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Feuchtner GM, Lacaita PG, Barbieri F, Deeg J, Plank F, Beyer C, Senoner T, Friedrich G, Widmann G. Gender differences in the diagnostic efficacy of coronary CTA: Overutilization of coronary CTA in pre- and perimenopausal females? Int J Cardiol 2024; 409:132181. [PMID: 38754587 DOI: 10.1016/j.ijcard.2024.132181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES Public campaigns such as the "Go-red-for-women"-initiative have raised heart-disease awareness and may trigger overutilization of coronary computed tomography angiography (CTA). Objective was to investigate the diagnostic efficacy of coronary CTA stratified by age and gender. METHODS 1882 consecutive patients (58.9 ± 11 years;42.5% females) with low-to-intermediate pre-test-probability of coronary artery disease (CAD) referred to coronary CTA according to ESC-2019 guidelines, were included. Diagnostic efficacy was defined by the 1)negative CTA-rate 2)obstructive CAD (>50%stenosis) 3)High-risk-plaque and 4)CAC-score. RESULTS The negative CTA rate was higher in females compared to males with 360/801 vs 292/1081 (45% vs 27%;p < 0.001). Females had a higher likelihood (OR 2.2:95%CI:1.81-2.67) of a negative CTA than males, despite they were older (p < 0.001). Obstructive disease prevalence was 25.6% and acceptable in both sexes (males vs females: 28.4% vs 21.8%;p = 0.0012). Males had more high-risk-plaque (23.6% vs 11.5%;p < 0.001). When stratifying age groups, negative CTA rate was highest in females <47 years (82.8%), but lower in males with 68.1% (p < 0.001), while obstructive disease prevalence was not different (males:6.5% vs females:4.6%:p = 0.874). Above 50 years, negative CTA rate (39.1% vs 17.6%,p < 0.001;OR 3.02:95%CI:2.381-3.823) was higher, and the obstructive disease rate was lower in females (24.8% vs 34.7%,p = 0.0003). SSPSTm(V.25,IBM) was used for statistical analysis. CONCLUSIONS Above 50 years of age, diagnostic efficacy of coronary CTA is high in both males and females. In females <47 years, the negative CTA rate was highest with 82.8% and obstructive disease prevalence was low (4.6%), still justifying testing but recommending the use of specific tools (PROMISE minimal risk score) or other clinical tests for pre-selection.
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Affiliation(s)
- Gudrun M Feuchtner
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Pietro G Lacaita
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria
| | - Fabian Barbieri
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany
| | - Johannes Deeg
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria
| | - Fabian Plank
- Tyrol Clinicum Hall, Department of Cardiology, Milser Strasse 10, Hall 6060, Austria
| | - Christoph Beyer
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria
| | - Thomas Senoner
- Department of Anaesthesiology and Intensive Care, Innsbruck Medical University, Anichstrasse 35, Innsbruck A 6020, Austria
| | - Guy Friedrich
- Department of Internal Medicine, Cardiology, Anichstrasse 35, Innsbruck 6020, Austria
| | - Gerlig Widmann
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria
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Little MP, Bazyka D, de Gonzalez AB, Brenner AV, Chumak VV, Cullings HM, Daniels RD, French B, Grant E, Hamada N, Hauptmann M, Kendall GM, Laurier D, Lee C, Lee WJ, Linet MS, Mabuchi K, Morton LM, Muirhead CR, Preston DL, Rajaraman P, Richardson DB, Sakata R, Samet JM, Simon SL, Sugiyama H, Wakeford R, Zablotska LB. A Historical Survey of Key Epidemiological Studies of Ionizing Radiation Exposure. Radiat Res 2024; 202:432-487. [PMID: 39021204 PMCID: PMC11316622 DOI: 10.1667/rade-24-00021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/23/2024] [Indexed: 07/20/2024]
Abstract
In this article we review the history of key epidemiological studies of populations exposed to ionizing radiation. We highlight historical and recent findings regarding radiation-associated risks for incidence and mortality of cancer and non-cancer outcomes with emphasis on study design and methods of exposure assessment and dose estimation along with brief consideration of sources of bias for a few of the more important studies. We examine the findings from the epidemiological studies of the Japanese atomic bomb survivors, persons exposed to radiation for diagnostic or therapeutic purposes, those exposed to environmental sources including Chornobyl and other reactor accidents, and occupationally exposed cohorts. We also summarize results of pooled studies. These summaries are necessarily brief, but we provide references to more detailed information. We discuss possible future directions of study, to include assessment of susceptible populations, and possible new populations, data sources, study designs and methods of analysis.
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Affiliation(s)
- Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | | | - Alina V. Brenner
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Vadim V. Chumak
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | - Harry M. Cullings
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Grant
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194, Japan
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Gerald M. Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay aux Roses France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Martha S. Linet
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | | | | | - Preetha Rajaraman
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - David B. Richardson
- Environmental and Occupational Health, 653 East Peltason, University California, Irvine, Irvine, CA 92697-3957 USA
| | - Ritsu Sakata
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Jonathan M. Samet
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Steven L. Simon
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Hiromi Sugiyama
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16 Street, 2 floor, San Francisco, CA 94143, USA
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3
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Matarèse BFE, Desai R, Oughton DH, Mothersill C. EGO to ECO: Tracing the History of Radioecology from the 1950's to the Present Day. Radiat Res 2024; 202:273-288. [PMID: 39021078 DOI: 10.1667/rade-24-00035.1] [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: 01/30/2024] [Accepted: 05/09/2024] [Indexed: 07/20/2024]
Abstract
This paper starts with a brief history of the birth of the field of radioecology during the Cold War with a focus on US activity. We review the establishment of the international system for radiation protection and the science underlying the guidelines. We then discuss the famous ICRP 60 statement that if "Man" is protected, so is everything else and show how this led to a focus in radioecology on pathways to "Man" rather than concern about impacts on environments or ecosystems. We then review the contributions of Radiation Research Society members and papers published in Radiation Research which contributed to the knowledge base about effects on non-human species. These fed into international databases and computer-based tools such as ERICA and ResRad Biota to guide regulators. We then examine the origins of the concern that ICRP 60 is not sufficient to protect ecosystems and discuss the establishment of ICRP Committee 5 and its recommendations to establish reference animals and plants. The review finishes with current concerns that reference animals and plants (RAPs) are not sufficient to protect ecosystems, given the complexity of interacting factors such as the climate emergency and discusses the efforts of ICRP, the International Union of Radioecologists and other bodies to capture the concepts of ecosystem services and ecosystem complexity modelling in radioecology.
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Affiliation(s)
- Bruno F E Matarèse
- Department of Haematology, University of Cambridge, Cambridge CB2 1TN, United Kingdom
- Department of Physics, University of Cambridge, Cambridge CB2 1TN, United Kingdom
| | - Rhea Desai
- Department of Biology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | | | - Carmel Mothersill
- Department of Biology, McMaster University, Hamilton, ON L8S 4L8, Canada
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Li J, Zhang X, Liu J, Su C, Cui J, Yang L, Gu Y. Case report: Low-dose radiation-induced meningioma with a short latency period. Front Oncol 2024; 14:1413610. [PMID: 39011474 PMCID: PMC11246846 DOI: 10.3389/fonc.2024.1413610] [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] [Received: 04/07/2024] [Accepted: 06/17/2024] [Indexed: 07/17/2024] Open
Abstract
Patients with radiation-induced meningioma (RIM), most of whom had received head radiation therapy or had been exposed to ionizing radiation during childhood or adolescence, are at risk of developing cranial meningiomas throughout their lifetimes because of the long latency period. Although intermediate-to-high-dose ionizing radiation exposure is an established risk factor for RIM, risk factors for low-dose RIM remain incompletely defined. This study presents the case of a 56-year-old woman diagnosed with radiation-induced giant meningioma 2.5 years after undergoing an interventional embolization procedure for a brain aneurysm. This is the first report of RIM attributable to a brain intervention with an extremely short latency period. The total radiation dose received by the patient during the operation was 1367.3 mGy, representing a low dose. Our case report strengthens the evidence that even low radiation doses can increase the risk of RIM. These findings provide a realistic basis for the theoretical study of RIM and suggest some new ideas for RIM treatment. The need for caution in the use of radioactive treatments and optimization of interventional procedures is highlighted.
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Affiliation(s)
- Jinyang Li
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Xiangmao Zhang
- Department of Neurosurgery, Zibo Central Hospital, Zibo, China
| | - Jing Liu
- Department of Pharmacy Intravenous Admixture Service, Zibo Central Hospital, Zibo, China
| | - Chunxia Su
- Department of Admissions Service Center, Zibo Central Hospital, Zibo, China
| | - Junxiang Cui
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Liling Yang
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Yinghao Gu
- Department of Neurosurgery, Zibo Central Hospital, Zibo, China
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Ye ZY, Bai JY, Ye ZM, Zhao XS, Song FL, Zhou ZT, Shan BC, Zhou XZ. Surgical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with ankylosing spondylitis. BMC Musculoskelet Disord 2024; 25:484. [PMID: 38898448 PMCID: PMC11188516 DOI: 10.1186/s12891-024-07597-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Spinal fractures in patients with ankylosing spondylitis (AS) mainly present as instability, involving all three columns of the spine, and surgical intervention is often considered necessary. However, in AS patients, the significant alterations in bony structure and anatomy result in a lack of identifiable landmarks, which increases the difficulty of pedicle screw implantation. Therefore, we present the clinical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with AS. METHODS A retrospective review was conducted on a series of 12 patients diagnosed with AS. All patients sustained thoracolumbar fractures between October 2018 and October 2022 and underwent posterior robotic-assisted percutaneous fixation procedures. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union. The clinical outcomes were assessed using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). To investigate the achieved operative correction, pre- and postoperative radiographs in the lateral plane were analyzed by measuring the Cobb angle. RESULTS The 12 patients had a mean age of 62.8 ± 13.0 years and a mean follow-up duration of 32.7 ± 18.9 months. Mean hospital stay duration was 15 ± 8.0 days. The mean operative time was 119.6 ± 32.2 min, and the median blood loss was 50 (50, 250) ml. The VAS value improved from 6.8 ± 0.9 preoperatively to 1.3 ± 1.0 at the final follow-up (P < 0.05). The ODI value improved from 83.6 ± 6.1% preoperatively to 11.8 ± 6.6% at the latest follow-up (P < 0.05). The average Cobb angle changed from 15.2 ± 11.0 pre-operatively to 8.3 ± 7.1 at final follow-up (P < 0.05). Bone healing was consistently achieved, with an average healing time of 6 (5.3, 7.0) months. Of the 108 screws implanted, 2 (1.9%) were improperly positioned. One patient experienced delayed nerve injury after the operation, but the nerve function returned to normal upon discharge. CONCLUSION Posterior robotic-assisted percutaneous internal fixation can be used as an ideal surgical treatment for thoracolumbar fractures in AS patients. However, while robot-assisted pedicle screw placement can enhance the accuracy of pedicle screw insertion, it should not be relied upon solely.
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Affiliation(s)
- Zhi-Yuan Ye
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, 215004, China
- Department of Orthopedics, Sihong Hospital, Sihong, Jiangsu, China
| | - Jin-Yu Bai
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, 215004, China
| | - Zhi-Min Ye
- Department of Image, Sihong Geriatric Hospital, Sihong, Jiangsu, China
| | - Xu-Shen Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, 215004, China
| | - Fang-Long Song
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, 215004, China
| | - Zhen-Tao Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, 215004, China
| | - Bing-Chen Shan
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, 215004, China
| | - Xiao-Zhong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, 215004, China.
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6
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Wakeford R. What about the workers? JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:020202. [PMID: 38776882 DOI: 10.1088/1361-6498/ad4eea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
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7
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Hunter N, Haylock R. Extended analysis of solid cancer incidence among nuclear industry workers in the UK 1955-2011: comparison of workers first hired in earlier and later periods. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021515. [PMID: 38754384 DOI: 10.1088/1361-6498/ad4c72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/16/2024] [Indexed: 05/18/2024]
Abstract
To address points arising from the recent study of nuclear workers in the USA and the International Nuclear Workers Study (INWORKS), concerning the difference in solid cancer risk estimates between those first hired in earlier and later calendar years, subsidiary analyses were conducted on a cohort of 172 452 workers in the National Registry for Radiation Workers (NRRW) from the UK. A total of 18 310 incident first primary solid cancer cases were registered in the period from 1955 until 2011 in the NRRW cohort and workers accrued 5.25 million person-years of follow-up. Incidences rates of all solid cancers combined, lung cancer and solid cancer excluding lung cancer were examined in terms of external radiation doses in the full cohort and in a sub-cohort of workers who had no record of internal exposure monitoring and were defined by the periods of first hire before and after the beginning of the years 1960, 1965 and 1970. All analyses were carried out using Poisson Regression. These analyses demonstrated that only for lung cancer between the pre-1965 and post-1964 periods is there strong evidence for a difference in the risks using the NRRW full cohort. In the other calendar period breakdowns and for the other cancer groups, there is no clear evidence of differences in the risks. The NRRW estimation of risks between recent and early workers is not generally consistent with the US workers cohort or the INWORKS evaluations that later hired workers are at much higher solid cancer risk than earlier hired workers, although INWORKS contains a significant part of the latest updated NRRW cohort as well as the US data. The conclusion that the INWORKS and US study data demonstrate a real difference in excess solid cancer risk from external radiation exposure between earlier and later workers is premature. The results presented here should also be treated with caution because of the limited corroborating evidence from other published studies. Information on internal doses, neutron doses as well as non-radiation factors such as smoking and asbestos exposure would be needed to make definitive inferences.
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Affiliation(s)
- Nezahat Hunter
- UK Health Security Agency, Harwell Campus, Didcot, Oxon OX11 0RQ, United Kingdom
| | - Richard Haylock
- UK Health Security Agency, Harwell Campus, Didcot, Oxon OX11 0RQ, United Kingdom
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8
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Chauhan V, Beaton D, Tollefsen KE, Preston J, Burtt JJ, Leblanc J, Hamada N, Azzam EI, Armant O, Bouffler S, Azimzadeh O, Moertl S, Yamada Y, Tanaka IB, Kaiser JC, Applegate K, Laurier D, Garnier-Laplace J. Radiation Adverse Outcome pathways (AOPs): examining priority questions from an international horizon-style exercise. Int J Radiat Biol 2024; 100:982-995. [PMID: 38718325 DOI: 10.1080/09553002.2024.2348072] [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: 12/11/2023] [Accepted: 04/14/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE The Organisation for Economic Co-operation and Development (OECD) Adverse Outcome Pathway (AOP) Development Programme is being explored in the radiation field, as an overarching framework to identify and prioritize research needs that best support strengthening of radiation risk assessment and risk management strategies. To advance the use of AOPs, an international horizon-style exercise (HSE) was initiated through the Radiation/Chemical AOP Joint Topical Group (JTG) formed by the OECD Nuclear Energy Agency (NEA) High-Level Group on Low Dose Research (HLG-LDR) under the auspices of the Committee on Radiological Protection and Public Health (CRPPH). The intent of the HSE was to identify key research questions for consideration in AOP development that would help to reduce uncertainties in estimating the health risks following exposures to low dose and low dose-rate ionizing radiation. The HSE was conducted in several phases involving the solicitation of relevant questions, a collaborative review of open-ended candidate questions and an elimination exercise that led to the selection of 25 highest priority questions for the stated purpose. These questions were further ranked by over 100 respondents through an international survey. This final set of questions was judged to provide insights into how the OECD's AOP approach can be put into practice to meet the needs of hazard and risk assessors, regulators, and researchers. This paper examines the 25 priority questions in the context of hazard/risk assessment framework for ionizing radiation. CONCLUSION By addressing the 25 priority questions, it is anticipated that constructed AOPs will have a high level of specificity, making them valuable tools for simplifying and prioritizing complex biological processes for use in developing revised radiation hazard and risk assessment strategies.
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Affiliation(s)
- Vinita Chauhan
- Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Danielle Beaton
- Isotopes, Radiobiology and Environment Directorate, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Knut Erik Tollefsen
- Norwegian Institute for Water Research (NIVA), Oslo, Norway
- Centre for Environmental Radioactivity, Norwegian University of Life Sciences (NMBU), Ås, Norway
| | - Julian Preston
- Office of Air and Radiation, Radiation Protection Division, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Julie J Burtt
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Julie Leblanc
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Chiba, Japan
| | - Edouard I Azzam
- Isotopes, Radiobiology and Environment Directorate, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Olivier Armant
- Institut de Radioprotection Et de Sûreté Nucléaire (IRSN), PSE-ENV/SERPEN/LECO, Cadarache, France
| | | | - Omid Azimzadeh
- Federal Office of Radiation Protection, Oberschleissheim, Germany
| | - Simone Moertl
- Federal Office of Radiation Protection, Oberschleissheim, Germany
| | - Yutaka Yamada
- Department of Radiation Effects Research, Institute for Radiological Science, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Ignacia B Tanaka
- Department of Radiobiology, Institute for Environmental Sciences, Aomori, Japan
| | | | - Kimberly Applegate
- Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, USA (retired)
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay aux Roses, France
| | - Jacqueline Garnier-Laplace
- On secondment from IRSN to the Committee on Radiological Protection and Public Health's secretariat, Paris, France
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Wojcik A, Thierry-Chef I, Friedl AA, Rühm W. Minimum reporting standards about dosimetry of radiation sources used in radiation research studies. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2024; 63:181-183. [PMID: 38376815 DOI: 10.1007/s00411-024-01063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
The necessity of precise dosimetry and its documentation in research is less obvious than in medicine and in radiological protection. However, in radiation research, results can only be validated if experiments were carried out with sufficient precision and described with sufficient details, especially information regarding dosimetry. In order to ensure this, an initiative was launched to establish reproducible dosimetry reporting parameters in published studies. Minimum standards for reporting radiation dosimetry information were developed and published in parallel in the International Journal of Radiation Biology and Radiation Research. As editors of Radiation and Environmental Biophysics, we support this initiative and reproduce the agreed minimum irradiation parameters that should be reported in publications on radiation biology submitted to our journal.
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Affiliation(s)
- Andrzej Wojcik
- MBW Department, Centre for Radiation Protection Research, Stockholm University, Stockholm, Sweden.
| | | | - Anna A Friedl
- University Hospital, Ludwig-Maximilians-University LMU Munich, Munich, Germany
| | - Werner Rühm
- Federal Office for Radiation Protection, Neuherberg, Germany
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10
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Frush DP, Vassileva J, Brambilla M, Mahesh M, Rehani M, Samei E, Applegate K, Bourland J, Ciraj-Bjenlac O, Dahlstrom D, Gershan V, Gilligan P, Godthelp B, Hjemly H, Kainberger F, Mikhail-Lette M, Holmberg O, Paez D, Schrandt S, Valentin A, Van Deventer T, Wakeford R. Recurrent medical imaging exposures for the care of patients: one way forward. Eur Radiol 2024:10.1007/s00330-024-10659-x. [PMID: 38592419 DOI: 10.1007/s00330-024-10659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/17/2023] [Accepted: 01/23/2024] [Indexed: 04/10/2024]
Abstract
Medical imaging is both valuable and essential in the care of patients. Much of this imaging depends on ionizing radiation with attendant responsibilities for judicious use when performing an examination. This responsibility applies in settings of both individual as well as multiple (recurrent) imaging with associated repeated radiation exposures. In addressing the roles and responsibilities of the medical communities in the paradigm of recurrent imaging, both the International Atomic Energy Agency (IAEA) and the American Association of Physicists in Medicine (AAPM) have issued position statements, each affirmed by other organizations. The apparent difference in focus and approach has resulted in a lack of clarity and continued debate. Aiming towards a coherent approach in dealing with radiation exposure in recurrent imaging, the IAEA convened a panel of experts, the purpose of which was to identify common ground and reconcile divergent perspectives. The effort has led to clarifying recommendations for radiation exposure aspects of recurrent imaging, including the relevance of patient agency and the provider-patient covenant in clinical decision-making. CLINICAL RELEVANCE STATEMENT: An increasing awareness, generating some lack of clarity and divergence in perspectives, with patients receiving relatively high radiation doses (e.g., ≥ 100 mSv) from recurrent imaging warrants a multi-stakeholder accord for the benefit of patients, providers, and the imaging community. KEY POINTS: • Recurrent medical imaging can result in an accumulation of exposures which exceeds 100 milli Sieverts. • Professional organizations have different perspectives on roles and responsibilities for recurrent imaging. • An expert panel reconciles differing perspectives for addressing radiation exposure from recurrent medical imaging.
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Affiliation(s)
- Donald Paul Frush
- Department of Radiology, Duke University Medical Center, Durham, NC, 27705, USA.
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Marco Brambilla
- Department of Medical Physics, University Hospital of Novara, Novara, Italy
| | - Mahadevappa Mahesh
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Madan Rehani
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Ehsan Samei
- Department of Radiology, Duke University Medical Center, Durham, NC, 27705, USA
| | | | - John Bourland
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Vesna Gershan
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Paddy Gilligan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Barbara Godthelp
- Authority for Nuclear Safety and Radiation Protection, The Hague, The Netherlands
| | - Hakon Hjemly
- International Society of Radiographers and Radiological Technologists, London, UK
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Suz Schrandt
- ExPPect, Founder & CEO, and Patients for Patient Safety US, Champion (Affiliate, WHO PFPS Network), Arlington, VA, USA
| | - Andreas Valentin
- Department of Internal Medicine With Cardiology & Intensive Care Medicine Clinic Donaustadt Vienna Health Care Group, Vienna, Austria
| | | | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
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11
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Picano E, Vano E. Updated Estimates of Radiation Risk for Cancer and Cardiovascular Disease: Implications for Cardiology Practice. J Clin Med 2024; 13:2066. [PMID: 38610831 PMCID: PMC11012972 DOI: 10.3390/jcm13072066] [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: 02/20/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
This review aims to furnish an updated assessment of the societal healthcare load, including cancer and cardiovascular disease resulting from diagnostic radiologic operations. The previously projected additional cancer risk of 0.9% in a United States 2004 study referred to radiological conditions in 1996 with an X-ray exposure of 0.50 millisievert (mSv) per capita annually. Radiological exposure (radiology + nuclear medicine) has escalated to 2.29 mSv (2016) per capita per year. Low-dose exposures were previously assumed to have a lower biological impact, since they allow the DNA repair system to mitigate molecular damage. However, epidemiological data matured and disproved this assumption, as shown by updated cancer risk assessments derived from the World Health Organization 2013 and the German Institute of Radioprotection 2014 data. The risk of cardiovascular disease aligns within the same order of magnitude as cancer risk and compounds it, as shown by a comprehensive meta-analysis of 93 studies. The collective societal burden arising from the augmented risks of cancer and cardiovascular disease attributable to diagnostic radiology and nuclear medicine is higher than previously thought.
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Affiliation(s)
- Eugenio Picano
- Cardiology Clinic, University Center Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia
| | - Eliseo Vano
- Cardiology Department, Medical Faculty, Complutense University, 28040 Madrid, Spain;
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12
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Macé L, Brizais C, Bachelot F, Manoury A, Thomé S, Gloaguen C, Garali I, Magneron V, Monceau V, Sache A, Voyer F, Elie C, Roy L, Gensdarmes F, Klokov D, Block ML, Ibanez C. Exposure to tungsten particles via inhalation triggers early toxicity marker expression in the rat brain. Inhal Toxicol 2024; 36:261-274. [PMID: 38836331 DOI: 10.1080/08958378.2024.2349895] [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: 10/03/2023] [Accepted: 04/26/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE Our work is focused on tungsten, considered as an emerging contaminant. Its environmental dispersion is partly due to mining and military activities. Exposure scenario can also be occupational, in areas such as the hard metal industry and specific nuclear facilities. Our study investigated the cerebral effects induced by the inhalation of tungsten particles. METHODS Inhalation exposure campaigns were carried out at two different concentrations (5 and 80 mg/m3) in single and repeated modes (4 consecutive days) in adult rats within a nose-only inhalation chamber. Processes involved in brain toxicity were investigated 24 h after exposure. RESULTS AND DISCUSSION Site-specific effects in terms of neuroanatomy and concentration-dependent changes in specific cellular actors were observed. Results obtained in the olfactory bulb suggest a potential early effect on the survival of microglial cells. Depending on the mode of exposure, these cells showed a decrease in density accompanied by an increase in an apoptotic marker. An abnormal phenotype of the nuclei of mature neurons, suggesting neuronal suffering, was also observed in the frontal cortex, and can be linked to the involvement of oxidative stress. The differential effects observed according to exposure patterns could involve two components: local (brain-specific) and/or systemic. Indeed, tungsten, in addition to being found in the lungs and kidneys, was present in the brain of animals exposed to the high concentration. CONCLUSION Our data question the perceived innocuity of tungsten relative to other metals and raise hypotheses regarding possible adaptive or neurotoxic mechanisms that could ultimately alter neuronal integrity.
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Affiliation(s)
- Léo Macé
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Chloé Brizais
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Florence Bachelot
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Annabelle Manoury
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Sébastien Thomé
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Céline Gloaguen
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Imène Garali
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Victor Magneron
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Virginie Monceau
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Amandine Sache
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Frédéric Voyer
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Christelle Elie
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - Laurence Roy
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
| | - François Gensdarmes
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Sûreté Nucléaire, Service du Confinement et de l'Aérodispersion des Polluants, Gif-sur-YvetteCedex, France
| | - Dmitry Klokov
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | - Michelle L Block
- Department of Pharmacology and Toxicology, The Stark Neurosciences Research Institute, IN University School of Medicine, Indianapolis, IN, USA
| | - Chrystelle Ibanez
- Institut de Radioprotection et de Sûreté Nucléaire, Pôle Santé Environnement, Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants, Avenue de la Division Leclerc, Fontenay aux Roses, France
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13
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Gonzalez M, Mathelin C. [Breast cancer: An occupational disease for healthcare workers exposed to night work?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:65-67. [PMID: 38036285 DOI: 10.1016/j.gofs.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- M Gonzalez
- Service de pathologie professionnelle et médecine du travail, CHRU de Strasbourg, 67092 Strasbourg cedex, France
| | - C Mathelin
- Service de chirurgie, ICANS, CHRU de Strasbourg, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
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14
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Wollschläger D. Book review: Attribution of radiation health effects and inference of radiation risks-considerations for application of the IAEA safety standards, IAEA Safety Reports Series No. 122. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:017001. [PMID: 38263728 DOI: 10.1088/1361-6498/ad1fe2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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