Radiation from "extra" images acquired with abdominal and/or pelvic CT: effect of automatic tube current modulation

PURPOSE

To retrospectively determine the number and usefulness of images acquired beyond the intended anatomic area of interest with abdominal and/or pelvic computed tomography (CT) and to assess the effect of automatic tube current modulation (ATCM) on associated radiation.

MATERIALS AND METHODS

Superior and inferior levels at routine abdominal and/or pelvic CT were defined as the dome of the diaphragm and the inferior margin of the pubic symphysis, respectively. Records of 106 consecutive examinations (male-to-female ratio, 45:61; age range, 21-86 years) performed from June 1 to June 30, 2003, were reviewed to determine the number of "extra" images. Sixty-two abdominal and/or pelvic CT examinations performed concurrently with chest or thigh CT or for trauma were not included in the 106. Abdominal and/or pelvic CT was performed with either ATCM (n = 44) or manual selection of tube current (n = 62). CT parameters recorded for each extra image included tube current, peak kilovoltage, and gantry rotation time. Mean and median tube current-time products were calculated for extra images. Extra images were analyzed for pathologic findings. Statistical analysis was performed with the Student t test.

RESULTS

Extra images were acquired above the dome of the diaphragm in 103 (97%) of 106 examinations and below the pubic symphysis in 100 (94%) of 106. A total of 1,280 extra images were acquired in 106 examinations (mean, 12 images per examination). Nineteen additional findings were observed on extra images. With ATCM, mean tube current-time product was 74.5 and 120.6 mAs for extra images acquired above the diaphragm and below the pubic symphysis, respectively; with manual selection, mean tube current-time products were 167.5 and 168.3 mAs (P <.05).

CONCLUSION

Most extra images acquired at abdominal and/or pelvic CT contributed no additional information. With ATCM, the radiation dose was reduced by a mean of 56% (median, 72%) for extra images above the diaphragm and 29% (median, 36%) for images below the pubic symphysis, compared with dose levels with manual selection.

Biodistribution and radiation dosimetry of the serotonin transporter ligand 11C-DASB determined from human whole-body PET

11C-Labeled 3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile (DASB) is a selective radioligand for the in vivo quantitation of serotonin transporters (SERTs) using PET. The goal of this study was to provide dosimetry estimates for 11C-DASB based on human whole-body PET.

METHODS

Dynamic whole-body PET scans were acquired for 7 subjects after the injection of 669 +/- 97 MBq (18.1 +/- 2.6 mCi) of 11C-DASB. The acquisition for each subject was obtained at 14 time points for a total of 115 min after injection of the radioligand. Regions of interest were placed over compressed planar images of source organs that could be visually identified to generate time-activity curves. Radiation burden to the body was calculated from residence times of these source organs using the MIRDOSE3.1 program.

RESULTS

The organs with high radiation burden included the lungs, urinary bladder wall, kidneys, gallbladder wall, heart wall, spleen, and liver. The activity peaked within 10 min after the injection of 11C-DASB for all these organs except two--the excretory organs gallbladder and urinary bladder wall, which had peak activities at 32 and 22 min, respectively. Monoexponential fitting of activity overlying the urinary bladder suggested that approximately 12% of activity was excreted via the urine. Simulations in which the urinary voiding interval was decreased from 4.8 to 0.6 h produced only modest effects on the dose to the urinary bladder wall. With a 2.4-h voiding interval, the calculated effective dose was 6.98 microGy/MBq (25.8 mrem/mCi).

CONCLUSION

The estimated radiation burden of 11C-DASB is relatively modest and would allow multiple PET examinations of the same research subject per year.

An IMRT dose distribution study using commercial verification software

The introduction of IMRT requires users to confirm that the isodose distributions and relative doses calculated by their planning system match the doses delivered by their linear accelerators. To this end the commercially available software, VeriSoft (PTW-Freiburg, Germany) was trialled to determine if the tools and functions it offered would be of benefit to this process. The CMS XiO (Computerized Medical System, St. Louis, MO) treatment planning system was used to generate IMRT plans that were delivered with an upgraded Elekta SL15 linac. Kodak EDR2 film sandwiched in RW3 solid water (PTW-Freiburg, Germany) was used to measure the IMRT fields delivered with 6 MV photons. The isodose and profiles measured with the film generally agreed to within +/- 3% or +/- 3 mm with the planned doses, in some regions (outside the field) the match fell to within +/- 5%. The isodose distributions of the planning system and the film could be compared on screen, allowing for electronic records of the comparison to be kept if desired. The features of this software would be of benefit to an IMRT QA program.

Pilot study to reduce dioxins in the human body

OBJECTIVE

The accumulation of dioxins, characterized by its lipophilicity and persistency in human tissue, is a great concern since many of these compounds elicit adverse health effects and developmental toxicity. Although the half-life of dioxins in the human body have been described to be as long as 3-25 years, there are very few drugs or methods that can exclude them from the human body. Thus, it is necessary to establish a new method to reduce them and prevent adverse health effects. Here, a pilot study to reduce the dioxins accumulated in the human body using the cholesterol-lowering drug, colestimide, is reported.

PATIENTS AND METHODS

Eight male and two female subjects were investigated. All of them were treated with colestimide for six months, and the dioxin level of the blood samples was assessed before and after the treatment. The dioxins in the blood samples were measured by gas-chromatography/mass spectrometry.

RESULTS

Nine out of the ten subjects completed the treatment, and their blood samples were analyzed. The mean dioxin level in the blood samples before the treatment was 44.0 +/- 8.22 pg-TEQ/g-fat. Six months later, the mean dioxin level was lowered about 20% on average to 34.7 +/- 5.49 pg-TEQ/g-fat.

CONCLUSION

Previous studies have reported that the blood dioxin level increases with age. In this study, the results suggest that colestimide can decrease the blood dioxin level of humans. A randomized placebo-controlled clinical study including large numbers of subjects are needed to confirm the present result.

Anatomic Variations Due to Radical Prostatectomy

BACKGROUND AND PURPOSE

A quantitative estimate of the impact of prostatectomy on pelvic anatomy is unavailable, even if it would be an important prerequisite for a precise definition of clinical target volume (CTV) in post-prostatectomy radiotherapy. The purpose of this study was to investigate the impact of prostatectomy on the definition of CTV, on the position of bladder and rectum and their implications for three-dimensional conformal radiotherapy (3-D CRT).

PATIENTS AND METHODS

Six patients eligible for radical retropubic prostatectomy were considered. Each patient underwent a planning CT between 1 week and 1 month before surgery (CTpre), and then CT was repeated in the same positioning 1-2 months after surgery (CTpost). For each patient the CT(pre/post) scans were matched; rectum, bladder and CTV were contoured on both CT scans for each patient by one observer. Two different CTVs were contoured: CTV1: prostate + seminal vesicles in CTpre; prostate + seminal vesicles surgical bed in CTpost; CTV2: prostate in CTpre; prostate surgical bed in CT(post). After image registration, the contours of rectum, bladder and CTV1/2 drawn on CTpost were transferred on CTpre. The corresponding planning target volumes (PTVs) were generated, and for each PTV, a conformal four field technique using 18-MV X-rays was planned. The volumes of CTV1, CTV2, PTV1, PTV2, rectum and bladder pre- and post-surgery were compared. Differences in 3-D position of these structures before and after surgery were analyzed by beam's eye view (BEV) images. Pre- and post-surgery dose-volume histograms (DVHs) of rectum and bladder were compared together with the fraction of rectum/bladder receiving at least 95% of the ICRU dose (V95), the treated volume (TV, body included in the 95% isodose) and the irradiated volume (IV, body included in the 50% isodose).

RESULTS

For both CTV1 and CTV2, the volumes were significantly reduced after prostatectomy (average reduction around 30 cm3 for both; range 0-60 cm3). This reduction was mainly due to a more caudal definition of the cranial edge of CTV after prostatectomy (average difference for CTV2: 1.5 cm; range 0-2.5 cm). Concerning the bladder, a systematic posterior shift of the bladder base (average: 1.5 cm) was found and was correlated with a significant reduction of V95 for bladder (around 10 cm3; p = 0.03). V95 of the rectum, TV and IV also resulted to be significantly lower after surgery. The average reduction of V95 for the rectum was relatively small (2.5 cm3 of rectal wall).

CONCLUSION

The impact of prostatectomy on CTV definition is high. A significant reduction of CTV, PTV, TV and IV may be expected after surgery with a consequent reduction of the portions of rectum/bladder irradiated with adjuvant radiotherapy.

Exposure assessment of male recruits in Slovenia to cadmium and lead due to biological monitoring

AIMS

In Slovenia, there were no data available for an assessment of cadmium and lead levels in the population till 2001. The present study was conducted to evaluate the cadmium and lead burden from all sources (air, food, water) with the aim of obtaining initial information on cadmium and lead levels in blood of healthy and occupationally unexposed young males.

METHODS

There were 464 participants included in the analysis of blood cadmium and lead levels, aged between 18 and 27 years, the median age being 20 years. Blood samples of maximum 2 ml were taken from the cubital vein for analysis of cadmium and lead levels.

RESULTS

There were 463 blood samples analyzed for cadmium and 464 for lead. Of all tested persons, 38.2% had less than 0.5 microg/l of cadmium in their blood and 28.2% up to 1 microg/l. The median level of blood cadmium was 0.5 microg/l. The percentage of recruits with blood lead level over 100 microg was 3.1%. The median level of blood lead was 35 microg/l. The differences in blood levels of both pollutants were statistically significant with regard to the region of permanent residence (P<0.001).

CONCLUSIONS

The results of the study give a good assessment of cadmium and lead burdening of young Slovene male population. The information obtained provides a foundation for further comparative research at the international level as well as for further study and risk assessment of individual population groups exposed to greater risk due to their lifestyle and eating habits.

On homogeneity within critical groups

Since the 1960s, the methodology recommended by the International Commission on Radiological Protection (ICRP) for assessment of individual doses has developed significantly, yet the specific recommendations related to the characteristics of 'critical groups' for the purposes of protection of the public have been interpreted but are relatively unchanged. This paper examines developments relevant to the criteria for appropriate homogeneity of habits within critical groups. It is suggested that, with the need for additivity of effective doses summed over different contributing exposure pathways, an important criterion for selection of the critical group is homogeneity of summed effective doses rather than, necessarily, of the underlying factors such as ages and habits focusing on a particular pathway. This implies that there need be less emphasis than before on the term 'critical pathway'. However, examples of recent retrospective assessments near UK nuclear establishments are given and it is shown that, in practice, critical groups selected on the basis of summed effective doses are still fairly homogeneous in terms of detailed habits.

Iodine-123-vascular endothelial growth factor-165 (123I-VEGF165). Biodistribution, safety and radiation dosimetry in patients with pancreatic carcinoma

AIM

Imaging with radiolabelled vascular endothelial growth factor (VEGF) has been developed for the localisation and diagnosis of a variety of human solid tumors including gastrointestinal tumors.

METHODS

In this study we investigated the biodistribution, safety and absorbed dose of iodine-123 radiolabelled VEGF(165) ((123)I-VEGF(165)) in 9 patients with pancreatic carcinoma. Following intravenous administration of (123)I-VEGF(165) (189+/-17 MBq; <130 pmole (<5 microg) VEGF(165) per patient), sequential images were recorded during the initial 30 min PI. Serial whole-body images were acquired in anterior and posterior views at various time points. All patients underwent single-photon emission tomography (SPET) imaging. Dosimetry calculations were performed on the basis of gamma camera data. Estimates of radiation absorbed dose were calculated using the MIRDOSE 3 program.

RESULTS

The highest absorbed organ doses were found to be thyroid (0.058+/-0.004 mGy/MBq), spleen (0.046+/- 0.017 mGy/MBq), urinary bladder (0.04+/-0.02 mGy/MBq), lungs (0.034+/-0.009 mGy/MBq) and kidneys (0.033+/-0.005 mGy/MBq). The effective dose was estimated to be 0.017+/-0.002 mSv/MBq. A majority of primary pancreatic tumors and their metastases were visualized by (123)I-VEGF(165) scan.

CONCLUSION

In vitro binding results confirmed specific binding of (123)I-VEGF(165) to pancreatic tumor cells and tissues. (123)I-VEGF(165) shows favorable dosimetry and is a safe radiopharmaceutical that may be of potential value for the imaging of VEGF receptor status in vivo.

Cancer risk estimates for gamma-rays with regard to organ-specific doses. Part I: All solid cancers combined

A previous analysis of the solid cancer mortality data for 1950-1990 from the Japanese life-span study of the A-bomb survivors has assessed the solid cancer risk coefficients for gamma-rays in terms of the low dose risk coefficient ERR/Gy, i.e. the initial slope of the ERR vs. dose relation, and also in terms of the more precisely estimated intermediate dose risk coefficient, ERR(D1)/D1, for a reference dose, D1, which was chosen to be 1 Gy. The computations were performed for tentatively assumed values 20-50 of the neutron RBE against the reference dose and in terms of organ-averaged doses, rather than the traditionally applied colon doses. The resulting risk estimate for a dose of 1 Gy was about half as large as the most recent UNSCEAR estimate. The present assessment repeats the earlier analysis with two major extensions. It parallels computations based on organ-average doses with computations based on organ-specific doses and it updates the previous results by using the cancer mortality data for 1950-1997 which have recently been made available. With an assumed neutron RBE of 35, the resulting intermediate dose estimate of the lifetime attributable risk (LAR) for solid cancer mortality for a working population (ages 25-65 years) is 0.059/Gy with the attained-age model, and 0.044/Gy with the age-at-exposure model. For a population of all ages, 0.055/Gy is obtained with the attained-age model and 0.073/Gy with the age-at-exposure model. These values are up to about 20% higher than those obtained in the previous analysis with the 1950-1990 data. However, considerably more curvature in the dose-effect relation is now supported by the computations. A dose and dose-rate reduction factor DDREF=2 is now much more in line with the data than before. With this factor the LAR for a working population is--averaged over the age-at-exposure and the age-attained model--equal to 0.026/Gy. This is only half as large as the current ICRP estimate which is also based on the assumption DDREF=2.

Radon-induced lung cancer in French and Czech miner cohorts described with a two-mutation cancer model

A two-mutation carcinogenesis model with clonal expansion of pre-malignant cells is used to describe lung cancer mortality data from studies on French and Czech miners with relatively low exposures to radon. The aim was to derive radon-induced lung cancer risk estimates applicable to different populations using a model description consistent with both cellular dose-response relationships, and previous model analyses of animal and human epidemiological data. The significantly different baseline lung cancer risks for the two cohorts that include the effects from the unknown smoking habits, are described with different background model parameters. A uniform description of the effect of radon for both miner cohorts is achieved by applying the same multiplicative effect for radon on the background mutation rates in the model. Incorporating the effects of decreased cellular proliferation at very advanced age improves the description of the baseline lung cancer risk, but does not lead to significant changes in the estimated radiation parameters. Here, a multi-stage model demonstrates the possibility of transferring radon-induced lung cancer risks across populations. The inherent age-time dose-rate relationships in the model allow for extrapolation to lifelong exposures to residential radon concentrations. The resulting cumulated (lifetime) risks from continuous exposure to low-level radon concentrations were found to agree with the results of the BEIR VI models.

Bone marrow dosimetry and safety of high 131I activities given after recombinant human thyroid-stimulating hormone to treat metastatic differentiated thyroid cancer

Recombinant human thyroid-stimulating hormone (rhTSH) recently was introduced as a radioiodine administration adjunct that avoids levothyroxine (LT-4) withdrawal and resultant hypothyroidism. The pharmacokinetics of 131I after rhTSH administration are known to differ from those after LT-4 withdrawal but are largely nondelineated in the radioiodine therapy setting. We therefore sought to calculate the red marrow absorbed dose of high therapeutic activities of 131I given after rhTSH administration to patients with metastatic or inoperable locally recurrent differentiated thyroid cancer. We also sought to evaluate the clinical and laboratory effects of this therapy on the bone marrow.

METHODS

Fourteen consecutive patients received in total 17 131I treatments (7.4 GBq). Blood and urine samples were obtained at fixed intervals, and their activities were measured in a well counter. Based on blood activity, renal clearance of the activity, and residence times in red marrow and the remainder of the body, the red marrow absorbed dose was calculated using the MIRD schema. Additionally, we monitored for potential hematologic toxicity and compared platelet counts before and 3 mo after treatment.

RESULTS

The mean +/- SD absorbed dose per unit of administered (131)I in the red marrow was 0.16 +/- 0.07 mGy/MBq. The corresponding total red marrow absorbed dose was 1.15 +/- 0.52 Gy (range, 0.28-1.91 Gy). In none of the patients was hematologic toxicity observed. The mean +/- SD platelet count (n = 13 treatments) was 243 +/- 62 x 10(9)/L before treatment and 233 +/- 87 x 10(9)/L 3 mo later, a slight and statistically insignificant decrease. After rhTSH-aided administration of high activities of 131I, the bone marrow absorbed dose remained under 2 Gy, the level long considered the safety threshold for all radioiodine therapy.

CONCLUSION

Our specific findings imply that when clinically warranted, rhTSH should allow an increase in the therapeutic radioiodine activity. Such an increase might improve efficacy while preserving safety and tolerability; this possibility should be assessed in further studies.

The bell should toll for the linear no-threshold model

The linear no-threshold (LNT) model has been a convenient tool in the practice of radiation protection but it is not supported by scientific data at doses less than about 100 mSv or at chronic dose rates up to at least 200 mSv yr(-1). Radiation protection practices based on the LNT model yield no demonstrable benefits to health when applied at lower annual doses. The assumption that such exposures are harmful may not even be conservative and has helped to foster an unwarranted fear of low-level radiation. For its new recommendations, to be issued probably in 2005, the ICRP has said that it expects to continue the application of the LNT model 'above a few millisieverts per year'. National societies for radiation protection may wish to consider the need to lobby the ICRP, through the auspices of IRPA, to further relax adherence to the LNT assumption-up to 'a few tens of millisieverts per year'.

[The reliability of conclusions based on hair mineral analysis in individual diagnostic]

The advantages of ubtaining samples for hair mineral analysis (HMA) as well as the possibility to measure former exposures and in addition to carry out segment analysis make it desirable to work with HMA in order to find a diagnosis. The laboratories which offer HMA differ distinctly in their procedure of analysis and quality control. HMA is generally not usable for individual diagnostic with two exceptions (arsenic and methylmercury) because of the large number of factors of individual and environmental influences and sources of error of the method of analysis. HMA can be used for cadmium, lead, and zinc in order to compare a single person with a larger population. Further research into the relationship of content of elements in hair and other tissues of the body is desirable.

Radiation protection recommendations for I-131 thyrotoxicosis, thyroid cancer and phaeochromocytoma patients

Iodine-131 patients pose a radiation risk to their family members, carers and colleagues. Doses from thyrotoxicosis and thyroid cancer patients undergoing standard treatments have been well characterised in the literature. However the resulting precautions cannot be easily adapted to circumstances where the patient has an unusual affliction, or an atypical family or occupational environment. In this study, a model for calculating dose from an I-131 patient is derived from first principles. The model is combined with existing results from the literature to determine a distance weighting factor between patients and family members. This technique reduces the uncertainty in the dose calculations by removing the need to guess the unknown patterns of close contact, a problem common to all previous dose calculation techniques. Data is presented for four unusual I-131 treatments; a child thyroid cancer patient, two thyroid cancer dialysis patients and a phaeochromocytoma patient. The model is used to calculate appropriate periods of restricted contact for these patients. The recommendations provide a useful guide for future unusual I-131 treatments.

Evaluation of Dose-Volume Histograms after Prostate Seed Implantation

BACKGROUND AND PURPOSE

Permanent interstitial brachytherapy by seed implantation is a treatment alternative for low-volume low-risk prostate cancer and a complex interdisciplinary treatment with a learning curve. Dose-volume histograms are used to assess postimplant quality. The authors evaluated their learning curve based on dose-volume histograms and analyzed factors influencing implantation quality.

PATIENTS AND METHODS

Since 1999, 38 patients with a minimum follow-up of 6 months were treated at the authors' institution with seed implantation using palladium-103 or iodine-125, initially using the preplan method and later real-time planning. Postimplant CT was performed after 4 weeks. The dose-volume indices D90, V100, V150, the Dmax of pre- and postplans, and the size and position of the volume receiving the prescribed dose (high-dose volume) of the postplans were evaluated. In six patients, postplan imaging both by CT and MRI was used and prostate volumes were compared with preimplant transrectal ultrasound volumes. The first five patients were treated under external supervision.

RESULTS

Patients were divided into three consecutive groups for analysis of the learning curve (group 1: n = 5 patients treated under external supervision; group 2: n = 13 patients; group 3: n = 20 patients). D90post for the three groups were 79.3%, 74.2%, and 99.9%, the V100post were 78.6%, 73.5%, and 88.2%, respectively. The relationship between high-dose volume and prostate volume showed a similar increase as the D90, while the relationship between high-dose volume lying outside the prostate and prostate volume remained constant. The ratio between prostate volumes from transrectal ultrasound and CT imaging decreased with increasing D90post, while the preplanning D90 and V100 remained constant. The different isotopes used, the method of planning, and the implanted activity per prostate volume did not influence results.

CONCLUSION

A learning curve characterized by an increase in the D90post can be observed and results in a stable technique after 18 patients. An important factor influencing the learning curve in addition to the precision of seed positioning is organ volume definition on postimplant imaging.

The Incidence of Inclusion of the Sigmoid Colon and Small Bowel in the Planning Target Volume in Radiotherapy for Prostate Cancer

BACKGROUND AND PURPOSE

In radiotherapy for prostate cancer, the rectum is considered the dose-limiting organ. The incidence of overlap between the sigmoid colon and/or small bowel and the planning target volume (PTV) as well as the dose to sigmoid colon and small bowel were investigated.

PATIENTS AND METHODS

The CT data of 75 prostate cancer patients were analyzed. The clinical target volume (CTV) consisted of prostate and seminal vesicles. The PTV was defined as a three-dimensional expansion of the CTV with a 10-mm margin in craniocaudal and a 7-mm margin in the other directions. All patients were planned to a mean CTV dose of at least 76 Gy. Minimum CTV dose was set at 70 Gy. Dose inhomogeneity within the CTV was kept between 12% and 17%. Sigmoid colon was defined upward from the level where the rectum turned in a transverse plane. Contrast-filled small bowel was contoured on all slices where it was visible. The presence of sigmoid colon and/or small bowel in close vicinity to or overlapping with the PTV was recorded. For each case, the dose to the sigmoid colon and small bowel was calculated.

RESULTS

The PTV was found to overlap with the sigmoid colon in 60% and with the small bowel in 19% of the cases. In these patients, mean maximum dose to the sigmoid colon was 76.2 Gy (5th-95th percentile: 70.0-80.7 Gy). Mean maximum dose to the small bowel was 74.9 Gy (5th-95th percentile: 68.0-80.0 Gy).

CONCLUSION

When systematically investigating the anatomic position of sigmoid colon and small bowel in patients accepted for prostate irradiation, parts of both organs were often observed in close vicinity to the PTV. Apart from the rectum, these organs may be dose-limiting in prostate radiotherapy.

Stable Intrachromosomal Biomarkers of Past Exposure to Densely Ionizing Radiation in Several Chromosomes of Exposed Individuals

A multicolor banding (mBAND) fluorescence in situ hybridization technique was used to investigate the presence inhuman populations of a stable biomarker-intrachromosomal chromosome aberrations-of past exposure to high-LET radiation. Peripheral blood lymphocytes were taken from healthy Russian nuclear workers occupationally exposed from 1949 onward to either plutonium, gamma rays or both. Metaphase spreads were produced and chromosomes 1 and 2 were hybridized with mBAND FISH probes and scored for intra-chromosomal aberrations. A large yield of intrachromosomal aberrations was observed in both chromosomes of the individuals exposed to high doses of plutonium, whereas there was no significant increase over the (low) background control rate in the population who were exposed to high doses of gamma rays. Interchromosome aberration yields were similar in both the high plutonium and the high gamma-ray groups. These results for chromosome 1 and 2 confirm and extend data published previously for chromosome 5. Intrachromosomal aberrations thus represent a potential biomarker for past exposure to high-LET radiations such as alpha particles and neutrons and could possibly be used as a biodosimeter to estimate both the dose and type of radiation exposure in previously exposed populations.

Dose assessment for the Metlino and Muslyumovo populations who lived along the Techa river from 1949 to 1954

In the period from 1949 to 1956, liquid radioactive waste was routinely and accidentally discharged by the Mayak Production Association, Southern Urals, Russia, into the Techa river. Based on a novel approach, the contamination of the Techa river water, the bottom sediments and the adjacent flood plains was modelled, and internal and external doses were estimated for two villages located downstream of the site of liquid radioactive waste release. Altogether, 11 radionuclides that occurred in the liquid radioactive waste were included in the calculations. The results suggest significantly higher doses than previously assumed, with the major contribution in the year 1951. Radionuclides with half-lives of less than 1 year, such as 89Sr, 131I, 95Zr+95Nb, 103Ru+103mRh, 140Ba+140La, and 144Ce+144Pr, represent the major sources and, in contrast, long-lived radionuclides, such as 90Sr and 137Cs that have so far been assumed to be most important, did not dominate the doses. For adults from the village Metlino, located 7 km downstream of the site of liquid radioactive waste discharge, the committed effective doses due to intake of radionuclides were calculated to be about 2.3 Sv, while the external doses were between about 1.2 Sv and 6.9 Sv. On the other hand, for adults from Muslyumovo, located 75 km downstream, the committed effective doses due to intake of radionuclides were calculated to be about 0.5 Sv, while the external doses were between 0.5 Sv and 2.0 Sv. The values for the skin doses to the Metlino and Muslyumovo populations were about 7.1 Sv and 1.3 Sv, respectively. It is concluded that the current dose estimates for the residents of the Techa river need, therefore, reevaluation.

Polyzyklische aromatische Kohlenwasserstoffe (PAH) im Innenraum

In recent years, the use of tar-containing parquet glue led to intensive discussion because of the health effects associated with indoor pollution caused by polycyclic aromatic hydrocarbons (PAH) contained in these materials. In addition to environmental tobacco smoke, fossil and organic fuels in stoves, cookers, firesides and other combustion processes contribute to the build up of PAH in the indoor environment. However, food remains to be the greatest source of PAH exposure to man; >90% of the daily PAH intake is food related. In the present review, an attempt will be made to throw light on the question of whether PAH exposure from indoor air sources may cause health effects.

Patient dose in digital mammography

In the present investigation, we analyze the dose of 5034 patients (20,137 images) who underwent mammographic examinations with a full-field digital mammography system. Also, we evaluate the system calibration by analyzing the exposure factors as a function of breast thickness. The information relevant to this study has been extracted from the image DICOM header and stored in a database during a 3-year period (March 2001-October 2003). Patient data included age, breast thickness, kVp, mAs, target/filter combination, and nominal dose values. Entrance surface air kerma (ESAK) without backscatter was calculated from the tube output as measured for each voltage used under clinical conditions and from the tube loading (mAs) included in the DICOM header. Mean values for the patient age and compressed breast thickness were 56 years (SD: 11) and 52 mm (SD: 13), respectively. The majority of the images was acquired using the STD (for standard) automatic mode (98%). The most frequent target/filter combination automatically selected for breast smaller than 35 mm was Mo/Mo (75%); for intermediate thicknesses between 35 and 65 mm, the combinations were Mo/Rh (54%) and Rh/Rh (38.5%); Rh/Rh was the combination selected for 91% of the cases for breasts thicker than 65 mm. A wide kVp range was observed for each target/filter combination. The most frequent values were 28 kVp for Mo/Mo, 29 kVp for Mo/Rh, and 29 and 30 kV for Rh/Rh. Exposure times ranged from 0.2 to 4.2 s with a mean value of 1.1 s. Average glandular doses (AGD) per exposure were calculated by multiplying the ESAK values by the conversion factors tabulated by Dance for women in the age groups 50 to 64 and 40 to 49. This approach is based on the dependence of breast glandularity on breast thickness and age. The total mean average glandular dose (AGD(T)) was calculated by summing the values associated with the pre-exposure and with the main exposure. Mean AGD(T) per exposure was 1.88 mGy (CI 0.01) and the mean AGD(T) per examination was 3.8 mGy, with 4 images per examination on average. The mean dose for cranio-caudal view (CC) images was 1.8 mGy, which is lower than that for medio-lateral oblique (MLO) view because the thickness for CC images was on average 10% lower than that for MLO images. Mean AGD(T) for the oldest group of women (1.90) was 3% higher than the AGD(T) for the younger group (1.85) due to the larger compressed breast thickness of women in the older group (10% on average). Differences between the corresponding AGD(T) values of each age group were lowest for breast thicknesses in the range 40-60 mm, being slightly higher for the women in the older group.

Radiation dose estimate in small animal SPECT and PET

Calculations of radiation dose are important in assessing the medical and biological implications of ionizing radiation in medical imaging techniques such as SPECT and PET. In contrast, radiation dose estimates of SPECT and PET imaging of small animals are not very well established. For that reason we have estimated the whole-body radiation dose to mice and rats for isotopes such as 18F, 99mTc, 201Tl, (111)In, 123I, and 125I that are used commonly for small animal imaging. We have approximated mouse and rat bodies with uniform soft tissue equivalent ellipsoids. The mouse and rat sized ellipsoids had a mass of 30 g and 300 g, respectively, and a ratio of the principal axes of 1:1:4 and 0.7:1:4. The absorbed fractions for various photon energies have been calculated using the Monte Carlo software package MCNP. Using these values, we then calculated MIRD S-values for two geometries that model the distribution of activity in the animal body: (a) a central point source and (b) a homogeneously distributed source, and compared these values against S-value calculations for small ellipsoids tabulated in MIRD Pamphlet 8 to validate our results. Finally we calculated the radiation dose taking into account the biological half-life of the radiopharmaceuticals and the amount of activity administered. Our calculations produced S-values between 1.06 x 10(-13) Gy/Bq s and 2.77 x 10(-13) Gy/Bq s for SPECT agents, and 15.0 x 10(-13) Gy/Bq s for the PET agent 18F, assuming mouse sized ellipsoids with uniform source distribution. The S-values for a central point source in an ellipsoid are about 10% higher than the values obtained for the uniform source distribution. Furthermore, the S-values for mouse sized ellipsoids are approximately 10 times higher than for the rat sized ellipsoids reflecting the difference in mass. We reviewed published data to obtain administered radioactivity and residence times for small animal imaging. From these values and our computed S-values we estimated that the whole body dose in small animals ranges between 6 cGy and 90 cGy for mice and between about 1 cGy and 27 cGy for rats. The whole body dose in small animal imaging can be very high in comparison to the lethal dose to mice (LD50/30 approximately 7 Gy). For this reason the dose in small animal imaging should be monitored carefully and the administered activity should be kept to a minimum. These results also underscore the need of further development of instrumentation that improves detection efficiency and reduces radiation dose in small animal imaging.

An investigation of accelerator head scatter and output factor in air

Our purpose in this study was to investigate whether the Monte Carlo simulation can accurately predict output factors in air. Secondary goals were to study the head scatter components and investigate the collimator exchange effect. The Monte Carlo code, BEAMnrc, was used in the study. Photon beams of 6 and 18 MV were from a Varian Clinac 2100EX accelerator and the measurements were performed using an ionization chamber in a mini-phantom. The Monte Carlo calculated in air output factors was within 1% of measured values. The simulation provided information of the origin and the magnitude of the collimator exchange effect. It was shown that the collimator backscatter to the beam monitor chamber played a significant role in the beam output factors. However the magnitude of the scattered dose contributions from the collimator at the isocenter is negligible. The maximum scattered dose contribution from the collimators was about 0.15% and 0.4% of the total dose at the isocenter for a 6 and 18 MV beam, respectively. The scattered dose contributions from the flattening filter at the isocenter were about 0.9-3% and 0.2-6% of the total dose for field sizes of 4x4 cm2-40x40 cm2 for the 6 and 18 MV beam, respectively. The study suggests that measurements of head scatter factors be done at large depth well beyond the depth of electron contamination. The insight information may have some implications for developing generalized empirical models to calculate the head scatter.

Comparison study of MOSFET detectors and diodes for entrancein vivodosimetry in 18 MV x-ray beams

The feasibility of dual bias dual metal oxide semiconductor field effect transistors (MOSFETs) for entrance in vivo dose measurements in high energy x-rays beams (18 MV) was investigated. A comparison with commercially available diodes for in vivo dosimetry for the same energy range was performed. As MOSFETs are sold without an integrated build-up cap, different caps were tested: 3 cm bolus, 2 cm bolus, 2 cm hemispherical cap of a water equivalent material (Plastic Water) and a metallic hemispherical cap. This metallic build-up cap is the same as the one that is mounted on the in vivo diode used in this study. Intrinsic precision and response linearity with dose were determined for MOSFETs and diodes. They were then calibrated for entrance in vivo dosimetry in an 18 MV x-ray beam. Calibration included determination of the calibration factor in standard reference conditions and of the correction factors (CF) when irradiation conditions differed from those of reference. Correction factors for field size, source surface distance, wedge, and temperature were determined. Sensitivity variation with accumulated dose and the lifetime of both types of detectors were also studied. Finally, the uncertainties of entrance in vivo measurements using MOSFET and diodes were discussed. Intrinsic precision for MOSFETs for the high sensitivity mode was 0.7% (1 s.d.) as compared to the 0.05% (1 s.d.) for the studied diodes. The linearity of the response with dose was excellent (R2 = 1.000) for both in vivo dosimetry systems. The absolute values of the studied correction factors for the MOSFETs when covered by the different build-up caps were of the same order of those determined for the diodes. However, the uncertainties of the correction factors for MOSFETs were significantly higher than for diodes. Although the intrinsic precision and the uncertainty on the CF was higher for MOSFET detectors than for the studied diodes, the total uncertainty in entrance dose determination, once they were calibrated, was of 2.9% (1 s.d.) while for diodes it was 2.0% (1 s.d.). MOSFETs showed no sensitivity variation with accumulated dose or temperature. When used in the high sensitivity mode, after approximately 50 Gy of accumulated dose MOSFETs could no longer be used as radiation dosimeters. In conclusion, MOSFETs can be used for entrance in vivo dosimetry in high energy x-rays beams if covered by an appropriate build-up cap. Metallic build-up caps, such as those used for in vivo diodes, have the advantage of greater patient comfort and less perturbation of the treatment field than the other build-up caps tested, while keeping the correction factors of the same order.

Output ratio in air for MLC shaped irregular fields

For accurate monitor unit calculation, it is important to calculate the output ratio in air, Sc, for an irregular field shaped by MLC. We have developed an algorithm to calculate Sc based on an empirical model [Med. Phys. 28, 925-937 (2001)] by projecting each leaf position to the isocenter plane. Thus it does not require the exact knowledge of the head geometry. Comparisons were made for three different types of MLC: those with MLC replacing the inner collimator jaws; those with MLC replacing the outer collimator jaws; and those with MLC as a tertiary attachment. When the MLC leaf positions are substantially different from the secondary collimators (or the rectangular field encompassing the irregular field), one observes an up to 5% difference in the value of head-scatter correction factor, HCF, defined as the ratio of output ratio in air between the MLC shaped irregular field and that of the rectangular field encompassing the irregular field. No collimator exchange effect was observed for rectangular fields shaped by MLC (e.g., 5x30 and 30x5 cm2 diagonal) when the secondary collimators are fixed, unlike that for the rectangular fields shaped by the inner and outer collimator jaws, where it can be 1-2%. For the same MLC shaped irregular field, the value of Sc increases from the Elekta, to the Siemens, to the Varian accelerators, with an up to 4% difference. The calculation agrees with measurement to within 1.2% for points both on and off the central-axis. The fitting parameters used in the algorithm are derived from measurements for square field sizes on the central-axis.

Ionization chamber-based reference dosimetry of intensity modulated radiation beams

The present paper addresses reference dose measurements using thimble ionization chambers for quality assurance in IMRT fields. In these radiation fields, detector fluence perturbation effects invalidate the application of open-field dosimetry protocol data for the derivation of absorbed dose to water from ionization chamber measurements. We define a correction factor C(Q)IMRT to correct the absorbed dose to water calibration coefficient N(D, w)Q for fluence perturbation effects in individual segments of an IMRT delivery and developed a calculation method to evaluate the factor. The method consists of precalculating, using accurate Monte Carlo techniques, ionization chamber, type-dependent cavity air dose, and in-phantom dose to water at the reference point for zero-width pencil beams as a function of position of the pencil beams impinging on the phantom surface. These precalculated kernels are convolved with the IMRT fluence distribution to arrive at the dose-to-water-dose-to-cavity air ratio [D(a)w (IMRT)] for IMRT fields and with a 10x10 cm2 open-field fluence to arrive at the same ratio D(a)w (Q) for the 10x10 cm2 reference field. The correction factor C(Q)IMRT is then calculated as the ratio of D(a)w (IMRT) and D(a)w (Q). The calculation method was experimentally validated and the magnitude of chamber correction factors in reference dose measurements in single static and dynamic IMRT fields was studied. The results show that, for thimble-type ionization chambers the correction factor in a single, realistic dynamic IMRT field can be of the order of 10% or more. We therefore propose that for accurate reference dosimetry of complete n-beam IMRT deliveries, ionization chamber fluence perturbation correction factors must explicitly be taken into account.