R Kramer

MAX06 and FAX06: update of two adult human phantoms for radiation protection dosimetry.

The International Commission on Radiological Protection (ICRP) is currently preparing new recommendations which will replace those released in ICRP 1991, 1990 Recommendations of the ICRP ICRP Publication 60 (Oxford: Pergamon). The draft report previews a change for the effective dose with respect to the number of organs and tissues to be included in its calculation. In the future, adipose tissue, connective tissue, the extrathoracic airways, the gall bladder, the heart wall, the lymphatic nodes, the prostate and the salivary glands have to be taken into account for the determination of the effective dose. This study reports on a second segmentation of the recently introduced male adult voxel (MAX) and female adult voxel (FAX) phantoms with regard to the new organs and tissues, but also presents a revised representation of the skeletons, which had not been adjusted to ICRP-based volumes in the first release of the two phantoms.

FASH and MASH: female and male adult human phantoms based on polygon mesh surfaces: I. Development of the anatomy

Among computational models, voxel phantoms based on computer tomographic (CT), nuclear magnetic resonance (NMR) or colour photographic images of patients, volunteers or cadavers have become popular in recent years. Although being true to nature representations of scanned individuals, voxel phantoms have limitations, especially when walled organs have to be segmented or when volumes of organs or body tissues, like adipose, have to be changed. Additionally, the scanning of patients or volunteers is usually made in supine position, which causes a shift of internal organs towards the ribcage, a compression of the lungs and a reduction of the sagittal diameter especially in the abdominal region compared to the regular anatomy of a person in the upright position, which in turn can influence organ and tissue absorbed or equivalent dose estimates. This study applies tools developed recently in the areas of computer graphics and animated films to the creation and modelling of 3D human organs, tissues, skeletons and bodies based on polygon mesh surfaces. Female and male adult human phantoms, called FASH (Female Adult meSH) and MASH (Male Adult meSH), have been designed using software, such as MakeHuman, Blender, Binvox and ImageJ, based on anatomical atlases, observing at the same time organ masses recommended by the International Commission on Radiological Protection for the male and female reference adult in report no 89. 113 organs, bones and tissues have been modelled in the FASH and the MASH phantoms representing locations for adults in standing posture. Most organ and tissue masses of the voxelized versions agree with corresponding data from ICRP89 within a margin of 2.6%. Comparison with the mesh-based male RPI_AM and female RPI_AF phantoms shows differences with respect to the material used, to the software and concepts applied, and to the anatomies created.

FASH and MASH: female and male adult human phantoms based on polygon mesh surfaces: II. Dosimetric calculations

Female and male adult human phantoms, called FASH (Female Adult meSH) and MASH (Male Adult meSH), have been developed in the first part of this study using 3D animation software and anatomical atlases to replace the image-based FAX06 and the MAX06 voxel phantoms. 3D modelling methods allow for phantom development independent from medical images of patients, volunteers or cadavers. The second part of this study investigates the dosimetric implications for organ and tissue equivalent doses due to the anatomical differences between the new and the old phantoms. These differences are mainly caused by the supine position of human bodies during scanning in order to acquire digital images for voxel phantom development. Compared to an upright standing person, in image-based voxel phantoms organs are often coronally shifted towards the head and sometimes the sagittal diameter of the trunk is reduced by a gravitational change of the fat distribution. In addition, volumes of adipose and muscle tissue shielding internal organs are sometimes too small, because adaptation of organ volumes to ICRP-based organ masses often occurs at the expense of general soft tissues, such as adipose, muscle or unspecified soft tissue. These effects have dosimetric consequences, especially for partial body exposure, such as in x-ray diagnosis, but also for whole body external exposure and for internal exposure. Using the EGSnrc Monte Carlo code, internal and external exposure to photons and electrons has been simulated with both pairs of phantoms. The results show differences between organ and tissue equivalent doses for the upright standing FASH/MASH and the image-based supine FAX06/MAX06 phantoms of up to 80% for external exposure and up to 100% for internal exposure. Similar differences were found for external exposure between FASH/MASH and REGINA/REX, the reference voxel phantoms of the International Commission on Radiological Protection. Comparison of effective doses for external photon exposure showed good agreement between FASH/MASH and REGINA/REX, but large differences between FASH/MASH and the mesh-based RPI_AM and the RPI_AF phantoms, developed at the Rensselaer Polytechnic Institute (RPI).

MAX meets ADAM: a dosimetric comparison between a voxel-based and a mathematical model for external exposure to photons

The International Commission on Radiological Protection intends to revise the organ and tissue equivalent dose conversion coefficients published in various reports. For this purpose the mathematical human medical internal radiation dose (MIRD) phantoms, actually in use, have to be replaced by recently developed voxel-based phantoms. This study investigates the dosimetric consequences, especially with respect to the effective male dose, if not only a MIRD phantom is replaced by a voxel phantom, but also if the tissue compositions and the radiation transport codes are changed. This task will be resolved by systematically replacing in the mathematical ADAM/GSF exposure model, first the radiation transport code, then the tissue composition and finally the phantom anatomy, in order to arrive at the voxel-based MAX/EGS4 exposure model. The results show that the combined effect of these replacements can decrease the effective male dose by up to 25% for external exposures to photons for incident energies above 30 keV for different field geometries, mainly because of increased shielding by a heterogeneous skeleton and by the overlying adipose and muscle tissue, and also because of the positions internal organs have in a realistically designed human body compared to their positions in the mathematically constructed phantom.

Standing adult human phantoms based on 10th, 50th and 90th mass and height percentiles of male and female Caucasian populations.

Computational anthropomorphic human phantoms are useful tools developed for the calculation of absorbed or equivalent dose to radiosensitive organs and tissues of the human body. The problem is, however, that, strictly speaking, the results can be applied only to a person who has the same anatomy as the phantom, while for a person with different body mass and/or standing height the data could be wrong. In order to improve this situation for many areas in radiological protection, this study developed 18 anthropometric standing adult human phantoms, nine models per gender, as a function of the 10th, 50th and 90th mass and height percentiles of Caucasian populations. The anthropometric target parameters for body mass, standing height and other body measures were extracted from PeopleSize, a well-known software package used in the area of ergonomics. The phantoms were developed based on the assumption of a constant body-mass index for a given mass percentile and for different heights. For a given height, increase or decrease of body mass was considered to reflect mainly the change of subcutaneous adipose tissue mass, i.e. that organ masses were not changed. Organ mass scaling as a function of height was based on information extracted from autopsy data. The methods used here were compared with those used in other studies, anatomically as well as dosimetrically. For external exposure, the results show that equivalent dose decreases with increasing body mass for organs and tissues located below the subcutaneous adipose tissue layer, such as liver, colon, stomach, etc, while for organs located at the surface, such as breasts, testes and skin, the equivalent dose increases or remains constant with increasing body mass due to weak attenuation and more scatter radiation caused by the increasing adipose tissue mass. Changes of standing height have little influence on the equivalent dose to organs and tissues from external exposure. Specific absorbed fractions (SAFs) have also been calculated with the 18 anthropometric phantoms. The results show that SAFs decrease with increasing height and increase with increasing body mass. The calculated data suggest that changes of the body mass may have a significant effect on equivalent doses, primarily for external exposure to organs and tissue located below the adipose tissue layer, while for superficial organs, for changes of height and for internal exposures the effects on equivalent dose are small to moderate.

Comparison between effective doses for voxel-based and stylized exposure models from photon and electron irradiation

For the last two decades, the organ and tissue equivalent dose as well as effective dose conversion coefficients recommended by the International Commission on Radiological Protection (ICRP) have been determined with exposure models based on stylized MIRD5-type phantoms representing the human body with its radiosensitive organs and tissues according to the ICRP Reference Man released in Publication No. 23, on Monte Carlo codes sometimes simulating rather simplified radiation physics and on tissue compositions from different sources. Meanwhile the International Commission on Radiation Units and Measurements (ICRU) has published reference data for human tissue compositions in Publication No. 44, and the ICRP has released a new report on anatomical reference data in Publication No. 89. As a consequence many of the components of the traditional stylized exposure models used to determine the effective dose in the past have to be replaced: Monte Carlo codes, human phantoms and tissue compositions. This paper presents results of comprehensive investigations on the dosimetric consequences to be expected from the replacement of the traditional stylized exposure models by the voxel-based exposure models. Calculations have been performed with the EGS4 Monte Carlo code for external and internal exposures to photons and electrons with the stylized, gender-specific MIRD5-type phantoms ADAM and EVA on the one hand and with the recently developed tomographic or voxel-based phantoms MAX and FAX on the other hand for a variety of exposure conditions. Ratios of effective doses for the voxel-based and the stylized exposure models will be presented for external and internal exposures to photons and electrons as a function of the energy and the geometry of the radiation field. The data indicate that for the exposure conditions considered in these investigations the effective dose may change between +60% and -50% after the replacement of the traditional exposure models by the voxel-based exposure models.

CALDose_X?a software tool for the assessment of organ and tissue absorbed doses, effective dose and cancer risks in diagnostic radiology

CALDose_X is a software tool that provides the possibility of calculating incident air kerma (INAK) and entrance surface air kerma (ESAK), two important quantities used in x-ray diagnosis, based on the output of the x-ray equipment. Additionally, the software uses conversion coefficients (CCs) to assess the absorbed dose to organs and tissues of the human body, the effective dose as well as the patients cancer risk for radiographic examinations. The CCs, ratios between organ or tissue absorbed doses and measurable quantities, have been calculated with the FAX06 and the MAX06 phantoms for 34 projections of 10 commonly performed x-ray examinations, for 40 combinations of tube potential and filtration ranging from 50 to 120 kVcp and from 2.0 to 5.0 mm aluminum, respectively, for various field positions, for 29 selected organs and tissues and simultaneously for the measurable quantities, INAK, ESAK and kerma area product (KAP). Based on the x-ray irradiation parameters defined by the user, CALDose_X shows images of the phantom together with the position of the x-ray beam. By using true to nature voxel phantoms, CALDose_X improves earlier software tools, which were mostly based on mathematical MIRD5-type phantoms, by using a less representative human anatomy.

Skeletal dosimetry in the MAX06 and the FAX06 phantoms for external exposure to photons based on vertebral 3D-microCT images

3D-microCT images of vertebral bodies from three different individuals have been segmented into trabecular bone, bone marrow and bone surface cells (BSC), and then introduced into the spongiosa voxels of the MAX06 and the FAX06 phantoms, in order to calculate the equivalent dose to the red bone marrow (RBM) and the BSC in the marrow cavities of trabecular bone with the EGSnrc Monte Carlo code from whole-body exposure to external photon radiation. The MAX06 and the FAX06 phantoms consist of about 150 million 1.2 mm cubic voxels each, a part of which are spongiosa voxels surrounded by cortical bone. In order to use the segmented 3D-microCT images for skeletal dosimetry, spongiosa voxels in the MAX06 and the FAX06 phantom were replaced at runtime by so-called micro matrices representing segmented trabecular bone, marrow and BSC in 17.65, 30 and 60 microm cubic voxels. The 3D-microCT image-based RBM and BSC equivalent doses for external exposure to photons presented here for the first time for complete human skeletons are in agreement with the results calculated with the three correction factor method and the fluence-to-dose response functions for the same phantoms taking into account the conceptual differences between the different methods. Additionally the microCT image-based results have been compared with corresponding data from earlier studies for other human phantoms.

Skeletal dosimetry for external exposure to photons based on µCT images of spongiosa from different bone sites

Micro computed tomography (microCT) images of human spongiosa have recently been used for skeletal dosimetry with respect to external exposure to photon radiation. In this previous investigation, the calculation of equivalent dose to the red bone marrow (RBM) and to the bone surface cells (BSC) was based on five different clusters of micro matrices derived from microCT images of vertebrae, and the BSC equivalent dose for 10 microm thickness of the BSC layer was determined using an extrapolation method. The purpose of this study is to extend the earlier investigation by using microCT images from eight different bone sites and by introducing an algorithm for the direct calculation of the BSC equivalent dose with sub-micro voxel resolution. The results show that for given trabecular bone volume fractions (TBVFs) the whole-body RBM equivalent dose does not depend on bone site-specific properties or imaging parameters. However, this study demonstrates that apart from the TBVF and the BSC layer thickness, the BSC equivalent dose additionally depends on a so-called trabecular bone structure (TBS) effect, i.e. that the contribution of photo-electrons released in trabecular bone to the BSC equivalent dose also depends on the bone site-specific structure of the trabeculae. For a given bone site, the TBS effect is also a function of the thickness of the BSC layer, and it could be shown that this effect would disappear almost completely, should the BSC layer thickness be raised from 10 to 50 microm, according to new radiobiological findings.

Dose to medium versus dose to water as an estimator of dose to sensitive skeletal tissue

The purpose of this study is to determine whether dose to medium, D(m), or dose to water, D(w), provides a better estimate of the dose to the radiosensitive red bone marrow (RBM) and bone surface cells (BSC) in spongiosa, or cancellous bone. This is addressed in the larger context of the ongoing debate over whether D(m) or D(w) should be specified in Monte Carlo calculated radiotherapy treatment plans. The study uses voxelized, virtual human phantoms, FAX06/MAX06 (female/male), incorporated into an EGSnrc Monte Carlo code to perform Monte Carlo dose calculations during simulated irradiation by a 6 MV photon beam from an Elekta SL25 accelerator. Head and neck, chest and pelvis irradiations are studied. FAX06/MAX06 include precise modelling of spongiosa based on microCT images, allowing dose to RBM and BSC to be resolved from the dose to bone. Modifications to the FAX06/MAX06 user codes are required to score D(w) and D(m) in spongiosa. Dose uncertainties of approximately 1% (BSC, RBM) or approximately 0.5% (D(m), D(w)) are obtained after up to 5 days of simulations on 88 CPUs. Clinically significant differences (>5%) between D(m) and D(w) are found only in cranial spongiosa, where the volume fraction of trabecular bone (TBVF) is high (55%). However, for spongiosa locations where there is any significant difference between D(m) and D(w), comparisons of differential dose volume histograms (DVHs) and average doses show that D(w) provides a better overall estimate of dose to RBM and BSC. For example, in cranial spongiosa the average D(m) underestimates the average dose to sensitive tissue by at least 5%, while average D(w) is within approximately 1% of the average dose to sensitive tissue. Thus, it is better to specify D(w) than D(m) in Monte Carlo treatment plans, since D(w) provides a better estimate of dose to sensitive tissue in bone, the only location where the difference is likely to be clinically significant.