Skeletal dosimetry for external exposure to photons based on µCT images of spongiosa from different bone sites

A cell-based dosimetry model for radium-223 dichloride therapy using bone micro-CT images and GATE simulations

Dosimetry at the cellular level has outperformed macrodosimetry in terms of agreement with toxicity effects in clinical studies. This fact has encouraged dosimetry studies aiming to quantify the absorbed doses needed to reach radiotoxicity at the cellular level and to inform recommendations on the administration of radium-223. The aim of this work is to qualitatively and quantitatively evaluate the absorbed doses of radium-223 and the interactions of the doses at the cellular level. The analysis was performed by Monte Carlo simulations in GATE using micro-CT image of a mouse. Two physics lists available in the GATE code were tested. The influence of single and multiple scattering models on the absorbed dose distribution and number of particle hits was also studied. In addition, the fuzzy c-means clustering method was used for data segmentation. The segmentation method was suitable for these analyses, particularly given that it was unsupervised. There was no significant difference in the estimated absorbed dose between the two proposed physics lists. The absorbed dose values were not significantly influenced by scattering, although single scattering resulted in twice as many interactions as multiple scattering. The absorbed dose histogram at the voxel level shows heterogeneous absorbed dose values within each shell, but the observations from the graph of the medians were comparable to those in the literature. The interaction histogram indicates 10⁴ events, although some voxels had no interactions with alpha particles. However, the voxels did not show absorbed doses capable of deterministic effects in the deepest part of the bone marrow. The absorbed dose distribution in images of mouse trabecular bone was compatible with simple geometric models, with absorbed doses capable of deterministic effects near the bone surface. The interaction distributions need to be correlated with in vivo studies for better interpretation.

ELECTRON ABSORBED FRACTIONS IN AN IMAGE-BASED MICROSCOPIC SKELETAL DOSIMETRY MODEL OF CHINESE ADULT MALE

Based on the Chinese reference adult male voxel model, a set of microscopic skeletal models of Chinese adult male is constructed through the processes of computed tomography (CT) imaging, bone coring, micro-CT imaging, image segmentation, merging into macroscopic bone model and implementation in Geant4. At the step of image segmentation, a new bone endosteum (BE) segmentation method is realized by sampling. The set of model contains 32 spongiosa samples with voxel size of 19 μm cubes. The microscopic spongiosa bone data for Chinese adult male are provided. Electron absorbed fractions in red bone marrow (RBM) and BE are calculated. Source tissues include the bone marrow (red and yellow), trabecular bone (surfaces and volumes) and cortical bone (surfaces and volumes). Target tissues include RBM and BE. Electron energies range from 10 keV to 10 MeV. Additionally, comparison of the result with other investigations is provided.

Depth-dependent concentrations of hematopoietic stem cells in the adult skeleton: Implications for active marrow dosimetry

PURPOSE

The hematopoietically active (or red) bone marrow is the target tissue assigned in skeletal dosimetry models for assessment of stochastic effects (leukemia induction) as well as tissue reactions (marrow toxicity). Active marrow, however, is in reality a surrogate tissue region for specific cell populations, namely the hematopoietic stem and progenitor cells. Present models of active marrow dosimetry implicitly assume that these cells are uniformly localized throughout the marrow spaces of trabecular spongiosa. Data from Watchman et al. and Bourke et al., however, clearly indicate that there is a substantial spatial concentration gradient of these cells with the highest concentrations localized near the bone trabeculae surfaces. The purpose of the present study was thus to explore the dosimetric implications of these spatial gradients on active marrow dosimetry.

METHODS

Images of several bone sites from a 45-yr female were retagged to group active marrow voxels into 50 μm increments of marrow depth, after which electron and alpha-particle depth-dependent specific absorbed fractions were computed for four source tissues - active marrow, inactive marrow, bone trabeculae volumes, and bone trabeculae surfaces. Corresponding depth-dependent S values (dose to a target tissue per decay in a source tissue) were computed and further weighted by the relative target cell concentration. These depth-weighted radionuclide S values were systematically compared to the more traditional volume-averaged radionuclide S values of the MIRD schema for both individual bones of the skeleton and their skeletal-averaged quantities.

RESULTS

For both beta-emitters and alpha-emitters localized in the active and inactive marrow, depth-weighted S values were shown to differ from volume-averaged S values by only a few percent, as dose gradients across the marrow tissues are nonexistent. For bone volume and bone surface sources of alpha-emitters and lower energy beta-emitters, when marrow dose gradients are expected, explicit consideration of target cell spatial concentration gradients are shown to significantly impact marrow dosimetry.

CONCLUSIONS

For medical isotopes currently utilized for treatment of skeletal metastases, namely ¹⁵³ Sm and ²²³ Ra, accounting for hematopoietic stem and progenitor cell concentration gradients resulted in maximum percent differences to reference skeletal-averaged S values of ~21% and 55%, respectively.

HDRK-Woman: whole-body voxel model based on high-resolution color slice images of Korean adult female cadaver

In a previous study, we constructed a male reference Korean phantom; HDRK-Man (High-Definition Reference Korean-Man), to represent Korean adult males for radiation protection purposes. In the present study, a female phantom; HDRK-Woman (High-Definition Reference Korean-Woman), was constructed to represent Korean adult females. High-resolution color photographic images obtained by serial sectioning of a 26 year-old Korean adult female cadaver were utilized. The body height and weight, the skeletal mass, and the dimensions of the individual organs and tissues were adjusted to the reference Korean data. The phantom was then compared with the International Commission on Radiological Protection (ICRP) female reference phantom in terms of calculated organ doses and organ-depth distributions. Additionally, the effective doses were calculated using both the HDRK-Man and HDRK-Woman phantoms, and the values were compared with those of the ICRP reference phantoms.

Development of newborn and 1-year-old reference phantoms based on polygon mesh surfaces

The purpose of this study is the development of paediatric reference phantoms for newborn and 1-year-old infants to be used for the calculation of organ and tissue equivalent doses in radiation protection. The study proposes a method for developing anatomically highly sophisticated paediatric phantoms without using medical images. The newborn and 1-year-old hermaphrodite phantoms presented here were developed using three-dimensional (3D) modelling software applied to anatomical information taken from atlases, textbooks and images provided by the Department of Anatomy of the Federal University of Pernambuco, Brazil. The method uses polygon mesh surfaces to model body contours, the shape of organs as well as their positions and orientations in the human body. Organ and tissue masses agree with corresponding data given by the International Commission on Radiological Protection for newborn and 1-year-old reference children. Bones were segmented into cortical bone, spongiosa, medullary marrow and cartilage to allow for the use of μCT images of trabecular bone for skeletal dosimetry. Anatomical results show 3D images of the phantoms' surfaces, organs and skeletons, as well as tables with organ and tissue masses or skeletal tissue volumes. Dosimetric results present comparisons of organ and tissue absorbed doses or specific absorbed fractions between the newborn and 1-year-old phantoms and corresponding data for other paediatric stylised or voxel phantoms. Most differences were found to be below 10%.

Response functions for computing absorbed dose to skeletal tissues from photon irradiation--an update

A comprehensive set of photon fluence-to-dose response functions (DRFs) is presented for two radiosensitive skeletal tissues-active and total shallow marrow-within 15 and 32 bone sites, respectively, of the ICRP reference adult male. The functions were developed using fractional skeletal masses and associated electron-absorbed fractions as reported for the UF hybrid adult male phantom, which in turn is based upon micro-CT images of trabecular spongiosa taken from a 40 year male cadaver. The new DRFs expand upon both the original set of seven functions produced in 1985, and a 2007 update calculated under the assumption of secondary electron escape from spongiosa. In this study, it is assumed that photon irradiation of the skeleton will yield charged particle equilibrium across all spongiosa regions at energies exceeding 200 keV. Kerma coefficients for active marrow, inactive marrow, trabecular bone and spongiosa at higher energies are calculated using the DRF algorithm setting the electron-absorbed fraction for self-irradiation to unity. By comparing kerma coefficients and DRF functions, dose enhancement factors and mass energy-absorption coefficient (MEAC) ratios for active marrow to spongiosa were derived. These MEAC ratios compared well with those provided by the NIST Physical Reference Data Library (mean difference of 0.8%), and the dose enhancement factors for active marrow compared favorably with values calculated in the well-known study published by King and Spiers (1985 Br. J. Radiol. 58 345-56) (mean absolute difference of 1.9 percentage points). Additionally, dose enhancement factors for active marrow were shown to correlate well with the shallow marrow volume fraction (R(2) = 0.91). Dose enhancement factors for the total shallow marrow were also calculated for 32 bone sites representing the first such derivation for this target tissue.

A review of voxel model development and radiation protection applications at ENEA

The need of organ absorbed dose evaluation for radiation protection purposes stimulated, since the late 1960s, the development of anthropoid models to be used with radiation transport codes. Very significant improvements were introduced during the years, passing from stylised analytical human models to realistic voxel models based on computed tomography scans or MRI scans, and finally to advanced surface-geometry models. Besides illustrating the main contributions in this field from various international laboratories, this paper illustrates some applications of voxel models to internal (including in vivo monitoring) and external dosimetry for radiation protection.

FASH and MASH: female and male adult human phantoms based on polygon mesh surfaces: I. Development of the anatomy

Among computational models, voxel phantoms based on computer tomographic (CT), nuclear magnetic resonance (NMR) or colour photographic images of patients, volunteers or cadavers have become popular in recent years. Although being true to nature representations of scanned individuals, voxel phantoms have limitations, especially when walled organs have to be segmented or when volumes of organs or body tissues, like adipose, have to be changed. Additionally, the scanning of patients or volunteers is usually made in supine position, which causes a shift of internal organs towards the ribcage, a compression of the lungs and a reduction of the sagittal diameter especially in the abdominal region compared to the regular anatomy of a person in the upright position, which in turn can influence organ and tissue absorbed or equivalent dose estimates. This study applies tools developed recently in the areas of computer graphics and animated films to the creation and modelling of 3D human organs, tissues, skeletons and bodies based on polygon mesh surfaces. Female and male adult human phantoms, called FASH (Female Adult meSH) and MASH (Male Adult meSH), have been designed using software, such as MakeHuman, Blender, Binvox and ImageJ, based on anatomical atlases, observing at the same time organ masses recommended by the International Commission on Radiological Protection for the male and female reference adult in report no 89. 113 organs, bones and tissues have been modelled in the FASH and the MASH phantoms representing locations for adults in standing posture. Most organ and tissue masses of the voxelized versions agree with corresponding data from ICRP89 within a margin of 2.6%. Comparison with the mesh-based male RPI_AM and female RPI_AF phantoms shows differences with respect to the material used, to the software and concepts applied, and to the anatomies created.

FASH and MASH: female and male adult human phantoms based on polygon mesh surfaces: II. Dosimetric calculations

Female and male adult human phantoms, called FASH (Female Adult meSH) and MASH (Male Adult meSH), have been developed in the first part of this study using 3D animation software and anatomical atlases to replace the image-based FAX06 and the MAX06 voxel phantoms. 3D modelling methods allow for phantom development independent from medical images of patients, volunteers or cadavers. The second part of this study investigates the dosimetric implications for organ and tissue equivalent doses due to the anatomical differences between the new and the old phantoms. These differences are mainly caused by the supine position of human bodies during scanning in order to acquire digital images for voxel phantom development. Compared to an upright standing person, in image-based voxel phantoms organs are often coronally shifted towards the head and sometimes the sagittal diameter of the trunk is reduced by a gravitational change of the fat distribution. In addition, volumes of adipose and muscle tissue shielding internal organs are sometimes too small, because adaptation of organ volumes to ICRP-based organ masses often occurs at the expense of general soft tissues, such as adipose, muscle or unspecified soft tissue. These effects have dosimetric consequences, especially for partial body exposure, such as in x-ray diagnosis, but also for whole body external exposure and for internal exposure. Using the EGSnrc Monte Carlo code, internal and external exposure to photons and electrons has been simulated with both pairs of phantoms. The results show differences between organ and tissue equivalent doses for the upright standing FASH/MASH and the image-based supine FAX06/MAX06 phantoms of up to 80% for external exposure and up to 100% for internal exposure. Similar differences were found for external exposure between FASH/MASH and REGINA/REX, the reference voxel phantoms of the International Commission on Radiological Protection. Comparison of effective doses for external photon exposure showed good agreement between FASH/MASH and REGINA/REX, but large differences between FASH/MASH and the mesh-based RPI_AM and the RPI_AF phantoms, developed at the Rensselaer Polytechnic Institute (RPI).

An ICRP-based Chinese adult male voxel model and its absorbed dose for idealized photon exposures--the skeleton

A site-specific skeleton voxel model for a Chinese adult male was constructed in this paper upon a previous Chinese individual voxel model. The whole skeleton was divided into 19 site-specific bones and bone groups; the mass of various skeleton tissues at each bone site, e.g. red bone marrow, was specified according to Asian reference data and the distribution data from ICRP Publication 70. The resultant voxel model (called CAM) has a resolution of 1.741 mm x 1.741 mm in plane, and the total bone mass is 8397.8 g which is almost equal to the Asian reference value. Dose coefficients for the red bone marrow and bone surface in CAM were calculated, and then compared with those from Rex, CMP and ICRP 74. It shows that the dose to RBM in Rex is generally 12% lower than that to CAM in low-energy range (30-150 keV) for AP, LAT, ROT and ISO geometries. It is also found that the RBM dose from mathematical models, i.e. CMP and ICRP 74, is underestimated by -30% in AP geometry and overestimated by 30% in PA geometry for low-energy photons. Meanwhile, the bone surface dose in the low-energy range is overestimated by 150% and 75% in CMP and ICRP 74, respectively, if compared with that from CAM.

A study of predicted bone marrow distribution on calculated marrow dose from external radiation exposures using two sets of image data for the same individual

Red bone marrow is among the tissues of the human body that are most sensitive to ionizing radiation, but red bone marrow cannot be distinguished from yellow bone marrow by normal radiographic means. When using a computational model of the body constructed from computed tomography (CT) images for radiation dose, assumptions must be applied to calculate the dose to the red bone marrow. This paper presents an analysis of two methods of calculating red bone marrow distribution: 1) a homogeneous mixture of red and yellow bone marrow throughout the skeleton, and 2) International Commission on Radiological Protection cellularity factors applied to each bone segment. A computational dose model was constructed from the CT image set of the Visible Human Project and compared to the VIP-Man model, which was derived from color photographs of the same individual. These two data sets for the same individual provide the unique opportunity to compare the methods applied to the CT-based model against the observed distribution of red bone marrow for that individual. The mass of red bone marrow in each bone segment was calculated using both methods. The effect of the different red bone marrow distributions was analyzed by calculating the red bone marrow dose using the EGS4 Monte Carlo code for parallel beams of monoenergetic photons over an energy range of 30 keV to 6 MeV, cylindrical (simplified CT) sources centered about the head and abdomen over an energy range of 30 keV to 1 MeV, and a whole-body electron irradiation treatment protocol for 3.9 MeV electrons. Applying the method with cellularity factors improves the average difference in the estimation of mass in each bone segment as compared to the mass in VIP-Man by 45% over the homogenous mixture method. Red bone marrow doses calculated by the two methods are similar for parallel photon beams at high energy (above about 200 keV), but differ by as much as 40% at lower energies. The calculated red bone marrow doses differ significantly for simplified CT and electron beam irradiation, since the computed red bone marrow dose is a strong function of the cellularity factor applied to bone segments within the primary radiation beam. These results demonstrate the importance of properly applying realistic cellularity factors to computation dose models of the human body.

Radiation dose from kilovoltage cone beam computed tomography in an image-guided radiotherapy procedure

PURPOSE

Image-guided radiation therapy has emerged as the new paradigm in radiotherapy. This work is to provide detailed information concerning the additional imaging doses to patients' radiosensitive organs from a kilovoltage cone beam computed tomography (kV CBCT) scan procedure.

METHODS AND MATERIALS

The Vanderbilt-Monte-Carlo-Beam-Calibration (VMCBC; Vanderbilt University, Nashville, TN) algorithm was used to calculate radiation dose to organs resulting from a kV CBCT imaging guidance procedure. Eight patients, including 3 pediatric and 5 adult patients, were investigated. The CBCT scans in both full- and half-fan modes were studied.

RESULTS

For a head-and-neck scan in half-fan mode, dose-volume histogram analyses show mean doses of 7 and 8 cGy to the eyes, 5 and 6 cGy to the spinal cord, 5 and 6 cGy to the brain, and 18 and 23 cGy to the cervical vertebrae for an adult and a 29-month-old child, respectively. The dose from a scan in full-fan mode is 10-20% lower than that in half-fan mode. For an abdominal scan, mean doses are 3 and 7 cGy to prostate and 7 and 17 cGy to femoral heads for a large adult patient and a 31-month-old pediatric patient, respectively.

CONCLUSIONS

Doses to radiosensitive organs can total 300 cGy accrued over an entire treatment course if kV CBCT scans are acquired daily. These findings provide needed data for clinicians to make informed decisions concerning additional imaging doses. The dose to bone is two to four times greater than dose to soft tissue for kV x-rays, which should be considered, especially for pediatric patients.