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Nakdhamabhorn S, Pillai BM, Chotivichit A, Suthakorn J. Sensorless Based Haptic Feedback Integration In Robot-assisted Pedicle Screw Insertion For Lumbar Spine Surgery: A preliminary cadaveric study. Comput Struct Biotechnol J 2024; 24:420-433. [PMID: 38841212 PMCID: PMC11152607 DOI: 10.1016/j.csbj.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024] Open
Abstract
Pedicle screw fixation is an essential surgical technique for addressing various spinal pathologies, including degenerative diseases, trauma, tumors, neoplasms, and infections. Despite its efficacy, the procedure poses significant challenges, notably the limited visibility of spinal anatomical landmarks and the consequent reliance on surgeon's hand-eye coordination. These challenges often result in inaccuracies and high radiation exposure due to the frequent use of fluoroscopy X-ray guidance. Addressing these concerns, this study introduces a novel approach to pedicle screw insertion by utilizing a robot-assisted system that incorporates sensorless based haptics incorporated 5-DOF surgical manipulation. This innovative system aims to minimize radiation exposure and reduce operating time while improving the surgeon's hand posture capabilities. The developed prototype, expected to be implemented using bilateral control, was tested through preliminary cadaveric experiments focused on the insertion of both percutaneous and open pedicle screws at the L4-L5 level of the lumbar spine. Validation of the Sensorless Haptic Feedback feature was an integral part of this study, aiming to enhance precision and safety. The results, confirmed by fluoroscopic x-ray images, demonstrated the successful placement of two percutaneous and two open pedicle screws, with average position and torque errors of 0.011 radians and 0.054 Nm for percutaneous screws, and 0.0116 radians and 0.0057 Nm for open screws, respectively. These findings underscore the potential of the sensorless haptic feedback in a robot-assisted pedicle screw insertion system to significantly reduce radiation exposure and improve surgical outcomes, marking a significant advancement in spinal surgery technology.
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Affiliation(s)
- Sakol Nakdhamabhorn
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Branesh M. Pillai
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Areesak Chotivichit
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Jackrit Suthakorn
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
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Vano E, Fernández-Soto JM, Sánchez-Casanueva RM, Ten Morón JI. Improving a regional project on diagnostic reference levels for interventional procedures (OPRIPALC) with the support of a dose management system for the protection of patients and staff. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021520. [PMID: 38834050 DOI: 10.1088/1361-6498/ad53d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/04/2024] [Indexed: 06/06/2024]
Abstract
Interventional radiology is a clinical practice with important benefits for patients, but which involves high radiation doses. The optimisation of radiation protection (RP) for paediatric interventional cardiology is a priority for both patients and staff. The use of diagnostic reference levels (DRLs) has been proposed by the International Commission on Radiological Protection to improve RP in imaging procedures. Dose management systems (DMSs) allow the automatic collection of dosimetric, geometric and technical data to assist the optimisation process, with a continuous audit of the procedures, generating alerts to implement corrective actions when necessary. Patient dose indicators may be analysed individually and for different radiation events (fluoroscopy and cine runs). Occupational doses per procedure may be analysed (if electronic dosimeters are available) and linked with patient doses for an integrated approach to RP. Regional optimisation programmes require data collection and processing from several countries to set and periodically update the DRLs. Patient data is anonymised, and each participating hospital has access to their data in a central computer server. Using DMSs may be one of the best ways to support these programs in the collection and analysis of data, raising alerts about high patient and occupational doses and suggesting optimisation actions.
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Affiliation(s)
- E Vano
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - J M Fernández-Soto
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - R M Sánchez-Casanueva
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - J I Ten Morón
- Unidad Técnica de Imagen Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
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Matsubara K, Nakajima A, Hirosawa A, Yoshikawa R, Ichikawa N, Fukushima K, Fukuda A. Effect of radioprotective curtain length on the scattered dose rate distribution and endoscopist eye lens dose with an over-couch fluoroscopy system. Phys Eng Sci Med 2024; 47:691-701. [PMID: 38483784 PMCID: PMC11166833 DOI: 10.1007/s13246-024-01398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/29/2024] [Indexed: 06/12/2024]
Abstract
Sufficient dose reduction may not be achieved if radioprotective curtains are folded. This study aimed to evaluate the scattered dose rate distribution and physician eye lens dose at different curtain lengths. Using an over-couch fluoroscopy system, dH*(10)/dt was measured using a survey meter 150 cm from the floor at 29 positions in the examination room when the curtain lengths were 0% (no curtain), 50%, 75%, and 100%. The absorbed dose rates in the air at the positions of endoscopist and assistant were calculated using a Monte Carlo simulation by varying the curtain length from 0 to 100%. The air kerma was measured by 10 min fluoroscopy using optically stimulated luminescence dosimeters at the eye surfaces of the endoscopist phantom and the outside and inside of the radioprotective goggles. At curtain lengths of 50%, 75%, and 100%, the ratios of dH*(10)/dt relative to 0% ranged from 80.8 to 104.1%, 10.5 to 61.0%, and 11.8 to 24.8%, respectively. In the simulation, the absorbed dose rates at the endoscopist's and assistant's positions changed rapidly between 55 and 75% and 65% and 80% of the curtain length, respectively. At the 0%, 50%, 75%, and 100% curtain lengths, the air kerma at the left eye surface of the endoscopist phantom was 237 ± 29, 271 ± 30, 37.7 ± 7.5, and 33.5 ± 6.1 μGy, respectively. Therefore, a curtain length of 75% or greater is required to achieve a sufficient eye lens dose reduction effect at the position of the endoscopist.
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Affiliation(s)
- Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan.
| | - Asuka Nakajima
- Department of Radiological Technology, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
- Division of Radiology, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ayaka Hirosawa
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
- Department of Medical Technology, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyoma, Toyama, 930-8550, Japan
| | - Ryo Yoshikawa
- Department of Radiology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Nao Ichikawa
- Department of Quantum Medical Technology, Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
- Department of Radiological Technology, Faculty of Health Science, Kobe Tokiwa University, 2-6-2 Otani-Cho, Nagata-Ku, Kobe, Hyogo, 653-0838, Japan
| | - Kotaro Fukushima
- Department of Quantum Medical Technology, Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
| | - Atsushi Fukuda
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, 10-6 Sakaemachi, Fukushima, Fukushima, 960-1295, Japan
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Pondard S, Desport C, Munier M, Kien N, Rousseau H, Merignac O, Popotte C, Moreno R. Multicentric characterization of organ-based tube current modulation in head computed tomography: A dosimetric and image quality study. Phys Med 2024; 122:103389. [PMID: 38820806 DOI: 10.1016/j.ejmp.2024.103389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 04/29/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024] Open
Abstract
PURPOSE To evaluate the efficiency of organ-based tube current modulation (OBTCM) in head Computed Tomography (CT) for different radiology departments and manufacturers. MATERIALS AND METHODS Five CT scanners from four radiology departments were evaluated in this study. All scans were performed using a standard and a routine head protocol. A scintillating fiber optic detector was placed directly on the gantry to measure the tube exit kerma. Image quality was quantified on a 16-cm HEAD phantom by measuring the signal-to-noise ratio (SNR) and the standard deviation of the Hounsfield units (HU) of circular regions of interest placed in the phantom. The Noise Power Spectrum (NPS) was also studied. Measured values were compared on images with and without OBTCM. RESULTS The reduction rates in tube exit kerma, on the anterior part, vary between 11 % and 74 % depending on the CT scanner and the protocol used. The tube exit kerma on the posterior part remains unchanged in GE and Canon CT scanners. On the contrary, the tube exit kerma to the posterior part increases by up to 39 % in Siemens CT scanner. Image noise and SNR increase by up to 10 % in the five CT scanners. Nonetheless, the differences in noise and SNR are statistically significant (p-value < 0.05).The analysis of the NPS indicates that the noise texture remains unchanged. CONCLUSION OBTCM reduces the tube exit kerma to the anterior part of the gantry without reducing substantially image quality for head protocols.
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Affiliation(s)
- Séléna Pondard
- Alara Expertise, 7 Allée de l'Europe, 67960 Entzheim, France.
| | | | - Mélodie Munier
- Fibermetrix, 7 Allée de l'Europe, 67960 Entzheim, France; Alara Group, 7 Allée de l'Europe, 67960 Entzheim, France
| | - Nicolas Kien
- Alara Expertise, 7 Allée de l'Europe, 67960 Entzheim, France
| | - Hervé Rousseau
- Service de Radiologie, CHU Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhes, 31400 Toulouse, France; Institut des maladies métaboliques et cardiovasculaires (I2MC) - UMR1297, Université de Toulouse, 1 Avenue Jean Poulhès, BP64225, 31432 Toulouse, France
| | - Olivier Merignac
- Service de Radiologie Diagnostique et Interventionnelle adulte, Hôpital de Bicetre, DMU 14 Smart Imaging, AP-HP, 78 Rue du Général Leclerc 94270, Le Kremlin‑Bicetre, France; Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, 4 place du Général Leclerc, 91401 Orsay, France
| | | | - Ramiro Moreno
- Alara Expertise, 7 Allée de l'Europe, 67960 Entzheim, France; Service de Radiologie, CHU Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhes, 31400 Toulouse, France; Institut des maladies métaboliques et cardiovasculaires (I2MC) - UMR1297, Université de Toulouse, 1 Avenue Jean Poulhès, BP64225, 31432 Toulouse, France.
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Tanaka M, Schol J, Sakai D, Sako K, Yamamoto K, Yanagi K, Hiyama A, Katoh H, Sato M, Watanabe M. Low Radiation Protocol for Intraoperative Robotic C-Arm Can Enhance Adolescent Idiopathic Scoliosis Deformity Correction Accuracy and Safety. Global Spine J 2024; 14:1504-1514. [PMID: 36695112 DOI: 10.1177/21925682221147867] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY DESIGN Retrospective case-series study. OBJECTIVES To assess (1) low cone beam CT (CBCT) mediated intraoperative navigation to limit radiation exposure without compromising surgical accuracy, and (2) the potential of intraoperative C-arm CBCT navigation to augment pedicle screw (PS) placement accuracy in AIS surgery compared to pre-surgery CT-based planning. METHODS The first part involved a prospective phantom study, comparing radiation doses for conventional CT, and standard (6sDCT) and a low dose (5sDCT) Artis Zeego®-imaging. Next, 5sDCT- and 6sDCT-navigation were compared on PS accuracy and radiation exposure during AIS correction. The final part compared surgical AIS deformity correction through intraoperative 5sDCT navigation to a matched cohort treated using conventional pre-surgery CT-scans for navigation. Outcome parameters included operation time, skin dose (SD), dose area product (DAP), intraoperative blood loss, postoperative complications, and PS deviation rates. RESULTS The phantom study demonstrated a reduction in radiation for the 5sDCT protocol. Moreover, 5sDCT-imaged patients (n = 15) showed a significantly lower SD (-27.41%) and DAP (-30.92%), without compromising PS accuracy compared with 6sDCT-settings (n = 15). Finally, AIS correction through intraoperative CBCT C-arm navigation (n = 27) significantly reduced screw deviation rates (6.83% versus 10.75%, P = .016) without increasing operation times, compared with conventional CT (n = 37). CONCLUSIONS Intraoperative navigation using a CBCT C-arm system improved the accuracy of PS insertion and reduced surgery time. Moreover, it reduced radiation exposure compared with conventional CT, which was further curtailed by adapting the low-dose 5sDCT protocol. In short, our study highlights the benefits of intraoperative CBCT navigation for PS placement in AIS surgery.
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Affiliation(s)
- Masahiro Tanaka
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Jordy Schol
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Kosuke Sako
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Kazuyuki Yamamoto
- Department of Diagnostic Radiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Kensuke Yanagi
- Department of Diagnostic Radiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
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Uniyal SC, Singh V, Rawat A, Gururani K, Belwal CM. An audit of patient radiation doses during interventional cardiology procedures in Uttarakhand, India, and establishment of local diagnostic reference levels. Radiol Phys Technol 2024; 17:476-487. [PMID: 38652208 DOI: 10.1007/s12194-024-00805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
The objective of this study was to investigate patient radiation doses by a dose audit of three common interventional cardiology (IC) procedures: coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA) and CA-PTCA procedures performed in IC centres in the Uttarakhand state of India, for the establishment of local diagnostic reference levels (DRLs) and the estimation of average effective dose (Eav) for these procedures. For each procedure, the values of kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of cine images were recorded from 1233 CA, 458 PTCA and 736 CA-PTCA procedures performed over a 12-month period at 13 IC centres of the state. From the recorded dose data, 0.6%, 1.53% and 7.9% patients were identified to have exceeded the PKA trigger level of 500 Gy cm2 for possible skin injury for CA, PTCA and CA-PTCA procedures, respectively. The 3rd quartile of the distribution of the recorded PKA values for each type of procedure was calculated to estimate local DRL values. The estimated values of DRLs and Eav were 37, 153 and 224 Gy cm2, and 6.72, 23.97 and 34.79 mSv for CA, PTCA and CA-PTCA procedures, respectively. For about 77% of the surveyed centres, the recorded patient doses were in agreement with the international standards. The local DRLs proposed in this study may be used to achieve patient dose optimization during IC procedures and the obtained patient dose data may also be archived into national dose database for the establishment of national DRLs.
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Affiliation(s)
- Satish C Uniyal
- Department of Medical Physics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India.
| | - Vikram Singh
- Department of Medical Physics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Anurag Rawat
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Kunal Gururani
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Chandra Mohan Belwal
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
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Ohno S, Konta S, Shindo R, Yamamoto K, Isobe R, Inaba Y, Suzuki M, Zuguchi M, Chida K. Effect of backscatter radiation on the occupational eye-lens dose. JOURNAL OF RADIATION RESEARCH 2024:rrae034. [PMID: 38818635 DOI: 10.1093/jrr/rrae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/21/2024] [Indexed: 06/01/2024]
Abstract
We quantified the level of backscatter radiation generated from physicians' heads using a phantom. We also evaluated the shielding rate of the protective eyewear and optimal placement of the eye-dedicated dosimeter (skin surface or behind the Pb-eyewear). We performed diagnostic X-rays of two head phantoms: Styrofoam (negligible backscatter radiation) and anthropomorphic (included backscatter radiation). Radiophotoluminescence glass dosimeters were used to measure the eye-lens dose, with or without 0.07-mm Pb-equivalent protective eyewear. We used tube voltages of 50, 65 and 80 kV because the scattered radiation has a lower mean energy than the primary X-ray beam. The backscatter radiation accounted for 17.3-22.3% of the eye-lens dose, with the percentage increasing with increasing tube voltage. Furthermore, the shielding rate of the protective eyewear was overestimated, and the eye-lens dose was underestimated when the eye-dedicated dosimeter was placed behind the protective eyewear. We quantified the backscatter radiation generated from physicians' heads. To account for the effect of backscatter radiation, an anthropomorphic, rather than Styrofoam, phantom should be used. Close contact of the dosimeter with the skin surface is essential for accurate evaluation of backscatter radiation from physician's own heads. To assess the eye-lens dose accurately, the dosimeter should be placed near the eye. If the dosimeter is placed behind the lens of the protective eyewear, we recommend using a backscatter radiation calibration factor of 1.2-1.3.
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Affiliation(s)
- Saya Ohno
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Satoe Konta
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Ryota Shindo
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Keisuke Yamamoto
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Rio Isobe
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Yohei Inaba
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4, Aoba, Sendai 980-8579, Japan
| | - Masatoshi Suzuki
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4, Aoba, Sendai 980-8579, Japan
| | - Masayuki Zuguchi
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4, Aoba, Sendai 980-8579, Japan
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Hulthén M, Tsapaki V, Karambatsakidou A. Estimating brain and eye lens dose for the cardiologist in interventional cardiology-are the dose levels of concern? Br J Radiol 2024; 97:1191-1201. [PMID: 38711194 DOI: 10.1093/bjr/tqae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/06/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES To establish conversion coefficients (CCs), between mean absorbed dose to the brain and eye lens of the cardiologist and the air kerma-area product, PKA, for a set of projections in cardiac interventional procedures. Furthermore, by taking clinical data into account, a method to estimate the doses per procedure, or annual dose, is presented. METHODS Thermoluminescence dosimeters were used together with anthropomorphic phantoms, simulating a cardiologist performing an interventional cardiac procedure, to estimate the CCs for the brain and eye lens dose for nine standard projections, and change in patient size and x-ray spectrum. Additionally, a single CC has been estimated, accounting for each projections fraction of use in the clinic and associated PKA using clinical data from the dose monitoring system in our hospital. RESULTS The maximum CCs for the eye lens and segment of the brain, is 5.47 μGy/Gycm2 (left eye lens) and 1.71 μGy/Gycm2 (left brain segment). The corresponding weighted CCs: are 3.39 μGy/Gycm2 and 0.89 μGy/Gycm2, respectively. CONCLUSIONS Conversion coefficients have been established under actual scatter conditions, showing higher doses on the left side of the operator. Using modern interventional x-ray equipment, interventional cardiac procedures will not cause high radiation dose levels to the operator when a ceiling mounted shield is used, otherwise there is a risk that the threshold dose values for cataract will be reached. ADVANCE IN KNOWLEDGE In addition to the CCs for the different projections, methods for deriving a single CC per cardiac interventional procedure and dose per year were introduced.
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Affiliation(s)
- Markus Hulthén
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Virginia Tsapaki
- Dosimetry and Medical Radiation Physics Section, Human Health Division, IAEA, Vienna, Austria
| | - Angeliki Karambatsakidou
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
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Matsuya Y, Sato T, Yachi Y, Date H, Hamada N. The impact of dose rate on responses of human lens epithelial cells to ionizing irradiation. Sci Rep 2024; 14:12160. [PMID: 38802452 PMCID: PMC11130169 DOI: 10.1038/s41598-024-62679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
The knowledge on responses of human lens epithelial cells (HLECs) to ionizing radiation exposure is important to understand mechanisms of radiation cataracts that are of concern in the field of radiation protection and radiation therapy. However, biological effects in HLECs following protracted exposure have not yet fully been explored. Here, we investigated the temporal kinetics of γ-H2AX foci as a marker for DNA double-strand breaks (DSBs) and cell survival in HLECs after exposure to photon beams at various dose rates (i.e., 150 kVp X-rays at 1.82, 0.1, and 0.033 Gy/min, and 137Cs γ-rays at 0.00461 Gy/min (27.7 cGy/h) and 0.00081 Gy/min (4.9 cGy/h)), compared to those in human lung fibroblasts (WI-38). In parallel, we quantified the recovery for DSBs and cell survival using a biophysical model. The study revealed that HLECs have a lower DSB repair rate than WI-38 cells. There is no significant impact of dose rate on cell survival in both cell lines in the dose-rate range of 0.033-1.82 Gy/min. In contrast, the experimental residual γ-H2AX foci showed inverse dose rate effects (IDREs) compared to the model prediction, highlighting the importance of the IDREs in evaluating radiation effects on the ocular lens.
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Affiliation(s)
- Yusuke Matsuya
- Faculty of Health Sciences, Hokkaido University, Kita-12 Nishi-5, Kita-ku, Sapporo, 060-0812, Japan.
- Research Group for Radiation Transport Analysis, Nuclear Science and Engineering Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata, Tokai, Ibaraki, 319-1195, Japan.
| | - Tatsuhiko Sato
- Research Group for Radiation Transport Analysis, Nuclear Science and Engineering Center, Japan Atomic Energy Agency (JAEA), 2-4 Shirakata, Tokai, Ibaraki, 319-1195, Japan
| | - Yoshie Yachi
- Graduate School of Health Sciences, Hokkaido University, Kita-12 Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Hiroyuki Date
- Faculty of Health Sciences, Hokkaido University, Kita-12 Nishi-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Chiba, 270-1194, Japan.
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Harbron RW. Estimates of cardiovascular disease risk from CT scans may be premature. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:024503. [PMID: 38770744 DOI: 10.1088/1361-6498/ad4b27] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Richard W Harbron
- Newcastle University, Newcastle upon Tyne, United Kingdom
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
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11
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Ito H, Matsubara K, Kobayashi I, Shimakawa Y, Murayama D, Sakai T, Isobe T, Yanagawa N, Ochi S. Relationship between assistant's lens exposure and dose information during computed tomography examinations. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021513. [PMID: 38722292 DOI: 10.1088/1361-6498/ad4903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
According to International Commission of Radiological Protection, the equivalent dose limit for the eye lens for occupational exposure is recommended to be 20 mSv yr-1, averaged over 5 years, with no single year above 50 mSv. Some studies reported the measurement of assistant's lens exposure in diagnostic computed tomography (CT) examinations, but further investigation is still required in the association between the lens dose for assistants and various dose parameters. Therefore, we measured the assistant's lens exposure using small optically stimulated luminescence dosimeters. The type of occupation, type of assistance, total scan time, total mAs, total scan length, and dose-length product (DLP) were recorded and analyzed in association with air kerma at the lens position. The assistance was classified into four types: 'assisted ventilation,' 'head holding,' 'body holding,' and 'raising patient's arm.' The air kerma of lens position was not significantly different for each assistance type (p< 0.05, Kruskal-Wallis test). Further, the lens doses for assistants correlated with DLP, but with various strengths of correlation with the assistance type and were influenced by the distance from the CT gantry. In conclusion, lens dose during assistance and DLP demonstrated the strongest correlation. 'Raising patient's arm' and 'head holding' exhibited stronger correlations, which required less table movement during the CT scan than 'assisted ventilation' and 'body holding'.
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Affiliation(s)
- Hajime Ito
- Department of Radiology, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba 283-8686, Japan
- Department of Quantum Medical Technology, Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan
| | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan
| | - Ikuo Kobayashi
- Research Institute of Nuclear Engineering, University of Fukui, 1-3-33 Kanawa, Tsuruga, Fukui 914-0055, Japan
| | - Yurie Shimakawa
- Department of Radiology, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba 283-8686, Japan
| | - Daichi Murayama
- Department of Radiology, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba 283-8686, Japan
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba 283-8686, Japan
| | - Tomonori Isobe
- Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Noriyuki Yanagawa
- Department of Radiological Technology, Faculty of Health Sciences, Tsukuba International University, 6-20-1, Manabe, Tsuchiura, Ibaraki 300-0051, Japan
| | - Shigehiro Ochi
- Department of Radiology, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba 283-8686, Japan
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12
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Shindo R, Ohno S, Yamamoto K, Konta S, Inaba Y, Suzuki M, Zuguchi M, Chida K. Comparison of shielding effects of over-glasses-type and regular eyewear in terms of occupational eye dose reduction. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:023501. [PMID: 38701771 DOI: 10.1088/1361-6498/ad4714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/03/2024] [Indexed: 05/05/2024]
Abstract
Given the new recommendations for occupational eye lens doses, various lead glasses have been used to reduce irradiation of interventional radiologists. However, the protection afforded by lead glasses over prescription glasses (thus over-glasses-type eyewear) has not been considered in detail. We used a phantom to compare the protective effects of such eyewear and regular eyewear of 0.07 mm lead-equivalent thickness. The shielding rates behind the eyewear and on the surface of the left eye of an anthropomorphic phantom were calculated. The left eye of the phantom was irradiated at various angles and the shielding effects were evaluated. We measured the radiation dose to the left side of the phantom using RPLDs attached to the left eye and to the surface/back of the left eyewear. Over-glasses-type eyewear afforded good protection against x-rays from the left and below; the average shielding rates on the surface of the left eye ranged from 0.70-0.72. In clinical settings, scattered radiation is incident on physicians' eyes from the left and below, and through any gap in lead glasses. Over-glasses-type eyewear afforded better protection than regular eyewear of the same lead-equivalent thickness at the irradiation angles of concern in clinical settings. Although clinical evaluation is needed, we suggest over-glasses-type Pb eyewear even for physicians who do not wear prescription glasses.
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Affiliation(s)
- Ryota Shindo
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Saya Ohno
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Keisuke Yamamoto
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Satoe Konta
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Yohei Inaba
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4 Aoba, Sendai 980-8579, Japan
| | - Masatoshi Suzuki
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4 Aoba, Sendai 980-8579, Japan
| | - Masayuki Zuguchi
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4 Aoba, Sendai 980-8579, Japan
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13
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Chauhan V, Beaton D, Tollefsen KE, Preston J, Burtt JJ, Leblanc J, Hamada N, Azzam EI, Armant O, Bouffler S, Azimzadeh O, Moertl S, Yamada Y, Tanaka IB, Kaiser JC, Applegate K, Laurier D, Garnier-Laplace J. Radiation Adverse Outcome pathways (AOPs): examining priority questions from an international horizon-style exercise. Int J Radiat Biol 2024:1-14. [PMID: 38718325 DOI: 10.1080/09553002.2024.2348072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/14/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE The Organisation for Economic Co-operation and Development (OECD) Adverse Outcome Pathway (AOP) Development Programme is being explored in the radiation field, as an overarching framework to identify and prioritize research needs that best support strengthening of radiation risk assessment and risk management strategies. To advance the use of AOPs, an international horizon-style exercise (HSE) was initiated through the Radiation/Chemical AOP Joint Topical Group (JTG) formed by the OECD Nuclear Energy Agency (NEA) High-Level Group on Low Dose Research (HLG-LDR) under the auspices of the Committee on Radiological Protection and Public Health (CRPPH). The intent of the HSE was to identify key research questions for consideration in AOP development that would help to reduce uncertainties in estimating the health risks following exposures to low dose and low dose-rate ionizing radiation. The HSE was conducted in several phases involving the solicitation of relevant questions, a collaborative review of open-ended candidate questions and an elimination exercise that led to the selection of 25 highest priority questions for the stated purpose. These questions were further ranked by over 100 respondents through an international survey. This final set of questions was judged to provide insights into how the OECD's AOP approach can be put into practice to meet the needs of hazard and risk assessors, regulators, and researchers. This paper examines the 25 priority questions in the context of hazard/risk assessment framework for ionizing radiation. CONCLUSION By addressing the 25 priority questions, it is anticipated that constructed AOPs will have a high level of specificity, making them valuable tools for simplifying and prioritizing complex biological processes for use in developing revised radiation hazard and risk assessment strategies.
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Affiliation(s)
- Vinita Chauhan
- Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Danielle Beaton
- Isotopes, Radiobiology and Environment Directorate, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Knut Erik Tollefsen
- Norwegian Institute for Water Research (NIVA), Oslo, Norway
- Centre for Environmental Radioactivity, Norwegian University of Life Sciences (NMBU), Ås, Norway
| | - Julian Preston
- Office of Air and Radiation, Radiation Protection Division, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Julie J Burtt
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Julie Leblanc
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Chiba, Japan
| | - Edouard I Azzam
- Isotopes, Radiobiology and Environment Directorate, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Olivier Armant
- Institut de Radioprotection Et de Sûreté Nucléaire (IRSN), PSE-ENV/SERPEN/LECO, Cadarache, France
| | | | - Omid Azimzadeh
- Federal Office of Radiation Protection, Oberschleissheim, Germany
| | - Simone Moertl
- Federal Office of Radiation Protection, Oberschleissheim, Germany
| | - Yutaka Yamada
- Department of Radiation Effects Research, Institute for Radiological Science, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Ignacia B Tanaka
- Department of Radiobiology, Institute for Environmental Sciences, Aomori, Japan
| | | | - Kimberly Applegate
- Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, USA (retired)
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay aux Roses, France
| | - Jacqueline Garnier-Laplace
- On secondment from IRSN to the Committee on Radiological Protection and Public Health's secretariat, Paris, France
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14
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Nessipkhan A, Matsuda N, Takamura N, Oriuchi N, Ito H, Kiguchi M, Nishihara K, Tamaru T, Awai K, Kudo T. Occupational radiation exposure among medical personnel in university and general hospitals in Japan. Jpn J Radiol 2024:10.1007/s11604-024-01579-3. [PMID: 38705937 DOI: 10.1007/s11604-024-01579-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE This study aimed to compare the occupational radiation exposure of medical workers between general hospitals and university hospitals. METHODS Radiation exposure data from three hospitals in Hiroshima city, including one university hospital and two general hospitals, were collected using personal dosimeters. Monthly radiation doses were analyzed, and the annual sum of radiation exposure dose was calculated for 538 subjects in general hospitals and 1224 subjects in the university hospital. To assess the impact of locality, additional data from Nagasaki University Hospital and Fukushima Medical University Hospital were included for comparative analysis. Professional affiliations, such as doctors, nurses, and radiological technologists, were considered in the evaluation. RESULTS The study revealed slight but significant differences in radiation doses between general and university hospitals. In general hospitals, except for radiological technologists, a slightly higher radiation dose was observed compared to university hospitals. Despite the annual increase in the use of medical radiation, the majority of hospital workers in both settings adhered to safety guidelines, with occupational radiation exposure remaining below the limit of detection (LOD). Workers who involved in fluoroscopic procedure, whether at university or general hospitals, had higher radiation doses than those who did not. CONCLUSION The study's primary conclusion is that workers in general hospitals experience a slight but significantly higher radiation dose and a lower percentage below the LOD compared to university hospitals. The observed difference is attributed to the greater workload at general hospitals than at university hospitals, and also may be due to the different nature of university hospital and general hospital. University hospitals, characterized by greater academic orientation, tend to benefit from comprehensive support systems, specialized expertise, and advanced technology, leading to more structured and regulated radiation control. These findings provide a basis for targeted interventions, improved safety protocols.
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Affiliation(s)
- Arman Nessipkhan
- Department of Radioisotope Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan.
| | - Naoki Matsuda
- Department of Radiation Biology and Protection, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Noboru Takamura
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Noboru Oriuchi
- Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Ito
- Department of Radiology, Faculty of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masao Kiguchi
- Department of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Kiyoto Nishihara
- Department of Radiological Technology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takayuki Tamaru
- Department of Radiology, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takashi Kudo
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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15
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Yoshida T, Sasaki K, Hayakawa T, Kawadai T, Shibasaki T, Kawasaki Y. Recommendation for reducing the crystalline lens exposure dose by reducing imaging field width in cone-beam computed tomography for image-guided radiation therapy: an anthropomorphic phantom study. Radiol Phys Technol 2024:10.1007/s12194-024-00810-0. [PMID: 38691308 DOI: 10.1007/s12194-024-00810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/23/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024]
Abstract
In cone-beam computed tomography (CBCT) for image-guided radiation therapy (IGRT) of the head, we evaluated the exposure dose reduction effect to the crystalline lens and position-matching accuracy by narrowing one side (X2) of the X-ray aperture (blade) in the X-direction. We defined the ocular surface dose of the head phantom as the crystalline lens exposure dose and measured using a radiophotoluminescence dosimeter (RPLD, GD-352 M) in the preset field (13.6 cm) and in each of the fields when blade X2 aperture was reduced in 0.5 cm increments from 10.0 to 5.0 cm. Auto-bone matching was performed on CBCT images acquired five times with blade X2 aperture set to 13.6 cm and 5.0 cm at each position when the head phantom was moved from - 5.0 to + 5.0 mm in 1.0 mm increment. The maximum reduction rate in the crystalline lens exposure dose was - 38.7% for the right lens and - 13.2% for the left lens when blade X2 aperture was 5.0 cm. The maximum difference in the amount of position correction between blade X2 aperture of 13.6 cm and 5.0 cm was 1 mm, and the accuracy of auto-bone matching was similar. In CBCT of the head, reduced blade X2 aperture is a useful technique for reducing the crystalline lens exposure dose while ensuring the accuracy of position matching.
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Affiliation(s)
- Tatsuya Yoshida
- Department of Radiology, Koritsu Tatebayashi Kosei General Hospital, Gunma, Japan.
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Gunma, Japan.
| | - Koji Sasaki
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Gunma, Japan
| | - Tomoki Hayakawa
- Department of Radiology, Koritsu Tatebayashi Kosei General Hospital, Gunma, Japan
| | - Toshiyuki Kawadai
- Department of Radiology, Koritsu Tatebayashi Kosei General Hospital, Gunma, Japan
| | - Takako Shibasaki
- Department of Radiology, Koritsu Tatebayashi Kosei General Hospital, Gunma, Japan
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16
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Carrothers E, Appleby M, Lai V, Kozbenko T, Alomar D, Smith BJ, Hamada N, Hinton P, Ainsbury EA, Hocking R, Yauk C, Wilkins RC, Chauhan V. AOP report: Development of an adverse outcome pathway for deposition of energy leading to cataracts. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2024. [PMID: 38644659 DOI: 10.1002/em.22594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024]
Abstract
Cataracts are one of the leading causes of blindness, with an estimated 95 million people affected worldwide. A hallmark of cataract development is lens opacification, typically associated not only with aging but also radiation exposure as encountered by interventional radiologists and astronauts during the long-term space mission. To better understand radiation-induced cataracts, the adverse outcome pathway (AOP) framework was used to structure and evaluate knowledge across biological levels of organization (e.g., macromolecular, cell, tissue, organ, organism and population). AOPs identify a sequence of key events (KEs) causally connected by key event relationships (KERs) beginning with a molecular initiating event to an adverse outcome (AO) of relevance to regulatory decision-making. To construct the cataract AO and retrieve evidence to support it, a scoping review methodology was used to filter, screen, and review studies based on the modified Bradford Hill criteria. Eight KEs were identified that were moderately supported by empirical evidence (e.g., dose-, time-, incidence-concordance) across the adjacent (directly linked) relationships using well-established endpoints. Over half of the evidence to justify the KER linkages was derived from the evidence stream of biological plausibility. Early KEs of oxidative stress and protein modifications had strong linkages to downstream KEs and could be the focus of countermeasure development. Several identified knowledge gaps and inconsistencies related to the quantitative understanding of KERs which could be the basis of future research, most notably directed to experiments in the range of low or moderate doses and dose-rates, relevant to radiation workers and other occupational exposures.
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Affiliation(s)
- Emma Carrothers
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Meghan Appleby
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Vita Lai
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Tatiana Kozbenko
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Dalya Alomar
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Benjamin J Smith
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Chiba, Japan
| | - Patricia Hinton
- Defense Research & Development Canada, Canadian Forces Environmental Medicine Establishment, Toronto, Ontario, Canada
| | - Elizabeth A Ainsbury
- Radiation, Chemical and Environmental Hazards Division, UK Health Security Agency, Birmingham, UK
- Environmental Research Group within the School of Public Health, Faculty of Medicine at Imperial College of Science, Technology and Medicine, London, UK
| | - Robyn Hocking
- Learning and Knowledge and Library Services, Health Canada, Ottawa, Ontario, Canada
| | - Carole Yauk
- Department of Biology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ruth C Wilkins
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Vinita Chauhan
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
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17
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Baudin C, Vacquier B, Thin G, Chenene L, Guersen J, Partarrieu I, Louet M, Ducou le Pointe H, Mora S, Verdun-Esquer C, Lestavel P, Rousseau F, Roy H, Bensefa-Colas L, Boyer L, Bernier MO. Radiation protection in a cohort of healthcare workers: knowledge, attitude, practices, feelings and IR-exposure in French hospitals. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021507. [PMID: 38569480 DOI: 10.1088/1361-6498/ad39f7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/03/2024] [Indexed: 04/05/2024]
Abstract
The number of healthcare workers occupationally exposed to ionizing radiation (IR) is increasing every year. As health effects from exposure to low doses IR have been reported, radiation protection (RP) in the context of occupational activities is a major concern. This study aims to assess the compliance of healthcare workers with RP policies, according to their registered cumulative dose, profession, and perception of radiation self-exposure and associated risk. Every healthcare worker from one of the participating hospitals in France with at least one dosimetric record for each year 2009, 2014, and 2019 in the SISERI registry was included and invited to complete an online questionnaire including information on the worker's occupational exposure, perception of IR-exposure risk and RP general knowledge. Hp(10) doses were provided by the SISERI system. Multivariate logistic regressions were used. Dosimeter wearing and RP practices compliance were strongly associated with 'feeling of being IR-exposed' (OR = 3.69, CI95% 2.04-6.66; OR = 4.60, CI95% 2.28-9.30, respectively). However, none of these factors was associated with RP training courses attendance. The main reason given for non-compliance is unsuitability or insufficient numbers of RP devices. This study provided useful information for RP policies. Making exposed workers aware of their own IR-exposure seems to be a key element to address in RP training courses. This type of questionnaire should be introduced into larger epidemiological studies. Dosimeter wearing and RP practices compliance are associated to feeling being IR-exposed. RP training courses should reinforce workers' awareness of their exposure to IR.
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Affiliation(s)
- Clémence Baudin
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SESANE/LEPID, BP 17, F-92260 Fontenay-aux-Roses, France
| | | | - Guillemette Thin
- Service de médecine du travail, Hôpital Cochin, AP-HP, Paris, France
| | - Lamine Chenene
- Service central de santé au travail, AP-HP, Paris, France
| | - Joël Guersen
- CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Martine Louet
- Service de médecine du travail, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | | | - Stéphanie Mora
- Service de médecine du travail, CHU de Bordeaux, Bordeaux, France
| | | | - Philippe Lestavel
- Bureau d'Analyse et de Suivi des Expositions Professionnelles, Institut de radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Frédéric Rousseau
- Bureau d'Analyse et de Suivi des Expositions Professionnelles, Institut de radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Hervé Roy
- Bureau d'Analyse et de Suivi des Expositions Professionnelles, Institut de radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | | | - Louis Boyer
- CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Odile Bernier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SESANE/LEPID, BP 17, F-92260 Fontenay-aux-Roses, France
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18
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Hoeijmakers EJI, Hoenen K, Bauwens M, Eekers DBP, Jeukens CRLPN, Wierts R. Dose rate conversion coefficients for ocular contamination in nuclear medicine: A Monte Carlo simulation with experimental validation. Med Phys 2024. [PMID: 38588509 DOI: 10.1002/mp.17073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/16/2024] [Accepted: 03/27/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Since 2011, the International Commission on Radiological Protection (ICRP) has recommended an annual eye lens dose limit of 20 mSv for radiation workers, averaged over 5 years, with no year exceeding 50 mSv. However, limited research has been conducted on dose rate conversion coefficients (DCCs) for direct contamination of the eye. PURPOSE This study aimed to accurately determine DCCs for the eye lens and cornea for ocular contamination with radionuclides used in nuclear medicine. METHODS DCCs for 37 radionuclides used in nuclear medicine were determined using two different methods. Method 1 involved conducting Monte Carlo (MC) simulations of an ICRU cylinder to determine the absorbed dose at a depth of 3 mm resulting from a point source. The accuracy of this simulation approach was validated by experimental thermoluminescent dosimeter (TLD) measurements for 18F, 68Ga, 99mTc, and 177Lu. In method 2, average DCCs were calculated for the eye lens (complete and radiosensitive parts) and the cornea for both a point source and thin surface contamination centered on the cornea using MC simulations on the adult mesh-type reference computational phantom of the eye from the ICRP (MRCP). RESULTS DCCs determined from TLD measurements showed excellent agreement (deviations: +1.4%, +4.7%, -3.1%, and -2.5% for 18F, 68Ga, 99mTc, and 177Lu, respectively) compared to MC simulations of the experimental set-up. For the 37 radionuclides, DCCs of the complete eye-lens for a point source ranged from 2.53 × 10-7 to 4.15 × 10-2 mGy MBq-1 s-1 for the adult MRCPs, being substantially smaller compared to DCCs determined via MC simulations of a ICRU cylinder. In general, point source and surface contamination showed comparable DCCs for the eye lens. Radionuclides emitting low-energy beta radiation or conversion electrons (e.g., 177Lu, 99mTc) showed low DCCs as the radiation does not penetrate to the depth of the eye lens, while radionuclides emitting high-energy beta radiation (e.g., 90Y) showed high DCCs. Overall, DCCs for the radiosensitive part of the eye lens were larger (up to a factor of 3) compared to the complete eye lens. DCCs for the cornea were larger than for the eye lens with a factor that strongly depended on the emitted radiation type. Especially alpha emitters (e.g., 211At, 223Ra) showed high DCCs for the cornea because of the short range of alpha radiation, leading to local maxima in the cornea and not reaching the eye lens. CONCLUSION DCCs at a depth of 3 mm in an ICRU cylinder and adult MRCP DCCs for both the complete and sensitive parts of the eye lens and cornea were determined for 37 radionuclides having applications in nuclear medicine. These DCCs are highly useful in radiation safety assessments and radiation dose calculations in ocular contamination incidents.
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Affiliation(s)
- Eva J I Hoeijmakers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kes Hoenen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Matthias Bauwens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Daniëlle B P Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Cécile R L P N Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Roel Wierts
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
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19
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Fukushima K, Matsubara K, Ichikawa N. Basic characteristics of Vision badge and its performance as an eye lens dosimeter for endoscopists. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021501. [PMID: 38507786 DOI: 10.1088/1361-6498/ad35cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 03/20/2024] [Indexed: 03/22/2024]
Abstract
Vision badge is an eye lens dosimeter to measureHp(3). This study aimed to evaluate the basic characteristics of the Vision badge and its performance as an eye lens dosimeter for endoscopists by phantom study. Energy dependence was evaluated by changing the tube voltage to 50 kV (effective energy of 27.9 keV), 80 kV (32.2 keV), and 120 kV (38.7 keV). Dose linearity was evaluated by changing the number of irradiation to 1, 5, and 40 times, which corresponded to 0.53, 5.32, and 21.4 mGy. Batch uniformity was evaluated by calculating the coefficient of variation ofHp(3) obtained from 10 Vision badges. Angular dependence was evaluated at 0° (perpendicular to the incident direction of x-rays), 30°, 60°, 75°, and 90°. The Vision badge and optically stimulated luminescence (OSL) dosimeter were attached to the inside of the radioprotective glasses, worn on the endoscopist phantom, and theHp(3) obtained from both dosimeters were compared. TheHp(3) obtained from the Vision badge with 38.7 keV was 3.8% higher than that with 27.9 keV. The Vision badge showed excellent linearity (R2= 1.00) with the air kerma up to 21.4 mGy. The coefficient of variation of theHp(3) for 10 Vision badges was 3.47%. The relative dose of the Vision badge decreased as the angle increased up to 75°, but increased at 90°. TheHp(3) obtained by the OSL dosimeter and the Vision badge were decreased as the endoscopist phantom was turned away from the patient phantom. TheHp(3) that was obtained by the Vision badge was 35.5%-55.0% less than that obtained by the nanoDot. In conclusion, the Vision badge showed specific angular dependence due to its shape, but satisfactory basic properties were exhibited for all characteristics. In phantom study, the Vision badge showed generally similar trends with the OSL dosimeter.
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Affiliation(s)
- Kotaro Fukushima
- Department of Quantum Medical Technology, Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa, Japan
| | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa, Japan
| | - Nao Ichikawa
- Department of Quantum Medical Technology, Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa, Japan
- Department of Radiological Technology, Faculty of Health Science, Kobe Tokiwa University, 2-6-2 Otani-cho, Nagata-ku, Kobe, Hyogo, Japan
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20
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Konishi M, Shimabukuro K, Hirokawa J, Sadatoki T, Katsuta T, Imano N, Nishibuchi I, Murakami Y, Kakimoto N. Radiation doses of medical radiation workers performing low-dose-rate brachytherapy with 198Au grains and 192Ir pins for patients with oral cancers. Oral Radiol 2024; 40:234-241. [PMID: 38108954 DOI: 10.1007/s11282-023-00728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Low-dose-rate brachytherapy (LDR-BT) with 198Au grains and 192Ir pins is an essential treatment option for oral cancer due to its high rate of local control and low invasiveness. However, the radiation exposure of medical radiation workers is concerning. Thus, we aimed to determine the radiation dose delivered to medical radiation workers during LDR-BT using 198Au grains and 192Ir pins for oral cancer. METHODS Thirty-two patients with oral cancer underwent 198Au grain interstitial LDR-BT between June 2016 and May 2023, and 23 patients with tongue cancer underwent 192Ir pin interstitial LDR-BT between March 2015 and November 2017 at our hospital. Dosimetry was performed by attaching a dosimeter to the chest pocket of the operator and assistant during 198Au grain or 192Ir pin LDR-BT. Since the operator also loads 198Au grains into the implantation device, the operator's radiation dose includes the dose received during this preparation. RESULTS Mean radiation doses of the operators with 198Au grain and 192Ir pin LDR-BT were 165.8 and 211.2 μSv, respectively. Statistically significant differences between the radioactive sources of 198Au grain and 192Ir pin LDR-BT were observed (p = 0.0459). The mean radiation doses of the assistants with 198Au grain and 192Ir pin LDR-BT were 92.0 and 162.0 μSv, respectively. Statistically significant differences were observed between the radioactive sources of 198Au grains and 192Ir pin LDR-BT (p = 0.0003). CONCLUSIONS Regarding radioactive source differences, 192Ir pin LDR-BT resulted in higher doses delivered to medical radiation workers than 198Au grain LDR-BT.
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Affiliation(s)
- Masaru Konishi
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan.
| | - Kiichi Shimabukuro
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Junichi Hirokawa
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Takashi Sadatoki
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Tsuyoshi Katsuta
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Nobuki Imano
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Naoya Kakimoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
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21
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Sasaki F, Yoshino H, Kusuhara A, Sato K, Tsuruga E. Involvement of retinoic acid‑inducible gene‑I in radiation‑induced senescence of human umbilical vein endothelial cells. Biomed Rep 2024; 20:70. [PMID: 38495345 PMCID: PMC10941717 DOI: 10.3892/br.2024.1758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
In 2012, the threshold radiation dose (0.5 Gy) for cardiovascular and cerebrovascular diseases was revised, and this threshold dose may be exceeded during procedures involving radiation such as interventional radiology. Therefore, in addition to regulating radiation dose, it is necessary to develop strategies to prevent and mitigate the development of cardiovascular disease. Cellular senescence is irreversible arrest of cell proliferation. Although cellular senescence is one of the mechanisms for suppressing cancer, it also has adverse effects. For example, senescence of vascular endothelial cells is involved in development of vascular disorders. However, the mechanisms underlying induction of cellular senescence are not fully understood. Therefore, the present study explored the factors involved in the radiation-induced senescence in human umbilical vein endothelial cells (HUVECs). The present study reanalyzed the gene expression data of senescent normal human endothelial cells and fibroblast after irradiation (NCBI Gene Expression Omnibus accession no. GSE130727) and microarray data of HUVECs 24 h after irradiation (NCBI Gene Expression Omnibus accession no. GSE76484). Numerous genes related to viral infection and inflammation were upregulated in radiation-induced senescent cells. In addition, the gene group involved in the retinoic acid-inducible gene-I (RIG-I)-like receptor (RLR) signaling pathway, which plays an important role to induce anti-viral response, was altered in irradiated HUVECs. Therefore, to investigate the involvement of RIG-I and melanoma differentiation-associated gene 5 (MDA5), which are RLRs, in radiation-induced senescence of HUVECs, the protein expression of RIG-I and MDA5 and the activity of senescence-associated β-galactosidase (SA-β-gal), a representative senescence marker, were analyzed. Of note, knockdown of RIG-I in HUVECs significantly decreased radiation-increased proportion of cells with high SA-β-gal activity (i.e., senescent cells), whereas this phenomenon was not observed in MDA5-knockdown cells. Taken together, the present results suggested that RIG-I, but not MDA5, was associated with radiation-induced senescence in HUVECs.
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Affiliation(s)
- Fuki Sasaki
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
| | - Hironori Yoshino
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
| | - Ayumu Kusuhara
- Department of Radiological Technology, School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
- Department of Radiology, Sapporo Teishinkai Hospital, Sapporo, Hokkaido 065-0033, Japan
| | - Kota Sato
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
| | - Eichi Tsuruga
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
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22
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Perdomo AA, Badawy MK, Mignone C, Forster JC. Exceeding radiation thresholds for cataract induction in diagnostic imaging: a paediatric case report. RADIATION PROTECTION DOSIMETRY 2024; 200:417-422. [PMID: 38195763 DOI: 10.1093/rpd/ncad310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
This case report investigates the radiation dose received by a paediatric patient with a ventricular assist device who underwent four non-contrast brain computed tomography (CT) scans, two brain perfusion CT scans and two head angiographic CT scans. The total estimated absorbed dose to the lens of the eye is above the 500 mGy radiation-induced cataract threshold. It is recommended that this patient and those with similar imaging histories have routine follow-up with an ophthalmologist. It is also recommended that radiation dose tracking and an electronic medical alert program be implemented to allow the identification of patients who may exceed tissue reaction thresholds.
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Affiliation(s)
- Amanda Alison Perdomo
- Department of Physics, University of Adelaide, Adelaide 5005, South Australia, Australia
- Department of Medical Imaging, The Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Victoria, Australia
| | - Mohamed Khaldoun Badawy
- Monash Health Imaging, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton 3800, VIC, Australia
| | - Cristina Mignone
- Department of Medical Imaging, The Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Victoria, Australia
| | - Jake Cameron Forster
- Department of Physics, University of Adelaide, Adelaide 5005, South Australia, Australia
- Medical Physics & Radiation Safety, South Australia Medical Imaging, Adelaide 5005, South Australia, Australia
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23
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Matsumoto H, Tokushige S, Takei Y, Uyama Y, Mura M, Hitomi G. [The Need for Lens Radiation Protection for Healthcare Provider in Open and Internal Fixation of the Hip Joint]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:287-295. [PMID: 38296460 DOI: 10.6009/jjrt.2024-1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Increased occupational exposure of radiation workers is a major problem during open reduction and internal fixation (ORIF) of the hip joint, as the surgeon's eye lens is in close proximity to the patient and the X-ray tube. The purposes of this study were to clarify the occupational exposure of radiation workers during ORIF of the hip joint and to examine the need for radiation protection measures. The radiation exposure of radiation workers was evaluated by making an airborne dose distribution map using phantom experiments. The radiation goggles attached with a small optically stimulated luminescence dosimeter were used in clinical practice to measure the lens dose received by the surgeon, and the necessity of radiation goggles was examined. The airborne dose distribution in ORIF of the hip joint showed a wider area of high dose rate during axial fluoroscopy of the femoral neck than during posterior-anterior fluoroscopy. In axial fluoroscopy of the femoral neck, the surgeon was always in the high dose rate range of 10 µGy/min or higher, the nurses were in the dose rate range of 4 to 10 µGy/min, and the radiologic technologists were in the dose rate range of 0.5 µGy/min or lower. The maximum 3 mm dose equivalent to the surgeon per case was 0.38 mSv. In contradiction, radiation goggles were useful in ORIF because they provided approximately 60% shielding. It is advisable to work with radiation goggles to avoid cataracts.
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Affiliation(s)
- Hiroki Matsumoto
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Shoya Tokushige
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Yasutaka Takei
- Department of Radiological Technology, Kawasaki University of Medical Welfare
| | - Yuji Uyama
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Masakatsu Mura
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Go Hitomi
- Department of Radiological Technology, Kawasaki Medical School Hospital
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24
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Fontanet Soler S, Bravo-Balado A, Skolarikos A, Seitz C, Traxer O, Talso M, Ventimiglia E, Villa L, Pietropaolo A, Keller EX, Kallidonis P, Sener TE, Nagele U, De Coninck V, Hameed Z, Tsaturyan A, Juliebø-Jones P, Mikoniatis I, Wiseman O, Tzelves L, Emiliani E. Trends in the use of radiation protection and radiation exposure of European endourologists: a prospective trial from the EULIS-YAU Endourology Group. World J Urol 2024; 42:163. [PMID: 38488927 DOI: 10.1007/s00345-024-04854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/06/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Due to the radiation exposure for the urology staff during endourology, our aim was to evaluate the trends of radiation protection in the operation room by endourologists from European centers and to estimate their annual radiation. METHODS We conducted a multicenter study involving experienced endourologists from different European centers to evaluate whether the protection and threshold doses recommended by the International Commission on Radiation Protection (ICRP) were being followed. A 36-question survey was completed on the use of fluoroscopy and radiation protection. Annual prospective data from chest, extremities, and eye dosimeters were collected during a 4-year period (2017-2020). RESULTS Ten endourologists participated. Most surgeons use lead aprons and thyroid shield (9/10 and 10/10), while leaded gloves and caps are rarely used (2/10 both). Six out of ten surgeons wear leaded glasses. There is widespread use of personal chest dosimeters under the apron (9/10), and only 5/10 use a wrist or ring dosimeter and 4 use an eye dosimeter. Two endourologists use the ALARA protocol. The use of ultrasound and fluoroscopy during PCNL puncture was reported by 8 surgeons. The mean number of PCNL and URS per year was 30.9 (SD 19.9) and 147 (SD 151.9). The mean chest radiation was 1.35 mSv per year and 0.007 mSv per procedure. Mean radiation exposure per year in the eyes and extremities was 1.63 and 11.5 mSv. CONCLUSIONS Endourologists did not exceed the threshold doses for radiation exposure to the chest, extremities and lens. Furthermore, the ALARA protocol manages to reduce radiation exposure.
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Affiliation(s)
- Sofia Fontanet Soler
- Department of Urology, Fundació Puigvert (IUNA), Autonoma University of Barcelona, Barcelona, Spain.
| | - Alejandra Bravo-Balado
- Department of Urology, Fundació Puigvert (IUNA), Autonoma University of Barcelona, Barcelona, Spain
| | - Andreas Skolarikos
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, Hôpitaux Universitaires Paris-EST, Assistance Publique Hôpitaux de Paris, Université Pierre Et Marie Curie Paris 6, Paris, France
| | - Michele Talso
- Department of Urology ASST Fatebenefratelli, Sacco University Hospital, Milan, Italy
| | - Eugenio Ventimiglia
- Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Villa
- Department of Urology, URI, IRCCS Ospe-Dale San Raffaele, Milan, Italy
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Tarik Emre Sener
- Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | | | - Zeeshan Hameed
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Ioannis Mikoniatis
- Department of Urology, Faculty of Medicine, Aristotle University of Thessaloniki School of Health Sciences, Thessaloniki, Greece
| | - Oliver Wiseman
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Esteban Emiliani
- Department of Urology, Fundació Puigvert (IUNA), Autonoma University of Barcelona, Barcelona, Spain
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Chen Y, Ma L, Cheng Z, Hu Z, Xu Y, Wu J, Dai Y, Shi C. Senescent fibroblast facilitates re-epithelization and collagen deposition in radiation-induced skin injury through IL-33-mediated macrophage polarization. J Transl Med 2024; 22:176. [PMID: 38369466 PMCID: PMC10874572 DOI: 10.1186/s12967-024-04972-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/09/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The need for radiotherapy among the elderly rises with increasing life expectancy and a corresponding increase of elderly cancer patients. Radiation-induced skin injury is one of the most frequent adverse effects in radiotherapy patients, severely limiting their life quality. Re-epithelialization and collagen deposition have essential roles in the recovery of skin injuries induced by high doses of ionizing radiation. At the same time, radiation-induced senescent cells accumulate in irradiated tissues. However, the effects and mechanisms of senescent cells on re-epithelialization and collagen deposition in radiation-induced skin injury have not been fully elucidated. RESULTS Here, we identified a role for a population of senescent cells expressing p16 in promoting re-epithelialization and collagen deposition in radiation-induced skin injury. Targeted ablation of p16+ senescent cells or treatment with Senolytics resulted in the disruption of collagen structure and the retardation of epidermal coverage. By analyzing a publicly available single-cell sequencing dataset, we identified fibroblasts as a major contributor to the promotion of re-epithelialization and collagen deposition in senescent cells. Notably, our analysis of publicly available transcriptome sequencing data highlighted IL-33 as a key senescence-associated secretory phenotype produced by senescent fibroblasts. Neutralizing IL-33 significantly impedes the healing process. Finally, we found that the effect of IL-33 was partly due to the modulation of macrophage polarization. CONCLUSIONS In conclusion, our data suggested that senescent fibroblasts accumulated in radiation-induced skin injury sites participated in wound healing mainly by secreting IL-33. This secretion regulated the local immune microenvironment and macrophage polarization, thus emphasizing the importance of precise regulation of senescent cells in a phased manner.
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Affiliation(s)
- Yan Chen
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Le Ma
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Zhuo Cheng
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Zhihe Hu
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yang Xu
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Jie Wu
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yali Dai
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Chunmeng Shi
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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Larsson MEV, Jonasson PI, Apell PS, Kearney PP, Lundh CJ. Evaluation of novel radiation protection devices during radiologically guided interventions. CVIR Endovasc 2024; 7:18. [PMID: 38353904 PMCID: PMC10866844 DOI: 10.1186/s42155-024-00430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND In radiologically guided interventions, medical practitioners are subjected to radiation exposure, which may lead to radiation-induced diseases. In this study, novel radiation shields for the head and neck were evaluated for their potential to reduce radiation exposure. METHOD An anthropomorphic phantom was exposed on its left side to scattered radiation from beneath to simulate the exposure of an operator in a x-ray operating room. Thermoluminescent dosimeters (TLDs) were positioned at different depths in five slices in the phantom, measuring personal dose equivalent. Two different set up situations were evaluated: a head protector designed to reduce radiation in the upper section of the head; and a novel thyroid protector prototype extended in the front and on both sides, designed to reduce radiation in the lower and middle sections of the head. A standard thyroid collar prototype and a ceiling mounted lead glass shield were used as comparisons. Furthermore, the head protector was evaluated in a clinical study in which TLDs were positioned to measure scattered radiation exposure to the heads of operators during endovascular interventions. RESULTS The extended thyroid protector reduced the scattered radiation in the throat, chin, and ear slices. Some shielding effect was seen in the brain and skull slices. The head protector showed a shielding effect in the skull slice up to two cm depth where it covered the phantom head. As expected, the ceiling mounted lead glass shield reduced the scattered radiation in all measuring points. CONCLUSIONS A ceiling mounted lead glass shield is an effective radiation protection for the head, but in clinical practice, optimal positioning of a ceiling mounted lead shield may not always be possible, particularly during complex cases when radiation protection may be most relevant. Added protection using these novel guards may compliment the shielding effect of the ceiling mounted lead shield. The head protector stand-alone did not provide sufficient protection of the head. The extended thyroid protector stand-alone provided sufficient protection in the lower and middle sections of the head and neck.
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Affiliation(s)
- Maria E V Larsson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Pernilla I Jonasson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Petra S Apell
- Texray AB, Gothenburg, Sweden
- Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
| | - Peter P Kearney
- Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - Charlotta J Lundh
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
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Kuriyama T, Moritake T, Nakagami K, Morota K, Hitomi G, Kitamura H. Background Factors Affecting the Radiation Exposure of the Lens of the Eye among Nurses in Interventional Radiology: A Quantitative Observational Study. NURSING REPORTS 2024; 14:413-427. [PMID: 38391077 PMCID: PMC10885035 DOI: 10.3390/nursrep14010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
With the International Commission on Radiological Protection's (ICRP) reduction in the radiation dose threshold for cataracts, evaluating and preventing radiation exposure to the lens of the eye among interventional radiology (IR) staff have become urgent tasks. In this study, we focused on differences in lens-equivalent dose (HT Lens) to which IR nurses in three hospitals were exposed and aimed to identify factors underlying these differences. According to analyses of time-, distance-, and shielding-related factors, the magnitude of the HT Lens dose to which IR nurses were exposed could be explained not by time or shielding but by the distance between the X-ray exposure field and the location of the IR nurse. This distance tended to be shorter in hospitals with fewer staff. The most effective means of reducing the exposure of the lenses of IR nurses' eyes to radiation is to position them at least two meters from the radiation source during angiography procedures. However, some hospitals must provide IR departments with comparatively few staff. In work environments where it is infeasible to reduce exposure by increasing distance, interventions to reduce time by managing working practices and investment in shielding equipment are also important. This study was not registered.
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Affiliation(s)
- Tomoko Kuriyama
- Department of Occupational and Community Health Nursing, School of Health Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu 807-8555, Japan
| | - Takashi Moritake
- Department of Radiation Regulatory Science Research, National Institute of Radiological Sciences, National Institute for Quantum Science and Technology, Chiba 263-8555, Japan
| | - Koichi Nakagami
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu 807-8556, Japan
| | - Koichi Morota
- Department of Radiology, Shinkomonji Hospital, Kitakyushu 800-0057, Japan
| | - Go Hitomi
- Department of Radiological Technology, Kawasaki Medical School Hospital, Kurashiki 701-0192, Japan
| | - Hiroko Kitamura
- Occupational Health Training Center, University of Occupational and Environmental Health, Japan, Kitakyushu 807-8555, Japan
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Maeda T, Hayashi H, Ando M, Kobayashi D, Nishigami R, Asahara T, Goto S, Lee C, Yamashita K, Higashino K, Konishi T, Murakami S, Maki M. Performance of elastic x-ray shield made by embedding Bi 2 O 3 particles in porous polyurethane. Med Phys 2024; 51:1061-1073. [PMID: 38103261 DOI: 10.1002/mp.16889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Many healthcare institutions have guidelines concerning the usage of protective procedures, and various x-ray shields have been used to reduce unwanted radiation exposure to medical staff and patients when using x-rays. Most x-ray shields are in the form of sheets and lack elasticity, which limits their effectiveness in shielding areas with movement, such as the thyroid. To overcome this limitation, we have developed an innovative elastic x-ray shield. PURPOSE The purpose of this study is to explain the methodology for developing and evaluating a novel elastic x-ray shield with sufficient x-ray shielding ability. Furthermore, valuable knowledge and evaluation indices are derived to assess our shield's performance. METHODS Our x-ray shield was developed through a process of embedding Bi2 O3 particles into porous polyurethane. Porous polyurethane with a thickness of 10 mm was dipped into a solution of water, metal particles, and chemical agents. Then, it was air-dried to fix the metal particles in the porous polyurethane. Thirteen investigational x-ray shields were fabricated, in which Bi2 O3 particles at various mass thicknesses (ranging from 585 to 2493 g/m2 ) were embedded. To determine the performance of the shielding material, three criteria were evaluated: (1) Dose Reduction Factor (D R F $DRF$ ), measured using inverse broad beam geometry; (2) uniformity, evaluated from the standard deviation (S D $SD$ ) of the x-ray image obtained using a clinical x-ray imaging detector; and (3) elasticity, evaluated by a compression test. RESULTS The elastic shield with small pores, containing 1200 g/m2 of the metal element (Bi), exhibited a well-balanced performance. TheD R F $DRF$ was approximately 80% for 70 kV diagnostic x-rays. This shield's elasticity was -0.62 N/mm, a loss of only 30% when compared to porous polyurethane without metal. Although the non-uniformity of the x-ray shield leads to poor shielding ability, it was found that the decrease in the shielding ability can be limited to a maximum of 6% when the shield is manufactured so that theS D $SD$ of the x-ray image of the shield is less than 10%. CONCLUSIONS It was verified that an elastic x-ray shield that offers an appropriate reduction in radiation exposure can be produced by embedding Bi2 O3 particles into porous polyurethane. Our findings can lead to the development of novel x-ray shielding products that can reduce the physical and mental stress on users.
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Affiliation(s)
- Tatsuya Maeda
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroaki Hayashi
- College of Medical, Pharmaceutical and Health Sciences, Kanazawa, Ishikawa, Japan
| | - Miku Ando
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Daiki Kobayashi
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Rina Nishigami
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takashi Asahara
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
- Okayama University Hospital, Kitaku, Okayama, Japan
| | - Sota Goto
- Faculty of Health Sciences, Kobe Tokiwa University, Kobe, Hyogo, Japan
| | - Cheonghae Lee
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, School of Medicine, Tokushima University, Tokushima, Tokushima, Japan
| | - Kosaku Higashino
- Department of Orthopedics and Rehabilitation, Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan
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Shavers M, Semones E, Tomi L, Chen J, Straube U, Komiyama T, Shurshakov V, Li C, Rühm W. Space agency-specific standards for crew dose and risk assessment of ionising radiation exposures for the International Space Station. Z Med Phys 2024; 34:14-30. [PMID: 37507310 PMCID: PMC10919966 DOI: 10.1016/j.zemedi.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023]
Abstract
The Partner Agencies of the International Space Station (ISS) maintain separate career exposure limits and shared Flight Rules that control the ionising radiation exposures that crewmembers can experience due to ambient environments throughout their space missions. In low Earth orbit as well as further out in space, energetic ions referred to as galactic cosmic radiation (GCR) easily penetrate spacecraft and spacecraft contents and consequently are always present at low dose rates. Protons and electrons that are trapped in the Earth's geomagnetic field are encountered intermittently, and a rare energetic solar particle event (SPE) may expose crew to (mostly) energetic protons. Space radiation protection goals are to optimize radiation exposures to maintain deleterious late effects at known and acceptable levels and to prevent any early effects that might compromise crew health and mission success. The conventional radiation protection metric effective dose provides a basic framework for limiting exposures associated with human spaceflight and can be communicated to all stakeholders. Additional metrics and uncertainty analyses are required to understand more completely and to convey nuanced information about potential impacts to an individual astronaut or to a space mission. Missions to remote destinations well beyond low Earth orbit (BLEO) are upcoming and bestow additional challenges that shape design and radiation protection needs. NASA has recently adopted a more permissive career exposure limit based upon effective dose and new restrictions on mission exposures imposed by nuclear technologies. This manuscript reviews the exposure limits that apply to the ISS crewmembers. This work was performed in collaboration with the advisory and guidance efforts of International Commission on Radiological Protection (ICRP) Task Group 115 and will be summarized in an upcoming ICRP Report.
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Affiliation(s)
- Mark Shavers
- KBR Human Health and Performance, NASA Johnson Space Centre, Houston, TX, USA.
| | - Edward Semones
- NASA Space Radiation Analysis Group-Johnson Space Centre, Houston, TX, USA
| | - Leena Tomi
- Canadian Space Agency, Saint-Hubert, Quebec, Canada
| | - Jing Chen
- Radiation Protection Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Ulrich Straube
- European Space Agency ESA, European Astronaut Center EAC, Space Medicine HRE-OM, Cologne, Germany
| | - Tatsuto Komiyama
- Japan Aerospace Exploration Agency (JAXA), Tsukuba Space Center, Ibaraki, Japan
| | | | - Chunsheng Li
- Radiation Protection Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Werner Rühm
- Federal Office of Radiation Protection, Munich, Germany
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Zanon C, Bini C, Toniolo A, Benetti T, Quaia E. Radiation Overuse in Intensive Care Units. Tomography 2024; 10:193-202. [PMID: 38393283 PMCID: PMC10892508 DOI: 10.3390/tomography10020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/20/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Radiological imaging is essential for acute patient management in Intensive Care Units (ICUs); however, it introduces the risk of exposure to ionizing radiation. This review synthesizes research on radiation exposure in ICU settings, highlighting its rise during the COVID-19 pandemic and the rise in repetitive imaging. Our analysis extends to radiation safety thresholds, revealing that some ICU patients exceed the diagnostic reference level, emphasizing the need to balance diagnostic utility against potential long-term risks, such as cancer. Prospective studies have demonstrated an increase in the median cumulative effective dose in patients with trauma over time, prompting calls for improved awareness and monitoring. Moreover, innovative dose-reduction strategies and optimized protocols, especially in neuro-ICUs, promise to mitigate these risks. This review highlights the essential but risky role of radiological imaging in critical care. It advocates for rigorous radiation management protocols to safeguard patient health while ensuring the continuity of high-quality medical care.
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Affiliation(s)
- Chiara Zanon
- Department of Radiology, University Hospital of Padua, 35128 Padua, Italy
| | - Costanza Bini
- Department of Radiology, University Hospital of Padua, 35128 Padua, Italy
| | - Alessandro Toniolo
- Department of Radiology, University Hospital of Padua, 35128 Padua, Italy
| | - Tommaso Benetti
- Department of Medicine, University of Padua, 35128 Padua, Italy
| | - Emilio Quaia
- Department of Radiology, University Hospital of Padua, 35128 Padua, Italy
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31
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Molinaro S, Mistretta F, Russo R, Risi G, Venturi F, Bergui M. Cineangiography versus standard digital subtraction angiography in mechanical thrombectomy: lowering the radiation exposure without sacrificing the outcome. J Neurointerv Surg 2024:jnis-2023-021289. [PMID: 38262728 DOI: 10.1136/jnis-2023-021289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Endovascular thrombectomy has become a standard procedure for the treatment of acute ischemic stroke caused by large vessel occlusion. Radiation exposure to the patient and operators during mechanical thrombectomy procedures is a concern. METHODS The use of a high frames per second unmasked protocol-cineangiography (CINE)-derived from cardiac intervention could mitigate radiation exposure without sacrificing procedural and clinical outcomes. RESULTS The analysis of a prospective-maintained monocentric database of 131 patients who underwent mechanical thrombectomy (65 with the CINE protocol and 66 with the conventional digital subtraction angiography (DSA) protocol) showed a significant reduction in radiation exposure for both air kerma (AK) and dose-area product (DAP) indicators (AK 463.7 mGy vs 772 mGy, P<0.01; DAP 41.35 Gy/cm2 CINE vs 83.77 Gy/cm2 DSA, P<0.01), with no differences regarding both safety and efficacy outcomes (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b 78.4% CINE and 81.5% DSA, P=0.79; overall complications rate both intracranial and extracranial 23% CINE and 19.6% DSA, P=0.65). There were no significant differences in post-thrombectomy radiographic hemorrhagic conversion rate (P=0.77) or functional independence on discharge defined as modified Rankin Scale score ≤2 (P=0.39). A post-hoc image assessment of vessel point occlusion and recanalization mTICI score performed by three experienced interventional neuroradiologists not involved in the procedure showed a non-significant difference between the two groups regarding occlusion point (0.928 vs 0.953, P=0.31) and recanalization grade (0.814 vs 0.847, P=0.62). CONCLUSIONS Our initial experience demonstrated that reduction of the quality of CINE images caused no modifications in safety and efficacy and should fit within the context of diagnostic requests in an intracranial revascularization procedure.
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Affiliation(s)
- Stefano Molinaro
- Interventional Neuroradiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesco Mistretta
- Department of Surgical Sciences, Università degli Studi di Torino, Torino, Italy
| | - Riccardo Russo
- Surgical Science, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Gaetano Risi
- Radiology, Università degli Studi di Torino, Torino, Italy
| | - Fabrizio Venturi
- Neuroradiology, Azienda Ospedaliera S Croce e Carle Cuneo, Cuneo, Italy
| | - Mauro Bergui
- Interventional Neuroradiology, Università degli Studi di Torino, Torino, Italy
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32
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Lin SN, Wu YM, Siow TY, Yeh CH, Toh CH, Tseng TY, Wong HF. Sclerotherapy with intralesional bleomycin injection under guidance of multi-slice CT for retrobulbar orbital low-flow vascular lesions-single-center experience. Br J Radiol 2024; 97:186-194. [PMID: 38263834 PMCID: PMC11027304 DOI: 10.1093/bjr/tqad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/02/2023] [Accepted: 10/22/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE This study investigated the safety and efficacy of sclerotherapy with intralesional bleomycin injection (IBI) for retrobulbar orbital low-flow vascular lesions under multi-slice computed tomography (CT) guidance. METHODS Between January 2010 and September 2021, consecutive patients with retrobulbar orbital low-flow vascular lesions who underwent CT-guided IBI at a tertiary centre in Taiwan were enrolled. Their medical records and imaging data were retrospectively collected. RESULTS This study enrolled 13 patients (7 male and 6 female patients; age range: 1-57 years; mean age: 25.9 years) with lymphatic malformation (LM, n = 4), venolymphatic malformation (n = 1), and venous malformation (VM, n = 8). The overall radiological response rate was 76.9% (10 of 13); the radiological response rate was 75.0% in the VM group (6 of 8) and 75.0% in the LM group (3 of 4). Moreover, 3 patients (23.1%) had minor complications and 1 (7.7%) had a major complication. The mean clinical and radiological follow-up was 8.3 months and no recurrence or progression was reported. CONCLUSION CT-guided IBI is an effective and relatively safe minimally invasive treatment for retrobulbar orbital low-flow vascular lesions, with an overall radiological response rate of 76.9% in a mean of 1.5 sessions and a low complication rate. ADVANCES IN KNOWLEDGE CT-guided sclerotherapy with IBI is a relatively safe, effective, and feasible alternative treatment option for retrobulbar orbital low-flow vascular lesions.
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Affiliation(s)
- Shin-Nan Lin
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Yi-Ming Wu
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Tiing-Yee Siow
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Cheng-Hong Toh
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Ti-Yung Tseng
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Ho-Fai Wong
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
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33
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Kvacheva YE, Kovalev AV, Gribunov YP, Shestakova IN. [Fatal radiation-induced injury resulting from the deliberate use of ionizing radiation source for illegal purposes]. Sud Med Ekspert 2024; 67:39-42. [PMID: 38587157 DOI: 10.17116/sudmed20246702139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
A rare clinical observation of death from prolonged uneven external irradiation due to the deliberate use of an ionizing radiation source for illegal purposes has been presented. The main difficulties of postmortem diagnosis of this type of radiation-induced injury, considering the features of histological examinations and special methods of retrospective dosimetric evaluations, have been identified.
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Affiliation(s)
- Yu E Kvacheva
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - A V Kovalev
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - Yu P Gribunov
- Central Clinical Hospital with a Polyclinic of the Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | - I N Shestakova
- Central Clinical Hospital with a Polyclinic of the Administrative Directorate of the President of the Russian Federation, Moscow, Russia
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34
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Liu MM, Ding CY, Li ZH, Yi RH, Ma LP, Ou XM, Liu HX, Gao L, Liu QJ. Multiple exposures to low-dose ionizing radiation induced the initiation and progression of pro-atherosclerotic phenotypes in mice and vascular endothelial cell damage. Sci Prog 2024; 107:368504241228668. [PMID: 38385346 PMCID: PMC10893836 DOI: 10.1177/00368504241228668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This study aimed to investigate the effects of low-dose radiation on the abdominal aorta of mice and vascular endothelial cells. METHODS Wild-type and tumor-bearing mice were exposed to 15 sessions of low-dose irradiation, resulting in cumulative radiation doses of 187.5, 375, and 750 mGy. The effect on the cardiovascular system was assessed. Immunohistochemistry analyzed protein expressions of PAPP-A, CD62, P65, and COX-2 in the abdominal aorta. Microarray technology, Gene Ontology analysis, and pathway enrichment analysis evaluated gene expression changes in endothelial cells exposed to 375 mGy X-ray. Cell viability was assessed using the Cell Counting Kit 8 assay. Immunofluorescence staining measured γ-H2AX levels, and real-time polymerase chain reaction quantified mRNA levels of interleukin-6 (IL-6), ICAM-1, and Cx43. RESULTS Hematoxylin and eosin staining revealed thickening of the inner membranes and irregular arrangement of smooth muscle cells in the media membrane at 375 and 750 mGy. Inflammation was observed in the inner membranes at 750 mGy, with a clear inflammatory response in the hearts of tumor-bearing mice. Immunohistochemistry indicated increased levels of PAPP-A, P65, and COX-2 post-irradiation. Microarray analysis showed 425 up-regulated and 235 down-regulated genes, associated with processes like endothelial cell-cell adhesion, IL-6, and NF-κB signaling. Cell Counting Kit 8 assay results indicated inhibited viability at 750 mGy in EA.hy926 cells. Immunofluorescence staining demonstrated a dose-dependent increase in γ-H2AX foci. Reverse transcription quantitative PCR results showed increased expression of IL6, ICAM-1, and Cx43 in EA.hy926 cells post 750 mGy X-ray exposure. CONCLUSION Repeated low-dose ionizing radiation exposures triggered the development of pro-atherosclerotic phenotypes in mice and damage to vascular endothelial cells.
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Affiliation(s)
- Meng-Meng Liu
- China CDC Key Laboratory of Radiological Protection and Nuclear Emergency, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Chun-Yan Ding
- China CDC Key Laboratory of Radiological Protection and Nuclear Emergency, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
- Department of Oncology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, P.R. China
| | - Zhi-Hui Li
- Department of Thoracic and Cardiovascular Surgery, Beijing Yanhua Hospital, Beijing, P.R. China
| | - Ru-Han Yi
- China CDC Key Laboratory of Radiological Protection and Nuclear Emergency, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Li-Ping Ma
- China CDC Key Laboratory of Radiological Protection and Nuclear Emergency, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Xiang-Ming Ou
- China CDC Key Laboratory of Radiological Protection and Nuclear Emergency, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Hai-Xiang Liu
- China CDC Key Laboratory of Radiological Protection and Nuclear Emergency, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Ling Gao
- China CDC Key Laboratory of Radiological Protection and Nuclear Emergency, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Qing-Jie Liu
- China CDC Key Laboratory of Radiological Protection and Nuclear Emergency, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
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Waisberg E, Ong J, Paladugu P, Kamran SA, Zaman N, Tavakkoli A, Lee AG. Radiation-induced ophthalmic risks of long duration spaceflight: Current investigations and interventions. Eur J Ophthalmol 2023:11206721231221584. [PMID: 38151034 DOI: 10.1177/11206721231221584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
PURPOSE As the average duration of space missions increases, astronauts will experience longer periods of exposure to risks of long duration space flight including microgravity and radiation. The risks from long-term exposure to space radiation remains ill-defined. We review the current literature on the possible and known risks of radiation on the eye (including radiation retinopathy) after long duration spaceflight. METHODS A PubMed and Google Scholar search of the English language ophthalmic literature was performed from inception to July 11, 2022. The following search terms were utilized independently or in conjunction to build this manuscript: "Radiation Retinopathy", "Spaceflight", "Space Radiation", "Spaceflight Associated Neuro-Ocular Syndrome", "Microgravity", "Hypercapnia", "Radiation Shield", "Cataract", and "SANS". A concise and selective approach of references was conducted in including relevant original studies and reviews. RESULTS A total of 65 papers were reviewed and 47 papers were included in our review. CONCLUSION We discuss the potential and developing countermeasures to mitigate these radiation risks in preparation for future space exploration. Given the complex nature of space radiation, no single approach will fully reduce the risks of developing radiation maculopathy in long-duration spaceflight. Understanding and appropriately overcoming the risks of space radiation is key to becoming a multi-planetary species.
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Affiliation(s)
- Ethan Waisberg
- Department of Ophthalmology, University of Cambridge, Cambridge, United Kingdom
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Joshua Ong
- Department of Ophthalmology, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Phani Paladugu
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, USA
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, USA
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
- Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Texas A&M College of Medicine, Bryant, Texas, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Arseneault M, Mawko G, Abraham RJ. 90Y Contamination in the Interventional Radiology Suite: VARSKIN Estimation of Skin and Eye Injury and Review of Mitigation Strategies. J Nucl Med Technol 2023; 51:290-295. [PMID: 37586853 DOI: 10.2967/jnmt.122.265108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 05/10/2023] [Indexed: 08/18/2023] Open
Abstract
Our objective was to demonstrate, through computer simulations, radiation exposure levels from a 90Y contamination event during radioembolization procedures to calculate the radiation doses from various contamination scenarios. We also provide reasonable safety protocols to prevent contamination and minimize radiation exposure during decontamination. Methods: Simulations were performed using the computer code VARSKIN+, version 1.0, to determine the amount of radiation exposure resulting from different contamination scenarios. Results: The annual radiation dose limit to the skin and the lens of the eye was exceeded within 23 s of exposure to a 44-MBq droplet. Double layers of surgical gloves and level 3 gowns provided some attenuation of radiation from 90Y contamination by reducing the dose rate by 39% and 44%, respectively. Two layers of surgical gloves offered the best ratio of radiation protection without compromising dexterity. Conclusion: This study demonstrated that radiation exposures during 90Y spills or contamination events can be considerable. Interventional radiology and nuclear medicine personnel must be mindful of the risks, follow strategies to prevent spills, and be familiar with recommended decontamination procedures for spills in the interventional radiology suite.
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Affiliation(s)
- Michael Arseneault
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; and
| | - George Mawko
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert J Abraham
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
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37
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El-Sheikh MM, Aziz MM, Abdelrahman SSM, Mohmad MAEH. The protective effect of crocin against testicular toxicity induced by ionizing radiation via AKT/FOXO pathway. ENVIRONMENTAL TOXICOLOGY 2023; 38:2981-2992. [PMID: 37615252 DOI: 10.1002/tox.23932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
Crocin, a pharmacologically active component of Crocus sativus L. (saffron), has been informed to be beneficial in the treatment of stress-related oxidative impairment. In the present study, we examined the protective role of crocin against testicular damage induced by radiation (acute and fractionated) and the alteration of the AKT/FOXO signaling pathway. Male Wister albino rats were exposed to acute dose of 6 Gy and a fractionated dose of gamma radiation (2 Gy every 2 days up to 6 Gy total doses). Rats were pretreated intraperitoneally with crocin in a dose of 50 mg/kg for seven consecutive days prior to exposure to irradiation at a level of 6 Gy and during the fractionated irradiation of rats. Control groups were run concurrently. Ionizing radiation caused changes in the level of oxidative stress biomarkers manifested as elevation of thiobarbituric acid reactive substance, total nitrate/nitrite and reactive oxygen species (ROS) associated with a decrease in catalase as well as in the level of inflammatory parameters (decrease in expression of Nrf2 which was related to a significant increase in expression of NF-κB p65). Irradiation produced cellular damage characterized by an increase in serum lactate dehydrogenase. These findings were aligned with increased expression of the forkhead box O-1 (FOXO-1) and activation of protein kinase B (AKT) pathway. Irradiation of rats led to reduction in serum testosterone level and testicular weights. Pretreatment with the indicated dose of crocin shielded against the changes in all the evaluated parameters. Administration of crocin can be introduced as a novel preclinical approach for regulation of testicular damage induced by radiation; via controlling the ongoing oxidative stress and inflammatory reaction as well as activation FOXO/AKT signaling pathway.
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Affiliation(s)
- Marwa M El-Sheikh
- Department of Drug Radiation Research, National Centre for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority, Cairo, Egypt
| | - Maha M Aziz
- Department of Drug Radiation Research, National Centre for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority, Cairo, Egypt
| | - Sahar S M Abdelrahman
- Department of Pathology, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
| | - Marwa Abd El Hameed Mohmad
- Department of Drug Radiation Research, National Centre for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority, Cairo, Egypt
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Nagamoto K, Kawachino T, Suetsugu Y, Saruwatari H, Nihei SI, Kunugita N. Eye lens dose in spine surgeons during myelography procedures: a dosimetry study. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:041509. [PMID: 37944177 DOI: 10.1088/1361-6498/ad0b3a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/09/2023] [Indexed: 11/12/2023]
Abstract
To determine the eye lens dose (3 mm dose equivalent [Hp(3)]) received by spine surgeons during myelography and evaluate the effectiveness of radiation-protective glasses and x-ray tube system positioning in reducing radiation exposure. This study included spine surgeons who performed myelography using over- or under-table x-ray tube systems. Hp(3) was measured for each examination using a radio-photoluminescence glass dosimeter (GD-352M) mounted on radiation-protective glass. This study identified significantly high Hp(3) levels, especially in the right eye lens in spinal surgeons. The median Hp(3) values in the right eye were 524 (391-719) and 58 (42-83)μSv/examination for over- and under-table x-ray tube systems, respectively. Further, Hp(3)AK, which was obtained by dividing the cumulative air kerma from Hp(3), was 8.09 (6.69-10.21) and 5.11 (4.06-6.31)μSv mGy-1for the over- and under-table x-ray tube systems, respectively. Implementing radiation-protective glasses resulted in dose reduction rates of 54% (50%-57%) and 54% (51%-60%) for the over- and under-table x-ray tube systems, respectively. The use of radiation protection glasses significantly reduced the radiation dose in the eye lens during myelography, with the most effective measures being the combination of using radiation protection glasses and an under-table x-ray tube system.
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Affiliation(s)
- Keisuke Nagamoto
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Tomonori Kawachino
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Yoshiki Suetsugu
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Hiromi Saruwatari
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Shun-Ichi Nihei
- Department of Emergency and Intensive Care Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Naoki Kunugita
- Department of Occupational and Community Health Nursing School of Health Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
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Kurihara C, Applegate KE, Jeong JH, Akahane K, Kang KW. Radiological protection in human research ethics using a case study: toward update of the ICRP Publication 62. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:044002. [PMID: 37857271 DOI: 10.1088/1361-6498/ad04f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/19/2023] [Indexed: 10/21/2023]
Abstract
The benefits of biomedical research involving humans are well recognised, along with the need for conformity to international standards of science and ethics. When human research involves radiation imaging procedures or radiotherapy, an extra level of expert review should be provided from the point of view of radiological protection. The relevant publication of the International Commission for Radiological Protection (ICRP) is now three decades old and is currently undergoing an update. This paper aims to provoke discussions on how the risks of radiation dose and the benefits of research should be assessed, using a case study of diagnostic radiology involving volunteers for whom there is no direct benefit. Further, the paper provides the current understanding of key concepts being considered for review and revision-such as the dose constraint and the novel research methods on the horizon, including radiation biology and epidemiology. The analysis revisits the perspectives described in the ICRP Publication 62, and considers the recent progress in both radiological protection ethics and medical research ethics.
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Affiliation(s)
| | - Kimberly E Applegate
- Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, United States of America
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Keiichi Akahane
- National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Laccetti AL, Bodei L, O'Donoghue JA, Weber WA, Morris MJ. A Phase 1, Open-label, Dose-Ascending Study to Evaluate the Safety and Tolerability of the Therapeutic Radiopharmaceutical 131I-MIP-1095 for the Treatment of Metastatic Castration-Resistant Prostate Cancer. Clin Nucl Med 2023; 48:937-944. [PMID: 37812518 DOI: 10.1097/rlu.0000000000004818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
PURPOSE 131I-MIP-1095 is a targeted radiotherapeutic that contains 131I, a β-particle emitter, and MIP-1095, a urea-based ligand for prostate-specific membrane antigen. We report the first phase 1, dose-escalation study of 131I-MIP-1095 in patients with metastatic castration-resistant prostate cancer (mCRPC). METHODS This study enrolled men with mCRPC refractory to second-generation antiandrogen(s) and taxane chemotherapy. Dosimetry/biodistribution assessments were performed. Safety and tolerability were determined in subjects who qualified for therapeutic administration of 131I-MIP-1095 with maximum tolerated activity examined in a dose-ascending manner (3 + 3 design methodology). Disease outcomes including prostate-specific antigen (PSA) change, tumor response, survival, and circulating tumor cell concentration were assessed. RESULTS A total of 9 subjects with mCRPC were included in this study. On the basis of dosimetry results, 5 of 9 patients were treated: 3 in cohort 1 (50 mCi) and 2 in cohort 2 (75 mCi). Accrual stopped at the cohort 2 activity level in response to the US Food and Drug Administration mandate for 131I-MIP-1095 manufacturing concerns. Parotid/salivary glands (3.5 Gy/Bq), liver (2.2 Gy/Bq), kidneys (1.3 Gy/Bq), and spleen (0.7 Gy/Bq) demonstrated the greatest extent of 131I-MIP-1095 exposure. There were no deaths, serious adverse events, or drug discontinuations due to treatment-emergent adverse events. Grade 1-2 thrombocytopenia, anemia, leukopenia, and dry mouth most commonly occurred. One subject (33.3%) exhibited maximum decline for the PSA response of 50% or greater. CONCLUSION 131I-MIP-1095 demonstrated favorable dosimetry, biodistribution, and safety, as well as a modest PSA response supporting further investigation for treatment of men with mCRPC.Clinical Trial Registration: ClinicalTrials.gov identifier: NCT03030885, Registered January 25, 2017 (https://clinicaltrials.gov/ct2/show/NCT03030885).
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Affiliation(s)
| | | | - Joseph A O'Donoghue
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wolfgang A Weber
- Department of Nuclear Medicine, University Hospital of the Technical University of Munich, Munich, Germany
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Hohberg M, Reifegerst M, Drzezga A, Wild M, Schmidt M. Prediction of Response to 177Lu-PSMA Therapy Based on Tumor-to-Kidney Ratio on Pretherapeutic PSMA PET/CT and Posttherapeutic Tumor-Dose Evaluation in mCRPC. J Nucl Med 2023; 64:1758-1764. [PMID: 37652546 DOI: 10.2967/jnumed.122.264953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
The aim of this study was to analyze the absorbed dose of 177Lu-PSMA in osseous versus lymphatic metastases in patients with metastatic castration-resistant prostate cancer across therapy cycles and to relate those data to therapeutic success. In addition, pretherapeutic prostate-specific membrane antigen (PSMA) PET/CT was evaluated for its ability to predict response behavior. Methods: The study comprised 30 patients with metastatic castration-resistant prostate cancer, each receiving at least 3 cycles of 177Lu-PSMA therapy. Prostate-specific antigen (PSA) values between baseline and 6 wk after the third therapy cycle were used to classify the patients as responders (PSA decline ≥ 50%) or nonresponders (unchanged or increasing PSA level). Quantitative SPECT/CT images were acquired 24, 48, and 168 h after application of 177Lu-PSMA. The absorbed dose for tumor lesions was calculated with dosimetry software. From the pretherapeutic PET/CT scan, the tumor-to-kidney uptake ratio was determined for different SUVs. Results: Regardless of patient response, the kidneys received a mean dose of 0.55 ± 0.20 Gy/GBq per cycle. In the first therapy cycle, the lymph node lesions received a mean dose of 3.73 ± 1.65 Gy/GBq in responders and 1.86 ± 1.25 Gy/GBq in nonresponders (P < 0.01). For bone lesions, the respective mean doses were 3.47 ± 2.00 Gy/GBq and 1.48 ± 0.95 Gy/GBq (P < 0.01). When successive therapy cycles were compared, the mean dose was found to have been reduced from the first to the second cycle by 27% for lymph nodes and by 33% for bone lesions. A significant difference (P < 0.01) in the ratio of lymph node and bone lesion uptake to kidney uptake between responders and nonresponders could be deduced from the pretherapeutic PET/CT scan. Conclusion: Significantly higher doses were achieved for lymph node and bone lesions in responders. The highest absorbed dose, for both lymphatic and osseous lesions, was achieved in the first cycle, decreasing in the second therapy cycle thereafter despite unchanged therapy activities. It may be possible to estimate the response to therapy from the ratio of tumor uptake to kidney uptake obtained from the pretherapeutic PSMA PET/CT scans.
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Affiliation(s)
- Melanie Hohberg
- Department of Nuclear Medicine and Cancer Center Cologne, University Hospital of Cologne, Cologne, Germany
| | - Manuel Reifegerst
- Department of Nuclear Medicine and Cancer Center Cologne, University Hospital of Cologne, Cologne, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine and Cancer Center Cologne, University Hospital of Cologne, Cologne, Germany
| | - Markus Wild
- Department of Nuclear Medicine and Cancer Center Cologne, University Hospital of Cologne, Cologne, Germany
| | - Matthias Schmidt
- Department of Nuclear Medicine and Cancer Center Cologne, University Hospital of Cologne, Cologne, Germany
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Iqbal AM, Li KY, Mahmood M, Gautam S. Safety of fluoroless radiofrequency catheter ablation for atrial fibrillation in patients with pre-existing cardiac implantable electronic device: A single-center study. Pacing Clin Electrophysiol 2023; 46:1387-1392. [PMID: 37713192 DOI: 10.1111/pace.14818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/27/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Radiofrequency catheter ablation (RFA) for atrial fibrillation (AF) is being increasingly performed without fluoroscopy. This study aims to determine the safety of fluoroless RFA for patients with pre-existing cardiac implantable electronic devices (CIED). METHODS This is a single-center, single-operator, retrospective, observational study of 225 consecutive fluoroless RFA procedures for AF from June 1, 2019 to June 1, 2022. All procedures were performed with intracardiac echocardiography (ICE) support. Patients with pre-existing CIED were extracted from the database. Each CIED was interrogated at the start and end of each procedure and at 30-day follow-up. Pre- and post-procedure CIED interrogations were compared for any change in device or lead parameters. Patients were tracked for any subsequent device malfunction. RESULTS Out of 225 fluoroless AF ablations, 25 (10.2%) had pre-existing CIED (14 dual-chamber pacemakers, three dual-chamber defibrillators, three single-chamber defibrillators, one single chamber pacemaker, and four biventricular devices). Mean patient age was 71 ± 6 years. The mean duration of indwelling CIED was 1804 ± 1645 days (range: 78-6267 days). One (4%) patient had lead-related fibrin on ICE imaging. There was no significant difference in lead(s) threshold, impedance, or sensing post procedure or at 30-day follow-up compared to pre procedure. None of the patients required lead revision. There were no intra- or post-op thromboembolic events or subsequent device infection. One patient underwent CIED extraction after 11 months for an unrelated secondary device infection. CONCLUSIONS Radiofrequency catheter ablation for AF can be safely performed without fluoroscopy in patients with pre-existing CIED.
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Affiliation(s)
- Arshad Muhammad Iqbal
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Kai Yu Li
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Mobasser Mahmood
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandeep Gautam
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
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Atamanyuk NI, Andreev SS, Peretykin AA, Styazhkina EV, Obvintseva NA, Tryapitsina GA, Pryakhin EA. Humanized Mice as a Model to Assess the Response of Human Hematopoietic Stem Cells to Irradiation. Bull Exp Biol Med 2023; 176:34-37. [PMID: 38091132 DOI: 10.1007/s10517-023-05962-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Indexed: 12/19/2023]
Abstract
NOD SCID mice were humanized by transplanting human hematopoietic cells isolated from umbilical cord blood. A dose-dependent death of hematopoietic cells and their subsequent recovery were shown after acute external γ-irradiation in the model of humanized mice. The proposed approach can be used for preclinical studies of radioprotective agents and for assessment of the impact of adverse factors on the survival rate and functional properties of human hematopoietic stem cells in vivo.
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Affiliation(s)
- N I Atamanyuk
- Urals Research Center for Radiation Medicine, Federal Medical-Biological Agency of Russia, Chelyabinsk, Russia.
| | - S S Andreev
- Urals Research Center for Radiation Medicine, Federal Medical-Biological Agency of Russia, Chelyabinsk, Russia
| | - A A Peretykin
- Urals Research Center for Radiation Medicine, Federal Medical-Biological Agency of Russia, Chelyabinsk, Russia
| | - E V Styazhkina
- Urals Research Center for Radiation Medicine, Federal Medical-Biological Agency of Russia, Chelyabinsk, Russia
- Chelyabinsk State University, Chelyabinsk, Russia
| | - N A Obvintseva
- Urals Research Center for Radiation Medicine, Federal Medical-Biological Agency of Russia, Chelyabinsk, Russia
| | - G A Tryapitsina
- Urals Research Center for Radiation Medicine, Federal Medical-Biological Agency of Russia, Chelyabinsk, Russia
- Chelyabinsk State University, Chelyabinsk, Russia
| | - E A Pryakhin
- Urals Research Center for Radiation Medicine, Federal Medical-Biological Agency of Russia, Chelyabinsk, Russia
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Igaki H, Nakamura S, Yamazaki N, Kaneda T, Takemori M, Kashihara T, Murakami N, Namikawa K, Nakaichi T, Okamoto H, Iijima K, Chiba T, Nakayama H, Nagao A, Sakuramachi M, Takahashi K, Inaba K, Okuma K, Nakayama Y, Shimada K, Nakagama H, Itami J. Acral cutaneous malignant melanoma treated with linear accelerator-based boron neutron capture therapy system: a case report of first patient. Front Oncol 2023; 13:1272507. [PMID: 37901311 PMCID: PMC10613025 DOI: 10.3389/fonc.2023.1272507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
This study reports the first patient treatment for cutaneous malignant melanoma using a linear accelerator-based boron neutron capture therapy (BNCT) system. A single-center open-label phase I clinical trial had been conducted using the system since November 2019. A patient with a localized node-negative acral malignant melanoma and the largest diameter of the tumor ≤ 15 cm who refused primary surgery and chemotherapy was enrolled. After administering boronophenylalanine (BPA), a single treatment of BNCT with the maximum dose of 18 Gy-Eq delivered to the skin was performed. The safety and efficacy of the accelerator-based BNCT system for treating localized cutaneous malignant melanoma were evaluated. The first patient with cutaneous malignant melanoma in situ on the second finger of the left hand did not develop dose-limiting toxicity in the clinical trial. After BNCT, the treatment efficacy was gradually observed, and the patient achieved PR within 6 months and CR within 12 months. Moreover, during the follow-up period of 12 months after BNCT, the patient did not exhibit a recurrence without any treatment-related grade 2 or higher adverse events. Although grade 1 adverse events of dermatitis, dry skin, skin hyperpigmentation, edema, nausea, and aching pain were noted in the patient, those adverse events were relieved without any treatment. This case report shows that the accelerator-based BNCT may become a promising treatment modality for cutaneous malignant melanoma. We expect further clinical trials to reveal the efficacy and safety of the accelerator-based BNCT for cutaneous malignant melanoma.
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Affiliation(s)
- Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
- Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research & Clinical Trial Center, Tokyo, Japan
| | - Satoshi Nakamura
- Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research & Clinical Trial Center, Tokyo, Japan
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Tokyo, Japan
- Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoya Kaneda
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Mihiro Takemori
- Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research & Clinical Trial Center, Tokyo, Japan
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Tokyo, Japan
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
- Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research & Clinical Trial Center, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Radiation Oncology, Jutendo University School of Medicine, Tokyo, Japan
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsu Nakaichi
- Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research & Clinical Trial Center, Tokyo, Japan
| | - Hiroyuki Okamoto
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Tokyo, Japan
| | - Kotaro Iijima
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Tokyo, Japan
- Department of Radiation Oncology, Jutendo University School of Medicine, Tokyo, Japan
| | - Takahito Chiba
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Tokyo, Japan
- Department of Radiological Science, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Hiroki Nakayama
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Tokyo, Japan
- Department of Radiological Science, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Ayaka Nagao
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Madoka Sakuramachi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
- Shin-Matsudo Accuracy Radiation Therapy Center, Shin-Matsudo Central General Hospital, Chiba, Japan
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Schaaf GW, Olson JD, Dugan GO, Pray BA, Cleary JA, Cline JM. Dose-Dependent Testicular Injury and Recovery after Total-Body Irradiation in Rhesus Monkeys. Radiat Res 2023; 200:321-330. [PMID: 37702414 PMCID: PMC10686015 DOI: 10.1667/rade-23-00008.1.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
Testicular injury is a well-documented acute effect of radiation exposure, though little is known about recovery years after irradiation, especially at higher doses. We examined the testes from 143 irradiated and control male rhesus monkeys, who were part of the Radiation Late Effects Cohort over a four-year period. Irradiated animals were exposed to doses ranging from 3.5 to 8.5 Gy of total-body irradiation. The testes were assessed using computed tomography (CT) volumetry, serum testosterone, and histology for deceased members of the cohort. Irradiated animals exhibited dose-dependent testicular atrophy as well as decreased serum testosterone during the winter breeding season when compared to age-matched unirradiated controls. No significant difference in summer testosterone levels was observed. Volumetric and histologic evidence of testicular recovery was present approximately three years postirradiation for animals who received ≤8 Gy. The study demonstrates dose-dependent testicular injury after total-body irradiation and provides evidence for volumetric and spermatogonial recovery even at lethal doses of total-body irradiation in rhesus monkeys.
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Affiliation(s)
- George W. Schaaf
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John D. Olson
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Greg O. Dugan
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Betsy A. Pray
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Jacob A. Cleary
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - J. Mark Cline
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Abay B, Sankeshwar JC, Kamel H. Decreasing Lens Irradiation on Brain Imaging: A Multi-CT Scanner Quality Improvement Project. Cureus 2023; 15:e47357. [PMID: 38022074 PMCID: PMC10657156 DOI: 10.7759/cureus.47357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS Cataracts, a leading global cause of blindness, are associated with ionising radiation exposure. This audit aimed to enhance lens exclusion during non-contrast head computed tomography (CT) scans at Newham University Hospital (NUH) using two CT scanners. METHODS A retrospective audit of non-contrast head CT scans at NUH excluded scans for trauma and imaging of orbital structures. A one-week audit in April 2023 assessed lens exclusion, compared to the Royal College of Radiologists (RCR) standards. A total of 101 consecutive scans were analysed and 63 (62%) scans were included in the final study. Thirty-eight percent of the scans were excluded according to the exclusion criteria of head, neck and facial traumas, orbital infections and papilledema. Results were presented, followed by a three-month radiographer re-education period, emphasizing gantry tilt and patient positioning. A reaudit in August 2023 evaluated outcomes. For the reaudit, 183 consecutive scans were analysed, with 131 (72%) scans included in the final study and 52 (28%) scans excluded according to the same exclusion criteria as the first audit. RESULTS Lens exclusion in non-contrast head CT scans improved significantly from 0/63 (0%) compliance to 19/131 (14.50%) (p=0005) compliance with the standards. Variability in radiographer practices, 'near misses' and time constraints were identified as challenges. Staff turnover impacted compliance. CONCLUSION This audit has shed light on a critical aspect of patient care in the field of radiology. This research underscores the importance of rigorous and standardised protocols in radiological procedures, particularly when it comes to protecting the lens of the eye. By enhancing lens exclusion during non-contrast head CT scans, we have taken a significant step in mitigating the risk associated with ionising radiation exposure. Although substantial improvements were made, achieving the RCR audit standard remained elusive. Ongoing re-education, reaudits and a multidisciplinary approach are necessary to optimise radiographer adherence and reduce ionising radiation exposure to the lens during head CT scans. This quality improvement project proves that continued emphasis on gantry tilt and patient positioning in radiographer education and training can make a significant difference in patient safety. As we move forward, let us remember that even small improvements can make a big difference in safeguarding the health and well-being of patients.
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Affiliation(s)
- Berk Abay
- General Surgery, Barts Health NHS Trust, London, GBR
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Petsaros S, Chatzipetros E, Donta C, Karaiskos P, Boziari A, Papadakis E, Angelopoulos C. Scattered Radiation Distribution Utilizing Three Different Cone-Beam Computed Tomography Devices for Maxillofacial Diagnostics: A Research Study. J Clin Med 2023; 12:6199. [PMID: 37834843 PMCID: PMC10573760 DOI: 10.3390/jcm12196199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
This study aimed to estimate scattered radiation and its spatial distribution around three cone-beam computed tomography (CBCT) devices, in order to determine potential positions for an operator to stand if they needed to be inside the CBCT room. The following devices were tested: Morita Accuitomo (CBCT1), Newtom Giano HR (CBCT2), Newtom VGi (CBCT3). Scattered radiation measurements were performed using different kVp, mA, and Field of View (FOV) options. An anthropomorphic phantom (NATHANIA) was placed inside the X-ray gantry to simulate clinical conditions. Scattered measurements were taken with the Inovision model 451P Victoreen ionization chamber once placed at fixed distances from each irradiation isocenter, away from the primary beam. A statistically significant (p < 0.001) difference was found in the mean value of the scattered radiation estimations between the CBCT devices. Scattered radiation was reduced with a different rate for each CBCT device as distance was increased. For CBCT1 the reduction was 0.047 μGy, for CBCT2 it was 0.036 μGy, and for CBCT3 it was 0.079 μGy, for every one meter from the X-ray gantry. Therefore, at certain distances from the central X-ray, the scattered radiation was below the critical level of 1 mGy, which is defined by the radiation protection guidelines as the exposure radiation limit of the general population. Consequently, an operator could stay inside the room accompanying the patient being scanned, if necessary.
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Affiliation(s)
- Sotirios Petsaros
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Street, Goudi, 11527 Athens, Greece; (S.P.); (E.C.); (C.D.); (E.P.)
| | - Emmanouil Chatzipetros
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Street, Goudi, 11527 Athens, Greece; (S.P.); (E.C.); (C.D.); (E.P.)
| | - Catherine Donta
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Street, Goudi, 11527 Athens, Greece; (S.P.); (E.C.); (C.D.); (E.P.)
| | - Pantelis Karaiskos
- Medical Physics Laboratory, Faculty of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Goudi, 11527 Athens, Greece;
| | - Argiro Boziari
- Greek Atomic Energy Commission, Agia Paraskevi, 15310 Attiki, Greece;
| | - Evangelos Papadakis
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Street, Goudi, 11527 Athens, Greece; (S.P.); (E.C.); (C.D.); (E.P.)
| | - Christos Angelopoulos
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Street, Goudi, 11527 Athens, Greece; (S.P.); (E.C.); (C.D.); (E.P.)
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48
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Raso AL, Lopes R, Leyton F, Neves E, Ribeiro EJ, Vasconcelos V, Nogueira MS. Applicability of 'Toolkit for Safety Assessment' tool to interventional radiology using probabilistic risk assessment techniques. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:031519. [PMID: 37714146 DOI: 10.1088/1361-6498/acfa0a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/15/2023] [Indexed: 09/17/2023]
Abstract
Interventional radiology brings extensive benefits to patients. Nevertheless, certain procedures may result in high doses of radiation, leading to health risks to occupationally exposed individuals (OEIs). Therefore, a more comprehensive risk analysis is essential to ensuring safety and minimising radiation exposures for all OEIs. The Toolkit for Safety Assessment (TOKSA) tool performs risk assessments based on the concepts described in 'General Safety Requirements' Part 3 (Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards) and Part 4 (Safety Assessment for Facilities and Activities). This tool was developed based on the 'Ibero-American Forum of Radiological and Nuclear Regulatory Agencies' risk models and can promote the use of the risk assessment processes by OEIs. The aim of this study was to experimentally analyse the applicability of the TOKSA tool in interventional radiology with the use/support of probabilistic risk assessment techniques. The results were used to reduce the risks associated with a hemodynamics room in a hospital in Belo Horizonte, Brazil.
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Affiliation(s)
- A L Raso
- Laboratory of Radioprotection Applied to Mammography-LARAM/Center for the Development of Nuclear Technology (CDTN), Belo Horizonte, MG, Brazil
| | - R Lopes
- National Commission of Nuclear Safety and Safeguards (CNSNS), Mexico City, Mexico
| | - F Leyton
- Personal Dosimetry Laboratory- LABODOP/University of Tarapaca, Arica, Chile
| | - E Neves
- SEMPER Hospital, Belo Horizonte, MG, Brazil
| | - E J Ribeiro
- Laboratory of Radioprotection Applied to Mammography-LARAM/Center for the Development of Nuclear Technology (CDTN), Belo Horizonte, MG, Brazil
| | - V Vasconcelos
- Laboratory of Radioprotection Applied to Mammography-LARAM/Center for the Development of Nuclear Technology (CDTN), Belo Horizonte, MG, Brazil
| | - M S Nogueira
- Laboratory of Radioprotection Applied to Mammography-LARAM/Center for the Development of Nuclear Technology (CDTN), Belo Horizonte, MG, Brazil
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Ryu JC, Yoon JT, Kim BJ, Kim MH, Moon EJ, Suh PS, Roh YH, Moon HH, Kwon B, Lee DH, Song Y. Impact of a selective lens dose reduction protocol in 3D rotational angiography on radiation exposure to the eye lens during cerebral angiography: a randomized controlled trial. J Neurointerv Surg 2023:jnis-2023-020730. [PMID: 37739793 DOI: 10.1136/jnis-2023-020730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/29/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND We aimed to investigate the radiation dose to the eye lens (lens dose) during cerebral angiography and to evaluate the effectiveness of the lens dose reduction protocol for 3-dimensional rotational angiography (3D-RA) in reducing overall lens dose exposure. METHODS We conducted a randomized, controlled clinical trial at a tertiary hospital with patients undergoing cerebral angiography. The lens dose reduction protocol in 3D-RA involved raising the table to position the patient's eye lens away from the rotation axis. The lens dose was estimated by measuring the entrance surface air kerma using a photoluminescent glass dosimeter. The lens doses of 3D-RA, overall examination, and image quality were analyzed and compared between the two groups. RESULTS A total of 20 participants (mean age, 58±9.4 years; including 12 men [60%]) were enrolled and randomly assigned to either the conventional group or the dose reduction group. The median lens dose in 3D-RA was significantly lower in the dose reduction group compared with the conventional group (1.1 mGy vs 4.5 mGy, p<0.001). The total dose was significantly lower in the dose reduction group (median of 7.5 mGy vs 10.2 mGy, p=0.003). In the conventional group, 3D-RA accounted for 46% of the total lens dose, while in the dose reduction group, its proportion decreased to 16%. No significant differences were observed in the image quality between the groups. CONCLUSION The lens dose reduction protocol resulted in a significant reduction in the lens dose of the 3D-RA as well as entire cerebral angiography, while maintaining the image quality.
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Affiliation(s)
- Jae-Chan Ryu
- Neurology, Korea University Ansan Hospital, Ansan, Korea (the Republic of)
| | - Jong-Tae Yoon
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Byung Jun Kim
- Advanced Therapies, Siemens Healthineers Co Ltd, Seoul, Korea (the Republic of)
| | - Mi Hyeon Kim
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Eun Ji Moon
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Pae Sun Suh
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Yun Hwa Roh
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Hye Hyeon Moon
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Boseong Kwon
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Deok Hee Lee
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Yunsun Song
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
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50
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Shim JH, Choi SY, Chang IH, Park SB. Dose Optimization Using a Deep Learning Tool in Various CT Protocols for Urolithiasis: A Physical Human Phantom Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1677. [PMID: 37763796 PMCID: PMC10538199 DOI: 10.3390/medicina59091677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: We attempted to determine the optimal radiation dose to maintain image quality using a deep learning application in a physical human phantom. Materials and Methods: Three 5 × 5 × 5 mm3 uric acid stones were placed in a physical human phantom in various locations. Three tube voltages (120, 100, and 80 kV) and four current-time products (100, 70, 30, and 15 mAs) were implemented in 12 scans. Each scan was reconstructed with filtered back projection (FBP), statistical iterative reconstruction (IR, iDose), and knowledge-based iterative model reconstruction (IMR). By applying deep learning to each image, we took 12 more scans. Objective image assessments were calculated using the standard deviation of the Hounsfield unit (HU). Subjective image assessments were performed by one radiologist and one urologist. Two radiologists assessed the subjective assessment and found the stone under the absence of information. We used this data to calculate the diagnostic accuracy. Results: Objective image noise was decreased after applying a deep learning tool in all images of FBP, iDose, and IMR. There was no statistical difference between iDose and deep learning-applied FBP images (10.1 ± 11.9, 9.5 ± 18.5 HU, p = 0.583, respectively). At a 100 kV-30 mAs setting, deep learning-applied FBP obtained a similar objective noise in approximately one third of the radiation doses compared to FBP. In radiation doses with settings lower than 100 kV-30 mAs, the subject image assessment (image quality, confidence level, and noise) showed deteriorated scores. Diagnostic accuracy was increased when the deep learning setting was lower than 100 kV-30 mAs, except for at 80 kV-15 mAs. Conclusions: At the setting of 100 kV-30 mAs or higher, deep learning-applied FBP did not differ in image quality compared to IR. At the setting of 100 kV-30 mAs, the radiation dose can decrease by about one third while maintaining objective noise.
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Affiliation(s)
- Jae Hun Shim
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
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