The MAX (Male Adult voXel) phantom has been developed from existing segmented images of a male adult body, in order to achieve a representation as close as possible to the anatomical properties of the reference adult male specified by the ICRP. The study describes the adjustments of the soft-tissue organ masses, a new dosimetric model for the skin, a new model for skeletal dosimetry and a computational exposure model based on coupling the MAX phantom with the EGS4 Monte Carlo code. Conversion coefficients between equivalent dose to the red bone marrow as well as effective MAX dose and air-kerma free in air for external photon irradiation from the front and from the back, respectively, are presented and compared with similar data from other human phantoms.

The International Commission on Radiological Protection (ICRP) has created a task group on dose calculations, which, among other objectives, should replace the currently used mathematical MIRD phantoms by voxel phantoms. Voxel phantoms are based on digital images recorded from scanning of real persons by computed tomography or magnetic resonance imaging (MRI). Compared to the mathematical MIRD phantoms, voxel phantoms are true to the natural representations of a human body. Connected to a radiation transport code, voxel phantoms serve as virtual humans for which equivalent dose to organs and tissues from exposure to ionizing radiation can be calculated. The principal database for the construction of the FAX (Female Adult voXel) phantom consisted of 151 CT images recorded from scanning of trunk and head of a female patient, whose body weight and height were close to the corresponding data recommended by the ICRP in Publication 89. All 22 organs and tissues at risk, except for the red bone marrow and the osteogenic cells on the endosteal surface of bone ('bone surface'), have been segmented manually with a technique recently developed at the Departamento de Energia Nuclear of the UFPE in Recife, Brazil. After segmentation the volumes of the organs and tissues have been adjusted to agree with the organ and tissue masses recommended by ICRP for the Reference Adult Female in Publication 89. Comparisons have been made with the organ and tissue masses of the mathematical EVA phantom, as well as with the corresponding data for other female voxel phantoms. The three-dimensional matrix of the segmented images has eventually been connected to the EGS4 Monte Carlo code. Effective dose conversion coefficients have been calculated for exposures to photons, and compared to data determined for the mathematical MIRD-type phantoms, as well as for other voxel phantoms.

The International Commission on Radiological Protection (ICRP) is currently preparing new recommendations which will replace those released in ICRP 1991, 1990 Recommendations of the ICRP ICRP Publication 60 (Oxford: Pergamon). The draft report previews a change for the effective dose with respect to the number of organs and tissues to be included in its calculation. In the future, adipose tissue, connective tissue, the extrathoracic airways, the gall bladder, the heart wall, the lymphatic nodes, the prostate and the salivary glands have to be taken into account for the determination of the effective dose. This study reports on a second segmentation of the recently introduced male adult voxel (MAX) and female adult voxel (FAX) phantoms with regard to the new organs and tissues, but also presents a revised representation of the skeletons, which had not been adjusted to ICRP-based volumes in the first release of the two phantoms.

CALDose_X is a software tool that provides the possibility of calculating incident air kerma (INAK) and entrance surface air kerma (ESAK), two important quantities used in x-ray diagnosis, based on the output of the x-ray equipment. Additionally, the software uses conversion coefficients (CCs) to assess the absorbed dose to organs and tissues of the human body, the effective dose as well as the patient's cancer risk for radiographic examinations. The CCs, ratios between organ or tissue absorbed doses and measurable quantities, have been calculated with the FAX06 and the MAX06 phantoms for 34 projections of 10 commonly performed x-ray examinations, for 40 combinations of tube potential and filtration ranging from 50 to 120 kVcp and from 2.0 to 5.0 mm aluminum, respectively, for various field positions, for 29 selected organs and tissues and simultaneously for the measurable quantities, INAK, ESAK and kerma area product (KAP). Based on the x-ray irradiation parameters defined by the user, CALDose_X shows images of the phantom together with the position of the x-ray beam. By using true to nature voxel phantoms, CALDose_X improves earlier software tools, which were mostly based on mathematical MIRD5-type phantoms, by using a less representative human anatomy.

3D-microCT images of vertebral bodies from three different individuals have been segmented into trabecular bone, bone marrow and bone surface cells (BSC), and then introduced into the spongiosa voxels of the MAX06 and the FAX06 phantoms, in order to calculate the equivalent dose to the red bone marrow (RBM) and the BSC in the marrow cavities of trabecular bone with the EGSnrc Monte Carlo code from whole-body exposure to external photon radiation. The MAX06 and the FAX06 phantoms consist of about 150 million 1.2 mm cubic voxels each, a part of which are spongiosa voxels surrounded by cortical bone. In order to use the segmented 3D-microCT images for skeletal dosimetry, spongiosa voxels in the MAX06 and the FAX06 phantom were replaced at runtime by so-called micro matrices representing segmented trabecular bone, marrow and BSC in 17.65, 30 and 60 microm cubic voxels. The 3D-microCT image-based RBM and BSC equivalent doses for external exposure to photons presented here for the first time for complete human skeletons are in agreement with the results calculated with the three correction factor method and the fluence-to-dose response functions for the same phantoms taking into account the conceptual differences between the different methods. Additionally the microCT image-based results have been compared with corresponding data from earlier studies for other human phantoms.

Female and male adult human phantoms, called FASH (Female Adult meSH) and MASH (Male Adult meSH), have been developed in the first part of this study using 3D animation software and anatomical atlases to replace the image-based FAX06 and the MAX06 voxel phantoms. 3D modelling methods allow for phantom development independent from medical images of patients, volunteers or cadavers. The second part of this study investigates the dosimetric implications for organ and tissue equivalent doses due to the anatomical differences between the new and the old phantoms. These differences are mainly caused by the supine position of human bodies during scanning in order to acquire digital images for voxel phantom development. Compared to an upright standing person, in image-based voxel phantoms organs are often coronally shifted towards the head and sometimes the sagittal diameter of the trunk is reduced by a gravitational change of the fat distribution. In addition, volumes of adipose and muscle tissue shielding internal organs are sometimes too small, because adaptation of organ volumes to ICRP-based organ masses often occurs at the expense of general soft tissues, such as adipose, muscle or unspecified soft tissue. These effects have dosimetric consequences, especially for partial body exposure, such as in x-ray diagnosis, but also for whole body external exposure and for internal exposure. Using the EGSnrc Monte Carlo code, internal and external exposure to photons and electrons has been simulated with both pairs of phantoms. The results show differences between organ and tissue equivalent doses for the upright standing FASH/MASH and the image-based supine FAX06/MAX06 phantoms of up to 80% for external exposure and up to 100% for internal exposure. Similar differences were found for external exposure between FASH/MASH and REGINA/REX, the reference voxel phantoms of the International Commission on Radiological Protection. Comparison of effective doses for external photon exposure showed good agreement between FASH/MASH and REGINA/REX, but large differences between FASH/MASH and the mesh-based RPI_AM and the RPI_AF phantoms, developed at the Rensselaer Polytechnic Institute (RPI).

Micro computed tomography (microCT) images of human spongiosa have recently been used for skeletal dosimetry with respect to external exposure to photon radiation. In this previous investigation, the calculation of equivalent dose to the red bone marrow (RBM) and to the bone surface cells (BSC) was based on five different clusters of micro matrices derived from microCT images of vertebrae, and the BSC equivalent dose for 10 microm thickness of the BSC layer was determined using an extrapolation method. The purpose of this study is to extend the earlier investigation by using microCT images from eight different bone sites and by introducing an algorithm for the direct calculation of the BSC equivalent dose with sub-micro voxel resolution. The results show that for given trabecular bone volume fractions (TBVFs) the whole-body RBM equivalent dose does not depend on bone site-specific properties or imaging parameters. However, this study demonstrates that apart from the TBVF and the BSC layer thickness, the BSC equivalent dose additionally depends on a so-called trabecular bone structure (TBS) effect, i.e. that the contribution of photo-electrons released in trabecular bone to the BSC equivalent dose also depends on the bone site-specific structure of the trabeculae. For a given bone site, the TBS effect is also a function of the thickness of the BSC layer, and it could be shown that this effect would disappear almost completely, should the BSC layer thickness be raised from 10 to 50 microm, according to new radiobiological findings.

The International Commission on Radiological Protection intends to revise the organ and tissue equivalent dose conversion coefficients published in various reports. For this purpose the mathematical human medical internal radiation dose (MIRD) phantoms, actually in use, have to be replaced by recently developed voxel-based phantoms. This study investigates the dosimetric consequences, especially with respect to the effective male dose, if not only a MIRD phantom is replaced by a voxel phantom, but also if the tissue compositions and the radiation transport codes are changed. This task will be resolved by systematically replacing in the mathematical ADAM/GSF exposure model, first the radiation transport code, then the tissue composition and finally the phantom anatomy, in order to arrive at the voxel-based MAX/EGS4 exposure model. The results show that the combined effect of these replacements can decrease the effective male dose by up to 25% for external exposures to photons for incident energies above 30 keV for different field geometries, mainly because of increased shielding by a heterogeneous skeleton and by the overlying adipose and muscle tissue, and also because of the positions internal organs have in a realistically designed human body compared to their positions in the mathematically constructed phantom.