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Biomedical subjects

C L Chapple

Publications and source records attributed to C L Chapple.

16 recordsLinked to original sources
PubMed2003

Is patient size important in dose determination and optimization in cardiology?

Patient dose determination and optimization have become more topical in recent years with the implementation of the Medical Exposures Directive into national legislation, the Ionising Radiation (Medical Exposure) Regulations. This legislation incorporates a requirement for new equipment to provide a means of displaying a measure of patient exposure and introduces the concept of diagnostic reference levels. It is normally assumed that patient dose is governed largely by patient size; however, in cardiology, where procedures are often very complex, the significance of patient size is less well understood. This study considers over 9000 cardiology procedures, undertaken throughout the north of England, and investigates the relationship between patient size and dose. It uses simple linear regression to calculate both correlation coefficients and significance levels for data sorted by both room and individual clinician for the four most common examinations, left ventrical and/or coronary angiography, single vessel stent insertion and single vessel angioplasty. This paper concludes that the correlation between patient size and dose is weak for the procedures considered. It also illustrates the use of an existing method for removing the effect of patient size from dose survey data. This allows typical doses and, therefore, reference levels to be defined for the purposes of dose optimization.

Body Constitution↗
PubMed2002

Effective dose in paediatric computed tomography.

There is limited data currently available for making dose and risk assessments for paediatric patients undergoing computed tomographic examination. A method has been developed to correlate the risk-related quantity, effective dose, to the more simply derived quantity dose-length product. This involved scanning a series of paediatric anthropomorphic phantoms containing thermoluminescent dosimeters to measure effective dose for scans of various anatomic regions. The quantity effective dose per dose-length product was calculated and plotted as a function of patient size. This showed a simple exponential relationship, and equations of fit were derived to enable the calculation of effective dose for a patient of any size. Measurements carried out on a second scanner and for alternative scan volumes indicated that the method could be generally utilized.

Adolescent↗
PubMed2000

Diagnostic reference levels in interventional radiology.

Following the release of European Directive EU 97/43, radiodiagnostic facilities within the European Union are required to implement a system of patient dose reviews based on comparisons with European, national and local diagnostic reference levels (DRLs). Establishing these levels for typical interventional radiology examinations presents a problem as definition of 'typical' examinations can be difficult, patient numbers are limited and these procedures are often performed at a few specialist centres. This paper uses dose-area product (DAP) gathered over a period of 3 years from 40 fluoroscopy rooms to investigate potential difficulties when it comes to forming diagnostic reference levels for interventional radiology. Comparison of DAP distributions with standard complex (fluoroscopy based) examinations such as barium enema reveals considerably more variation for interventional procedures. Two methods of forming a DRL are compared: pooled patient DAP distributions versus a distribution of DAP per room. The bootstrap resampling method is then applied to DAP distributions to form a confidence interval for the chosen DRL statistic. Potential error on a DRL formed at a local level from a limited number of patient dose readings and x-ray rooms is significant. The results are reviewed in the wider context of DRLs in general radiology. For complex examinations, it is suggested that the function of the DRL is best served by setting DRLs based on pooled size-corrected patient DAP distributions rather than distributions of average DAP per room.

Dose-Response Relationship, Radiation↗
PubMed1999

Case-control study of the pathogenesis and sequelae of symptomatic vertebral fractures in men.

To investigate the pathogenesis and sequelae of symptomatic vertebral fractures (VF) in men, we have performed a case-control study, comparing 91 men with VF (median age 64 years, range 27-79 years) with 91 age-matched control subjects. Medical history, clinical examination and investigations were performed in all patients and control subjects, to identify potential causes of secondary osteoporosis, together with bone mineral density (BMD) measurements. BMD was lower at the lumbar spine and all sites in the hip in patients with VF than in control subjects (p < 0.001). Potential underlying causes of secondary osteoporosis were found in 41% of men with VF, compared with 9% of control subjects (OR 7.1; 95% CI 3.1-16.4). Oral corticosteroid and anti-convulsant treatment were both associated with a significantly increased risk of VF (OR 6.1; 95% CI 1.3-28.4). Although hypogonadism was not associated with an increased risk of fracture, the level of sex hormone binding globulin was higher (p < 0.001) and the free androgen index lower (p < 0.001) in men with VF than control subjects. Other factors associated with a significantly increased risk of VF were family history of bone disease (OR 6.1; 95% CI 1.3-28.4), current smoking (OR 2.8; 95% CI 1.2-6.7) and alcohol consumption of more than 250 g/week (OR 3.8; 95% CI 1.7-8.7). Men with VF were more likely to complain of back pain (p < 0.001) and greater loss of height (p < 0.001) than control subjects, and had poorer (p < 0.001) scores for the energy, pain, emotion, sleep and physical mobility domains of the Nottingham Health Profile. We conclude that symptomatic VF in men are associated with reduced BMD, underlying causes of secondary osteoporosis such as corticosteroid and anti-convulsant treatment, family history of bone disease, current smoking and high alcohol consumption, and that they impair the perceived health of the individual.

Adrenal Cortex Hormones↗
PubMed1997

The impact of cardiology on the collective effective dose in the North of England.

Two cardiology X-ray rooms were monitored with dose-area product meters as part of a Regional Patient Dosimetry Programme. Dose-area product measurements on over 2000 patients undergoing examinations in the cardiology rooms are presented. The data have been corrected according to patient size where possible. In room A mean dose-area product values for coronary angiography, coronary angioplasty, radiofrequency ablation and mitral valvuloplasty were found to be 47.7, 72.2, 91.1 and 161.9 Gy cm2 respectively. In room B mean dose-area product values for coronary angiography and coronary angioplasty were found to be 23.4 and 51.6 Gy cm2 respectively. Observational studies were used to deduce the typical projections and technique factors. This typical examination was used to simulate an angiogram from which it was possible to derive factors to convert measured dose-area product values into estimates of effective dose. In room A, the effective doses were estimated to be 9.4, 14.2, 17.3 and 29.3 mSv for coronary angiography, coronary angioplasty, radiofrequency ablation and mitral valvuloplasty, respectively. The effective doses during coronary angiography and coronary angioplasty, performed in room B, were found to be 4.6 and 10.2 mSv, respectively. A regional survey of the frequency of these cardiac procedures was performed. It was deduced that the annual collective effective dose from these cardiac procedures in the North of England, the former Northern Region, was 45.7 manSv.

Angioplasty↗
PubMed1996

Assessment of effective dose to staff in brachytherapy.

The aim of this paper is to investigate the problem of monitoring effective dose to hospital staff who are involved in the treatment of tumors using sealed sources placed inside the body (brachytherapy). In addition, the use of an unsealed source to treat the thyroid was also considered. Radiation distributions produced by both sealed sources commonly used in brachytherapy (192I, 137Cs, 226Ra) and an unsealed source used in the treatment of the thyroid (131I) were used to irradiate a Rando phantom. The brachytherapy treatments of esophageal and gynecological carcinoma were simulated. The Rando phantom was loaded with lithium fluoride thermoluminescent dosimeters at positions corresponding to a number of radiosensitive organs. Film badges and electronic personal dosimeters were attached to the Rando phantom at various anatomical sites. The Rando phantom was positioned adjacent to the patient at an angle of 90 degrees to the longitudinal axis of the patient. Irradiations were performed with and without a portable lead screen used on the radiotherapy wards. Effective dose was estimated for each simulated radiotherapy treatment and compared with the personal monitor readings. The data were used as a basis for the provision of advice on the wearing of the film badge dosimeters and the design of portable lead screens. The data also permitted a comparison between the two types of dosimeter when used for personal monitoring in brachytherapy.

Brachytherapy↗
PubMed1995

The impact of digital imaging on patient doses during barium studies.

Barium studies performed on 10 digital and four non-digital fluoroscopic systems were monitored with dose-area product meters as part of a Regional Patient Dosimetry Audit programme. The data have been collected using a computer to read and reset the dose-area product meter and also to collect patient and examination details. A comparison of dose-area product measurements from digital and non-digital fluoroscopy units on over 10,000 barium studies is presented. The data have been corrected according to patient size. The mean size corrected dose-area product for a barium meal examination was found to be 7.62 Gy cm2 for a digital set compared with 15.45 Gy cm2 for a non-digital set with 2462 and 1308 patients included in each measurement series, respectively. Dose-area products were also a factor of approximately two lower for barium enema, barium swallow and barium follow-through examinations performed on digital systems.

Barium Sulfate↗
PubMed1995

A phantom based method for deriving typical patient doses from measurements of dose-area product on populations of patients.

One of the chief sources of uncertainty in the comparison of patient dosimetry data is the influence of patient size on dose. Dose has been shown to relate closely to the equivalent diameter of the patient. This concept has been used to derive a prospective, phantom based method for determining size correction factors for measurements of dose-area product. The derivation of the size correction factor has been demonstrated mathematically, and the appropriate factor determined for a number of different X-ray sets. The use of phantom measurements enables the effect of patient size to be isolated from other factors influencing patient dose. The derived factors agree well with those determined retrospectively from patient dose survey data. Size correction factors have been applied to the results of a large scale patient dose survey, and this approach has been compared with the method of selecting patients according to their weight. For large samples of data, mean dose-area product values are independent of the analysis method used. The chief advantage of using size correction factors is that it allows all patient data to be included in a survey, whereas patient selection has been shown to exclude approximately half of all patients. Reduction of the size of the data set may lead to mean dose-area product values that are less reliable indicators of typical practice. The use of size correction factors will be of particular benefit in the analysis of paediatric dosimetry data, where a wide range of sizes exist, even within accepted age bands.

Body Constitution↗
PubMed1994

Energy imparted to neonates during X-ray examinations in a special care baby unit.

Neonates in a special care baby unit may receive a large number of X-rays and their dosimetry is of particular importance. A method of calculating energy imparted to neonates has been developed and a survey carried out in one unit, over a period of 18 months. Entrance dose was calculated from the technique factors used and measurement of tube output. Technique factors were recorded by the radiographer for each exposure taken, and output was measured both with and without an incubator present. Field size was determined by measurements made retrospectively from the radiograph, and a Monte Carlo simulation was used to determine factors for conversion to imparted energy. 119 neonates were included in the survey, and the mean total energy imparted was found to be 0.09 mJ. The maximum value was a factor of nine greater than this. This study also highlighted the potential for dose reduction with regard to better collimation and shielding.

Humans↗
PubMed1993

Radiation doses to paediatric patients undergoing less common radiological procedures involving fluoroscopy.

A semi-automated dosimetry survey has been undertaken to monitor the radiation doses to patients in a paediatric fluoroscopy room. The doses were assessed using large area Diamentor ionization chambers to measure dose x area product, and by means of thermoluminescent dosemeters attached to the patient's skin in various places. Details of patients and examinations were entered into a computer, all information being stored on a data base. Many radiological examinations have been monitored, including renal and jejunal biopsies, nephrostograms, loopograms, tracheograms and fistulograms. Patients included in the study have been divided into three age bands for dose assessment. Radiation doses for different types of examination have been compared, including more common examinations for which data have been previously presented.

Adolescent↗
PubMed1992

Results of a survey of doses to paediatric patients undergoing common radiological examinations.

A survey has been performed to investigate typical radiation dose levels for children undergoing a number of common radiological examinations. Doses have been assessed using a Diamentor ionization chamber to measure dose-area product, and by attaching thermoluminescent dosemeters to the patient's skin to determine entrance and organ doses. The survey has been automated by using a personal computer for data collection and storage. Doses have been monitored for a large number of children, primarily in a dedicated paediatric X-ray room, and the results presented can be used as a baseline for making comparative measurements elsewhere. Entrance skin doses were found to range from 0.3 mGy to 5.7 mGy for radiographic examinations, and values of dose-area product from 3 to 225 cGy cm2. The corresponding dose ranges for fluoroscopic examinations are 7.4-26.2 mGy and 130-1241 cGy cm2.

Adolescent↗
PubMed1990

Automated quality assurance and patient dosimetry in diagnostic radiology.

It has been generally considered that improved methods of quality assurance would reduce the population dose from diagnostic radiology. This paper describes the development of a computerized method of automatically monitoring tube and generator parameters to perform on-line quality assurance, whilst undertaking various patient dosimetry measurements and calculations for each exposure. The method involves interfacing a microcomputer to a microprocessor controlled X-ray generator. Details of the various interfacing methods and modifications to the X-ray unit are given. The instrument enables quality assurance to be performed for every exposure by comparing tube and generator parameters against nominal settings. The software automatically warns the operator of any deviations from accepted limiting values. When a patient is examined, details of the examination and projection are entered into a database. The exposure area product and field size are monitored for each exposure. This data, together with information on tube potential and examination/projection is used to deduce patient entrance skin dose and energy imparted. Doses to individual organs are estimated using normalized organ dose data and a knowledge of tube potential and field size.

Equipment Design↗
PubMed1990

An investigation into the performance of an automated quality assurance and dosimetry system in diagnostic radiology.

A system has been developed to undertake automatic quality assurance and dosimetry for diagnostic radiology examinations. The accuracy and reproducibility of the measurements and calculations made by the system have been investigated in a laboratory study and compared with concurrent measurements of exposure parameters made using standard techniques. In a later set of experiments, doses measured using a RANDO phantom and thermoluminescent dosimeters were compared with those calculated by the automated system. Assessment was carried out over a wide range of exposure factors and for a number of different radiological examinations. It is deduced from the results that exposure parameters can be measured with comparable accuracy to standard techniques, and that the automated system is suitable for performing on-line dosimetry.

Humans↗