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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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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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Tao XG, Curriero FC, Mahesh M. Low Dose Radiation and Solid Tumors Mortality Risk. J Occup Environ Med 2024; 66:e230-e237. [PMID: 38527177 DOI: 10.1097/jom.0000000000003099] [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: 03/27/2024]
Abstract
BACKGROUND US nuclear capable shipyard workers have increased potential for occupational radiation exposure. OBJECTIVE The aim of the study is to examine solid tumor mortality risks at low doses. METHOD 437,937 workers working from 1957 to 2004 at eight US shipyards were studied. RESULTS Radiation workers with a median life-time dose at 0.82 mSv had a significantly lower solid tumor mortality risk (relative risk [RR]: 0.96, 95% confidence interval [CI]: 0.94-0.98) than nonradiation workers. Among 153,930 radiation workers, the RRs of solid tumors increased with increasing dose categories without statistical significance. The dose category >0-<25 mSv had significantly lower RR (0.95, 95% CI: 0.91-0.99) versus 0 dose and the excess relative risk was 0.05/100 mSv (95% CI: 0.01-0.08). CONCLUSIONS Solid tumor risk might increase with radiation dose, but not linearly at low doses. Actual mortality risk may be dependent on dose received.
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Affiliation(s)
- Xuguang Grant Tao
- From the Division of Occupational and Environmental Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (T.G.X.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (F.C.C.), and the Russell H. Morgan Department of Radiology and Radiological Science and Division of Cardiology Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (M.M.)
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Bos D, Demircioğlu A, Neuhoff J, Haubold J, Zensen S, Opitz MK, Drews MA, Li Y, Styczen H, Forsting M, Nassenstein K. Assessment of image quality and impact of deep learning-based software in non-contrast head CT scans. Sci Rep 2024; 14:11810. [PMID: 38782976 PMCID: PMC11116440 DOI: 10.1038/s41598-024-62394-4] [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: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
In this retrospective study, we aimed to assess the objective and subjective image quality of different reconstruction techniques and a deep learning-based software on non-contrast head computed tomography (CT) images. In total, 152 adult head CT scans (77 female, 75 male; mean age 69.4 ± 18.3 years) obtained from three different CT scanners using different protocols between March and April 2021 were included. CT images were reconstructed using filtered-back projection (FBP), iterative reconstruction (IR), and post-processed using a deep learning-based algorithm (PS). Post-processing significantly reduced noise in FBP-reconstructed images (up to 15.4% reduction) depending on the protocol, leading to improvements in signal-to-noise ratio of up to 19.7%. However, when deep learning-based post-processing was applied to FBP images compared to IR alone, the differences were inconsistent and partly non-significant, which appeared to be protocol or site specific. Subjective assessments showed no significant overall improvement in image quality for all reconstructions and post-processing. Inter-rater reliability was low and preferences varied. Deep learning-based denoising software improved objective image quality compared to FBP in routine head CT. A significant difference compared to IR was observed for only one protocol. Subjective assessments did not indicate a significant clinical impact in terms of improved subjective image quality, likely due to the low noise levels in full-dose images.
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Affiliation(s)
- Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Aydin Demircioğlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Julia Neuhoff
- Faculty of Medicine, University Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Marcel K Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Marcel A Drews
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Hanna Styczen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Kai Nassenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
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Imran S, Rao MS, Shah MH, Gaur A, Guernaoui AE, Roy S, Roy S, Bharadwaj HR, Awuah WA. Evolving perspectives in reverse cardio-oncology: A review of current status, pathophysiological insights, and future directives. Curr Probl Cardiol 2024; 49:102389. [PMID: 38184129 DOI: 10.1016/j.cpcardiol.2024.102389] [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: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/08/2024]
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of mortality worldwide, traditionally linked through adverse effects of cancer therapies on cardiovascular health. However, reverse cardio-oncology, a burgeoning field, shifts this perspective to examine how cardiovascular diseases influence the onset and progression of cancer. This novel approach has revealed a higher likelihood of cancer development in patients with pre-existing cardiovascular conditions, attributed to shared risk factors such as obesity, a sedentary lifestyle, and smoking. Underlying mechanisms like chronic inflammation and clonal hematopoiesis further illuminate the connections between cardiovascular ailments and cancer. This comprehensive narrative review, spanning a broad spectrum of studies, outlines the syndromic classification of cardio-oncology, the intersection of cardiovascular risk factors and oncogenesis, and the bidirectional dynamics between CVD and cancer. Additionally, the review also discusses the pathophysiological mechanisms underpinning this interconnection, examining the roles of cardiokines, genetic factors, and the effects of cardiovascular therapies and biomarkers in cancer diagnostics. Lastly, it aims to underline future directives, emphasising the need for integrated healthcare strategies, interdisciplinary research, and comprehensive treatment protocols.
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Affiliation(s)
- Shahzeb Imran
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Medha Sridhar Rao
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Muhammad Hamza Shah
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom; Centre for Anatomy, Deanery of Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Aditya Gaur
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Abderrahmane El Guernaoui
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Subham Roy
- Hull York Medical School, University of York, York, United Kingdom
| | - Sakshi Roy
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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Ylimaula S, Räsänen L, Hurskainen M, Peuna A, Julkunen P, Nieminen MT, Hanni M. X-ray scatter in projection radiography. RADIATION PROTECTION DOSIMETRY 2024; 200:120-129. [PMID: 37939724 PMCID: PMC10875324 DOI: 10.1093/rpd/ncad275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/23/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023]
Abstract
Projection radiography is the most common radiological modality, and radiation safety of it concerns both radiation workers and the public. We measured and generated a series of scattered radiation maps for projection radiography and estimated effective doses of the supporting person during exposure. Measured adult patient protocols included chest posterior-anterior, chest lateral, pelvis anterior-posterior (AP), abdomen AP and bedside chest AP. Maps concretise spatial distribution and the scattered radiation dose rates in different imaging protocols. Highest and lowest rates were measured in abdomen AP and bedside chest AP protocols, respectively. The effective dose of supporting person in abdomen AP examination at distance of 0.5 m was 300 nSv and in bedside supine chest AP examination at distance of 0.7 m was 0.5 nSv. The estimated annual effective dose of emergency unit radiographer was 0.11 mSv. The obtained effective dose values are small compared to annual dose limits of radiation workers and the public.
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Affiliation(s)
- Satu Ylimaula
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, 90220 Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, 90220 Oulu, Finland
| | - Lasse Räsänen
- Department of Diagnostic Radiology, Oulu University Hospital, 90220 Oulu, Finland
- Terveystalo Healthcare, 00100 Helsinki, Finland
| | - Miia Hurskainen
- Department of Technical Physics, University of Eastern Finland—Kuopio Campus, 70210 Kuopio, Finland
| | - Arttu Peuna
- Department of Diagnostic Services, Hospital Nova of Central Finland, Wellbeing Services County of Central Finland, Hoitajantie 3, 40620 Jyväskylä, Finland
| | - Petro Julkunen
- Department of Technical Physics, University of Eastern Finland—Kuopio Campus, 70210 Kuopio, Finland
- Department of Clinical Neurophysiology, Kuopio University Hospital, 70200 Kuopio, Finland
| | - Miika Tapio Nieminen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, 90220 Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, 90220 Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Matti Hanni
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, 90220 Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, 90220 Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Richardson DB, Leuraud K, Laurier D, Gillies M, Haylock R, Kelly-Reif K, Bertke S, Daniels RD, Thierry-Chef I, Moissonnier M, Kesminiene A, Schubauer-Berigan MK. Cancer mortality after low dose exposure to ionising radiation in workers in France, the United Kingdom, and the United States (INWORKS): cohort study. BMJ 2023; 382:e074520. [PMID: 37586731 PMCID: PMC10427997 DOI: 10.1136/bmj-2022-074520] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To evaluate the effect of protracted low dose, low dose rate exposure to ionising radiation on the risk of cancer. DESIGN Multinational cohort study. SETTING Cohorts of workers in the nuclear industry in France, the UK, and the US included in a major update to the International Nuclear Workers Study (INWORKS). PARTICIPANTS 309 932 workers with individual monitoring data for external exposure to ionising radiation and a total follow-up of 10.7 million person years. MAIN OUTCOME MEASURES Estimates of excess relative rate per gray (Gy) of radiation dose for mortality from cancer. RESULTS The study included 103 553 deaths, of which 28 089 were due to solid cancers. The estimated rate of mortality due to solid cancer increased with cumulative dose by 52% (90% confidence interval 27% to 77%) per Gy, lagged by 10 years. Restricting the analysis to the low cumulative dose range (0-100 mGy) approximately doubled the estimate of association (and increased the width of its confidence interval), as did restricting the analysis to workers hired in the more recent years of operations when estimates of occupational external penetrating radiation dose were recorded more accurately. Exclusion of deaths from lung cancer and pleural cancer had a modest effect on the estimated magnitude of association, providing indirect evidence that the association was not substantially confounded by smoking or occupational exposure to asbestos. CONCLUSIONS This major update to INWORKS provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality based on some of the world's most informative cohorts of radiation workers. The summary estimate of excess relative rate solid cancer mortality per Gy is larger than estimates currently informing radiation protection, and some evidence suggests a steeper slope for the dose-response association in the low dose range than over the full dose range. These results can help to strengthen radiation protection, especially for low dose exposures that are of primary interest in contemporary medical, occupational, and environmental settings.
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Affiliation(s)
- David B Richardson
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
| | - Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
| | | | | | - Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Stephen Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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Djokovic J, Jankovic S, Milovanovic A, Bulat P. Chromosomal Aberrations, Micronuclei, Blood Parameters and Received Doses in Workers Exposed to Ionizing Radiation. LA MEDICINA DEL LAVORO 2023; 114:e2023036. [PMID: 37534426 PMCID: PMC10415844 DOI: 10.23749/mdl.v114i4.14280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The aim of this study was to analyze the impact of low doses of ionizing radiation on healthcare workers using dosimeter data and several biomarkers of effects, and to asses the suitability of those tests. METHODS Data from the last medical examinations, obtained from the medical records of 148 employees were analysed. They were divided into three groups: nuclear medicine, interventional radiology and general radiology. The examination included hematological parameters and cytogenetical tests: unstable chromosomal aberrations (UCA) and micronucleus test (MNT). The received cumulative 5-year dose was calibrated into personal dose equivalents Hp(10). RESULTS A statistically significant difference was found between the groups in the UCAs (c2=6.634, p=0.036) with the highest UCA frequency in nuclear medicine. The ANOVA showed a statistically significant difference in the values of erythrocytes (F(2,140)=3.715, p=0.027), monocytes (F(2,127)=3.326, p=0.039) and platelets (F(2,135)=4.209, p=0.017), with higher erythrocytes and lower platelets in interventional radiology and lower monocytes in nuclear medicine, all with small effect size. The dose was significantly different among the groups (c2 =22,191; p<0.001). The nuclear medicine workers received a higher dose compared to interventional radiology (U=458, p<0.001) and general radiology (U=510.5, p<0.001). CONCLUSIONS Nuclear medicine employees are at a higher risk of developing neoplastic and blood-related diseases due to consistent exposure to low doses of ionizing radiation. Results suggest that UCA test might be more suitable for detecting radiation-induced damage at low doses than MNT. Compulsory monitoring of the health status at periodic examinations is required to prevent occupational diseases, esp. among the nuclear medicine workers.
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Kelly-Reif K, Bertke S, Daniels RD, Richardson DB, Schubauer-Berigan MK. Ionizing radiation and solid cancer mortality among US nuclear facility workers. Int J Epidemiol 2023; 52:1015-1024. [PMID: 37253388 PMCID: PMC10527884 DOI: 10.1093/ije/dyad075] [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: 12/12/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The risk of solid cancers from low-level protracted ionizing radiation is not well characterized. Nuclear workers provide valuable information on the effects of ionizing radiation in contemporary exposure scenarios relevant to workers and the public. METHODS We evaluated the association between penetrating ionizing radiation exposure and solid cancer mortality among a pooled cohort of nuclear workers in the USA, with extended follow-up to examine cancers with long latencies. This analysis includes 101 363 workers from five nuclear facilities, with 12 069 solid cancer deaths between 1944 and 2016. The association between cumulative equivalent dose measured in sieverts (Sv) and solid cancer subtypes were modelled as the excess relative rate per Sv (ERR Sv-1) using Cox regression. RESULTS For the association between ionizing radiation exposure and all solid cancer mortality we observed an elevated rate (ERR Sv-1=0.19; 95% CI: -0.10, 0.52), which was higher among a contemporary sub-cohort of workers first hired in 1960 or later (ERR Sv-1= 2.23; 95% CI: 1.13, 3.49). Similarly, we observed an elevated rate for lung cancer mortality (ERR Sv-1= 0.65; 95% CI: 0.09, 1.30) that was higher among contemporary hires (ERR Sv-1= 2.90; 95% CI: 1.00, 5.26). CONCLUSIONS Although concerns remain about confounding, measurement error and precision, this analysis strengthens the evidence base indicating there are radiogenic risks for several solid cancer types.
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Affiliation(s)
- Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Steven Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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Radiation and leukaemia: Which leukaemias and what doses? Blood Rev 2023; 58:101017. [PMID: 36220737 DOI: 10.1016/j.blre.2022.101017] [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: 08/11/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022]
Abstract
The cause(s) of most cases of leukaemia is unknown. Save for several rare inherited disorders the most convincingly-identified causes of leukaemia are exposures to ionizing radiations, to some chemicals and to some anti-cancer drugs. Data implicating ionizing radiations as a cause of leukaemias come from several sources including persons exposed to the atomic bomb explosions in Japan, persons receiving radiation therapy for cancer and other disorders, persons occupationally exposed to radiation such as radiologists and nuclear facility workers, cigarette smokers, and others. Although ionizing radiations can be a cause of almost all types of leukaemias, some are especially sensitive to induction such as acute and chronic myeloid leukaemias (AML and CML) and acute lymphoblastic leukaemia (ALL). Whether chronic lymphocytic leukaemia can be caused by radiation exposure is controversial. The mechanism(s) by which ionizing radiations cause leukaemia differs for different leukaemia types. I discuss these issues and close with a hypothesis which might explain why haematopoietic stem cells are localized to the bone marrow.
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Radiation exposure in acute myeloid leukaemia, diffuse large B-cell lymphoma, and multiple myeloma patients in the first year following diagnosis. Pol J Radiol 2023; 88:e75-e79. [PMID: 36910883 PMCID: PMC9995242 DOI: 10.5114/pjr.2023.125008] [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: 07/27/2022] [Accepted: 10/13/2022] [Indexed: 02/19/2023] Open
Abstract
Purpose Radiological examinations are critical in the evaluation of patients with haematological malignancies for diagnosis and treatment. Any dose of radiation has been shown in studies to be harmful. In this regard, we assessed the radiation exposure of 3 types of haematological malignancies (diffuse large B-cell lymphoma [DLBCL], acute myeloid leukaemia [AML], and multiple myeloma [MM]) in our centre during the first year after diagnosis. Material and methods In the first year after diagnosis we retrospectively reviewed the radiation exposure data of 3 types of haematological malignancies (DLBCL, AML, and MM). The total and median CED value (cumulative effective radiation dose in millisieverts [mSv]) of each patient was used. Each patient's total and median estimated CED value was calculated using a web-based calculator and recorded in millisieverts (mSv). Results The total radiation doses in one year after diagnosis (CED value) were 46.54 ± 37.12 (median dose: 36.2) in the AML group; 63.00 ± 42.05 (median dose: 66.4) in the DLBCL group; and 28.04 ± 19.81 (median dose: 26.0) in the MM group (p = 0.0001). There was a significant difference between DLBCL and MM groups. Conclusions In all 3 haematological malignancies, the radiation exposure was significant, especially in the DBLCL group, within the first year of diagnosis. It is critical to seek methods to reduce these dosage levels. In diagnostic radiology, reference values must be established to increase awareness and self-control and reduce patient radiation exposure. This paper is also the first to offer thorough details on the subject at hand, and we think it can serve as a guide for further investigation.
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Koterov AN, Tukov AR, Ushenkova LN, Kalinina MV, Biryukov AP. Average Accumulated Radiation Doses for Global Nuclear Workers: Low Doses, Low Effects, and Comparison with Doses for Medical Radiologists. BIOL BULL+ 2022. [DOI: 10.1134/s106235902212007x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Gun R, Crouch P. Cancer in nuclear test veterans. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:044501. [PMID: 36305693 DOI: 10.1088/1361-6498/ac9b63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Richard Gun
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Philip Crouch
- School of Public Health, University of Adelaide, Adelaide, Australia
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grabowicz W, Masiarek K, Górnik T, Grycewicz T, Brodecki M, Dabin J, Huet C, Vanhavere F, Domienik-Andrzejewska JK. The effect of lead free cap on the doses of ionizing radiation to the head of interventional cardiologists working in haemodynamic room. Int J Occup Med Environ Health 2022; 35:549-560. [PMID: 35446304 PMCID: PMC10464785 DOI: 10.13075/ijomeh.1896.01958] [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: 12/17/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES The study aim was to analyse the influence of the lead free cap on doses received by interventional cardiologists. The impact of lead free cap on doses to the head were evaluated in number of studies. As different methods used to assess the attenuation properties of protective cap can lead to ambiguous results, a detailed study was performed. MATERIAL AND METHODS The effectiveness of a lead free cap in reducing the doses to the skin was assessed in clinic by performing measurements with thermoluminescent dosimeters attached inside and outside the cap first during individual coronary angiography (CA) or CA/percutaneous transluminal coronary angioplasty (CA/PTCA) procedures and then cumulated during few procedures of the same type. In order to investigate the effect of the cap on reducing the doses to the brain additional measurements were performed with a male Alderson Rando and polymethyl methacrylate (PMMA) phantoms representing the physician and the patient, respectively for different projections. The brain dose per procedure, annual and cumulated during entire working practice were estimated for both cases working with and without the cap. RESULTS The dose reduction factor (RF) for the skin (the quotient of doses outside and inside the cap) vary from 1.1 up to 4.0 in clinical conditions; on average 2.3-fold reduction is observed in the most exposed left temple. The RFs determined for the part of the head covered by the cap range from 1.4 to 1.8 while for the brain from 1.0 to 1.1 depending on the projection. The estimated annual brain dose for interventional cardiologist performing yearly 550 CA/PTCA procedures without any protective shields is 7.2 mGy and it is reduced with the lead free cap by an average factor of 1.1. CONCLUSIONS The study results proved the considerable effectiveness of lead free cap to protect the skin but very limited to protect the brain. Int J Occup Med Environ Health. 2022;35(5):549-60.
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Affiliation(s)
- Włodzimierz grabowicz
- Medical University of Lodz, Department of Interventional Cardiology and Cardiac Arrythmias, Łódź, Poland
| | - Konrad Masiarek
- Medical University of Lodz, Department of Interventional Cardiology and Cardiac Arrythmias, Łódź, Poland
| | - Tomasz Górnik
- Medical University of Lodz, Department of Interventional Cardiology and Cardiac Arrythmias, Łódź, Poland
| | - Tomasz Grycewicz
- Medical University of Lodz, Department of Interventional Cardiology and Cardiac Arrythmias, Łódź, Poland
| | - Marcin Brodecki
- Nofer Institute of Occupational Medicine, Department of Radiation Protection, Łódź, Poland
| | | | - Christelle Huet
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux Roses Cedex, France
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15
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Haley B, Zander A, Popović J, Paunesku T, Woloschak GE. Findings from international archived data: Fractionation reduces mortality risk of ionizing radiation for total doses below 4 Gray in rodents. MUTATION RESEARCH. GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2022; 882:503537. [PMID: 36155139 DOI: 10.1016/j.mrgentox.2022.503537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 06/16/2023]
Abstract
Ionizing radiation is omnipresent and unavoidable on Earth; nevertheless, the range of doses and modes of radiation delivery that represent health risks remain controversial. Radiation protection policy for civilians in US is set at 1 mSv per year. Average persons from contemporary populations are exposed to several hundred milliSieverts (mSv) over their lifetimes from both natural and human made sources such as radon, cosmic rays, CT-scans (20-50 mSv partial body exposure per scan), etc. Health risks associated with these and larger exposures are focus of many epidemiological studies, but uncertainties of these estimates coupled with individual and environmental variation make it is prudent to attempt to use animal models and tightly controlled experimental conditions to supplement our evaluation of radiation risk question. Data on 11,528 of rodents of both genders exposed to x-ray or gamma-ray radiation in facilities in US and Europe were used for this analysis; animal mortality data argue that fractionated radiation exposures have about 2 fold less risk per Gray than acute radiation exposures in the range of doses between 0.25 and 4 Gy.
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Affiliation(s)
- Benjamin Haley
- Feinberg School of Medicine, Department of Radiation Oncology, Northwestern University, Chicago, IL 60611, USA; ClassDojo, 735 Tehama Street, San Francisco CA 94103, USA
| | - Alia Zander
- Feinberg School of Medicine, Department of Radiation Oncology, Northwestern University, Chicago, IL 60611, USA; Chicago-Tempus Headquarters and Lab, 600 West Chicago Avenue, Suite 510, Chicago, IL 60654, USA
| | - Jelena Popović
- Feinberg School of Medicine, Department of Radiation Oncology, Northwestern University, Chicago, IL 60611, USA
| | - Tatjana Paunesku
- Feinberg School of Medicine, Department of Radiation Oncology, Northwestern University, Chicago, IL 60611, USA
| | - Gayle E Woloschak
- Feinberg School of Medicine, Department of Radiation Oncology, Northwestern University, Chicago, IL 60611, USA.
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Breast Cancer Among Female Flight Attendants and the Role of the Occupational Exposures. J Occup Environ Med 2022; 64:822-830. [DOI: 10.1097/jom.0000000000002606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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D’Amore T, Klein G, Lonner J. The Use of Computerized Tomography Scans in Elective Knee and Hip Arthroplasty—What Do They Tell Us and at What Risk? Arthroplast Today 2022; 15:132-138. [PMID: 35573981 PMCID: PMC9095648 DOI: 10.1016/j.artd.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
The average background radiation exposure in the United States has nearly doubled over the previous quarter century, with almost all the increase derived from medical imaging. Nearly 2% of all cancers in the United States may be attributable to radiation from computerized tomography (CT) scans. Given the nondiagnostic nature of CT scans that are used in elective knee and hip arthroplasty today, special consideration should be given to the inherent risk of radiation exposure with routine use of this technology. Methods to decrease radiation exposure including modulating the settings of the CT machine and using alternative non-CT-based systems can decrease patient exposure to radiation from CT scans. The rapid evolution of CT technology in arthroplasty has allowed for expanded clinical applications, the benefits of which remain controversial.
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Affiliation(s)
| | | | - Jess Lonner
- Corresponding author. Rothman Orthopaedic Institute, 925 Chestnut Street5th Floor, Philadelphia PA, 19107, USA. Tel.: +1 800 321 9999.
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18
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Updated Standardized Mortality Ratio Evaluation of Disease Risks of Shipyard Workers Exposed to Low Dose Ionizing Radiation. J Occup Environ Med 2022; 64:e224-e230. [DOI: 10.1097/jom.0000000000002491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Dove AP, Cmelak A, Darrow K, McComas KN, Chowdhary M, Beckta J, Kirschner AN. The Use of Low-Dose Radiotherapy in Osteoarthritis: A Review. Int J Radiat Oncol Biol Phys 2022; 114:203-220. [DOI: 10.1016/j.ijrobp.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
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20
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Bos D, Yu S, Luong J, Chu P, Wang Y, Einstein AJ, Starkey J, Delman BN, Duong PAT, Das M, Schindera S, Goode AR, MacLeod F, Wetter A, Neill R, Lee RK, Roehm J, Seibert JA, Cervantes LF, Kasraie N, Pike P, Pahwa A, Jeukens CRLPN, Smith-Bindman R. Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry. Eur Radiol 2022; 32:1971-1982. [PMID: 34642811 PMCID: PMC8831291 DOI: 10.1007/s00330-021-08266-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 11/02/2022]
Abstract
OB JECTIVES The European Society of Radiology identified 10 common indications for computed tomography (CT) as part of the European Study on Clinical Diagnostic Reference Levels (DRLs, EUCLID), to help standardize radiation doses. The objective of this study is to generate DRLs and median doses for these indications using data from the UCSF CT International Dose Registry. METHODS Standardized data on 3.7 million CTs in adults were collected between 2016 and 2019 from 161 institutions across seven countries (United States of America (US), Switzerland, Netherlands, Germany, UK, Israel, Japan). DRLs (75th percentile) and median doses for volumetric CT-dose index (CTDIvol) and dose-length product (DLP) were assessed for each EUCLID category (chronic sinusitis, stroke, cervical spine trauma, coronary calcium scoring, lung cancer, pulmonary embolism, coronary CT angiography, hepatocellular carcinoma (HCC), colic/abdominal pain, appendicitis), and US radiation doses were compared with European. RESULTS The number of CT scans within EUCLID categories ranged from 8,933 (HCC) to over 1.2 million (stroke). There was greater variation in dose between categories than within categories (p < .001), and doses were significantly different between categories within anatomic areas. DRLs and median doses were assessed for all categories. DRLs were higher in the US for 9 of the 10 indications (except chronic sinusitis) than in Europe but with a significantly higher sample size in the US. CONCLUSIONS DRLs for CTDIvol and DLP for EUCLID clinical indications from diverse organizations were established and can contribute to dose optimization. These values were usually significantly higher in the US than in Europe. KEY POINTS • Registry data were used to create benchmarks for 10 common indications for CT identified by the European Society of Radiology. • Observed US radiation doses were higher than European for 9 of 10 indications (except chronic sinusitis). • The presented diagnostic reference levels and median doses highlight potentially unnecessary variation in radiation dose.
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Affiliation(s)
- Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Sophronia Yu
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Jason Luong
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Philip Chu
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Yifei Wang
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Andrew J Einstein
- Department of Medicine, Seymour, Paul, and Gloria Division of Cardiology, and Department of Radiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 10-203B, New York, NY, 10032, USA
| | - Jay Starkey
- Radiology St Luke's International Hospital, 9-1 Akashicho, Chuo City, Tokyo, 104-8560, Japan
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029-6574, USA
| | - Phuong-Anh T Duong
- Department of Radiology and Imaging Sciences, University of Utah, 50 N Medical Dr, Salt Lake City, UT, 84132, USA
| | - Marco Das
- Department of diagnostic and interventional Radiology, Helios Hospital Duisburg, An der Abtei 7-11, 47166, Duisburg, Germany
| | - Sebastian Schindera
- Institute of Radiology, Kantonsspital Aarau AG, Tellstrasse 25, 5001, Aarau, Switzerland
| | - Allen R Goode
- Department of Radiology and Medical Imaging, UVA Health, 1215 Lee St, Charlottesville, VA, 22908, USA
| | - Fiona MacLeod
- Radiology, John Radcliffe Hospital, Headley Way, Headington, OX3 9DU, Oxford, UK
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Rebecca Neill
- Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Road NE, AT 631-A, Atlanta, GA, 30322, USA
| | - Ryan K Lee
- Department of Radiology, Einstein Healthcare Network, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Jodi Roehm
- RAYUS Radiology, 5775 Wayzata Blvd., St. Louis Park, MN, 55416, USA
| | - James A Seibert
- Department of Radiology, UC Davis Health, 4860 Y Street, Sacramento, CA, 95817, USA
| | - Luisa F Cervantes
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA
| | - Nima Kasraie
- Radiology, UT Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX, 75235, USA
| | - Pavlina Pike
- Huntsville Hospital, 101 Sivley Rd SW, Huntsville, AL, 35801, USA
| | - Anokh Pahwa
- Department of Radiological Sciences, Olive View - UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA, 91342, USA
| | - Cécile R L P N Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands
| | - Rebecca Smith-Bindman
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
- Philip R Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St, San Francisco, CA, 94118, USA
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Trends in incidence and survival of patients with thymic epithelial tumor in a high-incidence Asian country: Analysis of the Korean Central Cancer Registry 1999-2017. J Thorac Oncol 2022; 17:827-837. [DOI: 10.1016/j.jtho.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 01/26/2022] [Accepted: 02/07/2022] [Indexed: 11/23/2022]
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22
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Whole Body MRI in the Detection of Lymph Node Metastases in Patients with Testicular Germ Cell Cancer. Life (Basel) 2022; 12:life12020212. [PMID: 35207499 PMCID: PMC8875751 DOI: 10.3390/life12020212] [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: 12/30/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Whole-Body Magnetic Resonance Imaging (WB-MRI) is increasingly used for metastatic screening in oncology. This prospective single center study assesses the diagnostic value of WB-MRI including diffusion weighted imaging (DWI) and identifies the sufficient protocol for metastatic lymph node detection in patients with testicular germ cell cancer (TGCC). Forty-three patients underwent contrast enhanced thoraco-abdominopelvic CT (TAP-CT) and WB-MRI with DWI for metastatic lymph node screening. Two independent readers reviewed CTs and WB-MRIs. The diagnostic performance of different imaging protocols (CT, complete WB-MRI, T1W + DWI, T2W + DWI), the agreement between these protocols and the reference standard, the reproducibility of findings and the image quality (Signal and contrast to Noise Ratios, Likert scale) were studied. Reproducibility was very good regardless of both lesion locations (retroperitoneal vs distant lymph nodes, other lesions) and the reader. Diagnostic accuracy of MRI was ≥95% (regardless of the locations and imaging protocol); accuracy of CT was ≥93%. There was a strict overlap of 95% CIs associated with this accuracy between complete WB-MRI, T1W + DWI and T2W + DWI, regardless of the reader. Higher Likert score and SNR were observed for DWI, followed by T2W and T1W sequences. In conclusion, a fast WB-MRI protocol including T2W and DWI is a sufficient, accurate, non-irradiating alternative to TAP-CT for metastatic lymph node screening in TGCC.
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Wakeford R. Radiation in the workplace - an opportunity for substantial epidemiological evidence. Int J Radiat Biol 2022; 98:533-536. [PMID: 35044294 DOI: 10.1080/09553002.2022.2031218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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Kadavigere R, Sukumar S. Estimation of radiation dose and establishment of local diagnostic reference levels for computed tomography of head in pediatric population. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:983-991. [PMID: 35786667 DOI: 10.3233/xst-221172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pediatric population is more sensitive to the effects of radiation than adults. Establishing diagnostic reference level (DRL) is an efficient dose optimization technique implemented by many countries for reducing radiation dose during Computed Tomography (CT) examinations. OBJECTIVES To estimate radiation dose and establish a new local diagnostic reference level for CT head examination in the pediatric population. MATERIALS AND METHODS We prospectively recruited 143 pediatric patients referred for CT head examination with age ranging from 0-5 years old. All patients had undergone CT head examination using the standard pediatric head protocol. Volumetric CT dose index (CTDIvol) and dose length product (DLP) were recorded. The effective dose was first calculated. Then, 75th percentile of dose indices was calculated to establish DRLs. RESULTS DRLs in terms of CTDIvol and DLP are 23.84 mGy, 555.99 mGy.cm for patients <1 years old and 28.65 mGy, 794.99 mGy.cm for patients from 1-5 years old, respectively. Mean effective doses for <1 years old patients and 1-5 years old patients are 2.91 mSv and 2.78 mSv respectively. CONCLUSION The study concludes that DRL in terms of CTDIvol is lower but DRL in terms of DLP and the effective dose is higher compared to a few other studies which necessitate the need for dose optimization.
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Affiliation(s)
- Rajagopal Kadavigere
- Department of Radio diagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Suresh Sukumar
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Duncan E, Mojica M, Ching K, Harwayne-Gidansky I. Low Concordance Between Pediatric Emergency Attendings and Pediatric Residents for Predictors of Serious Intracranial Injury. Pediatr Emerg Care 2022; 38:e422-e425. [PMID: 33273432 DOI: 10.1097/pec.0000000000002313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Minor head trauma is a common cause of pediatric emergency room visits. The Pediatric Emergency Care Applied Research Network head trauma clinical decision rules (PECARN-CDR) are designed to assist clinicians in determining which patients require imaging. However, only minimal data are available on the accuracy of residents' assessments using PECARN-CDR. Prior research suggests that trainees often come to erroneous conclusions about pediatric head trauma. The objective of the present study was to assess concordance between pediatric residents' and attending physicians' assessments of children with low-risk head trauma, with the ultimate goal of improving education in pediatric trauma assessment. METHODS This is a retrospective cohort study analyzing concordance between pediatric residents and pediatric emergency attendings who provided PECARN-CDR-based evaluations of low-risk head injuries. It is a planned subanalysis based on a prospectively collected, multicenter data set tracking pediatric head trauma encounters from July 2014 to June 2019. RESULTS Data were collected from 436 pediatric residents, who encountered 878 patients. In the case of patients younger than 2 years, low concordance between residents and attendings was observed for the following elements of the PECARN-CDR: severe mechanism (κ = 0.24), palpable skull fracture (κ = 0.23), Glasgow Coma Scale (GCS) score less than 15 (κ = 0.14), and altered mental status (AMS; κ = -0.03). There was moderate to high agreement between residents and attendings for loss of consciousness (κ = 0.71), nonfrontal hematoma (κ = 0.48), and not acting normally per parent (κ = 0.35). In the case of patients older than 2 years, there was low concordance for signs of basilar skull fracture (κ = 0.28) and GCS score less than 15 (κ = 0.10). Concordance was high to moderate for history of vomiting (κ = 0.88), loss of consciousness (κ = 0.67), severe headache (κ = 0.50), severe mechanism (κ = 0.44), and AMS (κ = 0.42). Residents were more conservative, that is, more likely to report a positive finding, in nearly all components of the PECARN-CDR. CONCLUSIONS Resident assessment of children presenting to the ED with minor head trauma is often poorly concordant with attending assessment on the major predictors of clinically important traumatic brain injury (abnormal GCS, AMS, signs of skull fracture) based on the PECARN-CDR. Future work may explore the reasons for low concordance and seek ways to improve pediatric resident education in the diagnosis and management of trauma.
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Affiliation(s)
- Ellen Duncan
- From the Bellevue Hospital Center/New York University School of Medicine, Departments of Emergency Medicine and Pediatrics, New York, NY
| | - Michael Mojica
- From the Bellevue Hospital Center/New York University School of Medicine, Departments of Emergency Medicine and Pediatrics, New York, NY
| | - Kevin Ching
- Cornell Medical Center, Departments of Emergency Medicine and Pediatrics, New York, NY
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Bos D, Zensen S, Opitz M, Haubold J, Forsting M, Nassenstein K, Guberina N, Wetter A. IMAGE QUALITY STUDY OF RADIATION-REDUCED COMBINED CHEST AND ABDOMEN/PELVIS CT COMPARED WITH A STANDARD PROTOCOL. RADIATION PROTECTION DOSIMETRY 2021; 196:190-198. [PMID: 34635920 DOI: 10.1093/rpd/ncab147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study is to examine radiation doses and image quality of a low-dose (LD) protocol for chest and abdomen/pelvis (CAP) CT compared with a standard (STD) protocol. A total of 361 patients were included between October 2019 and April 2020; 104 patients with LD-protocol (100 kV, ref mAs 80 (chest)/145 (abdomen/pelvis)) and 257 patients with STD-protocol (100 kV, ref mAs 100 (chest)/180 (abdomen/pelvis)) at second-generation dual-source CT. Radiation doses for CTDIvol and DLP, and objective and subjective image qualities of 50 examinations from each group were evaluated. The LD-protocol applied significantly lower radiation doses compared with the STD-protocol (p < 0.001), achieving a dose reduction by 37% for the median DLP in chest, 19% in abdomen/pelvis and 22% in total. Median total DLP was 342 mGy·cm (LD) vs. 436 mGy·cm (STD). The LD-CAP CT protocol achieved a significant dose reduction far below national diagnostic reference levels, ensuring acceptable and good image quality.
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Affiliation(s)
- Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Kai Nassenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
- Department of Diagnostic and Interventional Radiology, Neuroradiology, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany
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Wakeford R. Overview of epidemiological studies of nuclear workers: opportunities, expectations, and limitations . JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:1075-1092. [PMID: 34161930 DOI: 10.1088/1361-6498/ac0df4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
Epidemiological studies of those exposed occupationally to ionising radiation offer an important opportunity to directly check the assumptions underlying the international system of radiological protection against low-level radiation exposures. Recent nuclear worker studies, notably the International Nuclear Workers Study (INWORKS) and studies of the Mayak workforce in Russia, provide powerful investigations of a wide range of cumulative photon doses received at a low dose-rate over protracted periods, and broadly confirm radiation-related excess risks of leukaemia and solid cancers at around the levels predicted by standard risk models derived mainly from the experience of the Japanese atomic-bomb survivors acutely exposed principally to gamma radiation. However, the slope of the dose-response for solid cancers expressed in terms of the excess relative risk per unit dose, ERR/Gy, differs between INWORKS and Mayak, such that when compared with the slope derived from the atomic-bomb survivors, INWORKS does not provide obvious support for the use in radiological protection of a dose and dose-rate effectiveness factor greater than one whereas the Mayak workforce apparently does. This difference could be a chance effect, but it could also point to potential problems with these worker studies. Of particular concern is the adequacy of recorded doses received in the early years of operations at older nuclear installations, such as the potential for 'missed' photon doses. A further issue is how baseline cancer rates may influence radiation-related excess risks. There is scope for a considerable increase in the statistical power of worker studies, with longer follow-up capturing more deaths and incident cases of cancer, and further workforces being included in collaborative studies, but the difficulties posed by dosimetry questions should not be ignored and need to be the subject of detailed scrutiny.
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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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Abstract
Purpose of Review Sepsis is a leading cause of death worldwide. Groundbreaking international collaborative efforts have culminated in the widely accepted surviving sepsis guidelines, with iterative improvements in management strategies and definitions providing important advances in care for patients. Key to the diagnosis of sepsis is identification of infection, and whilst the diagnostic criteria for sepsis is now clear, the diagnosis of infection remains a challenge and there is often discordance between clinician assessments for infection. Recent Findings We review the utility of common biochemical, microbiological and radiological tools employed by clinicians to diagnose infection and explore the difficulty of making a diagnosis of infection in severe inflammatory states through illustrative case reports. Finally, we discuss some of the novel and emerging approaches in diagnosis of infection and sepsis. Summary While prompt diagnosis and treatment of sepsis is essential to improve outcomes in sepsis, there remains no single tool to reliably identify or exclude infection. This contributes to unnecessary antimicrobial use that is harmful to individuals and populations. There is therefore a pressing need for novel solutions. Machine learning approaches using multiple diagnostic and clinical inputs may offer a potential solution but as yet these approaches remain experimental.
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Boice JD, Cohen SS, Mumma MT, Hagemeyer DA, Chen H, Golden AP, Yoder RC, Dauer LT. Mortality from Leukemia, Cancer and Heart Disease among U.S. Nuclear Power Plant Workers, 1957-2011. Int J Radiat Biol 2021; 98:657-678. [PMID: 34669562 DOI: 10.1080/09553002.2021.1967507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of the Million Person Study (MPS) of Low Dose Health Effects is to examine the level of radiation risk for chronic exposures received gradually over time and not acutely as was the case for the Japanese atomic bomb survivors. Nuclear power plant (NPP) workers comprise nearly 15 percent of the MPS. Leukemia, selected cancers, Parkinson's disease, ischemic heart disease (IHD) and other causes of death are evaluated. METHODS AND MATERIAL The U.S. Nuclear Regulatory Commission's Radiation Exposure Information and Reporting System (REIRS) and the Landauer, Inc. dosimetry databases identified 135,193 NPP workers first monitored 1957-1984. Annual personal dose equivalents [Hp(10)] were available for each worker. Radiation records from all places of employment were sought. Vital status was determined through 2011. Mean absorbed doses to red bone marrow (RBM), esophagus, lung, colon, brain and heart were estimated by adjusting the recorded Hp(10) for each worker by scaling factors, accounting for exposure geometry and energy of the incident gamma radiation. Standardized mortality ratios (SMR) were calculated. Radiation risks were estimated using Cox proportional hazards models. RESULTS Nearly 50% of workers were employed for more than 20 years. The mean duration of follow-up was 30.2 y. Overall, 29,076 total deaths occurred, 296 from leukemia other than chronic lymphocytic leukemia (CLL), 3,382 from lung cancer, 140 from Parkinson's disease and 5,410 from IHD. The mean dose to RBM was 37.9 mGy (maximum 1.0 Gy; percent >100 mGy was 9.2%), 43.2 mGy to lung, 43.7 mGy to colon, 33.2 mGy to brain, and 43.9 mGy to heart. The SMRs (95% CI) were 1.06 (0.94;1.19) for leukemia other than CLL, 1.10 (1.07;1.14) for lung cancer, 0.90 (0.76;1.06) for Parkinson's disease, and 0.80 (0.78; 0.82) for IHD. The excess relative risk (ERR) per 100 mGy for leukemia other than CLL was 0.15 (90% CI 0.001; 0.31). For all solid cancers the ERR per 100 mGy (95% CI) was 0.01 (-0.03; 0.05), for lung cancer -0.04 (-0.11; 0.02), for Parkinson's disease 0.24 (-0.02; 0.50), and for IHD -0.01 (-0.06; 0.04). CONCLUSION Prolonged exposure to radiation increased the risk of leukemia other than CLL among NPP workers. There was little evidence for a radiation-association for all solid cancers, lung cancer or ischemic heart disease. Increased precision will be forthcoming as the different cohorts within the MPS are combined, such as industrial radiographers and medical radiation workers who were assembled and evaluated in like manner.
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Affiliation(s)
- John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
| | | | - Michael T Mumma
- International Epidemiology Institute, Rockville, MD, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Heidi Chen
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Hanfi M, Emad BM, Sayyed M, Khandaker MU, Bradley D. Natural radioactivity in the prospecting tunnel in Egypt: Dose rate and risk assessment. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109555] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Short Assay Design for Micronucleus Detection in Human Lymphocytes. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2322257. [PMID: 34552982 PMCID: PMC8452413 DOI: 10.1155/2021/2322257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
Abstract
There has been a constant need to develop new and faster cytogenetic assays to measure the instability induced by genotoxic agents in the field of cytogenetic research, an example of which is the micronucleus assay. Micronuclei are fragments or complete chromosomes that remain in the cytoplasm during mitosis. With their high sensitivity and specificity detection, their presence can indicate environmental and occupational genotoxic effects. However, the prolonged periods of cell incubation this assay necessitates are costly and extensive. Hence, it is essential to develop an improved assay that can achieve standardization by being reproducible in practice. The standard protocol for the detection of micronuclei in lymphocytes uses a total assay time of 72 hours. Theoretically, it is possible to reduce the incubation period, and consequently, the total assay time, considering a lymphocyte, completes its mitosis in 24 hours. This study, after careful review of literature, proposes an experimental design to reduce the incubation period and demonstrates its usefulness in practice through the design of a collaborative trial.
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Ravindra VM, Awad AW, Baker CM, Lee A, Anderson RCE, Gociman B, Patel KB, Smyth MD, Birgfeld C, Pollack IF, Goldstein JA, Imahiyerobo T, Siddiqi FA, Kestle JRW. Preoperative imaging patterns and intracranial findings in single-suture craniosynostosis: a study from the Synostosis Research Group. J Neurosurg Pediatr 2021; 28:344-350. [PMID: 34171835 DOI: 10.3171/2021.2.peds2113] [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: 01/06/2021] [Accepted: 02/08/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The diagnosis of single-suture craniosynostosis can be made by physical examination, but the use of confirmatory imaging is common practice. The authors sought to investigate preoperative imaging use and to describe intracranial findings in children with single-suture synostosis from a large, prospective multicenter cohort. METHODS In this study from the Synostosis Research Group, the study population included children with clinically diagnosed single-suture synostosis between March 1, 2017, and October 31, 2020, at 5 institutions. The primary analysis correlated the clinical diagnosis and imaging diagnosis; secondary outcomes included intracranial findings by pathological suture type. RESULTS A total of 403 children (67% male) were identified with single-suture synostosis. Sagittal (n = 267), metopic (n = 77), coronal (n = 52), and lambdoid (n = 7) synostoses were reported; the most common presentation was abnormal head shape (97%), followed by a palpable or visible ridge (37%). Preoperative cranial imaging was performed in 90% of children; findings on 97% of these imaging studies matched the initial clinical diagnosis. Thirty-one additional fused sutures were identified in 18 children (5%) that differed from the clinical diagnosis. The most commonly used imaging modality by far was CT (n = 360), followed by radiography (n = 9) and MRI (n = 7). Most preoperative imaging was ordered as part of a protocolized pathway (67%); some images were obtained as a result of a nondiagnostic clinical examination (5.2%). Of the 360 patients who had CT imaging, 150 underwent total cranial vault surgery and 210 underwent strip craniectomy. The imaging findings influenced the surgical treatment 0.95% of the time. Among the 24% of children with additional (nonsynostosis) abnormal findings on CT, only 3.5% required further monitoring. CONCLUSIONS The authors found that a clinical diagnosis of single-suture craniosynostosis and the findings on CT were the same with rare exceptions. CT imaging very rarely altered the surgical treatment of children with single-suture synostosis.
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Affiliation(s)
- Vijay M Ravindra
- 1Department of Neurosurgery, and
- 2Division of Neurosurgery, University of California, San Diego
- 3Department of Neurosurgery, Naval Medical Center San Diego, California
| | | | | | - Amy Lee
- 4Department of Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Richard C E Anderson
- 5Department of Neurosurgery, Columbia University, Morgan Stanley Children's Hospital, and
| | - Barbu Gociman
- 6Division of Plastic and Reconstructive Surgery, University of Utah, Salt Lake City, Utah
| | - Kamlesh B Patel
- 7Division of Plastic and Reconstructive Surgery, Department of Surgery, and
| | - Matthew D Smyth
- 8Department of Neurosurgery, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, Missouri
| | | | | | - Jesse A Goldstein
- 10Plastic Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Thomas Imahiyerobo
- 11Division of Plastic Surgery, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Faizi A Siddiqi
- 6Division of Plastic and Reconstructive Surgery, University of Utah, Salt Lake City, Utah
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Bos D, König B, Blex S, Zensen S, Opitz M, Maier S, Forsting M, Zylka W, Kühl H, Wetter A, Guberina N. Experimental examination of radiation doses from cardiac and liver CT perfusion in a phantom study as a function of organ, age and sex. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:512-525. [PMID: 34406127 DOI: 10.1088/1361-6498/abf71f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/12/2021] [Indexed: 06/13/2023]
Abstract
Cardiac and liver computed tomography (CT) perfusion has not been routinely implemented in the clinic and requires high radiation doses. The purpose of this study is to examine the radiation exposure and technical settings for cardiac and liver CT perfusion scans at different CT scanners. Two cardiac and three liver CT perfusion protocols were examined with the N1 LUNGMAN phantom at three multi-slice CT scanners: a single-source (I) and second- (II) and third-generation (III) dual-source CT scanners. Radiation doses were reported for the CT dose index (CTDIvol) and dose-length product (DLP) and a standardised DLP (DLP10cm) for cardiac and liver perfusion. The effective dose (ED10cm) for a standardised scan length of 10 cm was estimated using conversion factors based on the International Commission on Radiological Protection (ICRP) 110 phantoms and tissue-weighting factors from ICRP 103. The proposed total lifetime attributable risk of developing cancer was determined as a function of organ, age and sex for adults. Radiation exposure for CTDIvol, DLP/DLP10 cmand ED10 cmduring CT perfusion was distributed as follows: for cardiac perfusion (II) 144 mGy, 1036 mGy·cm/1440 mGy·cm and 39 mSv, and (III) 28 mGy, 295 mGy·cm/279 mGy·cm and 8 mSv; for liver perfusion (I) 225 mGy, 3360 mGy·cm/2249 mGy·cm and 54 mSv, (II) 94 mGy, 1451 mGy·cm/937 mGy·cm and 22 mSv, and (III) 74 mGy, 1096 mGy·cm/739 mGy·cm and 18 mSv. The third-generation dual-source CT scanner applied the lowest doses. Proposed total lifetime attributable risk increased with decreasing age. Even though CT perfusion is a high-dose examination, we observed that new-generation CT scanners could achieve lower doses. There is a strong impact of organ, age and sex on lifetime attributable risk. Further investigations of the feasibility of these perfusion scans are required for clinical implementation.
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Affiliation(s)
- Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Britta König
- Faculty of Physical Engineering, Westphalian University, Campus Gelsenkirchen, Neidenburger Str. 43, Gelsenkirchen 45897, Germany
| | - Sebastian Blex
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Sandra Maier
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Waldemar Zylka
- Faculty of Physical Engineering, Westphalian University, Campus Gelsenkirchen, Neidenburger Str. 43, Gelsenkirchen 45897, Germany
| | - Hilmar Kühl
- Department of Radiology, St Bernhard-Hospital Kamp-Lintfort GmbH, Bürgermeister-Schmelzing-Str. 90, Kamp-Lintfort 47475, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
- Department of Diagnostic and Interventional Radiology, Neuroradiology, Asklepios Klinikum Harburg, 21075 Hamburg, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
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Chauhan V, Leblanc J, Sadi B, Burtt J, Sauvé K, Lane R, Randhawa K, Wilkins R, Quayle D. COHERE - strengthening cooperation within the Canadian government on radiation research. Int J Radiat Biol 2021; 97:1153-1165. [PMID: 34133252 DOI: 10.1080/09553002.2021.1941379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/16/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Canadian Organization on Health Effects from Radiation Exposure (COHERE) is a government initiative to better understand biological and human health risks from ionizing radiation exposures relevant to occupational and environmental settings (<100 mGy, <6 mGy/h). It is currently a partnership between two federal agencies, Health Canada (HC) and the Canadian Nuclear Safety Commission (CNSC). COHERE's vision is to contribute knowledge to reduce scientific uncertainties from low dose and dose-rate exposures. COHERE will advance our understanding by bridging the knowledge gap between human health risks and linkages to molecular- and cellular-level responses to radiation. Research focuses on identifying sensitive, early, and key molecular events of relevance to risk assessment. CONCLUSIONS The initiative will address questions of relevance to better apprize Canadians, including radiation workers and members of the public and Indigenous peoples, on health risks from low dose radiation exposure and inform radiation protection frameworks at a national and international level. Furthermore, it will support global efforts to conduct collaborative undertakings and better coordinate research. Here, we describe a historical overview of the research conducted, the strategic research agenda that outlines the scientific framework, stakeholders, opportunities to harmonize internationally, and how research outcomes will better inform communication of risk to Canadians.
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Affiliation(s)
- Vinita Chauhan
- Radiation Protection Bureau, Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Julie Leblanc
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Baki Sadi
- Radiation Protection Bureau, Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Julie Burtt
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Kiza Sauvé
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Rachel Lane
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Kristi Randhawa
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Ruth Wilkins
- Radiation Protection Bureau, Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Debora Quayle
- Radiation Protection Bureau, Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
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Moorthy S. How Safe Are Radiation Doses in Diagnostic Radiology? A Historical Perspective and Review of Current Evidence. Indian J Radiol Imaging 2021; 31:653-660. [PMID: 34790311 PMCID: PMC8590548 DOI: 10.1055/s-0041-1735927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The "no dose is safe" linear no-threshold (LNT) model forms the basis for radiation safety in radiology practice. This model has its origins in observations of germline mutations in fruit flies exposed to X-rays. After World War II, quantitative risk estimates of radiation injury are primarily derived from the atomic bomb survivor Life Span Study. Current understanding of tissue response to radiation has raised doubts about the validity of LNT model at low doses encountered in the practice of diagnostic radiology. This article traces the evolution of basic radiation safety concepts and provides a bird's eye view of the Life Span Study and other studies which throw light on the matter. The arguments for an alternative, threshold, or even hermetic models of dose response are examined. The relevance of these developments to the nuclear power industry is also outlined.
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Affiliation(s)
- Srikanth Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences and Research Centre, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkara, Kochi, Kerala, India
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Bastos Oreiro M, Martín R, Gomez P, López Muñoz N, Rodriguez A, Liébana M, Navarro B, Sánchez-González B, Marí P, Pérez de Oteiza J, Gutiérrez A, Bento L, Domingo Doménech E, Vidal MJ, Del Campo R, Pérez Ceballos E, Infante M, Roldán A, García Belmonte D, Santero M, Sureda A, Sanz RG. SEGHI Study: Defining the Best Surveillance Strategy in Hodgkin Lymphoma after First-Line Treatment. Cancers (Basel) 2021; 13:2412. [PMID: 34067616 PMCID: PMC8156414 DOI: 10.3390/cancers13102412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
The optimal strategy for early surveillance after first complete response is unclear in Hodgkin lymphoma. Thus, we compared the various follow-up strategies in a multicenter study. All the included patients had a negative positron emission tomography/computed tomography at the end of induction therapy. From January 2007 to January 2018, we recruited 640 patients from 15 centers in Spain. Comparing the groups in which serial imaging were performed, the clinical/analytical follow-up group was exposed to significantly fewer imaging tests and less radiation. With a median follow-up of 127 months, progression-free survival at 60 months of the entire series was 88% and the overall survival was 97%. No significant differences in survival or progression-free survival were found among the various surveillance strategies. This study suggests that follow-up approaches with imaging in Hodgkin lymphoma provide no benefits for patient survival, and we believe that clinical/analytical surveillance for this group of patients could be the best course of action.
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Affiliation(s)
- Mariana Bastos Oreiro
- Department of Hematology, Gregorio Marañon Health Research Institute, Gregorio Marañón Hospital, 28007 Madrid, Spain;
| | - Reyes Martín
- Department of Hematology, Gregorio Marañon Health Research Institute, Gregorio Marañón Hospital, 28007 Madrid, Spain;
| | - Pilar Gomez
- Hematology Department, Hospital La Paz, 28046 Madrid, Spain;
| | - Nieves López Muñoz
- Hematology Department, Hospital 12 de Octubre, 28041 Madrid, Spain; (N.L.M.); (A.R.)
| | - Antonia Rodriguez
- Hematology Department, Hospital 12 de Octubre, 28041 Madrid, Spain; (N.L.M.); (A.R.)
| | - Marta Liébana
- Hematology Department, Hospital Puerta de Hierro, 28222 Madrid, Spain; (M.L.); (B.N.)
| | - Belén Navarro
- Hematology Department, Hospital Puerta de Hierro, 28222 Madrid, Spain; (M.L.); (B.N.)
| | | | - Pilar Marí
- Hematology Department, Hospital HM Madrid Sanchinarro, Universidad CEU San Pablo, 28050 Madrid, Spain; (P.M.); (J.P.d.O.)
| | - Jaime Pérez de Oteiza
- Hematology Department, Hospital HM Madrid Sanchinarro, Universidad CEU San Pablo, 28050 Madrid, Spain; (P.M.); (J.P.d.O.)
| | - Antonio Gutiérrez
- Hematology Department, Hospital Universitario Son Es pases (IdiSBa), 07120 Palma de Mallorca, Spain; (A.G.); (L.B.)
| | - Leyre Bento
- Hematology Department, Hospital Universitario Son Es pases (IdiSBa), 07120 Palma de Mallorca, Spain; (A.G.); (L.B.)
| | | | - María Jesús Vidal
- Hematology Department, Hospital Universitario de León, 24071 León, Spain;
| | - Raquel Del Campo
- Hematology Department, Hospital Universitario Son Llátzer, 07198 Palma de Mallorca, Spain;
| | - Elena Pérez Ceballos
- Hematology Department, Hospital General Universitario Morales Meseguer, 30008 Murcia, Spain;
| | - María Infante
- Hematology Department, Hospital Infanta Leonor, 28031 Madrid, Spain;
| | - Alicia Roldán
- Hematology Department, Hospital Infanfa Sofía, 28702 Madrid, Spain;
| | | | - Miriam Santero
- Hematology Department, Hospital de Torrejón, 28850 Torrejón de Ardóz, Spain;
| | - Anna Sureda
- Hematology Department, Hospital ICO, 08908 Barcelona, Spain; (E.D.D.); (A.S.)
| | - Ramón García Sanz
- Hematology Department, Hospital Clínico de Salamanca, 37008 Salamanca, Spain;
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Kulkarni O, Sugier PE, Guibon J, Boland-Augé A, Lonjou C, Bacq-Daian D, Olaso R, Rubino C, Souchard V, Rachedi F, Lence-Anta JJ, Ortiz RM, Xhaard C, Laurent-Puig P, Mulot C, Guizard AV, Schvartz C, Boutron-Ruault MC, Ostroumova E, Kesminiene A, Deleuze JF, Guénel P, De Vathaire F, Truong T, Lesueur F. Gene network and biological pathways associated with susceptibility to differentiated thyroid carcinoma. Sci Rep 2021; 11:8932. [PMID: 33903625 PMCID: PMC8076215 DOI: 10.1038/s41598-021-88253-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022] Open
Abstract
Variants identified in earlier genome-wide association studies (GWAS) on differentiated thyroid carcinoma (DTC) explain about 10% of the overall estimated genetic contribution and could not provide complete insights into biological mechanisms involved in DTC susceptibility. Integrating systems biology information from model organisms, genome-wide expression data from tumor and matched normal tissue and GWAS data could help identifying DTC-associated genes, and pathways or functional networks in which they are involved. We performed data mining of GWAS data of the EPITHYR consortium (1551 cases and 1957 controls) using various pathways and protein-protein interaction (PPI) annotation databases and gene expression data from The Cancer Genome Atlas. We identified eight DTC-associated genes at known loci 2q35 (DIRC3), 8p12 (NRG1), 9q22 (FOXE1, TRMO, HEMGN, ANP32B, NANS) and 14q13 (MBIP). Using the EW_dmGWAS approach we found that gene networks related to glycogenolysis, glycogen metabolism, insulin metabolism and signal transduction pathways associated with muscle contraction were overrepresented with association signals (false discovery rate adjusted p-value < 0.05). Additionally, suggestive association of 21 KEGG and 75 REACTOME pathways with DTC indicate a link between DTC susceptibility and functions related to metabolism of cholesterol, amino sugar and nucleotide sugar metabolism, steroid biosynthesis, and downregulation of ERBB2 signaling pathways. Together, our results provide novel insights into biological mechanisms contributing to DTC risk.
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Affiliation(s)
- Om Kulkarni
- Inserm, U900, Institut Curie, PSL University, Mines ParisTech, 75248, Paris, France
| | | | - Julie Guibon
- Inserm, U900, Institut Curie, PSL University, Mines ParisTech, 75248, Paris, France
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Anne Boland-Augé
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
| | - Christine Lonjou
- Inserm, U900, Institut Curie, PSL University, Mines ParisTech, 75248, Paris, France
| | - Delphine Bacq-Daian
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
| | - Robert Olaso
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
| | - Carole Rubino
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Vincent Souchard
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Frédérique Rachedi
- Centre Hospitalier Territorial de Polynésie Française, CHTPF, Pirae, Tahiti, 98713, Papeete, French Polynesia
| | | | - Rosa Maria Ortiz
- Instituto Nacional de Oncologia y de Radiobiologia, INOR, La Havana, Cuba
| | - Constance Xhaard
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
- University of Lorraine, INSERM CIC 1433, Nancy CHRU, Inserm U1116, FCRIN, INI-CRCT, 54000, Nancy, France
| | - Pierre Laurent-Puig
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, EPIGENETEC, 75006, Paris, France
| | - Claire Mulot
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, EPIGENETEC, 75006, Paris, France
| | - Anne-Valérie Guizard
- Registre Général des Tumeurs du Calvados, Centre François Baclesse, 14000, Caen, France
- Inserm U1086-UCNB, Cancers and Prevention, 14000, Caen, France
| | - Claire Schvartz
- Registre des Cancers Thyroïdiens, Institut Jean Godinot, 51100, Reims, France
| | | | - Evgenia Ostroumova
- Environment and Radiation Section, International Agency for Research on Cancer, 69008, Lyon, France
| | - Ausrele Kesminiene
- Environment and Radiation Section, International Agency for Research on Cancer, 69008, Lyon, France
| | - Jean-François Deleuze
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
| | - Pascal Guénel
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Florent De Vathaire
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Thérèse Truong
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, 94807, Villejuif, France
| | - Fabienne Lesueur
- Inserm, U900, Institut Curie, PSL University, Mines ParisTech, 75248, Paris, France.
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Shakoor H, Jehan N, Khan S, Khattak NU. Investigation of Radon Sources, Health Hazard and Risks assessment for children using analytical and geospatial techniques in District Bannu (Pakistan). Int J Radiat Biol 2021; 98:1176-1184. [PMID: 33428859 DOI: 10.1080/09553002.2021.1872817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Radon (Rn) is a radioactive, odorless, and colorless gas which has a half-life of 3.83 days. One of the main sources of Rn which is directly consumed by the population is Groundwater (Tube well, Bore well, Hand pump). Rn gas is found naturally in rock, soil and water and can be considered as main health risk factor in terms of lung cancer, stomach diseases, leukemia and childhood cancer. The objective of this study was to determine the concentration of Rn in the drinking water sources, appraisal of health risk for children in District Bannu, Pakistan. MATERIAL AND METHOD Total of 98 drinking water samples were analyzed by using RAD-7 detector. The experimental data was statistically analyzed by using Pearson's test. The experimental and epidemiological data of the study area are shown on map using ArcGIS version 10.5. RESULTS The analytical results show that Rn in drinking water was found varying from 10.1 Bq/l to 53.1 Bq/l with the average highest and lowest depth of 60 ft to 550 ft respectively. Pearson's test was used to show the concentration of Rn verses the depth of the water sources so +1 positive linear correlation was observed among the depth of water sources and the concentration of Rn. Out of 98 drinking water samples 40 sample were above the maximum contaminant level of 11.1 Bq/l (MCL) set by WHO, 2002. The effective doses (AED and DEing) for children ranges from 0.00001 to 3.792 mSv/y which exceeds the Permissible Exposure Limit (PEL) of Rn (0.1mSv/y) in 30 drinking water samples . On the basis of analytical results Rn high concentration areas are shown on the map using IDW model of interpolation and health risks were shown in areas where Rn content was above the maximum contaminant level. High correlations of diseases related to Rn were observed amongst the residence of the study area. Gastrointestinal diseases, brain tumor, lung cancer and kidney diseases were observed among the children of the study area. CONCLUSION From the overall analysis it was observed that high Rn concentration in drinking water may cause substantial health damage in children after long term exposure.
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Affiliation(s)
- Huma Shakoor
- Department of Environmental Sciences, University of Peshawar, Peshawar, Pakistan
| | - Noor Jehan
- Department of Environmental Sciences, University of Peshawar, Peshawar, Pakistan
| | - Sardar Khan
- Department of Environmental Sciences, University of Peshawar, Peshawar, Pakistan
| | - Nimat Ullah Khattak
- Department of Environmental Sciences, University of Peshawar, Peshawar, Pakistan
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Leuraud K, Richardson DB, Cardis E, Daniels RD, Gillies M, Haylock R, Moissonnier M, Schubauer-Berigan MK, Thierry-Chef I, Kesminiene A, Laurier D. Risk of cancer associated with low-dose radiation exposure: comparison of results between the INWORKS nuclear workers study and the A-bomb survivors study. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:23-39. [PMID: 33479781 PMCID: PMC7902587 DOI: 10.1007/s00411-020-00890-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/19/2020] [Indexed: 05/21/2023]
Abstract
The Life Span Study (LSS) of Japanese atomic bomb survivors has served as the primary basis for estimates of radiation-related disease risks that inform radiation protection standards. The long-term follow-up of radiation-monitored nuclear workers provides estimates of radiation-cancer associations that complement findings from the LSS. Here, a comparison of radiation-cancer mortality risk estimates derived from the LSS and INWORKS, a large international nuclear worker study, is presented. Restrictions were made, so that the two study populations were similar with respect to ages and periods of exposure, leading to selection of 45,625 A-bomb survivors and 259,350 nuclear workers. For solid cancer, excess relative rates (ERR) per gray (Gy) were 0.28 (90% CI 0.18; 0.38) in the LSS, and 0.29 (90% CI 0.07; 0.53) in INWORKS. A joint analysis of the data allowed for a formal assessment of heterogeneity of the ERR per Gy across the two studies (P = 0.909), with minimal evidence of curvature or of a modifying effect of attained age, age at exposure, or sex in either study. There was evidence in both cohorts of modification of the excess absolute risk (EAR) of solid cancer by attained age, with a trend of increasing EAR per Gy with attained age. For leukemia, under a simple linear model, the ERR per Gy was 2.75 (90% CI 1.73; 4.21) in the LSS and 3.15 (90% CI 1.12; 5.72) in INWORKS, with evidence of curvature in the association across the range of dose observed in the LSS but not in INWORKS; the EAR per Gy was 3.54 (90% CI 2.30; 5.05) in the LSS and 2.03 (90% CI 0.36; 4.07) in INWORKS. These findings from different study populations may help understanding of radiation risks, with INWORKS contributing information derived from cohorts of workers with protracted low dose-rate exposures.
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Affiliation(s)
- Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France.
| | - David B Richardson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Elisabeth Cardis
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Robert D Daniels
- National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH, USA
| | - Michael Gillies
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK
| | - Richard Haylock
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (PHE-CRCE), Chilton, UK
| | | | | | - Isabelle Thierry-Chef
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
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Chauhan V, Wilkins RC, Beaton D, Sachana M, Delrue N, Yauk C, O’Brien J, Marchetti F, Halappanavar S, Boyd M, Villeneuve D, Barton-Maclaren TS, Meek B, Anghel C, Heghes C, Barber C, Perkins E, Leblanc J, Burtt J, Laakso H, Laurier D, Lazo T, Whelan M, Thomas R, Cool D. Bringing together scientific disciplines for collaborative undertakings: a vision for advancing the adverse outcome pathway framework. Int J Radiat Biol 2021; 97:431-441. [PMID: 33539251 PMCID: PMC10711570 DOI: 10.1080/09553002.2021.1884314] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Decades of research to understand the impacts of various types of environmental occupational and medical stressors on human health have produced a vast amount of data across many scientific disciplines. Organizing these data in a meaningful way to support risk assessment has been a significant challenge. To address this and other challenges in modernizing chemical health risk assessment, the Organisation for Economic Cooperation and Development (OECD) formalized the adverse outcome pathway (AOP) framework, an approach to consolidate knowledge into measurable key events (KEs) at various levels of biological organisation causally linked to disease based on the weight of scientific evidence (http://oe.cd/aops). Currently, AOPs have been considered predominantly in chemical safety but are relevant to radiation. In this context, the Nuclear Energy Agency's (NEA's) High-Level Group on Low Dose Research (HLG-LDR) is working to improve research co-ordination, including radiological research with chemical research, identify synergies between the fields and to avoid duplication of efforts and resource investments. To this end, a virtual workshop was held on 7 and 8 October 2020 with experts from the OECD AOP Programme together with the radiation and chemical research/regulation communities. The workshop was a coordinated effort of Health Canada, the Electric Power Research Institute (EPRI), and the Nuclear Energy Agency (NEA). The AOP approach was discussed including key issues to fully embrace its value and catalyze implementation in areas of radiation risk assessment. CONCLUSIONS A joint chemical and radiological expert group was proposed as a means to encourage cooperation between risk assessors and an initial vision was discussed on a path forward. A global survey was suggested as a way to identify priority health outcomes of regulatory interest for AOP development. Multidisciplinary teams are needed to address the challenge of producing the appropriate data for risk assessments. Data management and machine learning tools were highlighted as a way to progress from weight of evidence to computational causal inference.
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Affiliation(s)
- Vinita Chauhan
- Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Ruth C. Wilkins
- Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | | | - Magdalini Sachana
- Environment Health and Safety Division, Environment Directorate, Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Nathalie Delrue
- Environment Health and Safety Division, Environment Directorate, Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Carole Yauk
- Department of Biology, University of Ottawa, Ottawa, Canada
| | - Jason O’Brien
- Ecotoxicology and Wildlife Health Division, Environment and Climate Change Canada, Ottawa, Canada
| | - Francesco Marchetti
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Canada
| | - Sabina Halappanavar
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Canada
| | - Michael Boyd
- U.S. Environmental Protection Agency, Office of Air and Radiation, Washington, DC, USA
| | - Daniel Villeneuve
- U.S. Environmental Protection Agency, Office of Research and Development, Duluth, MN, USA
| | | | - Bette Meek
- McLaughlin Centre, University of Ottawa, Ottawa, Canada
| | | | | | | | - Edward Perkins
- US Army Engineer Research and Development Center Jackson, Vicksburg, MS, USA
| | - Julie Leblanc
- Directorate of Environment and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Julie Burtt
- Directorate of Environment and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Holly Laakso
- Canadian Nuclear Laboratories, Chalk River, Canada
| | - Dominique Laurier
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Ted Lazo
- Radiological Protection and Human Aspects of Nuclear Safety Division, OECD Nuclear Energy Agency, Paris, France
| | - Maurice Whelan
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Russell Thomas
- U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Donald Cool
- Electric Power Research Institute, Charlotte, NC, USA
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Fenaux P, Haase D, Santini V, Sanz GF, Platzbecker U, Mey U. Myelodysplastic syndromes: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up †☆. Ann Oncol 2021; 32:142-156. [PMID: 33221366 DOI: 10.1016/j.annonc.2020.11.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- P Fenaux
- Service d'Hématologie Clinique, Groupe Francophone des Myélodysplasies (GFM), Department of Hematology, Hôpital St. Louis (Assistance Publique, Hôpitaux de Paris), Paris, France; Paris 7 University, Paris, France
| | - D Haase
- Department of Hematology and Medical Oncology, University Medical Center, Göttingen, Germany
| | - V Santini
- MDS Unit, Haematology, AOU Careggi, University of Florence, Florence, Italy
| | - G F Sanz
- Department of Haematology, Hospital Universitario La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - U Platzbecker
- Department of Hematology and Cellular Therapy, Medical Clinic and Policlinic 1, University Hospital Leipzig, Germany
| | - U Mey
- Department of Oncology and Haematology, Kantonsspital Graubuenden, Chur, Switzerland
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Koosha F, Pourbagheri-Sigaroodi A, Bakhshandeh M, Bashash D. Low-dose radiotherapy (LD-RT) for COVID-19-induced pneumopathy: a worth considering approach. Int J Radiat Biol 2021; 97:302-312. [PMID: 33320755 DOI: 10.1080/09553002.2021.1864049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE It seems that 2020 would be always remembered by the name of novel coronavirus (designated as SARS-CoV-2), which exerted its deteriorating effects on the health care, economy, education, and political relationships. In August 2020 more than eight hundred thousand patients lost their lives due to acute respiratory syndrome. In the limited list of therapeutic approaches, the effectiveness of low-dose radiation therapy (LD-RT) for curing inflammatory-related diseases have sparkled a light that probably this approach would bring promising advantages for COVID-19 patients. LD-RT owns its reputation from its ability to modulate the host inflammatory responses by blocking the production of pro-inflammatory cytokines and hampering the activity of leukocytes. Moreover, the cost-effective and availability of this method allow it to be applied to a large number of patients, especially those who could not receive anti-IL-6 treatments in low-income countries. But enthusiasm for applying LD-RT for the treatment of COVID-19 patients has been muted yet. CONCLUSION In this review, we take a look at LD-RT mechanisms of action in the treatment of nonmalignant diseases, and then through studying both the dark and bright sides of this approach, we provide a thorough discussion if LD-RT might be a promising therapeutic approach in COVID-19 patients.
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Affiliation(s)
- Fereshteh Koosha
- Department of Radiology Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Pourbagheri-Sigaroodi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Bakhshandeh
- Department of Radiology Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Bashash
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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van Herwaarden JA, Jansen MM, Vonken EJPA, Bloemert-Tuin T, Bullens RWM, de Borst GJ, Hazenberg CEVB. First in Human Clinical Feasibility Study of Endovascular Navigation with Fiber Optic RealShape (FORS) Technology. Eur J Vasc Endovasc Surg 2020; 61:317-325. [PMID: 33262088 DOI: 10.1016/j.ejvs.2020.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/15/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Endovascular procedures are conventionally conducted using two dimensional fluoroscopy. A new technology platform, Fiber Optic RealShape (FORS), has recently been introduced allowing real time, three dimensional visualisation of endovascular devices using fiberoptic technology. It functions as an add on to conventional fluoroscopy and may facilitate endovascular procedures. This first in human study assessed the feasibility of FORS in clinical practice. METHODS A prospective cohort feasibility study was performed between July and December 2018. Patients undergoing (regular or complex) endovascular aortic repair (EVAR) or endovascular peripheral lesion repair (EVPLR) were recruited. FORS guidance was used exclusively during navigational tasks such as target vessel catheterisation or crossing of stenotic lesions. Three types of FORS enabled devices were available: a flexible guidewire, a Cobra-2 catheter, and a Berenstein catheter. Devices were chosen at the physician's discretion and could comprise any combination of FORS and non-FORS devices. The primary study endpoint was technical success of the navigational tasks using FORS enabled devices. Secondary study endpoints were user experience and fluoroscopy time. RESULTS The study enrolled 22 patients: 14 EVAR and eight EVPLR patients. Owing to a technical issue during start up, the FORS system could not be used in one EVAR. The remaining 21 procedures proceeded without device or technology related complications and involved 66 navigational tasks. In 60 tasks (90.9%), technical success was achieved using at least one FORS enabled device. Users rated FORS based image guidance "better than standard guidance" in 16 of 21 and "equal to standard guidance" in five of 21 procedures. Fluoroscopy time ranged from 0.0 to 52.2 min. Several tasks were completed without or with only minimal X-ray use. CONCLUSION Real time navigation using FORS technology is safe and feasible in abdominal and peripheral endovascular procedures. FORS has the potential to improve intra-operative image guidance. Comparative studies are needed to assess these benefits and potential radiation reduction.
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Affiliation(s)
- Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Marloes M Jansen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Evert-Jan P A Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Trijntje Bloemert-Tuin
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Alchallah MO, Ismail H, Dia T, Shibani M, Alzabibi MA, Mohsen F, Turkmani K, Sawaf B. Assessing diagnostic radiology knowledge among Syrian medical undergraduates. Insights Imaging 2020; 11:124. [PMID: 33226458 PMCID: PMC7683655 DOI: 10.1186/s13244-020-00937-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The role of radiology in medicine and healthcare is rapidly expanding worldwide, but awareness about this field among medical students is poor. This is the first study to assess Syrian medical students' knowledge and attitude regarding radiology. METHODS This is a cross-sectional study conducted at the Syrian Private University, on November 8, 2019, on the International Day of Radiology during the war crisis. Data were collected through self-administered surveys and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., Chicago, IL, USA). RESULTS The questionnaire was completed by 269 students whose ages ranged between 17 and 30 years old. Males constituted 63.6% of the respondents. The results revealed adequate knowledge about the basics of radiology. 73.6% of the students had previously heard about interventional radiology. There were slight misconceptions with certain points in each section, especially those pertaining to the radiation exposure of each imaging method. Finally, the students expressed low interest in radiology as a future career (24.5%). CONCLUSIONS The level of awareness can affect a student's decision in considering radiology as a future career. Further evaluation of the methods of teaching, input from medical boards, curriculum advisors, and guidance from radiologists is required.
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Affiliation(s)
- Mhd Obai Alchallah
- Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Hlma Ismail
- Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Tala Dia
- Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Mosa Shibani
- Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic.
| | - Mhd Amin Alzabibi
- Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Fatema Mohsen
- Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Khaled Turkmani
- Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
- AL Kalamoon General Hospital, Ministry of Health, Damascus, Syrian Arab Republic
| | - Bisher Sawaf
- Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Harbron RW, Pasqual E. Ionising radiation as a risk factor for lymphoma: a review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:R151-R185. [PMID: 33017815 DOI: 10.1088/1361-6498/abbe37] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
The ability of ionising radiation to induce lymphoma is unclear. Here, we present a narrative review of epidemiological evidence of the risk of lymphoma, including chronic lymphocytic leukaemia (CLL) and multiple myeloma (MM), among various exposed populations including atomic bombing survivors, industrial and medical radiation workers, and individuals exposed for medical purposes. Overall, there is a suggestion of a positive dose-dependent association between radiation exposure and lymphoma. The magnitude of this association is highly imprecise, however, with wide confidence intervals frequently including zero risk. External comparisons tend to show similar incidence and mortality rates to the general population. Currently, there is insufficient information on the impact of age at exposure, high versus low linear energy transfer radiation, external versus internal or acute versus chronic exposures. Associations are stronger for males than females, and stronger for non-Hodgkin lymphoma and MM than for Hodgkin lymphoma, while the risk of radiation-induced CLL may be non-existent. This broad grouping of diverse diseases could potentially obscure stronger associations for certain subtypes, each with a different cell of origin. Additionally, the classification of malignancies as leukaemia or lymphoma may result in similar diseases being analysed separately, while distinct diseases are analysed in the same category. Uncertainty in cell of origin means the appropriate organ for dose response analysis is unclear. Further uncertainties arise from potential confounding or bias due to infectious causes and immunosuppression. The potential interaction between radiation and other risk factors is unknown. Combined, these uncertainties make lymphoma perhaps the most challenging malignancy to study in radiation epidemiology.
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Affiliation(s)
- Richard W Harbron
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, United Kingdom
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elisa Pasqual
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Richardson DB, Abalo K, Bernier MO, Rage E, Leuraud K, Laurier D, Keil AP, Little MP. Meta-analysis of published excess relative risk estimates. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2020; 59:631-641. [PMID: 32700049 PMCID: PMC10659128 DOI: 10.1007/s00411-020-00863-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/11/2020] [Indexed: 06/11/2023]
Abstract
A meta-analytic summary effect estimate often is calculated as an inverse-variance-weighted average of study-specific estimates of association. The variances of published estimates of association often are derived from their associated confidence intervals under assumptions typical of Wald-type statistics, such as normality of the parameter. However, in some research areas, such as radiation epidemiology, epidemiological results typically are obtained by fitting linear relative risk models, and associated likelihood-based confidence intervals are often asymmetric; consequently, reasonable estimates of variances associated with study-specific estimates of association may be difficult to infer from the standard approach based on the assumption of a Wald-type interval. Here, a novel method is described for meta-analysis of published results from linear relative risk models that uses a parametric transformation of published results to improve on the normal approximation used to assess confidence intervals. Using simulations, it is illustrated that the meta-analytic summary obtained using the proposed approach yields less biased summary estimates, with better confidence interval coverage, than the summary obtained using the more classical approach to meta-analysis. The proposed approach is illustrated using a previously published example of meta-analysis of epidemiological findings regarding circulatory disease following exposure to low-level ionizing radiation.
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Affiliation(s)
- David B Richardson
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Kossi Abalo
- Institut de Radioprotection et de Sûreté Nucléaire, Paris, France
| | | | - Estelle Rage
- Institut de Radioprotection et de Sûreté Nucléaire, Paris, France
| | - Klervi Leuraud
- Institut de Radioprotection et de Sûreté Nucléaire, Paris, France
| | | | - Alexander P Keil
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Mark P Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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The Risk of Cancer from CT Scans and Other Sources of Low-Dose Radiation: A Critical Appraisal of Methodologic Quality. Prehosp Disaster Med 2020; 35:3-16. [PMID: 32009606 DOI: 10.1017/s1049023x1900520x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Concern exists that radiation exposure from computerized tomography (CT) will cause thousands of malignancies. Other experts share the same perspective regarding the risk from additional sources of low-dose ionizing radiation, such as the releases from Three Mile Island (1979; Pennsylvania USA) and Fukushima (2011; Okuma, Fukushima Prefecture, Japan) nuclear power plant disasters. If this premise is false, the fear of cancer leading patients and physicians to avoid CT scans and disaster responders to initiate forced evacuations is unfounded. STUDY OBJECTIVE This investigation provides a quantitative evaluation of the methodologic quality of studies to determine the evidentiary strength supporting or refuting a causal relationship between low-dose radiation and cancer. It will assess the number of higher quality studies that support or question the role of low-dose radiation in oncogenesis. METHODS This investigation is a systematic, methodologic review of articles published from 1975-2017 examining cancer risk from external low-dose x-ray and gamma radiation, defined as less than 200 millisievert (mSv). Following the PRISMA guidelines, the authors performed a search of the PubMed, Cochrane, Scopus, and Web of Science databases. Methodologies of selected articles were scored using the Newcastle Ottawa Scale (NOS) and a tool identifying 11 lower quality indicators. Manuscript methodologies were ranked as higher quality if they scored no lower than seven out of nine on the NOS and contained no more than two lower quality indicators. Investigators then characterized articles as supporting or not supporting a causal relationship between low-dose radiation and cancer. RESULTS Investigators identified 4,382 articles for initial review. A total of 62 articles met all inclusion/exclusion criteria and were evaluated in this study. Quantitative evaluation of the manuscripts' methodologic strengths found 25 studies met higher quality criteria while 37 studies met lower quality criteria. Of the 25 studies with higher quality methods, 21 out of 25 did not support cancer induction by low-dose radiation (P = .0003). CONCLUSIONS A clear preponderance of articles with higher quality methods found no increased risk of cancer from low-dose radiation. The evidence suggests that exposure to multiple CT scans and other sources of low-dose radiation with a cumulative dose up to 100 mSv (approximately 10 scans), and possibly as high as 200 mSv (approximately 20 scans), does not increase cancer risk.
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Shallis RM, Weiss JJ, Deziel NC, Gore SD. Challenging the concept of de novo acute myeloid leukemia: Environmental and occupational leukemogens hiding in our midst. Blood Rev 2020; 47:100760. [PMID: 32988660 DOI: 10.1016/j.blre.2020.100760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/28/2020] [Accepted: 08/27/2020] [Indexed: 12/20/2022]
Abstract
Myeloid neoplasms like acute myeloid leukemia (AML) originate from genomic disruption, usually in a multi-step fashion. Hematopoietic stem/progenitor cell acquisition of abnormalities in vital cellular processes, when coupled with intrinsic factors such as germline predisposition or extrinsic factors such as the marrow microenvironment or environmental agents, can lead to requisite pre-leukemic clonal selection, expansion and evolution. Several of these entities have been invoked as "leukemogens." The known leukemogens are numerous and are found in the therapeutic, occupational and ambient environments, however they are often difficult to implicate for individual patients. Patients treated with particular chemotherapeutic agents or radiotherapy accept a calculated risk of therapy-related AML. Occupational exposures to benzene, dioxins, formaldehyde, electromagnetic and particle radiation have been associated with an increased risk of AML. Although regulatory agencies have established acceptable exposure limits in the workplace, accidental exposures and even ambient exposures to leukemogens are possible. It is plausible that inescapable exposure to non-anthropogenic ambient leukemogens may be responsible for many cases of non-inherited de novo AML. In this review, we discuss the current understanding of leukemogens as they relate to AML, assess to what extent the term "de novo" leukemia is meaningful, and describe the potential to identify and characterize new leukemogens.
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Affiliation(s)
- Rory M Shallis
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, USA.
| | - Julian J Weiss
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, USA
| | - Nicole C Deziel
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Steven D Gore
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, USA
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Daniels RD, Kendall GM, Thierry-Chef I, Linet MS, Cullings HM. Strengths and Weaknesses of Dosimetry Used in Studies of Low-Dose Radiation Exposure and Cancer. J Natl Cancer Inst Monogr 2020; 2020:114-132. [PMID: 32657346 PMCID: PMC7667397 DOI: 10.1093/jncimonographs/lgaa001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A monograph systematically evaluating recent evidence on the dose-response relationship between low-dose ionizing radiation exposure and cancer risk required a critical appraisal of dosimetry methods in 26 potentially informative studies. METHODS The relevant literature included studies published in 2006-2017. Studies comprised case-control and cohort designs examining populations predominantly exposed to sparsely ionizing radiation, mostly from external sources, resulting in average doses of no more than 100 mGy. At least two dosimetrists reviewed each study and appraised the strengths and weaknesses of the dosimetry systems used, including assessment of sources and effects of dose estimation error. An overarching concern was whether dose error might cause the spurious appearance of a dose-response where none was present. RESULTS The review included 8 environmental, 4 medical, and 14 occupational studies that varied in properties relative to evaluation criteria. Treatment of dose estimation error also varied among studies, although few conducted a comprehensive evaluation. Six studies appeared to have known or suspected biases in dose estimates. The potential for these biases to cause a spurious dose-response association was constrained to three case-control studies that relied extensively on information gathered in interviews conducted after case ascertainment. CONCLUSIONS The potential for spurious dose-response associations from dose information appeared limited to case-control studies vulnerable to recall errors that may be differential by case status. Otherwise, risk estimates appeared reasonably free of a substantial bias from dose estimation error. Future studies would benefit from a comprehensive evaluation of dose estimation errors, including methods accounting for their potential effects on dose-response associations.
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Affiliation(s)
- Robert D Daniels
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Gerald M Kendall
- Cancer Epidemiology Unit, NDPH, University of Oxford, Oxford, UK
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Harry M Cullings
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
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