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Johnson D, Li HH, Kimler BF. Dosimetry: Was and Is an Absolute Requirement for Quality Radiation Research. Radiat Res 2024; 202:102-129. [PMID: 38954476 DOI: 10.1667/rade-24-00107.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/09/2024] [Indexed: 07/04/2024]
Abstract
This review aims to trace the evolution of dosimetry, highlight its significance in the advancement of radiation research, and identify the current trends and methodologies in the field. Key historical milestones, starting with the first publications in the journal in 1954, will be synthesized before addressing contemporary practices in radiation medicine and radiobiological investigation. Finally, possibilities for future opportunities in dosimetry will be offered. The overarching goal is to emphasize the indispensability of accurate and reproducible dosimetry in enhancing the quality of radiation research and practical applications of ionizing radiation.
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Affiliation(s)
- Daniel Johnson
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas 66160-7321
| | - H Harold Li
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas 66160-7321
| | - Bruce F Kimler
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas 66160-7321
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Kahraman G, Haberal KM, Ağıldere AM. Establishment of local diagnostic reference levels for computed tomography with cloud-based automated dose-tracking software in Türkiye. Diagn Interv Radiol 2024; 30:205-211. [PMID: 37650522 PMCID: PMC11095070 DOI: 10.4274/dir.2023.232265] [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: 05/25/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The purpose of this study is to establish local diagnostic reference levels (LDRLs) for computed tomography (CT) procedures using cloud-based automated dose-tracking software. METHODS The study includes the dose data obtained from a total of 104,272 examinations performed on adult patients (>18 years) using 8 CT scanners over 12 months. The protocols included in our study were as follows: head CT without contrast, cervical spine CT without contrast, neck CT with contrast, chest CT without contrast, abdomen-pelvis CT without contrast, lumbar spine CT without contrast, high-resolution computed tomography (HRCT) of the chest, and coronary CT angiography (CTA). Dose data were collected using cloud-based automatic dose-tracking software. The 75th percentiles of the distributions of the median volume CT dose index (CTDIvol) and dose length product (DLP) values were used to determine the LDRLs for each protocol. The LDRLs were compared with national DRLs (NDRLs) and DRLs set in other countries. Inter-CT scanner variability, which is a measure of how well clinical practices are standardized, was determined for each protocol. Median values for each protocol were compared with the LDRLs for dose optimization in each CT scanner. RESULTS The LDRLs (for DLP and CTDIvol, respectively) were 839 mGy.cm and 41.2 mGy for head CT without contrast, 530.6 mGy.cm and 19.8 mGy for cervical spine CT without contrast, 431.9 mGy.cm and 15.5 mGy for neck CT with contrast, 364.8 mGy.cm and 9.3 mGy for chest CT without contrast, 588.9 mGy. cm and 11.2 mGy for abdomen-pelvis CT without contrast, 713 mGy.cm and 24.3 mGy for lumbar spine CT without contrast, 326 mGy.cm and 9.5 mGy for HRCT, and 642.3 mGy.cm and 33.4 mGy for coronary CTA. The LDRLs were comparable to or lower than NDRLs and DRLs set in other countries for most protocols. The comparisons revealed the need for immediate initiation of an optimization process for CT protocols with higher dose distributions. Furthermore, protocols with high inter-CT scanner variability revealed the need for standardization. CONCLUSION There is a need to update the NDRLs for CT protocols in Turkey. Until new NDRLs are established, local institutions in Turkey can initiate the optimization process by comparing their dose distributions to the LDRLs established in our study. Automated dose-tracking software can play an important role in establishing DRLs by facilitating the collection and analysis of large datasets.
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Affiliation(s)
- Gökhan Kahraman
- Başkent University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
| | - Kemal Murat Haberal
- Başkent University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
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Reis A, Sampaio C, Sousa W, Aguiar L, Bertelli L. Key topics for making decisions on decorporation terapies. RADIATION PROTECTION DOSIMETRY 2024; 200:707-714. [PMID: 38678315 DOI: 10.1093/rpd/ncae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/19/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024]
Abstract
Decorporation therapies increase the excretion of the incorporated material and therefore may reduce the probability of the occurrence of stochastic effects and may avoid deterministic effects in persons internally contaminated with radionuclides. The decision to initiate decorporation therapy should consider the effects of treatment in relation to the benefit provided. The literature presents threshold values above which treatment is recommended. The objective of this work is to collect and summarize recommendations on decorporation therapy. Ten key topics are presented for consideration by a multidisciplinary team when assessing the risk-benefit balance for performing decorporation therapy.
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Affiliation(s)
- Arlene Reis
- Institute of Radiation Protection and Dosimetry (IRD), Division of Dosimetry and Radiation Protection, Barra da Tijuca, RJ 22783-127, Brazil
| | - Camilla Sampaio
- Institute of Radiation Protection and Dosimetry (IRD), Division of Dosimetry and Radiation Protection, Barra da Tijuca, RJ 22783-127, Brazil
| | - Wanderson Sousa
- Institute of Radiation Protection and Dosimetry (IRD), Division of Dosimetry and Radiation Protection, Barra da Tijuca, RJ 22783-127, Brazil
| | - Laís Aguiar
- Institute of Radiation Protection and Dosimetry (IRD), Division of Dosimetry and Radiation Protection, Barra da Tijuca, RJ 22783-127, Brazil
| | - Luiz Bertelli
- L Bertelli & Associates, 6190 S Eagle Nest Drive Murray, UT, 84123, USA
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Soucy B, Lee D, Moreau-Bourbonnais A, Filiatrault M, Denis I, Chang MC, Boudier-Revéret M. Influence of resident involvement on fluoroscopy time and ionizing radiation exposure in fluoroscopy-guided spinal procedures. PM R 2024; 16:260-267. [PMID: 37639553 DOI: 10.1002/pmrj.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/05/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Fluoroscopic guidance has become the standard for a variety of medical procedures. Mastering these techniques requires practice, which may entail additional radiation for patients and providers. Despite their widespread use, the literature examining factors influencing radiation exposure in fluoroscopically guided pain procedures is scarce. OBJECTIVE To evaluate the influence of resident involvement on radiation exposure during fluoroscopy-guided spinal interventions. DESIGN Single-center, observational study. SETTING Outpatient physiatry clinic in a teaching hospital. PATIENTS All patients who received cervical or lumbar facet block(s) (FBs), transforaminal epidural steroid injection(s) (TFESIs) without digital subtraction, or a caudal epidural (CE) during the study period were included. INTERVENTIONS Resident involvement in the procedures: absent, observing, or participating. MAIN OUTCOME MEASURES Machine-indicated fluoroscopy time (seconds) and radiation dose (milligrays [mGy]). RESULTS Two hundred ninety six procedures were included: 188 FBs (58 cervical, 130 lumbar), 48 CEs, and 60 TFESIs. For lumbar FBs, fluoroscopy time and radiation dose increased significantly when residents performed them (meantime = 24.5 s, confidence interval [CI] = 20.4-28.7; meandose = 3.53 mGy, CI = 2.57-4.49) compared to when they observed (meantime = 9.9 s, CI = 8.1-11.7; meandose = 1.28 mGy, CI = 0.98-1.59) (mean difference: time = 14.63 s, CI = 9.31-19.94; dose = 2.25 mGy, CI = 1.17-3.33) and were absent during the procedure (meantime = 12.9 s, CI = 11.1-14.6; meandose = 1.65 mGy, CI = 1.40-1.89) (mean difference: time = 11.67 s, CI = 7.35-15.98; dose = 1.88 mGy, CI = 1.01-2.76). In the case of TFESIs, time, but not dose, increased significantly when residents observed (meantime = 39.1 s, CI = 30.7-47.6; meandose = 6.73 mGy, CI = 3.39-10.07) compared to when they were absent (meantime = 27.1 s, CI = 22.4-31.8; meandose = 4.41 mGy, CI = 3.06-5.76 (mean difference: time = 11.99 s, CI = 1.37-22.61; dose = 2.32 mGy, CI = -1.20-5.84). Finally, resident involvement did not significantly affect the outcomes for CEs (ptime = .032, pdose = .74) and cervical FBs (ptime = .64, pdose = .68). CONCLUSION Resident participation affected lumbar FBs the most, with an increase in both fluoroscopy time and radiation dose.
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Affiliation(s)
- Béatrice Soucy
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Dillon Lee
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Amélie Moreau-Bourbonnais
- Department of Physical Medicine and Rehabilitation, CISSS des Laurentides, Saint-Jérôme, Québec, Canada
| | - Marc Filiatrault
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Denis
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, South Korea
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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LaBella A, Kim DS, Chow JS, Padua HM, Zhang D. Age-specific Dose Catalog for Diagnostic Fluoroscopy and Fluoroscopically Guided Interventional Procedures from a Pediatric Hospital. Radiology 2024; 310:e232128. [PMID: 38226878 DOI: 10.1148/radiol.232128] [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: 01/17/2024]
Abstract
Background Fluoroscopy is an imaging modality associated with a wide range of dose levels, characterized using a variety of dose metrics, including effective dose. However, for clinical procedures, effective dose is a seldom-used and unregulated metric in the United States, and thus, it is not extensively studied in radiology despite potentially large clinical implications for patients, especially children and infants. Purpose To formulate and report a dose catalog across all diagnostic and interventional radiology (IR) fluoroscopy examination or procedure types at a specialized tertiary care pediatric hospital. Materials and Methods In this retrospective study, dose metrics taken from radiation dose structured reports of fluoroscopy between October 2014 and March 2023 were analyzed. The reports included fluoroscopy across 18 diagnostic examination types and 24 IR procedure types. The National Cancer Institute dosimetry system for Radiography and Fluoroscopy Monte Carlo software was used to estimate age-specific effective dose from dose-area product (DAP). The DAP-to-effective dose conversion factors were estimated per IR procedure type and diagnostic fluoroscopy examination type based on age. Results A total of 11 536 individual diagnostic fluoroscopy examinations (18 types) and 8017 individual IR procedures (24 types) were analyzed. Median effective dose values per diagnostic fluoroscopy examination type ranged from 0.0010 to 0.44 mSv (mean, 0.0808 mSv ± 0.0998 [SD]). Calculated DAP-to-effective dose conversion factors ranged from 0.04 to 2.48 mSv/Gy · cm2 (mean, 0.758 mSv/Gy · cm2 ± 0.614) across all diagnostic fluoroscopy examination types. Median effective dose values per IR procedure type ranged from 0.0007 to 3.90 mSv (mean, 0.6757 mSv ± 0.8989). Calculated DAP-to-effective dose conversion factors ranged from 0.001 to 0.87 mSv/Gy · cm2 (mean, 0.210 mSv/Gy · cm2 ± 0.235) across all IR procedure types. Conclusion A pediatric fluoroscopy dose catalog was created, including age-specific effective dose, using a repeatable robust method based on accurate clinical data. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Borrego and Balter in this issue.
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Affiliation(s)
- Andy LaBella
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115
| | - Don-Soo Kim
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115
| | - Jeanne S Chow
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115
| | - Horacio M Padua
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115
| | - Da Zhang
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115
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Ilo AM, Waltimo-Sirén J, Pakbaznejad Esmaeili E, Ekholm M, Kortesniemi M. The effect of optimum, indication-specific imaging fields on the radiation exposure from CBCT examinations of impacted maxillary canines and mandibular third molars. Acta Odontol Scand 2024; 82:66-73. [PMID: 38058132 DOI: 10.1080/00016357.2023.2258981] [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: 05/04/2023] [Accepted: 09/11/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Indication-specific optimum field-of-views (FOVs) have been assessed for CBCT scans of impacted maxillary canines and mandibular third molars, as 40∅ × 35 mm and 35∅ × 35 mm, respectively. The objective was to investigate possible changes in absorbed organs and effective doses, for these two imaging indications, performing CBCT examinations with optimum FOV sizes instead of commonly used FOVs. Additionally, radiation exposure-induced cancer risk was calculated for both imaging indications with optimum FOVs. METHODS An adult female head phantom (ATOM 702-D, CIRS, Norfolk, VA, USA) was scanned using Planmeca Viso G7 CBCT-device (Planmeca, Helsinki, Finland). Scanning factors, different FOV sizes, dose-area product (DAP) values and anatomical FOV locations were used for Monte Carlo PCXMC-simulation and ImpactMC software. In the PCXMC- simulation, 10-year-old child and 30-year-old adult phantoms were used to estimating effective and absorbed organ doses. RESULTS The effective dose varied from 58 µSv to 284 µSv for impacted maxillary canines, and from 38 µSv to 122 µSv for mandibular third molars, the lowest dose value for each corresponding to optimum FOV. Effective dose reduction between the optimum FOV and the smallest common FOV of 50∅ × 50 mm, maintaining other scanning factors constant, was 33% for impacted maxillary canines, and 45% for mandibular third molars. At all examinations, the highest absorbed organ doses were in salivary glands or in oral mucosa. CONCLUSIONS Optimum FOVs, 40∅ × 35 mm for impacted maxillary canine and 35∅ × 35 mm for mandibular third molar, could decrease effective doses received by young patients, and improve radiation safety in these common CBCT imaging procedures.
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Affiliation(s)
- Anne-Mari Ilo
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Janna Waltimo-Sirén
- Department of Pediatric Dentistry and Orthodontics, Institute of Dentistry, University of Turku, Turku, Finland
- Wellbeing Services County of South-West Finland, Finland
| | | | - Marja Ekholm
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry, University of Turku, Turku, Finland
- Wellbeing Services County of South-West Finland, Finland
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Mika Kortesniemi
- HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Camoni L, Santos A, Luporsi M, Grilo A, Pietrzak A, Gear J, Zucchetta P, Bar-Sever Z. EANM procedural recommendations for managing the paediatric patient in diagnostic nuclear medicine. Eur J Nucl Med Mol Imaging 2023; 50:3862-3879. [PMID: 37555902 PMCID: PMC10611649 DOI: 10.1007/s00259-023-06357-3] [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: 05/26/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE The manuscript aims to characterize the principles of best practice in performing nuclear medicine procedures in paediatric patients. The paper describes all necessary technical skills that should be developed by the healthcare professionals to ensure the best possible care in paediatric patients, as it is particularly challenging due to psychological and physical conditions of children. METHODS We performed a comprehensive literature review to establish the most relevant elements of nuclear medicine studies in paediatric patients. We focused the attention to the technical aspects of the study, such as patient preparation, imaging protocols, and immobilization techniques, that adhere to best practice principles. Furthermore, we considered the psychological elements of working with children, including comforting and distraction strategies. RESULTS The extensive literature review combined with practical conclusions and recommendations presented and explained by the authors summarizes the most important principles of the care for paediatric patient in the nuclear medicine field. CONCLUSION Nuclear medicine applied to the paediatric patient is a very special and challenging area, requiring proper education and experience in order to be performed at the highest level and with the maximum safety for the child.
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Affiliation(s)
- Luca Camoni
- University of Brescia, 25123, Brescia, Italy.
- Nuclear Medicine Department, University of Brescia, ASST Spedali Civili Di Brescia, P.Le Spedali Civili 1, 25123, Brescia, Italy.
| | - Andrea Santos
- Nuclear Medicine Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Marie Luporsi
- Department of Nuclear Medicine, Institut Curie, PSL Research University, 75005, Paris, France
- LITO Laboratory INSERM U1288, Institut Curie, 91440, Orsay, France
| | - Ana Grilo
- H&TRC - Health and Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Agata Pietrzak
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
- Nuclear Medicine Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Pietro Zucchetta
- Nuclear Medicine Department, Padova University Hospital, 35128, Padua, Italy
| | - Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Tel-Aviv University, Petach Tikva, Israel
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Khafaji M, Albadawi GH. Assessment of Scattered Dose to the Eye in Dentistry: A Systematic Review. Cureus 2023; 15:e43113. [PMID: 37560052 PMCID: PMC10407597 DOI: 10.7759/cureus.43113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/11/2023] Open
Abstract
Cone-beam computed tomography (CBCT) is a tool for dental imaging of impactions, maxillofacial discrepancies, facial trauma, and tumors. In addition, It is used in treatment planning for dental implants, orthognathic surgery, and general maxillofacial surgery. There are no standardized methods for utilizing CBCT dosimetry, and there is no consensus among dental and medical physics health professionals regarding dental CBCT imaging procedures. The eyes and thyroid glands are radiosensitive organs that lie outside the primary beam but receive a significant amount of radiation due to scattered radiation. This study aimed to assess the dose to eye lens in patients imaged using CBCT. This review aims to evaluate the scattered doses to the eye from CBCT among adult patients seeking dental treatment. The search included published articles in the Web of Science, PubMed (MeSH and Web PubMed), Medline, and Google Scholar databases using the appropriate keywords from January 2010 to July 2022. The inclusion criteria were based on the method of dose measurement (phantom studies using Optically stimulated luminescence (OSL) and Thermoluminescent dosimeter (TLD), language, and type of protocol used. A literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and flow chart. Out of 653 articles identified, 5 met the inclusion criteria. The results show that the scattered radiation dose ranged between 0.103 mSv and 8.3 mSv. This variation exists due to the difference in the field of vision (FOV), phantom exposure, dosimeters used, degree of rotation in the protocol, and finally, the scanner used. The scattered dose to the eye from CBCT is higher than the background radiation, with huge variability in the range of the dose measured. Clear guidelines for utilizing CBCT should be implemented, and dose reference levels should be established for benchmarking and optimization in practice.
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Affiliation(s)
- Mawya Khafaji
- Radiology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Chu PW, Kofler C, Mahendra M, Wang Y, Chu CA, Stewart C, Delman BN, Haas B, Lee C, Bolch WE, Smith-Bindman R. Dose length product to effective dose coefficients in children. Pediatr Radiol 2023; 53:1659-1668. [PMID: 36922419 PMCID: PMC10359359 DOI: 10.1007/s00247-023-05638-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The most accurate method for estimating effective dose (the most widely understood metric for tracking patient radiation exposure) from computed tomography (CT) requires time-intensive Monte Carlo simulation. A simpler method multiplies a scalar coefficient by the widely available scanner-reported dose length product (DLP) to estimate effective dose. OBJECTIVE Develop pediatric effective dose coefficients and assess their agreement with Monte Carlo simulation. MATERIALS AND METHODS Multicenter, population-based sample of 128,397 pediatric diagnostic CT scans prospectively assembled in 2015-2020 from the University of California San Francisco International CT Dose Registry and the University of Florida library of highly realistic hybrid computational phantoms. We generated effective dose coefficients for seven body regions, stratified by patient age, diameter, and scanner manufacturer. We applied the new coefficients to DLPs to calculate effective doses and assessed their correlations with Monte Carlo radiation transport-generated effective doses. RESULTS The reported effective dose coefficients, generally higher than previous studies, varied by body region and decreased in magnitude with increasing age. Coefficients were approximately 4 to 13-fold higher (across body regions) for patients <1 year old compared with patients 15-21 years old. For example, head CT (54% of scans) dose coefficients decreased from 0.039 to 0.003 mSv/mGy-cm in patients <1 year old vs. 15-21 years old. There were minimal differences by manufacturer. Using age-based conversion coefficients to estimate effective dose produced moderate to strong correlations with Monte Carlo results (Pearson correlations 0.52-0.80 across body regions). CONCLUSIONS New pediatric effective dose coefficients update existing literature and can be used to easily estimate effective dose using scanner-reported DLP.
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Affiliation(s)
- Philip W Chu
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, Box 0560, San Francisco, CA, 94143, USA
| | - Cameron Kofler
- Department of Radiology, The University of Chicago, Chicago, IL, USA
| | - Malini Mahendra
- Department of Pediatrics, Division of Pediatric Critical Care, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Yifei Wang
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, Box 0560, San Francisco, CA, 94143, USA
| | - Cameron A Chu
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, Box 0560, San Francisco, CA, 94143, USA
| | - Carly Stewart
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, Box 0560, San Francisco, CA, 94143, USA
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian Haas
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wesley E Bolch
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Rebecca Smith-Bindman
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, Box 0560, San Francisco, CA, 94143, USA.
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA.
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
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Fuciarelli TM, Patel S, Rollo CD. Differential impacts of ionizing radiation on a sexually dimorphic trait in male and female Acheta domesticus. Int J Radiat Biol 2023; 99:1749-1759. [PMID: 37262368 DOI: 10.1080/09553002.2023.2219731] [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: 10/26/2022] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE In many Orthopteran species, including crickets, forewings exhibit substantial sexual dimorphism driven by sexual selection. In the cricket, Acheta domesticus, females are the 'choosy' sex and males exhibit multiple sexual signals to attract and successfully mate. Male forewings have highly specialized structures critical for acoustic signaling and mating. In contrast, female forewings currently serve no known purpose in this flightless species. Forewings also differ morphologically with male forewings containing complex acoustic producing and resonating regions and females lacking any defined structures. Due to their importance to mating as well as their structural complexity, impacts of environmental stress that target cricket forewing development may therefore have more severe consequences in males than females. Here, we investigate the sensitivity of a sexually dimorphic trait, forewing morphology, to an early life environmental stressor. MATERIALS AND METHODS We applied ionizing radiation (0--27.8 Gy) as a stressor as dose can be precisely applied as well as its relevance in both environmental contamination and use in the Sterile Insect Technique. RESULTS A canonical variate analysis indicated that wing shape was significantly altered in males at all doses; .58 Gy, 2.3 Gy, 4.6 Gy, 16.2 Gy, and 23.2 Gy. In females, shape was significantly altered at 27.8 Gy and 23.2 Gy groups and to a lesser extent at .58 Gy and 16.2 Gy. Linear regression analysis of centroid size indicated a dose dependent decline in wing size in both sexes, with males exhibiting more decline. Fluctuating asymmetry, a measure of environmental sensitivity, revealed that males were more sensitive to shape changes due to stress than females. This difference in sensitivity is likely due to the complexity of male forewings. CONCLUSION These results expand understanding of sex dimorphism in stress responses and sensitivity to ionizing radiation.
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Affiliation(s)
| | - Selvi Patel
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - C David Rollo
- Department of Biology, McMaster University, Hamilton, ON, Canada
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11
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Metaxas V, Efthymiou F, Dimitroukas C, Delis H, Gatzounis G, Zampakis P, Tzortzidis F, Papadakos D, Constantoyannis C, Panayiotakis G. Lumbar discectomy and fusion: Organs’ dose and effective dose estimation using Monte Carlo simulation. Appl Radiat Isot 2023; 196:110781. [PMID: 36996533 DOI: 10.1016/j.apradiso.2023.110781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/19/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
In this study, the effect of patient- and procedure-related parameters on organs' dose (OD), peak skin dose (PSD) and effective dose (ED) during lumbar discectomy and fusion (LDF) was assessed. Intra-operative parameters obtained from 102 LDFs were inserted into VirtualDose-IR software implementing sex-specific and BMI-adjustable anthropomorphic phantoms for dosimetric calculations. Fluoroscopy time (FT), kerma-area product (KAP), cumulative and incident air-kerma (Kair) were also recorded from the dosimetric report of the mobile C-arm. An increase in KAP, Kair, PSD and ED was found for male or higher BMI patients, multi-level or fusion or L5/S1 procedures. However, a significant difference was found only for PSD and incident Kair between normal and obese patients and for FT between discectomy and discectomy and fusion procedures. The spleen, kidneys and colon received the highest doses. The BMI have a significant impact only for kidneys, pancreas, and spleen doses when comparing obese to overweight and for urinary bladder when comparing overweight to normal patients. Multi-level and fusion procedures resulted in significantly higher doses for lungs, heart, stomach, adrenals, gallbladder and kidneys, while pancreas and spleen doses significantly increased only for multi-level procedures. Additionally, a significant increase was found only for urinary bladder, adrenals, kidneys, and spleen ODs when comparing L5/S1 and L3/L4 levels. The mean ODs were lower compared to the literature. These data may aid neurosurgeons in optimising exposure techniques during LDF to keep patients' dose as low as is practicably possible.
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Affiliation(s)
- Vasileios Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Fotios Efthymiou
- Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Christos Dimitroukas
- Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece; Department of Medical Physics, University Hospital of Patras, 26504, Patras, Greece
| | - Harry Delis
- Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece
| | - George Gatzounis
- Department of Neurosurgery, University Hospital of Patras, 26504, Patras, Greece; Department of Neurosurgery, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Petros Zampakis
- Department of Radiology, University Hospital of Patras, 26504, Patras, Greece; Department of Radiology, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Fotios Tzortzidis
- Department of Neurosurgery, University Hospital of Patras, 26504, Patras, Greece
| | - Dimitrios Papadakos
- Department of Neurosurgery, University Hospital of Patras, 26504, Patras, Greece
| | - Constantine Constantoyannis
- Department of Neurosurgery, University Hospital of Patras, 26504, Patras, Greece; Department of Neurosurgery, School of Medicine, University of Patras, 26504, Patras, Greece
| | - George Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece; Department of Medical Physics, University Hospital of Patras, 26504, Patras, Greece.
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12
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Alemayehu TG, Bogale GG, Bazie GW. Occupational radiation exposure dose and associated factors among radiology personnel in Eastern Amhara, Ethiopia. PLoS One 2023; 18:e0286400. [PMID: 37228161 DOI: 10.1371/journal.pone.0286400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Ionizing radiation is being used more frequently in medicine, which has been linked to recognized biological effects such as cancer and mortality. Radiology services are becoming more widely available in Ethiopian health facilities but there is no compiled record of worker's radiation dose. So, assessing the magnitude and identifying the associated factors of occupational radiation exposure dose among radiology personnel help to design strategies for radiation protection. OBJECTIVE The study was designed to assess the occupational radiation exposure dose and associated factors among radiology personnel in eastern Amhara, northeast Ethiopia, 2021. METHODS Cross-sectional study was conducted from March 25 to April 30, 2021, in 57 health institutions among 198 radiology personnel. The study comprised all eligible radiology personnel. The data were collected using an electronic-based (Google form) self-administered questionnaire, and document review. The data were entered into an excel spread sheet and then, exported to Stata 14 software. Linear regression model was used to analyse the data after checking its assumptions. Variables with a p-value < 0.25 were entered into a multiple linear regression analysis, and those with a p-value < 0.05 were judged significant. VIF was used to check for multi-collinearity. Coefficient of determination was used to check the model fitness. RESULTS The mean (± SD) annual shallow and deep dose equivalents of radiology personnel were 1.20 (± 0.75) and 1.02 (± 0.70) mSv, respectively. Body mass index (β = 0.104, 95% CI: 0.07, 0.14), practice of timing (β = -0.43, 95% CI: -0.73, -0.13), working experience (β = -0.04, 95% CI: -0.048, -0.032), and practice of distancing (β = -0.26, 95% CI: -0.49, -0.17) were found to be statistically significant factors of annual deep dose equivalent. In addition, body mass index (β = 0.113, 95% CI: 0.08, 0.15), practice of timing (β = -0.62 95% CI: -0.93, -0.31) and, working experience (β = -0.044, 95% CI: -0.053, -0.036 had statistically significant associations with annual shallow dose equivalent. CONCLUSION The annual dose equivalents were two times higher than the global average of annual per caput effective dose due to medical exposure. Body mass index, practice of timing, working experience, and practice of distancing were factors of occupational radiation exposure dose. Strategies focusing on increasing the skill, experience, and lifestyle of radiology personnel would be supreme important means to reduce occupational radiation exposure dose.
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Affiliation(s)
| | - Getahun Gebre Bogale
- Department of Health Informatics, College of Medicine and Health Sciences, School of Public Health, Wollo University, Dessie, Ethiopia
| | - Getaw Walle Bazie
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences School of Public Health, Wollo University, Dessie, Ethiopia
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13
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Sadre Momtaz A, Safarnejad F. 18F-alfatide II internal dosimetry using the ICRP 110 adult reference phantoms and the ICRP 103 tissue weighting factors. Phys Med 2023; 107:102552. [PMID: 36857858 DOI: 10.1016/j.ejmp.2023.102552] [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] [Received: 08/18/2022] [Revised: 02/02/2023] [Accepted: 02/18/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE 18F-alfatide II is an arginine-glycine-aspartate (RGD) peptide-based PET tracer with promising imaging properties and pharmacokinetics. This study aims to calculate the absorbed and effective doses of 18F-alfatide II using the ICRP 110 adult reference phantoms and the ICRP 103 tissue weighting factors. METHODS The MIRD method was used in this study to calculate the absorbed dose of organs and tissues. The biokinetic data were taken from a previous study. These data are based on the whole-body PET imaging of mice. RESULTS The results show that the effective dose per unit activity administered of 18F-alfatide II is 1.33E-02 mSv/MBq. The urinary bladder wall receives the highest absorbed dose due to the administration of this radiopharmaceutical. Also, the effective dose of 18F-alfatide II is lower than that of 18F-FDG and some other RGD peptide-based tracers. CONCLUSIONS Dose calculation using ICRP 110 voxelized adult reference phantoms and ICRP 103 tissue weighting factors leads to more realistic and accurate results for 18F-alfatide II compared to the stylized phantoms. The calculated effective dose of 18F-alfatide II in the present study is lower than that of previously published data.
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Affiliation(s)
- Alireza Sadre Momtaz
- Department of Physics, Faculty of Sciences, University of Guilan, Rasht 41335-1914, Iran.
| | - Farzin Safarnejad
- Department of Physics, Faculty of Sciences, University of Guilan, Rasht 41335-1914, Iran
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14
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Ferrari C, Manenti G, Malizia A. Sievert or Gray: Dose Quantities and Protection Levels in Emergency Exposure. SENSORS (BASEL, SWITZERLAND) 2023; 23:1918. [PMID: 36850517 PMCID: PMC9959072 DOI: 10.3390/s23041918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Mitigation or even elimination of adverse effects caused by ionizing radiation is the main scope of the radiation protection discipline. The interaction of radiation with living matter is quantified and correlated with biological effects by dose. The Sievert is the most well-known quantity, and it is used with the equivalent and effective dose to minimize stochastic effects. However, Gray is the reference quantity for sizing tissue reactions that could occur under high-exposure conditions such as in a radiation emergency. The topics addressed in this review are the choice to move from Sievert to Gray, how the operational quantities for environmental and individual monitoring of the detectors should consider such a change of units, and why reference levels substitute dose levels in emergency exposure.
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Affiliation(s)
- Chiara Ferrari
- Department Industrial Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy
| | - Guglielmo Manenti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Andrea Malizia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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15
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Ounoughi N, Boukhellout A, Kharfi F. Neutron shielding assessment of a 16O hadron therapy room by means of Monte Carlo simulations with the PHITS code. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:011506. [PMID: 36599152 DOI: 10.1088/1361-6498/acaff0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Hadron radiation therapy is of great interest worldwide. Heavy-ion beams provide ideal therapeutic conditions for deep-seated local tumours. At the Heidelberg Ion Beam Therapy Center (HIT, Germany), protons and carbon ions are already integrated into the clinical routine, while16O ions are still used for research only. To ensure the protection of the technical staff and members of the public, it is required to estimate the neutron dose distribution for optimal working conditions and at different locations. The Particle and Heavy Ion Transport Code System (PHITS) is used in this work to evaluate the dose rate distribution of secondary neutrons in a treatment room at HIT where16O ions are used: an equivalent target in soft tissue is considered in the shielding assessment to simulate the interaction of the beam with patients. The angular dependence of neutron fluences and energy spectra around the considered phantom were calculated. Alongside the spatial distribution of the neutron and photon fluence, a map of the effective dose rate was estimated using the ICRP fluence-to-effective dose conversion coefficients, exploiting the PHITS code's built-in capabilities. The capability of the actual shielding design of the studied HIT treatment room was approved.
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Affiliation(s)
- Nabil Ounoughi
- Radiation Physics and Applications Laboratory, Mohammed Seddik Benyahia University, Jijel, Algeria
| | - Abdelmalek Boukhellout
- Radiation Physics and Applications Laboratory, Mohammed Seddik Benyahia University, Jijel, Algeria
| | - Faycal Kharfi
- Laboratory of Dosing, Analysis and Characterization in High Resolution (DAC), Ferhat Abbas Setif1 University, Setif, Algeria
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16
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Caelers I, Berendsen R, Droeghaag R, Pecasse N, Rijkers K, Van Hemert W, De Bie R, Van Santbrink H. Comparing radiation dose of image-guided techniques in lumbar fusion surgery with pedicle screw insertion; A systematic review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 13:100199. [PMID: 36747986 PMCID: PMC9898805 DOI: 10.1016/j.xnsj.2023.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
Background Context Fluoroscopic devices can be used to visualize subcutaneous and osseous tissue, a useful feature during pedicle screw insertion in lumbar fusion surgery. It is important that both patient and surgeon are exposed as little as possible, since these devices use potential harmful ionizing radiation. Purpose This study aims to compare radiation exposure of different image-guided techniques in lumbar fusion surgery with pedicle screw insertion. Study Design Systematic review. Methods Cochrane, Embase, PubMed and Web of Science databases were used to acquire relevant studies. Eligibility criteria were lumbar and/or sacral spine, pedicle screw, mGray and/or Sievert and/or mrem, radiation dose and/or radiation exposure. Image-guided techniques were divided in five groups: conventional C-arm, C-arm navigation, C-arm robotic, O-arm navigation and O-arm robotic. Comparisons were made based on effective dose for patients and surgeons, absorbed dose for patients and surgeons and exposure. Risk of bias was assessed using the 2017 Cochrane Risk of Bias tool on RCTs and the Cochrane ROBINS-I tool on NRCTs. Level of evidence was assessed using the guidelines of Oxford Centre for Evidence-based Medicine 2011. Results A total of 1423 studies were identified of which 38 were included in the analysis and assigned to one of the five groups. Results of radiation dose per procedure and per pedicle screw were described in dose ranges. Conventional C-arm appeared to result in higher effective dose for surgeons, higher absorbed dose for patients and higher exposure, compared to C-arm navigation/robotic and O-arm navigation/robotic. Level of evidence was 3 to 4 in 29 studies. Risk of bias of RCTs was intermediate, mostly due to inadequate blinding. Overall risk of bias score in NRCTs was determined as 'serious'. Conclusions Ranges of radiation doses using different modalities during pedicle screw insertion in lumbar fusion surgery are wide. Based on the highest numbers in the ranges, conventional C-arm tends to lead to a higher effective dose for surgeons, higher absorbed dose for patients and higher exposure, compared to C-arm-, and O-arm navigation/robotic. The level of evidence is low and risk of bias is fairly high. In future studies, heterogeneity should be limited by standardizing measurement methods and thoroughly describing the image-guided technique settings.
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Affiliation(s)
- I.J.M.H. Caelers
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands,Department of Neurosurgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands,Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, the Netherlands,Corresponding author.
| | - R.C.M. Berendsen
- Department of Medical Physics, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands
| | - R. Droeghaag
- Department of Orthopedic surgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands
| | - N.J.J. Pecasse
- Biomedical Sciences, Faculty of Health, Medicine and Life Sciences, Maastricht University, the etherlands
| | - K. Rijkers
- Department of Neurosurgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands,Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - W.L.W. Van Hemert
- Department of Orthopedic surgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands
| | - R.A. De Bie
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands,Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - H. Van Santbrink
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands,Department of Neurosurgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands,Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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17
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Abuqbeitah M, Demir M, Sönmezoğlu K, Sayman H, Kabasakal L, Sağer S, Asa S, Uslu-Beşli L, Rehani MM. Original research patients undergoing multiple 18F-FDG PET/CT scans: frequency, clinical indications, and cumulative dose. HEALTH AND TECHNOLOGY 2023. [DOI: 10.1007/s12553-022-00716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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18
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Ilori AO, Chetty N. Activity concentrations and radiological hazard assessments of 226Ra, 232Th, and 40K in soil samples of oil-producing areas of South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:2665-2677. [PMID: 34601976 DOI: 10.1080/09603123.2021.1984399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
The specific activity of natural radionuclide in soil samples of the oil-producing areas of South Africa was measured using a High Purity Germanium detector. The activity of226Ra, 232Th, and 40K in the soil range from 16.5 ± 1.3 to 64.9 ± 3.1, 16.8 ± 1.5 to 88.6 ± 1.2, 135.2 ± 17.5 to 604.8 ± 13.4 Bqkg-1 for Mossel Bay; 14.3 ± 1.2 to 48.9 ± 8.2, 22.3 ± 1.4 to 45.1 ± 3.2, 237.7 ± 10.9 to 486.5 ± 40.1 Bqkg-1 for Cape Town; 10.5 ± 1.1 to 25.8 ± 3.2, 13.1 ± 1.9 to 44.3 ± 5.2, 140.2 ± 10.9 to 229.8 ± 12.8 Bqkg-1 for Nelson Mandela Bay and 5.6 ± 2.2 to 13.1 ± 2.9, 4.5 ± 2.5 to 14.1 ± 2.7, 62.7 ± 22.6 to 126.5 ± 21.2 Bqkg-1 for Msunduzi. Most soil samples' radiological hazards were within the world average.
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Affiliation(s)
- Abiola Olawale Ilori
- School of Chemistry and Physics, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Naven Chetty
- School of Chemistry and Physics, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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19
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Xiao Z, Zhang Y, Speth J, Lee E, Mascia A, Lamba M. Evaluation of a conventionally shielded proton treatment room for FLASH radiotherapy. Med Phys 2022; 49:6765-6773. [PMID: 36114793 PMCID: PMC10091931 DOI: 10.1002/mp.15964] [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: 05/05/2022] [Revised: 07/27/2022] [Accepted: 08/28/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE FLASH radiotherapy (FLASH-RT) is the potential for a major breakthrough in cancer care, as preclinical results have shown significantly reduced toxicities to healthy tissues while maintaining excellent tumor control. However, FLASH conditions were not considered in the current proton facilities' shielding designs. The purpose of this study is to validate the adequacy of conventionally shielded proton rooms used for FLASH-RT. METHODS Clinical FLASH irradiations typically take place in a few 100 ms, orders of magnitude shorter than the response time of the wide-energy neutron detector (WENDI-II). The nozzle beam current (representing the dose rate) dependence of the WENDI-II detector response was empirically determined to stabilize with a beam current of ≤10 nA at the measurement point with the highest dose rate. A large, predefined proton transmission FLASH plan (250 MeV, 7 × 20 cm2 , 8 Gy at isocenter) was commissioned as part of a FLASH clinical trial. For purpose of this study, that field was adjusted from 250 to 244 MeV, allowing a lower beam current of 10 nA to provide reliable detector response. Radiation surveys were performed for the proton beams with/without extra beam stopper (30 × 30 × 40-cm3 solid water slabs) at 0°, 90°, 180°, and 270° gantry angles. RESULTS Ambient doses were recorded at seven different locations. A 170-nA beam current, commonly used for clinical FLASH plans, was chosen to normalize the average ambient dose rate to FLASH conditions. Assuming 200-Gy/h workload (25 FLASH beams, 8 Gy/beam), annual occupational dose at controlled areas was calculated. For all gantry angles, ≤0.4 mSv/year is expected at treatment room door. The highest ambient dose, 2.46 mSv/year, ∼5% of the maximum annual permissible occupational dose, was identified at the isocenter of the adjacent treatment room with 90° gantry. CONCLUSION These survey results indicate that our conventionally shielded proton rotating gantry rooms result in acceptable occupational and public doses when the transmission FLASH beams delivered at four cardinal gantry angles based on 200-Gy/h workload assumption. These findings support that FLASH clinical trials in our conventionally shielded proton facilities can be safely implemented.
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Affiliation(s)
- Zhiyan Xiao
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Yongbin Zhang
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joseph Speth
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Eunsin Lee
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anthony Mascia
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael Lamba
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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20
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Robotics Reduces Radiation Exposure in Minimally Invasive Lumbar Fusion Compared With Navigation. Spine (Phila Pa 1976) 2022; 47:1279-1286. [PMID: 35791068 DOI: 10.1097/brs.0000000000004381] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/17/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare robotics and navigation for minimally invasive elective lumbar fusion in terms of radiation exposure and time demand. SUMMARY OF BACKGROUND DATA Although various studies have been conducted to demonstrate the benefits of both navigation and robotics over fluoroscopy in terms of radiation exposure, literature is lacking in studies comparing robotics versus navigation. MATERIALS AND METHODS Patients who underwent elective one-level or two-level minimally invasive transforaminal lumbar interbody fusion (TLIF) by a single surgeon using navigation (Stryker SpineMask) or robotics (ExcelsiusGPS) were included (navigation 2017-2019, robotics 2019-2021, resulting in prospective cohorts of consecutive patients for each modality). All surgeries had the intraoperative computed tomography workflow. The two cohorts were compared for radiation exposure [fluoroscopy time and radiation dose: image capture, surgical procedure, and overall) and time demand (time for setup and image capture, operative time, and total operating room (OR) time]. RESULTS A total of 244 patients (robotics 111, navigation 133) were included. The two cohorts were similar in terms of baseline demographics, primary/revision surgeries, and fusion levels. For one-level TLIF, total fluoroscopy time, total radiation dose, and % of radiation for surgical procedure were significantly less with robotics compared with navigation (20 vs. 25 s, P <0.001; 38 vs. 42 mGy, P =0.05; 58% vs. 65%, P =0.021). Although time for setup and image capture was significantly less with robotics (22 vs. 25 min, P <0.001) and operative time was significantly greater with robotics (103 vs. 93 min, P <0.001), there was no significant difference in the total OR time (145 vs. 141 min, P =0.25). Similar findings were seen for two-level TLIF as well. CONCLUSION Robotics for minimally invasive TLIF, compared with navigation, leads to a significant reduction in radiation exposure both to the surgeon and patient, with no significant difference in the total OR time.
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21
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Necarsulmer J, Reed S, Arhin M, Shastri D, Quig N, Yap E, Ho J, Sasaki-Adams D. Cumulative Radiation Exposure in Aneurysmal Subarachnoid Hemorrhage: A Single-Institution Analysis. World Neurosurg 2022; 165:e432-e437. [PMID: 35738532 DOI: 10.1016/j.wneu.2022.06.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Diagnosis and management of aneurysmal subarachnoid hemorrhage (aSAH) depend heavily on imaging modalities that repeatedly expose patients to ionizing radiation. There is limited literature on cumulative radiation exposure in this patient population, which is a problem compounded by wide variation among institutions. The present study quantifies the cumulative cranial exposure to ionizing radiation resulting from diagnostic medical imaging and medical procedures during initial hospitalization for ruptured aSAH at a single academic institution and estimates the risk of future adverse events related to radiation injury. METHODS We performed a retrospective observational study of adults who presented to our institution during a nearly 3-year period with acute-onset aSAH, which was confirmed with diagnostic imaging, and had the aneurysm treated with either surgical clip ligation or endovascular embolization. RESULTS A total of 131 patients met the inclusion criteria. Eighty-eight patients (67%) were treated with endovascular embolization and 43 (32%) were treated with clip ligation. We found the average radiation dose to the head during the incident hospitalization for aSAH to be 4.40 Gy (95% confidence interval, 3.91-4.89). Angiography and interventional radiology procedures accounted for most of this exposure. CONCLUSIONS Most patients were exposed to levels of ionizing radiation that put them at considerable risk of deterministic radiation injury. Providers should be aware of the potential consequences of acute and long-term radiation exposure in this patient population, so they can monitor and counsel individuals accordingly and take steps to safely limit radiation exposure during aSAH management.
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Affiliation(s)
- Julie Necarsulmer
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA; Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Samuel Reed
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Martin Arhin
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Darshan Shastri
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Nathan Quig
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Edward Yap
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - James Ho
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA; Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Deanna Sasaki-Adams
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
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22
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Čiva LM, Beganović A, Busuladžić M, Jusufbegović M, Awad-Dedić T, Vegar-Zubović S. Dose Descriptors and Assessment of Risk of Exposure-Induced Death in Patients Undergoing COVID-19 Related Chest Computed Tomography. Diagnostics (Basel) 2022; 12:diagnostics12082012. [PMID: 36010362 PMCID: PMC9407529 DOI: 10.3390/diagnostics12082012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
For more than two years, coronavirus disease 19 (COVID-19) has represented a threat to global health and lifestyles. Computed tomography (CT) imaging provides useful information in patients with COVID-19 pneumonia. However, this diagnostic modality is based on exposure to ionizing radiation, which is associated with an increased risk of radiation-induced cancer. In this study, we evaluated the common dose descriptors, CTDIvol and DLP, for 1180 adult patients. This data was used to estimate the effective dose, and risk of exposure-induced death (REID). Awareness of the extensive use of CT as a diagnostic tool in the management of COVID-19 during the pandemic is vital for the evaluation of radiation exposure parameters, dose reduction methods development and radiation protection.
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Affiliation(s)
- Lejla M. Čiva
- Sarajevo Medical School, University Sarajevo School of Science and Technology, 71210 Ilidža, Bosnia and Herzegovina
| | - Adnan Beganović
- Radiation Protection and Medical Physics Department, Sarajevo University Clinical Center, 71000 Sarajevo, Bosnia and Herzegovina
- Faculty of Science, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
- Correspondence:
| | - Mustafa Busuladžić
- Faculty of Medicine, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Merim Jusufbegović
- Radiology Clinic, Sarajevo University Clinical Center, 71000 Sarajevo, Bosnia and Herzegovina
| | - Ta’a Awad-Dedić
- Healthcare Center of Sarajevo Canton, 71000 Sarajevo, Bosnia and Herzegovina
| | - Sandra Vegar-Zubović
- Radiology Clinic, Sarajevo University Clinical Center, 71000 Sarajevo, Bosnia and Herzegovina
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Zensen S, Bos D, Opitz M, Haubold J, Forsting M, Guberina N, Wetter A. Radiation exposure and establishment of diagnostic reference levels of whole-body low-dose CT for the assessment of multiple myeloma with second- and third-generation dual-source CT. Acta Radiol 2022; 63:527-535. [PMID: 33745295 DOI: 10.1177/02841851211003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the assessment of diseases causing skeletal lesions such as multiple myeloma (MM), whole-body low-dose computed tomography (WBLDCT) is a sensitive diagnostic imaging modality, which has the potential to replace the conventional radiographic survey. PURPOSE To optimize radiation protection and examine radiation exposure, and effective and organ doses of WBLDCT using different modern dual-source CT (DSCT) devices, and to establish local diagnostic reference levels (DRL). MATERIAL AND METHODS In this retrospective study, 281 WBLDCT scans of 232 patients performed between January 2017 and April 2020 either on a second- (A) or third-generation (B) DSCT device could be included. Radiation exposure indices and organ and effective doses were calculated using a commercially available automated dose-tracking software based on Monte-Carlo simulation techniques. RESULTS The radiation exposure indices and effective doses were distributed as follows (median, interquartile range): (A) second-generation DSCT: volume-weighted CT dose index (CTDIvol) 1.78 mGy (1.47-2.17 mGy); dose length product (DLP) 282.8 mGy·cm (224.6-319.4 mGy·cm), effective dose (ED) 1.87 mSv (1.61-2.17 mSv) and (B) third-generation DSCT: CTDIvol 0.56 mGy (0.47-0.67 mGy), DLP 92.0 mGy·cm (73.7-107.6 mGy·cm), ED 0.61 mSv (0.52-0.69 mSv). Radiation exposure indices and effective and organ doses were significantly lower with third-generation DSCT (P < 0.001). Local DRLs could be set for CTDIvol at 0.75 mGy and DLP at 120 mGy·cm. CONCLUSION Third-generation DSCT requires significantly lower radiation dose for WBLDCT than second-generation DSCT and has an effective dose below reported doses for radiographic skeletal surveys. To ensure radiation protection, DRLs regarding WBLDCT are required, where our locally determined values may help as benchmarks.
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Affiliation(s)
- Sebastian Zensen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Denise Bos
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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24
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Simon SL, Bouville A, Beck HL, Anspaugh LR, Thiessen KM, Hoffman FO, Shinkarev S. Dose Estimation for Exposure to Radioactive Fallout from Nuclear Detonations. HEALTH PHYSICS 2022; 122:1-20. [PMID: 34898514 PMCID: PMC8677604 DOI: 10.1097/hp.0000000000001501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT In recent years, the prospects that a nuclear device might be detonated due to a regional or global political conflict, by violation of present nuclear weapons test ban agreements, or due to an act of terrorism, has increased. Thus, the need exists for a well conceptualized, well described, and internally consistent methodology for dose estimation that takes full advantage of the experience gained over the last 70 y in both measurement technology and dose assessment methodology. Here, the models, rationale, and data needed for a detailed state-of-the-art dose assessment for exposure to radioactive fallout from nuclear detonations discussed in five companion papers are summarized. These five papers present methods and data for estimating radionuclide deposition of fallout radionuclides, internal and external dose from the deposited fallout, and discussion of the uncertainties in the assessed doses. In addition, this paper includes a brief discussion of secondary issues related to assessments of radiation dose from fallout. The intention of this work is to provide a usable and consistent methodology for both prospective and retrospective assessments of exposure from radioactive fallout from a nuclear detonation.
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Affiliation(s)
- Steven L. Simon
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - André Bouville
- National Cancer Institute, National Institutes of Health, Bethesda, MD (retired)
| | | | - Lynn R. Anspaugh
- Department of Radiology, University of Utah (Emeritus), Henderson, NV
| | | | | | - Sergey Shinkarev
- State Research Center-Burnasyan Federal Medical Biophysical Center, Federal Medical Biological Agency, Moscow, Russian Federation
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25
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Abstract
Nuclear medicine provides methods and techniques in that has benefited pediatric patients and their referring physicians for over 40 years. Nuclear medicine provides qualitative and quantitative information about overall and regional function of organs, systems, and lesions in the body. This involves applications in many organ systems including the skeleton, the brain, the kidneys and the heart as well as in the diagnosis and treatment of cancer. The practice of nuclear medicine requires the administration of radiopharmaceuticals which expose the patient to very low levels of ionizing radiation. Advanced approaches in the estimation of radiation dose from the internal distribution of radiopharmaceuticals in patients of various sizes and shapes have been developed in the past 20 years. Although there is considerable uncertainty in the estimation of the risk of adverse health effects from radiation at the very low exposure levels typically associated with nuclear medicine, some considers it prudent to be more cautious when applied to children as they are generally considered to be at higher risk than adults. Standard guidelines for administered activities for nuclear medicine procedures in children have been established including the North American consensus guidelines and the Paediatric Dosage Card developed by the European Association of Nuclear Medicine. As we move into the future, these guidelines would likely be reviewed in response to changes in clinical practice, a better understanding of radiation dosimetry as applied to children as well as new clinical applications, new advancements in the field with respect to both instrumentation and image reconstruction and processing.
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Affiliation(s)
- S Ted Treves
- Harvard Medical School; Brigham and Women's Hospital.
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26
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Ezzati AO, Mohajeri F. Optimization of newly developed and lead shields thicknesses for protecting taxi drivers from 99mTc injected patients. Appl Radiat Isot 2021; 179:110026. [PMID: 34781074 DOI: 10.1016/j.apradiso.2021.110026] [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: 06/27/2021] [Revised: 10/17/2021] [Accepted: 11/09/2021] [Indexed: 11/02/2022]
Abstract
Presently, public members are exposed to sources of ionizing radiation, and health risks due to radiation exposures should be a concern. This study aims to calculate the whole-body cumulative radiation exposure of taxi drivers. Also, this study will provide the effect of using a simple lead shield and three types of glass shield AVT6, TZN-D, and SLGC-E5, by calculating the effective annual dose of the taxi drivers that work in medical centers. Two MIRD phantoms as a driver and patient, a sample body of a taxi, pure lead, and glass sheets as a shield, were simulated using the MCNP code. We assumed that the patients had undergone the brain, liver, and kidney SPECT imaging by injecting 99mTC-HMPAO, 99mTC-sulfur colloid, and 99mTC-DMSA with the activity of 740MBq, 185MBq, and 333MBq, respectively. These shields are simulated on two sides of the driver, in the back and right side. The annual effective dose was calculated for 0-3.5 g/cm2 area densities. It was observed that the 0.45, 1.09, 1.28, and 2.11 g/cm2 of Pb, TZN-D, AVT6, and SLGC-E5 respectively decrease the effective dose below the allowed limit. According to the results, using the lead shield, the effective dose was reduced by a factor up to 7.25 times. It is recommended that taxi drivers wear a 0.4 mm lead shield or its equivalent when they have Tc-99 m injected patients.
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Affiliation(s)
- Ahad Ollah Ezzati
- University of Tabriz, Department of Physics, 29 Bahman Blvd, Tabriz, 5166616471, Iran.
| | - Farzane Mohajeri
- University of Tabriz, Department of Physics, 29 Bahman Blvd, Tabriz, 5166616471, Iran
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27
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Karim M, Harun H, Kayun Z, Aljewaw O, Azizan S, Rafiz N, Muhammad N. Paediatric radiation dose and cancer risk associated with body effective diameter during CT thorax examination. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Tamaddondoust RN, Wang Y, Jafarnejad SM, Graber TE, Alain T. The highs and lows of ionizing radiation and its effects on protein synthesis. Cell Signal 2021; 89:110169. [PMID: 34662715 DOI: 10.1016/j.cellsig.2021.110169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/19/2021] [Accepted: 10/06/2021] [Indexed: 11/03/2022]
Abstract
Ionizing radiation (IR) is a constant feature of our environment and one that can dramatically affect organismal health and development. Although the impacts of high-doses of IR on mammalian cells and systems have been broadly explored, there are still challenges in accurately quantifying biological responses to IR, especially in the low-dose range to which most individuals are exposed in their lifetime. The resulting uncertainty has led to the entrenchment of conservative radioprotection policies around the world. Thus, uncovering long-sought molecular mechanisms and tissue responses that are targeted by IR could lead to more informed policymaking and propose new therapeutic avenues for a variety of pathologies. One often overlooked target of IR is mRNA translation, a highly regulated cellular process that consumes more than 40% of the cell's energy. In response to environmental stimuli, regulation of mRNA translation allows for precise and rapid changes to the cellular proteome, and unsurprisingly high-dose of IR was shown to trigger a severe reprogramming of global protein synthesis allowing the cell to conserve energy by preventing the synthesis of unneeded proteins. Nonetheless, under these conditions, certain mRNAs encoding specific proteins are translationally favoured to produce the factors essential to repair the cell or send it down the path of no return through programmed cell death. Understanding the mechanisms controlling protein synthesis in response to varying doses of IR could provide novel insights into how this stress-mediated cellular adaptation is regulated and potentially uncover novel targets for radiosensitization or radioprotection. Here, we review the current literature on the effects of IR at both high- and low-dose on the mRNA translation machinery.
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Affiliation(s)
- Rosette Niloufar Tamaddondoust
- Molecular Biomedicine Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada; Radiobiology and Health, Canadian Nuclear Laboratories, Chalk River, Ontario, Canada.
| | - Yi Wang
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada; Radiobiology and Health, Canadian Nuclear Laboratories, Chalk River, Ontario, Canada
| | - Seyed Mehdi Jafarnejad
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast BT9 7AE, UK
| | - Tyson E Graber
- Molecular Biomedicine Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Tommy Alain
- Molecular Biomedicine Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada.
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29
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Abstract
Background: In 2013, the American Thyroid Association (ATA) issued a "Policy Statement on Thyroid Shielding During Diagnostic Medical and Dental Radiology." The recently updated National Council on Radiation Protection and Measurement Radiation Protection in Dentistry and Oral and Maxillofacial Imaging (NCRP Report No. 177) prompts this review of progress related to patient thyroid shielding since the ATA statement was published. Summary: Relevant publications appearing since the ATA statement were identified by querying PubMed for "thyroid and dental and (collar or shielding)" and substituting specific dental radiographic procedures in the search. The search was expanded by reviewing the cited papers in the PubMed-retrieved papers and by use of the Web of Science to retrieve papers citing the PubMed retrieved publications. Although many quantitative studies have appeared reflective of current dental radiographic instrumentation and practice, much more can be done to foster minimizing radiation to the thyroid. Conclusions: We list seven areas that should be pursued. Among them are harmonizing guidelines for the use of thyroid collars based on the recent studies and a comprehensive survey of current dental radiological practice patterns.
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Affiliation(s)
- Arthur B Schneider
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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30
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Stricklin DL, VanHorne-Sealy J, Rios CI, Scott Carnell LA, Taliaferro LP. Neutron Radiobiology and Dosimetry. Radiat Res 2021; 195:480-496. [PMID: 33587743 DOI: 10.1667/rade-20-00213.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/11/2021] [Indexed: 12/12/2022]
Abstract
As the U.S. prepares for the possibility of a radiological or nuclear incident, or anticipated lunar and Mars missions, the exposure of individuals to neutron radiation must be considered. More information is needed on how to determine the neutron dose to better estimate the true biological effects of neutrons and mixed-field (i.e., neutron and photon) radiation exposures. While exposure to gamma-ray radiation will cause significant health issues, the addition of neutrons will likely exacerbate the biological effects already anticipated after radiation exposure. To begin to understand the issues and knowledge gaps in these areas, the National Institute of Allergy and Infectious Diseases (NIAID), Radiation Nuclear Countermeasures Program (RNCP), Department of Defense (DoD), Defense Threat Reduction Agency (DTRA), and National Aeronautics and Space Administration (NASA) formed an inter-agency working group to host a Neutron Radiobiology and Dosimetry Workshop on March 7, 2019 in Rockville, MD. Stakeholder interests were clearly positioned, given the differences in the missions of each agency. An overview of neutron dosimetry and neutron radiobiology was included, as well as a historical overview of neutron exposure research. In addition, current research in the fields of biodosimetry and diagnostics, medical countermeasures (MCMs) and treatment, long-term health effects, and computational studies were presented and discussed.
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Affiliation(s)
- Daniela L Stricklin
- Previously - Arlington Division, Applied Research Associates, Inc., Arlington
| | - Jama VanHorne-Sealy
- Army Reactor Program, United States Army Nuclear and Countering Weapons of Mass Destruction Agency (USANCA), Department of Defense, Fort Belvoir, Virginia
| | - Carmen I Rios
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | - Lisa A Scott Carnell
- Biological and Physical Sciences Division, National Aeronautics and Space Administration (NASA), Langley Research Center, Hampton, Virginia
| | - Lanyn P Taliaferro
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
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31
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Vano E, Frija G, Loose R, Paulo G, Efstathopoulos E, Granata C, Andersson J. Dosimetric quantities and effective dose in medical imaging: a summary for medical doctors. Insights Imaging 2021; 12:99. [PMID: 34255191 PMCID: PMC8276901 DOI: 10.1186/s13244-021-01041-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
This review presents basic information on the dosimetric quantities used in medical imaging for reporting patient doses and establishing diagnostic reference levels. The proper use of the radiation protection quantity "effective dose" to compare doses delivered by different radiological procedures and different imaging modalities with its uncertainties and limitations, is summarised. The estimates of population doses required by the European Directive on Basic Safety Standards is commented on. Referrers and radiologists should be familiar with the dose quantities to inform patients about radiation risks and benefits. The application of effective dose on the cumulative doses from recurrent imaging procedures is also discussed. Patient summary: Basic information on the measurement units (dosimetric quantities) used in medical imaging for reporting radiation doses should be understandable to patients. The Working Group on "Dosimetry for imaging in clinical practice" recommended that a brief explanation on the used dosimetric quantities and units included in the examination imaging report, should be available for patients. The use of the quantity "effective dose" to compare doses to which patients are exposed to from different radiological procedures and its uncertainties and limitations, should also be explained in plain language. This is also relevant for the dialog on to the cumulative doses from recurrent imaging procedures. The paper summarises these concepts, including the need to estimate the population doses required by the European Directive on Basic Safety Standards. Referrers and radiologists should be familiar with the dose quantities to inform patients about radiation risks and benefits.
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Affiliation(s)
- Eliseo Vano
- Radiology Department, Complutense University, 28040, Madrid, Spain.
| | - Guy Frija
- Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
| | - Reinhard Loose
- Institute of Medical Physics, Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Graciano Paulo
- ESTESC-Coimbra Health School, Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854, Coimbra, Portugal
| | - Efstathios Efstathopoulos
- 2Nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Claudio Granata
- Department of Paediatric Radiology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Jonas Andersson
- Department of Radiation Sciences, Umea University, Umeå, Sweden
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32
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Koivisto J, van Eijnatten M, Ludlow J, Kiljunen T, Shi X, Wolff J. Comparative dosimetry of radiography device, MSCT device and two CBCT devices in the elbow region. J Appl Clin Med Phys 2021; 22:128-138. [PMID: 33811787 PMCID: PMC8130242 DOI: 10.1002/acm2.13245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of the study was to estimate and to compare effective doses in the elbow region resulting from four different x-ray imaging modalities. Absorbed organ doses were measured using 11 metal oxide field effect transistor (MOSFET) dosimeters that were placed in a custom-made anthropomorphic elbow RANDO phantom. Examinations were performed using Shimadzu FH-21 HR radiography device, Siemens Sensation Open 24-slice MSCT-device, NewTom 5G CBCT device, and Planmed Verity CBCT device, and the effective doses were calculated according to ICRP 103 recommendations. The effective dose for the conventional radiographic device was 1.5 µSv. The effective dose for the NewTom 5G CBCT ranged between 2.0 and 6.7 µSv, for the Planmed Verity CBCT device 2.6 µSv and for the Siemens Sensation MSCT device 37.4 µSv. Compared with conventional 2D radiography, this study demonstrated a 1.4-4.6 fold increase in effective dose for CBCT and 25-fold dose for standard MSCT protocols. When compared with 3D CBCT protocols, the study showed a 6-19 fold increase in effective dose using a standard MSCT protocol. CBCT devices offer a feasible low-dose alternative for elbow 3D imaging when compared to MSCT.
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Affiliation(s)
- Juha Koivisto
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - Maureen van Eijnatten
- Department of Oral and Maxillofacial Surgery/Oral PathologyVU University Medical CenterAmsterdamThe Netherlands
| | - John Ludlow
- University of North CarolinaAdams School of DentistryChapel HillNCUSA
| | | | - Xie‐Qi Shi
- Section of Oral Maxillofacial RadiologyDepartment of Clinical DentistryFaculty of Medicine and DentistryUniversity of BergenBergenNorway
| | - Jan Wolff
- Department of Oral Maxillofacial SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Division of Regenerative Orofacial MedicineHamburgGermany
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33
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Klumpp J, Bertelli L, Dumit S, Gadd M, Poudel D, Waters TL. Response to a Skin Puncture Contaminated with 238Pu at Los Alamos National Laboratory. HEALTH PHYSICS 2020; 119:704-714. [PMID: 33196523 DOI: 10.1097/hp.0000000000001250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The three principal pathways for intakes of plutonium are ingestion, inhalation, and contaminated wounds. In August 2018, a glovebox worker at Los Alamos National Laboratory (LANL) sustained a puncture from a thread of a braided steel cable contaminated with Pu. The puncture produced no pain, no blood, and little or no visible mark. As a result, the potential for a contaminated wound was not immediately recognized, and a wound count was not conducted until elevated urine bioassay results were received 12 d after the incident. This paper discusses the circumstances of the incident, along with the medical response and dose assessment, and a discussion of the risks and benefits of the medical interventions.
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Affiliation(s)
- John Klumpp
- Los Alamos National Laboratory, Radiation Protection Division, MS G761, Los Alamos, NM 87545
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34
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Vogel E, Leaver T, Wall F, Johnson B, Uglow M, Aarvold A. Repeated Pelvic Radiographs in Infants, After Harness Treatment for Developmental Dysplasia of the Hip, Carry Very Low Radiation Risk. Indian J Orthop 2020; 55:1543-1548. [PMID: 34987727 PMCID: PMC8688633 DOI: 10.1007/s43465-021-00438-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/02/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE There are no data on the effect of X-Ray irradiation to the vulnerable pelvic organs of babies during DDH follow-up. This study aims to calculate, for the first time, the radiation exposure to infants during follow-up for DDH harness treatment, and thus quantify the lifetime risk of malignancy. METHODS Patients who had completed 5 years' follow-up following successful Pavlik harness treatment were identified from the hospital DDH database. The radiation dose was extracted from the Computerised Radiology Information System database for every radiograph of every patient. The effective dose (ED) was calculated using conversion coefficients for age, sex and body region irradiated. Cumulative ED was compared to Health Protection Agency standards to calculate lifetime risk of malignancy from the radiographs. RESULTS All radiographs of 40 infants, successfully treated in Pavlik harness for DDH, were assessed. The mean number of AP pelvis radiographs was 7.00 (range: 6-9, mode: 7). The mean cumulative ED was 0.25 mSv (Range: 0.11-0.46, SD: 0.07). This is far lower than the annual 'safe' limit for healthcare workers of 20 mSv and is categorised as "Very Low Risk". CONCLUSION Clinicians involved in the treatment DDH can be re-assured that the cumulative radiation exposure from pelvic radiographs following Pavlik harness treatment is "Very Low Risk". Whilst being mindful of any radiation exposure in children, this study provides a scientific answer that help addresses parental concerns.
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Affiliation(s)
- Elizabeth Vogel
- Southampton Medical School, Southampton University, Southampton, UK
| | - Thomas Leaver
- Southampton Medical School, Southampton University, Southampton, UK
| | - Fiona Wall
- Medical Physics Department, University Hospital Southampton, Southampton, UK
| | - Ben Johnson
- Medical Physics Department, University Hospital Southampton, Southampton, UK
| | - Michael Uglow
- Paediatric Orthopaedics, Southampton Children’s Hospital, Southampton, UK
| | - Alexander Aarvold
- Southampton Medical School, Southampton University, Southampton, UK
- Paediatric Orthopaedics, Southampton Children’s Hospital, Southampton, UK
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35
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Philippou K, Christou CN, Socoliuc V, Vekas L, Tanasă E, Miclau M, Pashalidis I, Krasia‐Christoforou T. Superparamagnetic polyvinylpyrrolidone/chitosan/
Fe
3
O
4
electrospun nanofibers as effective U(
VI
) adsorbents. J Appl Polym Sci 2020. [DOI: 10.1002/app.50212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Christos N. Christou
- Department of Mechanical and Manufacturing Engineering University of Cyprus Nicosia Cyprus
| | - Vlad Socoliuc
- Center for Fundamental and Advanced Technical Research, Laboratory of Magnetic Fluids Romanian Academy – Timisoara Branch Timisoara Romania
| | - Ladislau Vekas
- Center for Fundamental and Advanced Technical Research, Laboratory of Magnetic Fluids Romanian Academy – Timisoara Branch Timisoara Romania
- Research Center for Complex Fluids Systems Engineering Politehnica University of Timisoara Timisoara Romania
| | - Eugenia Tanasă
- Faculty of Applied Chemistry and Materials Science, Politehnica University of Bucharest Bucharest Romania
| | - Marinela Miclau
- Applied Physics Department National Institute for Research and Development in Electrochemistry and Condensed Matter Timisoara Romania
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36
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Andrade ER, Reis ALQ, Alves DF, Alves IS, Andrade EVSL, Stenders RM, Federico CA, Silva AX. Urban critical infrastructure disruption after a radiological dispersive device event. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2020; 222:106358. [PMID: 32745885 DOI: 10.1016/j.jenvrad.2020.106358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
This study aims to evaluate the impacts of the activation of a hypothetical radiological dispersal device (RDD) on the urban critical infrastructure (health facilities and public transport). A densely populated urban region was chosen as a scenery. Additionally, the influence of local environmental factors in the post-detonation process was verified. The source term was Cs-137 due to its mobility in the environment and relative ease of access. The approach used for the evaluation of the consequences was a computer simulation by Gaussian modeling. The HotSpot Health Physics Codes software was applied in conjunction with the RESRAD-RDD software. The results suggest that there is a strong influence of the local atmospheric stability classes (Pasquill-Gifford classes) on both the total equivalent effective dose (TEDE) and soil contamination. Consequently, the impacts on critical urban infrastructure follow the same trend. The method used for comparing the simulated and reference limits was the proportional ratio. All calculated values for radioactive contamination were divided by the reference value adopted by the RESRAD-RDD model for urban critical infrastructure. The results indicate that the information compiled is useful to support the decision-making process, although it is not sufficient to provide care and support for longer periods than those considered in the initial response phase.
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Affiliation(s)
- Edson R Andrade
- Graduate Program in Development and Environment (PRODEMA - UFPB), Federal University of Paraiba, João Pessoa, Brazil; Defense Engineering Graduate Program, Military Institute of Engineering, (IME), Rio de Janeiro, Brazil; Nuclear Engineering Graduate Program, Federal University of Rio de Janeiro (COPPE/UFRJ), Rio de Janeiro, Brazil.
| | - André Luiz Q Reis
- Graduate Program in Development and Environment (PRODEMA - UFPB), Federal University of Paraiba, João Pessoa, Brazil; Defense Engineering Graduate Program, Military Institute of Engineering, (IME), Rio de Janeiro, Brazil.
| | - Daniel F Alves
- Aeronautics Technological Institute (ITA), Brazilian Air Force, São Paulo, Brazil; Institute for Advanced Studies (IEAv), Brazilian Air Force, São Paulo, Brazil.
| | - Isabela S Alves
- IBMEC, Faculty of Engineering, Graduate Program, Rio de Janeiro, Brazil.
| | | | | | - Claudio A Federico
- Institute for Advanced Studies (IEAv), Brazilian Air Force, São Paulo, Brazil.
| | - Ademir X Silva
- Nuclear Engineering Graduate Program, Federal University of Rio de Janeiro (COPPE/UFRJ), Rio de Janeiro, Brazil.
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Cuttler JM. The LNT Issue Is About Politics and Economics, Not Safety. Dose Response 2020; 18:1559325820949066. [PMID: 32952483 PMCID: PMC7476350 DOI: 10.1177/1559325820949066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 11/26/2022] Open
Abstract
The Sykes commentary advocates “a more sensible, graded approach for protection from low dose ionizing radiation” until the LNT dose-response issue is resolved. It urges scientists to stop criticizing the LNT model that links radiation to a risk of cancer and accept regulatory use of the threshold model to “protect” people, but with higher limits. It fails to mention the 120-year history of successful low-dose treatments of a wide variety of serious diseases, including cancers. The commentary ignores published evidence of a threshold at 1.1 Gy for radiogenic leukemia and a dose-rate threshold at about 0.6 Gy per year for lifespan shortening. LNT came from politicized science, replete with scientific misconduct and conflict of interest. Its acceptance created a false cancer scare that was likely intended to stop atomic bomb testing, but it has severely damaged human welfare. Many vitally important low-dose therapies were discarded when the radiation scare was disseminated in 1956. The rapid growth of nuclear energy ended with the media-inflamed public panic after the Three Mile Island accident in 1979. Extreme implementation of the precautionary principle made it uneconomic. Availability of a low-dose therapy for lung inflammation could have dramatically decreased the impact of the COVID-19 pandemic.
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Fisher DR. Should Hotel Housekeepers be Monitored? HEALTH PHYSICS 2020; 119:366. [PMID: 32740394 DOI: 10.1097/hp.0000000000001316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Darrell R Fisher
- Versant Medical Physics and Radiation Safety 229 Saint St. Richland, WA 99354
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Mutalik S, Tadinada A, Molina MR, Sinisterra A, Lurie A. Effective doses of dental cone beam computed tomography: effect of 360-degree versus 180-degree rotation angles. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:433-446. [PMID: 32616450 DOI: 10.1016/j.oooo.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aims of this study were to compare radiation absorbed dose (AD) and effective dose (ED) to tissues from cone beam computed tomography (CBCT) scans with 360-degree versus 180-degree rotations with use of different fields of view (FOV), to compare EDs calculated from measured ADs versus dose area product (DAP) values, and to compare doses to the lens of the eye (LOE) from different scan parameters. STUDY DESIGN ADs for each protocol were measured in tissues, including the LOE, by using an anthropometric phantom. EDs were calculated on the basis of dosimetry (EDm) and DAP values (EDd). Dose differences were determined with analysis of variance (ANOVA). RESULTS ADs and EDs were substantially lower for 180-degree rotation scans compared with 360-degree rotation scans (P < .01). Remainder tissues had the greatest effect on effective dose for most FOVs. Doses were generally lower with small FOVs compared with large FOVs. Most EDm values were lower than EDd values in large FOVs but higher in small FOVs. Differences in EDm and EDd were variable and unpredictable. LOE doses were smaller with the 180-degree scans and smaller FOVs. CONCLUSIONS Radiation doses were generally lower with 180-degree rotation scans and smaller FOVs. These parameters should be used for CBCT acquisitions, whenever possible, and should be made available in all units.
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Affiliation(s)
- Sunil Mutalik
- Sessional Faculty, University of Manitoba, Gerald Niznick College of Dentistry, Winnipeg, MB, Canada
| | - Aditya Tadinada
- Section of Oral & Maxillofacial Radiology, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
| | - Marco R Molina
- Department of Diagnostic Imaging, University of Connecticut School of Medicine, Farmigton, Connecticut, USA
| | - Andrés Sinisterra
- Section of Oral and Maxillofacial Radiology, University of Connecticut, School of Dental Medicine, Farmington, CT, USA
| | - Alan Lurie
- Section of Oral & Maxillofacial Radiology, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA.
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Portelli M, Militi A, Lo Giudice A, Lo Giudice R, Rustico L, Fastuca R, Nucera R. 3D Assessment of Endodontic Lesions with a Low-Dose CBCT Protocol. Dent J (Basel) 2020; 8:dj8020051. [PMID: 32414199 PMCID: PMC7345315 DOI: 10.3390/dj8020051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Cone beam computed tomography (CBCT) is often used in different fields of dental science, especially in complex anatomical districts like the endodontic one. The aim of this study is to propose a low-dose CBCT protocol useful in cases of endodontic lesions. Methods: The device used was a MyRay Hyperion X9-11x5; the low dose setting of the machine was 90 Kv, 27 mAs, CTDI/Vol 2.89 mGy. The absorbed organ doses have been evaluated with an anthropomorphic phantom loaded with thermoluminescent dosimeters positioned at the level of sensitive organs like brain, bone marrow, salivary glands, thyroid, esophagus, oral mucosa, extrathoracic airways, and lymph nodes. Equivalent and effective doses have been calculated; the last one has been calculated using the recommendations approved by the Main Commission of ICRP (International Commission Radiological Protection) in March 2007. For the assessment of image quality, five senior clinicians, independent and experienced clinicians, were asked to state if CBCT scans were accurate enough to assess endodontic lesions. Results: The use of a low-dose CBCT acquisition produced the lowest organ dose (5.01 microSv) at the level of the esophagus. Image quality has been considered accurate enough for endodontic diagnostic needs. Conclusions: CBCT low-dose protocol can be used over the standard one in endodontic special cases because it provides a significantly lower radiation dose to the patients while ensuring good image quality. However, further studies are necessary to evaluate the opportunity of low-dose CBCT exams in endodontic clinical practice.
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Affiliation(s)
- Marco Portelli
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
- Correspondence: ; Tel.: +0039090/2216910; Fax: +0039090/2216911
| | - Angela Militi
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
| | - Antonino Lo Giudice
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
| | - Roberto Lo Giudice
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
| | - Lorenzo Rustico
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
| | - Rosamaria Fastuca
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Via G. Piatti 10, 21100 Varese, Italy;
| | - Riccardo Nucera
- Dept. of Biomedical, Dental Science and Morphological and Functional Images Dental School, Faculty of Medicine, University of Messina, 98100 Messina, Italy; (A.M.); (A.L.G.); (R.L.G.); (L.R.); (R.N.)
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Shah A, Nassri M, Kay J, Simunovic N, Mascarenhas VV, Andrade AJ, Marin-Peña ÓR, Ayeni OR. Intraoperative radiation exposure in hip arthroscopy: a systematic review. Hip Int 2020; 30:267-275. [PMID: 31766894 DOI: 10.1177/1120700019887362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Fluoroscopy is used in hip arthroscopy (HA) for portal placement, instrument localisation, and guidance in bony resection. The recent increase in arthroscopic hip procedures may place patients and surgeons at risk for increased radiation exposure and radiation-induced complications. The purpose of the current systematic review was to assess intraoperative radiation exposure in HA. The systematic review was conducted according to PRISMA guidelines; inclusion criteria were studies assessing radiation exposure in HA. 9 studies including 994 patients were included. Mean age was 38.6 years and 48% (436 of 906) were female. Mean time of fluoroscopy exposure was 0.58 minutes. Dose area product was 129.5 cGycm2. Mean intraoperative absorbed radiation dose studies was 12.6 mGy. Mean intraoperative effective dose was 0.48 mSv. The mean occupational exposure to the surgeon per case was 0.0031 mSv. Higher patient body mass index (BMI) correlated to greater patient effective and cumulative dose (p < 0.05, r = 0.404), and greater occupational exposure (p < 0.001, r = 0.460). Increasing surgeon experience decreased fluoroscopy time (p = 0.039) and radiation dose (p = 0.002). Radiation dose and effective dose were well under the thresholds for deterministic effects (2 Gy) and annual radiation exposure for occupational workers (20 mSv). Intraoperative radiation exposure to patients and surgeons is within acceptable annual radiation limits. Ensuring careful selection of perioperative imaging modalities, proper protective shielding, specifically the use of leaded eyeglasses, and optimal C-arm positioning are key strategies to reduce radiation exposure to patients and surgeons alike.
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Affiliation(s)
- Ajay Shah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohammed Nassri
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Department of Radiology, Hospital da Luz, Lisbon, Portugal
| | | | - Óliver R Marin-Peña
- Orthopedic Surgery and Traumatology Department, University Hospital Infanta Leonor, Madrid, Spain
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Kriechenbauer BMT, Franiel T, Bürckenmeyer F, Aschenbach R, Diamantis I, Malouhi A, Steiniger B, Teichgräber U. Influence of Interventionists' Experience on Radiation Exposure of Patients Who Underwent Prostate Artery Embolization: 4-Year Results from a Retrospective, Single-Center Study. Cardiovasc Intervent Radiol 2020; 43:1194-1201. [PMID: 32342165 PMCID: PMC7369265 DOI: 10.1007/s00270-020-02461-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/19/2020] [Indexed: 11/01/2022]
Abstract
PURPOSE To assess radiation exposure in men undergoing prostate artery embolization (PAE) for the treatment for symptomatic, benign prostatic hyperplasia depending on growing experience of interventional radiologists over a 4-year period. METHODS A total of 250 consecutive patients underwent PAE at a single center. Data on radiation exposure [dose area product (DAP), effective dose (ED), entrance skin dose (ESD), and fluoroscopy time (FT)] were retrospectively evaluated. Primary outcomes of interest were patient radiation exposure in five consecutive groups of 50 patients each and Pearson correlation with the number of patients treated. RESULTS Median DAP, ED, and ESD during prostate artery embolization were significantly higher in the first compared to the second 50 patients (56 298 µGym2 vs. 24 709 µGym2, p < 0.001, 146.4 mSv vs. 64.2 mSv, p < 0.001, and 5.1 Gy vs. 2.4 Gy, p < 0.001, respectively). The following consecutive groups did not differ significantly from the respective preceding group in terms of DAP, ED, and ESD. Number of digital subtraction angiography series, FT, and procedure time decreased with increasing operator experience (Pearson's r = - 0.240, p < 0.001, r = - 0.269, p < 0.001, and r = - 0.504, p < 0.001, respectively). Bilateral prostate artery embolization was associated with less ESD and shorter FT than unilateral embolization (median 2.5 vs. 3.5 Gy, p = 0.02, and 26 min vs. 42 min, p < 0.001, respectively). CONCLUSION Exposure to radiation in men who underwent PAE decreased with growing operator experience and decreasing complexity of procedures.
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Affiliation(s)
| | - Tobias Franiel
- Department of Radiology, Jena University Hospital, Jena, Germany
| | | | - René Aschenbach
- Department of Radiology, Jena University Hospital, Jena, Germany
| | | | - Amer Malouhi
- Department of Radiology, Jena University Hospital, Jena, Germany
| | | | - Ulf Teichgräber
- Department of Radiology, Jena University Hospital, Jena, Germany. .,Institut für Diagnostische Und Interventionelle Radiologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
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Quinn BM, Gao Y, Mahmood U, Pandit-Taskar N, Behr G, Zanzonico P, Dauer LT. Patient-adapted organ absorbed dose and effective dose estimates in pediatric 18F-FDG positron emission tomography/computed tomography studies. BMC Med Imaging 2020; 20:9. [PMID: 31996149 PMCID: PMC6988339 DOI: 10.1186/s12880-020-0415-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Organ absorbed doses and effective doses can be used to compare radiation exposure among medical imaging procedures, compare alternative imaging options, and guide dose optimization efforts. Individual dose estimates are important for relatively radiosensitive patient populations such as children and for radiosensitive organs such as the eye lens. Software-based dose calculation methods conveniently calculate organ dose using patient-adjusted and examination-specific inputs. METHODS Organ absorbed doses and effective doses were calculated for 429 pediatric 18F-FDG PET-CT patients. Patient-adjusted and scan-specific information was extracted from the electronic medical record and scanner dose-monitoring software. The VirtualDose and OLINDA/EXM (version 2.0) programs, respectively, were used to calculate the CT and the radiopharmaceutical organ absorbed doses and effective doses. Patients were grouped according to age at the time of the scan as follows: less than 1 year old, 1 to 5 years old, 6 to 10 years old, 11 to 15 years old, and 16 to 17 years old. RESULTS The mean (+/- standard deviation, range) total PET plus CT effective dose was 14.5 (1.9, 11.2-22.3) mSv. The mean (+/- standard deviation, range) PET effective dose was 8.1 (1.2, 5.7-16.5) mSv. The mean (+/- standard deviation, range) CT effective dose was 6.4 (1.8, 2.9-14.7) mSv. The five organs with highest PET dose were: Urinary bladder, heart, liver, lungs, and brain. The five organs with highest CT dose were: Thymus, thyroid, kidneys, eye lens, and gonads. CONCLUSIONS Organ and effective dose for both the CT and PET components can be estimated with actual patient and scan data using commercial software. Doses calculated using software generally agree with those calculated using dose conversion factors, although some organ doses were found to be appreciably different. Software-based dose calculation methods allow patient-adjusted dose factors. The effort to gather the needed patient data is justified by the resulting value of the characterization of patient-adjusted dosimetry.
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Affiliation(s)
- Brian M Quinn
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Yiming Gao
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Gerald Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Pat Zanzonico
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Esaki T, Kawashima T. [Supplementing a Web-based Exposure Estimation System with Deep Learning for Automatic Classification of CT Images to Increase the Efficiency of Effective Dose Estimation]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:1107-1117. [PMID: 33229840 DOI: 10.6009/jjrt.2020_jsrt_76.11.1107] [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] [Indexed: 06/11/2023]
Abstract
PURPOSE Web-based exposure estimation systems are advantageous for estimating exposure doses for computed tomography (CT) scans. However, such systems depend on the imaging conditions of the slices, and a considerable amount of time and effort is needed to select the slices and extract their imaging conditions from the relevant CT volume data. In this study, we used a convolutional neural network (CNN) to automatically classify specific slices from available CT volume data for use by a Web-based exposure estimation system. We also proposed a method to automatically obtain the imaging conditions of these classified slices. The objective of this study was to improve the efficiency of effective dose estimation. METHOD We automatically classified specific slices from CT volume data using two different CNN architectures: VGG-16 and Xception. We organized the dataset into 5 categories corresponding to the contents of the specific slices. We also tested a 9-category version in which the slices were supplemented with their adjacent slices. We automatically obtained the imaging conditions from the DICOM tags of the specific slices that were classified from the CT volume data by the CNN and then estimated the effective exposure dose provided by the Web-based exposure estimation system. RESULT Using the 5-category dataset approach, the error in the effective exposure dose was 13% for VGG16 and 6% for Xception. When the 9-category approach was used, the error in the effective exposure dose was 0.8% for VGG16 and 0.6% for Xception. In both the architectures, less than 5 minutes was needed in the classification of the specific slices, followed by the extraction of their imaging conditions; however, VGG16 required the shortest processing time. CONCLUSION By supplementing a Web-based exposure estimation system with a CNN and adopting our proposed method, we were able to improve the efficiency of effective dose estimation.
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Affiliation(s)
- Toru Esaki
- Department of Radiologic Technology, Jichi Medical University Hospital
| | - Tomoaki Kawashima
- Department of Radiologic Technology, Jichi Medical University Hospital
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Bohari A, Hashim S, Ghoshal SK, Mohd Mustafa SN. ASSESSMENT ON THE INTERCHANGEABILITY OF PERSONAL EFFECTIVE DOSE ALGORITHMS IN FLUOROSCOPY-GUIDED INTERVENTIONS USING BLAND-ALTMAN ANALYSIS. RADIATION PROTECTION DOSIMETRY 2019; 186:462-468. [PMID: 31329977 DOI: 10.1093/rpd/ncz051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 06/10/2023]
Abstract
Long exposure to radiation from fluoroscopy-guided interventions (FGIs) can be detrimental to both patients and radiologists. The effective doses received by the interventional radiology staff after performing 230 FGIs in a year were assessed by using double dosimetry and five various algorithms. The Shapiro-Wilk test revealed normally-distributed data (p < 0.01), while the significant correlation coefficients between the effective doses ranged between 0.88 and 1.00. As for the Bland-Altman analysis, both Niklason and Boetticher algorithms strongly supported the absence of statistical significance between the estimated effective doses. This portrays that the occupational doses received by the interventional radiology staff during FGIs fall within the acceptable limit regardless of the varied algorithms applied. In short, the Niklason and Boetticher algorithms appeared to be the more interchangeable ones for effective evaluation of doses. This is in view of their strong mutual correlations and excellent agreement.
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Affiliation(s)
- Asmah Bohari
- Department of Physics, Faculty of Science, Universiti Teknologi Malaysia, 81310 Johor, Malaysia
| | - Suhairul Hashim
- Department of Physics, Faculty of Science, Universiti Teknologi Malaysia, 81310 Johor, Malaysia
- Centre for Sustainable Nanomaterials (CSNano), Ibnu Sina Institute for Scientific and Industrial Research (ISI-SIR), Universiti Teknologi Malaysia, 81310 Johor, Malaysia
| | - Sib Krishna Ghoshal
- Department of Physics, Faculty of Science, Universiti Teknologi Malaysia, 81310 Johor, Malaysia
- Centre for Sustainable Nanomaterials (CSNano), Ibnu Sina Institute for Scientific and Industrial Research (ISI-SIR), Universiti Teknologi Malaysia, 81310 Johor, Malaysia
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Cohen SL, Wang JJ, Chan N, O’Connell W, Shah R, Sanelli P, Raoof S. Lung Cancer Screening CT. Chest 2019; 156:1214-1222. [DOI: 10.1016/j.chest.2019.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/12/2019] [Accepted: 07/31/2019] [Indexed: 12/15/2022] Open
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Seibold P, Auvinen A, Averbeck D, Bourguignon M, Hartikainen JM, Hoeschen C, Laurent O, Noël G, Sabatier L, Salomaa S, Blettner M. Clinical and epidemiological observations on individual radiation sensitivity and susceptibility. Int J Radiat Biol 2019; 96:324-339. [PMID: 31539290 DOI: 10.1080/09553002.2019.1665209] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: To summarize existing knowledge and to understand individual response to radiation exposure, the MELODI Association together with CONCERT European Joint Programme has organized a workshop in March 2018 on radiation sensitivity and susceptibility.Methods: The workshop reviewed the current evidence on this matter, to inform the MELODI Strategic Research Agenda (SRA), to determine social and scientific needs and to come up with recommendations for suitable and feasible future research initiatives to be taken for the benefit of an improved medical diagnosis and treatment as well as for radiation protection.Results: The present paper gives an overview of the current evidence in this field, including potential effect modifiers such as age, gender, genetic profile, and health status of the exposed population, based on clinical and epidemiological observations.Conclusion: The authors conclude with the following recommendations for the way forward in radiation research: (a) there is need for large (prospective) cohort studies; (b) build upon existing radiation research cohorts; (c) use data from well-defined cohorts with good exposure assessment and biological material already collected; (d) focus on study quality with standardized data collection and reporting; (e) improve statistical analysis; (f) cooperation between radiobiology and epidemiology; and (g) take consequences of radiosensitivity and radiosusceptibility into account.
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Affiliation(s)
- Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland.,STUK - Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Dietrich Averbeck
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), DRF, Fontenay-aux-Roses Cedex, France
| | - Michel Bourguignon
- Department of Biophysics, Université Paris Saclay (UVSQ), Versailles, France
| | - Jaana M Hartikainen
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland.,Biobank of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Christoph Hoeschen
- Faculty of Electrical Engineering and Information Technology, Otto-von-Guericke University, Magdeburg, Germany
| | - Olivier Laurent
- Laboratoire d'épidémiologie des Rayonnements Ionisants, Institut de Radioprotection et de Sûreté Nucléaire, PSE-SANTE/SESANE/LEPID, BP17, 92260, Fontenay aux Roses, France
| | - Georges Noël
- Département Universitaire de Radiothérapie, Centre Paul-Strauss, Unicancer, Strasbourg cedex, France
| | - Laure Sabatier
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), DRF, Fontenay-aux-Roses Cedex, France
| | - Sisko Salomaa
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany
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Leblanc JE, Burtt JJ. Radiation Biology and Its Role in the Canadian Radiation Protection Framework. HEALTH PHYSICS 2019; 117:319-329. [PMID: 30907783 DOI: 10.1097/hp.0000000000001060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The linear no-threshold (linear-non-threshold) model is a dose-response model that has long served as the foundation of the international radiation protection framework, which includes the Canadian regulatory framework. Its purpose is to inform the choice of appropriate dose limits and subsequent as low as reasonably achievable requirements, social and economic factors taken into account. The linear no-threshold model assumes that the risk of developing cancer increases proportionately with increasing radiation dose. The linear no-threshold model has historically been applied by extrapolating the risk of cancer at high doses (>1,000 mSv) down to low doses in a linear manner. As the health effects of radiation exposure at low doses remain ambiguous, reducing uncertainties found in cancer risk dose-response models can be achieved through in vitro and animal-based studies. The purpose of this critical review is to analyze whether the linear no-threshold model is still applicable for use by modern nuclear regulators for radiation protection purposes, or if there is sufficient scientific evidence supporting an alternate model from which to derive regulatory dose limits.
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Buytaert D, Vandekerckhove K, Panzer J, Rubbens L, De Wolf D, Bacher K. Local DRLs and automated risk estimation in paediatric interventional cardiology. PLoS One 2019; 14:e0220359. [PMID: 31365573 PMCID: PMC6668795 DOI: 10.1371/journal.pone.0220359] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/15/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Cardiac catheterization procedures result in high radiation doses and often multiple procedures are necessary for congenital heart disease patients. However, diagnostic reference levels (DRL) remain scarce. Our first goal was finding the optimal DRL parameter and determining appropriate DRLs. The second goal was to calculate organ doses (OD), effective doses (ED) and lifetime attributable risks (LAR) per procedure and to provide conversion factors based on dose area product (DAP). MATERIALS AND METHODS DRLs are calculated for each procedure type, as the 75th percentile of the cumulative value per procedure from the corresponding parameter. All irradiation events in the DICOM Structured Reports were automatically processed and simulated using PCXMC, resulting in OD, ED and LAR. Using a Kruskal Wallis H test and subsequent pairwise comparisons, differences in median values of the DRL parameter between procedure types were assessed. RESULTS Linear regression showed a strong correlation and narrow confidence interval between DAP and product of body weight and fluoroscopy time (BWxFT), even when all procedures (diagnostic and interventional) are combined. Only 15% of the pairwise comparisons were statistically significant for DAP normalized to BWxFT (DAPBWxFT). The latter pairs contained less frequent procedure types with significant outliers. For DAP normalized to BW (DAPBW), 38% of the pairwise comparisons showed statistically significant differences. Conversion factors from DAPBW to OD and ED were reported for various weight groups, due to the higher correlation between DAPBW and both OD and ED than between DAP and both OD and ED. CONCLUSIONS The P75 of DAPBWxFT for all procedures combined serves as an appropriate DRL value. This facilitates local DRL determination in smaller paediatric centres, which often have insufficient data to produce appropriate DRLs for different procedure types. Conversion factors are more reliable starting from DAPBW instead of DAP and should be used according to the appropriate BW group.
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Affiliation(s)
- Dimitri Buytaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | | | - Joseph Panzer
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Lukas Rubbens
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Daniël De Wolf
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Klaus Bacher
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Advanced Robotic Angiography Systems for Image Guidance During Conventional Transarterial Chemoembolization. Invest Radiol 2019; 54:153-159. [DOI: 10.1097/rli.0000000000000519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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