151
|
Grunz JP, Pennig L, Fieber T, Gietzen CH, Heidenreich JF, Huflage H, Gruschwitz P, Kuhl PJ, Petritsch B, Kosmala A, Bley TA, Gassenmaier T. Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions. Eur Radiol 2020; 31:3600-3609. [PMID: 33280057 PMCID: PMC8128787 DOI: 10.1007/s00330-020-07563-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/24/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
Objectives Trauma evaluation of extremities can be challenging in conventional radiography. A multi-use x-ray system with cone-beam CT (CBCT) option facilitates ancillary 3-D imaging without repositioning. We assessed the clinical value of CBCT scans by analyzing the influence of additional findings on therapy. Methods Ninety-two patients underwent radiography and subsequent CBCT imaging with the twin robotic scanner (76 wrist/hand/finger and 16 ankle/foot/toe trauma scans). Reports by on-call radiologists before and after CBCT were compared regarding fracture detection, joint affliction, comminuted injuries, and diagnostic confidence. An orthopedic surgeon recommended therapy based on reported findings. Surgical reports (N = 52) and clinical follow-up (N = 85) were used as reference standard. Results CBCT detected more fractures (83/64 of 85), joint involvements (69/53 of 71), and multi-fragment situations (68/50 of 70) than radiography (all p < 0.001). Six fractures suspected in radiographs were ruled out by CBCT. Treatment changes based on additional information from CBCT were recommended in 29 patients (31.5%). While agreement between advised therapy before CBCT and actual treatment was moderate (κ = 0.41 [95% confidence interval 0.35–0.47]; p < 0.001), agreement after CBCT was almost perfect (κ = 0.88 [0.83–0.93]; p < 0.001). Diagnostic confidence increased considerably for CBCT studies (p < 0.001). Median effective dose for CBCT was 4.3 μSv [3.3–5.3 μSv] compared to 0.2 μSv [0.1–0.2 μSv] for radiography. Conclusions CBCT provides advantages for the evaluation of acute small bone and joint trauma by detecting and excluding extremity fractures and fracture-related findings more reliably than radiographs. Additional findings induced therapy change in one third of patients, suggesting substantial clinical impact. Key Points • With cone-beam CT, extremity fractures and fracture-related findings can be detected and ruled out more reliably than with conventional radiography. • Additional diagnostic information provided by cone-beam CT scans has substantial impact on therapy in small bone and joint trauma. • For distal extremity injury assessment, one-stop-shop imaging without repositioning is feasible with the twin robotic x-ray system.
Collapse
Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Tabea Fieber
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Julius Frederik Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Philipp Josef Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Aleksander Kosmala
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| |
Collapse
|
152
|
Potential application of γ-H2AX as a biodosimetry tool for radiation triage. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2020; 787:108350. [PMID: 34083048 DOI: 10.1016/j.mrrev.2020.108350] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/01/2023]
Abstract
Radiation triage and biological dosimetry are two initial steps in the medical management of exposed individuals following radiological accidents. Well established biodosimetry methods such as the dicentric (DC) assay, micronucleus (MN) assay, and fluorescence in-situ hybridization (FISH) translocation assay (for residual damage) have been used for this purpose for several decades. Recent advances in scoring methodology and networking among established laboratories have increased triage capacity; however, these methods still have limitations in analysing large sample numbers, particularly because of the ∼ 48 h minimum culture time required prior to analysis. Hence, there is a need for simple, and high throughput markers to identify exposed individuals in case of radiological/nuclear emergencies. In recent years, a few markers were identified, one being phosphorylated histone 2AX (γ-H2AX), which measured a nuclear foci or nuclear staining intensity that was found to be suitable for triage. Measurement of γ-H2AX foci formed at and around the sites of DNA double-strand breaks is a rapid and sensitive biodosimetry method which does not require culturing and is thus promising for the analysis of a large number of samples. In this review, we have summarized the recent developments of γ-H2AX assay in radiation triage and biodosimetry, focusing chiefly on: i) the importance of baseline frequency and reported values among different laboratories, ii) the influence of known and unknown variables on dose estimation, iii) quality assurance such as inter-laboratory comparison between scorers and scoring methods, and iv) current limitations and potential for future development.
Collapse
|
153
|
Effects of radiation dose reduction on diagnostic performance of 3rd generation Dual Source CT pulmonary angiography. Eur J Radiol 2020; 134:109426. [PMID: 33254062 DOI: 10.1016/j.ejrad.2020.109426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/19/2020] [Accepted: 11/14/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the effects of radiation dose reduction on diagnostic accuracy and image quality of pulmonary angiography CT (CTPA) in adults with suspected pulmonary embolism (PE). MATERIAL & METHODS 52 consecutive patients received CTPA for suspected PE. Realistic low-Dose CT simulations were generated using an offline software (ReconCT, Siemens Healthineers, Forchheim, Germany), as either filter back projections (FBP) or iterative reconstruction as ADMIRE (strength 3 or 5) with 25 %, 50 % and 75 % of the original dose. To assess image quality (overall image quality, noise, artifacts, and sharpness) and diagnostic confidence, a five-point scale was used. Patient-based and segment-based diagnostic accuracy was calculated for Low-dose computed tomography (LDCT)-reconstruction with original dose CTPA as a standard of reference. Furthermore, effective radiation doses were calculated using a commercially available dose management platform (Radimetrics, Bayer HealthCare, Leverkusen, Germany). RESULTS Among 52 patients, a total of 15 patients (28.8 %) had acute pulmonary artery embolism. The median dose-length product and effective dose for all 52 scans were 291.1 ± 210.1 mGy⋅cm and 5.8 ± 3.4 mSv. Overall subjective image quality was highest for ADMIRE 5 with 75 % and lowest for FBP with 25 % of the original dose (median [interquartile range]:5 [5] vs. 3 [2-3], p < 0.001. Patient-based diagnostic accuracy was perfect for all iteratively reconstructed data sets (ADMIRE 3 and 5) (sensitivity: 100 %, negative predictive value [NPV]: 100 %). LDCT data sets with FBP had perfect diagnostic accuracy at 50 % and 75 % of the original dose, which however decreased at 25 % of the original dose (sensitivity: 93 %; [NPV]: 97 %). Segment-based diagnostic accuracy was high for ADMIRE 3 and 5 down to 25 % dose reduction (sensitivity: 90.4 % specificity: 99.5 %) and lowest for FBP with 25 % dose reduction (sensitivity: 84.6 %, specificity: 98.9 %). Inter-class correlation regarding the detection of PE was almost perfect at all doses and recons (ICC: 96.1-1.0). Thus, accurate diagnosis for PE was possible for ADMIRE 3 and 5 datasets with 25 % of the original dose (1.45 mSv) and for FBP with 50 % of the original dose (2.9 mSv). CONCLUSION Our findings indicate that radiation dose reduction down to 25 % (1.45 mSv) of the original data via iterative reconstruction algorithms on a 3rd generation Dual Source CT (DSCT) scanner maintained the diagnostic accuracy and image quality for the assessment of PE in CTPA.
Collapse
|
154
|
Brady Z, Forsythe A, McBain-Miller J, Scurrah KJ, Smoll N, Lin Y, Lee C, Berrington de Gonzalez A, Roberts LJ, Mathews JD. Ct Dosimetry for The Australian Cohort Data Linkage Study. RADIATION PROTECTION DOSIMETRY 2020; 191:ncaa175. [PMID: 33200204 DOI: 10.1093/rpd/ncaa175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/14/2020] [Accepted: 10/03/2020] [Indexed: 06/11/2023]
Abstract
Children undergoing computed tomography (CT) scans have an increased risk of cancer in subsequent years, but it is unclear how much of the excess risk is due to reverse causation bias or confounding, rather than to causal effects of ionising radiation. An examination of the relationship between excess cancer risk and organ dose can help to resolve these uncertainties. Accordingly, we have estimated doses to 33 different organs arising from over 900 000 CT scans between 1985 and 2005 in our previously described cohort of almost 12 million Australians aged 0-19 years. We used a multi-tiered approach, starting with Medicare billing details for government-funded scans. We reconstructed technical parameters from national surveys, clinical protocols, regulator databases and peer-reviewed literature to estimate almost 28 000 000 individual organ doses. Doses were age-dependent and tended to decrease over time due to technological improvements and optimisation.
Collapse
Affiliation(s)
- Zoe Brady
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Radiology and Nuclear Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Anna Forsythe
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jasmine McBain-Miller
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katrina J Scurrah
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Nicolas Smoll
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Yaqi Lin
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Leo J Roberts
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - John D Mathews
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
155
|
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVE Examine patients' and physicians' estimates of radiation exposure related to spine surgery. SUMMARY OF BACKGROUND DATA Patients are commonly exposed to radiation when undergoing spine surgery. Previous studies suggest that patients and physicians have limited knowledge about radiation exposure in the outpatient setting. This has not been assessed for intraoperative imaging. METHODS A questionnaire was developed to assess awareness/knowledge of radiation exposure in outpatient and intraoperative spine care settings. Patients and surgeons estimated chest radiograph (CXR) equivalent radiation from: cervical and lumbar radiographs (anterior-posterior [AP] and lateral), computed tomography (CT), magnetic resonance imaging (MRI), intraoperative fluoroscopy, and intraoperative CT (O-arm). Results were compared to literature-reported radiation doses. RESULTS Overall, 100 patients and 26 providers completed the survey. Only 31% of patients were informed about outpatient radiation exposure, and only 23% of those who had undergone spine surgery had been informed about intraoperative radiation exposure. For lumbar radiographs, patients and surgeons underestimated CXR-equivalent radiation exposures: AP by five-fold (P < 0.0001) and seven-fold (P < 0.0001), respectively, and lateral by three-fold (P < 0.0001) and four-fold (P = 0.0002), respectively. For cervical CT imaging, patients and surgeons underestimated radiation exposure by 18-fold (P < 0.0001) and two-fold (P = 0.0339), respectively. For lumbar CT imaging, patients and surgeons underestimated radiation exposure by 31-fold (P < 0.0001) and three-fold (P = 0.0001), respectively. For intraoperative specific cervical and lumbar imaging, patients underestimated radiation exposure for O-arm by 11-fold (P < 0.0001) and 22-fold (P = 0.0002), respectively. Surgeons underestimated radiation exposure of lumbar O-arm by three-fold (P = 0.0227). CONCLUSION This study evaluated patient and physician knowledge of radiation exposure related to spine procedures. Underestimation of radiation exposure in the outpatient setting was consistent with prior study findings. The significant underestimation of intraoperative cross-sectional imaging (O-arm) is notable and needs attention in the era of increased use of such technology for imaging, navigation, and robotic spine surgery. LEVEL OF EVIDENCE 4.
Collapse
|
156
|
Nead KT, Mitra N, Weathers B, Pyle L, Emechebe N, Pucci DA, Jacobs LA, Vaughn DJ, Nathanson KL, Kanetsky PA. Lower abdominal and pelvic radiation and testicular germ cell tumor risk. PLoS One 2020; 15:e0239321. [PMID: 33175879 PMCID: PMC7657535 DOI: 10.1371/journal.pone.0239321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/04/2020] [Indexed: 11/18/2022] Open
Abstract
Background Testicular germ cell tumor (TGCT) incidence has increased in recent decades along with the use and dose of diagnostic radiation. Here we examine the association between reported exposure to diagnostic radiation and TGCT risk. Methods We conducted a case-control study of men with and without TGCT recruited from hospital- and population-based settings. Participants reported on exposures to 1) x-ray or CT below the waist and 2) lower GI series or barium enema, which consists of a series of x-rays of the colon. We also derived a combined measure of exposure. We used logistic regression to determine the risk of developing TGCT according to categories of exposures (0, 1–2, or ≥3 exposures) and age at first exposure, adjusting for age, year of birth, race, county, body mass index at diagnosis, family history of TGCT, and personal history of cryptorchidism. Results There were 315 men with TGCT and 931 men without TGCT in our study. Compared to no exposures, risk of TGCT was significantly elevated among those reporting at least three exposures to x-ray or CT (OR≥3 exposures, 1.78; 95% CI, 1.15–2.76; p = 0.010), lower GI series or barium enema (OR≥3 exposures, 4.58; 95% CI, 2.39–8.76; p<0.001), and the combined exposure variable (OR≥3 exposures, 1.59; 95% CI, 1.05–2.42; p = 0.029). The risk of TGCT was elevated for those exposed to diagnostic radiation at age 0–10 years, compared to those first exposed at age 18 years or later, although this association did not reach statistical significance (OR, 2.00; 95% CI, 0.91–4.42; p = 0.086). Conclusions Exposure to diagnostic radiation below the waist may increase TGCT risk. If these results are validated, efforts to reduce diagnostic radiation doses to the testes should be prioritized.
Collapse
Affiliation(s)
- Kevin T. Nead
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Epidemiology, Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Benita Weathers
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Louisa Pyle
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Division of Human Genetics and Metabolism, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Nnadozie Emechebe
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Donna A. Pucci
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Linda A. Jacobs
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - David J. Vaughn
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Katherine L. Nathanson
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Peter A. Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| |
Collapse
|
157
|
Wheeler JA, Weaver N, Balogh ZJ, Drobetz H, Kovendy A, Enninghorst N. Radiation Exposure in Patients with Isolated Limb Trauma: Acceptable or Are We Imaging Too Much? J Clin Med 2020; 9:E3609. [PMID: 33182418 PMCID: PMC7698133 DOI: 10.3390/jcm9113609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022] Open
Abstract
The aim of our study was to investigate the cumulative effective dose of radiation resulting from medical imaging in orthopaedic patients with isolated extremity trauma. Deidentified radiology records of consecutive patients without age restriction with isolated extremity trauma requiring operative treatment at a regional hospital were reviewed retrospectively over a 1-year period, and the effective dose per patient for each study type of plain film X-ray, computed tomography, and operative fluoroscopy was used to calculate cumulative effective dose. Values were summarised as mean, ± standard deviation, maximum, and proportion with overdose (>20 mSv). The study cohort included 428 patients (193 male and 235 female) with an average age of 44 years (±28). There were 447 procedures performed, i.e., all involved operative fluoroscopy, 116 involved computed tomography, and 397 involved X-ray. The mean cumulative effective dose per patient was 1.96 mSv (±4.98, 45.12). The mean cumulative effective dose for operative fluoroscopy was 0.32 mSv (±0.73, 5.91), for X-ray was 1.12 mSv (±3.6, 39.23) and for computed tomography was 2.22 mSv (±4.13, 20.14). The mean cumulative effective dose of 1.96 mSv falls below the recommended maximum annual exposure of 20 mSv. This study can serve as a guide for informing clinicians and patients of the acceptable radiation risk in the context of isolated extremity trauma.
Collapse
Affiliation(s)
- James A. Wheeler
- Lismore Base Hospital, Lismore, New South Wales 2480, Australia; (J.A.W.); (H.D.)
| | - Natasha Weaver
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; (N.W.); (N.E.)
| | - Zsolt J. Balogh
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; (N.W.); (N.E.)
- John Hunter Hospital, Newcastle, New South Wales 2305, Australia
| | - Herwig Drobetz
- Lismore Base Hospital, Lismore, New South Wales 2480, Australia; (J.A.W.); (H.D.)
| | - Andrew Kovendy
- North Coast Cancer Institute, North Coast, New South Wales 2450, Australia;
| | - Natalie Enninghorst
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; (N.W.); (N.E.)
| |
Collapse
|
158
|
Quan Y, Sun M, Tan Z, Eijkel JCT, van den Berg A, van der Meer A, Xie Y. Organ-on-a-chip: the next generation platform for risk assessment of radiobiology. RSC Adv 2020; 10:39521-39530. [PMID: 35515392 PMCID: PMC9057494 DOI: 10.1039/d0ra05173j] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/16/2020] [Indexed: 01/04/2023] Open
Abstract
Organ-on-a-chip devices have been widely used in biomedical science and technology, for example for experimental regenerative medicine and precision healthcare. The main advantage of organ-on-a-chip technology is the facility to build a specific human model that has functional responses on the level of organs or tissues, thereby avoiding the use of animal models, as well as greatly improving new drug discovery processes for personal healthcare. An emerging application domain for organs-on-chips is the study of internal irradiation for humans, which faces the challenges of the lack of a clear model for risk estimation of internal irradiation. We believe that radiobiology studies will benefit from organ-on-a-chip technology by building specific human organ/tissues in vitro. In this paper, we briefly reviewed the state-of-the-art in organ-on-a-chip research in different domains, and conclude with the challenges of radiobiology studies at internal low-dose irradiation. Organ-on-a-chip technology has the potential to significantly improve the radiobiology study as it can mimic the function of human organs or tissues, and here we summarize its potential benefits and possible breakthrough areas, as well as its limitations in internal low-dose radiation studies. Organ-on-a-chip technology has great potential for the next generation risk estimation of low dose internal irradiation, due to its success in mimicking human organs/tissues, which possibly can significantly improve on current animal models.![]()
Collapse
Affiliation(s)
- Yi Quan
- Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics (CAEP) Mianyang Sichuan 621000 China
| | - Miao Sun
- Joint Laboratory of Nanofluidics and Interfaces, School of Physical and Technology, Northwestern Polytechnical University Xi'an Shaanxi 710072 China
| | - Zhaoyi Tan
- Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics (CAEP) Mianyang Sichuan 621000 China
| | - Jan C T Eijkel
- BIOS, Lab on a Chip Group, MESA+ Institution for Nanotechnology, University of Twente 7522 NB Enschede The Netherlands
| | - Albert van den Berg
- BIOS, Lab on a Chip Group, MESA+ Institution for Nanotechnology, University of Twente 7522 NB Enschede The Netherlands
| | - Andries van der Meer
- Department of Applied Stem Cell Technologies, University of Twente 7522 NB Enschede The Netherlands
| | - Yanbo Xie
- Joint Laboratory of Nanofluidics and Interfaces, School of Physical and Technology, Northwestern Polytechnical University Xi'an Shaanxi 710072 China
| |
Collapse
|
159
|
Wang L, Wang Z, Cao Y, Lu W, Kuang L, Hua D. Strategy for Highly Efficient Radioprotection by a Selenium-Containing Polymeric Drug with Low Toxicity and Long Circulation. ACS APPLIED MATERIALS & INTERFACES 2020; 12:44534-44540. [PMID: 32902946 DOI: 10.1021/acsami.0c14000] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Because of the rapid development and extensive use of nuclear technology, ionizing radiation has become a large threat to human health. Until now, there has been no practicable radioprotector for routine clinical application because of severe side effects, high toxicity, and short elimination half-life. Herein, we develop a highly efficient radioprotection strategy using a selenium-containing polymeric drug with low toxicity and long circulation by removing reactive oxygen species (ROSs). The selenium-containing polymeric drug is prepared by copolymerization of vinyl phenylselenides (VSe) and N-(2-hydroxyethyl) acrylamide (HEA). The in vitro radioprotective efficacy of the polymeric drug is increased by 40% with lower cytotoxicity compared with the small-molecular VSe monomer. Importantly, the radioprotection activity of the polymeric drug shows more remarkable effects both in cell culture and mice model compared to the commercially available drug ebselen and also exhibits a much longer retention time in blood (half-life ∼ 10 h). This work may unfold a new area for highly efficient radioprotection by polymeric drugs instead of small-molecular agents.
Collapse
Affiliation(s)
- Lu Wang
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Suzhou 215123, China
| | - Ziyu Wang
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Suzhou 215123, China
| | - Yu Cao
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Suzhou 215123, China
| | - Weihong Lu
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Suzhou 215123, China
| | - Liangju Kuang
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Daoben Hua
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Suzhou 215123, China
- Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, China
| |
Collapse
|
160
|
Jain SF, Ishihara R, Wheelock L, Love T, Wang J, Deegan T, Majerus CR, Oarhe C, Allbery S. Feasibility of rapid magnetic resonance imaging (rMRI) for the emergency evaluation of suspected pediatric orbital cellulitis. J AAPOS 2020; 24:289.e1-289.e4. [PMID: 33049373 DOI: 10.1016/j.jaapos.2020.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the feasibility of noncontrast rapid magnetic resonance imaging (rMRI), compared with traditional contrast-enhanced computed tomography (CT) in assessing pediatric emergency department patients with suspected orbital cellulitis or orbital abscess. METHODS All subjects <19 years of age who presented emergently with suspected orbital cellulitis from July 1, 2017, to July 31, 2019, were included. Participants received both the standard contrast orbital CT, if deemed necessary, with the addition of the noncontrast rMRI after informed consent was obtained. No sedation was used for either examination. All clinical decisions were based on CT findings; rMRI was interpreted within 24 hours of the visit. Three pediatric radiologists, with 8-21 years' experience of pediatric neuroradiology, interpreted the rMRI, masked to the CT and clinical results. Results were analyzed for interobserver bias. RESULTS A total of 14 patients were enrolled during the study period. Mean age was 5.9 years (range, 0.33-13). Of the 14 patients, 13 (93%) were able to complete the rMRI at 1.5 and 3T; 1 patient (1.67 years of age) was unable to complete the rMRI (no images obtained). Of the 26 unilateral orbital units assessed, 3 were positive for retroseptal orbital cellulitis by CT and were diagnosed correctly by rMRI. Interobserver agreement was 100% in detecting presence or absence of retroseptal cellulitis. CT and rMRI findings were concordant in 100% of cases in differentiating preseptal vs orbital cellulitis. Kappa statistics for three-category ratings by three raters for right eye/orbit was 0.921 and for left eye/orbit was 0.9288, suggesting almost perfect agreement. Concordance correlation coefficients were 0.938 for the right eye and 0.955 for the left eye. CONCLUSIONS Noncontrast rMRI orbits showed findings concordant in all cases with contrast-enhanced CT for differentiating preseptal cellulitis from orbital cellulitis.
Collapse
Affiliation(s)
- Samiksha Fouzdar Jain
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska; Department of Pediatric Ophthalmology & Adult strabismus, Children's Hospital and Medical Center, Omaha, Nebraska.
| | - Rhys Ishihara
- Department of Pediatric Ophthalmology & Adult strabismus, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Lisa Wheelock
- Department of Radiology, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Terri Love
- Department of Radiology, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Jennifer Wang
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Thomas Deegan
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Chelsea Rae Majerus
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Christian Oarhe
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Sandra Allbery
- Department of Radiology, Children's Hospital & Medical Center, Omaha, Nebraska
| |
Collapse
|
161
|
Snelling PJ, Jones P, Keijzers G, Bade D, Herd DW, Ware RS. Nurse practitioner administered point-of-care ultrasound compared with X-ray for children with clinically non-angulated distal forearm fractures in the ED: a diagnostic study. Emerg Med J 2020; 38:139-145. [PMID: 32900856 DOI: 10.1136/emermed-2020-209689] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Paediatric distal forearm fractures are a common ED presentation. They can be diagnosed with point-of-care ultrasound (POCUS) as an alternative to X-rays. Given that ED nurse practitioners (NPs) are relied on for the diagnosis of paediatric fractures, it is important to describe the diagnostic accuracy of NP-conducted POCUS versus X-ray. METHODS This prospective diagnostic study was conducted in a tertiary paediatric hospital in Queensland, Australia, between February 2018 and April 2019. Participants were children aged 4-16 years with a clinically non-angulated, suspected distal forearm fracture. Diagnosis from 6-view NP-administered POCUS of the distal radius and ulna was compared against the reference standard of 2-view X-ray. Each patient received both imaging modalities. Overall forearm diagnosis was classified as 'no', 'buckle' or 'other' fracture for both modalities. The primary outcome was diagnostic accuracy for 'any' fracture ('buckle' and 'other' fractures combined). Secondary outcomes included diagnostic accuracy for 'other' fractures versus 'buckle' and 'no' fractures combined, and pain, imaging duration and preference for modality. RESULTS Of 204 recruited patients, 129 had X-ray-diagnosed forearm fractures. The sensitivity and specificity for NP-administered POCUS were 94.6% (95% CI 89.2% to 97.3%) and 85.3% (95% CI 75.6% to 91.6%), respectively. 'Other' fractures (mostly cortical breach fractures), when compared with 'buckle'/ 'no' fractures, had sensitivity 81.0% (95% CI 69.1% to 89.1%) and specificity 95.9% (95% CI 91.3% to 98.1%). Pain and imaging duration were clinically similar between modalities. There was a preference for POCUS by patients, parents and NPs. CONCLUSIONS NP-administered POCUS had clinically acceptable diagnostic accuracy for paediatric patients presenting with non-angulated distal forearm injuries. This included good sensitivity for diagnosis of 'any' fracture and good specificity for diagnosis of cortical breach fractures alone. Given the preference for POCUS, and the lack of difference in pain and duration between modalities, future research should consider functional outcomes comparing POCUS with X-ray in this population in a randomised controlled trial.
Collapse
Affiliation(s)
- Peter J Snelling
- School of Medicine, Griffith University Faculty of Health, Southport, Queensland, Australia .,Department of Emergency Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.,Sonography Innovation and Research Group (Sonar Group), Southport, Queensland, Australia.,Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Philip Jones
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Gerben Keijzers
- School of Medicine, Griffith University Faculty of Health, Southport, Queensland, Australia.,Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Southport, Queensland, Australia
| | - David Bade
- Department of Orthopaedics, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - David W Herd
- Department of Emergency Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| |
Collapse
|
162
|
Venerin AA, Venerina YA, Alexandrov YI. Cell functioning in norm and pathology in terms of the activity paradigm: Oncogenesis. Med Hypotheses 2020; 144:110240. [PMID: 33254546 DOI: 10.1016/j.mehy.2020.110240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/09/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023]
Abstract
Over the past years many theories of carcinogenesis have been developed. Nowadays, there are two prevalent theories of carcinogenesis - two-hit hypothesis, which considers mutations as the main factor in malignization and tissue hypothesis, which considers tissue homeostasis disruption for providing cells transformation. Both of these theories explain cancer origin basing on principles of the reactivity paradigm. This paradigm emphasizes role of different stimuli in malignization. However, this approach does not provide us with sufficient support in progress towards either understanding of cancer origin or effective treatment strategies. In contrast to the reactivity paradigm, we intend to explain oncogenesis within the activity paradigm. Upon this approach, cells' activity is goal-directed and is determined by a future event - the adaptive result. The adaptive result is a proper interaction between the cell and its environment, which provides the cell with required metabolites. To achieve this result cells have to cooperate with each other and synchronize their needs. If cells fail to satisfy their metabolic 'needs' they have to reorganize their activity. This results in morpho-functional restructuring of cells. Summing up, we consider carcinogenesis to be a part of goal-directed adaptive activity of cells. Morphological and genetic atypia of cancer cells is a variant reorganization of cells' activity. Consequently, for better treatment, we should bring both transforming cells and their microenvironment to a novel cooperation and reorganization of their activity.
Collapse
Affiliation(s)
- Andrey A Venerin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yana A Venerina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Yury I Alexandrov
- Shvyrkov's Lab, Neural Bases of Mind, Institute of Psychology, Russian Academy of Sciences, Moscow, Russia; Department of Psychology, National Research University Higher School of Economics, Moscow, Russia
| |
Collapse
|
163
|
Lang SD, Gilmer BB. A Dual-Motor Drill Reduces Plunge, Simultaneously Gauges Depth, and Saves Time When Placing Orthopedic Screws. Orthopedics 2020; 43:e465-e470. [PMID: 32501524 DOI: 10.3928/01477447-20200521-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/14/2019] [Indexed: 02/03/2023]
Abstract
The technique for placement of orthopedic hardware remains unchanged despite technological advances. The surgeon controls drill bit speed and advancement, which risks drill bit overpenetration, or plunge. Measurement is performed as an additional step, introducing measurement error and increasing operative time. A dual-motor drill was created to control drill variables and combine drilling and measurement into a single step. The purpose of this study was to determine whether a dual-motor drill could reduce drilling and measurement errors while increasing the speed of placement of orthopedic hardware. Five orthopedic surgeons drilled and measured 10 holes with a standard drill and a dual-motor drill in randomized bicortical bone blocks. The bone blocks were placed on standard ballistic gels, which left a defect from drill bit overpenetration that could be measured with a calibrated gauge. The accuracy of drilling was determined by the depth of the defect in the ballistic gel and was compared between groups. Finally, time for drilling and measurement was collected and compared between groups. Overpenetration for the dual-motor drill (0.5±0.3 mm) was significantly less than for the standard drill (8.4±1.9 mm) (P<.0001). Depth measurement error for the dual-motor drill (0.6±0.3 mm) was significantly less than for the standard drill (2.6±0.5 mm) (P<.0001). Drilling and measurement time for the dual-motor drill (6.0±2.2 seconds) was significantly less than for the standard drill (13.4±3.9 seconds) (P<.0001). Use of a dual-motor drill reduced overpenetration, improved measurement accuracy, and reduced time spent during placement of orthopedic hardware. [Orthopedics. 2020;43(5):e465-e470.].
Collapse
|
164
|
Effect of gender and occupations on uranium concentration in human blood and soil samples collected from Babylon, Iraq. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2020. [DOI: 10.2478/pjmpe-2020-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Uranium concentrations of human blood and soil samples have been studied at different ages and occupations in Babylon, Iraq. The technique of nuclear track detectors CR 39 with nuclear fission track analysis has been used to determine the uranium concentrations in this study. Results have shown that the concentrations of uranium ranged from 0.56 ± 0.06 to 1.24 ± 0.29 ppb with an average of 0.83 ± 0.18 ppb in blood samples. On the other hand, the concentrations of uranium in soil samples ranged from 0.93 ± 0.20 to 2.59 ± 0.15 ppm with an average of 1.72 ± 0.19 ppm. Moreover, the highest averages of concentration have been found in the city center of Babylon, reaching 1.09 ± 0.22 ppb and 2.10 ± 0.23 ppm in blood and soil samples, respectively. The results have further proved that gender and occupations have an effect in increasing the concentrations of uranium. In addition, the concentrations in blood samples are generally lower than the concentration in soil samples.
Collapse
|
165
|
Cruz da Silva R, Lopes JM, Barbosa da Silva L, Domingues AM, da Silva Pinheiro C, Faria da Silva L, Xavier da Silva A. Radiological evaluation of Ra-226, Ra-228 and K-40 in tea samples: A comparative study of effective dose and cancer risk. Appl Radiat Isot 2020; 165:109326. [PMID: 32777740 DOI: 10.1016/j.apradiso.2020.109326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/21/2020] [Accepted: 07/05/2020] [Indexed: 11/16/2022]
Abstract
Activity concentrations of tea samples were determined using high resolution gamma spectrometry.The values ranged from (421.00 ± 17.00) to (732.00 ± 30.00) Bq.kg -1 for K-40 and from (3.00 ± 0.80) to (27.00 ± 3.00) Bq.kg-1 for Ra-228. The values for Ra-226 were below 27.00 Bq.kg-1. The committed effective dose was estimated at 4.74-78.89 μSv.y-1 for adults and 13.55-445.84 μSv.y-1 for children. The cancer risk was higher for females. However, results showed that the tea consumption do not represent a radiological health risk to the population.
Collapse
Affiliation(s)
- Roberto Cruz da Silva
- Nuclear Engineering Department, Federal University of Rio de Janeiro, Av. Horácio Macedo, 2030, Bloco G, Sala 206 - CT, Fundão, 21945-970, Rio de Janeiro, RJ, Brazil.
| | - José Marques Lopes
- Geochemistry Department (Pospetro), Rua Barão de Jeremoabo, s/nº, 40170-110, Federal University of Bahia, Salvador, Brazil
| | - Leandro Barbosa da Silva
- Nuclear Engineering Department, Federal University of Rio de Janeiro, Av. Horácio Macedo, 2030, Bloco G, Sala 206 - CT, Fundão, 21945-970, Rio de Janeiro, RJ, Brazil
| | - Alessandro Mariano Domingues
- Nuclear Engineering Department, Federal University of Rio de Janeiro, Av. Horácio Macedo, 2030, Bloco G, Sala 206 - CT, Fundão, 21945-970, Rio de Janeiro, RJ, Brazil
| | - Carla da Silva Pinheiro
- Brazilian Marine Corps Technological Center, Av. Brasil, Parada de Lucas, 13478, 21010-076, Rio de Janeiro, RJ, Brazil
| | - Lucas Faria da Silva
- Chemistry School, Federal University of Rio de Janeiro, Av. Athos da Silveira Ramos, 149 - CT, Fundão, 21941-909, Rio de Janeiro, RJ, Brazil
| | - Ademir Xavier da Silva
- Nuclear Engineering Department, Federal University of Rio de Janeiro, Av. Horácio Macedo, 2030, Bloco G, Sala 206 - CT, Fundão, 21945-970, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
166
|
Cornacchia S, La Tegola L, Maldera A, Pierpaoli E, Tupputi U, Ricatti G, Eusebi L, Salerno S, Guglielmi G. Radiation protection in non-ionizing and ionizing body composition assessment procedures. Quant Imaging Med Surg 2020; 10:1723-1738. [PMID: 32742963 PMCID: PMC7378088 DOI: 10.21037/qims-19-1035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/08/2020] [Indexed: 01/06/2023]
Abstract
Body composition assessment (BCA) represents a valid instrument to evaluate nutritional status through the quantification of lean and fat tissue, in healthy subjects and sick patients. According to the clinical indication, body composition (BC) can be assessed by different modalities. To better analyze radiation risks for patients involved, BCA procedures can be divided into two main groups: the first based on the use of ionizing radiation (IR), involving dual energy X-ray absorptiometry (DXA) and computed tomography (CT), and others based on non-ionizing radiation (NIR) [magnetic resonance imaging (MRI)]. Ultrasound (US) techniques using mechanical waves represent a separate group. The purpose of our study was to analyze publications about IR and NIR effects in order to make physicians aware about the risks for patients undergoing medical procedures to assess BCA providing to guide them towards choosing the most suitable method. To this end we reported the biological effects of IR and NIR and their associated risks, with a special regard to the excess risk of death from radio-induced cancer. Furthermore, we reported and compared doses obtained from different IR techniques, giving practical indications on the optimization process. We also summarized current recommendations and limits for techniques employing NIR and US. The authors conclude that IR imaging procedures carry relatively small individual risks that are usually justified by the medical need of patients, especially when the optimization principle is applied. As regards NIR imaging procedures, a few studies have been conducted on interactions between electromagnetic fields involved in MR exam and biological tissue. To date, no clear link exists between MRI or associated magnetic and pulsed radio frequency (RF) fields and subsequent health risks, whereas acute effects such as tissue burns and phosphenes are well-known; as regards the DNA damage and the capability of NIR to break chemical bonds, they are not yet robustly demonstrated. MRI is thus considered to be very safe for BCA as well US procedures.
Collapse
Affiliation(s)
- Samantha Cornacchia
- Medical Physics Unit, Dimiccoli Hospital Barletta, Barletta, ASL Barletta-Andria-Trani, Italy
| | - Luciana La Tegola
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Arcangela Maldera
- Medical Physics Unit, Dimiccoli Hospital Barletta, Barletta, ASL Barletta-Andria-Trani, Italy
| | | | - Umberto Tupputi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Giovanni Ricatti
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | | | - Sergio Salerno
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
- “Dimiccoli” Hospital, University Campus of Barletta, Barletta, Italy
| |
Collapse
|
167
|
Gilbert ES, Little MP, Preston DL, Stram DO. Issues in Interpreting Epidemiologic Studies of Populations Exposed to Low-Dose, High-Energy Photon Radiation. J Natl Cancer Inst Monogr 2020; 2020:176-187. [PMID: 32657345 PMCID: PMC7355296 DOI: 10.1093/jncimonographs/lgaa004] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/02/2020] [Indexed: 01/19/2023] Open
Abstract
This article addresses issues relevant to interpreting findings from 26 epidemiologic studies of persons exposed to low-dose radiation. We review the extensive data from both epidemiologic studies of persons exposed at moderate or high doses and from radiobiology that together have firmly established radiation as carcinogenic. We then discuss the use of the linear relative risk model that has been used to describe data from both low- and moderate- or high-dose studies. We consider the effects of dose measurement errors; these can reduce statistical power and lead to underestimation of risks but are very unlikely to bring about a spurious dose response. We estimate statistical power for the low-dose studies under the assumption that true risks of radiation-related cancers are those expected from studies of Japanese atomic bomb survivors. Finally, we discuss the interpretation of confidence intervals and statistical tests and the applicability of the Bradford Hill principles for a causal relationship.
Collapse
Affiliation(s)
- Ethel S Gilbert
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Daniel O Stram
- Department of Preventive Medicine, School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
168
|
Van Acker JWG, Pauwels NS, Cauwels RGEC, Rajasekharan S. Outcomes of different radioprotective precautions in children undergoing dental radiography: a systematic review. Eur Arch Paediatr Dent 2020; 21:463-508. [PMID: 32557182 DOI: 10.1007/s40368-020-00544-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the effectiveness of all radioprotective measures in underage patients who undergo a dental radiodiagnostic examination. METHODS A systematic review was performed including randomised controlled trials (RCTs), or cluster trials, cohort studies, cross-sectional studies, case-control studies and comparative in vitro research. These studies examined the healthy underage human population (below 18 years) undergoing a dental radiodiagnostic examination. All radioprotective measures were included except for justification as an intervention. The primary outcomes were in vivo mortality and morbidity. Some surrogate or indirect outcomes such as in vitro effective dose and organ absorbed doses were also accepted. Secondary outcomes with regards to image quality and therapeutic value were also analysed. RESULTS Eighteen papers were eligible for implementation. Fifteen studies underwent narrative synthesis. Regression analysis was performed on three studies. CONCLUSION The following radioprotective measures can reduce the exposure dose. For lateral cephalometry: collimation, filtration, the fastest receptor type and circumstantial thyroid shielding. For oblique lateral radiographs: the shortest exposure time, a smaller horizontal angulation, a longer focus to skin distance. For intraoral radiography: rectangular collimation, the fastest image receptor speed and thyroid shielding when the thyroid gland is in line of or very close to the primary beam. For panoramic radiographs: collimation, the fastest receptor type and the use of automatic exposure control (AEC) or manual adjustment of intensity. For cone-beam computed tomography: collimation, the largest voxels size in relation to the treatment need, change in image settings such as ultra-low dose settings, shorter exposure time, a lower amount of projections, lower beam intensity, reduction of the potential, use of a thyroid shield except in two situations and the use of AEC. All of the changes in exposure parameters should be performed while maintaining a sufficient therapeutic value on an individual and indication-based level.
Collapse
Affiliation(s)
- J W G Van Acker
- Department of Paediatric Dentistry, PaeCoMeDiS Research Cluster, Ghent University, C. Heymanslaan 10 (P8), 9000, Ghent, Belgium.
| | - N S Pauwels
- Knowledge Center Ghent, Ghent University Hospital, C. Heymanslaan 10 (K3), 9000, Ghent, Belgium
| | - R G E C Cauwels
- Department of Paediatric Dentistry, PaeCoMeDiS Research Cluster, Ghent University, C. Heymanslaan 10 (P8), 9000, Ghent, Belgium
| | - S Rajasekharan
- Department of Paediatric Dentistry, PaeCoMeDiS Research Cluster, Ghent University, C. Heymanslaan 10 (P8), 9000, Ghent, Belgium
| |
Collapse
|
169
|
Cohen SL, Ward TJ, Makhnevich A, Richardson S, Cham MD. Retrospective analysis of 1118 outpatient chest CT scans to determine factors associated with excess scan length. Clin Imaging 2020; 62:76-80. [PMID: 32200203 PMCID: PMC7598945 DOI: 10.1016/j.clinimag.2019.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023]
Abstract
RATIONALE OBJECTIVES Excess z-axis scanning continues as an unnecessary source of radiation. This study seeks to determine patient, technologist and CT factors that affect excess scan length for chest CT. MATERIALS AND METHODS Retrospective evaluation of 1118 consecutive noncontrast chest CT scans, over twelve consecutive months, was performed for evaluation of scan length above and below the lung parenchyma. Scan length >2 cm was considered excessive. Bivariate analysis for mean excess scan length and presence of excess scan length analyzed technologist's exam volume during the study period, patient age, patient gender, day of week, and time of day as categorical variables. Technologists performing >100 chest CT scans during the study period were considered high-volume while all others were considered low-volume. RESULTS Mean excess scan length was 5 mm, 29 mm, and 33 mm above the lungs, below the lungs, and total. 81% and 95% of studies had excess scanning above the lungs and below the lungs respectively. Multivariable analysis showed that high volume technologists, male patients, and patients younger than 65 had a greater amount of excess scan length and presence of excessive scanning above the lungs; high volume technologists and male patients had a greater amount of excess scan length below the lungs, and high volume technologists and patients older than 65 had greater presence of excessive scanning below the lungs, each p < 0.001. CONCLUSIONS Excess scanning on chest CT is common, varies by patient age and gender and was significantly greater for high volume technologists.
Collapse
Affiliation(s)
- Stuart L Cohen
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America; Northwell Health Imaging, Manhasset, NY, United States of America; Imaging Clinical Effectiveness & Outcomes Research Program at Northwell Health, Manhasset, NY, United States of America; Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY, United States of America.
| | - Thomas J Ward
- Florida Hospital Radiology, Orlando, FL, United States of America
| | - Alex Makhnevich
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America; Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY, United States of America; Northwell Health Internal Medicine, Manhasset, NY, United States of America
| | - Safiya Richardson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America; Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY, United States of America; Northwell Health Internal Medicine, Manhasset, NY, United States of America
| | - Matthew D Cham
- University of Washington Radiology, Seattle, WA, United States of America
| |
Collapse
|
170
|
Smoll NR, Mathews JD, Scurrah KJ. CT scans in childhood predict subsequent brain cancer: Finite mixture modelling can help separate reverse causation scans from those that may be causal. Cancer Epidemiol 2020; 67:101732. [PMID: 32464497 DOI: 10.1016/j.canep.2020.101732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/02/2020] [Accepted: 04/16/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Excess brain cancers observed after computed tomography (CT) scans could be caused by ionizing radiation. However, as scans are often used to investigate symptoms of brain cancer, excess cancers could also be due to reverse causation bias. We used finite mixture models (FMM) to differentiate CT exposures that are plausibly causal from those due to reverse causation. METHODS Persons with at least one CT scan exposure and a subsequent diagnosis of brain cancer were selected from a cohort of 11 million young Australians. We fitted FMMs and used the posterior probability to inform the choice of exclusion periods. We validated our findings using a separate clinical dataset describing the time between first symptoms and brain cancer diagnosis (pre-diagnostic symptomatic interval; PSI). RESULTS The cohort included 1028 persons with a diagnosed brain tumor and exposed to a total of 1,450 CT scans. The best-fitting model was a generalized linear mixture model using the exponential distribution with three latent classes and two covariates (age at exposure and year of exposure). The 99th percentile classifier cutoff was 18.9 months. The sample-size weighted mean of the 99th percentile of the PSI, derived from clinical data, was 15.6 months. CONCLUSIONS To minimize reverse causation bias in studies of CT scan and brain cancer, the optimal exclusion period is one to two years (depending on the choice of classifier). This information will inform the interpretation of current and future studies.
Collapse
Affiliation(s)
- Nicolas R Smoll
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street Carlton, VIC, 3053, Australia
| | - John D Mathews
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street Carlton, VIC, 3053, Australia.
| | - Katrina J Scurrah
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street Carlton, VIC, 3053, Australia
| |
Collapse
|
171
|
Mantoglu B, Gonullu E, Akdeniz Y, Yigit M, Firat N, Akin E, Altintoprak F, Erkorkmaz U. Which appendicitis scoring system is most suitable for pregnant patients? A comparison of nine different systems. World J Emerg Surg 2020; 15:34. [PMID: 32423408 PMCID: PMC7236497 DOI: 10.1186/s13017-020-00310-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute appendicitis is the most common non-gynecological emergency during pregnancy. The diagnosis of appendicitis during pregnancy is challenging due to changes in both physiological and laboratory variables. Guidelines suggest patients with suspected acute appendicitis should be stratified based on clinical scoring systems, to optimize the use of diagnostic imaging and prevent unnecessary surgery. Surgeons require additional information beyond that provided by imaging studies before deciding upon exploratory laparoscopy in patients with a high suspicion of appendicitis. Various scoring methods have been evaluated for the diagnosis of acute appendicitis. However, there is no consensus on a method to use during pregnancy, and a detailed comparison of existing scoring methods for this purpose has not yet been conducted. The purpose of this study was to evaluate the efficacy of the most popular scoring systems applied to diagnose acute appendicitis during pregnancy. METHODS This single-center retrospective study included 79 pregnant patients who were admitted to the emergency department with abdominal pain between May 2014 and May 2019. The patients were diagnosed with acute appendicitis and underwent an appendectomy. As a control group, the study also included 79 non-pregnant patients who underwent appendectomy within the last 1.5 years. To ensure that the groups were similar, women in the case group were stratified according to age, and the proportions of women in the strata were determined. The women in the control group were similarly stratified. Women were randomly selected from the strata to prevent bias. Both laboratory and examination findings required for each scoring method were obtained and assessed separately for each patient. Negative appendectomy rates were evaluated according to pathology results. Categorical variables were compared using the chi-square test. A p value < 0.05 was considered to indicate significance. Receiver operator characteristic curve analysis was used to identify the best threshold value and to assess the performance of the test scores in terms of diagnosing appendicitis. RESULTS Among all scoring systems, the Tzanakis score was most efficacious at predicting appendicitis in non-pregnant women. The positive predictive value (PPV) of the Tzanakis score was 90.6%, whereas the negative predictive value (NPV) was 46.7%. The RIPASA score performed the best among the scoring systems in pregnant women. It was associated with a PPV of 94.40%, NPV of 44%, and sensitivity and specificity of 78.46% and 78.57%, respectively. CONCLUSION Although the RIPASA score can be used to efficaciously diagnose acute appendicitis in pregnant women, a specific scoring system is needed for diagnosis during the gestation period.
Collapse
Affiliation(s)
- Baris Mantoglu
- Department of General Surgery, Sakarya University Educating and Research Hospital, Sakarya, Turkey.
| | - Emre Gonullu
- Department of General Surgery, Sakarya University Educating and Research Hospital, Sakarya, Turkey
| | - Yesim Akdeniz
- Department of General Surgery, Sakarya University Educating and Research Hospital, Sakarya, Turkey
| | - Merve Yigit
- Department of General Surgery, Sakarya University Educating and Research Hospital, Sakarya, Turkey
| | - Necattin Firat
- Faculty of Medicine, Department of General Surgery, Sakarya University, Sakarya, Turkey
| | - Emrah Akin
- Department of General Surgery, Sakarya University Educating and Research Hospital, Sakarya, Turkey
| | - Fatih Altintoprak
- Faculty of Medicine, Department of General Surgery, Sakarya University, Sakarya, Turkey
| | - Unal Erkorkmaz
- Faculty of Medicine, Department of Biostatistics, Sakarya University, Sakarya, Turkey
| |
Collapse
|
172
|
Masamoto K, Fujibayashi S, Otsuki B, Fukushima Y, Koizumi K, Shimizu T, Shimizu Y, Murata K, Ikeda N, Matsuda S. Cervical spinal computed tomography utilizing model-based iterative reconstruction reduces radiation to an equivalent of three cervical X-rays. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2804-2813. [PMID: 32388669 DOI: 10.1007/s00586-020-06426-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/04/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate radiation dose and image quality of cervical spinal computed tomography scanned with low-radiation dose (LD-CT) utilizing model-based iterative reconstruction (MBIR). METHODS We retrospectively examined 14 patients (65.5 ± 13.9 years) who underwent both standard-radiation-dose CT (SD-CT) reconstructed with hybrid iterative reconstruction and LD-CT of cervical spine. The radiation dose, objective image quality indicator, which includes signal-to-noise and contrast-to-noise, and subjective image quality score of the anatomical landmarks in the SD-CT and LD-CT were statistically compared. In addition, the measurement errors of the length of C3 vertebrae (height, anteroposterior length, inner and outer pedicle diameters) between SD-CT and LD-CT were analyzed. RESULTS Radiation dose of LD-CT was reduced to one-sixth of the dose of SD-CT. The objective image quality indicator of LD-CT was significantly better than that of SD-CT. The subjective image quality of LD-CT was relatively worse than that of SD-CT but generally graded as clinically accepted or higher. There was no remarkable difference between SD-CT and LD-CT in the measurement value of height and anteroposterior length. Inner pedicle diameter was significantly (0.21 ± 0.13 mm) smaller, and outer pedicle diameter was (0.24 ± 0.14 mm) larger on LD-CT than on SD-CT. CONCLUSION Cervical spinal LD-CT that utilized MBIR enabled radical decrease in radiation dose and provided sufficient image quality for clinical use. This scanning protocol can be a good alternative for protecting patients from exposure to unnecessary radiation, especially when a patient requires multiple CT scans.
Collapse
Affiliation(s)
- Kazutaka Masamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yasuhiro Fukushima
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koji Koizumi
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yu Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Norimasa Ikeda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| |
Collapse
|
173
|
The expression profile of redox genes in human monocytes exposed in vitro to γ radiation. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
174
|
Radiation dose and risk of exposure-induced death associated with common computed tomography procedures in Yazd Province. Eur J Radiol 2020; 126:108932. [DOI: 10.1016/j.ejrad.2020.108932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 02/07/2020] [Accepted: 03/02/2020] [Indexed: 01/12/2023]
|
175
|
Protons Show Greater Relative Biological Effectiveness for Mammary Tumorigenesis with Higher ERα- and HER2-Positive Tumors Relative to γ-rays in APC Min/+ Mice. Int J Radiat Oncol Biol Phys 2020; 107:202-211. [PMID: 32036005 PMCID: PMC9835149 DOI: 10.1016/j.ijrobp.2020.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/12/2020] [Accepted: 01/23/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Exposure to ionizing radiation increases risk of breast cancer. Although proton radiation is encountered in outer space and in medicine, we do not fully understand breast cancer risks from protons owing to limited in vivo data. The purpose of this study was to comparatively assess the effects of γ-rays and protons on mammary tumorigenesis in APCMin/+ mice. METHODS AND MATERIALS Female APCMin/+ mice were exposed to 1 GeV protons (1.88 or 4.71 Gy) and 137Cs γ-rays (2 or 5 Gy). Mice were euthanized 100 to 110 days after irradiation, at which point mammary tumors were scored, tumor grades were assessed, and relative biological effectiveness was calculated. Molecular phenotypes were determined by assessing estrogen receptor α (ERα) and human epidermal growth factor receptor 2 (HER2) status. ERα downstream signaling was assessed by immunohistochemistry. RESULTS Exposure to proton radiation led to increased mammary tumor frequency at both proton radiation doses compared with γ-rays. The calculated relative biological effectiveness for proton radiation-induced mammary tumorigenesis was 3.11 for all tumors and >5 for malignant tumors relative to γ-rays. Tumor frequency per unit of radiation was higher at the lower dose, suggesting a saturation effect at the higher dose. Protons induced more adenocarcinomas relative to γ-rays, and proton-induced tumors show greater ERα and HER2 positivity and higher activation of the ERα downstream PI3K/Akt and cyclin D1 pathways relative to γ-rays. CONCLUSIONS Our data demonstrate that protons pose a higher risk of mammary tumorigenesis relative to γ-rays. We also show that proton radiation-induced tumors in APCMin/+ mice are ERα- and HER2-positive, which is consistent with our previous data on radiation-induced estrogenic response in wild-type mice. Although this study establishes APCMin/+ as a model with adequate signal-to-noise ratio for space radiation-induced mammary tumorigenesis, further studies will be required to address the uncertainties in space radiation-induced breast cancer risk estimation.
Collapse
|
176
|
Vingiani V, Abadia AF, Schoepf UJ, Fischer AM, Varga-Szemes A, Sahbaee P, Allmendinger T, Tesche C, Griffith LP, Marano R, Martin SS. Low-kV coronary artery calcium scoring with tin filtration using a kV-independent reconstruction algorithm. J Cardiovasc Comput Tomogr 2020; 14:246-250. [DOI: 10.1016/j.jcct.2019.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/16/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
|
177
|
Shah A, Nassri M, Kay J, Simunovic N, Mascarenhas VV, Andrade AJ, Marin-Peña ÓR, Ayeni OR. Intraoperative radiation exposure in hip arthroscopy: a systematic review. Hip Int 2020; 30:267-275. [PMID: 31766894 DOI: 10.1177/1120700019887362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Fluoroscopy is used in hip arthroscopy (HA) for portal placement, instrument localisation, and guidance in bony resection. The recent increase in arthroscopic hip procedures may place patients and surgeons at risk for increased radiation exposure and radiation-induced complications. The purpose of the current systematic review was to assess intraoperative radiation exposure in HA. The systematic review was conducted according to PRISMA guidelines; inclusion criteria were studies assessing radiation exposure in HA. 9 studies including 994 patients were included. Mean age was 38.6 years and 48% (436 of 906) were female. Mean time of fluoroscopy exposure was 0.58 minutes. Dose area product was 129.5 cGycm2. Mean intraoperative absorbed radiation dose studies was 12.6 mGy. Mean intraoperative effective dose was 0.48 mSv. The mean occupational exposure to the surgeon per case was 0.0031 mSv. Higher patient body mass index (BMI) correlated to greater patient effective and cumulative dose (p < 0.05, r = 0.404), and greater occupational exposure (p < 0.001, r = 0.460). Increasing surgeon experience decreased fluoroscopy time (p = 0.039) and radiation dose (p = 0.002). Radiation dose and effective dose were well under the thresholds for deterministic effects (2 Gy) and annual radiation exposure for occupational workers (20 mSv). Intraoperative radiation exposure to patients and surgeons is within acceptable annual radiation limits. Ensuring careful selection of perioperative imaging modalities, proper protective shielding, specifically the use of leaded eyeglasses, and optimal C-arm positioning are key strategies to reduce radiation exposure to patients and surgeons alike.
Collapse
Affiliation(s)
- Ajay Shah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohammed Nassri
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Department of Radiology, Hospital da Luz, Lisbon, Portugal
| | | | - Óliver R Marin-Peña
- Orthopedic Surgery and Traumatology Department, University Hospital Infanta Leonor, Madrid, Spain
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
178
|
Merter A, Karaeminogullari O, Shibayama M. Comparison of Radiation Exposure Among 3 Different Endoscopic Diskectomy Techniques for Lumbar Disk Herniation. World Neurosurg 2020; 139:e572-e579. [PMID: 32330613 DOI: 10.1016/j.wneu.2020.04.079] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumbar disk herniation can be successfully treated by lumbar endoscopic spinal procedures. However, one of the most important disadvantages of the endoscopic methods used is radiation exposure. There are multiple endoscopic spinal procedures and this study aims to compare unilateral biportal endoscopic diskectomy (UBED), percutaneous endoscopic lumbar diskectomy (PELD), and microendoscopic diskectomy (MED) methods in terms of radiation exposure. METHODS A total of 75 people were included in this prospective and multicenter study. The demographic characteristics, operating times (minutes), levels of surgery, lumbar disk herniation types, radiation exposures (dose area product [DAP]), and fluoroscopy times (seconds) of the groups were compared. RESULTS Mean DAP values were 1.39 Gy·cm2 in the UBED group, 2.46 Gy·cm2 in the PELD group, and 1.01 Gy·cm2 in the MED group. The UBED group had no statistically significant difference with the MED and PELD groups in terms of DAP (P = 0.281 and P = 0.058, respectively), whereas the PELD group had statistically significantly higher DAP values than the MED group (P = 0.016). The maximum mean duration of fluoroscopy usage time was 34.9 seconds in the PELD group, 19.3 seconds in the UBED group, and 4.6 seconds in the MED group. The differences between the groups were significant (P ≤ 0.001). CONCLUSIONS The more the level of invasiveness is reduced in spinal surgery, the greater the exposure to radiation. In this study, the groups are listed as PELD > UBED > MED according to the duration and level of radiation exposure.
Collapse
Affiliation(s)
- Abdullah Merter
- Department of Orthopedics, Spine Section, School of Medicine, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey.
| | - Oguz Karaeminogullari
- Department of Orthopedics, Spine Section, Bayindir Sogutozu Hospital, Ankara, Turkey
| | - Motohide Shibayama
- Department of Orthopedics, Spine Section, Aichi Spine Hospital, Aichi Prefecture, Japan
| |
Collapse
|
179
|
Kretz T, Mueller KR, Schaeffter T, Elster C. Mammography Image Quality Assurance Using Deep Learning. IEEE Trans Biomed Eng 2020; 67:3317-3326. [PMID: 32305886 DOI: 10.1109/tbme.2020.2983539] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE According to the European Reference Organization for Quality Assured Breast Cancer Screening and Diagnostic Services (EUREF) image quality in mammography is assessed by recording and analyzing a set of images of the CDMAM phantom. The EUREF procedure applies an automated analysis combining image registration, signal detection and nonlinear fitting. We present a proof of concept for an end-to-end deep learning framework that assesses image quality on the basis of single images as an alternative. METHODS Virtual mammography is used to generate a database with known ground truth for training a regression convolutional neural net (CNN). Training is carried out by continuously extending the training data and applying transfer learning. RESULTS The trained net is shown to correctly predict the image quality of simulated and real images. Specifically, image quality predictions on the basis of single images are of similar quality as those obtained by applying the EUREF procedure with 16 images. Our results suggest that the trained CNN generalizes well. CONCLUSION Mammography image quality assessment can benefit from the proposed deep learning approach. SIGNIFICANCE Deep learning avoids cumbersome pre-processing and allows mammography image quality to be estimated reliably using single images.
Collapse
|
180
|
Adliene D, Griciene B, Skovorodko K, Laurikaitiene J, Puiso J. Occupational radiation exposure of health professionals and cancer risk assessment for Lithuanian nuclear medicine workers. ENVIRONMENTAL RESEARCH 2020; 183:109144. [PMID: 32028181 DOI: 10.1016/j.envres.2020.109144] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Reconstruction and analysis of low doses received by the occupationally exposed medical radiation workers, especially nuclear medicine staff dealing with radioisotopes may significantly contribute to the understanding of radiation impact on individuals, assess and predict radiation related risks for the development of cancer or other specific diseases. METHODS A pool of 2059 annual effective doses corresponding to 272 job's positions occupied by nuclear medicine and radiology workers for a certain time period over 26 years in five Lithuanian hospitals was investigated in order to analyze the occupational exposure tendencies to medical staff. Requested data, measured in terms of whole body dose, personal dose equivalent Hp(10), was obtained from the National Register of Sources of Ionizing Radiation and Occupational Exposure. Considering that nuclear medicine staff is dealing with open sources/radioisotopes, doses to extremities, Hp(0.07), were measured using thermoluminescent dosimeters (TLD) of LiF:Mg, Ti type. Lifetime risk estimations for the development of specific cancer (thyroid cancer and leukemia) for exposed radiation workers were performed using risk models included in BEIR VII report (BEIR VII, 2006). The conservative assessment of the thyroid exposure was performed using RadRAT 4.1.1 tool. RESULTS Doses to radiology technologists and radiology nurses were found to be highest over the years. However, their annual doses never exceeded dose limit of 20 mSv and were following the same decreasing tendency as the doses of other personnel. There was no increase of doses to nuclear medicine staff observed after installation of two new PET/CT machines, indicating increased radiation protection culture and application of relevant technical and protective measures by the staff. Measured fingertip doses were 2-3 times higher than the hand doses measured with TLD ring and were dependent on the type and frequency of the nuclear medicine examination procedure and on the type and activity of isotopes used for examination. CONCLUSIONS For the first time, retrospective dose evaluation for the cohort of medical radiation workers was performed in the country. It enabled estimation of lifetime attributable risk for the development of two cancer types: thyroid and leukemia cancer among occupationally exposed medical radiation staff. Projected risk was low, ~10-5, however it was found that the risk of thyroid cancer for female staff was 5.7 times higher than for the males. Obtained results will be used for the predictive assessment of possible radiation induced health effects to occupationally exposed medical radiation workers.
Collapse
Affiliation(s)
- D Adliene
- Kaunas University of Technology, Kaunas, Lithuania.
| | - B Griciene
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - K Skovorodko
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; State Research Institute the Center for Physical Sciences and Technology, Vilnius, Lithuania
| | | | - J Puiso
- Kaunas University of Technology, Kaunas, Lithuania
| |
Collapse
|
181
|
Eskandari A, Mahmoudzadeh A, Shirazi A, Esmaely F, Carnovale C, Cheki M. Melatonin a Promising Candidate for DNA Double-Stranded Breaks Reduction in Patients Undergoing Abdomen-Pelvis Computed Tomography Examinations. Anticancer Agents Med Chem 2020; 20:859-864. [PMID: 32208125 DOI: 10.2174/1871521409666200324101701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/20/2019] [Accepted: 02/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Cancer incidence is 24% higher in children and young adults exposed to Computed Tomography (CT) scans than those unexposed. Non-repairing of ionizing radiation-induced DNA Double-Strand Breaks (DSBs) can initiate carcinogenesis. In the present study, we aimed to investigate the radioprotective potential of melatonin against DSBs in peripheral blood lymphocytes of patients undergoing abdomen-pelvis CT examinations. METHODS This double-blind, placebo-controlled clinical trial was conducted on thirty patients. These patients were divided into two groups; group one (control) patients who have undergone the CT examination received a single oral dose of placebo, while in group two, patients received a single oral dose of 100mg melatonin. In both the groups, blood samples were collected 5-10min before and 30 minutes after the CT examination. The lymphocytes from these samples were isolated and DSBs were analyzed using γH2AX immunofluorescence microscopy. RESULTS Compared to the control group, the use of melatonin 1h before the CT examination caused a significant reduction in γH2AX-foci, indicating a reduction in DSBs. In addition, no side effect was observed in patients following 100mg melatonin administration. CONCLUSION For the first time, this study has shown that melatonin has protective effects against radiationinduced genotoxicity in peripheral blood lymphocytes of patients undergoing abdomen-pelvis CT examinations. Therefore, melatonin can be considered as a promising candidate for reducing DSBs in patients undergoing abdomen-pelvis CT examinations.
Collapse
Affiliation(s)
- Ali Eskandari
- Department of Medical Radiation Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Aziz Mahmoudzadeh
- Department of Biosciences and Biotechnology, Malek-Ashtar University of Technology, Tehran, Iran
| | - Alireza Shirazi
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences and Health Services, Tehran, Iran
| | - Farid Esmaely
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences and Health Services, Tehran, Iran
| | - Carla Carnovale
- Department of Biomedical and Clinical Sciences L. Sacco, Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, Milan, Italy
| | - Mohsen Cheki
- Department of Radiologic Technology, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Toxicology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
182
|
Tanabe Y, Kido T, Kimura F, Kobayashi Y, Matsunaga N, Yoshioka K, Yoshimura N, Mochizuki T. Japanese Survey of Radiation Dose Associated With Coronary Computed Tomography Angiography - 2013 Data From a Multicenter Registry in Daily Practice. Circ J 2020; 84:601-608. [PMID: 32074543 DOI: 10.1253/circj.cj-19-0843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although coronary computed tomography angiography (CTA) is frequently used for identifying coronary artery disease, no studies have investigated the radiation dose in detail in Japan. The aim of this study was to estimate the radiation dose of coronary CTA in Japanese clinical practice and to identify the independent predictors associated with radiation dose.Methods and Results:A multicenter, retrospective, observational study (54 institutions) was conducted for estimating the radiation dose of coronary CTA in 2,469 patients between January and December 2013. Independent predictors associated with radiation dose were investigated on linear regression analysis. Median dose-length product (DLP) was 809.0 mGy·cm (IQR, 350.0-1,368.8 mGy·cm), corresponding to an estimated radiation dose of 11 mSv. The DLP per site significantly differed between institutions (median DLP per site, 92-2,131 mGy·cm; P<0.05). Independent predictors associated with radiation dose on multivariable linear regression were body weight, heart rate, non-stable sinus rhythm, scan length, tube voltage setting, electrocardiogram (ECG)-gated scanning protocol, and the image reconstruction technique (P<0.05 each). CONCLUSIONS The coronary CTA radiation dose was relatively high in 2013, and it varied significantly between institutions. Effective strategies for radiation dose reduction were low tube voltage ≤100 kVp, retrospective ECG-gated scanning with dose modulation technique, prospective ECG-gated scanning, and the iterative reconstruction technique.
Collapse
Affiliation(s)
- Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine
| | - Fumiko Kimura
- Department of Radiology, PsI clinic.,Department of Radiology, Dia Medical Net
| | - Yasuyuki Kobayashi
- Department of Medical Information and Communication Technology Research, Graduate School of Medicine, St. Marianna University School of Medicine
| | - Naofumi Matsunaga
- Department of Radiology, Yamaguchi University Graduate School of Medicine
| | | | - Norihiko Yoshimura
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine.,Department of Radiology, I.M. Sechenov First Moscow State Medical University
| |
Collapse
|
183
|
Increased Postoperative Use of Computed Tomography Following Emergency Surgery for Ileocaecal Crohn Disease. Surg Laparosc Endosc Percutan Tech 2020; 30:214-217. [PMID: 32150121 DOI: 10.1097/sle.0000000000000778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Multiple imaging modalities are often required for the relapsing nature of Crohn disease (CD). Computed tomography (CT) offers a rapid acquisition of images and shows high specificity and sensitivity. However, CT imaging exposes to a higher dose of ionizing radiation than other abdominal imaging modalities. The aim of this study was to compare the use of preoperative and postoperative CT scan in patients undergoing emergency and elective surgery for CD. METHODS All patients undergoing emergency and elective surgery for ileocaecal CD January 2014 to December 2018 were included in this prospective observational study. The study objective was to evaluate the frequency of use of CT scan perioperatively with the number and findings of preoperative and postoperative CT being the primary outcomes. The secondary outcomes were operating time, length of hospital stay, reoperations, and rehospitalization. RESULTS A total of 75 patients were included, 33 in the emergency group (43%) and 44 in the elective group (57%). There was a higher use of preoperative CT scan in the emergency surgery group, with 14 patients (42%) having a CT scan before surgery compared with 2 (5%) in the elective group (P=0.14). Thirteen patients (39.4%) had a postoperative CT scan in the emergency surgery group, compared with 10 patients (23.8%) in the elective surgery group. CONCLUSION Patients undergoing emergency surgery for CD are at increased risk of exposure to ionizing radiations due to high perioperative use of CT scan.
Collapse
|
184
|
Zakhvataev VE. Tidal variations of background ionizing radiation and circadian timing of the suprachiasmatic nucleus clock. Med Hypotheses 2020; 140:109667. [PMID: 32182557 DOI: 10.1016/j.mehy.2020.109667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023]
Abstract
Recently, correlations of different physiological processes in humans with variations in the local lunisolar gravitational tide force have been observed under highly controlled laboratory conditions. Understanding of the physical nature of this phenomenon needs a comprehensive study of its possible molecular mechanisms. One of the possible timing cues is the strong periodic variation of the emanation fields of radon-222 and its progeny produced by tidal deformations of geological environment. In the present work, we argue that this variation could induce temporal modulation of radiation-induced bystander signaling pathways associated with fundamental regulators of gene expression in the suprachiasmatic nucleus clock.
Collapse
Affiliation(s)
- V E Zakhvataev
- Federal Research Center "Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences", 660036 Krasnoyarsk, Russia; Siberian Federal University, 660041 Krasnoyarsk, Russia.
| |
Collapse
|
185
|
Patient radiation exposure for endovascular deep venous interventions. J Vasc Surg Venous Lymphat Disord 2020; 8:259-267. [DOI: 10.1016/j.jvsv.2019.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/26/2019] [Indexed: 11/18/2022]
|
186
|
Sengupta B, Medlin D, Sprunk M, Napolitano J, D'Avanzo J, Ran Zheng X, Dean D, Takacs E. X-ray cabinet to deliver highly characterized low-dose soft x-ray radiation to biological samples. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2020; 91:034104. [PMID: 32259947 DOI: 10.1063/1.5109233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 02/29/2020] [Indexed: 06/11/2023]
Abstract
We have designed, built, and tested a climate-controlled, radiation-shielded incubator cabinet for the purpose of analyzing the effects of low-dose x-ray radiation on biological tissues and cell cultures. Bremsstrahlung x rays incident on exchangeable fluorescence plates produce strong, quasi-monochromatic radiation directed toward a small container of biological samples. The x-ray source, sample, and detector are enclosed in an incubator-maintaining the optimal environment for biological samples to increase longevity to a maximum of 72 h. To demonstrate the capabilities of the setup, an example experiment is presented. Rat vascular smooth muscle cell growth was observed after irradiation with characteristic x rays of iron, copper, and calcium to impart doses of 2 mGy each. Cultures show significant spectrum dependent increases in cell number over controls at 48 h after irradiation. The experiment lends credence to the efficacy of the apparatus and shows promise for future low-dose bio-radiation studies.
Collapse
Affiliation(s)
- Bishwambhar Sengupta
- Department of Physics and Astronomy, Clemson University, Clemson, South Carolina 29634, USA
| | - Donald Medlin
- Department of Physics and Astronomy, Clemson University, Clemson, South Carolina 29634, USA
| | - Michael Sprunk
- Department of Mechanical Engineering, Clemson University, Clemson, South Carolina 29634, USA
| | - Justin Napolitano
- Department of Bioengineering, Clemson University, Clemson, South Carolina 29634, USA
| | - Jaclyn D'Avanzo
- Department of Physics and Astronomy, Clemson University, Clemson, South Carolina 29634, USA
| | - Xiao Ran Zheng
- Department of Physics and Astronomy, Clemson University, Clemson, South Carolina 29634, USA
| | - Delphine Dean
- Department of Bioengineering, Clemson University, Clemson, South Carolina 29634, USA
| | - Endre Takacs
- Department of Physics and Astronomy, Clemson University, Clemson, South Carolina 29634, USA
| |
Collapse
|
187
|
Measuring the dose-width product and proposing the local diagnostic reference level in panoramic dental radiography: a multi-center study from Iran. Oral Radiol 2020; 37:80-85. [PMID: 32065334 DOI: 10.1007/s11282-020-00428-z] [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: 03/18/2019] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although radiation exposure associated with dental radiography is relatively low, patient exposure must be kept practically low. Therefore, it is necessary for each country to establish its own diagnostic reference levels (DRLs) suitable for its equipment and practice. In the present study, dose-width product (DWP) values for panoramic dental radiography were measured and a local DRL was established. METHODS Five panoramic devices from five radiology clinics of Kashan, Iran were selected to measure the DWP values of panoramic dental radiography. To investigate the DWP values, the parameters of each patient's exposure (e.g., tube voltage, tube current, and exposure time) at these five radiology clinics were extracted. Then, the dose value received by each patient was measured based on a CT pencil chamber. Finally, the overall median DWP values for the patients with small, medium, and large sizes were obtained, and these values were considered as the local DRLs for panoramic dental radiography. RESULTS A total of 99 adult patients were included in the present study. The findings demonstrated that the median and third-quartile DWP values for these five radiology clinics ranged from 42.3 to 94.3 and 49.7 to 142.8 mGy mm, respectively. The local DRL values, which were established as the overall median DWP values, were 43.4, 52.0, and 80.3 mGy mm for the adults with small, medium, and large sizes, respectively. CONCLUSION The local DRL proposed in this study for the adult with standard/medium size was lower than those proposed by other reports and seemed acceptable for panoramic radiography in Kashan, Iran.
Collapse
|
188
|
Cohen EP, Olson JD, Tooze JA, Bourland JD, Dugan GO, Cline JM. Detection and quantification of renal fibrosis by computerized tomography. PLoS One 2020; 15:e0228626. [PMID: 32053617 PMCID: PMC7018060 DOI: 10.1371/journal.pone.0228626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/20/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives Reliable biomarkers for renal fibrosis are needed for clinical care and for research. Existing non-invasive biomarkers are imprecise, which has limited their utility. Methods We developed a method to quantify fibrosis by subject size-adjusted CT Hounsfield units. This was accomplished using CT measurements of renal cortex in previously irradiated non-human primates. Results Renal cortex mean CT Hounsfield units that were adjusted for body size had a very good direct correlation with renal parenchymal fibrosis, with an area under the curve of 0.93. Conclusions This metric is a promising and simple non-invasive biomarker for renal fibrosis.
Collapse
Affiliation(s)
- Eric P. Cohen
- Department of Medicine, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States of America
- Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, United States of America
- * E-mail:
| | - John D. Olson
- Department of Comparative Medicine, Wake Forest University, Wake Forest, North Carolina, United States of America
| | - Janet A. Tooze
- Department of Comparative Medicine, Wake Forest University, Wake Forest, North Carolina, United States of America
| | - J. Daniel Bourland
- Department of Comparative Medicine, Wake Forest University, Wake Forest, North Carolina, United States of America
| | - Greg O. Dugan
- Department of Comparative Medicine, Wake Forest University, Wake Forest, North Carolina, United States of America
| | - J. Mark Cline
- Department of Comparative Medicine, Wake Forest University, Wake Forest, North Carolina, United States of America
| |
Collapse
|
189
|
Lowe DJ, Herzog M, Mosler T, Cohen H, Felton S, Beli P, Raj K, Galanty Y, Jackson SP. Chronic irradiation of human cells reduces histone levels and deregulates gene expression. Sci Rep 2020; 10:2200. [PMID: 32042076 PMCID: PMC7010678 DOI: 10.1038/s41598-020-59163-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/24/2020] [Indexed: 01/10/2023] Open
Abstract
Over the past decades, there have been huge advances in understanding cellular responses to ionising radiation (IR) and DNA damage. These studies, however, were mostly executed with cell lines and mice using single or multiple acute doses of radiation. Hence, relatively little is known about how continuous exposure to low dose ionising radiation affects normal cells and organisms, even though our cells are constantly exposed to low levels of radiation. We addressed this issue by examining the consequences of exposing human primary cells to continuous ionising γ-radiation delivered at 6-20 mGy/h. Although these dose rates are estimated to inflict fewer than a single DNA double-strand break (DSB) per hour per cell, they still caused dose-dependent reductions in cell proliferation and increased cellular senescence. We concomitantly observed histone protein levels to reduce by up to 40%, which in contrast to previous observations, was not mainly due to protein degradation but instead correlated with reduced histone gene expression. Histone reductions were accompanied by enlarged nuclear size paralleled by an increase in global transcription, including that of pro-inflammatory genes. Thus, chronic irradiation, even at low dose-rates, can induce cell senescence and alter gene expression via a hitherto uncharacterised epigenetic route. These features of chronic radiation represent a new aspect of radiation biology.
Collapse
Affiliation(s)
- Donna J Lowe
- Radiation Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Didcot, Oxfordshire, OX11 0RQ, UK.
- Wellcome/Cancer Research UK Gurdon Institute and Department of Biochemistry, University of Cambridge, Cambridge, CB2 1QN, UK.
| | - Mareike Herzog
- Wellcome/Cancer Research UK Gurdon Institute and Department of Biochemistry, University of Cambridge, Cambridge, CB2 1QN, UK
| | | | - Howard Cohen
- Elizabeth House Surgery, Warlingham, Surrey, CR6 9LF, UK
| | - Sarah Felton
- Department of Dermatology, Churchill Hospital, Oxford, OX3 7LJ, UK
| | - Petra Beli
- Institute of Molecular Biology (IMB), 55128, Mainz, Germany
| | - Ken Raj
- Radiation Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Didcot, Oxfordshire, OX11 0RQ, UK
| | - Yaron Galanty
- Wellcome/Cancer Research UK Gurdon Institute and Department of Biochemistry, University of Cambridge, Cambridge, CB2 1QN, UK.
| | - Stephen P Jackson
- Wellcome/Cancer Research UK Gurdon Institute and Department of Biochemistry, University of Cambridge, Cambridge, CB2 1QN, UK.
| |
Collapse
|
190
|
Antioxidant status and cytogenetic damage in hospital workers occupationally exposed to low dose ionizing radiation. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2020; 850-851:503152. [PMID: 32247560 DOI: 10.1016/j.mrgentox.2020.503152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/26/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022]
Abstract
The aim of the present study was to assess the oxidative stress level and chromosomal damage induced by occupational exposure to low dose ionizing radiation (LDIR). Two hundred and eighteen hospital workers occupationally exposed to LDIR were included in this study, along with 118 healthy age- and gender-comparable controls. Occupational dosimetry records were collected over the last year and revealed that the accumulated annual dose for each hospital worker was below the permissible limit of the International Commission on Radiological Protection (ICRP). The individuals' oxidative and antioxidative status were determined by measuring the activities of copper zinc-superoxide dismutase (CuZn-SOD), glutathione peroxidase (GSH-Px), catalase (CAT) enzymes, and the levels of malondialdehyde (MDA) in erythrocytes. The effect of radiation on chromosomal integrity was measured by the frequency of micronuclei (MN) formation using the cytokinesis block technique. Our results showed that the activities of CuZn-SOD and CAT enzymes and MDA levels observed in the hospital workers were higher than those in the controls (p < 0.05). We did not find significant difference in GSH-Px enzyme activity between the two groups (p = 0.247). A higher frequency of MN was found in exposed groups than in the controls [3(1-5) ‰ versus 2(0.75-4) ‰; p<0.001]. The difference was significant for males (p = 0.012), but not females (p = 0.14). Multiple linear regression analysis showed differences in the oxidant activities and MN frequency between hospital workers and controls adjusted for age, gender, smoking status and drinking status. Correlation analysis indicated that the frequency of MN was positively associated with MDA levels (p < 0.05). Altogether, these results support the detrimental effects of chronic low dose radiation in humans, which involves the induction of oxidative stress and chromosomal damage.
Collapse
|
191
|
Ramesh PS, Devegowda D, Singh A, Thimmulappa RK. NRF2, p53, and p16: Predictive biomarkers to stratify human papillomavirus associated head and neck cancer patients for de-escalation of cancer therapy. Crit Rev Oncol Hematol 2020; 148:102885. [PMID: 32062315 DOI: 10.1016/j.critrevonc.2020.102885] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/25/2020] [Indexed: 01/18/2023] Open
Abstract
Patients with HPV associated (HPV+ve) head and neck squamous cell carcinoma (HNSCC), particularly oropharyngeal cancer, show better treatment response, higher survival rates, and lower risks of recurrence as compared to HPV-ve HNSCC patients. Despite increased sensitivity to treatment modality, HPV+ve HNSCC patients are subjected to the same intensive anti-cancer therapy as HPV-ve HNSCC patients and thus subjecting them to unwarranted long-term toxicity. To identify predictive biomarkers for risk-stratification, we have analyzed the mutational spectrum, and the evidence suggests that gain-of-function mutations in the NRF2 pathway are highly prevalent in HPV-ve HNSCC. At the same time, it is rare in HPV+ve HNSCC tumors. We have reviewed the importance of gain-of-NRF2 function and loss of p53 in the prognosis of HNSCC patients and discussed a predictive scoring system using a combination of HPV status (p16), NRF2 pathway and p53 to stratify HPV+ve HNSCC into good versus poor responders, which could immensely help in guiding future de-escalation treatment approaches in patients with HPV+ve HNSCC.
Collapse
Affiliation(s)
- Pushkal S Ramesh
- Centre of Excellence in Molecular Biology & Regenerative Medicine, Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru, India
| | - Devananda Devegowda
- Centre of Excellence in Molecular Biology & Regenerative Medicine, Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru, India
| | - Anju Singh
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - Rajesh K Thimmulappa
- Centre of Excellence in Molecular Biology & Regenerative Medicine, Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru, India.
| |
Collapse
|
192
|
Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2020; 139:e698-e800. [PMID: 30586767 DOI: 10.1161/cir.0000000000000603] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Karen K Stout
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Curt J Daniels
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jamil A Aboulhosn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Biykem Bozkurt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Craig S Broberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jack M Colman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephen R Crumb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Joseph A Dearani
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephanie Fuller
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michelle Gurvitz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Paul Khairy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michael J Landzberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Arwa Saidi
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Anne Marie Valente
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - George F Van Hare
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| |
Collapse
|
193
|
Distribution of radiation exposure in patients with partially stable and unstable pelvic ring fractures: first-time use of highly accurate assessment by Monte Carlo calculations. Eur J Trauma Emerg Surg 2020; 47:1201-1209. [PMID: 31919561 DOI: 10.1007/s00068-019-01297-w] [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: 06/07/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Radiological examinations including X-ray and CT play a critical role in the assessment and treatment of trauma patients. The ionizing radiation used is known to be carcinogenic. However, little is known about the total radiation exposure in trauma patients. The objective of this study was to accurately estimate radiation exposure of patients with severe pelvic ring fractures. METHODS In this retrospective dynamic cohort study, adult patients with partially stable and unstable pelvic ring fractures were included. For each patient, data concerning demography and injury characteristics were collected. Subsequently, the total effective radiation dose due to all trauma-related X-rays and CT scans during initial assessment, treatment and follow-up was calculated using Monte Carlo software. RESULTS A total of 114 patients were included. The median total effective dose was 49.7 millisievert (mSv). 57 patients (50.0%) received more than 50 mSv and 13 patients (11.4%) received more than 100 mSv. 62.4% of the total effective dose was received within the 24 h after admission. The median total effective dose for survivors (n = 95) was 52.0 mSv. Polytrauma patients received a significantly higher total effective dose than non-polytrauma patients. CONCLUSIONS This study showed that a substantial number of patients with partially stable and unstable pelvic ring fractures have an increased cancer risk due to trauma-related medical imaging. Physicians should be aware of the amount of radiation their patients are exposed to, and minimize imaging related increase of cancer risks during initial assessment, treatment and follow-up.
Collapse
|
194
|
Shafiee M, Borzoueisileh S, Rashidfar R, Dehghan M, Jaafarian Sisakht Z. Chromosomal aberrations in C-arm fluoroscopy, CT-scan, lithotripsy, and digital radiology staff. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2020; 849:503131. [PMID: 32087852 DOI: 10.1016/j.mrgentox.2020.503131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 01/03/2020] [Accepted: 01/04/2020] [Indexed: 11/16/2022]
Abstract
We have assessed chromosome-type aberrations and micronuclei in the peripheral lymphocytes of personnel working with C-arm fluoroscopy, multi-slice CT-scan, lithotripsy, and digital radiology medical procedures. The study population comprised of 46 exposed workers and 35 controls matched for age, gender, and other confounding factors. Chromosome-type aberrations and micronuclei were analyzed and compared with occupational dosimetry data. The highest frequency of both chromosome aberrations (1.62 CA/100 cells) and MN (MN = 7.47 ± 2.55) was observed in the operating room group. According to occupational dosimetry, surgeons and medical staff received 0-2.99 mSv over the previous year, well below the limit established by the International Committee on Radiation Protection. An increased level of chromosomal aberrations was observed among workers exposed in the operating rooms. We recommend that operating room radiation safety programs be improved and better supervised, in particular for orthopedic surgeons and personnel performing fluoroscopically guided procedures.
Collapse
Affiliation(s)
- Mohsen Shafiee
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Sajad Borzoueisileh
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
| | - Razieh Rashidfar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Dehghan
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | | |
Collapse
|
195
|
Antunes L, Bento MJ, Sobrinho-Simões M, Soares P, Boaventura P. Cancer incidence after childhood irradiation for tinea capitis in a Portuguese cohort. Br J Radiol 2020; 93:20180677. [PMID: 31674803 PMCID: PMC6948089 DOI: 10.1259/bjr.20180677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Our aim was to compare cancer incidence in a cohort exposed in childhood (1950-63) to a therapeutic dose of radiation in the North of Portugal and followed-up until the end of 2012, with the incidence rates for the same age and sex in the general population. METHODS A population-based North Region cancer registry (RORENO) was used to assess which members of the cohort developed cancer. The association between radiation exposure and overall and specific cancer sites was evaluated using standardised incidence ratios (SIR). RESULTS Over the full follow-up period, 3357 individuals of the 5356 original tinea capitis (TC) cohort (63%) were retrieved in the RORENO, and 399 new cancer cases were identified, representing an increased risk of 49% when compared with the general population (SIR = 1.49; 95% CI: 1.35-1.64). The risk was slightly higher in males than in females (SIR = 1.65; 95% CI: 1.43-1.89 vs SIR = 1.35; CI = 1.17-1.55). The risk was slightly higher in the individuals exposed to a higher radiation dose (SIR = 1.78; 95% CI: 1.22-2.51 for ≥630 R vs SIR = 1.46; 95% CI: 1.31-1.62 for 325-475 R). In females, there was an excess cancer risk in all cancers with the higher radiation dose (SIR = 2.00; 95% CI: 1.21-3.13 for ≥630 R vs SIR = 1.30; 95% CI: 1.11-1.51 for 325-475 R) which was not observed in males, and for combined dose categories significantly raised SIRs for thyroid and head and neck cancer, suggesting a possible higher radiosensitivity of females. An increased risk was also observed for some cancers located far from the irradiated area. CONCLUSIONS The results suggest an association between radiation exposure and later increased cancer risk for cancers located near the radiation exposed area, mainly thyroid, and head and neck cancers. Further studies are necessary to disentangle possible non-radiation causes for distant cancers increased risk. ADVANCES IN KNOWLEDGE This paper shows a possible association between childhood X-ray epilation and increased risk of cancer which was not previously investigated in the Portuguese TC cohort.
Collapse
Affiliation(s)
- Luís Antunes
- North Region Cancer Registry of Portugal, Department of Epidemiology, Portuguese Oncology Institute of Porto (IPO Porto), Rua Dr. António Bernardino de Almeida North Region Cancer Registry of Portugal, 4200-072 Porto, Portugal
| | - Maria José Bento
- North Region Cancer Registry of Portugal, Department of Epidemiology, Portuguese Oncology Institute of Porto (IPO Porto), Rua Dr. António Bernardino de Almeida North Region Cancer Registry of Portugal, 4200-072 Porto, Portugal
| | | | | | | |
Collapse
|
196
|
Alagic Z, Bujila R, Enocson A, Srivastava S, Koskinen SK. Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects. Skeletal Radiol 2020; 49:531-539. [PMID: 31501959 PMCID: PMC7021773 DOI: 10.1007/s00256-019-03309-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. MATERIALS AND METHODS An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT. RESULTS In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4-3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 μSv, 95% CI 0.47-0.59 vs. 0.53 ± 0.43 μSv, 95% CI 0.54-0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1-8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8-10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities. CONCLUSIONS Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times.
Collapse
Affiliation(s)
- Zlatan Alagic
- Functional Unit for Musculoskeletal Radiology Function Imaging and Physiology, Karolinska University Hospital, Karolinska Vägen Solna, 17176 Stockholm, Sweden ,Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Robert Bujila
- Functional Unit for Medical Radiation Physics and Nuclear Medicine, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden ,Department of Physics, Royal Institute of Technology, Stockholm, Sweden
| | - Anders Enocson
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Subhash Srivastava
- Functional Unit for Musculoskeletal Radiology Function Imaging and Physiology, Karolinska University Hospital, Karolinska Vägen Solna, 17176 Stockholm, Sweden
| | - Seppo K. Koskinen
- Functional Unit for Musculoskeletal Radiology Function Imaging and Physiology, Karolinska University Hospital, Karolinska Vägen Solna, 17176 Stockholm, Sweden ,Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
197
|
Qu N, Graven-Nielsen T, Lindstrøm R, Blogg Andersen Dc V, Hirata RP. Recurrent neck pain patients exhibit altered joint motion pattern during cervical flexion and extension movements. Clin Biomech (Bristol, Avon) 2020; 71:125-132. [PMID: 31726402 DOI: 10.1016/j.clinbiomech.2019.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Impaired sensorimotor ability has been demonstrated in recurrent neck pain patients. It is however not clear if cervical joint motion and pressure pain sensitivity in recurrent neck pain patients are different from asymptomatic controls. METHODS Cervical flexion and extension motions were examined by video-fluoroscopy and pressure pain thresholds were assessed bilaterally over C2/C3, C5/C6 facet joints and right tibialis anterior in eighteen recurrent neck pain patients and eighteen healthy subjects. Individual joint motion was analyzed by dividing fluoroscopic videos into 10 epochs. The motion opposite to the primary direction (anti-directional motion) and motion along with the primary direction (pro-directional motion) of each joint were extracted across epochs. Total joint motion was the sum of anti-directional and pro-directional motions. Joint motion variability was represented by the variance of joint motions across epochs. FINDINGS Compared to controls, recurrent neck pain patients showed: 1) decreased anti-directional motion at C2/C3 and C3/C4 (P < 0.05) and increased anti-directional motion at C5/C6 and C6/C7 (P < 0.05) during extension motion. 2) Increased overall anti-direction motion during flexion motion (P < 0.05). 3) Lower joint motion variability at C3/C4 during extension motion (P < 0.05). INTERPRETATION Recurrent neck pain patients showed a redistribution of anti-directional motion between the middle cervical spine and the lower cervical spine during cervical extension and increased overall anti-directional motion during cervical flexion compared with healthy controls. The anti-directional motion was more sensitive to neck pain compared to other cervical joint motion parameters in the present study.
Collapse
Affiliation(s)
- Ning Qu
- SMI, Department of Health and Science Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health and Science Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Rene Lindstrøm
- SMI, Department of Health and Science Technology, Faculty of Medicine, Aalborg University, Denmark
| | | | - Rogerio Pessoto Hirata
- SMI, Department of Health and Science Technology, Faculty of Medicine, Aalborg University, Denmark.
| |
Collapse
|
198
|
Chang J, Cao J, Huang Z, Wang B, Sui T, Cao X. Comparison of the modified Wiltse's approach with spinal minimally invasive system and traditional approach for the therapy of thoracolumbar fracture. J Biomed Res 2020; 34:379-386. [PMID: 32934191 PMCID: PMC7540240 DOI: 10.7555/jbr.34.20200008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation. However, this procedure involves massive paraspinal muscle stripping, inflicting surgical trauma, and prolonged X-ray exposure. In this study, we observed 127 patients with single-segment injury thoracolumbar fractures. Thirty-six patients were treated by the modified Wiltse's paraspinal approach with minimally invasive channel system, while 91 patients were treated via traditional posterior approach. Operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, screw placement accuracy, visual analogue scale score, and Cobb's angle of two groups were compared. The X-ray exposure times were notably reduced (4.2±1.6) in the new approach group (P<0.05). The pedicle screw placement accuracy and Cobb's angle after surgery were similar in the two groups. We conclude that modified Wiltse's paraspinal approach with spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.
Collapse
Affiliation(s)
| | | | | | - Boyao Wang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Tao Sui
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaojian Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| |
Collapse
|
199
|
A H P, S M R A, T B, M G, M M. Dosimetry of Occupational Radiation around Panoramic X-ray Apparatus. J Biomed Phys Eng 2019; 9:525-532. [PMID: 31750266 PMCID: PMC6820020 DOI: 10.31661/jbpe.v0i0.466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/20/2015] [Indexed: 11/16/2022]
Abstract
Background: Panoramic imaging is one of the most common imaging methods in dentistry. Regarding the side-effects of ionizing radiation, it is necessary to survey different aspects and details of panoramic imaging. In this study, we compared the absorbed x-ray dose around two panoramic x-ray units: PM 2002 CC Proline (Planmeca, Helsinki, Finland) and Cranex Tome (Soredex, Helsinki, Finland).
Materials and Methods: In this cross-sectional study, 15 thermoluminescet dosemeters (TLD-100) were placed in 3 semi-circles of 40cm, 80cm and 120cm radii in order to estimate x-ray dose. Around each unit, the number of TLDs in each semi-circle was 5 with equal intervals. The center of semicircles accords with the patient’s position. Each TLD was exposed 40 times. These dosemeters were read out with a Harshaw Model 4000 TLD Reader (USA). The calibration processing and the reading of dosemeters were performed by the Atomic Energy Organization of Iran.
Results: The mean absorbed dose in three lines of PM 2002 CC Proline was 123.2±15.1, 118.0±11.0 and 108.0±9.1 µSv, (p=0.013). The results were 140.4±15.2, 120.2±10.4 and 111.6±11.2 µSv in Cranex Tome (p=0.208), which reveals no significant difference between two systems.
Conclusion: There are no significant differences between the mean absorbed dose of surveyed models in panoramic imaging by two units (PM 2002 CC Proline and Cranex Tome). These results were less than occupational exposure recommended by ICRP, even at the highest calculated doses.
Collapse
Affiliation(s)
- Pakravan A H
- MD, Department of Prosthodontics, Faculty of Dentistry, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Aghamiri S M R
- PhD, Department of Radiation Medicine, Shahid Beheshti University, Tehran, Iran
| | - Bamdadian T
- MD, Department of Prosthesis, Faculty of Dentistry, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Gholami M
- PhD, Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- PhD, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moshfeghi M
- MD, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
200
|
Joo HM, Hong EH, Cho SJ, Nam SY, Kim JY. Preventative and Therapeutic Effects of Low-dose Ionizing Radiation on the Allergic Response of Rat Basophilic Leukemia Cells. Sci Rep 2019; 9:16079. [PMID: 31695078 PMCID: PMC6834612 DOI: 10.1038/s41598-019-52399-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 10/07/2019] [Indexed: 12/12/2022] Open
Abstract
The prevalence of allergies has increased over the last four decades. In allergic reactions, mast cells induce a hypersensitive immune response to a substance that is normally harmless. Ionizing radiation has different biological effects depending on the dose and dose rate. In this study, we investigated whether low-dose irradiation before (preventative effect) or after (therapeutic effect) an antigen-antibody reaction has an anti-allergic effect. To test this, we activated rat basophilic leukemia (RBL-2H3) mast cells with anti-2,4-dinitrophenyl IgE (antibody) and 2,4-dinitrophenyl human serum albumin, which served as an antigen. To test for both the potential of a preventative effect and a therapeutic effect, we irradiated mast cells both before and after mast cell activation, and we measured mediator release and signaling pathway activity. Low-dose ionizing radiation suppressed mediator release from RBL-2H3 mast cells activated by the antigen-antibody reaction regardless of when the mast cells were irradiated. These results were due to the suppression of FcεRI expression. Therefore, we suggest that low-dose ionizing radiation has a preventative and therapeutic effect in allergic reactions via the FcεRI-mediated RBL-2H3 mast cell activation system.
Collapse
Affiliation(s)
- Hae Mi Joo
- Radiation Health Institute, Korea Hydro & Nuclear Power Co., Ltd, Seoul, 132-703, Republic of Korea
| | - Eun Hee Hong
- Radiation Health Institute, Korea Hydro & Nuclear Power Co., Ltd, Seoul, 132-703, Republic of Korea
| | - Seong-Jun Cho
- Radiation Health Institute, Korea Hydro & Nuclear Power Co., Ltd, Seoul, 132-703, Republic of Korea
| | - Seon Young Nam
- Radiation Health Institute, Korea Hydro & Nuclear Power Co., Ltd, Seoul, 132-703, Republic of Korea
| | - Ji Young Kim
- Radiation Health Institute, Korea Hydro & Nuclear Power Co., Ltd, Seoul, 132-703, Republic of Korea.
| |
Collapse
|