Individual doses for women undergoing screening mammography examinations in Poland in 2007

Exposure doses to women undergoing screening mammography examinations should be kept as low as reasonably achievable, but they should ensure high enough image quality for adequate diagnosis. The aim of this study was to estimate the radiation risk according to the 'European guidelines for quality assurance in breast cancer screening and diagnosis', fourth edition (European Commission 2006). Materials for this study were obtained from data from 250 screening mammography facilities in Poland. For every mammography facility, a standard average glandular dose for routine exposure was calculated. Furthermore, average glandular doses for individual mammography examinations obtained according to the methods proposed by Dance et al (2000 Phys. Med. Biol. 45 3225-40) were calculated. The average glandular doses determined for 250 mammography facilities ranged from 0.12 to 14.56 mGy (the mean values ranged from 0.62 to 4.53 mGy). Only for 39 mammography facilities were all exposures found to be below the acceptable level for an average glandular dose, and for only 18 mammography facilities did no exposures exceed the achievable levels for an average glandular dose. Average glandular doses to women undergoing mammography screening attained unnecessary high values, and they were found to depend on the technical parameters of the mammography equipment and maintenance of mammography units by personnel in various mammography facilities.     

Mammography in New Zealand: radiation dose and image quality.

The mean glandular doses to the breast, image quality and machine performance have been determined for all mammographic x-ray facilities in New Zealand, during 1988-89. For 30 mm and 45 mm phantoms the mean doses per film were 1.03 +/- 0.56 mGy and 1.97 +/- 1.06 mGy. These doses are within international guide-lines. Image quality (detection of simulated microcalcifications, and contrast-detail performance) was found to depend on focal spot size/FFD combination, breast thickness, and film processing. The best machines could resolve 0.2 mm aluminium oxide specks with the contact technique. The use of a grid improved image quality as did magnification. Extended cycle film processing reduced doses, but the claimed improvement in image quality was not apparent from our data. The machine calibration parameters kVp, HVL and timer accuracy were in general within accepted tolerances. Automatic exposure controls in some cases gave poor control of film density with changing breast thickness.     

监测受检者入射体表剂量的热释光方法的质量保证

[目的]为保证医疗照射剂量监测结果的可靠性,开展热释光剂量（thermoluminescence dosimetry,TLD）方法的质量保证研究。[方法]在次级标准剂量学实验室进行TLD的分散性、剂量线性和能量响应特性实验;通过建立标准化退火和测量程序并对设备进行定期校正来控制监测质量。[结果]经分档后各档TLD的灵敏度差异〈4％;在0．3～20mGy的剂量范围内,所用TLD具有理想的剂量线性（R^2=0．9999）;在医用诊断X射线常见的能量范围内,所用TLD的能量响应变化〈1．0％;盲样测量结果表明,TLD的测量值与约定真值偏差在-2．55％～0．12％之间。[结论]通过加强TLD的质量保证,可以有效提高x射线诊断受检者入射体表剂量监测结果的可比性和准确性。     

自动管电流调节低剂量CT在尘肺诊断中的应用

目的 探讨自动管电流调节低剂量CT在尘肺诊断中的可行性及应用价值.方法 45例经专业机构确诊的尘肺患者均行固定管电流（150 mA）常规剂量CT扫描（固定组）和自动管电流调节低剂量CT扫描（ATCM组,固定噪声指数为14,管电流50～200 mA）,记录两组不同扫描条件下患者的容积CT剂量指数（CTDIvol）和剂量长度乘积（DLP）,采用双盲法分别对两种扫描方法所获取图像的质量、尘肺影像特征（阴影大小、阴影密集度、尘肺分期）进行评价,并进行统计学分析.结果 在尘肺的CT影像征象显示率方面,ATCM组可清晰地显示各种尘肺特征性表现,与固定组相比,两者在显示尘肺影像特征（阴影大小、阴影密集度以及尘肺分期）、图像质量方面比较差异均无统计学意义（P＞0.05）.固定组的CTDIvol、DLP分别为13.53 mGy和（337.13±13.53） mGy/cm,ATCM组分别为（7.39±0.45） mGy和（188.78±1.80） mGy/cm,两者比较差异有统计学意义（P＜0.05）.结论 自动管电流调节低剂量CT能全面反映尘肺的特征,图像质量可满足辅助诊断要求,并且能显著降低患者的辐射剂量,可代替常规剂量CT用于尘肺的筛选与辅助诊断.     

A survey of patient dose and image quality factors for CT scanners in Victoria

Image quality and dose parameters have been measured on most makes and models of CT scanners in Victoria. Image quality was assessed using a dose efficiency and imaging performance parameter (Q-value). Factors relating to patient dose were measured. Patient doses using CTDIw in mGy were determined for average size patients for the abdomen procedure. Guidance levels have been recommended for CT procedures in Victoria.     

低剂量多层CT在鼻咽部检查中的价值探讨

目的：观察不同低剂量多层cT在鼻咽部检查中的图像质量,建立合适的低剂量扫描条件,以达到临床诊断要求的同时,减少受检者接受的放射剂量。方法：前瞻性将360例鼻咽部cT平扫检查的患者随机分为三组,即常规剂量组（120kV,250mAs）、低剂量1组（120kV,100mAs）、低剂量2组（90kV,100mAs）,分析此三组鼻咽部cT图像质量和患者所接受的辐射剂量。结果：鼻咽部低剂量多层cT检查的图像质量能够达到诊断要求,能够清晰显示鼻咽壁、咽隐窝、咽鼓管咽口、咽旁间隙及卵圆孔等结构。三组CT剂量加权指数分别如下：常规剂量组为38．1mGy,低剂量1组为15．2mGy,低剂量2组为7.1mGy。三组cT剂量加权指数之间比较差异具有统计学意义（P〈O．05）。结论：低剂量2组的CT检查图像质量既可满足临床诊断要求,又可减少受检者接受的辐射剂量。     

安徽省CT机剂量与低对比度分辨力的检测与分析

目的　全省CT机辐射剂量水平与低对比度分辨力之间的关系。方法　根据卫生部规定的统一方法[1] 。结果　 177台CT机 ,头部中心平均CTDI2 7.8mGy ,体部中心平均CTDI9.2mGy ;177台CT机中 2 1台低对比度检测不合格和合格时头部中心平均CTDI分别为 :2 3.9mGy、39.7mGy。 5 6台一手机中有 3台低对比度分辨力首次检测不合格。结论　低对比度分辨力在头部中心剂量 30mGy～ 5 0mGy为最佳 ,同时必须加强对CT机检测 ,才能保证其应用质量     

自动管电流调制技术在腹部多层螺旋CT扫描中的应用

目的：探讨自动管电流调制技术在腹部多层螺旋CT扫描中降低辐射剂量的价值。方法：回顾性分析我院腹部多层螺旋CT检查120例．随机分为实验组与对照组各60例,分别采用自动管电流调制技术和固定管电流技术进行腹部CT检查,分别统计CT剂量权重指数（CTDIW）、剂量长度乘积（DLP）及有效管电量（mAs）,并对图像噪声特性、细节显示结果进行比较。结果：实验组与对照组在图像噪声特性、细节显示程度、病变特征显示及CT值差异不具显著性（P〉0．05）,实验组有效管电量为（296．74±19．15）mAs,较对照组的350mAs降低了约15．4％（P〈0．001）;实验组CTDIW为6．74±1．15,明显低于对照组9．6mGy（P〈0．001）;实验组DLP为（360．61±14．23）mCy·cm约为对照组675mGy·cm的53．4％（P〈0．001）。结论：正确使用自动管电流调制技术可以在确保图像质量的同时降低受检者所受辐射剂量。     

CT扫描野内表面防护不同材料的防护效果以及对图像质量的影响

目的 评价两种表面防护材料在CT扫描野内的辐射防护效果和扫描野的图像质量。方法 使用CTDI模体测量颈部扫描时周边的辐射量及CTDI_w,采用铋屏蔽和硫酸钙屏蔽为辐射防护材料的辐射量及CTDI_w,比较有无屏蔽以及两种屏蔽的防护效果差异。低剂量CT筛查60例,随机分为3组,分别为无屏蔽组以及使用铋屏蔽和硫酸钙屏蔽防护组,自动曝光控制扫描,管电压100 kV,参考管电流为23 mAs。对患者甲状腺和肺尖层面的图像质量评分,比较屏蔽对图像质量的影响。结果 模型研究中,无屏蔽组的探测点辐射量为6.17±0.21 mGy;小于床板侧（7.61±0.14）mGy和中心侧为（7.14±0.11）mGy（P<0.01）;而屏蔽组CTDI_w均小于无屏蔽组,且铋屏蔽组和硫酸钙屏蔽组与无屏蔽组CTDI_w分别为5.78、5.02、6.92 mGy（P<0.05）。临床研究中,3组低剂量筛查的有效剂量分别为（0.92±0.05）、（0.90±0.06）、（0.90±0.05）mSv（P>0.05）。3组甲状腺和肺尖成像质量均可满足诊断要求,且屏蔽组的甲状腺成像质量评分明显低于无屏蔽组（F=14.69,P<0.01）,其中硫酸钙屏蔽组评分最低;3组肺尖图像质量评分间差异没有统计学意义（F=1.57,P>0.05）。结论 铋屏蔽与硫酸钙屏蔽均可以作为肺癌CT筛查的甲状腺表面屏蔽使用,不影响肺组织诊断。     

64层MSCT冠状动脉成像低剂量扫描的临床探讨

目的探讨64层MSCT冠状动脉成像（CTcoronary angiography,CTCA）在固定噪声水平低剂量扫描中的临床应用。方法将连续行CTCA检查患者60例分为两组,回顾性分析30例作为固定mA组,随后采用前瞻性分析30例作为个体mA组,比较两组图像质量、噪声、CT剂量指数（CTDIvol）及有效剂量（effectivedose,ED）的差异。结果两组图像质量评分及噪声差异无统计学意义（P〉0.05）,个体mA组CTDIvol、ED分别为（99.29±9.04）mGy和（28.10±2.73）mSv,较固定mA组分别减少了10.64%、15.03%（P〈0.01）。结论 64层MSCT冠脉成像在固定噪声水平个性化调节mA的方法,可有效地减少辐射剂量。     

利用管电流自动调节技术降低常规头部CT的照射剂量

目的 探讨常规头部CT采用管电流自动调节技术(即TCM螺旋扫描模式)能否降低照射剂量和提高影像质量。方法 50例成人患者,分别接受常规头部CT的TCM螺旋和常规轴扫模式,常规轴扫参数:140 kV,170mA用于颅底部;120 kV,150 mA用于颅脑部,2s/周。TCM螺旋扫描参数:120 kV,280 mA(最大管电流阈值),0.8 s/周。扫描剂量直接取自设备剂量指示值(CTDI和DLP)。影像质量分别由两位专家采用双盲法,对头部CT的颅底、脑灰-白质层面以及全部影像逐层进行CT值、信噪比测量以及综合评估。结果 常规头部CT采用TCM螺旋扫描模式较轴扫模式可使患者有效降低管电流使用量(44±12)mA,扫描时间(4.8±0.8)s,照射剂量(38±0.9)%:[CTDI:(32.10±9.0)mGy、(55.00±7.2)mGy;DLP(442.10±72)mGy·cm、(668.00±26)mGy·cm];经计算人体吸收剂量可降低(1.5±0.4)mSv,并可有效提高影像质量。结论 经两种不同扫描模式所得影像的CT值测量结果及其他影像质量参数的对照,应用TCM螺旋扫描模式的影像质量完全可与轴扫描模式相媲美,同时具有可减少扫描时间和照射剂量的优越性。     

Analysis of quality assurance programmes for HIV screening in blood transfusion centres in Delhi.

The safety of blood transfusion has attained tremendous importance because of the problems posed by acquired immunodeficiency syndrome (AIDS) and other transfusion-transmissible diseases. While performing screening tests for human immunodeficiency virus (HIV) antibodies in donated blood is indispensable, it is also essential to introduce an effective quality assurance programme covering inspection of specimens, review of record-keeping, maintenance of equipment, and verification of results. We carried out an analysis of such quality assurance programmes during routine annual inspection of 11 blood transfusion centres in Delhi, India. The following parameters were studied: standardization of sample collection and handling; adherence to the recommended technical procedure; use of standard operating procedure; proper use of test reagents; laboratory record-keeping; proper handling of HIV-positive blood units; recording and communication of results; observation of safety guidelines; equipment quality control; and training of staff. A pretested closed-type questionnaire with a weighted scoring system was used for evaluation. Performance for each parameter was graded as follows: 76-100%, excellent; 51-75%, good; 26-50%, fair; and < 25%, poor. Centres were categorized according to the total score obtained for all parameters. Overall performance > 50% was considered satisfactory. Of the 11 centres, none was excellent overall, five were considered satisfactory, and six were unsatisfactory.     

低剂量CT影像引导下肺部肿瘤微创治疗的研究

目的探讨低剂量CT影像引导下肺部肿瘤微创治疗的可行性。方法采用随机对照试验设计,将符合纳入标准的160例肺部肿瘤的患者随机分配到对照组与试验组,分别使用不同辐射剂量的CT影像引导下微创治疗肺部肿瘤;记录不同剂量CT引导下肿瘤影像学特性、肿块大小、微创治疗肺部肿瘤的术中并发症(出血、气胸)影像学表现、CT剂量加权指数(CTDIvol)、扫描层数、剂量长度乘积Dose-Length Product(DLP)以及近期疗效等参数进行定量测量与差异性评价。结果表明试验组在降低毫安值,减少辐射剂量的同时,会产生一定噪声与伪影使到图像质量下降;但是两组CT影像引导下微创治疗肺部肿瘤过程的图像质量评价差异无统计学意义,显示试验组能达到对照组临床CT影像引导下肺部肿瘤微创治疗的要求。在扫描管电流剂量降低至15mA引导扫描时候,CT剂量加权指数(CTDIvol)从常规的17.95 mGy降低至2.26 mGy,降低幅度达87.41%。对照组CT下引导肺部肿瘤扫描的剂量长度乘积(DLP)远远大于试验组,试验组DLP值仅为对照组的35%。结论低剂量CT影像引导下肺部肿瘤微创治疗的方法,大大减低了患者辐射剂量,并可确保微创手术顺利实施的整个过程,本研究最低选用管电流15 mA CT引导技术值得同行借鉴与推广。     

Dose optimization for different medical imaging tasks from exposure index, exposure control factor, and MAS in digital radiography

ABSTRACT: In radiographic examination, not all medical imaging tasks require the same level of image quality or diagnostic information. Criteria should be established for different imaging tasks to avoid excessive doses where there is no clear net benefit in the diagnosis or the image quality. An exposure index provided by manufacturers would be a useful tool for this purpose. This study aims to establish an optimum exposure index to be used as a guideline for clinical imaging tasks to minimize radiation exposure for chest digital radiography. A three-level classification of image quality (high, medium, and low) for chest imaging tasks was carried out. An anthropomorphic phantom was employed to establish minimum exposure index and exposure (mAs) for clinical imaging task type I (corresponding to high image quality). The exposures of medium and low quality images derived from it. Thirty patients were exposed consecutively with these optimized exposure factors, and clinical tasks were considered, while another 30 patients were exposed with the exposure factors routinely used in practice. Image quality was assessed objectively by a consensus panel. The optimized exposure provided a significant reduction of the mean exposure index from 1,556 to 1,207 (p < 0.0001) and mean patient's entrance surface dose from 0.168 mGy to 0.092 mGy (p < 0.0001). The results show that a clinical-task-determined radiographic procedure is more conducive to radiation protection of patients. In this study, the posteroanterior chest imaging examination was chosen as an example. This procedure can also apply to other body parts and views.     

CT低剂量扫描结合AI辅助诊断系统在新型冠状病毒肺炎检查中的应用

目的:探讨CT低剂量扫描结合AI辅助诊断系统在新型冠状病毒肺炎(以下简称“新冠肺炎”)检查中的可行性。方法:随机抽取2020年2-3月在武汉火神山医院经核酸检测确诊的新冠肺炎患者60例,体质量指数(body mass index,BMI)为20~25 kg/cm^2。将患者随机分为低剂量组和常规剂量组,每组30例。低剂量组采用70 kVp管电压、自动管电流进行CT扫描,常规剂量组采用120 kVp管电压、自动管电流进行CT扫描。扫描完成后均采用Karl 3D迭代重建算法重建图像,结合AI辅助诊断系统对比2组图像质量及识别新冠肺炎特征性病灶情况,并分别计算2组患者所接受的有效辐射剂量。采用Mann-Whiteney U检验和独立样本t检验进行统计学分析。结果:低剂量组与常规剂量组在识别新冠肺炎特征性病灶及图像质量主观评分方面差异无统计学意义(P>0.05)。低剂量组的有效辐射剂量[(1.28±0.11)mSv]明显低于常规剂量组[(6.88±1.25)mSv],二者差异有显著统计学意义(P<0.05)。结论:对于BMI在20~25 kg/cm^2的新冠肺炎确诊患者,结合AI辅助诊断系统,采用70 kVp管电压进行CT检查,图像质量能够满足临床诊断要求,并可较大幅度降低患者所接受的有效辐射剂量,具有更高的安全性及临床应用价值。     

不同水模体直径和不同重建层厚对CT图像噪声的影响

目的 研究不同水模体直径和重建层厚等因素对CT图像噪声的影响，探讨CT质量控制检测中水模体合理的直径范围，为完善我国CT质量控制检测规范提供数据支持。方法 采用GE公司的Revolution型CT机，在两档剂量水平，即CTDI_W分别为30.20 mGy（120 kV、200 mAs）和49.82 mGy（120 kV、330 mAs）、图像重建层厚为5 mm和10 mm的条件下，分别对直径为16、18、20、22、24 cm的圆柱型均质水模体轴向扫描一圈，测量其CT值（水）和噪声等指标。比较不同水模体直径、不同层厚和不同剂量等条件下噪声测量值的差异。结果 噪声测量值随水模体直径增大而增大，随剂量增大而减小，在大小两档剂量水平下水模体直径分别为24、22 cm时的噪声值已超过现有检测标准；噪声随重建层厚的增大而减小。结论 噪声的测量结果与剂量、水模体直径、重建层厚等因素有关，在进行CT质量控制噪声项目的检测时，需规定所选择的剂量水平和层厚大小，并规定所选择水模体的直径大小。本研究结果提示CTDI_W在接近50 mGy的条件下，18~22 cm可能是比较合理的水模体直径范围。     

Externe Qualitätssicherung im Kinder- und Jugendgesundheitssurvey (KiGGS)

The results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) of the Robert Koch Institute (RKI) will be of great importance for health policy and research. Therefore, in this study internal quality assurance was supplemented by an external quality assurance which was carried out by the institute of epidemiology at the GSF National Research Center for Environment and Health. The subjects were the interviewer training, sampling and response, field work and data management. External quality assurance was defined as 'an audit of internal quality assurance measures and systematic observation and spot checks to ensure quality requirements were fulfilled'. The requirements followed the manual of operation and the recognized epidemiologic standards and guidelines. For the different subjects, tests and detailed check-lists were developed and used. The quality requirements were fulfilled: The field work was performed with high quality and remarkable engagement over the whole time from May 2003 to May 2006, which resulted in high response and data quality. An extensive, efficient quality management system was in place for the data management.     

ESR dosimetry study of population in the vicinity of the Semipalatinsk Nuclear Test Site

A tooth enamel electron spin resonance (ESR) dosimetry study was carried out with the purpose of obtaining the individual absorbed radiation doses of population from settlements in the Semipalatinsk region of Kazakhstan, which was exposed to radioactive fallout traces from nuclear explosions in the Semipalatinsk Nuclear Test Site and Lop Nor test base, China. Most of the settlements are located near the central axis of radioactive fallout trace from the most contaminating surface nuclear test, which was conducted on 29 August 1949, with the maximum detected excess dose being 430 ± 93 mGy. A maximum dose of 268 ± 79 mGy was determined from the settlements located close to radioactive fallout trace resulting from surface nuclear tests on 24 August 1956 (Ust-Kamenogorsk, Znamenka, Shemonaikha, Glubokoe, Tavriya and Gagarino). An accidental dose of 56 ± 42 mGy was found in Kurchatov city residents located close to fallout trace after the nuclear test on 7 August 1962. This method was applied to human tooth enamel to obtain individual absorbed doses of residents of the Makanchi, Urdzhar and Taskesken settlements located near the Kazakhstan–Chinese border due to the influence of nuclear tests (1964–1981) at Lop Nor. The highest dose was 123 ± 32 mGy.     

低剂量辐射对小鼠蛋白质代谢的影响

目的 :　了解一次性低剂量辐射对小鼠蛋白质代谢是否有影响 ,为辐射防护提供参考。方法 :　选用生长期和成年期小鼠各 3 0只 ,随机分成 3组 ,雄雌各半。分别接受 0 ,2 5 0 m Gy,5 0 0 m Gy60 Coγ射线一次全身照射 ,剂量率为 78.6 c Gy/min。每只动物每天定量给予 4g饲料 ,照射后第 7d起恢复自由进食 ,测定动物照射后连续 3 d的氮平衡 ,每 3 d称一次体重。照射后 1 0 d测定血红蛋白 (Hb) ,血清总蛋白 (TP)和血清非蛋白氮 (NPN)。结果 :　成年期小鼠在照射后 6 d时体重显著减少 (P<0 .0 1 ) ,恢复自由进食后体重减轻得到恢复。氮平衡试验中生长期小鼠 5 0 0 m Gy组 ,成年期 2 5 0 m Gy和 5 0 0 m Gy剂量组的正氮平衡低于相应的对照组 (P<0 .0 5 )。照射 5 0 0 m Gy使 Hb和 TP有所下降 ,同时 NPN升高 ,但未达到统计学显著差别。结论 :　一次性暴露于 2 5 0m Gy电离辐射对氮代谢有不良效应。     

Finger doses received during 153Sm injections.

This study was undertaken to determine the dose received by the skin of the fingers of clinical and laboratory staff during injections of 153Sm. The use of 153Sm, chelated with ethylenediaminetetramethylene phosphonic acid (153Sm-EDTMP), is coming into more frequent use in radionuclide therapy since its approval by the U.S. Food and Drug Administration in March 1997. 153Sm emits a range of medium-energy therapeutically useful beta particles that have been found beneficial in the palliation of metastatic bone cancer pain. It also emits a range of gamma rays. Calculations have been undertaken to provide the beta-particle and gamma-ray dose rates, at a depth within the skin corresponding roughly to the basal cell layer, when the finger is placed in direct contact with the external surface of a syringe containing 153Sm. The beta-particle dose rates were modeled using an empirically based Monte Carlo approach previously described by Beddoe and Kelly. The gamma-ray dose rates were modeled using a distributed point source approach previously reported by Pattison et al. In the calculations it is assumed that a typical administered activity is 2.6 GBq, with a finger-syringe contact time of 30 s. The skin dose, due to both beta particles and gamma rays when the finger is centrally placed over an active volume of 0.3 mL in a 1-mL syringe, is calculated to be 77 mGy per injection. Similarly, for an active volume of 1.0 mL in a 2.5-mL syringe, the dose is calculated to be 10 mGy per injection. In view of the ICRP recommended weekly skin dose limit of 10 mGy, both of the above two doses are excessive. If, however, the fingers are placed at the rear end of the syringe barrel, where they are only exposed to the gamma rays, the above two doses are reduced to 0.069 and 0.139 mGy per injection, respectively. Both of these two doses are well within the recommended weekly dose limits for the skin. It is found that the weekly dose limit for the skin is readily exceeded if the fingers are in direct contact with the external surface of the syringe and located over the active volume. However, if handled at the rear end of the syringe barrel, a typical weekly workload can be managed without exceeding the recommended dose limits.