MAX meets ADAM: a dosimetric comparison between a voxel-based and a mathematical model for external exposure to photons

Effective doses and risks from medical diagnostic x-ray examinations for male and female patients from childhood to old age

The consideration of risks from medical diagnostic x-ray examinations and their justification commonly relies on estimates of effective dose, although the quantity is actually a health-detriment-weighted summation of organ/tissue-absorbed doses rather than a measure of risk. In its 2007 Recommendations, the International Commission on Radiological Protection (ICRP) defines effective dose in relation to a nominal value of stochastic detriment following low-level exposure of 5.7 × 10^-2Sv^-1, as an average over both sexes, all ages, and two fixed composite populations (Asian and Euro-American). Effective dose represents the overall (whole-body) dose received by a person from a particular exposure, which can be used for the purposes of radiological protection as set out by ICRP, but it does not provide a measure that is specific to the characteristics of the exposed individual. However, the cancer incidence risk models used by ICRP can be used to provide estimates of risk separately for males and females, as a function of age-at-exposure, and for the two composite populations. Here, these organ/tissue-specific risk models are applied to estimates of organ/tissue-specific absorbed doses from a range of diagnostic procedures to derive lifetime excess cancer incidence risk estimates; the degree of heterogeneity in the distribution of absorbed doses between organs/tissues will depend on the procedure. Depending on the organs/tissues exposed, risks are generally higher in females and notably higher for younger ages-at-exposure. Comparing lifetime cancer incidence risks per Sv effective dose from the different procedures shows that overall risks are higher by about a factor of two to three for the youngest age-at-exposure group, 0-9 yr, than for 30-39 yr adults, and lower by a similar factor for an age-at-exposure of 60-69 yr. Taking into account these differences in risk per Sv, and noting the substantial uncertainties associated with risk estimates, effective dose as currently formulated provides a reasonable basis for assessing the potential risks from medical diagnostic examinations.

Typical effective dose values from diagnostic and interventional radiology

Effective dose (E) in medical procedures is of practical value for comparing doses from different types of procedures which is not possible with the different measurable dose quantities. In this survey we estimated and compared the values of E in 12 medical imaging procedures. The mean E for conventional X-ray in mSv were ranged between 0.01 for skull lateral to 0.5 for abdominal while the mean E for cardiac interventional radiology in mSv was up to 16 for percutaneous transluminal coronary angioplasty (PTCA). For dental radiology the mean E in μSv was 1.2 for intraoral and 10 for panoramic. In mammography the mean E was 0.5 mSv. Compared with the literature, chest postero-anterior (PA), lumbar spine AP, PTCA and mammography procedures had shown larger E values. The obtained results can help in justification of techniques.

Monte Carlo-based patient internal dosimetry in fluoroscopy-guided interventional procedures: A review

PURPOSE

This systematic review aims to understand the dose estimation approaches and their major challenges. Specifically, we focused on state-of-the-art Monte Carlo (MC) methods in fluoroscopy-guided interventional procedures.

METHODS

All relevant studies were identified through keyword searches in electronic databases from inception until September 2020. The searched publications were reviewed, categorised and analysed based on their respective methodology.

RESULTS

Hundred and one publications were identified which utilised existing MC-based applications/programs or customised MC simulations. Two outstanding challenges were identified that contribute to uncertainties in the virtual simulation reconstruction. The first challenge involves the use of anatomical models to represent individuals. Currently, phantom libraries best balance the needs of clinical practicality with those of specificity. However, mismatches of anatomical variations including body size and organ shape can create significant discrepancies in dose estimations. The second challenge is that the exact positioning of the patient relative to the beam is generally unknown. Most dose prediction models assume the patient is located centrally on the examination couch, which can lead to significant errors.

CONCLUSION

The continuing rise of computing power suggests a near future where MC methods become practical for routine clinical dosimetry. Dynamic, deformable phantoms help to improve patient specificity, but at present are only limited to adjustment of gross body volume. Dynamic internal organ displacement or reshaping is likely the next logical frontier. Image-based alignment is probably the most promising solution to enable this, but it must be automated to be clinically practical.

Effective dose in medicine

The International Commission on Radiological Protection (ICRP) developed effective dose as a quantity related to risk for occupational and public exposure. There was a need for a similar dose quantity linked to risk for making everyday decisions relating to medical procedures. Coefficients were developed to enable the calculation of doses to organs and tissues, and effective doses for procedures in nuclear medicine and radiology during the 1980s and 1990s. Effective dose has provided a valuable tool that is now used in the establishment of guidelines for patient referral and justification of procedures, choice of appropriate imaging techniques, and providing dose data on potential exposure of volunteers for research studies, all of which require the benefits from the procedure to be weighed against the risks. However, the approximations made in the derivation of effective dose are often forgotten, and the uncertainties in calculations of risks are discussed. An ICRP report on protection dose quantities has been prepared that provides more information on the application of effective dose, and concludes that effective dose can be used as an approximate measure of possible risk. A discussion of the way in which it should be used is given here, with applications for which it is considered suitable. Approaches to the evaluation of risk and methods for conveying information on risk are also discussed.

COMPARISON OF EXPERIMENTAL AND NUMERICAL METHODS OF PATIENT DOSE ESTIMATIONS IN CT USING ANTHROPOMORPHIC MODELS

The common methods for patient dose estimations in computed tomography (CT) are thermoluminescence dosemeter (TLD) measurements or the usage of software packages based on Monte Carlo simulations like CT-Expo or the newer CTVoxDos, which uses the ICRP Reference Adult Male (ICRP 110). Organ (OD) and effective doses of a CT protocol of the upper abdomen are compared. Compared to CTVoxDos, ODs inferred by TLD measurement using an anthropomorphic phantom differ by $\mathbf{(19\pm 16)\,\%}$ inside the primary radiation field, $\mathbf{(14\pm 2)\,\%}$ for partially primary irradiated organs and $\mathbf{(34\pm 38)\,\%}$ in the scattered radiation field. ODs estimated by CT-Expo show a mean deviation of $\mathbf{(16\pm 9)\,\%}$ (primary irradiated) and $\mathbf{(28\pm 31)\,\%}$ (scatter irradiated) from ODs estimated by CTVoxDos.

Advances in Computational Human Phantoms and Their Applications in Biomedical Engineering - A Topical Review

Over the past decades, significant improvements have been made in the field of computational human phantoms (CHPs) and their applications in biomedical engineering. Their sophistication has dramatically increased. The very first CHPs were composed of simple geometric volumes, e.g., cylinders and spheres, while current CHPs have a high resolution, cover a substantial range of the patient population, have high anatomical accuracy, are poseable, morphable, and are augmented with various details to perform functionalized computations. Advances in imaging techniques and semi-automated segmentation tools allow fast and personalized development of CHPs. These advances open the door to quickly develop personalized CHPs, inherently including the disease of the patient. Because many of these CHPs are increasingly providing data for regulatory submissions of various medical devices, the validity, anatomical accuracy, and availability to cover the entire patient population is of utmost importance. The article is organized into two main sections: the first section reviews the different modeling techniques used to create CHPs, whereas the second section discusses various applications of CHPs in biomedical engineering. Each topic gives an overview, a brief history, recent developments, and an outlook into the future.

Age-dependent comparison of monoenergetic photon organ and effective dose coefficients for pediatric stylized and voxel phantoms submerged in air

Dose rate coefficients computed using the University of Florida-National Cancer Institute pediatric series of voxel phantoms were compared with values computed using the Oak Ridge National Laboratory pediatric stylized phantoms in an air submersion exposure geometry. Simulations were conducted comparing phantoms classified within five ages: newborn, 1-year-old, 5-year-old, 10-year-old, and 15-year-old for both male and female sexes. This is a continuation of previous work comparing monoenergetic photon organ dose rate coefficients, as defined by ICRP Publication 103, for the male and female adult phantoms. With both the male and female data computed for each pediatric phantom age, effective dose rate coefficients and ratios were computed for voxel and stylized phantoms. Organ dose rate coefficients for the pediatric phantoms and ratios of organ dose rates for the voxel and stylized phantoms are provided for eight monoenergetic photon energies ranging from 30 keV to 5 MeV. Analysis of the contribution of the organs to effective dose is also provided. Comparison of effective dose rates between the voxel and stylized phantoms was within 5% between 500 keV and 5 MeV and within 10% between 70 keV and 5 MeV for phantoms  >1-year-old. Stylized newborn effective dose rates were consistently ~20% higher than the voxel counterpart, over all energies.

New Radiation Dosimetry Estimates for [18F]FLT based on Voxelized Phantoms

3'-Deoxy-3-[¹⁸F]fluorothymidine, or [¹⁸F]FLT, is a positron emission tomography (PET) tracer used in clinical studies for noninvasive assessment of proliferation activity in several types of cancer. Although the use of this PET tracer is expanding, to date, few studies concerning its dosimetry have been published. In this work, new [¹⁸F]FLT dosimetry estimates are determined for human and mice using Monte Carlo simulations. Modern voxelized male and female phantoms and [¹⁸F]FLT biokinetic data, both published by the ICRP, were used for simulations of human cases. For most human organs/tissues the absorbed doses were higher than those reported in ICRP Publication 128. An effective dose of 1.70E-02 mSv/MBq to the whole body was determined, which is 13.5% higher than the ICRP reference value. These new human dosimetry estimates obtained using more realistic human phantoms represent an advance in the knowledge of [¹⁸F]FLT dosimetry. In addition, mice biokinetic data were obtained experimentally. These data and a previously developed voxelized mouse phantom were used for simulations of animal cases. Concerning animal dosimetry, absorbed doses for organs/tissues ranged from 4.47 ± 0.75 to 155.74 ± 59.36 mGy/MBq. The obtained set of organ/tissue radiation doses for healthy Swiss mice is a useful tool for application in animal experiment design.

Computational phantoms, ICRP/ICRU, and further developments

Phantoms simulating the human body play a central role in radiation dosimetry. The first computational body phantoms were based upon mathematical expressions describing idealised body organs. With the advent of more powerful computers in the 1980s, voxel phantoms have been developed. Being based on three-dimensional images of individuals, they offer a more realistic anatomy. Hence, the International Commission on Radiological Protection (ICRP) decided to construct voxel phantoms representative of the adult Reference Male and Reference Female for the update of organ dose coefficients. Further work on phantom development has focused on phantoms that combine the realism of patient-based voxel phantoms with the flexibility of mathematical phantoms, so-called 'boundary representation' (BREP) phantoms. This phantom type has been chosen for the ICRP family of paediatric reference phantoms. Due to the limited voxel resolution of the adult reference computational phantoms, smaller tissues, such as the lens of the eye, skin, and micron-thick target tissues in the respiratory and alimentary tract regions, could not be segmented properly. In this context, ICRP Committee 2 initiated a research project with the goal of producing replicas of the ICRP Publication 110 phantoms in polygon mesh format, including all source and target regions, even those with micron resolution. BREP phantoms of the fetus and the pregnant female at various stages of gestation complete the phantoms available for radiation protection computations.

Germain J, Pandit-Taskar N, Xu XG, Bolch WE, Dauer LT. A comparison of pediatric and adult CT organ dose estimation methods

BACKGROUND

Computed Tomography (CT) contributes up to 50% of the medical exposure to the United States population. Children are considered to be at higher risk of developing radiation-induced tumors due to the young age of exposure and increased tissue radiosensitivity. Organ dose estimation is essential for pediatric and adult patient cancer risk assessment. The objective of this study is to validate the VirtualDose software in comparison to currently available software and methods for pediatric and adult CT organ dose estimation.

METHODS

Five age groups of pediatric patients and adult patients were simulated by three organ dose estimators. Head, chest, abdomen-pelvis, and chest-abdomen-pelvis CT scans were simulated, and doses to organs both inside and outside the scan range were compared. For adults, VirtualDose was compared against ImPACT and CT-Expo. For pediatric patients, VirtualDose was compared to CT-Expo and compared to size-based methods from literature. Pediatric to adult effective dose ratios were also calculated with VirtualDose, and were compared with the ranges of effective dose ratios provided in ImPACT.

RESULTS

In-field organs see less than 60% difference in dose between dose estimators. For organs outside scan range or distributed organs, a five times' difference can occur. VirtualDose agrees with the size-based methods within 20% difference for the organs investigated. Between VirtualDose and ImPACT, the pediatric to adult ratios for effective dose are compared, and less than 21% difference is observed for chest scan while more than 40% difference is observed for head-neck scan and abdomen-pelvis scan. For pediatric patients, 2 cm scan range change can lead to a five times dose difference in partially scanned organs.

CONCLUSIONS

VirtualDose is validated against CT-Expo and ImPACT with relatively small discrepancies in dose for organs inside scan range, while large discrepancies in dose are observed for organs outside scan range. Patient-specific organ dose estimation is possible using the size-based methods, and VirtualDose agrees with size-based method for the organs investigated. Careful range selection for CT protocols is necessary for organ dose optimization for pediatric and adult patients.

COMPARISON OF MONOENERGETIC PHOTON ORGAN DOSE RATE COEFFICIENTS FOR STYLIZED AND VOXEL PHANTOMS SUBMERGED IN AIR

As part of a broader effort to calculate effective dose rate coefficients for external exposure to photons and electrons emitted by radionuclides distributed in air, soil or water, age-specific stylized phantoms have been employed to determine dose coefficients relating dose rate to organs and tissues in the body. In this article, dose rate coefficients computed using the International Commission on Radiological Protection reference adult male voxel phantom are compared with values computed using the Oak Ridge National Laboratory adult male stylized phantom in an air submersion exposure geometry. Monte Carlo calculations for both phantoms were performed for monoenergetic source photons in the range of 30 keV to 5 MeV. These calculations largely result in differences under 10 % for photon energies above 50 keV, and it can be expected that both models show comparable results for the environmental sources of radionuclides.

Evaluation of staff, patient and foetal radiation doses due to endoscopic retrograde cholangiopancreatography (ERCP) procedures in a pregnant patient

The use of endoscopic retrograde cholangiopancreatography (ERCP) in pregnant patients is not rare. Most studies on the safety and efficacy of these procedures report short- and long-term pregnancy outcomes and but not foetal absorbed doses. This investigation reports on an ERCP procedure for a 40-y-old woman who was 32-34 weeks pregnant. Thermoluminescent dosemeters (TLD 100) were used to measure doses received by the patient and the staff. Additionally, Monte Carlo calculations were performed using a 3D computational phantom representing a 9-month pregnant patient to estimate the foetal absorbed dose. The results show that the spleen of the mother received the largest absorbed dose of 12.18 mGy since it was closer to the source than other internal organs. For the foetus and uterus, the lowest absorbed dose was found to be 0.01 mGy to the foetal brain, while the largest absorbed dose was estimated to be 0.13 mGy to the placenta.

Organ doses from environmental exposures calculated using voxel phantoms of adults and children

This paper presents effective and organ dose conversion coefficients for members of the public due to environmental external exposures, calculated using the ICRP adult male and female reference computational phantoms as well as voxel phantoms of a baby, two children and four adult individual phantoms--one male and three female, one of them pregnant. Dose conversion coefficients are given for source geometries representing environmental radiation exposures, i.e. whole body irradiations from a volume source in air, representing a radioactive cloud, a plane source in the ground at a depth of 0.5 g cm⁻², representing ground contamination by radioactive fall-out, and uniformly distributed natural sources in the ground. The organ dose conversion coefficients were calculated employing the Monte Carlo code EGSnrc simulating the photon transport in the voxel phantoms, and are given as effective and equivalent doses normalized to air kerma free-in-air at height 1 m above the ground in Sv Gy(-1). The findings showed that, in general, the smaller the body mass of the phantom, the higher the dose. The difference in effective dose between an adult and an infant is 80-90% at 50 keV and less than 40% above 100 keV. Furthermore, dose equivalent rates for photon exposures of several radionuclides for the above environmental exposures were calculated with the most recent nuclear decay data. Data are shown for effective dose, thyroid, colon and red bone marrow. The results are expected to facilitate regulation of exposure to radiation, relating activities of radionuclides distributed in air and ground to dose of the public due to external radiation as well as the investigation of the radiological effects of major radiation accidents such as the recent one in Fukushima and the decision making of several committees.

A comparison of organ doses between mathematical and voxel phantoms with the DS02 photon fluences

The purpose of this study is to quantify dosimetric differences if modern sophisticated voxel phantoms were used in the dosimetry system DS02 rather than the mathematical phantoms. The mathematical models (ADAM and EVA) and voxel phantoms (REX and REGINA) developed in Germany allow a useful comparison as they are very close in body weight, body height and organ masses. In this study, organ doses are calculated with published fluence-to-absorbed-dose conversion coefficients derived from those two model sets for unidirectional plane beam irradiation geometries, with DS02 photon energy spectra at various distances from the hypocentre in Hiroshima. Results showed that organ doses from mathematical models generally agree well with those from voxel phantoms except for a few organs at lateral irradiation geometries and eye lenses at antero-posterior irradiation, even though there were significant differences between the two phantom sets and various uncertainties in dose calculations.

Estimation of absorbed doses from paediatric cone-beam CT scans: MOSFET measurements and Monte Carlo simulations

The purpose of this study was to establish a dose estimation tool with Monte Carlo (MC) simulations. A 5-y-old paediatric anthropomorphic phantom was computed tomography (CT) scanned to create a voxelised phantom and used as an input for the abdominal cone-beam CT in a BEAMnrc/EGSnrc MC system. An X-ray tube model of the Varian On-Board Imager((R)) was built in the MC system. To validate the model, the absorbed doses at each organ location for standard-dose and low-dose modes were measured in the physical phantom with MOSFET detectors; effective doses were also calculated. In the results, the MC simulations were comparable to the MOSFET measurements. This voxelised phantom approach could produce a more accurate dose estimation than the stylised phantom method. This model can be easily applied to multi-detector CT dosimetry.

Photon SAF calculation based on the Chinese mathematical phantom and comparison with the ORNL phantoms

The Chinese mathematical phantom (CMP) is a stylized human body model developed based on the methods of Oak Ridge National Laboratory (ORNL) mathematical phantom series (OMPS), and data from Reference Asian Man and Chinese Reference Man. It is constructed for radiation dose estimation for Mongolians, whose anatomical parameters are different from those of Caucasians to some extent. Specific absorbed fractions (SAF) are useful quantities for the primary estimation of internal radiation dose. In this paper, a general Monte Carlo code, Monte Carlo N-Particle Code (MCNP) is used to transport particles and calculate SAF. A new variance reduction technique, called the "pointing probability with force collision" method, is implemented into MCNP to reduce the calculation uncertainty, especially for a small-volume target organ. Finally, SAF data for all 31 organs of both sexes of CMP are calculated. A comparison between SAF based on male phantoms of CMP and OMPS demonstrates that the differences apparently exist, and more than 80% of SAF data based on CMP are larger than that of OMPS. However, the differences are acceptable (the differences are above one order of magnitude only in less than 3% of situations) considering the differences in physique. Furthermore, trends in the SAF with increasing photon energy based on the two phantoms agree well. This model complements existing phantoms of different age, sex and ethnicity.

Effective dose: how should it be applied to medical exposures?

The effective dose (E) was created to provide a dose quantity that was related to the probability of health detriment due to stochastic effects from exposure to low doses of ionizing radiation. E is derived from the weighted sum of doses to tissues that are known to be sensitive to radiation and so can only be derived by calculation. The tissue weighting factors are derived from the extrapolation of epidemiological evidence. E was intended for use in radiation protection, but has found wide application in evaluation of doses for medical exposures involving only parts of the body. More reliance is often placed on E values and risk estimates based on E than the evidence on which it is based can justify. In this paper, the uncertainties in the estimated values of E for a reference patient and the associated risk coefficients are reviewed in order to provide an indication of how much reliance can be placed on E as an indicator of risk for patients. The relative uncertainty in estimated values of E for medical exposures for a reference patient is seen to be about +/-40%. The estimated risk of cancer may be a factor of three higher or lower when applied to a reference patient, and will be more variable when applied to an individual. A set of recommendations relating to the use of E and description of risk for medical exposures is proposed.

Hybrid computational phantoms of the male and female newborn patient: NURBS-based whole-body models

Anthropomorphic computational phantoms are computer models of the human body for use in the evaluation of dose distributions resulting from either internal or external radiation sources. Currently, two classes of computational phantoms have been developed and widely utilized for organ dose assessment: (1) stylized phantoms and (2) voxel phantoms which describe the human anatomy via mathematical surface equations or 3D voxel matrices, respectively. Although stylized phantoms based on mathematical equations can be very flexible in regard to making changes in organ position and geometrical shape, they are limited in their ability to fully capture the anatomic complexities of human internal anatomy. In turn, voxel phantoms have been developed through image-based segmentation and correspondingly provide much better anatomical realism in comparison to simpler stylized phantoms. However, they themselves are limited in defining organs presented in low contrast within either magnetic resonance or computed tomography images-the two major sources in voxel phantom construction. By definition, voxel phantoms are typically constructed via segmentation of transaxial images, and thus while fine anatomic features are seen in this viewing plane, slice-to-slice discontinuities become apparent in viewing the anatomy of voxel phantoms in the sagittal or coronal planes. This study introduces the concept of a hybrid computational newborn phantom that takes full advantage of the best features of both its stylized and voxel counterparts: flexibility in phantom alterations and anatomic realism. Non-uniform rational B-spline (NURBS) surfaces, a mathematical modeling tool traditionally applied to graphical animation studies, was adopted to replace the limited mathematical surface equations of stylized phantoms. A previously developed whole-body voxel phantom of the newborn female was utilized as a realistic anatomical framework for hybrid phantom construction. The construction of a hybrid phantom is performed in three steps: polygonization of the voxel phantom, organ modeling via NURBS surfaces and phantom voxelization. Two 3D graphic tools, 3D-DOCTOR and Rhinoceros, were utilized to polygonize the newborn voxel phantom and generate NURBS surfaces, while an in-house MATLAB code was used to voxelize the resulting NURBS model into a final computational phantom ready for use in Monte Carlo radiation transport calculations. A total of 126 anatomical organ and tissue models, including 38 skeletal sites and 31 cartilage sites, were described within the hybrid phantom using either NURBS or polygon surfaces. A male hybrid newborn phantom was constructed following the development of the female phantom through the replacement of female-specific organs with male-specific organs. The outer body contour and internal anatomy of the NURBS-based phantoms were adjusted to match anthropometric and reference newborn data reported by the International Commission on Radiological Protection in their Publication 89. The voxelization process was designed to accurately convert NURBS models to a voxel phantom with minimum volumetric change. A sensitivity study was additionally performed to better understand how the meshing tolerance and voxel resolution would affect volumetric changes between the hybrid-NURBS and hybrid-voxel phantoms. The male and female hybrid-NURBS phantoms were constructed in a manner so that all internal organs approached their ICRP reference masses to within 1%, with the exception of the skin (-6.5% relative error) and brain (-15.4% relative error). Both hybrid-voxel phantoms were constructed with an isotropic voxel resolution of 0.663 mm--equivalent to the ICRP 89 reference thickness of the newborn skin (dermis and epidermis). Hybrid-NURBS phantoms used to create their voxel counterpart retain the non-uniform scalability of stylized phantoms, while maintaining the anatomic realism of segmented voxel phantoms with respect to organ shape, depth and inter-organ positioning.

Applicability of dose conversion coefficients of ICRP 74 to Asian adult males: Monte Carlo simulation study

International Commission on Radiological Protection (ICRP) reported comprehensive dose conversion coefficients for adult population, which is exposed to external photon sources in the Publication 74. However, those quantities were calculated from so-called stylized (or mathematical) phantoms composed of simplified mathematical surface equations so that the discrepancy between the phantoms and real human anatomy has been investigated by several authors using Caucasian-based voxel phantoms. To address anatomical and racial limitations of the stylized phantoms, several Asian-based voxel phantoms have been developed by Korean and Japanese investigators, independently. In the current study, photon dose conversion coefficients of ICRP 74 were compared with those from a total of five Asian-based male voxel phantoms, whose body dimensions were almost identical. Those of representative radio-sensitive organs (testes, red bone marrow, colon, lungs, and stomach), and effective dose conversion coefficients were obtained for comparison. Even though organ doses for testes, colon and lungs, and effective doses from ICRP 74 agreed well with those from Asian voxel phantoms within 10%, absorbed doses for red bone marrow and stomach showed significant discrepancies up to 30% which was mainly attributed to difference of phantom description between stylized and voxel phantoms. This study showed that the ICRP 74 dosimetry data, which have been reported to be unrealistic compared to those from Caucasian-based voxel phantoms, are also not appropriate for Asian population.

Treating voxel geometries in radiation protection dosimetry with a patched version of the Monte Carlo codes MCNP and MCNPX

The question of Monte Carlo simulation of radiation transport in voxel geometries is addressed. Patched versions of the MCNP and MCNPX codes are developed aimed at transporting radiation both in the standard geometry mode and in the voxel geometry treatment. The patched code reads an unformatted FORTRAN file derived from DICOM format data and uses special subroutines to handle voxel-to-voxel radiation transport. The various phases of the development of the methodology are discussed together with the new input options. Examples are given of employment of the code in internal and external dosimetry and comparisons with results from other groups are reported.

Skeletal dosimetry in the MAX06 and the FAX06 phantoms for external exposure to photons based on vertebral 3D-microCT images

3D-microCT images of vertebral bodies from three different individuals have been segmented into trabecular bone, bone marrow and bone surface cells (BSC), and then introduced into the spongiosa voxels of the MAX06 and the FAX06 phantoms, in order to calculate the equivalent dose to the red bone marrow (RBM) and the BSC in the marrow cavities of trabecular bone with the EGSnrc Monte Carlo code from whole-body exposure to external photon radiation. The MAX06 and the FAX06 phantoms consist of about 150 million 1.2 mm cubic voxels each, a part of which are spongiosa voxels surrounded by cortical bone. In order to use the segmented 3D-microCT images for skeletal dosimetry, spongiosa voxels in the MAX06 and the FAX06 phantom were replaced at runtime by so-called micro matrices representing segmented trabecular bone, marrow and BSC in 17.65, 30 and 60 microm cubic voxels. The 3D-microCT image-based RBM and BSC equivalent doses for external exposure to photons presented here for the first time for complete human skeletons are in agreement with the results calculated with the three correction factor method and the fluence-to-dose response functions for the same phantoms taking into account the conceptual differences between the different methods. Additionally the microCT image-based results have been compared with corresponding data from earlier studies for other human phantoms.

On the need to revise the arm structure in stylized anthropomorphic phantoms in lateral photon irradiation geometry

Distributions of radiation absorbed dose within human anatomy have been estimated through Monte Carlo radiation transport techniques implemented for two different classes of computational anthropomorphic phantoms: (1) mathematical equation-based stylized phantoms and (2) tomographic image-based voxel phantoms. Voxel phantoms constructed from tomographic images of real human anatomy have been actively developed since the late 1980s to overcome the anatomical approximations necessary with stylized phantoms, which themselves have been utilized since the mid 1960s. However, revisions of stylized phantoms have also been pursued in parallel to the development of voxel phantoms since voxel phantoms (1) are initially restricted to the individual-specific anatomy of the person originally imaged, (2) must be restructured on an organ-by-organ basis to conform to reference individual anatomy and (3) cannot easily represent very fine anatomical structures and tissue layers that are thinner than the voxel dimensions of the overall phantom. Although efforts have been made to improve the anatomic realism of stylized phantoms, most of these efforts have been limited to attempts to alter internal organ structures. Aside from the internal organs, the exterior shapes, and especially the arm structures, of stylized phantoms are also far from realistic descriptions of human anatomy, and may cause dosimetry errors in the calculation of organ-absorbed doses for external irradiation scenarios. The present study was intended to highlight the need to revise the existing arm structure within stylized phantoms by comparing organ doses of stylized adult phantoms with those from three adult voxel phantoms in the lateral photon irradiation geometry. The representative stylized phantom, the adult phantom of the Oak Ridge National Laboratory (ORNL) series and two adult male voxel phantoms, KTMAN-2 and VOXTISS8, were employed for Monte Carlo dose calculation, and data from another voxel phantom, VIP-Man, were obtained from literature sources. The absorbed doses for lungs, oesophagus, liver and kidneys that could be affected by arm structures in the lateral irradiation geometry were obtained for both classes of phantoms in lateral monoenergetic photon irradiation geometries. As expected, those organs in the ORNL phantoms received apparently higher absorbed doses than those in the voxel phantoms. The overestimation is mainly attributed to the relatively poor representation of the arm structure in the ORNL phantom in which the arm bones are embedded within the regions describing the phantom's torso. The results of this study suggest that the overestimation of organ doses, due to unrealistic arm representation, should be taken into account when stylized phantoms are employed for equivalent or effective dose estimates, especially in the case of an irradiation scenario with dominating lateral exposure. For such a reason, the stylized phantom arm structure definition should be revised in order to obtain more realistic evaluations.

Age-dependent organ and effective dose coefficients for external photons: a comparison of stylized and voxel-based paediatric phantoms

This present study investigates the anatomical realism of conventional stylized models of children by comparing organ dose conversion coefficients for the ORNL paediatric phantom series with those determined in the UF (University of Florida) voxel paediatric phantoms. The latter includes whole-body models of a 9 month male, 4 year female, 8 year female, 11 year male and a 14 year male. Of these phantoms, the 1 year, 5 year and 10 year ORNL phantoms, and 9 month male, 4 year female and 11 year male UF voxel phantoms were selected for side-by-side comparisons under idealized external photon irradiation. Organ absorbed dose per unit air kerma (Gy/Gy) for various radiosensitive organs and tissues were calculated for monoenergetic photons over the energy range of 15 keV to 10 MeV and for six irradiation geometries: anterior-posterior (AP), posterior-anterior (PA), right lateral (RLAT), left lateral (LLAT), rotational (ROT) and isotropic (ISO). Differences in organ dose conversion coefficients for the gonads, bone marrow, colon, lung and stomach, to which prominent tissue weighting factors are assigned, were depicted and analysed. Two major causes of observed differences were suggested: differences in organ shape and position and the differences in tissue shielding by overlying tissue regions within the phantoms. Significant discrepancies caused by anatomical differences between the two types of phantoms are also reported for several organs, and in particular, the thyroid and urinary bladder. The results of this study suggest that the paediatric series of ORNL phantoms also have less realistic internal organ and body anatomy and that dose conversion coefficients from these stylized phantoms should be re-evaluated using paediatric voxel phantoms.

Comparison between effective doses for voxel-based and stylized exposure models from photon and electron irradiation

For the last two decades, the organ and tissue equivalent dose as well as effective dose conversion coefficients recommended by the International Commission on Radiological Protection (ICRP) have been determined with exposure models based on stylized MIRD5-type phantoms representing the human body with its radiosensitive organs and tissues according to the ICRP Reference Man released in Publication No. 23, on Monte Carlo codes sometimes simulating rather simplified radiation physics and on tissue compositions from different sources. Meanwhile the International Commission on Radiation Units and Measurements (ICRU) has published reference data for human tissue compositions in Publication No. 44, and the ICRP has released a new report on anatomical reference data in Publication No. 89. As a consequence many of the components of the traditional stylized exposure models used to determine the effective dose in the past have to be replaced: Monte Carlo codes, human phantoms and tissue compositions. This paper presents results of comprehensive investigations on the dosimetric consequences to be expected from the replacement of the traditional stylized exposure models by the voxel-based exposure models. Calculations have been performed with the EGS4 Monte Carlo code for external and internal exposures to photons and electrons with the stylized, gender-specific MIRD5-type phantoms ADAM and EVA on the one hand and with the recently developed tomographic or voxel-based phantoms MAX and FAX on the other hand for a variety of exposure conditions. Ratios of effective doses for the voxel-based and the stylized exposure models will be presented for external and internal exposures to photons and electrons as a function of the energy and the geometry of the radiation field. The data indicate that for the exposure conditions considered in these investigations the effective dose may change between +60% and -50% after the replacement of the traditional exposure models by the voxel-based exposure models.

An improved MCNP version of the NORMAN voxel phantom for dosimetry studies

In recent years voxel phantoms have been developed on the basis of tomographic data of real individuals allowing new sets of conversion coefficients to be calculated for effective dose. Progress in radiation studies brought ICRP to revise its recommendations and a new report, already circulated in draft form, is expected to change the actual effective dose evaluation method. In the present paper the voxel phantom NORMAN developed at HPA, formerly NRPB, was employed with MCNP Monte Carlo code. A modified version of the phantom, NORMAN-05, was developed to take into account the new set of tissues and weighting factors proposed in the cited ICRP draft. Air kerma to organ equivalent dose and effective dose conversion coefficients for antero-posterior and postero-anterior parallel photon beam irradiations, from 20 keV to 10 MeV, have been calculated and compared with data obtained in other laboratories using different numerical phantoms. Obtained results are in good agreement with published data with some differences for the effective dose calculated employing the proposed new tissue weighting factors set in comparison with previous evaluations based on the ICRP 60 report.

Application of the MAX/EGS4 exposure model to the dosimetry of the Yanango radiation accident

According to the International Atomic Energy Agency (IAEA), industrial radiography accounts for approximately half of all reported accidents for the nuclear related industry. Detailed information about these accidents have been published by the IAEA in its Safety Report Series, one of which describes the radiological accident which happened in 1999 in Yanango/Peru. Under unsettled circumstances an 192Ir source was lost from an industrial radiographic camera and later picked up by a welder, who normally had nothing to do with the radiographic work. The man put the source into the right back pocket of his jeans and continued working for at least another 6.5 h. This study uses the MAX/EGS4 exposure model in order to determine absorbed dose distributions in the right thigh of the MAX phantom, as well as average absorbed doses to radiosensitive organs and tissues. For this purpose, the Monte Carlo code for standard exposure situations has been modified in order to match the irradiation conditions of the accident as closely as possible. The results present the maximum voxel absorbed dose, voxel depth absorbed dose and voxel surface absorbed dose distributions, average organ and tissue doses and a maximum surface absorbed dose for zero depth.

Comparison of effective doses from various monoenergetic particles based on the stylised and the VIP-Man tomographic models

This study compares the effective doses from a MIRD-type stylised model with those derived from the scaled-down version of the tomographic VIP-Man model for photon, electron, neutron and proton beams. The effective dose results from these two models show that they differ from each other within approximately 10% for common high-energy photon beams, within approximately 16% for neutrons, and within approximately 4% for high-energy proton beams. However, for low-energy protons and common electron beams, the effective doses can be different in >100%. It is concluded that the use of a single tomographic models will not improve the operational radiation protection dosimetry involving external beam exposures.

All about FAX: a Female Adult voXel phantom for Monte Carlo calculation in radiation protection dosimetry

The International Commission on Radiological Protection (ICRP) has created a task group on dose calculations, which, among other objectives, should replace the currently used mathematical MIRD phantoms by voxel phantoms. Voxel phantoms are based on digital images recorded from scanning of real persons by computed tomography or magnetic resonance imaging (MRI). Compared to the mathematical MIRD phantoms, voxel phantoms are true to the natural representations of a human body. Connected to a radiation transport code, voxel phantoms serve as virtual humans for which equivalent dose to organs and tissues from exposure to ionizing radiation can be calculated. The principal database for the construction of the FAX (Female Adult voXel) phantom consisted of 151 CT images recorded from scanning of trunk and head of a female patient, whose body weight and height were close to the corresponding data recommended by the ICRP in Publication 89. All 22 organs and tissues at risk, except for the red bone marrow and the osteogenic cells on the endosteal surface of bone ('bone surface'), have been segmented manually with a technique recently developed at the Departamento de Energia Nuclear of the UFPE in Recife, Brazil. After segmentation the volumes of the organs and tissues have been adjusted to agree with the organ and tissue masses recommended by ICRP for the Reference Adult Female in Publication 89. Comparisons have been made with the organ and tissue masses of the mathematical EVA phantom, as well as with the corresponding data for other female voxel phantoms. The three-dimensional matrix of the segmented images has eventually been connected to the EGS4 Monte Carlo code. Effective dose conversion coefficients have been calculated for exposures to photons, and compared to data determined for the mathematical MIRD-type phantoms, as well as for other voxel phantoms.