Patient Dose Monitoring Research Articles

How Much Radiation Are Women in Saudi Arabia Receiving from Mammography? A Review

This review compiles and assesses data from recent studies on mammographic radiation doses in Saudi Arabia, aiming to evaluate mean glandular dose (MGD) exposure during mammography and its implications in breast cancer risk. The reviewed studies spanned from 2019 to 2023 and included a range of sample sizes and institutional settings, with patients’ ages from 27 to 85 years. Considerations such as the number of mammographic views and compressed breast thickness were examined. The studies reported average MGDs below the National Diagnostic Reference Level set by the Saudi Food and Drug Authority. However, limitations were noted regarding sample size selection and incomplete data on all mammographic projections. Despite these limitations, the findings highlight the need for continued assessment of patient doses to optimize mammography practices and address the absence of quality standardization acts in Saudi Arabia. These insights are critical for governing authorities to ensure that effective patient dose monitoring occurs regularly and that the establishment of minimum quality standards for breast cancer screening is intact.

Absolute dose measurement and energy dependence of LiF dosimeters in proton therapy beam dosimetry

Background: For the purpose of patient dose monitoring, thermoluminescent dosimeters (TLDs) can report any dose point of interest as in vivo dosimetry. However, energy dependence of TLDs may perturb proton beam dosimetry, particularly for low-energy proton beams. The purpose of this study was to evaluate the energy dependence of TLDs for proton beams and influence on dosimetry.

Patient dose monitoring software in radiology

An increase in the number of diagnostic procedures using ionizing radiation (computed tomography, interventional procedures, and the use of nuclear medicine) results in an increase in radiation exposure and, consequently, an increase in collective and individual doses of radiation to patients.
 Diagnostic studies from the international professional community are extensively focusing on issues such as management and dose optimization. Worldwide practice can resolve these issues using software for monitoring patient doses to automatically collect, analyze, and account for patient doses in various types of diagnostic studies. The software allows to obtain data on the doses of patients from X-ray procedures and detailed information about studies, track the total accumulated dose of the patient, and maintain statistics on the device, X-ray laboratory, and the medical organization. It also helps analyze the collected dosimetric data, deduce the causal relationship between dose indications and diagnostic procedure conditions, and monitor the effectiveness of the equipment.
 The basic capabilities of patient dose monitoring software (DMS) available on the global market were investigated. The major technical requirements for the software functional needed in practical work were defined.
 Modern DMS have a wide range of possibilities for automated collection, storage, and management of patient radiation exposure data in radiology departments. DMS increase the quality of healthcare services, provide patient safety, and optimize the workflow of medical organizations.

Patient dose and dose monitoring in Interventional Radiology

Synopsis:Throughout the past decades, diagnostic and interventional radiology have been known as major sources of radiation dose exposed to the world population. The International Basic Safety Standard (BSS) issued by the International Atomic Energy Agency (IAEA) clearly outlines key activities in radiation protection from medical exposure. Those activities include justification, optimization, and limitation of dose. The BSS requires optimization of protection and safety for each medical exposure. Key components of optimization include patient dosimetry and Dose Reference Levels (DRLs). Patient dose monitoring and audit have been used as tools for optimization and required by either regulation or accreditation such as the Joint Commission (JCI). The speaker aims to provide information regarding the concept of dosimetric parameters in fluoroscopic guided procedures in interventional radiology and cardiology, and the use of dose management software in radiological practice. How to start up the dose monitoring and audit in interventional cardiology, JCI compliance issues, DRLs and audit systems. Benefits of the dose management software in a purpose of national dose index registry will also be discussed. Synopsis: Throughout the past decades, diagnostic and interventional radiology have been known as major sources of radiation dose exposed to the world population. The International Basic Safety Standard (BSS) issued by the International Atomic Energy Agency (IAEA) clearly outlines key activities in radiation protection from medical exposure. Those activities include justification, optimization, and limitation of dose. The BSS requires optimization of protection and safety for each medical exposure. Key components of optimization include patient dosimetry and Dose Reference Levels (DRLs). Patient dose monitoring and audit have been used as tools for optimization and required by either regulation or accreditation such as the Joint Commission (JCI). The speaker aims to provide information regarding the concept of dosimetric parameters in fluoroscopic guided procedures in interventional radiology and cardiology, and the use of dose management software in radiological practice. How to start up the dose monitoring and audit in interventional cardiology, JCI compliance issues, DRLs and audit systems. Benefits of the dose management software in a purpose of national dose index registry will also be discussed.

Monitoring clinical exposure index and deviation index for dose optimization based on national diagnostic reference level: Focusing on general radiography of extremities.

The International Electrotechnical Commission established the concept of the exposure index (EI), target exposure index (EIT) and deviation index (DI). Some studies have conducted to utilize the EI as a patient dose monitoring tool in the digital radiography (DR) system. To establish the appropriate clinical EIT, this study aims to introduce the diagnostic reference level (DRL) for general radiography and confirm the usefulness of clinical EI and DI. The relationship between entrance surface dose (ESD) and clinical EI is obtained by exposure under the national radiography conditions of Korea for 7 extremity examinations. The EI value when the ESD is the DRL is set as the clinical EIT, and the change of DI is then checked. The clinical EI has proportional relationship with ESD and is affected by the beam quality. When the clinical EIT is not adjusted according to the revision of DRLs, there is a difference of up to 2.03 in the DI value and may cause an evaluation error of up to 1.6 times for patient dose. If the clinical EIT is periodically managed according to the environment of medical institution, the appropriate patient dose and image exposure can be managed based on the clinical EI, EIT, and DI.

Validation of organ dose calculations with PyMCGPU-IR in realistic interventional set-ups.

Interventional radiology procedures are associated with high skin dose exposure. The 2013/59/EURATOM Directive establishes that the equipment used for interventional radiology must have a device or a feature informing the practitioner of relevant parameters for assessing patient dose at the end of the procedure. This work presents and validates PyMCGPU-IR, a patient dose monitoring tool for interventional cardiology and radiology procedures based on MC-GPU. MC-GPU is a freely available Monte Carlo (MC) code of photon transport in a voxelized geometry which uses the computational power of commodity Graphics Processing Unit cards (GPU) to accelerate calculations. PyMCGPU-IR was validated against two different experimental set-ups. The first one consisted of skin dose measurements for different beam angulations on an adult Rando Alderson anthropomorphic phantom. The second consisted of organ dose measurements in three clinical procedures using the Rando Alderson phantom. The results obtained for the skin dose measurements show differences below 6%. For the clinical procedures the differences are within 20% for most cases. PyMCGPU-IR offers both, high performance and accuracy for dose assessment when compared with skin and organ dose measurements. It also allows the calculation of dose values at specific positions and organs, the dose distribution and the location of the maximum doses per organ. In addition, PyMCGPU-IR overcomes the time limitations of CPU-based MC codes.

Patient dose monitoring using exposure index against body mass index level on chest X-ray examination

The image quality factor is not merely a matter of whether the image is repeated or not, but also has a wide range of information and also has to maintain the protection method for the patient is the reception of the dose due to radiographic action. So it is necessary to monitor the patient's dose using the EI value. The factors that determine the EI value are the exposure factor and the thickness of the object or BMI (Body Mass Index). Exposure factors (kV and mAs) are factors that have been commonly used as patient dose monitoring, where the tube voltage is a component that changes more often with a relatively constant tube current. The study used data on patients with Thoracic examination at the age of 20-65 years which were then categorized into BMI. The analysis was carried out on the EI value contained in the radiographic image. The results showed that BMI in the normal, Light Grade Fat (LGF), Heavy Grade Fat (HGF) categories, respectively, the EI values were 1562, 1679, and 1955 for the female sex, and 1266, 1600, and 1821 for the male gender. Significantly (P?0.05) the EI value showed difference between female and male sexes.

CT-scan patient dose monitoring on thorax examination in general hospital Sanjiwani Gianyar

Currently, in the world of medicine, the use of medical devices is very important. Along with the development of technology, the need for imaging in radio diagnostics is getting higher. This can be seen from the increasing trend of using medical devices by experts that are tailored to the needs of patients. The progress of radiological examination is growing rapidly with the use of radiation sources, one of which is by using a CT-Scan (Computed Tomography Scanning). The use of CT-Scans must be monitored to ensure the protection and safety of workers, patients, and the public. Protection requirements that must be met in the use of radiation are optimization of radiation protection and safety. The optimization of radiation protection is determined from the diagnostic guide level or the Indonesian Diagnostic Reference Level (I-DRL). The data used in this study is a chest contrast examination with the category of adults (15 years and over). From the CT-Scan irradiation, the CTDIVol and DLP values ??were determined in the 3rd quartile (Q3=75 percentile).

Deep learning-enabled EPID-based 3D dosimetry for dose verification of step-and-shoot radiotherapy.

The study aims at a novel dosimetry methodology to reconstruct a 3D dose distribution as imparted to a virtual cylindrical phantom using an electronic portal imaging device (EPID). A deep learning-based signal processing strategy, referred to as 3DosiNet, is utilized to learn a mapping from an EPID image to planar dose distributions at given depths. The network was trained with the volumetric dose exported from the clinical treatment planning system (TPS). Given the latent inconsistency between measurements and corresponding TPS calculations, unsupervised learning is formulated in 3DosiNet to capture abstractive image features that are less sensitive to the potential variations. Validation experiments were performed using five regular fields and three clinical intensity-modulated radiation therapy (IMRT) cases. The measured dose profiles and percentage depth dose (PDD) curves were compared with those measured using standard tools in terms of the 1D gamma index. The mean gamma pass rates (2%/2mm) over the regular fields are 100% and 97.3% for the dose profile and PDD measurements, respectively. The measured volumetric dose was compared to the corresponding TPS calculation in terms of the 3D gamma index. The mean 2%/2mm gamma pass rates are 97.9% for square fields and 94.9% for the IMRT fields. The system promises to be a practical 3D dosimetric tool for pre-treatment patient-specific quality assurance and further developed for in-treatment patient dose monitoring.

Reference Person Dose-Area Product and Organ Dose-Area Product Estimates During Pelvis Radiography in Some Selected Centres in Lagos Conurbation, Nigeria

Background: In diagnostic radiology, focus on patient’s dose measurement has been on the estimation of entrance skin surface dose and its equivalent risk assessor (effective and organ doses). So, this study identified DAP’s as capable of performing same function as ESD in patient dose monitoring. Thus, reported estimates on dose area product (DAP) and the equivalent risk to organ’s exposed in adult patients during pelvis examination in Lagos State, Nigeria. Patients and Methods: Gender percentage ratio of 39.4 and 60.4 for male and female respectively, from six selected centres, exposed for both pelvis AP and LAT of the procedures were monitored using mathematical approach and dose Cal version 2.31 software, designed to monitor organ’s dose and DAP. Results: The average DAP and it equivalent organ dose area product (ODAP) values recorded from a population of 278 adult patients studied were found to be within expected limits for a reference adult person. Though, DAP for pelvis AP was found almost twice that recorded for the pelvis LAT. High and low organ DAP recorded for both gender from urinary bladder and lungs respectively for pelvis AP whilst these were pelvis bone and lungs for male and ovaries and lungs for female from pelvis LAT respectively. High values were equally recorded for the reproductive organs (Testicles and Ovaries) during pelvis AP. Conclusion: This study therefore suggest that better understanding of organ anatomical position in relation to specific examination will better promote as low as reasonable practicable.

Estimation of patient skin dose in fluoroscopy: summary of a joint report by AAPM TG357 and EFOMP.

Physicians use fixed C-arm fluoroscopy equipment with many interventional radiological and cardiological procedures. The associated effective dose to a patient is generally considered low risk, as the benefit-risk ratio is almost certainly highly favorable. However, X-ray-induced skin injuries may occur due to high absorbed patient skin doses from complex fluoroscopically guided interventions (FGI). Suitable action levels for patient-specific follow-up could improve the clinical practice. There is a need for a refined metric regarding follow-up of X-ray-induced patient injuries and the knowledge gap regarding skin dose-related patient information from fluoroscopy devices must be filled. The most useful metric to indicate a risk of erythema, epilation or greater skin injury that also includes actionable information is the peak skin dose, that is, the largest dose to a region of skin. The report is based on a comprehensive review of best practices and methods to estimate peak skin dose found in the scientific literature and situates the importance of the Digital Imaging and Communication in Medicine (DICOM) standard detailing pertinent information contained in the Radiation Dose Structured Report (RDSR) and DICOM image headers for FGI devices. Furthermore, the expertise of the task group members and consultants have been used to bridge and discuss different methods and associated available DICOM information for peak skin dose estimation. The report contributes an extensive summary and discussion of the current state of the art in estimating peak skin dose with FGI procedures with regard to methodology and DICOM information. Improvements in skin dose estimation efforts with more refined DICOM information are suggested and discussed. The endeavor of skin dose estimation is greatly aided by the continuing efforts of the scientific medical physics community, the numerous technology enhancements, the dose-controlling features provided by the FGI device manufacturers, and the emergence and greater availability of the DICOM RDSR. Refined and new dosimetry systems continue to evolve and form the infrastructure for further improvements in accuracy. Dose-related content and information systems capable of handling big data are emerging for patient dose monitoring and quality assurance tools for large-scale multihospital enterprises.

What is the point of innovation in patient dose monitoring?

The Medical Futurist says that radiology is one of the fastest growing and developing areas of medicine, and therefore this might be the speciality in which we can expect to see the largest steps in development. So why do they think that, and does it apply to dose monitoring? The move from retrospective dose evaluation to a proactive dose management approach represents a serious area of research. Indeed, artificial intelligence and machine learning are consistently being integrated into best-in-class dose management software solutions. The development of clinical analytics and dashboards are already supporting operators in their decision-making, and these optimisations - if taken beyond a single machine, a single department, or a single health network - have the potential to drive real and lasting change. The question is for whom exactly are these innovations being developed? How can the patient know that their scan has been performed to the absolute best that the technology can deliver? Do they know or even care how much their lifetime risk for developing cancer has changed post examination? Do they want a personalised size-specific dose estimate or perhaps an individual organ dose assessment to share on Instagram? Let's get real about the clinical utility and regulatory application of dose monitoring, and shine a light on the shared responsibility in applying the technology and the associated innovations.

NCINM: organ dose calculator for patients undergoing nuclear medicine procedures

Nuclear medicine is the second largest source of medical radiation exposure to the general population after computed tomography imaging. Informed decisions regarding the use of nuclear medicine procedures require a better understanding of the magnitude of radiation dose and associated health risks. However, existing model-based organ dose estimation tools rely on simplified human anatomy models or commercial programs. Therefore, we developed a publicly-available dose calculation tool based on more sophisticated human anatomy models. We calculated a comprehensive library of photon and electron specific absorbed fractions (SAF) for multiple combinations of source and target regions within a series of pediatric and adult computational human phantoms matching the International Commission on Radiological Protection (ICRP)’s reference data, combined with a Monte Carlo radiation transport code. Then, we derived a library of S values from these SAFs and the nuclear decay data from ICRP Publication 107. Finally, we created a graphical user interface, named National Cancer Institute Dosimetry System for Nuclear Medicine (NCINM), to facilitate the dosimetry process. Approximately 13 million S values were derived from 2 million SAFs computed in this work. Comprehensive comparisons were conducted at different steps of the dosimetry chain with data available in software OLINDA/EXM 1.0 and IDAC 2.1. For instance, median ratios of photon self-absorption SAFs available from OLINDA/EXM 1.0 and IDAC 2.1 to those calculated in this study were 1.3 (interquartile range = 1.1–1.6) and 1.0 (interquartile range = 0.98–1.0), respectively. SAF differences between NCINM and OLINDA/EXM 1.0 were explained by the large inter-phantom anatomical variability. Our results illustrate the importance of realistic human anatomy models for use in dosimetry software. More phantoms and radionuclides, as well as a biokinetic module, will soon be added. Applications of the NCINM program include computation of absorbed doses for use in radiation epidemiologic studies and patient dose monitoring in nuclear medicine.

SURVEY OF KEY RADIATION SAFETY PRACTICES IN INTERVENTIONAL RADIOLOGY: AN IRISH AND ENGLISH STUDY.

Interventional radiology is a rapidly evolving speciality with potential to deliver high patient radiation doses, as a result high standards of radiation safety practice are imperative. IR radiation safety practice must be considered before during and after procedures through appropriate patient consent, dose monitoring and patient follow-up. This questionnaire-based study surveyed fixed IR departments across Ireland and England to establish clinical practice in relation to radiation safety. Pre-procedure IR patient consent includes all radiation effects in 11% of cases. The patient skin dose surrogate parameter of Kerma to air at a reference point (Kar) is under-reported. Only 39% of respondents use a substantial radiation dose level and inform patients after these have been reached. Poor compliance with unambiguous, readily available best practice guidance was observed throughout highlighting patient communication, patient dose quantification and subsequent patient dose management concerns.

Automatic Mapping of CT Scan Locations on Computational Human Phantoms for Organ Dose Estimation.

To develop an algorithm to automatically map CT scan locations of patients onto computational human phantoms to provide with patient-specific organ doses. We developed an algorithm that compares a two-dimensional skeletal mask generated from patient CTs with that of a whole body computational human phantom. The algorithm selected the scan locations showing the highest Dice Similarity Coefficient (DSC) calculated between the skeletal masks of a patient and a phantom. To test the performance of the algorithm, we randomly selected five sets of neck, chest, and abdominal CT images from the National Institutes of Health Clinical Center. We first automatically mapped scan locations of the CT images on a computational human phantom using our algorithm. We had several radiologists to manually map the same CT images on the phantom and compared the results with the automated mapping. Finally, organ doses for automated and manual mapping locations were calculated by an in-house CT dose calculator and compared to each other. The visual comparison showed excellent agreement between manual and automatic mapping locations for neck, chest, and abdomen-pelvis CTs. The difference in mapping locations averaged over the start and end in the five patients was less than 1cm for all neck, chest, and AP scans: 0.9, 0.7, and 0.9cm for neck, chest, and AP scans, respectively. Five cases out of ten in the neck scans show zero difference between the average manual and automatic mappings. Average of absolute dose differences between manual and automatic mappings was 2.3, 2.7, and 4.0% for neck, chest, and AP scans, respectively. The automatic mapping algorithm provided accurate scan locations and organ doses compared to manual mapping. The algorithm will be useful in cases requiring patient-specific organ dose for a large number of patients such as patient dose monitoring, clinical trials, and epidemiologic studies.

OA098] Patient dose monitoring in interventional radiology

Purpose In light of ICRP recommendations and new European BSS that strengthen requirements concerning patient dose recording and reporting and the use of diagnostic reference levels (DRL), dose indicators were collected from a sample of subjects undergoing different type of interventional procedures, using a commercial Dose Archiving Communication System (DACS) software, directly communicating with the imaging modality, Philips XperFD20. This abstract presents preliminary results of six months of survey. Materials and Methods 400 patients were monitored. The procedures were grouped in 7 subset (N is the number subjects): 1-Embolization (N = 228); 2-Varicocele sclerosing treatment (N = 30); 3-Biliary intervention (N = 95); 4-HUPG Hepatic vein portosystemic gradient (N = 25); 5-TIPS (N = 12); 6-Portal Venography (N = 5); 7-Angioplasty (N = 5). Mean values, range, 50th and 75th percentile of the distribution were estimated for KAP (Kerma Area Product) that is a global index, fluoroscopy time FT and cumulative air Kerma (CK) at IRP (Intervention Reference Point), being the last quantity an indicator of the skin dose. Results Mean value (and 75° percentile) for KAP (expressed in cGy* cm 2 ), for the 7 procedures, were respectively: Procedure 1: 38855 (61866); Procedure 2: 1522 (1831); Procedure 3: 4696 (6983); Procedure 4: 15940 (22854); Procedure 5: 33244(36973); Procedure 6: 15516 (24988); Procedure 7: 11796 (6333). FT ranged from a few minutes to above 1 hour, with the mean value for the whole set of data being 11 min. The skin dose index CK exceeded the threshold values of 2-3-4-5 Gy in 7.8-2.4-1.1 and 0.4% of cases respectively. Conclusions Data are comparable with those reported by other authors and consistent with published DRL, with a wide variability due to different degrees of procedure complexity. Further data need to be collected in order to define our own DRL. The threshold values for manifestation of deterministic effects were passed in a relatively small fraction of cases, for which follow up is indicated [1] , [2] , [3] .

2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness.

2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness.

Patient dose monitoring and the use of diagnostic reference levels for the optimization of protection in medical imaging: current status and challenges worldwide.

Optimization is one of the key concepts of radiation protection in medical imaging. In practice, it involves compromising between the image quality and dose to the patient; the dose should not be higher than necessary to achieve an image quality (or diagnostic information) needed for the clinical task. Monitoring patient dose is a key requirement toward optimization. The concept of diagnostic reference level (DRL) was introduced by the International Commission on Radiological Protection as a practical tool for optimization. Unfortunately, this concept has not been applied consistently worldwide. To review the current strengths and weaknesses worldwide and to promote improvements, the International Atomic Energy Agency organized a Technical Meeting on patient dose monitoring and the use of DRLs on May 2016. This paper reports a summary of the findings and conclusions from the meeting. The strengths and weaknesses were generally different in less-developed countries compared with developed countries. Possible improvements were suggested in six areas: human resources and responsibilities, training, safety and quality culture, regulations, funding, and tools and methods. An overall conclusion was that radiation protection requires a patient-centric approach and a transfer from purely reactive to increasingly proactive optimization, whereby the best outcome is expected from good teamwork.

Patient Dose Monitoring and Focus on Nuclear Medicine Imaging Examinations

Patient Dose Monitoring and Focus on Nuclear Medicine Imaging Examinations

A comparative evaluation of luminescence detectors: RPL-GD-301, TLD-100 and OSL-AL2O3:C, using Monte Carlo simulations

The luminescent dosimeters are widely used in clinical practice, for the monitoring of patient dose in external radiation therapy. Three of the most common dosimeter categories are the thermoluminescence (TLDs), the radiophotoluminescence (RPLs) and the optically stimulated luminescence (OSLs), with similar physical processes on their properties. The aim of the present study is to compare and evaluate the dosimetric properties of three specific luminescent detectors namely: a) RPL glass dosimeter, commercially known as GD-301, b) lithium fluoride TLD-100 (LiF:Mg,Ti) and c) carbon-doped aluminum oxide (Al2O3:C). For this purpose, Monte Carlo simulations were applied, using the MCNP5 code to estimate the responses of these dosimeters in terms of absorbed dose, output factor, the angular and energy dependence. In the present study, we found that the differences between the output factors were less than ± 4.2% for all detector materials RPLGD, TLD and OSLD. The variations in sensitivity for angles up to ± 80 degrees from the central axis of the beam were approximately 0.5%, 0.8% and 1.5% for the TLD-100, GD-301 and Al2O3:C, respectively. The energy dependence of the RPL and OSL dosimeters are stated as less than a 2.2%, and within 5.8% for TLD.