Radiation exposure to comforters and carers during paediatric molecular radiotherapy

BACKGROUND

To show whether the incidental radiation exposure received by comforters and carers of children undergoing molecular radiotherapy was kept as low as reasonably achievable and was within English national dose constraints.

PROCEDURE

The radiation exposure of adult comforters and carers was routinely monitored with a whole body personal dose meter while the child was in hospital. Data were collected on iodine-131 meta-iodobenzylguanidine (¹³¹ I-mIBG), lutetium-177 DOTATATE (¹⁷⁷ Lu-DOTATATE), and iodine-131 sodium iodide (¹³¹ I-NaI) treatments.

RESULTS

Data were available for 50 treatments with high-administered activity double-infusion ¹³¹ I-mIBG and 12 single administrations; 15 ¹⁷⁷ Lu-DOTATATE treatments and 28 ¹³¹ I-NaI administrations. The median age was 7 years (1-18). The median administered activity of: ¹³¹ I-mIBG was 16.2 GBq (6.8-59 GBq) for double infusion patients and 8.1 GBq (5.26-16.25 GBq) for single administrations; ¹⁷⁷ Lu-DOTATATE was 7.2 GBq (2.5-7.5 GBq); and ¹³¹ I-NaI was 3 GBq for thyroid remnant ablation and 5.5 GBq for cancer therapy. The median number of comforters and carers for all administrations was 2 (range 1-9). The median exposure values for comforters and carers for high-administered activity ¹³¹ I-mIBG administrations was 302 µSv (0-5282 µSv); for single fraction ¹³¹ I-mIBG 163 µSv (3-3104 µSv); ¹⁷⁷ Lu-DOTATATE 6 µSv (1-79 µSv); and ¹³¹ I-NaI 37 µSv (0-274 µSv). Only one of the comforters and carers exceeded the dose constraint of 5 mSv.

CONCLUSIONS

Doses to comforters and carers were in all but one case within the dose constraint nationally recommended by the Health Protection Agency, now part of Public Health England. New evidence is presented which show that comforter and carer radiation exposure levels from paediatric molecular radiotherapy in routine clinical practice are acceptably low. Pediatr Blood Cancer 2015;62:235-239. © 2014 Wiley Periodicals, Inc.

Spatial structuring of arbuscular mycorrhizal communities in benchmark and modified temperate eucalypt woodlands

Arbuscular mycorrhizal fungi (AMF) are crucial to the functioning of the plant-soil system, but little is known about the spatial structuring of AMF communities across landscapes modified by agriculture. AMF community composition was characterized across four sites in the highly cleared south-western Australian wheatbelt that were originally dominated by forb-rich eucalypt woodlands. Environmentally induced spatial structuring in AMF composition was examined at four scales: the regional scale associated with location, the site scale associated with past management (benchmark woodlands with no agricultural management history, livestock grazing, recent revegetation), the patch scale associated with trees and canopy gaps, and the fine scale associated with the herbaceous plant species beneath which soils were sourced. Field-collected soils were cultured in trap pots; then, AMF composition was determined by identifying spores and through ITS1 sequencing. Structuring was strongest at site scales, where composition was strongly related to prior management and associated changes in soil phosphorus. The two fields were dominated by the genera Funneliformis and Paraglomus, with little convergence back to woodland composition after revegetation. The two benchmark woodlands were characterized by Ambispora gerdemannii and taxa from Gigasporaceae. Their AMF communities were strongly structured at patch scales associated with trees and gaps, in turn most strongly related to soil N. By contrast, there were few patterns at fine scales related to different herbaceous plant species, or at regional scales associated with the 175 km distance between benchmark woodlands. Important areas for future investigation are to identify the circumstances in which recolonization by woodland AMF may be limited by fungal propagule availability, reduced plant diversity and/or altered chemistry in agricultural soils.

High-Power High-Temperature Heterobipolar TransistorWith Gallium Nitride Emitter

A new heterobipolar transistor was made with the wide bandgap semicon-ductors gallium nitride (GaN) and silicon carbide (SiC). The heterojunction allows high injection efficiency, even at elevated temperatures. A record current gain of ten million was obtained at room temperature, decreasing to 100 at 535°C. An Arrhenius plot of current gain vs 1/T yields an activation energy of 0.43 eV that corresponds to the valence band barrier blocking the escape of holes from the base to the emitter. This activation energy is approximately equal to the difference of energy gaps between emitter and base. This Transistor can operate at high power without cooling. A power density of 30 KW/cm2 was sustained.

Pedal access in critical limb ischemia

Critical limb ischemia (CLI) commonly involves popliteal and infrapopliteal arterial occlusions. Surgical revascularization may be limited by poor distal targets, lack of autologous vein, and co morbid conditions. Endovascular therapy may be an option even in this group of patients with no surgical options, but is limited by the need to first cross these chronic total occlusions. Lesions that are uncrossable in antegrade fashion are often easily crossed via retrograde approach. The pedal approach (via anterior tibial, posterior tibial, or peroneal arteries) is a viable approach in limb salvage interventions where occlusions cannot be crossed with antegrade approach. A 13-step technique utilizing transpedal approach in my first 228 patients treated by this approach who had presented with CLI and had failed attempts at antegrade crossing of the occlusions is described. In this group of patients, transpedal approach was only utilized in patients with CLI. No claudicants were included. The pedal arteries were accessed successfully in 217/228 (95%) patients. Once pedal access was achieved successful intervention was accomplished in 199/217 (93%). There were no bleeding complications and only one pedal occlusion.

Monitoring policy and actions on food environments: rationale and outline of the INFORMAS policy engagement and communication strategies

The International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) proposes to collect performance indicators on food policies, actions and environments related to obesity and non-communicable diseases. This paper reviews existing communications strategies used for performance indicators and proposes the approach to be taken for INFORMAS. Twenty-seven scoring and rating tools were identified in various fields of public health including alcohol, tobacco, physical activity, infant feeding and food environments. These were compared based on the types of indicators used and how they were quantified, scoring methods, presentation and the communication and reporting strategies used. There are several implications of these analyses for INFORMAS: the ratings/benchmarking approach is very commonly used, presumably because it is an effective way to communicate progress and stimulate action, although this has not been formally evaluated; the tools used must be trustworthy, pragmatic and policy-relevant; multiple channels of communication will be needed; communications need to be tailored and targeted to decision-makers; data and methods should be freely accessible. The proposed communications strategy for INFORMAS has been built around these lessons to ensure that INFORMAS's outputs have the greatest chance of being used to improve food environments.