Organ dose determination in X-ray imaging

Organ dose is the absorbed radiation energy from ionizing radiation to an organ, divided by the organ mass. Organ doses of a patient cannot be measured directly in the patient, but their determination requires dose measurements in anthropomorphic patient models i.e. phantoms or Monte Carlo simulations. Monte Carlo simulations can be performed for example by using computational phantoms or patient s computed tomography (CT) images. Organ doses can be estimated based on measurable dose quantities, such as air kerma, kerma-area product and volume-weighted CT dose index, by using suitable conversion coefficients. Conversion coefficient is the organ dose divided by the measured or calculated examination-specific dose quantity. According to the current knowledge, the probability of radiation induced stochastic effects, which include cancer risk and risk of hereditary effects, increases linearly as a function of the radiation dose. The organ dose is a better quantity for estimating the patient specific risk than the effective dose, which is meant to be used only for populations, and it does not consider patient age or gender. Moreover, the tissue weighting factors that are used in the effective dose calculation are based on whole body irradiations, but in X-ray examinations only a part of the patient is exposed to radiation. The phantoms used in medical dosimetry are either computational or physical, and computational phantoms are further divided into mathematical and voxel phantoms. Phantoms from simplified to as realistic as possible have been developed to simulate different targets, but the organ doses determined based on them can differ largely from the real organ doses of the patient. There are also standard and reference phantoms in use, which offer a dose estimate to a so called average patient. Due to the considerable variation within patient anatomies, the real dose might differ from the dose to a standard or reference phantom. The aim of this thesis was to determine organ doses based on dose measurements and Monte Carlo simulations in four X-ray imaging modalities, including general radiography, CT, mammography and dental radiography. The effect of the patient and phantom thickness and radiation quality on the organ doses in a projection X-ray examination of the thorax was studied via Monte Carlo simulations by using both mathematical phantoms and patient CT images. The effect of the breast thickness on the mean glandular doses (MGDs) was determined based on measurements with phantoms of different thicknesses and collected diagnostic and screening data from patient examinations, and the radiation qualities used in patient and phantom exposures were studied. For fetal dose estimation, fetal dose conversion coefficients were determined based on phantom measurements in CT and dental radiography examinations. Additionally, the effect of lead shields on fetal and breast doses was determined in dental examinations. The difference between Monte Carlo simulated organ doses in patients and mathematical phantoms was large, for the examined organs up to 55% in projection imaging. In mammographic examinations, the difference between MGDs calculated based on collected patient data and phantom measurements was up to 30%. In mammography, patient dose data cannot be replaced by phantom measurements. The properties and limitations of the phantoms must be known when they are used. The estimation of the fetal dose based on conversion coefficients requires understanding about the cases where conversion coefficients are applicable. When used correctly, they provide a method for simple dose estimation, where the application specific dose quantity can be taken into account. The conversion coefficients determined in this thesis can be used to estimate the fetal dose in CT examination based on the volume-weighted CT dose index (CTDIvol), and in dental examinations based on the dose-area product (DAP). In projection imaging, the lung and breast doses decreased as the patient s anterior-posterior thickness increased, but in mammography, the MGDs increased as the compressed breast thickness increased. In CT examinations, the fetal dose remained almost constant in examination where the fetus was totally within the primary radiation beam. When the fetus was outside of the primary beam, the fetal dose increased exponentially with the decreasing distance of the fetus from the scan range. As a function of the half value layer (HVL), the conversion coefficients in the studied projection imaging examination were more convergent than as a function of the tube voltage. The HVL alone describes better the radiation quality than the tube voltage alone, which requires also the definition of the total filtration. In mammography, it is possible to irradiate a phantom and a patient with the same equivalent thickness with different radiation qualities when automatic exposure control is used. Despite the relatively large shielding effect achieved with lead shielding in dental imaging, the fetal dose without lead shielding and the related exposure-induced increase in the risk of childhood cancer death are minimal (less than 10 µGy and 10^-5 %), so there is no need for abdominal shielding. The exposure-induced increase in the risk of breast cancer death is of the same order of magnitude as the increase in the risk of childhood cancer death, so also breast shielding was considered irrelevant. Most important is that a clinically justified dental radiographic examination must never be avoided or postponed due to a pregnancy.

Grantor dc:publisher

Helsingin yliopisto

Year dc:date.issued

2016

Author dc:creator

• Kelaranta, Anna

• fysiikka

Statement dc:rights

• Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.
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Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/10138/166834

OAI record oai:identifier

https://helda.helsinki.fi/server/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Ahelda.helsinki.fi%3A10138%2F166834