H. Delis

Modeling granular phosphor screens by Monte Carlo methods

The intrinsic phosphor properties are of significant importance for the performance of phosphor screens used in medical imaging systems. In previous analytical-theoretical and Monte Carlo studies on granular phosphor materials, values of optical properties, and light interaction cross sections were found by fitting to experimental data. These values were then employed for the assessment of phosphor screen imaging performance. However, it was found that, depending on the experimental technique and fitting methodology, the optical parameters of a specific phosphor material varied within a wide range of values, i.e., variations of light scattering with respect to light absorption coefficients were often observed for the same phosphor material. In this study, x-ray and light transport within granular phosphor materials was studied by developing a computational model using Monte Carlo methods. The model was based on the intrinsic physical characteristics of the phosphor. Input values required to feed the model can be easily obtained from tabulated data. The complex refractive index was introduced and microscopic probabilities for light interactions were produced, using Mie scattering theory. Model validation was carried out by comparing model results on x-ray and light parameters (x-ray absorption, statistical fluctuations in the x-ray to light conversion process, number of emitted light photons, output light spatial distribution) with previous published experimental data on Gd2O2S: Tb phosphor material (Kodak Min-R screen). Results showed the dependence of the modulation transfer function (MTF) on phosphor grain size and material packing density. It was predicted that granular Gd2O2S: Tb screens of high packing density and small grain size may exhibit considerably better resolution and light emission properties than the conventional Gd2O2S: Tb screens, under similar conditions (x-ray incident energy, screen thickness).

Patient and staff dosimetry in vertebroplasty.

Study Design. Eleven vertebroplasty operations were studied in terms of radiation dose. Objective. Doses to patients and staff associated with vertebroplasty were measured. Occupational doses were compared with the annual dose limits, and the effectiveness of the used radiation protection means was estimated. Patient dose was estimated by means of both surface and effective dose, and the radiation-induced risk was evaluated. Summary of Background Data. Vertebroplasty is a recent minimally invasive technique for the restoration of vertebral body fractures. It involves fluoroscopic exposure, and so, it demands dose measurements for both patient and staff exposed to radiation. Methods. Thermoluminescent dosimeters (TLDs) were placed on the medical personnel and the effective dose was derived. Slow films were placed to patients’ skin to measure entrance surface dose. Furthermore, a Rando phantom loaded with TLDs was irradiated under conditions simulating vertebroplasty, in order to estimate effective dose to the patient. Results. Mean fluoroscopy time was 27.7 minutes. Patient’s mean skin dose was 688 mGy, while effective dose was calculated to be 34.45 mGy. It was estimated that the primary operator can perform about 150 vertebroplasty operations annually without exceeding the annual dose constraints, whereas occupational dose can be reduced by 76% using mobile shielding. Conclusions. Measures have to be taken to reduce patient’s skin dose, which, in extreme cases, may be close to deterministic effects threshold. The highest dose rates, recorded during the procedure, were found for primary operator’s hands and chest when no shielding was used.

Suitability of new anode materials in mammography: Dose and subject contrast considerations using Monte Carlo simulation

Mammography is the technique with the highest sensitivity and specificity, for the early detection of nonpalpable lesions associated with breast cancer. As screening mammography refers to asymptomatic women, the task of optimization between the image quality and the radiation dose is critical. A way toward optimization could be the introduction of new anode materials. A method for producing the x-ray spectra of different anode/filter combinations is proposed. The performance of several mammographic spectra, produced by both existing and theoretical anode materials, is evaluated, with respect to their dose and subject contrast characteristics, using a Monte Carlo simulation. The mammographic performance is evaluated utilizing a properly designed mathematical phantom with embedded inhomogeneities, irradiated with different spectra, based on combinations of conventional and new (Ru, Ag) anode materials, with several filters (Mo, Rh, Ru, Ag, Nb, Al). An earlier developed and validated Monte Carlo model, for deriving both image and dose characteristics in mammography, was utilized and overall performance results were derived in terms of subject contrast to dose ratio and squared subject contrast to dose ratio. Results demonstrate that soft spectra, mainly produced from Mo, Rh, and Ru anodes and filtered with k-edge filters, provide increased subject contrast for inhomogeneities of both small size, simulating microcalcifications and low density, simulating masses. The harder spectra (W and Ag anode) come short in the discrimination task but demonstrate improved performance when considering the dose delivered to the breast tissue. As far as the overall performance is concerned, new theoretical spectra demonstrate a noticeable good performance that is similar, and in some cases better compared to commonly used systems, stressing the possibility of introducing new materials in mammographic practice as a possible contribution to its optimization task. In the overall optimization task in terms of subject contrast to dose ratio, tube voltage was found to have a minor effect, while with respect to the filter material, a lesion specific performance was noticed, with Al filtered spectra showing improved characteristics in case of the inhomogeneities simulating microcalcifications, while softer k-edge filtered spectra are more suitable for the discrimination of inhomogeneities simulating masses.

Monte Carlo study on the imaging performance of powder Lu2SiO5:Ce phosphor screens under x-ray excitation: comparison with Gd2O2S:Tb screens.

Lu2SiO5: Ce (LSO) scintillator is a relatively new luminescent material which has been successfully applied in positron emission tomography systems. Since it has been recently commercially available in powder form, it could be of value to investigate its performance for use in x-ray projection imaging as both physical and scintillating properties indicate a promising material for such applications. In the present study, a custom and validated Monte Carlo simulation code was used in order to examine the performance of LSO, under diagnostic radiology (mammography and general radiography) conditions. The Monte Carlo code was based on a model using Mie scattering theory for the description of light attenuation. Imaging characteristics, related to image brightness, spatial resolution and noise of LSO screens were predicted using only physical parameters of the phosphor. The overall performance of LSO powder phosphor screens was investigated in terms of the: (i) quantum detection efficiency (ii) emitted K-characteristic radiation (iii) luminescence efficiency (iv) modulation transfer function (v) Swank factor and (vi) zero-frequency detective quantum efficiency [DQE(0)]. Results were compared to the traditional rare-earth Gd2O2S:Tb (GOS) phosphor material. The relative luminescence efficiency of LSO phosphor was found inferior to that of GOS. This is due to the lower intrinsic conversion efficiency of LSO (0.08 instead of 0.15 of GOS) and the relatively high light extinction coefficient mext of this phosphor (0.239 mircom(-1) instead of 0.218 /microm(-1) for GOS). However, the property of increased light extinction combined with the rather sharp angular distribution of scattered light photons (anisotropy factor g=0.624 for LSO instead of 0.494 for GOS) reduce lateral light spreading and improve spatial resolution. In addition, LSO screens were found to exhibit better x-ray absorption as well as higher signal to noise transfer properties in the energy range from 18 keV up to 50.2 keV (e.g. DQE(0)=0.62 at 18 keV and for 34 mg/cm2, instead of 0.58 for GOS). The results indicate that certain optical properties of LSO (optical extinction coefficient, scattering anisotropy factor) combined with the relatively high x-ray coefficients, make this material a promising phosphor which, under appropriate conditions, could be considered for use in x-ray projection imaging detectors.

Dosimetry during intramedullary nailing of the tibia.

Background Intramedullary nailing under fluoroscopic guidance is a common operation. We studied the intraoperative radiation dose received by both the patient and the personnel. Patients and methods 25 intramedullary nailing procedures of the tibia were studied. All patients suffered from tibial fractures and were treated using the Grosse-Kempf intramedullary nail, with free-hand technique for fixation of the distal screws, under fluoroscopic guidance. The exposure, at selected positions, was recorded using an ion chamber, while the dose area product (DAP) was measured with a DAP meter, attached to the tube head. Thermoluminescent dosimeters (TLDs) were used to derive the occupational dose to the personnel, and also to monitor the surface dose on the gonads of some of the patients. Results The mean operation time was 101 (48–240) min, with a mean fluoroscopic time of 72 seconds and a mean DAP value of 75 cGy·cm2. The surface dose to the gonads of the patients was less than 8.8 mGy during any procedure, and thus cannot be considered to be a contraindication for the use of this technique. Occupational dose differed substantially between members of the operating personnel, the maximum dose recorded being to the operator of the fluoroscopic equipment (0.11 mSv). Interpretation Our findings underscore the care required by the primary operator not to exceed the dose constraint of 10 mSv per year. The rest of the operating personnel, although they do not receive very high doses, should focus on the dose optimization of the technique.

Monte Carlo generated conversion factors for the estimation of average glandular dose in contact and magnification mammography

Magnification mammography is a special technique used in the cases where breast complaints are noted by a woman or when an abnormality is found in a screening mammogram. The carcinogenic risk in mammography is related to the dose deposited in the glandular tissue of the breast rather than the adipose, and average glandular dose (AGD) is the quantity taken into consideration during a mammographic examination. Direct measurement of the AGD is not feasible during clinical practice and thus, the incident air KERMA on the breast surface is used to estimate the glandular dose, with the help of proper conversion factors. Additional conversion factors adapted for magnification and tube voltage are calculated, using Monte Carlo simulation. The effect of magnification degree, tube voltage, various anode/filter material combinations and glandularity on AGD is also studied, considering partial breast irradiation. Results demonstrate that the estimation of AGD utilizing conversion factors depends on these parameters, while the omission of correction factors for magnification and tube voltage can lead to significant underestimation or overestimation of AGD. AGD was found to increase with filter materials k-absorption edge, anode materials k-emission edge, tube voltage and magnification. Decrease of the glandularity of the breast leads to higher AGD due to the increased penetrating ability of the photon beam in thick breasts with low glandularity.

Monte Carlo studies on the influence of focal spot size and intensity distribution on spatial resolution in magnification mammography

Magnification is a special technique applied in mammography in cases where breast complaints have already been noticed, aiming to examine a specific area of the breast. Small-sized focal spots are essential in such techniques in order to reduce the resultant geometrical unsharpness. The x-ray intensity distribution of the focal spot is another crucial parameter for such a technique as it affects the mammographic resolution. In this study a Monte Carlo simulation model is utilized, in order to examine the effect of a wide range of focal spot sizes and three representative intensity distributions on spatial resolution under magnification. A thick sharp edge consisting of lead, non-transparent to x-rays was imaged under various conditions for this purpose, and the corresponding spatial resolution was calculated through the modulation transfer function (MTF). Results demonstrate that focal spots larger than 0.10 mm can mainly be used for low degrees of magnification, especially when combined with double peak Gaussian intensity distribution of the focal spot (sum of two single peak Gaussian distributions with different centers), as the resultant spatial resolution is not as high as the corresponding from smaller foci or uniform and single peak Gaussian distributions. Moreover, for the degrees of magnification usually utilized in clinical practice they do not reach the acceptable limit of 12 lp mm(-1). The replacement of the x-ray tube when the focal spot starts being destroyed is very crucial as the possible alteration of single peak Gaussian distribution to double peak Gaussian results in the degradation of spatial resolution. A focal spot of 0.10 mm or smaller, combined with single peak Gaussian intensity distribution, can be considered appropriate even for higher degrees of magnification and its use can contribute in the effort to optimize the magnification views in mammography.

Contrast-to-noise ratio in magnification mammography: a Monte Carlo study

Magnification views are a common way to perform a secondary examination when suspicious abnormalities are found in a screening mammogram. The visibility of microcalcifications and breast lesions is restricted by the compromise between the image quality and the absorbed dose. In this study, image quality characteristics in magnification mammography were evaluated based on Monte Carlo techniques. A breast phantom was utilized, simulating a homogeneous mixture of adipose and glandular tissue in various percentages of glandularity, containing inhomogeneities of various sizes and compositions. The effect of the magnification degree, breast glandularity, tube voltage and anode/filter material combination on image quality characteristics was investigated in terms of a contrast-to-noise ratio (CNR). A performance index PI(nu) was introduced in order to study the overall performance of various anode/filter combinations under different exposure parameters. Results demonstrate that CNR is improved with the degree of magnification and degraded as the breast glandularity is increased. Degree of magnification 1.3 offers the best overall performance for most of the anode/filter combinations utilized. Under magnification conditions, the role of dose is demoted against the image quality, as magnification views are secondary, diagnostic examinations and not screening procedures oriented to non-symptomatic women. For decreased image quality weighting, some anode/filter combinations different from Mo/0.030 mmMo can be utilized as they offer a similar performance index. However, if the desired weighting for the image quality is high, the Mo/0.030 mmMo combination has the best overall performance.

Peripheral doses in patients undergoing Cyberknife treatment for intracranial lesions. A single centre experience

BackgroundStereotactic radiosurgery/radiotherapy procedures are known to deliver a very high dose per fraction, and thus, the corresponding peripheral dose could be a limiting factor for the long term surviving patients. The aim of this clinical study was to measure the peripheral dose delivered to patients undergoing intracranial Cyberknife treatment, using the MOSFET dosimeters. The influence of the supplemental shielding, the number of monitor units and the collimator size to the peripheral dose were investigated.MethodsMOSFET dosimeters were placed in preselected anatomical regions of the patient undergoing Cyberknife treatment, namely the thyroid gland, the nipple, the umbilicus and the pubic symphysis.ResultsThe mean peripheral doses before the supplemental shielding was added to the Cyberknife unit were 51.79 cGy, 13.31 cGy and 10.07 cGy while after the shielding upgrade they were 38.40 cGy, 10.94 cGy, and 8.69 cGy, in the thyroid gland, the umbilicus and the pubic symphysis, respectively. The increase of the collimator size corresponds to an increase of the PD and becomes less significant at larger distances, indicating that at these distances the PD is predominate due to the head leakage and collimator scatter.ConclusionWeighting the effect of the number of monitor units and the collimator size can be effectively used during the optimization procedure in order to choose the most suitable treatment plan that will deliver the maximum dose to the tumor, while being compatible with the dose constraints for the surrounding organs at risk. Attention is required in defining the thyroid gland as a structure of avoidance in the treatment plan especially in patients with benign diseases.

Peripheral dose measurement in high-energy photon radiotherapy with the implementation of MOSFET

AIM To study the peripheral dose (PD) from high-energy photon beams in radiotherapy using the metal oxide semiconductor field effect transistor (MOSFET) dose verification system. METHODS The radiation dose absorbed by the MOSFET detector was calculated taking into account the manufacturers Correction Factor, the Calibration Factor and the threshold voltage shift. PD measurements were carried out for three different field sizes (5 cm × 5 cm, 10 cm × 10 cm and 15 cm × 15 cm) and for various depths with the source to surface distance set at 100 cm. Dose measurements were realized on the central axis and then at distances (1 to 18 cm) parallel to the edge of the field, and were expressed as the percentage PD (% PD) with respect to the maximum dose (d(max)). The accuracy of the results was evaluated with respect to a calibrated 0.3 cm(3) ionization chamber. The reproducibility was expressed in terms of standard deviation (s) and coefficient of variation. RESULTS % PD is higher near the phantom surface and drops to a minimum at the depth of d(max), and then tends to become constant with depth. Internal scatter radiation is the predominant source of PD and the depth dependence is determined by the attenuation of the primary photons. Closer to the field edge, where internal scatter from the phantom dominates, the % PD increases with depth because the ratio of the scatter to primary increases with depth. A few centimeters away from the field, where collimator scatter and leakage dominate, the % PD decreases with depth, due to attenuation by the water. The % PD decreases almost exponentially with the increase of distance from the field edge. The decrease of the % PD is more than 60% and can reach up to 90% as the measurement point departs from the edge of the field. For a given distance, the % PD is significantly higher for larger field sizes, due to the increase of the scattering volume. Finally, the measured PD obtained with MOSFET is higher than that obtained with an ionization chamber with percentage differences being from 0.6% to 34.0%. However, when normalized to the central d(max) this difference is less than 1%. The MOSFET system, in the early stage of its life, has a dose measurement reproducibility of within 1.8%, 2.7%, 8.9% and 13.6% for 22.8, 11.3, 3.5 and 1.3 cGy dose assessments, respectively. In the late stage of MOSFET life the corresponding values change to 1.5%, 4.8%, 11.1% and 29.9% for 21.8, 2.9, 1.6 and 1.0 cGy, respectively. CONCLUSION Comparative results acquired with the MOSFET and with an ionization chamber show fair agreement, supporting the suitability of this measurement for clinical in vivo dosimetry.