• Journal of Radiation Protection and Research
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• 제46권4호
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• pp.151-159
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• 2021

Background: Computed tomography (CT) is one of the crucial diagnostic tools in modern medicine. However, careful monitoring of radiation dose for CT patients is essential since the procedure involves ionizing radiation, a known carcinogen. Materials and Methods: The most desirable CT dose descriptor for risk analysis is the organ absorbed dose. A variety of CT organ dose calculators currently available were reviewed in this article. Results and Discussion: Key common elements included in CT dose calculators were discussed and compared, such as computational human phantoms, CT scanner models, organ dose database, effective dose calculation methods, tube current modulation modeling, and user interface platforms. Conclusion: It is envisioned that more research needs to be conducted to more accurately map CT coverage on computational human phantoms, to automatically segment organs and tissues for patient-specific dose calculations, and to accurately estimate radiation dose in the cone beam computed tomography process during image-guided radiation therapy.

• 대한방사선기술학회지:방사선기술과학
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• 제38권1호
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• pp.51-61
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• 2015

모든 방사선 검사는 검사를 결정하고 실행하는 과정에서 정당성이 확보되어야하고 피폭선량과 영상의 화질에 대한 최적화가 이루어져야 할 뿐만 아니라 ALARA의 원칙에 따라 최소의 방사선을 사용하여 최적의 임상 정보를 얻을 수 있어야 한다. CT 검사는 방사선 검사 중에서 많은 피폭을 환자에게 조사하는 검사이다. 특히 방사선 민감도가 높은 소아 환자의 CT 검사 있어서는 특별한 주의가 필요하다. 임상에서 CT선량에 대한 정확한 이해와 정보는 환자에게 불필요한 방사선 피폭을 줄이고 안전한 검사를 제공하기 위해 절대적으로 필요하다. 이에 본 연구에서는 여러 선행 연구의 고찰을 통하여 CT의 피폭선량에 대한 개념을 확인하고 CT장치의 선량 저감화를 위한 각 파라미터의 이해와 American Association of Physicists in Medicine (AAPM)report 204에서 소개하고 있는 환자의 사이즈에 따른 피폭선량의 보정방법인 Size-Specific Dose Estimates(SSDE)와 XR 25의 개념을 이해하고자 한다.

• 한국방사선학회논문지
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• 제9권2호
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• pp.109-115
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• 2015

전산화단층촬영장치(computed tomography, CT)을 이용한 검사의 경우 방사선량의 분포가 일반 X선 장치와 차이가 있고 검사로 인한 방사선 피폭이 많은 것으로 알려져 있다. 그러나 검사 결과의 정확성에 대한 신뢰도가 높아 그 이용도는 계속적으로 증가하고 있다. 이와 같은 상황을 고려하여 기존에 발표된 자료를 바탕으로 CT장치, CT검사에서 방사선량, 진단참고준위 그리고 검사 시 방사선량 감소 방안에 대해 알아보았다.

• 한국의학물리학회지:의학물리
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• 제28권1호
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• pp.27-32
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• 2017

We investigated the effect of a commercial iterative reconstruction technique (iDose, Philips) on the image quality and the dose calculation for the treatment plan. Using the electron density phantom, the 3D CT images with five different protocols (50, 100, 200, 350 and 400 mAs) were obtained. Additionally, the acquired data was reconstructed using the iDose with level 5. A lung phantom was used to acquire the 4D CT with the default protocol as a reference and the low dose (one third of the default protocol) 4D CT using the iDose for the spine and lung plans. When applying the iDose at the same mAs, the mean HU value was changed up to 85 HU. Although the 1 SD was increased with reducing the CT dose, it was decreased up to 4 HU due to the use of iDose. When using the low dose 4D CT with iDose, the dose change relative to the reference was less than 0.5% for the target and OARs in the spine plan. It was also less than 1.1% in the lung plan. Therefore, our results suggests that this dose reduction technique is applicable to the 4D CT image acquisition for the radiation treatment planning.

• 대한방사선기술학회지:방사선기술과학
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• 제42권2호
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• pp.105-111
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• 2019

A medical personnel could be placed beside a patient together in CT room to do Ambu-bag for a seriously ill patients or emergency patient. At this time, the medical personnel can be exposed indirect radiation unnecessarily. In this case, it is necessary to recognize indirect radiation dose levels and methods to reduce them using actual clinical CT protocols such as Chest, Abdomen, and Brain CT. We researched surface radiation dose with or without radiation protectors such as apron and goggles according to different distances far from gantry using two different CT scanners (Fixed MDCT and mobile CT). As a result, for Chest, Abdomen, and Brain CT with Fixed MDCT, indirect radiation dose on thorax portion were 0.047, 0.089, 0.034 mSv without apron. Also, those with apron were 0.007, 0.012, 0.006 mSv. In case of mobile CT, it was 0.014 mSv without apron and 0.005 mSv with apron. By using protectors and increasing the distance, we could reduce it to 97%. Systematic management is necessary based on the measured data in order to minimize radiation damage due to indirect exposure dose.

• 한국의학물리학회지:의학물리
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• 제32권1호
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• pp.18-24
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• 2021

Purpose: Kilovoltage computed tomography (kV-CT) is essential for radiation treatment planning. However, kV-CT images are significantly distorted by artifacts when a metallic prosthesis is present in the patient's body. Thus, the accuracies of target delineation and treatment dose calculation are inevitably lowered. We evaluated the accuracy of the calculated doses using an image restoration method with hybrid CT, which was introduced in our previous study. Methods: A cylindrical phantom containing four metals, namely, silver, copper, tin, and tungsten, was scanned using kV-CT and megavoltage CT to produce hybrid CT images. We created six verification plans for three head and neck patients on kV-CT and hybrid CT images of the phantom and calculated their doses. The actual doses were measured with film patches during beam delivery using tomotherapy. We used the gamma evaluation method to compare dose distribution between kV-CT and hybrid CT with three gamma criteria, namely, 3%/3 mm, 2%/2 mm, and 1%/1 mm. Results: The gamma pass rates decreased as the gamma criteria were strengthened, and the pass rate of hybrid CT was higher than that of kV-CT in all cases. When the 1%/1 mm criterion was used, the difference in gamma pass rates between them was up to 13%p. Conclusions: According to our findings, we expect that the use of hybrid CT can be a suitable approach to avoid the effect of severe metal artifacts on the accuracy of dose calculation and contouring.

• Journal of Radiation Protection and Research
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• 제40권1호
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• pp.17-24
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• 2015

To improve accuracy of dose calculation on kilovoltage cone beam computed tomography (kV CBCT) images, a custom-made phantom was fabricated to acquire an accurate CT number to electron density curve by full scatter of cone beam x-ray. To evaluate the dosimetric accuracy, 9 volumetric modulated arc therapy (VMAT) plans for head and neck (HN) cancer and 9 VMAT plans for lung cancer were generated with an anthropomorphic phantom. Both CT and CBCT images of the anthropomorphic phantom were acquired and dose-volumetric parameters on the CT images with CT density curve (CTCT), CBCT images with CT density curve ($CBCT_{CT}$) and CBCT images with CBCT density curve ($CBCT_{CBCT}$) were calculated for each VMAT plan. The differences between $CT_{CT}$ vs. $CBCT_{CT}$ were similar to those between $CT_{CT}$ vs. $CBCT_{CBCT}$ for HN VMAT plans. However, the differences between $CT_{CT}$ vs. $CBCT_{CT}$ were larger than those between $CT_{CT}$ vs. $CBCT_{CBCT}$ for lung VMAT plans. Especially, the differences in $D_{98%}$ and $D_{95%}$ of lung target volume were statistically significant (4.7% vs. 0.8% with p = 0.033 for $D_{98%}$ and 4.8% vs. 0.5% with p = 0.030 for $D_{95%}$). In order to calculate dose distributions accurately on the CBCT images, CBCT density curve generated with full scatter condition should be used especially for dose calculations in the region of large inhomogeneity.

• 한국방사선학회논문지
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• 제6권4호
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• pp.281-290
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• 2012

경상북도에 소재한 3개 종합병원 영상의학과의 MDCT 검사 중 두부, 복부, 흉부 각 10건씩 30건을 대상으로 CTDIl, DLP, Slice 수, DLP/Slice 수를 조사하여 병원 간 프로토콜의 차이로 인한 MDCT의 피폭선량의 차이를 분석하였고, CT검사의 가장 많은 검사건수를 차지하고 프로토콜이 비교적 단순한 두부 CT를 Helical Scan과 Normal Scan으로 2회 실시하여 영상의 화질, CTDI, DLP, 안구의 피폭선량, 갑상선의 피폭선량의 차이를 분석하였다. 두부CT에서 조사대상 병원의 3분의 2에서 CTDI 참조준위(IAEA 50mGy, 우리나라 60mGy)를 초과하지 않은 A병원에 비하여 유의하게 높았다(p<0.001). DLP에서 조사병원의 3분의 1은 참조준위 IAEA 1,050mGy.cm, 우리나라 1,000mGy.cm의 권고량 보다 높았고, 3분의 2가 우리나라의 권고량을 초과하고 있었다. 참조준위를 초과하지 않은 A병원에 비하여 유의하게 높았다(p<0.001). Abdomen CT에서도 3분의 1은 CTDI 참조준위 IAEA 25mGy, 우리나라 20mGy보다 높은 119mGy를 보였고, DLP에서는 모든 조사대상 병원이 우리나라 권고량 700mGy.cm보다 높았다. 조사대상 병원 중 모든 검사에서 높은 선량을 보인 C병원은 MPR, 3D 검사의 비중이 높아 낮은 pitch, 높은 관전류 검사로 인한 피폭선량이 높았다. Scan 방법에 따른 피폭선량의 차이를 분석하고자 동일환자의 두부CT를 Normal scan과 Helical scan으로 각각 실시하여 분석한 결과 CTDI 및 DLP에서 Helical CT가 Normal scan에 비해 63.4%, 93.7% 높은 선량을 보였다(p<0.05, p<0.01). 그러나 갑상선의 피폭선량은 Normal scan이 87.26% 높았다(p<0.01). Helical CT의 선속은 종심부와 변연부의 모양이 종의 형태를 취하고 있어 두부CT에서 갑상선은 중심선속에서 벗어난 적은 선량으로 피폭된다. 또한 Helical scan시 Gantry 각을 수직으로 사용하였고, Normal scan시에는 Orbitomeatal line에 평행으로 정렬된 Gantry 각을 사용하여 Helical scan에서 갑상선은 피폭선량이 감소하였다. 그러나 본 연구에서 사용된 프로토콜은 식약청의 표준준위에 비해 높은 피폭선량을 보여 식약청의 권고량을 지키기 위해서는 낮은 관전류 높은 Pitch의 사용이 요구되었다. 이번 연구에서 Normal scan과 Helical scan에 따른 화질의 차이는 없는 것으로 분석되어 특별한 경우가 아니면 Normal scan의 표준화된 프로토콜을 사용하고 갑상선의 보호장구를 사용하는 것이 필요하였다. 이번 연구는 일지역의 CT검사 중 일부를 조사하여 분석하였으므로 CT검사의 전체를 평가하는데 무리가 있었다. 그러나 경우에 따라 환자피폭선량의 가이드 권고량을 초과하고 있음을 알 수 있었고, 병원 간의 피폭선량 편차도 있음을 확인 할 수 있었다. 이것을 개선하기 위하여 영상의학과 의사 및 방사선사는 CT 방사선량을 줄이는 최적화된 프로토콜로 CT검사를 시행해야 하고, 환자의 알권리를 위하여 피폭선량은 공개되어야 한다. 그러나 아직 많은 의사들과 방사선사는 이에 대한 인식이 부족하므로 개선을 위하여 CT선량 저감화의 교육프로그램, CT검사에 따른 피폭선량의 공개, 병원의 서비스평가 및 병원인증제 평가항목에 CT검사 피폭선량관리 및 공개항목을 추가 등의 관련기관의 노력과 의료종사자가 CT검사에서 행위의 최적화를 실현하는 최선의 프로토콜을 사용하는 노력이 필요하였다.

• Journal of Radiation Protection and Research
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• 제46권3호
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• pp.98-105
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• 2021

Background: In recent events of the coronavirus disease 2019 (COVID-19) pandemic, computed tomography (CT) scans are being globally used as a complement to the reverse-transcription polymerase chain reaction (RT-PCR) tests. It will be important to be aware of major organ dose levels, which are more relevant quantity to derive potential long-term adverse effect, for Korean pediatric and adult patients undergoing CT for COVID-19. Materials and Methods: We calculated organ dose conversion coefficients for Korean pediatric and adult CT patients directly from Korean pediatric and adult computational phantoms combined with Monte Carlo radiation transport techniques. We then estimated major organ doses delivered to the Korean child and adult patients undergoing CT for COVID-19 combining the dose conversion coefficients and the international survey data. We also compared our Korean dose conversion coefficients with those from Caucasian reference pediatric and adult phantoms. Results and Discussion: Based on the dose conversion coefficients we established in this study and the international survey data of COVID-19-related CT scans, we found that Korean 7-year-old child and adult males may receive about 4-32 mGy and 3-21 mGy of lung dose, respectively. We learned that the lung dose conversion coefficient for the Korean child phantom was up to 1.5-fold greater than that for the Korean adult phantom. We also found no substantial difference in dose conversion coefficients between Korean and Caucasian phantoms. Conclusion: We estimated radiation dose delivered to the Korean child and adult phantoms undergoing COVID-19-related CT examinations. The dose conversion coefficients derived for different CT scan types can be also used universally for other dosimetry studies concerning Korean CT scans. We also confirmed that the Caucasian-based CT organ dose calculation tools may be used for the Korean population with reasonable accuracy.

• Journal of Radiation Protection and Research
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• 제37권4호
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• pp.231-236
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• 2012

This study derived measures to reduce exposure doses by identifying factors which affect the external radiation dose rate of patients treated with radiopharmaceuticals for PET-CT tests. The external radiation dose rates were measured on three parts of head, thorax and abdomen at a distance of 50cm from the surface of 60 PET-CT patients. It showed there are changes in factors affecting the external radiation dose rate over time after the administration of F-18 FDG. The external radiation dose rate was lower in the patients with more water intake than those with less water intake before the injection of radiopharmaceuticals at all three points: right after the injection of radiopharmaceuticals (average 4.17 mins), after the pre-PEET-CT urination step (average 77.47 mins), and right after the PET-CT test (average 114.15 mins). The study also found there is a need to increase the amount of water intake before the injection of radiopharmaceuticals in order to maintain a low external radiation dose rate in patients. This strategy is only possible under the assumption that the quality of the video has not changed after conducting this study on the relations between the image and quality. This study also found a need to use radiopharmaceuticals with the minimum amount needed for each patient because F-FDG doses affects the external radiation dose rate at the point right after the injection of radiopharmaceuticals. Urination frequency was the most significant factor to affect the external radiation dose rates at the point right after the PET-CT test and the point after the pre-PET-CT urination step. There is a need to realize the strategy to increase the urination frequency of patients to maintain the external radiation dose rate low (average 77.47 mins) before and after the injection of radiopharmaceuticals. In addition, at this point, there is a need to take advantage of personal strategies because the external radiation dose rate is lower if the fasting time is shorter, the contrast medium is used, and the amount of water intake is increased after the administration of radiopharmaceuticals. Finally this study found the need to be able to generalize these findings through an in-depth research on the factors affecting the external radiation dose rate, which includes radiopharmaceutical dose, urination frequency, the amount of water intake, fasting time and the use of contrast medium.