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Candela-Juan C, Ciraj-Bjelac O, Sans Merce M, Dabin J, Faj D, Gallagher A, de Las Heras Gala H, Knežević Ž, Malchair F, De Monte F, Simantirakis G, Theodorakou C. Use of out-of-field contact shielding on patients in medical imaging: A review of current guidelines, recommendations and legislative documents. Phys Med 2021; 86:44-56. [PMID: 34052671 DOI: 10.1016/j.ejmp.2021.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022] Open
Abstract
The use of patient contact-shielding has become a topic of intensive scientific debate. While it has been common practice during the last decades, some studies have questioned the efficiency of using such shielding while others have highlighted the inconsistencies in its application. The objective of this work is to review current recommendations and legislative documents on the use of out-of-field shielding in X-ray imaging, including those from national authorities and from international and national organisations and professional bodies. The review, performed within the framework of the activities of EURADOS Working Group 12, covers available recommendations on use of contact shielding in adult, pregnant and paediatric patients in general radiography, fluoroscopy, computed tomography, mammography and dental radiology. It includes a comprehensive search of 83 documents from 32 countries and 6 international organisations over the last 39 years. In general, using shielding is recommended only under two conditions: if it does not compromise the diagnostic task and the performance of the procedure and/or if it reassures the patient and comforters that they are appropriately protected against potentially harmful effects of radiation. There are very few specific regulatory requirements to use shielding in a particular imaging modality, although they may consider use of shielding either as part of good radiological practice or as requirements for availability of protective or ancillary tools, without further specification of their use. There is a wide variety of positions among documents that recommend out-of-field shielding, those that do not recommend it and those that are not specific. Therefore, evidence-based consensus is still needed to ensure best and consistent practice.
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Affiliation(s)
- Cristian Candela-Juan
- Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain.
| | | | - Marta Sans Merce
- University Hospital of Geneva, Geneva, Switzerland; University Hospital of Lausanne, Lausanne, Switzerland
| | - Jérémie Dabin
- Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Dario Faj
- Medical Faculty of Osijek, University of Osijek, Croatia; Faculty of Dental Medicine and Health, University of Osijek, Croatia
| | - Aoife Gallagher
- Medical Physics Department, University Hospital Limerick, Ireland
| | | | - Željka Knežević
- Radiation Chemistry and Dosimetry Laboratory, Ruđer Bošković Institute, Zagreb, Croatia
| | | | - Francesca De Monte
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - George Simantirakis
- Licensing and Inspections Department, Greek Atomic Energy Commission, Ag. Paraskevi, Greece
| | - Chrysoula Theodorakou
- Christie Medical Physics and Engineering, The Christie NHS Foundation, Manchester, UK
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Peet SC, Kairn T, Lancaster CM, Trapp JV, Sylvander SR, Crowe SB. Measuring foetal dose from tomotherapy treatments. Med Dosim 2021; 46:342-346. [PMID: 33934977 DOI: 10.1016/j.meddos.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/26/2021] [Accepted: 03/20/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Treating pregnant women in the radiotherapy clinic is a rare occurrence. When it does occur, it is vital that the dose received by the developing embryo or foetus is understood as fully as possible. This study presents the first investigation of foetal doses delivered during helical tomotherapy treatments. Six treatment plans were delivered to an anthropomorphic phantom using a tomotherapy machine. These included treatments of the brain, unilateral and bilateral head-and-neck, chest wall, and upper lung. Measurements of foetal dose were made with an ionisation chamber positioned at various locations longitudinally within the phantom to simulate a variety of patient anatomies. All measurements were below the established limit of 100 mGy for a high risk of damage during the first trimester. The largest dose encountered was 75 mGy (0.125% of prescription dose). The majority of treatments with measurement positions less than 30 cm fell into the range of uncertain risk (50 - 100 mGy). All treatments with measurement positions beyond 30 cm fell into the low risk category (< 50 mGy). For the cases in this study, tomotherapy resulted in foetal doses that are at least on par with, if not significantly lower than, similar 3D conformal or intensity-modulated treatments delivered with other devices. Recommendations were also provided for estimating foetal doses from tomotherapy plans.
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Affiliation(s)
- Samuel C Peet
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia; School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland 4001, Australia.
| | - Tanya Kairn
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia; School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland 4001, Australia
| | - Craig M Lancaster
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia
| | - Jamie V Trapp
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland 4001, Australia
| | - Steven R Sylvander
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia
| | - Scott B Crowe
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia; School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland 4001, Australia
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Hauri P, Schneider U. Whole-body dose and energy measurements in radiotherapy by a combination of LiF:Mg,Cu,P and LiF:Mg,Ti. Z Med Phys 2017; 28:96-109. [PMID: 28807441 DOI: 10.1016/j.zemedi.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/07/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Long-term survivors of cancer who were treated with radiotherapy are at risk of a radiation-induced tumor. Hence, it is important to model the out-of-field dose resulting from a cancer treatment. These models have to be verified with measurements, due to the small size, the high sensitivity to ionizing radiation and the tissue-equivalent composition, LiF thermoluminescence dosimeters (TLD) are well-suited for out-of-field dose measurements. However, the photon energy variation of the stray dose leads to systematic dose errors caused by the variation in response with radiation energy of the TLDs. We present a dosimeter which automatically corrects for the energy variation of the measured photons by combining LiF:Mg,Ti (TLD100) and LiF:Mg,Cu,P (TLD100H) chips. METHODS The response with radiation energy of TLD100 and TLD100H compared to 60Co was taken from the literature. For the measurement, a TLD100H was placed on top of a TLD100 chip. The dose ratio between the TLD100 and TLD100H, combined with the ratio of the response curves was used to determine the mean energy. With the energy, the individual correction factors for TLD100 and TLD100H could be found. The accuracy in determining the in- and out-of-field dose for a nominal beam energy of 6MV using the double-TLD unit was evaluated by an end-to-end measurement. Furthermore, published Monte Carlo (M.C.) simulations of the mean photon energy for brachytherapy sources, stray radiation of a treatment machine and cone beam CT (CBCT) were compared to the measured mean energies. Finally, the photon energy distribution in an Alderson phantom was measured for different treatment techniques applied with a linear accelerator. Additionally, a treatment plan was measured with a cobalt machine combined with an MRI. RESULTS For external radiotherapy, the presented double-TLD unit showed a relative type A uncertainty in doses of -1%±2% at the two standard deviation level compared to an ionization chamber. The type A uncertainty in dose was in agreement with the theoretically calculated type B uncertainty. The measured energies for brachytherapy sources, stray radiation of a treatment machine and CBCT imaging were in agreement with M.C. simulations. A shift in energy with increasing distance to the isocenter was noticed for the various treatment plans measured with the Alderson phantom. The calculated type B uncertainties in energy were in line with the experimentally evaluated type A uncertainties. CONCLUSION The double-TLD unit is able to predict the photon energy of scatter radiation in external radiotherapy, X-ray imagine and brachytherapy sources. For external radiotherapy, the individual energy correction factors enabled a more accurate dose determination compared to conventional TLD measurements.
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Affiliation(s)
- Pascal Hauri
- Department of Physics, University of Zurich, Zurich, Switzerland; Radiotherapy Hirslanden, Hirslanden Medical Center, Aarau, Switzerland.
| | - Uwe Schneider
- Department of Physics, University of Zurich, Zurich, Switzerland; Radiotherapy Hirslanden, Hirslanden Medical Center, Aarau, Switzerland
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Lonski P, Ramachandran P, Franich R, Kron T. Surface dose measurements in and out of field: Implications for breast radiotherapy with megavoltage photon beams. Z Med Phys 2017; 27:318-23. [PMID: 28595775 DOI: 10.1016/j.zemedi.2017.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/30/2017] [Accepted: 05/15/2017] [Indexed: 11/22/2022]
Abstract
This study examines the difference in surface dose between flat and flattening filter free (FFF) photon beams in the context of breast radiotherapy. The surface dose was measured for 6MV, 6MV FFF, 10MV, 10MV FFF and 18MV photon beams using a thin window ionisation chamber for various field sizes. Profiles were acquired to ascertain the change in surface dose off-axis. Out-of-field measurements were included in a clinically representative half beam block tangential breast field. In the field centres of FFF beams the surface dose was found to be increased for small fields and decreased for large fields compared to flat beams. For FFF beams, surface dose was found to decrease off-axis and resulted in lower surface dose out-of-field compared to flat beams.
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Michot JM, Mazeron R, Dercle L, Ammari S, Canova C, Marabelle A, Rose S, Rubin E, Deutsch E, Soria JC, Ribrag V, Levy A. Abscopal effect in a Hodgkin lymphoma patient treated by an anti-programmed death 1 antibody. Eur J Cancer 2016; 66:91-4. [PMID: 27544928 DOI: 10.1016/j.ejca.2016.06.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/17/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Jean-Marie Michot
- Drug Development Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Renaud Mazeron
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Laurent Dercle
- Department of Nuclear Medicine, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Samy Ammari
- Drug Development Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Charles Canova
- Drug Development Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France; Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Aurelien Marabelle
- Drug Development Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | | | - Eric Rubin
- Merck and Co., Inc., North Wales, PA, USA
| | - Eric Deutsch
- Drug Development Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France; Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France; INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Jean-Charles Soria
- Drug Development Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Vincent Ribrag
- Drug Development Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France; Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Antonin Levy
- Drug Development Department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France; Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France; INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France; Univ Paris Sud, Université Paris-Saclay, F-94270, Le Kremlin-Bicêtre, France.
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