R Manger

Failure mode and effects analysis and fault tree analysis of surface image guided cranial radiosurgery

PURPOSE Surface image guided, Linac-based radiosurgery (SIG-RS) is a modern approach for delivering radiosurgery that utilizes optical stereoscopic imaging to monitor the surface of the patient during treatment in lieu of using a head frame for patient immobilization. Considering the novelty of the SIG-RS approach and the severity of errors associated with delivery of large doses per fraction, a risk assessment should be conducted to identify potential hazards, determine their causes, and formulate mitigation strategies. The purpose of this work is to investigate SIG-RS using the combined application of failure modes and effects analysis (FMEA) and fault tree analysis (FTA), report on the effort required to complete the analysis, and evaluate the use of FTA in conjunction with FMEA. METHODS A multidisciplinary team was assembled to conduct the FMEA on the SIG-RS process. A process map detailing the steps of the SIG-RS was created to guide the FMEA. Failure modes were determined for each step in the SIG-RS process, and risk priority numbers (RPNs) were estimated for each failure mode to facilitate risk stratification. The failure modes were ranked by RPN, and FTA was used to determine the root factors contributing to the riskiest failure modes. Using the FTA, mitigation strategies were formulated to address the root factors and reduce the risk of the process. The RPNs were re-estimated based on the mitigation strategies to determine the margin of risk reduction. RESULTS The FMEA and FTAs for the top two failure modes required an effort of 36 person-hours (30 person-hours for the FMEA and 6 person-hours for two FTAs). The SIG-RS process consisted of 13 major subprocesses and 91 steps, which amounted to 167 failure modes. Of the 91 steps, 16 were directly related to surface imaging. Twenty-five failure modes resulted in a RPN of 100 or greater. Only one of these top 25 failure modes was specific to surface imaging. The riskiest surface imaging failure mode had an overall RPN-rank of eighth. Mitigation strategies for the top failure mode decreased the RPN from 288 to 72. CONCLUSIONS Based on the FMEA performed in this work, the use of surface imaging for monitoring intrafraction position in Linac-based stereotactic radiosurgery (SRS) did not greatly increase the risk of the Linac-based SRS process. In some cases, SIG helped to reduce the risk of Linac-based RS. The FMEA was augmented by the use of FTA since it divided the failure modes into their fundamental components, which simplified the task of developing mitigation strategies.

Dose conversion coefficients for neutron exposure to the lens of the human eye

Dose conversion coefficients for the lens of the human eye have been calculated for neutron exposure at energies from 1 × 10(-9) to 20 MeV and several standard orientations: anterior-to-posterior, rotational and right lateral. MCNPX version 2.6.0, a Monte Carlo-based particle transport package, was used to determine the energy deposited in the lens of the eye. The human eyeball model was updated by partitioning the lens into sensitive and insensitive volumes as the anterior portion (sensitive volume) of the lens being more radiosensitive and prone to cataract formation. The updated eye model was used with the adult UF-ORNL mathematical phantom in the MCNPX transport calculations.

Advances in the Subcritical, Gas-Cooled, Fast Transmutation Reactor Concept

The design concept for a subcritical, He-cooled, fast reactor, fueled with transuranics (TRUs) from spent nuclear fuel in coated TRISO particles and driven by a tokamak D-T fusion neutron source, is being developed at Georgia Institute of Technology. The basic concept has been developed in two previous papers. This paper reports (a) advances in the design concept intended to enable achievement of “deep-burn” of the TRUs and passive safety, (b) investigations of the possibility of reprocessing the TRISO TRU fuel and of extending the strength of the fusion neutron source, (c) more extensive analyses to confirm and improve the design with respect to the adequacy of the fuel and nuclear performance, heat removal, tritium self-sufficiency and shielding, (d) more extensive analyses to confirm that the International Tokamak Experimental Reactor divertor, magnet and heating/current drive systems can be adapted, and (e) fuel cycle analyses to further investigate the contribution that such a reactor could make to closing the nuclear fuel cycle.

Using handheld plastic scintillator detectors to triage individuals exposed to a radiological dispersal device

After a radiological dispersal device (RDD) event, people could become internally contaminated by inhaling dispersed radioactive particles. A rapid method to screen individuals who are internally contaminated is desirable. Such initial screening can help in prompt identification of those who are highly contaminated and in prioritising individuals for further and more definitive evaluation such as laboratory testing. The use of handheld plastic scintillators to rapidly screen those exposed to an RDD with gamma-emitting radionuclides was investigated in this study. The Monte Carlo N-Particle transport code was used to model two commercially available plastic scintillation detectors in conjunction with anthropomorphic phantom models to determine the detector response to inhaled radionuclides. Biokinetic models were used to simulate an inhaled radionuclide and its progression through the anthropomorphic phantoms up to 30 d after intake. The objective of the study was to see if internal contamination levels equivalent to 250 mSv committed effective dose equivalent could be detected using these instruments. Five radionuclides were examined: (60)Co, (137)Cs, (192)Ir, (131)I and (241)Am. The results demonstrate that all of the radionuclides except (241)Am could be detected when placing either one of the two plastic scintillator detector systems on the posterior right torso of the contaminated individuals.

Guidance on the use of handheld survey meters for radiological triage: time-dependent detector count rates corresponding to 50, 250, and 500 mSV effective dose for adult males and adult females.

AbstractIn June 2006, the Radiation Studies Branch of the Centers for Disease Control and Prevention held a workshop to explore rapid methods of facilitating radiological triage of large numbers of potentially contaminated individuals following detonation of a radiological dispersal device. Two options were discussed. The first was the use of traditional gamma cameras in nuclear medicine departments operated as makeshift whole-body counters. Guidance on this approach is currently available from the CDC. This approach would be feasible if a manageable number of individuals were involved, transportation to the relevant hospitals was quickly provided, and the medical staff at each facility had been previously trained in this non-traditional use of their radiopharmaceutical imaging devices. If, however, substantially larger numbers of individuals (100’s to 1,000’s) needed radiological screening, other options must be given to first responders, first receivers, and health physicists providing medical management. In this study, the second option of the workshop was investigated—the use of commercially available portable survey meters (either NaI or GM based) for assessing potential ranges of effective dose (<50, 50–250, 250–500, and >500 mSv). Two hybrid computational phantoms were used to model an adult male and an adult female subject internally contaminated with 241Am, 60Cs, 137Cs, 131I, or 192Ir following an acute inhalation or ingestion intake. As a function of time following the exposure, the net count rates corresponding to committed effective doses of 50, 250, and 500 mSv were estimated via Monte Carlo radiation transport simulation for each of four different detector types, positions, and screening distances. Measured net count rates can be compared to these values, and an assignment of one of four possible effective dose ranges could be made. The method implicitly assumes that all external contamination has been removed prior to screening and that the measurements be conducted in a low background, and possibly mobile, facility positioned at the triage location. Net count rate data are provided in both tabular and graphical format within a series of eight handbooks available at the CDC website (http://www.bt.cdc.gov/radiation/clinicians/evaluation).

Evaluation of internal contamination levels after a radiological dispersal device incident using portal monitors.

Following a radioactive dispersal device (RDD) incident, it may be necessary to evaluate the internal contamination levels of a large number of potentially affected individuals to determine if immediate medical follow-up is necessary. Since the current laboratory capacity to screen for internal contamination is limited, rapid field screening methods can be useful in prioritising individuals. This study evaluated the suitability of a radiation portal monitor for such screening. A model of the portal monitor was created for use with models of six anthropomorphic phantoms in Monte Carlo N-Particle Transport Code Version 5 (MCNP) X-5 Monte Carlo Team (MCNP-A General Monte Carlo N-Particle Transport Code Version 5. LA-CP-03-0245. Vol. 2. Los Alamos National Laboratory, 2004.). The count rates of the portal monitor were simulated for inhalation and ingestion of likely radionuclides from an RDD for each of the phantoms. The time-dependant organ concentrations of the radionuclides were determined using Dose and Risk Calculation Software Eckerman, Leggett, Cristy, Nelson, Ryman, Sjoreen and Ward (Dose and Risk Calculation Software Ver. 8.4. ORNL/TM-2001/190. Oak Ridge National Laboratory, 2006.). Portal monitor count rates corresponding to a committed effective dose E(50) of 10 mSv are reported.

Application of systems and control theory-based hazard analysis to radiation oncology.

PURPOSE Both humans and software are notoriously challenging to account for in traditional hazard analysis models. The purpose of this work is to investigate and demonstrate the application of a new, extended accident causality model, called systems theoretic accident model and processes (STAMP), to radiation oncology. Specifically, a hazard analysis technique based on STAMP, system-theoretic process analysis (STPA), is used to perform a hazard analysis. METHODS The STPA procedure starts with the definition of high-level accidents for radiation oncology at the medical center and the hazards leading to those accidents. From there, the hierarchical safety control structure of the radiation oncology clinic is modeled, i.e., the controls that are used to prevent accidents and provide effective treatment. Using STPA, unsafe control actions (behaviors) are identified that can lead to the hazards as well as causal scenarios that can lead to the identified unsafe control. This information can be used to eliminate or mitigate potential hazards. The STPA procedure is demonstrated on a new online adaptive cranial radiosurgery procedure that omits the CT simulation step and uses CBCT for localization, planning, and surface imaging system during treatment. RESULTS The STPA procedure generated a comprehensive set of causal scenarios that are traced back to system hazards and accidents. Ten control loops were created for the new SRS procedure, which covered the areas of hospital and department management, treatment design and delivery, and vendor service. Eighty three unsafe control actions were identified as well as 472 causal scenarios that could lead to those unsafe control actions. CONCLUSIONS STPA provides a method for understanding the role of management decisions and hospital operations on system safety and generating process design requirements to prevent hazards and accidents. The interaction of people, hardware, and software is highlighted. The method of STPA produces results that can be used to improve safety and prevent accidents and warrants further investigation.

Initial clinical experience with surface image guided (SIG) radiosurgery for trigeminal neuralgia

Background: To evaluate the initial clinical experience with a surface image guided technique for stereotactic radiosurgery using minimal patient immobilization and real-time patient motion monitoring for the treatment of trigeminal neuralgia (TN). Methods: The study describes the first seven TN patients treated with this technique. Head positioning was achieved with a patient-specific head mold made out of expandable foam that conforms to the patient’s occiput. The face of each patient was left open and unobstructed for maximal comfort. The motion of a region of interest consisting of the forehead, eyes, nose, and temporal bones was monitored during treatment using a video surface imaging system (Vision RT Ltd., London, UK). Initial setup of the patient was performed with the surface imaging system using the treatment planning computed tomographic (CT) scan. Initial setup was confirmed and finalized with cone-beam CT (CBCT) and KV X-ray images prior to treatment. The dedicated linear accelerator used for delivery was a Trilogy (Varian Medical Systems, Palo Alto, CA) with 5 mm collimator with 13 arcs. Patients were monitored during treatment with surface imaging cameras and software, equipped with a beam stop mechanism if the patient’s motion was found to exceed a specified tolerance. Results: Seven patients with TN underwent single fraction radiosurgery to a dose range of 80-90 Gy with surface image guidance. All patients experienced pain relief. Four of the seven patients experienced complete resolution of pain. At a median follow-up of 31.4 months, two of seven patients developed pain recurrence. One patient reported intermittent facial numbness after SRS which resolved by 9 months post-treatment. Conclusions: The surface image guided technique using minimal immobilization and real time surface imaging has proven to be safe and effective in a small cohort of patients with TN. To our knowledge this is the first series describing the use of this technology in SRS for TN. Patient compliance is important, and appears improve given the speed and comfort of this technique. An additional degree of semi-rigid immobilization may be required in some patients.

A generic biokinetic model for Carbon-14.

The generic biokinetic model currently recommended by the International Commission on Radiological Protection (ICRP) for the treatment of systemic radiocarbon assumes uniform distribution of activity in tissues and a biological half-time of 40 d. This model is intended to generate cautiously high estimates of dose per unit intake of C-14 and, in fact, generally predicts a much higher effective dose than systemic models that have been developed on the basis of biokinetic studies of specific carbon compounds. The simplistic model formulation precludes its application as a bioassay model or adjustment to fit case-specific bioassay data. This paper proposes a new generic biokinetic model for systemic radiocarbon that is less conservative than the current ICRP model but maintains sufficient conservatism to overestimate the effective dose coefficients generated by most radiocarbon-compound-specific models. The proposed model includes two systemic pools with different biological half-times representing an initial systemic form of absorbed radiocarbon, a submodel describing the behaviour of labelled carbon dioxide produced in vivo, and three excretion pathways: breath, urine and faeces. Generic excretion rates along each path are based on multi-phase excretion curves observed in experimental studies of radiocarbons. The generic model structure is designed so that the user may adjust the level of dosimetric conservatism to fit the information at hand and may adjust parameter values for consistency with subject-specific or site-specific bioassay data.

Effective dose rate coefficients for exposure to contaminated soil

The Oak Ridge National Laboratory Center for Radiation Protection Knowledge has undertaken calculations related to various environmental exposure scenarios. A previous paper reported the results for submersion in radioactive air and immersion in water using age-specific mathematical phantoms. This paper presents age-specific effective dose rate coefficients derived using stylized mathematical phantoms for exposure to contaminated soils. Dose rate coefficients for photon, electron, and positrons of discrete energies were calculated and folded with emissions of 1252 radionuclides addressed in ICRP Publication 107 to determine equivalent and effective dose rate coefficients. The MCNP6 radiation transport code was used for organ dose rate calculations for photons and the contribution of electrons to skin dose rate was derived using point-kernels. Bremsstrahlung and annihilation photons of positron emission were evaluated as discrete photons. The coefficients calculated in this work compare favorably to those reported in the US Federal Guidance Report 12 as well as by other authors who employed voxel phantoms for similar exposure scenarios.