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Özsavran M, Kurt A, Kuzlu Ayyıldız T. "I Pumped That Milk Off My Breast and Dumped It in Trash": Breastfeeding Experiences of Mothers Working in hospital radiation settings-A Qualitative Study. Breastfeed Med 2023; 18:377-384. [PMID: 37130315 DOI: 10.1089/bfm.2023.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Purpose: The qualitative study was conducted to determine the breastfeeding experiences of mothers working in radiation areas in hospitals. Materials and Methods: The study was conducted in Turkey between December 2022 and February 2023 through in-depth interviews held with 13 mothers who met the inclusion criteria. The content analysis method was used in the analysis of the data. Results: As a result of the analyses of the data obtained in the interviews, four themes regarding the breastfeeding experiences of health professionals working in radiation environments in hospitals were identified. These themes were institutional/administrative obstacles, support systems, unhealthy childcare, and feeling of incompetence as a mother. The main theme of unhealthy childcare consisted of four categories, which were low-quality breast milk, toxic breast milk, frequent diseases, and future risk of cancer. The main theme of feeling of incompetence as a mother was composed of three categories, which were fear, feeling of guilt, and "Am I a mother?" The theme of institutional/administrative obstacles consisted of three categories, namely working environment, working duration, and awareness of managers. Finally, the theme of support systems included two categories, positive perceptions and negative perceptions. Conclusion: In this study, it was determined that the mothers who worked in radiation areas in hospitals experienced problems due to individual, social, and institutional factors. The main concern of the mothers was found to be hurting their infants with their breast milk. Suitable working environments and the adequacy of practices related to daycare centers, social support, and motherhood rights are the main needs of working mothers aiming to keep breastfeeding their infants.
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Affiliation(s)
- Musa Özsavran
- Department of Child Care and Youth Services, Child Development Program, Ahmet Erdogan Vocational School of Health Services, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Aylin Kurt
- Nursing Department, Faculty of Health Sciences, Bartın University, Bartın, Turkey
| | - Tülay Kuzlu Ayyıldız
- Nursing Department, Faculty of Health Sciences, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
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Broggio D, Célier D, Michel C, Isambert A. Contact restriction time after common nuclear medicine therapies: spreadsheet implementation based on conservative retention function and individual measurements. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:021504. [PMID: 36927533 DOI: 10.1088/1361-6498/acc4d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/16/2023] [Indexed: 06/18/2023]
Abstract
The increasing use of new radiopharmaceuticals invites us to reconsider some radiation protection issues, such as the contact restriction time that limits public exposure by nuclear medicine patients. Contact restriction time should be patient specific and conservative, and its assessment made easy for clinicians. Here a method is proposed based on conservative estimation of the whole-body retention function and at least one measurement of the patient's dose rate. Recommended values of the retention function are given for eight therapies:131I (Graves' disease, remnant ablation, patient follow-up, meta-iodobenzylguanidine),177Lu-prostate-specific membrane antigen and177Lu-DOTATATE therapies, and90Y and166Ho microsphere injection of the liver. The patient line source model for scaling dose rate from one distance to another is included in the restriction time calculation. The method is benchmarked against published values and the influence of the dose rate scaling and whole-body retention function illustrated. A spreadsheet is provided, along with the source code, with recommended values for the eight therapies. The recommended values can be changed as well as the dose rate scaling function, and other radiopharmaceuticals can be included in the spreadsheet provided retention functions are defined.
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Affiliation(s)
- D Broggio
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SDOS/LEDI, F-92260 Fontenay-aux-Roses, France
| | - D Célier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SER/UEM, F-92260 Fontenay-aux-Roses, France
| | - C Michel
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SER/UEM, F-92260 Fontenay-aux-Roses, France
| | - A Isambert
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SER/UEM, F-92260 Fontenay-aux-Roses, France
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Craig AJ, Taprogge J, Flux GD, Murray I. Radiation protection aspects for alpha therapies. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2023; 67:4-13. [PMID: 36633588 DOI: 10.23736/s1824-4785.22.03501-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The use of alpha emitting radiotherapeutics is increasing, with further growth expected due to a number of clinical trials currently running involving new alpha emitters. However, literature concerning radiation safety aspects of alpha emitting radionuclides is limited and most of the available literature concerns 223Ra. In general, the occupational exposure from alpha emitting radionuclides is expected to be low, as are doses to the public from external exposure. However, care must be taken to avoid skin contamination, inhalation, and ingestion. Not all alpha emitting radionuclides are identical, they often have very different associated decay chains and emissions. The decay chains and the manufacturing process should be carefully examined to identify any long-lived progeny or impurities. These may have an impact on the radiation safety processes required to limit occupational exposure and for waste management. Doses to the public must also be assessed, either arising directly from exposure to patients treated with radiotherapeutics, or via waste streams. Risk assessments should be in place when starting a new service covering all aspects of the preparation and administration, as well as any foreseeable incidents such as skin contamination or patient death, and the appropriate steps to take in these instances. It is imperative that with the increase in the use of alpha emitting radiotherapeutics more literature is published on radiation safety aspects, especially for new alpha emitting radiotherapeutics which often have very different characteristics than the currently established ones.
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Affiliation(s)
- Allison J Craig
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, UK - .,The Institute of Cancer Research, London, UK -
| | - Jan Taprogge
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, UK.,The Institute of Cancer Research, London, UK
| | - Glenn D Flux
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, UK.,The Institute of Cancer Research, London, UK
| | - Iain Murray
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, UK.,The Institute of Cancer Research, London, UK
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Holmberg O, Pinak M. How often does it happen? A review of unintended, unnecessary and unavoidable high-dose radiation exposures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:R189-R201. [PMID: 34157693 DOI: 10.1088/1361-6498/ac0d64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
High-dose radiation exposures of humans occur every year around the world, and may lead to harmful tissue reactions. This review aims to look at the available information sources that can help answering the question of how often these events occur yearly on a global scale. In the absence of comprehensive databases of global occurrence, publications on radiation accidents in all uses of radiation and on rates of high-dose events in different medical uses of radiation have been reviewed. Most high-dose radiation exposures seem to occur in the medical uses of radiation, reflecting the high number of medical exposures performed. In therapeutic medical uses, radiation doses are purposely often given at levels known to cause deterministic effects, and there is a very narrow range in which the medical practitioner can operate without causing severe unacceptable outcomes. In interventional medical uses, there are scenarios in which the radiation dose given to a patient may reach or exceed a threshold for skin effects, where this radiation dose may be unavoidable, considering all benefits and risks as well as benefits and risks of any alternative procedures. Regardless of if the delivered dose is unintended, unnecessary or unavoidable, there are estimates published of the rates of high-dose events and of radiation-induced tissue injuries occurring in medical uses. If this information is extrapolated to a global scenario, noting the inherent limitations in doing so, it does not seem unreasonable to expect that the global number of radiation-induced injuries every year may be in the order of hundreds, likely mainly arising from medical uses of radiation, and in particular from interventional fluoroscopy procedures and external beam radiotherapy procedures. These procedures are so frequently employed throughout the world that even a very small rate of radiation-induced injuries becomes a substantial number when scaled up to a global level.
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Affiliation(s)
- Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Miroslav Pinak
- Radiation Safety and Monitoring Section, International Atomic Energy Agency, Vienna, Austria
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Tramacere F, Sardaro A, Arcangeli S, Maggialetti N, Altini C, Rubini D, Rubini G, Portaluri M, Niccoli Asabella A. Safety culture to improve accidental event reporting in radiotherapy. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:1317-1327. [PMID: 34134092 DOI: 10.1088/1361-6498/ac0c01] [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: 02/12/2021] [Accepted: 06/16/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE The potential for unintended and adverse radiation exposure in radiotherapy (RT) is real and should be studied because RT is a highly complex, multistep process, which requires input from numerous individuals from different areas and steps of the RT workflow. The 'Incident' (I) is an event the consequence of which is not negligible from the point of view of protection or safety. A 'near miss' (NM) is defined as an event that is highly likely to happen but did not occur. The purpose of this work is to show that through systematic reporting and analysis of these adverse events, their occurrence can be reduced. MATERIALS AND METHODS Staff were trained to report every type of unintended and adverse radiation exposure and to provide a full description of it. RESULTS By 2018, 110 worksheets had been collected, with an average of 6.1 adverse events per year (with 780 patients treated per year, meaning an average incident rate of 0.78%). In 2001-2009, 37 events were registered (13 I and 24 NM), the majority of them were in the decision phase (12/37), while in 2010-2013, there were 42 (1 I and 41 NM) in both the dose-calculation and transfer phase (19/42). In 2014-2018, 31 events (1 I and 30 NM) were equally distributed across the phases of the RT process. In 9/15 cases of I, some checkpoint was introduced. CONCLUSION The complexity of the RT workflow is prone to errors, and this must be taken into account by encouraging a safety culture. The aim of this paper is to present the collected incidents and near misses and to show how organization and practice were modified by the acquired knowledge.
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Affiliation(s)
| | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari 'Aldo Moro', Bari, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, ASST Monza-University of Milan 'Bicocca', Milan, Italy
| | - Nicola Maggialetti
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Corinna Altini
- Interdisciplinary Department of Medicine, Nuclear Medicine Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Dino Rubini
- Section of Diagnostic Imaging, University of Bari 'Aldo Moro', Bari, Italy
| | - Giuseppe Rubini
- Interdisciplinary Department of Medicine, Nuclear Medicine Unit, University of Bari 'Aldo Moro', Bari, Italy
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Sanders JC, Showalter TN, Ouhib Z, Thomadsen BR, Jacob D, Agarwal M, Cohen GN, Giles M, Palaniswammy G, Solanki AA, Taunk NK. Safety practices and opportunities for improvement in brachytherapy: A patient safety practices survey of the American Brachytherapy Society membership. Brachytherapy 2020; 19:762-766. [PMID: 32952055 DOI: 10.1016/j.brachy.2020.08.014] [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: 05/25/2020] [Revised: 07/14/2020] [Accepted: 08/11/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Safe delivery of brachytherapy and establishing a safety culture are critical in high-quality brachytherapy. The American Brachytherapy Society (ABS) Quality and Safety Committee surveyed members regarding brachytherapy services offered, safety practices during treatment, quality assurance procedures, and needs to develop safety and training materials. METHODS AND MATERIALS A 22-item survey was sent to ABS membership in early 2019 to physicians, physicists, therapists, nurses, and administrators. Participation was voluntary. Responses were summarized with descriptive statistics and relative frequency distributions. RESULTS There were 103 unique responses. Approximately one in three was attending physicians and one in three attending physicists. Most were in practice >10 years. A total of 94% and 50% performed gynecologic and prostate brachytherapy, respectively. Ninety-one percent performed two-identification patient verification before treatment. Eighty-six percent performed a time-out. Ninety-five percent had an incident reporting or learning system, but only 71% regularly reviewed incidents. Half reviewed safety practices within the last year. Twenty percent reported they were somewhat or not satisfied with department safety culture, but 92% of respondents were interested in improving safety culture. Most reported time, communication, and staffing as barriers to improving safety. Most respondents desired safety-oriented webinars, self-assessment modules, learning modules, or checklists endorsed by the ABS to improve safety practice. CONCLUSIONS Most but not all practices use standards and quality assurance procedures in line with society recommendations. There is a need to heighten safety culture at many departments and to shift resources (e.g., time or staffing) to improve safety practice. There is a desire for society guidance to improve brachytherapy safety practices. This is the first survey to assess safety practice patterns among a national sample of radiation oncologists with expertise in brachytherapy.
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Affiliation(s)
- Jason C Sanders
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - Zoubir Ouhib
- Department of Radiation Oncology, Lynn Cancer Institute, Boca Raton, FL
| | | | - Dayee Jacob
- Department of Radiation Oncology, Christiana Care Health System, Wilmington, DE
| | - Manuj Agarwal
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Gil'ad N Cohen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matt Giles
- Department of Radiation Oncology, Winship Cancer Institute, Emory St. Joseph's Hospital, Atlanta, GA
| | | | - Abhishek A Solanki
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL
| | - Neil K Taunk
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
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