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This report is the final outcome and summary of the work of the EURADOS WG12, Sub-Group (SG) 3: Technical aspects on DAP calibration and CT calibration. Management of patient dose in the high dose procedures of interventional radiology (IR) and computed tomography (CT) requires regular and accurate determinations of the practical dose quantities, which are relevant for the basis of actual patient dose determination and setting of the diagnostic reference levels (DRL) or trigger levels for skin dose alert in IR. The accurate measurement of the required quantities is based on accurate calibrations. The complexity of IR procedures and the rapid development of the CT scanners have made an accurate dose measurement a challenging task. In this report, the recent dosimetric problems as well as the development to cope with these problems are reviewed. Further, the results of comparisons of KAP (DAP) meter calibrations, both at the level of standard dosimetry laboratories and at hospitals in field conditions, are briefly summarized. Based on the review and the comparison of calibrations, a few conclusions and recommendations are given.

The European Radiation Dosimetry Group, EURADOS is a network of scientists specialized in the field of dosimetry. One of the main topics of EURADOS working group 12 (WG 12) is dosimetry of medical staff, in particular eye lens dosimetry. There is an increased interest amongst the scientific community in this topic for occupationally exposed medical workers due to the new eye lens dose limit and there are many open questions and topics which need to be addressed within this field. An overview of the main tasks undertaken by the working group is presented: a literature review on eye lens dose data and on available procedures for estimating or measuring eye lens doses, the distribution of a questionnaire to European hospitals to collect feedback about the current status of eye lens monitoring in hospitals and the organization of an intercomparison between European individual dosimetry services to verify the performance of available eye lens dosemeters.

The medical staff performing interventional cardiology and radiology (IC/IR) procedures stand close to the patient and thus close to the primary radiation beam. Although they wear a lead apron and thyroid collar, their hands, legs and eyes are not protected. Therefore, these parts could receive significantly high doses. Moreover, thedose ranges for the same kind of procedures vary a lot, as many factors affect extremity and eye lens doses. Additionally, there is evidence that eye lens doses can be high in IR/IC, and cases of cataract have been reported in recent years. A lack of an appropriate eye lens dosemeter as well as an appropriate calibration procedure has been identified. Medical staff in IR/IC could benefit from the use of active personal dosemeters (APDs) as optimisation tool. However, a lack of appropriate APDs is identified for typical fields in IR and IC. Very few devices can detect low energy fields, and none of them are really designed for working in pulsed radiation fields. In the field of nuclear medicine (NM) the extremity doses to the technologists are also known to be very high. One can highlight the difficulties in estimating the dose distribution across the hands, and the need for greater knowledge of doses received during the main tasks of a nuclear medicine department, especially using unsealed sources. The ORAMED project, (www.oramed-fp7.eu) was set up to optimize the working procedures in these medical fields with respect to radiation protection. ORAMED wasstructured in 5 work packages: - Extremity and eye lens dosimetry in IR and IC - Development of practical eye lens dosimetry - Optimization of the use of APDs in IR and IC - Extremity dosimetry in NM - Training and dissemination A coordinated measurement program in European hospitals was organised both in IR/IC and NM departments. Moreover, simulations of the most representative workplaces/procedures were performed to determine the main parameters that influence the extremity and eye lens doses. Some dedicated studies on improving the eye lens dosimetry and active personal dosimetry were conducted. Based on the measurement and simulation results, a series of practical guidelines and training packages were developed. The influence of the different radiation protection measures (like shields)in IR/IChave been quantified, and clear monitoring requirements have been formulated for a series of medical procedures. A formalism for the use of the operational quantity for eye lens dose measurements have been worked out (calibration phantom, conversion coefficients, type test procedures, ...). A dedicated eye lens dosemeter has been developed that can be used in routine monitoring. The different existing APDs have been tested in fields that are representative for hospital fields (like pulsed fields), and a series of guidelines for the use of these APDs in hospitals have been made. Also, an improved APD device specifically for IR/IC fields has been developed.The extensive measurement and simulation campaign for extremity doses in NM lead to a systematic evaluation of the different radiation protection measures. These are condensed in a series of practical guidelines to be used. The dose distribution across the hands of the technologists was characterised, and recommendations for routine monitoring have been formulated. The outcome of the ORAMED project will improve the radiation protection standards for medical staff. The systematic measurements and simulations are the new standards that will be used for many years to come. The practical guidelines that have been developed can be used in the hospitals by the medical staff. In particular, the developments on the eye-lens dosimetry and the active personal dosemeters will result in an improvement of the practical measurement capabilities in the field.

The work package 3 of the ORAMED project, Collaborative Project (2008-11) supported by the European Commission within its seventh Framework Programme, is focused on the optimisation of the use of active personal dosemeters (APDs) in interventional radiology and cardiology (IR/IC). Indeed, a lack of appropriate APD devices is identified for these specific fields. Few devices can detect low-energy X rays (20-100 keV), and none of them are specifically designed for working in pulsed radiation fields. The work presented in this paper consists in studying the behaviour of some selected APDs deemed suitable for application in IR/IC. For this purpose, measurements under laboratory conditions, both with continuous and pulsed X-ray beams, and tests in real conditions on site in different European hospitals were performed. This study highlights the limitations of APDs for this application and the need of improving the APD technology so as to fulfil all needs in the IR/IC field.

Some activities of EURADOS Working Group 9 (WG9) are presently funded by the European Commission (CONRAD project). The objective of WG9 is to promote and co-ordinate research activities for the assessment of occupational exposures to staff at workplaces in interventional radiology (IR) and nuclear medicine. For some of these applications, the skin of the fingers is the limiting organ for individual monitoring of external radiation. Therefore, sub-group 1 of WG9 deals with the use of extremity dosemeters in medical radiation fields. The wide variety of radiation field characteristics present in a medical environment together with the difficulties in measuring a local dose that is representative for the maximum skin dose, usually with one single detector, makes it difficult to perform accurate extremity dosimetry. Sub-group 1 worked out a thorough literature review on extremity dosimetry issues in diagnostic and therapeutic nuclear medicine and positron emission tomography, interventional radiology and interventional cardiology and brachytherapy. Some studies showed that the annual dose limits could be exceeded if the required protection measures are not taken, especially in nuclear medicine. The continuous progress in new applications and techniques requires an important effort in radiation protection and training.