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Lyons A, Mohammed Ali A, England A, Moore N, Young R, Leamy B, Tam W, Bezzina P, Pongnapang N, McEntee MF. Expansion of Typical Values for Paediatric Patients in Ireland and Comparison with Published DRLs - Experiences of a Single Institution. J Med Imaging Radiat Sci 2024; 55:101421. [PMID: 38735771 DOI: 10.1016/j.jmir.2024.04.014] [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: 10/10/2023] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION To reduce the risks involved with ionising radiation exposure, typical values (TVs) and diagnostic reference levels (DRLs) have been established to help keep radiation doses 'as low as reasonably practicable. TVs/DRLs provide standardised radiation dose metrics that can be used for comparative purposes. However, for paediatrics, such values should consider the size of the child instead of their age. This study aimed to establish and compare paediatric TVs for chest, abdomen and pelvis radiography. METHODS Study methods followed processes for establishing paediatric DRLs as outlined by the Health Information and Quality Authority (HIQA). Kerma-area product (KAP) values, excluding rejected images, were retrospectively acquired from the study institution's Picture Archiving and Communications System (PACS). Paediatric patients were categorised into the following weight-based groupings (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg) and stratified based on the examination that was performed (chest, abdomen, and pelvis), and where it was performed (the different X-ray rooms). Anonymised data were inputted into Microsoft Excel for analysis. Median and 3rd quartile KAP values were reported together with graphical illustrations. RESULTS Data from 407 X-ray examinations were analysed. For the previously identified weight categories (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg), TVs for the chest were 0.10, 0.19, 0.37 and 0.53 dGy.cm2, respectively. For the abdomen 0.39, 1.04, 3.51 and 4.05 dGy.cm2 and for the pelvis 0.43, 0.87, 3.50 and 7.58 dGy.cm2. Between X-ray rooms TVs varied against the institutional TVs by -60 to 119 % (chest), -50 to 103 % (abdomen) and -14 and 24 %% (pelvis). CONCLUSION TVs in this study follow established trends with patient weight and examination type and are comparable with published literature. Variations do exist between individual examination rooms and reasons are multifactorial. Given that age and size do not perfectly correlate further work should be undertaken around weight-based TVs/DRLs in the paediatric setting.
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Affiliation(s)
- Andrew Lyons
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Ali Mohammed Ali
- Department of Medical Physics, College of Applied Medical Sciences, University of Kerbala, Karbala, Iraq
| | - Andrew England
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland.
| | - Niamh Moore
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Rena Young
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Brid Leamy
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Winnie Tam
- Department of Radiography, City, University of London, London, UK
| | - Paul Bezzina
- Department of Radiography, University of Malta, Msida, Malta
| | - Napapong Pongnapang
- Department of Radiological Technology, Mahidol University, Bangkok, Thailand
| | - Mark F McEntee
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
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2
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Eckstein A, Welkoborsky HJ. [Interdisciplinary Management of Orbital Diseases]. Laryngorhinootologie 2024; 103:S43-S99. [PMID: 38697143 DOI: 10.1055/a-2216-8879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Diagnosis and therapy of orbital diseases is an interdisciplinary challenge, in which i.e. otorhinolaryngologists, ophthalmologists, radiologists, radiation therapists, maxillo-facial surgeons, endocrinologists, and pediatricians are involved. This review article describes frequent diseases which both, otolaryngologists and ophthalmologists are concerned with in interdisciplinary settings. In particular the inflammatory diseases of the orbit including orbital complications, autoimmunological diseases of the orbit including Grave´s orbitopathy, and primary and secondary tumors of the orbit are discussed. Beside describing the clinical characteristics and diagnostic steps the article focusses on the interdisciplinary therapy. The review is completed by the presentation of most important surgical approaches to the orbit, their indications and possible complications. The authors tried to highlight the relevant facts despite the shortness of the text.
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Affiliation(s)
| | - H-J Welkoborsky
- Univ. Klinik für Augenheilkunde Universitätsmedizin Essen, Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Klinikum Nordstadt der KRH
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3
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Radiation Exposure and Lifetime Attributable Risk of Cancer Incidence and Mortality from Low- and Standard-Dose CT Chest: Implications for COVID-19 Pneumonia Subjects. Diagnostics (Basel) 2022; 12:diagnostics12123043. [PMID: 36553050 PMCID: PMC9777015 DOI: 10.3390/diagnostics12123043] [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: 10/14/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
Since the novel coronavirus disease 2019 (COVID-19) outbreak, there has been an unprecedented increase in the acquisition of chest computed tomography (CT) scans. Nearly 616 million people have been infected by COVID-19 worldwide to date, of whom many were subjected to CT scanning. CT exposes the patients to hazardous ionizing radiation, which can damage the genetic material in the cells, leading to stochastic health effects in the form of heritable genetic mutations and increased cancer risk. These probabilistic, long-term carcinogenic effects of radiation can be seen over a lifetime and may sometimes take several decades to manifest. This review briefly describes what is known about the health effects of radiation, the lowest dose for which there exists compelling evidence about increased radiation-induced cancer risk and the evidence regarding this risk at typical CT doses. The lifetime attributable risk (LAR) of cancer from low- and standard-dose chest CT scans performed in COVID-19 subjects is also discussed along with the projected number of future cancers that could be related to chest CT scans performed during the COVID-19 pandemic. The LAR of cancer Incidence from chest CT has also been compared with those from other radiation sources, daily life risks and lifetime baseline risk.
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Simma L, Fornaro J, Stahr N, Lehner M, Roos JE, Lima TVM. Optimising whole body computed tomography doses for paediatric trauma patients: a Swiss retrospective analysis. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021521. [PMID: 35354135 DOI: 10.1088/1361-6498/ac6274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
We aimed to evaluate the impact of a low-dose whole-body computed tomography (WBCT) protocol on radiation doses in paediatric major trauma patients. Retrospective cohort study of paediatric trauma patients (<16 years) at a national level 1 paediatric trauma centre (PTC) over a 6 year period prior and post introduction of a low-dose WBCT protocol (2014-2019). Demographic data, patient characteristics, CT device, and exposure information including scan range, dose-length product, and volume CT dose index were collected. Effective dose (ED) and exposure parameters were compared before and after protocol introduction. Forty-eight patients underwent WBCT during the study period. Prior to introduction of the low-dose protocol (n= 18), the ED was 20.6 mSv (median 20.1 ± 5.3 mSv [range 12.5-30.7]). After introduction of the low-dose WBCT protocol (n= 30), mean ED was 4.8 mSv (median 2.6 ± 5.0 [range: 0.8-19.1]). This resulted in a reduction of 77% in mean ED (pvalue <0.001). Significant radiation dose reduction of 77% can be achieved with low-dose WBCT protocols in PTCs.
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Affiliation(s)
- Leopold Simma
- Emergency Department, Children's Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Emergency Department, University Children's Hospital Zurich, University of Zurich, Steinwiessstrasse 75, Zurich, CH 8032, Switzerland
| | - Juergen Fornaro
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Nikolai Stahr
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Pediatric Radiology Department, Children's Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Markus Lehner
- Pediatric Surgery Department, Children's Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Justus E Roos
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Thiago Viana Miranda Lima
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Institute of Radiation Physics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Tajaldeen A, Kheiralla OAM, Alghamdi SS, Alsleem H, Al-Othman A, Abuelhia E, Aljondi R. Evaluation of Pediatric Imaging Modalities Practices of Radiologists and Technologists: A Survey-Based Study. J Multidiscip Healthc 2022; 15:443-453. [PMID: 35280855 PMCID: PMC8906869 DOI: 10.2147/jmdh.s351696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Abdulrahman Tajaldeen
- Department of Radiological Sciences, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Correspondence: Abdulrahman Tajaldeen, Email
| | - Osama A Mabrouk Kheiralla
- Department of Radiological Sciences, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Salem Saeed Alghamdi
- Department of Applied Radiologic Technology, College of Applied Medical Sciences, University of Jeddah, Jeddah, Saudi Arabia
| | - Haney Alsleem
- Department of Radiological Sciences, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Al-Othman
- Radiology Department, King Fahad University Hospital, Alkhobar, Saudi Arabia
| | - Elfatih Abuelhia
- Department of Radiological Sciences, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rowa Aljondi
- Department of Applied Radiologic Technology, College of Applied Medical Sciences, University of Jeddah, Jeddah, Saudi Arabia
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J. Welkoborsky H, Pitz S, Grass S, Breuer B, Pähler vor der Holte A, Bertram O, Wiechens B. Sinogenic Orbital Complications. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:31-37. [PMID: 34874263 PMCID: PMC9011833 DOI: 10.3238/arztebl.m2021.0379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/04/2021] [Accepted: 11/08/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The term "orbital complication" does not designate an independent nosological entity, but is rather a collective designation for diseases or disease effects that involve the orbit and its internal structures by extension from outside. In general, their most prominent manifestation is swelling of the orbital soft tissues, usually unilaterally. The incidence of sinogenic orbital complications is approximately 1.6 per 100 000 children and 0.1 per 100 000 adults per year. METHODS This review is based on publications retrieved by a selective search of the literature on the epidemiology, diagnosis, and treatment of sinogenic orbital complications. RESULTS Acute sinusitis is the most common cause of orbital complications. These are diseases of the orbit with potentially serious consequences for the eye and the risk of intracranial complications such as cavernous sinus thrombosis, meningitis, or brain abscess. Aside from acute sinusitis, many other infectious and non-infectious diseases can extend to and involve the orbit. Because of the complexity and severity of the condition, its diagnosis and treatment are always an interdisciplinary matter. The treatment is primarily conservative, under observation in a hospital, and generally consists of the treatment of acute sinusitis with measures to combat edema along with the administration of broad-spectrum antibiotics. Surgical intervention is needed in severe cases or if there is an abscess. An endonasal approach is usually used for drainage. CONCLUSION In 95-98% of cases in stages I-IV, healing is complete and without further sequelae. Even if vision is affected preoperatively, it usually recovers fully when therapy is appropriate. Approximately 15% of the patients who undergo surgery need more than one operative procedure.
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Affiliation(s)
- Hans J. Welkoborsky
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Hanover, Germany,Department for ENT Medicine, Center for Children and Adolescents, Hanover,*Regional Hospital Hanover Department of Otorhinolaryngology Haltenhoffstr. 41 30167 Hanover, Germany
| | - Susanne Pitz
- Academic Medical Center, Interdisciplinary Orbita Center, Department of Ophthalmology, Hanover,Bürger Hospital, Orbita Center, Ophthalmic Clinic, Frankfurt/M
| | - Sylvia Grass
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Hanover, Germany
| | - Boris Breuer
- Academic Medical Center, Interdisciplinary Orbita Center, Department of Ophthalmology, Hanover
| | - Anja Pähler vor der Holte
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Hanover, Germany
| | - Oliver Bertram
- Department for ENT Medicine, Center for Children and Adolescents, Hanover
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Berrington de Gonzalez A, Pasqual E, Veiga L. Epidemiological studies of CT scans and cancer risk: the state of the science. Br J Radiol 2021; 94:20210471. [PMID: 34545766 DOI: 10.1259/bjr.20210471] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
20 years ago, 3 manuscripts describing doses and potential cancer risks from CT scans in children raised awareness of a growing public health problem. We reviewed the epidemiological studies that were initiated in response to these concerns that assessed cancer risks from CT scans using medical record linkage. We evaluated the study methodology and findings and provide recommendations for optimal study design for new efforts. We identified 17 eligible studies; 13 with published risk estimates, and 4 in progress. There was wide variability in the study methodology, however, which made comparison of findings challenging. Key differences included whether the study focused on childhood or adulthood exposure, radiosensitive outcomes (e.g. leukemia, brain tumors) or all cancers, the exposure metrics (e.g. organ doses, effective dose or number of CTs) and control for biases (e.g. latency and exclusion periods and confounding by indication). We were able to compare results for the subset of studies that evaluated leukemia or brain tumors. There were eight studies of leukemia risk in relation to red bone marrow (RBM) dose, effective dose or number of CTs; seven reported a positive dose-response, which was statistically significant (p < 0.05) in four studies. Six of the seven studies of brain tumors also found a positive dose-response and in five, this was statistically significant. Mean RBM dose ranged from 6 to 12 mGy and mean brain dose from 18 to 43 mGy. In a meta-analysis of the studies of childhood exposure the summary ERR/100 mGy was 1.78 (95%CI: 0.01-3.53) for leukemia/myelodisplastic syndrome (n = 5 studies) and 0.80 (95%CI: 0.48-1.12) for brain tumors (n = 4 studies) (p-heterogeneity >0.4). Confounding by cancer pre-disposing conditions was unlikely in these five studies of leukemia. The summary risk estimate for brain tumors could be over estimated, however, due to reverse causation. In conclusion, there is growing evidence from epidemiological data that CT scans can cause cancer. The absolute risks to individual patients are, however, likely to be small. Ongoing large multicenter cohorts and future pooling efforts will provide more precise risk quantification.
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Affiliation(s)
- Amy Berrington de Gonzalez
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Elisa Pasqual
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Lene Veiga
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, MD, USA
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8
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Lawson M, Tully J, Ditchfield M, Metcalfe P, Qi Y, Kuganesan A, Badawy MK. A review of current imaging techniques used for the detection of occult bony fractures in young children suspected of sustaining non-accidental injury. J Med Imaging Radiat Oncol 2021; 66:68-78. [PMID: 34176229 DOI: 10.1111/1754-9485.13270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Non-accidental injuries remain a leading cause of preventable morbidity and mortality in young children. The accurate identification of the full spectrum of injuries in children presenting with suspected abuse is essential to ensure the appropriate protective intervention is taken. The identification of occult bone fractures in this cohort is important as it raises the level of concern about the mechanism of injury and maintaining the child's safety. Radiographic imaging remains the modality of choice for skeletal assessment; however, current studies report concerns regarding the ability of radiographs to detect certain fractures in the acute stage. As such, alternative modalities for the detection of fractures have been proposed. This article reviews the current literature regarding fracture detectability and radiation dose burden of imaging modalities currently used for the assessment of occult bony injury in young children in whom non-accidental injury is suspected.
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Affiliation(s)
- Michael Lawson
- Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,Centre for Medical and Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Joanna Tully
- Victorian Forensic Paediatric Medical Service, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Michael Ditchfield
- Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Metcalfe
- Centre for Medical and Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yujin Qi
- Centre for Medical and Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Mohamed K Badawy
- Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Tahmasebzadeh A, Paydar R, Soltani-Kermanshahi M, Maziar A, Reiazi R. Lifetime attributable cancer risk related to prevalent CT scan procedures in pediatric medical imaging centers. Int J Radiat Biol 2021; 97:1282-1288. [PMID: 34096826 DOI: 10.1080/09553002.2021.1931527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Evaluation of the organ dose in pediatric patients up to 15 years old and Estimation of lifetime attributable risk (LAR) of cancer incidence in pediatric computed tomography procedures. MATERIALS AND METHODS Data from 532 patients below 15 years old was collected and they were categorized into four age groups of <1, 1-5, 5-10, and 10-15 years old. NCICT software was used to calculate the organ dose, and LAR of cancer incidence has been estimated according to the BEIR VII report. RESULTS The highest median dose in all age groups was related to eye lens (head scan), thyroid (chest scan), and colon (abdomen-pelvic scan). The highest average LAR of cancer incidence was observed for breast cancer and colon cancer following a chest CT scan of the youngest group (<1-year-olds) [68.23 per 100,000] and abdomen-pelvic scans of the oldest group (10- to 15-year-olds) [57.30 per 100,000]. CONCLUSION This study shows that the average LAR is higher in females and it decreases with age in both genders. Although CT scan has an indispensable application in diagnosis, the patient dose should be taken into account before any examination specifically in pediatric patients.
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Affiliation(s)
- Atefeh Tahmasebzadeh
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Paydar
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Radiation Science, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Soltani-Kermanshahi
- Social Determinants of Health Research Center, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Asghar Maziar
- Department of Radiation Science, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Reiazi
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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10
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Khattab M, Hagan J, Staib LH, Mustafa A, Goodman TR. Cumulative diagnostic imaging radiation exposure in premature neonates. J Neonatal Perinatal Med 2021; 15:95-103. [PMID: 33843704 DOI: 10.3233/npm-210726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To date, there has been limited work evaluating the total cumulative effective radiation dose received by infants in the neonatal intensive care unit. Most previous publications report that the total radiation dose received falls within the safe limits but does not include all types of ionizing radiation studies typically performed on this vulnerable patient population. We aimed to provide an estimate of the cumulative effective ionizing radiation dose (cED) in microSieverts (μSv) received by premature infants ≤32 weeks from diagnostic studies performed throughout their NICU stay, and predictors of exposures. METHODS Retrospective chart review from 2004-2011. Data included demographics, gestational age (GA), birth weight (BW), length of stay (LOS), clinical diagnosis, and radiological studies. RESULTS 1045 charts were reviewed. Median GA = 30.0 weeks (SD 2.7, range 22.0-32.6). Median BW = 1340.0 grams (SD 445.4, range 420-2470). Median number of radiographic studies = 9 (SD 28.5, range 0-210). Median cED = 162μSv (range 0-9248). The cED was positively associated with LOS (p < 0.001) and inversely correlated with GA (p < 0.001) and BW (p < 0.001). Infants with intestinal perforation had the highest median cED 1661μSv compared to 162μSv for others (p < 0.001). CONCLUSION Our results provide an estimate of the cumulative effective radiation dose received by premature infants in a level 4 neonatal intensive care unit from all radiological studies involving ionizing radiation and identifies risk factors and predictors of such exposure. Radiation exposure in NICU is highest among the most premature and among infants who suffer from intestinal perforation.
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Affiliation(s)
- M Khattab
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - J Hagan
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - L H Staib
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - A Mustafa
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - T R Goodman
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
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Marcu LG, Chau M, Bezak E. How much is too much? Systematic review of cumulative doses from radiological imaging and the risk of cancer in children and young adults. Crit Rev Oncol Hematol 2021; 160:103292. [DOI: 10.1016/j.critrevonc.2021.103292] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/20/2021] [Accepted: 02/27/2021] [Indexed: 01/18/2023] Open
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12
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Bingyang B, Gang W, Zhiqing S, Li N, Zhou B, Xu S, Li D. A Preliminary Study of Personalized Head CT Scan in Pediatric Patients. Dose Response 2021; 19:1559325820985660. [PMID: 33746652 PMCID: PMC7940743 DOI: 10.1177/1559325820985660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 01/02/2023] Open
Abstract
Objectives: In the present study, we introduced a practical approach to quantify organ-specific radiation doses and investigated whether low-dose head circumference (HC)-based protocols for non-enhanced head computed tomography (CT) could reduce organs-specific radiation dose in pediatric patients while maintaining high image quality. Methods: A total of 83 pediatric patients were prospectively recruited. Without limits to the HC, 15 patients were selected as a convention group (CON group) and underwent non-enhanced head CT scan with standard-dose protocols (tube current-time products of 250mAs). Low-dose group (LD group), including remaining 68 pediatrics were divided into 3 subgroups based on the HC: 54.1-57.0 cm for LD200mAs group (HC-based protocols of 200mAs), 51.1-54.0 cm for LD150mAs group (HC-based protocols of 150mAs), 48.1-51.0 cm for LD100mAs group (HC-based protocols of 100mAs). Subjective and objective image quality was evaluated and measured by 2 experienced radiologists. Radimetrics was used to calculate organs-specific radiation dose, including the brain, eye lenses, and salivary glands. Results: In CON250mAs group, radiation doses in the brain and salivary glands were conversely correlated with HC, and pediatric patients with smaller HC received higher organs-specific radiation dose. Reducing tube current-time product from 250 to 100mAs could significantly reduce the organ-specific radiation dose. The subjective image quality score ≥ 3.0 is acceptable for diagnosis purposes. The signal to noise ratio (SNR) and the contrast to noise ratio (CNR) of bilateral thalamus and centrum semiovale in 3 LD subgroups were not statistically different compared with the CON group. Conclusion: Our research indicated that low-dose HC-based protocols of non-enhanced head CT scan can evidently reduce the organ-specific radiation doses, while maintaining high image quality. HC can serve as a vital tool to guide personalized low-dose head CT scan for pediatric patients.
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Affiliation(s)
| | - Wang Gang
- Third Hospital of Jilin University, Changchun, China
| | - Shao Zhiqing
- Jilin University First Hospital, Changchun, China
| | - Nan Li
- Jilin University First Hospital, Changchun, China
| | - BoXu Zhou
- Jilin University First Hospital, Changchun, China
| | - ShuJia Xu
- Jilin University First Hospital, Changchun, China
| | - Dan Li
- Jilin University First Hospital, Changchun, China
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Ploussi A, Syrgiamiotis V, Makri T, Hatzigiorgi C, Efstathopoulos EP. Local diagnostic reference levels in pediatric CT examinations: a survey at the largest children's hospital in Greece. Br J Radiol 2020; 93:20190358. [PMID: 32976036 PMCID: PMC7716000 DOI: 10.1259/bjr.20190358] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The increased frequency of pediatric CT examinations and the high radiosensitivity of children entail the need to determine DRLs and optimize CT protocols. The aim of the study was twofold. Firstly, to establish pediatric LDRLs according to age and weight for the most common types of CT examinations at the largest children's hospital in Greece. Secondly, to compare LDRLs with European DRLs. METHODS A total of 756 pediatric patients who underwent head, chest, and abdomen-pelvis CT examinations were included. Patients were categorized into age groups according to the hospital's protocols. All CT examinations were performed using iterative reconstruction algorithm and AEC. LDRLs were determined in terms of 75th percentile of CTDIvol and DLP. Values of LDRLs were subsequently regrouped into weight categories and compared with European DRLs. RESULTS Gathering all age groups for head CT examinations and all weight groups for body CT examinations, LDRLs were ranged from (22-68, 2-5, 2-10) mGy in terms of CTDIvol; (317-786, 22-168, 58-425) mGy.cm in terms of DLP per acquisition and (324-838, 42-265, 85-498) mGy.cm in terms of total DLP for head, chest and abdomen-pelvis CT examinations, respectively. CONCLUSION CTDI LDRLs were comparable to European DRLs for head and either comparable or lower than European DRLs for body CT examinations. DLP LDRLs were higher than European DRLs for head and lower for body CT examinations. ADVANCES IN KNOWLEDGE Age- and weight-based LDRLs for pediatric CT examinations were established for the largest children's hospital in Greece. Further investigations across the country are required for the establishment of national pediatric DRLs in Greece.
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Affiliation(s)
- Agapi Ploussi
- 2nd Department of Radiology, University General Hospital ‘Attikon’, School of Medicine, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | | | | | | | - Efstathios P. Efstathopoulos
- 2nd Department of Radiology, University General Hospital ‘Attikon’, School of Medicine, National and Kapodistrian University of Athens, 12462, Athens, Greece
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Brady Z, Forsythe A, McBain-Miller J, Scurrah KJ, Smoll N, Lin Y, Lee C, Berrington de Gonzalez A, Roberts LJ, Mathews JD. Ct Dosimetry for The Australian Cohort Data Linkage Study. RADIATION PROTECTION DOSIMETRY 2020; 191:ncaa175. [PMID: 33200204 DOI: 10.1093/rpd/ncaa175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/14/2020] [Accepted: 10/03/2020] [Indexed: 06/11/2023]
Abstract
Children undergoing computed tomography (CT) scans have an increased risk of cancer in subsequent years, but it is unclear how much of the excess risk is due to reverse causation bias or confounding, rather than to causal effects of ionising radiation. An examination of the relationship between excess cancer risk and organ dose can help to resolve these uncertainties. Accordingly, we have estimated doses to 33 different organs arising from over 900 000 CT scans between 1985 and 2005 in our previously described cohort of almost 12 million Australians aged 0-19 years. We used a multi-tiered approach, starting with Medicare billing details for government-funded scans. We reconstructed technical parameters from national surveys, clinical protocols, regulator databases and peer-reviewed literature to estimate almost 28 000 000 individual organ doses. Doses were age-dependent and tended to decrease over time due to technological improvements and optimisation.
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Affiliation(s)
- Zoe Brady
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Radiology and Nuclear Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Anna Forsythe
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jasmine McBain-Miller
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katrina J Scurrah
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Nicolas Smoll
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Yaqi Lin
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Leo J Roberts
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - John D Mathews
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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Daniels RD, Kendall GM, Thierry-Chef I, Linet MS, Cullings HM. Strengths and Weaknesses of Dosimetry Used in Studies of Low-Dose Radiation Exposure and Cancer. J Natl Cancer Inst Monogr 2020; 2020:114-132. [PMID: 32657346 PMCID: PMC7667397 DOI: 10.1093/jncimonographs/lgaa001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A monograph systematically evaluating recent evidence on the dose-response relationship between low-dose ionizing radiation exposure and cancer risk required a critical appraisal of dosimetry methods in 26 potentially informative studies. METHODS The relevant literature included studies published in 2006-2017. Studies comprised case-control and cohort designs examining populations predominantly exposed to sparsely ionizing radiation, mostly from external sources, resulting in average doses of no more than 100 mGy. At least two dosimetrists reviewed each study and appraised the strengths and weaknesses of the dosimetry systems used, including assessment of sources and effects of dose estimation error. An overarching concern was whether dose error might cause the spurious appearance of a dose-response where none was present. RESULTS The review included 8 environmental, 4 medical, and 14 occupational studies that varied in properties relative to evaluation criteria. Treatment of dose estimation error also varied among studies, although few conducted a comprehensive evaluation. Six studies appeared to have known or suspected biases in dose estimates. The potential for these biases to cause a spurious dose-response association was constrained to three case-control studies that relied extensively on information gathered in interviews conducted after case ascertainment. CONCLUSIONS The potential for spurious dose-response associations from dose information appeared limited to case-control studies vulnerable to recall errors that may be differential by case status. Otherwise, risk estimates appeared reasonably free of a substantial bias from dose estimation error. Future studies would benefit from a comprehensive evaluation of dose estimation errors, including methods accounting for their potential effects on dose-response associations.
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Affiliation(s)
- Robert D Daniels
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Gerald M Kendall
- Cancer Epidemiology Unit, NDPH, University of Oxford, Oxford, UK
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Harry M Cullings
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
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16
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Almqvist H, Mazya M, Falk Delgado A, Falk Delgado A. Radiological evaluation in patients with clinical suspicion of cerebral venous sinus thrombosis presenting with nontraumatic headache - a retrospective observational study with a validation cohort. BMC Med Imaging 2020; 20:24. [PMID: 32103735 PMCID: PMC7045590 DOI: 10.1186/s12880-020-00426-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical suspicion of cerebral venous sinus thrombosis (CVST) is imprecise due to non-specific symptoms such as headache. The aim was to retrospectively assess the diagnostic value of nonenhanced CT (neCT) in patients with nontraumatic headache and clinically suspected CVST. METHODS A retrospective consecutive series of patients referred 2013-2015 for radiology were evaluated. Eligible patients had nontraumatic headache and suspicion of CVST stated in the referral, investigated with CT venography (CTV) and nonenhanced CT (neCT). neCT scans were re-evaluated for the presence of CVST or other pathology. All CTVs were checked for the presence of CVST. The validation cohort consisted of 10 patients with nontraumatic CVT (2017-2019). RESULTS Less than 1% (1/104) had a suspected thrombus on neCT, confirmed by subsequent CTV. The remaining 99% had a CTV excluding CVST. Eleven percent had other imaging findings explaining their symptoms. In the patient with CVST, the thrombosed dural sinus was high attenuating (maximum HU 89) leading to the suspicion of CVST confirmed by CTV. The validation cohort (n = 10) confirmed the presence of a high attenuating (HU > 65) venous structure in the presence of a confirmed thrombus in all patients presenting within 10 days (suspicion written in referral, 10%). CONCLUSIONS Despite clinical suspicion, imaging findings of CVST in nontraumatic headache are uncommon. Evaluating neCT for high attenuation in dural sinuses, followed by CTV for confirmation in selected cases seems reasonable. CVST should be recognized by all radiologists and requires a high level of awareness when reading neCT for other indications.
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Affiliation(s)
- Håkan Almqvist
- Department of Clinical Neuroscience, Karolinska Institutet, 17176, Stockholm, Solna, Sweden.,Department of Neuroradiology, Karolinska University Hospital, 17176, Stockholm, Solna, Sweden
| | - Michael Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, 17176, Stockholm, Solna, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Falk Delgado
- Department of Clinical Neuroscience, Karolinska Institutet, 17176, Stockholm, Solna, Sweden. .,Department of Neuroradiology, Karolinska University Hospital, 17176, Stockholm, Solna, Sweden.
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Gunn C, O'Brien K, Fosså K, Tonkopi E, Lanca L, Martins CT, Muller H, Friedrich-Nel H, Abdolell M, Johansen S. A multi institutional comparison of imaging dose and technique protocols for neonatal chest radiography. Radiography (Lond) 2020; 26:e66-e72. [PMID: 32052771 DOI: 10.1016/j.radi.2019.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The focus on paediatric radiation dose reduction supports reevaluation of paediatric imaging protocols. This is particularly important in the neonates where chest radiographs are frequently requested to assess respiratory illness and line placement. This study aims to assess the impact of neonatal chest radiographic protocols on patient dose in four hospitals in different countries. METHODS Exposure parameters, collimation, focus to skin distance (FSD) and radiation dose from 200 neonatal chest radiographs were registered prospectively. Inclusion criteria consisted of both premature and full-term neonates weighing between 1000 and 5000 g. Only data from the examinations meeting diagnostic criteria and approved for the clinical use were included. Radiation dose was assessed using dose area product (DAP). RESULTS The lowest DAP value (4.58 mGy cm2) was recorded in the Norwegian hospital, employing a high kVp, low mAs protocol using a DR system. The Canadian hospital recorded the highest DAP (9.48), using lower kVp and higher mAs with a CR system, including the addition of a lateral projection. The difference in the mean DAP, weight, field of view (FOV) and kVp between the hospitals is statistically significant (p < 0.001). CONCLUSION Use of non-standardised imaging protocols in neonatal chest radiography results in differences in patient dose across hospitals included in the study. Using higher kVp, lower mAs and reducing the number of lateral projections to clinically relevant indications result in a lower DAP measured in the infant sample studied. Further studies to examine image quality based on exposure factors and added filtration are recommended. IMPLICATIONS FOR PRACTICE Reevaluation of paediatric imaging protocols presents an opportunity to reduce patient dose in a population with increased sensitivity to ionising radiation.
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Affiliation(s)
- C Gunn
- School of Health Sciences, Dalhousie University, Halifax, Canada
| | - K O'Brien
- Faculty of Medicine, Dalhousie University, Halifax, Canada; IWK Health Centre, Diagnostic Imaging, Halifax, Canada
| | - K Fosså
- Division of Diagnostics and Intervention, Oslo University Hospital, Rikshospitalet, Norway
| | - E Tonkopi
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - L Lanca
- ESTeSL - Escola Superior de Tecnologia da Saude de Lisboa, Instituto Poliecnico de Lisboa, Portugal; Karolinska Institutet, Stockholm, Sweden; Singapore Institute of Technology, Health and Social Sciences Cluster, Singapore
| | - C T Martins
- ESTeSL - Escola Superior de Tecnologia da Saude de Lisboa, Instituto Poliecnico de Lisboa, Portugal; Centro Hospitalar Lisboa Norte, EPE, Hospital de Santa Maria (HSM) Radiology Department, Lisboa, Portugal
| | - H Muller
- Central University of Technology, Free State (CUT), Faculty of Health and Environmental Sciences, South Africa; Department of Clinical Imaging Sciences, Universitas Academic Hospital, Bloemfontein, South Africa
| | - H Friedrich-Nel
- Department of Clinical Imaging Sciences, Universitas Academic Hospital, Bloemfontein, South Africa
| | - M Abdolell
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - S Johansen
- Oslo Metropolitan University (OsloMet), Faculty of Health Sciences, Oslo, Norway; Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Norway.
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Harbron RW, Ainsbury EA, Barnard SGR, Lee C, McHugh K, Berrington de González A, Edyvean S, Pearce MS. Radiation dose to the lens from CT of the head in young people. Clin Radiol 2019; 74:816.e9-816.e17. [PMID: 31375261 DOI: 10.1016/j.crad.2019.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 06/28/2019] [Indexed: 11/28/2022]
Abstract
AIM To determine cumulative scan frequencies and estimate lens dose for paediatric computed tomography (CT) head examinations in the context of potential cataract risk. MATERIALS AND METHODS The cumulative number of head-region CT examinations among a cohort of 410,997 children and young adults who underwent CT in the UK between 1985 and 2014 was calculated. Images from a sample of these head examinations (n=668) were reviewed to determine the level of eye inclusion. Lens dose per scan was estimated using the computer program, NCICT V1.0, for different levels of eye inclusion and exposure settings typical of past and present clinical practice. RESULTS In total 284,878 patients underwent 448,108 head-region CT examinations. The majority of patients (72%) had a single recorded head-region examination. A small subset (∼1%, n=2,494) underwent ≥10 examinations, while 0.1% (n=387) underwent ≥20. The lens was included within the imaged region for 57% of reviewed routine head examinations. In many cases, this appeared to be intentional, i.e. protocol driven. In others, there appeared to have been an attempt to exclude the eyes through gantry angulation. Estimated lens doses were 20-75 mGy (mean: 47 mGy) where the eye was fully included within the examination range and 2-7 mGy (mean: 3.1 mGy) where the lens was fully excluded. Potential cumulative lens doses ranged from ∼3 mGy to ∼4,700 mGy, with 2,335 patients potentially receiving >500 mGy. CONCLUSION The majority of young people will receive cumulative lens doses well below 500 mGy, meaning the risk of cataract induction is likely to be very small.
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Affiliation(s)
- R W Harbron
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, UK.
| | - E A Ainsbury
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - S G R Barnard
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - C Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - K McHugh
- Radiology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - A Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Edyvean
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - M S Pearce
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, UK
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19
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Abstract
A disease or symptom of disease spreading from the vicinity of the orbit to the internal structures of the orbit is referred to as an orbital complication. Orbital complications can have a traumatic, inflammatory, allergic, or autoimmunologic cause. They are more frequent in children than adults. The present review aims to provide a description of orbital complications, their etiology, pathogenesis, and treatment. Recent literature in the field is acknowledged and discussed, and results from the authors' own patient groups are analyzed. Particular attention is paid to orbital complications due to acute sinusitis and those caused by acute hemorrhage. The term "orbital phlegmon" frequently used for orbital complications with inflammatory causes is confusing and should be replaced by differentiated grading. Diagnosis and treatment of orbital complications requires interdisciplinary collaboration, whereby inclusion of ophthalmologists is particularly important. Treatment of orbital complications depends on their cause. In inflammatory cases affecting only the preseptal tissues and compartment, conservative therapy is indicated. If clinical findings worsen within 24 h of conservative therapy, or if the patient presents with a high-grade orbital complication with loss of visual acuity or impairment of globe mobility, surgery is required. In cases of acute hemorrhage into the orbit, a procedure for decreasing intra-orbital pressure is mandatory (i. e., canthotomy, cantholysis, orbital decompression).
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Affiliation(s)
- S Graß
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und regionale plastische Chirurgie, Kopf-Hals-Tumorzentrum, KRH Klinikum Nordstadt, Akademisches Lehrkrankenhaus, Haltenhoffstr. 41, 30167, Hannover, Deutschland.
| | - H-J Welkoborsky
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und regionale plastische Chirurgie, Kopf-Hals-Tumorzentrum, KRH Klinikum Nordstadt, Akademisches Lehrkrankenhaus, Haltenhoffstr. 41, 30167, Hannover, Deutschland
| | - H Möbius
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und regionale plastische Chirurgie, Kopf-Hals-Tumorzentrum, KRH Klinikum Nordstadt, Akademisches Lehrkrankenhaus, Haltenhoffstr. 41, 30167, Hannover, Deutschland
| | - S K Plontke
- Medizinische Fakultät Martin-Luther-Universität Halle-Wittenberg, Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - A Glien
- Medizinische Fakultät Martin-Luther-Universität Halle-Wittenberg, Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
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Bashier EH, Suliman II. RADIATION DOSE DETERMINATION IN ABDOMINAL CT EXAMINATIONS OF CHILDREN AT SUDANESE HOSPITALS USING SIZE-SPECIFIC DOSE ESTIMATES. RADIATION PROTECTION DOSIMETRY 2019; 183:443-448. [PMID: 30215799 DOI: 10.1093/rpd/ncy164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/07/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
In this study, we thought to estimate the radiation exposure of children undergoing multi-detector CT examinations using size-specific dose estimates (SSDE). Console-displayed volume computed tomography dose index (CTDIvol) were recorded for a total of 78 paediatric abdominal CT examinations performed in six hospitals. Measurements of the patient diameters were taken from the mid-slice location on the transverse and scout CT images. Size-specific conversion coefficients were used to translate CTDIvol to the SSDE, according AAPM Report 204. For children aged 0-1 y, CTDIvol, SSDEtrans (from transverse images) and SSDEsco (from scout images) were: 12.80 ± 16.10, 14.43 ± 13.22; and 14.37 ± 13.03 mGy; respectively. For children aged 1-5 y, CTDIvol, SSDEtrans and SSDEsco were: 12.11 ± 14.47, 18.8 ± 18.61 and 16.51 ± 13.55 mGy; respectively. The obtained doses are higher than the corresponding diagnostic reference levels. SSDE increase with patient size as results of tube current modulation and is therefore a valuable tool for dose optimisation.
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Affiliation(s)
- Einas H Bashier
- Sudan Atomic Energy Commission, Radiation Safety Institute, Khartoum, Sudan
| | - I I Suliman
- Sudan Atomic Energy Commission, Radiation Safety Institute, Khartoum, Sudan
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
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21
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Pediatric CT radiation exposure: where we were, and where we are now. Pediatr Radiol 2019; 49:469-478. [PMID: 30923878 DOI: 10.1007/s00247-018-4281-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/24/2018] [Accepted: 10/05/2018] [Indexed: 01/01/2023]
Abstract
Since the turn of the last millennium, the pediatric radiology community has blazed a patient-quality and safety trail in helping to effectively address the public and the news media's concerns about the implications of ionizing radiation from CT scanners in children. As such, this article (1) reviews the potential deleterious effects of ionizing radiation, (2) discusses why limiting radiation exposure in children is so important, (3) tells the history of pediatric CT radiation exposure concerns, (4) explains the interventions that took place to address these concerns and (5) touches on the current school of thought on pediatric CT dose reduction.
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Dos Santos M, Kereselidze D, Gloaguen C, Benadjaoud MA, Tack K, Lestaevel P, Durand C. Development of whole brain versus targeted dentate gyrus irradiation model to explain low to moderate doses of exposure effects in mice. Sci Rep 2018; 8:17262. [PMID: 30467388 PMCID: PMC6250717 DOI: 10.1038/s41598-018-35579-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 10/16/2018] [Indexed: 12/23/2022] Open
Abstract
Evaluation of the consequences of low to moderate doses of ionizing radiation (IR) remains a societal challenge, especially for children exposed to CT scans. Appropriate experimental models are needed to improve scientific understanding of how exposure of the postnatal brain to IR affects behavioral functions and their related pathophysiological mechanisms, considering brain complex functional organization. In the brain, the dorsal and ventral hippocampal dentate gyrus can be involved in distinct major behavioral functions. To study the long term behavioral effects of brain exposure at low to moderate doses of IR (doses range 0.25–1 Gy), we developed three new experimental models in 10-day-old mice: a model of brain irradiation and two targeted irradiation models of the dorsal and ventral dentate gyrus. We used the technological properties of the SARRP coupled with MR imaging. Our irradiation strategy has been twofold endorsed. The millimetric ballistic specificity of our models was first validated by measuring gamma-H2AX increase after irradiation. We then demonstrated higher anxiety/depressive-like behavior, preferentially mediate by the ventral part of the dentate gyrus, in mice after brain and ventral dentate gyrus IR exposure. This work provides new tools to enhance scientific understanding of how to protect children exposed to IR.
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Affiliation(s)
- M Dos Santos
- Institute for Radiological Protection and Nuclear Safety (IRSN), Research department of RAdiobiology and regenerative MEDicine (SERAMED), Laboratory of Radiobiology of Accidental exposures (LRAcc), Fontenay-aux-Roses, France
| | - D Kereselidze
- Institute for Radiological Protection and Nuclear Safety (IRSN), Research department on the Biological and Health Effects of Ionizing Radiation (SESANE), Laboratory of experimental Radiotoxicology and Radiobiology (LRTOX), Fontenay aux Roses, France
| | - C Gloaguen
- Institute for Radiological Protection and Nuclear Safety (IRSN), Research department on the Biological and Health Effects of Ionizing Radiation (SESANE), Laboratory of experimental Radiotoxicology and Radiobiology (LRTOX), Fontenay aux Roses, France
| | - M A Benadjaoud
- Institute for Radiological Protection and Nuclear Safety (IRSN), Research department of RAdiobiology and regenerative MEDicine (SERAMED), Fontenay-aux-Roses, France
| | - K Tack
- Institute for Radiological Protection and Nuclear Safety (IRSN), Research department on the Biological and Health Effects of Ionizing Radiation (SESANE), Laboratory of experimental Radiotoxicology and Radiobiology (LRTOX), Fontenay aux Roses, France
| | - P Lestaevel
- Institute for Radiological Protection and Nuclear Safety (IRSN), Research department on the Biological and Health Effects of Ionizing Radiation (SESANE), Laboratory of experimental Radiotoxicology and Radiobiology (LRTOX), Fontenay aux Roses, France
| | - C Durand
- Institute for Radiological Protection and Nuclear Safety (IRSN), Research department on the Biological and Health Effects of Ionizing Radiation (SESANE), Laboratory of experimental Radiotoxicology and Radiobiology (LRTOX), Fontenay aux Roses, France.
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Philippot G, Stenerlöw B, Fredriksson A, Sundell‐Bergman S, Eriksson P, Buratovic S. Developmental effects of neonatal fractionated co‐exposure to low‐dose gamma radiation and paraquat on behaviour in adult mice. J Appl Toxicol 2018; 39:582-589. [DOI: 10.1002/jat.3748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/26/2018] [Accepted: 10/07/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Gaëtan Philippot
- Department of Environmental ToxicologyUppsala University Uppsala Sweden
| | - Bo Stenerlöw
- Department of Immunology, Genetics and PathologyUppsala University Uppsala Sweden
| | | | - Synnöve Sundell‐Bergman
- Department of Soil and EnvironmentSwedish University of Agricultural Sciences Uppsala Sweden
| | - Per Eriksson
- Department of Environmental ToxicologyUppsala University Uppsala Sweden
| | - Sonja Buratovic
- Department of Environmental ToxicologyUppsala University Uppsala Sweden
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Averbeck D, Salomaa S, Bouffler S, Ottolenghi A, Smyth V, Sabatier L. Progress in low dose health risk research. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2018; 776:46-69. [DOI: 10.1016/j.mrrev.2018.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 12/11/2022]
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Journy NMY, Dreuil S, Boddaert N, Chateil JF, Defez D, Ducou-le-Pointe H, Garcier JM, Guersen J, Habib Geryes B, Jahnen A, Lee C, Payen-de-la-Garanderie J, Pracros JP, Sirinelli D, Thierry-Chef I, Bernier MO. Individual radiation exposure from computed tomography: a survey of paediatric practice in French university hospitals, 2010-2013. Eur Radiol 2018; 28:630-641. [PMID: 28836026 DOI: 10.1007/s00330-017-5001-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/12/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe computed tomography (CT) scanning parameters, volume CT dose index (CTDIvol) and dose-length product (DLP) in paediatric practice and compare them to current diagnostic reference levels (DRLs). METHODS The survey was conducted in radiology departments of six major university hospitals in France in 2010-2013. Data collection was automatised to extract and standardise information on scanning parameters from DICOM-header files. CTDIvol and DLP were estimated based on Monte Carlo transport simulation and computational reference phantoms. RESULTS CTDIvol and DLP were derived for 4,300 studies, four age groups and 18 protocols. CTDIvol was lower in younger patients for non-head scans, but did not vary with age for routine head scans. Ratios of 95th to 5th percentile CTDIvol values were 2-4 for most body parts, but 5-7 for abdominal examinations and 4-14 for mediastinum CT with contrast, depending on age. The 75th percentile CTDIvol values were below the national DRLs for chest (all ages) and head and abdominal scans (≥10 years). CONCLUSION The results suggest the need for a better optimisation of scanning parameters for routine head scans and infrequent protocols with patient age, enhanced standardisation of practices across departments and revision of current DRLs for children. KEY POINTS • CTDIvol varied little with age for routine head scans. • CTDIvol was lowest in youngest children for chest or abdominal scans. • Individual and inter-department variability warrant enhanced standardisation of practices. • Recent surveys support the need for revised diagnostic reference levels. • More attention should be given to specific protocols (sinuses, neck, spine, mediastinum).
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Affiliation(s)
- Neige M Y Journy
- Laboratoire d'épidémiologie des rayonnements ionisants, Unité Radioprotection de l'Homme, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France.
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA.
| | - Serge Dreuil
- Unité d'expertise en radioprotection médicale, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | - Nathalie Boddaert
- Service de radiologie pédiatrique, INSERM U1000, UMR 1163, Institut Imagine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75743, Paris Cedex 15, France
- PRES Sorbonne Paris, Cité Université René Descartes, 190 avenue de France, 75013, Paris, France
| | - Jean-François Chateil
- Service de radiologie et d'imagerie anténatale, de l'enfant et de la femme, Groupe Hospitalier Pellegrin, Centre Hospitalier Universitaire de Bordeaux, place Amélie Raba-Léon, 33000, Bordeaux, France
| | - Didier Defez
- Service de Physique Médicale, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Benite, France
| | - Hubert Ducou-le-Pointe
- Service de Radiologie, Hôpital d'Enfants Armand-Trousseau, 26 avenue du Dr A. Netter, 75012, Paris, France
| | - Jean-Marc Garcier
- Service de radiologie, Centre Hospitalier Universitaire Estaing, 1 place Lucie-Aubrac, 63003, Clermont-Ferrand Cedex 1, France
| | - Joël Guersen
- Pôle Imagerie et Radiologie Interventionnelle, Centre Hospitalier Universitaire Gabriel Montpied, 58 rue Montalembert, 63003, Clermont Ferrand cedex 1, France
| | - Bouchra Habib Geryes
- Direction des affaires médicales, de la qualité et la relation avec les usagers, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75743, Paris Cedex 15, France
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology (LIST), 5 avenue des Hauts-Fourneaux, L-4362, Esch/Alzette, Luxembourg, Luxembourg
| | - Choonsik Lee
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA
| | | | - Jean-Pierre Pracros
- Service d'imagerie pédiatrique, Hôpital Femme Mère Enfants, Groupe Hospitalier Est, 59 Boulevard Pinel, 69500, Bron, France
| | - Dominique Sirinelli
- Service de radiologie pediatrique, Hôpital Clocheville, Centre Hospitalier Régional Universitaire de Tours, 49 boulevard Béranger, 37000, Tours, France
| | - Isabelle Thierry-Chef
- Section of Environment and Cancer, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon cedex 08, France
| | - Marie-Odile Bernier
- Laboratoire d'épidémiologie des rayonnements ionisants, Unité Radioprotection de l'Homme, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
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Effects on adult cognitive function after neonatal exposure to clinically relevant doses of ionising radiation and ketamine in mice. Br J Anaesth 2018; 120:546-554. [PMID: 29452811 DOI: 10.1016/j.bja.2017.11.099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 10/31/2017] [Accepted: 11/10/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Radiological methods for screening, diagnostics and therapy are frequently used in healthcare. In infants and children, anaesthesia/sedation is often used in these situations to relieve the patients' perception of stress or pain. Both ionising radiation (IR) and ketamine have been shown to induce developmental neurotoxic effects and this study aimed to identify the combined effects of these in a murine model. METHODS Male mice were exposed to a single dose of ketamine (7.5 mg kg-1 body weight) s.c. on postnatal day 10. One hour after ketamine exposure, mice were whole body irradiated with 50-200 mGy gamma radiation (137Cs). Behavioural observations were performed at 2, 4 and 5 months of age. At 6 months of age, cerebral cortex and hippocampus tissue were analysed for neuroprotein levels. RESULTS Animals co-exposed to IR and ketamine displayed significant (P≤0.01) lack of habituation in the spontaneous behaviour test, when compared with controls and single agent exposed mice. In the Morris Water Maze test, co-exposed animals showed significant (P≤0.05) impaired learning and memory capacity in both the spatial acquisition task and the relearning test compared with controls and single agent exposed mice. Furthermore, in co-exposed mice a significantly (P≤0.05) elevated level of tau protein in cerebral cortex was observed. Single agent exposure did not cause any significant effects on the investigated endpoints. CONCLUSION Co-exposure to IR and ketamine can aggravate developmental neurotoxic effects at doses where the single agent exposure does not impact on the measured variables. These findings show that estimation of risk after paediatric low-dose IR exposure, based upon radiation dose alone, may underestimate the consequences for this vulnerable population.
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Computed tomography use in a large Italian region: trend analysis 2004-2014 of emergency and outpatient CT examinations in children and adults. Eur Radiol 2018; 28:2308-2318. [PMID: 29318431 DOI: 10.1007/s00330-017-5225-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 11/20/2017] [Accepted: 11/29/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To analyse CT use in recent years in a high-density Italian area (±10 million inhabitants, including 1 million children), focusing on developing age. METHODS Retrospective analysis of records from HealthCare IT System, covering >400 hospitals and clinics. Description of CT use between 2004-2014 in emergency and outpatient care and assessment of radiation exposure trend. RESULTS Over 9 million scans were performed. Emergency procedures showed a global increase of 230 %, mainly head examinations. In the global outpatient setting, the annual number of CT scans/person increased ±19 %. A moderate increase in CT examinations was observed in the developing age population, while a remarkable increase in dental, chest and abdominal procedures occurred for the 10- to 30-year age range. The increase in mean annual dose/capita in the global patient pool was approximately 42 %, increasing from 0.72-1.03 mSv. The population rate receiving an annual CT radiation dose/capita higher than 1 mSv tripled in the 11-year interval, increasing from 16-48 %. CONCLUSIONS The remarkable increase in radiation exposure raises a special concern for teenagers and young adults, whose risk tends to be underestimated. The fivefold increase in dental CTs in the younger age groups requires further investigations. KEY POINTS • Literature highlights a remarkable increase in CT use over the last decades. • The paediatric age had higher exposure to X-ray risk. • A detailed retrospective analysis of more than 9 million scans was performed. • Dental, chest, abdominal procedures increased remarkably in 10- to 30-year age range. • This study raises concern about exposure for teenagers and young adults.
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Mokhtar A, Elawdy M, El-Hamid MA, Refaie H, El-Diasty TA, Mogy SE. Radiation dose associated with common computed tomography examination. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Khattab M, Walker DM, Albertini RJ, Nicklas JA, Lundblad LK, Vacek PM, Walker VE. Frequencies of micronucleated reticulocytes, a dosimeter of DNA double-strand breaks, in infants receiving computed tomography or cardiac catheterization. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2017; 820:8-18. [DOI: 10.1016/j.mrgentox.2017.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 12/18/2022]
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Bertozzi M, Riccioni S, Valoncelli C, Appignani A. The Diagnosis and Management of Ovarian Cysts in Children. J Pediatr Adolesc Gynecol 2017; 30:265. [PMID: 28214196 DOI: 10.1016/j.jpag.2013.01.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/12/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Mirko Bertozzi
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy.
| | - Sara Riccioni
- Section of Radiology, Department of Surgical, Radiologic, and Odontostomatologic Sciences, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Carla Valoncelli
- Section of Radiology, Department of Surgical, Radiologic, and Odontostomatologic Sciences, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Antonino Appignani
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
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Martine RJ, Santangelo T, Colas L, Jean-Baptiste F, Duhamel A, Deschildre A, Remy J. Radiation dose levels in pediatric chest CT: experience in 499 children evaluated with dual-source single-energy CT. Pediatr Radiol 2017; 47:161-168. [PMID: 27830296 DOI: 10.1007/s00247-016-3731-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 09/24/2016] [Accepted: 10/07/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND The availability of dual-source technology has introduced the possibility of scanning children at lower kVp with a high-pitch mode, combining high-speed data acquisition and high temporal resolution. OBJECTIVE To establish the radiation dose levels of dual-source, single-energy chest CT examinations in children. MATERIALS AND METHODS We retrospectively recorded the dose-length product (DLP) of 499 consecutive examinations obtained in children <50 kg, divided into five weight groups: group 1 (<10 kg, n = 129); group 2 (10-20 kg, n = 176); group 3 (20-30 kg, n = 99), group 4 (30-40 kg, n = 58) and group 5 (40-49 kg, n = 37). All CT examinations were performed with high temporal resolution (75 ms), a high-pitch mode and a weight-adapted selection of the milliamperage. RESULTS CT examinations were obtained at 80 kVp with a milliamperage ranging between 40 mAs and 90 mAs, and a pitch of 2.0 (n = 162; 32.5%) or 3.0 (n = 337; 67.5%). The mean duration of data acquisition was 522.8 ± 192.0 ms (interquartile range 390 to 610; median 490). In the study population, the mean CT dose index volume (CTDIvol32) was 0.83 mGy (standard deviation [SD] 0.20 mGy; interquartile range 0.72 to 0.94; median 0.78); the mean DLP32 was 21.4 mGy.cm (SD 9.1 mGy.cm; interquartile range 15 to 25; median 19.0); and the mean size-specific dose estimate (SSDE) was 1.7 mGy (SD 0.4 mGy; interquartile range 1.5 to 1.9; median 1.7). The DLP32, CTDIvol32 and SSDE were found to be statistically significant in the five weight categories (P < 0.0001). CONCLUSION This study establishes the radiation dose levels for dual-source, single-kVp chest CT from a single center. In the five weight categories, the median values varied 15-37 mGy.cm for the DLP32, 0.78-1.25 mGy for the CTDIvol32 and 1.6-2.1 mGy for the SSDE.
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Affiliation(s)
- Remy-Jardin Martine
- Department of Thoracic Imaging, Hospital Calmette, CHU Lille (EA 2694) University of Lille, F-59000, Lille, France.
| | - Teresa Santangelo
- Department of Thoracic Imaging, Hospital Calmette, CHU Lille (EA 2694) University of Lille, F-59000, Lille, France.,Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lucie Colas
- Department of Thoracic Imaging, Hospital Calmette, CHU Lille (EA 2694) University of Lille, F-59000, Lille, France
| | - Faivre Jean-Baptiste
- Department of Thoracic Imaging, Hospital Calmette, CHU Lille (EA 2694) University of Lille, F-59000, Lille, France
| | - Alain Duhamel
- Department of Biostatistics; CHU Lille, University of Lille (EA 2694) , F-59000, Lille, France
| | - Antoine Deschildre
- Department of Pediatric Pulmonology,, CHU Lille - University of Lille, Lille, France
| | - Jacques Remy
- Department of Thoracic Imaging, Hospital Calmette, CHU Lille (EA 2694) University of Lille, F-59000, Lille, France
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Vilar-Palop J, Vilar J, Hernández-Aguado I, González-Álvarez I, Lumbreras B. Updated effective doses in radiology. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:975-990. [PMID: 27893456 DOI: 10.1088/0952-4746/36/4/975] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to review recent literature in order to provide updated values of the typical effective doses associated with the top 20 imaging tests for adults and children and for the most widely used set of weights (ICRP60) as well as for the most recent one (ICRP103). We performed a systematic research on radiation dosimetry in radiology published from 2007 onwards through the Medline, Embase and Cochrane Library Plus databases. We also included studies backed by scientific or governmental organizations. Other variables included: year and type of study (survey or descriptive), country, method and sample used for the measurement. Mean effective dose, minimum, maximum and standard deviation were calculated. We compared our results with previous evidence and with data from DDM2. We included 27 articles and 5 web references in the study. A total of 378 values from the 20 procedures included were obtained, 280 (74%) using ICRP60 and 98 (26%) using ICRP103. Effective doses for CT procedures in children were very similar to those for adults, with the exception of CT Trunk, but fluoroscopy procedures had consistently lower dose. There were differences between the current data with either ICRP60 or ICRP103, and the previous published data. In conclusion, we provided the best available evidence from literature to evaluate the effective dose received by each patient for the most typical examinations. According to the recommendations from the Report 154 and from the European Council Directive, these results could also be useful to estimate the range of average exposures to the population.
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Harbron R. What do recent epidemiological studies tell us about the risk of cancer from radiation doses typical of diagnostic radiography? Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2016.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pokora* R, Krille* L, Dreger S, Lee C, Günster C, Zeeb H, Blettner M. Computed Tomography in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:721-728. [PMID: 27866569 PMCID: PMC5150210 DOI: 10.3238/arztebl.2016.0721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/03/2016] [Accepted: 07/25/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND In 2001, calculations in models based on atomic bomb survivors indicated that children exposed to ionizing radiation by computed tomography (CT) would be expected to have an increased risk of cancer. This led to the issuance of new recommendations in Germany concerning CT in children. METHODS We analyzed data from the German pediatric CT cohort study together with data on children from a large general statutory health insurance provider (AOK) in order to characterize the secular trend in the use of CT in Germany. We used information from the Picture Archiving and Communication System (PACS) to estimate individual organ doses per scan and their development over time. RESULTS The number of CT scans performed on children in Germany each year declined by 29% from 2006 to 2012. Over the same period, younger children were exposed to lower organ doses during CT scanning, although some organ doses were higher in neonates than in older children. The highest organ doses were in the 7.6 to 12.5-year-old age group and affected the brain (37.12 mGy ± 19.68 mGy) and the lenses (41.24 mGy ± 20.08 mGy). In every age group, the organ doses declined from year to year. With approximately 21 000 children aged 0-13 undergoing CT each year (extrapolated from insurance data of 2008), one can expect 2.3 [-1.7; 6.3] additional new cases of leukemia and 1 [-2.3; 4.0] additional new tumor of the central nervous system to arise each year. CONCLUSION In view of the risks, children should undergo CT only for the indications listed by the German Commission on Radiological Protection (Strahlenschutzkommission). Further epidemiological studies are needed for estimation of the risk associated with the use of newer CT technology.
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Affiliation(s)
- Roman Pokora*
- *Roman Pokora and Lucian Krille are joint first authors
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Faculty of Medicine, Johannes Gutenberg University of Mainz
| | - Lucian Krille*
- *Roman Pokora and Lucian Krille are joint first authors
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Faculty of Medicine, Johannes Gutenberg University of Mainz
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Steffen Dreger
- Leibniz Institute for Prevention Research and Epidemiology – BIPS GmbH, Bremen
| | - Choonsik Lee
- National Cancer Institute (NCI), Rockville, Maryland, USA
| | | | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology – BIPS GmbH, Bremen
- University of Bremen, Research Focus Health Sciences Bremen
| | - Maria Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Faculty of Medicine, Johannes Gutenberg University of Mainz
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Zakhari R, Sterrett SE. Attitudes toward evidence-based clinical decision support tools to reduce exposure to ionizing radiation: The Canadian CT Head Rule. J Am Assoc Nurse Pract 2016; 28:659-667. [PMID: 27717240 DOI: 10.1002/2327-6924.12402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 07/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE A large degree of variation in clinical practice exists among clinicians evaluating and treating individuals with minor head injuries. Noncontrast head computerized tomography (CT) scans are commonly used to assess for intracranial damage in patients presenting with head injury. This practice is not supported by the evidence and poses harm to patients by increasing exposure to ionizing radiation. This form of radiation exposure increases the risk of developing cancers over the course of the individual's life, and further strains the limited resources of the healthcare system. PROJECT SUMMARY This article describes the findings of an evidence-based practice project assessing the attitudes of clinicians toward an evidence-based clinical decision support tool (Canadian CT Head Rule [CCHR]). The CCHR has 100% sensitivity in detecting all clinically important brain injuries and any injury requiring neurosurgical intervention. This clinical decision support (CDS) tool is designed to help guide clinicians in the prudent use of head CT scans in people ages 16-64 that have sustained minor head injuries. The Evidence-Based Attitude Scale was also used to identify which domains were most influential on willingness to adopt into clinical practice. CONCLUSIONS The results revealed an 84% increase in clinician knowledge of the use of the CCHR. A majority (83%) of participants reported moderate likelihood of adoption of the CDS tool into clinical practice if they found the tool appealing, and it was required by a governing authority. The use of CDS tools can help healthcare providers mitigate the risk associated with caring for complex patients. CDS tools provide a systematic method to evaluate patients with minor head injuries while assuring consistency of care and quality outcomes. This practice of assuring consistency and good patient outcomes is foundational to the concept of standard of care, which serves to improve clinical practice.
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Affiliation(s)
- Raymond Zakhari
- New York Presbyterian Hospital-Payne Whitney Clinic, New York, NY
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The changing use of pediatric CT in Australia. Pediatr Radiol 2016; 46:1199-208. [PMID: 26952101 DOI: 10.1007/s00247-016-3563-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 12/16/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite the medical benefits of CT, there are concerns about increased cancer risks following CT scans in childhood. OBJECTIVE To assess Australian temporal trends in pediatric CT scans funded through Medicare over the period 1985 to 2005, as well as changes in the types of CT scanners used. MATERIALS AND METHODS We studied de-identified electronic records of Medicare-funded services, including CT scans, that were available for children and adults younger than 20 years between 1985 and 2005. We assessed temporal trends using CT imaging rates by age, gender and anatomical region. Regulators provided CT scanner registration lists to identify new models installed in Australia and to date the introduction of new technologies. RESULTS Between 1985 and 2005, 896,306 Medicare-funded CT services were performed on 688,260 individuals younger than 20 years. The imaging rate more than doubled during that time period. There were more than 1,000 CT scanners on registration lists during the study period. There were both a sharp increase in the availability of helical scanning capabilities from 1994 and significant growth in multi-detector CT scanners from 2000. CONCLUSION Significant increases in the rate of pediatric CT scanning have occurred in Australia. This rate has stabilized since 2000, possibly a result of better understanding of cancer risks.
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Phelps AS, Gould RG, Courtier JL, Marcovici PA, Salani C, MacKenzie JD. How Much Does Lead Shielding during Fluoroscopy Reduce Radiation Dose to Out-of-Field Body Parts? J Med Imaging Radiat Sci 2016; 47:171-177. [DOI: 10.1016/j.jmir.2015.12.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/03/2015] [Accepted: 12/16/2015] [Indexed: 11/30/2022]
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Buratovic S, Stenerlöw B, Fredriksson A, Sundell-Bergman S, Eriksson P. Developmental effects of fractionated low-dose exposure to gamma radiation on behaviour and susceptibility of the cholinergic system in mice. Int J Radiat Biol 2016; 92:371-9. [PMID: 27043364 DOI: 10.3109/09553002.2016.1164911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To investigate whether neonatal exposure to fractionated external gamma radiation and co-exposure to radiation and nicotine can affect/exacerbate developmental neurotoxic effects, including altered behavior/cognitive function and the susceptibility of the cholinergic system in adult male mice. MATERIALS AND METHODS Neonatal male Naval Medical Research Institute (NMRI) mice were irradiated with one 200 mGy fraction/day and/or exposed to nicotine (66 μg/kg b.w.) twice daily on postnatal day (PND) 10, 10-11, 10-12 or 10-13 (nicotine only). At 2 months of age the animals were tested for spontaneous behavior in a novel home environment, habituation capacity and nicotine-induced behavior. RESULTS Fractionated irradiation and co-exposure to radiation and nicotine on three consecutive days disrupted behavior and habituation and altered susceptibility of the cholinergic system. All observed effects were significantly more pronounced in mice co-exposed to both radiation and nicotine. CONCLUSIONS The fractionated irradiation regime affects behavior/cognitive function in a similar manner as has previously been observed for single-dose exposures. Neonatal co-exposure to radiation and nicotine, during a critical period of brain development in general and cholinergic system development in particular, enhance these behavioral defects suggesting that the cholinergic system can be a target system for this type of developmental neurotoxic effects.
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Affiliation(s)
- Sonja Buratovic
- a Department of Environmental Toxicology , Uppsala University , Uppsala, Sweden
| | - Bo Stenerlöw
- b Department of Immunology, Genetics and Pathology , Uppsala University , Uppsala, Sweden
| | - Anders Fredriksson
- a Department of Environmental Toxicology , Uppsala University , Uppsala, Sweden
| | - Synnöve Sundell-Bergman
- c Department of Soil and Environment , Swedish University of Agricultural Sciences , Uppsala , Sweden
| | - Per Eriksson
- a Department of Environmental Toxicology , Uppsala University , Uppsala, Sweden
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Eriksson P, Buratovic S, Fredriksson A, Stenerlöw B, Sundell-Bergman S. Neonatal exposure to whole body ionizing radiation induces adult neurobehavioural defects: Critical period, dose--response effects and strain and sex comparison. Behav Brain Res 2016; 304:11-9. [PMID: 26876140 DOI: 10.1016/j.bbr.2016.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/03/2016] [Accepted: 02/07/2016] [Indexed: 02/06/2023]
Abstract
Development of the brain includes periods which can be critical for its normal maturation. The present study investigates specifically vulnerable peri-/postnatal periods in mice which are essential for understanding the etiology behind radiation induced neurotoxicity and functional defects, including evaluation of neurotoxicity between sexes or commonly used laboratory mouse strains following low/moderate doses of ionizing radiation (IR). Male Naval Medical Research Institute (NMRI) mice, whole body irradiated to a single 500 mGy IR dose, on postnatal day (PND) 3 or PND 10 showed an altered adult spontaneous behaviour and impaired habituation capacity, whereas irradiation on PND 19 did not have any impact on the studied variables. Both NMRI and C57bl/6 male and female mice showed an altered adult spontaneous behaviour and impaired habituation following a single whole body irradiation of 500 or 1000 mGy, but not after 20 or 100 mGy, on PND 10. The present study shows that exposure to low/moderate doses of IR during critical life stages might be involved in the induction of neurological/neurodegenerative disorder/disease. A specifically vulnerable period for radiation induced neurotoxicity seems to be around PND 3-10 in mice. Further studies are needed to investigate mechanisms involved in induction of developmental neurotoxicity following low-dose irradiation.
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Affiliation(s)
- Per Eriksson
- Department of Environmental Toxicology, Uppsala University, Norbyvägen 18A, SE-75236 Uppsala, Sweden.
| | - Sonja Buratovic
- Department of Environmental Toxicology, Uppsala University, Norbyvägen 18A, SE-75236 Uppsala, Sweden
| | - Anders Fredriksson
- Department of Environmental Toxicology, Uppsala University, Norbyvägen 18A, SE-75236 Uppsala, Sweden
| | - Bo Stenerlöw
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Synnöve Sundell-Bergman
- Department of Soil and Environment, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Baysson H, Journy N, Roué T, Ducou-Lepointe H, Etard C, Bernier MO. Exposition à la scanographie dans l’enfance et risque de cancer à long terme. Une synthèse des études épidémiologiques récentes. Bull Cancer 2016; 103:190-8. [DOI: 10.1016/j.bulcan.2015.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 10/29/2015] [Accepted: 11/02/2015] [Indexed: 10/24/2022]
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Suliman II, Khamis HM, Ombada TH, Alzimami K, Alkhorayef M, Sulieman A. Radiation exposure during paediatric CT in Sudan: CT dose, organ and effective doses. RADIATION PROTECTION DOSIMETRY 2015; 167:513-518. [PMID: 25377750 DOI: 10.1093/rpd/ncu321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/24/2014] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to assess the magnitude of radiation exposure during paediatric CT in Sudanese hospitals. Doses were determined from CT acquisition parameters using CT-Expo 2.1 dosimetry software. Doses were evaluated for three patient ages (0-1, 1-5 and 5-10 y) and two common procedures (head and abdomen). For children aged 0-1 y, volume CT air kerma index (Cvol), air Kerma-length product and effective dose (E) values were 19.1 mGy, 265 mGy.cm and 3.1 mSv, respectively, at head CT and those at abdominal CT were 8.8 mGy, 242 mGy.cm and 7.7 mSv, respectively. Those for children aged 1-5 y were 22.5 mGy, 305 mGy.cm and 1.1 mSv, respectively, at head CT and 12.6 mGy, 317 mGy.cm, and 5.1 mSv, respectively, at abdominal CT. Dose values and variations were comparable with those reported in the literature. Organ equivalent doses vary from 7.5 to 11.6 mSv for testes, from 9.0 to 10.0 mSv for ovaries and from 11.1 to 14.3 mSv for uterus in abdominal CT. The results are useful for dose optimisation and derivation of national diagnostic reference levels.
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Affiliation(s)
- I I Suliman
- Department of Radiology and Molecular Imaging, Medical Physics Section, College of Medicine and Health Sciences, Sultan Qaboos University, PO Box 35, 123 Al-Khod, Oman Sudan Atomic Energy Commission, Radiation Safety Institute, PO Box 3001, Khartoum, Sudan
| | - H M Khamis
- Sudan Atomic Energy Commission, Radiation Safety Institute, PO Box 3001, Khartoum, Sudan
| | - T H Ombada
- Faculty of Science and Technology, Department of Medical Physics, Al-Neelain University, PO Box 12702, Khartoum, Sudan
| | - K Alzimami
- Department of Radiological Sciences, Applied Medical Sciences College, King Saud University, PO Box 10219, Riyadh 11433, Saudi Arabia
| | - M Alkhorayef
- Department of Radiological Sciences, Applied Medical Sciences College, King Saud University, PO Box 10219, Riyadh 11433, Saudi Arabia
| | - A Sulieman
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Salman Bin Abdulaziz University, PO Box 422, Alkharj 11943, Saudi Arabia
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Inman M, Otley A, Dummer T, Cui Y, Schmidt MH, Parker L. Childhood exposure to ionizing radiation from computed tomography imaging in Nova Scotia. Paediatr Child Health 2015; 20:381-5. [PMID: 26526506 DOI: 10.1093/pch/20.7.381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Examining radiation dose in the paediatric population is particularly important due to the vulnerability of paediatric patients (increased radiosensitive tissues and postexposure life-years) and risk for future radiogenic malignancy. OBJECTIVES To evaluate trends in paediatric computed tomography (CT) use and ionizing radiation exposure using population-based data from Nova Scotia. METHODS A retrospective, population-based cohort study of CT use in patients <20 years of age, from January 1, 2004 to December 31, 2011, was performed in Nova Scotia. CT examination data were retrieved from a provincial imaging repository. Trends in CT use were described, and both annual and cumulative effective dose exposures were calculated. RESULTS In total, 29,452 CT events, involving up to 22,867 individuals were retrieved. Overall annual paediatric CT examination rates remained static (range 17.4 to 18.8 per 1000 per year). However, use in children <10 years of age decreased by >50% (P<0.001); this was counterbalanced by a steady increase among 15- to 19-year-olds (P<0.0001). Overall, 15.4% of scanned patients underwent ≥2 examinations, of which 58 patients (1.6%) exceeded 50 mSv of exposure. CONCLUSIONS Despite a static rate in CT imaging among the entire cohort, children <15 years of age and, particularly, those <10 years of age displayed marked reductions in CT use. This may reflect increased awareness of campaigns emphasizing judicious CT use, revised clinical practice guidelines and increased availability of alternative modalities. A small subgroup demonstrated high-dose exposure (>50 mSv), and rates in individuals >15 years of age steadily increased, suggesting further exposure reduction efforts are necessary.
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Affiliation(s)
- Mark Inman
- Department of Paediatrics, Dalhousie University; IWK Health Centre
| | - Anthony Otley
- Department of Paediatrics, Dalhousie University; IWK Health Centre
| | - Trevor Dummer
- Department of Paediatrics, Population Cancer Research Program, Dalhousie University, Halifax, Nova Scotia; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | - Yunsong Cui
- Population Cancer Research Program, Dalhousie University, Halifax, Nova Scotia
| | - Matthias H Schmidt
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia
| | - Louise Parker
- Departments of Medicine and Paediatrics, Population Cancer Resarch Program, Dalhousie University, Halifax, Nova Scotia
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Schweitzer T, Kunz F, Meyer-Marcotty P, Müller-Richter UDA, Böhm H, Wirth C, Ernestus RI, Linz C. Diagnostic features of prematurely fused cranial sutures on plain skull X-rays. Childs Nerv Syst 2015; 31:2071-80. [PMID: 26298825 DOI: 10.1007/s00381-015-2890-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/17/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The characteristic features of prematurely fused craniosynostosis in plain radiographs have already been described in literature, but there is no clinical trial investigating the individual features of every single form of craniosynostosis. We described suture-specific characteristics as well as its frequency of appearance in plain radiographs in every different form of craniosynostosis. Intraoperative findings served as control to confirm the diagnosis. METHODS One hundred twenty-seven children with prematurely fused cranial sutures who underwent a skull X-ray from 2008 to 2012 were investigated in the present study. In detail, 34 children with frontal, 60 with sagittal, 13 with unilateral and 14 with bilateral coronal synostosis and 3 with unilateral lambdoid craniosynostosis as well as 3 children with a bilateral lambdoid synostosis were included. RESULTS Typical radiological characteristics in craniosynostosis exist. These features as well as its frequency in craniosynostosis in plain skull radiographs are presented. In all cases, these typical features enabled a correct diagnosis, which was confirmed by intraoperative findings. CONCLUSION The frequency of the appearance of typical features is listed and may serve as a "mental internal check list" in the radiological approach to craniosynostosis. The study points out the value of plain skull X-rays as it enabled proper diagnosis in all investigated 127 cases.
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Affiliation(s)
- Tilmann Schweitzer
- Department of Neurosurgery, Section of Pediatric Neurosurgery, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
| | - Felix Kunz
- Department of Orthodontics, University Hospital of Würzburg, Würzburg, Germany
| | | | | | - Hartmut Böhm
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Clemens Wirth
- Department of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - Christian Linz
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg, Würzburg, Germany
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Kempf SJ, Sepe S, von Toerne C, Janik D, Neff F, Hauck SM, Atkinson MJ, Mastroberardino PG, Tapio S. Neonatal Irradiation Leads to Persistent Proteome Alterations Involved in Synaptic Plasticity in the Mouse Hippocampus and Cortex. J Proteome Res 2015; 14:4674-86. [PMID: 26420666 DOI: 10.1021/acs.jproteome.5b00564] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recent epidemiological data indicate that radiation doses as low as those used in computer tomography may result in long-term neurocognitive side effects. The aim of this study was to elucidate long-term molecular alterations related to memory formation in the brain after low and moderate doses of γ radiation. Female C57BL/6J mice were irradiated on postnatal day 10 with total body doses of 0.1, 0.5, or 2.0 Gy; the control group was sham-irradiated. The proteome analysis of hippocampus, cortex, and synaptosomes isolated from these brain regions indicated changes in ephrin-related, RhoGDI, and axonal guidance signaling. Immunoblotting and miRNA-quantification demonstrated an imbalance in the synapse morphology-related Rac1-Cofilin pathway and long-term potentiation-related cAMP response element-binding protein (CREB) signaling. Proteome profiling also showed impaired oxidative phosphorylation, especially in the synaptic mitochondria. This was accompanied by an early (4 weeks) reduction of mitochondrial respiration capacity in the hippocampus. Although the respiratory capacity was restored by 24 weeks, the number of deregulated mitochondrial complex proteins was increased at this time. All observed changes were significant at doses of 0.5 and 2.0 Gy but not at 0.1 Gy. This study strongly suggests that ionizing radiation at the neonatal state triggers persistent proteomic alterations associated with synaptic impairment.
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Affiliation(s)
| | - Sara Sepe
- Department of Genetics, Erasmus Medical Center , 3015 CE Rotterdam, The Netherlands
| | | | | | | | | | - Michael J Atkinson
- Chair of Radiation Biology, Technical University Munich , 80333 Munich, Germany
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Potential cancer risk associated with CT scans: Review of epidemiological studies and ongoing studies. PROGRESS IN NUCLEAR ENERGY 2015. [DOI: 10.1016/j.pnucene.2014.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bosch de Basea M, Pearce MS, Kesminiene A, Bernier MO, Dabin J, Engels H, Hauptmann M, Krille L, Meulepas JM, Struelens L, Baatout S, Kaijser M, Maccia C, Jahnen A, Thierry-Chef I, Blettner M, Johansen C, Kjaerheim K, Nordenskjöld A, Olerud H, Salotti JA, Andersen TV, Vrijheid M, Cardis E. EPI-CT: design, challenges and epidemiological methods of an international study on cancer risk after paediatric and young adult CT. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2015; 35:611-28. [PMID: 26226081 DOI: 10.1088/0952-4746/35/3/611] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
Computed tomography (CT) has great clinical utility and its usage has increased dramatically over the years. Concerns have been raised, however, about health impacts of ionising radiation exposure from CTs, particularly in children, who have a higher risk for some radiation induced diseases. Direct estimation of the health impact of these exposures is needed, but the conduct of epidemiological studies of paediatric CT populations poses a number of challenges which, if not addressed, could invalidate the results. The aim of the present paper is to review the main challenges of a study on the health impact of paediatric CTs and how the protocol of the European collaborative study EPI-CT, coordinated by the International Agency for Research on Cancer (IARC), is designed to address them. The study, based on a common protocol, is being conducted in Belgium, Denmark, France, Germany, the Netherlands, Norway, Spain, Sweden and the United Kingdom and it has recruited over one million patients suitable for long-term prospective follow-up. Cohort accrual relies on records of participating hospital radiology departments. Basic demographic information and technical data on the CT procedure needed to estimate organ doses are being abstracted and passive follow-up is being conducted by linkage to population-based cancer and mortality registries. The main issues which may affect the validity of study results include missing doses from other radiological procedures, missing CTs, confounding by CT indication and socioeconomic status and dose reconstruction. Sub-studies are underway to evaluate their potential impact. By focusing on the issues which challenge the validity of risk estimates from CT exposures, EPI-CT will be able to address limitations of previous CT studies, thus providing reliable estimates of risk of solid tumours and leukaemia from paediatric CT exposures and scientific bases for the optimisation of paediatric CT protocols and patient protection.
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Affiliation(s)
- Magda Bosch de Basea
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. Universitat Pompeu Fabra (UPF), Barcelona, Spain. CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Baysson H, Nkoumazok B, Barnaoui S, Réhel JL, Girodon B, Milani G, Boudjemline Y, Bonnet D, Laurier D, Bernier MO. Follow-up of children exposed to ionising radiation from cardiac catheterisation: the Coccinelle study. RADIATION PROTECTION DOSIMETRY 2015; 165:13-6. [PMID: 25833897 PMCID: PMC4501346 DOI: 10.1093/rpd/ncv039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Cardiac catheterisation has become an essential tool in the diagnosis and treatment of children with a wide variety of congenital and acquired forms of cardiovascular disease. Despite the clear clinical benefit to the patient, radiation exposure from paediatric cardiac catheterisation procedures (CCPs) may be substantial. Given children's greater sensitivity to radiation and the longer life span during which radiation health effects can develop, an epidemiological cohort study, named Coccinelle or 'Ladybird' (French acronym for 'Cohorte sur le risque de cancer après cardiologie interventionnelle pédiatrique'), is carried out in France to evaluate the risks of leukaemia and solid cancers in this population. A total number of 8000 included children are expected. Individual CCP-related doses will be assessed for each child included in the cohort. For each CCP performed, dosimetric parameters (dose-area product, fluoroscopy time and total number of cine frames) are retrieved retrospectively. Organ doses, especially to the lung, the oesophagus and the thyroid, are calculated with PCXMC software. The cohort will be followed up through linkage with French paediatric cancer registries.
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Affiliation(s)
- H Baysson
- Institut de Radioprotection et de Sûreté Nucléaire, BP 17, Fontenay aux Roses 92260, France
| | - B Nkoumazok
- Institut de Radioprotection et de Sûreté Nucléaire, BP 17, Fontenay aux Roses 92260, France
| | - S Barnaoui
- Institut de Radioprotection et de Sûreté Nucléaire, BP 17, Fontenay aux Roses 92260, France
| | - J L Réhel
- Institut de Radioprotection et de Sûreté Nucléaire, BP 17, Fontenay aux Roses 92260, France
| | - B Girodon
- Centre de Référence Malformations Cardiaques Congénitales Complexes, M3C Hôpital Necker-Enfants Malades, Université Paris Descartes, Paris, France
| | - G Milani
- Centre de Référence Malformations Cardiaques Congénitales Complexes, M3C Hôpital Necker-Enfants Malades, Université Paris Descartes, Paris, France
| | - Y Boudjemline
- Centre de Référence Malformations Cardiaques Congénitales Complexes, M3C Hôpital Necker-Enfants Malades, Université Paris Descartes, Paris, France
| | - D Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes, M3C Hôpital Necker-Enfants Malades, Université Paris Descartes, Paris, France
| | - D Laurier
- Institut de Radioprotection et de Sûreté Nucléaire, BP 17, Fontenay aux Roses 92260, France
| | - M O Bernier
- Institut de Radioprotection et de Sûreté Nucléaire, BP 17, Fontenay aux Roses 92260, France
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Kempf SJ, Moertl S, Sepe S, von Toerne C, Hauck SM, Atkinson MJ, Mastroberardino PG, Tapio S. Low-dose ionizing radiation rapidly affects mitochondrial and synaptic signaling pathways in murine hippocampus and cortex. J Proteome Res 2015; 14:2055-64. [PMID: 25807253 DOI: 10.1021/acs.jproteome.5b00114] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The increased use of radiation-based medical imaging methods such as computer tomography is a matter of concern due to potential radiation-induced adverse effects. Efficient protection against such detrimental effects has not been possible due to inadequate understanding of radiation-induced alterations in signaling pathways. The aim of this study was to elucidate the molecular mechanisms behind learning and memory deficits after acute low and moderate doses of ionizing radiation. Female C57BL/6J mice were irradiated on postnatal day 10 (PND10) with gamma doses of 0.1 or 0.5 Gy. This was followed by evaluation of the cellular proteome, pathway-focused transcriptome, and neurological development/disease-focused miRNAome of hippocampus and cortex 24 h postirradiation. Our analysis showed that signaling pathways related to mitochondrial and synaptic functions were changed by acute irradiation. This may lead to reduced mitochondrial function paralleled by enhanced number of dendritic spines and neurite outgrowth due to elevated long-term potentiation, triggered by increased phosphorylated CREB. This was predominately observed in the cortex at 0.1 and 0.5 Gy and in the hippocampus only at 0.5 Gy. Moreover, a radiation-induced increase in the expression of several neural miRNAs associated with synaptic plasticity was found. The early changes in signaling pathways related to memory formation may be associated with the acute neurocognitive side effects in patients after brain radiotherapy but might also contribute to late radiation-induced cognitive injury.
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Affiliation(s)
- Stefan J Kempf
- †Institute of Radiation Biology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
| | - Simone Moertl
- †Institute of Radiation Biology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
| | - Sara Sepe
- ‡Department of Genetics, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Christine von Toerne
- §Research Unit Protein Science, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
| | - Stefanie M Hauck
- §Research Unit Protein Science, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
| | - Michael J Atkinson
- †Institute of Radiation Biology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany.,∥Chair of Radiation Biology, Technical University Munich, Arcisstrasse 21, 80333 Munich, Germany
| | - Pier G Mastroberardino
- ‡Department of Genetics, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Soile Tapio
- †Institute of Radiation Biology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
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Hérin E, Gardavaud F, Chiaradia M, Beaussart P, Richard P, Cavet M, Deux JF, Haioun C, Itti E, Rahmouni A, Luciani A. Use of Model-Based Iterative Reconstruction (MBIR) in reduced-dose CT for routine follow-up of patients with malignant lymphoma: dose savings, image quality and phantom study. Eur Radiol 2015; 25:2362-70. [DOI: 10.1007/s00330-015-3656-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/03/2015] [Indexed: 11/29/2022]
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Niemann T, Colas L, Roser HW, Santangelo T, Faivre JB, Remy J, Remy-Jardin M, Bremerich J. Estimated risk of radiation-induced cancer from paediatric chest CT: two-year cohort study. Pediatr Radiol 2015; 45:329-36. [PMID: 25274469 DOI: 10.1007/s00247-014-3178-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 06/26/2014] [Accepted: 08/26/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND The increasing absolute number of paediatric CT scans raises concern about the safety and efficacy and the effects of consecutive diagnostic ionising radiation. OBJECTIVE To demonstrate a method to evaluate the lifetime attributable risk of cancer incidence/mortality due to a single low-dose helical chest CT in a two-year patient cohort. MATERIALS AND METHODS A two-year cohort of 522 paediatric helical chest CT scans acquired using a dedicated low-dose protocol were analysed retrospectively. Patient-specific estimations of radiation doses were modelled using three different mathematical phantoms. Per-organ attributable cancer risk was then estimated using epidemiological models. Additional comparison was provided for naturally occurring risks. RESULTS Total lifetime attributable risk of cancer incidence remains low for all age and sex categories, being highest in female neonates (0.34%). Summation of all cancer sites analysed raised the relative lifetime attributable risk of organ cancer incidence up to 3.6% in female neonates and 2.1% in male neonates. CONCLUSION Using dedicated scan protocols, total lifetime attributable risk of cancer incidence and mortality for chest CT is estimated low for paediatric chest CT, being highest for female neonates.
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Affiliation(s)
- Tilo Niemann
- Department of Radiology, Cantonal Hospital Baden, Im Ergel 1, 5400, Baden, Switzerland,
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