Khaled Soliman

In-Vivo Dosimetry Method for Measuring Peak Surface Dose Using Radiochromic Films during Computed Tomography Scanning of the Sinus

Purpose: During computed tomography (CT) helical scanning mode the patient surface dose distribution is assumed to be non-uniform, therefore point dose measurement methods may lead to imprecise estimation of the radiation dose received by the patient skin in particular. We have used XRQA2 films as in-vivo dosimeters to measure the entrance skin dose during sinus exams. Methods: The films were placed under the patient head rest in order to sample the entrance surface dose in-vivo. We have performed in-vivo film irradiation on 23 patients in this study to verify the clinical suitability of the method and were found adequate. Results: The measured average ESD in the sinus exam was 11.7 ± 1.0 mGy, the PSD was 15.7 ± 1.7 mGy and the CTDI(vol) was 13.3 ± 0.1 mGy. The ratio of ESD/CTDI(vol) and PSD/CTDI(vol) was 0.88 and 1.18 respectively. The results indicate that the scanner registered CTDI(vol) underestimates the PSD and in the same time it overestimates the ESD by 18% and 13.6% respectively. Conclusion: The observed differences between the ESD, PSD and CTDI(vol) although seem small for the radiation dose range measured during CT of the sinus [13.2 - 13.4] mGy, but important for the medical physicist to know, since monitoring of patients’ doses from CT examinations is becoming more mandatory. The use of radiochromic film as in-vivo dosimeter does not interfere with the clinical radiological exam and does not produce any image artifacts. The method can be used to study other CT examinations specially the ones with large beam width, high pitch factor and high dose exams. The method allows measurement of the peak skin dose, examination of the CT dose profile and the 2D dose distribution in the XZ plan.

Relationship between Patient-Dependent Parameters and Radiation Dose Rates Measured around Patients Undergoing PET/CT Imaging Using 18 F-FDG

Objectives: Patients undergoing 18F-FDG PET/CT imaging are considered external radiation sources. Accurate dose rate estimates are important for conducting realistic risk assessments and performing dose reconstruction in cases of accidental exposures. The patient radiation self-attenuation factor is assumed to be a function of the patient’s body size metrics, but we can use these metrics to predict the dose rate around the patients with accuracy. The objective of this work was first to measure the patient attenuation factor by performing direct dose rate measurements from patients undergoing PET/CT imaging studies using 18F-FDG. The second objective was to study the possible correlation between the measured dose rate constant per unit activity from the patients and their body size metrics; five metrics were tested in this work. The last objective was to measure the patients’ voiding factor. Methods: We have measured dose rates at one meter from 57 patients and noted the patient’s height (H), weight (W) and calculated patient size metrics namely: Equivalent Cylindrical Diameter (ECD), Equivalent Spherical Diameter (ESD) and the Body Mass Index (BMI). Results: The measured average dose rate was 92.2 ± 14 μSv·h-1·GBq-1 measured at one meter. Therefore, the dose rate constant of 92 μSv·h-1·GBq-1 proposed by the AAPM, TG-108 report is adequate for radiation protection purposes. There was no statistically significant correlation between the dose rate constant per unit activity and the patient body size metrics. We have measured a patient voiding factor of 0.89 ± 0.06 in comparison with 0.85 recommended by the AAPM. Conclusions: The presented data can be used by medical physicist working in nuclear medicine in formulating more accurate risk estimations resulting from radiation exposure from patients undergoing 18F-FDG PET/CT imaging.

Variability in the amount of fluorine-18 fluorodeoxyglucose excreted in urine measured from oncology patients during PET/computed tomography imaging.

The objectives of this work were to estimate the amount of fluorine-18 fluorodeoxyglucose (18F-FDG) excreted (AFE) in the patient urine during the uptake phase as percentage of the injected activity and to examine the effect of blood glucose levels (BGL) on the excreted amount and whether it varies among men and women using statistical analysis methods. Radiation dose rates were measured at 1 m from 50 patients, 24 men and 26 women, before and after the first void using a calibrated ionization chamber. The 18F-FDG was injected in the patients using a calibrated automatic dose injection system. Statistical analysis using hypothesis testing was carried out. Patients with BGL above 5 mmol/l had a higher AFE of 12.3% in comparison with 8.3% of the patients with BGL below 5 mmol/l. A statistically nonsignificant correlation (r=0.183, P<0.249) between AFE and BGL was found; a nonsignificant difference was found in the AFE measured among the male and female patients. The AFE measured was 12±6%, with a range of (2–30%). There was a wide variation in the first void time of 39±8 min, with a range of (17–68) min. A simple noninvasive measurement method is presented that enabled the estimation of the amount of 18F-FDG excreted from the patient during voiding. Statistical analysis concluded that the amount of 18F-FDG excreted does not depend on sex, but is perhaps influenced by BGL.

Effect of patient bladder voiding on radiation dose rates measured around patients undergoing PET/CT imaging using 18F-FDG

Accurate dose rate estimates is important for radiation protection specialists conducting risk assessments and performing dose reconstruction in cases of accidental exposures. Objectives: The objectives of this work was to experimentally evaluate the bladder voiding factor effect on the dose rate measured from patients undergoing PET/CT imaging studies using 18F-FDG by directly measuring the dose rate immediately before and after voiding, and compare the results with the current scientific literature. Results: The bladder voiding effect had a dose rate reduction factor of about 12% between dose rates measured before and after voiding. This measured reduction factor agreed with the 15% reported by the AAPM Task Group 108. We have also measured dose rates at one meter from 50 patients and found an average dose rate per unit activity of 93.7 μSv/hr/GBq. Our dose rate results were in excellent agreement with the results of current published data (92 μSv/hr/GBq, AAPM Task Group 108). Conclusions: The presented data can be applied in radiation protection optimization procedures, especially for the protection of the care givers from patients undergoing 18F-FDG PET/CT imaging when they are considered as external radiation source or hazard to others. The provided information will benefit medical physicist working in nuclear medicine and radiation safety policy makers.

Estimation of patient attenuation factor for iodine-131 based on direct dose rate measurements from radioiodine therapy patients.

The aim of the study was to measure the actual dose at 1 m from the patients per unit activity with the aim of providing a more accurate prediction of the dose levels around radioiodine patients in the hospital, as well as to compare our results with the literature. In this work the demonstration of a patient body tissue attenuation factor is verified by comparing the dose rates measured from the patients with those measured from the unshielded radioiodine capsules immediately after administration of the radioactivity. The normalized dose rate per unit activity is therefore proposed as an operational quantity that can be used to predict exposure rates to staff and patients’ relatives. The average dose rate measured from our patient per unit activity was 38.4±11.8 &mgr;Sv/h/GBq. The calculated attenuation correction factor based on our measurements was 0.55±0.17. The calculated dose rate from a radioiodine therapy patient should normally include a factor accounting for patient body tissue attenuation and scatter. The attenuation factor is currently neglected and not applied in operational radiation protection. Realistic estimation of radiation dose levels from radioiodine therapy patients when properly performed will reduce the operational cost and optimize institutional radiation protection practice. It is recommended to include patient attenuation factors in risk assessment exercises – in particular, when accurate estimates of total effective doses to exposed individuals are required when direct measurements are not possible. The information provided about patient attenuation might benefit radiation protection specialists and regulators.

Effect of patient? bladder voiding and body self attenuation on measured dose rates around patients undergoing PET/CT imaging using 18F-FDG

A new holistic paradigm is proposed for slowing our genomic-based biological clocks (e.g. regulation of telomere length), and decreasing heat energy exigencies for maintenance of physiologic homeostasis. Aging is considered the result of a progressive slow burn in small volumes of tissues with increase in the quantum entropic states; producing desiccation, microscopic scarring, and disruption of cooperative coherent states. Based upon piezoelectricity, i.e. photon-phonon transductions, physiologic PicoTesla range magnetic fields may decrease the production of excessive heat energy through target specific, bio molecular resonant interactions, renormalization of intrinsic electromagnetic tissue profiles, and autonomic modulation.Background: Management of spinal neoplasms has relied on open surgery and external beam radiotherapy (EBRT). Although primary spinal tumors are rare, their treatment remains a pervasive problem. This analysis sought to evaluate the safety and efficacy of CT-guided 125 I seed brachytherapy for recurrent paraspinous and vertebral primary tumors. Methods: From November 2002 to June 2014, 17 patients who met the inclusion criteria were retrospectively reviewed. 14 (82.4%) had previously undergone surgery, 15 (88.2%) had received conventional EBRT and 3 (17.6%) had chosen chemotherapy. The number of 125 I seeds implanted ranged from 7 to 122 (median 79) with specific activity of 0.5-0.8 mCi (median 0.7 mCi). The post-plan showed that the actuarial D90 of 125 I seeds were 90–183 Gy (median 137 Gy). The follow-up period ranged from 2 to 69 months (median 19 months). The local control rate was calculated by the Kaplan-Meier method. Results: For 5 Chondrosarcomas, the 1-, 2-, 3-year local control rates were 75%, 37.5%, and 37.5%, respectively, with a median of 34 months (range, 4–39 months). For 4 chordomas, the local control rate was 50% with a median follow-up of 13 months (range, 3–17 months). For 3 fibromatosis, all of them were survival without local recurrence at the end of follow-up. During the follow-up period, 35.3% (6/17) died from metastases, 17.6% (3/17) developed local recurrence by 8, 14 and 34 months while 64.7% (11/17) remained alive. 100% experienced pain relief and normal or improved ambulation, without more than Frankel grade 3 radiation myelopathy. Conclusions: Percutaneous 125 I seed implantation can be an alternative or retreatment for recurrent spinalBackground: Malaria is a major public health issue in Ethiopia in terms of both morbidity and mortality, with about 4-5 million Ethiopians affected each year. Because malaria is a serious problem and has severe health and economic burden, it is important to apply methods that will help understand influencing factors. Therefore, this study considers modelling of the dependence of malaria cases on spatial determinants and socio-economic, demographic and geographic variables.Objectives: Intraoperative radiation therapy (IORT) is an innovative treatment modality that the delivery of a large single dose of radiation to the tumor bed during the surgery. The radiotherapy success depends on the absorbed dose delivered to the tumor. The achievement better accuracy in patient treatment depends upon the measured dose by standard dosimeter such as ionization chamber, but because of the high density of electric charge/pulse produced by the accelerator in the ionization chamber volume, the standard correction factor for ion recombination ksat calculated with the classic two-voltage method is overestimated so the use of dose/pulse independent dosimeters such as chemical Fricke and ethanol chlorobenzene (ECB) dosimeters has been suggested.Background: More accurate characterization of coronary artery lesions is needed for evaluation of short and long term interventions in coronary disease. Recently, a method of coronary artery analysis has been done by quantitative coronary artery (QCA) and intravascular ultra sound imaging (IVUS). But three-dimensional (3D) QCA provides more accurate measurements by minimizing inherent limitations of two-dimensional (2D) QCA and IVUS. The aim of this study was to compare the measurements of stent length between 2D QCA, IVUS and 3D QCA.