Renata Kopeć

Status of eye lens radiation dose monitoring in European hospitals

A questionnaire was developed by the members of WG12 of EURADOS in order to establish an overview of the current status of eye lens radiation dose monitoring in hospitals. The questionnaire was sent to medical physicists and radiation protection officers in hospitals across Europe. Specific topics were addressed in the questionnaire such as: knowledge of the proposed eye lens dose limit; monitoring and dosimetry issues; training and radiation protection measures. The results of the survey highlighted that the new eye lens dose limit can be exceeded in interventional radiology procedures and that eye lens protection is crucial. Personnel should be properly trained in how to use protective equipment in order to keep eye lens doses as low as reasonably achievable. Finally, the results also highlighted the need to improve the design of eye dosemeters in order to ensure satisfactory use by workers.

Measurement of maximum skin dose in interventional radiology and cardiology and challenges in the set-up of European alert thresholds

To help operators acknowledge patient dose during interventional procedures, EURADOS WG-12 focused on measuring patient skin dose using XR-RV3 gafchromic films, thermoluminescent detector (TLD) pellets or 2D TL foils and on investigating possible correlation to the on-line dose indicators such as fluoroscopy time, Kerma-area product (KAP) and cumulative air Kerma at reference point (CK). The study aims at defining non-centre-specific European alert thresholds for skin dose in three interventional procedures: chemoembolization of the liver (CE), neuroembolization (NE) and percutaneous coronary interventions (PCI). Skin dose values of >3 Gy (ICRP threshold for skin injuries) were indeed measured in these procedures confirming the need for dose indicators that correlate with maximum skin dose (MSD). However, although MSD showed fairly good correlation with KAP and CK, several limitations were identified challenging the set-up of non-centre-specific European alert thresholds. This paper presents preliminary results of this wide European measurement campaign and focuses on the main challenges in the definition of European alert thresholds.

Characterisation of grids of point detectors in maximum skin dose measurement in fluoroscopically-guided interventional procedures.

PURPOSE Point detectors are frequently used to measure patients maximum skin dose (MSD) in fluoroscopically-guided interventional procedures (IP). However, their performance and ability to detect the actual MSD are rarely evaluated. The present study investigates the sampling uncertainty associated with the use of grids of point detectors to measure MSD in IP. METHOD Chemoembolisation of the liver (CE), percutaneous coronary intervention (PCI) and neuroembolisation (NE) procedures were studied. Spatial dose distributions were measured with XR-RV3 Gafchromic(®) films for 176 procedures. These distributions were used to simulate measurements performed using grids of detectors such as thermoluminescence detectors, with detector spacing from 1.4 up to 10 cm. RESULTS The sampling uncertainty was the highest in PCI and NE procedures. With 40 detectors covering the film area (36 cm × 44 cm), the maximum dose would be on average 86% and 63% of the MSD measured with Gafchromic(®) films in CE and PCI procedures, respectively. In NE procedures, with 27 detectors covering the film area (14 cm × 35 cm), the maximum dose measured would be on average 82% of the MSD obtained with the Gafchromic(®) films. CONCLUSION Thermoluminescence detectors show good energy and dose response in clinical beam qualities. However the poor spatial resolution of such point-like dosimeters may far outweigh their good dosimetric properties. The uncertainty from the sampling procedure should be estimated when point detectors are used in IP because it may lead to strong underestimation of the MSD.

Dose levels of the occupational radiation exposures in Poland based on results from the accredited dosimetry service at the IFJ PAN, Krakow

Individual dosimetry service based on thermoluminescence (TLD) detectors has started its activity at the Institute of Nuclear Physics (IFJ) in Krakow in 1965. In 2002, the new Laboratory of Individual and Environment Dosimetry (Polish acronym LADIS) was established and underwent the accreditation according to the EN-PN-ISO/IEC 17025 standard. Nowadays, the service is based on the worldwide known standard thermoluminescent detectors MTS-N (LiF:Mg,Ti) and MCP-N (LiF:Mg,Cu,P), developed at IFJ, processed in automatic thermoluminescent DOSACUS or RE2000 (Rados Oy, Finland) readers. Laboratory provides individual monitoring in terms of personal dose equivalent H(p)(10) and H(p)(0.07) in photon and neutron fields, over the range from 0.1 mSv to 1 Sv, and environmental dosimetry in terms of air kerma K(a) over the range from 30 μGy to 1 Gy and also ambient dose equivalent H*(10) over the range from 30 μSv to 1 Sv. Dosimetric service is currently performed for ca. 3200 institutions from Poland and abroad, monitored on quarterly and monthly basis. The goal of this paper is to identify the main activities leading to the highest radiation exposures in Poland. The paper presents the results of statistical evaluation of ∼ 100,000 quarterly H(p)(10) and K(a) measurements performed between 2002 and 2009. Sixty-five per cent up to 90 % of all individual doses in Poland are on the level of natural radiation background. The dose levels between 0.1 and 5 mSv per quarter are the most frequent in nuclear medicine, veterinary and industrial radiography sectors.

EYE LENS DOSES IN NUCLEAR MEDICINE: A MULTICENTRIC STUDY IN BELGIUM AND POLAND

This study aimed to investigate the level of the eye lens (EL) doses in nuclear medicine in the light of the new International Commission on Radiological Protection limit. In 7 Belgian and 1 Polish hospitals, 45 staff members were monitored for EL (Hp(3)) and whole-body (WB) (Hp(10)) doses using dedicated dosemeters. Weekly measurements were carried out and used to estimate annual doses. Mostly diagnostic procedures involving radionuclides such as (99m)Tc and (18)F were monitored; measurements were also performed for therapeutic procedures. The cumulative doses showed important variation across the participants. The weekly EL and WB doses ranged from 0.02 to 0.27 and 0.03 to 0.17 mSv, respectively; the annual EL and WB doses ranged from 0.6 to 9.3 and 0.9 to 8.0 mSv, respectively. Some correlation was found between the EL and the WB doses. No significant correlation with the manipulated activities was found.

Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures

PURPOSE The feasibility of setting-up generic, hospital-independent dose alert levels to initiate vigilance on possible skin injuries in interventional procedures was studied for three high-dose procedures (chemoembolization (TACE) of the liver, neuro-embolization (NE) and percutaneous coronary intervention (PCI)) in 9 European countries. METHODS Gafchromic® films and thermoluminescent dosimeters (TLD) were used to determine the Maximum Skin Dose (MSD). Correlation of the online dose indicators (fluoroscopy time, kerma- or dose-area product (KAP or DAP) and cumulative air kerma at interventional reference point (Ka,r)) with MSD was evaluated and used to establish the alert levels corresponding to a MSD of 2 Gy and 5 Gy. The uncertainties of alert levels in terms of DAP and Ka,r, and uncertainty of MSD were calculated. RESULTS About 20-30% of all MSD values exceeded 2 Gy while only 2-6% exceeded 5 Gy. The correlations suggest that both DAP and Ka,r can be used as a dose indicator for alert levels (Pearson correlation coefficient p mostly >0.8), while fluoroscopy time is not suitable (p mostly <0.6). Generic alert levels based on DAP (Gy cm2) were suggested for MSD of both 2 Gy and 5 Gy (for 5 Gy: TACE 750, PCI 250 and NE 400). The suggested levels are close to the lowest values published in several other studies. The uncertainty of the MSD was estimated to be around 10-15% and of hospital-specific skin dose alert levels about 20-30% (with coverage factor k = 1). CONCLUSIONS The generic alert levels are feasible for some cases but should be used with caution, only as the first approximation, while hospital-specific alert levels are preferred as the final approach.

Organic Scintillator for Real-Time Neutron Dosimetry

We developed a radiation detector based on an organic scintillator for spectrometry and dosimetry of out-of-field secondary neutrons from clinical proton beams. The detector consists of an EJ-299-34 crystalline organic scintillator, coupled by fiber optic cable to a silicon photomultiplier (SiPM). Proof of concept measurements were taken with 137Cs and 252Cf, and corresponding simulations were performed in MCNPX-PoliMi. Despite its small size, the detector is able to discriminate between neutron and gamma-rays via pulse shape discrimination. We simulated the response function of the detector to monoenergetic neutrons in the 100 keV-0 MeV range using MCNPX-PoliMi. The measured unfolded 252Cf neutron spectrum is in good agreement with the theoretical Watt fission spectrum. We determined the ambient dose equivalent by folding the spectrum with the fluence-to-ambient dose conversion coefficient, with a 1.4% deviation from theory. Some preliminary proton beam experiments were preformed at the Bronowice Cyclotron Center patient treatment facility using a clinically relevant proton pencil beam for brain tumor and craino-spinal treatment directed at a child phantom.

CALIBRATION OF GAFCHROMIC EBT3 FILM FOR DOSIMETRY OF SCANNING PROTON PENCIL BEAM (PBS)

Gafchromic EBT3 films are applied in proton radiotherapy for 2D dose mapping because they demonstrate spatial resolution well below 1 mm. However, the film response must be corrected in order to reach the accuracy of dose measurements required for the clinical use. The in-house developed AnalyseGafchromic software allows to analyze and correct the measured response using triple channel dose calibration, statistical scan-to-scan fluctuations as well as experimentally determined dose and LET dependence. Finally, the optimized protocol for evaluation of response of Gafchromic EBT3 films was applied to determine 30 × 40 cm2 dose profiles of the scanning therapy unit at the Cyclotron Centre Bronowice, CCB in Krakow, Poland.

GEOMETRICAL EFFICIENCY OF PLANE-PARALLEL IONIZATION CHAMBERS IN PROTON SCANNING BEAM

For commissioning of a proton therapy unit depth dose distributions must be determined and introduced into the Treatment Planning System. In pencil beam scanning (PBS) technique, integral depth dose (IDD) acquisition should be performed with detector large enough to ensure entire beam laterally broadened by scattered and secondary contributions. The purpose of this article is to quantify, using measurements and Monte Carlo transport calculations, the ionization chambers (IC) geometrical efficiency versus the chamber radius and proton beam energy. The geometrical efficiency of 0.99 was determined for energies up to 160 and 190 MeV for 4.08 and 6 cm radius IC. Much lower geometrical efficiency was obtained for the energy of 226.08 MeV and results in charge loss of 5.8 and 3.6%, respectively. Relative IDD differences between IC 4.08 and 6 cm in radius increase with proton energy and reach 2.4% at the mid-range depth for 226.08 MeV.

Occupational exposure in orthopedic procedures under fluoroscopic control

BACKGROUND In interventional radiology the highest radiation doses are usually recorded for both the medical staff and the patients. Interventional procedures with X-rays are implemented in a number of medical specializations. This paper concerns the exposure of interventional teams performing orthopedic procedures under X-rays control. MATERIAL AND METHODS Doses for interventional teams were measured in the 3 Łódź hospitals. Thermoluminescent dosemeters were applied to measure the following dose equivalents: Hp(3) for eye lens, Hp(0.07) for palm skin, Hp(10) at the level of the neck without a protective shield (i.e., collar) and Hp(10) for the whole body on the front surface of the trunk (measured under the protective apron at the level of the chest). RESULTS Doses for the operator who performs surgery, assisting physicians and scrub nurse were measured during 95 procedures. The highest doses were received by the operator the dose for eyes per 1 procedure did not exceed 0.1 mSv, the highest dose for hands was 1.6 mSv and the highest recorded effective dose was 0.02 mSv. CONCLUSIONS On the basis of the results of measurements and their comparison with the values reported in the literature it may be concluded that the obtained results fall within the published reference range (for non-vascular procedures). This proves the compatibility of practice in the monitored Łódź hospitals with routine methodology applied in other interventional departments. The measurement results confirm that the usage of thermoluminescent dosimetry is fully adequate for the evaluation of exposure in interventional radiology and that the usage of at least 2 dosemeters for that staff is necessary. Med Pr 2017;68(2):221-227.