Colin J. Martin

A review of radiology staff doses and dose monitoring requirements

Studies of radiation doses received during X-ray procedures by radiology, cardiology and other clinical staff have been reviewed. Data for effective dose (E), and doses to the eyes, thyroid, hands and legs have been analysed. These data have been supplemented with local measurements to determine the most exposed part of the hand for monitoring purposes. There are ranges of 60-100 in doses to individual tissues reported in the literature for similar procedures at different centres. While ranges in the doses per unit dose-area product (DAP) are between 10 and 25, large variations in dose result from differences in the sensitivity of the X-ray equipment, the type of procedure and the operator technique, but protection factors are important in maintaining dose levels as low as possible. The influence of shielding devices is significant for determining the dose to the eyes and thyroid, and the position of the operator, which depends on the procedure, is the most significant factor determining doses to the hands. A second body dosemeter worn at the level of the collar is recommended for operators with high workloads for use in assessment of effective dose and the dose to the eye. It is proposed that the third quartile values from the distributions of dose per unit DAP identified in the review might be employed in predicting the orders of magnitude of doses to the eye, thyroid and hands, based on interventional operator workloads. Such dose estimates could be employed in risk assessments when reviewing protection and monitoring requirements. A dosemeter worn on the little finger of the hand nearest to the X-ray tube is recommended for monitoring the hand.

Radiation dosimetry for diagnostic medical exposures

The number and complexity of medical procedures using X rays or radioactive materials are both steadily increasing. As a result, the dose from medical exposures now makes up the largest component of the radiation dose to the population in some developed countries. Key developments include the change from film to digital radiography, the increasing sophistication of interventional radiology allowing more complex procedures and the speed and facilities available with multi-slice computed tomography scanners that have extended the range of applications. It is crucial to have accurate dosimetry to monitor the impact of these developments, to ensure that techniques are optimised, and to provide information on health risk that clinicians can consider when justifying exposures. There are two aspects to dosimetry in radiology, assessment of doses to patients and measurement of equipment performance. The techniques that are used will be described, factors that influence doses and that must be considered when making measurements will be discussed, and future developments will be considered.

Personal dosimetry for interventional operators: when and how should monitoring be done?

OBJECTIVE Assessment of the potential doses to the hands and eyes for interventional radiologists and cardiologists can be difficult. A review of studies of doses to interventional operators reported in the literature has been undertaken. METHODS Distributions for staff dose to relevant parts of the body per unit dose-area product and for doses per procedure in cardiology have been analysed and mean, median and quartile values derived. The possibility of using these data to provide guidance for estimation of likely dose levels is considered. RESULTS Dose indicator values that could be used to predict orders of magnitude of doses to the eye, thyroid and hands from interventional operator workloads have been derived, based on the third quartile values, from the distributions of dose results analysed. CONCLUSION Dose estimates made in this way could be employed in risk assessments when reviewing protection and monitoring requirements. Data on the protection provided by different shielding and technique factors have also been reviewed to provide information for risk assessments. Recommendations on the positions in which dosemeters are worn should also be included in risk assessments, as dose measurements from suboptimal dosemeter use can be misleading.

ICRP Publication 113. Education and training in radiological protection for diagnostic and interventional procedures.

Abstract Guest editorial Preface Summary of recommendations Introduction The Healthcare professionals to be trained Priorities in topics to be included in the training Training opportunities and suggested methodologies Certification of training Annex A - Examples of suggested content for training courses Annex B - Outline of specific educational objectives for paediatric radiology Annex C - Example of some sources of training material Annex D - References containing information of interest for the present report

A study of the directional response of ultraviolet radiometers: I. Practical evaluation and implications for ultraviolet measurement standards

The directional responses of a range of ultraviolet radiometers commonly used for irradiance measurements of UVB and UVC have been studied. Radiometers with 24 diffuser/filter combinations were assessed using a deuterium source, and three different diffuser/filter designs were assessed using a monochromatic source. The directional responses of the radiometers have been calculated and expressed in terms of figures of merit similar to those described for (photopic) illuminance meters in BS 667 and CIE 69. Those radiometers that performed best for the measurement of both small and extended sources of UVB and UVC had raised PTFE diffusers. We conclude that UV radiometers with a directional response error f2 < 10% are readily available commercially, and that it would be appropriate for future ultraviolet standards to set an upper limit of 5% on f2. This would ensure that the overall uncertainty in irradiance measurements of extended ultraviolet sources is not dominated by the error in the directional response of the radiometer.

Practical radiation protection in healthcare

PART I - IONISING RADIATIONS: HAZARDS, DETECTION AND MEASUREMENT 1. The development of radiation protection 2. Interaction of ionising radiations with matter 3. Biological effects of ionising radiation 4. Radiation measurements PART II - PROTECTION AGAINST IONISING RADIATION 5. Ionising radiation legislation 6. Principles on control methods 7. Operational radiation protection 8. Personal monitoring 9. Control of radioactive substances 10. Intervention, incidents and emergencies PART III - IONISING RADIATIONS IN MEDICINE AND RESEARCH 11. Risk control in medical exposures 12. Diagnostic radiology: equipment 13. Diagnostic radiology: facility 14. Diagnostic radiology: patient dosimetry 15. Nuclear medicine and radionuclide laboratories 16. The nuclear medicine patient 17. Radiotherapy: external beam therapy 18. Radiotherapy: brachytherapy PART IV - NON-IONISING RADIATIONS 19. Lasers 20. Non-coherant optical radiation sources 21. Electromagnetic fields 22. Ultrasound

An assessment of the efficiency of methods for measurement of the computed tomography dose index (CTDI) for cone beam (CBCT) dosimetry by Monte Carlo simulation

The IEC has introduced a practical approach to overcome shortcomings of the CTDI100 for measurements on wide beams employed for cone beam (CBCT) scans. This study evaluated the efficiency of this approach (CTDIIEC) for different arrangements using Monte Carlo simulation techniques, and compared CTDIIEC to the efficiency of CTDI100 for CBCT. Monte Carlo EGSnrc/BEAMnrc and EGSnrc/DOSXYZnrc codes were used to simulate the kV imaging system mounted on a Varian TrueBeam linear accelerator. The Monte Carlo model was benchmarked against experimental measurements and good agreement shown. Standard PMMA head and body phantoms with lengths 150, 600, and 900 mm were simulated. Beam widths studied ranged from 20-300 mm, and four scanning protocols using two acquisition modes were utilized. The efficiency values were calculated at the centre (εc) and periphery (εp) of the phantoms and for the weighted CTDI (εw). The efficiency values for CTDI100 were approximately constant for beam widths 20-40 mm, where εc(CTDI100), εp(CTDI100), and εw(CTDI100) were 74.7  ±  0.6%, 84.6  ±  0.3%, and 80.9  ±  0.4%, for the head phantom and 59.7  ±  0.3%, 82.1  ±  0.3%, and 74.9  ±  0.3%, for the body phantom, respectively. When beam width increased beyond 40 mm, ε(CTDI100) values fell steadily reaching ~30% at a beam width of 300 mm. In contrast, the efficiency of the CTDIIEC was approximately constant over all beam widths, demonstrating its suitability for assessment of CBCT. εc(CTDIIEC), εp(CTDIIEC), and εw(CTDIIEC) were 76.1  ±  0.9%, 85.9  ±  1.0%, and 82.2  ±  0.9% for the head phantom and 60.6  ±  0.7%, 82.8  ±  0.8%, and 75.8  ±  0.7%, for the body phantom, respectively, within 2% of ε(CTDI100) values for narrower beam widths. CTDI100,w and CTDIIEC,w underestimate CTDI∞,w by ~55% and ~18% for the head phantom and by ~56% and ~24% for the body phantom, respectively, using a clinical beam width 198 mm. The CTDIIEC approach addresses the dependency of efficiency on beam width successfully and correction factors have been derived to allow calculation of CTDI∞.

A study of the directional response of ultraviolet radiometers: II. Implications for ultraviolet phototherapy derived from computer simulations

A theoretical model has been used to simulate irradiances for ultraviolet (UV) phototherapy cabinets and other sources. The accuracy of the simulation results has been checked by comparison with experimental measurements. The simulations have been used to study the influence of different factors on UV phototherapy exposure and to develop recommendations for the operation and calibration of phototherapy cabinets. Many radiometers used in the evaluation of skin doses have input optics with directional responses that are not proportional to the cosine of the angle of incidence for the UV radiation. Data on radiometer directional responses have been incorporated into the simulations, which show that the poor directional responses for some radiometers currently in use will give errors of 20-50% in the assessment of irradiance. The influence of lamp source geometries employed for radiometer calibration has been investigated. UV phototherapy dosimetry commonly uses a spectroradiometer and a radiometer in the transfer of irradiance calibrations from a small standard UV lamp to a large-area source with a different UV spectrum. Recommendations are given on the range of acceptability for radiometer directional responses and a method is described for determining whether these are fulfilled. Recommendations are made on the techniques that should be used for calibration.

The importance of radiometer angular response for ultraviolet phototherapy dosimetry.

The influence of the angular response of radiometer probes on measurements of irradiance in ultraviolet phototherapy has been studied. Irradiance measurements were made using nine ultraviolet (UV) radiometers employed by phototherapy centres in Scotland and Northern Ireland, and compared with measurements made using two spectroradiometers. The light sources used were UVB TL01 fluorescent lamps, arranged in different geometries. Irradiances within TL01 whole body treatment cabinets were assessed based on a comparison with one of the spectroradiometers. The results show variations of 50% in cabinet irradiance measurements made by different radiometers, even when they were calibrated using the same source geometry and spectroradiometer. Differences in radiometer probe design and construction lead to an under- or over-response at angles of incidence greater than zero. Angular responses of different probes were assessed using banks of fluorescent lamps. The differences found are large enough to account for the variations in measurements of cabinet irradiance. The variations in irradiance measurements are significant in terms of planning and monitoring patient exposure during TL01 phototherapy. Accurate dosimetry can only be achieved if radiometer probes have a good cosine response and recommendations are made for better calibration techniques.

An automated dosimetry system for testing whole-body ultraviolet phototherapy cabinets.

A new technique is described for automated ultraviolet dosimetry within whole-body phototherapy cabinets. A dual-head detector system has been designed, permitting simultaneous assessment of irradiance levels and radiant intensities from individual lamps. One detector is used in combination with a diffuser/filter system for the measurement of irradiance and the other is mounted at the end of a slit collimator to provide a measurement which can be related to the radiant intensities of the individual lamps. These quantities are derived from 800 separate measurements made during rotation of the detector head around a 360 degrees circle at a fixed height and position within the cabinet under remote computer software control. The device has advantages compared with standard techniques, enabling measurements to be made without the need for a person to be present in the cabinet. A full set of measurements is made with minimal switching of the power supply to the lamps. This simplifies the assessment and reduces the uncertainty from variation in output after the lamps are switched on. Variations in irradiance with orientation for the smaller phototherapy cabinets are clearly demonstrated. Plots of data from the collimated detector show peaks corresponding to the lamps and the surrounding reflectors. The plots enable failed lamps to be detected and peak values can be related to radiant intensities of individual lamps.