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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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Han CS, Hancock MJ, Downie A, Jarvik JG, Koes BW, Machado GC, Verhagen AP, Williams CM, Chen Q, Maher CG. Red flags to screen for vertebral fracture in people presenting with low back pain. Cochrane Database Syst Rev 2023; 8:CD014461. [PMID: 37615643 PMCID: PMC10448864 DOI: 10.1002/14651858.cd014461.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Low back pain is a common presentation across different healthcare settings. Clinicians need to confidently be able to screen and identify people presenting with low back pain with a high suspicion of serious or specific pathology (e.g. vertebral fracture). Patients identified with an increased likelihood of having a serious pathology will likely require additional investigations and specific treatment. Guidelines recommend a thorough history and clinical assessment to screen for serious pathology as a cause of low back pain. However, the diagnostic accuracy of recommended red flags (e.g. older age, trauma, corticosteroid use) remains unclear, particularly those used to screen for vertebral fracture. OBJECTIVES To assess the diagnostic accuracy of red flags used to screen for vertebral fracture in people presenting with low back pain. Where possible, we reported results of red flags separately for different types of vertebral fracture (i.e. acute osteoporotic vertebral compression fracture, vertebral traumatic fracture, vertebral stress fracture, unspecified vertebral fracture). SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 26 July 2022. SELECTION CRITERIA We considered primary diagnostic studies if they compared results of history taking or physical examination (or both) findings (index test) with a reference standard test (e.g. X-ray, magnetic resonance imaging (MRI), computed tomography (CT), single-photon emission computerised tomography (SPECT)) for the identification of vertebral fracture in people presenting with low back pain. We included index tests that were presented individually or as part of a combination of tests. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data for diagnostic two-by-two tables from the publications or reconstructed them using information from relevant parameters to calculate sensitivity, specificity, and positive (+LR) and negative (-LR) likelihood ratios with 95% confidence intervals (CIs). We extracted aspects of study design, characteristics of the population, index test, reference standard, and type of vertebral fracture. Meta-analysis was not possible due to heterogeneity of studies and index tests, therefore the analysis was descriptive. We calculated sensitivity, specificity, and LRs for each test and used these as an indication of clinical usefulness. Two review authors independently conducted risk of bias and applicability assessment using the QUADAS-2 tool. MAIN RESULTS This review is an update of a previous Cochrane Review of red flags to screen for vertebral fracture in people with low back pain. We included 14 studies in this review, six based in primary care, five in secondary care, and three in tertiary care. Four studies reported on 'osteoporotic vertebral fractures', two studies reported on 'vertebral compression fracture', one study reported on 'osteoporotic and traumatic vertebral fracture', two studies reported on 'vertebral stress fracture', and five studies reported on 'unspecified vertebral fracture'. Risk of bias was only rated as low in one study for the domains reference standard and flow and timing. The domain patient selection had three studies and the domain index test had six studies rated at low risk of bias. Meta-analysis was not possible due to heterogeneity of the data. Results from single studies suggest only a small number of the red flags investigated may be informative. In the primary healthcare setting, results from single studies suggest 'trauma' demonstrated informative +LRs (range: 1.93 to 12.85) for 'unspecified vertebral fracture' and 'osteoporotic vertebral fracture' (+LR: 6.42, 95% CI 2.94 to 14.02). Results from single studies suggest 'older age' demonstrated informative +LRs for studies in primary care for 'unspecified vertebral fracture' (older age greater than 70 years: 11.19, 95% CI 5.33 to 23.51). Results from single studies suggest 'corticosteroid use' may be an informative red flag in primary care for 'unspecified vertebral fracture' (+LR range: 3.97, 95% CI 0.20 to 79.15 to 48.50, 95% CI 11.48 to 204.98) and 'osteoporotic vertebral fracture' (+LR: 2.46, 95% CI 1.13 to 5.34); however, diagnostic values varied and CIs were imprecise. Results from a single study suggest red flags as part of a combination of index tests such as 'older age and female gender' in primary care demonstrated informative +LRs for 'unspecified vertebral fracture' (16.17, 95% CI 4.47 to 58.43). In the secondary healthcare setting, results from a single study suggest 'trauma' demonstrated informative +LRs for 'unspecified vertebral fracture' (+LR: 2.18, 95% CI 1.86 to 2.54) and 'older age' demonstrated informative +LRs for 'osteoporotic vertebral fracture' (older age greater than 75 years: 2.51, 95% CI 1.48 to 4.27). Results from a single study suggest red flags as part of a combination of index tests such as 'older age and trauma' in secondary care demonstrated informative +LRs for 'unspecified vertebral fracture' (+LR: 4.35, 95% CI 2.92 to 6.48). Results from a single study suggest when '4 of 5 tests' were positive in secondary care, they demonstrated informative +LRs for 'osteoporotic vertebral fracture' (+LR: 9.62, 95% CI 5.88 to 15.73). In the tertiary care setting, results from a single study suggest 'presence of contusion/abrasion' was informative for 'vertebral compression fracture' (+LR: 31.09, 95% CI 18.25 to 52.96). AUTHORS' CONCLUSIONS The available evidence suggests that only a few red flags are potentially useful in guiding clinical decisions to further investigate people suspected to have a vertebral fracture. Most red flags were not useful as screening tools to identify vertebral fracture in people with low back pain. In primary care, 'older age' was informative for 'unspecified vertebral fracture', and 'trauma' and 'corticosteroid use' were both informative for 'unspecified vertebral fracture' and 'osteoporotic vertebral fracture'. In secondary care, 'older age' was informative for 'osteoporotic vertebral fracture' and 'trauma' was informative for 'unspecified vertebral fracture'. In tertiary care, 'presence of contusion/abrasion' was informative for 'vertebral compression fracture'. Combinations of red flags were also informative and may be more useful than individual tests alone. Unfortunately, the challenge to provide clear guidance on which red flags should be used routinely in clinical practice remains. Further research with primary studies is needed to improve and consolidate our current recommendations for screening for vertebral fractures to guide clinical care.
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Affiliation(s)
- Christopher S Han
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Mark J Hancock
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Aron Downie
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Jeffrey G Jarvik
- Departments of Radiology and Neurological Surgery, and the UW Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Disorders, University of Washington School of Medicine, Seattle, USA
| | - Bart W Koes
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Department of General Practice, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Arianne P Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney (UTS), Sydney, Australia
| | | | - Qiuzhe Chen
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
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Xiao M, Zhang M, Lei M, Lin F, Chen Y, Chen J, Liu J, Ye J. Diagnostic accuracy of ultra-low-dose CT compared to standard-dose CT for identification of non-displaced fractures of the shoulder, knee, ankle, and wrist. Insights Imaging 2023; 14:40. [PMID: 36882617 PMCID: PMC9992673 DOI: 10.1186/s13244-023-01389-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/10/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVES To compare the performance of ultra-low-dose computed tomography (ULD-CT) with standard-dose computed tomography (SD-CT) for the diagnosis of non-displaced fractures of the shoulder, knee, ankle, and wrist. METHODS This prospective study enrolled 92 patients receiving conservative treatment for limb joint fractures who underwent SD-CT followed by ULD-CT at a mean interval of 8.85 ± 1.98 days. Fractures were characterized as displaced or non-displaced. Objective (signal-to-noise ratio, contrast-to-noise ratio) and subjective CT image quality were evaluated. Observer performance for ULD-CT and SD-CT detecting non-displaced fractures was estimated by calculating the area under the receiver operating characteristic (ROC) curve (Az). RESULTS The effective dose (ED) for the ULD-CT protocol was significantly lower than the ED for the SD-CT protocol (F = 422.21~2112.25, p < 0.0001); 56 patients (65 fractured bones) had displaced fractures, and 36 patients (43 fractured bones) had non-displaced fractures. Two non-displaced fractures were missed by SD-CT. Four non-displaced fractures were missed by ULD-CT. Objective and subjective CT image quality was significantly improved for SD-CT compared to ULD-CT. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of SD-CT and ULD-CT for non-displaced fractures of the shoulder, knee, ankle and wrist were similar: 95.35% and 90.70%; 100% and 100%; 100% and 100%; 99.72% and 99.44%; and 99.74% and 99.47%, respectively. The Az was 0.98 for SD-CT and 0.95 for ULD-CT (p = 0.32). CONCLUSION ULD-CT has utility for the diagnosis of non-displaced fractures of the shoulder, knee, ankle, and wrist and can support clinical decision-making.
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Affiliation(s)
- Mengqiang Xiao
- Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Meng Zhang
- Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Ming Lei
- Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Fenghuan Lin
- Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Yanxia Chen
- Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Jun Chen
- Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Jinfeng Liu
- Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Jingzhi Ye
- Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
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Gu X, Guo Z, Cai M, Shi Y, Wang S, Xie F. Paced breathing and respiratory movement responses evoked by bidirectional constant current stimulation in anesthetized rabbits. Front Bioeng Biotechnol 2023; 10:1109892. [PMID: 36714628 PMCID: PMC9877234 DOI: 10.3389/fbioe.2022.1109892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
Objective: Diaphragm pacing (DP) is a long-term and effective respiratory assist therapy for patients with central alveolar hypoventilation and high cervical spinal cord injury. The existing DP system has some limitations, especially high price, inconvenience preoperative evaluation methods and diaphragm fatigue easily. Our objective was to develop a DP system and evaluated reliability through hardware testing and animal experiments. Methods: A DP system with bidirectional constant current was designed, manufactured and tested. Effects of a wide range of stimulus amplitudes (range: .5-2.5 mA) and frequencies (range: 10-250 Hz) on airflow and corresponding inspired volume were investigated during DP. Differences in airflow characteristics under various stimulation parameters were evaluated using power function. ECG interference in diaphragm electromyography (EMGdi) was filtered out using stationary wavelet transform to obtain pure EMGdi (EMGdip). 80-min period with a tendency for diaphragm fatigue by root mean square (RMS) and centroid frequency (f c ) of EMGdip was studied. Results: The increase of stimulus frequency and amplitude in animals resulted in different degrees of increase in envoked volume. Significant difference in Airflow Index (b) between anesthesia and DP provided a simple, non-invasive and feasible solution for phrenic nerve conduction function test. Increased stimulation duration with the developed DP system caused less diaphragm fatigue. Conclusion: A modular, inexpensive and reliable DP was successfully developed. Its effectiveness was confirmed in animal experiments. Significance: This study is useful for design of future implantable diaphragmatic pacemakers for improving diaphragm fatigue and convenient assessment of respiratory activity in experiments.
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Affiliation(s)
- Xiaoyu Gu
- School of Biology and Medical Engineering, Beihang University, Beijing, China
| | - Zixuan Guo
- Medical School of Chinese PLA, Beijing, China
| | - Maolin Cai
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Yan Shi
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China,*Correspondence: Yan Shi, ; Fei Xie,
| | - Shoukun Wang
- School of Automation, Beijing Institute of Technology, Beijing, China
| | - Fei Xie
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China,*Correspondence: Yan Shi, ; Fei Xie,
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Pilot study to determine whether reduced-dose photon-counting detector chest computed tomography can reliably display Brody II score imaging findings for children with cystic fibrosis at radiation doses that approximate radiographs. Pediatr Radiol 2023; 53:1049-1056. [PMID: 36596868 DOI: 10.1007/s00247-022-05574-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/23/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Brody II score uses chest CT to guide therapeutic changes in children with cystic fibrosis; however, patients and providers are often reticent to undergo chest CT given concerns about radiation. OBJECTIVE We sought to determine the ability of a reduced-dose photon-counting detector (PCD) chest CT protocol to reproducibly display pulmonary disease severity using the Brody II score for children with cystic fibrosis (CF) scanned at radiation doses similar to those of a chest radiograph. MATERIALS AND METHODS Pediatric patients with CF underwent non-contrast reduced-dose chest PCD-CT. Volumetric inspiratory and expiratory scans were obtained without sedation or anesthesia. Three pediatric radiologists with Certificates of Added Qualification scored each scan on an ordinal scale and assigned a Brody II score to grade bronchiectasis, peribronchial thickening, parenchymal opacity, air trapping and mucus plugging. We report image-quality metrics using descriptive statistics. To calculate inter-rater agreement for Brody II scoring, we used the Krippendorff alpha and intraclass correlation coefficient (ICC). RESULTS Fifteen children with CF underwent reduced-dose PCD chest CT in both inspiration and expiration (mean age 8.9 years, range, 2.5-17.5 years; 4 girls). Mean volumetric CT dose index (CTDIvol) was 0.07 ± 0.03 mGy per scan. Mean effective dose was 0.12 ± 0.04 mSv for the total examination. All three readers graded spatial resolution and noise as interpretable on lung windows. The average Brody II score was 12.5 (range 4-19), with moderate inter-reader reliability (ICC of 0.61 [95% CI=0.27, 0.84]). Inter-rater reliability was moderate to substantial for bronchiectasis (0.52), peribronchial thickening (0.55), presence of opacity (0.62) and air trapping (0.70) and poor for mucus plugging (0.09). CONCLUSION Reduced-dose PCD-CT permits diagnostic image quality and reproducible identification of Brody II scoring imaging findings at radiation doses similar to those for chest radiography.
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Lee JH, Woo H, Jang JS, Kim JI, Na YC, Kim KR, Cho E, Lee JH, Park TY. Comparison of Concordance between Chuna Manual Therapy Diagnostic Methods (Palpation, X-ray, Artificial Intelligence Program) in Lumbar Spine: An Exploratory, Cross-Sectional Clinical Study. Diagnostics (Basel) 2022; 12:2732. [PMID: 36359575 PMCID: PMC9689192 DOI: 10.3390/diagnostics12112732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 10/15/2023] Open
Abstract
Before Chuna manual therapy (CMT), a manual therapy applied in Korean medicine, CMT spinal diagnosis using palpation or X-ray is performed. However, studies on the inter-rater concordance of CMT diagnostic methods, concordance among diagnostic methods, and standard CMT diagnostic methods are scarce. Moreover, no clinical studies have used artificial intelligence (AI) programs for X-ray image-based CMT diagnosis. Therefore, this study sought a feasible and standard CMT spinal diagnostic method and explored the clinical applicability of the CMT-AI program. One hundred participants were recruited, and the concordance within and among different diagnostic modalities was analyzed by dividing them into manual diagnosis (MD), X-ray image-based diagnosis (XRD) by experts and non-experts, and XRD using a CMT-AI program by non-experts. Regarding intra-group concordance, XRD by experts showed the highest concordance (used as a gold standard when comparing inter-group concordance), followed by XRD using the AI program, XRD by non-experts, and then MD. Comparing diagnostic results between the groups, concordance with the gold standard was the highest for XRD using the AI program, followed by XRD by non-experts, and MD. Therefore, XRD is a more reasonable CMT diagnostic method than MD. Furthermore, the clinical applicability of the CMT-AI program is high.
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Affiliation(s)
- Jin-Hyun Lee
- Institute for Integrative Medicine, Catholic Kwandong University International St. Mary’s Hospital, 25 Simgok-ro 100 Beon-gil, Seo-gu, Incheon 22711, Republic of Korea
| | - Hyeonjun Woo
- Department of Korean Medicine Rehabilitation, College of Korean Medicine, Wonkwang University, 460 Iksan-daero, Iksan-si 54538, Republic of Korea
| | - Jun-Su Jang
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea
| | - Joong Il Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea
| | - Young Cheol Na
- Department of Neurosurgery, Catholic Kwandong University International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25 Simgok-ro 100 Beon-gil, Seo-gu, Incheon 22711, Republic of Korea
| | - Kwang-Ryeol Kim
- Department of Neurosurgery, Catholic Kwandong University International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25 Simgok-ro 100 Beon-gil, Seo-gu, Incheon 22711, Republic of Korea
| | - Eunbyul Cho
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Wonkwang University, 460 Iksan-daero, Iksan-si 54538, Republic of Korea
| | - Jung-Han Lee
- Department of Korean Medicine Rehabilitation, College of Korean Medicine, Wonkwang University, 460 Iksan-daero, Iksan-si 54538, Republic of Korea
| | - Tae-Yong Park
- Institute for Integrative Medicine, Catholic Kwandong University International St. Mary’s Hospital, 25 Simgok-ro 100 Beon-gil, Seo-gu, Incheon 22711, Republic of Korea
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Han CS, Hancock MJ, Downie A, Jarvik JG, Koes BW, Machado GC, Verhagen AP, Williams CM, Maher CG. Red flags to screen for vertebral fracture in patients presenting with low back pain. Hippokratia 2022. [DOI: 10.1002/14651858.cd014461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christopher S Han
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
| | - Mark J Hancock
- Faculty of Medicine, Health and Human Sciences; Macquarie University; Sydney Australia
| | - Aron Downie
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
- Faculty of Medicine, Health and Human Sciences; Macquarie University; Sydney Australia
| | - Jeffrey G Jarvik
- Radiology and Neurological Surgery, Clinical Learning, Evidence And Research (CLEAR) Center; University of Washington School of Medicine; Seattle USA
| | - Bart W Koes
- Center for Muscle and Health; University of Southern Denmark; Odense Denmark
| | - Gustavo C Machado
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
| | - Arianne P Verhagen
- Discipline of Physiotherapy, Graduate School of Health; University of Technology ; Sydney Australia
| | | | - Christopher G Maher
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
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Shi HM, Sun ZC, Ju FH. Understanding the harm of low‑dose computed tomography radiation to the body (Review). Exp Ther Med 2022; 24:534. [PMID: 35911849 DOI: 10.3892/etm.2022.11461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hai-Min Shi
- Department of Gynecology and Obstetrics Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Zhi-Chao Sun
- Department of Medical Imaging, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Fang-He Ju
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310006, P.R. China
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10
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Omidi R, Zare MH, Zamani H, Dalvand S, Masjedi H, Razavi-Ratki SK, Rahbar S. Patterns and trends of population radiation exposure and projected the risk of exposure-induced death from gamma camera examinations in Yazd Province. J Med Imaging Radiat Sci 2021; 52:595-605. [PMID: 34782277 DOI: 10.1016/j.jmir.2021.08.020] [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: 04/08/2021] [Revised: 08/02/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The use of nuclear medicine examinations as imaging modalities has recently increased. This study aimed to assess the radiation dose delivered to patients from common diagnostic nuclear medicine examinations and estimate the risk of exposure-induced death (REID). In addition, the frequency of nuclear medicine procedures were evaluated from 2015-2018. MATERIALS AND METHODS The data were collected from adult patients who had undergone cardiac, skeletal, renal, lacrimal, and thyroid imaging. For each patient, the effective dose was calculated using dose conversion factors, and REID was estimated using PCXMC. The frequency of examinations between 2015 and 2018 was obtained from the hospital information system (HIS). RESULTS The highest estimated effective dose was attributed to the scans of myocardial stress (8.09 ± 1.28 mSv), myocardial rest (5.59 ± 1.27 mSv), and thyroid imaging (3.93 ± 0.55 mSv). In addition, cardiac stress examination had the highest REID values for solid cancers (212.5 ± 67.5) and bone scans had the highest REID values for leukemia (11.5 ± 2.5). A large increase in the number of myocardial perfusion scans was a significant contributor to an increase in collective effective dose from 23.37 man-Sv in 2015 to 49.47 man-Sv in 2018, a compound annual growth rate (CAGR) of 26%. CONCLUSION Although the annual frequency and per capita effective dose of nuclear medicine procedures in Yazd Province increased continuously, they were comparably lower than those reported for other countries. Despite this, the cancer risks of nuclear medicine scans at the individual level are negligible (around 0.01% excess fatal cancer risk), yet the increasing tendency for these examinations could be of concern.
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Affiliation(s)
- Reza Omidi
- Medical Physics Department, Student at Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Hosein Zare
- Medical Physics Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamed Zamani
- Medical Physics Department, Student at Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saman Dalvand
- Medical Physics Department, Student at Tarbiat Modares University, Tehran, Iran.
| | - Hamidreza Masjedi
- Medical Physics Department, Student at Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seid Kazem Razavi-Ratki
- Clinical Research Development Center of Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Shohadaye Gomnam Blvd, Yazd, Yazd Province, Yazd, Iran.
| | - Shiva Rahbar
- Medical Physics Department, Student at Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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11
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Virtual fracture clinic reduces patient X-ray volume for common wrist and ankle fractures. Ir J Med Sci 2021; 191:2117-2121. [PMID: 34655402 PMCID: PMC8520104 DOI: 10.1007/s11845-021-02812-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Abstract
Background Virtual fracture clinics (VFC) have been widely adopted worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic. They have been shown to be a safe and effective method of delivering trauma care for injuries which do not require immediate intervention or specialist management, whilst maintaining high levels of patient satisfaction. Aims Our aim was to evaluate whether VFCs reduce the volume of X-rays performed for common fractures of the wrist and ankle. Methods A retrospective cohort review was performed. The pre-VFC group consisted of 168 wrist and 108 ankle referrals from March to September 2019. The VFC group included 75 wrist and 68 ankle referrals, during the period March to September 2020. The total number of X-ray images, carried out within a 3-month period for each fracture was summated, with statistical analysis performed following fracture pattern classification. Findings A statistically significant decrease in mean X-rays was observed for isolated stable fracture patterns, such as non-displaced distal radius, − 0.976 (p = 0.00025), and Weber A ankle fractures, − 0.907 (p = 0.000013). A reduction was also observed for more complex fracture patterns such as dorsally displaced distal radius, − 0.701 (p = 0.129) and Weber B ankle fractures, − 0.786 (p = 0.235), though not achieving statistical significance. Conclusions Virtual fracture clinics can reduce X-ray frequency for common stable wrist and ankle fractures, with resultant benefits for both patients and healthcare systems. These benefits may be sustained in patient care beyond the current COVID-19 pandemic.
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Chen L, Perera RS, Radojčić MR, Beckenkamp PR, Ferreira PH, Hart DJ, Spector TD, Arden NK, Ferreira ML. Association of Lumbar Spine Radiographic Changes With Severity of Back Pain-Related Disability Among Middle-aged, Community-Dwelling Women. JAMA Netw Open 2021; 4:e2110715. [PMID: 34014327 PMCID: PMC8138688 DOI: 10.1001/jamanetworkopen.2021.10715] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Previous studies, using mostly cross-sectional data, provide conflicting evidence of an association between lumbar spine radiographic changes and the severity of back pain-related disability. Such conflicting evidence may be associated with widely unnecessary diagnostic imaging of the lumbar spine. OBJECTIVE To examine both cross-sectional and longitudinal associations between lumbar spine radiographic changes and the severity of back pain-related disability among middle-aged, community-dwelling women. DESIGN, SETTING, AND PARTICIPANTS This population-based prospective cohort study used data from the Chingford 1000 Women Study. Analyses included data collected from year 6 (1994-1996; physical activity was measured), year 9 (1997-1999; treated as baseline), and year 15 (2003-2005), with a total length of follow-up for longitudinal analyses of 6 years. Data were analyzed from April 17 to November 3, 2020. EXPOSURES Primary exposure was lumbar spine radiographic changes, defined using the Kellgren-Lawrence (K-L) grade. Secondary exposures were defined using presence of osteophytes and disc space narrowing. The composite score combined the number of lumbar spine segments with definite changes detected on radiographic images (ie, radiographic changes) (K-L grade ≥2, which means at least definite osteophyte and possible narrowing of disc space are present; osteophyte and disc space narrowing grade ≥1, which means at least mild or definite changes are present). MAIN OUTCOMES AND MEASURES Self-reported back pain-related disability measured in years 9 and 15 assessed by the St Thomas disability questionnaire. RESULTS Among 650 women (mean [SD] age, 61.3 [5.9] years) in cross-sectional analyses and 443 women (mean [SD] age, 60.6 [6.0] years) in longitudinal analyses, there was no evidence to support an association between higher number of lumbar segments with radiographic changes (K-L grade, osteophytes, and disc space narrowing) and more severe back pain-related disability (eg, cross-sectional analyses using the K-L grade; 1 segment vs 0 segment: adjusted odds ratio, 1.22 [95% CI, 0.76-1.96]). No interactions were found of an association between lumbar spine radiographic changes and the severity of back pain-specific disability with age, body mass index, or smoking status. CONCLUSIONS AND RELEVANCE In this cohort of middle-aged, community-dwelling women, there was no evidence to support an association between a higher number of lumbar segments with radiographic changes (K-L grade, osteophytes, and disc space narrowing) and more severe back pain-related disability cross-sectionally or over time. These findings provide further evidence against routinely using diagnostic imaging of the lumbar spine.
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Affiliation(s)
- Lingxiao Chen
- Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Romain S. Perera
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Maja R. Radojčić
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, United Kingdom
| | - Paula R. Beckenkamp
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paulo H. Ferreira
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Deborah J. Hart
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Nigel K. Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Manuela L. Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Mokubangele CM, Ebongue AN, Ouogue F, Bongue D, Moifo B. EVALUATION OF IRRADIATION DOSES DELIVERED TO PATIENTS IN COMPUTED TOMOGRAPHY EXAMINATIONS IN 10 RADIOLOGY DEPARTMENTS IN DOUALA-CAMEROON. RADIATION PROTECTION DOSIMETRY 2020; 191:288-295. [PMID: 33095233 DOI: 10.1093/rpd/ncaa124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 07/22/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
Computed tomography (CT) scan is currently the most irradiating radio diagnostic procedure for the patients. The effective dose delivered by a CT-scan exploration corresponds to 1-20 years of natural irradiation of an individual. Hence, there is need to evaluate this medical exposure, in order to provide indicators and propose guidelines for its daily practice. The purpose of this work was to assess patient exposure levels due to CT-scan exams and propose a local diagnostic reference levels for the most common CT examinations performed in the radiology units of Douala/Cameroon. Data from 1775 CT scans, amongst which 10 different types of common CT examinations on adults and children, were collected, of which 1378 were adult CT scans and 397 were pediatric CT scans. The dose-length product (DLP) values in the adult population for head, abdomen-pelvic and lumber spine CT scans were high as compared to the Institute for Radiological Protection and Nuclear Safety recommendations and previous local DRL with an increase of 36, 15 and 23%, respectively. A general decrease of the DLP for CT-scans examinations in the pediatric population was observed.
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Affiliation(s)
- Celestin Mpeke Mokubangele
- Centre for Atomic Molecular Physics and Quantum Optics (CEPAMOQ), University of Douala, P.O. Box 8580 Douala, Cameroon
| | | | - Francisse Ouogue
- Department of Radiology and Radiation Oncology, Faculty of Medicine and Biomedical Sciences, The University of Yaounde 1, Yaounde, Cameroon
| | - Daniel Bongue
- Centre for Atomic Molecular Physics and Quantum Optics (CEPAMOQ), University of Douala, P.O. Box 8580 Douala, Cameroon
| | - Boniface Moifo
- Department of Radiology and Radiation Oncology, Faculty of Medicine and Biomedical Sciences, The University of Yaounde 1, Yaounde, Cameroon
- Radiology Department, Yaounde Gynaeco-Obstetric and Pediatric Hospital, Yaounde, Cameroon
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14
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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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15
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Badenhorst D, Terblanche I, Ferreria N, Burger MC. Intramedullary fixation versus anatomically contoured plating of unstable ankle fractures: a randomized control trial. INTERNATIONAL ORTHOPAEDICS 2020; 44:561-568. [PMID: 31980861 DOI: 10.1007/s00264-020-04482-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/15/2020] [Indexed: 11/29/2022]
Abstract
AIM This study compared functional outcomes between anatomical shaped fibular plates and intramedullary nail fixation of adult patients who sustained unstable ankle fractures. METHODS A prospective randomized control trial was conducted between November 2013 and December 2016 on patients that presented with an unstable ankle fractures. They were randomized into a plate-and-screw group and a fibula nail group. At each post-operative visit the wounds were reviewed, and specific outcome measures were recorded, which included (i) the patient reported outcome measure (PROM) Olerud and Molander functional score, (ii) the Grimby score, (iii) swelling around the malleoli, (iv) plantar flexion, (v) dorsiflexion, (vi) inversion, and (vi) eversion. RESULTS Significant differences were observed in scar size (p < 0.001) and screening time (p < 0.001) whilst no differences were observed in functional and PROM measures. Although not statistically significant, of clinical value is one deep infection that occurred in the plate group, whilst no infections occurred in the nail group. CONCLUSION Both fixation methods yielded very similar functional results with differences only in scar size, screening time and swelling. Although none of these warrant a change in surgical decision-making processes, taken together, these factors potentially influence the decisions made in terms of surgical modalities used.
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Affiliation(s)
- Dhs Badenhorst
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg, Stellenbosch, 7505, South Africa
| | - Ips Terblanche
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg, Stellenbosch, 7505, South Africa
| | - N Ferreria
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg, Stellenbosch, 7505, South Africa
| | - M C Burger
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg, Stellenbosch, 7505, South Africa.
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16
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Computational dosimetry in a pediatric i-CAT procedure using virtual anthropomorphic phantoms. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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The Effects of Medical Diagnostic Low Dose X-rays after in vitro Exposure of Human Red Blood Cells: Hemolysis and Osmotic Fragility. TOXICOLOGY AND ENVIRONMENTAL HEALTH SCIENCES 2019. [DOI: 10.1007/s13530-019-0409-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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Im HW, Kim SY, Oh BM, Han TR, Seo HG. Radiation Dose During Videofluoroscopic Swallowing Studies and Associated Factors in Pediatric Patients. Dysphagia 2019; 35:84-89. [DOI: 10.1007/s00455-019-10006-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
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Downie A, Hancock M, Jenkins H, Buchbinder R, Harris I, Underwood M, Goergen S, Maher CG. How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years. Br J Sports Med 2019; 54:642-651. [DOI: 10.1136/bjsports-2018-100087] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 02/07/2023]
Abstract
ObjectivesTo (1) estimate the proportion of patients seeking care for low back pain (LBP) who are imaged and (2) explore trends in the proportion of patients who received diagnostic imaging over time. We also examined the effect of study-level factors on estimates of imaging proportion.Data sourcesElectronic searches of MEDLINE, Embase and CINAHL databases from January 1995 to December 2017.Eligibility criteria for selecting studiesObservational designs and controlled trials that reported imaging for patients presenting to primary care or emergency care for LBP. We assessed study quality and calculated pooled proportions by care setting and imaging type, with strength of evidence assessed using the GRADE system.Results45 studies were included. They represented 19 451 749 consultations for LBP that had resulted in 4 343 919 imaging requests/events over 21 years. Primary care: moderate quality evidence that simple imaging proportion was 16.3% (95% CI 12.6% to 21.1%) and complex imaging was 9.2% (95% CI 6.2% to 13.5%). For any imaging, the pooled proportion was 24.8% (95% CI 19.3%to 31.1%). Emergency care: moderate quality evidence that simple imaging proportion was 26.1% (95% CI 18.2% to 35.8%) and high-quality evidence that complex imaging proportion was 8.2% (95% CI 4.4% to 15.6%). For any imaging, the pooled proportion was 35.6% (95% CI 29.8% to 41.8%). Complex imaging increased from 7.4% (95% CI 5.7% to 9.6%) for imaging requested in 1995 to 11.4% (95% CI 9.6% to 13.5%) in 2015 (relative increase of 53.5%). Between-study variability in imaging proportions was only partially explained by study-level characteristics; there were insufficient data to comment on some prespecified study-level factors.Summary/conclusionOne in four patients who presented to primary care with LBP received imaging as did one in three who presented to the emergency department. The rate of complex imaging appears to have increased over 21 years despite guideline advice and education campaigns.Trial registration numberCRD42016041987.
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Synergistic effect of β-Bi2O3 and graphene/MWCNT in silicone-based polymeric matrices on diagnostic X-ray attenuation. APPLIED NANOSCIENCE 2019. [DOI: 10.1007/s13204-019-00972-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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De Roo B, Stichelbaut N, Hoste P, Verstraete K, Bacher K. The effective and collective dose to patients undergoing abdominopelvic and trunk computed tomography examinations: A Belgian multicentre study. Eur J Radiol 2019; 111:81-87. [DOI: 10.1016/j.ejrad.2018.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 10/27/2022]
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Ahmad IM, Abdalla MY, Moore TA, Bartenhagen L, Case AJ, Zimmerman MC. Healthcare Workers Occupationally Exposed to Ionizing Radiation Exhibit Altered Levels of Inflammatory Cytokines and Redox Parameters. Antioxidants (Basel) 2019; 8:antiox8010012. [PMID: 30609664 PMCID: PMC6356728 DOI: 10.3390/antiox8010012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 12/29/2022] Open
Abstract
Studies have shown an increased risk for a variety of cancers, specifically brain cancer, in healthcare workers occupationally exposed to ionizing radiation. Although the mechanisms mediating these phenomena are not fully understood, ionizing radiation-mediated elevated levels of reactive oxygen species (ROS), oxidative DNA damage, and immune modulation are likely involved. A group of 20 radiation exposed workers and 40 sex- and age-matched non-exposed control subjects were recruited for the study. We measured superoxide (O2•−) levels in whole blood of healthcare workers and all other measurements of cytokines, oxidative DNA damage, extracellular superoxide dismutase (EcSOD) activity and reduced/oxidized glutathione ratio (GSH/GSSG) in plasma. Levels of O2•− were significantly higher in radiation exposed workers compared to control. Similarly, a significant increase in the levels of interleukin (IL)-6, IL-1α and macrophage inflammatory protein (MIP)-1α in radiation exposed workers compared to control was observed, while there was no significance difference in the other 27 screened cytokines. A significant positive correlation was found between MIP-1α and O2•− levels with no correlation in either IL-6 or IL-1α. Further, a dose-dependent relationship with significant O2•− production and immune alterations in radiation exposed workers was demonstrated. There was no statistical difference between the groups in terms of oxidative DNA damage, GSH/GSSG levels, or EcSOD activity. Although the biologic significance of cytokines alterations in radiation exposed workers is unclear, further studies are needed for determining the underlying mechanism of their elevation.
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Affiliation(s)
- Iman M Ahmad
- Department of Medical Imaging and Therapeutic Sciences, College of Allied Health Professions, University of Nebraska Medical Center (UNMC), Omaha, NE 68198, USA.
| | - Maher Y Abdalla
- Department of Pathology and Microbiology, College of Medicine, UNMC, Omaha, NE 68198, USA.
| | | | - Lisa Bartenhagen
- Department of Medical Imaging and Therapeutic Sciences, College of Allied Health Professions, University of Nebraska Medical Center (UNMC), Omaha, NE 68198, USA.
| | - Adam J Case
- Department of Cellular and Integrative Physiology, College of Medicine, UNMC, Omaha, NE 68198, USA.
| | - Matthew C Zimmerman
- Department of Cellular and Integrative Physiology, College of Medicine, UNMC, Omaha, NE 68198, USA.
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Brown SR, Fearnhead NS, Faiz OD, Abercrombie JF, Acheson AG, Arnott RG, Clark SK, Clifford S, Davies RJ, Davies MM, Douie WJP, Dunlop MG, Epstein JC, Evans MD, George BD, Guy RJ, Hargest R, Hawthorne AB, Hill J, Hughes GW, Limdi JK, Maxwell-Armstrong CA, O'Connell PR, Pinkney TD, Pipe J, Sagar PM, Singh B, Soop M, Terry H, Torkington J, Verjee A, Walsh CJ, Warusavitarne JH, Williams AB, Williams GL, Wilson RG. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease. Colorectal Dis 2018; 20 Suppl 8:3-117. [PMID: 30508274 DOI: 10.1111/codi.14448] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/17/2018] [Indexed: 12/14/2022]
Abstract
AIM There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology. METHODS Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines. RESULTS All aspects of surgical care for IBD have been included along with 157 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.
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Affiliation(s)
- S R Brown
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - N S Fearnhead
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - O D Faiz
- St Mark's Hospital, Middlesex, Harrow, UK
| | | | - A G Acheson
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R G Arnott
- Patient Liaison Group, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - S K Clark
- St Mark's Hospital, Middlesex, Harrow, UK
| | | | - R J Davies
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M M Davies
- University Hospital of Wales, Cardiff, UK
| | - W J P Douie
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - J C Epstein
- Salford Royal NHS Foundation Trust, Salford, UK
| | - M D Evans
- Morriston Hospital, Morriston, Swansea, UK
| | - B D George
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R J Guy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Hargest
- University Hospital of Wales, Cardiff, UK
| | | | - J Hill
- Manchester Foundation Trust, Manchester, UK
| | - G W Hughes
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - J K Limdi
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | | | | | - T D Pinkney
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Pipe
- Patient Liaison Group, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - P M Sagar
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Singh
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M Soop
- Salford Royal NHS Foundation Trust, Salford, UK
| | - H Terry
- Crohn's and Colitis UK, St Albans, UK
| | | | - A Verjee
- Patient Liaison Group, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - C J Walsh
- Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Upton, UK
| | | | - A B Williams
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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24
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Nucera R, Lo Giudice A, Bellocchio M, Spinuzza P, Caprioglio A, Cordasco G. Diagnostic concordance between skeletal cephalometrics, radiograph-based soft-tissue cephalometrics, and photograph-based soft-tissue cephalometrics. Eur J Orthod 2018; 39:352-357. [PMID: 27932406 DOI: 10.1093/ejo/cjw072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective This study aims to investigate the diagnostic concordance between skeletal cephalometrics and soft-tissue cephalometrics in identifying facial lower third characteristics. Materials and methods We compared a skeletal cephalometric analysis (SCA) to a soft-tissue analysis performed on cephalometric radiographs (rSTCA) and to one performed on profile photograph (pSTCA). Ninety-six pre-treatment digital lateral cephalometric radiographs and 96 digital profile photographs were randomly selected for this study (patients' mean age: 18.33, SD: 3.38, age range: 14-29). Inclusion criteria were as follows: no skeletal asymmetry, well-aligned upper and lower dental arches, no history of orthodontic treatment, prosthodontic treatment, facial surgery and trauma, patient's age between 14 and 30 years, high-resolution images, exams taken with natural head position. Kruskas-Wallis and post hoc pairwise comparisons tests were used to find differences among the considered cephalometric methods. The diagnostic performance of the three methods was also assessed using the receiver-operating characteristic (ROC) curve analysis. Results Significant differences were found between SCA and rSTCA and between SCA and pSTCA in defining sagittal and vertical facial lower third characteristics (P < 0.05). No differences were found between rSTCA and pSTCA (P > 0.05) for the same facial characteristics. For each parameters investigated, pSTCA showed an area under the curve much closer to the perfect value of 1.00. Conclusion Poor diagnostic concordance was found between SCA and rSTCA and between SCA and pSTCA. pSTCA is a reliable method for evaluating the soft-tissue profile characteristics compared to that performed on cephalograms.
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Affiliation(s)
- Riccardo Nucera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging-Section of Orthodontics, School of Dentistry, University of Messina
| | - Antonino Lo Giudice
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging-Section of Orthodontics, School of Dentistry, University of Messina
| | - Mirea Bellocchio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging-Section of Orthodontics, School of Dentistry, University of Messina
| | - Paola Spinuzza
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging-Section of Orthodontics, School of Dentistry, University of Messina
| | - Alberto Caprioglio
- Department of Surgical and Morphological Sciences-Section of Orthodontics, School of Medicine, University of Insubria, Varese, Italy
| | - Giancarlo Cordasco
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging-Section of Orthodontics, School of Dentistry, University of Messina
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Jenkins HJ, Downie AS, Moore CS, French SD. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropr Man Therap 2018; 26:48. [PMID: 30479744 PMCID: PMC6247638 DOI: 10.1186/s12998-018-0217-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/02/2018] [Indexed: 12/26/2022] Open
Abstract
The use of routine spinal X-rays within chiropractic has a contentious history. Elements of the profession advocate for the need for routine spinal X-rays to improve patient management, whereas other chiropractors advocate using spinal X-rays only when endorsed by current imaging guidelines. This review aims to summarise the current evidence for the use of spinal X-ray in chiropractic practice, with consideration of the related risks and benefits. Current evidence supports the use of spinal X-rays only in the diagnosis of trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis. MRI is indicated to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis. Strong evidence demonstrates risks of imaging such as excessive radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased costs. In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.
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Affiliation(s)
- Hazel J Jenkins
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Aron S Downie
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Craig S Moore
- 2Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Simon D French
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.,3School of Rehabilitation Therapy, Queen's University, Kingston, ON Canada
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Vaiserman A, Koliada A, Zabuga O, Socol Y. Health Impacts of Low-Dose Ionizing Radiation: Current Scientific Debates and Regulatory Issues. Dose Response 2018; 16:1559325818796331. [PMID: 30263019 PMCID: PMC6149023 DOI: 10.1177/1559325818796331] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/31/2022] Open
Abstract
Health impacts of low-dose ionizing radiation are significant in important fields such as X-ray imaging, radiation therapy, nuclear power, and others. However, all existing and potential applications are currently challenged by public concerns and regulatory restrictions. We aimed to assess the validity of the linear no-threshold (LNT) model of radiation damage, which is the basis of current regulation, and to assess the justification for this regulation. We have conducted an extensive search in PubMed. Special attention has been given to papers cited in comprehensive reviews of the United States (2006) and French (2005) Academies of Sciences and in the United Nations Scientific Committee on Atomic Radiation 2016 report. Epidemiological data provide essentially no evidence for detrimental health effects below 100 mSv, and several studies suggest beneficial (hormetic) effects. Equally significant, many studies with in vitro and in animal models demonstrate that several mechanisms initiated by low-dose radiation have beneficial effects. Overall, although probably not yet proven to be untrue, LNT has certainly not been proven to be true. At this point, taking into account the high price tag (in both economic and human terms) borne by the LNT-inspired regulation, there is little doubt that the present regulatory burden should be reduced.
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Chung S. Computer-Assisted formulas predicting radiation-exposure-induced-cancer risk in interplanetary travelers: Radiation safety for astronauts in space flight to mars. JOURNAL OF MEDICAL SCIENCES 2018. [DOI: 10.4103/jmedsci.jmedsci_125_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Manosudprasit A, Haghi A, Allareddy V, Masoud MI. Diagnosis and treatment planning of orthodontic patients with 3-dimensional dentofacial records. Am J Orthod Dentofacial Orthop 2017; 151:1083-1091. [PMID: 28554454 DOI: 10.1016/j.ajodo.2016.10.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/01/2016] [Accepted: 10/01/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cephalometrics has been the foundation of orthodontic diagnosis for many years. However, for many orthodontic patients, a lateral cephalogram might not be necessary. The aim of this study was to compare the diagnosis and treatment planning agreement between standard records and nonradiographic 3-dimensional (3D) dentofacial photogrammetry records. METHODS Twenty patients had standard orthodontic records taken for their treatment as well as extraoral and intraoral 3D images. Twelve evaluators examined the standard records and then completed diagnosis and treatment planning questionnaires. They repeated the process 4 to 6 weeks later by using 3D photographic images along with the panoramic radiographs. Each evaluator also evaluated 2 random orthodontic cases twice with each method to evaluate consistency within each method. At the end of study, each evaluator was asked to complete a survey to document his or her experiences with the 3D photogrammetry method. Descriptive and kappa statistics were used to determine the agreement. RESULTS Most diagnosis parameters had fair agreement between the methods and within each method. Skeletal and dental relationships had excellent agreement between and within the methods as well as most treatment decisions such as the need for extractions and surgery. Most evaluators (91.7%) thought that cephalometric x-rays would be needed only some of the time in diagnosis and treatment planning. Most evaluators (83.33%) thought that cephalometric radiographs are not needed in patients with a Class I ± a quarter cusp with crowding or spacing. CONCLUSIONS Most diagnostic decisions had fair agreement within and between the 2 methods. The decision to extract and the need for orthognathic surgery had excellent agreement between the cephalometric and photogrammetric methods. The majority of examiners agreed that patients with Class I malocclusions ± a quarter cusp with no obvious skeletal discrepancy can be diagnosed and planned without a cephalometric radiograph.
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Affiliation(s)
- Amornrut Manosudprasit
- Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass.
| | - Arshan Haghi
- Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Mass
| | - Veerasathpurush Allareddy
- Department of Orthodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Mohamed I Masoud
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Mass
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Tungjai M, Phathakanon N, Rithidech KN. Effects of Medical Diagnostic Low-dose X Rays on Human Lymphocytes: Mitochondrial Membrane Potential, Apoptosis and Cell Cycle. HEALTH PHYSICS 2017; 112:458-464. [PMID: 28350700 DOI: 10.1097/hp.0000000000000647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Low-dose radiation is widely used across the world for the diagnosis of many diseases by means of a variety of imaging technologies. However, the harmful effects of exposure to low-dose radiation during medical examination remain controversial. The authors studied the effects of medical diagnostic low-dose x rays (i.e., 0.03, 0.05, or 0.1 mGy) after an in vitro exposure of human lymphocytes. Cells with no irradiation served as the non-irradiated control group. Three biological indicators were used to determine the effects of medical diagnostic low-dose x rays at 4, 8, 24, 48, and 72 h post-irradiation. These biological endpoints were mitochondrial membrane potential (ΔΨm), cell cycle, and apoptosis. Results indicated no changes in the ΔΨm, number of apoptotic cells, and cell cycle in lymphocytes exposed to these low doses of radiation, as compared to the corresponding non-irradiated lymphocytes at all harvest time-points. These results suggested that there were no harmful effects of the diagnostic low-dose x rays when human lymphocytes were exposed in an in vitro condition.
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Affiliation(s)
- Montree Tungjai
- *Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Intawaroroj Rd., Sripoom, Chiang Mai, 50200, Thailand; †Department of Pathology, Stony Brook University, Stony Brook, NY 11794-8691
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Nawfel RD, Young GS. Measured Head CT/CTA Skin Dose and Intensive Care Unit Patient Cumulative Exposure. AJNR Am J Neuroradiol 2017; 38:455-461. [PMID: 28104641 DOI: 10.3174/ajnr.a5040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/13/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Estimates of cumulative CT/CTA radiation dose based on volumetric CT dose index have raised concern that neurological intensive care unit patient exposures may reach thresholds for deterministic skin injury. Because the accuracy of volumetric CT dose index for this purpose in unknown, we set out to directly measure head CT and CTA peak skin dose, assess the relationship of volumetric CT dose index to measured peak skin dose, and determine whether multiple CT/CTA exposures in typical patients in the neurological intensive care unit produce cumulative doses approaching or exceeding single-dose deterministic thresholds for skin injury. MATERIALS AND METHODS In a prospective study from 2011-2013, nanoDot optical stimulated luminescence dosimeters were used to measure head CT/CTA peak skin dose in 52 patients (28 female, 24 male; mean age, 63 years) divided equally between 2 CT scanners. Volumetric CT dose index and dose-length product were recorded for each examination. Peak skin dose was also measured on an acrylic skull phantom in each scanner. A 2-tailed, unpaired t test was used to compare mean patient skin doses between the 2 scanners. The measured peak skin doses were then used to calculate cumulative peak skin dose in 4 typical patients in intensive care units who received multiple CT/CTA scans. RESULTS Head CT/CTA peak skin dose agreed between scanners in patients and phantoms: (scanner 1 CT/CTA: patients, 39.2 ± 3.7 mGy and 98.9 ± 5.3 mGy, respectively, versus phantom, 40.0 mGy and 105.4 mGy, respectively; scanner 2 CT/CTA: patients, 42.9 ± 9.4 mGy and 98.8 ± 7.4 mGy, respectively, versus phantom, 37.6 mGy and 95.2 mGy, respectively). Volumetric CT dose index overestimated peak skin dose by a factor of 1.4-1.9 depending on examination and CT scanner. Cumulative doses in 4 patients in the intensive care unit estimated from measured CT/CTA peak skin dose ranged from 1.9-4.5 Gy. CONCLUSIONS Directly measured radiation skin doses from head CT/CTA patient examinations are substantially lower than volumetric CT dose index. Measured peak skin dose confirms that multiple head CT/CTA examinations in representative patients in the neurological intensive care unit may produce cumulative doses exceeding the single-dose deterministic threshold for skin injury.
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Affiliation(s)
- R D Nawfel
- From the Department of Radiology (R.D.N., G.S.Y.), Brigham and Women's Hospital, Boston, Massachusetts
- Department of Radiology (R.D.N., G.S.Y.), Harvard Medical School, Boston, Massachusetts
| | - G S Young
- From the Department of Radiology (R.D.N., G.S.Y.), Brigham and Women's Hospital, Boston, Massachusetts
- Department of Radiology (G.S.Y.), Dana Farber Cancer Institute, Boston, Massachusetts
- Department of Radiology (R.D.N., G.S.Y.), Harvard Medical School, Boston, Massachusetts
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Schoenhals JE, Skrepnik T, Selek U, Cortez MA, Li A, Welsh JW. Optimizing Radiotherapy with Immunotherapeutic Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 995:53-71. [PMID: 28321812 DOI: 10.1007/978-3-319-53156-4_3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Several factors must be considered to successfully integrate immunotherapy with radiation into clinical practice. One such factor is that concepts arising from preclinical work must be tested in combination with radiation in preclinical models to better understand how combination therapy will work in patients; examples include checkpoint inhibitors, tumor growth factor-beta (TGF-β) inhibitors, and natural killer (NK) cell therapy. Also, many radiation fields and fractionation schedules typically used in radiation therapy had been standardized before the introduction of advanced techniques for radiation planning and delivery that account for changes in tumor size, location, and motion during treatment, as well as uncertainties introduced by variations in patient setup between treatment fractions. As a result, radiation therapy may involve the use of large treatment volumes, often encompassing nodal regions that may not be irradiated with more conformal techniques. Traditional forms of radiation in particular pose challenges for combination trials with immunotherapy. This chapter explores these issues in more detail and provides insights as to how radiation therapy can be optimized to combine with immunotherapy.
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Affiliation(s)
- Jonathan E Schoenhals
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tijana Skrepnik
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
| | - Ugur Selek
- Department of Radiation Oncology, Koc University, Istanbul, Turkey
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Anderson Central (Y2.5316), 1515 Holcombe Blvd., Unit 0097, Houston, TX, 77030, USA
| | - Maria A Cortez
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ailin Li
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Anderson Central (Y2.5316), 1515 Holcombe Blvd., Unit 0097, Houston, TX, 77030, USA.
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Power SP, Moloney F, Twomey M, James K, O’Connor OJ, Maher MM. Computed tomography and patient risk: Facts, perceptions and uncertainties. World J Radiol 2016; 8:902-915. [PMID: 28070242 PMCID: PMC5183924 DOI: 10.4329/wjr.v8.i12.902] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/29/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Since its introduction in the 1970s, computed tomography (CT) has revolutionized diagnostic decision-making. One of the major concerns associated with the widespread use of CT is the associated increased radiation exposure incurred by patients. The link between ionizing radiation and the subsequent development of neoplasia has been largely based on extrapolating data from studies of survivors of the atomic bombs dropped in Japan in 1945 and on assessments of the increased relative risk of neoplasia in those occupationally exposed to radiation within the nuclear industry. However, the association between exposure to low-dose radiation from diagnostic imaging examinations and oncogenesis remains unclear. With improved technology, significant advances have already been achieved with regards to radiation dose reduction. There are several dose optimization strategies available that may be readily employed including omitting unnecessary images at the ends of acquired series, minimizing the number of phases acquired, and the use of automated exposure control as opposed to fixed tube current techniques. In addition, new image reconstruction techniques that reduce radiation dose have been developed in recent years with promising results. These techniques use iterative reconstruction algorithms to attain diagnostic quality images with reduced image noise at lower radiation doses.
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JOURNAL CLUB: Scatter Radiation Dose From Digital Screening Mammography Measured in a Representative Patient Population. AJR Am J Roentgenol 2016; 206:359-64; quiz 365. [PMID: 26797364 DOI: 10.2214/ajr.15.14921] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to quantify the amount of scatter radiation received at the skin surface overlying the thyroid gland, salivary gland, lens of the eye, sternum, and uterus during a routine screening digital mammographic examination measured in a representative patient population. SUBJECTS AND METHODS The subjects were 207 women without symptoms with varied body mass indexes who underwent annual screening mammography while wearing six optically stimulated luminescence dosimeters placed at the bridge of the nose, right submandibular gland, right and left thyroid lobes, mid sternum, and 2 cm caudal to the umbilicus to assess scatter radiation dose to the skin. RESULTS The average scatter radiation doses at the skin surface during digital screening mammography in the representative population of women were as follows: overlying the right lobe of the thyroid, 0.24 mGy; left lobe of the thyroid, 0.25 mGy; salivary gland, 0.2 mGy; bridge of the nose, 0.025 mGy; sternum, 0.87 mGy; and umbilicus, 0.011 mGy. The scatter radiation doses at the umbilicus and the bridge of the nose were too low to measure with statistical confidence. Scatter radiation dose increased with increasing body mass index and increasing breast compression thickness. CONCLUSION Scatter radiation dose at the skin overlying organs of interest is a small fraction of the entrance skin dose to the breast. The low levels of scatter radiation measured do not support delaying clinically indicated mammography during early pregnancy.
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Vered Y, Chetrit A, Sgan-Cohen HD, Amitai T, Mann J, Even-Nir H, Sadetzki S. Caries Experience among Adults Exposed to Low to Moderate Doses of Ionizing Radiation in Childhood - The Tinea Capitis Cohort. Front Public Health 2016; 4:18. [PMID: 26942172 PMCID: PMC4763082 DOI: 10.3389/fpubh.2016.00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/01/2016] [Indexed: 12/12/2022] Open
Abstract
While the impact of therapeutic levels of ionizing radiation during childhood on dental defects has been documented, the possible effect of low doses on dental health is unknown. The study aim was to assess the association between childhood exposure to low-moderate doses of therapeutic radiation and caries experience among a cohort of adults 50 years following the exposure. The analysis was based on a sample of 253 irradiated (in the treatment of tinea capitis) and 162 non-irradiated subjects. The decayed, missing, and filled teeth (DMFT) index was assessed during a clinical dental examination and questions regarding dental care services utilization, oral hygiene behavior, current self-perceived mouth dryness, socio-demographic parameters, and health behavior variables were obtained through a face-to-face interview. An ordered multivariate logistic regression model was used to assess the association of the main independent variable (irradiation status) and other relevant independent variables on the increase in DMFT. Mean caries experience levels (DMFT) were 18.6 ± 7.5 for irradiated subjects compared to 16.4 ± 7.2 for the non-irradiated (p = 0.002). Controlling for gender, age, education, income, smoking, dental visit in the last year, and brushing teeth behavior, irradiation was associated with a 72% increased risk for higher DMFT level (95% CI: 1.19-2.50). A quantification of the risk by dose absorbed in the salivary gland and in the thyroid gland showed adjusted ORs of 2.21 per 1 Gy (95% CI: 1.40-3.50) and 1.05 per 1 cGy (95% CI: 1.01-1.09), respectively. Childhood exposure to ionizing radiation (0.2-0.4 Gy) might be associated with late outcomes of dental health. In line with the guidelines of the American Dental Association, these results call for caution when using dental radiographs.
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Affiliation(s)
- Yuval Vered
- Department of Community Dentistry, Hadassah Faculty of Dental Medicine, Hebrew University , Jerusalem , Israel
| | - Angela Chetrit
- Cancer and Radiation Epidemiology Unit, Chaim Sheba Medical Center, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel
| | - Harold D Sgan-Cohen
- Department of Community Dentistry, Hadassah Faculty of Dental Medicine, Hebrew University , Jerusalem , Israel
| | - Tova Amitai
- Cancer and Radiation Epidemiology Unit, Chaim Sheba Medical Center, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel
| | - Jonathan Mann
- Department of Community Dentistry, Hadassah Faculty of Dental Medicine, Hebrew University , Jerusalem , Israel
| | - Hadas Even-Nir
- Cancer and Radiation Epidemiology Unit, Chaim Sheba Medical Center, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel
| | - Siegal Sadetzki
- Cancer and Radiation Epidemiology Unit, Chaim Sheba Medical Center, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Thermoluminescent dosimeters for low dose X-ray measurements. Appl Radiat Isot 2016; 107:340-345. [DOI: 10.1016/j.apradiso.2015.11.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/30/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022]
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Villa L, Giusti G, Knoll T, Traxer O. Imaging for Urinary Stones: Update in 2015. Eur Urol Focus 2015; 2:122-129. [PMID: 28723526 DOI: 10.1016/j.euf.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/14/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Imaging is essential for the diagnosis and the clinical decision-making process of patients with urinary stones. OBJECTIVE To assess the benefits and limitations of various imaging techniques by specifically focusing on different phases of stone patients' management. EVIDENCE ACQUISITION PubMed and Web of Science databases were used to identify studies published in the last 10 yr on this argument. Search terms included 'urolithiasis', nephrolithiasis', or 'urinary stones' in combination (AND) with the terms 'imaging', 'computer tomography', 'ultrasonography', 'intravenous pyelogram', or 'radiation exposure'. Study selection was based on an independent peer-review process of all the authors after the structured data search. EVIDENCE SYNTHESIS Noncontrast-enhanced computer tomography (CT) provides the highest value of diagnostic accuracy for urinary stones. Stone composition can be specifically assessed through the use of dual-energy CT. When information about the anatomy of the renal collecting system is required or alternative pathologies are suspected, CT with contrast injection is recommended. Low-dose protocols allowed a drastic reduction of the effective dose administered to the patient, thus limiting the biological risk due to ionising radiations. Other strategies to contain the radiation exposure include the dual-split bolus dual energy CT and the adaptive statistical image reconstruction. Abdomen ultrasound may be a valid alternative as an initial approach since it does not change the outcome of patients compared with CT, and should be the imaging of choice in children and pregnant women. CONCLUSIONS Noncontrast-enhanced CT is the most accurate imaging technique to identify urinary stones. Abdomen ultrasound seems to be a valid alternative in the initial evaluation of urinary colic. New low-dose protocols and strategies have been developed to contain radiation exposure, which is a major issue especially in specific circumstances. PATIENT SUMMARY Noncontrast-enhanced computer tomography has been increasingly used for the diagnosis and management of urinary stones. Low-dose protocols as well as alternative imaging should be considered by clinicians in specific circumstances to minimise radiation exposure.
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Affiliation(s)
- Luca Villa
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Guido Giusti
- Department of Urology, IRCCS Ospedale San Raffaele Ville Turro, Milan, Italy
| | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Boeblingen, University of Tuebingen, Sindelfingen, Germany
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, Pierre et Marie Curie University, Paris, France
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Sadetzki S, Chetrit A, Sgan-Cohen HD, Mann J, Amitai T, Even-Nir H, Vered Y. Long-Term Effects of Exposure to Ionizing Irradiation on Periodontal Health Status - The Tinea capitis Cohort Study. Front Public Health 2015; 3:226. [PMID: 26539423 PMCID: PMC4610133 DOI: 10.3389/fpubh.2015.00226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/22/2015] [Indexed: 12/19/2022] Open
Abstract
Studies among long-term survivors of childhood cancer who had received high-dose irradiation therapy of 4–60 Gy, demonstrated acute and chronic dental effects, including periodontal diseases. However, the possible effects of low to moderate doses of radiation on dental health are sparse. The aim of this study is to investigate the association between childhood exposure to low–moderate doses of ionizing radiation and periodontal health following 50 years since exposure. The study population included 253 irradiated subjects (treated for Tinea capitis in the 1950s) and, 162 non-irradiated subjects. The estimated dose to the teeth was 0.2–0.4 Gy. Dental examination was performed according to the community periodontal index (CPI). Socioeconomic and health behavior variables were obtained through a personal questionnaire. Periodontal disease was operationally defined as “deep periodontal pockets.” A multivariate logistic regression model was used for the association of irradiation status and other independent variables with periodontal status. The results showed that among the irradiated subjects, 23%, (95% CI 18–28%) demonstrated complete edentulousness or insufficient teeth for CPI scoring as compared to 13% (95% CI 8–19%) among the non-irradiated subjects (p = 0.01). Periodontal disease was detected among 54% of the irradiated subjects as compared to 40% of the non-irradiated (p = 0.008). Controlling for education and smoking, the ORs for the association between radiation and periodontal disease were 1.61 (95% CI 1.01–2.57) and 1.95 (95% CI 1.1–3.5) for ever never and per 1 Gy absorbed in the salivary gland, respectively. In line with other studies, a protective effect for periodontal diseases among those with high education and an increased risk for ever smokers were observed. In conclusion, childhood exposure to low-moderate doses of ionizing radiation might be associated with later outcomes of dental health. The results add valuable data on the long-term health effects of exposure to ionizing radiation and support the implementation of the ALARA principle in childhood exposure to diagnostic procedure involving radiation.
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Affiliation(s)
- Siegal Sadetzki
- Cancer and Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center , Tel Hashomer , Israel ; Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Angela Chetrit
- Cancer and Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Harold D Sgan-Cohen
- Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University Hadassah Medical School , Jerusalem , Israel
| | - Jonathan Mann
- Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University Hadassah Medical School , Jerusalem , Israel
| | - Tova Amitai
- Cancer and Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Hadas Even-Nir
- Cancer and Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Yuval Vered
- Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University Hadassah Medical School , Jerusalem , Israel
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Safety and Protection. Oral Radiol 2014. [DOI: 10.1016/b978-0-323-09633-1.00003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jung YS, Park DI, Moon CM, Park SJ, Hong SP, Kim TI, Kim WH, Cheon JH. Radiation exposure from abdominal imaging studies in patients with intestinal Behçet disease. Gut Liver 2013; 8:380-7. [PMID: 25071902 PMCID: PMC4113057 DOI: 10.5009/gnl.2014.8.4.380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/25/2013] [Accepted: 07/05/2013] [Indexed: 12/20/2022] Open
Abstract
Background/Aims Recently, several studies have revealed that diagnostic imaging can result in exposure to harmful levels of ionizing radiation in inflammatory bowel disease patients. However, the extent of radiation exposure in intestinal Behcet disease (BD) patients has not been documented. The aim of this study was to estimate the radiation exposure from abdominal imaging studies in intestinal BD patients. Methods Patients with a diagnosis of intestinal BD established between January 1990 and March 2012 were investigated at a single tertiary academic medical center. The cumulative effective dose (CED) was calculated retrospectively from standard tables and by counting the number of abdominal imaging studies performed. High exposure was defined as CED >50 mSv. Results In total, 270 patients were included in the study. The mean CED was 41.3 mSv, and 28.1% of patients were exposed to high levels of radiation. Computed tomography (CT) accounted for 81.7% of the total effective dose. In multivariate analyses, predictors of high radiation exposure were azathioprine/6-mercaptopurine use, surgery, and hospitalization. Conclusions Approximately a quarter of intestinal BD patients were exposed to harmful levels of diagnostic radiation, mainly from CT examination. Clinicians should reduce the number of unnecessary CT examinations and consider low-dose CT profiles or alternative modalities such as magnetic resonance enterography.
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Affiliation(s)
- Yoon Suk Jung
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea ; Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Mo Moon
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Jung Park
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Pil Hong
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ho Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Candela-Juan C, Montoro A, Ruiz-Martínez E, Villaescusa JI, Martí-Bonmatí L. Current knowledge on tumour induction by computed tomography should be carefully used. Eur Radiol 2013; 24:649-56. [PMID: 24281269 DOI: 10.1007/s00330-013-3047-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/24/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
Abstract
Risks associated to ionising radiation from medical imaging techniques have focused the attention of the medical society and general population. This risk is aimed to determine the probability that a tumour is induced as a result of a computed tomography (CT) examination since it makes nowadays the biggest contribution to the collective dose. Several models of cancer induction have been reported in the literature, with diametrically different implications. This article reviews those models, focusing on the ones used by the scientific community to estimate CT detriments. Current estimates of the probability that a CT examination induces cancer are reported, highlighting its low magnitude (near the background level) and large sources of uncertainty. From this objective review, it is concluded that epidemiological data with more accurate dosimetric estimates are needed. Prediction of the number of tumours that will be induced in population exposed to ionising radiation should be avoided or, if given, it should be accompanied by a realistic evaluation of its uncertainty and of the advantages of CTs. Otherwise they may have a negative impact in both the medical community and the patients. Reducing doses even more is not justified if that compromises clinical image quality in a necessary investigation. Key Points • Predictions of radiation-induced cancer should be discussed alongside benefits of imaging. • Estimates of induced cancers have noticeable uncertainties that should always be highlighted. • There is controversy about the acceptance of the linear no-threshold model. • Estimated extra risks of cancer are close to the background level. • Patients should not be alarmed by potential cancer induction by CT examinations.
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Affiliation(s)
- Cristian Candela-Juan
- Radioprotection Department, La Fe University and Polytechnic Hospital, Valencia, 46026, Spain,
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Gay F, Pavia Y, Pierrat N, Lasalle S, Neuenschwander S, Brisse HJ. Dose reduction with adaptive statistical iterative reconstruction for paediatric CT: phantom study and clinical experience on chest and abdomen CT. Eur Radiol 2013; 24:102-11. [DOI: 10.1007/s00330-013-2982-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/03/2013] [Accepted: 07/17/2013] [Indexed: 01/21/2023]
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Das Roy L, Giri S, Singh S, Giri A. Effects of radiation and vitamin C treatment on metronidazole genotoxicity in mice. Mutat Res 2013; 753:65-71. [PMID: 23416157 DOI: 10.1016/j.mrgentox.2013.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 01/26/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
Abstract
The impact of exposure to low dose radiation (LDR) on human health is not clear. Besides, cross adaptation or sensitization with pharmaceutical agents may modify the risk of LDR. In the present study, we analyzed the interaction of radiation and metronidazole (MTZ) in inducing chromosome aberration (CA) and micronucleus (MN) in the bone marrow cells of Balb/C mice in vivo. Further, we evaluated the efficacy of vitamin C to reduce MTZ induced genotoxicity. We found that 10, 20 and 40mg/kg of MTZ induced dose dependent increase in the frequency of CA (r=0.9923, P<0.01) as well as MN (r=0.9823, P<0.05) in polychromatic erythrocytes. However, MTZ did not affect the ratio of polychromatic erythrocytes to normochromatic erythrocytes indicating lack of cytotoxicity. Supplementation with vitamin C prior to MTZ treatment significantly reduced the frequency of CA (P<0.001) as well as MN (P<0.001). Radiation (0.5Gy) exposure prior to MTZ treatment produced a less than additive (for CA) to additive (for MN) effects. However, radiation exposure following MTZ treatment produced additive (for CA) and synergistic (for MN) effects. Further, vitamin C pre-treatment also reduced the genotoxicity indices following the combined treatment of MTZ and radiation. Our findings suggest that MTZ may sensitize bone marrow cells to radiation exposure and enhances genotoxicity. We recommend more studies on the interaction of LDR and marketed pharmaceuticals to minimize possible harmful outcomes through appropriate precautionary measures.
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Affiliation(s)
- Lopamudra Das Roy
- Department of Life Science & Bioinformatics, Assam University, Silchar, India
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Minhas AS, Frush DP. Compendium of Resources for Radiation Safety in Medical Imaging Using Ionizing Radiation. J Am Coll Radiol 2013; 10:354-60, 360.e1-2. [DOI: 10.1016/j.jacr.2012.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
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Cone beam computed tomography in paediatric dentistry: overview of recent literature. Eur Arch Paediatr Dent 2013; 14:131-40. [DOI: 10.1007/s40368-013-0029-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chun SH, Park GY, Han YK, Kim SD, Kim JS, Lee CG, Yang K. Effect of low dose radiation on differentiation of bone marrow cells into dendritic cells. Dose Response 2012; 11:374-84. [PMID: 23983665 DOI: 10.2203/dose-response.12-041.lee] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Low dose radiation has been shown to be beneficial to living organisms using several biological systems, including immune and hematopoietic systems. Chronic low dose radiation was shown to stimulate immune systems, resulting in controlling the proliferation of cancer cells, maintain immune balance and induce hematopoietic hormesis. Since dendritic cells are differentiated from bone marrow cells and are key players in maintaining the balance between immune activation and tolerance, it may be important to further characterize whether low dose radiation can influence the capacity of bone marrow cells to differentiate into dendritic cells. We have shown that bone marrow cells from low dose-irradiated (γ-radiation, 0.2Gy, 15.44mGy/h) mice can differentiate into dendritic cells that have several different characteristics, such as expression of surface molecules, cytokine secretion and antigen uptake capacity, when compared to dentritic cells differentiated from the control bone marrow cells. These differences observed in the low dose radiation group can be beneficial to living organisms either by activation of immune responses to foreign antigens or tumors, or maintenance of self-tolerance. To the best of our knowledge, this is the first report showing that total-body low dose radiation can modulate the capacity of bone marrow cells to differentiate into dendritic cells.
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Affiliation(s)
- Sung Hak Chun
- Research Center, Dongnam Institute of Radiological & Medical Sciences, Busan 619-953, Korea
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Daniels RD, Bertke S, Waters KM, Schubauer-Berigan MK. Risk of leukaemia mortality from exposure to ionising radiation in US nuclear workers: a pooled case-control study. Occup Environ Med 2012; 70:41-8. [PMID: 23000827 DOI: 10.1136/oemed-2012-100906] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To follow-up on earlier studies of the leukaemogenicity of occupational ionising radiation exposure. METHODS We conducted a nested case-control analysis of leukaemia mortality in a pooled cohort of US nuclear workers followed through 2005. Each case was matched to four controls on attained age. Exposures were estimated from available records. General relative risk models were used to estimate the excess relative risk (ERR) of leukaemia, excluding chronic lymphocytic (CLL), acute myeloid leukaemia, chronic myeloid leukaemia and CLL while controlling for potential confounders. Preferred exposure lags and time-windows of risks were calculated using joint maximum likelihood. Dose-response was also examined using linear, linear-quadratic, categorical and restricted cubic spline models. RESULTS There were 369 leukaemia deaths in 105 245 US nuclear workers. The adjusted ERR for non-CLL leukaemia was 0.09 (95% CI -0.17 to 0.65) per 100 mGy. Elevated non-CLL risks were observed from exposures occurring 6-14 years prior to attained age of cases (ERR per 100 mGy=1.9; 95% CI <0 to 8.0). Lagged models indicated non-linearity of risk at very low (<10 mGy) and high (>100 mGy) doses, which contributed to the imprecision of results in linear models. Similar risk attenuation was not evident in time-windows-based models. CONCLUSIONS Risk estimates were in reasonable agreement with previous estimates, with the temporality of non-CLL leukaemia risk as a dominant factor in dose-response analyses. Future research should focus on methods that improve evaluations of the dose-response, particularly in the low-dose range.
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Affiliation(s)
- Robert D Daniels
- National Institute for Occupational Safety and Health (NIOSH), Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), Industrywide Studies Branch (IWSB), Cincinnati, OH 45226, USA.
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Olipitz W, Wiktor-Brown D, Shuga J, Pang B, McFaline J, Lonkar P, Thomas A, Mutamba JT, Greenberger JS, Samson LD, Dedon PC, Yanch JC, Engelward BP. Integrated molecular analysis indicates undetectable change in DNA damage in mice after continuous irradiation at ~ 400-fold natural background radiation. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1130-6. [PMID: 22538203 PMCID: PMC3440074 DOI: 10.1289/ehp.1104294] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 04/26/2012] [Indexed: 05/25/2023]
Abstract
BACKGROUND In the event of a nuclear accident, people are exposed to elevated levels of continuous low dose-rate radiation. Nevertheless, most of the literature describes the biological effects of acute radiation. OBJECTIVES DNA damage and mutations are well established for their carcinogenic effects. We assessed several key markers of DNA damage and DNA damage responses in mice exposed to low dose-rate radiation to reveal potential genotoxic effects associated with low dose-rate radiation. METHODS We studied low dose-rate radiation using a variable low dose-rate irradiator consisting of flood phantoms filled with 125Iodine-containing buffer. Mice were exposed to 0.0002 cGy/min (~ 400-fold background radiation) continuously over 5 weeks. We assessed base lesions, micronuclei, homologous recombination (HR; using fluorescent yellow direct repeat mice), and transcript levels for several radiation-sensitive genes. RESULTS We did not observe any changes in the levels of the DNA nucleobase damage products hypoxanthine, 8-oxo-7,8-dihydroguanine, 1,N6-ethenoadenine, or 3,N4-ethenocytosine above background levels under low dose-rate conditions. The micronucleus assay revealed no evidence that low dose-rate radiation induced DNA fragmentation, and there was no evidence of double strand break-induced HR. Furthermore, low dose-rate radiation did not induce Cdkn1a, Gadd45a, Mdm2, Atm, or Dbd2. Importantly, the same total dose, when delivered acutely, induced micronuclei and transcriptional responses. CONCLUSIONS These results demonstrate in an in vivo animal model that lowering the dose-rate suppresses the potentially deleterious impact of radiation and calls attention to the need for a deeper understanding of the biological impact of low dose-rate radiation.
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Affiliation(s)
- Werner Olipitz
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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Theoretical increase of thyroid cancer induction from cervical spine multidetector computed tomography in pediatric trauma patients. J Trauma Acute Care Surg 2012; 72:403-9. [PMID: 22327982 DOI: 10.1097/ta.0b013e31823a4bd7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The trend of increasing cervical spine multidirectional computed tomography (MDCT) imaging of pediatric trauma patients is characteristic of the overall dramatic increase in computed tomography utilization in the United States. The purpose of this study is to compare the amount of radiation a pediatric trauma patient absorbs to the thyroid from plain radiographs and MDCT of the cervical spine and to express risk by calculation of theoretical thyroid cancer induction. METHODS A retrospective evaluation of pediatric trauma patients admitted from October 1, 2004, to October 31, 2009, was performed at an academic, Level I trauma center. Inclusion criteria were Level I/II trauma patients, cervical spine imaging performed at our institution, and age <18 years. Absorbed thyroid radiation was calculated for patients receiving plain radiographs or MDCT. Thyroid cancer risk was calculated using the 2006 Biological Effects on Ionizing Radiation VII report. RESULTS Six hundred seventeen patients met inclusion criteria: 224 received cervical spine radiographs and 393 received cervical spine MDCT. The mean thyroid radiation absorbed from radiographs was 0.90 mGy for males and 0.96 mGy for females compared with 63.6 mGy (males) and 64.2 mGy (females) receiving MDCT (p < 0.001). The median excess relative risk of thyroid cancer induction from one cervical spine MDCT in males was 13.0% and females was 25.0%, compared with 0.24% (males) and 0.51% (females) for radiographs (p < 0.001). CONCLUSIONS The significant difference in radiation that MDCT delivers to the pediatric trauma patient when compared with plain radiographs should temper routine use of computed tomography in pediatric cervical spine clearance algorithms.
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White SC, Mallya SM. Update on the biological effects of ionizing radiation, relative dose factors and radiation hygiene. Aust Dent J 2012; 57 Suppl 1:2-8. [DOI: 10.1111/j.1834-7819.2011.01665.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Stuart C White
- Section of Oral and Maxillofacial Radiology, School of Dentistry, The University of California, Los Angeles, CA 90095-1668, USA.
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Duport P, Jiang H, Shilnikova NS, Krewski D, Zielinski JM. Database of radiogenic cancer in experimental animals exposed to low doses of ionizing radiation. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2012; 15:186-209. [PMID: 22458255 DOI: 10.1080/10937404.2012.659136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
For decades, there have been debates regarding the nature of the relationship between exposure to low doses of ionizing radiation and cancer risk. Under the linear no-threshold hypothesis, which serves as a theoretical basis for current radiation protection standards, the risk of cancer at low levels of exposure is presumed to be directly proportional to dose. Opponents of this hypothesis claim that there are threshold doses for radiation carcinogenesis, or even a reduction in cancer risk at low doses (a phenomenon referred to as "radiation hormesis"). Epidemiological, animal, molecular, and cellular studies were conducted to resolve this controversy, although each of these study types has its strengths and limitations. Although the results of animal experiments are not directly applicable to humans, data can substantially add to our knowledge on the form of relationship between radiation dose and cancer risk in a wide range of doses. Laboratory animals are a homogeneous population with little biological variability; animal experiments are conducted under controlled conditions with good estimates of radiation doses. In order to address the question of whether or not the dose-response curve for radiation carcinogens is linear at low doses, a comprehensive database of animal carcinogenesis experiments was assembled involving exposure to different types of ionizing gradation. The database includes virtually all publicly accessible data on the induction of radiogenic cancer in laboratory mammals. This review provides a descriptive overview of the experiments included in the database, along with a qualitative assessment of the shape of the dose-response relationship for radiation carcinogenesis at low doses in experimental animals.
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Affiliation(s)
- Philippe Duport
- Institute of the Environment, University of Ottawa, Ottawa, Ontario, Canada
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