (p = 0.10). Modulation of RES function had no significant influence on the whole body, blood or liver content of 131I MAb C241 activity in non-tumour-bearing animals. In tumour-bearing animals, RES stimulation with Zymosan increased the whole body, liver and blood content of 131I activity. The two tested methods of iodination gave similar results.

Ferrous sulphate gels for determination of absorbed dose distributions using MRI technique: basic studies

Two gels have been found to be suitable to load with ferrous sulphate solution. In these soft tissue equivalent phantoms, the absorbed dose distribution can be measured after irradiation in clinically used MR imaging equipment. The present studies were carried out using a 0.25 T NMR analyser without imaging properties. A ferrous sulphate solution, 0.05 M with respect to sulphuric acid, can be gelled with 4% gelatin to give a dosemeter which has a response which is linearly correlated (r = 0.998) with the absorbed dose in the interval 0-40 Gy. Ferrous sulphate solution can also be gelled with 1% agarose, but this gel has to be purged with oxygen to obtain a linear relationship (r = 0.997) in the same absorbed dose interval. The ferrous sulphate loaded gels have a sensitivity which is a factor of 2.2 or 4.0 times higher for gelatin and agarose, respectively, than the ordinary dosemeter solution. Because the standard deviation of background measurements is higher for the gels than for the dosemeter solution, the minimum detectable absorbed dose is about the same, or 1.0 Gy, for the two gels and the dosemeter solution. The sensitivity of the ferrous sulphate loaded gels shows no dependence on dose rate if the mean dose rate and the absorbed dose per pulse are within the limits normally used by accelerators for radiotherapy.

Repeated quantitative bone scintigraphy in patients with prostatic carcinoma treated with orchiectomy

Bone scintigraphy was performed in 16 men with newly diagnosed prostatic carcinoma before orchiectomy as well as 2 weeks and 2 months after operation. The uptake in the lower thoracic and lumbar vertebrae was registered up to 240 min after injection of 99mTc-MDP and was then calculated for each patient and vertebra. The relative standard deviation in measured uptake due to measuring technique was estimated to be +/- 7%. In eight patients, who had normal bone scintigraphies before orchiectomy, there were no changes in the uptake values after operation. The remaining eight patients had widespread metastatic involvement prior to treatment. Six of these patients showed a so called "flare phenomenon" in the abnormal vertebrae which means an initial increase in uptake after operation followed by a decreased uptake in response to therapy. One patient had a continuously increased uptake in all the abnormal vertebrae which correlated well with the clinical progression of the disease, while in another patient both reactions were seen. Thus, repeated quantitative bone scintigraphies using 99mTc-MDP can be made in a reproducible way and can be a useful tool to follow a patient's response to treatment.

A method for in vivo analysis of platinum after chemotherapy with cisplatin

A method to quantify the concentration of platinum in vivo by x-ray fluorescence (XRF) analysis is described. The measurement system consists of a roentgen apparatus, operated at 155 kV and 25 mA, and a high-purity germanium detector. In order to reduce the amount of scattered radiation in the detector the connecting links between the roentgen tube and scatterer, scatterer and patient, patient and detector, are arranged in a three-axial geometry with mutually orthogonal directions. With this system, quantification of platinum can be achieved with a minimum detectable concentration of 8 micrograms/g, for a measuring time of 30 min and an organ depth of 4 cm. The method can be used to follow the uptake and retention of platinum in patients treated with cisplatin, a frequently used cytostatic agent for tumour therapy.

Patient exposure when using 99Tcm-DTPA for evaluation of cerebrospinal fluid shunt patency

The absorbed dose from 99Tcm-DTPA was estimated from 12 investigations in 9 patients who were evaluated for the patency of ventriculo-peritoneal shunts. The distribution of 99Tcm-DTPA in the ventricles, urinary bladder and peritoneal cavity was determined in regions of interest from repeated static gamma camera images. The effective dose equivalent was calculated to be less than 0.10 mSv for an injected activity of 15 MBq.

Biological monitoring, by in vivo XRF measurements, of occupational exposure to lead, cadmium, and mercury

In vivo X-ray fluorescence (XRF) techniques were used for biological monitoring of lead, cadmium, and mercury. Lead accumulates in bone, the level of which may thus be used for monitoring of exposure. However, there was no close association between lead levels in bone and exposure time, partly because of differences in exposure patterns and partly, probably, because of variations in the toxicokinetics of lead. There are at least two separate bone lead compartments. The average over-all half-time is probably 5-10 yr. The finger bone level may be an index of the lead status of the total skeleton. In lead workers, the mobilization of bone lead causes an "internal" lead exposure and affects the blood lead level considerably. In cadmium workers, in vivo XRF is a sensitive and risk-free method for assessment of accumulation in kidney cortex, the critical tissue as to toxic effects; workers displayed increased levels. However, there was no clear association with duration and intensity of exposure, cadmium levels in urine, or microglobulinuria. Determinations of kidney cadmium may add important information on the state of accumulation and, thus, risk of kidney damage. Workers exposed to elemental mercury vapor, as well as fishermen exposed to methyl mercury, had mercury levels in bone below the detection limit of the XRF method.

Decrease of skeletal lead levels in man after end of occupational exposure

Lead levels in finger bone were monitored using an in vivo X-ray fluorescence technique in retired lead workers. Eight subjects followed for 2-5 yr directly after end of exposure all displayed a decrease. Their average half-time was 7 (range 3-15) yr. In a second group of six persons, followed from year 7 to year 13 after finishing lead work, a decrease was seen in all but one. The average half-time for this group was 8 (range 2 infinity) yr. The mean value for both groups was 7 yr. The results show that there is a decrease of lead in bone after the end of exposure and that it is considerably faster than estimated earlier from various data on lead metabolism.

Excretion of radionuclides in human breast milk after the administration of radiopharmaceuticals

The fraction of injected activity that was excreted through the breast milk of nursing mothers at different times after the injection of various radiopharmaceuticals has been measured in 21 patients. For 99mTc-labeled radiopharmaceuticals the total excreted fraction was 10% for pertechnetate and 1.5-3% for MAA, plasmin, diethylenetriaminepentaacetic acid (DTPA), and methylene diphosphonate (MDP). For [125I]hippuran and [131I]hippuran the corresponding value was 3%. For the above mentioned radiopharmaceuticals the activity concentration in the milk decreased exponentially with an effective half-life of approximately 4 hr. For chromium-51 ethylenediaminetetraacetic acid ([51Cr]EDTA) and [99mTc]RBC, much smaller amounts were excreted in the breast milk. The absorbed dose to various organs of the baby has been calculated. We conclude that when [99mTc]pertechnetate, [99mTc]MAA, [99mTc]plasmin, [125I]hippuran, or [131I]hippuran are used the child should be fed just before the administration of the radionuclide to the mother and the next three milk fractions should not be used. For [99mTc]DTPA and [99mTc]MDP as well as [51Cr]EDTA, only the first fraction should not be used. According to our earlier investigations breast feeding has to be stopped for at least 3 wk after investigations with [125I]fibrinogen.

Effective dose equivalent from radiopharmaceuticals

The concept of "effective dose equivalent", which was introduced by the International Commission on Radiological Protection (ICRP) for occupationally exposed workers, has also created the possibility of expressing by means of a single figure, the radiation risk to patients undergoing different medical radiodiagnostic procedures. In this study, we present the effective dose equivalent for various nuclear-medicine investigations. The figures given are primarily based on a review of data contained in the literature on the mean absorbed dose to various organs. In many cases, however, our own calculations, using biokinetic data derived from the literature, have been used. It was found that for the different radiopharmaceuticals, the effective dose equivalent per activity unit administered extends over an interval of five orders of magnitude, from 0.00015 to 20 mSv/MBq. For the technetium-labelled compounds, the absorbed dose for 90% of the substances lies within the narrower interval between 0.0060 and 0.025 mSv/MBq. With the aid of the figures presented, each nuclear medicine department will be able to estimate the effective dose equivalent and, hence, the risk to patients undergoing different investigations.

Lead in finger-bone analysed in vivo in active and retired lead workers

In 75 active lead workers the median lead level in finger-bone (bone-Pb), as determined in vivo by an X-ray fluorescence method, was 43 micrograms/g (range less than 20-122). In 32 retired workers the median level was even higher, 59 micrograms/g (range less than 20-135), which indicates a slow turnover rate of lead in finger-bone. This was confirmed in 18 of the "active" workers, in whom bone-Pb was studied in connection with an exposure-free period. In spite of a significant decrease in blood-lead levels (B-Pb), no systematic change of bone-Pb occurred. There was an increase of bone-Pb with time of employment, but with a large interindividual variation. No association was found between bone-Pb and present B-Pb in the active lead workers. However, in the retired ones, B-Pb rose with increasing bone-Pb. The bone-lead pool thus causes an "internal" lead exposure.