1
|
Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
|
2
|
Boissonnat G, Morichau-Beauchant P, Reshef A, Villa C, Désauté P, Simon AC. Performance of automatic exposure control on dose and image quality: comparison between slot-scanning and flat-panel digital radiography systems. Med Phys 2023; 50:1162-1184. [PMID: 36069636 DOI: 10.1002/mp.15954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND EOSedge™* (EOS Imaging, Paris, France) is an X-ray imaging system using automatic exposure control (AEC) with tube current modulation, in order to optimize dose deposition in patients. PURPOSE This study aims at characterizing EOSedge organ dose deposition in comparison to a digital radiography (DR) system and the previous EOS system (EOS-1st generation), in relation to their respective image quality levels. METHOD Organ doses were measured in an anthropomorphic female adult phantom and a 5-year-old pediatric phantom using optically stimulated luminescence (OSL) dosimeters, which were carefully calibrated within the studied energy range. Organ doses were recorded on the EOSedge and the Fuji Visionary DRF (Fujifilm Medical Systems U.S.A., Inc, Lexington, MA). The resulting effective doses were compared to the EOS-1st-generation values present in the literature. Image quality assessment was carried out on end-user images. Quantitative image quality metrics were computed for all tested modalities on a quality assurance phantom. Qualitative assessment of EOSedge image quality was based on anthropomorphic phantom acquisitions against the EOS-1st-generation system, and on clinical images against the tested DR system. RESULTS For a full-spine exam, and on the female adult phantom (respectively, the pediatric phantom), an effective dose of 92 μSv (respectively, 32 μSv) was obtained on EOSedge, and 572 μSv (respectively, 179 μSv) on the DR system; these values were compared to effective dose values of 290 μSv (respectively, 200 μSv) from the literature on EOS-1st generation, leading to an effective dose reduction factor of 6 with respect to the DR system, and of 3-6 with respect to EOS-1st generation. EOSedge provides the best compromise between contrast-to-noise ratio (CNR) and dose, with more consistent CNR values than the other tested modalities, in a range of attenuation from 10 to 40 cm of poly(methyl methacrylate) (PMMA). Within this range, EOSedge is also comparable to DR for 10 and 20 cm of PMMA, and better than DR for 30 and 40 cm of PMMA, both in terms of spatial resolution and low-contrast detection. The anatomical landmarks of interest in the follow-up of spinal deformities can be detected in all tested modalities. CONCLUSION Results showed that EOSedge provides significant dose reduction factors for full spine imaging in both adults and children compared to the other tested modalities, without compromising image quality. We believe that this work could help raise awareness on the capabilities of modern X-ray systems, when equipped with appropriate AEC strategies, to perform ultra-low-dose, long-axis images.
Collapse
|
3
|
Lu MY, Ting CY, Jao JC. Effective dose and radiation risk under 640-slice abdominal computed tomography examination without contrast medium injection. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:657-666. [PMID: 35367977 DOI: 10.3233/xst-211101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical imaging plays a crucial role in modern medicine. In order to provide fast and accurate medical diagnosis, computed tomography (CT) is a commonly used tool in radiological examinations, and 640-slice CT is the most advanced CT imaging modality. OBJECTIVE To evaluate the radiation dose and the risk under 640-slice abdominal CT examination. METHODS Examinations were performed using a 640-slice CT scanner on an Alderson-Rando anthropomorphic phantom. The used scanning acquisition parameters were the same as those used on abdominal examination without contrast medium injection in clinical practice. To measure the absorbed doses, optically stimulated luminescence dosimeters (OSLDs) were put into liver, stomach, bladder, gonads, colon, small intestine, bone marrow, and skin. RESULTS According to the 1990 Recommendations of the International Commission on Radiological Protection (ICRP Publication 60), the calculated effective doses received from this examination were 0.90 mSv in males and 0.89 mSv in females. According to the 2007 Recommendations of the International Commission on Radiological Protection (ICRP Publication 103), the calculated effective dose received from this examination was 0.83 mSv in both sexes. CONCLUSIONS Radiation doses obtained from the abdominal 640-slice CT examination are lower than the yearly cumulative doses received from natural radiation, revealing there is no deterministic effect and radiation risk is relatively low; therefore, this CT examination is considered safe.
Collapse
Affiliation(s)
- Ming-Yi Lu
- Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
- Division of Radiology and Nuclear Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Chien-Yi Ting
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, R.O.C
| | - Jo-Chi Jao
- Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| |
Collapse
|
4
|
Ding GX, Osmundson EC, Shinohara E, Newman NB, Price M, Kirschner AN. Monte Carlo study on dose distributions from total skin electron irradiation therapy (TSET). Phys Med Biol 2021; 66. [PMID: 33706289 DOI: 10.1088/1361-6560/abedd7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
Total skin electron therapy (TSET) has been used to treat mycosis fungoides since the 1950s. Practitioners of TSET rely on relatively crude, phantom-based point measurements for commissioning and treatment plan dosimetry. Using Monte Carlo simulation techniques, this study presents whole-body dosimetry for a patient receiving rotational, dual-field TSET. The Monte Carlo codes, BEAMnrc/DOSXYZnrc, were used to simulate 6 MeV electron beams to calculate skin dose from TSET. Simulations were validated with experimental measurements. The rotational dual-field technique uses extended source-to-surface distance with an acrylic beam degrader between the patient and incident beams. Simulations incorporated patient positioning: standing on a platform that rotates during radiation delivery. Resultant patient doses were analyzed as a function of skin depth-dose coverage and evaluated using dose-volume-histograms (DVH). Good agreement was obtained between simulations and measurements. For a cylinder with a 30 cm diameter, the depths that dose fell to 50% of the surface dose was 0.66 cm, 1.15 cm and 1.42 cm for thicknesses of 9 mm, 3 mm and without an acrylic scatter plate, respectively. The results are insensitive to cylinder diameter. Relatively uniform skin surface dose was obtained for skin in the torso area although large dose variations (>25%) were found in other areas resulting from partial beam shielding of the extremities. To achieve 95% mean dose to the first 5 mm of skin depth, the mean dose to skin depth of 5-10 mm and depth of 10-15 mm from the skin surface was 74% (57%) and 50% (25%) of the prescribed dose when using a 3mm (9 mm) thickness scatter plate, respectively. As a result of this investigation on patient skin dose distributions we changed our patient treatments to use a 3 mm instead of a 9 mm thickness Acrylic scatter plate for clinically preferred skin depth dose coverage.
Collapse
Affiliation(s)
- George X Ding
- Department of Radiation Oncology , Vanderbilt University School of Medicine, Nashville, Tennessee, UNITED STATES
| | - Evan C Osmundson
- Department of Radiation Oncology , Vanderbilt University School of Medicine, Nashville, Tennessee, UNITED STATES
| | - Eric Shinohara
- Department of Radiation Oncology , Vanderbilt University School of Medicine, Nashville, Tennessee, UNITED STATES
| | - Neil B Newman
- Department of Radiation Oncology , Vanderbilt University School of Medicine, Nashville, Tennessee, UNITED STATES
| | - Michael Price
- Department of Radiation Oncology , Vanderbilt University School of Medicine, Nashville, Tennessee, UNITED STATES
| | - Austin N Kirschner
- Department of Radiation Oncology , Vanderbilt University School of Medicine, Nashville, Tennessee, UNITED STATES
| |
Collapse
|
5
|
Upasani VV, Bandaralage H, Farnsworth CL. 3D cone-beam tomosynthesis provides axial imaging of the spine with lower radiation compared to computed tomography. Spine Deform 2021; 9:41-49. [PMID: 32930997 DOI: 10.1007/s43390-020-00199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/29/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Three imaging techniques were compared using porcine spines. OBJECTIVES To compare image acquisition time, radiation exposure, pedicle width measurement, assessment of screw breach, and image artifact between cone-beam tomosynthesis (CBT) single mode, CBT dual mode (stereotactic CBT), and computed tomography (CT) imaging with and without spinal implants. CT is the standard for axial imaging of orthopedic procedures. CBT technology is being developed, allowing real-time intraoperative imaging and 3D surgical guidance. CBT may deliver useful axial imaging quicker with less radiation than current technologies. METHODS Six porcine spines were instrumented with bilateral pedicle screws at six levels connected with 5.5 mm rods. Dosimeters were attached to four surfaces of spines. CT, CBT single and CBT dual images were acquired pre-implant and post-implant. Image acquisition and 3D reconstruction times were recorded. Pedicle widths were measured before and after instrumentation. Screw medial breaches were graded (0: no breach, 1: < 2 mm, 2: 2-4 mm, 3: > 4 mm). Artifact and/or distortion of each image was ranked (0 = none, 1 = mild, 2 = moderate, 3 = large). Image acquisition and reconstruction times, radiation dose, pedicle width, screw breach and artifact were compared between techniques. RESULTS Total image acquisition and reconstruction times of CBT was significantly less (single: 9.9 ± 0.2 s, p < 0.001; dual: 60.0 ± 8.7 s, p < 0.001) than CT (250.3 ± 36.7 s). CBT had significantly less radiation exposure than CT (CT: 0.7 ± 0.1 rad, single: 0.03 ± 0.02 rad, dual: 0.07 ± 0.03 rad; p < 0.001). No difference in pedicle width change pre-implant to post-implant was found (CT: p = 0.449, single: p = 0.430, dual: p = 0.528). Pedicle width (pre-implant: p > 0.5, post-implant: p > 0.9) and pedicle width change (p > 0.4) was similar amongst all techniques. Breach assessment was not different between groups (p = 0.257). CBT images had consistently lower artifact grades than CT. CONCLUSIONS Although CBT axial image quality appeared subjectively inferior to CT, it enabled consistent assessment of pedicle width and screw breach, at half time and 10× lower radiation exposure. With continued refinements, CBT technology may allow for adequate intra-operative axial imaging using low radiation exposure.
Collapse
Affiliation(s)
- Vidyadhar V Upasani
- University of California San Diego, San Diego, CA, USA.
- Rady Children's Hospital-San Diego, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA.
| | - Harsha Bandaralage
- Rady Children's Hospital-San Diego, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA
| | - Christine L Farnsworth
- Rady Children's Hospital-San Diego, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA
| |
Collapse
|
6
|
Kearney M, Coffey M, Leong A. A review of Image Guided Radiation Therapy in head and neck cancer from 2009-201 - Best Practice Recommendations for RTTs in the Clinic. Tech Innov Patient Support Radiat Oncol 2020; 14:43-50. [PMID: 32566769 PMCID: PMC7296359 DOI: 10.1016/j.tipsro.2020.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/17/2020] [Accepted: 02/11/2020] [Indexed: 02/06/2023] Open
Abstract
Radiation therapy (RT) is beneficial in Head and Neck Cancer (HNC) in both the definitive and adjuvant setting. Highly complex and conformal planning techniques are becoming standard practice in delivering increased doses in HNC. A sharp falloff in dose outside the high dose area is characteristic of highly complex techniques and geometric uncertainties must be minimised to prevent under dosage of the target volume and possible over dosage of surrounding critical structures. CTV-PTV margins are employed to account for geometric uncertainties such as set up errors and both interfraction and intrafraction motion. Robust immobilisation and Image Guided Radiation Therapy (IGRT) is also essential in this group of patients to minimise discrepancies in patient position during the treatment course. IGRT has evolved with increased 2-Dimensional (2D) and 3-Dimensional (3D) IGRT modalities available for geometric verification. 2D and 3D IGRT modalities are both beneficial in geometric verification while 3D imaging is a valuable tool in assessing volumetric changes that may have dosimetric consequences for this group of patients. IGRT if executed effectively and efficiently provides clinicians with confidence to reduce CTV-PTV margins thus limiting treatment related toxicities in patients. Accumulated exposure dose from IGRT vary considerably and may be incorporated into the treatment plan to avoid excess dose. However, there are considerable variations in the application of IGRT in RT practice. This paper aims to summarise the advances in IGRT in HNC treatment and provide clinics with recommendations for an IGRT strategy for HNC in the clinic.
Collapse
Affiliation(s)
- Maeve Kearney
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
| | - Mary Coffey
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
| | - Aidan Leong
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand.,Bowen Icon Cancer Centre, Wellington, New Zealand
| |
Collapse
|
7
|
Obesso A, Alejo L, Huerga C, Sánchez-Muñoz F, Corredoira E, Fernández-Prieto A, Frutos R, Marín B, Garzón G, Peralta J, Ubeda C, Guibelalde E. Eye lens radiation exposure in paediatric interventional treatment of retinoblastoma. Sci Rep 2019; 9:20113. [PMID: 31882988 PMCID: PMC6934545 DOI: 10.1038/s41598-019-56623-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/10/2019] [Indexed: 11/25/2022] Open
Abstract
Retinoblastoma represents 3% of cancers in children under fifteen years of age. The standard paediatric treatment for saving the affected eye is supraselective intra-arterial chemotherapy performed in interventional rooms. In order to address the radiation toxicity due to the angiography, the aim of this study was to determine the typical dose value corresponding to the procedure, estimate the paediatric patients' eye lens dose and study the relationship between dose indicators and dose to the lens. An automatic dose management software was installed in two interventional rooms to obtain the distribution of the dose indicators kerma-area product and reference-point air kerma, getting a typical value 16 Gy·cm2 and 130 mGy, respectively (n = 35). The eye lens dose estimates were obtained with photoluminescent dosimeters placed on the patient's eyelids. In the left eye, the entrance surface air kerma was 44.23 ± 2.66 mGy, and 12.72 ± 0.89 mGy in the right eye (n = 10). There was a positive correlation between dose to the lens per procedure and dose indicators, with R2 > 0.65 for both eyes. Based on this information, the threshold for the onset of radiation-induce cataracts (500 mGy) will be exceeded if the treatment is performed for more than 8 sessions.
Collapse
Affiliation(s)
- A Obesso
- Medical Physics Department, La Paz University Hospital, Madrid, Spain
| | - L Alejo
- Medical Physics Department, La Paz University Hospital, Madrid, Spain.
| | - C Huerga
- Medical Physics Department, La Paz University Hospital, Madrid, Spain
| | - F Sánchez-Muñoz
- Medical Physics Department, La Paz University Hospital, Madrid, Spain
| | - E Corredoira
- Medical Physics Department, La Paz University Hospital, Madrid, Spain
| | | | - R Frutos
- Neuroradiology Department, La Paz University Hospital, Madrid, Spain
| | - B Marín
- Neuroradiology Department, La Paz University Hospital, Madrid, Spain
| | - G Garzón
- Neuroradiology Department, La Paz University Hospital, Madrid, Spain
| | - J Peralta
- Paediatric Ophthalmology Department, La Paz University Hospital, Madrid, Spain
| | - C Ubeda
- Medical Technology Department Health Sciences Faculty, Tarapaca University, Arica, Chile
| | - E Guibelalde
- Radiology Department, Complutense University, Madrid, Spain
| |
Collapse
|
8
|
Kry SF, Alvarez P, Cygler JE, DeWerd LA, Howell RM, Meeks S, O'Daniel J, Reft C, Sawakuchi G, Yukihara EG, Mihailidis D. AAPM TG 191: Clinical use of luminescent dosimeters: TLDs and OSLDs. Med Phys 2019; 47:e19-e51. [DOI: 10.1002/mp.13839] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Stephen F. Kry
- The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Paola Alvarez
- The University of Texas MD Anderson Cancer Center Houston TX USA
| | | | | | | | - Sanford Meeks
- University of Florida Health Cancer Center Orlando FL USA
| | | | | | | | | | | |
Collapse
|
9
|
Scarboro SB, Cody D, Stingo FC, Alvarez P, Followill D, Court L, Zhang D, McNitt‐Gray M, Kry SF. Calibration strategies for use of the nanoDot OSLD in CT applications. J Appl Clin Med Phys 2019; 20:331-339. [PMID: 30426664 PMCID: PMC6333198 DOI: 10.1002/acm2.12491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/26/2018] [Accepted: 10/06/2018] [Indexed: 11/06/2022] Open
Abstract
Aluminum oxide based optically stimulated luminescent dosimeters (OSLD) have been recognized as a useful dosimeter for measuring CT dose, particularly for patient dose measurements. Despite the increasing use of this dosimeter, appropriate dosimeter calibration techniques have not been established in the literature; while the manufacturer offers a calibration procedure, it is known to have relatively large uncertainties. The purpose of this work was to evaluate two clinical approaches for calibrating these dosimeters for CT applications, and to determine the uncertainty associated with measurements using these techniques. Three unique calibration procedures were used to calculate dose for a range of CT conditions using a commercially available OSLD and reader. The three calibration procedures included calibration (a) using the vendor-provided method, (b) relative to a 120 kVp CT spectrum in air, and (c) relative to a megavoltage beam (implemented with 60 Co). The dose measured using each of these approaches was compared to dose measured using a calibrated farmer-type ion chamber. Finally, the uncertainty in the dose measured using each approach was determined. For the CT and megavoltage calibration methods, the dose measured using the OSLD nanoDot was within 5% of the dose measured using an ion chamber for a wide range of different CT scan parameters (80-140 kVp, and with measurements at a range of positions). When calibrated using the vendor-recommended protocol, the OSLD measured doses were on average 15.5% lower than ion chamber doses. Two clinical calibration techniques have been evaluated and are presented in this work as alternatives to the vendor-provided calibration approach. These techniques provide high precision for OSLD-based measurements in a CT environment.
Collapse
Affiliation(s)
- Sarah B. Scarboro
- The University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Graduate School of Biomedical SciencesThe University of Texas Health Science Center HoustonHoustonTXUSA
| | - Dianna Cody
- The University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Graduate School of Biomedical SciencesThe University of Texas Health Science Center HoustonHoustonTXUSA
| | - Francesco C. Stingo
- The University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Graduate School of Biomedical SciencesThe University of Texas Health Science Center HoustonHoustonTXUSA
| | - Paola Alvarez
- The University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - David Followill
- The University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Graduate School of Biomedical SciencesThe University of Texas Health Science Center HoustonHoustonTXUSA
| | - Laurence Court
- The University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Graduate School of Biomedical SciencesThe University of Texas Health Science Center HoustonHoustonTXUSA
| | - Di Zhang
- Biomedical Physics Graduate ProgramDavid Geffen School of Medicine at UCLALos AngelesCAUSA
- Present address:
Toshiba American Medical SystemsTustinCAUSA
| | - Michael McNitt‐Gray
- The Department of Radiological SciencesDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Stephen F. Kry
- The University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Graduate School of Biomedical SciencesThe University of Texas Health Science Center HoustonHoustonTXUSA
| |
Collapse
|
10
|
Musa Y, Hashim S, Ghoshal S, Bradley D, Ahmad N, Karim M, Hashim A, Kadir A. General radiographic attributes of optically stimulated luminescence dosimeters: A basic insight. Radiat Phys Chem Oxf Engl 1993 2018. [DOI: 10.1016/j.radphyschem.2018.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Ding GX, Alaei P, Curran B, Flynn R, Gossman M, Mackie TR, Miften M, Morin R, Xu XG, Zhu TC. Image guidance doses delivered during radiotherapy: Quantification, management, and reduction: Report of the AAPM Therapy Physics Committee Task Group 180. Med Phys 2018; 45:e84-e99. [PMID: 29468678 DOI: 10.1002/mp.12824] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND With radiotherapy having entered the era of image guidance, or image-guided radiation therapy (IGRT), imaging procedures are routinely performed for patient positioning and target localization. The imaging dose delivered may result in excessive dose to sensitive organs and potentially increase the chance of secondary cancers and, therefore, needs to be managed. AIMS This task group was charged with: a) providing an overview on imaging dose, including megavoltage electronic portal imaging (MV EPI), kilovoltage digital radiography (kV DR), Tomotherapy MV-CT, megavoltage cone-beam CT (MV-CBCT) and kilovoltage cone-beam CT (kV-CBCT), and b) providing general guidelines for commissioning dose calculation methods and managing imaging dose to patients. MATERIALS & METHODS We briefly review the dose to radiotherapy (RT) patients resulting from different image guidance procedures and list typical organ doses resulting from MV and kV image acquisition procedures. RESULTS We provide recommendations for managing the imaging dose, including different methods for its calculation, and techniques for reducing it. The recommended threshold beyond which imaging dose should be considered in the treatment planning process is 5% of the therapeutic target dose. DISCUSSION Although the imaging dose resulting from current kV acquisition procedures is generally below this threshold, the ALARA principle should always be applied in practice. Medical physicists should make radiation oncologists aware of the imaging doses delivered to patients under their care. CONCLUSION Balancing ALARA with the requirement for effective target localization requires that imaging dose be managed based on the consideration of weighing risks and benefits to the patient.
Collapse
Affiliation(s)
- George X Ding
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
| | - Parham Alaei
- University of Minnesota, Minneapolis, MN, 55455, USA
| | - Bruce Curran
- Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Ryan Flynn
- University of Iowa, Iowa City, IA, 52242, USA
| | | | | | | | | | - X George Xu
- Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
| | - Timothy C Zhu
- University of Pennsylvania, Philadelphia, PA, 19104, USA
| |
Collapse
|
12
|
de las Heras Gala H, Schöfer F, Schöfer H, Sánchez Casanueva R, Zervides C, Mair K, Al-Zoubi Q, Renger B, de las Heras Gala T, Schlattl H. A patient-centric approach to quality control and dosimetry in CT including CBCT. Phys Med 2018; 47:92-102. [DOI: 10.1016/j.ejmp.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/08/2017] [Accepted: 02/07/2018] [Indexed: 11/16/2022] Open
|
13
|
Poirier Y, Kuznetsova S, Villarreal-Barajas JE. Characterization of nanoDot optically stimulated luminescence detectors and high-sensitivity MCP-N thermoluminescent detectors in the 40-300 kVp energy range. Med Phys 2017; 45:402-413. [DOI: 10.1002/mp.12691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 10/10/2017] [Accepted: 10/27/2017] [Indexed: 01/04/2023] Open
Affiliation(s)
- Yannick Poirier
- Department of Radiation Oncology; University of Maryland School of Medicine; Baltimore MD 21201 USA
| | - Svetlana Kuznetsova
- Department of Physics and Astronomy; University of Calgary; Calgary AB T2N 1N4 Canada
- Department of Oncology; University of Calgary; Calgary AB T2N 1N4 Canada
| | | |
Collapse
|
14
|
Reproducibility assessment of commercial optically stimulated luminescence system in diagnostic X-ray beams. J Radioanal Nucl Chem 2017. [DOI: 10.1007/s10967-017-5571-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
15
|
Ahmed MF, Shrestha N, Schnell E, Ahmad S, Akselrod MS, Yukihara EG. Characterization of Al2O3optically stimulated luminescence films for 2D dosimetry using a 6 MV photon beam. Phys Med Biol 2016; 61:7551-7570. [DOI: 10.1088/0031-9155/61/21/7551] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
16
|
Mail N, Yusuf M, Alothmany N, Kinsara AA, Abdulkhaliq F, Ghamdi SM, Saoudi A. A methodology for on-board CBCT imaging dose using optically stimulated luminescence detectors. J Appl Clin Med Phys 2016; 17:482-499. [PMID: 27685143 PMCID: PMC5874125 DOI: 10.1120/jacmp.v17i5.6378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/07/2016] [Accepted: 05/24/2016] [Indexed: 11/23/2022] Open
Abstract
Cone‐beam computed tomography CBCT systems are used in radiation therapy for patient alignment and positioning. The CBCT imaging procedure for patient setup adds substantial radiation dose to patient's normal tissue. This study presents a complete procedure for the CBCT dosimetry using the InLight optically‐stimulated‐luminescence (OSL) nanoDots. We report five dose parameters: the mean slice dose (DMSD); the cone beam dose index (CBDIW); the mean volume dose (DMVD); point‐dose profile, D(FOV); and the off‐field Dose. In addition, CBCT skin doses for seven pelvic tumor patients are reported. CBCT‐dose measurement was performed on a custom‐made cylindrical acrylic body phantom (50 cm length, 32 cm diameter). We machined 25 circular disks (2 cm thick) with grooves and holes to hold OSL‐nanoDots. OSLs that showed similar sensitivities were selected and calibrated against a Farmer‐type ionization‐chamber (0.6 CT) before being inserted into the grooves and holes. For the phantom scan, a standard CBCT‐imaging protocol (pelvic sites: 125 kVp, 80 mA and 25 ms) was used. Five dose parameters were quantified: DMSD, CBDIW, DMVD, D(FOV), and the off‐field dose. The DMSD for the central slice was 31.1±0.85 mGy, and CBDIW was 34.5±0.6 mGy at 16 cm FOV. The DMVD was 25.6±1.1 mGy. The off‐field dose was 10.5 mGy. For patients, the anterior and lateral skin doses attributable to CBCT imaging were 39.04±4.4 and 27.1±1.3 mGy, respectively. OSL nanoDots were convenient to use in measuring CBCT dose. The method of selecting the nanoDots greatly reduced uncertainty in the OSL measurements. Our detailed calibration procedure and CBCT dose measurements and calculations could prove useful in developing OSL routines for CBCT quality assessment, which in turn gives them the property of high spatial resolution, meaning that they have the potential for measurement of dose in regions of severe dose‐gradients. PACS number(s): 87.57.‐s, 87.57.Q, 87.57.uq
Collapse
Affiliation(s)
- Noor Mail
- King Abdullah International Medical Research Center (KAIMRC); National Guard Health Affairs.
| | | | | | | | | | | | | |
Collapse
|
17
|
Rampado O, Giglioli FR, Rossetti V, Fiandra C, Ragona R, Ropolo R. Evaluation of various approaches for assessing dose indicators and patient organ doses resulting from radiotherapy cone-beam CT. Med Phys 2016; 43:2515. [DOI: 10.1118/1.4947129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
18
|
Scarboro SB, Cody D, Alvarez P, Followill D, Court L, Stingo FC, Zhang D, McNitt-Gray M, Kry SF. Characterization of the nanoDot OSLD dosimeter in CT. Med Phys 2015; 42:1797-807. [PMID: 25832070 DOI: 10.1118/1.4914398] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The extensive use of computed tomography (CT) in diagnostic procedures is accompanied by a growing need for more accurate and patient-specific dosimetry techniques. Optically stimulated luminescent dosimeters (OSLDs) offer a potential solution for patient-specific CT point-based surface dosimetry by measuring air kerma. The purpose of this work was to characterize the OSLD nanoDot for CT dosimetry, quantifying necessary correction factors, and evaluating the uncertainty of these factors. METHODS A characterization of the Landauer OSL nanoDot (Landauer, Inc., Greenwood, IL) was conducted using both measurements and theoretical approaches in a CT environment. The effects of signal depletion, signal fading, dose linearity, and angular dependence were characterized through direct measurement for CT energies (80-140 kV) and delivered doses ranging from ∼5 to >1000 mGy. Energy dependence as a function of scan parameters was evaluated using two independent approaches: direct measurement and a theoretical approach based on Burlin cavity theory and Monte Carlo simulated spectra. This beam-quality dependence was evaluated for a range of CT scanning parameters. RESULTS Correction factors for the dosimeter response in terms of signal fading, dose linearity, and angular dependence were found to be small for most measurement conditions (<3%). The relative uncertainty was determined for each factor and reported at the two-sigma level. Differences in irradiation geometry (rotational versus static) resulted in a difference in dosimeter signal of 3% on average. Beam quality varied with scan parameters and necessitated the largest correction factor, ranging from 0.80 to 1.15 relative to a calibration performed in air using a 120 kV beam. Good agreement was found between the theoretical and measurement approaches. CONCLUSIONS Correction factors for the measurement of air kerma were generally small for CT dosimetry, although angular effects, and particularly effects due to changes in beam quality, could be more substantial. In particular, it would likely be necessary to account for variations in CT scan parameters and measurement location when performing CT dosimetry using OSLD.
Collapse
Affiliation(s)
- Sarah B Scarboro
- The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Graduate School of Biomedical Sciences, The University of Texas Health Science Center Houston, Houston, Texas 77030; and The Methodist Hospital, Houston, Texas 77030
| | - Dianna Cody
- The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and Graduate School of Biomedical Sciences, The University of Texas Health Science Center Houston, Houston, Texas 77030
| | - Paola Alvarez
- The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - David Followill
- The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and Graduate School of Biomedical Sciences, The University of Texas Health Science Center Houston, Houston, Texas 77030
| | - Laurence Court
- The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and Graduate School of Biomedical Sciences, The University of Texas Health Science Center Houston, Houston, Texas 77030
| | - Francesco C Stingo
- The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and Graduate School of Biomedical Sciences, The University of Texas Health Science Center Houston, Houston, Texas 77030
| | - Di Zhang
- Biomedical Physics Graduate Program, David Geffen School of Medicine at UCLA, Los Angeles, California 90095 and Toshiba American Medical Systems, Tustin, California 92780
| | - Michael McNitt-Gray
- The Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Stephen F Kry
- The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and Graduate School of Biomedical Sciences, The University of Texas Health Science Center Houston, Houston, Texas 77030
| |
Collapse
|
19
|
Alaei P, Spezi E. Imaging dose from cone beam computed tomography in radiation therapy. Phys Med 2015; 31:647-58. [PMID: 26148865 DOI: 10.1016/j.ejmp.2015.06.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/29/2015] [Accepted: 06/05/2015] [Indexed: 12/26/2022] Open
Abstract
Imaging dose in radiation therapy has traditionally been ignored due to its low magnitude and frequency in comparison to therapeutic dose used to treat patients. The advent of modern, volumetric, imaging modalities, often as an integral part of linear accelerators, has facilitated the implementation of image-guided radiation therapy (IGRT), which is often accomplished by daily imaging of patients. Daily imaging results in additional dose delivered to patient that warrants new attention be given to imaging dose. This review summarizes the imaging dose delivered to patients as the result of cone beam computed tomography (CBCT) imaging performed in radiation therapy using current methods and equipment. This review also summarizes methods to calculate the imaging dose, including the use of Monte Carlo (MC) and treatment planning systems (TPS). Peripheral dose from CBCT imaging, dose reduction methods, the use of effective dose in describing imaging dose, and the measurement of CT dose index (CTDI) in CBCT systems are also reviewed.
Collapse
Affiliation(s)
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, Wales, UK; Velindre Cancer Centre, Cardiff, Wales, UK
| |
Collapse
|
20
|
Editor's Choice – Minimizing Radiation Exposure During Endovascular Procedures: Basic Knowledge, Literature Review, and Reporting Standards. Eur J Vasc Endovasc Surg 2015; 50:21-36. [DOI: 10.1016/j.ejvs.2015.01.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/27/2015] [Indexed: 12/30/2022]
|
21
|
The use of the TL and OSL phenomena for determination of absorbed dose rates of 90Sr+90Y sources by a postal method. RADIAT MEAS 2014. [DOI: 10.1016/j.radmeas.2014.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
22
|
Light induced fading associated with the application of OSL to personal dosimetry. RADIAT MEAS 2014. [DOI: 10.1016/j.radmeas.2014.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
23
|
Yukihara EG, McKeever SW, Akselrod MS. State of art: Optically stimulated luminescence dosimetry – Frontiers of future research. RADIAT MEAS 2014. [DOI: 10.1016/j.radmeas.2014.03.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
24
|
Chaikh A, Gaudu A, Balosso J. Monitoring methods for skin dose in interventional radiology. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0301.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|