Dose Measurements Research Articles

Quantifying preferences for urea cycle disorder treatments using a discrete choice experiment

Aims: Urea cycle disorders (UCDs) can cause ammonia accumulation and central nervous system toxicity. Nitrogen-binding medications can be efficacious but certain attributes may negatively impact adherence. This study sought to quantify the administration-related attributes influencing overall prescription selection and patient adherence. Methods: A web-based, quantitative survey including discrete choice experiment (DCE) methodology captured responses from health care providers for patients with UCDs. A series of hypothetical treatment profile sets with attributes such as route of administration, taste/odor, preparation instructions, packaging, dose measurement, and weight use restrictions were presented. From 16 sets of 3 hypothetical product profiles, respondents evaluated attributes most preferred for prescription selection or patient adherence. Attributes assumed a higher overall preference if relative importance (RI) scores were >16.67% (the value if all attributes were of equal importance). Preference weight scores were assessed. A nine-point Likert scale assessed respondent attitudes, such as satisfaction. Results: A total of 51 respondents completed the survey. Respondents reported dissatisfaction with current treatments (mean [SD] = 5.4 [1.7]). For prescription selection, four attributes achieved RI >16.67%: taste/odor (24%), weight restrictions (21%), preparation instructions (18%), and route of administration (17%). For adherence, three attributes related to administration achieved RI >16.67%: taste/odor (28%), preparation instructions (21%), and route of administration (17%). Preference weights for “taste/odor masked” were higher than “not taste/odor masked” for prescription selection (mean [SD]; 1.52 [1.10] vs -1.52 [1.10]) and treatment adherence (73.8 [55.2] vs -73.8 [55.2]). Limitations: This study contained a relatively small sample size. Survey respondent selection, the use of hypothetical product profiles, and exclusion of non-pharmacologic treatment options could have contributed to potential biases. Conclusions: Among attributes tested, taste/odor was the most important attribute influencing overall preference for both prescribing and patient adherence, with taste/odor masking preferred. Optimizing nitrogen-binding medications through masking taste/odor may support improved patient adherence and outcomes in UCDs.

FDI Inflows and Economic Growth: A Novel Application of Dose-Response Functions

In this work we estimate different dose-response functions linking FDI inflows received by developing countries with their economic growth. Although the impact of FDI on the economic growth of host countries has been widely investigated in literature, findings have been ambiguous. Our study proposes a novel ‘dose-response’ approach which allows the response of recipients to different amounts of treatment in terms of FDI inflow to be observed. Our findings show that the estimated dose-response functions are statistically significant for treatment values greater than 20%, after the treatment has been rescaled to a percentage measure of the maximum dose observed, and increasing at a decreasing rate, therefore suggesting three relevant results: a) a country receiving a greater amount of FDI inflows will present a higher economic growth; b) there might be a minimum amount of FDI inflows required to reach some policy effectiveness; c) the initial amounts of FDI inflow are more effective than the subsequent ones. Results will help policymakers to better isolate the effect of FDI on economic growth and conduct informed FDI cost-benefit analysis.

Comparison between manual-calculated and IndoseCT-calculated SSDE based on Deff and Dw methods on truncated CT images

IntroductionSize-specific dose estimation (SSDE) is suggested for accurate measurement of CT dose. Various methods have been developed for SSDE calculation by both manual and automated methods. However, truncation artefact may affect the specific size determination and SSDE calculation. In this article, we evaluate how truncation affects measurements of SSDE and compare the manual SSDE measurement based on individual sizes (effective diameter, Deff and water equivalent diameter, DW) with the automated calculation using IndoseCT software on truncated CT images. MethodsA phantom study was conducted using Siemens SOMATOM Definition AS + CT scanner with two CTDI phantoms of different sizes, 22 cm and 32 cm. Phantom images were acquired by varying the phantom positioning to simulate truncation percentages (TP) of 5%, 10%, 15%, and 20%. The SSDE values were manually calculated based on the Deff and Dw methods (AAPM, 2014). SSDE was also calculated automatically using IndoseCT software (Version 20 b) and compared with manual calculation. The percentage error due to different TP was calculated in comparison to the non-truncated image (TP 0%). The errors due to truncation on SSDE calculation was also compared between both manual and automated methods. Statistical analysis was carried out to determine the statistical differences and correlation. ResultsThe findings show that Deff for non-truncated image yields better results with lower percentage errors (mean PEmanual = 0.75% and mean PEautomated = 0.14%) as compared to Dw (mean PEmanual = 6.11% and mean PEautomated = 5.81%). There is a positive strong correlation between percentage error and truncation percentage. There are strong positive correlations between TP and percentage error, PE (r = 0.96 and r = 0.94) in determination of SSDEDeff and SSDEDw, respectively. Deff approach resulted higher percentage error as compared to Dw. ConclusionTruncation is strongly correlated with SSDE calculation, and therefore correction for truncation artefact is crucial to minimise error in SSDE measurement. The automated calculation of SSDE can be confidently replaced the manual method in both Deff and Dw approaches to ensure rapid and accurate SSDE measurement.

X-ray-Sensitive Doped CaF2-Based MRI Contrast Agents for Local Radiation Dose Measurement.

Ionizing radiation has become widely used in medicine, with application in diagnostic techniques, such as computed tomography (CT) and radiation therapy (RT), where X-rays are used to diagnose and treat tumors. The X-rays used in CT and, in particular, in RT can have harmful side effects; hence, an accurate determination of the delivered radiation dose is of utmost importance to minimize any damage to healthy tissues. For this, medical specialists mostly rely on theoretical predictions of the delivered dose or external measurements of the dose. To extend the practical use of ionizing radiation-based medical techniques, such as magnetic resonance imaging (MRI)-guided RT, a more precise measurement of the internal radiation dose internally is required. In this work, a novel approach is presented to measure dose in liquids for potential future in vivo applications. The strategy relies on MRI contrast agents (CAs) that provide a dose-sensitive signal. The demonstrated materials are (citrate-capped) CaF2 nanoparticles (NPs) doped with Eu3+ or Fe2+/Fe3+ ions. Free electrons generated by ionizing radiation allow the reduction of Eu3+, which produces a very small contrast in MRI, to Eu2+, which induces a strong contrast. Oxidative species generated by high-energy X-rays can be measured indirectly using Fe2+ because it oxidizes to Fe3+, increasing the contrast in MRI. Notably, in the results, a strong increase in the proton relaxation rates is observed for the Eu3+-doped NPs at 40 kV. At 6 MV, a significant increase in proton relaxation rates is observed using CaF2 NPs doped with Fe2+/Fe3+ after irradiation. The presented concept shows great promise for use in the clinic to measure in vivo local ionizing radiation dose, as these CAs can be intravenously injected in a saline solution.

Silicon carbide detectors for dosimetry and monitoring of ultra-high dose rate beams

FLASH radiotherapy, which employs ultra-high dose rate (UHDR) beams with a mean dose rate > 40 Gy/s and a total irradiation time < 200 ms to treat tumors, exhibits remarkable ability to spare healthy tissue while maintaining the same efficiency in treating tumors. However, UHDR presents challenges in dosimetry and beam monitoring, as the dosimeters recommended for conventional radiotherapy, i.e. the ionization chambers, show saturation at such high dose rates and dose delivered per pulse and hence cannot be employed for accurate dosimetry in the future clinical transition of FLASH radiotherapy. This implies the need to develop alternative techniques and dosimeters able to sustain the peculiar conditions of the UHDR beams. This study investigates the feasibility of using a new generation of Silicon Carbide (SiC) detectors for the measurement of the instantaneous dose rate of UHDR electron beams. An experimental investigation was conducted with the ElectronFLASH linac developed by the SIT Sordina company and able to accelerate 7 and 9 MeV electron pulsed beams at FLASH regimes. The signalsproduced in the SiC detectors were acquired and compared with the signals detected by the monitoring system currently mounted along the LINAC, i.e. two AC current transformers supplied by the Bergoz company. The main purpose of the experiment was to demonstrate the capability of the developed SiC detector to measure the single pulse duration and waveform with high time resolution and accuracy. The test was performed by using both 7 and 9 MeV electron beams and has shown promising results.

Prospective assessment of entrance skin dose and targets for radiation reduction during abdominal plain films in pediatric urology patients

Abdominal radiographs are frequently used for evaluation of bowel and bladder dysfunction in pediatric urology. However, the dose of radiation delivered with each study is estimated from machine settings as opposed to measurement of the true entrance skin dose. In addition, the correlation of radiographic constipation with patient symptoms has been questioned. To evaluate the practices for obtaining abdominal radiographs and the true entrance skin dose of radiation for each examination in order to identify targets for radiation reduction. Pediatric urology patients were prospectively enrolled from June 2022 through June 2023. Dosimeters were attached to the navel to collect entrance skin doses from single view abdominal x-ray. Estimated doses were compared to measured entrance skin dose as well as patient characteristics. Exam parameters were evaluated to identify targets for radiation reduction. A total of 75 patients were recruited for this study with a median age of 10.0 years (IQR 6-14). Most evaluations were done to assess for bowel and bladder dysfunction (68 exams, 91%). The protocol for exams was not standardized resulting in 27% of patients undergoing a medium or high dose strength and 55% undergoing 1 or more image. The median estimated dose was 0.63mGy (IQR 0.3-1.2mGy). The median measured dose was 0.77mGy (IQR 0.31-2.01mGy) which was significantly different than the estimations (p<0.001). The estimated dose, measured dose and estimate error were all found to be positively correlated with patient characteristics including age and body mass index (See Figure). Increasing age and body mass index also showed a higher likelihood of increased dose strength and image acquisition. The measured entrance skin dose of radiation is significantly higher than prior estimates. The measured dose but also the estimate error increased with patient age and size which is likely related to higher settings used for image acquisition as patients age. Standardized protocols using low dose settings and limiting image acquisition to the pelvis may reduce radiation exposure in children with bowel and bladder dysfunction while providing adequate diagnostic data. Radiation dose for abdominal radiographs is higher than previously estimated. Older and larger children received higher doses which may be mediated by increased dose strength and image acquisition. Standardization of protocols could lower radiation exposure.

A phantom study investigating effective strategies for reducing fetal dose in pregnant patients with head and neck cancer

PurposeTo measure the out-of-field doses for various treatment planning techniques and assess the impact on fetal dose with and without the use of custom shielding. Materials and methodsA total of six treatment plans were generated with different treatment techniques such as 3-dimensional conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT), utilizing both 6 MV flattened beams and flattening filter-free (FFF) beams. The measurements were carried out both out-of-field at the surface and at depth to assess the dose reduction achieved by removing the flattening filter and incorporating shielding. ResultsThe custom-made frame shielding can effectively reduce the surface dose with a maximum reduction of 15.2% observed in VMAT plans and achieve a maximum reduction of 100% for cone beam computed tomography (CBCT) imaging. Out-of-field dose measurements conducted at depth, positioned 58 cm inferior to the target isocenter, reveal that the shielding effectiveness consistently remains the greatest for 3DCRT technique. A maximum reduction of 21% is observed when utilizing a flattening filter-free beam. ConclusionThe results of this study indicate that the 3DCRT technique exhibits the least amount of scatter radiation both near and far from the treatment isocenter, which is the most suitable approach for radiation therapy of pregnant patients. In cases where meeting dose constraints for critical organs becomes challenging, VMAT technique emerges as the most suitable treatment technique for reducing out-of-field doses. Additionally, a flattening filter-free beam significantly reduces out-of-field doses due to lower contributions from head scatter.

Is the use of gonad protection protectors necessary during infants chest radiography?

Introduction and objectivesTo compare gonad doses with and without a gonad protector and to optimize the use of gonadal protectors in infants thorax radiography. Materials and methodsTwo pediatric anthropomorphic phantoms are used: an X-ray system for KXO-50SS/DRX-3724HD, and a digital radiography system for CALNEO Smart C12, with and without a gonad protector during infants thorax radiography. A real time skin dosimeter is placed on the X-ray system, and a real time skin dosimeter is inserted on the front side of the mammary gland, the front and back sides of the true pelvis level, and on the ovaries and testes. The X-ray system is irradiated 15 times using phantoms with and without a gonad protector. The measured entrance patient doses values of for the real time skin dosimeter are compared for each phantom, with and without the gonad protector. ResultsThe medium of measured entrance patient doses values for front side dose of the true pelvis level with and without the protector are 10.00 and 5.00 μGy at newborn, and 10.00 and 0.00μGy at one year, respectively. The medium of measured entrance patient doses values for the back side dose of the true pelvis level with and without the protector are 0.00 and 0.00 μGy at both newborn one year, respectively. The measured entrance patient doses cannot be detected in the ovaries and testes with or without the protector. No significant differences are observed in the measured entrance patient doses values for the front and back side doses of the pelvis, ovaries, and testes at newborn and one year, with and without the protector (p>0.05). ConclusionsNo significant difference was observed in gonad dose measurements with and without the gonad protector during infants chest radiography. We believe that gonadal protector wearing is not necessary.

A novel AP/PA total body irradiation technique using abutting IMRT fields at extended SSD.

To develop a Total Body Irradiation (TBI) technique using IMRT at extended SSD that can be performed in any size Linac room. Patients studied were placed on a platform close to the floor, directly under the gantry with cranial-caudal axis parallel to the gantry rotation plane and at SSD ∼200cm. Two abutting fields with the same external isocenter at gantry angles of±21˚, collimator angle of 90˚, and field size of 25×40 cm2 are employed for both supine and prone positions. An iterative optimization algorithm was developed to generate a uniform dose at the patient mid-plane with adequate shielding to critical organs such as lungs and kidneys. The technique was validated in both phantom and patient CT images for treatment planning, and dose measurement and QA were performed in phantom. A uniform dose distribution in the mid-plane within±5% of the prescription dose was reached after a few iterations. This was confirmed with ion-chamber measurements in phantom. The mean dose to lungs and kidneys can be adjusted according to clinical requirements and can be as low as ∼25% of the prescription dose. For a typical prescription dose of 200 cGy/fraction, the total MU was ∼2400/1200 for the superior/inferior field. The overall treatment time for both supine/prone positions was ∼54 min to meet the maximum absorbed dose rate criteria of 15 cGy/min. IMRT QA with portal dosimetry shows excellent agreement. We have developed a promising TBI technique using abutting IMRT fields at extended SSD. The patient is in a comfortable recumbent position with good reproducibility and less motion during treatment. An additional benefit of this technique is that full 3D dose distribution is available from the TPS with a DVH summary for organs of interest. The technique allows precise sparing of lungs and kidneys and can be executed in any linac room.

Evaluation of Radiation Exposure and Influential Factors in Cone-Beam Computed Tomography (CBCT) of the Head and Abdomen during Interventional Procedures.

Cone-beam computed tomography (CBCT) is a widely used imaging technique in interventional radiology. Although CBCT offers great advantages in terms of improving comprehension of complex angioarchitectures and guiding therapeutic decisions, its additional degree of radiation exposure has also aroused considerable concern. In this study, we aimed to assess radiation exposure and its influential factors in patients undergoing CBCT scans of the head and abdomen during interventional procedures. A total of 752 patients were included in this retrospective study. Dose area product (DAP) and reference air kerma (RAK) were used as measures of patient dose. The results showed that the median values of DAP were 53.8 (50.5-64.4) Gy⋅cm2 for head CBCT and 47.4 (39.6-54.3) Gy⋅cm2 for that of the abdomen. Male gender and body mass index (BMI) were characterized by increased DAP and RAK values in both head and abdominal CBCT scans. Larger FOV size was associated with a higher DAP but a lower RAK value, especially in head CBCT scans. Exposure parameters under automatic exposure control (AEC) also varied according to patient BMI and gender. In conclusion, the patients received slightly higher radiation doses from head CBCT scans than from those applied to the abdomen. BMI, gender, and FOV size were the key factors that influenced the radiation dose administered to the patients during CBCT scans. Our results may help to define and minimize patients' exposure to radiation.

Preliminary study on the correlation between accelerated current and dose in water for an electron-based LINAC

Purpose: Intraoperative electron radiotherapy (IOeRT) is considered the first clinical translation of FLASH with electrons. A crucial aspect is represented by the precise dose monitoring and measurement; to this aim, we propose a method fully based on Monte Carlo (MC) simulation that uses as input the beam current measurement and the beam optics simulation. To validate this approach, we chose the NOVAC11 (produced by Sordina IORT Technologies SpA) accelerator, which provides a well-studied model.Methods: We used FLUKA and FRED MC software to simulate in detail the geometry of the NOVAC11 and the coupled applicator usually adopted in clinical practice to deliver the dose in the surgical bed. The simulation results of the longitudinal and off-axis profiles and dose per pulse obtained in a water phantom with different applicators are compared to the experimental data.Results: A very good agreement not only for the relative dosimetry in both the longitudinal and off-axis profiles, with a gamma index pass rate of 100% with 3%/3 mm acceptance criteria, but also for the absolute dosimetry was obtained.Conclusion: The results completely validate the MC description of the system and provide a reliable evaluation of the dose per pulse and output factor with an accuracy of the order of few % for different sets of applicator diameters and lengths.

Halogen-Regulated Tc and X-ray Radiation Detection in 2D Hybrid Perovskite Ferroelastic Semiconductor.

Organic-inorganic hybrid perovskites (OIHPs) have received particular attention due to their characteristic structural tunability and flexibility. These features make OIHPs behave with excellent modifications on macroscopic properties, such as ferroicity or semiconductor performances, etc. Herein, we report two 2D hybrid stibium-based halide perovskite (C3H7N)3Sb2X9 (X = Br, 1; Cl, 2) ferroelastic semiconductor possessing dual switching properties of dielectric and second harmonic generation (SHG). Notably, these two hybrids exhibit halogen-regulated ferroelasticity and semiconductor properties. There is a significant difference in Curie temperature (Tc) and X-ray radiation detection sensitivity (S), i.e., the ΔTc and ΔS are 38 K and 87 μC Gyair-1 cm-2, respectively. Meanwhile, crystals 1 and 2 do not show dark current drift in cyclic measurements of different radiation doses with stable switching ratios of 30 and 10, separately. Meanwhile, these results were proven by scientific experimental results and density functional theory (DFT) calculations. Our work presents a facile and practical method to regulate macroproperties on the molecular level, providing a new vision to develop hybrid perovskite ferroic-photoelectric materials.

Dependence of surface dose on atomic number in megavoltage photon beams.

Surface dose in megavoltage photon radiotherapy has a significant clinical impact on the skin-sparing effect. In previously published works, it was established that the presence of medium atomic number (Z) absorbers, such as tin, decreases the surface dose. It was concluded that high-Z absorbers, such as lead, increase the surface dose, relative to medium-Z absorbers, due to the increased contributions from photoelectrons and electron-positron pairs. The purpose of this investigation is to revisit these conclusions in the context of photon beams from modern linacs. A metric estimating the relative intensity of charged particles emitted in the forward direction, , was proposed using cross-sections for the photon interactions. The values were calculated for various absorbers using energy spectra of 6 and 10 MV photon beams from a Varian TrueBeam linac. Monte Carlo (MC) simulations were performed using TOPAS MC code to calculate the surface dose for various absorbers. Surface dose measurements were performed with 6 and 10 MV photon beams with tin and lead absorbers. The values were found to decrease as a function of Z for both 6 and 10 MV photon beams indicating that the surface dose from electrons emitted in the forward direction consistently decreases with increasing Z. With the increasing Z of the absorbers, both experimental and MC-calculated surface dose decreased without exhibiting a minimum at medium-Z absorbers. The surface dose for lead and tin was determined to be within 1% of each other for both 6 and 10 MV photon beams using MC simulations and experimental measurements. Therefore, no statistically significant difference in surface dose was found between the tin and lead absorbers disproving the presence of any minima in the surface dose versus the Z curve as has been reported in the literature. Surface dose for modern photon beams can be reduced using both medium and high Z absorbers since a consistent decrease in surface dose was found with increasing absorber Z.

RADIOLOGICAL PROTECTION OF PATIENT WITH LIVER METASTASIS OF STRUMA OVARII SUBMITTED TO SODIUM IODIDE THERAPY (I-131)

This paper presents as main objective to discuss Radiological Protection in Iodotherapy of patients with rare Hepatic metastasis of the Struma Ovarii Cancer. This was followed up for 28 days with periodic measurements of the external dose rate of the patient submitted to therapy with I-131, carried out two meters away. During the first therapeutic session, 14 days without close contact with children of their living and work were suggested. After the first 14 days of follow-up it was found by measurements and hepatic uptake of I-131, that restrictions should be maintained for another 14 days. The patient was accompanied during the whole period of social intercourse restriction. Measurements were compared with estimated dose rates of routine treatment of papillary or follicular-type thyroid cancer. The elimination of I-131 demonstrated by the dose rate measurements was shown to adjust significantly with the curve used, with correlation coefficient R = 0.9225. In contrast, the estimated curves for activities of 100, 150 and 200 mCi present better fit with R = 0.9999. The time needed for the dose rate to decrease in the level of release of the restrictions of living together was 4 times greater than the time for patients with thyroid cancer who do not live with children younger than 5 years or pregnant women; and 2 times greater than the time for patients who live with children or pregnant women. It can be concluded that different from a thyroid cancer, in this case, when treated with I-131, one can capture and retain an amount of activity that makes it impossible to release the restrictions of living together before at least 28 days. This work also suggests that the release of living restrictions depends on the biological elimination of I-131 in the patient's body. And the physiological and social conditions of each individual.

Evaluating Radiation Exposure for Patients During Pelvic X-ray Exams in Dhaka Metropolitan Area, Bangladesh

Objectives: This study aims to comprehensively assess Entrance Skin Dose (ESD) variability across diverse age groups in various diagnostic areas such as RGU, MCU, Fistulogram, Sinogram, and radiography of SI Joint, Coccyx, and Hip Joint in the pelvic region. The investigation delves into elucidating the range and mean ESD values while identifying factors contributing to fluctuations, enabling precise understanding and strategies for managing radiation exposure in pelvic X-ray examinations. Method &amp; Materials: A qualitative research study took place in one of the hospitals in Dhaka City, Bangladesh, with participation from 138 patients. Radiation protocols in Dhaka City used consistent methods for diverse ages during X-ray examinations. Detailed data on Entrance Skin Dose for various exams like pelvic, SI joint, and fistulogram were meticulously collected and analyzed, aiding in understanding demographic-specific radiation variations. Result: The diverse dataset of Entrance Skin Dose (ESD) measurements across varying age groups in pelvic X-ray examinations reveals a range of ESD values, highlighting fluctuations within specific ages. The overall mean ESD averages approximately 1.87, indicating a moderate consistency in radiation exposure across ages. Notably, certain age brackets, such as patients aged 24 and those in their early teens, exhibit higher ESD values, while others, like ages 15 and 72–76, showcase notable variability. These findings underscore the need for tailored imaging protocols and monitoring strategies in clinical practice. Conclusion: In conclusion, this comprehensive examination underscores the intricate relationship between age, diagnostic areas, and the variability of ESD values, highlighting the need for nuanced approaches in healthcare management to ensure optimized patient outcomes while minimizing radiation exposure risks.

Dosimetry audit in advanced radiotherapy using in-house developed anthropomorphic head & neck phantom

The treatment of head and neck (H&N) cancer presents formidable challenges due to the involvement of normal tissue and organs at risk (OARs) in the close vicinity. Ensuring the precise administration of the prescribed dose demands prior dose verification. Considering contour irregularity and heterogeneity in the H&N region, an anthropomorphic and heterogeneous H&N phantom was developed and fabricated locally for conducting the dosimetry audit in advanced radiotherapy treatments. This specialized phantom emulates human anatomy and incorporates a removable cylindrical insert housing a C-shaped planning target volume (PTV) alongside key OARs including the spinal cord, oral cavity, and bilateral parotid glands. Acrylonitrile Butadiene Styrene (ABS) was chosen for PTV and parotid fabrication, while Delrin was adopted for spinal cord fabrication. A pivotal feature of this phantom is the incorporation of thermoluminescent dosimeters (TLDs) within the PTV and OARs, enabling the measurement of delivered dose. To execute the dosimetry audit, the phantom, accompanied by dosimeters and comprehensive guidelines, was disseminated to multiple radiotherapy centers. Subsequently, hospital physicists acquired computed tomography (CT) scans to generate treatment plans for phantom irradiation. The treatment planning system (TPS) computed the anticipated dose distribution within the phantom, and post-irradiation TLD readings yielded actual dose measurements. The TPS calculated and TLD measured dose values at most of the locations inside the PTV were found comparable within ± 4%. The outcomes affirm the suitability of the developed anthropomorphic H&N phantom for precise dosimetry audits of advanced radiotherapy treatments.

Prospective comparison of positron emission tomography (PET)/magnetic resonance and PET/computed tomography dosimetry in hepatic malignant neoplastic disease after 90Y radioembolization treatment.

90Y radioembolization is an established treatment modality for hepatic malignancies. Successful radioembolization requires optimal dose delivery to tumors while minimizing dosages to parenchyma. Post-treatment positron emission tomography (PET)/computed tomography (CT) dosimetry is the established benchmark, whereas PET/magnetic resonance (MR) is an emerging modality. The goal of this study was to assess the intermodality agreement between PET/MR and PET/CT 90Y dosimetry. In this single-institution study, 18 patients (20 treatment sessions) with a primary or metastatic hepatic malignancy underwent both PET/MR and PET/CT after 90Y radioembolization. Patients were randomized to undergo one modality first, followed by the other. The region of interest was delineated using MR images and tumor and liver dosimetry was calculated. Intermodality agreement was assessed using the Bland-Altman method. A generalized linear model was used to assess the effect of baseline variables on intermodality dose differences. PET/MR underestimated tumor and liver absorbed doses when compared to PET/CT by -3.7% (P=0.042) and -5.8% (P=0.029), respectively. A coverage probability plot demonstrated that 80% and 90% of tumor dose measurements fell within intermodality differences of 11% and 18%, respectively. PET/MR underestimated tumor dose at both low (<1 GBq) and high (>3 GBq) injected activity levels (P<0.001) by -22.3 [standard deviation (SD) =13.5] and -24.3 (SD =18.7), respectively. Although PET/MR significantly underestimated the absorbed dose when compared to PET/CT, the intermodality agreement was high and the degree of underestimation was better than previously reported. Intermodality differences were more pronounced at low and high injected doses. Additional studies are required to assess the clinical implications of these findings.

Radiation Exposure Characteristics among Healthcare Workers: Before and After Japan's Ordinance Revision.

Radioactive materials and ionizing radiation have both medical value and disease risks, necessitating radiation dose measurement and risk reduction strategies. The International Commission on Radiological Protection (ICRP) lowered the lens of the eye exposure limit, leading to Japan's revised "Ionizing Radiation Ordinance." However, the effects on radiation exposure in medical settings and compliance feasibility remain unclear. To examine the impact of the revision to the "Ionizing Radiation Ordinance" and use it for measures to reduce exposure to radiation, a comprehensive analysis was conducted on data collected from Nagasaki University Hospital, Hiroshima University Hospital, and Fukushima Medical University Hospital in 2018, 2020, and April to September 2021. This included information on age, sex, occupation, department, and monthly radiation doses of workers, aiming to assess the impact of the revision to the "Ionizing Radiation Ordinance" on radiation exposure before and after its enforcement. Out of 9,076 cases studied, 7,963 (87.7%) had radiation doses below the measurable limit throughout the year. Only 292 cases (3.2%) exceeded 1 mSv y -1 , with 9 doctors and 2 radiological technologists surpassing 5 mSv y -1 . Radiological technologists showed significantly higher doses compared to doctors, dentists, and nurses (p < 0.01), while male subjects had significantly higher exposure doses than females (p < 0.01). No significant changes in radiation exposure were observed before and after the revision of the Ionizing Radiation Ordinance; however, variations in radiation exposure control were noted, particularly among nurses and radiological technologists, suggesting the impact of the revision and the need for tailored countermeasures to reduce radiation dose in each group.

Multi-point calorimeter using distributed fiber Bragg gratings for small field dosimetry in radiotherapy.

The interest of using fiber Bragg gratings (FBGs) dosimeters in radiotherapy (RT) lies in their (i) microliter detection volume, (ii) customizable spatial resolution, (iii) multi-point dose measurement, (iv) real-time data acquisition and (v) insensitivity to Cherenkov light. These characteristics could prove very useful for characterizing dose distributions of small and nonstandard fields with high spatialresolution. We developed a multi-point FBGs dosimeter customized for small field RT dosimetry with a spatial resolution of 1mm. The 3cm-long multi-point dosimeter is made by embedding a 80 silica fiber containing an array of thirty (30) co-located 1mm-long fs-written FBGs inside a plastic cylinder with an UV curing optical adhesive. With its higher thermal expansion coefficient, the plastic cylinder increases the sensitivity of the dosimeter by stretching the fiber containing the FBGs when the temperature rises slightly due to radiation energy deposition. Irradiations (2000MU at 600MU/min) were performed with a Varian TrueBeam linearaccelerator. The dose profile of a 2 2cm 6MV beam was measured with a mean relative difference of 1.8% (excluding the penumbra region). The measured output factors for a 6MV beam are in general agreement with the expected values within the experimental uncertainty (except for the 2 2cm field). The detector response to different energy of photon and electron beams is within 5% of the mean response ( pm/Gy). The calorimeter's post-irradiation thermal decay is in agreement with thetheory. An energy-independent small field calorimeter that allows dose profile and output factor measurements for RT using FBGs was developed, which, to our knowledge, has never been done before. This type of detector could prove really useful for small field dosimetry, but also potentially for MRI-LINAC since FBGs are insensitive to magnetic fields and for FLASH since FBGs have been used to measure doses up to100kGy.

A Vision for Global CT Radiation Dose Optimization

The topic of CT radiation dose management is receiving renewed attention since the recent approval by CMS for new CT dose measures. Widespread variation in CT dose persists in practices across the world, suggesting that current dose optimization techniques are lacking. The author outlines a proposed strategy for facilitating global CT radiation dose optimization. CT radiation dose optimization can be defined as the routine use of CT scan parameters that consistently produce images just above the minimum threshold of acceptable image quality for a given clinical indication, accounting for relevant patient characteristics, using the most dose-efficient techniques available on the scanner. To accomplish this, an image quality–based target dose must be established for every protocol; for nonhead CT applications, these target dose values must be expressed as a function of patient size. As variation in outcomes is reduced, the dose targets can be decreased to more closely approximate the minimum image quality threshold. Maintaining CT radiation dose optimization requires a process control program, including measurement, evaluation, feedback, and control. This is best accomplished by local teams made up of radiologists, medical physicists, and technologists, supported with protected time and needed tools, including analytics and protocol management applications. Other stakeholders critical to facilitating CT radiation dose management include researchers, funding agencies, industry, regulators, accreditors, payers, and the ACR. Analogous coordinated approaches have transformed quality in other industries and can be the mechanism for achieving the universal goal of CT radiation dose optimization.