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Wollschläger D, Jahnen A, Hermen J, Giussani A, Stamm G, Borowski M, Huisinga C, Mentzel HJ, Braun J, Sigmund G, Wagner J, Adolph J, Gunschera J, Koerber F, Schiefer A, Müller B, Lenzen H, Doering T, Entz K, Kunze C, Starck P, Staatz G, Mildenberger P, Pokora R. Pediatric computed tomography doses in Germany from 2016 to 2018 based on large-scale data collection. Eur J Radiol 2023; 163:110832. [PMID: 37059005 DOI: 10.1016/j.ejrad.2023.110832] [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: 07/25/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE Accumulating evidence from epidemiological studies that pediatric computed tomography (CT) examinations can be associated with a small but non-zero excess risk for developing leukemia or brain tumor highlights the need to optimize doses of pediatric CT procedures. Mandatory dose reference levels (DRL) can support reduction of collective dose from CT imaging. Regular surveys of applied dose-related parameters are instrumental to decide when technological advances and optimized protocol design allow lower doses without sacrificing image quality. Our aim was to collect dosimetric data to support adapting current DRL to changing clinical practice. METHOD Dosimetric data and technical scan parameters from common pediatric CT examinations were retrospectively collected directly from Picture Archiving and Communication Systems (PACS), Dose Management Systems (DMS), and Radiological Information Systems (RIS). RESULTS We collected data from 17 institutions on 7746 CT series from the years 2016 to 2018 from examinations of the head, thorax, abdomen, cervical spine, temporal bone, paranasal sinuses and knee in patients below 18 years of age. Most of the age-stratified parameter distributions were lower than distributions from previously-analyzed data from before 2010. Most of the third quartiles were lower than German DRL at the time of the survey. CONCLUSIONS Directly interfacing PACS, DMS, and RIS installations allows large-scale data collection but relies on high data-quality at the documentation stage. Data should be validated by expert knowledge or guided questionnaires. Observed clinical practice in pediatric CT imaging suggests lowering some DRL in Germany is reasonable.
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Affiliation(s)
- Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology (LIST), Esch-sur-Alzette, Luxembourg
| | - Johannes Hermen
- Luxembourg Institute of Science and Technology (LIST), Esch-sur-Alzette, Luxembourg
| | | | - Georg Stamm
- Department of Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Markus Borowski
- Department of Radiology and Nuclear Medicine, Städtisches Klinikum Braunschweig, Braunschweig, Germany
| | - Carolin Huisinga
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Hans-Joachim Mentzel
- Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Jochen Braun
- Diagnosticum Neuburg MVZ, Neuburg an der Donau, Germany
| | | | - Joachim Wagner
- Institute for Radiology and Interventional Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Juergen Adolph
- Department of Radiology, Klinikum Worms gGmbH, Worms, Germany
| | - Jana Gunschera
- Department of Radiology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - Friederike Koerber
- Institute for Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Anna Schiefer
- Pediatric Radiology, Klinikum Nuremberg, Nuremberg, Germany
| | - Birgit Müller
- Institute of Medical Physics, Klinikum Nuremberg, Nuremberg, Germany
| | - Horst Lenzen
- Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | | | - Kathrin Entz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Kunze
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Peter Starck
- Institute for Diagnostic and Interventional Radiology, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Gundula Staatz
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology. University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter Mildenberger
- Department of Diagnostic and Interventional Radiology. University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roman Pokora
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Amalaraj T, Jeyasugiththan J, Satharasinghe D, Pallewatte AS. Dose reference level based on size-specific dose estimate (SSDE) and feasibility of deriving effective body diameter using tube current and time product (mAs) for adult chest and abdomen computed tomography (CT) procedures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:011505. [PMID: 36626827 DOI: 10.1088/1361-6498/acb1bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
This study aimed to establish dose reference level (NDRLSSDE) based on size-specific dose estimate (SSDE) derived using effective diameter (Deff) for adult chest and abdomen computed tomography (CT) procedures and to explore the feasibility of drivingDeffusing the product of tube current and time (mAs). In this retrospective study, dose data, scan parameters and patient body dimensions at the mid-slice level from 14 CT units (out of 63 total) were extracted. Additionally, the mAs values of the axial slice at the samez-location where the diameter measurements were made (mAsz) were recorded. Pearson's correlation (r) analysis was used to determine the relationship ofDeffwith patient BMI, weight, and mAsz. The NDRLSSDEfor the chest and abdomen were 9.72 mGy and 13.4 mGy, respectively. The BMI and body weight were less correlated (r= 0.24 andr= 0.33, respectively) withDeff. The correlation between mAszandDeffwas considerably strong (r= 0.78) and can be used to predictDeffaccurately. The absolute dose differences between SSDEs calculated using the AAPM-204 method and mAszwas less than 1.1 mGy (15%). Therefore, mAszis an efficient parameter to deriveDeff. Further, the direct conversion factors to estimate SSDEs at different locations along thez-direction in the scan region from corresponding mAs and CTDIvolwere calculated. The NDRLSSDEsuggested in the present study can be used as a reference for size-dependent dose optimisation in Sri Lanka, and existing NDRL based on CTDIvolunderestimate the average adult CT dose by 36.0% and 39.7% for chest and abdomen regions respectively. The results show that using mAszto determine SSDE is a simple and practical approach with an accuracy of 95% and 85% for abdomen and chest scans, respectively. However, the obtained linear relationship betweenDeffand mAs is highly dependent on the ATCM technique and the user-determined noise levels of the scanning protocol. Finally, the phantom study resulted in the strongest correlation (r= 0.99) between theDwzand mAsz, and the prediction of patient size would be more precise thanDeffmethod.
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Affiliation(s)
- T Amalaraj
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka
| | | | | | - A S Pallewatte
- Department of Radiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Patient size as a parameter for determining Diagnostic Reference Levels for paediatric Computed Tomography (CT) procedures. Phys Med 2022; 102:55-65. [PMID: 36126468 DOI: 10.1016/j.ejmp.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/28/2022] [Accepted: 09/12/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The paediatric radiation dose has never been studied in Sri Lanka, nor has a national diagnostic reference level (NDRL) established. Therefore, the primary aim of this study was to propose diagnostic reference levels (DRL) and achievable dose (AD) values for paediatric CT examinations based on size. METHODS A total of 658 paediatric (0-15 years) non-contrast-enhanced (NC) studies of head, chest and abdomen regions performed during six months in two dedicated paediatric hospitals (out of the three such institutions in the country) were included. For head examinations, the dose indexes were analysed based on age, while for body examinations, both age and effective diameter (Deff) were used. The median and the third quartile of the pooled dose distribution were given as AD and NDRL, respectively. RESULTS The AD ranges for the head, chest and abdomen regions based on CTDIvol were 45.8-57.2 mGy, 2.9-10.0 mGy and 3.8-10.3 mGy. The corresponding NDRL ranges were 45.8-95.8 mGy, 3.5-14.1 mGy and 4.5-11.9 mGy. The AD ranges based on SSDEdeff and deff were 3.5-9.6 mGy and 4.1-10.3 mGy in chest and abdomen regions. The corresponding NDRL were 4.5-14.1 mGy and 6.1-10.6 mGy. CONCLUSION Other institutions can use the present study DRLs as a reference dose for paediatric CT. The AD values can be used as a baseline for target dose optimisations, reducing doses up to 90%.
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Amalaraj T, Satharasinghe D, Pallewatte A, Jeyasugiththan J. Establishment of national diagnostic reference levels for computed tomography procedures in Sri Lanka: first nationwide dose survey. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021504. [PMID: 34875641 DOI: 10.1088/1361-6498/ac40e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/06/2021] [Indexed: 06/13/2023]
Abstract
The main purpose of this study was to establish for the first time national diagnostic reference levels (NDRLs) for common computed tomography (CT) procedures in Sri Lanka. Patient morphometric data, exposure parameters and dose data such as volume CT dose index (CTDIvol) and dose-length product (DLP) were collected from 5666 patients who underwent 22 types of procedure. The extreme dose values were filtered before analysis to ensure that the data come from standard size patients. The median of the dose distribution was calculated for each institution, and the third quartile value of the median distribution was considered as the NDRL. Based on the inclusion and exclusion criteria, data from 4592 patients and 17 procedure types were considered for establishment of a NDRL, covering 41% of the country's CT machines. The proposed NDRLs based on CTDIvoland DLP were: non-contrast-enhanced (NC) head, 82.2 mGy/1556 mGy cm; contrast-enhanced (CE) head, 82.2 mGy/1546 mGy cm; chest NC, 7.4 mGy/350 mGy cm; chest CE, 8.3 mGy/464 mGy cm; abdomen NC, 10.5 mGy/721 mGy cm; abdomen arterial (A) phase, 13.4 mGy/398 mGy cm; abdomen venous (V) phase, 10.8 mGy/460 mGy cm; abdomen delay (D) phase, 12.6 mGy/487 mGy cm; sinus NC, 30.2 mGy/452 mGy cm; lumbar spine NC, 24.1 mGy/1123 mGy cm; neck NC, 27.5 mGy/670 mGy cm; high-resolution CT of chest, 10.3 mGy/341 mGy cm; kidneys ureters and bladder NC, 19.4 mGy/929 mGy cm; chest to pelvis (CAP) NC, 10.8 mGy/801 mGy cm; CAP A, 10.4 mGy/384 mGy cm; CAP V, 10.5 mGy/534 mGy cm; CAP D, 16.8 mGy/652 mGy cm. Although the proposed NDRLs are comparable with those of other countries, the observed broad dose distributions between the CT machines within Sri Lanka indicate that dose optimisation strategies for the country should be implemented for most of the CT facilities.
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Affiliation(s)
- T Amalaraj
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka
| | | | - Aruna Pallewatte
- Department of Radiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Worrall M, Holubinka M, Havariyoun G, Hodgson K, Edyvean S, Holroyd J, Davis A, Dunn M, Gardiner A. Analysis and results from a UK national dose audit of paediatric CT examinations. Br J Radiol 2022; 95:20210796. [PMID: 34767475 PMCID: PMC8722233 DOI: 10.1259/bjr.20210796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To present the results following a UK national patient dose audit of paediatric CT examinations, to propose updated UK national diagnostic reference levels (DRLs) and to analyse current practice to see if any recommendations can be made to assist with optimisation. METHODS A UK national dose audit was undertaken in 2019 focussing on paediatric CT examinations of the head, chest, abdomen/pelvis and cervical spine using the methods proposed by the International Commission on Radiological Protection. The audit pro-forma contained mandatory fields, of which the post-examination dosimetry (volume CT dose index and dose-length product) and the patient weight (for body examinations) were the most important. RESULTS Analysis of the data submitted indicates that it is appropriate to propose national DRLs for CT head examinations in the 0-<1, 1-<5, 5-<10 and 10-<15 year age ranges. This extends the number of age categories of national DRLs from those at present and revises the existing values downwards. For CT chest examinations, it is appropriate to propose national DRLs for the first time in the UK for the 5-<15, 15-<30, 30-<50 and 50-<80 kg weight ranges. There were insufficient data received to propose national DRLs for abdomen/pelvis or cervical spine examinations. Recommendations towards optimisation focus on the use of tube current (mA) modulation, iterative reconstruction and the selection of examination tube voltage (kVp). CONCLUSION Updated UK national DRLs are proposed for paediatric CT examinations of the head and chest. ADVANCES IN KNOWLEDGE A national patient dose audit of paediatric CT examinations has led to the proposal of updated national DRLs.
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Affiliation(s)
| | - Mike Holubinka
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | | | - Kirsten Hodgson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Sue Edyvean
- Public Health England, London, United Kingdom
| | | | - Anne Davis
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Matthew Dunn
- Nottingham University Hospitals NHS Trust, London, United Kingdom
| | - Anna Gardiner
- Cambridge University Hospitals NHS Foundation Trust, England, United Kingdom
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Bos D, Zensen S, Opitz MK, Haubold J, Nassenstein K, Kinner S, Schweiger B, Forsting M, Wetter A, Guberina N. Diagnostic reference levels for chest computed tomography in children as a function of patient size. Pediatr Radiol 2022; 52:1446-1455. [PMID: 35378606 PMCID: PMC9271112 DOI: 10.1007/s00247-022-05340-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Radiation exposures from computed tomography (CT) in children are inadequately studied. Diagnostic reference levels (DRLs) can help optimise radiation doses. OBJECTIVE To determine local DRLs for paediatric chest CT performed mainly on modern dual-source, multi-slice CT scanners as a function of patient size. MATERIALS AND METHODS Five hundred thirty-eight chest CT scans in 345 children under 15 years (y) of age (median age: 8 y, interquartile range [IQR]: 4-13 y) performed on four different CT scanners (38% on third-generation and 43% on second-generation dual-source CT) between November 2013 and December 2020 were retrospectively analysed. Examinations were grouped by water-equivalent diameter as a measure of patient size. DRLs for volume CT dose index (CTDIvol) and dose-length product (DLP) were determined for six different patient sizes and compared to national and European DRLs. RESULTS The DRLs for CTDIvol and DLP are determined for each patient size group as a function of water-equivalent diameter as follows: (I) < 13 cm (n = 22; median: age 7 months): 0.4 mGy, 7 mGy·cm; (II) 13 cm to less than 17 cm (n = 151; median: age 3 y): 1.2 mGy, 25 mGy·cm; (III) 17 cm to less than 21 cm (n = 211; median: age 8 y): 1.7 mGy, 44 mGy·cm; (IV) 21 cm to less than 25 cm (n = 97; median: age 14 y): 3.0 mGy, 88 mGy·cm; (V) 25 cm to less than 29 cm (n = 42; median: age 14 y): 4.5 mGy, 135 mGy·cm; (VI) ≥ 29 cm (n = 15; median: age 14 y): 8.0 mGy, 241 mGy·cm. Compared with corresponding age and weight groups, our size-based DRLs for DLP are 54% to 71% lower than national and 23% to 85% lower than European DRLs. CONCLUSION We developed DRLs for paediatric chest CT as a function of patient size with substantially lower values than national and European DRLs. Precise knowledge of size-based DRLs may assist other institutions in further dose optimisation in children.
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Affiliation(s)
- Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Marcel K Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Kai Nassenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Sonja Kinner
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Bernd Schweiger
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
- Department of Diagnostic and Interventional Radiology, Neuroradiology, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Germany
| | - Nika Guberina
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
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Alzimami K, Sulieman A, Omer H, Jambi LK, Alfuraih A, Al Hossain N, Babikir E, Alkhorayef M, Khandaker MU, Bradley D. Evaluation of pediatric radiation doses in computed tomography procedures in the Kingdom of Saudi Arabia. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hawarihewa PM, Satharasinghe D, Amalaraj T, Jeyasugiththan J. An assessment of Sri Lankan radiographer's knowledge and awareness of radiation protection and imaging parameters related to patient dose and image quality in computed tomography (CT). Radiography (Lond) 2021; 28:378-386. [PMID: 34728139 DOI: 10.1016/j.radi.2021.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION As computed tomography (CT) examinations have considerably risen, safe operation is essential to reduce the patients' dose. The main objective of this study was to evaluate the level of knowledge and awareness regarding the CT exposure parameters and radiation protection in CT imaging among Sri Lankan radiographers. METHODS An online survey-based study was devised and distributed among the Sri Lankan CT radiographers working in 63 CT units. Questions were divided into three subsections that collected data on the participants' demographic features, knowledge of the radiation protection, and imaging parameters. RESULTS Eighty-eight radiographers from 32 CT units (out of 63 CT units) distributed across 11 districts (out of 27 districts) participated in this survey.The percentages of correct responses for the questions related to radiation protection, imaging parameters, noise, Diagnostic Reference Level (DRL), and CT dosimetric parameters were 71%, 79%, 87%, 50%, and 66%, respectively. Although the years of experience did not influence any of above aspects, the level of education significantly impacted the knowledge about radiation protection, exposure parameters, and noise. CONCLUSION The radiographer's knowledge of radiation protection and most imaging parameters associated with patient safety and image quality is satisfactory. However, findings also show that participants should fill the knowledge gap in radiation-related risks, CT exposure parameters, dosimetric parameters, and DRL. IMPLICATIONS FOR PRACTICE The study suggests the necessity of initiating continuous education programs for radiographers in line with national radiation protection legislation requirements that can be linked with code of practice.
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Affiliation(s)
- P M Hawarihewa
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka
| | - D Satharasinghe
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka
| | - T Amalaraj
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka
| | - J Jeyasugiththan
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka.
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