Diagnostic Reference Levels for Computed Tomography Examinations in Iran: A Nationwide Radiation Dose Survey

Introduction: International Commission on Radiological Protection introduced three basic principles of radiation protection, namely justification, optimization, and dose limit. Medical exposure has no dose limits, and generally, diagnostic reference levels are used as a tool for optimization of patient protection. Material and Methods: Dosimetry was performed on 20 CT scanners located in 14 cities in 12 provinces of Iran. A calibrated pencil-shaped ionization chamber, standard head and body CT dosimetry phantoms and a radiation monitor were used to determine and calculate Computed Tomography Dose Index (CTDI) and Dose Length Product (DLP). The DLP-based estimates of effective dose were derived using effective dose conversion coefficients. Results: The nCTDIw values for head phantoms fell within the range of 22.05-168.38 and 43.77-426.69 µGy/mAs for 5 and 10mm slice thicknesses, respectively. These values for body phantom were 4.65-146.39 and 9.43-308.92 µGy/mAs for 5 and 10mm slice thicknesses, respectively. The third quartile of CTDIvol and DLP values for head CT examinations were 49.85 mGy and 1161.00 mGy-cm, respectively. The body CT examinations had the values of 8.89 mGy and 370.97 mGy-cm, respectively. The findings of this study revealed that the above-mentioned values can be considered as national diagnostic reference levels for head and body CT examinations in Iran. Conclusion: The results of the current study suggested that there is a need to re-assess DRLs for CT examinations at regular time intervals by the appropriate regulatory authority which can improve the continuous performance of CT scanners in Iran

Time-Dependent Induction of the Nucleotide Excision Repair Gene XPA and RAD51 in Homologous Recombination in Human Lymphocytes Exposed to Low Doses of Ionizing Radiation

Introduction: The aim of the present study was to understand the effect of low-doses of ionizing radiation (LDIR) on repair genes expression in blood samples that were taken from healthy donors. The next purpose was to examine the time-effect on the modified gene expression caused by low-doses of ionizing radiation.Material and Methods: The RNA of peripheral blood lymphocytes (PBLs) taken from four healthy donors was isolated at different time points after exposure including 4, 24, 48, 72, and 168 hours and then cDNA was synthesized. Modification of XPA and RAD51 expression levels due to LDIR (2, 5, 10 cGy) were evaluated by relative quantitative reverse transcription-polymerase chain reaction.Results: Significant up-regulation of both repair genes was observed at the 4 and 168 h following to 10 cGy.  Also, this dose could increase expression levels of RAD51 at 48 and 72 h after radiation. For lower doses at 5 cGy, only XPA levels were significantly up-regulated after 168 h. A significant regression was found between the XPA levels and the dose, at 168 h after irradiation to PBLs that can represent a new potential biomarker for biological dosimetry purposes.Conclusion: The results of this study could support the hypothetical role of the different DNA repair pathways in response to LDIR. This led us to propose a molecular biodosimetry method for ionizing radiation in the range of LDIR

A Monte Carlo study on dose enhancement and photon contamination production by various nanoparticles in electron mode of a medical linac

The aim of this study is the evaluation of electron dose enhancement and photon contamination production by various nanoparticles in the electron mode of a medical linac. MCNPX Monte Carlo code was used for simulation of Siemens Primus linac as well as a phantom and a tumor loaded with nanoparticles. Electron dose enhancement by Au, Ag, I and Fe2O3 nanoparticles of 7, 18 and 30 mg/ml concentrations for 8, 12 and 14 MeV electrons was calculated. The increase in photon contamination due to the presence of the nanoparticles was evaluated as well. The above effects were evaluated for 500 keV and 10 keV energy cut-offs defined for electrons and photons. For 500 keV energy cut-off, there was no significant electron dose enhancement. However, for 10 keV energy cut-off, a maximum electron dose enhancement factor of 1.08 was observed for 30 mg/ml of gold nanoparticles with 8 MeV electrons. An increase in photon contamination due to nanoparticles was also observed which existed mainly inside the tumor. A maximum photon dose increase factor of 1.07 was observed inside the tumor with Au nanoparticles. Nanoparticles can be used for the enhancement of electron dose in the electron mode of a linac. Lower energy electron beams, and nanoparticles with higher atomic number, can be of greater benefi t in this field. Photons originating from nanoparticles will increase the photon dose inside the tumor, and will be an additional advantage of the use of nanoparticles in radiotherapy with electron beams

A Monte Carlo study on dose enhancement and photon contamination production by various nanoparticles in electron mode of a medical linac

The aim of this study is the evaluation of electron dose enhancement and photon contamination production by various nanoparticles in the electron mode of a medical linac. MCNPX Monte Carlo code was used for simulation of Siemens Primus linac as well as a phantom and a tumor loaded with nanoparticles. Electron dose enhancement by Au, Ag, I and Fe2O3 nanoparticles of 7, 18 and 30 mg/ml concentrations for 8, 12 and 14 MeV electrons was calculated. The increase in photon contamination due to the presence of the nanoparticles was evaluated as well. The above effects were evaluated for 500 keV and 10 keV energy cut-offs defined for electrons and photons. For 500 keV energy cut-off, there was no significant electron dose enhancement. However, for 10 keV energy cut-off, a maximum electron dose enhancement factor of 1.08 was observed for 30 mg/ml of gold nanoparticles with 8 MeV electrons. An increase in photon contamination due to nanoparticles was also observed which existed mainly inside the tumor. A maximum photon dose increase factor of 1.07 was observed inside the tumor with Au nanoparticles. Nanoparticles can be used for the enhancement of electron dose in the electron mode of a linac. Lower energy electron beams, and nanoparticles with higher atomic number, can be of greater benefit in this field. Photons originating from nanoparticles will increase the photon dose inside the tumor, and will be an additional advantage of the use of nanoparticles in radiotherapy with electron beams

Evaluation of Dose Calculation Accuracy of Isogray Treatment Planning System in Craniospinal Radiotherapy

Introduction: Craniospinal radiotherapy is a therapeutic technique for central nervous system (CNS) tumors, which requires meticulous attention to technique and dosimetry.Treatment planning system (TPS) is one of the main equipment in radiotherapy; therefore, the evaluation of its accuracy is essential for dose calculation. The present study evaluates the validity of Isogray TPS in craniospinal irradiation techniques. Material and Methods: The computed tomography (CT) images of the brain and spine of the Rando phantom were acquired. Two techniques were designed. In technique 1, the whole CNS was irradiated with 6 MV photon beam. In technique 2, the brain and spine were irradiated with 6 MV photon and 18 MeV electron beam, respectively. The tumor and organs at risk doses were measured by thermoluminescent dosimeter (TLD). In addition, photon and electron dose measurements inside and outside the treatment field were accomplished using TLD, and then compared to the corresponding values calculated by TPS. Results: According to the results, in both electron and photon beams, the differences between the doses calculated by TLD and TPS for the points inside the treatment field were less than 4% for 90% of the measurement points. However, for the points outside the treatment field borders, the differences ranged within 10-40%. These differences were indicative of the sufficient dosimetric accuracy of Isogray TPS. Conclusion: The comparison of dosimetry results with those of TPS results revealed the accuracy of Isogray TPS. In both techniques, the maximum difference between the TLD- and TPS-measured doses was observed in the mandible

Assessment of Radiation Dose to the Lens of the Eye and Thyroid of Patients Undergoing Head and Neck Computed Tomography at Five Hospitals in Mashhad, Iran

Introduction: In recent years, the number of computed tomography (CT) scans, which is a high-dose technique, has increased significantly. Head and neck CT is performed frequently and thyroid, particularly in children, has always been considered a sensitive organ. In recent years, radiobiologists and health physicists have been more concerned about the safety of lenses of the eyes, as cataract is no longer considered a deterministic effect. Material and Methods: In the present study, incurred doses to the thyroid and lens of the eye of 140 patients who underwent common head and neck CT at five hospitals were measured by thermoluminescent dosimeters (TLD-100). The patients were divided into two age groups of pediatrics and adults. TLD chips were placed on the patient’s skin surface. For each patient, scan parameters, sex and age were recorded. Exposed TLDs were read by a manual TLD reader. Results: The verage absorbed dose of the thyroid, as well as the lenses of the left and right eyes were 5.89±1.74, 15.84±2.81 and 16.25±2.57, respectively, for the pediatric patients and 5.00±1.17, 17.64±1.69 and 24.41±1.89 for adults. Patient-specific organ doses were influenced by the scanned region, scan protocol and patient's age. Conclusion: In the present study, the mean eye dose was much lower than the 500 mGy threshold recommended by International Commission on Radiological Protection (ICRP) for lens of the eye damage, thus, it appears to be clinically safe. While CT scan remains a crucial tool, further dose reduction can be achieved by controlling different factors affecting patient doses

Assessment of Patient Dose from CT Examinations in Khorasan, Iran

Abstract Introduction Computed Tomography scans are a very important tool for diagnosis and assessment of response to treatment in the practice of medicine. Ionizing radiation in medical imaging is undoubtedly one of the most powerful diagnostic tools in medicine. Yet, as with all medical interventions, there are potential risks in addition to the clear potential benefits. Materials and Methods Two reference dose quantities have been defined in order to promote the use of good technique in CT. These are weighted CT dose index (CTDI w ) in (mGy) for a single slice in serial scanning or per rotation in helical scanning, and dose-length product (DLP) per complete examination (mGy.cm), All measurements were performed using a pencil shaped ionization chamber introduced into polymethyl methacrylate cylindrical brain and body phantoms. This survey was performed on 7 CT scanners in Khorasan Province-Iran. Results DLP for brain, chest, abdomen and pelvic examinations had a range of 255 -1026, 76-1277, 48-737, 69-854 mGy.cm, respectively. Conclusion The results obtained in this study show that the DLP values obtained in this province are lower than European Commission reference dose levels (EC RDL), in other words performance of all the scanners were satisfactory

Assessment of Patient Dose from CT Examinations in Khorasan, Iran

Introduction Computed Tomography scans are a very important tool for diagnosis and assessment of response to treatment in the practice of medicine. Ionizing radiation in medical imaging is undoubtedly one of the most powerful diagnostic tools in medicine. Yet, as with all medical interventions, there are potential risks in addition to the clear potential benefits. Materials and Methods Two reference dose quantities have been defined in order to promote the use of good technique in CT. These are weighted CT dose index (CTDIw) in (mGy) for a single slice in serial scanning or per rotation in helical scanning, and dose–length product (DLP) per complete examination (mGy.cm), All measurements were performed using a pencil shaped ionization chamber introduced into polymethyl methacrylate cylindrical brain and body phantoms. This survey was performed on 7 CT scanners in Khorasan Province-Iran. Results DLP for brain, chest, abdomen and pelvic examinations had a range of 255 - 1026, 76-1277, 48-737, 69-854 mGy.cm, respectively. Conclusion The results obtained in this study show that the DLP values obtained in this province are lower than European Commission reference dose levels (EC RDL), in other words performance of all the scanners were satisfactory

Evaluation of Dose Distribution Accuracy in HDR Brachytherapy of Esophagus Cancer Based on MRI Normoxic Polymer Gel Dosimetry

Introduction: The purpose of this work was to study the ability of MRI normoxic polymer gel dosimetry for evaluating the dose distribution in HDR brachytherapy of esophagial cancer at Imam Reza brachytherapy center (Mashhad, Iran). Materials and Methods: Initially, 2liters of normoxic gel (MAGIC) was fabricated and then poured into 12 calibration test tubes and placed in a perspex walled phantom. The gel phantom was irradiated with a brachytherapy remote-afterloader unit using a cobalt-60 brachytherapy source and the test tubes were irradiated with a range of known doses with a cobalt-60 teletherapy unit. Imaging was performed with a multi-spin-echo protocol and a T2 quantitative technique using a Siemens 1.5 T MRI machine. The MRI images were transferred to a computer and then image processing was performed in the MATLAB environment to extract R2 maps of the irradiated area. Results: In this study and at the reference point, the dose deviation between the gel dosimetry and the calculated data was 4.5%. The distance to agreement (DTA) for dose profiles was 2.7 mm. Also, dose sensitivity of the MAGIC gel dosimeter was 0.693 S-1Gy-1 (R2 =0.9376). Conclusion: In this work, the data obtained from TPS calculations were found in very good agreement with the measured results provided by gel dosimetry. It was evaluated using a comparison of isodoses and dose at the reference point, and dose profile verification. It is also concluded that the gel dosimetry systems have proven to be a useful tool for dosimetry in clinical radiotherapy applications

Calculation the Received dose by gonads arising from some common diagnostic radiography

Background and Aim: The basic aim in radiography is to acquire a good image from the body organs, but never the issue of the patient's protection against the harmful effects of ionizing radiation should be neglected. One of the most important factors for assessing the radiation risk is the dose received by sensitive organs such as gonads. Radiation damage to the gonads can be lead to genetic damages at the progeny of the radiated individuals, and that damage can be transmitted to the next generation. Materials and Methods: In this study the thermoluminescence dosimeters were used to measure the entrance skin dose. DAP values for each examination and also the patients information such as age,  size, weight and machine setting like that mA, time, kVp and focal spot to film distance were recorded. By means of PCXMC software version 2 gonadal doses were calculated. Results: The maximum dose received by the testicles was for the pelvis AP projection, 0.45mGy and for the ovaries maximum dose was for abdomen PA, 0.306 mGy. The minimum dose received by the testicles and ovaries was for lumbar LAT 0.065, 0.101 respectively. Conclusion: One of the ways for patient and gonadal dose reduction is to use appropriate shields for radiosensitive organs such as gonads. Hence its recommended to use appropriate shields for gonads because of their high radiosensitivity