Dose Management in Diagnostic Radiology - application of the DICOM imaging standard and a Monte Carlo dose engine for exposure surveillance

Abstract: Ionizing radiation is used in diagnostic radiology with a large contribution to the health of the patients. The regulations to limit the detrimental effects, e.g. cancer induction, are based on recommendations from the International Commission on Radiological Protection (ICRP). Epidemiological evidence for radiation induced cancer is expressed as a function of absorbed dose in the irradiated organs. The committee for Biological Effects of Ionizing Radiation has favored the use of Lifetime Attributable Risk, a risk estimator applicable to individuals exposed in medical applications. The imaging in radiology complies with a technical standard that potentiates the retrieval of exposure information that can be used in optimization of patient exposure. The information can also be used as input in organ dose calculations.The aims were to apply the benefits of the technical image standard to radiation safety management by automated collection and analysis of exposure data and to adapt a Therapy Planning System (TPS) for radiotherapy to calculate dose for a Computed Tomography (CT) machine.An automated workflow for extraction, communication and analysis of exposure data from the image files in the central image archive was defined and implemented at the institution (papers I-II). A source model for Monte Carlo simulation of the CT was developed taking into consideration the energy spectrum of the photons, the spiral movement of the X-ray beam, the beam shaping filter and the tube current modulation (paper III). The source model was used exploring the possibilities to utilize the tissue characterization methods and segmentation tools available in the TPS to devise a strategy to automate organ dose calculations for patients undergoing thorax examinations in a CT (paper IV).The exposure data workflow was finalized showing that the technical standard for images could supply a framework for automated assembly and analysis of the data, supporting the local implementation of optimization. The CT was modeled with regard to its irradiation characteristics with uncertainties in the dose calculations below 4%. Dose calculations with the tissue characterization methods available in the TPS deviated by less than 2% from measurements and a strategy for automation of organ dose calculations was devised that could facilitate individual risk estimates in CT.