Evaluation of the reduction of radiation dose received by pediatric patients in new-generation biplane angiocardiography: Randomized controlled study

Objective

We aimed to evaluate the safety and efficacy of radiation dose reduction with a new-generation biplane angiocardiography system in patients undergoing transcatheter isolated patent ductus arteriosus (PDA) closure.

Materials and methods

Fifty pediatric patients who underwent transcatheter PDA closure were randomly divided into two groups as normal radiation dose and low dose. Patients who required additional procedures other than PDA closure were excluded. PDA closure was performed according to the angiographic measurement of the defect. After the procedure, age, weight, sex, PDA measurements, and radiation measurements such as dose-area product (DAP, Gy.cm2) and air kerma (AK, mGy) were compared between the groups.

Results

There was no statistically significant difference between the groups in age, sex, weight, PDA diameter, PDA type, device used, and device diameter (p > 0.05). While there was no statistically significant difference between the groups in terms of cine recording, number of recorded images, and fluoroscopy time (p > 0.05), there was a statistically significant difference between the total DAP, cine and fluoroscopy DAP, total AK, frontal and lateral tube AK, and DAP/kg (mGy.m2/kg) measurements (p < 0.05).

Conclusion

Transcatheter PDA closure with a low radiation dose is as effective as that with a normal radiation dose. The radiation dose received by the patient during the procedure was significantly reduced. With the vision provided by this study, it seems possible to work with a low radiation dose in other groups of patients.

Accurate gamma-ray dose measurement up to 10 MeV by glass dosimeter with a sensitivity control filter for BNCT

Glass dosimeters are very useful and convenient detection elements in radiation dosimetry. In this study, this glass dosimeter was applied to a BNCT treatment field. Boron Neutron Capture Therapy (BNCT) is a next-generation radiation therapy that can selectively kill only cancer cells. In the BNCT treatment field, both neutrons and secondary gamma-rays are generated. In other words, it is a mixed radiation field of neutrons and gamma-rays. We thus proposed a novel method to measure only gamma-ray dose in the mixed field using two RPLGD (Radiophoto-luminescence Glass Dosimeter) and two sensitivity control filters in order to control the dose response of the filtered RPLGD to be proportional to the air kerma coefficients, even if the gamma-ray energy spectrum is unknown. As the filter material iron was selected, and it was finally confirmed that reproduction of the air kerma coefficients was excellent within an error of 5.3% in the entire energy range up to 10 MeV. In order to validate this method, irradiation experiments were carried out using standard gamma-ray sources. As the result, the measured doses were in acceptably good agreement with the theoretical calculation results by PHITS. In the irradiation experiment with a volume source in a nuclear fuel storage room, the measured dose rates showed larger compared with survey meter values. In conclusion, the results of the standard sources showed the feasibility of this method, however for the volume source the dependence of the gamma-ray incident angle on the dosimeter was found to be not neglected. In the next step, it will be necessary to design a thinner filter in order to suppress the effect of the incident angle.

Air kerma rate from radionuclides distributed in forest ecosystem

This study evaluates the air kerma rate in radioactively contaminated forests. The air kerma rates created by plane sources of monoenergetic photons in the energy range 0.02-3 MeV located at different depths in soil up to 50 g cm-2 and at different heights in the forest medium from 0.05 to 50 m were calculated using numeric solution of the transport (Boltzmann) equation. To simplify the practical use of the results obtained by solving the Boltzmann equation, the study additionally includes approximation formulae for calculating air kerma rate separately from contaminated soil, crowns and trunks of trees in a forest ecosystem for 20 radionuclides - fission products that significantly contribute to the external dose. Biomaterial of trunks and crowns was modeled as uniformly distributed in corresponding layers and homogeneously mixed with air. Different distributions of radionuclides in soil were considered including plane source located at different depths, exponential and uniform distribution. Based on the results, the effect of forest biomass presence as an absorbing and scattering medium on the air kerma rate at 1 m above soil was evaluated. The estimated relative difference in air kerma rate at 1 m above soil in the forest medium and in free air for monoenergetic photon sources with energies 0.1 MeV, 0.66 MeV and 3 MeV did not correlate significantly with the energy of photons. Its maximum value in forest medium with biomass density of 5 kg m-3 was 15-20% for the source at soil depth ∼0.3 g cm-2, decreasing to less than 5% when it is at soil depth greater than 7 g cm-2. An example calculation of the air kerma rate dynamics is presented for the initial period after radioactive fallout considering weathering processes (rainfall and wind action) that contribute to the transfer of activity from the canopies to the forest floor. The differences in air kerma rate values, as an integral characteristic of the gamma radiation field from a radioactive cloud in the forest and in the open area, were evaluated.

Radiation dose during interventional cardiology procedures: portable C-arm vs. a new generation fluoroscopy system

INTRODUCTION

Occupational exposure to ionizing radiation poses health risks for veterinary interventionalists. There are limited veterinary studies evaluating radiation dose in the cardiac catheterization laboratory. The purpose of this study was to report direct radiation dose exposure to patients during common interventional cardiology procedures and compare these doses between two fluoroscopy units.

ANIMALS

One hundred and fifty-four client-owned dogs.

MATERIALS AND METHODS

Patient dose during procedures using a portable C-arm were retrospectively analyzed and compared to those performed in a contemporary interventional suite. Fluoroscopy equipment, procedure type, operator, patient weight, fluoroscopy time, dose area product, and air kerma were recorded and statistically modeled using univariable and multivariable linear regression to evaluate the effect of each factor.

RESULTS

Patient dose population (154 dogs), comprised 61 patent ductus arteriosus occlusions, 60 balloon pulmonary valvuloplasties, and 33 pacemaker implantations. Patient dose was significantly lower in the group utilizing a newer generation fluoroscopy unit vs. the group utilizing an older portable C-arm, positively correlated with patient weight, and highest during balloon pulmonary valvuloplasties compared to patent ductus arteriosus occlusions or pacemaker implantations (all p<0.010).

DISCUSSION

Newer fluoroscopy systems can be equipped with technologies that improve image quality while reducing patient dose and radiation exposure to interventional personnel.

CONCLUSIONS

We documented a significant reduction in patient radiation dose using a newer fluoroscopy system as compared to an older portable C-arm for interventional cardiology procedures in animals. Improved knowledge of patient radiation dose factors may promote better radiation safety protocols in veterinary interventional cardiology.

Dose calibration of Health Canada's Fixed Point Surveillance system for environmental radiation monitoring in terms of air kerma and H*(10)

The environmental radiation exposure in Canada has been monitored since 2002 by Health Canada's Fixed Point Surveillance network. The network consists of over eighty 7.6 cm × 7.6 cm sodium iodide spectrometers, and routinely reports to the public the environmental gamma radiation level throughout Canada. This paper describes the latest dose calibrations to air kerma and ambient dose equivalent for the future upgraded network. The calibration curves were developed using Monte Carlo techniques and further optimized via experiments in various reference fields. The dose calibration was validated over a wide range of gamma energy, dose measurement range, and angle of incidence under laboratory conditions. In environmental monitoring situations, the angular distribution of radiation exposure was analytically calculated by assuming a semi-infinite plume source, semi-infinite planar source, and infinite volume sources for the respective exposure scenarios of radioactive plume, ground contamination, and soil source. By coupling the resultant radiation angular distribution with detector's angular variation on dose response, the overall accuracy of dose measurement in each of these environmental scenarios was estimated. The accuracy is expected to be within ±3.7% for plume radiation, -5.6% for ¹³⁷Cs ground contamination, and 0% to -17.1% for soil radioactive sources. The under-estimation for soil sources is mainly caused by absorption of radiation in the electronic system underneath the crystal.

Doses and spectra, of leaking-out and scattered photons from X-ray tubes used in dentistry

Diagnosis by X-ray image are procedures widely used to improve the diagnosis or to follow the evolution of a medical procedure, also are used to support the cancer treatment with linear accelerators. The procedure involves the X-ray unit and the detection system, while the X-ray beam is projected onto the patient; along this procedure X-rays are scattered out from the patient body and X-rays leak-out from the X-ray unit. Both, the scattered and the leaking out radiation, are important during the evaluation or the design of the shielding barriers. X-ray tube features like voltage, electric current, target and filter are related to the dose due to the scattered and leakage radiation. Also, the dose due to the scattered radiation depends upon the scattering angle; while the dose due to the leaking out radiation, depend upon the X-ray tube housing. The objective of this work was to estimate, using Monte Carlo methods, the X-ray spectra and doses (air Kerma and Ambient dose equivalent) produced by scattered and leaking out radiation of 70, 80 and 90 kV X-ray units.

Practical dosimetry procedure of air kerma for kilovoltage X-ray imaging in radiation oncology using a 0.6-cc cylindrical ionization chamber with a cobalt absorbed dose-to-water calibration coefficient

In this study, we implemented a practical dosimetry procedure of air kerma for kilovoltage X-ray beams using a 0.6-cc cylindrical ionization chamber, and validated the procedure with the accuracy of the measurements using the 0.6-cc chamber compared to the measurements using a 6-cc chamber and a semiconductor device. In addition, the kerma area products (KAPs) were compared with the dose reference levels of radiology. A modified air kerma formalism using a 0.6-cc cylindrical ionization chamber air kerma formalism with a cobalt absorbed dose-to-water calibration coefficient was implemented. Validation of the formalism showed good agreement between the 0.6-cc chamber and the 6-cc chamber (< 5%), and between the 0.6-cc chamber and the semiconductor device (< 2%) in the 60-120 kV range. The KAPs for four RO machines had difference factors of 0.04-15.4 and 0.01-4.1 from their median and maximum dose reference levels in radiology, respectively.

Influence of distant scatterer on air kerma measurement in the evaluation of diagnostic X-rays using Monte Carlo simulation

The evaluation of the entrance surface dose (ESD) ensures safe radiation doses for X-ray imaging patients. The air kerma free-in-air value used to estimate ESD may be affected by those X-rays that scatter from the scatterer placed behind the chamber at the time of measurement, thereby leading to assessment errors. Therefore, the influence of scattered radiation on air kerma measurements was investigated. Monte Carlo simulations were performed for various detector-to-scatterer distances and scatterer materials. The simulation results were compared with actual measurements to confirm the simulation accuracy. The source-chamber distance was set to 50 and 100 cm for the experimental measurements and simulation, respectively, and the chamber-scatterer distance was varied. The Monte Carlo simulation results reproduced the actual measurements with an accuracy of 3.5%. The effect of backscattering varied with the tube voltage and irradiation field size. The effect was observed in the order of prominence for the following scatterer materials: water-equivalent phantom, acrylic, concrete, lead, and iron. Furthermore, this effect decreased exponentially with increasing chamber-scatterer distance. For a field size of 10 × 10 cm², the finite-distance backscatter factor decreased with an increasing chamber-scatterer distance for all materials. The cause of backscattering in diagnostic X-ray energy regions differs depending on the scatterer material, as well as the photon energy and field size. Backscattering decreases exponentially as the distance between the detector and scatterer increases.

The empirical formula for calculating the incident air Kerma in intraoral radiographic imaging

OBJECTIVES

The aim of this paper is to determine the empirical formula for calculating the incident air kerma (Ki), used as a patient dose descriptor in the intraoral radiographic imaging.

METHODS

The data for the formula were collected during the regular annual inspection of intraoral dental X-ray units in 2018, 2019 and early 2020. The measurement data of 50 X-ray units were processed to develop the formula. Exposure factors for imaging molars of the upper jaw of an average patient in a clinical setting were used in the measurement. The formula validity was statistically evaluated using coefficient of correlation, standard error of the fitted function and the mean relative percentage deviation.

RESULTS

The measurement values of the radiation doses and calculated values obtained by using the final formula showed good agreement - the mean relative percentage deviation values less than ±15%.

CONCLUSIONS

Although there are differences in X-ray units, voltages, manufacturers and device architectures (single-phase and high-frequency), the measurement data comply well with computed ones in all cases.

Perioperative Measurement of Radiation Exposure to Radiation-Sensitive Organs of Patients Undergoing Lumbar Surgeries Using a Thermoluminescent Dosimeter

OBJECTIVE

To introduce a method of accurately measuring the equivalent dose received by radiation-sensitive organs using the thermoluminescent dosimeter (TLD) and to provide reference values for future studies associated with radiation protection in patients undergoing lumbar spine surgeries.

METHODS

After careful selection and preparation, TLD chips were used to obtain measurements from the eyes, thyroid glands, breasts, and gonads of 20 patients undergoing lumbar spine surgeries. The results were obtained via air kerma conversion-related calculations.

RESULTS

The overall radiation exposures absorbed perioperatively by the eyes, thyroid glands, right breasts, left breasts, right ovaries, left ovaries, and testes were 0.41 ± 0.13, 1.43 ± 0.45, 6.95 ± 3.63, 9.50 ± 6.14, 29.86 ± 28.62, 23.47 ± 22.10, and 5.41 ± 1.86 mSv, respectively. A single computed tomography (CT) scan contributed to more than 75% of the overall dose received regardless of the position used.

CONCLUSIONS

Patients received significantly higher radiation doses from CT scans than from regular digital radiograph examinations. These radiation doses were concentrated in the regional area of scanning. Our results indicate the necessity and benefits of radiation protection measures, especially for the organs researched herein, when patients undergoing lumbar surgeries require radiographic diagnostic examinations.

Reference natural radionuclide concentrations in Australian soils and derived terrestrial air kerma rate

Sediment from drainage catchment outlets has been shown to be a useful means of sampling large land masses for soil composition. Naturally occurring radioactive material concentrations (uranium, thorium and potassium-40) in soil have been collated and converted to activity concentrations using data collected from the National Geochemistry Survey of Australia. Average terrestrial air kerma rate data are derived using the elemental concentration data, and is tabulated for Australia and states for use as baseline reference information.

Determination of the conventional true value of gamma-ray air kerma in a minitype reference radiation

To develop mobile calibration equipment for gamma-ray dose or dose rate meters in the field of radiation protection, a minitype reference radiation (MRR) of 0.5m×0.5m×0.5m cube was set up and used for investigation. Two types, which add up to 12 daily used gamma-ray dose rate meters, were used as samples to determine the conventional true value of air kerma (CAK) at the point of test in the MRR. A gamma-ray spectrometer was also used to monitor the scattering gamma rays in the MRR, which were applied further to characterize the disturbance of scattering gamma ray in CAK determination. On the basis of the sample data sets of CAKs, scattering gamma spectra and air kerma values at the point of test without sample meters, a CAK prediction model at the point of test was developed by the least square support vector machine, which is a multiple nonlinear regression method. For reducing the amount of data and improving the regression efficiency, principal component analysis (PCA) was used to extract feature components from the scattering gamma-ray spectra before regression. A relative standard uncertainty of 4.65% was achieved in determining CAK in the MRR using the constructed prediction model.

Practical method for determination of air kerma by use of an ionization chamber toward construction of a secondary X-ray field to be used in clinical examination rooms

We propose a new practical method for the construction of an accurate secondary X-ray field using medical diagnostic X-ray equipment. For accurate measurement of the air kerma of an X-ray field, it is important to reduce and evaluate the contamination rate of scattered X-rays. To determine the rate quantitatively, we performed the following studies. First, we developed a shield box in which an ionization chamber could be set at an inner of the box to prevent detection of the X-rays scattered from the air. In addition, we made collimator plates which were placed near the X-ray source for estimation of the contamination rate by scattered X-rays from the movable diaphragm which is a component of the X-ray equipment. Then, we measured the exposure dose while changing the collimator plates, which had diameters of 25-90 mm(ϕ). The ideal value of the exposure dose was derived mathematically by extrapolation to 0 mm(ϕ). Tube voltages ranged from 40 to 130 kV. Under these irradiation conditions, we analyzed the contamination rate by the scattered X-rays. We found that the contamination rates were less than 1.7 and 2.3 %, caused by air and the movable diaphragm, respectively. The extrapolated value of the exposure dose has been determined to have an uncertainty of 0.7 %. The ionization chamber used in this study was calibrated with an accuracy of 5 %. Using this kind of ionization chamber, we can construct a secondary X-ray field with an uncertainty of 5 %.

Terrestrial gamma radiation baseline mapping using ultra low density sampling methods

Baseline terrestrial gamma radiation maps are indispensable for providing basic reference information that may be used in assessing the impact of a radiation related incident, performing epidemiological studies, remediating land contaminated with radioactive materials, assessment of land use applications and resource prospectivity. For a large land mass, such as Queensland, Australia (over 1.7 million km(2)), it is prohibitively expensive and practically difficult to undertake detailed in-situ radiometric surveys of this scale. It is proposed that an existing, ultra-low density sampling program already undertaken for the purpose of a nationwide soil survey project be utilised to develop a baseline terrestrial gamma radiation map. Geoelement data derived from the National Geochemistry Survey of Australia (NGSA) was used to construct a baseline terrestrial gamma air kerma rate map, delineated by major drainage catchments, for Queensland. Three drainage catchments (sampled at the catchment outlet) spanning low, medium and high radioelement concentrations were selected for validation of the methodology using radiometric techniques including in-situ measurements and soil sampling for high resolution gamma spectrometry, and comparative non-radiometric analysis. A Queensland mean terrestrial air kerma rate, as calculated from the NGSA outlet sediment uranium, thorium and potassium concentrations, of 49 ± 69 nGy h(-1) (n = 311, 3σ 99% confidence level) is proposed as being suitable for use as a generic terrestrial air kerma rate background range. Validation results indicate that catchment outlet measurements are representative of the range of results obtained across the catchment and that the NGSA geoelement data is suitable for calculation and mapping of terrestrial air kerma rate.