aossop oquiprent ble 7.7 Results of celeulaton for orthopaedic tru KK, per annum (mGy)_Gccupancy (%) Required transmi AZM 16 38 08 ‘9mm gypsum wallboard AC2.2m:0 33 1 Nothing: 7.4.2 Coronary care unit—pacemaker insertion Mobile C-arms are used in coronary care units for pacemaker insertions. Typically, the KAP for the insertion of a temporary pacemaker is approximately 5 Gy eth’. These are relatively infrequent procedures with generally fewer than two patients pér week. The average weekly KAP is therefore unlikely to exceed 10Gy cm”. The procedures rooms ‘in which pacing is carried out tend to be relatively sinall, so less attenuation is provided by the inverse square law, In this example, the workload is assessed at 10 Gy om? per week, which is S00 Gym? pet year. Pacings ate carried out at §5kV. The construction of coronary care units is such that the distance to the nearest wall is 1.51 and the unit is adjacent to the ward secretary's office. Occupancy is therefore 100%, Details of the calculation and results are shown in Table 7.8, The specification of 27 mm gypsum wallboard can easily be achieved by facing each side of the partition with 15mm wallboard, Table 7.8 Results of calculation for coronaty care unit K,.ber annum {mGy) Occupancy (%) Required transmission Shielding required i 00 ~~S~CSS~SCSCSCS*« Ym gypsum wala ‘Recinon Shilling tor Degree Recobay »Chapter 8 CT installations 8.1 Introduction The use of CT has more than doubled in the UK over the past decade and is now reported to account for 68% of the collective dose to the UK public from all X-ray procedures (Hart et al, 2010). CT scanning uses heavily filtered beams with tube potentials of 120-140KV that give high levels of Compton scattered radiation. The net result is that CT rooms require the highest level of protection of any X-ray facility. ‘The primary beam is intercepted and effectively attenuated by the scanner detectors and gantry hardware, so the protection required is against scattered radiation. As with R&F procedures, the level of scattered radiation generated from a CT scan is related to the amount of radiation incident on the skin of the patient. Therefore, a similar approach to the assessment of scatter level and CT workload can be adopted, based on quantities used to assess patient doses and diagnostic reference levels. Methodologies based on the CT dose index and DLP have been described in NCRP (2004). A method based on DLP is recommended and described in this report using scatter factors derived from measurements on various CT scanners (Wallace et al, 2012). The method is closely related to that for other modalities linked to the KAP. In the first edition, calculations were based on isodose plots of scatter levels from standard cylindrical phantoms provided by the manufacturer, for which the scatter levels often differed significantly from those measured using anatomical phantoms (Van Every and Petty, 1992; Burrage and Causer, 2006). This method required the total tube current time product workload in mAs, which is more difficult to estimate now that scanners have tube current modulation that allows for differences in body attenuation. The performance of the various methods has been assessed and compared in several studies (Larson et al, 2007; Cole and Platten, 2008; Wallace et al, 2012). beara tat te Swdter wn latte 3° 8.2 Methodology cat be wed un ‘pertead ah fare tor 8.2.1 DLP scatter factors CT scanning differs from other radiology techniques in that the X-ray tube is rotated in a 360° arc around the body. The dose distribution is well defined and reproducible because the X-ray tube follows the same path in space for every rotation. The radiation. / scattered from a body at the isocentre is of a similar magnitude in all directions ( apart from that of the gantry, and the resulting pattern of scattered radiation has the _ appearance of an hourglass which has 360° symmetry about the axis of rotation. This is illustrated in Figures 8.1 and 8.2 which show plots of scatter kerma as @ function of DLP based on measurements made for scans of the head and the body with anatdmical phantoms during the preparation of this report (Wallace et al, 2012). The scatter pattern o Rackation Sing for Diagnostic RacologyFr netatoting is determined by the volume of tissue irradiated and intervening attenuators in the form. of the gantry and the patient’s body. Scatter factors of the form: (8.1) s,-% (8.1) DLP where: values of K, represent the scatter air kerma at 1m from the isocentre: for particular directions have been derived from the results and are listed in Table 8.1. 4 Gyimey em — 0.05 pGyiniGy om —0.02 ueylnigy cm “0.01 uGyin}By om —aossyeymyon 0.002 weyiney can “0.001 wGylinay ora 0.0005 pisyimey em 1 uGyimey em 0.08 uGy/mey em 0.02 uGyimeyem 70.01 wGyimigy om 0.005 uGyimGy om 0.002 yGyimey em “0,001 yGylingy em 0.0005 uGyimcy cm ial a | Figure 8.1 Isodose curves showing scatter air kerma distributions per unit DLP for ecans of anatomical phantoms for (a) @ CT body scan and (b) a CT head scan, derived from scatter ai kerma measurements made during the preparation of this publication ' Relea Sheng fr Oségnoté Racotony 8caer 8 0.1 yay on 1005 weynsyem 0.02 weyindy em 1201 wOyimoy om 0008 poyiny en oon yayincy en (2001 uoyimoy en 0.06 yyy em im) Figure &.2_Isodose curves showing scatter ar kerma distribution in the vertical plane for @ CT body scan showing the levels that might be expected on adjacent floors without shielding, The heights of adjacent ‘foors are similar to those on which the calculations have been based. Table 8.1 CT scatter factors giving the air kerma at 1m from the scanner isocentre at different angles. with respect to the scan plane from body and head scans (Wallace et al, 2012) Examination Sector of CT scanner Angular range (*) (see ‘Scatter air kerma per unit DLP Figure 8.1) at 1m [Gy (mGyem)"] Body Front 90 to -20 0.36 Body Rear 400 90 03 Body Gantry 20 to. 40 0.04 Head Front and rear 90 to ~20, and 40 to 90 ota Head Ganty -20t0.40 0.014 To facilitate the description of positions, the side of the gantry on which the couch is situated will be described as the front, and the other side, which is often towards the head of the patient, as the rear. Three scatter factors are given for body scans and two for head scans associated with different positions around the scanner. The range of orientations over which each factor should be issed are described in terms of the angles with the scan plane: +90° representing the rear of the gantry, 0° the scan plane and 90° the foot of the couch (see Figure 8.1). In all CT scanners, the isocentre is closer to the front of the gantry and the ratio of the distances from the two sides of the gantry is approximately 2:3. The scatter air kerma at greater distances from the isocentre can be derived by application of the inverse square law. 8 dation Shioking for agnostic Racotogyerinstatotons The scatter factor for the body at the front of the gantry will overestimate’the scatter at the foot of the couch which is attenuated by the trunk, but this allows for sedins ef shorter quality assurance (QA) phantoms for which attenuation is more limited. A slightly lower factor can be used for the rear of the gantry for body scans. The results for the head are smuch lower than those for the body (Wallace et al, 2012). Separate factors are given for directions shielded by the gantry, so that this can be taken into account where appropriate. ‘The factors given in Table 8.1 have been chosen to provide a reasonable assessment of scatter air kerma levels for all scanners with tube potentials between 120 and 140kV (Wallace et al, 2012). : ‘The CT scanner gantry provides effective protection against the primary beam. and scatter in the direction perpendicular to the scanner axis; the allowance tHiat should be made for this is considered in Section 8.2.2. The scatter kerma tises from a low level at 20°, reaching the maximum between ~30° and —35°. Therefore, calculations of the amount of shielding on the front side of the gantry can be based on the nearest point on ‘the barrier at angles between ~30° and -90°, but the shielding should extend to an angle of—20" to ensure that all parts not protected by the gantry are included. Calculations for the rear of the gantry should be based on the nearest point on the barrier between 40° and 90°. In order to illustrate the distributions derived from the-method recommended, the positions of the 0.02 uGy (mGyem)+ isodose lines calculated using the factors in ‘Table 8:1 are compared with the position of the corresponding isodose contours derived from measurements in Figure 8.3 for the body and head. They provide reasonable yet conservative representations of the scatter air kerma distributions. CT scanners are generally positioned atan acute angle to the walls. This often provides more space for trolley access and enables the radiographer to.view the patient within ‘the scanner gantry. It may’ also improve the visual assessment of the patient, position within the gantry. Because ‘of scanner angulation, scatfer kerma from the patient not attenuated by the gantry is usually incident almost perpendicularly on the side walls. Asa result, effects of any increases in the distance of the wall from the i$ocentre and ‘the path length of the radiation through the wall are small and seldom provide any substantive advantages in protection. However, shielding from the gantry is useful when determining protection of the ceiling and floor (see Section 8.4.1), , 8.2.2. Gantry shielding ‘The CT scanner gantry will provide some protection against scatter within a 60° are around the scan plane (see Figures 8.1 and 8.2). The protection this affords. can be taken into account, although it is recommended that in all but the most exceptional circumstances the level of protection in each wall should be constant. The gantry will transmit only 10% of the scatter air kerma'to an angle of ~20° to the isocentre towards the front of the couch and 40° to-the rear; scatter factors for these directions are given in Table 8.1 and isodose contours produced with these factors are shown in Figure 8.3. ‘The gantry position must be known accurately if account is to be taken ofits shielding; if inforniation on the exact position of the isocentre is not known, it should be assumed ‘that the ratio of distances to the front and rear sides of the gantry is. 2:3. Although it is recommended that parts of the walls protected by'the gantry should be shielded to the same level as the femainder, it may be possible to use less shielding for Fadlaton Siasng for Diagn Rastoleny a‘chapters —Measured dose contour 0.02 uGy/mGy cm —Calculated dose contour 0.02 uGy/mGy cm b) —— Measured dose contour 0.02 uGyimGy cm —Calculated dose contour 0.02 GyimGy cm Figure 8.3. Isodose curves comparing measured scatter air kerma distributions for scans of anatomical phantoms in terms of the 0.02)xGy(m@yem)" contour per unit OLP and isodose lines calculated using the factors recommended for shielding calculations in Table 8.1 for (a) a body scan and (b) a head scan. os Radiation Shleling or Diagnostic RacotoaycTntanesone doors and penetrations lying within the arc protected by the scauner gantry. It is useful to consider the gantry position with regard to the location of large penetrations stich as ducis for air conditioning. : 8.3 Workload and shielding calculations i 8.3.1 Workload considerations : ‘The workload in the department should be predicted in terms of the DLP from scans of the head and body. This would ideally be obtained from an audit of Idcal practice, but the DLP for protocols representing the bulk of examinations to be performed on the scanner may be used if data on the full range of exantinations’ are limited: Data for 38 CT scanners in hospitals within the regions served by members of the. working party preparing this report have been assembled to provide information on typical CT workloads in different hospitals; the results are rounded and stimmarised in Table 8.2. The head group encompasses all examinations using a small field of view, including those of Jimbs and joints. The total number of head and body exerninations performed over a year varied significantly depending on the location, the population served and local specialisations. The mean DLPs for individual examinations provide an indication of likely values, but the third-quartile vaiues for the distributions of ‘mean room results were between 900 and 1000 mGy cm, so a local assessment should be made. A degree of caution must be exercised in planning new facilities because the radiation levels delivered may vary'as new scannet technology is introduced. Such changes allow scans to be performed more rapidly and increase patient throughput; as technology improves, thetange of procedures for which CT ithe technique of choice is likely-to expand, 8.3.2 Scatter calculation ‘The scatter air kerma (K,,,) at Lm from the isocentre of the CTT scannei in different directions can be predicted from equations of the form: Koy=(N, X50 * DLP, Sq.) + OV, 50% DLP, Sop) (8.2) where 4), and W, ate the number of body and head scans per week, respectively, for a ‘50-week year, DLP, and DLP, ate representative values for the DLPs for the body and head and S,,, and S,.,, are the corresponding scatter factors from Table 8.1. An inverse square law should then be used to determine the dose at distances corresponding to ‘walls forming the boundaries of the scanner room. Direct exposure to scattered radiation from CT facilities at some distance, and the level of radiation scattered from concrete Table 8.2_Represontative values of CT scanner workload from data collected Scan Mean DLP per Mean total DLP Thi quale total Range of DLPs Mean Range of ype exam (mGycm), perannum = DLP perannum = perannum number of numbers of (Gyan) {Gyem) {Gyem) exams (7) _exams (r) Body 850 1900) 3409) 70-5000 2400 | 80-6400 Head 870 1300. 2500 50-3600 1400: 100-4300 Total 860 200 5500 Bo0-8600 3800! 1000-9500 ‘Radiation Sting to Doqroate Racin %Chapor roof slabs ate both likely to give'substantial doses to those exposed, so some shielding of entire walls up to the ceiling slab will almost certainly be required. ‘Rooms smaller than the 38m? recommended are frequently used, and for these cases walls closep to the isocentre may need considerably greater protection. Although additional lead sheets localised to such areas can be used (Harpen, 1998), this is not generally récommended, and close liaison with the construction company would be required to:ensure that additional protection of this type was located in the correct position. ‘Once the; scatter air kerma levels at the positions where exposed personnel or mentbers of the public might be present have been calculated, the required transmission values can be derived fom comparisons with the dose criteria. Barrier requirements can then be calculated using the secondary CT transmission parameters for lead at T20KV (a=2.246; B=5.73; y=0.547) or 140KV (a 342) (see ‘Table 4.3). Parameters for concrete are at 120KV (a: 658) or 140kV (a=0.0336; 6=0.0122; y=0.519). In cases where both 120 and 140kV are used regularly in'clinical practice, it would be prudent to use transmission data for L40kV. 8.4 Specific CT shielding considerations 8.4.1. Ceiling and floor protection ‘The level of protection required in the floor and ceiling for modern helical scanners is often greater than that provided by a'standard concrete floor (Langer anid Gray, 1998). Floor aud ceiling slabs in new buildings are often thinner as well as being made from lightweight concrete and may require additional protection. The conerete is frequently poured on & metal base with a ridged cross-section giving a trapezoidal variation in thickness (see Section 3.1.4), and here the minimum thickness should be used in calculating the protection. This may be only 80mm, and ceiling slabs of this type are likely to require additional protection. ‘Taking account of positions of radiosensitive organs, requirements for shielding the ceiling should be calculated at 0.5m. above the next floor level, while those for the floor should be assessed at a height of 1.0m above the floor below (see Figure 8.2). A consequence of the gantry attenuation is that the higher levels of scattered radiation are incident on the floor and ceiling at an oblique angle. For X-rays incident at and angle 4,,an obliquity factor (cos 0) can be applied to both the distance to the barrier and the barrier thickness in calculations, and a value for 0=30° is recommended. Where a gantry tiltis:employed for a substantial proportion of head scans, it would be prudent to reduce the 30° angle to take account of this, although Van Every and Petty (1992) have shown that the effect on scatter levels incident on the ceiling is small. The thickness of barrier (T,) required to attenuate radiation incident at angle @ can be calculated fom the equation: 14, (1 +008 02 3) where ¢, is the thickness of material to provide the required attenuation for X-rays at normal incidence. 100 Factoion Shang fr Discos: Reoogy(oT hatatatione Uniting ray for calculation of protection for celing Length L of area for secondary scatter caloulation Ceiling slab au = Proposed location for duct Coting hight h directly from patient Figure 8.4 Diagram showing a section through a CT scan room defining the area of ceiling slab contributing to tertiary scatter that will iradiate staff in the control cubicle, The area is limited by the X-ray path at 30° to the vertical through shielding by the gantry. The dashed line indicates the region for installation of additional protection for tertiary scatter. The scatter level is determined by the heights of the ceiling h and the barrier b. 8.4.2 Contributions from tertiary scatter The shielding of walls to a height of 2m will almost certainly be insufficient for a CT installation. The level of radiation scattered downwards from the ceiling slab into the control cubicle or into an adjacent room is likely to exceed the dose constraint for protection of persons in rooms to the side of the scanning room (see Figure 8.4). ‘Therefore, shielding would normally be to the full height of a room. In rooms with false ceilings, it will in most cases be necessary to extend the wall shielding to the roof slab. The level of protection required in the upper part of the room is unlikely to be as high as that required in the lower parts of the walls, given that only a few percent of the radiation will be scattered. Code 3 can be used if this gives any advantage, but frequently the simplest option is to specify protection to the same level as the remainder of the wall, to avoid confusion. The scatter level depends on the heights of the ceiling slab and the protective barrier (Martin et al, 2012), as described in Section 2.4, and the scatter in iGy is given by an equation of the form: Soci (Coup My, 5) * (DLP, + DLP,/2) (4) ting where bis the height of the barrier in metres and C,,,,and m,, ,are constants dependent on the height of the ceiling (see Table 2.4), and the DLP, and DLP, are in Gy cm®. ‘Measurements reported by McRobbie (1997) indicated that scattering from a concrete barrier will reduce the dose rate to approximately 1% of that incident on the ceiling slab, which is in line with these results. Equation 8.4 can be used to determine the thickness of lead required in the section above the main primary barrier (see Figure 8.4). If the Raton Shioing for Diagnose Racooay 101chapter distance between the false ceiling and the ceiling slab is large, it may be more cost- effective to include the lead in the false ceiling, because this will provide additional protection to both the floor above and the adjacent rooms; in this case, Code 3 lead will almost certainly suffice. ‘The control cubicle for a CT scanner would normally include a protected door. It is unlikely that a cubicle without a door would be acceptable, given that a number of staff, including radiographers, radiologists, nurses and other clinicians may need to be accommodated. Moreover, tertiary scatter from the adjacent wall into the area occupied by staff is likely to be significant. The level of tertiary scatter from the wall in »Gy can be calculated using Equation 2.6 with the DLP workloads: Syay=12x(DLP, + DLP,/2) °°! (85) where dis the distance of the isocentre from the wall adjacent to the door in metres. 8.5 Worked examples ACT scanner in a busy city hospital is to be located in a room measuring 5.55 7m, with the operator’s cubicle in an adjacent room. The separation of floor and ceiling slabs is 4.0m. Each is constructed from lightweight concrete (density, 1840kgm™) with a minimum thickness of 100mm. The scanner isocentre is located 0.9m above floor level. The scanner is to be located towards the left side of the room, as shown in the plan (see Figure 8.5). Patients will enter through the double door on the right. hand wall. The scanner is positioned at an angle of 12° so that the operator can obt Wall B Reception area High level ventilation duct Position 2 Figure 8.5 Plan of the CT room layout used in the worked WallC example. Distances to the respective walls A-D) that will be used Corridor inthe calculations of uunattenuated scatter d,, dy d,, and d, are given. Wall A Clinic area Control cubicle 02 dation Shing for Diagnostic Racologyer isitaions a good view of the patient within the gantry. The door from the cubicle ihto the room is located in the right-hand corner to maximise the space, and the opetator cubicle window extends for most of the remaining length of the wall to providé a complete view of the scanner and the other door. The distance to Wall.A on the left side of the figure is 2.5m, that to Wall B is 2m, that to Wall C containing the door giving access to the corridor is 3.2m-and that to the control cubicle window is 3.5m. ‘The projected workload forthe CT scanner comprises 90 body and 60 head éxaminations per week; few are undertaken at 140KV, so transmission data for 120kV ‘will be used. Average DLPs for both the body and the head are-taken as 900mGy em, which gives a ‘workload that is towards the busier end of the range, Substituting the weekly workload for body and head scans into Equation 8.2 together with the CT scatter, factors (see ‘Table 8.1) gives an annual DLP for the body: DLP,=90%50900mGy cin=4,05 x 10'mGycn=4.05x 108Gyein (8.6) and for the head: i DLP,=60% 50x 900mGy em=2.70x 10°mGy em=2.70x 10°Gyem (8.7) ‘The air kerma at 1m from the isocentre (K,,,) to the front of the gantry then equals: cx (4.05 x 10x 0.36) + (2.70 108%0.14) hGy= 184% 104uGy! (8.8) A slightly lower value can be used for the rear, if this offers any advantage. The ait kerma at. I m from the isocentre (K,,,) at the rear of the couch is equal to: x2" (4.05 X 10° <0.3)+2.70% 1080.14) HGy=160% 14uGy | 9) ‘The gantry offers protection at angles between ~30° (front of gantry) and-+40° (rear) to the plane of rotation (seo Figure 8.5). The protection offered by the gantry would izive an equivalent air kerma at 1 in fom the isocentre (K.,.) equal to: pan = (4.05% 100.04) + 2.70 105% 0.014) uGy=20x10'uGy (8.10) Calculations of shielding requirements for various aspects of the scanner room ate even in the Examples 82-¢ using adose consirant of 0.3 mGy per annum. Results are summarised in Table 8.3. Example 8a: walls to the rear of the gantry Wall A Scattet air kerma at the rear side of the gantry is incident on Wall A at angles between 40° and 90° with the scan plane. Because the gantry is aligned at an angle of 12°, the nearest point of exposure will be at an angle of (40°~12°)=28°. The distance to the wall at the-rear from the isocentre is d,=2.S/eos 28°~=2,8m, At the front, the higher scatter is incident at angles over 30° to the scan plane, so here the highest scatter will be at an angle of (30° 12°)=42°, Because the difference in the cosines of the two angles of incidence is approximately 1.2, similar to the difference in scatter factors on the front and rear (Table 8.1), the calculations for either side of the gantry will give a similar result. The occupancy in the clinic on the other side of the wall is 50%. Radian Shitting or Diagnostic Radiology : 108Box.8.1 \ Calculation for Wall A The annual 2 io kerma incident on the wall is given by: Kg Kel 160 «1042 8%,6)=2045 10% Gy “The ruled ensmisson forthe brrer=$00(204% 10'x08)=80%10" “The protector can be provided by 1 Sm flead or-4mm of tender conte: Wall B Scatter is incident perpendicularly on Wall B at the rear of the gantry. The occupaney in the reception area on the other side is 100%. Box8.2 = Caiculation for Wall B Seater ae Kerma incident perpendicularly on Wall B is given by: Koga Key? #160 1052, 0",.G)=400% 10 4Gy “The required transmission fr tke barier=300/(08 «10° 1.0)=0'75>10% ican be provided by 2.2mm of eador 178mm of standard concrete. Because this is the closest wall to the isocentte and is not protected by the gantry, this, will determine the shielding of the walls for the whole room, which will be specified as Code 5 lead. Example 8b: Wall'C Scatter air kerma at the front of the gantry is incident on Wall C at angles between 0° and 50° with the scan plane. The region where:a higher scatter level is ineident lies between 30° and 50° to the scan plane and includes the doar to the corridor. The ‘occupancy in the area outside the door is estimated to be 50%. The highest scatter kerma is incident at an angle of 30°—12°= 18? to the wall/door. ‘The shortest distance (@) from the isocentre to scatter incident on the wall and door is: : d3.2c0s 18°=3.4m 1) ‘The occupancy in the corridor ouside the door is 20%. Boxes | ‘Calculation for door in Wall C The annual air kerma incident.on the door to-the consider (K,) is given by: Keo" Keyde = 184 10S 44uGy 159310 Gy “The required fansinission for tho barrier = 3004159.x10*<0 2)=0% 10% “The required Yansmiasion is provided by 1.2mm ef ead (Code 2) ‘The obliquity of the incident radiation could be taken into account in determining the lead thickness, but the advantages are limited for angles of incidence less than 30°. ‘Tertiary scatter from the adjacent wall could give staff behind the barrier a substantial dose if there were no door in place. The annual dose from tertiary scatter calculated usiig Equation 8.5 would be: S,,=10(DLP,+DLP,/2)% 892 105.4% 10? eH Gym 11 10 wGy (8.12) Thus, the door to a CT control cubicle is always likely to require shielding to protect ‘staff behind the barrier from tertiary scatter. 108 : action shiotang for Diegnosti ReaogycTinstatations Example 8c: CT operator’s cubicle—Wall D The ocetipancy in the area is taken to be 100%. Box 8.4 ‘Calculation for cubicle window | ‘The annual air kerma incident on the window ofthe operator cubile (Kg) whieh is a distance d, of 3.5m from the Isocentre.is given by: Ko Keng = 1841018. wGy= 150% 10° sy The required transmission forthe bartier= 900/150 10" .0)=2,0%10°, ‘This transmission is:provided by the equivalent of 7.8 mm of lead. Wall above cubicle window ‘The cubicle window extends to a height of 2m, but X-rays will be scattered down from the ceiling slab into the cubicle. The level of scatter for a ceiling of height-4m with a 2m high barrier can be predicted by substituting the annual DLP workload into Equation 8.4 with coefficients from Table 2.4 for a'4m high ceiling and a barrier height bof 2m. i Box 85 Calculation for wall above cubicle window ‘The air Kerma scattered (S,.) from the ceiling slab incident on an operator ie given by: Sqr 19-(0.206>2 0/4 086125) 10%p.G)~32 10% ASY t “he esr ranemision forthe bari = 300/23 10° 1 )=0.09. : Proton fs proved by 0.5mm of ead or 50mm of standard canerte at 12010 \ In this situation, even if the barrier was raised to a height of 3m, the ait kerma scattered from the ceiling slab would still be 1.6mGy and additional protéction would ‘be required, The only situation where it may be possible to.avoid protection to the roof is in departments with workloads at the lower end of the workload range (sce Table 8.2), ‘where protection up to the height of the false ceiling may be an option, but care must be taken in the spevification because it would be considerably more expensive to install such shielding at a later stage. Example 8d: celling—CT room ‘The radiosensitive ‘organs of'a person sitting in the room above the CT scanner will be about 0.5m from the structural ceiling and so will be at a height of 3.6m above the isocentre, The Radiology Department has no control (or knowledge) of any ture changes in use of this area, so an occupancy of 100% is assumed. L Boxe. Calculation for ceiling “Tho distance along the tne of galt sce wil bed, =(3.6fe08 30")=4 27. ‘Applying on inverse squere nw creation along then of grastost scatter wil give: ‘Annus! air ema incident on a poreon onthe fidor above (K) Te vo by: Sg? Ky 2 WY 184 108 25 Gy = 108 TOE Gy “The reguied transmission forthe Baier =300/(104» 10°%7,0)=2.9%102 “The protection requited in te root 1.7inm of lead or 144mm of Sadard Concrete The suites (FoF ightweight concrete (density. 1840kg v*) would be: Te=141%2850/1840=180mm Racitio Shiting for Diegnaste Redibgy a5chap 8 ‘The thickness of the roof slab is 100mm and the distance along the line of scatter is 100/cos 30? 112mm. Because radiation is incident obliquely, an equivalent barrier thickness equal to the mean of the actual thickness and thet jn the dicection of scatter can be assumed (106mm). Thus the protection provided by the structural conerete in the floor is insufficient, ‘The thickness of barrier (T,) required to attenuate radiation incident at angle can be calculated from the Equation 8.3. Thus for this example, 7, =180%(1+cos 30°)2=168mm, so 681m of lightweight concrete would-be required in addition to the existing 100mm, “The existing lightweight concrete roof slab has a transmission of 13% 10° at a 30° angle of incidence, so the addition of Code 3 lead will be more than sufficient to provide the additional protection. Box8.7 5 ‘Specification of additional protection for the coiling ‘A total thickness of 168/mmn of ight ccnorte is nbqured, or the Sitio of Codes Lead to the existing +100%mm thick galing siab of hahtweight concrete is needed to give the required level of protection forthe for above. A similar level of proteotion will be required for the floor. Example .8e: ventilation duct A ventilation duct with an area of 0.5m? must be sited in the wall adjacent to the corridor. The floor above contains a ward for which the occupancy factor is 100%. Position 1 above door It has been proposed that the duct would be located above the door and the diagonal cistance through the penetration to a point 0.5m above the next floor level (d,)is 5.5m. Position 2 shielded by gantry An altematiye position would be to site the ventilation duct in a region protected by the gantry (see Figure 8.5). Boxes | ‘Calculation for ventilation duct protection—Position 1 Kgs ® Keyl? = 184% 1048. 5°46)=067> 10° NOY ‘The eqred anamision or prtecton= 300K x10 0)=50% 108 “This transmission is given by 181mm of lightweight concrete for direct incidence. As the angle of incidence is 20", ‘this equates to: Tater» (hee a0"y2= 160mm “Therefore the 100mm thick ceiling stab will not provide sufficient protection, Abaffle made from Code 3 lead would be requited to protect against direct exposure. 8.6 Things to be aware-of The ceiling Slab may not provide sufficient protection for rooms on the floor above to the side of the scanning room should the wall protection not extend up to the underside of the soffit, Areas on all sides of the scanning room are likely to require protection against tertiary scatter from the ceiling slab. The protection requirement in walls above 2m is unlikely to exceed that provided by Code-3 lead. 108 -Rasaton Sting ee Degnoste Resotay(CTinslatatone Box 8.9 Calculation for ventilation duct protection—Position 2 shielded by gantry : the venilatin duct ware tobe sted in region protected by the ganty (see Figures 84 and 8.9), thea emma eval woul ba Ka" Ky, =20% 1045 Stuy =6.6% 10yGy i “Tho rosie ranaraeion or proleatisn™ 300/68 6% 10°x1.0)45% 102, “The roteeonrequed would be Gomm otkgmwoight onerete anda an angle of would be afforded by 7, =00x(1e0s 30)2-84mm ‘So the protection afforded by tho 100mm ticksoot slab is auicen and no baff wil be required ied is sited within Ui Xray shadow of tho gait. Box 8.10 Final specification for CT scanning room | ‘Atal peet by Code load manfred to BSEN 12542005, oh halt of te le ct. Protection in the walls above the level ofthe else caling tobe with at east Code: ead, “The door to the condor te be protected by a least 1.2mm lead (Code). ‘The control cubicle window is to be protected by 2m lead-ecuelent glass at 120K, “The door othe contol cube is o be protcte by a leat 7mm of ead (Code 4. “The floor and ceiing require protection eauivalent to 168mm oFighveight concrete or Code 3 lead tothe 100mm thick slabs. “Tv Yeniation duct isto be sited to the left the door. fookng om the inside ofthe room. is « bas conisiring Code 3 lead shout be instalec. ‘The region of highest scatter occurs at angles between 30° and 40° to the vertical to the front of the gantry, so an angle of 30° is considered when calculating the transmission requirements. However, because the level of scatter to the side of the-ganiry gradually inereases from an angle of 20° to the scan plane, the region from 20% upwards is considered when specifying the extent of wall and door protection requirements. CT control cubicles will always require shielded doors to protectagainsttettiary scatter. The walls of any CT room will require protection with at least Code lead, even if the workload is af the lower end of the normal range. Gantry shielding, should be considered in determining the location Of any large penetrations, CT simulators are used in a similar manner to conventional CT scanners, but a larger field of view is normally chosen, The amount of scatter is similar to that for other CT scanners. However, because a lager field of view is selected, the DLP ‘displayed is likely to be calibrated for the body. The scaiter factor for scans of the head when the DLP is displayed in terms of that for the body is a similar order to that forthe body, so calculations of protection for CT simulators should be based on the factors for the body. 8.7 Mobile CT scanners within hospitals Mobile head CT equipment is now available for use in intensive care. A similar methodology based on a head DLP scatter factor of 0.14 wGy (mGy em)" could be used to predict likely scatter levels from projected workloads, but the protection afforded by ihe gantry is likely to be less. An assessment of protection issues for a mobile CT unit has been published by Stevens et al (2009). They recommend fitting a pair of 0.5mm Jead-equivalent lead/rubber. shadow shields. at the side of the couch, which could be angled towards the patient to limit scatter towards the feet, anda 1.0mm lead shield across the rear adjacent to the head fo limit scatter in this direction. Rotiaton Shietiing for Diagnose Roda ‘or(wu) Bx ope: ‘Guuystem syoroucd. 7 Goh - - ve os = wee lh sO SSOOHOIML fut) wbyoser GuryBiem 2}2:0U09 os zee _ = 39 et - edt OP pe ssouyoiy, (uw) 50 a “a a £9, ve zy wz STL peal jo seeuyoIyL 600 ObNEZ AOLXEZ wOLKOZ WOLKGH «OLHO'S GOLXt'S cOLxQL0 -Olxo'e —_uoIss|usueLL oo} Ok 000k oz 001 0S (te) Asuedn200 (hor Wee. eDEXZ'E DLXPOL COLXSOL OLXOSL OLxO' WOLxL9. OLxBSL -OLxOOh 10" Box 10.3 | Final specification Lead requlted¢ 1.82mm (Code 8) tote Wale and sided, Other contract durations of a few months can be common. The calculation above remains valid provided the duration is less than 40% of the year, It should also be noted that no one would realistically be as close.as 2m, so this is very much a worst- case scenario. 10.4.3 Mobile CT scanner Acypical layout fora CT scanner installed into a mobile trailer is shown in Figure 10.3. ‘The resulting weight is typically 20 tonnes. In general, the design of the shielding for a mobile unit is concemed with. dose limitation to people within the trailer (staff, patients and accompanying persons) and amembers of the public outside the trailer at ground level. However, if the trailer is located cloge to a building, there may. be issues of doses to the floors above ground level in the building, Site-specific issues cannot be predicted by the shielding designer and therefore must be subject to separate risk assessments. ‘The critical direction for a CT scanner is parallel to the axis of the scanner (see Figure 8.1); so that for a mobile scanner as shown in Figure 10.3 the highest doses are likely to be encountered when the trailer is parked end-on to a building. 1m aditon Sting or Diagnose Racoboayscotaroous 13m 35- arm 3 Eatininent we [X Figure 10.3 Plan showing layout of mobite CT scanner. Example calculation: mobile CT The worked example below considers the requirements for the walls using the ‘methodology: of Chapter 8. The calculation for the screen between the X-ray unit and the control area is identical to that in Chapter 8 and is not covered here. ! ‘The annual dose at Lm for a high workload CT scanner (see Section 8.5: 90 body scans and 60 head scans per week) is 191 10*pGy. The, closest distance to any person immediately outside the van is taken as 2m; therefore, the annual dose is 48x10" nGy. Mobile scariners ate likely to be operational at a single site only for shorter periods. A typical maximum duration of contract might be 2 days per week ‘throughout a year; therefore, at any site the maximum air kerma is likely io be 48% 10! 2/5 uGy= 19.2% 10° Gy per year. ‘Transtnission required for the walls=300/(59.2* 10*)= 1.6% 10%, For the roof, the nearest window to the scanner is likely to be at least 8m away and the same methodology can be used. Air kerma for 2 days per week operation over 1 year=(191 x 10° 2/5)/8! Gy = 1.2 104uGy. Transmission for the roof=300/(1.2 x 10°)=2.5x 10%, Box 10.4 Final specification Lead required ie 1.8mm tothe walls end-stide-out 0.85 mm lad is requied fr the roof this example, 10.4.4 Mobile mammography vans A report by the NHS Breast Screening Programme (NHSBSP, 2000) states that the external walls of the trailer are likely to be adequate for protection purposes. Tt is the responsibility of the shielding designer to check that this assumption is valid. Particular issues to be considered are ocoupaney outside the trailer and the height of the unit above ground level. Radian Shika er Diagnoets Rasotoay 10coop 0 Mobile mammography facilities are commonly operated in areas such as car parks with public'access. Although there are fikely to be members of the public inthe vicinity at most times, occupancy by a single individual will be very low, particularly when it is recognised that trailers are. not operated in the same location for more than a few weeks in any year. The designer may therefore consider it justified to use the minimum. ‘occupancy factor of 5%. The floor of the trailer is generally at Least 70 om above ground level so that the image receptor will normally be-at head height of above for those standing outside the van, and the position of maximum scatter will be at or above head height even for jateral beams. For this reason; the shielding designer may choose to use'a reduced scatter factor. Simpkin (1996) showed that the scatter at 90° is flower than the maximum value at 163° by'a factor of six. It is therefore recommended that for the external walls a scatter factor of 1.3 jwGy per image may be used rather than the factor of 7.6 Gy for the internal walls. In designing internal partitions, separate calculations may be required for low- ‘occupancy areas (changing cubicles and waiting area) and the reception desk, for which high occupancy must be assumed. Itshould be noted that aluminium is often used for intemal partitions in mammography trailers. However, it should also be noted that the transmission factors in Chapter 4 are an overestithate because they are primary rather than secondary transmission factors, 10.4.5 Corisiderations in the’ siting of mobile trailers ‘The hospital Radiation Protector Adviser should be consulted on the positioning and use of the trailers for cardiac catheterisation laboratories-or CT scamners. Trailers can be large (up to 3.8*.15m long and 4m to the top of the trailer), and sost are extremely heavy. Typical sizes and weights of mobile scanners ate shown in. Table 10.7. Detailed information is generally available from the trailer manufacturer; however, many of these are not UK based. Trailers generally require a three-phase supply and a suitable “pad” for parking, Some ‘require a water supply as well. Links to the hospital building may be considered for patient comfort and protection from the elements. Because tiailers need to be parked in an-area. with easy access to the hospital, their location must be given careful consideration. The following points may need to be teken into account with regard to protection when siting mobile trailers! ¢ The proximity of adjacent occupied aréas in buildings. If the trailer is located close to a building, there may be issues of doses to the floors above ground level in the building, © Overhariging buildings, ot occasions where the trailer may be parked under a building. Many trailers'do not have lead in their roofs. Where this is the case, the dose to persons in the floor above may need fo be considered. Orientation of the CT scanner trailers. Ifa trailer is parked so that the CT seaiimer is parallel to the building, self shielding-in the gantry should mean that the scatter air kenma is significantly lower adjacent to the building, and less likely to present protection issues. ry Racation Sticking Sor Diagnostic ReseoayMicetareous © The critical direction for a CT scanner is parallel to the axis of the scanner, and the highest doses are likely to be encountered when the trailer is parked end-on to a building. © Pasticular care may be required if the trailer pad is lower than the adjacent ground level. This situation has beon observed at some sites. Siting issues must be subject to a risk assessment. The local risk assessor Would need to know the height of the isocentre of the CT scanner or the C-arm above ground. level and the height of the shielding provided in the sides of the trailer. 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