Introduction: Magnetic resonance (MR) imaging is one of the most important diagnostic tools in modern medicine. Compared to other imaging modalities, it provides superior soft tissue contrast of all parts of the body and it is considered to be safe for patients. Today almost all MR is performed in a nonquantitative manner, only comparing neighboring tissue in the search for pathology. It is possible to quantify MR-signals and relate them to their physical entities, but time consuming and complicated calibration procedures have prevented this being used in a practical manner for clinical routines. The aim of this work is to develop and improve quantification methods in MRspectroscopy (MRS) and MR-imaging (MRI). The techniques are intended to be applied to diffuse diseases, where conventional imaging methods are unable to perform accurate staging or to reveal metabolic changes associated with disease development. Methods: Proton (1H) MRS was used to characterize the white matter in the brain of multiple sclerosis (MS) patients. Phosphorus (31P) MRS was used to evaluate the energy metabolism in patients with diffuse liver disease. A new quantitative MRI (qMRI) method was invented for accurate, rapid and simultaneous quantification of B1, T1, T2, and proton density. A method for automatic assessment of visceral adipose tissue volume based on an in- and out-ofphase imaging protocol was developed. Finally, a method for quantification of the hepatobiliary uptake of liver specific T1 enhancing contrast agents was demonstrated on healthy subjects. Results: The 1H MRS investigations of white matter in MS-patients revealed a significant correlation between tissue concentrations of Glutamate and Creatine on the one hand and the disease progression rate on the other, as measured using the MSSS. High accuracy, both in vitro and in vivo, of the measured MR-parameters from the qMRI method was observed. 31P MRS showed lower concentrations of phosphodiesters, and a higher metabolic charge in patients with cirrhosis, compared to patients with mild fibrosis and to controls. The adipose tissue quantification method agreed with estimates obtained using manual segmentation, and enabled measurements which were insensitive to partial volume effects. The hepatobiliary uptake of Gd-EOB-DTPA and Gd-BOPTA was significantly correlated in healthy subjects. Conclusion: In this work, new methods for accurate quantification of MR parameters in diffuse diseases in the liver and the brain were demonstrated. Several applications were shown where quantitative MR improves the interpretation of observed signal changes in MRI and MRS in relation to underlying differences in physiology and pathophysiology.

In radiotherapy, cancer is treated with ionizing radiation, most commonly bremsstrahlung photons from electrons of several MeV. Secondary electrons produced in photon-interactions results in dose deposition. The treatment response is low for low doses, raises sharply for normal treatment doses and saturates at higher doses. This response pattern applies to both eradication of tumors and to complications in healthy tissues. Well controlled treatments require accurate dosimetry since the uncertainty in delivered dose will be magnified 1 to 5 times in treatment response variations. Techniques that superpose many small radiation fields to concentrate the dose to a localized target are becoming increasingly used. A detector with high spatial resolution suitable for such fields is a silicon diode. To maintain the current accuracy of the dosimetric calibration of 1.5%, diode measurements relative to this calibration should preferably be possible at 0.5% accuracy level. The main limitation of silicon diodes is their over-response to low-energy photons. This problem has been adressed with the insertion of a high atomic number filter in diodes. For modeling diode detector response one must quantify the spectral variations in the irradiated medium resulting from variations of the beam parameters. This requires understanding of the particle transport and can be achieved by Monte Carlo simulations. However, the small dimensions of the detector geometry compared to surrounding medium makes a direct application of Monte Carlo impractical due to the large amount of CPU time necessary to reach statistically satisfactory results. In this work a fast method for spectra calculations is used, based on superposition of mono-energetic fluence pencil kernels. Building on this base a general model for silicon response functions in photon fields is developed. The incident photons are bipartitioned into a low and a high energy component. The high energy part is treated with the Spencer-Attic cavity theory while the low energy part and scattered photons are treated with large cavity theory. The deviations from electron equilibrium are investigated and handled with correction factors. The result is used to correct unshielded diode measurements, with an overall uncertainty less than 0.5%, except for very small fields where the precision is around 1-2%, thus eliminating the need for less predictable shielded diodes for measurements in photon fields.

BACKGROUND: Because of superior soft tissue contrast, the use of magnetic resonance imaging (MRI) as a complement to computed tomography (CT) in the target definition procedure for radiotherapy is increasing. To keep the workflow simple and cost effective and to reduce patient dose, it is natural to strive for a treatment planning procedure based entirely on MRI. In the present study, we investigate the dose calculation accuracy for different treatment regions when using bulk density assignments on MRI data and compare it to treatment planning that uses CT data. METHODS: MR and CT data were collected retrospectively for 40 patients with prostate, lung, head and neck, or brain cancers. Comparisons were made between calculations on CT data with and without inhomogeneity corrections and on MRI or CT data with bulk density assignments. The bulk densities were assigned using manual segmentation of tissue, bone, lung, and air cavities. RESULTS: The deviations between calculations on CT data with inhomogeneity correction and on bulk density assigned MR data were small. The maximum difference in the number of monitor units required to reach the prescribed dose was 1.6%. This result also includes effects of possible geometrical distortions. CONCLUSIONS: The dose calculation accuracy at the investigated treatment sites is not significantly compromised when using MRI data when adequate bulk density assignments are made. With respect to treatment planning, MRI can replace CT in all steps of the treatment workflow, reducing the radiation exposure to the patient, removing any systematic registration errors that may occur when combining MR and CT, and decreasing time and cost for the extra CT investigation.

No description available.

Radiation therapy is an important method to treat cancer with the aim to deliver as high doses as reasonably achievable to the tumor while protecting the surrounding healthy tissue and organs at risk, OARs. Therefore, it is essential to have high accuracy in the dose delivered clinically and quality assurances are required. In the meantime, radiation therapy techniques are becoming more advanced and complex, introducing a significant risk of random and systematic errors that needs to be investigated. Hence, the need of independent dose verifications has increased. The purpose of the present work is to design and create a mailed audit system for external evaluation of the dose to water in relevant points in a phantom, including influences from the whole treatment chain, from computed tomography, CT, scanning, to contouring of structures, treatment planning and treatment delivery. The measurements were performed using an anthropomorphic Polymethyl methacrylate, PMMA, phantom designed to be relevant for the head-and-neck region containing inserts corresponding to tumour, salivary glands and medulla made of PMMA and that are easily distinguishable from the surroundings for contouring. Inhomogeneities of both Teflon, corresponding to the spinal cord, and air were also included. Pellet shaped electron paramagnetic resonance, EPR, dosimeters made of lithium formate with a diameter of 4.5 mm and height of 5 mm were made for the measurements. The dosimeters can be placed in various positions in the different structures of the phantom using PMMA tubes and can be analyzed using a spectrometer. In order to test the precision and accuracy of the EPR dosimetry method, measurements with three blind tests were performed simultaneously with an ionization chamber for comparison of absorbed doses. For the audit measurement, the audit phantom was CT scanned twice both with a Siemens CT scan and GE (General Electric)) CT scan for comparison of Hounsfield Units, HU, and dose distributions. The target and the OARs were contoured in the treatment planning system, TPS, (Varian, Eclipse) and a dynamic Intensity modulated radiation therapy, IMRT, treatment plan was created. The treatment plan consisted of seven coplanar 6 MV fields giving the target a dose of 5 Gy delivered with a Varian, Clinac iX accelerator. The absorbed doses to water were determined in seven locations: three points in the target, one in each parotis, one in the medulla and one in the air cavity. The absorbed doses were determined using the signal from the EPR dosimeters and were compared to the planned doses. Also, the measured and reconstructed volumes of the structures were compared. The blind tests doses obtained from the EPR dosimeters agreed with the results obtained from the ionization chamber within 1% and are well below the calculated uncertainties (1 SD) in the EPR measurements. The absorbed doses and the dose distributions were not affected by any spread in HU and the absorbed doses had an agreement within 0.5% in comparison between the Siemens and GE CT studies. The determined doses agreed with planned doses within 4% for all the structures except the air cavity. This deviation is not covered by the calculated standard uncertainty. However, the deviation does fall within two standard deviations, corresponding to a confidence interval of 95%. Also the measured and planned volumes had an agreement within 2.5% for smaller structures and within 5% for larger structures. Repeating the whole measurement chain with other dosimeter batches is required using two or three dosimeters in each measurement point for higher precision. A conclusion can be made that this work showed promising initial results for an audit system for evaluation of the dose to water in relevant points in a phantom, including influences from the whole treatment chain.

<p>Radioiodine has been used in nuclear medicine for the treatment of thyroid diseases such as Thyroid Cancer and Thyrotoxicosis for many years. The treatment renders the patient radioactive. To minimize the dose to the patients’ relatives and the general public, restric-tions are imposed on the behaviour of the patient. This project presents the person dose equivalents actually received by family members of radioiodine patients following such restrictions. The family members wore hospital ID-bands on left and right wrists for up to four weeks. Each ID-band contained two LiF: Mg, Ti Thermo Luminescence Dosimeters (TLD) calibrated to measure air kerma. The TLDs were analysed and a total person dose equivalent received by the relative was calculated from the measured air kerma values. The results were compared to the dose constraints imposed by The Swedish Radiation Protection Authority (SSI FS 2000:3) in order to confirm that the new set of restrictions used at Karolinska University Hospital Huddinge maintains the dose to family members below the applicable limits.</p><p>A total number of 22 relatives were recruited, 8 elderly, 7 adults and 7 children. Of the recruited relatives 4 (2 adults, 2 children) were excluded from the study as they had lost their dosimeter ID-bands or had other reasons not to participate in the study. This leaves the number of relatives used for data analysis at 18 individuals (8 elderly, 5 adults and 5 children) with a min age of 10 years and max age of 80 years.</p><p>The observed average person dose equivalent of 0.43 mSv (max, 1.27; min, 0.12) indi-cates that the new method of individualised restriction used at Karolinska University Hospital Huddinge work as desired in keeping the dose to family members at an accept-able level. The accuracy of the clinical study has been shown to depend greatly on the method by which the dose is investigated but also on the properties of the TLD material used. There is a potential underestimation of air kerma due to fading of up to 30 %. In addition there are contributing uncertainties from both the calibration method and the conversion to person dose equivalent with the combined uncertainty estimated to be 14%.</p>

<p>The protection of the unborn child in pregnant women from ionizing radiation is very important because the foetus is particularly sensitive to the effects of radiation. In case of pregnant members of staff working with ionising radiation, the unborn child is treated as a member of the general public, and a dose limit of 1 mSv during pregnancy is applied in order to protect the foetus.</p><p>The purpose of this work was to collect relevant information on exposure conditions and entrance doses of occupationally exposed workers in diagnostic radiology and nuclear medicine, and to give guidelines on how to estimate foetal doses for pregnant staff in such workplaces.</p><p>With X-ray procedures, an accumulated dose of 2 mSv during pregnancy, measured on the trunk (breast or waist) and behind a lead apron, is sufficient to ensure a foetal dose below 1 mSv. For staff working with nuclear medicine, the corresponding limit is 1.5 mSv taking into account external exposure from 99mTc. When internal contamination cannot be neglected, additional precautions need to be considered.</p>

<p>The International Atomic Energy Agency (IAEA) and the World Health Organisation (WHO) operate the IAEA/WHO TLD postal dose audit programme. The purpose of the programme is to verify the beam calibration in radiotherapy centres in developing countries and to check the Secondary Standards Dosimetry Laboratories (SSDLs). Thermoluminescence dosimeters (TLDs) are used as transfer dosimeters and the evaluation of these are done at the IAEA Dosimetry Laboratory. In the present work the uncertainties in the process of dose determination from TLD readings have been evaluated.</p><p>The analysis comprises the TLD reading reproducibility, uncertainties in the calibration coefficient, and uncertainties in factors correcting for fading of TL signal, influence of TLD holder, energy response and dose response non-linearity. The individual uncertainties were combined to estimate the total uncertainty in the evaluated dose from TLD readings. Experimental data from 2001-2005 were used in the analysis.</p><p>The total uncertainty has been estimated to be 1.2 % for irradiations with 60Co -rays and 1.6 % for irradiations with high-energy X-rays. Results from irradiations by the Bureau International des Poids et Mesures (BIPM), Primary Standard Dosimetry Laboratories (PSDLs), Secondary Standard Dosimetry Laboratories (SSDLs) and reference centres compare favourably with the estimated uncertainties.</p><p>The largest uncertainty components are in the energy correction factor (for high-energy X-rays) with a value of 1.1 % and in the dose response non-linearity correction factor with a value of 0.9 %.</p><p>It has been shown that the acceptance limits of 5 % for TLD results of hospitals and 3.5 % for SSDLs are justified when related to the uncertainties in the dose calculations and the uncertainty in the determination of absorbed dose to water at the centre, as discussed in IAEA TRS-398 (IAEA, 2000), provided that it is followed.</p>

<p>Background: This is a retrospective study of patients treated with stereotactic body radiation therapy (SBRT) with the stereotactic body frame for centrally located lung tumours. The purpose was to investigate the doses to the different structures of the tracheobronchial tree and to relate these doses to the incidence of atelectasis. The goal was to estimate a tolerance dose for the bronchi. Materials: The patient material consisted of 71 patient treated at the Karolinska University Hospital for a total of 102 tumours between November 1993 and March 2004. The patient group consisted of 36 men and 35 women with a mean age at the treatment of 67 years (range 34-87). The group was a mixture of patients with primary lung cancer and pulmonary metastases. Methods: After rereading and reactivating the dose plans for the patients in the treatment planning system (TPS) the different tracheobronchial structures (trachea, right mainstem bronchus, right superior bronchus, right intermedius bronchus, right medius bronchus, right inferior bronchus, left mainstem bronchus, left superior bronchus, left intermedius bronchus, left inferior bronchus) were outlined. The dose distribution in each structure was calculated and a dose-volume histogram (DVH) was created. Patients were allocated to four groups, i.e. patients with right sided tumours (22), left sided tumours (14), mediastinal tumours (23) and bilateral tumours (10). After that the maximum and mean doses to all structures were analysed. An oncologist reviewed the medical records for the patients and especially looked for atelectasis. The doses were related to the incidence of atelectasis.</p><p>Results and Conclusions: For the patient group with right sided tumours it seems like the maximum doses to the bronchi are higher for the patients with atelectasis in comparison with patients without atelectasis. A better correlation between atelectasis and maximum doses rather than mean doses was observed for these patients. At this moment the results are too preliminary, so it is not possible to suggest a tolerance dose for the bronchi. What can be said is that the maximum doses to the bronchi for patients with right sided tumours without atelectasis are below 250 Gy3 expressed in biologically equivalent dose (BED) with α/β=3Gy, while at least one bronchi structure in the atelectasis patients received a maximum dose above 250 Gy3.</p>

<p>Background: Stereotactic body radiation therapy (SBRT) is a relatively new method which has been employed e.g. in the treatment of liver tumours. Little dosimetric data has been published for SBRT in the liver. The aim of this retrospective study was to quantify the dosimetric parameters that influence the toxicity of the healthy liver, and the effect on the tumour, for SBRT to liver tumours in patients treated at Karolinska University Hospital. A comparison was made to relating published studies.</p><p>Patients and Methods: The patient group to be studied were treated at Karolinska University Hospital for liver metastases with SBRT between July 1993 and October 2004. There were 64 patients treated with 71 treatment plans for 81 tumours. Differential dose volume histograms were collected for the clinical target volume (CTV), the planning target volume (PTV) and the liver excluding the CTV, from all dose plans. Since different fractionation schedules were used, the doses were normalised using the linear quadratic model, to be comparable. The doses to the uninvolved liver were evaluated with the mean liver dose, the Lyman-Kutcher-Burman (LKB) effective volume normal tissue complication probability (NTCP) model as well as the critical volume NTCP-model. A comparison was made to the studies of Dawson et al (2002) and Schefter et al (2005). The doses to the CTV were evaluated using the equivalent uniform dose tumour control probability (TCP) model, and related to target size and date of treatment.</p><p>Results: When the mean doses to the uninvolved liver (the liver volume without tumour tissue) were compared to Dawson and Ten Haken’s results (2005), 20 treatments out of 71 were predicted to give a risk of radiation induced liver disease (RILD) higher than 50%. The effective volume calculations predicted that 18 treatments gave a risk of RILD higher than 50%, when compared to the results of Dawson et al (2002). According to the critical volume model and the parameter values of Schefter et al (2005), our data predict that 10 of the treatments gave a risk of liver function failure, to an unspecified risk level. Treatments of large tumours resulted in higher doses to the liver. The doses to the CTV showed that the maximum prescribed dose decreased with increasing CTV.</p><p>Discussion and Conclusions: An evaluation of clinical data is necessary to make a full analysis of the treatments of this study. Such an analysis is planned for the future.</p>