Antti Kosunen

Patient dose in interventional radiology: A European survey

Patient doses for a few common fluoroscopy-guided procedures in interventional radiology (IR) (excluding cardiology) were collected from a few radiological departments in 13 European countries. The major aim was to evaluate patient doses for the basis of the reference levels. In total, data for 20 procedures for about 1300 patients were collected. There were many-fold variations in the number of IR equipment and procedures per population, in the entrance dose rates, and in the patient dose data (total dose area product or DAP, fluoroscopy time and number of frames). There was no clear correlation between the total DAP and entrance dose rate, or between the total DAP and fluoroscopy time, indicating that a number of parameters affect the differences. Because of the limited number of patients, preliminary reference levels were proposed only for a few procedures. There is a need to improve the optimisation of IR procedures and their definitions and grouping, in order to account for their different complexities.

Boron neutron capture therapy (BNCT) in Finland: Technological and physical prospects after 20 years of experiences

Boron Neutron Capture Therapy (BNCT) is a binary radiotherapy method developed to treat patients with certain malignant tumours. To date, over 300 treatments have been carried out at the Finnish BNCT facility in various on-going and past clinical trials. In this technical review, we discuss our research work in the field of medical physics to form the groundwork for the Finnish BNCT patient treatments, as well as the possibilities to further develop and optimize the method in the future. Accordingly, the following aspects are described: neutron sources, beam dosimetry, treatment planning, boron imaging and determination, and finally the possibilities to detect the efficacy and effects of BNCT on patients.

A tandem calibration method for kerma–area product meters

For measurements of the kerma-area product (KAP) in diagnostic x-ray imaging, a method for calibrating field KAP meters with a reference KAP meter is presented. In this tandem calibration method, the field KAP chamber is positioned similarly as in measurements with patients. The reference KAP chamber is placed at a specified distance and used in the x-ray beam simultaneously with the field KAP chamber. The tandem method provides a feasible and practical way for calibrating field KAP meters of any type in their clinical position. Accurate measurements of the irradiation geometry are not required, but comprehensive calibration for the reference KAP meter is needed.

Effects of radiation quality on the calibration of kerma-area product meters in x-ray beams

The calibration coefficients of kerma-area product meters significantly depend on the energy spectrum of the x-ray beam. This effect was examined by measuring the calibration coefficients for several radiation qualities in the range generally used in diagnostic x-ray imaging. The intention was to determine the calibration coefficients for other radiation qualities by interpolation between the measured values, relative to one or more suitable parameters. The x-ray tube voltage, total filtration and half-value thickness were examined as possible specifiers of the energy distribution. No single parameter provided an interpolation of calibration coefficients with the accuracy recommended by the ICRU and IAEA, except for a narrow range of radiation qualities. At least two of the parameters are needed to reliably specify the radiation quality for the interpolation of calibration coefficients.

Modelling of brain tissue substitutes for phantom materials in neutron capture therapy (NCT) dosimetry

The aim of this study was to define the most suitable brain tissue phantom material for neutron capture therapy (NCT). The calculated distributions of the thermal neutron fluence and the fast neutron and γ dose in normal brain tissue defined by ICRU were compared to those in four brain tissue substitutes: water, PMMA and two normal brain tissue substitute liquids, A and B, defined by us. Liquid B is an excellent material to simulate the neutron and γ interactions in normal brain tissue and it can be considered for use in situations for which higher accuracy is required, although it may not be suitable for routine use. Water is a suitable brain tissue substitute for periodic epithermal beam calibration, for routine quality control and for intercomparison of beams in NCT dosimetry.

Staff dosimetry in interventional cardiology: survey on methods and level of exposure

In interventional cardiac procedures, staff operates near the patient in a non-uniformly scattered radiation field. Consequently, workers may receive, over a period, relatively high radiation doses. The measurement of individual doses to personnel becomes critical due to the use of protective devices and, as a consequence of the large number of methods proposed to assess the effective dose, great variability in monitoring programmes is expected among European countries. SENTINEL consortium has conducted a survey on staff dosimetry methods and on the level of staff exposure in 12 European cardiac centres demonstrating the urgent need to harmonise dosimetry methods. From the dosimetry survey, constraint annual effective dose of 1.4 mSv and Hp(0.07) over the protective apron of 14 mSv are proposed for the optimisation the exposure the most-exposed operator.

Occupational radiation doses in interventional radiology: simulations

In interventional radiology, occupational radiation doses can be high. Therefore, many authors have established conversion coefficients from the dose-area product data or from the personal dosemeter reading to the effective dose of the radiologist. These conversion coefficients are studied also in this work, with an emphasis on sensitivity of the results to changes in exposure conditions. Comparison to earlier works indicates that, for the exposure conditions examined in this work, all previous models discussed in this work overestimate the effective dose of the radiologist when a lead apron and a thyroid shield are used. Without the thyroid shield, underestimation may occur with some models.

The energy dependence of the response of a patient dose calibrator

Kerma-area product (KAP) meters used for patient exposure monitoring in diagnostic x-ray imaging can be calibrated in situ with a reference KAP meter. The drawback of this tandem calibration method is the large energy dependence of the response of the reference KAP meter when typical KAP ionization chambers are used for this purpose. The energy dependence of a novel, large-area KAP meter (patient dose calibrator, PDC, Radcal) was therefore experimentally investigated. Its response was examined by measuring the calibration coefficients for standard calibration radiation qualities and several radiation qualities in the range generally used in diagnostic x-ray imaging. The PDC type of KAP meter has a smaller energy dependence than conventional KAP meters, and the half-value layer can be used as a radiation quality specifier for PDC-type chambers with an uncertainty of less than 2%. The accuracy of the tandem calibration method can be improved by using this type of KAP meter as a reference meter.

Gafchromic EBT3 film dosimetry in electron beams - energy dependence and improved film read-out.

For megavoltage photon radiation, the fundamental dosimetry characteristics of Gafchromic EBT3 film were determined in  60Co gamma ray beam with addition of experimental and Monte Carlo (MC)‐simulated energy dependence of the film for 6 MV photon beam and 6 MeV, 9 MeV, 12 MeV, and 16 MeV electron beams in water phantom. For the film read‐out, two phase correction of scanner sensitivity was applied: a matrix correction for scanning area and dose‐dependent correction by iterative procedure. With these corrections, the uniformity of response can be improved to be within ±50 pixel values (PVs). To improve the read‐out accuracy, a procedure with flipped film orientations was established. With the method, scanner uniformity can be improved further and dust particles, scratches and/or dirt on scanner glass can be detected and eliminated. Responses from red and green channels were averaged for read‐out, which decreased the effect of noise present in values from separate channels. Since the signal level with the blue channel is considerably lower than with other channels, the signal variation due to different perturbation effects increases the noise level so that the blue channel is not recommended to be used for dose determination. However, the blue channel can be used for the detection of emulsion thickness variations for film quality evaluations with unexposed films. With electron beams ranging from 6 MeV to 16 MeV and at reference measurement conditions in water, the energy dependence of the EBT3 film is uniform within 0.5%, with uncertainties close to 1.6% (k=2). Including 6 MV photon beam and the electron beams mentioned, the energy dependence is within 1.1%. No notable differences were found between the experimental and MC‐simulated responses, indicating negligible change in intrinsic energy dependence of the EBT3 film for 6 MV photon beam and 6 MeV–16 MeV electron beams. Based on the dosimetric characteristics of the EBT3 film, the read‐out procedure established, the nearly uniform energy dependence found and the estimated uncertainties, the EBT3 film was concluded to be a suitable 2D dosimeter for measuring electron or mixed photon/electron dose distributions in water phantom. Uncertainties of 3.7% (k=2) for absolute and 2.3% (k=2) for relative dose were estimated. PACS numbers: 87.53.Bn, 87.55.K‐, 87.55.QrFor megavoltage photon radiation, the fundamental dosimetry characteristics of Gafchromic EBT3 film were determined in  60Co gamma ray beam with addition of experimental and Monte Carlo (MC)-simulated energy dependence of the film for 6 MV photon beam and 6 MeV, 9 MeV, 12 MeV, and 16 MeV electron beams in water phantom. For the film read-out, two phase correction of scanner sensitivity was applied: a matrix correction for scanning area and dose-dependent correction by iterative procedure. With these corrections, the uniformity of response can be improved to be within ±50 pixel values (PVs). To improve the read-out accuracy, a procedure with flipped film orientations was established. With the method, scanner uniformity can be improved further and dust particles, scratches and/or dirt on scanner glass can be detected and eliminated. Responses from red and green channels were averaged for read-out, which decreased the effect of noise present in values from separate channels. Since the signal level with the blue channel is considerably lower than with other channels, the signal variation due to different perturbation effects increases the noise level so that the blue channel is not recommended to be used for dose determination. However, the blue channel can be used for the detection of emulsion thickness variations for film quality evaluations with unexposed films. With electron beams ranging from 6 MeV to 16 MeV and at reference measurement conditions in water, the energy dependence of the EBT3 film is uniform within 0.5%, with uncertainties close to 1.6% (k=2). Including 6 MV photon beam and the electron beams mentioned, the energy dependence is within 1.1%. No notable differences were found between the experimental and MC-simulated responses, indicating negligible change in intrinsic energy dependence of the EBT3 film for 6 MV photon beam and 6 MeV-16 MeV electron beams. Based on the dosimetric characteristics of the EBT3 film, the read-out procedure established, the nearly uniform energy dependence found and the estimated uncertainties, the EBT3 film was concluded to be a suitable 2D dosimeter for measuring electron or mixed photon/electron dose distributions in water phantom. Uncertainties of 3.7% (k=2) for absolute and 2.3% (k=2) for relative dose were estimated. PACS numbers: 87.53.Bn, 87.55.K-, 87.55.Qr.

Computational study of the required dimensions for standard sized phantoms in boron neutron capture therapy dosimetry

The minimum size of a water phantom used for calibration of an epithermal neutron beam of the boron neutron capture therapy (BNCT) facility at the VTT FiR 1 research reactor is studied by Monte Carlo simulations. The criteria for the size of the phantom were established relative to the neutron and photon radiation fields present at the thermal neutron fluence maximum in the central beam axis (considered as the reference point). At the reference point, for the most commonly used beam aperture size at FiR 1 (14 cm diameter), less than 1% disturbance of the neutron and gamma radiation fields in a phantom were achieved with a minimum a 30 cm x 30 cm cross section of the phantom. For the largest 20 cm diameter beam aperture size, a minimum 40 cm x 40 cm cross-section of the phantom and depth of 20 cm was required to achieve undisturbed radiation field. This size can be considered as the minimum requirement for a reference phantom for dosimetry at FiR 1. The secondary objective was to determine the phantom dimensions for full characterization of the FiR 1 beam in a rectangular water phantom. In the water scanning phantom, isodoses down to the 5% level are measured for the verifications of the beam model in the dosimetric and treatment planning calculations. The dose distribution results without effects caused by the limited phantom size were achieved for the maximum aperture diameter (20 cm) with a 56 cm x 56 cm x 28 cm rectangular phantom. A similar approach to study the required minimum dimensions of the reference and water scanning phantoms can be used for epithermal neutron beams at the other BNCT facilities.