Developing nuclear medicine in developing countries: IAEA's possible mission.
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Developing Countries↗
Biomedical subjects
Pedro Andreo
Publications and source records attributed to Pedro Andreo.
IAEA's role in the global management of cancer-focus on upgrading radiotherapy services.
The International Atomic Energy Agency (IAEA) is an intergovernmental organization composed by 138 Member States within the United Nations. It has a mandate to seek to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world. Within the IAEA structure, the Division of Human Health contributes to the enhancement of the capabilities in Member States to address needs related to prevention, diagnosis and treatment of health problems through the development and application of nuclear and radiation techniques within a framework of quality assurance. In view of the increasing cancer incidence rates in developing countries the activities in improving management of cancer have become increasingly important. This review will outline the IAEA's role in cancer management focusing on activities related to improving radiotherapy worldwide.
Humans↗
Electron beam quality correction factors for plane-parallel ionization chambers: Monte Carlo calculations using the PENELOPE system.
Simulations of three plane-parallel ionization chambers have been used to determine directly the chamber- and quality-dependent factors fc,Q, instead of the product (Sw,air p)Q, and kQ,Q0 (or kQ,Q,int) for a broad range of electron beam qualities (4-20 MeV) using divergent monoenergetic beams and phase-space data from two accelerators. An original calculation method has been used which circumvents the weakness of the so far assumed independence between stopping-power ratios and perturbation factors. Very detailed descriptions of the geometry and materials of the chambers have been obtained from the manufacturers, and prepared as input to the PENELOPE 2003 Monte Carlo system using a computer code that includes correlated sampling and particle splitting. Values of the beam quality factors have been determined for the case of an electron reference beam. The calculated values have been compared with those in the IAEA TRS-398 dosimetry protocol and the differences analysed. The results for a NACP-02 chamber show remarkably good agreement with TRS-398 at high electron beam qualities but differ slightly at low energies. Arguments to explain the differences include questioning the undemonstrated assumption that the NACP is a 'perturbation-free' chamber even at very low electron beam energies. Results for Wellhöfer PPC-40 and PPC-05 chambers cannot be compared with data from others for these chambers because no calculations or reliable experimental data exist. It has been found that the results for the PPC-40 are very close to those of a Roos chamber, but the values for the PPC-05 are considerably different from those of a Markus chamber, and rather approach those of a Roos chamber. Results for monoenergetic electrons and accelerator phase-space data have been compared to assess the need for detailed and costly simulations, finding very small differences. This questions the emphasis given in recent years to the use of 'realistic' source data for accurate electron beam dosimetry.
Algorithms↗
Ion beam transport in tissue-like media using the Monte Carlo code SHIELD-HIT.
The development of the Monte Carlo code SHIELD-HIT (heavy ion transport) for the simulation of the transport of protons and heavier ions in tissue-like media is described. The code SHIELD-HIT, a spin-off of SHIELD (available as RSICC CCC-667), extends the transport of hadron cascades from standard targets to that of ions in arbitrary tissue-like materials, taking into account ionization energy-loss straggling and multiple Coulomb scattering effects. The consistency of the results obtained with SHIELD-HIT has been verified against experimental data and other existing Monte Carlo codes (PTRAN, PETRA), as well as with deterministic models for ion transport, comparing depth distributions of energy deposition by protons, 12C and 20Ne ions impinging on water. The SHIELD-HIT code yields distributions consistent with a proper treatment of nuclear inelastic collisions. Energy depositions up to and well beyond the Bragg peak due to nuclear fragmentations are well predicted. Satisfactory agreement is also found with experimental determinations of the number of fragments of a given type, as a function of depth in water, produced by 12C and 14N ions of 670 MeV u(-1), although less favourable agreement is observed for heavier projectiles such as 16O ions of the same energy. The calculated neutron spectra differential in energy and angle produced in a mimic of a Martian rock by irradiation with 12C ions of 290 MeV u(-1) also shows good agreement with experimental data. It is concluded that a careful analysis of stopping power data for different tissues is necessary for radiation therapy applications, since an incorrect estimation of the position of the Bragg peak might lead to a significant deviation from the prescribed dose in small target volumes. The results presented in this study indicate the usefulness of the SHIELD-HIT code for Monte Carlo simulations in the field of light ion radiation therapy.
Algorithms↗
Advances in the determination of absorbed dose to water in clinical high-energy photon and electron beams using ionization chambers.
During the last two decades, absorbed dose to water in clinical photon and electron beams was determined using dosimetry protocols and codes of practice based on radiation metrology standards of air kerma. It is now recommended that clinical reference dosimetry be based on standards of absorbed dose to water. Newer protocols for the dosimetry of radiotherapy beams, based on the use of an ionization chamber calibrated in terms of absorbed dose to water, N(D,w), in a standards laboratory's reference quality beam, have been published by several national or regional scientific societies and international organizations. Since the publication of these protocols multiple theoretical and experimental dosimetry comparisons between the various N(D,w) based recommendations, and between the N(D,w) and the former air kerma (NK) based protocols, have been published. This paper provides a comprehensive review of the dosimetry protocols based on these standards and of the intercomparisons of the different protocols published in the literature, discussing the reasons for the observed discrepancies between them. A summary of the various types of standards of absorbed dose to water, together with an analysis of the uncertainties along the various steps of the dosimetry chain for the two types of formalism, is also included. It is emphasized that the NK-N(D,air) and N(D,w) formalisms have very similar uncertainty when the same criteria are used for both procedures. Arguments are provided in support of the recommendation for a change in reference dosimetry based on standards of absorbed dose to water.
Algorithms↗
Positron flight in human tissues and its influence on PET image spatial resolution.
The influence of the positron distance of flight in various human tissues on the spatial resolution in positron emission tomography (PET) was assessed for positrons from carbon-11, nitrogen-13, oxygen-15, fluorine-18, gallium-68 and rubidium-82. The investigation was performed using the Monte Carlo code PENELOPE to simulate the transport of positrons within human compact bone, adipose, soft and lung tissue. The simulations yielded 3D distributions of annihilation origins that were projected on the image plane in order to assess their impact on PET spatial resolution. The distributions obtained were cusp-shaped with long tails rather than Gaussian shaped, thus making conventional full width at half maximum (FWHM) measures uncertain. The full width at 20% of the maximum amplitude (FW20M) of the annihilation distributions yielded more appropriate values for root mean square addition of spatial resolution loss components. Large differences in spatial resolution losses due to the positron flight in various human tissues were found for the selected radionuclides. The contribution to image blur was found to be up to three times larger in lung tissue than in soft tissue or fat and five times larger than in bone tissue. For (18)F, the spatial resolution losses were 0.54 mm in soft tissue and 1.52 mm in lung tissue, compared with 4.10 and 10.5 mm, respectively, for (82)Rb. With lung tissue as a possible exception, the image blur due to the positron flight in all human tissues has a minor impact as long as PET cameras with a spatial resolution of 5-7 mm are used in combination with (18)F-labelled radiopharmaceuticals. However, when ultra-high spatial resolution PET cameras, with 3-4 mm spatial resolution, are applied, especially in combination with other radionuclides, the positron flight may enter as a limiting factor for the total PET spatial resolution--particularly in lung tissue.
Adipose Tissue↗
The IAEA/WHO TLD postal dose quality audits for radiotherapy: a perspective of dosimetry practices at hospitals in developing countries.
BACKGROUND AND PURPOSE: The IAEA/WHO TLD postal programme for external audits of the calibration of high-energy photon beams used in radiotherapy has been in operation since 1969. This work presents a survey of the 1317 TLD audits carried out during 1998-2001. The TLD results are discussed from the perspective of the dosimetry practices in hospitals in developing countries, based on the information provided by the participants in their TLD data sheets. MATERIALS AND METHODS: A detailed analysis of the TLD data sheets is systematically performed at the IAEA. It helps to trace the source of any discrepancy between the TLD measured dose and the user stated dose, and also provides information on equipment, dosimetry procedures and the use of codes of practice in the countries participating in the IAEA/WHO TLD audits. RESULT: The TLD results are within the 5% acceptance limit for 84% of the participants. The results for accelerator beams are typically better than for Co-60 units. Approximately 75% of participants reported dosimetry data, including details on their procedure for dose determination from ionisation chamber measurements. For the remaining 25% of hospitals, who did not submit these data, the results are poorer than the global TLD results. Most hospitals have Farmer type ionisation chambers calibrated in terms of air kerma by a standards laboratory. Less than 10% of the hospitals use new codes of practice based on standards of absorbed dose to water. CONCLUSION: Despite the differences in dosimetry equipment, traceability to different standards laboratories and uncertainties arising from the use of various dosimetry codes of practice, the determination of absorbed dose to water for photon beams typically agrees within 2% among hospitals. Correct implementation of any of the dosimetry protocols should ensure that significant errors in dosimetry are avoided.
Calibration↗
Protocols for the dosimetry of high-energy photon and electron beams: a comparison of the IAEA TRS-398 and previous international codes of practice. International Atomic Energy Agency.
A new international Code of Practice for radiotherapy dosimetry co-sponsored by several international organizations has been published by the IAEA, TRS-398. It is based on standards of absorbed dose to water, whereas previous protocols (TRS-381 and TRS-277) were based on air kerma standards. To estimate the changes in beam calibration caused by the introduction of TRS-398, a detailed experimental comparison of the dose determination in reference conditions in high-energy photon and electron beams has been made using the different IAEA protocols. A summary of the formulation and reference conditions in the various Codes of Practice, as well as of their basic data, is presented first. Accurate measurements have been made in 25 photon and electron beams from 10 clinical accelerators using 12 different cylindrical and plane-parallel chambers, and dose ratios under different conditions of TRS-398 to the other protocols determined. A strict step-by-step checklist was followed by the two participating clinical institutions to ascertain that the resulting calculations agreed within tenths of a per cent. The maximum differences found between TRS-398 and the previous Codes of Practice TRS-277 (2nd edn) and TRS-381 are of the order of 1.5-2.0%. TRS-398 yields absorbed doses larger than the previous protocols, around 1.0% for photons (TRS-277) and for electrons (TRS-381 and TRS-277) when plane-parallel chambers are cross-calibrated. For the Markus chamber, results show a very large variation, although a fortuitous cancellation of the old stopping powers with the ND,w/NK ratios makes the overall discrepancy between TRS-398 and TRS-277 in this case smaller than for well-guarded plane-parallel chambers. Chambers of the Roos-type with a 60Co ND,w calibration yield the maximum discrepancy in absorbed dose, which varies between 1.0% and 1.5% for TRS-381 and between 1.5% and 2.0% for TRS-277. Photon beam calibrations using directly measured or calculated TPR20,10 from a percentage dose data at SSD = 100 cm were found to be indistinguishable. Considering that approximately 0.8% of the differences between TRS-398 and the NK-based protocols are caused by the change to the new type of standards, the remaining difference in absolute dose is due either to a close similarity in basic data or to a fortuitous cancellation of the discrepancies in data and type of chamber calibration. It is emphasized that the NK-ND,air and ND,w formalisms have very similar uncertainty when the same criteria are used for both procedures. Arguments are provided in support of the recommendation for a change in reference dosimetry based on standards of absorbed dose to water.
Air↗
Performance analysis and determination of the p(wall) correction factor for 60Co gamma-ray beams for Wellhöfer Roos-type plane-parallel chambers.
The wall perturbation correction factor p(wall) in 60Co for Wellhöfer Roos-type plane-parallel ionization chambers is determined experimentally and compared with the results of a previous study using PTW-Roos chambers (Palm et al 2000 Phys. Med. Biol. 45 971-81). Five ionization chambers of the type Wellhöfer PPC-35 (or its equivalent PPC-40) are used for the analysis. Wall perturbation correction factors are obtained by assuming N(D,air) chamber factors determined by cross-calibration in a high-energy electron and in a 60Co gamma-ray beam to be equal, and by assigning any differences to the wall perturbation factor. The procedure yields a p(wall) value of 1.018 (u(c) = 0.010), which is slightly higher than the value 1.014 (u(c) = 0.010) formerly obtained for the PTW-Roos chambers using the N(D,air) method. The chamber-to-chamber variation in p(wall) for the Wellhöfer-Roos chambers is found to be very small, with a maximum difference of 0.3%. The effect of using new p(cav) values for graphite-walled Farmer-type chambers used in water in electron beams is to decrease p(wall) by approximately 0.5%. The long- and short-term stability of the Roos-type chambers manufactured by Wellhöfer is investigated by measurements at the IAEA Dosimetry Laboratory in Vienna, Austria, and at the Sahlgrenska University Hospital in Göteborg, Sweden. Calibrations made at the IAEA over several months show variations in the N(D,w) calibration factors larger than expected. based on previous experiences with PTW-Roos chambers. Measurements of the short-term stability of the Wellhöfer-Roos chambers show a marked increase in chamber response for the time the chambers are immersed in water, pointing to a possible problem in the chamber design. As a consequence of these findings, Wellhöfer is currently working on a re-design of the chamber to solve the stability problem.
Biophysical Phenomena↗
Secondary particle production in tissue-like and shielding materials for light and heavy ions calculated with the Monte-Carlo code SHIELD-HIT.
The Monte Carlo code SHIELD has been modified into a version named SHIELD-HIT which extends the transport of hadron cascades in shielding materials to that of ions in tissue-like materials, and includes ion energy-loss straggling, multiple scattering, track-length calculations and production of secondary particles, which includes all generations, for ion interactions with the media. Calculations using SHIELD-HIT have been performed for 1H, 12C and 26Fe ions with energies up to 1000 MeV/u transported through water, soft tissue and aluminium. These have been validated by comparing Monte Carlo results with experimental data and results from other Monte Carlo codes for ion transport. Good agreement has been found for depth-dose distributions of protons and 12C ions in water up to depths well beyond the Bragg peak, where nuclear fragmentation effects dominate and for the production of secondary particles at different depths. Detailed track-length fluence spectra of secondary particles have been calculated for various combinations of projectiles and targets of interest for space radiation and radiotherapy applications. The secondary particle spectra in water from carbon ions have been used for calculations of stopping-power ratios for ionization chamber dosimetry, confirming the values recommended by the IAEA Code of Practice for radiotherapy dosimetry with heavy ions.
Carbon↗