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Ryu JC, Yoon JT, Kim BJ, Kim MH, Moon EJ, Suh PS, Roh YH, Moon HH, Kwon B, Lee DH, Song Y. Impact of a selective lens dose reduction protocol in 3D rotational angiography on radiation exposure to the eye lens during cerebral angiography: a randomized controlled trial. J Neurointerv Surg 2023:jnis-2023-020730. [PMID: 37739793 DOI: 10.1136/jnis-2023-020730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/29/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND We aimed to investigate the radiation dose to the eye lens (lens dose) during cerebral angiography and to evaluate the effectiveness of the lens dose reduction protocol for 3-dimensional rotational angiography (3D-RA) in reducing overall lens dose exposure. METHODS We conducted a randomized, controlled clinical trial at a tertiary hospital with patients undergoing cerebral angiography. The lens dose reduction protocol in 3D-RA involved raising the table to position the patient's eye lens away from the rotation axis. The lens dose was estimated by measuring the entrance surface air kerma using a photoluminescent glass dosimeter. The lens doses of 3D-RA, overall examination, and image quality were analyzed and compared between the two groups. RESULTS A total of 20 participants (mean age, 58±9.4 years; including 12 men [60%]) were enrolled and randomly assigned to either the conventional group or the dose reduction group. The median lens dose in 3D-RA was significantly lower in the dose reduction group compared with the conventional group (1.1 mGy vs 4.5 mGy, p<0.001). The total dose was significantly lower in the dose reduction group (median of 7.5 mGy vs 10.2 mGy, p=0.003). In the conventional group, 3D-RA accounted for 46% of the total lens dose, while in the dose reduction group, its proportion decreased to 16%. No significant differences were observed in the image quality between the groups. CONCLUSION The lens dose reduction protocol resulted in a significant reduction in the lens dose of the 3D-RA as well as entire cerebral angiography, while maintaining the image quality.
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Affiliation(s)
- Jae-Chan Ryu
- Neurology, Korea University Ansan Hospital, Ansan, Korea (the Republic of)
| | - Jong-Tae Yoon
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Byung Jun Kim
- Advanced Therapies, Siemens Healthineers Co Ltd, Seoul, Korea (the Republic of)
| | - Mi Hyeon Kim
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Eun Ji Moon
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Pae Sun Suh
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Yun Hwa Roh
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Hye Hyeon Moon
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Boseong Kwon
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Deok Hee Lee
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
| | - Yunsun Song
- Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
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Cheng KL, Huang JY, Weng JH, Chiou JY, Lan CT, Tung KC. 18F-FDG PET/CT Did Not Increase the Risk of Cataract Occurrence in Oncology Patients: A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137651. [PMID: 35805310 PMCID: PMC9265417 DOI: 10.3390/ijerph19137651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/11/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
This study aimed to evaluate the risk of cataract formation associated with radiation exposure from 18F-FDG PET/CT in oncology patients, using data from Taiwan’s National Health Insurance Research Database. The exposed group (Group E) consisted of oncology patients receiving 18F-FDG PET/CT within the first year of a cancer diagnosis. The comparison group (Group C) included subjects who had never been exposed to 18F-FDG PET/CT radiation and were propensity score-matched by date of enrolment, age, sex, cancer type, associated comorbidities, and CT utilization. Multiple Cox proportional hazard regression analysis was used to estimate the hazard ratio (HR) of cataract risk due to radiation exposure, while adjusting for potential confounding factors. A total of 703 patients and 1406 matched subjects were in Groups E and C, respectively. The incidence of cataract formation was not significantly higher among subjects in Group E (adjusted HR = 1.264; 95% confidence interval [CI] = 0.845–1.891). Our results revealed that 18F-FDG PET/CT was not a significant risk factor for developing cataracts in oncology patients.
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Affiliation(s)
- Kai-Lun Cheng
- Department of Veterinary Medicine, National Chung Hsing University, 250 Kuo Kuang Road, Taichung 40227, Taiwan;
- Department of Medical Imaging, Chung Shan Medical University Hospital, 110 Jianguo North Road, Taichung 40201, Taiwan
- School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, 110 Jianguo North Road, Taichung 40201, Taiwan
| | - Jing-Yang Huang
- Center for Health Data Science, Chung Shan Medical University Hospital, 110 Jianguo North Road, Taichung 40201, Taiwan;
- Institute of Medicine, College of Medicine, Chung Shan Medical University, 110 Jianguo North Road, Taichung 40201, Taiwan
| | - Jui-Hung Weng
- Department of Nuclear Medicine, Chung Shan Medical University Hospital, 110 Jianguo North Road, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, 110 Jianguo North Road, Taichung 40201, Taiwan
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, 110 Jianguo North Road, Taichung 40201, Taiwan;
| | - Chyn-Tair Lan
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, 110 Jianguo North Road, Taichung 40201, Taiwan;
| | - Kwong-Chung Tung
- Department of Veterinary Medicine, National Chung Hsing University, 250 Kuo Kuang Road, Taichung 40227, Taiwan;
- Correspondence:
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Liu PK, Chang YC, Wang NK, Ryu J, Tsai RK, Hsu SL, Hung JY, Hsu CY, Tai MH, Tsai MJ. The association between cataract and sleep apnea: a nationwide population-based cohort study. J Clin Sleep Med 2022; 18:769-777. [PMID: 34633283 PMCID: PMC8883097 DOI: 10.5664/jcsm.9714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The association between sleep apnea (SA) and cataract was confirmed in a comprehensive large-scale study. This study aimed to investigate whether SA was associated with increased risk of cataract. METHODS The 18-year nationwide retrospective population-based cohort study used data retrieved from the Taiwan National Health Insurance Database. We selected adult patients with a diagnosis of SA, based on diagnostic codes (suspected SA cohort) or on presence of diagnosis after polysomnography (SA cohort), and matched each of them to 5 randomly selected, and age- and sex-matched control participants. The incidence rate of cataract was compared between patients with SA and the controls. The effect of SA on incident cataract was assessed using multivariable Poisson regression and Cox regression analyses. RESULTS A total of 6,438 patients in the suspected SA cohort were matched with 32,190 controls (control A cohort), including 3,616 patients in the SA cohort matched with 18,080 controls (control B cohort). After adjusting for age, sex, residency, income level, and comorbidities, the incidence rates of cataract were significantly higher in the SA cohorts than in the corresponding control cohorts. SA was an independent risk factor for incident cataract (adjusted hazard ratio [95% confidence interval]: 1.4 [1.2-1.6]). In patients with SA, elder age, heart disease, chronic pulmonary disease, and diabetes mellitus were independent risk factors for incident cataract. CONCLUSIONS Our study revealed a significantly higher risk for developing cataract in patients with SA. Physicians caring for patients with SA should be aware of this ophthalmic complication. CITATION Liu P-K, Chang Y-C, Wang N-K, et al. The association between cataract and sleep apnea: a nationwide population-based cohort study. J Clin Sleep Med. 2022;18(3):769-777.
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Affiliation(s)
- Pei-Kang Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, New York
| | - Yo-Chen Chang
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, New York
| | - Joseph Ryu
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, New York
| | - Rong-Kung Tsai
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Shiuh-Liang Hsu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jen-Yu Hung
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yao Hsu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Hong Tai
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Center for Neuroscience, National Sun Yat-sen University, Kaohsiung, Taiwan
- Graduate Program in Marine Biotechnology, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ming-Ju Tsai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Rivera-López R, García-López C, Sánchez-Moreno JM, Rivera-López RA, Almansa-López J, Rivera-Fernández R, Molina-Navarro E, Jiménez-Fernández M, Ortiz-Pérez S, Ramírez-Hernández JA. High Incidence of Cataracts in the Follow-Up of Patients Undergoing Percutaneous Coronary Intervention for Chronic Coronary Total Occlusion. J Clin Med 2021; 10:jcm10215002. [PMID: 34768525 PMCID: PMC8584919 DOI: 10.3390/jcm10215002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Development of cataracts is a well-known adverse effect of ionizing radiation, but little information is available on their incidence in patients after other medical procedures, such as cardiac catheterizations. The study objective was to determine the incidence of cataracts in a cohort of patients undergoing percutaneous coronary intervention (PCI) for chronic coronary total occlusion (CTO) and its association with radiation dose. The study analyzed the incidence of cataracts during the follow-up of 126 patients who underwent chronic total coronary PCI, using Cox regression to identify predictive factors of cataract development. The study included 126 patients, 86.9% male, with a mean age of 60.5 years (range, 55.0-68.0 years). Twenty-three (18.2% n = 23) developed cataracts during a mean follow-up of 49.5 months (range 37.3-64.5 months). A higher incidence was observed in patients who received more than 5 Gy (29.0% vs. 14.7%, Hazard ratio (HR = 2.84 [1.19-6.77]). Multivariate analysis revealed a relationship between cataract development during the follow-up and a receipt of radiation dose >5 Gy (HR = 2.60, 95% confidence interval [CI 1.03-6.61]; p = 0.03), presence or history of predisposing eye disease (HR = 4.42, CI:1.57-12.40), diabetes (HR = 3.33 [1.22-9.24]), and older age, as in >57 (HR, 6.40 [1.81-22.61]). An elevated incidence of cataracts was observed in patients after PCI for CTO. The onset of cataracts is related to the radiation dose during catheterization, which is a potentially avoidable effect of which operators should be aware.
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Affiliation(s)
- Ricardo Rivera-López
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
| | - Celia García-López
- Department of Ophtalmology, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain
- Correspondence: ; Tel.: +34-958020009
| | - José M. Sánchez-Moreno
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | | | - Julio Almansa-López
- Radiophysics Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | | | - Eduardo Molina-Navarro
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | - Miriam Jiménez-Fernández
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | - Santiago Ortiz-Pérez
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
- Department of Ophtalmology, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain
- University of Granada (UGR), 18016 Granada, Spain;
| | - José A. Ramírez-Hernández
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
- Medicine Department, University of Granada (UGR), 18016 Granada, Spain
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Ainsbury EA, Dalke C, Hamada N, Benadjaoud MA, Chumak V, Ginjaume M, Kok JL, Mancuso M, Sabatier L, Struelens L, Thariat J, Jourdain JR. Radiation-induced lens opacities: Epidemiological, clinical and experimental evidence, methodological issues, research gaps and strategy. ENVIRONMENT INTERNATIONAL 2021; 146:106213. [PMID: 33276315 DOI: 10.1016/j.envint.2020.106213] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/11/2020] [Accepted: 08/25/2020] [Indexed: 06/12/2023]
Abstract
In 2011, the International Commission on Radiological Protection (ICRP) recommended reducing the occupational equivalent dose limit for the lens of the eye from 150 mSv/year to 20 mSv/year, averaged over five years, with no single year exceeding 50 mSv. With this recommendation, several important assumptions were made, such as lack of dose rate effect, classification of cataracts as a tissue reaction with a dose threshold at 0.5 Gy, and progression of minor opacities into vision-impairing cataracts. However, although new dose thresholds and occupational dose limits have been set for radiation-induced cataract, ICRP clearly states that the recommendations are chiefly based on epidemiological evidence because there are a very small number of studies that provide explicit biological and mechanistic evidence at doses under 2 Gy. Since the release of the 2011 ICRP statement, the Multidisciplinary European Low Dose Initiative (MELODI) supported in April 2019 a scientific workshop that aimed to review epidemiological, clinical and biological evidence for radiation-induced cataracts. The purpose of this article is to present and discuss recent related epidemiological and clinical studies, ophthalmic examination techniques, biological and mechanistic knowledge, and to identify research gaps, towards the implementation of a research strategy for future studies on radiation-induced lens opacities. The authors recommend particularly to study the effect of ionizing radiation on the lens in the context of the wider, systemic effects, including in the retina, brain and other organs, and as such cataract is recommended to be studied as part of larger scale programs focused on multiple radiation health effects.
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Affiliation(s)
- Elizabeth A Ainsbury
- Public Health England (PHE) Centre for Radiation, Chemical and Environmental Hazards, Oxon, United Kingdom.
| | - Claudia Dalke
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Germany.
| | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan.
| | - Mohamed Amine Benadjaoud
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), BP 17, 31 avenue de la division Leclerc, Fontenay-aux-Roses, France.
| | - Vadim Chumak
- National Research Centre for Radiation Medicine, Ukraine.
| | | | - Judith L Kok
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Mariateresa Mancuso
- Laboratory of Biomedical Technologies, Italian National Agency for New Technologies, Energy and Sustainable Economic Development, (ENEA), Rome, Italy.
| | - Laure Sabatier
- Commissariat à l'Energie Atomique et aux Energies Alternatives, Saclay, France.
| | | | - Juliette Thariat
- Laboratoire de physique corpusculaire IN2P3/ENSICAEN -UMR6534 - Unicaen - Normandie University, France
| | - Jean-René Jourdain
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), BP 17, 31 avenue de la division Leclerc, Fontenay-aux-Roses, France.
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Harbron RW, Ainsbury EA, Barnard SGR, Lee C, McHugh K, Berrington de González A, Edyvean S, Pearce MS. Radiation dose to the lens from CT of the head in young people. Clin Radiol 2019; 74:816.e9-816.e17. [PMID: 31375261 DOI: 10.1016/j.crad.2019.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 06/28/2019] [Indexed: 11/28/2022]
Abstract
AIM To determine cumulative scan frequencies and estimate lens dose for paediatric computed tomography (CT) head examinations in the context of potential cataract risk. MATERIALS AND METHODS The cumulative number of head-region CT examinations among a cohort of 410,997 children and young adults who underwent CT in the UK between 1985 and 2014 was calculated. Images from a sample of these head examinations (n=668) were reviewed to determine the level of eye inclusion. Lens dose per scan was estimated using the computer program, NCICT V1.0, for different levels of eye inclusion and exposure settings typical of past and present clinical practice. RESULTS In total 284,878 patients underwent 448,108 head-region CT examinations. The majority of patients (72%) had a single recorded head-region examination. A small subset (∼1%, n=2,494) underwent ≥10 examinations, while 0.1% (n=387) underwent ≥20. The lens was included within the imaged region for 57% of reviewed routine head examinations. In many cases, this appeared to be intentional, i.e. protocol driven. In others, there appeared to have been an attempt to exclude the eyes through gantry angulation. Estimated lens doses were 20-75 mGy (mean: 47 mGy) where the eye was fully included within the examination range and 2-7 mGy (mean: 3.1 mGy) where the lens was fully excluded. Potential cumulative lens doses ranged from ∼3 mGy to ∼4,700 mGy, with 2,335 patients potentially receiving >500 mGy. CONCLUSION The majority of young people will receive cumulative lens doses well below 500 mGy, meaning the risk of cataract induction is likely to be very small.
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Affiliation(s)
- R W Harbron
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, UK.
| | - E A Ainsbury
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - S G R Barnard
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - C Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - K McHugh
- Radiology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - A Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Edyvean
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - M S Pearce
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, UK
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