Fast Monte Carlo codes for occupational dosimetry in interventional radiology

Enhancing X-ray quality and dose reduction: Evaluation with additional filters, Contrast-Detail Phantom and Monte Carlo simulation

PURPOSE

In radiology, achieving high image quality while minimizing radiation dose exposure is essential. For these purpose, understanding the technical parameters affecting both dose and image quality is crucial.

METHODS

This study aimed to evaluate, through both experimental and computational approaches, different combinations of additional filters of 0.1, 0.2, and 0.3 mm Cu and equipment voltage (96 to 133 kVp) for one of the most commonly performed radiological examinations, the Posteroanterior (PA) chest X-ray. The objective was to determine the optimal trade-off between dose and image quality and define the best radiographic technique for this examination. This balance was achieved through Figures of Merit (FOM). Experimentally, image quality was quantified and evaluated using a method called the Image Quality Figure Inverse (IQFinv), obtained with the Contrast-Detail Phantom from the brand Artinis (CDRAD Phantom), and the dose was measured using the air kerma-area product (PKA). The PKA values obtained were corrected through Monte Carlo simulations to estimate the patient dose. This was done for each combination of filter and kVp. Furthermore, these spectra were used to simulate the experimental setup to determine the energy deposited at the skin (0.07 mm) and at various depths within the phantom.

RESULTS

The experimental results demonstrated that the optimal trade-offs between image quality and radiation dose were achieved with the combinations of 96 kVp and 0.3 mm Cu and 102 kVp with 0.2 mm Cu. Compared to the routine protocol (109 kVp, 0 mm Cu), these techniques reduced PKA by approximately 13% and 12%, respectively, while improving IQFinv by about 8% and 9%. Computational simulations reproduced the experimental results, showing that the best relationships between patient dose and image quality were achieved with the same techniques in both cases.

CONCLUSION

Our results show that CDRAD Phantom and Monte Carlo simulations can be explored as a method that enables dosimetry in patients by representing real situations, thus allowing the selection of the correct radiographic technique (kVp and additional filtration). The correct selection of these technical parameters significantly reduces the patient's dose while increasing image quality.

Assessment of occupational eye lens dose in interventional cardiology suites in Sri Lanka

PURPOSE

The research investigates the occupational eye lens dose of interventional cardiologists and examines several methodologies for measuring eye lens doses, including direct methods using Hp(3) dosimeters and indirect methods using surrogate dosimeters. Moreover, the study scrutinizes factors impacting the evaluation of eye lens dose, making a substantial contribution to the field within Sri Lanka.

METHODOLOGY

Twelve interventional cardiologists underwent monitoring for eye lens doses utilizing both direct (Hp(3)) and indirect (Hp(10) and Hp(0.07)) measurements. Annual equivalent occupational eye lens doses were computed for each practitioner, and an analysis was carried out to compare direct and surrogate dosimeter readings, examining over/underestimation. Additionally, the research explored factors influencing eye lens doses among cardiologists.

RESULTS

This study highlighted a critical need for enhanced protective measures, particularly due to the highest annual occupational equivalent eye lens dose recorded at 34 ± 4.1 mSv exceeding the annual dose limit. The study revealed robust correlations (R2=0.99) between direct readings and surrogate dosimeters. However, the indirect measurements marginally underestimated the direct Hp(3) dose values. Factors such as patient Body Mass Index, Air Kerma, Dose Area Product, Fluoroscopy Time, and operator height significantly impacted eye lens dose (p<0.0001). However, years of experience exhibited no significant association with eye lens dose among operators.

CONCLUSION

This study emphasized the pivotal role in evaluating equivalent eye lens doses for interventional cardiologists in Sri Lanka, along with the viability of indirect measurements in estimating Hp(3) eye lens radiation doses in the absence of dedicated eye dosimeters.

Directional vector visualization of scattered rays in mobile c-arm fluoroscopy

Previous radiation protection-measure studies for medical staff who perform X-ray fluoroscopy have employed simulations to investigate the use of protective plates and their shielding effectiveness. Incorporating directional information enables users to gain a clearer understanding of how to position protective plates effectively. Therefore, in this study, we propose the visualization of the directional vectors of scattered rays. X-ray fluoroscopy was performed; the particle and heavy-ion transport code system was used in Monte Carlo simulations to reproduce the behavior of scattered rays in an X-ray room by reproducing a C-arm X-ray fluoroscopy system. Using the calculated results of the scattered-ray behavior, the vectors of photons scattered from the phantom were visualized in three dimensions. A model of the physician was placed on the directional vectors and dose distribution maps to confirm the direction of the scattered rays toward the physician when the protective plate was in place. Simulation accuracy was confirmed by measuring the ambient dose equivalent and comparing the measured and calculated values (agreed within 10%). The directional vectors of the scattered rays radiated outward from the phantom, confirming a large amount of backscatter radiation. The use of a protective plate between the patient and the physician's head part increased the shielding effect, thereby enhancing radiation protection for the physicians compared to cases without the protective plate. The use of directional vectors and the surrounding dose-equivalent distribution of this method can elucidate the appropriate use of radiation protection plates.

Dose assesment with fast Monte Carlo codes in interventional radiology

This study presents the performance of two fast Monte Carlo codes, PENELOPE/penEasyIR and MCGPU-IR in order to assess operator doses in interventional radiology. In particular, it aims to validate the calculations when workers are protected with shielding located between the patient and the operator. The experiments are performed in a calibration laboratory and measurements are gathered using Thermo EPD and Mirion DMC personal active dosemeters. Calculation efficiency of the fast Monte Carlo codes is approximately four orders of magnitude greater than for a standard Monte Carlo code. Satisfactory agreement between measurements and calculations is shown.

Technical note: Simulation of lung counting applications using Geant4

A Geant4 simulation package has been developed to investigate and test detector configurations for lung counting applications. The objective of this study was to measure radiation emitted from the human body and to make a qualitative comparison of the results of the simulation with an experiment. Experimental data were measured from a plastic phantom with a set of lungs containing ²⁴¹Am activity. For comparison, simulations in which ²⁴¹Am activity was uniformly distributed inside the lungs of the ICRP adult reference computational phantom were made. The attenuation of photons by the chest wall was simulated and from this photopeak efficiency and photon transmission were calculated as a function of photon energy. The transmission of 59.5 keV gamma rays, characteristic of the decay of ²⁴¹Am, was determined from the computational phantom as a function of the angular position of the detector. It was found that the simulated detector response corresponds well with that from an experiment. The simulated count rate below 100 keV was 10.0(7) % greater compared to the experimental measurement. It was observed that 58.3(4) % of photons are attenuated for energies below 100 keV by the chest wall. In the simulation, the transmission of 59.5 keV gamma rays varied from 13.8(2) % to 38.0(4) % as a function of the angular position of the detector. The results obtained from the simulations show a satisfactory agreement with experimental data and the package can be used in the development of future body counting applications and enables optimization of the detection geometry.

Feasibility study of computational occupational dosimetry: evaluating a proof-of-concept in an endovascular and interventional cardiology setting

Individual monitoring of radiation workers is essential to ensure compliance with legal dose limits and to ensure that doses are As Low As Reasonably Achievable. However, large uncertainties still exist in personal dosimetry and there are issues with compliance and incorrect wearing of dosimeters. The objective of the PODIUM (Personal Online Dosimetry Using Computational Methods) project was to improve personal dosimetry by an innovative approach: the development of an online dosimetry application based on computer simulations without the use of physical dosimeters. Occupational doses were calculated based on the use of camera tracking devices, flexible individualised phantoms and data from the radiation source. When combined with fast Monte Carlo simulation codes, the aim was to perform personal dosimetry in real-time. A key component of the PODIUM project was to assess and validate the methodology in interventional radiology workplaces where improvements in dosimetry are needed. This paper describes the feasibility of implementing the PODIUM approach in a clinical setting. Validation was carried out using dosimeters worn by Vascular Surgeons and Interventional Cardiologists during patient procedures at a hospital in Ireland. Our preliminary results from this feasibility study show acceptable differences of the order of 40% between calculated and measured staff doses, in terms of the personal dose equivalent quantity H_p(10), however there is a greater deviation for more complex cases and improvements are needed. The challenges of using the system in busy interventional rooms have informed the future needs and applicability of PODIUM. The availability of an online personal dosimetry application has the potential to overcome problems that arise from the use of current dosimeters. In addition, it should increase awareness of radiation protection among staff. Some limitations remain and a second phase of development would be required to bring the PODIUM method into operation in a hospital setting. However, an early prototype system has been tested in a clinical setting and the results from this two-year proof-of-concept PODIUM project are very promising for future development.

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

INTRODUCTION

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.

METHODOLOGIES

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.

RESULTS

The results obtained for the skin dose measurements show differences below 6%. For the clinical procedures the differences are within 20% for most cases.

CONCLUSIONS

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.

Occupational radiation dose of personnel involved in sentinel node biopsy procedure

INTRODUCTION

Sentinel node biopsy is a procedure used for axillary nodal staging in breast cancer surgery. The process uses radioactive ^99mTc isotope for mapping the sentinel node(s) and all the staff involved in the procedure is potentially exposed to ionizing radiation. The colloid for radiolabelling (antimone-sulphide) with ^99mTc isotope (half-life 6 h) is injected into the patient breast. The injection has activity of 18.5 MBq. The surgeon removes the primary tumor and detects active lymph nodes with gamma detection unit. The tumor as well as the active nodal tissue is transferred to pathologist for the definitive findings. The aim of the study was to measure dose equivalents to extremities and whole body for all staff and suggest practice improvement in order to minimize exposure risk.

MATERIALS AND METHODS

The measurements of the following operational quantities were performed: Hp(10) personal dose equivalent to whole body and Hp(0.07) to extremities for staff as well as ambiental dose for operating theatre and during injection. Hp(0.07) were measured at surgeon's finger by ring thermoluminescent dosimeter (TLD) type MTS-N, and reader RADOS RE2000. Surgeon and nurse were wearing TLD personal dosimeter at the chest level. Anesthesiologist and anesthetist were wearing electronic personal dosimeters, while pathologist was wearing ring TLD while manipulating tissue samples. Electronic dosimeters used were manufactured by Polimaster, type PM1610. All TLD and electronic dosimeters data were reported, including background radiation. Background radiation was also monitored separately. Personal TLDs are standard for this type of personal monitoring, provided by accredited laboratory. Measurements of ambiental dose in workplaces of other staff involved around the patient was performed before the surgery took place, by calibrated survey meters manufactured by Atomtex, type 1667. The study involved two surgeons and one pathologist, two anesthesiologists and three anesthetists during two months period.

RESULTS AND DISCUSSION

The doses received by all staff are evaluated using passive and active personal dosimeters and ambiental dose monitors and practice was improved based on results collected. Average annual whole body dose for all staff involved in the procedure was less than 0.8 mSv. Extremity dose equivalents to surgeon and pathologist were far below the limits set for professionally exposed (surgeon) and for public (pathologist).

CONCLUSIONS

Although has proven to be very safe for all staff, additional measures for radiation protection, in accordance to ALARA principle (As Low As Reasonably Achievable) should be conducted. The recommendations for practice improvement with respect to radiation protection were issued.

Technical note: MC-GPU breast dosimetry validations with other Monte Carlo codes and phase space file implementation

PURPOSE

To validate the MC-GPU Monte Carlo (MC) code for dosimetric studies in X-ray breast imaging modalities: mammography, digital breast tomosynthesis, contrast enhanced digital mammography, and breast-CT. Moreover, to implement and validate a phase space file generation routine.

METHODS

The MC-GPU code (v. 1.5 DBT) was modified in order to generate phase space files and to be compatible with PENELOPE v. 2018 derived cross-section database. Simulations were performed with homogeneous and anthropomorphic breast phantoms for different breast imaging techniques. The glandular dose was computed for each case and compared with results from the PENELOPE (v. 2014) + penEasy (v. 2015) and egs _ brachy (EGSnrc) MC codes. Afterward, several phase space files were generated with MC-GPU and the scored photon spectra were compared between the codes. The phase space files generated in MC-GPU were used in PENELOPE and EGSnrc to calculate the glandular dose, and compared with the original dose scored in MC-GPU.

RESULTS

MC-GPU showed good agreement with the other codes when calculating the glandular dose distribution for mammography, mean glandular dose for digital breast tomosynthesis, and normalized glandular dose for breast-CT. The latter case showed average/maximum relative differences of 2.3%/27%, respectively, compared to other literature works, with the larger differences observed at low energies (around 10 keV). The recorded photon spectra entering a voxel were similar (within statistical uncertainties) between the three MC codes. Finally, the reconstructed glandular dose in a voxel from a phase space file differs by less than 0.65%, with an average of 0.18%-0.22% between the different MC codes, agreement within approximately 2 σ statistical uncertainties. In some scenarios, the simulations performed in MC-GPU were from 20 up to 40 times faster than those performed by PENELOPE.

CONCLUSIONS

The results indicate that MC-GPU code is suitable for breast dosimetric studies for different X-ray breast imaging modalities, with the advantage of a high performance derived from GPUs. The phase space file implementation was validated and is compatible with the IAEA standard, allowing multiscale MC simulations with a combination of CPU and GPU codes.