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BOOKS AND PUBLICATIONS
Book Reviews
Shielding Techniques for Radiation On-
cology Facilities. Patton H. McGinley.
Medical Physics Publishing, Madison, WI,
1998. 147 pp. Price: $62.95.
The first place a medical physicist
looks for help to calculate the necessary
shielding for a new radiation therapy facil-
ity is in the NCRP reports. Report #s 49
共1976兲 and 51 共1977兲 deal with x-rays and
gamma rays up to 10 and 100 MeV, re-
spectively, while report # 79 共1984兲 deals
exclusively with neutrons. For a facility
with a 6 MV linear accelerator, all the nec-
essary shielding information is to be
readily found in Report # 49. For a dual
energy linear accelerator with a maximum
energy of 15 or 18 MV, additional infor-
mation can be found in report # 51; the
problem of neutrons at x-ray energies ⭓10
MV can be handled using report # 79. It
cannot have escaped the average physi-
cists’ notice that the information in these
reports is comprehensive only for low en-
ergy x-rays and, even then, there are some
deficiencies. For example, the reports
equate head leakage TVLs with primary
beam TVLs, there are no scatter factors for
high energy x-rays and practical methods
for calculating door shielding thicknesses
of lead with or without borated polyethyl-
ene 共BPE兲 are not provided. Since those
NCRP reports first came out, the field of
radiation therapy has undergone a rapid
transformation from low to high energy
therapy machines, so these problems have
now become more pressing. However,
there has been substantial research in this
area over the past few years, the results of
which need to be included in the old re-
ports. It is for this reason that Report # 49
is currently under revision by an AAPM
task group and an NCRP committee to in-
clude all new information for x-rays and
neutrons.
This book on shielding techniques by
Patton McGinley not only fills the gaps left
by the outdated NCRP reports, but, more
importantly, provides practical methods
for solving all of the typical problems en-
countered by the shielding designer. It
covers areas from low to high energy x-ray
beams, from rooms with mazes to those
without and from simple concrete barriers
to complex arrangements involving lead or
steel in addition to concrete. It also in-
cludes information on skyshine, design of
HDR and brachytherapy rooms, ozone pro-
duction, air activation, and advice on writ-
ing reports for regulatory authorities. The
chapters are well organized, so that one
1556 Med. Phys. 25 „8…, August 1998
can readily turn to a particular topic for
reference, as is the usual wont when de-
signing a room. The book is considerably
helped by the aid of example calculations
at the end of each section; this will cer-
tainly clarify any misunderstandings about
the calculational methodology. This is a
comprehensive, well-written, easy-to-read
book that I believe is as necessary to a
shielding designer as the NCRP reports,
since it translates those reports into practi-
cal terms and includes much updated infor-
mation.
There are a few minor points that do
not mar this volume but could well be cor-
rected or incorporated in the next edition.
The introduction on the ‘‘history of room
shielding’’ is curious for its omission of
any discussion of 60Co units; this is prob-
ably because the section was taken from
one written by the author for Health Phys-
ics to celebrate the Roentgen centenary. In
the same section, the betatron’s mode of
operation is not clearly explained. Room
designers, who are used to dealing with
workloads in terms of cGy per week and
maximum permissible doses of mSv per
week, would find it a great inconvenience
to discover all the tables with dose equiva-
lents outside the room in terms of
‘‘nSv s⫺1’’ and for dose rates at isocenter
in terms of ‘‘6.67 cGy s⫺1.’’ These are
units that the typical designer would never
use and they would most likely do as I did,
namely pencil in each table the equivalent
values using conventional units. The only
omission for shielding consideration is an
x-ray or electron-only facility that uses
lead with or without BPE instead of con-
crete. Solutions to calculational problems
left for the reader should have been pro-
vided.
This is the first self-help book on this
topic on the market and is therefore a wel-
come addition. It should certainly be con-
sidered a must-buy for all shielding de-
signers. Finally, the publishers should be
congratulated on producing a book with an
attractive cover; addition of the artwork is
a welcome change from the standard plain
jacket.
Reviewed by Peter J. Biggs
Peter J. Biggs, Ph.D., is Associate Profes-
sor and Acting Head, Division of Radia-
tion Biophysics, at the Massachusetts Gen-
eral Hospital in Boston, Massachusetts.
Recommended Standards for the Rou-
tine Performance Testing of Diagnostic
X-Ray Imaging Systems. IPEM Report
No. 77. The Institute of Physics and Engi-
neering in Medicine, 4 Campleshon Road,
York, YO2 1PE, England. First Edition
1997, Reprinted 1998 共with minor correc-
tions兲. 64 pp. Price: £10.00, plus postage
and handling 共softcover兲.
This report contains outlines concern-
ing the quality assurance testing 共not ac-
ceptance testing兲 of x-ray imaging sys-
tems. After an introduction, the main
chapters are: Radiographic Equipment;
Films, Intensifying Screens, Processors
and the Darkroom; Mammographic Equip-
ment; Dental Equipment; Image Intensifi-
ers 共Fluoroscopy and Fluorography兲; Digi-
tal Fluoroscopy Systems, Computed
Tomography; and Patient Dose Measure-
ments.
Each of these chapters first contains a
table listing the physical parameters that
are important to measure. For each physi-
cal parameter the following recommenda-
tions are given: the level of expertise 共A or
B兲 for those performing the test, the fre-
quency of testing, the priority or impor-
tance of the test 共1 or 2兲, the ‘‘remedial
level’’—a level of performance at which
remedial action needs to be initiated, and
the ‘‘suspension level’’—a level of perfor-
mance at which the equipment should be
removed from clinical use immediately un-
til the performance is corrected. Following
this table are very short ‘‘Explanatory
Paragraphs’’ for each physical parameter
containing: a ‘‘Suggested Method,’’ ‘‘Ref-
erences,’’ and ‘‘Comments.’’ The ‘‘Sug-
gested Method’’ does not actually describe
the method of performing the test—it sim-
ply lists the normal test equipment in very
general terms. The authors state that ‘‘No
attempt has been made to give detailed test
methods here.’’ In fact, methods of testing
are not really discussed at all. These meth-
ods are discussed in the citations listed un-
der ‘‘References.’’
This report is of limited utility if one
does not have access to the referenced
documents, particularly these frequently
referenced ones: Assurance of Quality in
the Diagnostic X-ray Department, 1988,
BIR; Measurement of the Performance
Characteristics of Diagnostic X-ray Sys-
tems used in Medicine—Report 32 共2nd
edition兲—Parts I–VI 共6 documents兲,
1996–1998, IPEMB; The Commissioning
and Routine Testing of Mammographic X-
ray Systems—Report No. 59, 1989, IPEM.
The present report is clearly designed to be
used in conjunction with a number of other
British publications.
The material covered in the initial
tables of each chapter appear to be fairly
well thought out and can be helpful for
someone desiring guidance on the type of
tests useful in a quality assurance program
along with test frequencies and tolerance
limits. One should be reminded that ‘‘re-
medial levels’’ or ‘‘suspension levels’’ in
© 1998 Am. Assoc. Phys. Med. 1556
this report do not necessarily correspond to
U.S. government regulatory limits, includ-
ing MQSA. As might be expected with
such a compendium, I would take issue
with some of the recommendations; also
there are a number of important omissions.
The brief titles of physical parameters with
little, if any, further explanations may con-
fuse the reader at times. Following are
some examples from Chapter 3, ‘‘Radio-
graphic Equipment.’’ For tube potential
the remedial level of ‘‘⫾10% of intended’’
seems somewhat too lenient; ⫾5% would
probably be more appropriate. For AEC
systems the physical parameter ‘‘Resultant
film density’’ seems ill defined even when
the reference is consulted. The AEC sys-
tem should be checked for consistent per-
formance as both the tube potential and pa-
tient thickness are varied. For conventional
radiographic equipment, the report omits
tests of automatic collimation, focal spot
size, beam quality 共HVL兲, grid alignment,
image artifacts, and the AEC backup timer.
For conventional tomography, image reso-
lution tests are omitted.
A number of good documents on the
performance testing of x-ray imaging
equipment have come out of Britain over
the years. If you have found these docu-
ments useful, you may also find this latest
IPEM Report No. 77 to be a worthwhile
additional reference.
Reviewed by Frank N. Ranallo
Frank N. Ranallo, Ph.D., is an Assistant
Professor (CHS) of Medical Physics at the
University of Wisconsin-Madison. His re-
search interests include the optimization of
the design and use of medical imaging
equipment and the development of instru-
mentation and methods to test the perfor-
mance of medical imaging systems.
Exposure of the Pregnant Patient to Di-
agnostic Radiations—A Guide to Medi-
cal Management. 2nd Edition. Louis K.
Wagner, Ph.D., Richard G. Lester, M.D.,
and Luis R. Saldana, M.D. Medical Phys-
ics Publishing, Madison, WI 53705, 1997.
259 pp. Price: $69.95 共hardcover兲.
One of the most troubling moments in
my career was seeing the emotional tur-
moil of a young lady who had been told by
her physician that she should seriously
consider terminating her pregnancy solely
because she had received a chest x-ray.
Unfortunately, many of those who counsel
women concerning the risks of a radiologi-
cal procedure unknowingly performed dur-
ing pregnancy, or of the risks of a radio-
logical procedure contemplated during a
known pregnancy, do not have accurate in-
formation for these purposes. I found the
first edition of this book, published in
1985, to be an excellent source of such in-
formation and had guarded my copy care-
fully while it was out of print for several
1557 Med. Phys. 25 „8…, August 1998
years. Now this book is back in print, in a
second edition, updated, and with an im-
proved and expanded format.
The explanations in this edition are
quite clear and to the point. Even in the
introduction the authors clear up possible
misunderstandings by defining the terms
‘‘gestation age,’’ ‘‘conception age,’’ and
‘‘menstrual age,’’ and also the terms ‘‘em-
bryo,’’ ‘‘fetus,’’ and ‘‘conceptus.’’ 共My
note: what we usually refer to as a ‘‘fetal
dose calculation’’ should more properly be
called a ‘‘conceptus dose calculation’’—as
it is in this book.兲
The book is divided into three parts
plus appendices. Part I is titled ‘‘Diagnos-
tic Radiations and Risks to Unborn Chil-
dren’’ and is composed of four chapters.
Chapter 1 explains some basic concepts
about radiation, x-ray examinations, and
radionuclide examinations. Some funda-
mental radiobiology is discussed empha-
sizing effects on the conceptus, including
the classic graphs from Russell and Brent.
The nature of nonionizing radiations from
ultrasound and MRI are also explained.
The mechanisms for possibly harmful ef-
fects from ultrasound and from the static
magnetic fields, field gradients, and radio-
frequency fields of MRI are discussed.
Chapter 2 summarizes the basic units of
radiation and radioactivity. Also, the mea-
sures and units of importance in ultrasound
and MRI are explained.
Chapter 3 describes the various types of
diagnostic x-ray procedures and the vari-
ous factors which affect conceptus dose.
Several tables provide approximate dose
ranges or limits for various types of x-ray
examination. A number of important con-
cepts are clearly stated. For example when
discussing the calculation of conceptus
dose from CT the authors state:
It is essential not to use the CTDI for
the abdomen as a reliable model for
dose estimation to the conceptus.
CTDI is likely to underestimate the ac-
tual dose for many reasons. 关Bold and
italics are the authors’兴
Five reasons are then given for this state-
ment. This chapter also discusses the many
factors which affect the conceptus dose
from nuclear medicine examinations. To
aid in the calculation of dose from radio-
pharmaceuticals the authors include a
comprehensive table, extending over six
pages, of the estimated conceptus dose per
administered activity for various radio-
pharmaceuticals at different conception
ages.
Chapter 4 discusses the prenatal risks
from ionizing radiation in detail and also
describes the possible risks from ultra-
sound, magnetic fields, and radiofrequency
waves. The possible effects of ionizing ra-
diation include prenatal death, growth re-
tardation, small head size, severe mental
retardation, intellectual deficit, seizures,
other malformations, malignancies, and
heritable mutations. The level of risks in-
dicated by numerous scientific studies 共this
chapter alone gives 152 references, 78 of
them within the last 10 years兲, along with
the sensitive periods, are presented in a
comprehensive but concise manner. Going
beyond the simple description of risks the
authors try to give some perspective to
these risks. A good example is Table 4-1:
the ‘‘Percent Likelihood of NOT Develop-
ing Childhood Cancer after Prenatal Diag-
nostic Irradiation.’’ Table 4-2 gives an ex-
cellent summary of the effects of
diagnostic levels of radiation on the con-
ceptus and is one of the single most useful
pages of information in the book.
Part II of this book is titled, ‘‘The
Clinical Management of the Pregnant Pa-
tient Needing Diagnostic Study.’’ Here we
are faced with decisions concerning the di-
agnostic imaging of a patient known to be
pregnant. This section starts off with a de-
tailed flow diagram for decision making in
these situations. In Chapters 5, 6, and 7 the
authors proceed through the decision mak-
ing process: ‘‘Stage I, Preliminary Consid-
erations,’’ ‘‘Stage II, Assessing the
Risks—What are the Data?,’’ and ‘‘Stage
III, To Proceed or Not to Proceed.’’ Again
the authors try to put the benefits and risks
into proper perspective. They state: ‘‘To
put risks into perspective, the physician
should be aware of the normal risks of
pregnancy and the multiple teratogenic
factors in modern living.’’ Thus in Table
7-1 they list agents or conditions 共other
than radiation兲 with associated risks during
pregnancy, which I found quite interesting.
In stage I they discuss topics such as emer-
gency versus elective procedures and
screening for pregnancy; in stage II, esti-
mating conceptus doses, determining ges-
tational age, and risks of delaying a study;
in stage III, decisions to delay a study,
minimizing the dose in the study, and
counseling the patient.
Part III is titled, ‘‘The Clinical Evalua-
tion of Pregnant Patients Previously Ex-
posed to Diagnostic Radiations.’’ Again
this section starts off with a detailed flow
diagram for decision making. In Chapters
8, 9, and 10 the authors proceed through
the decision making process in a manner
similar to part II.
Chapter 11 describes 23 case studies,
illustrating the concepts discussed in the
rest of the book. For example the first two
cases are ‘‘Broadside motor vehicle acci-
dent, pelvic injury’’ and ‘‘Herniated disk
in 34-year-old woman.’’ I found this chap-
ter a welcome addition to the new edition.
Some readers may find the appendices
the most useful part of the book. Appendix
A, ‘‘Conceptus Dose Calculations for X-
Ray Examinations,’’ provides exten-
© 1998 Am. Assoc. Phys. Med. 1557
siveguidance in the calculation of concep-
tus dose with numerous tables, graphs, and
equations. Several examples are numeri-
cally worked out, comparing the results of
as many as four different methods of ob-
taining the conceptus dose. Doses from CT
scans are covered in depth. Also the some-
times confusing topic of doses when the
conceptus is outside the primary beam is
discussed. In a similar fashion, Appendix
B covers the calculation of conceptus dose
for radionuclide studies.
Exposure of the Pregnant Patient to
Diagnostic Radiations is clear, compre-
hensive, and extraordinarily useful. The
discussions in this book are thoughtful and
balanced, drawing from a large store of
referenced publications. In short, it is a
‘‘classic.’’ It is rare to find a technical
book so well done and so on target in fill-
ing an unmet need: I know of no other
publication that comes close to compre-
hensively describing the concerns of diag-
nostic radiation exposures to the pregnant
1558 Med. Phys. 25 „8…, August 1998
patient. This book should be part of the
essential library of any diagnostic medical
physicist. I also highly recommend it to
radiologists and genetic counselors. Any-
one involved in the counseling of pregnant
patients exposed to diagnostic radiation or
in the decision making for diagnostic pro-
cedures on pregnant patients should defi-
nitely have access to a copy of this book.
Its clear, logical explanations, figures,
tables, flow charts, and numerous worked-
out examples make it an excellent instruc-
tional book for those that need to learn
about this subject. Yet still it remains a
uniquely useful reference for those already
familiar with the field, and I would be sur-
prised if the ‘‘old pros’’ did not gain sub-
stantial valuable new information and in-
sights from this book.
Reviewed by Frank N. Ranallo
Frank N. Ranallo, Ph.D. is an Assistant
Professor (CHS) of Medical Physics at
theUniversity of Wisconsin-Madison and
the Radiation Consultant to the Wisconsin
Teratogen Project—Clinical Genetics De-
partment.
Books Received
The editor acknowledges receipt of the fol-
lowing publications which may be re-
viewed in later issues if they are judged to
be of sufficient interest to the majority of
readers, subject to space limitations. Read-
ers interested in reviewing books should
advise the Book Review Editor of their
availability, qualifications, and interests.
Practical Nuclear Medicine. P. F.
Sharp, H. G. Gemmell, and F. W. Smith.
Oxford University Press, New York. 345
pp. Price: $59.50.
© 1998 Am. Assoc. Phys. Med. 1558