放疗中呼吸引起的组织深度波动对吸收剂量的影响

目的研究放疗中呼吸引起的组织深度波动对吸收剂量的影响。方法在不同能量、组织深度波动幅度、呼吸频率及平均测量深度时，分别用研制的能模拟组织深度波动的辐射剂量测量水箱进行测量，以获得“组织深度波动因子”（Fdw）进行比较。结果组织深度波动确实对实际吸收剂量有影响，而且组织深度波动幅度、呼吸频率及射线能量越大，Fdw值越小，即对吸收剂量的影响越大，而Fdw与平均测量深度无关。结论放疗中必须根据患者的呼吸频率、所用射线类型及呼吸引起的组织深度波动幅度用Fdw对肿瘤或组织的实际吸收剂量进行修正，以提高疗效。     

An empirical model for calculating electron dose distributions

Dose-distributions in radiation fields are calculated for purpose of irradiation planning from measured depth dose and cross-distributions predominantly. Especially in electron fields the measuring effort is high to this, because these distributions have to be measured for all occurring irradiation parameters and in many different tissue depths. At the very least it can be shown for the 6...10 MeV electron radiation of the linear accelerator Neptun 10p that all required distributions can be calculated from each separately measured depth dose and cross-distribution. For this depth dose distribution and the measured border decrease of cross-distribution are tabulated and the abscissas are submitted to a linear transformation x' = k.x. In case of depth dose distribution the transformation factor k is dependent on electron energy only and in cross-distribution on tissue depth and source-surface-distance additionally.     

Measurement of the average radiation dose to the local skin and thyroid gland during intracranial aneurysm coil embolization

IntroductionIntracranial aneurysm coil embolisation is a fluoroscopically guided procedure associated with high radiation dose. The increase in the number of coil embolisation procedures raises concern for the amount of radiation and the associated radiation risks to the patients. This research study was conducted to determine the average radiation dose to patients’ thyroid glands and local skin during intracranial aneurysm coil embolisation and to establish preliminary local diagnostic reference levels for this procedure. In this paper, local skin dose refers to the absorbed radiation dose on the areas of the skin exposed to radiation during intracranial aneurysm coil embolisation, namely neck, face and scalp.MethodsThis study employed air-kerma area product meters to determine the local skin dose and diagnostic reference levels during intracranial aneurysm coil embolisation. In addition, thyroid radiation doses were measured using thermo-luminescent dosimeters on a phantom during simulation of embolisation procedures.ResultsThe local skin doses as determined by air-kerma area product ranged between 33 and 125 Gy.cm2. The mean thyroid dose was 9.87 mGy. The established local diagnostic reference level was 52.1 Gy cm², 17.8 min’ fluoroscopy time and 503 image frames.ConclusionThe average air-kerma area product values and the proposed diagnostic reference levels were lower than most published values for intracranial aneurysm coil embolisation.Implications for practiceThe established local diagnostic reference levels are recommended for use as radiation dose optimisation tool at the research site. The findings of this study cannot be generalised or applied to other hospitals. The complexity of the embolisation procedures was not classified for this study. Further research on diagnostic reference levels for intracranial aneurysm coil embolisation, taking into account the complexity of the procedures, is recommended.     

Performance comparison of neutron and X-ray sensitive photo-stimulated imaging plates.

Statistical characteristics of photo-stimulated luminescent (PSL) signals are studied using thermal neutrons, X- and gamma-rays. It is shown that the statistical fluctuation of PSL is described simply by the PSL value itself and is independent of radiation type, except for short-range high-LET particles. However, it is expected that the spatial resolution should be affected if the range of electrons or secondaries were much longer than the instrumental resolution (pixel size). When output PSL signals are compared between X- and gamma-rays, the PSL values were proportional to the exposed air dose, independent of X-ray energy. However, signals from 60Co gamma-rays were approximately 1% of 22-40 kV X-ray output at the same dose.     

Effectiveness of a novel real-time dosimeter in interventional radiology: a comparison of new and old radiation sensors

Radiation dose management is important in interventional radiology (IR) procedures, such as percutaneous coronary intervention, to prevent radiation-induced injuries. Therefore, radiation dose should be monitored in real time during IR. This study evaluated the fundamental characteristics of a novel real-time skin dosimeter (RTSD) developed at our institution. In addition, we compared the performance of our new and old radiation sensors and that of a skin dose monitor (SDM), with ion chamber reference values. We evaluated the fundamental characteristics (e.g., energy dependence, dose dependence, and angular dependence) of the RTSD developed by us in the diagnostic X-ray energy range. The performance of our RTSD was similar to that of the SDM. In particular, the new radiation sensor of our RTSD demonstrated better dose rate dependence compared to the old sensor. In addition, the new sensor had the advantage of being small in size and thus minimally affecting the X-ray images compared to the old sensor. Therefore, the developed skin dosimeter and radiation sensor may be useful in real-time measurement of patients’ exposure to and multi-channel monitoring of radiation in IR procedures. The new dosimeter system can be recommended for visualization and management of the radiation dose to which the patients’ skin is exposed.     

Establishing diagnostic reference levels for interventional procedures in Kenya

PurposeTo quantify ionizing radiation exposure to patients during interventional procedures and establish national diagnostic reference levels (NDRLs) for clinical radiation exposure management.MethodsThe cumulative reference point air kerma, kerma area product, fluoroscopy time and other operational parameters were monitored for 50 children and 261 adult patient procedures in five catheterization medical laboratories in Kenya. To estimate the risk associated with the exposure, effective doses were derived from the kerma area product using conversion factors from Monte Carlo models.ResultsAbout 3% of the measured cumulative reference point air kerma for the interventional procedures approached the threshold dose limit with the potential to cause deterministic effects such as skin injuries. In interventional cardiology, the results obtained for both children and adults indicated 33% were below the diagnostic reference levels (DRLs). In adult interventional radiology, 29% for cumulative reference point air kerma, and 43% for kerma area product and fluoroscopy time respectively were below the diagnostic reference levels. NDRLs were proposed for routine use in the procedures considered and for the non-existent DRLs situations in paediatric interventional cardiology.ConclusionThe measured patient doses were above the DRLs available in the literature indicating a need for radiation optimization through, continuous monitoring and recording of patient dose. To promote radiation safety, facilities performing interventional procedures need to establish a radiation monitoring notification threshold for possible deterministic effects, in addition to the use of the newly established national diagnostic reference levels, as a quality assurance measure.     

Evaluation of patient dose from diagnostic X-ray using glass badges

Radiography is used in medical practices based on the principles of justification and optimization. Patients' exposure doses should be kept as low as still allows for image quality that does not disturb the diagnostic processes. To optimize diagnostic radiological procedures, the international commission on radiological protection (ICRP) advocated the establishment of diagnosis reference levels (DRLs) in the new basic recommendation (Publication 103) in 2007 by stating that "The DRL should be expressed as a readily measurable patient-dose-related quantity for the specified procedure." In this context, a simple and standardized dosimetric method is needed to verify the adaptability of a radiation dose to the DRLs. As a measuring instrument that has good availability, high accuracy, and easy operability, we adopted the glass badge system, which has been used for individual exposure dose management. We evaluated the accuracy of the system as a tool of simplified dosimetry of diagnostic X-rays by comparing it to the standard dosimetry of an ionization chamber. In an energy range of 50 to 140 kV for X-ray exposure, the glass badge showed values within 7% of or closer to those measured by the standard ionization chamber. Moreover, the glass badge measurement was independent of the rectification modes of the X-ray tubes. In conclusion, glass badge measurement is feasible for verifying diagnostic X-ray doses in relation to DRLs and can be widely used in hospitals and clinics.     

Simulation of photon energy spectra from Varian 2100C and 2300C/D Linacs: Simplified estimates with PENELOPE Monte Carlo models

Photon energy spectra of Varian Clinac 2100C and 2300C/D treatment heads were calculated with PENELOPE-2006, using simplified Monte Carlo models. These spectra constitute the basis of beam models used for the calculation of correction factors required for the Austrian absorbed dose to water primary standard. To validate the models, simulated depth dose curves in water and calculated radiation quality factors (TPR_20,10) were compared with ionization chamber measurements. In addition the results are discussed in context with detailed Monte Carlo studies from the literature in reference to mean spectral photon energy and degree of equivalence between simulated and calculated percentage-depth-dose curves. Mean absolute deviations between measured and simulated depth dose curves smaller than 2.0% were found. The differences between simulation and measurement of TPR_20,10 were smaller than 2.6%. This shows the usefulness of the simplified beam models in applications since their dependence on energy spectra and radiation quality is small in comparison to its energy range.     

Somatostatin-receptor-targeted alpha-emitting 213Bi is therapeutically more effective than beta(-)-emitting 177Lu in human pancreatic adenocarcinoma cells

INTRODUCTION: Advance clinical cancer therapy studies of patients treated with somatostatin receptor (sstr)-targeted [DOTA(0)-Tyr(3)]octreotide (DOTATOC) labeled with low-linear-energy-transfer (LET) beta(-)-emitters have shown overall response rates in the range of 15-33%. In order to improve outcomes, we sought to compare the therapeutic effectiveness of sstr-targeted high-LET alpha-emitting (213)Bi to that of low-LET beta(-)-emitting (177)Lu by determining relative biological effectiveness (RBE) using the external gamma-beam of (137)Cs as reference radiation. METHODS: Sstr-expressing human pancreatic adenocarcinoma Capan-2 cells and A549 control cells were used for this study. The effects of different radiation doses of (213)Bi and (177)Lu labeled to 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid and sstr-targeted DOTATOC were investigated with a clonogenic cell survival assay. Apoptosis was measured using the Cell Death Detection ELISA(PLUS) 10x kit. RESULTS: Using equimolar DOTATOC treatment with concurrent irradiation with a (137)Cs source as reference radiation, the calculated RBE of [(213)Bi]DOTATOC was 3.4, as compared to 1.0 for [(177)Lu]DOTATOC. As measured in terms of absorbance units, [(213)Bi]DOTATOC caused a 2.3-fold-greater release of apoptosis-specific mononucleosomes and oligonucleosomes than [(177)Lu]DOTATOC at the final treatment time of 96 h (P<.001) in sstr-expressing Capan-2 cells. CONCLUSIONS: In conclusion, at the same absorbed dose, [(213)Bi]DOTATOC is therapeutically more effective in decreasing survival than is [(177)Lu]DOTATOC in human pancreatic adenocarcinoma cells due to its comparatively higher RBE.     

6MV医用电子直线加速器的蒙特卡罗模拟

目的 探讨入射电子束的能量和径向强度分布对百分深度剂量曲线和离轴比的影响,并寻找与百分深度剂量曲线和离轴比的测量值最接近的两者参数组合.方法 利用OMEGA/EGSnre系统,模拟Varian 600C医用电子直线加速器,计算水模体百分深度剂量曲线和10 cm深度处离轴比.若测量值和计算值的相对误差经过剂量最大点后在2%之内,则接受入射电子束值.结果 电子束的能量在经过剂量最大点后对深度剂量曲线没有明显影响.离轴比对能量敏感,能量越高,离轴比尖角越小.径向强度分布对深度剂量曲线在误差允许的范围内没有影响,而离轴比曲线对电子束径向强度分布非常敏感.随着径向强度分布半高全宽增大而减小.深度剂量曲线的计算值与测量值一致.在射野范围内,离轴比曲线计算值和测量值一致;但在半影区和射野外,个别测量点的最大误差达到了18.5%.结论 在射野内找到了电子柬能量和径向强度分布的最优参数组合,而在半影区和射野外,未能找到合适的两者参数组合.     

6 MV医用电子直线加速器的蒙特卡罗模拟

目的 探讨入射电子束的能量和径向强度分布对百分深度剂量曲线和离轴比的影响,并寻找与百分深度剂量曲线和离轴比的测量值最接近的两者参数组合.方法 利用OMEGA/EGSnre系统,模拟Varian 600C医用电子直线加速器,计算水模体百分深度剂量曲线和10 cm深度处离轴比.若测量值和计算值的相对误差经过剂量最大点后在2%之内,则接受入射电子束值.结果 电子束的能量在经过剂量最大点后对深度剂量曲线没有明显影响.离轴比对能量敏感,能量越高,离轴比尖角越小.径向强度分布对深度剂量曲线在误差允许的范围内没有影响,而离轴比曲线对电子束径向强度分布非常敏感.随着径向强度分布半高全宽增大而减小.深度剂量曲线的计算值与测量值一致.在射野范围内,离轴比曲线计算值和测量值一致;但在半影区和射野外,个别测量点的最大误差达到了18.5%.结论 在射野内找到了电子柬能量和径向强度分布的最优参数组合,而在半影区和射野外,未能找到合适的两者参数组合.

Abstract：

Objective To analyze the influence of the mean energy and the full-width of half msximum(FWHM)of incident electron beam intensity distilbution(assumed Gaussian distribution)on depth dose curves and off-axis ratios and to derive a most optimal combination of mean energy and FWHM of incident electron beam intensity distribution.Methods The study simulated 6 MV photon beam produced by Varian 600C medical linear accelerator with OMEGA/EGSnrc by matching the relative error of calculated and measured depth dose curves past depth of maximum dose and off-axis ratios at a depth of 10.0 cm in water within 2%.Results The depth dose curves were relatively insensitive to the mean energy past depth of maximum dose and the FWHM of the incident electron beam intensity distribution.Dose profiles were sensitive tO the mean energy and FWHM.The dose profiles horns decreased as the mean energy and tlle FWHM of the ineident electron beam intensity distilbution increased.The calculated value of the depth dose curves matched well with the measured value.The calculated value of the off-axis ratio was consistent with the measured value within the radiation field.However, the maximum errors of individual measurement points in the penumbra region and OUt of the field reached 18.5%.Conclusions In the field.the most optimal combination of mean energy and FWHM of incident electron beam intensitv distribution Can be derived, however,can not be derived out of the field and in the penumbra region.     

Radiation dose and image information in computed radiography. A phantom study of angle measurements in the weight-bearing knee

Purpose: To establish a correlation between radiation dose and diagnostic accuracy when employing a new digital method for angle determinations. The specific intention was to determine how far the radiation dose can be reduced without losing measuring accuracy and to compare this radiation dose with that employed with our conventional method.Material and Methods: An image succession of an anthropomorphic phantom was generated with a computed radiography (CR) system, by reducing the exposure stepwise. The images were archived and transferred to a workstation for evaluation. The intraobserver variation of two angle determinations was used as an indicator of the evaluation accuracy. Patient radiation doses were measured with thermoluminescent dosimeters. The energy imparted, indicating the relative risk associated with exposure to ionising radiation, and the effective dose, which determines the absolute risk, were calculated.Results and Conclusion: No significant correlation was found between patient dose and measuring accuracy within the evaluated exposure interval. At the lowest exposure of the CR system, the energy imparted to the patient was 30 μJ. Compared with our conventional analogue method this is a reduction by 98%. The effective dose was as low as 1.5 μSv. The CR technique creates possibilities to adapt exposure parameters, and thus the radiation dose to the patient, according to the purpose of the investigation.     

Microdosimetric specification of radiation quality in neutron radiation therapy

The neutron beams used by various radiotherapy centres are of widely differing energies, and differences of up to 50 per cent in the relative biological effectiveness (RBE) between different beams have been found in radiobiological experiments. Moreover, at some facilities RBE variations have been observed with increasing depth in a phantom. In spite of this evidence, there is no quantitative and uniquely accepted specification of radiation quality used in practice. The urgency of an adequate solution of this problem is illustrated by the fact that in radiation therapy the usual accuracy requirement for the quantity of radiation, i.e. the absorbed dose to be delivered to the tumour, is 3.5 per cent (1 SD). In this paper a pragmatic solution for the specification of radiation quality for fast neutron therapy is proposed. It is based on empirical RBE versus lineal energy response or weighting functions. These were established by using existing radiobiological data and microdosimetric spectra measured under identical irradiation conditions at several European neutron irradiation units.     

Microdosimetric Specification of Radiation Quality in Neutron Radiation Therapy

Summary

The neutron beams used by various radiotherapy centres are of widely differing energies, and differences of up to 50 per cent in the relative biological effectiveness (RBE) between different beams have been found in radiobiological experiments. Moreover, at some facilities RBE variations have been observed with increasing depth in a phantom. In spite of this evidence, there is no quantitative and uniquely accepted specification of radiation quality used in practice. The urgency of an adequate solution of this problem is illustrated by the fact that in radiation therapy the usual accuracy requirement for the quantity of radiation, i.e. the absorbed dose to be delivered to the tumour, is 3.5 per cent (1SD). In this paper a pragmatic solution for the specification of radiation quality for fast neutron therapy is proposed. It is based on empirical RBE versus lineal energy response or weighting functions. These were established by using existing radiobiological data and microdosimetric spectra measured under identical irradiation conditions at several European neutron irradiation units.     

Detection size dependence of field factor for narrow beam]

An absorbed dose in the narrow beam is calculated based on the depth dose distribution and a field factor. The field factor has to be measured with especially high accuracy because it is highly variable. The field factor was calculated when detection size was changed, by using Monte Carlo simulation, which had no energy dependency or geometrical error. Then the relation between field factor and detection size in the narrow beam was investigated. An absorbed dose in peak depth and reference depth according to detection size was calculated for each field size. Detection size dependency was recognized in the case of measuring a field factor, because the absorbed dose tended to decrease as detection size increased. The absorbed dose in the narrow beam has to be calculated within a change of +/- 2%. The change in peak depth according to detection size was eliminated, and then the relation between an absorbed dose at the ideal detection size of 0 mm phi by extrapolation and detection size which has a deference of 2% from it, were acquired. In addition, the maximum usable detection size was estimated in the case of measuring the field factor.     

Method of estimating patient skin dose from dose displayed on medical X-ray equipment with flat panel detector

The International Electrotechnical Commission has stipulated that medical X-ray equipment for interventional procedures must display radiation doses such as air kerma in free air at the interventional reference point and dose area product to establish radiation safety for patients (IEC 60601-2-43). However, it is necessary to estimate entrance skin dose for the patient from air kerma for an accurate risk assessment of radiation skin injury. To estimate entrance skin dose from displayed air kerma in free air at the interventional reference point, it is necessary to consider effective energy, the ratio of the mass-energy absorption coefficient for skin and air, and the backscatter factor. In addition, since automatic exposure control is installed in medical X-ray equipment with flat panel detectors, it is necessary to know the characteristics of control to estimate exposure dose. In order to calculate entrance skin dose under various conditions, we investigated clinical parameters such as tube voltage, tube current, pulse width, additional filter, and focal spot size, as functions of patient body size. We also measured the effective energy of X-ray exposure for the patient as a function of clinical parameter settings. We found that the conversion factor from air kerma in free air to entrance skin dose is about 1.4 for protection.     

Development of a personal dosimetry system based on optically stimulated luminescence of alpha-Al2O3:C for mixed radiation fields.

To develop a personal optically stimulated luminescence (OSL) dosimetry system for mixed radiation fields using alpha-Al2O3:C, a discriminating badge filter system was designed by taking advantage of its optically stimulable properties and energy dependencies. This was done by designing a multi-element badge system for powder layered alpha-Al2O3:C material and an optical reader system based on high-intensity blue light-emitting diode (LED). The design of the multielement OSL dosimeter badge system developed allows the measurement of a personal dose equivalent value Hp(d) in mixed radiation fields of beta and gamma. Dosimetric properties of the personal OSL dosimeter badge system investigated here were the dose response, energy response and multi-readability. Based on the computational simulations and experiments of the proposed dosimeter design, it was demonstrated that a multi-element dosimeter system with an OSL technology based on alpha-Al2O3:C is suitable to obtain personal dose equivalent information in mixed radiation fields.     

Radiation exposure at chest CT: a statement of the Fleischner Society

The introduction of helical single-detector row computed tomography (CT) and, more recently, multi-detector row CT has greatly increased the clinical indications for CT. Correspondingly, CT examinations now account for greater than one-half of the radiation dose due to medical procedures in the population of North America. The level of CT radiation dose, especially in the pediatric population, is of concern to radiologists, medical physicists, government regulators, and the media. This review addresses this problem with particular reference to radiation dose in chest CT. Specifically it outlines the topics of measurement units used to quantify radiation exposure, factors affecting CT scanner dose efficiency, scanner settings that determine the administered radiation dose, and radiation dose reduction in chest CT. A table of reference dose values is provided. Given the wide variation documented in chest CT radiation exposure, the authors suggest that reference standards be promoted to minimize excessive CT radiation exposure. In addition, further research into the complex relationship between radiation exposure, image quality, and diagnostic accuracy should be encouraged in order to establish the minimum radiation dose necessary to provide adequate diagnostic information for standard clinical questions.     

成年人CT扫描中辐射剂量和诊断参考水平的探讨

目的 通过全国范围内CT辐射剂量的调查,了解成年人辐射剂量的现状,进而探讨成年人CT的诊断参考水平不符,需要根据我国的实际建立自己的DRL。方法 2015年9月至2016年3月在全国30个省、自治区、直辖市调查168家医院,其中三级和二级医院各约占一半。随机调查年度状态检测合格的168台CT,包括了临床应用中普遍使用的品牌和型号。每台CT收集头颅、鼻窦、颈部、胸部、腹部、盆腔、腰椎、尿路造影、冠状动脉CT血管造影（CTA）、颅脑CTA、颈部CTA和胸腹CTA共12个检查项目、每个项目10个随机病例。以容积CT剂量指数（CTDI_vol）和剂量长度乘积（DLP）作为剂量参量,每个检查项目的所有数据按照大小排序,取25%、50%和75%位数,其中75%位数为参考水平。所得剂量数值与国际相关放射防护组织发布的DRL进行比较。结果 共收集16 244个标准体型成年病例的剂量数据,经逐一检查剔除274个无效数据,剩余15 970个病例数据。全国范围内不同的CT使用单位,同一检查项目的CTDI_vol、DLP和扫描期项都有很大差异。与国际放射防护组织发布的数据相比,不同检查项目的诊断参考水平的差异程度各不相同,颅脑诊断水平与参考值相当、胸部腹部较低。剂量指数值最大的几种检查项目为头颅、冠状动脉CTA、颅脑CTA和鼻窦。尿路造影的CTDI_vol虽然仅为20 mGy,但DLP却高达2 620 mGy·cm。结论 我国现有的CT剂量水平与国际相关组织发布的诊断标准水平（DRL）不符,需要根据我国的实际建立自己的DRL。     

Performance of a prototype of an extrapolation minichamber in various radiation beams.

An extrapolation minichamber was developed for measuring doses from weakly penetrating types of radiation. The chamber was tested at the radiotherapeutic dose level in a beam from a (90)Sr+(90)Y check source, in a beam from a plane (90)Sr+(90)Y ophthalmic applicator, and in several reference beams from an X-ray tube. Saturation, ion collection efficiency, stabilization time, extrapolation curves, linearity of chamber response vs. air kerma rate, and dependences of the response on the energy and irradiation angle were characterized. The results are satisfactory; they show that the chamber can be used in the dosimetry of (90)Sr+(90)Y beta particles and low-energy X-ray beams.