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Organ dose and risk assessment in paediatric radiography using the PCXMC 2.0

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2015 J. Phys.: Conf. Ser. 637 012014

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BIOMEP 2015 IOP Publishing
Journal of Physics: Conference Series 637 (2015) 012014 doi:10.1088/1742-6596/637/1/012014

Organ dose and risk assessment in paediatric radiography using

the PCXMC 2.0

A Ladia, G Messaris, H Delis, G Panayiotakis

Department of Medical Physics, School of Medicine, University of Patras,
Patras,26500, Greece
E-mail: panayiot@upatras.gr

Abstract. Abdominal and chest radiographs are the most common examinations in
paediatric radiology. X-ray examination of children attracts particular interest,
mainly due to the increased risk for the expression of delayed radiogenic cancers as
they have many years of expected life remaining. This study aims to calculate the
organ dose and estimate the radiation Risk of Exposure Induced cancer Death
(REID) to paediatric patients, using the PCXMC 2.0 Monte Carlo code.Patient data
and exposure parameters were recorded during examinations of 240 patients,
separated in four age groups undergoing chest or abdomen examinations.The organs
received the highest dose in all patient groups were liver, lungs, stomach, thyroid,
pancreas, breast, spleen in chest radiographs and liver, lungs, colon, stomach and
ovaries, uterus (for girls) and prostate (for boys) in abdomen radiographs. The
effective dosefor the chest was 0.49 x10-2- 1.07x10-2 , while for the abdomen
-2 -2
1.85x10 - 3.02x10 . The mean REID value was1.254 x10-5 for the abdomen
-5
and0.645x10 for the chest.

1. Introduction
Abdominal and chest radiographs are the most common examinations in paediatric radiology. X-ray
examination of children attracts particular interest, mainly due to the increased risk for the
expression of delayed radiogenic cancers, as they have many years of expected life remaining.
Additionally, their smaller sizes bring all organs within or closer to the useful x-ray field, resulting to
a higher overall exposure per radiograph [1].
Entrance surface dose (ESD) is one of the dosimetric quantities used in radiography and is
useful to determine the level of patient doses, though it is not directly related to risk [2]. The
evaluation of risk to paediatric patients requires the dose for various tissues and organs. One
common method for evaluating organ doses is based on measurements using thermoluminescence
dosemeters (TLD). TLD dosimetry, however, is laborious and time consuming [3-4]. Another
method for estimating organ dose is Monte Carlo (MC) simulation. Monte Carlo simulation is a
method applied extensively. The PCXMC code was developed at the Medical Radiation Laboratory
of the Finnish Radiation and Nuclear Safety Authority for calculating patient doses in diagnostic
radiology utilized relative simple measurements [5].
This study aims to calculate the mean value of the organ and effective doses, using the Monte
Carlo PCXMC 2.0 code and estimate the radiation risk for paediatric patients in routine radiographic
examinations. The calculation of the dose to each organ separately, in combination with the effective
dose, provides an estimate of radiation risk.

2.Materials and methods

2.1.Measurements
Exposure parameters (tube load, tube voltage, tube current, Field Of View (FOV), Focus Skin
Distance (FSD) and patient data (sex, age, weight, and height) were recorded for each examination at

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BIOMEP 2015 IOP Publishing
Journal of Physics: Conference Series 637 (2015) 012014 doi:10.1088/1742-6596/637/1/012014

the Karamandaneio Children Hospital of Patras, using the GE Model MS 18S radiology unit with
tube filtration 3.5 mm Al. In this study, 120 paediatric patients underwent chest examination and 120
abdominal examinations. The chest radiographs were posterior-anterior and the abdomen
radiographs anterior-posterior projection. No special preparation took place before
examinations.Children were selected so that their anatomical characteristics (weight and height) to
be representative of age groups (1, 5, 10, 15 years old) according to the requirements of the code
used. The nominal anatomical data were based on the mathematical hermaphrodic phantom models
of Christy and Eckerman [6-9].

2.2. Monte Carlo simulation

The PCXMC 2.0 code was used to calculate the dose of each organ separately and the effective dose
of chest and abdomen x-ray examinations.All doses were calculated based on the exposure and
patient data recorded. Photons were emitted isotropically from a point source into the solid angle
specified by the FSD and FOV [6-9].The simulations were made using Intel Core 2 Duo
processor of 2.66 GHz CPU powered by Asus and 4 GB installed memory (RAM). The number of x-
ray photons involved in each simulation was 2 in order to assure a low relative statistical
uncertainty of 0.1 %. The time required for each simulation was 20 to 30 minutes.

2.3. Effective doses and risk assessment.

The effective dose, for each radiograph examination, was computed according to the equation[10]:

E= [ ] (1)

where is the tissue weighting factor and , the equivalent doses for tissue T of male and
female.
For the assessment of cancer risk resulting from an exposure to ionizing radiation [Risk of
Exposure Induced cancer Death (REID)], the BEIRVII mathematical model was used, for all age
groups. The REID values were calculated using the formula[7-8]:

(e, D)= ( | )- (t)] S ( | ) (2)

where ( | ) is the mortality rate at age t due to death cause c, given that the subject was alive at
the age of exposure e and the corresponding dose at the age was D, (t) is the background mortality
rate related to the death because c, S( | )is the conditional probability that the subject is alive at
age t, given a dose D at the age of exposure e.

3. Results and discussion

The patient data and the exposure parameters for chest and abdomen radiographs are presented in
Table 1 and 2, respectively.

Table 1. Patients data and exposure parameters for chest radiographs.

Age FSD Tubevoltage
weight (kg) height (cm) Tubeload (mAs)
(y) (cm) (kVp)
Range Mean Range Mean Mean Range Mean Range Mean
1 6.80-13 9.60 63-100 76.70 122 75-80 77.70 1.12-6.24 2.60
5 12.50-22 16.70 89-120 100.70 151 72-82 79.10 1.89-6.89 3.89
10 31-38 30.80 95-150 129.70 147 77-98 80.30 2.02-9.41 5.40
15 42-76 52.20 140-178 156.40 158 78-95 82.30 2.06-9.91 5.66

2
BIOMEP 2015 IOP Publishing
Journal of Physics: Conference Series 637 (2015) 012014 doi:10.1088/1742-6596/637/1/012014

Table 2. Patients data and exposure parameters for abdomen radiographs.

Age FSD Tubevoltage
weight (kg) height (cm) Tubeload (mAs)
(y) (cm) (kVp)
Range Mean Range Mean Mean Range Mean Range Mean
1 8-13.50 10.26 62-90 79.60 118 70-80 75.50 3.21-12.50 6.21
5 14-26 19.40 92-120 111.00 151 70-80 74.40 3.89-17.20 7.86
10 27-39 32.23 120-145 135.60 150 70-80 76.60 3.95-18.25 10.04
15 40-61 49.20 145-165 151.10 160 70-80 75.50 8.89-22.60 15.43

Table 3. Organ doses in chest examinations.

Organ Dose (mGy) x 10
1y 5y 10 y 15 y
Liver 4.10 3.23 3.28 2.66
Lungs 4.71 4.66 6.07 5.84
Stomach 4.23 7.82 2.10 1.61
Thyroid 4.57 1.35 1.00 0.61
Pancreas 4.04 3.12 3.12 2.50
Breast 1.96 1.77 2.42 1.00
Spleen 3.15 2.98 2.95 2.35

Table 4. Organ dosesin abdomenexaminations.

sex Organ Dose (mGy) x 10
1y 5y 10 y 15 y
Liver 1.61 1.40 0.96 1.91
Lungs 0.98 0.59 0.59 0.52
Stomach 3.91 3.89 3.31 3.31
Colon 3.33 3.20 3.03 3.74
Ovaries 3.07 3.03 3.50 3.03
girls
Uterus 3.35 3.36 3.66 3.29
boys Prostate 3.09 3.25 3.34 3.28

Table 5. Mean Effective dose for chest and abdomen examinations.

Age (y) Mean Effective Dose (mSv) x 10
chest abdomen
1 0.94 3.02
5 1.07 1.26
10 0.49 2.11
15 0.98 1.85

3
BIOMEP 2015 IOP Publishing
Journal of Physics: Conference Series 637 (2015) 012014 doi:10.1088/1742-6596/637/1/012014

Table 6. Mean REID values for all patient groups for both examinations.
REID x10-5
Chest 0.645
Abdomen 1.254

Tables 3-6 present the organ dose, effective dose and the REID values, according to ICRP 103, for
each examination and age group. The dose contribution analysis for all age groups indicates that
some organs received greater dose amounts, such as liver, lungs, stomach, thyroid, pancreas, breast,
spleen in chest radiographs and liver, lungs, colon, stomach and ovaries, uterus (for girls),
prostate(for boys) in abdomen radiographs. The dose of the other organs was negligible.

4. Conclusions
The organs received the highest doses in all patient groups studied were liver, lungs, stomach,
thyroid, breast, pancreas, spleen in chest radiography and liver lungs, colon, stomach and ovaries,
uterus (for girls) and prostate (for boys) in abdomen radiography.The value of mean effective dose
was up to four times higher for abdomen compared to chest. The value of REID for girls was slightly
greater than boys for each examination. The mean REID value was almost double(1.254x10-5 )for
abdomencompared to chest(0.645x10-5). The risk was extremely low for both chest and abdomen
examinations for all patient groups studied.

References
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[2] Ribeiro L.A., Yoshimura E.M. 2008Rad. Meas.43972976.
[3] Yakoumakis E. et al 2007 Rad. Prot. Dosim. 124 348-52.
[4] Kiljunen T et al 2009 Acta Rad. 50 114-124.
[5] Servomaa A. Tapiovaara M. 1998 Rad. Prot. Dosim. 80 213-219.
[6] Eckerman, K. F., Cristy, M. and Ryman, J. C. 1996 The ORNL mathematical
phantomSeries. Available on http://ats.ronl.gov/documents/mird2.pdf.
[7] International Commission on Radiological Protection (ICRP). Basic for dosimetric
quantities in radiological protection. Annex B of main Recommendations. Publication
103 2006 Elsevier.
[8] BEIR - Committee to Access Health Risk from exposure to low levels of ionizing
radiation. BEIR VII. 2006 National Academy of Science.
[9] Tapiovaara M, SiiskonenT. PCXMC A montecarlo program for calculating patient doses
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[10] Yakoumakis E et al 2015 Rad. Prot. Dosim.163 202-209.