An Overview of Radiation Monitoring Programs in Radiology

An Overview of Radiation Monitoring Programs in Radiology Edward Wong Chief Radiographer, HKSH 16 April 2011

Nuclear Plant Leakage

Radiation Horrors • No Color, no Smell • Deterministic effects – – Threshold dose Redness of skin • Stochastic effects – – Younger affect most Exposure to 1 Sievert of radiation is estimated to increase the lifetime risk of fatal cancer by around 5% (Atomic Bomb Study)

Radiation Horrors • No Color, no Smell • Deterministic effects – – Threshold dose Redness of skin • Stochastic effects – – Younger affect most Exposure to 1 Sievert of radiation is estimated to increase the lifetime risk of fatal cancer by around 5% (Atomic Bomb Study)

Radiation Horrors • No Color, no Smell • Deterministic effects – – Threshold dose Redness of skin • Stochastic effects – – Younger affect most Exposure to 1 Sievert of radiation is estimated to increase the lifetime risk of fatal cancer by around 5% (Atomic Bomb Study)

Public Awareness Working 200 hours before CRT monitor Eat 130 Bananas CXR (0. 1 m. Sv) 2 months Background Radiation in Hong Kong Smoking 7 Cigarettes Travel 10 hours by Plane

Educational Pamphlet

Educational Pamphlet Accuracy of dose information ? What is the examination dose level of your institute ?

Dose Measurement Quantity Unit Determination Exposure Coulombs (C) Measure the amount of ionization produced in air /Kg Absorbed Dose Gray (Gy) or J/Kg Measure the radiation energy absorbed by the patient Equivalent Dose Sievert (Sv) Multiply Absorbed Dose by a quality factor (QF) to show harmful effects, e. g. X-ray & Gamma: QF=1; Alpha particle: QF=20 Effective Dose Sv Multiply Equivalent Dose by a tissue weighting (TW) factor, i. e. Colon: TW=0. 12; Skin: TW=0. 01; Whole Body: TW=1 (ICRP 2007) Example: 100 m. Sv to skin = Effective dose of 1 m. Sv

Device for measurement Film badge TLD Various detectors and Phantoms DAP and printer TLD-100 chips (Harshaw)

Dose Area Product Meter • Reading includes SID variation • Reading includes Collimation factors • DAP do not measure backscatter • DAP do not measure wedge or added filters • m. Gy/cm 2

Monte Carlo simulations • The assessment of conversion factors began more than 30 years ago • Use tissue-equivalent plastic body phantoms containing organs into which dosimeters are inserted and Monte Carlo simulations are applied • Common available standard includes an adult with a body mass of 70 kg; children aged 15, 10, 5, 1 year and newborns • Effective dose: can’t measure routinely • Entrance Skin Dose is commonly used

Effective Dose Calculation The geometry of patient exposure is less predictable and varies during the procedure X-ray Fluoro CT The fundamental radiation dose parameter in CT is the CT dose index (CTDI & CTDIvol). To assess patient dose exposure after scanning a certain distance use dose-length product (CTDIvol × scan length) Verdun F R et al. Radiographics 2008; 28: 1807 -1816

Use ESD & DAP to calculate the Effective Dose Hart. D, Jones DG, Wall BF. Estimation of effective dose in diagnostic radiology from entrance dose and dose-area product measurement (NRPB-R 262). Chilton, England: NRPB, 1994.

Dose Reference Levels (DRL) • Introduced by ICRP • Dose level for typical exams for group of standard-sized patients • DRL are typically set at the 3 rd quartile of dose distribution from a survey

DRL for monitoring Calculation of Entrance Skin Dose (ESD) for Supine and Erect Abdomen in Digital Radiography for HA hospitals ESD = (DAP*BSF/Field. Size)*(SID/FSD)^2 FSD, focus-to-skin distance = SID - 25 cm BSF, backscatter factor estimated from NRPB SR 262 (e. g. 80 k. Vp = 1. 458)

Information from DICOM Header k. Vp = 110 Protocol = Chest SID = 1800 mm FSD = 1750 mm FOV (collimation) = 35. 1 cm x 37. 1 cm m. As = 3. 376 DAP = 1. 5766 m. Gy/cm 2 Position = PA Mapping to PACS database is required

Results of DRL A B C D E Hospitals F G

Usage of DRL Complied by ACR for Appropriateness Criteria

CR vs DR • CR: no k. Vp and m. As data • Vendors have their own calculation of Exposure Index (EI) which give feedback about detector dose level • AAPM try to standardize the EI • Complicated by collimation detection and post processing

Freeware for CT dose • • • Image Server PHP/my. SQL OCR

Move dose info to Database • Difficult to handle more than one scanner • Need mapping ?

Fluoroscopy ?

DICOM Structure Report & IHE enhancement • Store Dose Information - Similar to Images Stored • Query Dose Information • Retrieve Dose Information • Submit Dose Report

Dedicated Dose Monitoring

Reports and Alerts LA Law: 5 Gy collective dose over 18 months or 4 Gy single examination !!!

IAEA Smart Card Project 2009 • • • Tracking life time dose record for patient e. HR for recording or Radiation Passport Access anywhere by digital signature Data for monitoring public radiation level Refine existing standard on dosimetry Enhancement in DICOM & IHE-REM for dose report and dose information communication

Thanks www. pacs. hk wongthe@gmail. com