ESTIMATION OF ORGAN DOSES OF PATIENT UNDERGOING … · 2015. 5. 13. · F 45 68 159 184 21.7 113.4 1.439 1.122 F 75 49 158 180 11.7 73.5 0.906 0.858 F 45 65 165 137 36 162.7 1.439

ESTIMATION OF ORGAN DOSES OF PATIENT UNDERGOING

HEPATIC CHEMOEMBOLIZATION PROCEDURES

William Jaramillo, Richard Kramer, Helen Khoury, Vinicius Saito

and Gustavo Andrade

Department of Nuclear Energy - Federal University of Pernambuco

Recife, Brazil

X Congreso Regional Latinoamericano de Protección y seguridad Radiológica IRPA

Introduction

Hepatic chemoembolization

Previous studies

(maximum skin dose) Few organ doses studies?


Organ doses conversion coefficients in IR

… if patient size is neglected when choosing DCC, the organ and effective dose

will be underestimated to an underweight patient and will be overestimated to an

overweight patient, with errors as large as 113% for certain projections.

Therefore, the use of phantoms with different body masses and/or heights for

the Monte Carlo calculations would certainly improve the organ and tissue

absorbed dose assessments for populations such as patients


Objective

The aim of this study is to evaluate the organ and tissue absorbed doses as

well as radiation risks of patients undergoing hepatic chemoembolization

procedures performed in two hospitals in the city of Recife-Brazil.


• Patients

50 hepatic chemoembolization procedures were investigated for 48

patients diagnosed with hepatocellular carcinoma which have been treated

in two hospitals in Recife Brazil.

Hospital A Hospital B

Methodology


Methodology

• Data collection


Methodology

• Calibration of KAP meters

𝑓 =𝐾𝑎 ∗ 𝐴𝑟𝑒𝑎

𝐾𝐴𝑃


Conversion coefficients estimation


Risk conversion coefficients assessment


Results and discussion

Anthropometric data of the patients

Mean values of irradiation and dose parameters per hospital and gender for all

patients


Conversion coefficients

HVL (mmAl)

Organ dose (mGy/Gy*cm2) 5,487 6,307 7,78 8,42 8,97

ADRENALS 1,141 1,113 1,407 1,283 1,398

BLADDER WALL 0,009 0,013 0,023 0,019 0,026

BRAIN *** *** 0,001 *** ***

ORAL MUCOSA 0,011 0,008 0,017 0,011 0,014

COLON WALL 0,194 0,19 0,27 0,237 0,263

BREASTS,glandular 0,148 0,118 0,195 0,153 0,178

KIDNEYS 1,398 1,298 1,615 1,481 1,555

LIVER 0,659 0,628 0,862 0,755 0,835

LUNGS 0,476 0,412 0,593 0,472 0,505

OESOPHAGUS 0,276 0,25 0,405 0,322 0,38

OVARIES *** *** 0,04 0,038 0,041

PANCREAS 0,544 0,521 0,748 0,656 0,745

SMALL INTESTINE WALL 0,238 0,237 0,345 0,295 0,333

SKIN ENTRANCE 7,2cm X 7,2cm 2,897 3,138 3,108 3,251 3,254

SPLEEN 0,224 0,196 0,313 0,244 0,278

STOMACH WALL 0,388 0,383 0,531 0,481 0,541

SALIVARY GLANDS 0,007 0,006 0,012 0,008 0,011

THYMUS 0,154 0,126 0,251 0,169 0,197

THYROID 0,024 0,028 0,051 0,037 0,041

EXTRATHORARCIC AIRWAYS 0,005 0,005 0,01 0,006 0,007

UTERUS 0,021 0,025 0,045 0,035 0,045

HEART WALL 0,411 0,348 0,582 0,43 0,478

LYMPHATIC NODES 0,243 0,215 0,331 0,259 0,287

GALL BLADDER WALL 0,335 0,348 0,474 0,446 0,488

SKELETON AVERAGE 0,557 0,545 0,655 0,616 0,633

MAXIMUM RBM ABSORBED DOSE 0,627 0,585 0,867 0,713 0,8

MAXIMUM BSC ABSORBED DOSE 0,877 0,823 1,239 1,014 1,105

WEIGHTED FASH DOSE 0,274 0,255 0,367 0,311 0,346

RISK OF CANCER INCIDENCE: CASES PER

100000/AKAP(Gy*cm**2) 0,981 1,996 1,797 1,840 2,65 RISK OF CANCER MORTALITY: CASES

PER 100000/AKAP(Gy*cm**2) 0,927 1,456 1,595 1,527 1,889


Conversion coefficients

HVL (mmAl)

Organ dose (mGy/Gy*cm2) 5,487 6,307 7,78 8,42 8,97

ADRENALS 0,681 0,73 0,749 0,824 0,886

BLADDER WALL 0,011 0,011 0,016 0,027 0,028

ORAL MUCOSA *** 0,005 0,006 0,008 0,008

COLON WALL 0,137 0,127 0,144 0,174 0,183

BREASTS, glandular 0,067 0,081 0,051 0,062 0,076

KIDNEYS 0,907 0,947 0,904 0,948 0,988

LIVER 0,386 0,379 0,404 0,45 0,476

LUNGS 0,264 0,293 0,309 0,348 0,365

OESOPHAGUS 0,188 0,231 0,253 0,296 0,312

PANCREAS 0,359 0,394 0,395 0,436 0,468

SMALL INTESTINE WALL 0,159 0,161 0,18 0,213 0,227

SKIN ENTRANCE 7,2cm X 7,2cm 2,949 3,046 3,141 3,209 3,173

SPLEEN 0,128 0,146 0,159 0,197 0,21

STOMACH WALL 0,223 0,267 0,271 0,3 0,32

SALIVARY GLANDS *** *** 0,005 0,006 0,006

THYMUS 0,076 0,086 0,105 0,137 0,148

THYROID 0,018 0,021 0,029 0,04 0,043

EXTRATHORARCIC AIRWAYS *** 0,003 0,004 0,005 0,005

HEART WALL 0,211 0,235 0,26 0,318 0,334

LYMPHATIC NODES 0,155 0,151 0,161 0,204 0,218

GALL BLADDER WALL 0,207 0,237 0,24 0,275 0,282

SKELETON AVERAGE 0,39 0,387 0,386 0,44 0,446

MAXIMUM RBM ABSORBED DOSE 0,526 0,568 0,595 0,691 0,721

MAXIMUM BSC ABSORBED DOSE 0,739 0,805 0,848 0,979 1,017

WEIGHTED MASH DOSE 0,17 0,185 0,19 0,218 0,231

RISK OF CANCER INCIDENCE: CASES PER

100000/AKAP(Gy*cm**2) 0,873 1,126 0,744 1,118 1,349 RISK OF CANCER MORTALITY: CASES PER

100000/AKAP(Gy*cm**2) 0,751 0,876 0,692 0,966 1,101


Calculated organ absorbed doses

Organs or tissues showing the highest doses are the skin, kidneys, adrenals,

liver, pancreas, and the skeletal tissues red bone marrow (RBM) and the bone

surface cells (BSC). X Congreso Regional Latinoamericano de Protección y seguridad Radiológica IRPA

Calculated organ absorbed doses

• Patient carried out more than one chemoembolization

• Heart absorbed dose = 498 mGy

• Absorbed dose thresold for circulatory disease to heart or brain≈ 0.5

Gy (ICRP, 2012)


Risk assessment

Hospital A

Cancer incidence Cancer mortality

Gender Age Mass Height Images

Fluoroscopy

Time KAP

Cases per 105 per

KAP

Cases per 105 per

KAP

(y) (kg) (cm) Number (min) (Gy*cm2) 10-5 (Gy*cm2)-1 10-5 (Gy*cm2)-1

F 45 68 159 184 21.7 113.4 1.439 1.122

F 75 49 158 180 11.7 73.5 0.906 0.858

F 45 65 165 137 36 162.7 1.439 1.122

mean 55.0 60.7 160.7 167.0 23.1 116.5 1.261 1.034

M 70 49.7 156 218 11.2 131.4 0.760 0.695

M 64 66 171 323 47.1 193.9 0.896 0.788

M 70 81 168 354 31.2 731.1 0.576 0.533

M 72 53 160 176 25.8 139.0 0.696 0.649

M 35 81 169 362 14.3 235.8 0.841 0.663

M 65 53 165 139 12.3 187.1 0.862 0.759

M 72 49 162 128 14.2 65.4 0.696 0.649

M 63 73.7 166 176 12.6 186.7 0.765 0.665

M 62 69 163 206 26.9 319.8 0.783 0.676

mean 63.7 63.9 164.4 231.3 21.7 243.4 0.764 0.675


Risk assessment

• Apart from the exposure conditions, especially the tube potential, and the

patients mass and height, risk CCs depend on gender and age. Radiological

cancer risks are higher for women than for men, mainly because of the

increased breast cancer risk, and are higher for younger patients.


Conclusions

• In addition to reaching the thresholds for skin injuries to patients, other

important organs can receive significant radiation doses in hepatic

chemoembolization procedures compared with other diagnostic procedures.

• The results show that apart from irradiation parameters, such as tube voltage,

filtration, etc, organ and tissue absorbed doses depend aditionally on the

patient´s body mass. Organ and tissue absorbed doses increase with the

patient´s body mass.

• In this work, organ and tissue conversion coefficients for the air kerma–area

product for PA projection were calculated based on the anthropometric

characteristics of the patients for a range of beam qualities used in hepatic

chemoembolization interventional procedures that can serve to optimize

radiological protection of patients submitted to this medical procedure.


Gracias por su atención!


Documents

ESTIMATION OF ORGAN DOSES OF PATIENT UNDERGOING … · 2015. 5. 13. · F 45 68 159 184 21.7 113.4 1.439 1.122 F 75 49 158 180 11.7 73.5 0.906 0.858 F 45 65 165 137 36 162.7 1.439