Dose Uncertainty Research Articles

On the Way to Accounting for Lung Modulation Effects in Particle Therapy of Lung Cancer Patients-A Review.

Particle therapy presents a promising alternative to conventional photon therapy for treating non-small cell lung cancer (NSCLC). However, the heterogeneous structure of lung tissue leads to the degradation of the Bragg peak and thereby to the degradation of the dose distribution. This review offers a comprehensive overview of the models developed to account for these modulation effects. It summarizes studies focused on determining modulation power as a predictor of this so-called lung modulation. In addition, the review covers early investigations on dose uncertainties caused by lung modulation in CT-based lung phantoms and patient anatomies and discusses future challenges in integrating these solutions into clinical treatment planning routines.

Dose Reconstruction for Epidemiological Studies among Ukrainian Chernobyl Cleanup Workers.

The present paper provides an overview of the methods and summarizes the results of estimating radiation doses and their uncertainties for Ukrainian-American epidemiological studies among the Chernobyl (Chornobyl) cleanup workers. After the Chernobyl accident occurred on April 26, 1986, more than 300,000 Ukrainian cleanup workers took part between 1986 and 1990 in decontamination and recovery activities at the site of the Chernobyl Nuclear Power Plant. The U.S. National Cancer Institute in collaboration with the Ukrainian National Research Center for Radiation Medicine conducted several epidemiological studies in this population. An important part of these studies was the reconstruction of the study participants' radiation doses and the assessment of uncertainties in doses. A method called realistic analytical dose reconstruction with uncertainty estimation (RADRUE) was used to calculate the doses from external irradiation during cleanup missions, which was the main exposure pathway for most study participants. At the initial phase of the accident during the atmospheric releases of radioactivity from the destroyed reactor, the cleanup workers also received doses from inhalation of radionuclides. In addition, study participants received doses at their places of residence, especially those who lived in highly contaminated areas. The radiation doses estimated for 2,048 male cleanup workers included in the Ukrainian-American epidemiological studies varied widely: (i) bone-marrow doses from external irradiation in the case-control study of leukemia of 1,000 cleanup workers ranged from 3.7 × 10-5 mGy to 3.3 Gy (mean = 92 mGy); (ii) thyroid doses in the case-control study of thyroid cancer in 607 persons from all exposure pathways combined were from 0.15 mGy to 9.0 Gy (mean = 199 mGy); (iii) gonadal doses in 183 cleanup workers from all exposure pathways combined in the study of germline mutations in the offspring after parental irradiation (trio study) ranged from 0.58 mGy to 4.1 Gy (mean = 392 mGy); (iv) thyroid doses in the human factor uncertainties study among 47 persons were from 20 mGy to 2.1 Gy (mean = 295 mGy); and (v) lung doses in the study of germline genetic variants associated with host susceptibility to COVID-19 estimated for 211 cleanup workers were from 0.024 mGy to 2.5 Gy (mean = 249 mGy). Doses of female cleanup workers were much lower than those of male cleanup workers: the mean doses for female cleanup workers were 27 mGy for 34 women included in the trio study and 56 mGy for 48 women participated in the study of germline genetic variants associated with host susceptibility to COVID-19. Uncertainties in dose estimates included two components: (i) inherent uncertainties arising from the stochastic random variability of the parameters used in exposure assessment and from a lack of knowledge about the true values of the parameters; and (ii) human factor uncertainties due to poor memory recall resulting in incomplete, inaccurate, or missing responses during personal interviews with cleanup workers conducted long after exposure. This paper also discusses possible developments and improvements in the methods to assess the radiation doses and associated uncertainties for cleanup workers.

Application of INTDOSKIT tool for assessment of uncertainties on dose coefficients for ingestion of uranium by workers

The International Commission on Radiological Protection (ICRP) has developed the Human Alimentary Tract Model (HATM) to calculate radiation doses from the ingestion of radionuclides for the protection of workers and the public. In parallel, the ICRP's Occupational Intake of Radionuclides (OIR) series provides biokinetic models and dose coefficients based on a reference human, primarily for regulatory purposes. Although these coefficients are not usually checked for uncertainties, the investigation of such uncertainties is crucial to ensure their reliability in radiation protection. This study uses INTDOSKIT, a software tool developed using the R programming language and RStudio as the Integrated Development Environment (IDE), to calculate doses and explore uncertainties following ingestion of U-238 by workers. Two scenarios were investigated: Case I, using the latest HATM model and the systemic uranium model from ICRP publications 100 and 137 respectively, and Case II, based on data from literature, using older ICRP models. In both cases, intake of U-238 in its soluble form (Type F) was modeled and the results were validated using the ICRP OIR dataviewer software. Following validation, uncertainty and sensitivity analyses were performed. In Case I, uncertainties were assigned to the particle transport parameters in both the systemic model model and HATM as well as the uranium uptake fraction into the blood. While in Case II they were limited to the uptake fraction (f1) and the systemic uranium model. A Monte Carlo simulation of 60,000 runs was performed for both cases, sampling model parameters from their respective probability distributions to generate dose distributions. The influence of each parameter on these distributions was also analyzed. Probability distributions were inferred to the calculated dose values using the maximum likelihood estimation method and the Kolmogorov-Smirnov goodness-of-fit. The results showed that for both cases the committed effective dose coefficient, e (50), followed a lognormal distribution. Case I had a geometric mean of 3.2E-08 Sv/Bq and GSD of 2.0, while case II had a slightly lower geometric mean of 3.1E-08 Sv/Bq and GSD of 1.9. Sensitivity analysis showed that the main contributor to dose uncertainty was the fraction of uranium absorbed from the small intestine into the blood. Both cases showed similar trends, with slightly higher results in case I. Overall, this study demonstrates the effectiveness of INTDOSKIT in calculating dose coefficients and analyzing uncertainties. It suggests that while the ICRP reference values remain useful for protection, the incorporation of additional statistical measures and distribution characteristics could further enhance radiation protection strategies.

Quality assurance of magnetic resonance imaging for a polymer gel dosimeter using a 3D-printed phantom

PurposeQuality assurance (QA) of magnetic resonance imaging (MRI) for gel dosimetry using an in-house phantom was established to ensure consistent dosimetric performance. MethodsA normoxic N-vinylpyrrolidone-based gel dosimeter sensitized with an inorganic salt was used. Each individual gel dosimeter, in addition to a specially designed image QA phantom, was imaged at three institutions with different MRI systems. ResultsBoth the gel dosimeter and QA phantom had linear dose–response curves at all institutions, with correlation coefficients = 1.00 and ≥ 0.99, respectively. Minor inter-institutional variations in the sensitivity (gel dosimeter, 0.096 ± 0.010 s−1Gy−1; QA phantom, 0.140 ± 0.003 s−1Gy−1) and offset value (gel dosimeter, 2.188 ± 0.222 s−1; QA phantom, 3.318 ± 0.081 s−1) were found. Dose uncertainties for the gel dosimeter ranged from 3.2% to 3.5% at 10 Gy and 1.7%–2.1% at 20 Gy, and these were comparable with the corresponding QA phantom uncertainties. Dose resolutions were 0.8–1.2 Gy for the gel dosimeter and 0.6–1.4 Gy for the QA phantom. Uniformity factors were ≥98% at all institutions. Spatial linearity had a geometric distortion ≤1.0%, Gamma passing rates of 95%–100% met recommended QA guidelines; strong correlations between the QA phantom and gel dosimeter were also obtained for each of these measures. ConclusionOur study demonstrates the viability of applying MRI acquisition parameters validated using a QA phantom to polymer gel dosimetry across diverse MRI systems. This approach enables robust QA measures, focusing on effective management of uniformity and dose uncertainty.

Dosimetric implications of kidney anatomical volume changes in 177Lu-DOTATATE therapy

IntroductionThis study aims to evaluate the use of CT-based whole kidney parenchyma (WKP) segmentation in 177Lu-DOTATATE dosimetry. Specifically, it investigates whether WKP volumes change during treatment and evaluates the accuracy of applying a single delineated WKP volume for dosimetry. Furthermore, it aims to determine the cause of WKP volume changes—whether caused by radiation or amino acid infusion—by comparing them with spleen volume changes as a marker for radiation-induced alterations.MethodsSPECT/CT images of 18 patients were acquired over the abdomen approximately 4 h (h) (D0), 24 h (D1), 48 h (D2) and 168 h (D7) post-administration of 177Lu-DOTATATE. CT guided WKP volumes were measured before (baseline) and during treatment. Kidney activity concentrations at each time point were derived from CT-segmented WKP overlaid on SPECT scans. The accuracy of using WKP segmentation from a single CT for all time points was assessed against the gold standard of segmenting each WKP individually. Time-integrated activity calculations were based on a tri-exponential curve fit of the kidney activity concentration over time. Kidney absorbed doses were estimated under the assumption of local energy deposition. Additionally, the impact of various partial volume correction methods on dosimetry was evaluated.ResultsWhole-kidney parenchyma (WKP) volumes, ranging from 31 to 243 mL, showed a gradual increase from baseline (mean ± SD = 130.6 ± 46.1 mL) at the initial time points D0 (138.5 ± 44.7 mL) and D1 (139.4 ± 41.6 mL), followed by a slight decrease at D2 (132.8 ± 44.5 mL) and a further decrease at D7 (129.2 ± 42.7 mL). The volume increase at D0 and D1 was statistically significant. Spleen volume did not change during treatment, suggesting that amino acid infusion rather than irradiation effects caused WKP volume changes. Bland-Altman analysis revealed WKP volume biases of 8.77% (D0 vs. BL), 10.77% (D1 vs. BL), 1.10% (D2 vs. BL), and 1.10% (D7 vs. BL), with corresponding uncertainties of 24.4%, 23.6%, 25.4%, and 25.4%, respectively. When WKP segmentation from a single CT is applied across all SPECTs, these WKP volume changes could overestimate the activity concentration and mean absorbed doses up to 4.3% and 2.5%, respectively. The absorbed dose uncertainties using a recovery coefficient (RC) of 0.85 for single-time-point WKP delineation increase the absorbed dose uncertainty by 4% compared to the use of patient-specific RCs and time specific segmentation of WKP volumes.ConclusionsKidney volume exhibited significant variation form D0 to D7, affecting the precision of dosimetry calculation, primarily due to errors in whole-kidney parenchyma (WKP) delineation. Notably, using WKP segmentation from a single CT scan applied to sequential SPECT images introduce further uncertainty and may lead to an overestimation of the absorbed dose. The fluctuations in kidney volume are most likely attributable to amino acid infusion.

Cardiorespiratory motion characteristics and their dosimetric impact on cardiac stereotactic body radiotherapy.

Cardiac stereotactic body radiotherapy (CSBRT) is an emerging and promising noninvasive technique for treating refractory arrhythmias utilizing highly precise, single or limited-fraction high-dose irradiations. This method promises to revolutionize the treatment of cardiac conditions by delivering targeted therapy with minimal exposure to surrounding healthy tissues. However, the dynamic nature of cardiorespiratory motion poses significant challenges to the precise delivery of dose in CSBRT, introducing potential variabilities that can impact treatment efficacy. The complexities of the influence of cardiorespiratory motion on dose distribution are compounded by interplay and blurring effects, introducing additional layers of dose uncertainty. These effects, critical to the understanding and improvement of the accuracy of CSBRT, remain unexplored, presenting a gap in current clinical literature. To investigate the cardiorespiratory motion characteristics in arrhythmia patients and the dosimetric impact of interplay and blurring effects induced by cardiorespiratory motion on CSBRT plan quality. The position and volume variations in the substrate target and cardiac substructures were evaluated in 12 arrhythmia patients using displacement maximum (DMX) and volume metrics. Moreover, a four-dimensional (4D) dose reconstruction approach was employed to examine the dose uncertainty of the cardiorespiratory motion. Cardiac pulsation induced lower DMX than respiratory motion but increased the coefficient of variation and relative range in cardiac substructure volumes. The mean DMX of the substrate target was 0.52cm (range: 0.26-0.80cm) for cardiac pulsation and 0.82cm (range: 0.32-2.05cm) for respiratory motion. The mean DMX of the cardiac structure ranged from 0.15 to 1.56cm during cardiac pulsation and from 0.35 to 1.89cm during respiratory motion. Cardiac pulsation resulted in an average deviation of -0.73% (range: -4.01%-4.47%) in V25 between the 3D and 4D doses. The mean deviations in the homogeneity index (HI) and gradient index (GI) were 1.70% (range: -3.10%-4.36%) and 0.03 (range: -0.14-0.11), respectively. For cardiac substructures, the deviations in D50 due to cardiac pulsation ranged from -1.88% to 1.44%, whereas the deviations in Dmax ranged from -2.96% to 0.88% of the prescription dose. By contrast, the respiratory motion led to a mean deviation of -1.50% (range: -10.73%-4.23%) in V25. The mean deviations in HI and GI due to respiratory motion were 4.43% (range: -3.89%-13.98%) and 0.18 (range: -0.01-0.47) (p<0.05), respectively. Furthermore, the deviations in D50 and Dmax in cardiac substructures for the respiratory motion ranged from -0.28% to 4.24% and -4.12% to 1.16%, respectively. Cardiorespiratory motion characteristics vary among patients, with the respiratory motion being more significant. The intricate cardiorespiratory motion characteristics and CSBRT plan complexity can induce substantial dose uncertainty. Therefore, assessing individual motion characteristics and 4D dose reconstruction techniques is critical for implementing CSBRT without compromising efficacy and safety.

Quantifying dose uncertainties resulting from cardiorespiratory motion in intensity-modulated proton therapy for cardiac stereotactic body radiotherapy.

Cardiac stereotactic body radiotherapy (CSBRT) with photons efficaciously and safely treats cardiovascular arrhythmias. Proton therapy, with its unique physical and radiobiological properties, can offer advantages over traditional photon-based therapies in certain clinical scenarios, particularly pediatric tumors and those in anatomically challenging areas. However, dose uncertainties induced by cardiorespiratory motion are unknown. This study investigated the effect of cardiorespiratory motion on intensity-modulated proton therapy (IMPT) and the effectiveness of motion-encompassing methods. We retrospectively included 12 patients with refractory arrhythmia who underwent CSBRT with four-dimensional computed tomography (4DCT) and 4D cardiac CT (4DcCT). Proton plans were simulated using an IBA accelerator based on the 4D average CT. The prescription was 25 Gy in a single fraction, with all plans normalized to ensure that 95% of the target volume received the prescribed dose. 4D dose reconstruction was performed to generate 4D accumulated and dynamic doses. Furthermore, dose uncertainties due to the interplay effect of the substrate target and organs at risk (OARs) were assessed. The differences between internal organs at risk volume (IRV) and OARreal (manually contoured on average CT) were compared. In 4D dynamic dose, meeting prescription requirements entails V25 and D95 reaching 95% and 25 Gy, respectively. The 4D dynamic dose significantly differed from the 3D static dose. The mean V25 and D95 were 89.23% and 24.69 Gy, respectively, in 4DCT and 94.35% and 24.99 Gy, respectively, in 4DcCT. Eleven patients in 4DCT and six in 4DcCT failed to meet the prescription requirements. Critical organs showed varying dose increases. All metrics, except for Dmean and D50, significantly changed in 4DCT; in 4DcCT, only D50 remained unchanged with regards to the target dose uncertainties induced by the interplay effect. The interplay effect was only significant for the Dmax values of several OARs. Generally, respiratory motion caused a more pronounced interplay effect than cardiac pulsation. Neither IRV nor OARreal effectively evaluated the dose discrepancies of the OARs. Complex cardiorespiratory motion can introduce dose uncertainties during IMPT. Motion-encompassing techniques may mitigate but cannot entirely compensate for the dose discrepancies. Individualized 4D dose assessments are recommended to verify the effectiveness and safety of CSBRT.

The impact of plan complexity on calculation and measurement-based pre-treatment verifications for sliding-window intensity-modulated radiotherapy

Background and purposeIn sliding-window intensity-modulated radiotherapy, increased plan modulation often leads to increased plan complexities and dose uncertainties. Dose calculation and/or measurement checks are usually adopted for pre-treatment verification. This study aims to evaluate the relationship among plan complexities, calculated doses and measured doses. Materials and methodsA total of 53 plan complexity metrics (PCMs) were selected, emphasizing small field characteristics and leaf speed/acceleration. Doses were retrieved from two beam-matched treatment devices. The intended dose was computed employing the Anisotropic Analytical Algorithm and validated through Monte Carlo (MC) and Collapsed Cone Convolution (CCC) algorithms. To measure the delivered dose, 3D diode arrays of various geometries, encompassing helical, cross, and oblique cross shapes, were utilized. Their interrelation was assessed via Spearman correlation analysis and principal component linear regression (PCR). ResultsThe correlation coefficients between calculation-based (CQA) and measurement-based verification quality assurance (MQA) were below 0.53. Most PCMs showed higher correlation rpcm-QA with CQA (max: 0.84) than MQA (max: 0.65). The proportion of rpcm-QA ≥ 0.5 was the largest in the pelvis compared to head-and-neck and chest-and-abdomen, and the highest rpcm-QA occurred at 1 %/1mm. Some modulation indices for the MLC speed and acceleration were significantly correlated with CQA and MQA. PCR’s determination coefficients (R2) indicated PCMs had higher accuracy in predicting CQA (max: 0.75) than MQA (max: 0.42). ConclusionsCQA and MQA demonstrated a weak correlation. Compared to MQA, CQA exhibited a stronger correlation with PCMs. Certain PCMs related to MLC movement effectively indicated variations in both quality assurances.

Дозы на весь организм и их неопределенность при облучении мышей на гамма-радиобиологической установке ИГУР-1М

In the experimental department of the Urals research center for radiation medicine (Chelyabinsk, Russia) the radiobiological studies are carried out with the IGUR-1M gamma installation. In this study, the numerical experiment has been performed to specify the radiation doses in experimental mice and corresponding uncertainties. We evaluate the factors converting the dose in air measured by the ionization chamber to the dose to an organism, which is dependent on the height of the cage with the animals. The relative standard uncertainties of radiation doses for mice under 7 days of age do not exceed 7%. For more active older animals, the uncertainty of the delivered radiation doses can reach 10%.

Evaluation of uncertainty in personal dose measured using CaSO4:Dy-based TLD badge at different workplaces.

The metrological quality of a measurement is characterised by evaluating the uncertainty in the measurement. In this paper, uncertainty in personal dose measured using individual monitoring CaSO4:Dy-based thermoluminescence dosimeter badge is evaluated by application of the guide to the expression of uncertainty in measurement method. The present dose reporting quantity, whole body dose (WBD) and the proposed quantity, personal dose equivalent, Hp(10) has been used as measurands. The influence of various input quantities on the measurement were analyzed through tests that conform to the requirements of the International Electrotechnical Commission IEC 62387. The study found that the expanded uncertainties for WBD and Hp(10) measurements were 63.4% and 41.4%, respectively, corresponding to a 95% coverage probability for workplace fields covering a wide photon energy range (33-1250keV). However, the uncertainty estimates were quite lower for the type of workplaces that are identified using the dose evaluation algorithm. The input quantities, namely, the response to a mixture of photon beam qualities and photon energy and angular dependence contribute the most to the total uncertainty.

Designing an improved model of the adult female ICRP reference phantom dedicated to mammography procedure

Mammography is an x-ray-based imaging method to examine breast abnormalities. Since low-energy photons are used in mammography, doses to different organs would depend strongly on the phantom posture and anatomy. Until now, a few studies have been performed on doses delivered to different organs during mammography. However, in none of them, the correct posture of the patient has been considered. In the present study, the effect of accurate patient positioning, on doses to organs in the chest region were investigated through Monte Carlo simulations. The results show the rotation of the phantom head, may affect organ doses up to 60%. Also, ignoring the head in dosimetry calculations changes scattering effects and causes dose uncertainty of about 8% for these organs. Moreover, according to the obtained results, not compressing the breast causes serious dose misestimation. Finally, using developed phantoms dedicated for mammography, total doses received by different organs have been calculated for the tube voltages of 25, 28, 30 and 35 kVp and for craniocaudal and mediolateral oblique views.

The characteristics of the vertical distribution of radionuclide in free troposphere from simplified release scenarios: a case study

Dose estimation in the upper air is not studied as much as on ground level or in boundary layer. However, there is a need from stakeholders in aviation industry for a reasonable estimation of the radioactive plume impact at cruising levels. This study aims to provide a quantitative estimation of the dose and how reliable it is for dispersion processes up to seven days. A Lagrangian atmospheric dispersion model is used to estimate quantitively the vertical extension of radionuclides from simplified hypothetical radionuclide release scenarios. Sources at different latitudes are selected for simulation in a boreal winter case. Three meteorological data are examined to test the sensitivity of vertical plume distribution to driving meteorological data. The vertical distribution of air concentration of radionuclides is investigated and the associated uncertainties are analysed. It is found that the vertical extension of plumes is sensitive to meteorological data being used where vertical turbulent velocities play an important role. It is therefore necessary to address the uncertainties of air concentration or dose in the free troposphere and caution must be taken when providing the results to stakeholders.

Monte Carlo evaluation of uncertainties in photon and electron TG-51 absorbed dose calibration.

The accuracy of dose delivery to all patients treated with medical linacs depends on the accuracy of beam calibration. Dose delivery cannot be any more accurate than this. Given the importance of this, it seems worthwhile taking another look at the expected uncertainty in TG-51 photon dose calibration and a first look at electron calibration. This work builds on the 2014 addendum to TG-51 for photons and adds to it by also considering electrons. In that publication, estimates were made of the uncertainty in the dose calibration. In this paper, we take a deeper look at this important issue. The methodology used here is more rigorous than previous determinations as it is based on Monte Carlo simulation of uncertainties. It is assumed that mechanical QA has been performed following TG-142 prior to beam calibration and that there are no uncertainties that exceed the tolerances specified by TG-142. Despite the different methodology and assumptions, the estimated uncertainty in photon beam calibration is close to that in the addendum. The careful user should be able to easily reach a 95% confidence interval (CI) of±2.3% for photon beam calibration with standard instrumentation. For electron beams calibrated with a Farmer chamber, the estimated uncertainties are slightly larger, and the 95% CI is ±2.6% for 6 MeV and slightly smaller than this for 18 MeV. There is no clear energy dependence in these results. It is unlikely that the user will be able to improve on these uncertainties as the dominant factor in the uncertainty resides in the ion chamber dose calibration factor . For both photons and electrons, reduction in the ion chamber depth uncertainty below about 0.5mm and SSD uncertainty below 1mm have almost no effect on the total dose uncertainty, as uncertainties beyond the user's control totally dominate under these circumstances.

Dosimetric Impact of Delineation and Motion Uncertainties on the Heart and Substructures in Lung Cancer Radiotherapy

AimsDelineation variations and organ motion produce difficult-to-quantify uncertainties in planned radiation doses to targets and organs at risk. Similar to manual contouring, most automatic segmentation tools generate single delineations per structure; however, this does not indicate the range of clinically acceptable delineations. This study develops a method to generate a range of automatic cardiac structure segmentations, incorporating motion and delineation uncertainty, and evaluates the dosimetric impact in lung cancer. Materials and methodsEighteen cardiac structures were delineated using a locally developed auto-segmentation tool. It was applied to lung cancer planning CTs for 27 curative (planned dose ≥50 Gy) cases, and delineation variations were estimated by using ten mapping-atlases to provide separate substructure segmentations. Motion-related cardiac segmentation variations were estimated by auto-contouring structures on ten respiratory phases for 9/27 cases that had 4D-planning CTs. Dose volume histograms (DVHs) incorporating these variations were generated for comparison. ResultsVariations in mean doses (Dmean), defined as the range in values across ten feasible auto-segmentations, were calculated for each cardiac substructure. Over the study cohort the median variations for delineation uncertainty and motion were 2.20–11.09 Gy and 0.72–4.06 Gy, respectively. As relative values, variations in Dmean were between 18.7%–65.3% and 7.8%–32.5% for delineation uncertainty and motion, respectively. Doses vary depending on the individual planned dose distribution, not simply on segmentation differences, with larger dose variations to cardiac structures lying within areas of steep dose gradient. ConclusionRadiotherapy dose uncertainties from delineation variations and respiratory-related heart motion were quantified using a cardiac substructure automatic segmentation tool. This predicts the ‘dose range’ where doses to structures are most likely to fall, rather than single DVH curves. This enables consideration of these uncertainties in cardiotoxicity research and for future plan optimisation. The tool was designed for cardiac structures, but similar methods are potentially applicable to other OARs.

Comparative analysis of dosimetric uncertainty using Gafchromic™ EBT4 and EBT3 films in radiochromic film dosimetry

Advancements in radiotherapy dosimetry aim to enhance precision and accuracy, with Gafchromic™ EBT4 film emerging as a promising tool. However, its performance compared to EBT3 remains underexplored, necessitating a comprehensive analysis of dosimetric uncertainties. This study evaluates the efficacy of EBT4 in radiochromic dosimetry, comparing it to EBT3. Employing a 6 MV beam quality, absorbed doses ranging from 0 to 10 Gy were investigated using different measurement quantities and fitting functions. Gafchromic™ EBT3 and EBT4 films (8′′ × 10″) were irradiated in a water-equivalent phantom, with calibration doses delivered using a Varian Truebeam Stx linear accelerator. Two measurement quantities, pixel values (PV) and net change transmittance (netΔT), were analyzed, along with calibration functions including a rational function for PV and a logarithmic function for netΔT. Uncertainty analyses considered experimental, fitting, and calibration dose uncertainties. Dose-response curves for EBT3 and EBT4 films demonstrated robust fits, emphasizing the reliability of both. EBT4 consistently exhibited lower uncertainties, particularly below 2 Gy, showcasing superior precision in low-dose scenarios. The choice of response quantity and calibration function influenced results, with PV-rational function excelling for doses 2–10 Gy, and netΔT-logarithmic function showing enhanced precision in the 0–2 Gy range. The uncertainty analysis emphasized EBT4's superior performance, especially in low-dose ranges, with lower relative uncertainties and absolute errors, indicating enhanced reliability in dose measurements. The study underscores EBT4's potential to contribute to improved accuracy in various clinical scenarios. However, users should tailor the choice of response quantities and calibration functions to specific dose calibration ranges, suggesting a nuanced approach.

Comparison of a 3D CZT and conventional SPECT/CT system for quantitative Lu-177 SPECT imaging

PurposeNext-generation SPECT/CT systems with CdZnTe (CZT) digital detectors in a ring-like setup are emerging to perform quantitative Lu-177 SPECT imaging in clinical routine. It is essential to assess how the shorter acquisition time might affect the image quality and uncertainty on the mean absorbed dose of the tumors and organs at risk compared to a conventional system.Methods A NEMA Image Quality phantom was scanned with a 3D CZT SPECT/CT system (Veriton, by Spectrum Dynamics) using 6 min per bed position and with a conventional SPECT/CT system (Symbia T16, by Siemens) using 16 min per bed position. The sphere-to-background ratio was 12:1 and the background activity concentration ranged from 0.52 to 0.06 MBq/mL. A clinical reconstruction protocol for dosimetry purposes was determined for both systems by maximizing the sphere-to-background ratio while keeping the coefficient of variation of the background as low as possible. The corresponding image resolution was determined by the matching filter method and used for a dose uncertainty assessment of both systems following an established uncertainty model..ResultsThe optimized iterative reconstruction protocol included scatter and attenuation correction for both systems and detector response modeling for the Siemens system. For the 3D CZT system, 6 iterations and 8 subsets were combined with a Gaussian post-filter of 3 mm Full Width Half Maximum (FWHM) for post-smoothing. For the conventional system, 16 iterations and 16 subsets were applied with a Gaussian post-smoothing filter of 1 mm FWHM. For these protocols, the sphere-to-background ratio was 18.5% closer to the true ratio for the conventional system compared to the 3D CZT system when considering the four largest spheres. Meanwhile, the background coefficient of variation was very similar for both systems. These protocols resulted in SPECT image resolution of 14.8 mm and 13.6 mm for the 3D CZT and conventional system respectively. Based on these resolution estimates, a 50% dose uncertainty corresponded to a lesion volume of 28 mL for the conventional system and a lesion volume of 33 mL for the 3D CZT system. ConclusionsAn optimized reconstruction protocol for a Veriton system with 6 min of acquisition time per bed position resulted in slightly higher dose uncertainties than a conventional Symbia system using 16 min of acquisition time per bed position. Therefore, a 3D CZT SPECT/CT allows to significantly reduce the acquisition times with only a very limited impact on dose uncertainties such that quantitative Lu-177 SPECT/CT imaging becomes much more accessible for treatment concurrent dosimetry. Nevertheless, the uncertainty of SPECT-based dose estimates remains high.

EANM guidance document: dosimetry for first-in-human studies and early phase clinical trials

The numbers of diagnostic and therapeutic nuclear medicine agents under investigation are rapidly increasing. Both novel emitters and novel carrier molecules require careful selection of measurement procedures. This document provides guidance relevant to dosimetry for first-in human and early phase clinical trials of such novel agents. The guideline includes a short introduction to different emitters and carrier molecules, followed by recommendations on the methods for activity measurement, pharmacokinetic analyses, as well as absorbed dose calculations and uncertainty analyses. The optimal use of preclinical information and studies involving diagnostic analogues is discussed. Good practice reporting is emphasised, and relevant dosimetry parameters and method descriptions to be included are listed. Three examples of first-in-human dosimetry studies, both for diagnostic tracers and radionuclide therapies, are given.

Влияние фактора полиморбидности на прогноз пожизненных радиационных рисков смертности от злокачественных новообразований

The forecast of lifetime radiation risks in exposed cohorts is currently carried out without considering the heterogeneity of cohort members in terms of their degree of polymorbidity. Polymorbidity is characterized by a reduction in the life expectancy of a person in the presence of several chronic diseases. Therefore, considering the polymorbidity factor can significantly affect the estimate of lifetime radiation risk. The purpose of this study is to investigate the effect of the polymorbidity factor of patients on the estimates of lifetime radiation risks of mortality from malignant neoplasms, as well as to compare the impact of polymorbidity factors and uncertainty of radiation doses on these estimates. To calculate the lifetime attributable radiation risk (LAR) per 1 mSv, the radiation risk models recommended by Publication 103 of the International Commission on Radiological Protection were used. The calculations are based on official medical and statistical data of 2021 for the Russian population. The effect of polymorbidity on human lifespan and on LAR estimates was considered using the classic Charlson Comorbidity Index (CCI). To assess the effect of the uncertainty of radiation doses on the LAR value, an example of a lognormal dose distribution with a standard geometric deviation of 2.2 (i.e., with a 90% uncertainty factor of 3.6) was chosen, which is typical for the population living in the areas of the Kaluga and Bryansk regions of Russia contaminated as a result of the Chernobyl accident. Simulation modeling was used to assess the effect of radiation dose uncertainty. It is shown that the variability of estimates of the lifetime radiation risk of mortality from malignant neoplasms due to the polymorbidity factor is comparable to the variability of this radiation risk due to the uncertainty of doses with an 90% uncertainty factor of 3.6. Thus, when calculating radiation risks in persons exposed to radiation, it is necessary to consider the presence or absence of chronic diseases, since this significantly affects the final assessments of radiation risks. Underestimation or overestimation of risk can be from 1.5 times or more.

A Study on the Uncertainty of the Average Glandular Dose in Quality Control of Mammographic X-ray Units

【Purpose】 Accurate control of X-ray units and dosimeters and analysis of the uncertainties associated with the accurate measurement of radiation doses are essential for the effective establishment and application of diagnostic reference levels. In this study, the uncertainty of the average glandular dose (AGD) in the quality control of mammography equipment was evaluated in detail, and recommendations were provided to improve the accuracy and safety of radiological practice. 【Methods】 In the uncertainty analysis of the AGD, the relative standard uncertainties in the measurements of the half-value layer, the incident air kerma, and the conversion factor were considered and finally expressed as expanded uncertainties, the intervals of which were clearly defined. 【Results】 From the AGD measurements using two types of dosimeters, it was found that the primary sources of uncertainty are the uncertainty of the calibration factors of the dosimeters and the uncertainty of the conversion factors.【Conclusion】 To reduce uncertainty, the use of regularly calibrated dosimeters is effective and reliable. Two types of dosimeters are commonly used; the results of this study may serve as a reference value for the uncertainty of AGD in quality control in medical facilities.

Multi-institutional investigation into the robustness of intra-cranial multi-target stereotactic radiosurgery plans to delivery errors.

The use of modulated techniques for intra-cranial stereotactic radiosurgery (SRS) results in highly modulated fields with small apertures, which may be susceptible to uncertainties in the delivery device. This study aimed to quantify the impact of simulated delivery errors on treatment plan dosimetry and how this is affected by treatment planning system (TPS), plan geometry, delivery technique, and plan complexity. A beam modelling error was also included as context to the dose uncertainties due to treatment delivery errors. Delivery errors were assessed for multiple-target brain SRS plans obtained through the Trans-Tasman Radiation Oncology Group (TROG) international treatment planning challenge (2018). The challenge dataset consisted of five intra-cranial targets, each with a prescription of 20Gy. Of the final dataset of 54 plans, 51 were created using the volumetric modulated arc therapy (VMAT) technique and three used intensity modulated arc therapy (IMRT). Thirty-five plans were from the Varian Eclipse TPS, 17 from Elekta Monaco TPS, and one plan each from RayStation and Philips Pinnacle TPS. The errors introduced included: monitor unit calibration errors, multi-leaf collimator (MLC) bank offset, single MLC leaf offset, couch rotations, and collimator rotations. Dosimetric leaf gap (DLG) error was also included as a beam modelling error. Dose to targets was assessed via dose covering 98% of planning target volume (PTV) (D98%), dose covering 2% of PTV (D2%), and dose covering 99% of gross tumor volume (GTV) (D99%). Dose to organs at risk (OARs) was assessed using the volume of normal brain receiving 12Gy (V12Gy), mean dose to normal brain, and maximum dose covering 0.03cc brainstem (D0.03cc). Plan complexity was also assessed via edge metric, modulation complexity score (MCS), mean MLC gap, mean MLC speed, and plan modulation (PM). PTV D98% showed high robustness on average to most errors with the exception of a bank shift of 1.0mm and large rotational errors ≥1.0° for either the couch or collimator. However, in some cases, errors close to or within generally accepted machine tolerances resulted in clinically relevant impacts. The greatest impact upon normal brain V12Gy, mean dose to normal brain, and D0.03cc brainstem was found for DLG error in alignment with other recent studies. All delivery errors had on average a minimal impact across these parameters. Comparing plans from the Monaco TPS and the Eclipse TPS, showed a lesser increase to V12Gy, mean dose to normal brain, and D0.03cc brainstem for Monaco plans (p<0.01) when DLG error was simulated. Monaco plans also correlated to lower plan complexity. Using Spearman's correlation coefficient (r) a strong negative correlation (r≤-0.8) was found between the mean MLC gap and dose to OARs for DLG errors. Reducing MLC complexity and using larger mean MLC gaps is recommended to improve plan robustness and reduce sensitivity to delivery and modelling errors. For cases in which the calculated dose distribution or dose indices are close to the clinically acceptable limits, this is especially important.