Beruflich Dokumente
Kultur Dokumente
1093/jicru/ndi016
doi:10.1093/jicru/ndi017
POLICY
The ICRU endeavors to collect and evaluate the
latest data and information pertinent to the problems of radiation measurement and dosimetry and
to recommend the most acceptable values and techniques for current use.
The Commissions recommendations are kept
under continual review in order to keep abreast of
the rapidly expanding uses of radiation.
The ICRU feels that it is the responsibility of
national organizations to introduce their own
detailed technical procedures for the development
and maintenance of standards. However, it urges
that all countries adhere as closely as possible to
the internationally recommended basic concepts of
radiation quantities and units.
The Commission feels that its responsibility lies in
developing a system of quantities and units having
the widest possible range of applicability. Situations
may arise from time to time when an expedient
solution of a current problem may seem advisable. Generally speaking, however, the Commission
In addition, the ICRU is evaluating the possibility of expanding its program to encompass nonionizing radiation, particularly the quantities and
units aspects.
The Commission continually reviews radiation
science with the aim of identifying areas where the
development of guidance and recommendations can
make an important contribution.
OPERATING FUNDS
In recent years, principal financial support has
been provided by the European Commission, the
National Cancer Institute of the U.S. Department
of Health and Human Services and the International
Atomic Energy Agency. In addition, during the last
10 years, financial support has been received from
the following organizations:
Belgian Nuclear Research Centre
Canadian Nuclear Safety Commission
Eastman Kodak Company
Electricite de France
Fuji Medical Systems
Hitachi, Ltd.
International Radiation Protection Association
International Society of Radiology
Ion Beam Applications
Italian Radiological Association
Japan Industries Association of Radiological Systems
Japanese Society of Radiological Technology
MDS Nordion
National Institute of Standards and Technology
Nederlandse Vereniging voor Radiologie
Philips Medical Systems, Incorporated
Radiation Research Society
Siemens
Varian
In addition to the direct monetary support provided by these organizations, many organizations
provide indirect support for the Commissions program. This support is provided in many forms,
including, among others, subsidies for (1) the time
of individuals participating in ICRU activities,
(2) travel costs involved in ICRU meetings, and (3)
meeting facilities and services.
In recognition of the fact that its work is made
possible by the generous support provided by all of
the organizations supporting its program, the Commission expresses its deep appreciation.
Andre Wambersie
Chairman, ICRU
Brussels, Belgium
doi:10.1093/jicru/ndi018
CONTENTS
PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.1
1.2
1.3
1.4
1.5
1.6
1.7
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21
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3.3
3.4
3.5
Photon spectrum .
Half-value layer . .
X-ray tube voltage
Total filtration . .
X-ray tube output .
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25
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34
MEASUREMENT METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
4.1
4.2
4.3
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CONTENTS
4.4
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6 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
APPENDIX A
BACKSCATTER FACTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
APPENDIX B
APPENDIX C
APPENDIX D
APPENDIX E
APPENDIX F
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
doi:10.1093/jicru/ndi019
PREFACE
The mission and main objective of the International Commission on Radiation Units and Measurements (ICRU) are to develop a coherent system of
radiological quantities and units that is accepted
worldwide and applied in all fields where ionizing
radiation is used. The ICRU also develops recommendations on how to measure radiation-related
quantities to ensure a reliable exchange of results.
In addition, within the framework of this mission,
there is often a need for the definition of new terms
and concepts that could be adopted universally. The
ultimate goal of the ICRU is to improve harmonization in the concepts and the methods used to describe
and to report radiation applications, and thereby
facilitate the exchange of information between centres using radiation in medicine, science, and industry. The foundation of the ICRU by the First
Congress of Radiology in 1925 was to solve exactly
this harmonization problem.
The present Report is the first report published
by the ICRU that deals with patient dosimetry for
x rays used in diagnostic medical imaging. The
impetus for this report derives from the broad and
systemic application of x rays for diagnostic and
interventional imaging. The increasing number of
patients that benefits from radiology and the
increasing number and types of procedures that are
applied to these patients have resulted in a dramatic
increase of the population dose, which, in developed
countries, often exceeds the natural radiation levels.
The situation in developing countries will sooner or
later exhibit the same trend (UNSCEAR, 2000).
The relation between image quality and patient
dose has always been a matter of concern for the
radiology community. To initiate the production of
objective information, the European Commission
conducted several trials for various types of examination currently performed in diagnostic radiology.
As an example, a first trial, involving 24 radiology
departments
from
10
European
countries
(1987/1988) compared entrance doses for PA chest
radiography. The entrance surface doses ranged
from 0.03 to 12 mGy, i.e., a ratio of about 400 (Maccia
et al., 1989). A second larger study (1991) involved
83 radiology departments from 16 countries. As
an example, in the second study, for PA chest radiographs, the mean entrance doses measured in
the participating departments ranged from 0.1 to
0.5 mGy, i.e., a ratio of 5 between the maximum
and the minimum mean doses (EC, 1996a). This
ratio was worse in the first study. Most interesting
is the fact that there was no correlation between the
quality of the image and the dose to the patient. The
quality of the images was evaluated by the information content of the film as assessed by a team of
experienced radiologists. Several other studies of
this kind were initiated (e.g., for breast, lumbar
spine), and quality criteria were established (CEC,
1990; EC, 1996b; ICRU, 2003).
A particular source of concern is that among the
different examinations some modern CT procedures
that are remarkably powerful in their diagnostic
capabilities deliver significant doses to large regions
of the body. The diagnostic power of the radiological
procedures to solve medical issues is of course the
first priority. Because of the increasing doses
delivered to an increasing number of patients, however, it becomes important and timely to optimize
the technical conditions, i.e., to reduce the patient
exposure for the same quality of diagnostic information. This is simply common sense and is in agreement with the recommendations of the radiation
protection commissions and agencies, and also of
national and international authorities.
An additional issue is the recent development and
rapid growth of interventional radiology, especially
in cardiology. The exposures are high for the patient
(and possibly also for the radiologists), and the number of reported cases of acute tissue reactions1 with
different severity is increasing. The need for accurate dosimetry becomes critical especially for the
skin, which is one of the tissues at highest risk.
For patient dosimetry in radiology, the required
accuracy depends on the clinical situation and the
dose range involved. It is, in general, much lower
than the accuracy required in radiation therapy. In
any case the quantities measured should always be
1
x rays, emitted from a point source and characterized by half-value layers of 0.310 mm of Al, are
collimated to penetrate the volume of interest. The
use of different irradiation conditions, in terms of
incident radiation quality and beam geometry in
relation to the patients body, has led to the development of specific dosimetric methods and the definition of appropriate quantities quantities different
from those used for occupational and environmental
exposures.
Not surprisingly, the exposure conditions
assumed in deriving the relationships between the
effective dose and the operational quantities for
occupational and environmental exposures are not
appropriate for patient dosimetry in medical
imaging. In the first case one is dealing with whole
body irradiation by broad beams of photons or neutrons while, in the second case, strictly collimated
beams are used resulting in partial-body patient
irradiations.
Whereas some of the dosimetric concepts and techniques used in radiotherapy have been successfully
employed in medical x-ray imaging, additional dosimetric quantities and measurement methods are
required for patient dosimetry for procedures such
as fluoroscopy, CT, and mammography. Conversion
coefficients are often used in practice to relate directly measurable quantities to doses to different
critical organs or at specific reference points. When
deterministic effects are considered a possibility,
doses to the more heavily irradiated sites of the
body need to be critically evaluated.
The present Report provides a detailed framework
of recommendations for assessing patient dose in
radiological imaging. Moreover, this framework is
suitable for the accurate, harmonized exchange of
information as well as to provide an assessment to
avoid or reduce the severity of tissue reactions. This
report will be soon followed by a second one, exclusively focused upon CT dosimetry and its image quality. The recent development and rapid growth of CT
applications, and the specific issues that are raised,
deserve a special ICRU Report.
Andre Wambersie
Paul M. DeLuca
Johannes Zoetelief
September 2005
doi:10.1093/jicru/ndi020
GLOSSARY
AEC
AP
BM
CC
CT
CTDI
DICOM
DRL
FID
FOV
FSD
GI
GSD
HVL
LAT
LAO
L LAT
LPO
LSJ
ML
MRI
OBL
PA
PMMA
RAO
R LAT
RPO
TLD
TMJ
doi:10.1093/jicru/ndi021
ABSTRACT
This report presents specifications of x-ray beams
and quantities, and units for dose measurement and
calculation in medical x-ray imaging, including
application-specific quantities, and new symbols. It
addresses measurement methods for normalization
quantities and for quantities recommended for the
establishment and use of diagnostic reference levels.
It presents methods for determining organ and tissue doses as well as doses in localized regions of
organs and tissues, including detailed information
doi:10.1093/jicru/ndi022
EXECUTIVE SUMMARY
In Section 1 it is emphasized that medical
imaging was virtually the first application of
x rays. The health risks of irradiation became
evident only later. Appropriate quantities to measure the amount of irradiation of an object had to be
developed, leading to quantities like exposure, absorbed dose, and kerma. It is furthermore stressed
that there is a need for harmonization of quantities
and terminology for different applications in medical imaging using x rays. The two purposes of
patient dosimetry of x rays used in medical imaging
are to set and check standards of good practice and
to assess the risks of detriment or harm. Image
quality is stressed to be of paramount importance
in medical imaging but is the subject of other ICRU
Reports.
Specifications of x-ray beams used for medical
imaging are presented in Section 2. It is recommended to characterize the radiation quality of x-ray
beams used for medical imaging by a combination
of various parameters, including first and second
half-value layer, HVL1 and HVL2, the ratio of
HVL1 and HVL2, the tube voltage, and the total
filtration. In most cases a combination of three of
these parameters will be sufficient for characterization. The radiation intensity is also an important characteristic of an x-ray tube (including
filtration). For this purpose the x-ray tube output
is defined.
Quantities and units for dose measurement
and calculation in medical x-ray imaging are
dealt with in Section 3. Relevant basic dosimetric
qualities are presented in first instance. Several
application-specific qualities have been found useful for measurements in medical x-ray imaging,
but ambiguity remains in the names of quantities and their use. Therefore, application-specific
quantities and new symbols are defined. Concerning risk-related quantities, mean organ and tissue
doses are defined as well as absorbed dose to the
more heavily irradiated regions of tissues in relation to deterministic effects. Dose-conversion coefficients relate the specified dosimetric quantities to
a normalization quality. Both types of dosimetric
doi:10.1093/jicru/ndi023
INTRODUCTION
(ii) The second was the lack of standards and references to assist the interpretation of the results.
For further developments of x-ray dosimetry the
elaboration of an adequate standard dosimeter was
of major importance (Kustner, 1924) and led to the
development of sophisticated and precise instrumentation based on ionization of air. The way to
dose quantification and understanding of biological
and technical aspects of x-ray diagnosis was opened.
Patient and staff dosimetry reflected the impact of
theories on biological effects at the time, resulting in
the use of derived quantities. Skin dosimetry with
the entrance skin exposure, related to cosmetic and
deterministic damage, was used to discuss limits of
patient exposure (Braun et al., 1928). For radiation
dosimetry, in the time period between the late 1920s
and the early 1950s the quantity exposure was
replaced by the quantity of absorbed dose (Taylor,
1990).
In the 1950s interest was focused on the induction
of genetic effects and cancer, mostly leukaemia. Consequently, the anatomical sites included most often
in patient dose studies were the skin, the gonads,
and the active bone marrow (BM). The doses at the
skin could be directly measured with ionization
chamber dosimeters. The doses to the gonads and
the active BM were taken to be representative of
the totality of likely radiation effects. The absorbed
dose to the male gonads was usually taken to be the
same as that measured directly to the closely adjacent skin, whereas mean absorbed doses to the
female gonads or the active BM were related to
skin dose using the results of dose measurements
in physical phantoms. A large number of dosimeters
were required to obtain even approximate estimates
of the mean dose to widely distributed tissues such
as the active BM and many different exposure conditions were needed to simulate the most common
types of x-ray examination. Nationwide surveys
using these dosimetric techniques combined with
studies of the numbers of x-ray examinations took
place in several countries in the period from 1955 up
to the early 1970s. Attention was focused on providing estimates of the genetically significant dose
data on the x-ray spectrum, could be readily converted into the total radiant energy in the beam. Hence
it could be used to make estimates of the total energy
imparted to the patient or the integral dose
(Carlsson, 1963) as it was then known. The integral
dose, defined as the mass integral of the absorbed
dose over the total body (expressed in units of g rad,
or erg), was seen to be more closely related to the
likely biological effects than the exposurearea
product. It had the considerable advantage over
organ doses that it could be derived directly from
exposurearea product measurements. As long as
other details of the exposure conditions were available, it allowed a reliable estimate of the energy that
was deposited in the patient. This fraction is critically dependent on the x-ray beam quality, the size
and position of the x-ray beam in the patient, the
thickness of the part being x-rayed, and the proportion of the beam intercepted by the patient. Because
the integral dose was often easier and more practical
to estimate than the doses to individual organs,
many studies in the 1960s and 1970s reported
doses to patients in this way.
In the 1980s the names and definitions of the
quantities and units used in diagnostic radiology,
as in other areas of radiation dosimetry, underwent
major changes following the publication of revised
recommendations by the ICRU (1980), which advocated adoption of the International System of Units.
As a result, exposure was replaced by air kerma (AK)
(unit: joule per kilogram with the special name
gray) as the quantity in which dosimeters were calibrated and linked to the national primary standards. Absorbed doses were also expressed in gray,
thus improving the numerical agreement between
the quantity measured by dosimeters and the
absorbed dose to soft tissue (to within 5 % for medical
x rays and most tissue-equivalent materials).
Exposurearea product (R cm2) was replaced by
kermaarea product (Gy cm2) or (absorbed)
dosearea product (DAP) (also Gy cm2) and integral
doses were expressed as the total energy imparted to
the patient in joules.
The limitations of the concept of the total energy
imparted to the body and its relation to possible
radiation effects became more apparent when computational methods of dosimetry became more
advanced. They allowed the mean absorbed doses
to individual tissues and organs of relevance to radiation protection to be calculated. Using simple geometrical models of the body and of typical medical
x-ray beams, Monte Carlo radiation transport codes
enabled researchers to calculate organ doses normalized to easily measured quantities such as the
entrance skin exposure, the ESD, or the DAP for a
wide range of medical x-ray exposure conditions.
10
INTRODUCTION
whom the ICRP derived the risk coefficients. Furthermore, the conditions of a low dose and especially
a low dose rate, assumed by the ICRP, may arguably
not always be met in practice in radiology.
1.2.1
In the early years of application of x rays in radiology, several cases of acute and severe skin reactions were reported. With the improvement of the
equipment, the use of safer working procedures, and
better training, the number and severity of these
accidents decreased rapidly and even became exceptional. In recent years, however, with the rapid
development of interventional radiology, acute skin
reactions became again a major concern for patient
safety (Figures 1.1 and 1.2).
At high dose (>2 Gy), the severity of the lesions
can be predicted from the local absorbed dose in the
skin and underlying dermis. Therefore, the skin
dose in the most heavily irradiated area is usually
the most relevant quantity to be determined in
interventional radiology. This implies that both the
maximum dose as well as the surface irradiated
above the tolerance dose be evaluated (ICRP Publication 59, 1991b). In interventional radiological
procedures, one of the main practical issues is often
the identification of the skin region that receives the
highest dose, as discussed in Section 3.
1.2.2
1.2.2.1
1.2.2.2
Late effects
Cancer induction
1.2.2.3
Genetic risk
12
INTRODUCTION
reconstruction with a reasonable accuracy to predict
the severity of the possible harm.
Required accuracy
Figure 1.3. Calibration of dosimeters to be used in a diagnostic radiology. (1) The reference dosimeter used in diagnostic radiology is
calibrated (directly or through transfer dosimeters) at a Standards Laboratory in air kerma free-in-air (left). (2) In diagnostic radiology,
the dosimeter can be used to measure the entrance surface dose (skin dose) provided appropriate conversion coefficients are applied, i.e.,
from air kerma free-in-air to absorbed dose in water including backscatter (right). In addition to skin dose, the chamber can also be used to
determine the dose at any point in the patient. (3) The transmission chamber, regularly calibrated (Section 4.2.4), is used as a monitor. It
provides the DAP or the air kermaarea product (KAP), depending on how it is calibrated. From the radiological parameters (Section
1.3.4.1), the readings of the reference and KAP dosimeters, in principle, organ doses can be computed for any organ using complex Monte
Carlo programs. The resulting conversion coefficients are valid within strict limits and specific for each radiological procedure (from
Wambersie et al., 2006, by permission of Oxford University Press).
and position, and irradiated region, should be recorded for the standard medical imaging procedures. In
recent equipment, in particular in direct digital radiology systems (flat panel detectors), recording of
these parameters is made automatically (Figure 1.4).
To the extent that the tube output remains constant relative to these parameters, this set of
information allows evaluating doses at reference
points where previous calibration has been performed at the surface or inside a phantom. Information obtained on the phantom can then be used to
evaluate the dose to the patients, but only for routine
procedures and with the necessary care.
The ICRU recommends that the radiographic conditions of the irradiations be reported as completely
as possible. When these are carefully reported, it will
be possible later on to apply better conversion coefficients when available and to derive more relevant
quantities.
INTRODUCTION
Figure 1.4. Correlation between radiological parameters, transmission monitor readings [air kermaarea product (KAP) or dose area
product (DAP), and clinically relevant dosimetric quantities (see arrows 3 and 1, respectively). This correlation should be checked at
regular intervals depending on the type of radiological examination, the irradiated organs and level of exposures, and the type of patients
(pregnant women, children, etc.]. The radiological parameters include tube voltage (kV), tube currentexposure time product (mAs),
filtration, field size (at a given distance), and exposure time for fluoroscopy (Section 1.3.4.1). The clinically relevant dosimetric quantities
include the skin (entrance) dose on the beam axis, skin surface (and regions) irradiated above the tolerance dose for induction of
deterministic effects at clinically relevant points and/or organs. Left part Regular checks of the correlation between the radiological
parameters and the readings of the KAP (or DAP) dosimeter (arrows 2) guarantee output stability and the reliability of both dosimetric
approaches. It improves the confidence in the two sets of dosimetric results. Right part In the absence of a KAP (or DAP) meter, regular
checks of the correlation (arrow 3) between the radiological parameters and the readings of the reference ionization chamber, at reference
points, may also provide some guarantee on the stability and reliability of the dosimetry. This latter procedure, however, should be limited
to simple, routine, and well-defined radiological examinations and is not recommended for examinations of pregnant women and children.
Courtesy: A. Wambersie.
procedures. KAP or DAP can be used as normalization quantities to derive relevant dosimetric
quantities, such as organ doses, using conversion
coefficients (Sections 1.3.3 and 3.4).
Continuous monitoring of KAP relative to the
radiographic parameters of exposure listed previously (Section 1.3.4.1) improves the confidence in
both approaches.
1.3.4.3 Monte Carlo computation
Sophisticated Monte Carlo programs have been
designed to calculate doses at specified points or
average organ doses in phantoms starting from the
radiographic parameters and/or the KAP or DAP
(Figure 1.5). The results from these approaches are
available mainly for standard, well-established
radiological procedures. The use of such Monte
Carlo codes needs considerable expertise when
applied for specific or uncommon procedures.
1.3.5
Discussion
Figure 1.5. Visual representation of the photon tracks (primary and scattered radiation) and energy distribution (colour code: light gray,
2040 kV; medium gray, 4060 kV; dark gray, 6080 kV) of a Monte Carlo simulation for a PA view of a pelvic exposure, as part of an
angiographic examination of the lower limbs. The exposure was assumed to be performed at a peak tube voltage of 80 kV, a total filtration
of 4.6 mm Aleq, and a focus-to-skin distance of 55 cm. As model for the patient, the mathematical phantom BODYBUILDER was used.
Conversion coefficients can be retrieved between different calculated values, such as a specific organ dose or DAP/KAP. Reproduced with
permission from Dr. L. Struelens.
INTRODUCTION
names are used in practice for the same quantity,
for example, entrance surface air kerma, air kerma,
and entrance air kerma. The same abbreviation ESD
is used for both entrance surface dose (absorbed dose
determined free-in-air most likely expressed in air)
and entrance skin dose (absorbed dose most likely
expressed in skin tissue).
The kermaarea product is often used for dose
assessment for more complex examinations, including radiography and fluoroscopy. Although the name
does not state this explicitly, the kerma is usually
expressed in air free-in-air and the backscatter from
a patient or a phantom is not to be included.
In interventional radiology, the value of the
kermaarea product for a complete examination
has been used as an indicator for the occurrence of
stochastic effects, whereas information on the maximum dose at skin entrance (that is, the dose at the
location of the skin where it is highest) is of importance with respect to the possible occurrence of deterministic effects. The maximum dose at skin entrance
is also referred to as the peak skin dose (Miller et al.,
2002) and defined as the highest dose delivered to
any portion of the patients skin.
For the assessment of organ doses and quality
assurance in CT, the CTDI has been defined as the
integral of the absorbed dose profile along a line
parallel to the axis of rotation of the scanner divided
by the nominal slice thickness (Shope et al., 1981). In
the literature, different methods can be found for the
practical assessment of CTDI. These include differences in the boundaries of integration, the use of a
phantom or measurement free-in-air, and differences in the material in which the absorbed dose is
expressed, for example, polymethylmethacrylate
(PMMA) or air.
The present situation in patient dosimetry for
medical x-ray imaging clearly indicates the need
for dose quantities recommended for the different
applications and the need for using the same, selfconsistent, system for names, symbols, and units.
selection of the quantities in the radiological departments (EC, 1997; ICRP Publication 73, 1996).
Dosimetry for CT raises specific issues. For CT,
skin dose and dose at a point do not have the same
significance as for conventional radiography, and
specific indexes thus need to be introduced. The CT
dose index (CTDI) has been defined for the assessment of organ dose and QA (Sections 3.2 and 4.2.5).
Several methods were published for the practical
assessment of CTDI (IEC, 1999; EC 2000).
For interventional radiology, where the avoidance
of deterministic effects becomes important, doseconversion coefficients relating the absorbed
dose to the more heavily irradiated site at the
surface of the body to normalization quantities
(Section 3.4) are not yet commonly available, except
for some coronary procedures. In particular, the
point (place on skin) where the maximum dose is
obtained may not always be known in advance
(Section 3.3.1).
1.4 NEED FOR HARMONIZATION OF
QUANTITIES AND TERMINOLOGY
Various quantities and terminologies have been
used for the specification of dose on the central
beam axis at the point where the x-ray beam enters
the patient (or a phantom representing the patient).
These include the exposure at skin entrance (ESE),
the input radiation exposure, the entrance surface
air kerma (ESAK), the entrance air kerma, the AK,
the ESD, the entrance skin dose (ESD), and the
integral skin dose (ISH and EC, 1998).
ICRU Reports 33 and 60 (1980, 1998c) recommended the use of the International System of Units (SI).
In ICRU Report 33 it is stated that the special unit
of exposure, the rontgen, should be dropped by
1985 and be replaced by the SI unit C/kg. Consequently, the approximate numerical equivalence
of exposure, AK, and absorbed dose to air was lost.
As a result of the introduction of the SI, exposure has
been replaced by air kerma (free-in-air) as the
quantity in which dosimeters are calibrated at
standards laboratories.
Sometimes it seemed to be the convention that
kerma implies absence of backscatter and absorbed
dose implies the presence of backscatter. However,
the presence or absence of backscatter cannot be
derived from the definitions of kerma and absorbed
dose (ICRU, 1998c). Calibrations of dosimeters are
generally made in terms of air kerma free-in-air.
Therefore, it is often assumed that kerma is
expressed only in air. However, the ICRU (1998c)
explicitly states that one can refer to a value of
kerma for a specified material at a point in free
space, or inside a different material. Different
INTRODUCTION
application specific quantities, risk related quantities, dose-conversion coefficients, and quantities
recommended for establishment and use of DRLs.
Section 4 discusses the methodology to be used for
the measurement of specific dose quantities including incident AK, ESAK, KAP and various quantities
to be used for CT dosimetry. It considers the choice
and calibration of dosimeters, the practical measurement technique, the measurement uncertainty, and
the advantages and disadvantages of phantombased and patient measurements. The derivation of
backscatter factors, which can be used to relate
incident AK and ESAK to ESD, is treated in
Appendix A. The conversion coefficients used to
estimate organ and tissue doses are covered in Section 5. Two approaches to determine the conversion
coefficients are considered: measurements in physical phantoms and computational methods. The latter use Monte Carlo techniques to simulate radiation
transport through computer-based models of the
patient. This is usually the more useful approach.
The main features of the computational method and
the associated uncertainties in the conversion coefficients are discussed. Results of such calculations
are available from a number of sources for conventional projection imaging, CT, and mammography.
Conclusions, including recommendations on the
selection of the most appropriate conversion coefficient for a particular examination or procedure, are
presented in Section 6. Organ dose-conversion coefficients from different sources are considered in
Appendices BF.
1.7
19
2.1
PHOTON SPECTRUM
20
40
60
80
doi:10.1093/jicru/ndi024
20
40
60
80
HVL
2.3
20
40
60
80
100
120
20
40
60
80
100
120
100
120
20
40
60
80
100
120
20
40
60
80
Figure 2.2. Calculated spectra (IPEM, 1997) of filtered x-ray beams with almost the same HVL1 but generated at different tube voltages
in a tungsten anode (constant potential, anode angle 16 ) and with different filtration. Top left tube voltage, 60 kV; filtration, 4.3 mm
Al; HVL1, 2.74 mm Al; HVL2, 3.5 mm Al. Top right tube voltage, 75 kV; filtration, 2.9 mm Al; HVL1, 2.74 mm Al; HVL2, 3.9 mm Al;
Bottom left tube voltage, 90 kV; filtration, 2.0 mm Al; HVL1, 2.72 mm Al; HVL2, 4.3 mm Al. Bottom right tube voltage, 110 kV;
filtration, 1.2 mm Al; HVL1, 2.68 mm Al; HVL2, 4.8 mm Al. Reproduced with permission from Dr. J. Th. M. Jansen.
2.5
TOTAL FILTRATION
Y d Ka d=PIt :
2:1
24
doi:10.1093/jicru/ndi025
dR
:
da
3:1
Unit: J/m2.
The conversion of energy refers to the transfer of
energy from ionizing particles to secondary ionizing
particles. The quantity kerma relates to the kinetic
energy of all the charged particles liberated by
uncharged particles; the energy expended against
the binding energies, usually a relatively small
component, is, by definition, not included.
The kerma, K, is the quotient of dEtr by dm, where
dEtr is the sum of the initial kinetic energies of all
the charged particles liberated by uncharged particles in a mass dm of material (ICRU, 1998c), thus
K
dEtr
:
dm
these particles
K
3:3
3:4
d
:
dm
3:6
3:2
Cmtr
:
r
Dt Cmen =rt :
3:7
secondary electrons is not necessarily absorbed locally by the irradiated material as the electrons slow
down. A small fraction g of the electron energy is
converted directly into photon energy (mostly
bremsstrahlung), but this fraction is negligible for
materials of low atomic numbers Z and for the electron energies associated with medical x-ray imaging
[for example, g 6:6 104 for 100 keV electrons in
air (ICRU, 1984)]. Strictly,
men
1 gmtr
:
r
r
3:9
3:8
dD
D_
:
dt
3:10
dQ
:
dm
3:11
Unit: C/kg.
The exposure relates to the first stage of the interaction process in the same way as air kerma. Exposure is essentially the ionization equivalent of air
kerma. When bremsstrahlung losses are negligible,
the relationship between them is given by
Ka
XWa
,
e
3:12
APPLICATION-SPECIFIC QUANTITIES
(free-in-air)
(free-in-air)
(free-in-air)
(free-in-air)
(with backscatter)
(with backscatter)
(free-in-air)
(free-in-air)
(free-in-air or
in phantom)
x-ray tube
focal spot
position
collimator
air kerma area product PKA meter
focal spotto-surface
distance
dFSD
table
image receptor
absorbed dose to tissue at a point in the patient Dt
Figure 3.1. Simple exposure arrangement for radiography showing some of the dosimetric and geometric quantities recommended in the
present Report for determination of patient dose.
27
name them in terms of air kerma, except when measured or calculated inside a phantom or a patient. In
the latter case absorbed dose is the preferred quantity. Additional qualifying words are used to indicate
the position of measurement and whether backscattered radiation from the patient is to be included
or not. To indicate whether backscatter is included
or not in the air kerma the terms incident (no backscatter) and entrance surface (including backscatter)
are used. For the first four quantities, subscripts are
added to the symbol for the quantity. The first subscript specifies the material in which the quantity
is expressed, for example, air indicated by a.
The second subscript indicates the measurement
condition i.e., incident or entrance surface quantity
indicated by i or e. Thus incident air kerma and
entrance surface air kerma are denoted as Ka,i and
Ka,e, respectively.
The air kermaarea product is the integral of
the air kerma over the area of the x-ray beam in a
plane perpendicular to the beam axis. If the air
kerma is constant over the beam area, the integral
becomes equal to the product of the air kerma and
the area, hence the name air kermaarea product.
The symbol recommended in this Report for the
air kermaarea product is PKA. The symbol P indicates that the quantity is a product and the subscript
KA indicates that the factors in the product are
the air kerma and area. The air kermaarea
product rate, P_ KA , is defined as the quotient of the
increment in the air kermaarea product by the time
interval dt.
Like the air kermaarea product, the air
kermalength product can be defined as the integral
of the air kerma along a line. This quantity is useful
in CT where the line is chosen to be parallel to the
axis of rotation of the CT scanner. If the air kerma is
constant over a length L and equal to zero elsewhere
along the line, the integral becomes equal to the
product of the air kerma and the length, hence the
name air kermalength product. The symbol recommended in the present Report for the air kerma
length product is PKL. The symbol P indicates that
the quantity is a product and the subscript KL
indicates that the factors in the product are the air
kerma and length. Similarly the doselength product, PDL, can be defined.
Also for dosimetry in CT, the CT air kerma index
(symbol CK) for measurements free-in-air can be
defined as the air kermalength product, PKL
divided by the nominal slice thickness, T or the
sum of slice thicknesses in the case of a multiple
slice scanner. As the nominal slice thickness is
used (rather than the actual slice thickness), the
symbol CK is used instead of air kerma with a relevant subscript.
Quantity name
Symbol
Field of application
Ka,i
K_ a;i
Ka,e
K_ a;e
PKA
P_ KA
PKL
CK
Radiography and
fluoroscopy
Fluoroscopy
Radiography and
fluoroscopy
Fluoroscopy
Radiography and
fluoroscopy
Radiography and
fluoroscopy
CT
CT
3:13
3:18
The PKA has the useful property of being approximately (when air attenuation and scatter and extra
focal irradiation can be neglected) invariant with
distance from the x-ray tube focal spot, as long as
the plane of measurement or calculation is not so
close to the patient or phantom as to receive a significant contribution from backscattered radiation.
Usually, the position of the plane does not need to
be specified.
The air kermaarea product rate, P_ KA is the quotient of dPKA by dt, where dPKA is the increment of the
air kermaarea product in the time interval dt, thus
P_ KA dPKA =dt:
3:19
3:14
Ka;e Ka;i B:
3:15
The backscatter factor depends on the x-ray spectrum, the x-ray field size, and the thickness and
composition of the patient or phantom. Additional
information on back scatter factors, including tables,
is given in Appendix A.
The entrance-surface air-kerma rate, K_ a;e , is the
quotient of dKa,e by dt, where dKa,e is the increment
of entrance surface air kerma in the time interval dt,
thus
K_ a;e
dKa;e
:
dt
For measurements inside the standard CT dosimetry phantoms, the air kermalength product inphantom, PKL,p, can be defined similarly to PKL.
3.2.5
This quantity relates particularly to the fanshaped beams used in CT. The CT air kerma index
is the integral of the CT axial air kerma profile,
Ka(z), along the axis of rotation of the CT scanner, z
for a single rotation with a single slice divided by the
nominal slice thickness T. In the present Report it is
given the symbol CK,
Z
1 1
PKL
:
3:22
CK
Ka z dz
T 1
T
3:16
CK
29
PKL
:
Ni Ti
3:23
CK;PMMA;w
CK;PMMA;100;c 2CK;PMMA;100;p
: 3:26
3
n CK;PMMA;w
CK;PMMA;w
,
PIt
3:27
where j represents each serial scan sequence forming part of an examination and Nj is the number of
slices, each of thickness Tj (cm) and tube-current
exposuretime product PIt j (mAs), in a particular
sequence.
Unit: J/kg, or Gy.
Any variations in applied tube voltage setting during the examination will require corresponding
changes in the value of nCK,PMMA,wi used.
In the case of helical (spiral) scanning
X
PKL;CT
3:29
n CK;PMMA;wi Ti Ii ti ,
3.3
RISK-RELATED QUANTITIES
The fundamental dosimetric quantity in radiological protection is the absorbed dose D. At low dose
levels, the mean absorbed doses in organs or tissues
30
3.3.3
DT
T
:
mT
3:31
for example by applying the nominal fatality coefficients (ICRP, 1991b), for assessment of detriment
from exposure due to medical x-ray imaging. Such
assessments could be inappropriate because of
potential differences in health status, gender, and
age between a particular group of patients and the
reference population for whom the ICRP derived the
risk coefficients. Furthermore, the conditions of low
dose and especially of low dose rate may not always
be met in practice in medical imaging. For an assessment of the risk due to induction of stochastic
and deterministic effects by medical x-ray imaging
detailed knowledge is required of organ doses,
absorbed-dose distribution, and the age and gender
of the group of patients concerned, rather than
effective dose. Therefore, in the present Report
effective dose is not further discussed.
3:34
DT
:
Ka;i
3:35
DT
:
Ka;e
3:36
DT
:
PKA
3:37
DG
:
Ka;i
3:38
DT
:
CK
3:39
quantities is considered useful, for example, fluoroscopy time, total number of images and air
kermaarea product.
3.5.3
3.5.4
The CT air kermalength product PKL,CT determined for the standard CT dosimetry phantoms is
proposed by the EC (2000) as a quantity for establishment and use of DRLs for a complete CT
examination. Since there is only limited experience
with the use of the CT air kermalength product
for establishment and use of DRLs, this quantity
is recommended provisionally in the present
Report.
34
doi:10.1093/jicru/ndi026
MEASUREMENT METHODS
Methods are required for the measurement of normalization quantities used in the dose-conversion
coefficients and of quantities recommended for
establishment and use of DRLs. Measurements of
these quantities rely on the use of (i) ionization
chambers, or (ii) solid-state dosimeters, including
those employing radiothermoluminescence. Calibration procedures and accuracy requirements for
these dosimeters when applied to measure x rays
used in medical imaging are discussed first.
K
,
M
4:1
The expanded uncertainty is equal to the combined standard uncertainty multiplied by the coverage factor. The
combined standard uncertainty is obtained by combining
in quadrature the standard deviations corresponding to
the uncertainties estimated by statistical means (type A
uncertainties) and by non-statistical means (type B uncertainties) cf. Table 4.4.
36
MEASUREMENT METHODS
Table 4.1. Examples of standard radiation qualities for the calibration of dosimeters in general radiography (Reproduced
from IEC, 2004, with permission from IEC)*. An emitting target of tungsten for the x-ray tube is specified. RQR qualities
refer to unattenuated beams and RQA qualities to attenuated beams.
Radiation
quality
Approximatea x-ray
tube voltage/kV
Added filtration/mm Al
(simulating
patient thickness)
Nominal first
HVL/mm Alb
Homogeneity
coefficient
RQR 2
RQR 3
RQR 4
RQR 5c
RQR 6
RQR7
RQR 8
RQR 9
RQR 10
RQA 2
RQA 3
RQA 4
RQA 5d
RQA 6
RQA 7
RQA 8
RQA 9
RQA 10
40
50
60
70
80
90
100
120
150
40
60
60
70
80
90
100
120
150
1.42
1.78
2.19
2.58
3.01
3.48
3.97
5.00
6.57
2.2
3.8
5.4
6.8
8.2
9.2
10.1
11.6
13.3
0.81
0.76
0.74
0.71
0.69
0.68
0.68
0.68
0.72
4
10
16
21
26
30
34
40
45
RQT 8
RQT 9c
RQT 10
Approximatea
x-ray tube
voltage/kV
Added filtration/
mm Cu (simulating
patient thickness)
Nominal
first HVL/
mm Alb
100
120
150
0.2
0.25
0.3
6.9
8.4
10.1
Radiation
quality
Approximatea
x-ray tube
voltage/kV
Added filtration/mm
Al (simulating
patient thickness)
Nominal
first HVL/
mm Alb
RQR-M1
RQR-M2c
RQR-M3
RQR-M4
RQA-M1
RQA-M2
RQA-M3
RQA-M4
25
28
30
35
25
28
30
35
2
2
2
2
0.28
0.31
0.33
0.36
0.56
0.60
0.62
0.68
37
Uncertainty component
Type B uncertaintyb
(1 SD) %
Measurement of air kerma with the reference instrument (secondary or tertiary standard)
Air kerma calibration coefficient of the reference instrument
0.56
Constancy of the air kerma calibration coefficient
Reading accuracy
0.50
Differences in calibration spectra
Correction for temperature and atmospheric pressure
0.03
Correction for ion recombination
Measurement of air kerma with the instrument to be calibrated
Positioning at the calibration distance
Non-uniformity of the calibration field
Correction for temperature and atmospheric pressure
Reading accuracy
0.81
0.29
0.58
0.00
0.06
0.06
0.03
0.50
0.90
1.04
1.38
2.76
The uncertainty at one standard deviation estimated by statistical means (ISO, IEC, OIML, BIPM, 1992; IAEA 1994).
The uncertainty at one standard deviation estimated by non-statistical means (ISO, IEC, OIML, BIPM, 1992; IAEA 1994).
c
The combination in quadrature of the standard deviations corresponding to type A and type B uncertainties.
d
The combined standard uncertainty multiplied by the coverage factor (ISO, IEC, OIML, BIPM, 1992; IAEA 1994).
b
4.1.3
Calibration of TLDs
MEASUREMENT METHODS
1
0.95
Relative response
0.9
0.85
0.8
0.75
C80
Free-in-air
C60
Free-in-air
Mo/Mo PMMA-phantom
0.7
Mo/Mo Free-in-air
0.65
0.6
15
30
45
60
75
90
to measure Ka,e on patients, calibration on a phantom might be more appropriate. In the latter
case Ka,e should be derived from Ka,i obtained
with a reference dosimeter calibrated in terms of
air kerma and employing air kerma based backscatter factors, B according to Eq. (3.15). A set of backscatter factors was selected by Petoussi-Henss et al.
(1998) to be used for the calibration of dosimeters onphantom. When used for measurement of Ka,e on
patients, TLDs are usually encapsulated to protect
them against dirt, grease, etc. Consequently, the
TLDs should be calibrated inside the encapsulation
used.
The response of a given TLD can be affected by the
shape and size of the detector and packaging and is
dependent on the direction of the incoming radiation
(McKinlay, 1981; Oberhofer and Scharmann, 1981;
Horowitz, 1984; McKeever et al., 1995), differing
upon exposure free-in-air or in-phantom (Figure 4.1;
Zoetelief et al., 2000). Therefore, the direction of the
radiation during calibration should be the same as
that during the patient dose measurements. For
example, for measurement of the CT axial air
kerma profile for CT using stacks of TLD chips, the
calibration of the TLD chips should be based on calibration normal to the side of the stack.
radiation qualities will, however, overcome the latter problem. Ionization chambers and their energy
response for mammography beams have been published by DeWerd et al. (2002).
Dosimeters
For dosimetry in medical x-ray imaging, ionization chamber systems and TLD systems are most
commonly used. Suitable ionization chamber dosimeters have advantages over TLD systems in that
their accuracy, precision, and energy independence
are better. In addition, ionization chambers can be
read out directly, contrary to TLDs, which have to be
transported to a reading system after irradiation.
Advantages of TLDs are their small size, which
make them suitable for dose measurements on
patients, and their capacity of storing dose information over longer periods of time. This makes them
suitable for dosimetry at a distance, for example, at a
central laboratory, TLDs being transported by mail.
Scintillation as well as film dosimeters have also
been used for measurements on patients (Section
4.4), their main characteristics are presented in
this section.
4.2.1.1
4.2.1.2
TLDs
General information on dosimetry using ionization chambers can be found elsewhere (ICRU, 1970,
1973; Boag, 1987; IAEA, 1996b). More detailed
information relevant to medical imaging has been
published by Dutreix and Bridier (1985), for
example. Some aspects, specific to medical x-ray
imaging are presented below. Free-in-air air kerma
measurements are best made with suitably designed
ionization chambers of typically between 0.6 and
180 cm3 volume. The chambers should have airequivalent walls so that their energy response in
terms of air kerma is substantially uniform for all
relevant x-ray spectra. The leakage current should
be very small compared with the ionization current
produced by the minimum dose rate to be measured
and the response should not be affected appreciably
by ion recombination at high dose rates. Dosimeters
should be calibrated in a manner traceable to a
national primary standard of air kerma as described
in Section 4.1.
There are special requirements for ionization
chambers used for air-kerma measurements in
mammography: these are a thin entrance wall to
reduce attenuation at low photon energies, and ideally a structure that does not appreciably disturb the
primary radiation field. Thin entrance window
chambers with small volumes generally have a
rather massive construction on the exit side, which
implies that the charge produced in the cavity contains a significant contribution from scattered radiation. Calibration at appropriate mammographic
4.2.1.3
Scintillation dosimeters
MEASUREMENT METHODS
The radiological film dosimeter is known to have a
very poor tissue-equivalence, because of the high
atomic number of the film emulsion. Two types of
slow KODAK films have been investigated with
respect to their use in interventional radiology. The
X-OMAT-V film, with a long tradition as a radiotherapy portal dose verification film, shows an increase
in sensitivity by a factor of 20 at peak tube voltage of
70 kV compared with 60Co gamma rays (1.17 and
1.33 MeV) (Vano et al., 1997). The more recent
EDR2 film does not show a significant variation in
sensitivity between peak tube voltages of 60 and
110 kV (Guibelalde et al., 2003).
Using X-OMAT-V films doses of up to 500 mGy can
be explored and the corresponding linear dose range
is from 20 to 200 mGy. For the EDR2 film, doses up to
1000 mGy can be measured and the linear dose range
is from 50 to 500 mGy (Guibelalde et al., 2003). The
EDR2 film is, thus, more suitable for higher-dose
radiological procedures than the X-OMAT-V film.
The tissue-equivalence of the radiochromic film is
considerably better than that of the radiological film,
consequently less variation of its response as a function of energy is expected. Nevertheless, a sensitivity
variation of up to 5 % between peak tube voltages of
60 and 100 kV has been observed by Giles and
Murphy (2002). For the radiochromic film dosimeter
the dose dependence has been found to be linear up
to an absorbed dose of 10 Gy (Giles and Murphy,
2002). This type of film is thus particularly suited
to evaluate the high doses delivered to the most
heavily irradiated regions, for example, the skin
during some interventional radiological procedures.
100
CaF2:Dy
10
CaSO4:Dy
Al2O3:C
LiF:Mg,Ti
1
Li2B4O7:Mn,Si
BeO
0.1
10
100
Photon energy (keV)
1000
4.2.2
There are usually several steps required to determine incident air kerma. The most commonly used
method of determining Ka,i relies on the measurement of the x-ray tube output, Y(d) (Sections 2.5 and
3.2.1). To derive Ka,i, Y(d) has to be corrected for the
focal spot-to-surface distance, dFSD, and combined
with the recording of the post-exposure PIt after
examination of a patient or a phantom. The method
is usually suitable only for x-ray machines with a
post-exposure display of PIt or units with manual
exposure only. Alternatively, Ka,i can be derived
from a measurement of Ka,e by applying an appropriate backscatter factor [Eq. (3.15); Appendix A].
The incident air kerma, Ka,i, can be derived from
the air kerma free-in-air at a distance, d, from the
x-ray tube focal spot, Ka(d)
Ka;i Ka d
41
d2
,
d2FSD
4:2
d2
:
d2FSD
4:3
4.2.4
MEASUREMENT METHODS
The plates are often made to be transparent to visible light to allow use of a light beam collimator. The
electrometer and display unit are connected to the
chamber by a long cable so that the display can be
positioned for easy access to read and reset. The
response of the PKA meter will depend on whether
the chamber is installed on an overtable or undertable x-ray tube (Section 4.1.2).
The requirements for air kermaarea product
(PKA) meters are similar to dosimeters in general,
as described in Section 4.1. This means that
re-calibration should be made at intervals not exceeding 2 years, and whenever the instrument has been
repaired or its performance is suspect (AAPM, 1992).
Re-calibration at one radiation quality, the reference
quality, is often sufficient, as it is unlikely that
the dependence of the response on radiation energy
would change significantly. However, sometimes it
will be important to check comprehensively the
dependence of the response on the dose rate, particularly if the dosimeter is used at widely varying dose
rates. Corrections for ion recombination are usually
insignificant but must be considered when using
very high instantaneous dose rates. Simple constancy
checks and checks of the various functions are recommended before each use of the instrument.
Estimates of the uncertainty in the (in situ) calibration coefficient of a PKA meter are 6 % at the 95 %
confidence level (Shrimpton and Wall, 1982; Larsson
et al., 1996) for overtable geometry. For undertable
geometry, the table may reduce the calibration coefficient by 1520 % compared with the overtable
situation (Carlsson and Alm Carlsson, 1990).
Commonly, PKA meters consist of PMMA coated
with a conducting material. Carbon is often used for
this purpose as it is approximately air-equivalent,
however, to achieve light transparency other conducting materials are used. These materials contain high atomic number elements resulting in a
relatively strong energy dependence compared with
ionization chambers coated with graphite (Larsson
et al., 1996; Bednarek and Rudin, 2000). For example,
the addition of additional copper filtration may
affect the calibration coefficient by several per cent.
Experience with ageing of air kermaarea product
meters, for example, when installed at interventional radiology systems and submitted to very
large doses during several years is still limited. Simple constancy checks of the instrument should be
able to reveal ageing.
Some PKA meters are capable of distinguishing
between values accumulated during radiography
and fluoroscopy. If this distinction is made purely
on the basis of a threshold in P_ KA (difference in
tube current exposure time product rate between
fluoroscopy and radiography), errors can occur. For
43
30
25
20
15
10
0
1
10
11
12
13
Patient number
Figure 4.4. Air kermaarea products, PKA values for fluoroscopy (white) and images (black) during colon examination of 13 patients
(Geleijns, 2000, private communication). The data for the 13 patients have been ordered in accordance with the total PKA for the
examination. Reproduced with permission from Dr. J. Geleijns.
after insertion of a rectal cannula, a barium suspension of low density and high viscosity was administered and a single contrast study was performed.
Second, after partial evacuation, air was insufflated
for the double contrast study of the rectum and the
colon. From this information it has to be determined
whether the increase in P_ KA belonged to a continuous, prolonged signal, which is indicative of fluoroscopy, or to a short pulse, which is indicative of
radiography (imaging). If radiography was recognized, the PKA value for the radiograph was calculated from all PKA samples in the pulse, which
included the PKA sample acquired at the start of
the pulse (for which the value might be low).
Although a standard protocol for colon examination
was implemented (Table 4.6), deviations from the
protocol were common and had to be taken into
account during analysis. The PKA for each radiographic projection (image) and each fluoroscopy
interval can be estimated only after careful assignment of the corresponding projection (Table 4.6.) to
each peak in the P_ KA signal (i.e., to each radiograph).
The distribution of PKA over the various projections
is shown in Table 4.6. For fluoroscopy, it is assumed
that the exposure conditions can be mimicked by the
subsequent radiograph, except for differences in
radiation quality (i.e., tube voltage). Consecutive
PKA for fluoroscopy and radiographs (images) during
colon examination of 13 patients are shown in
Figure 4.4. The figure illustrates the differences
occurring in practice even when a standard protocol
is implemented.
MEASUREMENT METHODS
CK
b
a
Ka(z)
PKL/L
-L/2
0
DISTANCE TO CENTER OF SLICE , z
Figure 4.5. A single slice CT axial air kerma, Ka(z) profile with the
corresponding values of CK, PKL/L, L, and T, where L and T are
the chamber length and the nominal slice thickness, respectively.
By definition, the area under the single slice dose profile (the
dotted line) is equal to the area of either rectangle.
thickness, or the sum of the nominal slice thicknesses in the case of multi-slice scanners.
For a measurement of CK,PMMA, the CT dosimetry
phantoms (Figure 4.7) should be used. The phantom
should be fixed on the table in such a way that its
longitudinal axis coincides with the axis of rotation
of the gantry and that its centre corresponds to the
centre of the slice, or the centre of the slices for a
multi-slice scanner. The pencil ionization chamber
should be inserted in the phantom in such a way that
its centre corresponds to the longitudinal central
plane of the phantom for each of the five measurement positions, i.e., one at the centre and four at
1 cm below the surface (Figure 4.7). Unused holes
should be plugged.
For radiotherapy, similar problems arise for measurements inside phantoms with ionization chambers
calibrated in terms of air kerma free-in-air as for
dosimetry for x rays used in medical imaging.
According to the IAEA (1996b) an ionization chamber calibrated for the x-ray quality considered can be
used to derive the absorbed dose to water in a water
phantom by using the relation
m
Dw Mu NK en
ka;w ,
4:4
r w;a
gantry
axis of rotation
table
gantry
the arrangement
for
Ka;PMMA Mu NK ka;PMMA ,
4:5
MEASUREMENT METHODS
air kerma and the length of the chamber, L, divided
by the nominal slice thickness, or the sum of the
nominal slice thicknesses in the case of a multislice scanner. Note that for multi-slice CT, the use
of a 100 mm long ionization chamber may in some
cases be less appropriate than for single slice CT.
This is because of the increase in irradiated combined slice thickness associated with the multi-slice
technique. When the rotation differs from 360 this
should be noted. Special attention should be given to
the orientation of the peripheral measurement positions. Thus the CK,PMMA,100,c can be obtained from
the measurement at the central position and
CK,PMMA,100,p as the average of measurements at
four peripheral positions. By using Eqs (3.263.28),
the CT air kermalength product, PKL,CT for a complete conventional (serial CT) examination can be
derived from CK,PMMA,100,c and CK,PMMA,100,p. In the
case of helical scanning, PKL,CT can be derived from
CK,PMMA,100,c and CK,PMMA,100,p by using Eqs (3.26),
(3.27), and (3.29).
4.2.5.2 TLDs
TLDs placed in a row within a suitable plastic
holder can be used to measure the CT axial air
kerma profile free-in-air. The TLDs should be contiguous in the region of the primary beam, but away
from this region, they can be separated by spacers. It
is noted that TLDs can be arranged in a stack or
placed side by side. The latter arrangement is applicable for measurement of CK but does not give a good
Figure 4.10. Typical free-in-air CT axial air kerma profile Ka(z) for a nominal slice thickness of 4 mm measured by TLDs (A) and the
resulting CK (B) (after Shrimpton et al., 1991; Survey of CT Practices in the UK, Part 2: Dosimetric Aspects, NRPB-R249; HMSO, London,
UK).
47
Standard dosimetric phantoms have simple reproducible geometry and are used to compare measurements under defined conditions of irradiation.
Standard phantoms as proposed by the ICRU
(1992c), but made out of PMMA, are used for dosimetry for mammography and for CT. The standard
mammography phantom described by the ICRU has
a thickness from 2 to 8 cm. However, often only one
thickness is recommended, for example, 4.5 cm (EC,
1996b). The cross-sectional dimensions recommended by the EC (1996b) are somewhat larger than
that described by the ICRU, i.e., either semicircular
with a radius of at least 100 mm or rectangular with
an area of at least 150 mm 100 mm.
It should be borne in mind that the phantoms
at best represent (parts of) average-sized adult
patients, and, therefore, do not allow accurate dose
assessments for individuals of different sizes or body
composition. However, the use of a phantom that
mimics the attenuation and beam hardening in a
specific part of a standard patient correctly has the
advantage that the number of measurements
required to derive the incident air kerma is considerably smaller than that for measurements with
patients.
4.4
MEASUREMENT METHODS
measurements. These latter dosimeters have not
been used on patients because the filters, needed to
compensate for the poor tissue-equivalence, appear
on the radiological image. Therefore, they are not
further discussed here.
Table 4.5. Main characteristics of four TLD phosphorsa (see, e.g., Vij, 1993; McKeever et al., 1995).
Phosphor
Dopant
Li2B4O7
Mn
LiF
Mg, Ti
LiF
Mg, Cu, P
CaF2
Dy
0.95
5 % month1
0.5
100
1.35
<5 % y1
1
50
1.3
<5 % y1
30
5
14.5
1 % d1
15
1
All four phosphors are commercially available as chips (dimensions: 3.2 mm 3.2 mm 0.9 mm).
Fading % loss at 20 C per year (y), month or day (d).
c
Read-out per unit air kerma compared with that of LiF: Mg, Ti.
b
Figure 4.11. Three-dimensional representation of the patient skin dose distribution (mGy) as measured with a grid of TLDs for a coronary
angiography in a biplane setting. Results from a Belgian multi-center study on skin doses of patients treated with prolonged cardiological
interventions. Study sponsored by the Federal Agency of Nuclear Control in Belgium. With permission from E. Bogaert, K. Bacher,
H. Thierens.
49
PKAc/Gy cm2
Nominal tube
voltage/kV
HVL1/mm Al
dFIDb/cm
dFSDb/cm
Field size on
image cm cm
125
133
141
133
133
133
125
125
7.5
7.8
8.0
7.8
7.8
7.8
7.5
7.5
126
126
126
126
126
126
126
151
97
93
77
97
91
94
98
122
24 30
24 30
24 30
12 15
24 30
24 30
24 15
35 43
0.37
0.74
1.91
0.31
0.55
0.84
0.71
1.04
96
109
102
102
96
109
102
102
96
96
96
6.1
6.6
6.3
6.3
6.1
6.6
6.3
6.3
6.1
6.1
6.1
126
126
126
126
126
126
126
126
126
151
151
93
77
93
79
97
70
91
94
98
122
122
24 30
24 30
24 30
24 30
24 30
24 30
24 30
24 30
24 15
35 43
35 43
0.45
2.51
0.74
0.92
0.61
2.95
0.83
0.70
0.65
1.11
0.73
Projection
20.9
12.8
AP is anteroposterior, LLAT left lateral, LPO left posterior oblique, PA posteroanterior, RLAT right lateral, RPO right posterior
oblique.
b
dFID is focal spot-to-image receptor distance, dFSD focal spot-to-surface distance.
c
The air kermaarea products, PKA were measured on an overtable x-ray tube, 0.1 mm Cu filtration, fluoroscopy is performed at 110 kV.
d
Air kermaarea product, PKA is given for one single exposure.
The basic characteristics of scintillation dosimeters are presented in Section 4.2.3. One of the potential advantages of scintillation dosimeters is realtime information. Although one would expect widespread clinical applications, only a limited number of
studies explored the possibilities of scintillation dosimeters in interventional radiology. Wagner and
Pollock (1999) used scintillation dosimetry for miscellaneous high-dose fluoroscopically guided procedures and Hwang et al. (1998) for cardiac
interventional radiology.
4.4.1.3 Skin dose measurements on patients
with film dosimeters
The basic characteristics of film dosimeters are
presented in Section 4.2.4. For complicated procedures, where the position of the peak skin dose is hard
to predict, film dosimeters offer unique possibilities.
When wrapped around the patient, the film provides
information on the dose distribution at the level of
the skin. The energy of the x-ray beam should not
50
MEASUREMENT METHODS
Figure 4.12 shows an illustration of the use of slow
films to measure patient skin dose during cardiac
interventional radiology. The use of additional thermoluminescent or optically stimulated luminescent
dosimeters at the positions of the film where the
highest doses are expected allows verification the
calibration of the film.
4.4.2 Derivation of the skin dose from the
air kermaarea product PKA
Skin dose can, under certain conditions, be
derived from the air kermaarea product
PKA. There are basically two methods to derive the
skin dose from the air kermaarea product. The first
method determines both quantities independently
on a significant number of patients and derives, by
pooling the data, conversion coefficients for calculating the skin dose. Waite and Fitzgerald (2001) correlated air kermaarea product PKA and skin dose
measurements (using TLD arrays) on a population
of patients undergoing percutaneous transluminal
coronary angioplasty (PTCA) and neurological procedures. The correlation between skin dose and air
kermaarea product was found satisfactory for the
neurological patients but was poor for the PTCA
patient group. Van de Putte et al. (2000) found also
a poor correlation for a population of patients undergoing cardiac procedures. As pointed out by the
authors, this can be explained by the fact that the
cardiac radiological procedures implied more
patient-to-patient differences in geometry.
Relying
purely
on
geometrical
factors
(Figure 4.13), the skin dose can be derived from the
air kermaarea product, provided the field area at
the level of the patients skin is known assuming
that conditions of scattered radiation are similar.
This method is straightforward when the collimation, as well as the focus-to-skin distance, is kept
constant throughout the full duration of the examination. This is valid for simple procedures, but not
for complicated examinations as used in interventional radiology for which multiple angulations,
field sizes, and focus-to-patient distances are often
applied. Although an inherent loss of accuracy cannot be avoided, useful information can be obtained
by assigning to each type of procedure a nominal
geometry and, on the basis of this geometry, to
derive the skin dose from the air kermaarea product readout. For different interventional radiological
procedures McParland (1998) analysed the uncertainties in the skin dose values, caused by realistic
deviations from the nominal geometry, and showed
that the estimated dose values were at least within
40 % and generally within 30 % of those actually
received.
Figure 4.13. Derivation of skin dose from air kermaarea product and geometrical factors. Top left: The transmission chamber is calibrated
against a reference ionization chamber, which has been calibrated in air kerma free-in-air. The reference chamber is positioned, on the
beam axis, at a reference distance d0 of 60 cm from the tube focal spot. This point is chosen 20 cm above the position of the patient couch
and corresponds approximately to the point of entrance of the beam axis at the patient skin Beam dimensions of 10 cm 10 cm at the
reference distance d0 are selected (checked by film). The signal of the transmission chamber is expressed in terms of air kermaareaproduct in Gy m2 (or convenient multiples). Top right: For distances differing from the reference distance (e.g., d0 dx), the beam area is
increased by [(d0 dx)/d0]2 and the dose on the beam axis is decreased by the same factor. The air kermaarea product thus remains
unchanged. Bottom: The irradiation geometry is modified compared with that in the top: the tube is located under the couch and the
backscatter from the patient is introduced. The transmission chamber is calibrated against a reference ionization chamber, which has been
calibrated in absorbed dose to water (tissue), under patient (backscatter) conditions. As indicated above, the air kermaarea product
remains unchanged when modifying the distance between the tube focus and the entrance skin of the patient (for the indicated range).
Courtesy: A. Wambersie.
MEASUREMENT METHODS
Calculated
from DICOM
2.7 Gy
-40
-20
10
60
-40
right and left of the patient
Figure 4.15. Peak skin dose assessment using data from the DICOM header compared with results on skin dose using slow film and TLDs.
Top right: A slow film is positioned on the back of the patient to measure the skin dose distribution during an interventional cardiology
procedure guided by fluoroscopy. Top left: The details of the duly processed slow film (with the grey scale inverted) are shown. Note that in
this case, the film is clearly saturated and some TLDs positioned on the film to measure skin dose and to verify the calibration (dose versus
film density) give a dose value of 2.4 Gy. This is not necessarily the peak skin dose if the TLD was not at the position where the maximum
dose is imparted. Bottom left: A diagram with the doses in the different radiation fields obtained from the information contained in the
DICOM header of the series of images is shown. In some cases, this calculation allows to estimate with a better approach the peak skin
dose. In the reported case, the estimation from DICOM header gives a peak skin dose of 2.7 Gy (shown top right). Reproduced with
permission from E. Vano.
doi:10.1093/jicru/ndi027
the marrow cavities is expected from increased photoelectron emission by surrounding bone (Spiers,
1963). The bremsstrahlung produced in the tissues
of the human body by secondary electrons is negligible for photons with energies <150 keV.
Organ doses are obtained by summing, in each
organ, all energy depositions from primary and scattered photons, and dividing by the total organ mass.
The result is the mean absorbed dose in the entire
organ regardless of the fraction of the organ irradi1
ated. The standard uncertainty of the mean is
dependent on the number of histories. A history
comprises the path of the primary photon, the secondary particles it produces in the regions of interest, and the locations and quantities of energy
deposition. According to the central limit theorem
(Feller, 1968), the standard uncertainty of the
mean decreases in inverse proportion to the square
root of the number of primary photons followed, i.e.,
the number of histories. The standard uncertainty of
the mean are computed as a measure of the reliability of the results from Monte Carlo calculations.
Mathematical phantoms
56
Figure 5.1. Various cross sections of the female mathematical phantom EVA (based on data of Kramer et al., 1982). Horizontal
cross sections refer from top to bottom to various levels in the head, the chest region, the abdomen region, and the legs. Reproduced
with permission from Dr. F.W. Schultz.
5.2.2.2
Voxel phantoms
Figure 5.2. The exterior surface (top) and selected internal organs
(bottom) of the child phantom (Zankl et al., 1988; Veit et al., 1989,
with permission).
5.2.5.1
1976) were not directly comparable because of different anatomical and technical assumptions, but a
comparison was instructive (Kereiakes and Rosenstein, 1980). Even the same HVL1 does not yield the
same results. When the same spectra are used the
differences are smaller.
The more significant differences in the two
approaches are described in Table 5.1.
For identical x-ray fields and HVL1, the Ellis et al.
(1975) absorbed dose values were up to a factor of
23 higher. When the same beam quality from the
experimental approach was used in the Monte Carlo
code, the absorbed doses were a factor of 1.21.8
times higher than those obtained with the corresponding softer beam qualities. The effect of the differences in lung models was to increase the active
BM dose at those sites directly behind the lungs by
up to 25 %. These results accounted for much of the
difference obtained between the two approaches.
5.2.5.4
5.2.5.5
Appendix C
Appendix D
Appendix F
No. of No. of
Normalization Phantom
organs spectra quantity
Referencea
General radiology
8
16
26
24
1
1
1
1
12
14
90
10
17
3
Ka,i
Ka,i
Ka,e, PKA
Ka,i, PKA
Ka,i
Ka,i
Ka,i
Ka,i
Ka,i
20d
Ka,i
24
6
20
Ka,i, PKA
Ka,I
20
26
72
Ka,i, PKA
5/6
16/11
1b
Ka,i
24
Ka,i, PKA
208
slices
104 slices
45 slices
66 slices
23
23
CKe
22
35
37
3
2
2
CK
CK
CK
54
40
68
c
Mammography
Fluoroscopy:
Upper GI tract
Coronary
Arteries
Fluoroscopy
Pediatric
radiography
Radiography/
Fluoroscopy
CT adult
CT Pediatric
6
1
1
1
12
17
3b
40
c
MIRD hermaphrodite
ADAM EVA
Cristy hermaphrodite
Cristy hermaphroditec
Reference
Breasts
ADAM
EVA
ADAM
EVA
Cristy hermaphroditec
0, 1, 5 years
hermaphrodite
0,1,5,10,15 years
hermaphrodite
Voxel baby
Voxel child
Christy
hermaphroditec
Cristy
hermaphrodite
ADAM EVA
Voxel baby
Voxel child
62
doi:10.1093/jicru/ndi028
CONCLUSIONS
64
doi:10.1093/jicru/ndi029
HVL/ Field 10 cm 10 cm
Field 20 cm 20 cm
Field 25 cm 25 cm
mm Al
Water ICRU tissue PMMA Water ICRU tissue PMMA Water ICRU tissue PMMA
50
60
70
70
70
80
80
80
90
90
90
100
100
100
110
120
120
130
150
150
150
1.74
2.08
2.41
2.64
3.96
2.78
3.04
4.55
3.17
3.45
5.12
3.24
3.88
5.65
3.59
4.73
6.62
4.32
4.79
6.80
8.50
2.5 mm Al
2.5 mm Al
2.5 mm Al
3.0 mm Al
3.0 mm Al 0.1 mm Cu
2.5 mm Al
3.0 mm A1
3.0 mm A1 0.1 mm Cu
2.5 mm Al
3.0 mm Al
3.0 mm Al 0.1 mm Cu
2.5 mm Al
3.0 mm Al
3.0 mm Al 0.1 mm Cu
2.5 mm A1
3.0 mm Al
3.0 mm Al 0.1 mm Cu
2.5 mm Al
2.5 mm Al
3.0 mm Al
3.0 mm Al 0.1 mm Cu
1.24
1.28
1.30
1.32
1.38
1.32
1.34
1.40
1.34
1.35
1.41
1.34
1.36
1.41
1.35
1.37
1.41
1.36
1.36
1.39
1.40
1.25
1.28
1.31
1.32
1.39
1.33
1.34
1.40
1.34
1.36
1.41
1.34
1.37
1.42
1.35
1.38
1.42
1.36
1.36
1.39
1.41
1.33
1.36
1.39
1.40
1.48
1.41
1.42
1.49
1.43
1.44
1.50
1.42
1.45
1.50
1.43
1.46
1.50
1.44
1.44
1.47
1.48
1.26
1.31
1.34
1.36
1.45
1.37
1.39
1.48
1.40
1.42
1.50
1.40
1.44
1.51
1.42
1.46
1.53
1.44
1.45
1.50
1.53
1.27
1.32
1.36
1.37
1.47
1.39
1.40
1.50
1.41
1.43
1.51
1.41
1.45
1.53
1.43
1.48
1.54
1.45
1.46
1.51
1.54
1.36
1.41
1.45
1.47
1.58
1.48
1.51
1.61
1.51
1.53
1.62
1.51
1.55
1.64
1.53
1.58
1.64
1.55
1.55
1.61
1.64
1.26
1.31
1.35
1.36
1.46
1.38
1.40
1.49
1.41
1.42
1.51
1.41
1.45
1.53
1.43
1.48
1.54
1.45
1.46
1.52
1.55
1.28
1.32
1.36
1.38
1.47
1.39
1.41
1.51
1.42
1.44
1.53
1.42
1.46
1.55
1.44
1.49
1.56
1.47
1.48
1.53
1.57
1.36
1.42
1.46
1.48
1.59
1.50
1.52
1.63
1.53
1.55
1.65
1.53
1.57
1.66
1.55
1.60
1.67
1.57
1.58
1.63
1.67
Table A.2. Backscatter factors calculated by Monte Carlo techniques in an anthropomorphic phantom (Hart et al., 1994a;
1994b).
HVL1/mm Al
2.0
2.5
3.0
4.0
60
80
80
110
Total filtration/mm Al
2.5
2.0
3.0
2.5
Projection
Lateral LSJa
11 cm 14 cm
AP Abdomen
26 cm 35cm
PA Chest
30 cm 38cm
1.23
1.25
1.27
1.29
1.31
1.37
1.41
1.45
1.23
1.27
1.30
1.34
APPENDIX A
Table A.3. Backscatter factors for a semi-circular PMMA phantom of 10 cm radius and 5 cm thickness, for three
mammographic spectra; dFSD: 65 cm; semi-circular field with 10 cm radius at the phantom surface (based on data of Kramer
et al., 2001).
Anode: Molybdenum
Filtration: 30 mm Molybdenum
Anode: Molybdenum
Filtration: 25 mm Rhodium
Anode: Rhodium
Filtration: 25 mm Rhodium
Peak tube
voltage/kV
HVL1/mm Al
Peak tube
voltage/kV
HVL1/mm Al
Peak tube
voltage/kV
HVL1/mm Al
24
25
26
28
30
32
34
35
36
38
40
0.282
0.295
0.306
0.325
0.340
0.353
0.364
0.369
0.373
0.381
0.388
1.08
1.09
1.09
1.09
1.10
1.10
1.10
1.11
1.10
1.11
1.10
24
25
26
28
30
32
34
35
36
38
40
0.328
0.343
0.356
0.375
0.391
0.403
0.412
0.416
0.420
0.427
0.433
1.09
1.09
1.10
1.10
1.11
1.11
1.11
1.12
1.11
1.12
1.12
24
25
26
28
30
32
34
35
36
38
40
0.297
0.316
0.330
0.362
0.391
0.418
0.441
0.452
0.462
0.481
0.497
1.09
1.09
1.10
1.11
1.11
1.12
1.12
1.13
1.13
1.13
1.14
67
doi:10.1093/jicru/ndi030
GENERAL DESCRIPTION
B.2.2
Lungs
Active BM1
Thyroid
Female breasts
Testes
Ovaries
Uterus (surrogate for the embryo; first two months
of pregnancy)
Total trunk tissue (excludes lungs and skeletal
tissue)
1
The coefficients are presented for 12 beam qualities expressed in terms of HVL1 (from 1.0 to 6.5 mm
Al in 0.5 mm Al steps) without identification of a
specific tube voltage. In preparing the tabulations,
27 diagnostic x-ray spectra were applied, 9 in each of
the categories shown below.
Range of peak
tube voltage/kV
Range of HVL1/
mm Al
4570
8090
98120
1.03.6
1.75.5
3.16.0
For the range of the peak tube voltage and conventional aluminum filtration combinations used in
diagnostic radiology, the data presented should have
uncertainties of <10 % when HVL1 alone is used to
describe beam quality (Rosenstein, 1988). Data are
also presented for the AP skull, PA chest, and AP
abdominal projections and views when an erbium
composite filter (3.2 mm erbium composite plus
2.0 mm Al) is used.
A sample tabulation for the AP thoracic spine for
the range of HVL1 from 2.5 to 4.0 mm Al is given
in Table B.1.
Additional information is provided in the
Handbook to permit corrections for the following
circumstances.
Cholecystography PA
Lithotripsy AP
Upper GI Tract AP,
PA, LAT
Upright abdomen AP
Lumber spine AP, LAT
Abdominal AP, PA, LAT
Sacrum, Coccyx AP, LAT
Sacroiliac joint AP
Pelvis, Lumbopelvic
AP, LAT
Urethrogram AP
Cystography AP
(a) When the testes are closer to the x-ray field edge
than indicated by the reference conditions;
(b) When more or less active BM is included in
the x-ray field because of the actual field
size and;
(c) When the testes, ovaries, or uterus are shielded, particularly for the AP view in the region
of the abdomen.
APPENDIX B
Table B.1. Sample tabulation: Handbook of Tissue Doses
for Projections Common in Diagnostic Radiology (Adults)
(Rosenstein, 1988).
(DT/mGy)/(Ka,i/mGy)
HVL1/mm Al
Male
Lungs
Active BM
Thyroid
Trunk tissue
Testes
Female
Lungs
Active BM
Thyroid
Trunk tissue
Breasts
Ovaries
Uterus
2.5
3.0
3.5
4.0
0.159
0.023
0.107
0.067
0.187
0.029
0.123
0.078
0.212
0.033
0.137
0.087
0.233
0.038
0.148
0.095
0.120
0.019
0.107
0.054
0.411
0.140
0.024
0.123
0.062
0.444
0.001
0.159
0.029
0.137
0.070
0.470
0.001
0.001
0.175
0.032
0.148
0.075
0.493
0.002
0.002
a
a
B.3.2
B.2.3
Illustrative calculation
B:1
*
Townes field incident at 30 caudal on the anterior skin
surface.
**
OBL views field incident at 45 to the normal on the anterior
skin surface (i.e., posterior oblique).
The tissues or organs for which conversion coefficients are tabulated are as follows.
Testes
Ovaries
Thyroid
AP abdomen
Newborn
dFID/cm
102
Field size at image receptor to:
Body part/cm cm
13 13
Film size/cm cm
20 25
Active BM
Lungs
Total body (includes all body tissues)
HVL1/mm
Al collimation
2.7
2.7
2.7
3.7
2.5
2.5
2.1
2.4
2.7
3.0
3.1
3.4
2.5
Film
size
Body
part
Film
size
Testes
Newborn
1 year
5 year
Newborn
1 year
5 year
Newborn
1 year
5 year
Newborn
1 year
5 year
Newborn
1 year
5 year
Newborn
1 year
5 year
0.098
(0.120)
(0.143)
0.445
0.308
0.308
(0.006)
1.039
(1.221)
(1.221)
0.445
0.308
0.308
(0.029)
(0.010)
(0.003)
0.182
0.113
0.079
0.501
0.259
0.116
0.428
0.300
0.231
0.164
(0.120)
(0.143)
0.639
0.422
0.422
(0.006)
1.142
(1.221)
(1.221)
0.639
0.422
0.422
(0.029)
(0.010)
(0.003)
0.241
0.160
0.115
0.567
0.291
0.140
0.478
0.348
0.273
Active BM
Lungs
a
a
0.104
0.079
0.063
0.056
0.040
0.045
0.212
0.191
0.180
a
a
0.145
0.114
0.095
0.075
0.055
0.054
0.242
0.224
0.215
B.4.1
Illustrative calculation
2.0
Body
part
Total body
B.3.4
23 30
28 36
Age
HVL1/
mm Al
18 21
25 30
Organ
Thyroid
65
80
90
80
98
105
5 year old
102
(DT/mGy)/(Ka,i/mGy)
Ovaries
Peak tube
voltage/kV
1 year old
102
B:2
APPENDIX B
The specifications for these tabulations reflect
practice in the United States.
The five tabulations resulting from the Monte
Carlo calculations are presented as a function of
HVL1 (from 0.2 to 2.4 mm Al) without identification
of a specific tube voltage. In preparing the tabulations, 51 mammographic x-ray spectra were used, as
listed below.
Target
type
No. of Range of
Range of
spectra tube
HVL1/mm
voltage/kV Al
Tungsten (W)
19
MoW alloy
14
Molybdenum (Mo) 18
2550
2050
3050
0.42.3
0.21.6
0.31.3
B.4.3
B.4.4
Illustrative calculation
A women undergoes a single CC view mammogram. The breast is compressed to 6 cm and the
composition is 25 % glandular tissue. The examination is performed with an HVL1 of 0.6 mm Al,
a dFID of 76 cm, and a field size of 20 cm 25 cm.
The mean dose to the glandular tissue due to this
examination is
DBreast 6:1 mGy 0:292 1:78 mGy,
73
B:3
(DT/mGy)/(Ka,i/mGy)
Glandular tissue content (by weight)
25 %
50 %
75 %
HVL1/mm Al
0.2
0.3
0.4
0.5
0.6
0.8
1.0
0.070
0.137
0.190
0.242
0.292
0.384
0.458
0.061
0.121
0.170
0.218
0.266
0.354
0.427
0.054
0.110
0.154
0.201
0.247
0.332
0.404
B.5.2
Upper esophagus
Middle esophagus
Lower esophagus
Gastroesophageal junction
Stomach
Duodenum
The Monte Carlo procedure and the anthropomorphic phantoms (ADAM and EVA) used to produce the Handbook for Upper GI examinations is
the adaptation of the BRHGAM code (Warner, 1973)
by the GSF Forschungszentrum fur Umwelt und
Gesundheit (Kramer et al., 1982). The mathematical
phantom representing the reference male patient
(ADAM) is a modification of the original MIRD-5
phantom (Snyder et al., 1969), including an update
of the active BM distribution by Cristy (1981). The
reference female patient (EVA) is the ADAM phantom reduced uniformly to 83 % of its original size,
with the unique female tissues instead of the unique
male tissues (Kramer et al., 1982).
To better represent the upper GI simulations
an esophagus and a duodenum were added to the
phantom, and a double contrast medium was simulated in the esophagus, duodenum, and stomach
(Stern et al., 1995a). The contrast medium consisted
of a 1 mm thick lining of barium sulphatewater
against the inner organ walls, with air filling the
rest of the volume of the organ.
The dynamic upper GI fluoroscopic examination
was approximated with a set of six discrete x-ray
fields developed by Suleiman (1989). Each discrete
x-ray field is a projection of distinct anatomical portions of the upper GI tract: upper, middle, or lower
esophagus, gastroesophageal junction, stomach, and
duodenum. For each component projection,
a separate Monte Carlo calculation was made with
Bladder
Liver
Testes
Ovaries
Uterus (surrogate for the embryo;
first 2 months of pregnancy)
Total trunk tissue (excludes lungs
and skeletal tissue)
Colon
The coefficients are presented for three beam
qualities (HVL1 of 4.0, 5.0, and 5.5 mm Al). These
beam qualities span the range of fluoroscopic x-ray
tube potentials and aluminum filtrations used in
clinical practice (Conway, 1994). The beam qualities
cited approximate those measured above a tabletop
present in the beam path of undertable x-ray tubes.
For the usual range of tube voltages and aluminum
filtration combinations used in Upper GI fluoroscopy, the results should have uncertainties of
<10 % when HVL1 alone is used to describe beam
74
APPENDIX B
fields provided in the Handbook. A practical method
of accomplishing this task is to videotape a clinically
representative examination and add a permanent
visual display of time and the sequence of frames.
The videotape can then be analysed and the clinical
examination subdivided into the fluoroscopic scan
segments and radiographic spot films corresponding
to the anatomical projections and views in the Handbook. The irradiation time associated with each of
the fluoroscopic scan segments can be evaluated from
the visual display. An example of this segmentation
is provided in the Handbook.
An example of the determination of Ka,i for each
of the discrete x-ray fields and the determination of
a separate representative beam quality for fluoroscopic scans and radiographic spot films is also
provided in the Handbook.
quality. In preparing the tabulations, three diagnostic x-ray spectra were applied, as shown below.
HVL1/mm Al
80
100
120
4.0
5.0
5.5
B.5.4
4.0
Tissue
Male
Thyroid
Oesophagus
Breast
Lung
Active BM
Stomach
Colon
Bladder
Liver
Testis
Uterus
Ovary
Trunk
5.0
Female
Male
5.5
Female
Male
Female
0.011
0.016
0.008
0.016
0.013
0.354
0.021
0.017
0.021
0.010
0.019
0.015
0.400
0.024
0.001
0.080
0.018
0.023
0.011
0.021
0.016
0.422
0.027
0.011
0.014
0.297
0.016
0.001
0.091
0.071
0.040
0.015
0.017
0.342
0.021
0.001
0.105
a
0.001
0.002
0.040
0.046
0.017
0.018
0.354
0.024
0.001
0.110
0.048
B:4
0.084
0.002
0.003
0.046
Illustrative calculation
0.002
0.002
0.048
B:5
The Monte Carlo procedure and the anthropomorphic phantoms (ADAM and EVA) used to produce the Handbook for examinations of the coronary
arteries is the adaptation of the BRHGAM code
(Warner, 1973) by the GSF Forschungszentrum
fur Umwelt und Gesundheit (Kramer et al., 1982).
The mathematical phantom representing the reference male patient (ADAM) is a modification of the
original MIRD-5 phantom (Snyder et al., 1969), with
the addition of an esophagus by Zankl et al. (1992)
and the addition of a supporting tabletop at the back
of the phantoms (Stern et al., 1995b). The reference
female patient (EVA) is the ADAM phantom reduced
uniformly to 83 % of its original size, with the unique
female tissues instead of the unique male tissues
(Kramer et al., 1982).
The simulated examinations of the coronary arteries are based on a series of distinct x-ray fields commonly used in coronary interventional radiology,
derived from analyses of practice at the Institut de
Cardiologie de Montreal (Lesperance, 1982; Haddadi
and Renaud, 1993). The scope of views and arterial
projections represented are generally applicable to a
broad range of examinations following a variety of
clinical protocols in many different venues. For each
arterial projection, a separate Monte Carlo calculation was made with ADAM and EVA for the relevant
complex oblique x-ray field in divergent-beam geometry, with specific x-ray spectra representative of
clinical practice (Stern et al., 1995b).
B.6.2
The tissues or organs for which conversion coefficients are tabulated are as follows.
APPENDIX B
Table B.5. Sample tabulation: Handbook of Tissue Doses
for Fluoroscopic and Cineangiographic Examinations of
the Coronary Arteries (Stern et al., 1995b).
Peak tube
voltage/kV
ADAM
60
90
120
EVA
50
80
110
Total filtration/
mm Al
HVL1/mm Al
3.5
4.0
4.3
2.5
4.0
5.5
3.3
3.9
4.2
2.0
3.5
5.0
(DT/mGy)/(Ka,i/Gy)
Male
HVL1/mm Al
2.5
4.0
5.5
2.0
3.5
5.0
Entrance skin
in primary field
Brain
Thyroid
Thymus
Active BM
Oesophagus
Lung
Breast
Heart
Adrenal
Spleen
Pancreas
Stomach
Liver
Kidney
Colon
Small intestine
Ovary
Uterus
Urinary bladder
Testis
1000
1120
1180
950
1090
1170
0.003
0.12
2.2
6.1
14
34
0.020
0.50
6.5
12
33
53
0.041
0.85
9.9
16
47
65
30
36
4.9
5.4
2.4
4.4
3.2
0.071
0.091
62
62
11
14
6.3
9.7
6.8
0.31
0.40
86
78
15
20
9.3
14
9.3
0.56
0.72
0.003
0.021
0.002
0.044
0.004
0.001
0.075
1.6
5.2
11
31
3.0
23
32
3.8
3.8
1.7
3.5
2.7
0.043
0.050
0.007
0.005
0.001
0.018
0.53
6.7
12
32
55
9.4
63
64
11
13
6.3
9.9
7.1
0.32
0.39
0.076
0.071
0.023
0.045
1.1
12
17
51
71
15
95
87
17
22
10
15
11
0.67
0.82
0.19
0.17
0.054
Female
B.6.4
Illustrative calculation
78
doi:10.1093/jicru/ndi031
GENERAL DESCRIPTION
1. Projections Common
in Diagnostic Radiology
(Adults)
2. Projections Common
in Diagnostic Radiology
(Paediatric)
3. Organ Doses for
CT Examinations
of Adults
4. Organ Doses for
CT Examinations in
Pediatric Radiology
(GSF-Bericht 11/90,
Drexler et al., 1990).
(Zankl et al., 1988;
1989).
(GSF-Bericht 30/91,
Zankl et al., 1991).
(GSF-Bericht 30/93,
Zankl et al., 1993).
For the calculations on adult patients, genderspecific mathematical human phantoms have been
used, whereas the calculations in paediatric radiology have used voxel phantoms. The adaptation
of the data to individual patients is discussed.
Details are described in the GSF Report Series:
The Calculation of Dose from External Exposures
Using Reference Human Phantoms and Monte
Table C.2. Tissues or organs for which organ doseconversion coefficients are given for radiographic
examinations of adults.
Brain
Eye lenses
Thyroid
Breast
Lungs
Spleen
Pancreas
Stomach wall
Small intestine
At various dFSD.
Oesophagus
Adrenals
Liver
Kidneys
The beam geometry is given by the focus-tosurface distance dFSD, the focus-to-image receptor
distance dFID, the field size at the image receptor
plane, and the direction of incidence on the human
body. The organ dose-conversion coefficients for each
projection are calculated by simulating 2 106 incident photons for the exposure under consideration.
The exposure conditions have been selected to be in
close accordance with routine exposure conditions
common in Europe.
Details are described in the GSF Report Series:
The Calculation of Dose from External Exposures
Using Reference Human Phantoms and Monte Carlo
Methods (Kramer et al., 1982; Drexler et al., 1990;
1993).
C.2.2
Bladder wall
Muscle
Skin
The Report of Drexler et al. (1990) presents a series of tabulations of organ dose-conversion coefficients for 40 common radiographic examinations
including techniques for pregnant women
(Table C.1). Additional organ dose tabulations are
provided for 28 projections with technical parameters as published in the EC Quality Criteria Document (1996a). The organs and tissues for which
organ dose-conversion coefficients are presented is
listed in Table C.2.
A sample tabulation for the lung PA projection is
given in Table C.3. Organ dose-conversion coefficients are provided for the ADAM and the EVA
phantoms. Each x-ray examination is investigated
for three tube voltages. A total filtration of 2.5 mm Al
is used for all the radiographic projections. The last
column in the table presents the coefficient of variation of the organ dose-conversion coefficients estimated from the Monte Carlo calculation.
C.2.3
Colon upper
Colon lower
Ovaries
Uterus
Testes
Active bone marrow
Skeleton
Skin entrance
Skin exit
35 cm 35 cm dFID
180 cm
150 cm
35 cm 40 cm dFSD
19 cm
Total filtration 2.5 mm Al
20 cm
125
c.va
Tube voltage/kV
90
140
Organ
Thyroid
Breast
Lungs
Spleen
Pancreas
Stomach wall
Small intestine
Colon (upper)b
Colon (lower)c
Active bone marrow
Skeleton
Surface (entrance)
Surface (exit)
0.06
0.54
0.25
0.17
0.07
d
d
d
0.11
0.30
1.24
0.04
0.06
0.13
0.57
0.18
0.12
0.06
d
d
d
0.12
0.32
1.24
0.05
0.10
0.68
0.33
0.25
0.11
d
0.01
d
0.16
0.35
1.27
0.07
0.10
0.19
0.72
0.24
0.17
0.10
d
0.01
d
0.17
0.38
1.32
0.08
0.12
0.73
0.35
0.27
0.12
0.01
0.01
d
0.17
0.36
1.35
0.09
0.12
0.22
0.76
0.26
0.19
0.11
0.01
0.01
d
0.18
0.39
1.34
0.10
0.035
0.006
0.002
0.009
0.012
0.013
0.02
0.035
0.001
0.001
0.001
0.04
Coefficient of variation.
Caecum Ascending Transverse.
c
Descending Sigmoid Rectum.
d
Less than 0.01.
b
C:2
The value of Ka,i for the relevant radiographic projection and the applied tube voltage, field size, and
filtration are required to estimate the DT. For cases
where Ka,i is not known, the report presents a graph
to estimate Ka,i from tube voltage, filtration, tubecurrent exposure-time product, PIt, and the focal
APPENDIX C
Table C.4. Exposure parameters used as input data for the dose calculation of the BABY phantom.
Type of examination
Voltage/kV
Height of field/cm
Width of field/cm
dFIDa/cm
PKAa/mGy cm2
Ka,ia/mGy
Thorax AP
Abdomen AP
Pelvis AP
Skull AP
Skull LAT
65
70
70
70
65
13.8
20.0
11.6
22.9
19.8
14.5
16.3
13.9
15.1
20.1
150
100
100
100
100
6.93
19.4
7.9
69.8
51.3
39.7
76.2
56.5
275
179
dFID, focus-to-image receptor distance; PKA, dose-area product; Ka,i, incident air kerma.
spot-to-surface distance, dFSD. In addition, recommendation is given in the Report on how to proceed,
when physical exposure parameters in a special
case considered differ from those assumed in the
tabulations.
C.2.4
Illustrative calculation
Breast dose from a PA chest examination performed with a tube voltage of 125 kV, 2.5 mm Al
filtration, a PIt of 4 mAs, a dFSD of 150 cm, corresponding to a dFID of 180 cm and a field size of 35 cm
35 cm at dFID for the female phantom
DBreast 0:19 0:4 mGy 0:076 mGy,
C:3
C.3.2
Thorax AP
DT/mGy
Abdomen AP
DT/mGy
Pelvis AP
DT/mGy
Skull AP
DT/mGy
Skull LAT
DT/mGy
Bladder wall
Brain
Eye lenses
Heart
Lungs
Ovaries
Small intestine wall
Stomach wall
Testes
Thymus
Thyroid
Total skeleton
Active BM pelvis
Active BM ribs
Active BM skull
Total active BM
0.02
0.28
0.86
23.3
18.6
0.02
0.13
0.88
0.00
27.4
34.2
22.1
0.01
7.53
1.43
3.02
60.9
0.04
0.00
37.1
23.8
52.1
69.0
70.0
10.1
4.38
1.12
39.1
29.2
13.3
0.07
5.83
47.6
0.00
0.00
0.14
0.11
42.1
25.8
0.99
67.3
0.06
0.02
15.7
22.1
0.10
0.00
2.81
0.02
88.9
295
6.99
16.6
0.03
0.26
0.78
0.01
51.7
212
304
0.07
11.7
86.9
43.9
0.00
60.2
125
1.66
2.68
0.00
0.07
0.29
0.03
6.04
90.3
186
0.04
1.46
52.1
22.8
Table C.6. Exposure parameters used as input data for the dose calculation of the CHILD phantom, relevant for 57-yearold patients in Germany.
Type of examination
Voltage/kV
Field width/cm
Field height/cm
dFIDa/cm
dPIDa/cm
Skull AP
Skull LAT
Thorax AP
Thorax PA
Abdomen AP
Pelvis AP
70
70
60
60
70
70
26.5
26.5
25.7
26.7
25.6
26.2
31.0
30.5
19.0
19.7
39.4
22.7
110
110
100
150
110
110
10
10
0
10
10
10
Table C.7. Organ dose-conversion coefficients, i.e., DT/Ka,i for different types of examination (Table C.6) for the CHILD
phantom.
Type of examination
Body organs and tissues
Brain
Eye lenses
Lungs
Ovaries
Testes
Thymus
Thyroid
Uterus
Skeleton (hard bone)
Active BM
Total body
Skull AP
Skull LAT
Thorax AP
Thorax PA
0.285
1.30
0.047
0.351
0.563
0.020
0.003
0.006
0.466
0.003
0.003
0.002
0.479
0.001
0.173
0.417
0.060
0.585
0.238
0.163
0.694
0.078
0.123
0.691
0.066
0.122
0.616
0.799
0.001
0.351
0.042
0.126
0.502
0.061
0.136
Abdomen AP
Pelvis AP
0.002
0.200
0.569
0.124
0.036
0.012
0.627
0.449
0.075
0.235
0.001
0.505
0.184
a
a
0.636
0.309/0.303b
0.057
0.137/0.131b
C.3.3
APPENDIX C
Table C.8. Radiation qualities in CT for which organ doseconversion coefficients were calculated.
C:4
Radiation quality
C.3.4
Illustrative calculations
Tube voltage/kV
Total filtration/mma
Mean photon energy/keV
HVL1/mm Al
80
50.5
5.38
The total filtration is the same for each of the spectra considered.
Table C.9. Organs and tissues for which CT organ doseconversion coefficients were calculated.
Adrenals
Bladder
Brain
Breasts
Colon
Eye lenses
Kidneys
Liver
Lungs
Ovaries
Pancreas
Total active bone marrow
Skin
Small Intestine
Skeleton
Spleen
Stomach
Testes
Thymus
Thyroid
Uterus
The bones for which the dose to the active bone marrow is listed
separately are the following.
C:6
Arm bones
Clavicles
Cranium
Facial skeleton
Leg bones
Pelvis
Ribs
Scapulae
Cervical spine
Thoracic spine
Lumbar spine
C.4.3
C.4.2
125
2.2 Al 0.2 Cu
64.4
7.98
C:5
C.4.1
66.0
8.06
137
C:7
4546
4445
4344
4243
4142
4041
3940
3839
3738
3637
3536
3435
3334
3233
3132
3031
2930
Volume
ratio
%
1.0
14.6
26.6
32.5
9.7
8.7
6.2
0.8
Coefficient of
variation
0.0105
0.0114
0.0144
0.0195
0.0220
0.0301
0.0515
0.0695
0.0817
0.0465
0.0382
0.0327
0.0240
0.0188
0.0151
0.0129
0.0104
0.0104
0.0115
0.0148
0.0194
0.0222
0.0290
0.0487
0.0639
0.0816
0.0461
0.0390
0.0323
0.0230
0.0183
0.0158
0.0124
0.0106
0.0073
0.0077
0.0103
0.0134
0.0157
0.0221
0.0375
0.0479
0.0624
0.0335
0.0274
0.0235
0.0169
0.0129
0.0106
0.0085
0.0068
0.031
0.029
0.026
0.023
0.022
0.019
0.016
0.014
0.013
0.016
0.018
0.019
0.021
0.023
0.025
0.028
0.031
Volume
ratio
%
8.6
24.7
33.5
15.9
9.5
6.9
0.9
Coefficient of
variation
0.0074
0.0080
0.0100
0.0121
0.0131
0.0187
0.0221
0.0280
0.0471
0.0716
0.0921
0.0623
0.0433
0.0382
0.0268
0.0209
0.0163
0.0069
0.0080
0.0098
0.0122
0.0137
0.0179
0.0226
0.0288
0.0462
0.0697
0.0903
0.0611
0.0440
0.0385
0.0271
0.0202
0.0166
0.0048
0.0051
0.0067
0.0079
0.0097
0.0137
0.0161
0.0207
0.0341
0.0523
0.0691
0.0452
0.0311
0.0281
0.0192
0.0149
0.0120
0.04
0.038
0.034
0.031
0.029
0.024
0.023
0.02
0.017
0.014
0.013
0.015
0.018
0.018
0.021
0.023
0.026
In the Report doses are given in this case for slices 71 down to 24.
zu
X
c organ, z:
In the case where a CT-examination consists of various sections with different physical exposure parameters, the organ doses have to be calculated for
each section separately.
The method described above can also be applied
to examinations performed by spiral or multi-slice
CT, provided CK is correctly determined for these
techniques.
C.4.4
Illustrative calculation
C:9
C:8
zl
84
APPENDIX C
Table C.11. Radiation qualities use for the calculation of
organ dose-conversion coefficients for paediatric CTexaminations.
Radiation quality
Tube voltage/kV
Total filtration/mma
Mean photon energy/keV
HVL1 Al
80
Adrenals
Bladder
Brain
Breasts
Colon
Eye lenses
Oesophagus
Kidneys
125
2.2 Al 0.2 Cu
50.5
5.38
64.4
7.98
The total filtration is the same for each of the spectra considered.
Liver
Lungs
Ovaries
Pancreas
Active BM
Skeleton
Skin
Small intestine
Spleen
Stomach
Testes
Thymus
Thyroid
Tissue
Uterus
The bones for which the dose to the active BM is listed separately
are:
Arm bones
Clavicles
Cranium
Leg bones
Cervical spine
Thoracic spine
Lumbar spine and sacrum
Sternum
Mandible
Pelvis
Ribs
Scapulae
The organs and tissues for which organ doseconversion coefficients were calculated are listed in
Table C.12. The doses to the active BM are
given both as dose to the active BM in the single
bones listed in Table C.12 and as the mean dose to
the total active BM distributed in the body. The dose
to the skeleton is given as the mean dose to the
C.5.4
Illustrative calculation
Conversion coefficients
80 kV
01
12
23
34
45
56
67
78
89
910
1011
1112
1213
1314
1415
1516
1617
1718
1819
1920
2021
2122
2223
2324
2425
2526
2627
2728
2829
2930
3031
2.4
8.1
13.7
16.9
18.1
17.1
12.4
7.5
3.3
0.4
Coefficient of variation
125 kV
360
180
360
180
0.0276
0.0685
0.102
0.119
0.124
0.116
0.0886
0.0593
0.0319
0.0140
0.0084
0.0054
0.0038
0.0027
0.0021
0.0016
0.0012
0.0009
0.0007
0.0005
0.0003
0.0003
0.0002
0.0002
0.0002
0.0001
0.0001
0.0001
0.0001
*
*
0.0287
0.0711
0.1028
0.120
0.125
0.115
0.0838
0.0550
0.0289
0.0128
0.0082
0.0052
0.0038
0.0027
0.0022
0.0017
0.0013
0.0010
0.0007
0.0005
0.0004
0.0314
0.0795
0.1178
0.140
0.146
0.1361
0.105
0.0709
0.0398
0.0181
0.0108
0.0071
0.0051
0.0037
0.0030
0.0024
0.0018
0.0014
0.0011
0.0008
0.0006
0.0005
0.0004
0.0003
0.0003
0.0002
0.0002
0.0001
0.0001
0.0001
0.0001
0.0322
0.0813
0.120
0.141
0.147
0.1361
0.101
0.0667
0.0369
0.0170
0.0108
0.0071
0.0052
0.0037
0.0030
0.0024
0.0019
0.0015
0.0011
0.0008
0.0006
0.0005
0.0004
0.0003
0.0003
0.0002
0.0002
0.0001
0.0001
0.0001
0.0001
0.0002
0.0002
0.0002
0.0001
0.0001
0.0001
0.0001
*
*
0.0034
0.0023
0.0019
0.0017
0.0017
0.0017
0.0020
0.0024
0.0031
0.0045
0.0057
0.0071
0.0084
0.0099
0.0109
0.0124
0.0141
0.0162
0.0185
0.0211
0.0254
0.0288
0.0308
0.0343
0.0383
0.0433
0.0490
0.0556
0.0634
0.0721
0.0835
An asterisk as table entry means that the organ dose-conversion coefficient is <0.00005.
C:10
86
doi:10.1093/jicru/ndi032
GENERAL DESCRIPTION
(NRPB-R262,
NRPB-SR262,
Hart et al., 1994a,b)
(NRPB-R279,
NRPB-SR279,
Hart et al., 1996a,b)
(NRPB-R250,
NRPB- SR250
Jones and Shrimpton,
1991, 1993)
Details of the Monte Carlo code and the mathematical phantom developed at NRPB are described
by Jones and Wall (1985). Conversion coefficients
relating DT to Ka,e and to PKA were calculated
by simulating typical x-ray examination exposure
conditions on a hermaphrodite mathematical phantom representing a typical adult patient. Four million photon histories were followed for each x-ray
examination field simulated. The phantom was
based on Cristys adult hermaphrodite phantom
(Cristy, 1980) with Kramers modified neck region
(Kramer et al., 1982), a breast tissue composition of
50 % fat and 50 % water, and with an esophagus. The
arms of the phantom, which lie alongside the trunk,
were removed when lateral projections through the
trunk were simulated.
D.2.2
Report NRPB-SR262 (Hart et al., 1994b) is a software report, which includes a computer disk containing files of conversion coefficients relating DT
to Ka,e and to PKA for the 68 radiographic projection
(e.g., Head) and view (e.g., AP) combinations listed
below.
Head AP, PA
Head LAT L and R
Cervical spine AP
Cervical spine LAT L and R
Throat LAT L and R
Shoulder AP L and R
Oesophagus RAO, LAO, LPO
Thoracic spine AP
Thoracic spine LAT L and R
Chest AP, PA
Chest LAT L and R
Heart AP, PA
using the conversion coefficients listed in NRPBSR262 is Ka,e or PKA for each radiograph and the
corresponding tube voltage and total beam filtration.
Organ doses can be estimated for any combination
of the 68 radiographic projections and views, using a
software package called XDOSE developed at the
National Radiation Laboratory, Christchurch, New
Zealand. This software processes the data in NRPBSR262 according to the requirements of the user. An
example of part of the results produced by this software for a PA chest radiograph and an AP abdominal radiograph with specified exposure factors is
shown in Table D.1.
D.2.3
Lungs
Oesophagus
Ovaries
Pancreas
Active BM
Residual tissues
(muscle)
Skeleton (bone
surfaces)
Skin
Small intestine
Duodenum AP, PA
Duodenum RAO, LPO
LSJ LAT L and R
Abdomen AP, PA
Small intestine AP, PA
Pelvis/colon AP, PA
Colon RAO, LPO, LAO
Urinary bladder AP
Hip AP L and R
Rectum AP, PA
Rectum LAT L and R
Rectum LPO, RAO
D.2.4
Illustrative calculation
Spleen
Stomach
Testes
Thymus
Thyroid
Upper large
intestine
Urinary
bladder
Uterus
APPENDIX D
Table D.1. Organ doses DT/mGy calculated for chest PA
and abdomen AP examinations using NRPB-SR262 Monte
Carlo data and the software package XDOSE for the
examination conditions given in Section D.2.4.
Organ
D.3.2
DT/mGy
Adrenals
Brain
Breasts
Eye lens
Gall bladder
Stomach
Small intestine
Upper large intestine
Lower large intestine
Heart
Kidneys
Liver
Lungs
Ovaries
Pancreas
Skin
Spleen
Testes
Thymus
Thyroid
Urinary bladder
Uterus
Oesophagus
Muscle
Total bone
Active BM
Chest PA
Abdomen AP
0.0970
0.0006
0.0197
0.0003
0.0187
0.0238
0.0025
0.0032
0.0006
0.0362
0.0608
0.0419
0.0846
0.0005
0.0453
0.0163
0.0803
0.00
0.0184
0.0108
0.0001
0.0005
0.0490
0.0181
0.0485
0.0274
0.261
0.00
0.0199
0.00
1.95
1.95
1.64
1.98
1.32
0.0675
0.366
1.08
0.0474
1.28
0.872
0.387
0.507
0.243
0.0094
0.0003
2.61
1.67
0.0643
0.531
0.289
0.217
Head AP,
PA, LAT
Cervical spine
AP, PA, LAT
Chest AP,
PA, LAT
0
1
5
10
15
Weight/
kg
3.47
9.26
19.0
31.9
54.4
Height/
cm
51.5
75.0
109.0
138.6
164.0
Thickness
of head/cm
Thickness
of trunk/
cm
AP
LAT
AP
LAT
11.6
15.7
18.1
18.8
19.5
9.0
12.3
14.3
14.9
15.5
9.8
13.0
15.0
16.8
19.6
12.7
17.6
22.9
27.8
34.5
Lumbar spine
AP, PA, LAT
Abdomen AP, PA
Pelvis AP, PA
Urinary
bladder
AP, PA
Adrenals
Brain
Breasts
Eye lens
Gall bladder
Heart
Kidneys
Liver
Lower large
intestine
89
Lungs
Oesophagus
Ovaries
Pancreas
Active BM
Residual
tissues (muscle)
Skeleton
(bone surfaces)
Skin
Small intestine
Spleen
Stomach
Testes
Thymus
Thyroid
Upper
large intestine
Urinary bladder
Uterus
D.3.3
D.3.4
Organ doses DT for chest PA and abdomen AP examinations were calculated using NRPB-SR279 Monte
Carlo data (Hart et al., 1996b) for child of 1 year.
The chest PA examination is performed with a tube
voltage of 90 kV, a filtration of 2.00 mm Al and of 0.10
mm Cu, and at the reference dFSD. The entrance air
kerma Ka,e for the chest examination is 0.05 mGy.
The abdomen AP examination is performed with a
tube voltage of 90 kV, a filtration of 2.00 mm Al and
0.10 mm Cu, and at the reference dFSD. The entrance
air kerma Ka,e for the abdomen examination is 0.40
mGy. The results of the organ dose calculation are
given in Table D.2.
Adrenals
Brain
Breasts
Eye lens
Gall bladder
Stomach
Small intestine
Upper large intestine
Lower large intestine
Heart
Kidneys
Liver
Lungs
Ovaries
Pancreas
Skin
Spleen
Testes
Thymus
Thyroid
Urinary bladder
Uterus
Oesophagus
Muscle
Total bone
Active BM
Abdomen AP
0.0215
0.0002
0.0105
0.0002
0.0026
0.0049
0.0008
0.0009
0.0002
0.0144
0.0029
0.0081
0.0311
0.0004
0.0079
0.0063
0.0107
0.00
0.0080
0.0060
0.0001
0.0003
0.0177
0.0068
0.0259
0.0060
0.0796
0.0001
0.0102
0.0002
0.252
0.271
0.211
0.242
0.152
0.0440
0.0796
0.226
0.0390
0.184
0.167
0.0468
0.118
0.0335
0.0065
0.0024
0.264
0.216
0.0508
0.0748
0.0860
0.0274
The same Monte Carlo code and adult hermaphrodite mathematical phantom were used as in the
calculations for conventional x-ray examinations
(see Appendix D.2.1). Only the esophagus was missing from the phantom described in Appendix D.2.1.
The arms of the phantom remained alongside the
trunk for all simulated CT examinations, as is the
usual practice with patients.
To simulate the distinct exposure conditions prevailing during CT examinations, the x-ray source
was rotated around the long axis of the phantom.
Organ doses were determined for the individual irradiation of 208 contiguous 5-mm-thick transverse
slabs of the phantom ranging from the top of the
head to the top of the legs. A line x-ray source of
the same length of each irradiated slab (5 mm) was
used, with the photons emitted normally from the
source into a fan-shaped beam spanning the width of
the phantom. An abrupt cut-off of the x-ray beam at
the edges and faces of the fan (i.e., perfect collimation) is a feature of this model. Conversion coefficients were calculated relating the organ doses to
the kerma on the axis of rotation of the scanner
free-in-air, i.e., with no phantom or patient present.
The imperfect collimation of the x-ray beam in the
axial direction, which occurs in practice, can lead to
a build-up of dose in adjacent scans. However, this is
taken account of by measuring the CT kerma index
free-in-air, CK, under the exposure conditions, i.e.,
slice thickness, tube voltage, and tube-current
exposure-time product, PIt. The value of CK
is then multiplied by the conversion coefficients
to estimate the organ doses for the degree of
beam collimation achieved by the CT scanner of
Illustrative calculation
90
APPENDIX D
distance, and total filtration), selected to cover 27
models of CT scanner from five different manufacturers, which were in common use in the UK in the
late 1980s (Table D.3). Shaped (bow-tie) filters
have been modelled where necessary. The exposure
conditions assumed for the 23 sets of calculations
and the appropriate CT scanner models are listed
below.
Report NRPB-R250 (Jones and Shrimpton, 1991)
contains tables of conversion coefficients relating
doses to 27 organs or regions of the phantom to the
CK,m for each of the 208 5 mm slabs and for four of
the datasets listed below. Report NRPB-SR250 is a
software report that contains a computer disk on
which the conversion coefficients for all the datasets
listed below are recorded.
The 27 organs and regions of the phantom for
which conversion coefficients have been calculated
are the following.
Table D.3. Exposure conditions for calculation of normalized organ doses for CT using Monte Carlo techniques according
to Jones and Shrimpton (1991, 1993).
Monte Carlo
data set no.
1
2
3
4
5
6
7
8
9c
10
11
12
13
14
15
16
17
18
19
20c
21c
22c
23c
Siemens
Somatom 2,DR1/2/3
Somatom DRG,DRG1
Somatom DRH,CR,CR512
Picker
1200SX
1200SX
GE
CT 8800,9000I/II/HP
CT 8800,9000I/II/HP
CT 9800,9800Quick
CT 9800,9800Quick
CT MAX
CT PACE
CGR
CE 10000,12000
Philipse
Tomoscan 305N,310,350 (GE No. 2, no Cu)
Tomoscan 305N,310,350 (GE No. 2, with Cu)
Tomoscan 310,350 (GE No.3, no Cu)
Tomoscan 310,350 (GE No. 3, with Cu)
Tomoscan TX
Tomoscan CX,CX/S
Tomoscan LX
Tomoscan TX
Tomoscan TX
Tomoscan LX
Tomoscan LX
Tube
voltage/kV
Focus to axis
distance/mm
Flat filter/
Shaped filter/
Al mm
Cu mm
Option
Type
125
125
125
760
700
700
2.2
2.2
2.2
0.25
0.4
0.2
130
130
640
640
0.7
0.7
HEAD
BODY
LEXANa
LEXANa
120
120
120
140
120
120
780
780
630
630
525
525
2.7
2.7
2.7
2.7
2.6
2.7
HEAD
BODY
PMMA
PMMA
PTFEb
PTFEb
PTFEb
PTFEb
130
750
1.0
0.3
PEEKd
120
120
120
120
120
120
120
100
130
100
130
487
487
608
608
606
606
606
606
606
606
606
3.5
3.5
3.5
3.5
1.4
1.4
1.4
1.4
1.4
1.4
1.4
0.25
0.25
0.1
0.1
0.1
0.1
0.1
0.1
0.1
Al
Al
Al
Al
Al
Al
Al
Al
Al
Al
Al
LEXAN is polycarbonate.
PTFE is polytetrafluoroethylene.
c
Datasets 9, 20, 21, 22, and 23 relate to alternative applied potential settings for selected scanners.
d
PEEK is polyetheretherketone.
e
Philips Tomoscan 300 series scanners have options for the variation of focus-to-axis distance (geometric enlargement setting) and for the
inclusion of additional copper filtration.
b
91
Adrenals
Brain
Breasts
Eye lens
Gall bladder
Heart
Kidneys
Liver
Lower large
intestine
D.4.3
Lungs
Ovaries
Pancreas
Active BM
Skeleton
(bone surfaces)
Skin
Small intestine
Spleen
Stomach
Testes
Thymus
Thyroid
Upper large
intestine
Urinary bladder
Uterus
Head region
Trunk region
Leg region
Organ
DT/mGy
Adrenals
Brain
Breasts
Eye lens
Gall bladder
Stomach
Small intestine
ULI
LLI
Oesophagus
Heart
Kidneys
Liver
Lungs
Ovaries
Pancreas
Skin
Spleen
Testes
Muscle
Thymus
Thyroid
Urinary bladder
Uterus
Head region
Trunk region
Leg region
Bone
ABM
2.97
0.08
17.50
0.07
0.76
1.55
0.10
0.14
0.02
31.90
23.10
0.61
2.37
20.60
0.02
2.30
3.24
1.75
0.0004
3.73
31.90
1.86
0.005
0.029
0.62
7.86
0.0002
9.76
5.05
Illustrative calculation
Organ doses DT for routine chest CT examinations, region 1, according to NRPB-R250 combined
with CTDOSE. The scan was performed with a tube
voltage of 125 kV, PIt of 350 mAs, CK,m/PIt of
0.220 mGy (mAs)1, slice thickness of 10 mm,
table increment of 10 mm, number of slices 20,
start position of 430 mm, and end position of 650
mm. The resulting organ doses are given in
Table D.4.
92
doi:10.1093/jicru/ndi033
GENERAL
E:1
Plan
16 cm
Elevation
variable
thickness
0.4 cm or 0.5 cm
Adipose tissue
50 : 50 Adipose and glandular tissue
Figure E.1. Mathematical model of the breast used in Monte
Carlo calculations of average glandular dose. Shown are the
superficial layer (either 0.4 cm of glandular tissue or 0.5 cm of
adipose tissue) and the central region consisting of 50 % adipose
and 50 % glandular tissue by mass (Reproduced from Dance,
1990, with permission from IOP, UK). The 50:50 breast model
was first suggested by Hammerstein et al. (1979).
Range of variation
Spectra at same HVL1 for same tube voltage and anode-filter combination
Photon interaction data: MCPLIB (1988) versus XCOM (Berger and Hubbell, 1987)
Presence or absence of compression plate
Composition and thickness of superficial layer Hammersteins tissue composition
ICRU tissue composition
Tissue composition Hammerstein versus ICRU
Fraction of glandular tissue in central region (HVL1: 0.4 mm Al, 6-cm-thick breast, 25 %
glandular tissue versus 50 % glandular tissue)
7 %
10 %
34 % (3 mm PMMA)
1119 % (breast thickness 8-2 cm)
310 % (breast thickness 8-2 cm)
1114 % (at breast thickness 8-2 cm)
1013 %
Table E.2. Conversion coefficient cG that relates Ka,i to DG for a 5-cm-thick breast having a central region of 50 % adipose
and 50 % glandular tissue by mass (tissue compositions according to Hammerstein et al., 1979).
HVL1
Rosenstein et al.
(1985)a
mm Al
0.30
0.35
0.40
0.45
0.50
0.55
0.60
0.65
(Mo/Mo)
0.171 (0.160)
0.217 (0.200)
0.314
Dance
(1990)b
Wu et al.
(1991)
Wu et al. (1994)d
Dance et al.
(2000)e
0.164
0.187
0.209
0.232
0.258
0.287
0.310
0.332
0.146
0.172
0.195
0.168 (Mo/Mo)
0.1910.198 (W/MoMo/Mo)
0.2210.229 (Mo/RhRh/Rh)
0.257 (Rh/Rh)
0.273 (W/Rh)
0.294 (W/Rh)
0.1510.153
0.1740.180
0.1960.209
0.2200239
0.2420.260
0.164
0.1880.194
0.2160.224
0.2410.253
0.270
0.296
0.321
Conversion coefficients for tungsten targets; conversion coefficients given in brackets refer to Mo and Mo/W targets
HVL1 range: 0.250.45 mm Al: Mo/Mo; 0.450.70 mm Al: W/Mo; 0.500.80 mm Al: W/Rh; 0.550.90 mm Al: W/Pd; 0.502.00 mm Al: W/Al.
c
Anode/filter materials include Mo/Mo, W/Mo, Mo/Rh, Rh/Rh and W/Rh.
d
Lower values refer to Mo/Rh and higher values to Rh/Rh. Values can differ by 5 % depending on differences in tube voltage.
e
Anode filter combinations also include Mo/Mo, Mo/Rh, Rh/Al, Rh/Rh and W/Rh (Dance, 1990).
b
SCOPE
Three approaches for dose assessment in mammography are presented in this appendix. The first
method (Appendix E.3) concerns determination of
DG for a 4.5 (ACR, 1992) or 5-cm-thick standard
breast (EC, 1996b). According to the American College of Radiology (ACR) protocol, Ka,i is measured
using a mammographic phantom equivalent to
4.5 cm compressed breast tissue. The EC recommends Ka,i measurements for 5-cm-thick breasts or
alternatively for a 4.5-cm-thick PMMA phantom
(used in practice to mimic a standard breast). DG
then results from measured Ka,i and application of
the appropriate conversion coefficient cG, selected
on the basis of HVL1.
The second method (Appendix E.4) also takes
into account the variation in compressed breast
APPENDIX E
Table E.3. Differences in conversion coefficients cG due to differences in technical parameters in mammography.
Technical parameter
Variation
CONVERSION COEFFICIENT; CG
HVL1 / mm Al
Figure E.2. Calculated conversion coefficients for mammary gland cG for a 5.0-cm-thick breast model with a central region consisting of
50 % adipose and 50 % glandular tissue as a function of the HVL1 for various anode/filter combinations (EC, 1996b). The anode the
anode material is indicated by the chemical symbol, the filter thickness is given in mm and the filter material by the trailing symbol.
23
0.23
0.24
0.25
0.26
0.27
0.28
0.29
0.30
0.31
0.32
0.33
0.34
0.35
0.36
0.37
0.38
0.39
0.40
0.41
0.42
0.43
0.44
0.45
W/Ala
0.124
0.129
0.133
0.138
0.144
0.148
0.154
0.159
0.164
0.169
0.174
0.179
24
0.132
0.137
0.141
0.146
0.151
0.156
0.161
0.166
0.171
0.176
0.181
0.186
25
0.139
0.144
0.148
0.153
0.158
0.163
0.168
0.172
0.177
0.182
0.187
0.192
26
0.146
0.151
0.155
0.161
0.165
0.170
0.174
0.179
0.184
0.189
0.194
0.198
27
0.153
0.157
0.162
0.166
0.171
0.176
0.180
0.185
0.190
0.195
0.200
0.204
28
0.158
0.163
0.168
0.172
0.177
0.181
0.186
0.192
0.196
0.201
0.205
0.210
29
0.164
0.169
0.173
0.178
0.182
0.187
0.193
0.197
0.202
0.206
0.211
0.216
30
31
0.170
0.174
0.180
0.185
0.189
0.194
0.198
0.203
0.208
0.212
0.217
0.221
0.176
0.181
0.186
0.190
0.195
0.200
0.203
0.208
0.212
0.218
0.222
32
0.182
0.187
0.192
0.196
0.201
0.204
0.209
0.213
0.219
0.223
0.228
33
0.182
0.187
0.192
0.196
0.201
0.205
0.210
0.214
0.219
0.223
0.228
0.233
0.194
0.200
0.205
0.211
0.217
0.221
0.227
0.233
0.237
0.243
0.247
0.252
0.257
0.262
0.267
0.271
W/Al target-filter combination, peak tube voltage 45 kV, filter thickness 1.6 mm.
HVL1 in mm Al.
APPENDIX E
Table E.5. Conversion coefficients for calculating DG for a
5.0 cm standard breast from Ka,i for 4.5-cm-thick standard
PMMA phantom (EC, 1996b).
cG
0.30
0.35
0.40
0.45
0.50
0.55
0.60
0.65
0.177
0.202
0.223
0.248
0.276
0.304
0.326
0.349
HVL1/mm Al
1.4
0% glandularity
1.2
1.0
0.8
100% glandularity
0.6
2
6 cm
7 cm
8 cm
0.30
0.35
0.40
0.45
0.50
0.55
0.60
0.65
0.135
0.154
0.172
0.192
0.214
0.236
0.261
0.282
0.114
0.130
0.145
0.163
0.177
0.202
0.224
0.244
0.098
0.112
0.126
0.140
0.154
0.175
0.195
0.212
0.390
0.433
0.473
0.509
0.543
0.573
0.587
0.622
0.274
0.309
0.342
0.374
0.406
0.437
0.466
0.491
0.207
0.235
0.261
0.289
0.318
0.346
0.374
0.399
0.183
0.208
0.232
0.258
0.285
0.311
0.399
0.363
0.164
0.187
0.209
0.232
0.258
0.287
0.310
0.332
DG Ka;i cG cs,
E:2
where c corrects for any difference in breast composition from 50 % glandular tissue, and the factor s for
any difference from the cG tabulation by Dance
(1990) due to the use of a different x-ray spectrum.
Correction factors c are tabulated against HVL1 and
breast thickness. They are available as a function of
glandularity and for breasts of typical glandularity
at a given breast thickness for women in the age
groups 4049 years and 5064 years.
97
doi:10.1093/jicru/ndi034
F.2
INTRODUCTION
Ovaries
Testes
Active BM
Lungs
Colonb
Stomach
Liver
Thyroid
Oesophagus
Breasts
Urinary bladder
Bone surfacea
Skin
Adrenals
Brain
Kidneys
Pancreas
Small intestine
Spleen
Thymus
Uterus
Musclec
Gall bladder
Heart
Table F.1. Principal dimensions of the mathematical phantoms (Cristy 1980). The arms of a phantom can be included at the
sides of the trunk or be removed.
Newborn
1 year old
5 years old
10 years old
15 years old
Adult
Weight/
kg
Total height/cm
Trunk height/cm
Trunk thickness/cm
Trunk widtha/cm
Trunk widthb/cm
Leg length/cm
3.51
9.36
19.1
32.1
54.5
71.1
51.5
75.0
109.0
138.6
164.0
174.0
21.6
30.7
40.8
50.8
63.1
70.0
9.8
13.0
15.0
16.8
19.6
20.0
10.9
15.1
19.6
23.8
29.7
34.4
12.7
17.6
22.9
27.8
34.5
40.0
16.8
26.5
48.0
66.0
78.0
80.0
Excluding arms.
Including arms.
Skeleton
Active BM
Breast tissue
Lung tissue
Other soft tissues
F.3
Density/g cm3
Ca
1.49
0.99
0.975
0.296
0.99
7.04
10.18
11.70
10.21
10.47
22.79
47.48
38.04
10.01
23.02
3.87
2.18
0.00
2.80
2.34
48.56
39.70
50.26
75.96
63.21
7.68
0.29
0.00
0.78
0.39
10.06
0.17
0.00
0.24
0.58
MATHEMATICAL PHANTOMS
PCXMC allows further modification of the phantoms by letting the user change their weight, M, or
height, h. Using these body size measurements, the
program calculates scaling factors
sz h=h0 ,
F:1
F:2
APPENDIX F
Dose in active bone marrow
300
250
PCXMC
NRPB
mGy/Gy
200
150
100
50
15hp60
15ha60
10ha60
5ha60
15aa60
5cr60
1aa60
5aa60
10aa60
15hp120
5ca60
15ca60
15ha120
1ca60
10ca60
0pp60
10ha120
0ca60
15cp60
1ha60
0aa60
0ha60
5ha120
5cr120
15ca120
15aa120
5ca120
1aa120
1ca120
0pp120
10ca120
0ca120
10aa120
1ha120
0aa120
0ha120
15cp120
Examination condition
Figure F.1. A comparison of the conversion factors calculated by PCXMC with the data of Hart et al. (1996b) according to (Tapiovaara
et al., 1997). Conversion coefficient from air kerma to dose in the active BM. All doses correspond to a Ka,i value of 1 Gy. In the examination condition, the first digits show the patients age, the letters show the examination (a, abdomen; c, chest; h, head; p, pelvis) and
projection (a, AP; p, PA; r, right lateral), and the last digits show the x-ray spectrum (60, 60 kV, total filtration 3 mm Al; 120, 120 kV, total
filtration 3 mm Al and 0.2 mm Cu, 17 x-ray tube anode angle). The uncertainty bars shown correspond to two standard deviations of
the data.
F.5
102
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