Clinical studies have demonstrated that hybrid single photon emission computed tomography (SPECT)/CT for various diagnostic issues has an added value as compared to SPECT alone. However, the combined acquisition of functional and anatomical images can substantially increase radiation exposure to patients, in particular when using a hybrid system with diagnostic CT capabilities. It is, therefore, essential to carefully balance the diagnostic needs and radiation protection requirements. To this end, the evidence on health effects induced by ionizing radiation is outlined. In addition, the essential concepts for estimating radiation doses and lifetime attributable cancer risks associated with SPECT/CT examinations are presented taking into account both the new recommendations of the International Commission on Radiological Protection (ICRP) as well as the most recent radiation risk models. Representative values of effective dose and lifetime attributable risk are reported for ten frequently used SPECT radiopharmaceuticals and five fully diagnostic partial-body CT examinations. A diagnostic CT scan acquired as part of a combined SPECT/CT examination contributes considerably to, and for some applications even dominates, the total patient exposure. For the common SPECT and CT examinations considered in this study, the lifetime attributable risk of developing a radiation-related cancer is less than 0.27 %/0.37 % for men/women older than 16 years, respectively, and decreases markedly with increasing age at exposure. Since there is no clinical indication for a SPECT/CT examination unless an emission scan has been indicated, the issue on justification comes down to the question of whether it is necessary to additionally acquire a low-dose CT for attenuation correction and anatomical localization of tracer uptake or even a fully diagnostic CT. In any case, SPECT/CT studies have to be optimized, e.g. by adapting dose reduction measures from state-of-the-art CT practice, and exposure levels should not exceed the national diagnostic reference levels for standard situations.

Background The exposure of a pregnant woman to X-rays is an event that can cause uncertainty for all concerned. This review provides guidance on how to assess such a situation and how to determine the dose to the unborn child. In general, the use of X-rays in pregnant women in radiology should be avoided. If possible, alternatives should be used, or examinations postponed to a time after the pregnancy. This review gives a summary of the procedure for determining the radiation exposure of a pregnant woman. Method Based on the previous report of 2002 and the literature on prenatal radiation exposure published thereafter, the DGMP/DRG report on the procedure for the assessment of prenatal radiation exposure was adapted to the current state of science and technology. Results Typically, only relatively low radiation exposures of less than 20 mSv occur for the unborn child in X-ray diagnostics in the vast majority of cases. At these dose level the additional risk of damage to the embryo or fetus caused by the radiation is low and therefore only a rough conservative estimate using tabulated values are made. Only in a few types of examination (CT and interventional radiology) higher doses values might occur in the uterus. Instead of dose estimates (step 1 in the two-step model) in these cases the calculation of dose (step 2) are required and further action by the physician may be necessary. Conclusions During the assessment, it is useful to initially use simple conservative estimation procedures to quickly determine whether a case falls into this large group less than 20 mSv, where there is a very low risk to the unborn child. If this is the case, the pregnant woman should be informed immediately by the doctor who performed the examination/treatment. This avoids a psychological burden on the patient. The DGMP/DRG report suggests a relatively simple, clearly structured procedure with advantages for all parties involved (physician, medical physics experts, MTRA and patient). Key points:  Citation Format

Personalized dosimetry in computed tomography (CT) can be realized by a full Monte Carlo (MC) simulation of the scan procedure. Essential input data needed for the simulation are appropriate CT x-ray source models and a model of the patient’s body which is based on the CT image. The purpose of this work is to develop comprehensive procedures for the determination of CT x-ray source models and their verification by comparison of calculated and measured dose distributions in physical phantoms. Mobile equipment together with customized software was developed and used for non-invasive determination of equivalent source models of CT scanners under clinical conditions. Standard and physical anthropomorphic CT dose phantoms equipped with real-time CT dose probes at five representative positions were scanned. The accumulated dose was measured during the scan at the five positions. ImpactMC, an MC-based CT dose software program, was used to simulate the scan. The necessary inputs were obtained from the scan parameters, from the equivalent source models and from the material-segmented CT images of the phantoms. 3D dose distributions in the phantoms were simulated and the dose values calculated at the five positions inside the phantom were compared to measured dose values. Initial results were obtained by means of a General Electric Optima CT 660 and a Toshiba (Canon) Aquilion ONE. In general, the measured and calculated dose values were within relative uncertainties that had been estimated to be less than 10%. The procedures developed were found to be viable and rapid. The procedures are applicable to any scanner type under clinical conditions without making use of the service mode with stationary x-ray tube position. Results show that the procedures are well suited for determining and verifying the equivalent source models needed for personalized CT dosimetry based on post-scan MC calculations.

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Active personal electronic dosimeters (APDs) exhibit limitations in pulsed radiation fields, which cannot be overcome without the use of new detection technology. As an interim solution, this paper proposes a method by which some conventional dosimeters can be operated in a way such that, based on the basic knowledge about the pulsed radiation field, any dosimetric failure of the dosimeter is signalised by the instrument itself. This method is not applicable to all combinations of APD and pulsed radiation field. The necessary requirements for the APD and for the parameters of the pulsed radiation field are given in the paper. Up to now, all such requirements for APDs have not been tested or verified in a type test. The suitability of the method is verified for the use of one APD used in two clinical pulsed fields.

ZusammenfassungNeun Jahre nach der letzten bundesweiten Erhebung von Daten zur Häufigkeit und Strahlenexposition nuklearmedizinischer Untersuchungen wurde in 71 Einrichtungen erneut ein umfangreicher Datensatz für die Jahre 2016 und 2017 zusammengetragen und analysiert. Die Auswertung basierte auf möglichst vollständigen Daten sämtlicher Untersuchungen des Erhebungszeitraums. Erstmalig wurden ebenfalls Daten zu computertomografischen (CT)-Untersuchungen im Rahmen der Hybridbildgebung erfasst. Die relative Häufigkeit untersuchter Organbereiche hat sich im Vergleich zur Vorgängerstudie relevant geändert. Die relative Häufigkeit von Schilddrüsen- und Skelettuntersuchungen ist deutlich rückläufig. Der Anteil der PET-Bildgebung hat sich mehr als verdoppelt. Die anhand applizierter Aktivitäten berechnete effektive Dosis sank im Mittel um mehr als 25 %, was jedoch vornehmlich auf Änderungen in den Dosiskoeffizienten zurückzuführen ist. Bei Untersuchungen, für die diagnostische Referenzwerte (DRW) existieren, sind Konvergenzen applizierter Aktivitäten zu diesen Werten erkennbar. Bei anderen Untersuchungen ist die Verteilung der in Einrichtungen im Mittel applizierten Aktivitäten teilweise recht heterogen. Die Höhe der Dosis der CT-Untersuchungen, die im Rahmen der Hybridbildgebung durchgeführt werden, unterscheidet sich relevant zwischen einzelnen Einrichtungen. Darüber hinaus besteht eine deutliche Überlappung der Verteilungen der Dosiswerte bei diagnostischen CT-Untersuchungen und solchen, die nach Aussage der Anwender ausschließlich zur Schwächungskorrektur und anatomischen Koregistrierung durchgeführt wurden.

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