VirtualDose: a software for reporting organ doses from CT for adult and pediatric patients

Influence of X-ray spectrum and bowtie filter characterisation on the accuracy of Monte Carlo simulated organ doses: Validation in a whole-body CT scanning mode

PURPOSE

For patient-specific CT dosimetry, Monte Carlo dose simulations require an accurate description of the CT scanner. However, quantitative spectral information and information on the bowtie filter material and shape from the manufacturer is often not available. In this study, the influence of different X-ray spectra and bowtie filter characterisation methods on simulated CT organ doses is studied.

METHODS

Using ImpactMC, organ doses of whole-body CTs were simulated in twenty adult whole-body voxel models, generated from PET/CT examinations previously conducted in these patients. Simulated CT organ doses based on the manufacturer X-ray spectra and bowtie filter data were compared with those obtained using alternative characterisation models, including spectrum generators and experimentally measured dose data. A total of four different X-ray spectra and one bowtie filter model were defined based on these data.

RESULTS

For all X-ray spectra and bowtie filter combinations, estimated CT organ doses are within 6% from those resulting from simulations with the CT characterisation models provided by the manufacturer. While varying the bowtie filter model results in CT organ dose differences smaller than 1%, dose differences up to 6% are observed when X-ray spectra are not based on the quantitative data from the manufacturer.

CONCLUSIONS

Estimated organ doses slightly depend on the applied CT characterisation model. When manufacturer's data are not available, half-value layer and dose measurements provide sufficient input to obtain equivalent X-ray spectra and bowtie filter profiles, respectively.

Development of a TOPAS Monte Carlo (MC) model extension to simulate the automatic exposure control function of a C-arm CBCT

PURPOSE

Accurate simulation of organ doses in C-arm CBCT is critical for estimating personalised patient dosimetry. However, system complexities such as automatic exposure control (AEC) and the incorporation of DICOM images into simulations are challenging. The aim of this study was to develop a model for mimicking the operation of an AEC system, which maintains a constant dose to the detector through mA modulation in order to facilitate more accurate MC dosimetry models for C-arm CBCT.

METHODS

A Siemens Artis Q Interventional Radiology (IR) C-arm system [Siemens, Erlangen, Germany] was modelled in TOol for PArticle Simulation (TOPAS) by incorporating system specifications such as rotational speed, number of projections and exam protocol parameters. A novel threshold scorer, AECScorer, was developed to model the AEC functionality. MC simulations were performed using a variety of imaged volumes including a CTDI phantom, an anthropomorphic phantom and a patient DICOM dataset.

RESULTS

The AECScorer extension provides a framework for a conditional scoring function within TOPAS which allows for the simulation of an AEC system. The AECScorer successfully equalises the dose to the detector for simple phantoms and DICOM imaging datasets by adjusting the number of histories simulated at each CBCT projection. This AECSCorer tool is applicable to other medical imaging systems requiring AEC simulation.

CONCLUSIONS

We demonstrate a novel threshold scorer in TOPAS for a C-arm CBCT setup. The presented AECScorer is the first step towards providing a system-, patient- and protocol-specific dose estimates from CBCT dosimetry applications.

Incidence and Mortality Life-Attributable Risks for Patients Subjected to Recurrent CT Examinations and Cumulative Effective Dose Exceeding 100 mSv

Computed tomography (CT) multi-detector array has been heavily utilized over the past decade. While transforming an individual's diagnosis, the risk of developing pathogenesis as a result remains a concern. The main aim of this institutional cumulative effective dose (CED) review is to highlight the number of adult individuals with a record of CED ≥ 100 mSv over a time span of 5 years. Further, we aim to roughly estimate both incidence and mortality life-attributable risks (LARs) for the shortlisted individuals. CT studies performed over one year, in one dedicated trauma and emergency facility, were retrospectively retrieved and analyzed. Individuals with historical radiological CED ≥ 100 mSv were short-listed. LARs were defined and established based on organ, age and gender. Out of the 4406 CT studies reviewed, 22 individuals were found with CED ≥ 100 mSv. CED varied amongst the short-listed individuals, with the highest CED registered being 223.0 mSv, for a 57-year-old male, cumulated over an average study interval of 46.3 days. The highest median mortality risk was for females, 214 per 100,000 registered for the age group 51-60 years. While certain clinical indications and diseases require close follow-up using radiological examinations, the benefit-to-risk ratio should be carefully considered, particularly when CT is requested.

A Historical Survey of Key Epidemiological Studies of Ionizing Radiation Exposure

In this article we review the history of key epidemiological studies of populations exposed to ionizing radiation. We highlight historical and recent findings regarding radiation-associated risks for incidence and mortality of cancer and non-cancer outcomes with emphasis on study design and methods of exposure assessment and dose estimation along with brief consideration of sources of bias for a few of the more important studies. We examine the findings from the epidemiological studies of the Japanese atomic bomb survivors, persons exposed to radiation for diagnostic or therapeutic purposes, those exposed to environmental sources including Chornobyl and other reactor accidents, and occupationally exposed cohorts. We also summarize results of pooled studies. These summaries are necessarily brief, but we provide references to more detailed information. We discuss possible future directions of study, to include assessment of susceptible populations, and possible new populations, data sources, study designs and methods of analysis.

Dose, dose, dose, but where is the patient dose?

The article reviews the historical developments in radiation dose metrices in medical imaging. It identifies the good, the bad, and the ugly aspects of current-day metrices. The actions on shifting focus from International Commission on Radiological Protection (ICRP) Reference-Man-based population-average phantoms to patient-specific computational phantoms have been proposed and discussed. Technological developments in recent years involving AI-based automatic organ segmentation and 'near real-time' Monte Carlo dose calculations suggest the feasibility and advantage of obtaining patient-specific organ doses. It appears that the time for ICRP and other international organizations to embrace 'patient-specific' dose quantity representing risk may have finally come. While the existing dose metrices meet specific demands, emphasis needs to be also placed on making radiation units understandable to the medical community.

Radiation doses and diagnostic reference levels for common CT scans in adults in Northwest region of Iran

This study aims to estimate organ dose and cancer risks, establish region-specific diagnostic reference levels (DRLs), and determine achievable doses (ADs) for common CT procedures in adults in the northwest of Iran. Effective and organ doses were estimated using VirtualDoseCT software in a sample of 480 adult patients who underwent head, sinus, chest, and abdomen-pelvis (AP) CT scans. The guidelines provided by the BEIR VII report were utilized to estimate cancer risks. Effective and organ doses for specific procedures were determined, with the highest mean organ dose being observed in the brain during head CT examinations, with a value of 54.02 mGy. It was observed that the lungs in chest examinations and the colon in AP examinations had the highest risk of cancer, with rates of 30.72 and 21.37 per 100,000 persons, respectively. Higher cancer risk values were generally exhibited by females compared to males. The DRLs for common CT examinations were established as follows: Head CT (CTDIvol 41 mGy, DLP 760 mGy cm), Sinus CT (CTDIvol 16 mGy, DLP 261 mGy cm), Chest CT (CTDIvol 8 mGy, DLP 287 mGy cm), and AP CT (CTDIvol 9 mGy, DLP 508 mGy cm). Significant variations in dose distribution among facilities were identified, indicating the need for optimization. The study highlights the importance of minimizing radiation exposure to critical organs and promoting patient safety in CT examinations. The establishment of region-specific DRLs and ADs can help optimize radiation doses and reduce cancer risks for patients.

Reconstruction of organ doses for patients undergoing computed tomography examinations in Canada 1992-2019

We derived the first comprehensive organ dose library for Canadian pediatric and adult patients who underwent computed tomography (CT) scans between 1992 and 2019 to support epidemiological analysis of radiation risk. We calculated organ absorbed doses for Canadian CT patients in two steps. First, we modeled Computed Tomography Dose Index (CTDI) values by patient age, scan body part, and scan year for the scan period between 1992 and 2019 using national survey data conducted in Canada and partially the United Kingdom survey data as surrogates. Second, we converted CTDI values to organ absorbed doses using a library of organ dose conversion coefficients built in an organ dose calculation program, the National Cancer Institute dosimetry system for CT. In result, we created a library of doses delivered to 33 organs and tissues by different patient ages and genders, scan body parts and scan years. In the scan period before 2000, the organs receiving the greatest dose in the head, chest and abdomen-pelvis scans were the active marrow (3.7-15.2 mGy), lungs (54.7-62.8 mGy) and colon (54.9-68.5 mGy), respectively. We observed organ doses reduced by 24% (pediatric head and torso scans, and adult head scans) and 55% (adult torso scans) after 2000. The organ dose library will be used to analyse the risk of radiation exposure from CT scans in the Canadian CT patient cohort.

COVID-19 and cancer risk arising from ionizing radiation exposure through CT scans: a cross-sectional study

BACKGROUND

The surge in the utilization of CT scans for COVID-19 diagnosis and monitoring during the pandemic is undeniable. This increase has brought to the forefront concerns about the potential long-term health consequences, especially radiation-induced cancer risk. This study aimed to quantify the potential cancer risk associated with CT scans performed for COVID-19 detection.

METHODS

In this cross-sectional study data from a total of 561 patients, who were referred to the radiology center at Imam Hossein Hospital in Shahroud, was collected. CT scan reports were categorized into three groups based on the radiologist's interpretation. The BEIR VII model was employed to estimate the risk of radiation-induced cancer.

RESULTS

Among the 561 patients, 299 (53.3%) were males and the average age of the patients was 49.61 ± 18.73 years. Of the CT scans, 408 (72.7%) were reported as normal. The average age of patients with normal, abnormal, and potentially abnormal CT scans was 47.57 ± 19.06, 54.80 ± 16.70, and 58.14 ± 16.60 years, respectively (p-value < 0.001). The average effective dose was 1.89 ± 0.21 mSv, with 1.76 ± 0.11 mSv for males and 2.05 ± 0.29 mSv for females (p-value < 0.001). The average risk of lung cancer was 3.84 ± 1.19 and 9.73 ± 3.27 cases per 100,000 patients for males and females, respectively. The average LAR for all cancer types was 10.30 ± 6.03 cases per 100,000 patients.

CONCLUSIONS

This study highlights the critical issue of increased CT scan usage for COVID-19 diagnosis and the potential long-term consequences, especially the risk of cancer incidence. Healthcare policies should be prepared to address this potential rise in cancer incidence and the utilization of CT scans should be restricted to cases where laboratory tests are not readily available or when clinical symptoms are severe.

Low-dose radiation from CT examination induces DNA double-strand breaks and detectable changes of DNA methylation in peripheral blood cells

BACKGROUND

Radiation burden from CT examinations increases rapidly with the increased clinical use frequency. Previous studies have disclosed the association between radiation exposure and increased double-strand breaks (DSBs) and changes in DNA methylation. However, whether the induced DSBs by CT examination recover within 24h and whether a CT examination induces detectable gene-specific methylation changes are still unclear. The aim of the present study was to analyze γ-H2AX in the peripheral blood lymphocyte (PBL) of healthy adults before and after CT examination and to discover the differentially methylated positions (DMPs) along with an analysis of DNA methylation changes caused by CT examination.

MATERIALS AND METHODS

Peripheral blood samples of 4 ml were drawn from 20 healthy volunteers at three time points: before CT examination, after CT examination 1h, and after CT examination 24h. γ-H2AX immunofluorescence and Illumina Infinium Human Methylation EPIC BeadChip (850k BeadChip) were used respectively for the test of DSBs and the epigenome-wide DNA methylation analysis. Linear mixed-effect (LME) models were used to evaluate the impacts of doses represented by different parameters and foci on genome-wide DNA methylation.

RESULTS

The number of γ-H2AX foci per cell at 1h showed linear dose-responses for the radiation doses represented by CT index volume (CTDIvol), dose length product (DLP), and blood absorbed dose, respectively. Residual γ-H2AX foci was observed after CT examination at 24h (p < .001). DMPs and γ-H2AX foci changes could be found within 1h. One CpG site related to PAX5 was significantly changed by using most of the parameters in LME models and did not recover till 24h.

CONCLUSIONS

Residual γ-H2AX foci exist after CT examination at 24h. The DNA methylation changes induced by CT examination may not recover within 24h. The DNA methylation had been changed as early as at 1h. The PAX5-related CpG site may be a potential biomarker of low-dose radiation.

CLINICAL RELEVANCE

The biological effects and the cancer risks of CT examination are still unclear. The present study is an effort to document the CT scan-induced events in 24h in vivo. The CT scanning area should be strictly limited, and non-essential repeated operations shouldn't be performed within 24h.

Management of pregnant or potentially pregnant patients undergoing diagnostic and interventional radiology procedures: Investigation of clinical routine practice

It is well known that foetuses are highly sensitive to ionising radiation and special attention to justification and optimisation of radiological procedures involving a pregnant patient is required. A task to review, validate and compare different approaches to managing the pregnant patient and to estimating the associated foetal doses arising from a diagnostic or interventional radiology (DIR) procedure was designed in the framework of EURADOS working group 12. As a first step, a survey of radiation protection practice including dosimetry considerations among EURADOS members was performed using online questionnaire. Then, to evaluate the possible differences in the estimated foetal doses, a comparison of assessed dose values was made for three cases of pregnant patients that underwent different CT procedures. More than 120 professionals from 108 institutions and 17 countries that are involved in managing pregnant patients undergoing DIR procedures answered the questionnaire. Most of the respondents use national or hospital guidelines on the management of pregnant patients undergoing DIR procedures. However, the guidelines differ considerably among respondents. Comparison of foetal dose assessments performed by dosimetry experts showed the variety of methods used as well as large variability of estimated foetal doses in all three cases. Although European and International commission on radiation protection guidelines already exist, they are more than 20 years old and, in some aspects, they are obsolete. This paper shows that there is a need to revise and update these guidelines.

A closer look at the utilized radiation doses during computed tomography pulmonary angiography (CTPA) for COVID-19 patients

Introduction

CTPA stands for computed tomography pulmonary angiography. CTPA is an X-ray imaging that combines X-rays and computer technology to create detailed images of the pulmonary arteries and veins in the lungs. This test diagnoses and monitors conditions like pulmonary embolism, arterial blockages, and hypertension. Coronavirus (COVID-19) has threatened world health over the last three years. The number of (CT) scans increased and played a vital role in diagnosing COVID-19 patients, including life-threatening pulmonary embolism (PE). This study aimed to assess the radiation dose resulted from CTPA for COVID-19 patients.

Methods

Data were collected retrospectively from CTPA examinations on a single scanner in 84 symptomatic patients. The data collected included the dose length product (DLP), volumetric computed tomography dose index (CTDIvol), and size-specific dose estimate (SSDE). The organ dose and effective dose were estimated using VirtualDose software.

Results

The study population included 84 patients, 52% male and 48% female, with an average age of 62. The average DLP, CTDIvol, and SSDE were 404.2 mGy cm, 13.5 mGy, and 11.6 mGy\, respectively. The mean effective doses (mSv) for males and females were 3.01 and 3.29, respectively. The maximum to minimum organ doses (mGy) between patients was 0.8 for the male bladder and 7.33 for the female lung.

Conclusions

The increase in CT scans during the COVID-19 pandemic required close dose monitoring and optimization. The protocol used during CTPA should guarantee a minimum radiation dose with maximum patient benefits.

Quantitative analysis of 99mTc-pertechnetate thyroid uptake with a large-field CZT gamma camera: feasibility and comparison between SPECT/CT and planar acquisitions

PURPOSE

The main objective of this study was to evaluate the ability of a large field Cadmium Zinc Telluride (CZT) camera to estimate thyroid uptake (TU) on single photon emission computed tomography (SPECT) images with and without attenuation correction (Tomo-AC and Tomo-NoAC) compared with Planar acquisition in a series of 23 consecutive patients. The secondary objective was to determine radiation doses for the tracer administration and for the additional Computed Tomography (CT) scan.

METHODS

Cross-calibration factors were determined using a thyroid phantom, for Planar, Tomo-AC and Tomo-NoAC images. Then Planar and SPECT/CT acquisitions centered on the thyroid were performed on 5 anthropomorphic phantoms with activity ranging from 0.4 to 10 MBq, and 23 patients after administration of 79.2 ± 3.7 MBq of [^99mTc]-pertechnetate. We estimated the absolute thyroid activity (AThA) for the anthropomorphic phantoms and the TU for the patients. Radiation dose was also determined using International Commission on Radiological Protection (ICRP) reports and VirtualDose^TMCT software.

RESULTS

Cross-calibration factors were 66.2 ± 4.9, 60.7 ± 0.7 and 26.5 ± 0.3 counts/(MBq s), respectively, for Planar, Tomo-AC and Tomo-NoAC images. Theoretical and estimated AThA for Planar, Tomo-AC and Tomo-NoAC images were statistically highly correlated (r < 0.99; P < 10^-4) and the average of the relative percentage difference between theoretical and estimated AThA were (8.6 ± 17.8), (- 1.3 ± 5.2) and (12.8 ± 5.7) %, respectively. Comparisons between TU based on different pairs of images (Planar vs Tomo-AC, Planar vs Tomo-NoAC and Tomo-AC vs Tomo-NoAC) showed statistically significant correlation (r = 0.972, 0.961 and 0.935, respectively; P < 10^-3). Effective and thyroid absorbed doses were, respectively (0.34_CT + 0.95_NM) mSv, and (3.88_CT + 1.74_NM) mGy.

CONCLUSION

AThA estimation using Planar and SPECT/CT acquisitions on a new generation of CZT large-field cameras is feasible. In addition, TU on SPECT/CT was as accurate as conventional planar acquisition, but the CT induced additional thyroid exposure. Trial registration Name of the registry: Thyroid Uptake Quantification on a New Generation of Gamma Camera (QUANTHYC).

TRIAL NUMBER

NCT05049551. Registered September 20, 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT05049551?cntry=MC&draw=2&rank=4 .

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.

Computed tomography with adjusted dose for body mass index may be superior to whole-body radiography especially in elderly patients with multiple myeloma

BACKGROUND

Whole-body skeletal radiography has traditionally been used in the management of multiple myeloma for defining treatment strategies. For several reasons, radiography has been replaced by computed tomography (CT) covering the same regions.

PURPOSE

To evaluate the body mass index (BMI) adjusted effective radiation dose from two different methods of whole-body radiologic imaging for multiple myeloma assessment.

MATERIAL AND METHODS

The current investigation analyses the dose to patients resulting from the two methods, conventional radiography supplemented with tomosynthesis (203 examinations) and CT (264 examinations). All patients subject to myeloma staging for 4.5 years were included in the study. Exposure parameters were collected from the PACS and conversion factors were calculated using the software packages PCXMC and VirtualDose enabling the calculation of the effective dose to each patient based on BMI. The Mann-Whitney U test was used for comparisons between groups.

RESULTS

Patients were subject to a median effective dose of 2.5 mSv for conventional radiography and 5.1 mSv for CT, a statistically significant difference.

CONCLUSION

The effective dose for whole-body CT in assessing multiple myeloma is twice as high as for whole-body skeletal survey with modern digital radiography, but at a low level and considerably less than the levels quoted in the earlier studies of ∼30 mSv when the technique was first explored.

Development of a generalized method to allow the estimation of doses to the ICRP reference adults from CT, on the basis of normalized organ and CTDI dose data determined by Monte Carlo calculation for a range of contemporary scanners

Objective. Development of a method to provide organ and effective dose coefficients to reference adults for any CT scanner based on values ofCTDImeasured both in air and in standard CT dosimetry phantoms.Approach. Results from previous Monte Carlo simulations for a range of contemporary CT scanners have been analyzed to provide linear models relating values of organ dose (normalized toCTDI_free-in-air), for each slab of 3 reference phantoms (ICRP Male/Female, and AH hermaphrodite), to similarly normalized values ofCTDIin standard CT dosimetry phantoms. Three methods have been investigated to apply the models to values ofCTDIfor a 'new' scanner not previously simulated: a Generic approach using averaged normalized organ dose profiles for whole body exposure of the phantoms; and two processes for matching the scanner, on the basis of normalized organ doses or effective dose (_nE_103,phan), to one of the 102 sets of dose coefficients previously calculated for 12 contemporary CT scanner models, from 4 manufacturers, operating under a range of conditions.Main results. The merit of each method has been quantitatively assessed when applied to both the present contemporary scanners with each test data set being excluded in turn during the matching process, and also to 3 previously-simulated older scanners. Whereas all three methods appear viable, with all doses being within 1% and 10% for the contemporary and old scanners respectively, matching to_nE_103,phanis overall the approach preferred in practice, yielding an uncertainty of around 6% in estimated values of_nE_103,phan. The present methodology also provides superior performance when compared against some other common normalization factors forE_103,phan.Significance. The CT dose model and the data sets will be incorporated into a new CT dosimetry tool that will be made available from UKHSA in support of facilitating improvements in patient protection.

ESTIMATION OF FETAL AND PEDIATRIC DOSES FROM CHEST CT EXAMINATIONS USING VIRTUALDOSE SOFTWARE

Pregnant women and children sometimes had to undergo chest computed tomography (CT) scans during the Corona Virus Disease 2019 (COVID-19) pandemic. This study estimated the fetal and pediatric doses from chest CT scans. Organ doses and effective doses were calculated using the VirtualDose-CT software. Two groups of computational human phantoms, pregnant females and pediatric patients were used in this study. The results of doses normalized to volumetric CT Dose Index (CTDIvol) can be used universally for other dosimetry studies. Based on our calculations and international survey data of CTDIvol, fetal absorbed doses from COVID-19-related chest CT were found to be 0.04-0.36, 0.05-0.44 and 0.07-0.61 mGy for 3, 6 and 9 months of pregnancy, respectively. When the scan range is extended to the abdominal region, fetal doses increase by almost 4-fold. Effective doses for COVID-19-related chest CT were 1.62-13.77, 1.58-13.46, 1.57-13.33 and 1.29-10.98 mSv for the newborn, 1-, 5- and 10-y-old children, respectively. In addition, the effects of specific axial scan ranges exceeding the thorax region were evaluated. Although doses from chest CT scans are small, such data allow radiologists and patients to be informed of the dose levels and ways to avoid unnecessary radiation.

Establishment of Diagnostic Reference Levels in Cone Beam Computed Tomography Scans in the United Arab Emirates

This study aimed to address the knowledge gap in assessing the radiation doses from cone beam computed tomography (CBCT) procedures, establishing a typical value, and estimating effective and organ doses. A total of 340 patients aged 18-80 years were included in this study. Organ doses were estimated using VirtualDose IR software. The typical values were based on median values estimated as 1000 mGy cm². The mean ED (µSv) per procedure was 149.5 ± 56, and the mean of the peak skin dose during the CBCT examination was 39.29 mGy. The highest organ dose was received by the salivary glands (2.71 mGy), the extrathoracic region (1.64 mGy), thyroid (1.24 mGy) and eyes (0.61 mGy). The patients' doses were higher than in previous studies. Staff awareness, education, training and dose optimisation are highly recommended. With the establishment of local DRLs, patient dosages can be reduced successfully without compromising image quality.

CT scanner-specific organ dose coefficients generated by Monte Carlo calculation for the ICRP adult male and female reference computational phantoms

Objective.Provide analyses of new organ dose coefficients (hereafter also referred to as normalized doses) for CT that have been developed to update the widely-utilized collection of data published 30 years ago in NRPB-SR250.Approach.In order to reflect changes in technology, and also ICRP recommendations concerning use of the computational phantoms adult male (AM) and adult female (AF), 102 series of new Monte Carlo simulations have been performed covering the range of operating conditions for 12 contemporary models of CT scanner from 4 manufacturers. Normalized doses (relative to free air on axis) have been determined for 39 organs, and for every 8 mm or 4.84 mm slab of AM and AF, respectively.Main results.Analyses of results confirm the significant influence (by up to a few tens of percent), on values of normalized organ (or contributions to effective dose (E_103,phan)), for whole body exposure arising from selection of tube voltage and beam shaping filter. Use of partial (when available) rather than a Full fan beam reduced both organ and effective dose by up to 7%. Normalized doses to AF were larger than corresponding figures for AM by up to 30% for organs and by 10% forE_103,phan. Additional simulations for whole body exposure have also demonstrated that: practical simplifications in the main modelling (point source, single slice thickness, neglect of patient couch and immobility of phantom arms) have sufficiently small (<5%) effect onE_103,phan; mis-centring of the phantom away from the axis of rotation by 5 mm (in any direction) leads to changes in normalized organ dose andE_103,phanby up to 20% and 6%, respectively; and angular tube current modulation can result in reductions by up to 35% and <15% in normalized organ dose andE_103,phan, respectively, for 100% cosine variation.Significance.These analyses help advance understanding of the influence of operational scanner settings on organ dose coefficients for contemporary CT, in support of improved patient protection. The results will allow the future development of a new dose estimation tool.

Organs' absorbed dose and comparison of different methods for effective dose calculation in computed tomography of parathyroid glands

Objective:To estimate organs' absorbed dose from the two-phase CT of parathyroid glands, effective dose (ED) based on three different methods, and compare the dose values with those reported by other published protocols.Methods:Volumetric-computed-tomography-dose-index (CTDIvol), dose-length-product (DLP), and the corresponding scan length during each phase of a parathyroid protocol were recorded, for seventy-six patients. One k-factor, and two different k-factors for the neck and chest area were used to estimate the ED from DLP. A Monte Carlo software, VirtualDoseCT, was also used for the estimation of organs' absorbed dose and ED.Results:Two-phase parathyroid CT resulted in a mean ED of 3.93 mSv, 4.29 mSv and 4.21 mSv according to the one k-factor, two k-factors, and VirtualDoseCT methods, respectively. The two k-factors method resulted in a slight overestimation of 1.9% in total ED compared to VirtualDoseCT. No statistically significant difference was found in ED values between these methods (Wilcoxon test, p>0.05), except for female patients in the pre-contrast phase. The organs inside the SFOV received the following doses: thymus 23.3 mGy, lungs 11.5 mGy, oesophagus 9.2 mGy, thyroid 6.9 mGy, and breast 6.3 mGy. The ED and organs' dose (OD) values were significantly lower in the pre-contrast than in the arterial phase (Wilcoxon test, p<0.001). A statistically significant difference was observed between male and female patients for the pre-contrast phase (Mann-Whitney test, p<0.05), regarding the ED values obtained with the two k-factors method and VirtualDoseCT software.Conclusions:The two k-factors method could be applied for the ED estimation in clinical practice, if appropriate software is not available. An extensive range of ED values derived from the literature, mainly depending on the acquisition protocol parameters and the estimation method.

Comparison of organ and effective dose estimations from different Monte Carlo simulation-based software methods in infant CT and comparison with direct phantom measurements

Purpose

Computational dosimetry software is routinely used to evaluate the organ and effective doses from computed tomography (CT) examinations. Studies have shown a significant variation in dose estimates between software in adult cohorts, and few studies have evaluated software for pediatric dose estimates. This study aims to compare the primary organ and effective doses estimated by four commercially available CT dosimetry software to thermoluminescent dosimeter (TLD) measurements in a 1‐year‐old phantom.

Methods

One hundred fifteen calibrated LiF (Mg, Cu, P)‐TLD 100‐H chips were embedded within an anthropomorphic phantom representing a 1‐year‐old child at positions that matched the approximate location of organs within an infant. The phantom was scanned under three protocols, each with whole‐body coverage. The mean absorbed doses from 25 radiosensitive organs and skeletal tissues were determined from the TLD readings. Effective doses for each of the protocols were subsequently calculated using ICRP 103 formalism. Dose estimates by the four Monte Carlo–based dose calculation systems were determined and compared to the directly measured doses.

Results

Most organ doses determined by computation dosimetry software aligned to phantom measurements within 20%. Additionally, comparisons between effective doses are calculated using computational and direct measurement methods aligned within 20% across the three protocols. Significant variances were found in bone surface dose estimations among dosimetry methods, likely caused by differences in bone tissue modeling.

Conclusion

All four‐dosimetry software evaluated in this study provide adequate primary organ and effective dose estimations. Users should be aware, however, of the possible estimated uncertainty associated with each of the programs.

Real-time estimation of patient-specific dose distributions for medical CT using the deep dose estimation

PURPOSE

With the rising number of computed tomography (CT) examinations and the trend toward personalized medicine, patient-specific dose estimates are becoming more and more important in CT imaging. However, current approaches are often too slow or too inaccurate to be applied routinely. Therefore, we propose the so-called deep dose estimation (DDE) to provide highly accurate patient dose distributions in real time METHODS: To combine accuracy and computational performance, the DDE algorithm uses a deep convolutional neural network to predict patient dose distributions. To do so, a U-net like architecture is trained to reproduce Monte Carlo simulations from a two-channel input consisting of a CT reconstruction and a first-order dose estimate. Here, the corresponding training data were generated using CT simulations based on 45 whole-body patient scans. For each patient, simulations were performed for different anatomies (pelvis, abdomen, thorax, head), different tube voltages (80 kV, 100 kV, 120 kV), different scan trajectories (circle, spiral), and with and without bowtie filtration and tube current modulation. Similar simulations were performed using a second set of eight whole-body CT scans from the Visual Concept Extraction Challenge in Radiology (Visceral) project to generate testing data. Finally, the DDE algorithm was evaluated with respect to the generalization to different scan parameters and the accuracy of organ dose and effective dose estimates based on an external organ segmentation.

RESULTS

DDE dose distributions were quantified in terms of the mean absolute percentage error (MAPE) and a gamma analysis with respect to the ground truth Monte Carlo simulation. Both measures indicate that DDE generalizes well to different scan parameters and different anatomical regions with a maximum MAPE of 6.3% and a minimum gamma passing rate of 91%. Evaluating the organ dose values for all organs listed in the International Commission on Radiological Protection (ICRP) recommendation, shows an average error of 3.1% and maximum error of 7.2% (bone surface).

CONCLUSIONS

The DDE algorithm provides an efficient approach to determine highly accurate dose distributions. Being able to process a whole-body CT scan in about 1.5 s, it provides a valuable alternative to Monte Carlo simulations on a graphics processing unit (GPU). Here, the main advantage of DDE is that it can be used on top of any existing Monte Carlo code such that real-time performance can be achieved without major adjustments. Thus, DDE opens up new options not only for dosimetry but also for scan and protocol optimization.

Technical note: Evaluation of a V‐Net autosegmentation algorithm for pediatric CT scans: Performance, generalizability and application to patient‐specific CT dosimetry

PURPOSE

This study developed and evaluated a fully convolutional network (FCN) for pediatric CT organ segmentation and investigated the generalizability of the FCN across image heterogeneities such as CT scanner model protocols and patient age. We also evaluated the autosegmentation models as part of a software tool for patient-specific CT dose estimation.

METHODS

A collection of 359 pediatric CT datasets with expert organ contours were used for model development and evaluation. Autosegmentation models were trained for each organ using a modified FCN 3D V-Net. An independent test set of 60 patients was withheld for testing. To evaluate the impact of CT scanner model protocol and patient age heterogeneities, separate models were trained using a subset of scanner model protocols and pediatric age groups. Train and test sets were split to answer questions about the generalizability of pediatric FCN autosegmentation models to unseen age groups and scanner model protocols, as well as the merit of scanner model protocol or age-group-specific models. Finally, the organ contours resulting from the autosegmentation models were applied to patient-specific dose maps to evaluate the impact of segmentation errors on organ dose estimation.

RESULTS

Results demonstrate that the autosegmentation models generalize to CT scanner acquisition and reconstruction methods which were not present in the training dataset. While models are not equally generalizable across age groups, age-group-specific models do not hold any advantage over combining heterogeneous age groups into a single training set. Dice similarity coefficient (DSC) and mean surface distance results are presented for 19 organ structures, for example, median DSC of 0.52 (duodenum), 0.74 (pancreas), 0.92 (stomach), and 0.96 (heart). The FCN models achieve a mean dose error within 5% of expert segmentations for all 19 organs except for the spinal canal, where the mean error was 6.31%.

CONCLUSIONS

Overall, these results are promising for the adoption of FCN autosegmentation models for pediatric CT, including applications for patient-specific CT dose estimation.

Dose quantities for measurement and comparison of doses to individual patients in computed tomography (CT)

The dose quantities displayed routinely on CT scanners, the volume averaged CT dose index (CTDI_vol) and dose length product, provide measures of doses calculated for standard phantoms. The American Association of Medical Physics has published conversion factors for the adjustment of CTDI_volto take account of variations in patient size, the results being termed size-specific dose estimate (SSDE). However, CTDI_voland SSDE, while useful in comparing and optimising doses from a set procedure, do not provide risk-related information that takes account of the organs and tissues irradiated and associated cancer risks. A derivative of effective dose that takes account of differences in body and organ sizes and masses, referred to here as size-specific effective dose (SED), can provide such information. Data on organ doses from NCICT software that is based on Monte Carlo simulations of CT scans for 193 adult phantoms have been used to compute values of SED for CT examinations of the trunk and results compared with corresponding values of SSDE. Relationships within ±8% were observed between SED and SSDE for scans extending over similar regions for phantoms with a wide range of sizes. Coefficients have been derived from fits of the data to estimate SED values from SSDEs for different regions of the body for scans of standard lengths based on patient height. A method developed to take account of differences in scan length gave SED results within ±5% of values calculated using the NCI phantom library. This approach could potentially be used to estimate SED from SSDE values, allowing their display at the time a CT scan is performed.

Evaluation of the Correction Methods Using Age and BMI for Estimating CT Organ Dose Using a Radiophotoluminescence Glass Dosimeter and a Monte Carlo-based Dose Calculator

ABSTRACT

The size-specific dose estimates (SSDE) have been recommended to replace the volume computed tomography dose index (CTDIvol) because it takes patient size into account. On the other hand, organ dose is thought to be a more appropriate quantity in the radiation protection field due to its correlation with radiation risk. The web-based computed tomography (CT) dose calculator WAZA-ARIv2 only offers organ doses for adults with four different body shapes and for children with five different ages. Since the American Association of Physicists in Medicine (AAPM) offers the conversion factors for SSDE and the correlation of SSDE with organ dose has been demonstrated, implementation of the conversion table might improve the accuracy of WAZA-ARIv2. This study aimed to evaluate a body mass index (BMI)-based and age-based correction method for estimation of the organ dose by using a radiophotoluminescence dosimeter (RGD), an anthropomorphic phantom, and the dose calculator WAZA-ARIv2. RGDs were individually calibrated by using an ISOVOLT TITAN-320 x-ray generator. The ratio of the SSDE conversion factors (CFSSDE) was used as the comparison index. For the BMI-based correction method, the ratio of CFSSDE values for the adult phantoms was expected to be 1.065, and the average ratio of the organ doses for the adult phantoms was 1.163 ± 0.169. For the age-based correction method, the ratio of CFSSDE value for 5- and 10-y-old pediatric phantoms was expected to be 0.889, and the ratios of the organ doses were 0.866 ± 0.024 and 0.909 ± 0.047 for the WAZA-ARIv2 dosimetry system and RGD dosimetry system, respectively. In conclusion, both evaluations of the experimental results showed the consistency between WAZA-ARIv2 and the SSDE conversion factor table. Moreover, the importance of taking the measurement position into account when applying the mass attenuation coefficient was demonstrated according to this study.

COMPARISON OF ORGAN ABSORBED DOSES IN WHOLE-BODY COMPUTED TOMOGRAPHY SCANS OF PAEDIATRIC AND ADULT PATIENT MODELS ESTIMATED BY DIFFERENT METHODS

This study aimed to identify the uncertainty in estimations of organ absorbed dose using dedicated software by comparing with corresponding doses measured in physical phantoms. The comparison was performed for whole-body computed tomography (CT) obtained as part of positron emission tomography. Whole-body CT scans provide an advantage in terms of comparison because all organs are in the primary beam of the irradiated area. Organ doses estimated by the different software programs (CT-Expo, VirtualDose and NCICT) were compared by thermoluminescent detector measurements in anthropomorphic phantoms in 1-y-old, 5-y-old and adult patients. Differences were within ~15% in 12 major organs. However, differences of ~30% were observed in organs located at slightly different positions in the computational models compared to the physical phantoms. All investigated programs were deemed suitable for accurate estimation of organ absorbed dose.

Estimating Specific Patient Organ Dose for Chest CT Examinations with Monte Carlo Method

Purpose: The purpose of this study was to preliminarily estimate patient-specific organ doses in chest CT examinations for Chinese adults, and to investigate the effect of patient size on organ doses. Methods: By considering the body-size and body-build effects on the organ doses and taking the mid-chest water equivalent diameter (WED) as a body-size indicator, the chest scan images of 18 Chinese adults were acquired on a multi-detector CT to generate the regional voxel models. For each patient, the lungs, heart, and breasts (glandular breast tissues for both breasts) were segmented, and other organs were semi-automated segmented based on their HU values. The CT scanner and patient models simulated by MCNPX 2.4.0 software (Los Alamos National LaboratoryLos Alamos, USA) were used to calculate lung, breast, and heart doses. CTDIvol values were used to normalize simulated organ doses, and the exponential estimation model between the normalized organ dose and WED was investigated. Results: Among the 18 patients in this study, the simulated doses of lung, heart, and breast were 18.15 ± 2.69 mGy, 18.68 ± 2.87 mGy, and 16.11 ± 3.08 mGy, respectively. Larger patients received higher organ doses than smaller ones due to the higher tube current used. The ratios of lung, heart, and breast doses to the CTDIvol were 1.48 ± 0.22, 1.54 ± 0.20, and 1.41 ± 0.13, respectively. The normalized organ doses of all the three organs decreased with the increase in WED, and the normalized doses decreased more obviously in the lung and the heart than that in the breasts. Conclusions: The output of CT scanner under ATCM is positively related to the attenuation of patients, larger-size patients receive higher organ doses. The organ dose normalized by CTDIvol was negatively correlated with patient size. The organ doses could be estimated by using the indicated CTDIvol combined with the estimated WED.

Development of Chinese mesh-type pediatric reference phantom series and application in dose assessment of Chinese undergoing computed tomography scanning

Pediatric patients are in a growing stage with more dividing cells than adults. Therefore, they are more sensitive to the radiation dose when undergoing computed tomography (CT) scanning. It is necessary and essential to assess the organ absorbed dose and effective dose to children. Monte Carlo simulation with computational phantoms is one of the most used methods for dose calculation in medical imaging and radiotherapy. Because of the vast change of the pediatric body with age increasing, many research groups developed series pediatric phantoms for various ages. However, most of the existing pediatric reference phantoms were developed based on Caucasian populations, which is not conformable to Chinese pediatric patients. The use of different phantoms can contribute to a difference in the dose calculation. To assess the CT dose of Chinese pediatric patients more accurately, we developed the Chinese pediatric reference phantoms series, including the 3-month (CRC3m), 1-year-old (CRC01), 5-year-old (CRC05), 10-year-old (CRC10), 15-year-old male (CRCM15), and a 15-year-old female (CRCF15) phantoms. Furthermore, we applied them to dose assessment of patients undergoing CT scanning. The GE LightSpeed 16 CT scanner was simulated and the paper presents the detailed process of phantoms development and the establishment of the CT dose database (with x-ray tube voltages of 120, 100 and 80 kVp, with collimators of 20, 10, and 5 mm width, with filters for head and body), compares for the 1-year-old results with other results based on different phantoms and analyzes the CT dose calculation results. It was found that the difference in phantoms' characteristics, organ masses and positions had a significant impact on the CT dose calculation outcomes. For the 1-year-old phantom, the dose results of organs fully covered by the x-ray beam were within 10% difference from the results of other studies. For organs partially covered and not covered by the scan range, the maximum differences came up to 84% (stomach dose, chest examinations) and 463% (gonads dose, chest examinations) respectively. The findings are helpful for the dose optimization of Chinese pediatric patients undergoing CT scanning. The developed phantoms could be applied in dose estimation of other medical modalities.

A scanner-specific framework for simulating CT images with tube current modulation

Although tube current modulation (TCM) is routinely implemented in modern computed tomography (CT) scans, no existing CT simulator is capable of generating realistic images with TCM. The goal of this study was to develop such a framework to (1) facilitate patient-specific optimization of TCM parameters and (2) enable future virtual imaging trials (VITs) with more clinically realistic image quality and x-ray flux distributions. The framework was created by developing a TCM module and integrating it with an existing CT simulator (DukeSim). The developed module utilizes scanner-calibrated TCM parameters and two localizer radiographs to compute the mAs for each simulated CT projection. This simulation pipeline was validated in two parts. First, DukeSim was validated in the context of a commercial scanner with TCM (SOMATOM Force, Siemens Healthineers) by imaging a physical CT phantom (Mercury, Sun Nuclear) and its computational analogue. Second, the TCM module was validated by imaging a computational anthropomorphic phantom (ATOM, CIRS) using DukeSim with real and module-generated TCM profiles. The validation demonstrated DukeSim's realism in terms of noise magnitude, noise texture, spatial resolution, and image contrast (with average differences of 0.38%, 6.31%, 0.43%, and -9 HU, respectively). It also demonstrated the TCM module's realism in terms of projection-level mAs and resulting noise magnitude (2.86% and -2.60%, respectively). Finally, the framework was applied to a pilot VIT simulating images of three computational anthropomorphic phantoms (XCAT, with body mass indices (BMIs) of 24.3, 28.2, and 33.0) under five different TCM settings. The optimal TCM for each phantom was characterized based on various criteria, such as minimizing mAs or maximizing image quality. 'Very Weak' TCM minimized noise for the 24.3 BMI phantom, while 'Very Strong' TCM minimized noise for the 33.0 BMI phantom. This illustrates the utility of the developed framework for future optimization studies of TCM parameters and, more broadly, large-scale VITs with scanner-specific TCM.

Radiation dose from computed tomography scans for Korean pediatric and adult patients

Background

In recent events of the Coronavirus Disease 2019 (COVID-19) pandemic, CT scans are being globally used as a complement to the reverse-transcription polymerase chain reaction (RT-PCR) tests. It will be important to be aware of major organ dose levels, which are more relevant quantity to derive potential long-term adverse effect, for Korean pediatric and adult patients undergoing CT for COVID-19.

Materials and Methods

We calculated organ dose conversion coefficients for Korean pediatric and adult CT patients directly from Korean pediatric and adult computational phantoms combined with Monte Carlo radiation transport techniques. We then estimated major organ doses delivered to the Korean child and adult patients undergoing CT for COVID-19 combining the dose conversion coefficients and the international survey data. We also compared our Korean dose conversion coefficients with those from Caucasian reference pediatric and adult phantoms.

Results and discussion

Based on the dose conversion coefficients we established in this study and the international survey data of COVID-19-related CT scans, we found that Korean 7-year-old child and adult males may receive about 4 - 32 mGy and 3 - 21 mGy of lung dose, respectively. We learned that the lung dose conversion coefficient for the Korean child phantom was up to 1.5-fold greater than that for the Korean adult phantom. We also found no substantial difference in dose conversion coefficients between Korean and Caucasian phantoms.

Conclusion

We estimated radiation dose delivered to the Korean child and adult phantoms undergoing COVID-19-related CT examinations. The dose conversion coefficients derived for different CT scan types can be also used universally for other dosimetry studies concerning Korean CT scans. We also confirmed that the Caucasian-based CT organ dose calculation tools may be used for the Korean population with reasonable accuracy.

Evaluation of Radiation Doses from Computed Tomography Conducted in Al Jouf Region (Saudi Arabia)

A safe radiation dose from computed tomography (CT) is normally specified through the Computed Tomography Dose Index (CTDI) as an “effective dose.” Radiation exposure from CT is relatively high in comparison with other radiological tests. In this paper, we evaluate doses used on adult patients during typical CT scans, in Al Jouf, the northern region of Saudi Arabia. Scanning processes were taken place in different parts of the body; including the pelvis, head, abdomen, and chest. The dose indices were calculated using the CT-expo v2.5 computer software. A comparison of the results with similar investigations, regionally and globally, was made. Other comparisons between displayed and calculated dose indices were also performed. The main values of CT volume are the dose index (CTDIvol) and dose-length product (DLP). The effectiveness results for head CTs were 45.0 mGy, 488 mGy.cm, and 5.2 mSv; while for pelvic CTs they were 16.4 mGy, 391 mGy.cm, and 4.0 mSv; whereas for abdominal CTs they were 22.2 mGy, 613 mGy.cm, and 6.5 mSv; finally they were 17.5 mGy, 380 mGy.cm, and 3.9 mSv for chest CTs. It is confirmed that the values obtained are within the internationally accepted values, except for the values of the head examination, in which the effective dose value of 5.2 mSv was higher than the recommended value. This work gives an overview of the doses received by adult patients during regular CT examination. It is the first regional CT dose survey and provides a baseline for improvement and quality control in the region of Al Jouf.

Conversion factors to derive organ doses for canine subjects undergoing CT examinations

Although a large number of CT scans are being conducted on small animals, especially in Western countries, little is known of absorbed dose from veterinary CT scans. In the current retrospective analytical study, we estimated the radiation dose delivered to dogs from CT scans with various scan protocols and compared the results with those of human patients. We adopted a total of three computerized canine models with three sizes combined with a computer simulation model of a CT scanner. The eyes of the dog model received the greatest dose, 1.10 mGy/mGy, in the head scan, followed by a brain dose of 0.85 mGy/mGy. In the chest, abdomen-pelvis (AP), chest-abdomen-pelvis, and head-chest-abdomen-pelvis scans, the heart wall (0.93 mGy/mGy), ovaries (0.99 mGy/mGy), lungs (1.12 mGy/mGy), and thyroid (1.23 mGy/mGy) received the greatest organ doses, respectively. The smallest dog model received up to 1.4-fold greater organ doses than the largest dog in both the chest and AP scans. Overall, the medium-size canine model received organ doses comparable to those of the 1-year-old child model in the head scan, the 5-year-old child in chest scan, and the 10-year-old child in AP scan. The organ dose conversion factors derived from this study should help evaluate absorbed dose for canine patients undergoing CT exams.

Radiation protection perspective to recurrent medical imaging: what is known and what more is needed?

This review summarises the current knowledge about recurrent radiological imaging and associated cumulative doses to patients. The recent conservative estimates are for around 0.9 million patients globally who cumulate radiation doses above 100 mSv, where evidence exists for cancer risk elevation. Around one in five is estimated to be under the age of 50. Recurrent imaging is used for managing various health conditions and chronic diseases such as malignancies, trauma, end-stage kidney disease, cardiovascular diseases, Crohn's disease, urolithiasis, cystic pulmonary disease. More studies are needed from different parts of the world to understand the magnitude and appropriateness. The analysis identified areas of future work to improve radiation protection of individuals who are submitted to frequent imaging. These include access to dose saving imaging technologies; improved imaging strategies and appropriateness process; specific optimisation tailored to the clinical condition and patient habitus; wider utilisation of the automatic exposure monitoring systems with an integrated option for individual exposure tracking in standardised patient-specific risk metrics; improved training and communication. The integration of the clinical and exposure history data will support improved knowledge about radiation risks from low doses and individual radiosensitivity. The radiation protection framework will need to respond to the challenge of recurrent imaging and high individual doses. The radiation protection perspective complements the clinical perspective, and the risk to benefit analysis must account holistically for all incidental and long-term benefits and risks for patients, their clinical history and specific needs. This is a step toward the patient-centric health care.

Radiation Dose to the Fetus From Computed Tomography of Pregnant Patients-Development and Validation of a Web-Based Tool

OBJECTIVE

Estimations of radiation dose absorbed by the fetus from computed tomography (CT) in pregnant patients is mandatory, but currently available methods are not feasible in clinical routine. The aims of this study were to develop and validate a tool for assessment of fetal dose from CT of pregnant patients and to develop a user-friendly web interface for fast fetal dose calculations.

METHODS

In the first study part, 750 Monte Carlo (MC) simulations were performed on phantoms representing pregnant patients at various gestational stages. The MC code simulating vendor-independent dose distributions was validated against CT dose index (CTDI) measurements performed on CT scanners of 2 vendors. The volume CTDI-normalized fetal dose values from MC simulations were used for developing the computational algorithm enabling fetal dose assessments from CT of various body regions at different exposure settings. In the institutional review board-approved second part, the algorithm was validated against patient-specific MC simulations performed on CT data of 29 pregnant patients (gestational ages 8-35 weeks) who underwent CT. Furthermore, the tool was compared with a commercially available software. A user-friendly web-based interface for fetal dose calculations was created.

RESULTS

Weighted CTDI values obtained from MC simulations were in excellent agreement with measurements performed on the 2 CT systems (average error, 4%). The median fetal dose from abdominal CT in pregnant patients was 2.7 mGy, showing moderate correlation with maternal perimeter (r = 0.69). The algorithm provided accurate estimates of fetal doses (average error, 11%), being more accurate than the commercially available tool. The web-based interface (www.fetaldose.org) enabling vendor-independent calculations of fetal doses from CT requires the input of gestational age, volume CTDI, tube voltage, and scan region.

CONCLUSIONS

A tool for fetal dose assessments from CT of pregnant patients was developed and validated being freely available on a user-friendly web interface.

Patient-Informed Organ Dose Estimation in Clinical CT: Implementation and Effective Dose Assessment in 1048 Clinical Patients

OBJECTIVE. The purpose of this study is to comprehensively implement a patient-informed organ dose monitoring framework for clinical CT and compare the effective dose (ED) according to the patient-informed organ dose with ED according to the dose-length product (DLP) in 1048 patients. MATERIALS AND METHODS. Organ doses for a given examination are computed by matching the topogram to a computational phantom from a library of anthropomorphic phantoms and scaling the fixed tube current dose coefficients by the examination volume CT dose index (CTDIvol) and the tube-current modulation using a previously validated convolution-based technique. In this study, the library was expanded to 58 adult, 56 pediatric, five pregnant, and 12 International Commission on Radiological Protection (ICRP) reference models, and the technique was extended to include multiple protocols, a bias correction, and uncertainty estimates. The method was implemented in a clinical monitoring system to estimate organ dose and organ dose-based ED for 647 abdomen-pelvis and 401 chest examinations, which were compared with DLP-based ED using a t test. RESULTS. For the majority of the organs, the maximum errors in organ dose estimation were 18% and 8%, averaged across all protocols, without and with bias correction, respectively. For the patient examinations, DLP-based ED was significantly different from organ dose-based ED by as much as 190.9% and 234.7% for chest and abdomen-pelvis scans, respectively (mean, 9.0% and 24.3%). The differences were statistically significant (p < .001) and exhibited overestimation for larger-sized patients and underestimation for smaller-sized patients. CONCLUSION. A patient-informed organ dose estimation framework was comprehensively implemented applicable to clinical imaging of adult, pediatric, and pregnant patients. Compared with organ dose-based ED, DLP-based ED may overestimate effective dose for larger-sized patients and underestimate it for smaller-sized patients.

Evaluation of Organ Doses for Pediatric Computed Tomography Using a Newly Designed Radiophotoluminescence Glass Dosimeter and Comparison with a Monte Carlo Simulation-based Dose Calculator

ABSTRACT

Management of patient dose is an effective way to help optimize computed tomography (CT) scanning conditions and CT dose. Organ dose is one of the preferred quantities for radiation protection because of its correlation with radiation risk. To date, the WAZA-ARI dose calculator is the only freely available CT dose calculator also applicable for pediatric patients. However, no reports of its evaluation have appeared since the latest version of WAZA-ARI was released. In this study, to evaluate the latest version of WAZA-ARI, we measured the organ dose in a 5-y-old anthropomorphic phantom by a newly developed radiophotoluminescence glass dosimeter (RGD) dosimetry system and compared these results with the calculation results from WAZA-ARI. The newly designed RGDs have less angular dependence because of the additional filter. RGDs were individually calibrated with the ISOVOLT TITAN-320 x-ray generator. All the experimental measurements for this study were performed using a CT scanner. To consider the difference of CT output between the nominal and actual machine, the measured CTDIair was used to correct the calculation results obtained from WAZA-ARI. After the corrections using the measured CTDIair, the calculation results from WAZA-ARI were relatively lower than the measured results with a range of 8-20%, which corresponds to the dose difference caused by the difference in effective diameter. In conclusion, the calculation accuracy of WAZA-ARI is guaranteed when the normalization factor specific to each CT scanner (CTDIair) and the shape of the phantom are taken into consideration.

Challenges estimating patient organs doses undergoing enhanced chest CT examination: exploratory study

Purpose: Estimate organs doses (ODs) of patients subjected to unenhanced (S1) and enhanced (S2) chest CT studies relying on image parameters such as Hounsfield Units (HUs).Materials and Methods: CT scans and images of a total of 16 patients who underwent two series of chest CT studies were obtained and retrospectively examined. OD increments of liver and pancreas for both series (S1 & S2) were estimated using two different independent methods, namely simulation approach using CT-EXPO and Amato's phantom-based fitting model (APFM). HUs were quantified for each organ by manually drawing fixed area-sized regions of interest (ROIs). The mean HUs were collected to obtain the ODs increments following APFM. Regression analysis was applied to find and assess the relationship between the HUs and the OD increments estimated using APFM and that using CT-EXPO. Spearman Coefficient and Wilcoxon Matched Pairedt-testwere conducted to show statistical correlation and difference between ODs increments using the two methods.Results:A strong significant difference was depicted between S1 and S2 scan series of liver and pancreas using CT-EXPO simulation. Mean HU values for S1 were lower than S2, resulting in statistically significant (p < 0.0001) HU changes. CT-EXPO simulation yielded significantly higher difference in ODs compared to the APFM for liver (p = 0.0455) and pancreas (p = 0.0031). Regression analysis revealed a strong relationship between HU of S1 and S2 and ODs increments using APFM in both organs (R² = 0.99), dissimilar to CT-EXPO (R² = 0.39 in liver andR² = 0.05 in pancreas).Conclusions: Although CT-EXPO allows for estimating ODs accounting for major acquisition scan parameters, it is not a reliable tool to evaluate the impact of contrast enhancement on ODs. On the other hand, the APFM accounts for contrast enhancement accumulation yet only provides relative OD increments, an information of limited clinical use.

Patients undergoing multiphase CT scans and receiving a cumulative effective dose of ≥ 100 mSv in a single episode of care

OBJECTIVES

To estimate the number of patients who receive a cumulative effective dose (CED) of ≥ 100 mSv from computed tomography (CT) in a single day or episode of care.

METHODS

We examined 28,870 patients who underwent 49,834 CT examinations in a tertiary care centre in Italy in 2.5 years. Radiation exposures were retrieved from the hospital's automatic exposure monitoring system. Two cohorts were identified as those who received a CED of ≥ 100 mSv in a single day and within a month starting from the first examination. Organ doses were estimated for the first cohort.

RESULTS

Among the 1765 (6.1%) patients who received CED ≥ 100 mSv in the observation period, 427 received a CED of ≥ 100 mSv within a month (and 70 patients in a single day). This group represented 1.5% of all patients who underwent CT exams and 24% of those who received CED ≥ 100 mSv in the observation period. The clinical indication for referral included cancer in 132 patients (31%) and non-oncological indications in 295 patients (69%). In 68/70 patients with CED > 100 mSv in a single day, at least one organ/tissue received a dose of ≥ 100 mGy.

CONCLUSIONS

The finding of a sizeable percentage of patients undergoing CT exams and receiving CED ≥ 100 mSv in a single episode of care points toward the need of imaging appropriateness criteria, to revise the routine protocols, to replace older machines, and to provide to the radiologist the patient's prior radiation history to facilitate an appropriate decision-making process.

KEY POINTS

• Patients can receive effective doses greater than 100 mSv in a single CT or in multiple CT examinations performed in a single episode of care in 1.5% of patients in a 2.5-year period. • In this study, the clinical indication for CT referral was non-oncological in 69% of patients. • The patient's prior radiation history should be provided to the referring physicians and the radiological medical practitioner to facilitate an appropriate decision-making process.

Comparison of estimated and calculated fetal radiation dose for a pregnant woman who underwent computed tomography and conventional X-ray examinations based on a phantom study

This study aimed to determine the mean fetal doses for patients who underwent computed tomography (CT) and/or conventional X-ray (CXR) examinations. In addition to developing an approach to estimate the fetal dose based on data registered in the picture archive and communication system (PACS), the radiation doses for pregnant women and their fetuses were estimated using the VirtualDoseCT and VirtualDoseIR softwares. To verify the data, the fetal dose was measured using thermoluminescent dosimeters (TLDs) implanted at different uterus sites of an anthropomorphic pregnant phantom. Calculated fetal dose values were estimated in relation to the dose-area product (DAP) and volume CT dose index (CTDI_vol). DAP and CTDI_vol were obtained from data registered in the PACS. The fetal doses varied between < 0.001 and 3.9 mGy and between 0.26 and 16.21 mGy for the CXR and CT examinations, respectively. These values were similar to those of previous studies on both imaging modalities. The conversion factors obtained to calculate fetal doses for CXR examinations were between 0.01 and 0.73 mGy/Gy cm², whereas they varied between 0.02 and 0.61 mGy/mGy for CT examinations. Overall, the fetal dose conversion factors based on DAP and CTDI_vol values can be used for fast fetal dose estimations in common CXR and CT examinations.

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.

The uncertainty of thyroid dose estimate in chest CT

Dose to the thyroid from helical chest CT can vary significantly due to the random tube start point, pitch factor, thyroid position relative to the isocenter, and beam width. We used optically stimulated luminescence dosimeters (OSLDs) and an adult anthropomorphic phantom to investigate the uncertainty of thyroid dose estimate. Maximum gap or overlap in the helical beam was estimated using the above factors. Using the maximum gap/overlap over the thyroid, different possible scenarios were simulated and the degree of missed thyroid tissue by the primary beam was estimated. Results showed a variation of >30% in the average thyroid dose, and >50% if a single dosimeter was used to determine dose to the thyroid. Furthermore, measured doses were compared to those calculated by Monte Carlo simulation software, which automatically matches the anatomy of the localizer radiograph with the stylized computational phantom used for dose calculation. The difference was significant: the dose given by the Monte Carlo software was ∼50% lower than the average dose measured with the phantom in all three chest protocols. In addition, the software does not take the effect of the random tube start angle into account.

FDG PET/CT in a Pregnant Woman With Breast Cancer

This 37-year-old woman was diagnosed with breast cancer during pregnancy. After multidisciplinary meeting, she was referred to our department for an FDG PET/CT for staging, and chemotherapy with weekly infusion of paclitaxel was initiated before childbirth. We estimated the fetal dose from the PET/CT procedure, and our results show that, if deemed necessary, this examination can reasonably be performed during pregnancy. The patient gave birth vaginally at term to an apparently healthy girl.

Virtual clinical trials in medical imaging: a review

The accelerating complexity and variety of medical imaging devices and methods have outpaced the ability to evaluate and optimize their design and clinical use. This is a significant and increasing challenge for both scientific investigations and clinical applications. Evaluations would ideally be done using clinical imaging trials. These experiments, however, are often not practical due to ethical limitations, expense, time requirements, or lack of ground truth. Virtual clinical trials (VCTs) (also known as in silico imaging trials or virtual imaging trials) offer an alternative means to efficiently evaluate medical imaging technologies virtually. They do so by simulating the patients, imaging systems, and interpreters. The field of VCTs has been constantly advanced over the past decades in multiple areas. We summarize the major developments and current status of the field of VCTs in medical imaging. We review the core components of a VCT: computational phantoms, simulators of different imaging modalities, and interpretation models. We also highlight some of the applications of VCTs across various imaging modalities.

Potential biological damage of human peripheral blood lymphocytes induced by computed tomography examination of the oromaxillofacial region

OBJECTIVES

The aim of this study was to examine whether oromaxillofacial computed tomography (CT) examination causes biologic damage in lymphocytes and whether the biologic damage is related to radiation dose, patient age, or gender.

STUDY DESIGN

Peripheral blood was taken from 51 individuals and divided into control, in vivo, and in vitro irradiation groups. Biologic damage was assessed by comparing rates of chromosomal aberrations (CAs), including dicentric chromosomes (dics), centric rings, and acentric fragments; and nuclear aberrations, including micronuclei (MN), nuclear buds (NBUDs), and nucleoplasmic bridges (NPBs) in the peripheral blood before and after CT examination. Absorbed and effective doses were calculated with the software VirtualDose, and the blood dose was estimated accordingly.

RESULTS

The rates of acentric fragments, MN, NBUDs, and NPBs in the in vivo (P ≤ .008) and in vitro (P ≤ .003) irradiation groups were significantly higher than those in the control groups. The acentric fragment rate (P = .013) and MN rate (P = .002) were higher in the in vitro group than in the in vivo group. There was no correlation between change rates of CAs and nuclear aberrations with radiation dose. Positive correlations of MN rates with age were found in all groups (ρ ≥ 0.590).

CONCLUSIONS

Certain doses of radiation in oromaxillofacial CT examination may induce CAs and nuclear aberrations in lymphocytes.

Adult patient-specific CT organ dose estimations using automated segmentations and Monte Carlo simulations

We aimed to determine feasibility in calculating patient-specific organ doses for abdominal computed tomography (CT) exams using an automated segmentation technique dedicated to abdominal organs combined with Monte Carlo simulation of a clinical CT scanner. We conducted the automated segmentation of five major abdominal organs (left and right kidneys, pancreas, spleen, and liver) for ten adult patients and calculated organ-specific doses for each patient. We observed significant variability (Coefficient of Variation up to 32%) in organ mass across the ten patients, which was up to two-fold greater or smaller than the reference organ mass for the ICRP reference adult male and female. Comparison of patient-specific organ dose per CTDI_vol with those from the ICRP reference phantoms confirmed that reference phantom-based dose reporting programs cannot capture inter-patient dose variability, and dosimetric errors can go up to nearly 40%. We demonstrated an automated method for patient-specific organ dose calculations, which took about 45 min per patient. When the automatic segmentation method is extended to more organs and faster Monte Carlo calculation technique is employed, our method should be useful for patient-specific dose monitoring at the organ level and for epidemiological investigations of health risks in CT patients.

DNA double-strand breaks of human peripheral blood lymphocyte induced by CT examination of oral and maxillofacial region

OBJECTIVES

To explore whether a computed tomography (CT) examination of the head and neck region induces biological damage and whether the damage was correlated with the radiation dose.

MATERIALS AND METHODS

Peripheral blood was taken from 33 individuals who received head and neck CT examinations. Blood samples were divided into three groups: the control group and the in vivo and in vitro irradiation groups. The number of DNA double-strand breaks was estimated by comparing the changes in the rates of γ-H2AX foci formation in the peripheral blood before and after CT examination. The absorbed dose and effective dose were calculated with the software VirtualDose based on the Monte Carlo method, and the absorbed doses in blood were estimated accordingly.

RESULTS

The γ-H2AX foci rates were increased in the in vivo (p < 0.001) and in vitro irradiation groups (p < 0.001) after CT examination when compared with those in the control group. The rate of γ-H2AX foci formation showed linear dose-responses for the CT dose index volume (CTDI_vol), dose-length product (DLP), and blood dose after CT examination.

CONCLUSIONS

A CT examination of the head and neck region provides a high enough radiation dose to induce DNA double-strand breaks in cells in the peripheral blood. There was a linear correlation between the formation of DNA double-strand breaks and radiation doses after CT examination.

CLINICAL RELEVANCE

In addition to ensuring image quality, in a real clinical situation, the scanning area should be strictly administered, and repeated operations should be avoided to minimise the patient's radiation dose.