IDAC-ALPHA: AN ALPHA DOSIMETRY SOFTWARE FOR NORMAL ORGANS AND TISSUES

Radiopharmaceuticals have been used for the treatment of various forms of cancer since the 1940s. In recent years, the advantages of alpha emitting radionuclides have emerged as a favourable treatment option. However, most alpha emitting radionuclides have long decay chains with long-lived daughter radionuclides. This leads to uncertainties in the dosimetry for normal organs and tissues, when established dosimetry models are employed. The aim of this project is to assign each progeny its own biokinetic behaviour. The novel dosimetry model was applied to 223Ra-dichloride, frequently used for the treatment of patients with metastatic bone disease from castration-resistant prostate cancer. In this dosimetry model, individual biokinetics for each daughter radionuclide was included. This resulted in a decrease in absorbed dose to bone surfaces and red marrow and increased absorbed dose to liver and kidney, when compared with dosimetry models assuming that the daughter nuclides follow the biokinetics of the parent radionuclide.

Education Satisfaction among Pharmacy Graduates in Sweden

Education satisfaction is considered important for development of a professional identity and to increase learning. The aim was to investigate and compare education satisfaction over time among pharmacists who have graduated from the pharmacy programs at Umeå University, Sweden. Data concerning education satisfaction were collected using an alumni survey of pharmacists who graduated between 2015 and 2018. This was compared with pharmacists graduating between 2006 and 2014. The majority of the pharmacy graduates were very satisfied with their education (96%) and thought that the programs gave them a clear professional identity (92%). No differences in education satisfaction between graduation years 2015 and 2018 and 2006 and 2014 were found. A majority of the graduates considered that the knowledge and skills acquired during their education were useful in their present job (83%). Of the graduates who thought that the studies gave them a clear professional identity, a higher proportion were satisfied with their job (p < 0.001) and thought that their work duties reflected their studies (p = 0.005). Exploring education satisfaction may help educators to further develop the education and to better prepare the students for their professional working life.

Job Satisfaction among Swedish Pharmacists

Understanding the role of pharmacists’ job satisfaction is important because a lack of job satisfaction might have negative impacts on patient care and safety. The aim of this cross-sectional study was to explore and compare job satisfaction among pharmacists graduating from the pharmacy programs at Umeå University, Sweden. Data concerning job satisfaction and associated factors were collected using an alumni survey conducted among pharmacists graduating between 2015 and 2018. Ethical committee approval is not required for this type of study in Sweden. A majority (92.6%) of the pharmacy graduates were female. A majority of the graduates (91.4%) were satisfied with their job most of the time or all of the time, which was similar to a previous investigation among pharmacists graduating between 2006 and 2014. High access to continuous professional development (CPD) was associated with higher job satisfaction (odds ratio (OR): 18.717 (95% confidence interval (CI): 1.685–207.871)). In total, 65.6% considered access to CPD to be high (i.e., satisfactory to very good). Variables like gender, age, employee category, workplace, years since graduation, and income did not affect job satisfaction. Knowledge regarding job satisfaction will enable employers to respond to employees’ needs, decrease turnover, and improve the work environment.

Tritium in urine from members of the general public and occupationally exposed workers in Lund, Sweden, prior to operation of the European Spallation Source

A powerful neutron source, the European Spallation Source (ESS), is currently under construction in Lund, Sweden (~90 000 inhabitants). Levels of tritium (³H) in urine were estimated in members of the public in Lund and employees at the ESS using liquid scintillation counting, to obtain baseline levels before the start of operation of the ESS. These were compared with levels in other occupationally exposed radiation workers. Both the spallation reaction in the ESS tungsten target and the activation of various materials by the protons produced by the 5 MW linear accelerator will generate tritium, which will be released into the atmosphere mainly as tritiated water (HTO). Urinary HTO activity concentrations were determined in a total of 55 individuals belonging to four different categories: ESS employees, neighbours of the ESS, members of the general public in Lund and exposed workers from other facilities. The participants were asked to provide information on their beverage intake the day before urine sampling. The urine samples were filtered on activated charcoal and distilled before analysis. The effect of sample preparation on the isotope fractionation of urine samples was investigated by isotope ratio mass spectrometry (IRMS) of ²H/¹H, which showed no influence. IRMS was also used to investigate if the ratio between the stable hydrogen isotopes (²H/¹H) could provide useful data of the origin, and hence the tritium concentration, of various types of drinking water. Urinary HTO activity concentrations determined using liquid scintillation counting (LSC) were found to be below the minimum detectable activity (MDA) of 2.1 Bq⋅L^-1 for most of the participants. Five of the workers actively handling organic tritiated material were found to have activity concentrations between 3.5 and 11 Bq⋅L^-1, which were higher than the average value in local tap water of 1.5 ± 0.6 Bq⋅L^-1. The results will be used to evaluate the radiological impact on the population from future releases of tritium resulting from the operation of the ESS.

ICRP Publication 140: Radiological Protection in Therapy with Radiopharmaceuticals

Radiopharmaceuticals are increasingly used for the treatment of various cancers with novel radionuclides, compounds, tracer molecules, and administration techniques. The goal of radiation therapy, including therapy with radiopharmaceuticals, is to optimise the relationship between tumour control probability and potential complications in normal organs and tissues. Essential to this optimisation is the ability to quantify the radiation doses delivered to both tumours and normal tissues. This publication provides an overview of therapeutic procedures and a framework for calculating radiation doses for various treatment approaches. In radiopharmaceutical therapy, the absorbed dose to an organ or tissue is governed by radiopharmaceutical uptake, retention in and clearance from the various organs and tissues of the body, together with radionuclide physical half-life. Biokinetic parameters are determined by direct measurements made using techniques that vary in complexity. For treatment planning, absorbed dose calculations are usually performed prior to therapy using a trace-labelled diagnostic administration, or retrospective dosimetry may be performed on the basis of the activity already administered following each therapeutic administration. Uncertainty analyses provide additional information about sources of bias and random variation and their magnitudes; these analyses show the reliability and quality of absorbed dose calculations. Effective dose can provide an approximate measure of lifetime risk of detriment attributable to the stochastic effects of radiation exposure, principally cancer, but effective dose does not predict future cancer incidence for an individual and does not apply to short-term deterministic effects associated with radiopharmaceutical therapy. Accident prevention in radiation therapy should be an integral part of the design of facilities, equipment, and administration procedures. Minimisation of staff exposures includes consideration of equipment design, proper shielding and handling of sources, and personal protective equipment and tools, as well as education and training to promote awareness and engagement in radiological protection. The decision to hold or release a patient after radiopharmaceutical therapy should account for potential radiation dose to members of the public and carers that may result from residual radioactivity in the patient. In these situations, specific radiological protection guidance should be provided to patients and carers.

Night-time diuresis pattern in children with and without primary monosymptomatic nocturnal enuresis

INTRODUCTION

Night-time polyuria as the dominating pathophysiological mechanism for primary monosymptomatic nocturnal enuresis (PMNE) has been put in question with nocturnal detrusor overactivity and high arousal thresholds as alternatives. An earlier finding of night-time polyuria in 12% of healthy non-enuretic schoolchildren underscores that excessive night-time diuresis per se is unlikely the major cause of PMNE.

OBJECTIVE

The objective of this study was to compare the night-time diuresis pattern in children with and without PMNE and to evaluate the role of night-time polyuria in provoking enuretic episodes in children with PMNE.

STUDY DESIGN

Night-time diuresis pattern was recorded in 27 children with PMNE, aged 6-15 years, and 29 non-enuretic children, aged 6-13 years. Using a portable ultrasound recorder, the bladder volume was estimated at 15-min intervals for at least three nights with the child sleeping in its own bed at home. The volume of enuretic episodes was controlled using preweighed diapers. All voids were registered by time and volume. Diuresis during night time was estimated from the slope of regression lines fitted to ultrasound recording points. Mean night-time diuresis was calculated from total urine production during the night and time interval from the last void before bedtime to the first morning void.

RESULTS

Night-time bladder filling pattern was recorded from 189 nights, giving 149 interpretable patterns for analysis (77 children with PMNE and 72 dry children). The night-time diuresis pattern was similar for children with or without PMNE, showing large variability between different nights of the same child. Most nights displayed a smooth bladder filling at constant low rate, whereas other nights showed an early phase with high diuresis followed by a longer period of low diuresis with no difference between the two groups.

DISCUSSION

Night-time diuresis has been non-invasively monitored in children while asleep in their own beds at home. The pattern of night-time diuresis varies considerably between different nights of the same child, with no obvious differences in any diuresis parameters between children with or without PMNE.

CONCLUSION

Non-enuretic children have similar diuresis pattern and maximal night-time diuresis values as children with PMNE, making it unlikely that PMNE is caused by night-time polyuria per se (Summary figure). Delayed maturation of sleep mechanisms such as decreased arousability or sleep inhibition of the micturition reflex is more likely to be the main etiology for enuresis.

In Vivo X-Ray Fluorescence Analysis for Medical Diagnosis

Occupational exposure to lead is common in many industrial applications and hence it is of considerable medical interest to control the body-burden of lead in living man. More than 90 % of the lead in the body is concentrated in bone and hence in vivo measurements of the lead in the skeleton should give the most satisfactory way for estimating the body-burden. The routine method used today for checking on lead contamination is that of measurements on blood samples. However, since the concentration of lead in the blood is a sensitive function of the actual exposure conditions, this method provides only a poor indication of the total body-burden and the integrated lead exposure.

Lead and Barium in Archaeological Roman Skeletons Measured by Nondestructive X-Ray Fluorescence Analysis

Lead is a non-essential toxic metal of considerable topicality. It is accumulated in the skeleton, which contains 90% of the total body burden.

It is known that during the Roman period the intake of lead was high. The Romans used kitchen utensils made of lead and lead pipes for drinking water. The most important source of lead for people of the upper social classes was sapa, a compound added to wine to sweeten and perserve it.

Using non-destructive X-ray fluorescence analysis, lead and barium concentrations of archaeological Roman bones have been measured. We have earlier used a similar technique to determine lead concentration in the human skeleton in vivo.

ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging

Abstract –

The International Commission on Radiological Protection (ICRP) first introduced the term ‘diagnostic reference level’ (DRL) in 1996 in Publication 73. The concept was subsequently developed further, and practical guidance was provided in 2001. The DRL has been proven to be an effective tool that aids in optimisation of protection in the medical exposure of patients for diagnostic and interventional procedures. However, with time, it has become evident that additional advice is needed. There are issues related to definitions of the terms used in previous guidance, determination of the values for DRLs, the appropriate interval for re-evaluating and updating these values, appropriate use of DRLs in clinical practice, methods for practical application of DRLs, and application of the DRL concept to newer imaging technologies. This publication is intended as a further source of information and guidance on these issues. Some terminology has been clarified. In addition, this publication recommends quantities for use as DRLs for various imaging modalities, and provides information on the use of DRLs for interventional procedures and in paediatric imaging. It suggests modifications in the conduct of DRL surveys that take advantage of automated reporting of radiation-dose-related quantities, and highlights the importance of including information on DRLs in training programmes for healthcare workers. The target audience for this publication is national, regional, and local authorities; professional societies; and facilities that use ionising radiation for medical purposes, and responsible staff within these facilities. A full set of the Commission’s recommendations is provided.

Who enrols and graduates from web-based pharmacy education - Experiences from Northern Sweden

INTRODUCTION

As a response to the shortage of prescriptionists in Northern Sweden, a web-based Bachelor of Science in Pharmacy program was introduced at Umeå University in 2003. This study explored who is likely to enrol and graduate from the web-based bachelor program and whether the program has addressed the shortage of prescriptionists in rural Northern Sweden.

METHODS

Data from three different sources were included in this study; the initial cohort including students admitted to the program in 2003 (survey), the entire cohort including all people admitted to the program between 2003 and 2014 (university's admissions data) and the alumni cohort including graduates who participated in an alumni survey in 2015.

RESULTS

A typical student of the web-based pharmacy program is female, over 30 years of age, married or in a de-facto relationship and has children. Furthermore, the students graduating before 2009 were more likely to live in Northern Sweden compared to those graduating later.

DISCUSSION AND CONCLUSION

The results indicate that the introduction of a web-based bachelor of pharmacy program at Umeå University was to some extent able to address the shortage of prescriptionists in Northern Sweden. Web-based education may potentially help address the maldistribution of health professionals by providing flexible education opportunities.

Quantitative Bone Scintigraphy in Prostatic Carcinoma - Long-Term Response to Treatment

Quantitative bone scintigraphy was performed in 24 patients with prostatic carcinoma before orchiectomy and up to one to four years after operation. The gamma camera count rate was recorded over the lower thoracic and all lumbar vertebrae 4 h after injection of 99mTc-MDP. Twelve patients had normal bone scintigrams throughout the study. They showed from two years after operation a slight increase in count rate values compared with the preoperative values, probably due to hormonal changes after orchiectomy and to age-related alterations in skeletal metabolism. Twelve patients had abnormal bone scintigrams. They showed as a response to treatment the flare phenomenon with an increase in count rate over the abnormal vertebrae when measured two weeks after operation followed by a decrease after two months. The lowest count rate values were obtained between six months and one year after operation. Thereafter the count rate seemed to remain on the same level. An increase in count rate was connected to progression of disease and the patients died of prostatic carcinoma within one year thereafter.

Physicians' perspectives on clinical pharmacy services in Northern Sweden: a qualitative study

BACKGROUND

In many countries, clinical pharmacists are part of health care teams that work to optimize drug therapy and ensure patient safety. However, in Sweden, clinical pharmacy services (CPSs) in hospital settings have not been widely implemented and regional differences exist in the uptake of these services. Physicians' attitudes toward CPSs and collaborating with clinical pharmacists may facilitate or hinder the implementation and expansion of the CPSs and the role of the clinical pharmacist in hospital wards. The aim of this study was to explore physicians' perceptions regarding CPSs performed at hospital wards in Northern Sweden.

METHODS

Face-to-face semi-structured interviews were conducted with a purposive sample of nine physicians who had previously worked with clinical pharmacists between November 2014 and January 2015. Interviews were digitally recorded, transcribed and analysed using a constant comparison method.

RESULTS

Different themes emerged regarding physicians' views of clinical pharmacy; two main interlinked themes were service factors and pharmacist factors. The service was valued and described in a positive way by all physicians. It was seen as an opportunity for them to learn more about pharmacological treatment and also an opportunity to discuss patient medication treatment in detail. Physicians considered that CPSs could improve patient outcomes and they valued continuity and the ability to build a trusting relationship with the pharmacists over time. However, there was a lack of awareness of the CPSs. All physicians knew that one of the pharmacist's roles is to conduct medication reviews, but most of them were only able to describe a few elements of what this service encompasses. Pharmacists were described as "drug experts" and their recommendations were perceived as clinically relevant. Physicians wanted CPSs to continue and to be implemented in other wards.

CONCLUSIONS

All physicians were positive regarding CPSs and were satisfied with the collaboration with the clinical pharmacists. These findings are important for further implementation and expansion of CPSs, particularly in Northern Sweden.

Cardiac Blood Pool Imaging — A Clinical Comparison between Red Blood Cells Labeled with 99mTc in vivo and in vitro and 99mTc-Labeled Human Serum Albumin

In 25 patients undergoing radiocardiographic determination of ventricular function, three methods for blood pool imaging were compared. 99mTc was used to label human serum albumin (HSA) and red blood cells (RBC) in vivo or in vitro. The activity concentration of 99mTc in blood was measured during 2 hrs after injection and a significantly higher concentration was found with RBC compared to HSA already after 15 min. The left ventricular to background count rate ratio was significantly lower for HSA after 90 min compared to RBC. There was no statistical difference in 99mTc activity concentration in blood or in left ventricular to background count rate ratio during the two hrs when the two RBC-labeling procedures were compared. 99mTc-labeled RBC are superior to 99mTc-labeled HSA for gated blood pool studies and especially for repeated determinations of ventricular function. Because the in vivo labeling is the most convenient method it has been adopted as the clinical routine at our hospital.

Radiological protection of foetuses and breast-fed children of occupationally exposed women in nuclear medicine - Challenges for hospitals

This paper describes issues of concern for protecting foetuses and breast-fed children of occupationally exposed women in nuclear medicine from unnecessary exposure of ionising radiation. The protection principle is to ensure the same level of protection for the foetus and child as for the general public. Therefore international radiation protection standards recommend a dose constraint of 1mSv to a foetus during the remaining time of pregnancy after it is known/declared and a yearly dose constraint of 1mSv to a breast-fed child. It is not self-evident how to guarantee this level of radiation protection. The exposure situation in nuclear medicine is complex. Exploring existing reported occupational exposure levels suggests great variability between work tasks and facilities. The standards and guidelines found give no detailed advice. Therefore each facility needs to systematically review external and internal exposure levels in order to plan appropriate protection measures and issue their own guidelines and rules. One strategy might be that each facility defines tasks that do not require any restrictions and lists such duties that are not suitable to do when pregnant or breastfeeding, taking also potential exposure levels into consideration. This paper gives examples of such types of work. Information to the staff about the necessity of declaring pregnancy or breastfeeding is of fundamental importance. The internal policies issued by the hospital management should make clear the basis for taking care of pregnant and breastfeeding employees.

Pharmacists' satisfaction with their work: Analysis of an alumni survey

BACKGROUND

The level of job satisfaction among practicing pharmacists is important because it has been found to affect job performance and employee turnover. The Swedish pharmacy market has undergone major changes in recent years, and little is known about pharmacists' job satisfaction.

OBJECTIVES

The objective of this study was to investigate the level of job satisfaction and associated factors among graduates from the web-based pharmacy programs at Umeå University.

METHODS

Job satisfaction of pharmacists was measured as part of an alumni survey conducted with those who graduated from the pharmacy programmes between 2006 and 2014. Data analysis included descriptive statistics, and logistic regression was used to explore factors affecting job satisfaction.

RESULTS

The total number of graduates who completed the survey was 222 (response rate 43%.) The majority of respondents were female (95%), and most were employed at a community pharmacy (85%). The mean age was 39.7 years. The majority of graduates (91%) were satisfied with their job "most of the time" or "all of the time", and 87% of the respondents would "definitely" or "maybe" choose the same career again. The multivariate analysis showed that increasing years in the current position (OR: 0.672 (0.519-0.871)) was associated with lower job satisfaction. Older age (OR: 1.123 (1.022-1.234)), the perception that the knowledge and skills acquired during university education is useful in the current job (OR: 4.643 (1.255-17.182)) and access to continuing professional development (OR: 9.472 (1.965-45.662)) were associated with higher job satisfaction.

CONCLUSION

Most graduates from the web-based pharmacy programmes were satisfied with their current job. Access to continuing professional development seems to be important for the level of job satisfaction among pharmacists.

RETROSPECTIVE DOSIMETRY USING SALTED SNACKS AND NUTS: A FEASIBILITY STUDY

The possibility of using ordinary household table salt for dosimetry is suggested by its high sensitivity to ionising radiation, which generates a readout of optically stimulated luminescence (OSL). However, to exploit this finding for retrospective human dosimetry, it would be needed to find salt in close proximity to the exposed individual. Finding salty snacks frequently tucked into handbags, backpacks or pockets seemed to be a possibility; these items therefore became the test materials of the present study. The aluminium or cardboard packages used to exclude the moisture that makes crisps and nuts go soft and stale also helps to retain the induced OSL signal. Therefore, different snacks, either their salt component alone or mixed with the snack, are exposed to ionising radiation and then were assessed for their dosimetric properties. The results indicate the feasibility of using some salty snacks for dosimetry, with a minimum detectable dose as low as 0.2 mGy.

Radiation Dose to Patients and Personnel during Fluoroscopy at Percutaneous Renal Stone Extraction

The radiation dose to patients and personnel was estimated during 11 percutaneous renal stone extractions. For the patients the energy imparted, the mean absorbed dose to various organs, and the effective dose equivalent were estimated. For different personnel categories some organ doses and the effective dose equivalent were also estimated. Large differences in the radiation dose between patients were observed. The mean effective dose equivalent to the patient was 4.2 (range 0.6–8.3) mSv, and the energy imparted 285 (range 50–500) mJ. These figures are comparable to those reported for routine colon examination and urography. For the personnel there were also large differences between individuals and categories. The highest radiation dose was received by the radiologist. It was estimated that a radiologist who performs 150 percutaneous renal stone extractions per year will receive a yearly contribution to his/her effective dose equivalent of 2.4 mSv. Even when the contribution from other diagnostic and interventional radiologic procedures is added, the total effective dose equivalent hardly exceeds 5 mSv or 1/10 of the present dose limit for persons engaged in radiologic work. For the hands of the radiologist there is a risk of doses closer to the present limit for single organs or tissues of 500 mSv/year.

Patient Exposure When Using 99Tcm-Dtpa for Evaluation of Cerebrospinal Fluid Shunt Patency

The absorbed dose from 99Tcm-DTPA was estimated from 12 investigations in 9 patients who were evaluated for the patency of ventriculo-peritoneal shunts. The distribution of 99Tcm-DTPA in the ventricles, urinary bladder and peritoneal cavity was determined in regions of interest from repeated static gamma camera images. The effective dose equivalent was calculated to be less than 0.10 mSv for an injected activity of 15 MBq.

Digital Chest Radiography with a Large Image Intensifier

A digital system for chest radiography based on a large image intensifier was compared with a conventional film-screen system. The diagnostic performance was evaluated with special reference to the digital monitor images with a modified version of receiver operating characteristic (ROC) analysis—free response ROC (FROC) analysis—on a chest equivalent phantom. Measurements of spatial resolution and energy imparted were also performed. The detectability of low-contrast objects as well as spatial resolution was better for the full-size film-screen radiographs than for both the digital monitor images and the 100 mm photofluorograms. The image-intensifier system has a potential for considerable dose savings in relation to the conventional technique provided that fluoroscopy is excluded in the positioning of the patients.