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Rehani MM, Xu XG. Dose, dose, dose, but where is the patient dose? RADIATION PROTECTION DOSIMETRY 2024; 200:945-955. [PMID: 38847407 DOI: 10.1093/rpd/ncae137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 06/25/2024]
Abstract
The article reviews the historical developments in radiation dose metrices in medical imaging. It identifies the good, the bad, and the ugly aspects of current-day metrices. The actions on shifting focus from International Commission on Radiological Protection (ICRP) Reference-Man-based population-average phantoms to patient-specific computational phantoms have been proposed and discussed. Technological developments in recent years involving AI-based automatic organ segmentation and 'near real-time' Monte Carlo dose calculations suggest the feasibility and advantage of obtaining patient-specific organ doses. It appears that the time for ICRP and other international organizations to embrace 'patient-specific' dose quantity representing risk may have finally come. While the existing dose metrices meet specific demands, emphasis needs to be also placed on making radiation units understandable to the medical community.
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Affiliation(s)
- Madan M Rehani
- Massachusetts General Hospital, Radiology Department, Boston, MA, 02114, United States
| | - Xie George Xu
- University of Science and Technology of China (USTC), College of Nuclear Science & Technology, Hefei, Anhui Province, 230026, China
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Chiang YT, Chen SM, Tsui HM, Juang HH, Lin CW, Chiang MH, Liu CH, Hu SW, Kao WT, Chen KC, Tzou KY, Wu CC, Wu WL, Tsui KH. Ultrasound-guided extracorporeal shock wave lithotripsy with minimal x-ray exposure prevented genitourinary tract injury patients with urolithiasis in Taiwan. Sci Prog 2023; 106:368504231220988. [PMID: 38130182 PMCID: PMC10864817 DOI: 10.1177/00368504231220988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND This study investigated the use of ultrasound-guided extracorporeal shock wave lithotripsy (ESWL) to break stones in the genitourinary tract and prevent genitourinary injury. Our goals were to achieve accurate focusing and minimal X-ray exposure for the benefit of the patients. METHODS The LiteMed LM-9200 lithotripter with ultrasonography and fluoroscopy was used for two different procedures: autoaimed and autoperiodical. These procedures enabled dual focusing on stone localization and tracking. RESULTS Out of 108 patients who underwent autoperiodical procedures, 29 had no gross hematuria. Among the 335 patients who received autoaimed procedures, 194 had no gross hematuria. The average duration of X-ray exposure during autoperiodical and autoaimed procedures was 120 and 50 s, respectively. CONCLUSION The ultrasound-guided ESWL with minimal X-ray exposure was found to be useful in treating genitourinary upper-tract urolithiasis in the autoaimed procedure. Patients who underwent the autoaimed procedure experienced less gross hematuria compared to those who underwent the autoperiodical procedure.
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Affiliation(s)
- Yi-Te Chiang
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Shao-Ming Chen
- Department of Urology, Heping Campus, Taipei City Hospital, Taipei, Taiwan
| | - Hsuan-Mao Tsui
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Horng-Heng Juang
- Department of Anatomy, School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Wei Lin
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Meng-Han Chiang
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Hung Liu
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Su-Wei Hu
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Wei-Tang Kao
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Chou Chen
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Kai-Yi Tzou
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Wen-Ling Wu
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Ke-Hung Tsui
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
- Department of Urology, Shuang Ho Hospital, Shuang Ho Cancer Center, Taipei Cancer Center, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
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Portugal M, Baptista M, Vaz P, Belchior A. Patients’ organ dose and risk assessment in interventional cardiology procedures. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Indrakanti S, Li X, Rehani MM. Patients undergoing multiple 18F-FDG PET/CT exams: Assessment of frequency, dose and disease classification. Br J Radiol 2022; 95:20211225. [PMID: 35348374 PMCID: PMC10996321 DOI: 10.1259/bjr.20211225] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To analyse the frequency, demographics, primary disease and cumulative effective dose of patients undergoing two or more 18F-FDG PET/CT examinations in a year. METHODS In a retrospective study performed at a tertiary-care hospital, patients who underwent ≥2 18F-FDG PET/CT scans in a calendar year were identified for two consecutive years. The CT radiation dose was calculated using dose-length-product and sex-specific conversion factors. The primary malignancy of patients was retrieved from electronic medical records. RESULTS 10,714 18F-FDG PET/CT exams were performed for 6,831 unique patients in 2 years, yielding an average of 1.6 exams per patient. The maximum number of 18F-FDG PET/CT examinations any patient underwent in a single year was seven. 20.9% patients had ≥2 18F-FDG PET/CT exams in any single year. Thirty nine percent patients in the cohort were below 60 years age. The median dose for 18F-FDG PET/CT examination was 25.1 mSv and maximum value reaching 1.7 to 2.9 times the median value. Cumulative effective dose (CED) was≥100 mSv in 12-13% of the patients. The cumulative dose for both years combined demonstrated the 25th percentile, 50th percentile and 75th percentile as well as the mean to be over 100 mSv, with the 25th percentile being 109 mSv. The dominant primary malignancies contributing to serial 18F-FDG PET/CTs in decreasing frequency were melanoma, non-Hodgkin's lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin's lymphoma. CONCLUSIONS A sizeable number of patients undergo≥2 18F-FDG PET/CT exams with one out of every eight patients receiving cumulative dose≥100 mSv and that includes patients with long-life expectancy. ADVANCES IN KNOWLEDGE The study found that one of five patients had≥2 18F-FDG PET/CT exams in a calendar year, one of four patients in two years and one of eight patients received cumulative dose≥100 mSv. Top malignancies associated with serial imaging in decreasing order of frequency included melanoma, non-Hodgkin's lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin's lymphoma.
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Affiliation(s)
| | - Xinhua Li
- Radiology department, Massachusetts General
Hospital, Boston, MA,
USA
| | - Madan M. Rehani
- Radiology department, Massachusetts General
Hospital, Boston, MA,
USA
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Zewde N, Ria F, Rehani MM. Organ doses and cancer risk assessment in patients exposed to high doses from recurrent CT exams. Eur J Radiol 2022; 149:110224. [DOI: 10.1016/j.ejrad.2022.110224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
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Martin CJ, Barnard M. How much should we be concerned about cumulative effective doses in medical imaging? JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:011514. [PMID: 34673564 DOI: 10.1088/1361-6498/ac31c1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
The International Atomic Energy Agency issued a statement calling for action to strengthen the radiation protection of patients undergoing recurrent imaging. This followed reports of patients receiving cumulative effective doses over 100 mSv from multiple computed tomography examinations. In order to evaluate excess risks of cancer incidence among UK patients, data from an exposure management system covering three hospitals within one trust have been studied over 5½ years. Cumulative effective doses for 105 757 patients, from whom 719 (0.68%) received effective dose over 100 mSv, have been analysed using age and sex specific risk factors for stochastic effects. Two cancers might be expected to be initiated in the patients receiving over 100 mSv, while five might be expected to develop cancer among patients receiving 50-100 mSv. However, the calculations ignore health conditions for which the patients are being treated that may shorten their lives, and rely on the linear-no-threshold dose-effect model which is a subject of debate, so they are likely to overestimate cancer incidence. If health of the patients receiving >100 mSv is taken into account, the risk of mortality from cancer initiated by medical exposure might be the order of 1 in 2000. Recommendations on further strengthening of optimisation should be applied to imaging procedures for all patients with special focus on those performed on children and adolescents.
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Affiliation(s)
- Colin J Martin
- Department of Clinical Physics and Bioengineering, University of Glasgow, Gartnaval Royal Hospital, Glasgow, United Kingdom
| | - Michael Barnard
- Department of Radiation Physics and Protection, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Samara ET, Saltybaeva N, Sans Merce M, Gianolini S, Ith M. Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice. Phys Med 2022; 94:102-109. [PMID: 35030383 DOI: 10.1016/j.ejmp.2021.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Patient shielding during medical X-ray imaging has been increasingly criticized in the last years due to growing evidence that it often provides minimal benefit and may even compromise image quality. In Europe, and as also shown in a short assessment in Switzerland, the use of patient shielding is inhomogeneous. The aim of this study was to systematically review recent literature in order to assess benefits and appraise disadvantages related to the routine use of patient shielding. METHODS To evaluate benefits and disadvantages related to the application of patient shielding in radiological procedures, a systematic literature review was performed for CT, radiography, mammography and fluoroscopy-guided medical X-ray imaging. In addition, reports from medical physics societies and authorities of different countries were considered in the evaluation. RESULTS The literature review revealed 479 papers and reports on the topic, from which 87 qualified for closer analysis. The review considered in- and out-of-plane patient shielding as well as shielding for pregnant and pediatric patients. Dose savings and other dose and non-dose related effects of patient shielding were considered in the evaluation. CONCLUSIONS Although patient shielding has been used in radiological practice for many years, its use is no longer undisputed. The evaluation of the systematic literature review of recent studies and reports shows that dose savings are rather minimal while significant dose- and non-dose-related detrimental effects are present. Consequently, the routine usage of patient protection shielding in medical X-ray imaging can be safely discontinued for all modalities and patient groups.
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Affiliation(s)
- Eleni Theano Samara
- Radiation Protection Unit, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Natalia Saltybaeva
- Radiation Protection Unit, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marta Sans Merce
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | | | - Michael Ith
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Switzerland
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Bastiani L, Paolicchi F, Faggioni L, Martinelli M, Gerasia R, Martini C, Cornacchione P, Ceccarelli M, Chiappino D, Della Latta D, Negri J, Pertoldi D, Negro D, Nuzzi G, Rizzo V, Tamburrino P, Pozzessere C, Aringhieri G, Caramella D. Patient Perceptions and Knowledge of Ionizing Radiation From Medical Imaging. JAMA Netw Open 2021; 4:e2128561. [PMID: 34643721 PMCID: PMC8515210 DOI: 10.1001/jamanetworkopen.2021.28561] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Although imaging has become a standard tool of modern medicine, its widespread use has been paralleled by an increasing cumulative radiation dose to patients despite technological advancements and campaigns calling for better awareness and minimization of unnecessary exposures. OBJECTIVE To assess patients' knowledge about medical radiation and related risks. DESIGN, SETTING, AND PARTICIPANTS A survey study of hospitals in Italy was conducted; all patients in waiting rooms for medical imaging procedures before undergoing imaging examinations at 16 teaching and nonteaching hospitals were approached to take the survey. The survey was performed from June 1, 2019, to May 31, 2020. MAIN OUTCOMES AND MEASURES Survey respondents' basic knowledge of ionizing radiation levels and health risks, earlier imaging tests performed, and information and communication about radiation protection issues. RESULTS Among 3039 patients invited to participate, the response rate was 94.3% (n = 2866). Participants included 1531 women (53.4%); mean (SD) age was 44.9 (17.3) years. Of the 2866 participants, 1529 (53.3%) were aware of the existence of natural sources of ionizing radiation. Mammography (1101 [38.4%]) and magnetic resonance imaging (1231 [43.0%]) were categorized as radiation-based imaging modalities. More than half of the 2866 patients (1579 [55.1%]; P = .03) did not know that chest computed tomography delivers a larger dose of radiation than chest radiography, and only 1499 (52.3%) knew that radiation can be emitted after nuclear medicine examinations (P = .004). A total of 667 patients (23.3%) believed that radiation risks were unrelated to age, 1273 (44.4%) deemed their knowledge about radiation risks inadequate, and 2305 (80.4%) preferred to be informed about radiation risks by medical staff. A better knowledge of radiation issues was associated with receiving information from health care professionals (odds ratio [OR], 1.71; 95% CI, 1.43-2.03; P < .001) and having a higher educational level (intermediate vs low: OR, 1.48; 95% CI, 1.17-1.88; P < .001; high vs low: OR, 2.68; 95% CI, 2.09-3.43; P < .001). CONCLUSIONS AND RELEVANCE The results of this survey suggest that patients undergoing medical imaging procedures have overall limited knowledge about medical radiation. Intervention to achieve better patient awareness of radiation risks related to medical exposures may be beneficial.
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Affiliation(s)
- Luca Bastiani
- Institute of Clinical Physiology of the Italian National Research Council, Pisa, Italy
| | - Fabio Paolicchi
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Massimo Martinelli
- Italian National Research Council Institute of Information Science and Technologies, Signals & Images Laboratory, Pisa, Italy
| | - Roberta Gerasia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy
| | - Chiara Martini
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Patrizia Cornacchione
- UOC Oncological Radiotherapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, A. Gemelli University Hospital Foundation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Rome, Italy
| | - Matteo Ceccarelli
- Department of Physics, University of Cagliari, Calgiari, Italy
- Clinical Physiology of the Italian National Research Council/Institute of Materials, Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Dante Chiappino
- Department of Radiology, Institute of Clinical Physiology of the Italian National Research Council /Tuscany Region “Gabriele Monasterio Foundation,” Massa, Italy
| | - Daniele Della Latta
- Monasterio Foundation, Tuscany Region “Gabriele Monasterio Foundation, Massa, Italy
- Now with TeraRecon Inc, Durham, North Carolina
| | - Jacopo Negri
- Department of Radiology, Macerata Hospital, Macerata, Italy
| | - Donatella Pertoldi
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Donato Negro
- Department of Medicine-DIMED University Hospital of Padua, Padua, Italy
| | | | - Vincenzo Rizzo
- Nuclear Medicine Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Paola Tamburrino
- Foggia United Hospitals, University Hospital of Foggia, Foggia, Italy
| | - Chiara Pozzessere
- Radiology Unit, AUSL Toscana Centro San Giuseppe Hospital, Empoli, Italy
| | - Giacomo Aringhieri
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
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Visweswaran S, Raavi V, Abdul Syed Basheerudeen S, Kanagaraj K, Prasad A, Selvan Gnana Sekaran T, Pattan S, Shanmugam P, Ozimuthu A, Joseph S, Perumal V. Comparative analysis of physical doses and biomarker changes in subjects underwent Computed Tomography, Positron Emission Tomography-Computed Tomography, and interventional procedures. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2021; 870-871:503404. [PMID: 34583824 DOI: 10.1016/j.mrgentox.2021.503404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/30/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
Even though the medical uses of ionizing radiation are well-acknowledged globally as vital tools for the improvement of human health, they also symbolize the major man-made sources of radiation exposure to the population. Estimation of absorbed dose and biological changes after radiation-based imaging might help to better understand the effects of low dose radiation. Because of this, we measured the Entrance Surface Dose (ESD) at different anatomical locations using Lithium tetraborate doped with manganese (Li2B4O7: Mn), recorded Dose Length Product (DLP) and Dose Area Product (DAP), analyzed Chromosomal Aberration (CA), Micronucleus (MN), gamma-H2AX (γ-H2AX), and p53ser15 proteins in the blood lymphocytes of patients (n = 267) underwent Computed Tomography (CT), Positron Emission Tomography-CT (PET/CT), and interventional procedures and healthy volunteers (n = 19). The DLP and effective doses obtained from PET/CT procedures were significantly higher (p < 0.05) when compared to CT. Fluoroscopic time and DAP were significantly higher (p < 0.05) in therapeutic compared to diagnostic interventional procedures. All the anatomical locations registered a significant amount of ESD, the ESD obtained from CT and interventional procedures were significantly (p < 0.05) higher when compared to PET/CT. Fluoroscopic time did not correlate with the ESD (eye, head, thyroid, and shoulder; R2 = 0.03). CA frequency after PET/CT was significantly higher (p < 0.001) when compared to CT and interventional procedures. MN frequency was significantly higher in 24-hs (p < 0.001) post-interventional procedure compared to 2-hs. The mean ± SD of mean fluorescence intensity of γ-H2AX and p53ser15 obtained from all subjects underwent PET/CT and interventional procedures did not show a significant difference (p > 0.05) between pre- and post-procedure. However, the relative fluorescence intensity of γ-H2AX and p53ser15 was >1 in 58.5 % and 65.8 % of subjects respectively. Large inter-individual variation and lack of correlation between physical dose and biomarkers suggest the need for robust dosimetry with a large sample size to understand the health effects of low dose radiation.
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Affiliation(s)
- Shangamithra Visweswaran
- Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, 600 116, India
| | - Venkateswarlu Raavi
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research (Deemed to be University), Tamaka, Kolar, Karnataka, 563 103, India
| | - Safa Abdul Syed Basheerudeen
- Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, 600 116, India
| | - Karthik Kanagaraj
- Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, 600 116, India
| | - Akshaya Prasad
- Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, 600 116, India
| | - Tamizh Selvan Gnana Sekaran
- Central Research Lab, K.S. Hegde Medical Academy, NITTE (Deemed to be University), Mangalore, Karnataka, 575 018, India
| | - Sudha Pattan
- Department of Radiology & Imaging Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, 600 116, India
| | - Panneerselvam Shanmugam
- Department of Radiology & Imaging Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, 600 116, India
| | - Annalakshmi Ozimuthu
- Safety, Quality & Resource Management Group, Health Safety and Environment Group, Homi Bhabha National Institute, Indira Gandhi Center for Atomic Research, Kalpakkam, Tamil Nadu, 603 102, India
| | - Santhosh Joseph
- Department of Neuro-Radiology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, 600 116, India
| | - Venkatachalam Perumal
- Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, 600 116, India.
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Rehani MM, Brady Z. Contemporary issues in radiation protection in medical imaging: introductory editorial. Br J Radiol 2021; 94:bjr20219004. [PMID: 34545765 DOI: 10.1259/bjr.20219004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Zoe Brady
- Department of Radiology, Alfred Health, Melbourne, Australia.,Department of Neuroscience, Monash University, Melbourne, Australia
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Winford E, Bharija A. Referring physician perspective on how to handle frequent use of CT imaging. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:597-600. [PMID: 34161937 DOI: 10.1088/1361-6498/ac0df3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
The increasing use of computed tomography (CT) and other relatively high radiation dose exams in a recurrent manner result in radiation risks to individual patients. Recent studies have provided alarming information not only to the radiological community but also to referring physicians. We, as referring physicians, are often implicated in the overuse of imaging. However, a recent paper rightfully summarized the situation that despite the best use of available clinical decision support system for prescribing an imaging exam at a major hospital in the USA, many patients were found to have high cumulative doses. Motivated by the cue provided by the paper in this very journal, we decided to come forward with a possible solution taking the example of the drug prescription system that we routinely use. We provide a template to translate prescription drug monitoring program to ionising radiation imaging. We suggest that all body CT exams should be monitored at an individual, prescriber, and institution level for frequency of use. Furthermore, there should be radiation risk stratification of an individual patient based on the cumulative radiation burden in recent years. Further, an individual's radiation risk-stratified in different risk levels should be available for use by the referring/ordering clinicians at the point of care. Finally, we feel distanced by the use of multiple scary radiation dose quantities in different imaging modalities and would prefer as simple a metric as 'milligram.'
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Affiliation(s)
- Elliott Winford
- Massachusetts General Hospital, Boston, MA, United States of America
| | - Ankur Bharija
- Medicine Department Stanford University School of Medicine, Stanford, CA, United States of America
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Moghadam N, Rehani MM, Nassiri MA. Assessment of patients' cumulative doses in one year and collective dose to population through CT examinations. Eur J Radiol 2021; 142:109871. [PMID: 34332245 DOI: 10.1016/j.ejrad.2021.109871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/30/2021] [Accepted: 07/16/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE To estimate percentage of patients undergoing multiple CT exams leading to cumulative effective dose (CED) of more than 25, 50, 75 and 100 mSv in one year and assess per capita and the collective effective dose. METHODS Data from a regional hospital network was collected retrospectively using radiation dose monitoring system at 6 facilities with 8 CT scanners. The data was analyzed to find number of patients in different dose groups, their age, gender, number of CT exams and exams needed to reach 100 mSv based on age groups. RESULTS In one year 43,010 patients underwent 75,252 CT examinations. The number of exams per 1000 population was 153. Further 27% of the patients were younger than 55- years and 15.9% of them were younger than 45-year-old. A total of 0.67% of patients received a CED > 100 mSv; 3.5% had CED > 50 mSv, 11.9% with CED > 25 mSv and the maximum CED was 529 mSv. The minimum time to reach 100 mSv was a single CT exam. Seven patients received > 100 mSv in a single CT exam. 0.36% of patients had 10 or more CT exams in one year and 3.8% had 5 or more CT exams. The mean CED was 12.3 mSv, the average individual effective dose was 1.1 mSv and the collective effective dose was 521.3 person-Sv. CONCLUSIONS The alarming high CED received by large number of patients and with high collective dose to population requires urgent actions by all stake holders in the best interest of patient radiation safety.
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Affiliation(s)
- Narjes Moghadam
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Québec, Canada.
| | - Madan M Rehani
- Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Moulay Ali Nassiri
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Québec, Canada; Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
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Vassileva J, Holmberg O. Radiation protection perspective to recurrent medical imaging: what is known and what more is needed? Br J Radiol 2021; 94:20210477. [PMID: 34161167 DOI: 10.1259/bjr.20210477] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This review summarises the current knowledge about recurrent radiological imaging and associated cumulative doses to patients. The recent conservative estimates are for around 0.9 million patients globally who cumulate radiation doses above 100 mSv, where evidence exists for cancer risk elevation. Around one in five is estimated to be under the age of 50. Recurrent imaging is used for managing various health conditions and chronic diseases such as malignancies, trauma, end-stage kidney disease, cardiovascular diseases, Crohn's disease, urolithiasis, cystic pulmonary disease. More studies are needed from different parts of the world to understand the magnitude and appropriateness. The analysis identified areas of future work to improve radiation protection of individuals who are submitted to frequent imaging. These include access to dose saving imaging technologies; improved imaging strategies and appropriateness process; specific optimisation tailored to the clinical condition and patient habitus; wider utilisation of the automatic exposure monitoring systems with an integrated option for individual exposure tracking in standardised patient-specific risk metrics; improved training and communication. The integration of the clinical and exposure history data will support improved knowledge about radiation risks from low doses and individual radiosensitivity. The radiation protection framework will need to respond to the challenge of recurrent imaging and high individual doses. The radiation protection perspective complements the clinical perspective, and the risk to benefit analysis must account holistically for all incidental and long-term benefits and risks for patients, their clinical history and specific needs. This is a step toward the patient-centric health care.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
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Abstract
Millions of patients benefit from medical imaging every single day. However, we have entered an unprecedented era in imaging practices wherein 1 out of 125 patients can be exposed to effective dose >50 mSv from a single CT exam and 3 out of 10,000 patients undergoing CT exams could potentially receive cumulative effective doses > 100 mSv in a single day. Recurrent imaging with CT, fluoroscopically guided interventions, and hybrid imaging modalities such as positron emission tomography/computed tomography (PET/CT) is more prevalent today than ever before. Presently, we do not know the cumulative doses that patients may be receiving across all imaging modalities combined. Furthermore, patients with diseases with longer life expectancies are being exposed to high doses of radiation enabling radiation effects to manifest over a longer time period. The emphasis in the past on improving justification of imaging and optimization of technique and practice has proved useful. While that must continue, the current situation requires imaging device manufacturers to urgently develop imaging technologies that are safer for patients as high doses have been observed in patients where imaging has been justified through clinical decision-support and optimized by keeping doses below the national benchmark doses. There is a need to have a critical look at the fundamental principles of radiation protection as cumulative doses are likely to increase in the coming years.
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Rehani MM. Old enemy, new threat: you can't solve today's problems with yesterday's solution. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:452-458. [PMID: 33535195 DOI: 10.1088/1361-6498/abe2ba] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
The radiation protection principles of justification, optimization, and dose limitation as enumerated by the International Commission on Radiological Protection have been guiding light for the profession for over three decades. The dose limitation does not apply to medical exposure but keeping patients' doses low is achieved through optimization, particularly by developing and using diagnostic reference levels (DRLs). There are new findings that demonstrate that despite using the best possible approaches to justification and optimization including as well use of DRLs, a very large number of patients are receiving doses in excess of 100 mSv of effective dose or organ doses exceeding 100 mGy. A non-ignorable fraction of patients is receiving such high doses in a single day. The magnitude of such patients creates the need for a relook into the principles with the intent to understand what can be done to attend to today's problems. A look at other areas such as approaches, and principles used in the pharmaceutical industry and in traffic management throws some light into what can be learnt from these examples. It appears that the system needs to be enriched to deal with the protection of the individual patient. The currently available approaches and even the principles are largely based on the protection of the population or group of patients. The third level of justification for individual needs further refinement to take into account series of imaging many patients are needing, and cumulative radiation doses involved, many of which happen in a short duration of 1 to 5 years. There is every likelihood of patient radiation doses continuing to increase further that underscores the need for timely attention. This paper provides several suggestions to deal with the situation.
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Affiliation(s)
- Madan M Rehani
- Radiology Department, Massachusetts General Hospital, 175 Cambridge Str., Suite 244, Boston, MA, United States of America
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Editorial. Phys Med 2020; 79:ii-v. [DOI: 10.1016/j.ejmp.2020.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/20/2022] Open
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