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Weiß D, Beeres M, Rochwalsky U, Vogl TJ, Schlößer R. Radiation exposure and estimated risk of radiation-induced cancer from thoracic and abdominal radiographs in 1307 neonates. Eur Radiol 2024:10.1007/s00330-024-10942-x. [PMID: 39014087 DOI: 10.1007/s00330-024-10942-x] [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: 11/10/2023] [Revised: 05/11/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE This study examined radiation exposure and the possible risk of radiation-induced cancer in a large sample of newborn and premature patients. MATERIAL AND METHODS In this retrospective study, we included all hospitalised neonates treated at our university hospital who received at least one X-ray examination from 1 January 2013 to 31 December 2018. We evaluated the dose area product (DAP), effective dose (ED), and estimated risk. The International Commission on Radiological Protection Publication 60 defines values (2.8-13 × 10-2 Sv-1) to calculate the estimated risk in relation to the ED. RESULTS Of the 3843 patients (aged 241.1 ± 35.45 days) treated in the neonatal care unit, 1307 (34%) received at least one X-ray. The mean number of X-ray examinations per patient was 3.19 and correlated negatively with birth weight. The mean cumulative DAP was 5.9 mGy*cm2, and the cumulative ED was 23.7 µSv per hospital stay. Patients with a birth weight of < 1000 g showed the highest cumulative ED and DAP (p < 0.001). Patients with a birth weight of < 2500 g had the highest ED and DAP per image (p < 0.001). The highest radiation exposure (ED/DAP) occurred for thoracic/abdominal examinations, especially for neonates < 500 g (p < 0.001). CONCLUSION There is a strong correlation between immaturity, the number of X-ray examinations, and radiation exposure. The total exposure was minimal, and the number of X-rays per patient has been decreasing in recent years. CLINICAL RELEVANCE Possible risks to newborns and premature infants caused by ionising X-rays are often the subject of scientific and clinical discussion. Nevertheless, conventional X-ray imaging remains a frequently used tool, and total exposure remains at a very low level. KEY POINTS The number of X-rays per patient has been decreasing in a large university hospital. Half of all patients received only one X-ray; most had a birth weight over 1500 g. This radiation risk can be classified as 'minimal' for patients with a birth weight of < 500 g and as 'negligible' for others.
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Affiliation(s)
- Deliah Weiß
- Paediatrics and Adolescent Medicine/Department of Neonatology, Clinic of the Goethe University, Frankfurt, Germany
| | - Martin Beeres
- Institute for Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany.
- Clinic for Neuroradiology, Marburg University Hospital, Marburg, Germany.
| | - Ulrich Rochwalsky
- Paediatrics and Adolescent Medicine/Department of Neonatology, Clinic of the Goethe University, Frankfurt, Germany
| | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Rolf Schlößer
- Paediatrics and Adolescent Medicine/Department of Neonatology, Clinic of the Goethe University, Frankfurt, Germany
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Safari A, Falahati F, Bahaedini N, Fardid R, Mesbahi SE. Assessment of radiation exposure risks in patients undergoing elastic stable intramedullary nailing: Insights from intraoperative fluoroscopy. Radiography (Lond) 2024; 30:1225-1231. [PMID: 38909418 DOI: 10.1016/j.radi.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Elastic stable intramedullary nailing (ESIN) is a well-defined and appropriate treatment of choice for long bone fractures. Despite its benefits, the risk of cancer from imaging devices is of particular concern for younger adults. So, this survey was conducted to estimate the doses administered to patients undergoing ESIN of long bone fractures utilizing a 2-dimensional (2D) C-arm fluoroscopy machine during surgery, as well as the carcinogenic risk associated with the use of the machine. METHODS This study was conducted on 147 patients who required ESIN for long-bone fractures. Patients' demographic data, surgical data and imaging information were collected. For each patient, the organ doses and the effective doses were computed with the Monte Carlo PCXMC 2.0 simulation software. The cancer risk models proposed in the Biological Effects of Ionizing Radiation VII (BEIR VII) Phase 2 report were used to evaluate the risk of exposure-induced cancer death (REID) values. RESULTS For all patients, the highest organ dose was delivered to the gonads. The mean effective dose was 0.026 ± 0.015 mSv and 1.3E-04 ± 1E-04 mSv for ESIN of femur and tibia fractures, respectively. Males had a mean REID of 1 per million, while females had a mean REID of 0.19 per million. The younger males had considerably higher REID values. The effective dose was significantly correlated with age, gender, and irradiation time. CONCLUSION Low levels of effective doses and cancer risks associated with the utilization of the fluoroscopy machine in current practice were found in ESIN treatment of long-bone fractures. IMPLICATIONS FOR PRACTICE This outcome will help to raise surgeons' awareness of radiation risks and encourage them to initiate measures to keep radiation dose and exposure time as low as reasonably achievable.
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Affiliation(s)
- A Safari
- Ionizing and Non-Ionizing Radiation Protection Research Center (INIRPRC), School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Radiology, Paramedical School, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - F Falahati
- Ionizing and Non-Ionizing Radiation Protection Research Center (INIRPRC), School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Radiology, Paramedical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - N Bahaedini
- Medical Imaging and Radiation Protection, Emtyiaz Trauma Center, Shiraz, Iran
| | - R Fardid
- Ionizing and Non-Ionizing Radiation Protection Research Center (INIRPRC), School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Radiology, Paramedical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S E Mesbahi
- Medical Imaging and Radiation Protection, Emtyiaz Trauma Center, Shiraz, Iran; Department of Biomedical Engineering, AmirKabir University of Technology, Tehran, Iran
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Fallahmohammadi G, Nodeh ZK, Mahdavi M. Patient-specific Effective Dose Estimation from Dose-Length Product in Lung Computed Tomography Using Monte Carlo Simulation. JOURNAL OF MEDICAL SIGNALS & SENSORS 2024; 14:11. [PMID: 38993205 PMCID: PMC11111127 DOI: 10.4103/jmss.jmss_53_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 07/03/2023] [Accepted: 09/21/2023] [Indexed: 07/13/2024]
Abstract
Background Computed tomography (CT) imaging has a large portion in the dose of patients from radiological procedures; therefore, accurate calculation of radiation risk estimation in this modality is inevitable. In this study, a method for determining the patient-specific effective dose using the dose-length product (DLP) index in lung CT scan using Monte Carlo (MC) simulation is introduced. Methods EGSnrc/BEAMnrc MC code was used to simulate a CT scanner. The DOSxyznrc simulation code was used to simulate a specific voxelized phantom from the patient's lungs and irradiate it according to X-ray parameter of routing lung CT scan, and dose delivered to thorax organs was calculated. Three types of phantoms were simulated according to three different body habits (slim, standard, and fat patients) in two groups of men and women. A factor was used to convert the relative dose per particle in MC code to the absolute dose. The dose was calculated in all lung organs, and the effective dose was calculated for all three groups of patient body habits. DLP index and volume CT dose index (CTDIvol) were extracted from the patient's dose report in the CT scanner. The DLP to effective dose conversion factor (k-factor) for patients with different body habitus was calculated. Results Lung radiation dose in slim, standard, and fat patients in men was 0.164, 0.103, and 0.078 mGy/mAs and in women was 0.164, 0.105, and 0.079 mGy/mAs, respectively. The k-factor in the group of slim patients, especially in women, was higher than in other groups. Conclusions CT scan dose indexes for slim patients are reported to be underestimated in studies. The dose report in CT scan systems should be modified in proportion to the patient's body habitus, to accurately estimate the radiation risk.
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Affiliation(s)
- Gholamreza Fallahmohammadi
- Department of Radiology, Faculty of Allied Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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4
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Loveland J, Mackenzie A. Radiation doses received in the UK breast screening programmes 2019-2023. Br J Radiol 2024; 97:787-793. [PMID: 38291906 PMCID: PMC11027334 DOI: 10.1093/bjr/tqad039] [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: 09/06/2023] [Revised: 11/05/2023] [Accepted: 11/20/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE To report the latest UK mammography dose survey results and to compare radiation doses from digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in UK breast screening. METHODS Anonymized exposure factors were collected for 111 152 screening cases and 5113 assessment cases from 405 x-ray sets across the United Kingdom using an online submission system linked to a national database of mammography quality control data. Output and beam quality measurements from each set were combined with exposure data to estimate mean glandular doses (MGD). RESULTS FFDM doses increased by ∼10% compared to the 2016-2019 national survey but compressed breast thicknesses (CBT) remained similar. DBT doses were 34%-40% higher than FFDM overall and 34% higher than FFDM for breasts 50-60 mm thick. We found a possible overestimation of PMMA breast equivalent thicknesses at low CBTs, but the evidence was not conclusive. CONCLUSION Recent changes to the mix of x-ray models in use in UK breast screening have resulted in higher FFDM breast doses. DBT doses in the NHSBSP are on average higher than FFDM by ∼34%-40%. ADVANCES IN KNOWLEDGE This is the first national study to report DBT and FFDM MGDs in UK breast screening.
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Affiliation(s)
- John Loveland
- National Coordinating Centre for the Physics in Mammography (NCCPM), Royal Surrey NHS Foundation Trust, 18 Frederick Sanger Road Surrey Research Park, Guildford, GU2 7YD, United Kingdom
| | - Alistair Mackenzie
- National Coordinating Centre for the Physics in Mammography (NCCPM), Royal Surrey NHS Foundation Trust, 18 Frederick Sanger Road Surrey Research Park, Guildford, GU2 7YD, United Kingdom
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5
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Wong YM, Ong CC, Liang CR, Tan CA, Teo LLS. Image quality, contrast enhancement and radiation dose of electrocardiograph- versus non-electrocardiograph-triggered computed tomography angiography of the aorta. Singapore Med J 2024; 65:84-90. [PMID: 34688230 PMCID: PMC10942131 DOI: 10.11622/smedj.2021166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Computed tomography angiography of the aorta (CTAA) is the modality of choice for investigating aortic disease. Our aim was to evaluate the image quality, contrast enhancement and radiation dose of electrocardiograph (ECG)-triggered and non-ECG-triggered CTAA on a 256-slice single-source CT scanner. This allows the requesting clinician and the radiologist to balance radiation risk and image quality. METHODS We retrospectively assessed the data of 126 patients who had undergone CTAA on a single-source CT scanner using ECG-triggered (group 1, n = 77) or non-ECG-triggered (group 2, n = 49) protocols. Radiation doses were compared. Qualitative (4-point scale) and quantitative image quality assessments were performed. RESULTS The mean volume CT dose index, dose length product and effective dose in group 1 were 12.4 ± 1.9 mGy, 765.8 ± 112.4 mGy cm and 13.0 ± 1.9 mSv, respectively. These were significantly higher compared to group 2 values (9.1 ± 2.6 mGy, 624.1 ± 174.8 mGy cm and 10.6 ± 3.0 mSv, respectively) ( P < 0.001). Qualitative assessment showed the image quality at the aortic root-proximal ascending aorta was significantly higher in group 1 (median 3) than in group 2 (median 2, P < 0.001). Quantitative assessment showed significantly better mean arterial attenuation, signal-to-noise ratio and contrast-to-noise ratio in ECG-triggered CTAA compared to non-ECG-triggered CTAA. CONCLUSION ECG-triggered CTAA in a single-source scanner has superior image quality and vessel attenuation of aortic root/ascending aorta, but a higher radiation dose of approximately 23%. Its use should be considered specifically when assessing aortic root/ascending aorta pathology.
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Affiliation(s)
- Ying Mei Wong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Chong Ri Liang
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Choon Ann Tan
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Lynette Li San Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore
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Saenko V, Mitsutake N. Radiation-Related Thyroid Cancer. Endocr Rev 2024; 45:1-29. [PMID: 37450579 PMCID: PMC10765163 DOI: 10.1210/endrev/bnad022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/18/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Radiation is an environmental factor that elevates the risk of developing thyroid cancer. Actual and possible scenarios of exposures to external and internal radiation are multiple and diverse. This article reviews radiation doses to the thyroid and corresponding cancer risks due to planned, existing, and emergency exposure situations, and medical, public, and occupational categories of exposures. Any exposure scenario may deliver a range of doses to the thyroid, and the risk for cancer is addressed along with modifying factors. The consequences of the Chornobyl and Fukushima nuclear power plant accidents are described, summarizing the information on thyroid cancer epidemiology, treatment, and prognosis, clinicopathological characteristics, and genetic alterations. The Chornobyl thyroid cancers have evolved in time: becoming less aggressive and driver shifting from fusions to point mutations. A comparison of thyroid cancers from the 2 areas reveals numerous differences that cumulatively suggest the low probability of the radiogenic nature of thyroid cancers in Fukushima. In view of continuing usage of different sources of radiation in various settings, the possible ways of reducing thyroid cancer risk from exposures are considered. For external exposures, reasonable measures are generally in line with the As Low As Reasonably Achievable principle, while for internal irradiation from radioactive iodine, thyroid blocking with stable iodine may be recommended in addition to other measures in case of anticipated exposures from a nuclear reactor accident. Finally, the perspectives of studies of radiation effects on the thyroid are discussed from the epidemiological, basic science, and clinical points of view.
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Affiliation(s)
- Vladimir Saenko
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
| | - Norisato Mitsutake
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
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Jayan B, Krishnan M, Saraswathy S, Gupta S, Agarwal M, Sahai K. Multicentric evaluation of conventional dosimetry vs bio-dosimetry over a period of two years for a three-point contact. Med J Armed Forces India 2023; 79:378-385. [PMID: 37441291 PMCID: PMC10334216 DOI: 10.1016/j.mjafi.2021.03.008] [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: 12/09/2020] [Accepted: 03/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background Dental radiology represents the best model for evaluating the effects of low-dose ionizing radiation. Therefore, this study evaluated the awareness on radiation hygiene among dental ancillary personnel through a questionnaire and their absorbed doses by physical and biologic dosimetry. Methods The multicentric study included two groups. Group I (N = 30) consisted of dental staff involved in dental radiology. An equal number of personnel who were not related to radiology formed the control group. Knowledge (K), attitude (A), and practice (P) of participants were assessed using a KAP questionnaire. Radiation exposure was evaluated by physical dosimetry at 3 time periods: at the beginning of the study (T1), after 10 months (T2), and at the end after 20 months (T3). Similarly, biologic dosimetry was also carried out at 3 time points by dicentric chromosome aberration assay. The data were compared using percentage analysis, analysis of variance (one-way analysis of variance), and Student's t- test. Results The KAP survey demonstrated enhanced understanding of radiation protection measures and its sound practice by the participants. Physical dosimetry showed a significant increase in absorbed dose at 3 time points: T1, T2, and T3. However, no chromosomal aberrations were observed in blood lymphocytes for any of the participants in the optimized 4-day biodosimetry protocol. Conclusion Good radiation protection protocols-safe distance from the radiation source and wear of lead aprons and thyroid collars-ensured low absorbed doses. The 4-day protocol is an important step toward developing biodosimetry laboratories in the Armed Forces Medical Services for clinical and national radiation countermeasure strategies.
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Affiliation(s)
- Balakrishnan Jayan
- Commandant, Army Dental Centre, (Research & Referral), Delhi Cantt, India
| | - Manu Krishnan
- Commanding Officer & Classified Specialist (Orthodontics), 17 Corps Dental Unit, C/o 99 APO, India
| | - Seema Saraswathy
- Faculty (Biochemistry), Army College of Medical Sciences (ACMS), Delhi, India
| | - Shilpi Gupta
- Senior Research Fellow (Dental Research & Implantology), Institute of Nuclear Medicine & Allied Sciences (INMAS), Defence Research & Development Organization (DRDO), Timarpur, Delhi, India
| | - Manisha Agarwal
- Associate Professor (Lab Sciences), Command Hospital (Eastern Command), Kolkata, India
| | - Kavita Sahai
- Deputy Commandant, Command Hospital (Northern Command), C/o 56 APO, India
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Ingleby HR, Bonilha HS, Steele CM. A Tutorial on Diagnostic Benefit and Radiation Risk in Videofluoroscopic Swallowing Studies. Dysphagia 2023; 38:517-542. [PMID: 34254167 DOI: 10.1007/s00455-021-10335-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
The videofluoroscopic swallowing study (VFSS) is a key tool in assessing swallowing function. As with any diagnostic procedure, the probable benefits of the study must be weighed against possible risks. The probable benefit of VFSS is an accurate assessment of swallowing function, enabling patient management decisions potentially leading to improved patient health status and quality of life. A possible (though highly unlikely) risk in VFSS is carcinogenesis, arising from the use of ionizing radiation. Clinicians performing videofluoroscopic swallowing studies should be familiar with both sides of the risk benefit equation in order to determine whether the study is medically justified. The intent of this article is to provide the necessary background for conversations about benefit and risk in videofluoroscopic swallowing studies.
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Affiliation(s)
- Harry R Ingleby
- Division of Medical Physics, CancerCare Manitoba; Departments of Radiology and Physics & Astronomy, University of Manitoba, 675 McDermot Avenue, Winnipeg, MB, R3E 0V9, Canada.
| | - Heather S Bonilha
- Departments of Rehabilitation Sciences; Health Science and Research; and Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Catriona M Steele
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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9
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Ahmed NA. Typical effective dose values from diagnostic and interventional radiology. Appl Radiat Isot 2023; 192:110611. [PMID: 36516635 DOI: 10.1016/j.apradiso.2022.110611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
Effective dose (E) in medical procedures is of practical value for comparing doses from different types of procedures which is not possible with the different measurable dose quantities. In this survey we estimated and compared the values of E in 12 medical imaging procedures. The mean E for conventional X-ray in mSv were ranged between 0.01 for skull lateral to 0.5 for abdominal while the mean E for cardiac interventional radiology in mSv was up to 16 for percutaneous transluminal coronary angioplasty (PTCA). For dental radiology the mean E in μSv was 1.2 for intraoral and 10 for panoramic. In mammography the mean E was 0.5 mSv. Compared with the literature, chest postero-anterior (PA), lumbar spine AP, PTCA and mammography procedures had shown larger E values. The obtained results can help in justification of techniques.
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Affiliation(s)
- Nada A Ahmed
- Sudan Atomic Energy Commission, Radiation Safety Institute, P.O. Box 3001, Khartoum, Sudan; Physics Department, Faculty of Science, Taibah University, AL- Madina al Munawarah, Saudi Arabia.
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Kiani M, Chaparian A. Evaluation of image quality, organ doses, effective dose, and cancer risk from pediatric brain CT scans. Eur J Radiol 2023; 158:110657. [PMID: 36542932 DOI: 10.1016/j.ejrad.2022.110657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The present study was conducted to assess organ doses, effective dose, and image quality, and to estimate the risk of exposure-induced cancer death (REID) in pediatric brain computed tomography examinations. METHODS This investigation was performed on 179 pediatric patients (99 men and 80 women) under 12 years old who underwent non-contrast brain CT scans. Patients were classified into four age groups of ≤ 1, 2-5, 6-9, and 10-12 years old. Organ doses and effective doses were calculated using the ImpactDose program. Cancer risk models presented in the BEIR VII report were used to estimate REID values. Image quality assessment in this study was performed by measuring image quality parameters such as noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). RESULTS The highest organ dose in all age groups belonged to the brain. The mean REID values were 12.34 per 100,000 males and 16.77 per 100,000 females. REID values decreased with the increasing age of patients in both genders and were higher for female children than male children. The mean SNR of gray matter, SNR of white matter, and CNR were 11.04, 10.5, and 2.31, respectively. CONCLUSIONS According to the results of this study, brain CT scans in children are associated with an increased potential risk of cancer. Therefore, minimizing unnecessary radiation exposure in pediatric patients and using alternative imaging modalities are of particular importance. Moreover, optimizing the radiation parameters while maintaining the diagnostic image quality in children should be considered.
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Affiliation(s)
- M Kiani
- Medical Physics Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Chaparian
- Medical Physics Department, Isfahan University of Medical Sciences, Isfahan, Iran.
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Comparison of X-ray films in term of kVp, mA, exposure time and distance using Radiographic Chest Phantom as a radiation quality. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Abstract
Headache is a common presenting symptom in the ambulatory setting that often prompts imaging. The increased use and associated health care money spent in the setting of headache have raised questions about the cost-effectiveness of neuroimaging in this setting. Neuroimaging for headache in most cases is unlikely to reveal significant abnormality or impact patient management. In this article, reasons behind an observed increase in neuroimaging and its impact on health care expenditures are discussed. The typical imaging modalities available and various imaging guidelines for common clinical headache scenarios are presented, including recommendations from the American College of Radiology.
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13
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Loveland J, Young KC, Oduko JM, Mackenzie A. Radiation doses in the United Kingdom breast screening programmes 2016-2019. Br J Radiol 2022; 95:20211400. [PMID: 35604717 PMCID: PMC10996325 DOI: 10.1259/bjr.20211400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To record the radiation doses involved in UK breast screening and to identify any changes since previous publications related to technical factors and the population screened. METHODS Mammographic exposure factors for 68,998 women imaged using 411 X-ray sets spread across the UK were compiled. Local output and half value layer measurements for each X-ray set were used to estimate mean glandular dose (MGD) using the standard UK method. RESULTS Mean MGDs in digital mammography have increased by 11% since 2010-12 for both medio-lateral oblique (MLO) and cranio-caudal (CC) views. The mean compressed breast thickness (CBT) has increased (4.8% CC, 5.2% MLO) over the same period. The mean MLO CBT value of 62.4 ± 0.1 mm is outside the 50 to 60 mm range used for diagnostic reference levels. The increase in MGD is consistent with the CBT changes. The mean MGD in the 50 to 60 mm CBT range is 1.44 ± 0.03 mGy for MLO views. CBT varies with age and peaks at 51. CONCLUSIONS Mean CBT has increased with time, and this has increased mean MGDs for digital mammography. CBT also varies with age. ADVANCES IN KNOWLEDGE Updated average MGDs in the UK are provided. There is evidence that breast size is increasing in the UK and that mean CBT is affected by age-related changes in the breast.
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Affiliation(s)
- John Loveland
- National Coordinating Centre for the Physics in Mammography
(NCCPM), Level B, St Luke’s Wing, Royal Surrey NHS Foundation
Trust, Guildford,
UK
| | - Kenneth C Young
- National Coordinating Centre for the Physics in Mammography
(NCCPM), Level B, St Luke’s Wing, Royal Surrey NHS Foundation
Trust, Guildford,
UK
| | - Jennifer M Oduko
- National Coordinating Centre for the Physics in Mammography
(NCCPM), Level B, St Luke’s Wing, Royal Surrey NHS Foundation
Trust, Guildford,
UK
| | - Alistair Mackenzie
- National Coordinating Centre for the Physics in Mammography
(NCCPM), Level B, St Luke’s Wing, Royal Surrey NHS Foundation
Trust, Guildford,
UK
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14
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Ali M, Alameen S, Bashir A, Saeed A, Salah H, Tamam N, Sulieman A, Bradley D. Estimate of effective dose for adult patients from nuclear medicine examinations in Sudan. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Avramova-Cholakova S, Dyakov I, Yordanov H, O'Sullivan J. Comparison of patient effective doses from multiple CT examinations based on different calculation methods. Phys Med 2022; 99:73-84. [PMID: 35660792 DOI: 10.1016/j.ejmp.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/15/2022] Open
Abstract
The aim of this study is to compare effective dose (E) estimations based on different methods for patients with recurrent computed tomography (CT) examinations. Seventeen methods were used to determine the E of each phase as well as the total E of the CT examination. These included three groups of estimations: based on the use of published E, calculated from typical or patient-specific values of volume computed tomography dose index (CTDIvol) and dose-length product (DLP) multiplied by conversion coefficients, and based on patient-specific calculations with use of software. The E from a single phase of the examination varied with a ratio from 1.3 to 6.8 for small size patients, from 1.2 to 6.5 for normal size patients, and from 1.7 up to 18.1 for large size patients, depending on the calculation method used. The cumulative effective dose (CED) ratio per patient for the different size groups varied as follows: from 1.4 to 2.5 (small), from 1.7 to 4.3 (normal), and from 2.2 up to 6.3 (large). The minimum CED across patients varied from 38 up to 200 mSv, while the variation of maximum CED was from 122 up to 538 mSv. Although E is recommended for population estimations, it is sometimes needed and used for individual patients in clinical practice. Its value is highly dependent on the method applied. Individual estimations of E can vary up to 18.1 times and CED estimations can differ up to 6 times. The related large uncertainties should always be taken into account.
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Affiliation(s)
- Simona Avramova-Cholakova
- Radiological Sciences Unit, Imperial College Healthcare NHS Trust, Fulham Palace Rd, Hammersmith, London W6 8RF, UK.
| | - Iliya Dyakov
- Acibadem City Clinic UMBAL, Tsarigradsko shose 66 A, Sofia 1784, Bulgaria.
| | - Hristomir Yordanov
- Technical University - Sofia, FDIBA, Kliment Ohrisdki blvd 8, 1754 Sofia, Bulgaria.
| | - James O'Sullivan
- Radiological Sciences Unit, Imperial College Healthcare NHS Trust, Fulham Palace Rd, Hammersmith, London W6 8RF, UK. James.O'
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Lawson M, Berk K, Badawy M, Qi Y, Kuganesan A, Metcalfe P. Comparison of organ and effective dose estimations from different Monte Carlo simulation-based software methods in infant CT and comparison with direct phantom measurements. J Appl Clin Med Phys 2022; 23:e13625. [PMID: 35522240 PMCID: PMC9194989 DOI: 10.1002/acm2.13625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/09/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Computational dosimetry software is routinely used to evaluate the organ and effective doses from computed tomography (CT) examinations. Studies have shown a significant variation in dose estimates between software in adult cohorts, and few studies have evaluated software for pediatric dose estimates. This study aims to compare the primary organ and effective doses estimated by four commercially available CT dosimetry software to thermoluminescent dosimeter (TLD) measurements in a 1‐year‐old phantom. Methods One hundred fifteen calibrated LiF (Mg, Cu, P)‐TLD 100‐H chips were embedded within an anthropomorphic phantom representing a 1‐year‐old child at positions that matched the approximate location of organs within an infant. The phantom was scanned under three protocols, each with whole‐body coverage. The mean absorbed doses from 25 radiosensitive organs and skeletal tissues were determined from the TLD readings. Effective doses for each of the protocols were subsequently calculated using ICRP 103 formalism. Dose estimates by the four Monte Carlo–based dose calculation systems were determined and compared to the directly measured doses. Results Most organ doses determined by computation dosimetry software aligned to phantom measurements within 20%. Additionally, comparisons between effective doses are calculated using computational and direct measurement methods aligned within 20% across the three protocols. Significant variances were found in bone surface dose estimations among dosimetry methods, likely caused by differences in bone tissue modeling. Conclusion All four‐dosimetry software evaluated in this study provide adequate primary organ and effective dose estimations. Users should be aware, however, of the possible estimated uncertainty associated with each of the programs.
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Affiliation(s)
- Michael Lawson
- Monash Health Imaging, Monash Health, Clayton, Victoria, Australia.,Centre for Medical Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kemal Berk
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mohamed Badawy
- Monash Health Imaging, Monash Health, Clayton, Victoria, Australia.,Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Yujin Qi
- Centre for Medical Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ahilan Kuganesan
- Monash Health Imaging, Monash Health, Clayton, Victoria, Australia
| | - Peter Metcalfe
- Centre for Medical Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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Radiation dose of fluoroscopy-guided versus ultralow-dose CT-fluoroscopy-guided lumbar spine epidural steroid injections. Skeletal Radiol 2022; 51:1055-1062. [PMID: 34611727 DOI: 10.1007/s00256-021-03920-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Compare radiation dose of lumbar spine epidural steroid injections (ESIs) performed under fluoroscopy guidance and ultralow-dose CT-fluoroscopy guidance. MATERIALS AND METHODS Retrospective review of consecutive lumbar ESIs performed using fluoroscopy, between May 2017 and April 2019, and using ultralow-dose CT-fluoroscopy, between August 2019 and February 2021, was performed. Ultralow-dose CT-fluoroscopy technique omits a planning CT scan, utilizes CT-fluoroscopy, and minimizes radiation dose parameters. Patient characteristics (age, sex, height, weight, body mass index (BMI)), procedural characteristics (anatomic level, type of ESI, procedure time, pain reduction, complications, trainee participation), and radiation dose were compared. Chi-square tests and two-sample t-tests were performed for statistical analysis. RESULTS One hundred and forty-seven patients (mean age 55.8 ± 16.7; 85 women) underwent ESIs using fluoroscopy. Sixty-six patients (mean age 60.9 ± 16.7; 33 women) underwent ESIs using ultralow-dose CT-fluoroscopy. The effective dose for the fluoroscopy group was 0.30 mSv ± 0.34, compared to 0.15 mSV ± 0.11 for ultralow-dose CT-fluoroscopy (p < 0.001). The average age in the CT-fluoroscopy group was older (p = 0.04), and there was more trainee participation in the fluoroscopy group (p < 0.001); otherwise there was no statistically significant difference in patient or procedural characteristics between the conventional fluoroscopy group and the ultralow-dose CT-fluoroscopy group. There was no statistically significant difference in immediate post-procedure pain reduction between the groups (p = 0.16). Four intrathecal injections occurred only in the fluoroscopy group, though this difference was not significant (p = 0.18). CONCLUSION Ultralow-dose CT-fluoroscopy technique for image-guided lumbar spine ESIs can lower radiation dose compared to fluoroscopy-guided technique.
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Radiation dose reduction for chest radiography of infants in intensive care units using a high peak kilovoltage-technique. Pediatr Radiol 2022; 52:874-882. [PMID: 35106646 DOI: 10.1007/s00247-021-05262-x] [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: 04/06/2021] [Revised: 10/24/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chest radiography is an important tool in the care of infants in intensive care units. Image optimization must be monitored to minimize radiation exposure in this susceptible population. OBJECTIVE To examine the use of a high tube peak kilovoltage technique to achieve radiation dose reduction while maintaining adequate image quality. MATERIALS AND METHODS A retrospective study was conducted. Radiation doses of chest radiographs performed in the pediatric intensive care units in our institution were calculated. The radiographs were divided into two groups based on the value of the peak kilovoltage used: above and below 60 kilovolts (kV). Image quality was blindly assessed by two fellowship-trained pediatric radiologists. Air kerma, effective dose and quality score for the high versus the low peak kilovoltage group were compared and analyzed. RESULTS The study included 376 radiographs. One hundred and seven radiographs were performed using peak kilovoltage values equal to or above 60 kV and 269 radiographs were performed using values under 60 kV. The average air kerma for the lower peak kilovoltage group was 56.6 microgray (µGy) (30.7-81.9) vs. 22.9 µGy (11.8-34.4) for the higher peak kilovoltage group (P<0.0001). The mean difference in effective dose between the groups was 11.68 (P<0.0001). The mean difference for the quality score was 0.06 (±0.03, P=0.10), not statistically significant. CONCLUSION A high peak kilovoltage technique may enable a statistically significant radiation dose reduction without compromising the diagnostic value of the image.
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Howard A, West RM, Iball G, Panteli M, Baskshi MS, Pandit H, Giannoudis PV. Should Radiation Exposure be an Issue of Concern in Children With Multiple Trauma? Ann Surg 2022; 275:596-601. [PMID: 32740254 DOI: 10.1097/sla.0000000000004204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were 3-fold: first, establish the level of radiation exposure experienced by the pediatric trauma patients; second, model the level of risk of developing fatal carcinogenesis; and third, test whether pattern of injury was predictive of the level of exposure. SUMMARY BACKGROUND DATA There are certain conditions that cause children to be exposed to increased radiation, that is, scoliosis, where level of radiation exposure is known. The extent that children are exposed to radiation in the context of multiple traumas remains unclear. METHODS Patients below the age of 16 years and with an Injury Severity Score (ISS) ≥10, treated by a Major Trauma Center for the period January 2008 to December 2018 were identified. The following data were extracted for the year following the patient's injury: number, doses, and type of radiological examination.The sex and age of the patient was taken into account in the calculation of the risk of developing a carcinogenesis. RESULTS The median radiation dose of the 425 patients identified in the 12 months following injury, through both CT and radiographs, was 24.3 mSv. Modeling the predictive value of pattern of injury and other relevant clinical values, ISS was proportionately predictive of cumulative dose received. CONCLUSION A proportion of younger polytrauma patients were exposed to high levels of radiation that in turn mean an increased risk of carcinogenesis. However, the ISS, age, injury pattern, and length of hospital stay are predictive of both risks, enabling monitoring and patient advisement of the risks.
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Affiliation(s)
- Anthony Howard
- Leeds Orthopaedic Trauma Sciences, LIRMM, Leeds University, Leeds, UK
| | - Robert M West
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Gareth Iball
- Clinical Scientist, Leeds Teaching Hospital, Leeds, Leeds, UK
| | - Michalis Panteli
- Leeds Orthopaedic Trauma Sciences, LIRMM, Leeds University, Leeds, UK
- NIHR Clinical Lecturer, Leeds University, Leeds, UK
| | | | - Hemant Pandit
- Leeds Orthopaedic Trauma Sciences, LIRMM, Leeds University, Leeds, UK
- Leeds University, Leeds, UK
| | - Peter V Giannoudis
- Leeds Orthopaedic Trauma Sciences, LIRMM, Leeds University, Leeds, UK
- Leeds University, Leeds, UK
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20
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Ben-Rejeb N, Ben-Sellem D. Estimation of additional dosimetry from low-dose CT scan to 99mTc-HMDP SPECT/CT. J Med Imaging Radiat Sci 2021; 53:87-92. [PMID: 34836833 DOI: 10.1016/j.jmir.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Currently, the addition of computed tomography (CT) to a gamma-camera has revolutionized nuclear medicine. Indeed the CT, because of its good spatial resolution, of the attenuation correction of the single photon emission computed tomography (SPECT) images and of a better anatomical localization of lesions, improves the sensitivity, specificity and accuracy of the examination. Despite the fact that the hybrid camera uses a low-dose non-diagnostic scanner, increases the overall delivered dose of radiation. METHODS The aim of this study was to evaluate the contribution of CT to the total effective dose of 99mTc-HMDP (hydroxymethylenediphosphonate labelled with technetium 99 metastable) SPECT/CT for an adult oncologic population. This prospective study included 103 patients (75 women and 28 men) aged 28 to 79 years. RESULTS The mean effective doses of SPECT, CT and SPECT/CT were respectively 3.8 mSv, 3.3 mSv and 7.1 mSv, respectively. The average contribution of CT scans to the total effective dose for SPECT/CT examination was 45 ± 9.7%, and ranged from 10 to 67.4%. The lowest value was for the thorax area. CONCLUSION This radiation dose is not negligible. But, taking into account the benefit of hybrid imaging, this additional radiation remains justifiable. Nevertheless, the "As Low as Reasonably Achievable (ALARA)'' principle must be respected to ensure that the patient is not subjected to unnecessarily high levels of radiation.
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Affiliation(s)
- Naima Ben-Rejeb
- Université de Tunis El Manar, Laboratoire de recherche en Biophysique et Technologies Médicales (LRBTM), Institut Supérieur des Technologies Médicales de Tunis (ISTMT), 1006, Tunis, Tunisia.
| | - Dorra Ben-Sellem
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Laboratoire de recherche en Biophysique et Technologies Médicales (LRBTM) ISTMT, Institut Salah AZAIEZ: Service de Médecine Nucléaire, 1006, Tunis, Tunisia
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21
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Chipiga L, Golikov V, Vodovatov A, Bernhardsson C. COMPARISON OF ORGAN ABSORBED DOSES IN WHOLE-BODY COMPUTED TOMOGRAPHY SCANS OF PAEDIATRIC AND ADULT PATIENT MODELS ESTIMATED BY DIFFERENT METHODS. RADIATION PROTECTION DOSIMETRY 2021; 195:246-256. [PMID: 34132330 DOI: 10.1093/rpd/ncab086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
This study aimed to identify the uncertainty in estimations of organ absorbed dose using dedicated software by comparing with corresponding doses measured in physical phantoms. The comparison was performed for whole-body computed tomography (CT) obtained as part of positron emission tomography. Whole-body CT scans provide an advantage in terms of comparison because all organs are in the primary beam of the irradiated area. Organ doses estimated by the different software programs (CT-Expo, VirtualDose and NCICT) were compared by thermoluminescent detector measurements in anthropomorphic phantoms in 1-y-old, 5-y-old and adult patients. Differences were within ~15% in 12 major organs. However, differences of ~30% were observed in organs located at slightly different positions in the computational models compared to the physical phantoms. All investigated programs were deemed suitable for accurate estimation of organ absorbed dose.
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Affiliation(s)
- Larisa Chipiga
- Research Institute of Radiation Hygiene, 197101, Mira St 8, St. Petersburg, Russian Federation
- Granov Russian Research Centre of Radiology and Surgery Technology, Leningradskaya St 70, St. Petersburg, Russian Federation
- Almazov National Medical Research Centre, Akkuratova St 2, St. Petersburg, Russian Federation
| | - Vladislav Golikov
- Research Institute of Radiation Hygiene, 197101, Mira St 8, St. Petersburg, Russian Federation
| | - Aleksandr Vodovatov
- Research Institute of Radiation Hygiene, 197101, Mira St 8, St. Petersburg, Russian Federation
| | - Christian Bernhardsson
- Medical Radiation Physics, ITM, Lund University, Skåne University Hospital, 20502, Inga Marie Nilssons gata 49, Malmö, Sweden
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22
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Benn DK. Reply to "Details Matter when Estimating Radiation Risk"). Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:254-255. [PMID: 34753696 DOI: 10.1016/j.oooo.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Douglas K Benn
- Dental and Maxillofacial Radiology Omaha, Omaha, NE, USA.
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23
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Efthymiou FO, Metaxas VI, Dimitroukas CP, Kakkos SK, Panayiotakis GS. KERMA-AREA PRODUCT, ENTRANCE SURFACE DOSE AND EFFECTIVE DOSE IN ABDOMINAL ENDOVASCULAR ANEURYSM REPAIR. RADIATION PROTECTION DOSIMETRY 2021; 194:121-134. [PMID: 34227656 DOI: 10.1093/rpd/ncab082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/15/2021] [Accepted: 05/09/2021] [Indexed: 06/13/2023]
Abstract
This study aims to evaluate patient radiation dose during fluoroscopically guided endovascular aneurysm repair (EVAR) procedures. Fluoroscopy time (FT) and kerma-area product (KAP) were recorded from 87 patients that underwent EVAR procedures with a mobile C-arm fluoroscopy system. Effective dose (ED) and organs' doses were calculated utilising appropriate conversion coefficients based on the recorded KAP values. Entrance surface dose (ESD) was calculated based on KAP values and technical parameters. The mean FT was 22.7 min (range 6.4-76.8 min), resulting in a mean KAP of 36.6 Gy cm2 (range 2.0-167.8 Gy cm2), a mean ED of 6.2 mSv (range 0.3-28.5 mSv) and a mean ESD of 458 mGy (range 26-2098 mGy). The corresponding median values were 17.4 min, 25.6 Gy cm2, 4.4 mSv and 320 mGy. The threshold of 2 Gy for skin erythema was exceeded in two procedures for a focus-to-skin distance (FSD) of 40 cm and six procedures when an FSD of 30 cm was considered. The highest doses absorbed by the adrenals, kidneys, spleen and pancreas and ranged between 3.7 and 313.3 mGy (average 66.8 mGy), 3.3 and 285.1 mGy (average 60.8 mGy), 1.3 and 111.1 mGy (average 23.7 mGy), 1.1 and 92.1 mGy (average 19.6 mGy), respectively. A wide range of patient doses was reported in the literature. The radiation dose received by the patients was comparative or lower than most of the previously reported values. However, higher doses can be revealed due to the X-ray system's non-optimum use and extended FTs, mainly affected by complex clinical conditions, patients' body habitus and vascular surgeon experience. The large variation of patient doses highlights the potential to optimise the EVAR procedure by considering the balance between the radiation dose and the required image quality. Additional studies need to be conducted in increasing the vascular surgeons' awareness regarding patient dose and radiation protection issues during EVAR procedures.
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Affiliation(s)
- Fotios O Efthymiou
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Christos P Dimitroukas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Vascular Surgery, University Hospital of Patras, 26504 Patras, Greece
| | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
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Lambert RGW, Hermann KGA, Diekhoff T. Low-dose computed tomography for axial spondyloarthritis: update on use and limitations. Curr Opin Rheumatol 2021; 33:326-332. [PMID: 33927123 DOI: 10.1097/bor.0000000000000803] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Recent developments in low-dose computed tomography (ldCT) have greatly reduced radiation exposure levels. This article reviews what a ldCT is and its use and limitations for imaging axial spondyloarthritis. RECENT FINDINGS Detection of structural damage in bone with CT is far superior to radiography and ldCT of the sacroiliac joints (SIJ) can now be done at radiation exposure levels equivalent to, or even less than, conventional radiography. ldCT should be considered a 'first-choice' test for arthritis imaging, and wherever available, SIJ ldCT may completely replace conventional radiography. Radiation exposure in the spine with ldCT is lower than conventional CT. However, it is unclear whether the additional information regarding structural damage changes in the spine provided by ldCT will alter patient management sufficiently often to merit switching from spinal radiography to ldCT in routine clinical practice. In addition, ldCT cannot assess osteitis disease activity for which MRI remains the best test. SUMMARY ldCT of the sacroiliac joints (SIJ) can be done at radiation exposure levels equivalent to, or less than, radiography and ldCT may completely replace SIJ radiography. However, the role of spinal ldCT for spondyloarthritis is not clear and MRI is far superior for detecting disease activity.
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Affiliation(s)
- Robert G W Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Kay Geert A Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Harrison JD, Balonov M, Bochud F, Martin CJ, Menzel HG, Smith-Bindman R, Ortiz-López P, Simmonds JR, Wakeford R. The use of dose quantities in radiological protection: ICRP publication 147 Ann ICRP 50(1) 2021. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:410-422. [PMID: 33571972 DOI: 10.1088/1361-6498/abe548] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
The International Commission on Radiological Protection has recently published a report (ICRP Publication 147;Ann. ICRP50, 2021) on the use of dose quantities in radiological protection, under the same authorship as this Memorandum. Here, we present a brief summary of the main elements of the report. ICRP Publication 147 consolidates and clarifies the explanations provided in the 2007 ICRP Recommendations (Publication 103) but reaches conclusions that go beyond those presented in Publication 103. Further guidance is provided on the scientific basis for the control of radiation risks using dose quantities in occupational, public and medical applications. It is emphasised that best estimates of risk to individuals will use organ/tissue absorbed doses, appropriate relative biological effectiveness factors and dose-risk models for specific health effects. However, bearing in mind uncertainties including those associated with risk projection to low doses or low dose rates, it is concluded that in the context of radiological protection, effective dose may be considered as an approximate indicator of possible risk of stochastic health effects following low-level exposure to ionising radiation. In this respect, it should also be recognised that lifetime cancer risks vary with age at exposure, sex and population group. The ICRP report also concludes that equivalent dose is not needed as a protection quantity. Dose limits for the avoidance of tissue reactions for the skin, hands and feet, and lens of the eye will be more appropriately set in terms of absorbed dose rather than equivalent dose.
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Affiliation(s)
- J D Harrison
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0BP, United Kingdom
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Didcot, Oxon OX11 0RQ, United Kingdom
| | - M Balonov
- Research Institute of Radiation Hygiene, 197101 St. Petersburg, Russia
| | - F Bochud
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C J Martin
- Department of Clinical Physics, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - H-G Menzel
- International Commission on Radiation Units and Measurements, Heidelberg, Germany
| | - R Smith-Bindman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States of America
| | - P Ortiz-López
- Retired from the International Atomic Energy Agency, Vienna, Austria
| | - J R Simmonds
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Didcot, Oxon OX11 0RQ, United Kingdom
- Retired, Wantage, United Kingdom
| | - R Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, United Kingdom
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Koivisto J, van Eijnatten M, Ludlow J, Kiljunen T, Shi X, Wolff J. Comparative dosimetry of radiography device, MSCT device and two CBCT devices in the elbow region. J Appl Clin Med Phys 2021; 22:128-138. [PMID: 33811787 PMCID: PMC8130242 DOI: 10.1002/acm2.13245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of the study was to estimate and to compare effective doses in the elbow region resulting from four different x-ray imaging modalities. Absorbed organ doses were measured using 11 metal oxide field effect transistor (MOSFET) dosimeters that were placed in a custom-made anthropomorphic elbow RANDO phantom. Examinations were performed using Shimadzu FH-21 HR radiography device, Siemens Sensation Open 24-slice MSCT-device, NewTom 5G CBCT device, and Planmed Verity CBCT device, and the effective doses were calculated according to ICRP 103 recommendations. The effective dose for the conventional radiographic device was 1.5 µSv. The effective dose for the NewTom 5G CBCT ranged between 2.0 and 6.7 µSv, for the Planmed Verity CBCT device 2.6 µSv and for the Siemens Sensation MSCT device 37.4 µSv. Compared with conventional 2D radiography, this study demonstrated a 1.4-4.6 fold increase in effective dose for CBCT and 25-fold dose for standard MSCT protocols. When compared with 3D CBCT protocols, the study showed a 6-19 fold increase in effective dose using a standard MSCT protocol. CBCT devices offer a feasible low-dose alternative for elbow 3D imaging when compared to MSCT.
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Affiliation(s)
- Juha Koivisto
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - Maureen van Eijnatten
- Department of Oral and Maxillofacial Surgery/Oral PathologyVU University Medical CenterAmsterdamThe Netherlands
| | - John Ludlow
- University of North CarolinaAdams School of DentistryChapel HillNCUSA
| | | | - Xie‐Qi Shi
- Section of Oral Maxillofacial RadiologyDepartment of Clinical DentistryFaculty of Medicine and DentistryUniversity of BergenBergenNorway
| | - Jan Wolff
- Department of Oral Maxillofacial SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Division of Regenerative Orofacial MedicineHamburgGermany
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Tipnis SV, Huda W, Wilmskoetter J, Martin-Harris B, Bonilha HS. Radiation Effective Doses to Adults Undergoing Modified Barium Swallow Studies. Dysphagia 2021; 37:399-406. [PMID: 33891192 DOI: 10.1007/s00455-021-10291-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/25/2021] [Indexed: 12/21/2022]
Abstract
Modified Barium Swallow Studies (MBSSs) are important tests to aid the diagnosis of swallowing impairment and guide treatment planning. Since MBSSs use ionizing radiation, it is important to understand the radiation exposure associated with the exam. This study reports the average radiation dose in routine clinical MBSSs, to aid the evidence-based decision-making of clinical providers and patients. We examined the MBSSs of 200 consecutive adult patients undergoing clinically indicated exams and used kilovoltage (kV) and Kerma Area Product to calculate the effective dose. While 100% of patients underwent the exam in the lateral projection, 72% were imaged in the upper posterior-anterior (PA) projection and approximately 25% were imaged in the middle and lower PA projection. Average kVs were 63 kV, 77 kV, 78.3 kV, and 94.3 kV, for the lateral, upper, middle, and lower PA projections, respectively. The average effective dose per exam was 0.32 ± 0.23 mSv. These results categorize a typical adult MBSS as a low dose examination. This value serves as a general estimate for adults undergoing MBSSs and can be used to compare other sources of radiation (environmental and medical) to help clinicians and patients assess the risks of conducting an MBSS. The distinction of MBSS as a low dose exam will assuage most clinician's fears, allowing them to utilize this tool to gather clinically significant information about swallow function. However, as an X-ray exam that uses ionizing radiation, the principles of ALARA and radiation safety must still be applied.
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Affiliation(s)
- Sameer V Tipnis
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Walter Huda
- Department of Radiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03766, USA
| | - Janina Wilmskoetter
- Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, 77 President St. MSC 700 office 311, Charleston, SC, 29425, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
- Otolaryngology-Head and Neck Surgery and Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Heather Shaw Bonilha
- Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, 77 President St. MSC 700 office 311, Charleston, SC, 29425, USA.
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
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Meiboom MF, Hoffmann W, Weitmann K, von Boetticher H. Tables for effective dose assessment from diagnostic radiology (period 1946-1995) in epidemiologic studies. PLoS One 2021; 16:e0248987. [PMID: 33793615 PMCID: PMC8016243 DOI: 10.1371/journal.pone.0248987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
Diagnostic radiology is a leading cause of man-made radiation exposure to the population. It is an important factor in many epidemiological studies as variable of interest or as potential confounder. The effective dose as a risk related quantity is the most often stated patient dose. Nevertheless, there exists no comprehensive quantification model for retrospective analysis for this quantity. This paper gives a catalog of effective dose values for common and rare examinations and demonstrates how to modify the dose values to adapt them to different calendar years using a quantification concept already used for retrospective analysis of the red bone marrow dose. It covers the time period of 1946 to 1995 and allows considering technical development and different practical standards over time. For an individual dose assessment, if the dose area product is known, factors are given for most examinations to convert the dose area product into the effective dose. Additionally factors are stated for converting the effective dose into the red bone marrow dose or vice versa.
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Affiliation(s)
- Merle Friederike Meiboom
- Center for Radiology and Nuclear Medicine, Gesundheit Nord gGmbH—Klinikverbund Bremen, Bremen, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Kerstin Weitmann
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Heiner von Boetticher
- Division for Medical Radiation Physics, Faculty VI: Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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De Mauri A, Matheoud R, Guzzardi G, Vaccarone V, David P, Brambilla M, Chiarinotti D. Ionizing radiation exposure from dialysis tunneled catheters procedures: European directive and legal implications. J Vasc Access 2021; 23:500-507. [PMID: 33719706 DOI: 10.1177/11297298211001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Advances in medical imaging and interventional procedures have been associated with increased exposure to ionizing radiation. Thus, the International Commission on Radiological Protection (ICRP) established uniform safety standards to protect the general public against the dangers arising from ionizing radiations. In Europe, the ICRP standards are listed in the European Directive 2013/59/EURATOM, which should be transposed into national legislation by member states. They require that the administered dose must be part of the radiological report and identify the practitioners' responsibilities in justifying and optimizing the dose and correctly informing the patient.Despite these indications, the literature lacks information about the dose from fluoroscopically inserted dialysis tunneled central venous catheters (td-CVC). This study aimed to quantify the effective dose and organ dose to relevant organs in td-CVC to comply with the EU statements. METHODS We revised fluoroscopically-guided procedures of td-CVC insertion, considering dose per area product, fluoroscopic time, effective dose, organ dose, and anatomical district. We also compared these parameters with those of fluoroscopically inserted oncological central venous devices (Port-a-cath). RESULTS The dose-area product, fluoroscopic time, and organ dose for td-CVC were 13 ± 22.2 Gy*cm2, 81 ± 129 s, and 1.9 ± 3.3 mSv. The radiological parameters for the left internal jugular, subclavian and femoral veins were similar but higher than for the right internal jugular vein. The radiological parameters were significantly higher for td-CVC than for Port-a-cath. CONCLUSIONS Fluoroscopically inserted td-CVC are associated with a relatively low dose of ionizing radiation, with considerable variability due to the anatomical puncture site and previous accesses' history. In light of the European Directive, it is a concern for nephrologists to be aware of the administered ionizing dose to comply with their legal responsibilities.
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Affiliation(s)
- Andreana De Mauri
- Nephrology and Dialysis Department, "Maggiore della Carità" University Hospital, Novara, Italy.,Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Roberta Matheoud
- Medical Physics Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Giuseppe Guzzardi
- Radiology Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Valentina Vaccarone
- Radiology Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Paola David
- Nephrology and Dialysis Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Marco Brambilla
- Medical Physics Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Doriana Chiarinotti
- Nephrology and Dialysis Department, "Maggiore della Carità" University Hospital, Novara, Italy
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Peng R, Mardakhaev E, Shmukler A, Levsky JM, Haramati LB. Meeting ACR Dose Guidelines for CT Lung Cancer Screening in an Overweight and Obese Population. Acad Radiol 2021; 28:381-386. [PMID: 32284173 DOI: 10.1016/j.acra.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/01/2022]
Abstract
RATIONALE AND OBJECTIVES Lung cancer screening adoption coincides with a growing obesity epidemic. Maintaining high-quality imaging at low radiation dose is challenging in obesity. We investigate the feasibility of meeting American College of Radiology (ACR) dose guidelines for lung cancer screening in a predominantly overweight and obese population. MATERIALS AND METHODS Radiation dose (Volumetric CT dose index [CTDIvol], dose-length product), and body mass index (BMI) were collected for baseline screening CTs December, 2012-December, 2017. Dose metrics were analyzed according to BMI classification (normal <25, overweight 25-29, obese ≥30 kg/m2), using k = 0.014 mSv/mGy*cm. Results were compared to ACR dose guidelines and mean national 2017 Lung Cancer Screening Registry dose metrics. Analysis used Kruskal-Wallis (SPSS, version 24.0.0, IBM corp, Armonk, NY). RESULTS Study population comprised 1478 patients (49.2% [727] women: mean BMI 28.1 ± 6.5 kg/m2, 26.9% [397] normal weight, 35.9% [530] overweight, 37.2% [551] obese). ACR dose requirements were met for both genders in all BMI classifications. Dose metrics were higher in men than in women; median effective dose and CTDIvol were 1.39 (0.8-1.58) mSv and 2.78 (1.41-2.80) mGy in men versus 1.16 (0.71-1.43) mSv and 2.70 (1.4-2.78) mGy in women. There were significant differences in dose metrics between men and women in the same BMI classification and between BMI classifications (p < 0.001). Mean dose metrics in our program were considerably lower than 2017 national average- mean CTDIvol and effective dose 2.45 ± 1.14 mGy and 1.26 ± 0.59 mSv versus 3.24 mGy and 1.35 mSv, respectively for our program and nationally. Mean dose metrics were also lower in our obese patients versus obese patients nationally. CONCLUSION ACR dose metrics for lung cancer screening were met and can be appropriately tailored in a predominantly overweight and obese population clinical program.
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Affiliation(s)
- Robert Peng
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, New York 10467.
| | - Edward Mardakhaev
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, New York 10467
| | - Anna Shmukler
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, New York 10467
| | - Jeffrey M Levsky
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, New York 10467
| | - Linda B Haramati
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, New York 10467
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Harrison JD, Balonov M, Bochud F, Martin C, Menzel HG, Ortiz-Lopez P, Smith-Bindman R, Simmonds JR, Wakeford R. ICRP Publication 147: Use of Dose Quantities in Radiological Protection. Ann ICRP 2021; 50:9-82. [PMID: 33653178 DOI: 10.1177/0146645320911864] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Radiation dose from medical imaging in end stage renal disease patients: a Nationwide Italian Survey. J Nephrol 2021; 34:791-799. [PMID: 33387337 DOI: 10.1007/s40620-020-00911-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES End stage renal disease (ESRD) patients are exposed to the risk of ionizing radiation during repeated imaging studies. The variability in diagnostic imaging policies and the accompanying radiation doses across various renal units is still unknown. We studied this variability at the centre level and quantified the associated radiation doses at the patient level. METHODS Fourteen Italian nephrology departments enrolled 739 patients on haemodialysis and 486 kidney transplant patients. The details of the radiological procedures performed over one year were recorded. The effective doses and organ doses of radiation were estimated for each patient using standardized methods to convert exposure parameters into effective and organ doses RESULTS: Computed tomography (CT) was the major contributor (> 77%) to ionizing radiation exposure. Among the haemodialysis and kidney transplant patients, 15% and 6% were in the high (≥ 20 mSv per year) radiation dose groups, respectively. In haemodialysis patients, the most exposed organs were the liver (16 mSv), the kidney (15 mSv) and the stomach (14 mSv), while the uterus (6.2 mSv), the lung (5.7 mSv) and the liver (5.5 mSv) were the most exposed in kidney transplant patients. The average cumulative effective dose (CED) of ionizing radiation among centres in this study was highly variable both in haemodialysis (from 6.4 to 18.8 mSv per patient-year; p = 0.018) and even more so in kidney transplant (from 0.6 to 13.7 mSv per patient-year; p = 0.002) patients. CONCLUSIONS Radiation exposure attributable to medical imaging is high in distinct subgroups of haemodialysis and transplant patients. Furthermore, there is high inter-centre variability in radiation exposure, suggesting that nephrology units have substantially different clinical policies for the application of diagnostic imaging studies.
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Oakley PA, Harrison DE. Radiophobic Fear-Mongering, Misappropriation of Medical References and Dismissing Relevant Data Forms the False Stance for Advocating Against the Use of Routine and Repeat Radiography in Chiropractic and Manual Therapy. Dose Response 2021; 19:1559325820984626. [PMID: 33628151 PMCID: PMC7883173 DOI: 10.1177/1559325820984626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/14/2022] Open
Abstract
There is a faction within the chiropractic profession passionately advocating against the routine use of X-rays in the diagnosis, treatment and management of patients with spinal disorders (aka subluxation). These activists reiterate common false statements such as "there is no evidence" for biomechanical spine assessment by X-ray, "there are no guidelines" supporting routine imaging, and also promulgate the reiterating narrative that "X-rays are dangerous." These arguments come in the form of recycled allopathic "red flag only" medical guidelines for spine care, opinion pieces and consensus statements. Herein, we review these common arguments and present compelling data refuting such claims. It quickly becomes evident that these statements are false. They are based on cherry-picked medical references and, most importantly, expansive evidence against this narrative continues to be ignored. Factually, there is considerable evidential support for routine use of radiological imaging in chiropractic and manual therapies for 3 main purposes: 1. To assess spinopelvic biomechanical parameters; 2. To screen for relative and absolute contraindications; 3. To reassess a patient's progress from some forms of spine altering treatments. Finally, and most importantly, we summarize why the long-held notion of carcinogenicity from X-rays is not a valid argument.
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D'Alessio A, Cannillo B, Guzzardi G, Cernigliaro M, Carriero A, Brambilla M. Conversion factors for effective dose and organ doses with the air Kerma area product in hysterosalpingography. Phys Med 2020; 81:40-46. [PMID: 33373780 DOI: 10.1016/j.ejmp.2020.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022] Open
Abstract
Histerosalpingography (HSG) remains the dominant diagnostic tool for investigation of infertility in women. Conversion factors used to estimate effective (E) and organ doses (HT) from air Kerma area product (KAP) are needed to estimate patient doses in HSG, performed with state-of-the-art fluoroscopic X-ray systems with digital detectors. In this study, estimates of E and HT for six critical organs/tissues, were derived on an individual basis in 120 HSG procedures and in 1410 irradiation events, performed on two X-ray systems from information available through the radiation dose structured report using Monte Carlo methods. Mean values of E and Hovaries were1.0 ± 0.9 mSv and 5.6 ± 5.4 mGy. E/KAP conversion factors of 0.13; 0.18; 0.28 and 0.35 mSv Gy-1cm-2 were established for irradiation events with a Cu filtration of 0.0; 0.1; 0.4 and 0.9 mm. A high agreement was obtained between E estimated through Monte Carlo methods and E/KAP conversion factors accounting separately for the different modes of fluoroscopy and the radiography component of HSG, with a systematic error of 0 mSv and lower/upper limits of agreement of -0.6 and 0.5 mSv. On the contrary, the use of a single coefficient of conversion did not provide accurate estimates of E, showing a bias of -0.4 mSv and lower and upper limits of agreement of -1.9 and 1.2 mSv. An algorithm for the estimation of effective and organ doses from KAP has been established in HSG procedures depending on the Cu filtration in the X-ray irradiation events.
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Affiliation(s)
- Andrea D'Alessio
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Barbara Cannillo
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Giuseppe Guzzardi
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | | | - Alessandro Carriero
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Marco Brambilla
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy.
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Abstract
The International Commission on Radiological Protection (ICRP) developed effective dose as a quantity related to risk for occupational and public exposure. There was a need for a similar dose quantity linked to risk for making everyday decisions relating to medical procedures. Coefficients were developed to enable the calculation of doses to organs and tissues, and effective doses for procedures in nuclear medicine and radiology during the 1980s and 1990s. Effective dose has provided a valuable tool that is now used in the establishment of guidelines for patient referral and justification of procedures, choice of appropriate imaging techniques, and providing dose data on potential exposure of volunteers for research studies, all of which require the benefits from the procedure to be weighed against the risks. However, the approximations made in the derivation of effective dose are often forgotten, and the uncertainties in calculations of risks are discussed. An ICRP report on protection dose quantities has been prepared that provides more information on the application of effective dose, and concludes that effective dose can be used as an approximate measure of possible risk. A discussion of the way in which it should be used is given here, with applications for which it is considered suitable. Approaches to the evaluation of risk and methods for conveying information on risk are also discussed.
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Affiliation(s)
- C.J. Martin
- Department of Clinical Physics and Bioengineering,
University of Glasgow, Gartnavel Royal Hospital, Glasgow G12 0XH, UK
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High-Dose Fluoroscopically Guided Procedures in Patients: Radiation Management Recommendations for Interventionalists. Cardiovasc Intervent Radiol 2020; 44:849-856. [PMID: 33184693 DOI: 10.1007/s00270-020-02703-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/31/2020] [Indexed: 12/19/2022]
Abstract
The article is part of the series of articles on radiation protection. You can find further articles in the special section of the CVIR issue. In addition to the risks from fluoroscopic-guided interventional procedures of tissue injuries, recent studies have drawn attention to the risk of stochastic effects. Guidelines exist for preprocedural planning and radiation management during the procedure. The concept of a substantial radiation dose level (SRDL) is helpful for patient follow-up for tissue injury. The uncommon nature of tissue injuries requires the interventionalist to be responsible for follow-up of patients who receive substantial radiation doses. Dose management systems for recognizing and avoiding higher patient exposures have been introduced. The European Directive provides a legal framework and requirements for equipment, training, dose monitoring, recording and optimization that are helpful in radiation risk management.
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The role of ICRP in medicine: past, present and future. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-019-00349-w] [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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Martin CJ, Harrison JD, Rehani MM. Effective dose from radiation exposure in medicine: Past, present, and future. Phys Med 2020; 79:87-92. [DOI: 10.1016/j.ejmp.2020.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/18/2020] [Accepted: 10/23/2020] [Indexed: 01/20/2023] Open
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Lee SK, Kim JS, Yoon SW, Kim JM. Development of CT Effective Dose Conversion Factors from Clinical CT Examinations in the Republic of Korea. Diagnostics (Basel) 2020; 10:E727. [PMID: 32967352 PMCID: PMC7554984 DOI: 10.3390/diagnostics10090727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to determine the conversion factors for the effective dose (ED) per dose length product (DLP) for various computed tomography (CT) protocols based on the 2007 recommendations of the International Commission on Radiological Protection (ICRP). CT dose data from 369 CT scanners and 13,625 patients were collected through a nationwide survey. Data from 3793 patients with a difference in height within 5% of computational human phantoms were selected to calculate ED and DLP. The anatomical CT scan ranges for 11 scan protocols (adult-10, pediatric-1) were determined by experts, and scan lengths were obtained by matching scan ranges to computational phantoms. ED and DLP were calculated using the NCICT program. For each CT protocol, ED/DLP conversion factors were calculated from ED and DLP. Estimated ED conversion factors were 0.00172, 0.00751, 0.00858, 0.01843, 0.01103, 0.02532, 0.01794, 0.02811, 0.02815, 0.02175, 0.00626, 0.00458, 0.00308, and 0.00233 mSv∙mGy-1∙cm-1 for the adult brain, intra-cranial angiography, C-spine, L-spine, neck, chest, abdomen and pelvis, coronary angiography, calcium scoring, aortography, and CT examinations of pediatric brain of <2 years, 4-6 years, 9-11 years, and 13-15 years, respectively. We determined ED conversion factors for 11 CT protocols using CT data obtained from a nationwide survey in Korea and Monte Carlo-based dose calculations.
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Affiliation(s)
- Sang-Kyung Lee
- Health Science Research Center, Korea University, Seoul 02841, Korea;
| | - Jung Su Kim
- Department of Radiologic Technology, Daegu Health College, Daegu 41453, Korea;
| | - Sang-Wook Yoon
- Department of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Pocheon-si 13496, Gyeonggi-do, Korea
| | - Jung Min Kim
- School of Health and Environmental Science, Korea University, Seoul 02841, Korea
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Oakley PA, Navid Ehsani N, Harrison DE. 5 Reasons Why Scoliosis X-Rays Are Not Harmful. Dose Response 2020; 18:1559325820957797. [PMID: 32963506 PMCID: PMC7488912 DOI: 10.1177/1559325820957797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Radiographic imaging for scoliosis screening, diagnosis, treatment, and management is the gold standard assessment tool. Scoliosis patients receive many repeat radiographs, typically 10-25 and as many as 40-50, equating to a maximum 50 mGy of cumulative exposure. It is argued this amount of radiation exposure is not carcinogenic to scoliosis patients for 5 main reasons: 1. Estimated theoretical cumulative effective doses remain below the carcinogenic dose threshold; 2. Scoliosis patient x-rays are delivered in serial exposures and therefore, mitigate any potential cumulative effect; 3. Linear no-threshold cancer risk estimates from scoliosis patient cohorts are flawed due to faulty science; 4. Standardized incidence/mortality ratios demonstrating increased cancers from aged scoliosis cohorts are confounded by the effects of the disease entity itself making it impossible to claim cause and effect resulting from low-dose radiation exposures from spinal imaging; 5. Children are not more susceptible to radiation damage than adults. Radiophobia concerns from patients, parents, and doctors over repeat imaging for scoliosis treatment and management is not justified; it adds unnecessary anxiety to the patient (and their parents) and interferes with optimal medical management. X-rays taken in the evidence-based management of scoliosis should be taken without hesitation or concern about negligible radiation exposures.
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Bågenholm A, Løvhaugen P, Sundset R, Ingebrigtsen T. DIAGNOSTIC IMAGING AND IONIZING RADIATION EXPOSURE IN A LEVEL 1 TRAUMA CENTRE POPULATION MET WITH TRAUMA TEAM ACTIVATION: A ONE-YEAR PATIENT RECORD AUDIT. RADIATION PROTECTION DOSIMETRY 2020; 189:35-47. [PMID: 32060518 DOI: 10.1093/rpd/ncaa010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
This audit describes ionizing and non-ionizing diagnostic imaging at a regional trauma centre. All 144 patients (males 79.2%, median age 31 years) met with trauma team activation from 1 January 2015 to 31 December 2015 were included. We used data from electronic health records to identify all diagnostic imaging and report radiation exposure as dose area product (DAP) for conventional radiography (X-ray) and dose length product (DLP) and effective dose for CT. During hospitalization, 134 (93.1%) underwent X-ray, 122 (84.7%) CT, 92 (63.9%) focused assessment with sonography for trauma (FAST), 14 (9.7%) ultrasound (FAST excluded) and 32 (22.2%) magnetic resonance imaging. One hundred and sixteen (80.5%) underwent CT examinations during trauma admissions, and 73 of 144 (50.7%) standardized whole body CT (SWBCT). DAP values were below national reference levels. Median DLP and effective dose were 2396 mGycm and 20.42 mSv for all CT examinations, and 2461 mGycm (national diagnostic reference level 2400) and 22.29 mSv for a SWBCT.
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Affiliation(s)
- Anna Bågenholm
- Department of Radiology, University Hospital of North Norway, Tromsø N-9038, Norway
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, Tromsø N-9037, Norway
| | - Pål Løvhaugen
- PET-Imaging Center, University Hospital of North Norway, Tromsø N-9038, Norway
| | - Rune Sundset
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, Tromsø N-9037, Norway
- PET-Imaging Center, University Hospital of North Norway, Tromsø N-9038, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, Tromsø N-9037, Norway
- Department of Neurosurgery, ENT and Ophthalmology, University Hospital of North Norway, Tromsø N-9038, Norway
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Individual Calculation of Effective Dose and Risk of Malignancy Based on Monte Carlo Simulations after Whole Body Computed Tomography. Sci Rep 2020; 10:9475. [PMID: 32528028 PMCID: PMC7289876 DOI: 10.1038/s41598-020-66366-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/14/2020] [Indexed: 01/30/2023] Open
Abstract
Detailed knowledge about radiation exposure is crucial for radiology professionals. The conventional calculation of effective dose (ED) for computed tomography (CT) is based on dose length product (DLP) and population-based conversion factors (k). This is often imprecise and unable to consider individual patient characteristics. We sought to provide more precise and individual radiation exposure calculation using image based Monte Carlo simulations (MC) in a heterogeneous patient collective and to compare it to phantom based MC provided from the National Cancer Institute (NCI) as academic reference. Dose distributions were simulated for 22 patients after whole-body CT during Positron Emission Tomography-CT. Based on MC we calculated individual Lifetime Attributable Risk (LAR) and Excess Relative Risk (ERR) of cancer mortality. EDMC was compared to EDDLP and EDNCI. EDDLP (13.2 ± 4.5 mSv) was higher compared to EDNCI (9.8 ± 2.1 mSv) and EDMC (11.6 ± 1.5 mSv). Relative individual differences were up to -48% for EDMC and -44% for EDNCI compared to EDDLP. Matching pair analysis illustrates that young age and gender are affecting LAR and ERR significantly. Because of these uncertainties in radiation dose assessment automated individual dose and risk estimation would be desirable for dose monitoring in the future.
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Walsh C. Interpretation of risk for low dose radiation exposures: inconsistencies, philosophical problems and fallacies. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:646-653. [PMID: 32168501 DOI: 10.1088/1361-6498/ab7fba] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Low doses of radiation are used in diagnostic tests such as X-rays or CT exams. A Linear No Threshold model (LNT) is used to assess radiation risk. According to this model, risk decreases linearly with a decreasing dose, with no lower threshold. However, there is no definitive evidence to support risk at very low doses and the model relies on extrapolation to estimate risk at doses below a few 10 s mSv. The simplicity of the LNT model can disguise the more complex questions that arise when the facts are uncertain. There is a considerable debate over how best to interpret and communicate these risks for low dose exposures. This paper criticises arguments on both sides of this debate. In discussing the case for asserting risk we argue that it is only as a scientific model that LNT should be used to make predictions that can be tested. Taking the further step of using these calculations to state how many cancers are caused by the use of X-rays requires a strong scientific model and the disputed status of the LNT model and the consequent uncertainty as to whether low dose radiation definitely causes cancer, is the major obstacle to making these types of claims. In discussing arguments which tend to dismiss risk, we identify the hidden premises needed to support these claims. Differences between a prudent model and a scientific model are considered. A 'reductio ad absurdum' objection, and fallacies of ambiguity, where 'insignificant risk' may be confused with 'inconsequential risk', are also discussed. Disagreement over the interpretation of risk has the potential to disrupt the optimum use of medical imaging technology. While communication of risk need not address the underlying philosophical complexities, advice from the radiation protection community must be rooted in an awareness of these issues if inconsistencies are to be avoided.
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Radiation dose and risk of exposure-induced death associated with common computed tomography procedures in Yazd Province. Eur J Radiol 2020; 126:108932. [DOI: 10.1016/j.ejrad.2020.108932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 02/07/2020] [Accepted: 03/02/2020] [Indexed: 01/12/2023]
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Oakley PA, Harrison DE. Death of the ALARA Radiation Protection Principle as Used in the Medical Sector. Dose Response 2020; 18:1559325820921641. [PMID: 32425724 PMCID: PMC7218317 DOI: 10.1177/1559325820921641] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022] Open
Abstract
ALARA is the acronym for "As Low As Reasonably Achievable." It is a radiation protection concept borne from the linear no-threshold (LNT) hypothesis. There are no valid data today supporting the use of LNT in the low-dose range, so dose as a surrogate for risk in radiological imaging is not appropriate, and therefore, the use of the ALARA concept is obsolete. Continued use of an outdated and erroneous principle unnecessarily constrains medical professionals attempting to deliver high-quality care to patients by leading to a reluctance by doctors to order images, a resistance from patients/parents to receive images, subquality images, repeated imaging, increased radiation exposures, the stifling of low-dose radiation research and treatment, and the propagation of radiophobia and continued endorsement of ALARA by regulatory bodies. All these factors result from the fear of radiogenic cancer, many years in the future, that will not occur. It has been established that the dose threshold for leukemia is higher than previously thought. A low-dose radiation exposure from medical imaging will likely upregulate the body's adaptive protection systems leading to the prevention of future cancers. The ALARA principle, as used as a radiation protection principle throughout medicine, is scientifically defunct and should be abandoned.
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Brambilla M, Cannillo B, Guzzardi G, D'Alessio A, Galbiati A, Matheoud R, Carriero A. Conversion factors for effective dose and organ doses with the air kerma area product in patients undergoing percutaneous transhepatic biliary drainage and trans arterial chemoembolization. Phys Med 2020; 72:7-15. [PMID: 32179407 DOI: 10.1016/j.ejmp.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/29/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022] Open
Abstract
Conversion factors used to estimate effective (E) and organ doses (HT) from air Kerma area product (KAP) are required to estimate population doses in percutaneous transhepatic biliary drainage (PTBD) and trans arterial chemoembolization (TACE) interventional procedures. In this study, E and HT for ten critical organs/tissues, were derived in 64 PTBD and 48 TACE procedures and in 14,540 irradiation events from dosimetric, technical and geometrical information included in the radiation dose structured report using the PCXMC Monte Carlo model, and the ICRP 103 organ weighting factors. Conversion factors of: 0.13; 0.19; 0.26 and 0.32 mSv Gy-1 cm-2 were established for irradiation events characterized by a Cu filtration of 0.0; 0.1; 0.4 and 0.9 mm, respectively. While a single coefficient of conversion is not able to provide estimates of E with enough accuracy, a high agreement is obtained between E estimated through Monte Carlo methods and E estimated through E/KAP conversion factors accounting separately for the different modes of fluoroscopy and the fluorography component of the procedures. An algorithm for the estimation of effective and organ doses from KAP has been established in biliary procedures which considers the Cu filtration in the X-ray irradiation events. A similar algorithm could be easily extended to other interventional procedures and incorporated in radiation dose monitoring systems to provide dosimetric estimates automatically with enough accuracy to assess population doses.
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Affiliation(s)
- M Brambilla
- Medical Physics Department, University Hospital "Maggiore della Carità" Novara, Italy.
| | - B Cannillo
- Medical Physics Department, University Hospital "Maggiore della Carità" Novara, Italy
| | - G Guzzardi
- Radiology Department, University Hospital "Maggiore della Carità" Novara, Italy
| | - Andrea D'Alessio
- Medical Physics Department, University Hospital "Maggiore della Carità" Novara, Italy
| | - Andrea Galbiati
- Radiology Department, University Hospital "Maggiore della Carità" Novara, Italy
| | - Roberta Matheoud
- Medical Physics Department, University Hospital "Maggiore della Carità" Novara, Italy
| | - A Carriero
- Radiology Department, University Hospital "Maggiore della Carità" Novara, Italy
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Miller DL. Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures. Med Phys 2020; 47:975-982. [DOI: 10.1002/mp.13990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Donald L. Miller
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring MD 20993USA
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A H P, S M R A, T B, M G, M M. Dosimetry of Occupational Radiation around Panoramic X-ray Apparatus. J Biomed Phys Eng 2019; 9:525-532. [PMID: 31750266 PMCID: PMC6820020 DOI: 10.31661/jbpe.v0i0.466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/20/2015] [Indexed: 11/16/2022]
Abstract
Background: Panoramic imaging is one of the most common imaging methods in dentistry. Regarding the side-effects of ionizing radiation, it is necessary to survey different aspects and details of panoramic imaging. In this study, we compared the absorbed x-ray dose around two panoramic x-ray units: PM 2002 CC Proline (Planmeca, Helsinki, Finland) and Cranex Tome (Soredex, Helsinki, Finland).
Materials and Methods: In this cross-sectional study, 15 thermoluminescet dosemeters (TLD-100) were placed in 3 semi-circles of 40cm, 80cm and 120cm radii in order to estimate x-ray dose. Around each unit, the number of TLDs in each semi-circle was 5 with equal intervals. The center of semicircles accords with the patient’s position. Each TLD was exposed 40 times. These dosemeters were read out with a Harshaw Model 4000 TLD Reader (USA). The calibration processing and the reading of dosemeters were performed by the Atomic Energy Organization of Iran.
Results: The mean absorbed dose in three lines of PM 2002 CC Proline was 123.2±15.1, 118.0±11.0 and 108.0±9.1 µSv, (p=0.013). The results were 140.4±15.2, 120.2±10.4 and 111.6±11.2 µSv in Cranex Tome (p=0.208), which reveals no significant difference between two systems.
Conclusion: There are no significant differences between the mean absorbed dose of surveyed models in panoramic imaging by two units (PM 2002 CC Proline and Cranex Tome). These results were less than occupational exposure recommended by ICRP, even at the highest calculated doses.
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Affiliation(s)
- Pakravan A H
- MD, Department of Prosthodontics, Faculty of Dentistry, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Aghamiri S M R
- PhD, Department of Radiation Medicine, Shahid Beheshti University, Tehran, Iran
| | - Bamdadian T
- MD, Department of Prosthesis, Faculty of Dentistry, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Gholami M
- PhD, Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- PhD, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moshfeghi M
- MD, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Varghese A, Keshava SN, Moses V, Koshy G, Mammen S, Ahmed M, Livingstone RS. Radiation dose reference card for interventional radiology procedures: Experience in a tertiary referral centre. Indian J Radiol Imaging 2019; 29:247-252. [PMID: 31741591 PMCID: PMC6857258 DOI: 10.4103/ijri.ijri_35_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/20/2019] [Accepted: 08/31/2019] [Indexed: 11/07/2022] Open
Abstract
Background: Fluoroscopy-guided interventions can potentially increase radiation risk to patients, if awareness on angiographic imaging technique and radiation dose is neglected. Aim: To develop patient radiation dose reference card from standardized imaging techniques for various radiology interventions performed using flat detector based angiography system. Materials and Methods: Real-time monitoring of angiographic exposure parameters and radiation dose were performed for 16 types of radiological interventions. Effective dose (ED) was estimated from dose area product (DAP) using PCXMC Monte Carlo simulation software. Radiation risk levels were estimated based on Biological Effects of Ionising radiation (BEIR) report VII predictive models for an Asian population. Results: Pulse rates of 7.5 pps and 0.6 mm Copper filtration during fluoroscopy and 4 frames per second (fps) and 0.1-0.3 mm Cu filtration during image acquisitions were found to reduce radiation dose. Owing to increased number of image acquisitions, DAP was highest during diagnostic spinal angiography 186.7 Gycm2 (44.0–377.5). This resulted in highest ED of 59.4 mSv with moderate risk levels (1 in 1000 to 1 in 500). Most of the radiological interventions had low radiation risk levels (1 in 10,000 to 1 in 1000). Conclusion: The patient radiation dose reference card is valuable to the medical community and can aid in patient counselling on radiation induced risk from radiological interventions.
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Affiliation(s)
- Anna Varghese
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Shyamkumar N Keshava
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Vinu Moses
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - George Koshy
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Suraj Mammen
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Munawwar Ahmed
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Roshan S Livingstone
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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The role of imaging in the diagnosis and management of axial spondyloarthritis. Nat Rev Rheumatol 2019; 15:657-672. [DOI: 10.1038/s41584-019-0309-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/15/2022]
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