Eye Lens Dosimetry Research Articles

TU‐E‐201‐03: Eye Lens Dosimetry in Radiotherapy Using Contact Lens‐Shaped Applicator

TU‐E‐201‐03: Eye Lens Dosimetry in Radiotherapy Using Contact Lens‐Shaped Applicator

TU‐E‐201‐02: Eye Lens Dosimetry From CT Perfusion Studies

TU‐E‐201‐02: Eye Lens Dosimetry From CT Perfusion Studies

First results of an eye lens dosimetry survey in an interventional cardiology department

The eye lens annual dose limit for exposed personnel to ionizing radiation has recently been revised by the ICRP—International Commission on Radiological Protection and the proposed new limit has been accepted by European legislation through the Council Directive 2013/59/EURATOM 2013.Among medical exposed personnel, the staff performing interventional cardiology are usually affected by relevant doses. For this reason a survey, employing dosemeters characterized in terms of Hp(3), was performed in order to get the order of magnitude of the doses received by the eye lens, at least as a first guess.The survey showed that the annual dose limit can easily be reached if a proper radiation protection approach is not implemented.

Development of an applicator for eye lens dosimetry during radiotherapy.

To develop an applicator for in vivo measurements of lens dose during radiotherapy. A contact lens-shaped applicator made of acrylic was developed for in vivo measurements of lens dose. This lens applicator allows the insertion of commercially available metal oxide semiconductor field effect transistors (MOSFETs) dosemeters. CT images of an anthropomorphic phantom with and without the applicator were acquired. Ten volumetric modulated arc therapy plans each for the brain and the head and neck cancer were generated and delivered to an anthropomorphic phantom. The differences between the measured and the calculated doses at the lens applicator, as well as the differences between the measured and the calculated doses at the surface of the eyelid were acquired. The average difference between the measured and the calculated doses with the applicator was 3.1 ± 1.8 cGy with a micro MOSFET and 2.8 ± 1.3 cGy with a standard MOSFET. The average difference without the lens applicator was 4.8 ± 5.2 cGy with the micro MOSFET and 5.7 ± 6.5 cGy with the standard MOSFET. The maximum difference with the micro MOSFET was 10.5 cGy with the applicator and 21.1 cGy without the applicator. For the standard MOSFET, it was 6.8 cGy with the applicator and 27.6 cGy without the applicator. The lens applicator allowed reduction of the differences between the calculated and the measured doses during in vivo measurement for the lens compared with in vivo measurement at the surface of the eyelid. By using an applicator for in vivo dosimetry of the eye lens, it was possible to reduce the measurement uncertainty.

Occupational exposure to the whole body, extremities and to the eye lens in interventional radiology in Poland, as based on personnel dosimetry records at IFJ PAN

Abstract We report results of measurements of Hp(10) from whole body dosimeters (about 53 thousand readouts), of Hp(0.07) from finger ring dosimeters (23 thousand readouts) and of Hp(3) from eye lens dosimeters (100 readouts), issued in the years 2010–12 to over 150 medical departments in Poland which apply X-rays in radiology, interventional radiology (haemodynamic, angiology, cardiac surgery), urology, orthopaedics, electrophysiology or electro-cardiology. In all measurements thermoluminescence detectors (TLD) were used: the well-known standard MTS-N (LiF:Mg, Ti) for whole body and extremity dosimetry, and the high-sensitivity MCP-N (LiF:Mg, Cu, P) for eye lens dosimetry and environmental monitoring. We analysed the data base of the accredited Laboratory of Individual and Environmental Dosimetry (LADIS) at the Institute of Nuclear Physics PAN which offers its dosimetry service to these departments on a regular basis. We found that in the population of radiation workers that studied over the years 2010–2012 in 84%, 87%, and 34% of Hp(10), Hp(0.07) and Hp(3) measurements, respectively, the level of 0.1 mSv/quarter did not exceed, indicating lack of their occupational exposure. In the remaining 16%, 13% and 66% of individual cases, the 0.1 mSv/quarter exceeded, occasionally reaching several hundreds of mSv/quarter.

Calibration of an eye lens dosemeter in terms of Hp(3) to be used in interventional radiology

Recently, the International Commission on Radiological Protection has reviewed epidemiological evidences suggesting that there were tissue reaction effects in the eye lens below the previously considered absorbed dose threshold. A new statement related to the eye lens was issued that changed the absorbed dose threshold and reduced the dose limits for occupationally exposed persons. As consequence, some planned exposures require eye lens dosimetry and a debate was raised on the adequacy of the dosimetric quantity and on its method of measurement. The aim of this work was to study the methodology for calibrating the EYE-D TM holder with a TLD-100H Harshaw chip detector and to determine its angular and energy dependences in terms of personal dose equivalent, H p (3). • Results of calibration of the eye lens dosemeters, in terms of H p (3). • The proposal of phantoms and specific dosemeters for eye lens have proved viable. • The tests carried out met the limits of acceptance proposed by ISO. • The good performance of the tests may suggest a reduction in the acceptance limits.

Extremity and eye lens dosimetry for medical staff performing vertebroplasty and kyphoplasty procedures

Measurements of doses to hands, legs and eyes are reported for operators in four different hospitals performing vertebroplasty or kyphoplasty. The results confirm that occupational doses can be high for interventional spine procedures. Extremity and eye lens doses were measured with thermoluminescent dosimeters positioned on the ring fingers, wrists, legs and near the eyes of interventional radiologists and neurosurgeons, over a period of 15 months. Doses were generally larger on the left side for all positions monitored. The median dose to the left finger was 225 μSv per procedure, although a maximum of 7.3 mSv was found. The median dose to the right finger was 118 μSv, but with an even higher maximum of 7.7 mSv. A median left eye dose of 34 μSv (maximum 836 μSv) was found, while the legs received the lowest doses with a median of 13 μSv (maximum 332 μSv) to the left leg. Annual dose to the hand assessed by the cumulated doses almost reached the annual dose limit of 500 mSv, while annual dose to the eyes exceeded the eye lens dose limit of 20 mSv yr−1. Different x-ray systems and radiation protection measures were tested, like the use of lead gloves and glasses, tweezers, cement delivery systems and a magnetic navigation system. These measurements showed that doses can be significantly reduced. The use of lead glasses is strongly recommended for protection of the eyes.

TH‐A‐144‐01: Lens of the Eye Dosimetry

International Commission on Radiological Protection (ICRP) issued a statement in 2011 decreasing the threshold for the lens of the eye to 0.5 Gy from earlier figure of 5 Gy for chronic and 0.5–2.0 Gy for acute exposures. Further, ICRP has reduced the dose limit for workers from150 mSv/y to 20 mSv/y, averaged over defined period of 5 years. Interventional radiology and cardiology are areas with high potential for risk to eye lens. If radiation protection is not practiced, the eye lens dose to workers in these areas can reach or exceed the regulatory limit. There are recent reports of eye lens injuries among interventionalists and support professionals in interventional suite. As against well established personal whole‐body dosimetry, eye lens dosimetry practically does not exist. Accurate assessment of eye lens dose is one of the most important aspects of correlating doses with observed lens opacities among workers in interventional suites. There are two approaches for practical dosimetry: a) passive dosimeters; and b) active dosimeters. Besides practical dosimetry, approaches are based either on retrospective dose assessment using scatter radiation dose levels or correlations between patient dose indices and eye doses to the operators. In cases when practical individual monitoring is not established or when it is not reliable, the later approaches are often the only possible. At present, there is no clear consensus in the literature on the correlation between the patient dose and the dose to the eyes of the medical staff. Some authors provided a reasonable good relationship between PKA and dose to staff members, but there are also reports claiming that the establishment of the correlation between PKA and eye lens doses is associated with difficulties. The retrospective assessment needs to be based on the reconstruction of the laboratory workload (types and numbers of procedures), usually with questionnaires and the application of many assumptions about past activity (procedures performed, corresponding doses based on previous dosimetric studies and the use of radiation protection tools). This approach is also related to a “typical” procedure in terms of fluoroscopy time and number of cine series, which may not always reflect the real clinical situation. Accurate dose measurements are a prerequisite for investigation of low dose effects to the lens of the eye. This can be done only if dedicated and suitable calibrated dosimeters are available. With current state of technology and practice, only an approximate retrospective analysis can be accomplished. This is often not adequate for verification of compliance with regulatory dose limits. Future challenges include development of practical methods for regular monitoring of individual eye lens doses and development of better techniques to estimate eye dose from measurements at same reference points. While the situation with dosimetry is gloomy, it is very optimistic with eye protection. “Eye lens radiation dose from brain perfusion CT exams”.CT perfusion imaging requires repeatedly exposing one location of the head to monitor the uptake and washout of iodinated contrast. The accumulated radiation dose to the eye lens can be high, leading to concerns about potential radiation injury from these scans. CTDIvol assumes continuous z coverage and can overestimate eye lens dose in CT perfusion scans where the table do not increment. The radiation dose to the eye lens from clinical CT brain perfusion studies can be estimate using Monte Carlo simulation methods on voxelized patient models. MDCT scanners from four major manufacturers were simulated and the eye lens doses were estimated using the AAPM posted clinical protocols. They were also compared to CTDIvol values to evaluate the overestimation from CTDIvol. The efficacy of eye lens dose reduction techniques such as tilting the gantry and moving the scan location away from the eyelens were also investigated. Eye lens dose ranged from 81 mGy to 279 mGy, depending on the scanner and protocol used. It is between 59% and 63% of the CTDIvol values reported by the scanners. The eye lens dose is significantly reduced when the eye lenses were not directly irradiated. CTDIvol should not be interpreted as patient dose; this study has shown it to overestimate dose to the eye lens. These results may be used to provide more accurate estimates of actual dose to ensure that protocols are operated safely below thresholds. Tilting the gantry or moving the scanning region further away from the eyes are effective for reducing lensdose in clinical practice. These actions should be considered when they are consistent with the clinical task and patient anatomy.Learning Objectives:1. To understand current methods for estimation and measurement of eye lens dose for occupationally exposure.2. To understand correlation between patient dose indies and staff eye dose.3. To become familiar with method of eye dose estimation for patient in specific situation of brain perfusion CT.

Fluence to Hp(3) conversion coefficients for neutrons from thermal to 15 MeV

The recent statement on tissue reactions issued by the International Commission on Radiological Protection in April 2011 recommends a very significant reduction in the equivalent dose annual limit for the eye lens from 150 to 20 mSv y(-1); this has stimulated a lot of interest in eye lens dosimetry in the radiation protection community. Until now no conversion coefficients were available for the operational quantity Hp(3) for neutrons. The scope of the present work was to extend previous evaluations of H*(10) and Hp(10) performed at the PTB in 1995 to provide also Hp(3) data for neutrons. The present work is also intended to complete the studies carried out on photons during the last 4 y within the European Union-funded ORAMED (optimisation of radiation protection for medical staff) project.

Eye lens dosimetry in interventional cardiology: results of staff dose measurements and link to patient dose levels

Workers involved in interventional cardiology procedures receive high eye lens dose if protection is not used. Currently, there is no suitable method for routine use for the measurement of eye dose. Since most angiography machines are equipped with suitable patient dosemeters, deriving factors linking staff eye doses to the patient doses can be helpful. In this study the patient kerma-area product, cumulative dose at an interventional reference point and eye dose in terms of Hp(3) of the cardiologists, nurses and radiographers for interventional cardiology procedures have been measured. Correlations between the patient dose and the staff eye dose were obtained. The mean eye dose was 121 µSv for the first operator, 33 µSv for the second operator/nurse and 12 µSv for radiographer. Normalised eye lens doses per unit kerma-area product were 0.94 µSv Gy⁻¹ cm⁻² for the first operator, 0.33 µSv Gy⁻¹ cm⁻² for the second operator/nurse and 0.16 µSv Gy⁻¹ cm⁻² for radiographers. Statistical analysis indicated that there is a weak but significant (p < 0.01) correlation between the eye dose and the kerma-area product for all three staff categories. These values are based on a local practice and may provide useful reference for other studies for validation and for wider utilisation in assessing the eye dose using patient dose values.

On the operational quantity Hp(3) for eye lens dosimetry

In the past the operational quantity Hp(3) has been defined for calibration purposes in a slab phantom. Recently, an additional phantom in the form of a cylinder was suggested for eye lens dosimetry as a cylinder much better approximates the shape of a head than a slab. Therefore, this work investigates whether the quantity Hp(3), when defined in the respective calibration phantom, adequately estimates the eye lens dose (or is at least conservative) depending on the phantom: it turns out that in most cases both calibration phantoms are similarly well suited. Finally, the definition of the eye lens dose is discussed together with possible consequences on the definition of Hp(3): the consideration of only the radiation sensitive volume of the lens causes Hp(3) not to be conservative in beta radiation fields.

Extensions to the Beta Secondary Standard BSS 2

Since several years, the irradiation facility for beta radiation, the Beta Secondary Standard BSS 2 developed at PTB, has been in worldwide use for the performance of irradiations with calibrated beta sources. Due to recent developments in eye tumor therapy, in eye lens dosimetry, and in soft- and hardware technology, several extensions have been added to the BSS 2.These extensions are described in this paper: 1. The possibility of using a 106Ru/106Rh beta source was added as this radionuclide is often used in tumor therapy. 2. The (small) contribution due to photon radiation was included in the dose (rate) reported by the BSS 2, as this was missing in the past. 3. The quantity personal dose equivalent at a depth of 3 mm, Hp(3), was implemented due to recent findings on the radio sensitivity of the eye lens regarding cataract induction and the subsequent lowering of the dose limit from 150 mSv down to 20 mSv per year; 4. The correction for ambient conditions (air temperature, pressure, and relative humidity) was improved in order to adequately handle the quantity Hp(3) and in order to extend the range of use beyond 25°C. 5. A checksum test was added to the software to secure the calibration data against (un)intended changes. 6. The connection of the PC and the BSS 2 has been changed to a network interface (TCP/IP) in order to be able to use up-to-date computers not containing a parallel and a serial port. 7. A rod phantom was added in order to make sure the mechanical set-up is of high quality.All these extensions have been implemented in the PTB's BSS 2 model. The routine implementation of extension 1 is still under investigation by the manufacturer. The commercially available BSS 2 will contain extensions 2 to 6 starting approximately in 2012, while extension 7 has already been incorporated since 2011. Extensions 2 to 4 will also be available for old BSS 2 versions via a software update, starting approximately at the beginning of 2012. Extension 6 will be available via hardware change by the manufacturer.

Eye lens dosimetry for interventional procedures – Relation between the absorbed dose to the lens and dose at measurement positions

This study investigated the relationship between the absorbed dose to the lens of the eye and the absorbed dose at different measurement positions near the eye of interventional radiologists. It also visualised the dose distribution inside the head, both when protective eyewear were used and without such protection. The best position for an eye lens dosimeter was found to be at the side of the head nearest to the radiation source, close to the eye. Positioning the dosimeter at the eyebrow could lead to an underestimation of the lens dose of as much as 45%. The measured dose distribution showed that the absorbed dose to the eye lenses was high compared to the other parts of the head, which stresses the importance of wearing protective eyewear. However, many models of eyewear were found to be deficient as the radiation could slip through at several places, e.g. at the cheek. The relationship between the absorbed dose to the lens and the kerma-area-product (P-KA) delivered to the patient was also studied. (C) 2011 Elsevier Ltd. All rights reserved. (Less)

Proposals for the type tests criteria and calibration conditions of passive eye lens dosemeters to be used in interventional cardiology and radiology workplaces

Abstract The paper is aimed at making a proposal for the type test and calibration of eye lens passive dosemeters especially used in the interventional cardiology/radiology (IC/IR). Starting from the only existing standard dealing with eye lens dosimetry using TLDs ( ISO 12794 ), parameters such as, detection threshold, energy and angle dependence of response criteria have been reviewed and it has been tried to harmonise them as much as possible with the IEC 62387 requirements, taking into account the particular use at IC/IR workplaces. Conversion coefficients from air kerma to dose equivalent at 3 mm depth for RQR and ISO radiation qualities, employed for type test and calibration purposes, have been calculated in a new phantom introduced within the ORAMED (Optimization of RAdiation protection for MEDical staff) project. This phantom is more representative of the head so that the estimation of H lens by H p (3) is more accurate.

Radiation and cataract

When this paper was about to go to press, the International Commission on Radiological Protection released a statement recommending a change in the threshold dose for the eye lens and dose limits for eye for occupationally exposed persons. It is clear that the earlier published threshold for radiation cataract is no longer valid. Epidemiological studies among Chernobyl clean-up workers, A bomb survivors, astronauts, residents of contaminated buildings, radiological technicians and recent surveys of staff in interventional rooms indicate that there is an increased incidence of lens opacities at doses below 1 Gy. Nevertheless, eye lens dosimetry is at a primitive stage and needs to be developed further. Despite uncertainties concerning dose threshold and dosimetry, it is possible to significantly reduce the risk of radiation cataract through the use of appropriate eye protection. By increasing awareness among those at risk and better adoption and increased usage of protective measures, radiation cataract can become preventable despite lowering of dose limits.

Hp(0.07) photon dosemeters for eye lens dosimetry: calibration on a rod vs. a slab phantom

In recent years, several papers dealing with eye lens dosimetry have been published as epidemiological studies are implying that the induction of cataracts occurs even at eye lens doses of less than 500 mGy. For that reason, the necessity to monitor the eye lens may become more important than it was before. However, only few dosemeters for the appropriate quantity H(p)(3) are available. Partial-body dosemeters are usually designed to measure the quantity H(p)(0.07) calibrated on a rod phantom representing a finger while a slab phantom much better represents the head. Therefore, in this work it was investigated whether dosemeters designed for the quantity H(p)(0.07) calibrated on a rod phantom can also be worn on the head (close to the eyes) and still deliver correct results (H(p)(0.07) on a head). For that purpose, different types of partial-body dosemeters from routine use were irradiated at different photon energies on both a rod and a slab phantom. It turned out that their response values are within ±5% independent of the phantom if the quantity value for the respective phantom is used. Thus, partial-body dosemeters designed for the quantity H(p)(0.07) calibrated on a rod phantom may be worn on the head and used to monitor the eye lens dose due to photon radiation via the measurement of H(p)(0.07) on the head.

Principles for the design and calibration of radiation protection dosemeters for operational and protection quantities for eye lens dosimetry

The work package two of the ORAMED project--Collaborative Project (2008-2011) supported by the European Commission within its seventh Framework Programme--is devoted to the study of the eye lens dosimetry. A first approach is to implement the use of H(p)(3) by providing new sets of conversion coefficients and well suited calibration and type test procedures. This approach is presented in other papers in the proceedings of this conference. Taking into account that the eye lens is an organ close to the surface of the body, another approach would be to directly estimate the absorbed dose to the eye lens, D(lens,est) through a special calibration procedure although this quantity is not directly measurable. This paper is a methodological paper that tries to identify the critical aspects of a dosimetry in terms of D(lens).

Eye lens dosimetry: task 2 within the ORAMED project

The ORAMED (Optimization of RAdiation protection for MEDical staff) project is funded by EU-EURATOM within the 7° Framework Programme. Task 2 of the project is devoted to study the dose to the eye lens. The study was subdivided into various topics, starting from a critical revision of the operational quantity H(p)(3), with the corresponding proposal of a cylindrical phantom simulating as best as possible the head in which the eyes are located, the production of a complete set of air kerma to dose equivalent conversion coefficients for photons from 10 keV to 10 MeV, and finally, the optimisation of the design of a personal dosemeter well suited to respond in terms of H(p)(3). The paper presents some preliminary results.

Monte Carlo determination of the conversion coefficients Hp(3)/Ka in a right cylinder phantom with 'PENELOPE' code. Comparison with 'MCNP' simulations

This work has been performed within the frame of the European Union ORAMED project (Optimisation of RAdiation protection for MEDical staff). The main goal of the project is to improve standards of protection for medical staff for procedures resulting in potentially high exposures and to develop methodologies for better assessing and for reducing, exposures to medical staff. The Work Package WP2 is involved in the development of practical eye-lens dosimetry in interventional radiology. This study is complementary of the part of the ENEA report concerning the calculations with the MCNP-4C code of the conversion factors related to the operational quantity H(p)(3). In this study, a set of energy- and angular-dependent conversion coefficients (H(p)(3)/K(a)), in the newly proposed square cylindrical phantom made of ICRU tissue, have been calculated with the Monte-Carlo code PENELOPE and MCNP5. The H(p)(3) values have been determined in terms of absorbed dose, according to the definition of this quantity, and also with the kerma approximation as formerly reported in ICRU reports. At a low-photon energy (up to 1 MeV), the two results obtained with the two methods are consistent. Nevertheless, large differences are showed at a higher energy. This is mainly due to the lack of electronic equilibrium, especially for small angle incidences. The values of the conversion coefficients obtained with the MCNP-4C code published by ENEA quite agree with the kerma approximation calculations obtained with PENELOPE. We also performed the same calculations with the code MCNP5 with two types of tallies: F6 for kerma approximation and *F8 for estimating the absorbed dose that is, as known, due to secondary electrons. PENELOPE and MCNP5 results agree for the kerma approximation and for the absorbed dose calculation of H(p)(3) and prove that, for photon energies larger than 1 MeV, the transport of the secondary electrons has to be taken into account.

ENEA extremity dosemeter based on LiF(Mg,Cu,P) to evaluate Hp(3, )

Recent epidemiological studies suggest a rather low-dose threshold (<0.5 Gy) for the induction of a cataract of the eye lens. Some other studies even assume that there is no threshold at all. Therefore, protection measures have to be optimised and current dose limits for the eye lens may be reduced in the future. ICRP Publication 103 on H(p)(d), in §(136), reads that '… a depth d = 3 mm has been proposed for the rare case of monitoring the dose to the lens of the eye. In practice, however, H(p)(3) has rarely been monitored and H(p)(0.07) can be used for the same monitoring purpose… '. As recommended on the EU 'Technical recommendations for monitoring individuals occupationally exposed to external radiation', a test on the ENEA TL extremity dosemeter is herein reported. The results within the actual EU founded Optimization of RAdiation protection for MEDical staff (ORAMED) Project, whose WP2 is aimed at the quantity H(p)(3) and eye lens dosimetry in practice, are taken into account. The paper summarises the main aspects of the study carried out at ENEA-Radiation Protection Institute (Bologna, Italy) to provide practical solutions (in the use and the design) to evaluate the response of the ENEA TL extremity dosemeter in terms of H(p)(3).