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The purpose of this study was to verify the maintenance of low-contrast detectability at different CT dose reduction levels, in patients of different sizes, as a consequence of the application of iterative reconstruction at different strengths combined with tube current modulation. Anthropomorphic abdominal phantoms of two sizes (small and large) were imaged at a fixed noise with iterative algorithm ASIR-V percentages in the range between 0 and 70% and corresponding dose reductions in the range of 0–83%. A total of 1400 images with and without liver low-contrast simulated lesions were evaluated by five radiologists, using the receiver operating characteristics (ROC) paradigm and evaluating the area under the ROC curve (AUC). The human observer results were then compared with AUC obtained with a channelized Hotelling observer (CHO). CNR values were also calculated. For the small phantom, the AUC values lie between 0.90 and 0.93 for human evaluations of images acquired without iterative reconstruction, with 30% ASIR-V and with 50% ASIR-V. The AUC decreased significantly to 0.81 (p = 0.0001) at 70% ASIR-V. The CHO results were in coherence with human observer scores. Also, similar results were observed for the large size phantom. CNR values were stable for the different ASIR-V percentages. The iterative algorithm maintained the low-contrast detectability up to a dose reduction of about 70%, following application of a 50% ASIR-V combined with automatic tube current modulation, regardless of the phantom size. At further dose reductions using greater iterative percentages, a significant decrease in detectability was observed.

To evaluate the radiation dose reduction during endovascular aneurysm repair (EVAR) after the reconfiguration of a Philips AlluraXper FD20 X-ray system. Between 2013 and 2015, we implemented a low-dose protocol (Eco dose) increasing the filtration with 1 mm of Al and 0.1 of Cu on both fluoroscopy and fluorography and halving the frames per second in fluoroscopy. The switch was complemented by hybrid operating room staff education and training in radiation protection. We compared two samples of 50 patients treated before the switch (normal dose) with 50 patients treated after the switch (Eco dose). Procedures were categorized into two different grades of complexity, standard and complex, intended as fenestrated/chimney/snorkel and EVAR plus additional embolization to prevent endoleak type II. We evaluated patient demographics, Air Kerma (AK), dose area product (DAP), and procedural data (fluoroscopy time, number of fluorographies, and iodinated contrast). Staff radiation dose was measured with film badge dosimeter on C-arm. The Eco-dose protocol witnessed a DAP reduction of 53% in standard EVARs and of 57% in complex EVARs and an AK reduction of 45% in standard and 57% in complex EVAR. The image quality in 2016 was perceived acceptable, as proven by the fact that fluoroscopy time, number of fluorographies, and contrast medium volumes did not have to be increased. We achieved a reduction in staff dose of 25.6%. Optimized angiographic system setting significantly reduced the radiation dose both to the patients and to the staff assuring safe EVAR procedures.

The aim of this study was to evaluate the impact on dose reduction and image quality of the new iterative reconstruction technique: adaptive statistical iterative reconstruction (ASIR-V).Fifty consecutive oncologic patients acted as case controls undergoing during their follow-up a computed tomography scan both with ASIR and ASIR-V. Each study was analyzed in a double-blinded fashion by 2 radiologists. Both quantitative and qualitative analyses of image quality were conducted.Computed tomography scanner radiation output was 38% (29%-45%) lower (P0.0001) for the ASIR-V examinations than for the ASIR ones. The quantitative image noise was significantly lower (P0.0001) for ASIR-V. Adaptive statistical iterative reconstruction-V had a higher performance for the subjective image noise (P = 0.01 for 5 mm and P = 0.009 for 1.25 mm), the other parameters (image sharpness, diagnostic acceptability, and overall image quality) being similar (P0.05).Adaptive statistical iterative reconstruction-V is a new iterative reconstruction technique that has the potential to provide image quality equal to or greater than ASIR, with a dose reduction around 40%.

Purpose This study investigated the benefits of implementing a cluster analysis technique to extract relevant information from a computed tomography (CT) dose registry archive. Methods A CT patient dose database consisting of about 12,000 examinations and 29,000 single scans collected from three CT systems was interrogated. The database was divided into six subsets according to the equipment and the reference phantoms in the definition of the dose indicators. Hierarchical (single, average, and complete linkage, Ward) and not hierarchical (K-means) clustering methods were implemented using R software. The suitable number of clusters for each CT system was determined by analysing the dendrogram, the within clusters sum of squares, and the cluster content. Summary statistics were produced for each cluster, and the outliers of the dose indicator distribution were investigated. Results Ward clustering identified the most common combinations of scanning parameters for each group. The optimal number of clusters for each CT equipment system ranged from 5 to 15. The main diagnostic applications were then extracted from each cluster. Outlier analysis of the dose indicator distribution of each cluster revealed potential improper settings that resulted in increased patient dose. Conclusions Clustering methods applied to CT patient dose archives provide a quick and effective overview of the main combinations of currently used exposure parameters and the consequences for dose indicator distributions, also when protocol labels and/or study descriptions are not homogeneous.

The purpose of this study was to optimize an aorta angiographic CT protocol, by investigating the best combination of tube current modulation, iterative algorithm strength and kV reduction. Anthropomorphic phantoms of three sizes were imaged by CT with different values of noise index, of iterative algorithm ASIR percentages and kV in the range 80–120. Quantitative noise and contrast noise ratios were evaluated at different phantom locations. Three radiologists assessed the subjective image quality by comparing the image series with the one acquired with the reference protocol (120 kV, slice thickness 0.625, noise index 28, ASIR 40 %). Although the highest CNR values were obtained for the 80 kV acquisitions, qualitative scores were higher for 100 and 120 kV at the same noise index. An optimized protocol was established with a NI of 39.2, ASIR 60 %, 100 kV for small- and medium-sized patients and 120 kV for large-sized patients, with a dose reduction of 47 %. When different dose reduction parameters are available, anthropomorphic phantoms of different sizes help to find the optimal combination. For aorta studies, 100 kV with relative high values of noise indexes and iterative levels provides the best balance between dose reduction and image quality.

Purpose The use of unsealed sources (either in nuclear medicine or in radiochemical bio-laboratories) involves the risk of internal contamination for workers after partial evaporation of the unsealed source during its use. This issue was already addressed in [1] , the aim of this work is to extend that work towards a comprehensive model taking into account also the airborne contamination after radionuclide evaporation from the cumulated surface contamination of the working area. Methods The above mentioned model takes into account the manipulation time (tm, the manipulated activity (A), the frequency of manipulations, the total time the workers spend in the laboratory (on an yearly basis), the air exchange ratio (R) and the half-life of the manipulated radionuclides. According to the actual working conditions, the model evaluates firstly the radionuclide air concentration as a function of time and thereafter the committed effective dose depending on the time spent in the laboratory by the worker. Results During tm the radioisotope manipulation determines both air contamination (AC) and probabilistic surface contamination (SC). After tm AC decreases due to R, whereas surface contamination increases after each manipulation, decreasing only through physical decay, thus leading to an asymptotic SC in the long run. SC is more relevant for long-life radioisotopes. Conclusions Application of the model to an actual bio-laboratory case shows that contribution to inhaled activity from surface contamination may be relevant or even dominant especially for long-life radionuclide (i.e. 3H and 14C). Great care should be used in cleaning the working surfaces after each manipulation to avoid or at last reduce to a reasonable level surface contamination. Smear test looks the test of choice to accurately verify the effective contamination level.

Purpose Daily images from CBCT could deliver significant dose to the patient, which should be considered and evaluated. It is essential to associate the absorbed dose delivered by the imaging procedures to the treatment of each patient. Aim of this work is to calculate organ doses for patients undergoing Cone Beam CT (CBCT) when treated with radiotherapy. Methods The system in use was an Elekta CBCT (XVI) and the protocols analysed were four: head, pelvis, chest and chest 4D with different parameters. The formula for organ dose calculation was obtained from Rampado et al. [1] where dose to organs were evaluated by means of Monte Carlo simulation in phantom; the effect of patient size were also accounted for. Dose to organs involved in CBCT scans is: D T = D W , 1 Ph · ( D T / D W , 1 Ph ) tab · a · e - bx where D W , 1 Ph is the measured dose in a phantom for the specific protocol, x is the effective diameter of the patient, ( D T / D W , 1 Ph ) tab , a and b are tabulated data from the article cited above. Patients were analyzed from March to June 2017. For each case were registered: the effective diameter from simulation CT, CBCT protocol, number of CBCT scans. Results Two hundred patients were considered. For head protocol, the mean CBCT doses were about 20 ± 10 mGy for all organs. Instead, doses of about 400 ± 150 mGy were evaluated for pelvis protocol. CBCT Doses for Chest 4D protocol were lower than other chest ones (about 50 ± 25 mGy vs 400 ± 150 mGy). This difference was due to number of CBCT scans/treatment fractions. Conclusions Doses from CBCT procedures should be accounted for; based on organ doses calculation, a program of dose optimization could be performed.

Gafchromic® XR-QA films were developed for patient dosimetry in diagnostic radiology. A possible application of these films is the measurement of doses in computed tomography. In this study a method to evaluate the CTDI using Gafchromic XR-QA film and a flatbed scanner was developed and tested. Film samples were cut to dimensions of 6 × 170 mm 2 in order to have an integration area similar to that of a pencil ionization chamber, with the possibility of changing the integration length. Prior to exposing these films to a computed tomography beam, the angular dependence of the film dose response was investigated by exposing film strips to a static x-ray beam at different angles in the range 0°–180°. A difference of 49% was found between the response with the axis beam parallel to the film surface (90°) and with the axis beam perpendicular (0° and 180°). Integrating over a 360° exposure like the one in computed tomography, a difference of less than 2% was estimated, which is comparable with the measurement error obtainable with XR-QA film. A calibration with a CT beam in the scout mode was performed and film strips were then exposed to single axial scans and to helical scans both in air and in phantoms. Two different types of flatbed scanners were used to read the film samples, a Microtek ScanMaker 9800XL scanner and an Epson Expression 10000 XL scanner, and the accuracy of the results were compared. For beam collimations above 10 mm differences between CTDI measured by film and CTDI measured by ionization chamber below 9% were found for the Epson scanner, with an average estimated error at 1 σ level of 5%. For the Microtek scanner and for the same film samples, differences below 11% with an average error at 1 σ level of 8% were founded. The 1 σ uncertainty of the measured CTDI was provided by the method for each measurement, and it was shown that about the 95% of the differences between the CTDI measurements with radiochromic films and with the ionization chamber were below the estimated 2 σ uncertainty, for both scanners. After an accurate calibration procedure and the consideration of the uncertainty associated with the measurement, Gafchromic® XR-QA films can be used to evaluate the CTDI.

The purpose of this study was to compare exposure of patient and operator to ionising radiation during percutaneous vertebroplasty performed under combined computed tomography (CT) and fluoroscopic guidance or fluoroscopic guidance alone.With the collaboration of our physics department, we measured exposure on ten patients undergoing vertebroplasty with combined CT and fluoroscopic guidance and on ten undergoing vertebroplasty with fluoroscopic guidance alone.Mean operator dose was approximately 0.8 microSv during vertebroplasty done with combined CT and fluoroscopic guidance and 5.8 microSv in procedures with fluoroscopic guidance alone. Mean patient dose was approximately 6 mSv for combined guidance and 8 mSv for fluoroscopic guidance, a difference that was not found to be statistically significant.Although combined CT and fluoroscopic guidance is normally preferred for difficult areas such as the cervical and upper thoracic vertebrae, to ensure operator radiation protection, the technique should also be considered for areas normally treated under fluoroscopic guidance alone. However, a larger patient series is needed to correctly evaluate the real contribution of low-dose CT to patient exposure.

The purpose of this study was to evaluate the radiation dose to patients during radiological contrast studies performed after vertical banded gastroplasty (VBG) or Roux-en-Y gastric bypass (RYGBP) surgery in patients with morbid obesity.Dose evaluations were performed on a sample of 39 patients (32 women and 7 men) with a mean weight of 117 kg (range 68-175 kg) and a mean body mass index (BMI) of 43.7 (range 22.2-54.9). Between the second and seventh postoperative day, patients underwent radiological follow-up after oral administration of approximately 70 ml of water-soluble iodinated contrast material (Gastrografin) and images acquired in anteroposterior, right and left oblique projections with the patient upright and then supine. Exposure conditions, dose-area product (DAP) and entrance skin dose (ESD) were recorded for each procedure. On the basis of these data, the effective dose (ED) was calculated using simulation software based on the Monte Carlo method for determining the absorbed dose to organs. To assess the optimal exposure conditions and the dose contributions of fluoroscopy and radiography, the effective dose rates were also evaluated using Plexiglas phantoms of different thickness to simulate different patient sizes.The phantom measurements showed a fourfold dose increase when passing from normal-sized patients to obese patients. Mean DAP value obtained from in-vivo measurements was 70 Gy cm(2) (range 17-147 Gy cm(2)), and mean effective dose was 21 mSv (range 5-45 mSv).When performing radiological contrast studies in patients with morbid obesity, every possible precaution should be taken to minimise patient dose. Special care should be taken to evaluate justification of the radiological procedure.

This study was undertaken to evaluate patient dose in paediatric liver transplant recipients treated by percutaneous biliary drainage and bilioplasty procedures.Effective dose rates and entrance skin-dose (ESD) rates per minute of fluoroscopy were measured by using a plexiglas phantom (thickness 10 cm) simulating the patient and by varying the exposure parameters (type of pulsed fluoroscopy, image intensifier diameter, presence of diaphragms) to identify the technique delivering the lowest patient dose. In vivo measurements were performed during three interventional procedures.The effective dose rate proved to be lowest for a particular type of pulsed fluoroscopy, with maximum magnification and with field-limiting diaphragms. The in vivo measurements showed a maximum ESD value of around 50 MGY (the threshold for transient erythema is 2,000 MGY, ICRP 60). The effective dose values were in the range of 0.9-1.5 MSV.We established exposure parameters providing the desired image quality with the lowest dose for the equipment used and for a specific type of interventional procedure. The measured ESD values allow us to exclude the risk of deterministic effects on the skin. The effective dose values and considerations regarding the likelihood of radiation-induced cancer led to the conclusion that the radiological risk for the patient is largely justified by the benefits of these kinds of procedure.

Introduction The Abdus Salam International Centre for Theoretical Physics (ICTP) and the Trieste University have initiated in 2014 a Master of Advanced Studies in Medical Physics a two-years training programme in Medical Physics. The programme is designated to provide young promising graduates in physics, mainly from developing countries, with a post-graduated theoretical and clinical training suitable to be recognised as Clinical Medical Physicist in their countries. Presently, the 3 cycles of the programme has seen 49 participants from 33 Countries: Africa (19), Asia (11), Central and South America (14), and Europe (5), selected from more than 400 applicants per year. Scholarships are awarded to candidates from developing countries with support of the IAEA, TWAS, KFAS, IOMP, EFOMP and ICTP. Material and methods The programme is developed following the recommendations of IOMP and IAEA for education and clinical training. In the first year 332 lectures and 228 h of exercises are devoted to all main fields of medical physics. The second year is spent in one of the 12 medical physics department of the hospitals’ network for the clinical training in: radiation oncology or diagnostic and nuclear medicine, on a programme developed adapting the IAEA (TCS37, TCS47 and TCS50) and AFRA guidelines. Conclusions IOMP, EFOMP and IAEA are seeing this initiative as an answer to the growing demand of Medical Physicists in developing Countries, representing an important European contribution to the development of medical physics in the developing world.

The Abdus Salam International Centre for Theoretical Physics (ICTP) and the Trieste University have initiated in 2014 a Master of Advanced Studies in Medical Physics (www.ictp.it/programmes/mmp.aspx), a two-years training programme in Medical Physics, co- sponsored by the Academy of Sciences for the Developing World (TWAS).

Conventional radiology is performed by means of digital detectors, with various types of technology and different performance in terms of efficiency and image quality. Following the arrival of a new digital detector in a radiology department, all the staff involved should adapt the procedure parameters to the properties of the detector, in order to achieve an optimal result in terms of correct diagnostic information and minimum radiation risks for the patient. The aim of this study was to develop and validate a software capable of simulating a digital X-ray imaging system, using graphics processing unit computing. All radiological image components were implemented in this application: an X-ray tube with primary beam, a virtual patient, noise, scatter radiation, a grid and a digital detector. Three different digital detectors (two digital radiography and a computed radiography systems) were implemented. In order to validate the software, we carried out a quantitative comparison of geometrical and anthropomorphic phantom simulated images with those acquired. In terms of average pixel values, the maximum differences were below 15%, while the noise values were in agreement with a maximum difference of 20%. The relative trends of contrast to noise ratio versus beam energy and intensity were well simulated. Total calculation times were below 3 seconds for clinical images with pixel size of actual dimensions less than 0.2 mm. The application proved to be efficient and realistic. Short calculation times and the accuracy of the results obtained make this software a useful tool for training operators and dose optimisation studies.

The purpose of this paper is to describe the automation of quality control procedures on photo-stimulable imaging plates by means of an image-processing tool providing automatic reading of the images and automatic calculation of the quality parameters monitored.Quality-control procedures were performed according to the main available guidelines. The quality assurance programme was applied to several Kodak and Philips devices in four radiological departments. The automatic image-processing tool was developed using public domain software (Java-based ImageJ software) and contains both reading and computation procedures.The quality checks and algorithms described were successfully applied, proving useful for identification of defective plates and for implementation of the quality assurance programme. The use of automation allowed significant savings in the time required for quality checks.Completely automated image reading allows substantial economic and human resources savings, as it eliminates much of the transfer, reproduction, processing and filing procedures.

Quality controls for testing the performance of computed radiography (CR) systems have been recommended by manufacturers and medical physicists' organizations. The purpose of this work was to develop a set of image processing tools for quantitative assessment of computed radiography quality control parameters. Automatic image analysis consisted in detecting phantom details, defining regions of interest and acquiring measurements. The tested performance characteristics included dark noise, uniformity, exposure calibration, linearity, low-contrast and spatial resolution, spatial accuracy, laser beam function and erasure thoroughness. CR devices from two major manufacturers were evaluated. We investigated several approaches to quantify the detector response uniformity. We developed methods to characterize the spatial accuracy and resolution properties across the entire image area, based on the Fourier analysis of the image of a fine wire mesh. The implemented methods were sensitive to local blurring and allowed us to detect a local distortion of 4% or greater in any part of an imaging plate. The obtained results showed that the developed image processing tools allow us to implement a quality control program for CR with short processing time and with absence of subjectivity in the evaluation of the parameters.

Due to the rapid increase of the number of computed tomography examinations for dental purposes we are facing the problem of dose reduction without loss of image quality. The purpose of this work is to investigate the image quality variation in relation to scan parameters that affect dose. Subjective evaluations and quantitative measurements of image quality indices were performed on images obtained from geometrical and anatomical phantoms. Obtained results agree on the possibility of a significant dose reduction maintaining a diagnostic image quality.

Interventional neuroradiology can involve very high entrance skin doses to patients and has the potential to induce deterministic radiation effects to the skin. A monitoring system indicating the maximum entrance skin dose during procedures could be useful to avoid skin injuries and to optimize technical parameters. Such evaluation is difficult, because exposure conditions change many times during each procedure. A data acquisition system for real time estimation of patient dose was developed, using a transmission ionization chamber connected to a personal computer, simultaneously measuring air kerma and dose area product. Input data were processed by a software that provided a map of entrance skin dose and stored all the information in a database. The method was first applied during 16 interventional procedures and was found to be suitable to this application thanks to the short time necessary for dose measurements, simplicity of use and absence of interference with the procedure execution. The uncertainty of estimation of maximum entrance skin dose was evaluated to be about 20% at the 1 sigma level.

Dental CT dose evaluations are commonly performed using thermoluminescent dosimeters (TLD) inside anthropomorphic phantoms. Radiochromic films with good sensitivity in the X-ray diagnostic field have recently been developed and are commercially available as GAFCHROMIC XR-QA. There are potential advantages in the use of radiochromic films such as a more comprehensive dosimetry thanks to the adjustable size of the film samples. The purpose of this study was to investigate the feasibility of using radiochromic films for dental CT dose evaluations. Film samples were cut with a width of 5mm and a length of 25 mm (strips), the same size as the Alderson Rando anthropomorphic phantom holes used in this study. Dental CT dose measurements were performed using simultaneously both TLD and radiochromic strips in the same phantom sites. Two equipment types were considered for dental CT examinations: a 16 slice CT and a cone beam CT. Organ equivalent doses were then obtained averaging the measurements from the sites of the same organ and effective doses were calculated using ICRP 103 weighting factors. The entire procedure was repeated four times for each CT in order to compare also the repeatability of the two dosimeter types. A linear correlation was found between the absorbed dose evaluated with radiochromic films and with TLD, with slopes of 0.930 and 0.944 (correlation r>0.99). The maximum difference between the two dosimeter's measurements was 25%, whereas the average difference was 7%. The measurement repeatability was comparable for the two dosimeters at cumulative doses above 15 mGy (estimated uncertainty at 1 sigma level of about 5%), whereas below this threshold radiochromic films show a greater dispersion of data, of about 10% at 1 sigma level. We obtained, using respectively Gafchromic and TLD measurements, effective dose values of 107 μSv and 117 μSv (i.e. difference of 8.6%) for the cone beam CT and of 523 μSv and 562 μSv (i.e. difference of 7%) for the multislice CT. This study demonstrates the feasibility of radiochromic films for dental CT dosimetry, pointing out a good agreement with the results obtained using TLD, with potential advantages and the chance of a more extensive dose investigation.

Gafchromic XR-QA films were developed for patient dosimetry in diagnostic radiology. A possible application of these films is the measurement of doses in computed tomography. In this study a method to evaluate the CTDI using Gafchromic XR-QA film and a flatbed scanner was developed and tested. Film samples were cut to dimensions of 6 x 170 mm2 in order to have an integration area similar to that of a pencil ionization chamber, with the possibility of changing the integration length. Prior to exposing these films to a computed tomography beam, the angular dependence of the film dose response was investigated by exposing film strips to a static x-ray beam at different angles in the range 0 degrees-180 degrees. A difference of 49% was found between the response with the axis beam parallel to the film surface (90 degrees) and with the axis beam perpendicular (0 degrees and 180 degrees). Integrating over a 360 degrees exposure like the one in computed tomography, a difference of less than 2% was estimated, which is comparable with the measurement error obtainable with XR-QA film. A calibration with a CT beam in the scout mode was performed and film strips were then exposed to single axial scans and to helical scans both in air and in phantoms. Two different types of flatbed scanners were used to read the film samples, a Microtek ScanMaker 9800XL scanner and an Epson Expression 10000 XL scanner, and the accuracy of the results were compared. For beam collimations above 10 mm differences between CTDI measured by film and CTDI measured by ionization chamber below 9% were found for the Epson scanner, with an average estimated error at 1 sigma level of 5%. For the Microtek scanner and for the same film samples, differences below 11% with an average error at 1 sigma level of 8% were founded. The 1 sigma uncertainty of the measured CTDI was provided by the method for each measurement, and it was shown that about the 95% of the differences between the CTDI measurements with radiochromic films and with the ionization chamber were below the estimated 2 sigma uncertainty, for both scanners. After an accurate calibration procedure and the consideration of the uncertainty associated with the measurement, Gafchromic XR-QA films can be used to evaluate the CTDI.

The purpose of this work was to evaluate the statistical distribution of patient dose for different examinations by using the data stored in a DICOM image archive of a direct digital radiography system. An automatic procedure to extract dose data and exposure parameters from the image archives was implemented. During a 4.5-month period, 8,292 images were collected. Exposure parameters and the air kerma area product (P KA) stored in the image DICOM header were examined for each image. The entrance surface air kerma (K a,e), a quantity comparable to the current diagnostic reference levels (DRL), was estimated considering the P KA and the geometric parameters of each examination. P KA and K a,e distributions showed highly variable values. The obtained K a,e values were substantially lower than the DRL. DRL were more than six times the mean value of K a,e distribution for the abdomen anteroposterior (AP) and lumbar spine lateral (LAT) projections, whereas the ratio was equal to 2.7 for posteroanterior (PA) chest examinations. The method adopted proved to be effective for characterising the dose of each examination by means of the statistical analysis of the dose quantities over extensive samples. The dose values obtained and the comparison with the DRL showed that this radiographic device allows substantial dose savings compared with estimations made for nondigital or for phosphor-based systems.

Gafchromic® XR-R films are a useful tool to evaluate entrance skin dose in interventional radiology. Another dosimetric quantity of interest in diagnostic and interventional radiology is the dose area product (DAP). In this study, a method to evaluate DAP using Gafchromic® XR-R films and a flat-bed scanner was developed and tested. Film samples were exposed to an x-ray beam of 80 kVp over a dose range of 0–10 Gy. DAP measurements with films were obtained from the digitalization of a film sample positioned over the x-ray beam window during the exposure. DAP values obtained with this method were compared for 23 cardiological interventional procedures with DAP values displayed by the equipment. The overall one-sigma dose measurement uncertainty depended on the absorbed dose, with values below 6% for doses above 1 Gy. A maximum discrepancy of 16% was found, which is of the order of the differences in the DAP measurements that may occur with different calibration procedures. Based on the results presented, after an accurate calibration procedure and a thorough inspection of the relationship between the actual dose and the direct measured quantity (net optical density or net pixel value variation), Gafchromic® XR-R films can be used to assess the DAP.

There is a growing interest in Gafchromic films for patient dosimetry in radiotherapy and in radiology. A new model (XR-QA) with high sensitivity to low dose was tested in this study. The response of the film to different x-ray beam energies (range 28-145 kVp with various filtrations, dose range 0-100 mGy) and to visible light was investigated, together with the after exposure darkening properties. Exposed films were digitized with a commercially available, optical flatbed scanner. A single functional form for dose versus net pixel value variation has been determined for all the obtained calibration curves, with a unique fit parameter different for each of the used x-ray beams. The film response was dependent on beam energy, with higher colour variations for the beams in the range 80-140 kVp. Different sources of uncertainties in dose measurements, governed by the digitalization process, the film response uniformity and the calibration curve fit procedure, have been considered. The overall one-sigma dose measurement uncertainty depended on the beam energy and decreased with increasing absorbed dose. For doses above 10 mGy and beam energies in the range 80-140 kVp the total uncertainty was less than 5%, whereas for the 28 kVp beam the total uncertainty at 10 mGy was about 10%. The post-exposure colour variation was not negligible in the first 24 h after the exposure, with a consequent increase in the calculated dose of about 10%. Results of the analysis of the sensitivity to visible light indicated that a short exposure of this film to ambient and scanner light during the measurements will not have a significant impact on the radiation dosimetry.

Dose estimation in interventional neuroradiology can be useful to limit skin radiation injuries. The purpose of this study was to evaluate the role of entrance skin dose (ESD) maps in planning exposure condition optimisation. Thirteen cerebral angiography and five embolisation procedures were monitored, measuring ESD, dose‐area product (DAP) and other operational parameters. A transmission ionisation chamber, simultaneously measuring air kerma and DAP, measured dose-related quantities. Data acquisition software collected dosimetric and geometrical data during the interventional procedure and provided a distribution map of ESD on a standard phantom digital image, with maximum value estimation. Values of 88‐ 1710 mGy for maximum skin dose and 16.7‐343 Gy cm 2 for DAP were found. These data confirm the possibility of deterministic effects during therapeutic interventional neuroradiological procedures like cerebral embolisation. ESD maps are useful to retrospectively study the exposure characteristics of a procedure and plan patient exposure optimisation.

The use of functional magnetic resonance imaging (fMRI) for clinical applications and basic neuroscience is constantly increasing. The discussion about minimum performance requirement for a correct implementation of fMRI is still open, and one of the critical points is the magnetic field strength. We tested the feasibility of fMRI at 1.0 T during motor and cognitive tasks. Fourteen healthy subjects were scanned during a motor task and 12 while performing the Tower of London task. In the activated areas, the percentage signal change due to BOLD (blood oxygenation level dependent) contrast was analysed. To check basic image quality of the acquisition system we measured quality indices in a temporal series of images of a phantom. Motor and cognitive brain activations matched previous results obtained at higher field strengths. The mean percentage change over subjects in the motor task was in the range 1.3–2.6% for the primary motor area and 0.8–6.7% for the cerebellum. In the cognitive task, the mean percentage change over subjects was 0.7–1.2% for a frontal area and 0.6–2.8% for a parietal area. The percentage noise of the phantom temporal series was less than 0.4%. Percentage changes and signal to noise ratio, although lower than that obtained with high-field systems, allowed activation maps to be obtained in all subjects. Our results replicate previous fMRI results demonstrating reproducible motor-related brain activations and extend the field to a complex cognitive task, thus providing evidence of the safety for routine clinical use of 1-T equipment.

The National Radiological Protection Board has recommended the introduction of dose-width product (DWP) for the measurement of patient dose in panoramic dental radiology. The present work describes a method for measuring DWP using a pencil ionization chamber. The technique was tested on five panoramic dental units; the reproducibility of the method was 5.7%. In order to test the method, DWP was also assessed using thermoluminescent dosemeters and film. The results obtained agreed within 8.6% with those obtained using the pencil ionization chamber method. The proposed method appears to be simple and precise.

Aims and Background Peritumoral injection of 99mTc-labeled colloids for lymphoscintigraphy and radioguided surgery does not entail any relevant radiation burden to the patients. The real issue about radiation protection concerns the personnel involved in the procedure besides the nuclear medicine personnel. The aim of our study was to evaluate the cumulative doses to personnel involved during the injection of radiolabeled compounds under ultrasound or stereotactic guidance and the radiation burden to the personnel involved in the surgical incision of the tumor 24 hours after the administration of 99mTc-labeled colloids. Methods and Study Design We performed environmental contamination tests (SMEAR TEST) and exposure evaluation in the operating room. Results In the operating room the removed activity in the analyzed samples was less than 0.5Bq/g and exposure to the personnel was less than 6μSv/h. The evaluations made during ultrasound guidance demonstrated an equivalent and effective dose less than 20μSv. Conclusions Our results show that during ultrasound or stereotactic administration of radiolabeled compounds the radiation burden to the personnel involved in the procedure is virtually negligible. The surgeons too are exposed to a negligible radiation dose.

To verify the suitability of indicative quantities to evaluate the risk related to patient exposure, in abdominal and vascular interventional radiology, by the study of correlations between dosimetric quantities and other indicators.We performed in vivo measurements of entrance skin dose (ESD) and dose area product (DAP) during 48 procedures to evaluate the correlation among dosimetric quantities, and an estimation of spatial distribution of exposure and effective dose (E). To measure DAP we used a transmission ionization chamber and to evaluate ESD and its spatial distribution we used radiographic film packed in a single envelope and placed near the patient's skin. E was estimated by a calculation software using data from film digitalisation.From the data derived for measurements in 27 interventional procedures on 48 patients we obtained a DAP to E conversion factor of 0.15 mSv / Gy cm2, with an excellent correlation (r=.99). We also found a good correlation between DAP and exposure parameters such as fluoroscopy time and number of images. The greatest effective dose was evaluated for a multiple procedure in the hepatic region, with a DAP value of 425 Gy cm2. The greatest ESD was about 550 mGy. For groups of patients undergoing similar interventional procedures the correlation between ESD and DAP had conversion factors from 6 to 12 mGy Gy-1 cm-2.The evaluation of ESD and E by slow films represents a valid method for patient dosimetry in interventional radiology. The good correlation between DAP and fluoroscopy time and number of images confirm the suitability of these indicators as basic dosimetric information. All the ESD values found are lower than threshold doses for deterministic effects.

Heavy alcohol intake and/or lipotrope-deficient diet induced hepatocellular injury and mesangial deposition of IgA and often IgG in Lewis rats. The experimental animals showing more severe urinary abnormalities and histologic damage in the glomeruli had increased levels of IgA antibodies to dietary antigens and altered intestinal permeability. Based on human studies, the prolonged circulation of IgA-containing complexes associated with the liver disease could be envisaged as important for the development of mesangial IgA deposits. In order to verify this hypothesis, four groups (G) of Lewis rats were studied: G1 received thrice a weak an intragastric infusion of 1.5 ml/100 g body wt of whiskey; G2 rats were nourished with lipotrope-deficient diet; G3 rats were given both whiskey and LD diet; G4 rats were nourished with regular chow. After 12 weeks, heat-aggregated rat monomeric IgA was labeled with 133I and intravenously injected. Three control subgroups of rats, one given whiskey, one nourished with LD diet, and one with regular chow, were injected with radiolabeled heat-aggregated rat IgG. A large field-of-view digital gamma camera, equipped with an ultra-high-resolution collimator and interfaced to a dedicated computer, was used to analyze tracer kinetics and fate. The liver was the main organ involved in clearance of both test probes. The hepatic mean transit (MTT) was 11.4 +/- 11 min in G1 (proteinuria of 6.9 +/- 1.41 mg/day and hematuria +/+2), 221 +/- 19 min in G2 (proteinuria 9.1 +/- 0.64 mg/day and hematuria +2/+3), and 230 +/- 15 min in G3 (proteinuria 9.5 +/- 0.58 mg/day and hematuria +2/+3). In each case MTT value was found to be significantly prolonged compared to G4 (85 +/- 4 min). The multiple regression analysis showed that MTT values, proteinuria, and hematuria were significantly correlated (P < 0.01). Controls had trace amount proteinuria (0.82 +/- 0.17 mg/day, significantly lower than for each study group, P < 0.08) and undetectable hematuria. Similar results were obtained in control rats injected with aggregated IgG; i.e., MTT values were more prolonged in rats given whiskey or LD diet than normally nourished rats (P < 0.01). The lipotrope-deficient diet and the chronic alcohol abuse per se seem to lead to critical changes in hepatic uptake and catabolism of both an IgA and an IgG aggregate, which could account in turn for the reported appearance of renal immunoglobulin deposits in this experimental model. Due to the comparable delay in removal of IgA and IgG probes in equally nourished animals, additional factors are likely to be involved in the prominent deposition of IgA.

Pathophysiological changes in ureteral kinetics can be monitored externally and non-invasively by means of a time-space matrix approach during the excretory phase of fast-frame routine renography. The main limitations of this method are poor space-time resolution and, in some cases, an inadequate visualization of the peristaltic waves. A new approach to the study of ureteral contractions using the power spectrum obtained from Fourier transforms of the ureteral time-activity curves was developed. The FORTRAN program was tested by an experimental simulation, and its subsequent application on fifty-one subjects indicated that the method is a useful complement to the space-time matrix technique. Moreover, evaluation of the power spectrum offers several advantages for the study of the pathophysiological parameters of peristalsis.

The charge collected in the depletion region of a charge coupled device (CCD) owing to the passage of low energy beta-particles is exploited in order to obtain localized information of the hits distribution from exposure to radioactively labelled test patterns. An image field of 8.64×5.82 mm2 is stored as a matrix of 290×218 pixels each represented by an 8 bit word. Factors governing system performance are analyzed and compared with conventional autoradiography.