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Negre M, Agramunt S, Ferran N, Paredes P. Update on radiation protection of the thyroid gland. Rev Esp Med Nucl Imagen Mol 2024; 43:500026. [PMID: 38950775 DOI: 10.1016/j.remnie.2024.500026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/28/2024] [Indexed: 07/03/2024]
Abstract
In recent years, concern about the effects of ionizing radiation on exposed individuals has led to the need to regulate and quantify the use of diagnostic and therapeutic techniques. Geopolitical events in recent times have also increased the population's perception of insecurity regarding ionizing radiation, and we increasingly face patients reluctant to undergo certain types of scans in our nuclear medicine services and, albeit less frequently, in radiology services. This article aims to summarise the extent to which ionizing radiation is present in our daily lives and how diagnostic and therapeutic procedures can affect our health, particularly from the perspective of their effects on the thyroid gland, one of the body's most radiation-sensitive organs.
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Affiliation(s)
- M Negre
- Servicio de Medicina Nuclear IDI-Girona, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - S Agramunt
- Servicio de Protección Radiológica, ICO Girona, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - N Ferran
- Servicio de Medicina Nuclear IDI-Girona, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - P Paredes
- Servicio de Medicina Nuclear, Hospital Clínic Barcelona, Barcelona, Spain; Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain.
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Cicone F, Sjögreen Gleisner K, Sarnelli A, Indovina L, Gear J, Gnesin S, Kraeber-Bodéré F, Bischof Delaloye A, Valentini V, Cremonesi M. The contest between internal and external-beam dosimetry: The Zeno's paradox of Achilles and the tortoise. Phys Med 2024; 117:103188. [PMID: 38042710 DOI: 10.1016/j.ejmp.2023.103188] [Citation(s) in RCA: 1] [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: 09/18/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023] Open
Abstract
Radionuclide therapy, also called molecular radiotherapy (MRT), has come of age, with several novel radiopharmaceuticals being approved for clinical use or under development in the last decade. External beam radiotherapy (EBRT) is a well-established treatment modality, with about half of all oncologic patients expected to receive at least one external radiation treatment over their disease course. The efficacy and the toxicity of both types of treatment rely on the interaction of radiation with biological tissues. Dosimetry played a fundamental role in the scientific and technological evolution of EBRT, and absorbed doses to the target and to the organs at risk are calculated on a routine basis. In contrast, in MRT the usefulness of internal dosimetry has long been questioned, and a structured path to include absorbed dose calculation is missing. However, following a similar route of development as EBRT, MRT treatments could probably be optimized in a significant proportion of patients, likely based on dosimetry and radiobiology. In the present paper we describe the differences and the similarities between internal and external-beam dosimetry in the context of radiation treatments, and we retrace the main stages of their development over the last decades.
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Affiliation(s)
- Francesco Cicone
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy; Nuclear Medicine Unit, "Mater Domini" University Hospital, Catanzaro, Italy.
| | | | - Anna Sarnelli
- Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Luca Indovina
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden NHSFT & Institute of Cancer Research, Sutton, UK
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland; University of Lausanne, Lausanne, Switzerland
| | - Françoise Kraeber-Bodéré
- Nantes Université, Université Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Médecine Nucléaire, F-44000 Nantes, France
| | | | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marta Cremonesi
- Unit of Radiation Research, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Saldarriaga Vargas C, Andersson M, Bouvier-Capely C, Li WB, Madas B, Covens P, Struelens L, Strigari L. Heterogeneity of absorbed dose distribution in kidney tissues and dose–response modelling of nephrotoxicity in radiopharmaceutical therapy with beta-particle emitters: A review. Z Med Phys 2023:S0939-3889(23)00037-5. [PMID: 37031068 DOI: 10.1016/j.zemedi.2023.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 04/08/2023]
Abstract
Absorbed dose heterogeneity in kidney tissues is an important issue in radiopharmaceutical therapy. The effect of absorbed dose heterogeneity in nephrotoxicity is, however, not fully understood yet, which hampers the implementation of treatment optimization by obscuring the interpretation of clinical response data and the selection of optimal treatment options. Although some dosimetry methods have been developed for kidney dosimetry to the level of microscopic renal substructures, the clinical assessment of the microscopic distribution of radiopharmaceuticals in kidney tissues currently remains a challenge. This restricts the anatomical resolution of clinical dosimetry, which hinders a thorough clinical investigation of the impact of absorbed dose heterogeneity. The potential of absorbed dose-response modelling to support individual treatment optimization in radiopharmaceutical therapy is recognized and gaining attraction. However, biophysical modelling is currently underexplored for the kidney, where particular modelling challenges arise from the convolution of a complex functional organization of renal tissues with the function-mediated dose distribution of radiopharmaceuticals. This article reviews and discusses the heterogeneity of absorbed dose distribution in kidney tissues and the absorbed dose-response modelling of nephrotoxicity in radiopharmaceutical therapy. The review focuses mainly on the peptide receptor radionuclide therapy with beta-particle emitting somatostatin analogues, for which the scientific literature reflects over two decades of clinical experience. Additionally, detailed research perspectives are proposed to address various identified challenges to progress in this field.
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Kiragga F, Erem G, Kisembo H, Mayanja JMK, Mubuuke AG, Nankya E, Nalwoga K. Typical Diagnostic Reference Levels of Common Indications for Computed Tomography Scans Among Adult Patients in Uganda: a Cross-sectional Study. RESEARCH SQUARE 2023:rs.3.rs-2683913. [PMID: 36993740 PMCID: PMC10055658 DOI: 10.21203/rs.3.rs-2683913/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Background Medical exposure to ionizing radiation has increased due to an increase in the number of computerized tomography (CT) scan examinations performed. The International Commission on Radiological Protection (ICRP) recommends indication-based diagnostic reference levels (IB-DRLs) as an effective tool that aids in optimizing CT scan radiation doses. In many low-income settings, there is a lack of IB-DRLs to support optimization of radiation doses. Objective To establish typical DRLs for common CT scan indications among adult patients in Kampala, Uganda. Methodology A cross sectional study design was employed involving 337 participants enrolled from three hospitals using systematic sampling. The participants were adults who had been referred for a CT scan. The typical DRL of each indication was determined as the median value of the pooled distribution of CTDIvol (mGy) data and the median value of the pooled distribution of total DLP (tDLP)(mGy.cm) data from three hospitals. Comparison was made to anatomical, and indication based DRLs from other studies. Results 54.3% of the participants were male. The following were typical DRLs for: acute stroke (30.17mGy and 653mGy.cm); head trauma (32.04mGy and 878mGy.cm); interstitial lung diseases/ high resolution chest CT scan (4.66mGy and 161mGy.cm); pulmonary embolism (5.03mGy and 273mGy.cm); abdominopelvic lesion (6.93mGy and 838mGy.cm) and urinary calculi (7.61mGy and 975mGy.cm). Indication based total Dose Length Product (tDLP) DRLs was lower than tDLP DRLs of a whole anatomical region by 36.4% on average. Most of the developed typical IB-DLP DRLs were lower or comparable to values from studies in Ghana and Egypt in all indications besides urinary calculi while they were higher than values in a French study in all indications besides acute stroke and head trauma. Conclusion Typical IB-DRLs is a good clinical practice tool for optimization of CT doses and therefore recommended for use to manage CT radiation dose. The developed IB-DRLs varied from international values due to differences in selection of CT scan parameters and standardization of CT imaging protocols may narrow the variation. This study can serve as baseline for establishment of national indication-based CT DRLs in Uganda.
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Pouget JP, Konijnenberg M, Eberlein U, Glatting G, Gabina PM, Herrmann K, Holm S, Strigari L, van Leeuwen FWB, Lassmann M. An EANM position paper on advancing radiobiology for shaping the future of nuclear medicine. Eur J Nucl Med Mol Imaging 2023; 50:242-246. [PMID: 36066665 PMCID: PMC9816280 DOI: 10.1007/s00259-022-05934-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jean-Pierre Pouget
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 208 Rue des Apothicaires, 34298, Montpellier, France.
| | - Mark Konijnenberg
- Radiology & Nuclear Medicine Department, Erasmus MC, Rotterdam, The Netherlands
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | | | - Pablo Minguez Gabina
- Department of Medical Physics and Radiation Protection, Gurutzeta-Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Søren Holm
- Department of Nuclear Medicine, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
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Rainford L, Santos J, Alves F, Figueiredo JP, Hoeschen C, Damilakis J, Frija G, Andersson J, McNulty J, Foley S, Bacher K, Nestle U, Hierath M, Paulo G. Education and training in radiation protection in Europe: an analysis from the EURAMED rocc-n-roll project. Insights Imaging 2022; 13:142. [PMID: 36057698 PMCID: PMC9440860 DOI: 10.1186/s13244-022-01271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background A Strengths, weaknesses, opportunities and threats analysis was performed to understand the status quo of education and training in radiation protection (RP) and to develop a coordinated European approach to RP training needs based on stakeholder consensus and existing activities in the field. Fourteen team members represented six European professional societies, one European voluntary organisation, two international healthcare organisations and five professions, namely: Medical Physicists; Nuclear Medicine Physicians; Radiologists; Radiation Oncologists and Radiographers. Four subgroups analysed the “Strengths”, “Weaknesses”, “Opportunities” and “Threats” related to E&T in RP developed under previous European Union (EU) programmes and on the Guidelines on Radiation Protection Education and Training of Medical Professionals in the EU.
Results Consensus agreement identified four themes for strengths and opportunities, namely: (1) existing structures and training recommendations; (2) RP training needs assessment and education & training (E&T) model(s) development; (3) E&T dissemination, harmonisation, and accreditation; (4) financial supports. Weaknesses and Threats analysis identified two themes: (1) awareness and prioritisation at a national/global level and (2) awareness and prioritisation by healthcare professional groups and researchers. Conclusions A lack of effective implementation of RP principles in daily practice was identified. EuRnR strategic planning needs to consider processes at European, national and local levels. Success is dependent upon efficient governance structures and expert leadership. Financial support is required to allow the stakeholder professional agencies to have sufficient resources to achieve a pan European radiation protection training network which is sustainable and accredited across multiple national domains.
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Affiliation(s)
- Louise Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Room A201, UCD Health Science Centre, Belfield Campus, Dublin 4, Ireland.
| | - Joana Santos
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Coimbra, Portugal
| | - Francisco Alves
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Coimbra, Portugal
| | - João Paulo Figueiredo
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Coimbra, Portugal
| | - Christoph Hoeschen
- Institute of Medical Technology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | | | | | - Jonas Andersson
- Department of Radiation Sciences, Radiation Physics, Umeå, Sweden
| | - Jonathan McNulty
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Room A201, UCD Health Science Centre, Belfield Campus, Dublin 4, Ireland
| | - Shane Foley
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Room A201, UCD Health Science Centre, Belfield Campus, Dublin 4, Ireland
| | - Klaus Bacher
- Division of Medical Physics, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany.,Department of Radiation Oncology, University Hospital Freiburg, Freiburg im Breisgau, Germany
| | - Monika Hierath
- European Institute for Biomedical Imaging Research (EIBIR), Vienna, Austria
| | - Graciano Paulo
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Coimbra, Portugal
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Bockhold S, Foley SJ, Rainford LA, Corridori R, Eberstein A, Hoeschen C, Konijnenberg MW, Molyneux-Hodgson S, Paulo G, Santos J, McNulty JP. Exploring the translational challenge for medical applications of ionising radiation and corresponding radiation protection research. J Transl Med 2022; 20:137. [PMID: 35303930 PMCID: PMC8932076 DOI: 10.1186/s12967-022-03344-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/06/2022] [Indexed: 01/19/2023] Open
Abstract
Background Medical applications of ionising radiation and associated radiation protection research often encounter long delays and inconsistent implementation when translated into clinical practice. A coordinated effort is needed to analyse the research needs for innovation transfer in radiation-based high-quality healthcare across Europe which can inform the development of an innovation transfer framework tailored for equitable implementation of radiation research at scale. Methods Between March and September 2021 a Delphi methodology was employed to gain consensus on key translational challenges from a range of professional stakeholders. A total of three Delphi rounds were conducted using a series of electronic surveys comprised of open-ended and closed-type questions. The surveys were disseminated via the EURAMED Rocc-n-Roll consortium network and prominent medical societies in the field. Approximately 350 professionals were invited to participate. Participants’ level of agreement with each generated statement was captured using a 6-point Likert scale. Consensus was defined as median ≥ 4 with ≥ 60% of responses in the upper tertile of the scale. Additionally, the stability of responses across rounds was assessed. Results In the first Delphi round a multidisciplinary panel of 20 generated 127 unique statements. The second and third Delphi rounds recruited a broader sample of 130 individuals to rate the extent to which they agreed with each statement as a key translational challenge. A total of 60 consensus statements resulted from the iterative Delphi process of which 55 demonstrated good stability. Ten statements were identified as high priority challenges with ≥ 80% of statement ratings either ‘Agree’ or ‘Strongly Agree’. Conclusion A lack of interoperability between systems, insufficient resources, unsatisfactory education and training, and the need for greater public awareness surrounding the benefits, risks, and applications of ionising radiation were identified as principal translational challenges. These findings will help to inform a tailored innovation transfer framework for medical radiation research. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03344-4.
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Affiliation(s)
- Sophie Bockhold
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Shane J Foley
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Louise A Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | | | | | - Christoph Hoeschen
- Institute of Medical Engineering, Otto Von Guericke Universität Magdeburg, Magdeburg, Germany
| | - Mark W Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
| | | | - Graciano Paulo
- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Coimbra, Coimbra, Portugal
| | - Joana Santos
- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Coimbra, Coimbra, Portugal
| | - Jonathan P McNulty
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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Glasow A, Patties I, Priest ND, Mitchel REJ, Hildebrandt G, Manda K. Dose and Dose Rate-Dependent Effects of Low-Dose Irradiation on Inflammatory Parameters in ApoE-Deficient and Wild Type Mice. Cells 2021; 10:3251. [PMID: 34831473 PMCID: PMC8625495 DOI: 10.3390/cells10113251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 12/14/2022] Open
Abstract
Anti-inflammatory low-dose therapy is well established, whereas the immunomodulatory impact of doses below 0.1 Gy is much less clear. In this study, we investigated dose, dose rate and time-dependent effects in a dose range of 0.005 to 2 Gy on immune parameters after whole body irradiation (IR) using a pro-inflammatory (ApoE-/-) and a wild type mouse model. Long-term effects on spleen function (proliferation, monocyte expression) were analyzed 3 months, and short-term effects on immune plasma parameters (IL6, IL10, IL12p70, KC, MCP1, INFγ, TGFβ, fibrinogen, sICAM, sVCAM, sE-selectin/CD62) were analyzed 1, 7 and 28 days after Co60 γ-irradiation (IR) at low dose rate (LDR, 0.001 Gy/day) and at high dose rate (HDR). In vitro measurements of murine monocyte (WEHI-274.1) adhesion and cytokine release (KC, MCP1, IL6, TGFβ) after low-dose IR (150 kV X-ray unit) of murine endothelial cell (EC) lines (H5V, mlEND1, bEND3) supplement the data. RT-PCR revealed significant reduction of Ki67 and CD68 expression in the spleen of ApoE-/- mice after 0.025 to 2 Gy exposure at HDR, but only after 2 Gy at LDR. Plasma levels in wild type mice, showed non-linear time-dependent induction of proinflammatory cytokines and reduction of TGFβ at doses as low as 0.005 Gy at both dose rates, whereas sICAM and fibrinogen levels changed in a dose rate-specific manner. In ApoE-/- mice, levels of sICAM increased and fibrinogen decreased at both dose rates, whereas TGFβ increased mainly at HDR. Non-irradiated plasma samples revealed significant age-related enhancement of cytokines and adhesion molecules except for sICAM. In vitro data indicate that endothelial cells may contribute to systemic IR effects and confirm changes of adhesion properties suggested by altered sICAM plasma levels. The differential immunomodulatory effects shown here provide insights in inflammatory changes occurring at doses far below standard anti-inflammatory therapy and are of particular importance after diagnostic and chronic environmental exposures.
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Affiliation(s)
- Annegret Glasow
- Department of Radiation Oncology, University of Leipzig, 04103 Leipzig, Germany;
| | - Ina Patties
- Department of Radiation Oncology, University of Leipzig, 04103 Leipzig, Germany;
| | - Nicholas D. Priest
- Département de Chimie, Université Laval, Québec, QC G1V 0A6, Canada;
- Radiological Protection Research and Instrumentation Branch, Canadian Nuclear Laboratories (Retired), Chalk River, ON K0J 1J0, Canada;
| | - Ronald E. J. Mitchel
- Radiological Protection Research and Instrumentation Branch, Canadian Nuclear Laboratories (Retired), Chalk River, ON K0J 1J0, Canada;
| | - Guido Hildebrandt
- Department of Radiation Oncology, University of Rostock, 18059 Rostock, Germany; (G.H.); (K.M.)
| | - Katrin Manda
- Department of Radiation Oncology, University of Rostock, 18059 Rostock, Germany; (G.H.); (K.M.)
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Taprogge J, Carnegie-Peake L, Murray I, Gear JI, Flux GD. Adjustment of the iodine ICRP population pharmacokinetic model for the use in thyroid cancer patients after thyroidectomy. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:1034-1044. [PMID: 34261047 DOI: 10.1088/1361-6498/ac149a] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
Biokinetic models developed for healthy humans are not appropriate to describe biokinetics in thyroid cancer patients following thyroidectomy. The aim of this study was to adjust the population model for iodine proposed by the International Commission on Radiological Protection (ICRP) for the use in these patients. Rate constants of the ICRP publication 128 model for iodine were adjusted using the population modelling software package Monolix to describe activity retention in whole-body, thyroid, blood and protein-bound iodine observed in 23 patients. The new set of rate constants was compared to the four uptake scenarios proposed in ICRP publication 128. Flow from the inorganic iodide in blood compartment into the first thyroid compartment decreases to 0.15 d-1compared to a value of 7.27 d-1for the ICRP publication 128 model with a medium uptake. The transfer from first to second thyroid compartments and the outflow from the second thyroid compartment increases. An increased turnover rate of extrathyroidal organic iodine is observed. The rate constant from inorganic iodide in blood to kidney was also adjusted. Overall a good agreement was found between the adjusted model and the activity retention in thyroid cancer patients. The adjustment of population pharmacokinetic models to describe the biokinetic properties of specific patient populations for therapeutic radiopharmaceuticals is essential to capture the changes in biokinetics. The proposed set of rate constants for the established ICRP publication 128 model can be used to more accurately assess radiation protection requirements for the treatment of thyroid cancer patients using radioiodine.
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Affiliation(s)
- Jan Taprogge
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton SM2 5PT, United Kingdom
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - Lily Carnegie-Peake
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton SM2 5PT, United Kingdom
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - Iain Murray
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton SM2 5PT, United Kingdom
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - Jonathan I Gear
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton SM2 5PT, United Kingdom
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
| | - Glenn D Flux
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton SM2 5PT, United Kingdom
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, United Kingdom
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10
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Rühm W, Cool D, Clement C. Radiological protection revisited-the story continues. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:507-510. [PMID: 34671853 PMCID: PMC8551099 DOI: 10.1007/s00411-021-00949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/07/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Werner Rühm
- Helmholtz Center Munich, Institute of Radiation Medicine, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
| | - Donald Cool
- Vice Chair, International Commission on Radiological Protection, Charlotte, NC, USA
| | - Christopher Clement
- Scientific Secretary, International Commission on Radiological Protection, Ottawa, Canada
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11
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Aerts A, Eberlein U, Holm S, Hustinx R, Konijnenberg M, Strigari L, van Leeuwen FWB, Glatting G, Lassmann M. EANM position paper on the role of radiobiology in nuclear medicine. Eur J Nucl Med Mol Imaging 2021; 48:3365-3377. [PMID: 33912987 PMCID: PMC8440244 DOI: 10.1007/s00259-021-05345-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 12/16/2022]
Abstract
With an increasing variety of radiopharmaceuticals for diagnostic or therapeutic nuclear medicine as valuable diagnostic or treatment option, radiobiology plays an important role in supporting optimizations. This comprises particularly safety and efficacy of radionuclide therapies, specifically tailored to each patient. As absorbed dose rates and absorbed dose distributions in space and time are very different between external irradiation and systemic radionuclide exposure, distinct radiation-induced biological responses are expected in nuclear medicine, which need to be explored. This calls for a dedicated nuclear medicine radiobiology. Radiobiology findings and absorbed dose measurements will enable an improved estimation and prediction of efficacy and adverse effects. Moreover, a better understanding on the fundamental biological mechanisms underlying tumor and normal tissue responses will help to identify predictive and prognostic biomarkers as well as biomarkers for treatment follow-up. In addition, radiobiology can form the basis for the development of radiosensitizing strategies and radioprotectant agents. Thus, EANM believes that, beyond in vitro and preclinical evaluations, radiobiology will bring important added value to clinical studies and to clinical teams. Therefore, EANM strongly supports active collaboration between radiochemists, radiopharmacists, radiobiologists, medical physicists, and physicians to foster research toward precision nuclear medicine.
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Affiliation(s)
- An Aerts
- Radiobiology Unit, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Uta Eberlein
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany.
| | - Sören Holm
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, GIGA-CRC in vivo Imaging, University of Liège, Liège, Belgium
| | - Mark Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Lidia Strigari
- Medical Physics Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerhard Glatting
- Medical Radiation Physics, Department of Nuclear Medicine, Ulm University, Ulm, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
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Botwe BO, Schandorf C, Inkoom S, Faanu A, Rolstadaas L, Goa PE. National indication-based diagnostic reference level values in computed tomography: Preliminary results from Ghana. Phys Med 2021; 84:274-284. [PMID: 33775566 DOI: 10.1016/j.ejmp.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/09/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This study was conducted to develop national indication-based DRL values for common indications of adult computed tomography (CT) examinations for clinical application in Ghana. MATERIALS AND METHODS The methodological approach recommended by the International Commission on Radiological Protection (ICRP), Publication 135, for the development of DRLs, was employed. Studies on CT infrastructure, common indications and quality control tests were first undertaken. A sample of 20 CT dose descriptor/quantity data sets were collected from each centre for each indication. Overall, 3960 data sets were collected for all identified common indications from 71.4% of the total CT scanners in Ghana (25/35). The data were collected from image folders reported and accepted by radiologists. The objective image quality was assessed through a signal to noise ratio (SNR) analysis prior to using the data and extracting DRL values. RESULTS Clinical indications and their respective DRL values in terms of volume weighted CT dose index (CTDIvol) and dose length product (DLP) were cerebrovascular accident (CVA)/stroke (77 mGy; 1313 mGy.cm), head trauma/injury (76 mGy; 1596 mGy.cm), brain tumour/space occupying lesion (SOL) (77 mGy; 2696 mGy.cm), lung tumour/cancer (12 mGy; 828 mGy.cm) and chest lesion with chronic kidney disease (CKD) (13 mGy; 467 mGy.cm). Others were abdominopelvic lesion (17 mGy; 1299 mGy.cm), kidney stones (15 mGy; 731 mGy.cm), urothelial malignancy/CT-intravenous urogram (CT-IVU) (11 mGy; 1449 mGy.cm) and pulmonary embolism (PE) (14 mGy; 942 mGy.cm). CONCLUSION National Indication-based DRL values developed in this study are recommended to be used to manage CT radiation dose in Ghana.
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Affiliation(s)
- Benard Ohene Botwe
- Radiography Department, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu Campus, Accra, Ghana; Department of Nuclear Safety and Security, School of Nuclear and Allied Sciences, University of Ghana, Atomic Campus, Accra, Legon, Ghana.
| | - Cyril Schandorf
- Department of Nuclear Safety and Security, School of Nuclear and Allied Sciences, University of Ghana, Atomic Campus, Accra, Legon, Ghana
| | - Stephen Inkoom
- Medical Physics Department, School of Nuclear and Allied Sciences, University of Ghana, Atomic Campus, Accra, Ghana; Radiation Protection Institute (RPI), Ghana Atomic Energy Commission, Accra, Ghana
| | - Augustine Faanu
- Radiological and Non-ionizing Radiation Directorate, Nuclear Regulatory Authority, Accra, Ghana
| | - Linn Rolstadaas
- Clinic of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Pål Erik Goa
- Clinic of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway; Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
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Dabin J, Blidéanu V, Ciraj Bjelac O, Deleu M, De Monte F, Feghali JA, Gallagher A, Knežević Ž, Maccia C, Malchair F, Sans Merce M, Simantirakis G. Accuracy of skin dose mapping in interventional cardiology: Comparison of 10 software products following a common protocol. Phys Med 2021; 82:279-294. [PMID: 33706118 DOI: 10.1016/j.ejmp.2021.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Online and offline software products can estimate the maximum skin dose (MSD) delivered to the patient during interventional cardiology procedures. The capabilities and accuracy of several skin dose mapping (SDM) software products were assessed on X-ray systems from the main manufacturers following a common protocol. METHODS Skin dose was measured on four X-ray systems following a protocol composed of nine fundamental irradiation set-ups and three set-ups simulating short, clinical procedures. Dosimeters/multimeters with semiconductor-based detectors, radiochromic films and thermoluminescent dosimeters were used. Results were compared with up to eight of 10 SDM products, depending on their compatibility. RESULTS The MSD estimates generally agreed with the measurements within ± 40% for fundamental irradiation set-ups and simulated procedures. Only three SDM products provided estimates within ± 40% for all tested configurations on at least one compatible X-ray system. No SDM product provided estimates within ± 40% for all combinations of configurations and compatible systems. The accuracy of the MSD estimate for lateral irradiations was variable and could be poor (up to 66% underestimation). Most SDM products produced maps which qualitatively represented the dimensions, the shape and the relative position of the MSD region. Some products, however, missed the MSD region when situated at the intersection of multiple fields, which is of radiation protection concern. CONCLUSIONS It is very challenging to establish a common protocol for quality control (QC) and acceptance testing because not all information necessary for accurate MSD calculation is available or standardised in the radiation dose structured reports (RDSRs).
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Affiliation(s)
- Jérémie Dabin
- Belgian Nuclear Research Centre (SCK CEN), Boeretang 200, 2400 Mol, Belgium.
| | - Valentin Blidéanu
- Commissariat à l'Energie Atomique (CEA), CEA-Saclay, 91191 Gif-sur-Yvette, France
| | - Olivera Ciraj Bjelac
- University of Belgrade, Vinca Institute of Nuclear Sciences and School of Electrical Engineering (VINCA), M .P. Alasa 12-14, 11351 Vinca, Serbia
| | - Marine Deleu
- University Hospital of Geneva (HUG), Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland; University Hospital of Lausanne (CHUV), Rue du Grand Pré 1, 1007 Lausanne, Switzerland
| | - Francesca De Monte
- Veneto Institute of Oncology IOV - IRCCS (IOV), Via Gattamelata 64, 35128 Padua, Italy
| | - Joëlle Ann Feghali
- Department of Radiology, Bicêtre University Hospital, 94270 Le Kremlin-Bicêtre, France
| | - Aoife Gallagher
- University Hospital Limerick (UHL), St. Nessan's Road, Dooradoyle, V94135 Limerick, Ireland
| | - Željka Knežević
- Ruđer Bošković Institute (RBI), Bijenicka 54, 10000 Zagreb, Croatia
| | - Carlo Maccia
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé (CAATS), 119-121 Grande Rue, 92310 Sèvres, France
| | - Françoise Malchair
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé (CAATS), 119-121 Grande Rue, 92310 Sèvres, France
| | - Marta Sans Merce
- University Hospital of Geneva (HUG), Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland; University Hospital of Lausanne (CHUV), Rue du Grand Pré 1, 1007 Lausanne, Switzerland
| | - George Simantirakis
- Greek Atomic Energy Commission (EEAE), P. Grigoriou & Neapoleos, 15341 Athens, Greece
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Grosser OS, Wissel H, Klopfleisch M, Kupitz D, Paetzold N, Pech M, Kreissl MC. Time course and local distribution of skin exposure of hand and fingers from [68Ga]Ga-DOTA-NOC synthesis using a self-shielded module. Nuklearmedizin 2020; 59:308-315. [PMID: 32215881 DOI: 10.1055/a-1134-4374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM The study examined the local dose distribution as well as the time course of skin exposure of hand and fingers from [68Ga]Ga-DOTA-NOC synthesis using a self-shielded synthesis module. METHODS A compact calibrated electronic dosimeter (ED) with a miniaturized probe was used for real-time measurements of skin dose equivalent Hp (0.07) (reference point: left and right index finger). A time resolved assessment of exposure during radiotracer production was performed. Additionally, thermoluminescence dosimeters (TLD) were used to determine local dose distribution for five different positions (e. g. fingertips). Cumulated Hp (0.07) estimated by ED was analysed and correlated with the measurements obtained by a TLD positioned close to the ED. RESULTS The cumulative skin exposure from the production process measured by ED, was 74.7 ± 32.7 µSv/GBq and 40.1 ± 14.3 µSv/GBq for the right and left hand, respectively. The exposure recorded by the ED was in the average 19.4 % ± 40.0 % (median = 21.3 %) lower compared to the results from TLD. Highest exposure was recorded during synthesis (guided hand: 24.5 ± 12.2 µSv/GBq) and measuring of product yield including preparation of probes for quality control (guided hand: 36.1 ± 12.7 µSv/GBq). The highest local exposure was measured by a TLD close to the tip of the index finger of the guiding hand (range: 773-1257 µS/GBq). CONCLUSION The chosen methodology using ED, proved to be a good concept for identifying procedure steps with an increased exposure level and to determine the time course of skin exposure and to identify procedure steps for further optimization of handling. Furthermore, miniaturized electronic dosimeters may be used for online surveillance of local exposure rates at hands and fingers.
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Affiliation(s)
- Oliver Stephan Grosser
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
| | - Heiko Wissel
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
| | - Maurice Klopfleisch
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
| | - Dennis Kupitz
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
| | - Nadine Paetzold
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
- Second Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Michael C Kreissl
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
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Schmitz D, Vogl T, Nour-Eldin NEA, Radeleff B, Kröger JC, Mahnken AH, Ittrich H, Gehl HB, Plessow B, Böttcher J, Tacke J, Wispler M, Rosien U, Schorr W, Joerdens M, Glaser N, Fuchs ES, Tal A, Friesenhahn-Ochs B, Leimbach T, Höpner L, Weber M, Gölder S, Böhmig M, Hetjens S, Rudi J, Schegerer A. Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study. Eur Radiol 2019; 29:3390-3400. [PMID: 31016441 DOI: 10.1007/s00330-019-06208-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/20/2019] [Accepted: 03/27/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Percutaneous biliary interventions (PBIs) can be associated with a high patient radiation dose, which can be reduced when national diagnostic reference levels (DRLs) are kept in mind. The aim of this multicentre study was to investigate patient radiation exposure in different percutaneous biliary interventions, in order to recommend national DRLs. METHODS A questionnaire asking for the dose area product (DAP) and the fluoroscopy time (FT) in different PBIs with ultrasound- or fluoroscopy-guided bile duct punctures was sent to 200 advanced care hospitals. Recommended national DRLs are set at the 75th percentile of all DAPs. RESULTS Twenty-three facilities (9 interventional radiology depts. and 14 gastroenterology depts.) returned the questionnaire (12%). Five hundred sixty-five PBIs with 19 different interventions were included in the analysis. DAPs (range 4-21,510 cGy·cm2) and FTs (range 0.07-180.33 min) varied substantially depending on the centre and type of PBI. The DAPs of initial PBIs were significantly (p < 0.0001) higher (median 2162 cGy·cm2) than those of follow-up PBIs (median 464 cGy·cm2). There was no significant difference between initial PBIs with ultrasound-guided bile duct puncture (2162 cGy·cm2) and initial PBIs with fluoroscopy-guided bile duct puncture (2132 cGy·cm2) (p = 0.85). FT varied substantially (0.07-180.33 min). CONCLUSIONS DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. PBI with US-guided bile duct puncture did not reduce DAP, when compared to PBI with fluoroscopy-guided bile duct puncture. National DRLs of 4300 cGy·cm2 for initial PBIs and 1400 cGy·cm2 for follow-up PBIs are recommended. KEY POINTS • DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. • PBI with US-guided bile duct puncture did not reduce DAP when compared to PBI with fluoroscopy-guided bile duct puncture. • DRLs of 4300 cGy·cm2for initial PBIs (establishing a transhepatic tract) and 1400 cGy·cm2for follow-up PBIs (transhepatic tract already established) are recommended.
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Affiliation(s)
- Daniel Schmitz
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and St. Hedwig Hospital, Academic Teaching Hospital of Heidelberg University, Bassermannstr.1, 68165, Mannheim, Germany.
| | - Thomas Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Boris Radeleff
- Department for Diagnostic and Interventional Radiology, Sana Municipal Hospital Hof, Hof, Germany
| | - Jens-Christian Kröger
- Institute for Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany
| | - Andreas H Mahnken
- Institute for Diagnostic and Interventional Radiology, University Hospital Marburg, Marburg, Germany
| | - Harald Ittrich
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg, Hamburg, Germany
| | - Hans-Björn Gehl
- Institute for Diagnostic Radiology, Municipal Hospital Bielefeld, Bielefeld, Germany
| | - Bernd Plessow
- Radiological Institute, University Medicine Greifswald, Greifswald, Germany
| | - Joachim Böttcher
- Institute for Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Josef Tacke
- Institute for Diagnostic and Interventional Radiology/Neuroradiology, Municipal Hospital Passau, Passau, Germany
| | - Markus Wispler
- Community Hospital Havelhöhe, Gastroenterology, Berlin, Germany
| | - Ulrich Rosien
- Medical Clinic, Israelite Hospital Hamburg, Hamburg, Germany
| | - Wolfgang Schorr
- Department of Gastroenterology and Interventional Endoscopy, Barmherzige Brüder Hospital Regensburg, Regensburg, Germany
| | - Markus Joerdens
- Department of Gastroenterology, Oncology and Infectiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nicolas Glaser
- Clinic for Internal Medicine II: Gastroenterology, Oncology, Endocrinology and Infectiology, University Hospital Freiburg, Freiburg, Germany
| | - Erik-Sebastian Fuchs
- Department of Gastroenterology, Infectiology, Diabetology and Gastrointestinal Oncology (Medical Clinic C), Ludwigshafen Municipal Hospital, Ludwigshafen, Germany
| | - Andrea Tal
- Medical Clinic I: Gastroenterology and Hepatology, Pneumology and Allergology, Endocrinology and Diabetology as Nutritional Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Bettina Friesenhahn-Ochs
- Clinic for Internal Medicine II: Gastroenterology, Hepatology, Endocrinology, Diabetology and Nutritional Medicine, Saarland University Hospital, Homburg, Germany
| | - Thomas Leimbach
- Clinic for Gastroenterology, Hepatology, Gastrointestinal Oncology, Municipal Hospital Bogenhausen Munich, Munich, Germany
| | - Lars Höpner
- Clinic for Gastrointestinal Diseases/Medical Clinic I, Municipal Clinic of Braunschweig, Braunschweig, Germany
| | - Marko Weber
- Clinic for Internal Medicine IV: Gastroenterology, Hepatology, Infectiology, Interdisciplinary Endoscopy, University Hospital Jena, Jena, Germany
| | - Stefan Gölder
- Medical Clinic III - Gastroenterology, Municipal Hospital Augsburg, Augsburg, Germany
| | - Michael Böhmig
- Medical Clinic I (Gastroenterology, Hepatology, Oncology, Infectiology), Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Svetlana Hetjens
- Department of Medical Statistics and Biomathematics of Mannheim University Hospital, Heidelberg University-Hospital, Heidelberg, Germany
| | - Jochen Rudi
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and St. Hedwig Hospital, Academic Teaching Hospital of Heidelberg University, Bassermannstr.1, 68165, Mannheim, Germany
| | - Alexander Schegerer
- Department for Radiation Protection and Health, Federal Office of Radiation Protection, Salzgitter, Germany
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National audit on the appropriateness of CT and MRI examinations in Luxembourg. Insights Imaging 2019; 10:54. [PMID: 31111303 PMCID: PMC6527721 DOI: 10.1186/s13244-019-0731-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/13/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES In Luxembourg, the frequency of CT and MRI examinations per inhabitant is among the highest in Europe. A national audit was conducted to evaluate the appropriateness of CT and MRI examinations according to the national referral guidelines for medical imaging. METHODS Three hundred and eighty-eight CT and 330 MRI requests corresponding to already performed examinations were provided by all radiology departments in Luxembourg. Four external radiologists evaluated the clinical elements for justification present in each request. They consensually assessed the appropriateness of each requested examination with regard to the national referral guidelines and their clinical experience. RESULTS The appropriateness rate (AR) was higher for MRI requests than for CT requests (79% vs. 61%; p < 0.001). AR was higher for requests referred by medical specialists rather than by general practitioners, both for CT requests (70% vs. 37%; p < 0.001) and MRI requests (83% vs. 64%; p = 0.002). For CT, AR was higher when the requests concerned paediatric rather than adult patients (82% vs. 58%; p < 0.001), when the radiology departments were equipped with both CT and MRI units rather than with only CT units (65% vs. 47%, p = 0.004) and when the requests concerned head-neck (79%), chest (77%) and chest-abdominal-pelvic (81%) areas rather than spinal (28%), extremity (51%) and abdominal-pelvic (63%) areas (p < 0.001). CONCLUSIONS The appropriateness of CT and MRI in Luxembourg is not satisfactory and collective efforts to improve should be continued. The focus should be on general practitioners and on spinal CT examinations.
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Abstract
This Strategic Research Agenda identifies current challenges and needs in healthcare, illustrates how biomedical imaging and derived data can help to address these, and aims to stimulate dedicated research funding efforts.Medicine is currently moving towards a more tailored, patient-centric approach by providing personalised solutions for the individual patient. Innovation in biomedical imaging plays a key role in this process as it addresses the current needs for individualised prevention, treatment, therapy response monitoring, and image-guided surgery.The use of non-invasive biomarkers facilitates better therapy prediction and monitoring, leading to improved patient outcomes. Innovative diagnostic imaging technologies provide information about disease characteristics which, coupled with biological, genetic and -omics data, will contribute to an individualised diagnosis and therapy approach.In the emerging field of theranostics, imaging tools together with therapeutic agents enable the selection of best treatments and allow tailored therapeutic interventions.For prenatal monitoring, the use of innovative imaging technologies can ensure an early detection of malfunctions or disease.The application of biomedical imaging for diagnosis and management of lifestyle-induced diseases will help to avoid disease development through lifestyle changes.Artificial intelligence and machine learning in imaging will facilitate the improvement of image interpretation and lead to better disease prediction and therapy planning.As biomedical imaging technologies and analysis of existing imaging data provide solutions to current challenges and needs in healthcare, appropriate funding for dedicated research is needed to implement the innovative approaches for the wellbeing of citizens and patients.
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Salomaa S. DoReMi special issue: integrating European low dose research. Int J Radiat Biol 2019; 95:1-2. [PMID: 30495968 DOI: 10.1080/09553002.2018.1547442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sisko Salomaa
- a University of Eastern Finland , Kuopio , Finland.,b Finnish Radiation and Nuclear Safety Authority , P.O. Box 14 , Helsinki 00881 , Finland
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Costa PF, Testanera G, Camoni L, Terwinghe C, Bailey EA, Bolus NE, Alden TM. Technologist Approach to Global Dose Optimization. J Nucl Med Technol 2018; 47:75-82. [PMID: 30413598 DOI: 10.2967/jnmt.118.218131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/25/2018] [Indexed: 01/15/2023] Open
Abstract
Nuclear medicine technologists are specialized health professionals who cover a wide range of tasks from clinical routine (including image acquisition and processing, radiopharmaceutical dispensing and administration, patient care, and radioprotection tasks) to leading clinical research in the field of nuclear medicine. As a fundamental concern in all radiation sciences applied to medicine, protection of individuals against the harmful effects of ionizing radiation must be constantly revised and applied by the professionals involved in medical exposures. The acknowledgment that nuclear medicine technologists play a prominent role in patient management and several procedural steps, both in diagnostic and in therapeutic nuclear medicine applications, carries the duty to be trained and knowledgeable on the topic of radiation protection and dose optimization. An overview on selected topics related to dose optimization is presented in this article, reflecting the similarities and particularities of dose reduction-related principles, initiatives, and practicalities from a global perspective.
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Affiliation(s)
- Pedro Fragoso Costa
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Giorgio Testanera
- Barts Health NHS Trust, Department of Nuclear Medicine, St. Bartholomew's Hospital, London, United Kingdom
| | - Luca Camoni
- Nuclear Medicine Unit, Department of Nuclear Medicine, Spedali Civili of Brescia, Brescia, Italy
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Hamada N, Salomaa S, Dörr W. Toward tailoring radiation protection strategies at an individual level. Int J Radiat Biol 2018; 94:951-954. [DOI: 10.1080/09553002.2018.1513178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
| | - Sisko Salomaa
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Wolfgang Dörr
- Applied and Translational Radiobiology (ATRAB), Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
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Vento V, Soler R, Fabre D, Gavit L, Majus E, Brenot P, Gargiulo M, Haulon S. Optimizing imaging and reducing radiation exposure during complex aortic endovascular procedures. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 60:41-53. [PMID: 30160093 DOI: 10.23736/s0021-9509.18.10673-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Improvements in endovascular technologies and development of custom-made fenestrated and branched endografts currently allow clinicians to treat complex aortic lesions such as thoraco-abdominal and aortic arch aneurysms once treatable with open repair only. These advances are leading to an increase in the complexity of endovascular procedures which can cause long operation times and high levels of radiation exposure. This in turn places pressure on the vascular surgery community to display more superior interventional skills and radiological practices. Advanced imaging technology in this context represents a strong pillar in the treatment toolbox for delivering the best care at the lowest risk level. Delivering the best patient care while managing the radiation and iodine contrast media risks, especially in frail and renal impaired populations, is the challenge aortic surgeons are facing. Modern hybrid rooms are equipped with a wide range of new imaging applications such as fusion imaging and cone-beam computed tomography (CBCT). If these technologies contribute to reducing radiation, they can be complex and intimidating to master. The aim of this review is to discuss the fundamentals of good radiological practices and to describe the various imaging tools available to the aortic surgeon, both those available today and those we anticipate will be available in the near future, from equipment to software, to perform safe and efficient complex endovascular procedures.
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Affiliation(s)
- Vincenzo Vento
- Aortic Center, Department of Aortic and Vascular Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Division of Vascular Surgery, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Raphael Soler
- Aortic Center, Department of Aortic and Vascular Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Dominique Fabre
- Aortic Center, Department of Aortic and Vascular Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | | | | | - Philippe Brenot
- Aortic Center, Department of Aortic and Vascular Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Mauro Gargiulo
- Division of Vascular Surgery, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Stéphan Haulon
- Aortic Center, Department of Aortic and Vascular Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson, France -
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Abstract
While many areas of radiation protection have formed so-called 'platforms' in Europe which provide strategic research agendas for their areas of interest, this did not happen for a long while for medical exposure, which is the application of ionising radiation that causes the greatest man-made exposure, at least in first world countries. Finally, in 2015, a European medical radiation protection strategic research agenda was set up, and a corresponding platform was launched in 2016. This was named 'EURAMED' - the European Alliance for Medical Radiation Protection Research. In its strategic research agenda, EURAMED defined its vision for medical radiation protection and the corresponding research needed. Five major topics were identified, ranging from measurements of medical application-related parameters such as exposures and image quality and radiation biology aspects relevant for medical applications to individual optimisation strategies, to optimal use of techniques and harmonisation of practises, and finally to justification of the use of ionising radiation in medicine, all based on sufficient infrastructures for quality assurance. The ultimate goal is to reduce radiation exposure and risk individually for patients and staff by interdisciplinary research between clinicians, physicists, and engineers. Therefore, it is essential that the results are translated into clinical practice.
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Affiliation(s)
- C Hoeschen
- Institute for Medical Technology, Faculty for Electrical Engineering and Information Technology, Otto-von-Guericke-University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
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Dondi M, Paez D, Torres L, Marengo M, Delaloye AB, Solanki K, Van Zyl Ellmann A, Lobato EE, Miller RN, Giammarile F, Pascual T. Implementation of Quality Systems in Nuclear Medicine: Why It Matters. An Outcome Analysis (Quality Management Audits in Nuclear Medicine Part III). Semin Nucl Med 2018; 48:299-306. [DOI: 10.1053/j.semnuclmed.2017.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Massalha S, Lugassi R, Raysberg E, Koskosi A, Lechtenberg G, Israel O, Kennedy JA. Evaluation of Staff Radiation Exposure during Transthoracic Echocardiography Close to Myocardial Perfusion Imaging. J Am Soc Echocardiogr 2018; 31:763-770. [PMID: 29625886 DOI: 10.1016/j.echo.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Transthoracic echocardiography (TTE) and myocardial perfusion imaging (MPI) are used in cardiac patients. In this study the radiation exposure of sonographers performing TTE following MPI was evaluated. METHODS Of 40 study patients, 30 underwent same-day 99mTc sestamibi MPI and TTE, while another 10 underwent only TTE. Patients who underwent both studies were divided into three groups: right-handed TTE performed by an echocardiographer and right- and left-handed TTE performed by a cardiac sonographer. Seven thermoluminescent radiation dosimeter badges monitored the forehead, wrists, anterolateral right and left chest, sternal notch, and umbilical region of each examiner. Group characteristics were compared. Radiation exposures were deemed positive if >0.1 mSv. RESULTS There were no statistical differences in patient weight and body mass index. The left-handed approach group had higher residual radioactivity (979 ± 73 vs 884 ± 73 MBq [P < .01] and 906 ± 81 MBq [P < .04]), but no statistical difference in duration of TTE, compared with the other two MPI groups. Radiation exposure was positive in the right anterolateral chest and hand (0.45 and 1 mSv, respectively) for the echocardiographer, the right anterolateral chest and wrist and umbilical region (0.59, 1.06, and 0.15 mSv, respectively) for the right-handed sonographer, and the left chest and hand (0.12 and 0.34 mSv, respectively) for the left-handed sonographer. Dosimeters indicated no radiation exposure in the TTE-only group. CONCLUSIONS Staff members performing TTE after MPI are exposed to radiation that might warrant monitoring. Altering study sequence, adopting a left-handed approach, and using other radiation-reducing techniques can minimize the degree of exposure.
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Affiliation(s)
- Samia Massalha
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.
| | - Rachel Lugassi
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Elyahu Raysberg
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Amjad Koskosi
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | | | - Ora Israel
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - John A Kennedy
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; Faculty of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel
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Rühm W, Friedl AA, Wojcik A. Coordinated radiation protection research in Europe: is it the beginning of a new era? RADIATION AND ENVIRONMENTAL BIOPHYSICS 2018; 57:1-4. [PMID: 29260314 DOI: 10.1007/s00411-017-0727-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 06/07/2023]
Affiliation(s)
- W Rühm
- Institute for Radiation Protection, Helmholtz Center Munich, 85764, Neuherberg, Germany.
| | - Anna A Friedl
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - A Wojcik
- Centre for Radiation Protection Research, Stockholm University, Stockholm, Sweden
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Kreuzer M, Auvinen A, Cardis E, Durante M, Harms-Ringdahl M, Jourdain JR, Madas BG, Ottolenghi A, Pazzaglia S, Prise KM, Quintens R, Sabatier L, Bouffler S. Multidisciplinary European Low Dose Initiative (MELODI): strategic research agenda for low dose radiation risk research. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2018; 57:5-15. [PMID: 29247291 PMCID: PMC5816101 DOI: 10.1007/s00411-017-0726-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/10/2017] [Indexed: 05/05/2023]
Abstract
MELODI (Multidisciplinary European Low Dose Initiative) is a European radiation protection research platform with focus on research on health risks after exposure to low-dose ionising radiation. It was founded in 2010 and currently includes 44 members from 18 countries. A major activity of MELODI is the continuous development of a long-term European Strategic Research Agenda (SRA) on low-dose risk for radiation protection. The SRA is intended to identify priorities for national and European radiation protection research programs as a basis for the preparation of competitive calls at the European level. Among those key priorities is the improvement of health risk estimates for exposures close to the dose limits for workers and to reference levels for the population in emergency situations. Another activity of MELODI is to ensure the availability of European key infrastructures for research activities, and the long-term maintenance of competences in radiation research via an integrated European approach for training and education. The MELODI SRA identifies three key research topics in low dose or low dose-rate radiation risk research: (1) dose and dose rate dependence of cancer risk, (2) radiation-induced non-cancer effects and (3) individual radiation sensitivity. The research required to improve the evidence base for each of the three key topics relates to three research lines: (1) research to improve understanding of the mechanisms contributing to radiogenic diseases, (2) epidemiological research to improve health risk evaluation of radiation exposure and (3) research to address the effects and risks associated with internal exposures, differing radiation qualities and inhomogeneous exposures. The full SRA and associated documents can be downloaded from the MELODI website ( http://www.melodi-online.eu/sra.html ).
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Affiliation(s)
- M Kreuzer
- Department of Radiation Protection and Health, Federal Office for Radiation Protection, BfS, Neuherberg, Germany.
| | - A Auvinen
- University of Tampere, Tampere, Finland
- STUK, Helsinki, Finland
| | - E Cardis
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - M Durante
- Institute for Fundamental Physics and Applications, TIFPA, Trento, Italy
| | - M Harms-Ringdahl
- Centre for Radiation Protection Research, Stockholm University, Stockholm, Sweden
| | - J R Jourdain
- Institute for Radiological Protection and Nuclear Safety, IRSN, Fontenay-aux-roses, France
| | - B G Madas
- Environmental Physics Department, MTA Centre for Energy Research, Budapest, Hungary
| | - A Ottolenghi
- Physics Department, University of Pavia, Pavia, Italy
| | - S Pazzaglia
- Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - K M Prise
- Queens University Belfast, Belfast, UK
| | - R Quintens
- Belgian Nuclear Research Centre, SCK-CEN, Mol, Belgium
| | - L Sabatier
- French Atomic Energy Commission, CEA, Paris, France
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