THE IMPORTANCE OF FEEDBACK IN MONITORING PATIENTS' RADIATION DOSES IN MAMMOGRAPHY

The majority of medical facilities in the Slovak Republic archive diagnostic images of their patients in a picture archiving and communicating system (PACS). Data from the PACS system can be used to analyse patient radiation dose and perform internal and external quality control through dose monitoring software systems. However, appropriate use of such systems requires the provision of feedback and the ability of staff to identify causes of diagnostic reference level exceedances. The present pilot study evaluated the use of a Dose quality control system (DQC) for monitoring the radiation dose of the patients in the ongoing mammography screening, with subsequent identification of alerts triggered by the system.

UPTAKE AND DISTRIBUTION OF RADIOSTRONTIUM IN TOMATO TREATED WITH ARBUSCULAR MYCORRHIZAL FUNGI

Arbuscular mycorrhizal fungi (AMF) were inoculated into the root system of edible tomato plants to investigate their effect on the uptake and distribution of strontium radionuclide in the tissues of plants grown under laboratory conditions. The experiments were carried out in a sterile mixture of topsoil and sand, where in one series of experiments contaminated soil with 85Sr was used. Seeds were inoculated with a mixture of AMF at sowing, the second, control series was without application of AMF. Determination of radioactivity in soil and in different parts of tomato plants was carried out by gamma-spectrometric measurement. The obtained results and statistical analysis indicated a significant association between AMF inoculation of plants and the change in the distribution of 85Sr. The presence of AMF reduced the translocation of 85Sr from the root system to the aerial parts of tomato plants.

PRECAUTION IN THE USE OF EFFECTIVE DOSE IN CORONARY CT ANGIOGRAPHY

The effective dose is a quantity used in clinical practice for statistical evaluation of the radiation dose of patients undergoing different types of examinations. Coronary computed tomography angiography (CCTA) is a specific examination whose calculated effective dose may be subject to several biases. For this reason, it is important to consider factors (different examination techniques, heart rate and patient habitus) that may influence its resulting value. Another critical factor is the methodological procedure for calculating the effective dose and cardiac-specific coefficient used to estimate effective dose from the dose-length product in computed tomography. Because CCTA is increasingly used in cardiology, it is recommended that the chest coefficient be replaced with a new cardiac coefficient when calculating the effective dose.

Comparison of pencil-type ionization chamber calibration results and methods between dosimetry laboratories

A comparison of calibration results and procedures in terms of air kerma length product, PKL, and air kerma, K, was conducted between eight dosimetry laboratories. A pencil-type ionization chamber (IC), generally used for computed tomography dose measurements, was calibrated according to three calibration methods, while its residual signal and other characteristics (sensitivity profile, active length) were assessed. The results showed that the "partial irradiation method" is the preferred method for the pencil-type IC calibration in terms of PKL and it could be applied by the calibration laboratories successfully. Most of the participating laboratories achieved high level of agreement (>99%) for both dosimetry quantities (PKL and K). Estimated relative standard uncertainties of comparison results vary among laboratories from 0.34% to 2.32% depending on the quantity, beam quality and calibration method applied. Detailed analysis of the assigned uncertainties have been presented and discussed.

D-IMRT verification with a 2D pixel ionization chamber: dosimetric and clinical results in head and neck cancer

Dynamic intensity-modulated radiotherapy (D-IMRT) using the sliding-window technique is currently applied for selected treatments of head and neck cancer at Institute for Cancer Research and Treatment of Candiolo (Turin, Italy). In the present work, a PiXel-segmented ionization Chamber (PXC) has been used for the verification of 19 fields used for four different head and neck cancers. The device consists of a 32x32 matrix of 1024 parallel-plate ionization chambers arranged in a square of 24x24 cm2 area. Each chamber has 0.4 cm diameter and 0.55 cm height; a distance of 0.75 cm separates the centre of adjacent chambers. The sensitive volume of each single ionization chamber is 0.07 cm3. Each of the 1024 independent ionization chambers is read out with a custom microelectronics chip.The output factors in water obtained with the PXC at a depth of 10 cm were compared to other detectors and the maximum difference was 1.9% for field sizes down to 3x3 cm2. Beam profiles for different field dimensions were measured with the PXC and two other types of ionization chambers; the maximum distance to agreement (DTA) in the 20-80% penumbra region of a 3x3 cm2 field was 0.09 cm. The leaf speed of the multileaf collimator was varied between 0.07 and 2 cm s-1 and the detector response was constant to better than 0.6%. The behaviour of the PXC was measured while varying the dose rate between 0.21 and 1.21 Gy min-1; the mean difference was 0.50% and the maximum difference was 0.96%. Using fields obtained with an enhanced dynamic wedge and a staircase-like (step) IMRT field, the PXC has been tested for simple 1D modulated beams; comparison with film gave a maximum DTA of 0.12 cm. The PXC was then used to check four different IMRT plans for head and neck cancer treatment: cervical chordoma, parotid, ethmoid and skull base. In the comparison of the PXC versus film and PXC versus treatment planning system, the number of pixels with gamma parameter<or=1 was 97.7% and 97.6%, respectively.

External audits of electron beams using mailed TLD dosimetry: preliminary results

AIM

A feasibility study has been performed to investigate the possibility of using mailed thermoluminescence dosimetry (TLD) for external audits of clinical electron beams in Europe.

METHODS

In the frame of the EC Network Project for Quality Assurance in Radiotherapy, instruction sheets and mailing procedures have been defined for mailed TLD dosimetry using the dedicated holder developed by a panel of experts of the International Atomic Energy Agency (IAEA). Three hundred and thirty electron beam set-ups have been checked in the reference centres and some local centres of the EC Network Project and in addition through the centres participating to the EORTC Radiotherapy Group trial 22922.

RESULTS

The mean ratio of measured dose to stated dose is 0.2% and the standard deviation of measured dose to stated dose is 3.2%. In seven beam set-ups, deviations greater than 10% were observed (max. 66%), showing the usefulness of these checks.

CONCLUSION

The results of this feasibility study (instruction sheets, mailing procedures, holder) are presently endorsed by the EQUAL-ESTRO structure in order to offer in the future to all ESTRO members the possibility to request external audits of clinical electron beams.

A comparative description of three multipurpose phantoms (MPP) for external audits of photon beams in radiotherapy: the water MPP, the Umeå MPP and the EC MPP

AIM

To present a technical description and intercomparison of three multipurpose phantoms (MPP) developed for mailed dosimetry checks of therapeutic photon beams in reference and non-reference conditions.

MATERIALS

The W-MPP is a water MPP, whereas the Umeâ-MPP, made of perspex (PMMA, Plexiglas), and the EC-MPP, made of polystyrene, are solid MPPs. The W-MPP uses only thermoluminescent dosimeters (TLD) for dosimetry checks, the EC MPP uses film and TLD; the Umeâ phantom uses film and TLD, and offers in addition the possibility for ionization chamber measurements. Either using TLD or films, the MPPs have been designed to check on-axis and off-axis the following irradiation conditions: square and rectangular fields, asymmetric fields, wedged beams, oblique incidence and, for the solid MPPs, also the influence of inhomogeneities.

RESULTS AND DISCUSSION

The MPPs have been compared for different aspects going from their dosimetric performance (number of dosimetric parameters that can be checked) to some practical consideration in the use of the different MPPs (set-up time, stability, instruction sheets, etc.). From a comparison between the solid multi-purpose phantoms, it turns out that the EC-MPP is capable of checking the largest number of dosimetric parameters per beam, but has the longest set-up time ( approximately 2 h) per beam according to the users. The Umeå-MPP has a smaller number of set-ups (hence a smaller average time) and also includes some parameters not checked with the EC-MPP (e.g. SSD accuracy). The major drawback however of the Umeå-MPP is considered to be its high density (>1.1 g/cm(3)) which increases the difficulty of the analysis with the treatment planning system. The W-MPP checks the smallest number of parameters, but is the fastest in set-up time, the easiest for mailing, and is water equivalent, which is advantageous for the TPS checks. The major drawback of this MPP is however the inability to check complete dose distribution (film) or inhomogeneities.

External audit of photon beams by mailed film dosimetry: feasibility study

A feasibility study for mailed film dosimetry has been performed. The global reproducibility of the method is better than 2%. It is shown that the normalized sensitometric curve does not depend on photon beam quality in the range from Co-60 gamma-rays to 18 MV x-rays, although the dose per optical density decreases when the energy increases. The fading of the latent image before film processing is only 3% per month and the normalized sensitometric curve is not modified after a period of 51 days between irradiation and processing. Sets of films were mailed to three different institutes for irradiation and returned for processing and evaluation after more than two months in order to verify that mailing of irradiated and unprocessed films does not produce unwanted artefacts. Finally the feasibility of external audits with mailed film dosimetry is illustrated by comparison of beam profiles measured with films and ionization chambers in a polystyrene phantom.