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Hamada N. Noncancer Effects of Ionizing Radiation Exposure on the Eye, the Circulatory System and beyond: Developments made since the 2011 ICRP Statement on Tissue Reactions. Radiat Res 2023; 200:188-216. [PMID: 37410098 DOI: 10.1667/rade-23-00030.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/07/2023]
Abstract
For radiation protection purposes, noncancer effects with a threshold-type dose-response relationship have been classified as tissue reactions (formerly called nonstochastic or deterministic effects), and equivalent dose limits aim to prevent occurrence of such tissue reactions. Accumulating evidence demonstrates increased risks for several late occurring noncancer effects at doses and dose rates much lower than previously considered. In 2011, the International Commission on Radiological Protection (ICRP) issued a statement on tissue reactions to recommend a threshold of 0.5 Gy to the lens of the eye for cataracts and to the heart and brain for diseases of the circulatory system (DCS), independent of dose rate. Literature published thereafter continues to provide updated knowledge. Increased risks for cataracts below 0.5 Gy have been reported in several cohorts (e.g., including in those receiving protracted or chronic exposures). A dose threshold for cataracts is less evident with longer follow-up, with limited evidence available for risk of cataract removal surgery. There is emerging evidence for risk of normal-tension glaucoma and diabetic retinopathy, but the long-held tenet that the lens represents among the most radiosensitive tissues in the eye and in the body seems to remain unchanged. For DCS, increased risks have been reported in various cohorts, but the existence or otherwise of a dose threshold is unclear. The level of risk is less uncertain at lower dose and lower dose rate, with the possibility that risk per unit dose is greater at lower doses and dose rates. Target organs and tissues for DCS are also unknown, but may include heart, large blood vessels and kidneys. Identification of potential factors (e.g., sex, age, lifestyle factors, coexposures, comorbidities, genetics and epigenetics) that may modify radiation risk of cataracts and DCS would be important. Other noncancer effects on the radar include neurological effects (e.g., Parkinson's disease, Alzheimer's disease and dementia) of which elevated risk has increasingly been reported. These late occurring noncancer effects tend to deviate from the definition of tissue reactions, necessitating more scientific developments to reconsider the radiation effect classification system and risk management. This paper gives an overview of historical developments made in ICRP prior to the 2011 statement and an update on relevant developments made since the 2011 ICRP statement.
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Affiliation(s)
- Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Chiba, Japan
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2
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Wei F, Tuong ZK, Omer M, Ngo C, Asiatico J, Kinzel M, Pugazhendhi AS, Khaled AR, Ghosh R, Coathup M. A novel multifunctional radioprotective strategy using P7C3 as a countermeasure against ionizing radiation-induced bone loss. Bone Res 2023; 11:34. [PMID: 37385982 DOI: 10.1038/s41413-023-00273-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 07/01/2023] Open
Abstract
Radiotherapy is a critical component of cancer care but can cause osteoporosis and pathological insufficiency fractures in surrounding and otherwise healthy bone. Presently, no effective countermeasure exists, and ionizing radiation-induced bone damage continues to be a substantial source of pain and morbidity. The purpose of this study was to investigate a small molecule aminopropyl carbazole named P7C3 as a novel radioprotective strategy. Our studies revealed that P7C3 repressed ionizing radiation (IR)-induced osteoclastic activity, inhibited adipogenesis, and promoted osteoblastogenesis and mineral deposition in vitro. We also demonstrated that rodents exposed to clinically equivalent hypofractionated levels of IR in vivo develop weakened, osteoporotic bone. However, the administration of P7C3 significantly inhibited osteoclastic activity, lipid formation and bone marrow adiposity and mitigated tissue loss such that bone maintained its area, architecture, and mechanical strength. Our findings revealed significant enhancement of cellular macromolecule metabolic processes, myeloid cell differentiation, and the proteins LRP-4, TAGLN, ILK, and Tollip, with downregulation of GDF-3, SH2B1, and CD200. These proteins are key in favoring osteoblast over adipogenic progenitor differentiation, cell matrix interactions, and shape and motility, facilitating inflammatory resolution, and suppressing osteoclastogenesis, potentially via Wnt/β-catenin signaling. A concern was whether P7C3 afforded similar protection to cancer cells. Preliminarily, and remarkably, at the same protective P7C3 dose, a significant reduction in triple-negative breast cancer and osteosarcoma cell metabolic activity was found in vitro. Together, these results indicate that P7C3 is a previously undiscovered key regulator of adipo-osteogenic progenitor lineage commitment and may serve as a novel multifunctional therapeutic strategy, leaving IR an effective clinical tool while diminishing the risk of adverse post-IR complications. Our data uncover a new approach for the prevention of radiation-induced bone damage, and further work is needed to investigate its ability to selectively drive cancer cell death.
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Affiliation(s)
- Fei Wei
- Biionix Cluster, and Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Zewen Kelvin Tuong
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
- Cellular Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Mahmoud Omer
- Biionix Cluster, and Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Christopher Ngo
- Biionix Cluster, and Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Jackson Asiatico
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, USA
| | - Michael Kinzel
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, USA
| | - Abinaya Sindu Pugazhendhi
- Biionix Cluster, and Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Annette R Khaled
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Ranajay Ghosh
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, USA
| | - Melanie Coathup
- Biionix Cluster, and Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL, USA.
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Ramanan B, Pizano A, Timaran CH, Siah M, Baig S, Shih M, Guild J, Kirkwood ML. Operator Lower Leg Radiation Dose during Fluoroscopically Guided Interventions is Effectively Reduced by Wearing Lead-Equivalent Leg Wraps. Ann Vasc Surg 2023; 89:161-165. [PMID: 36162628 DOI: 10.1016/j.avsg.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The intensity of radiation scatter that emanates from the X-ray beam during fluoroscopically guided interventions is greater below the fluoroscopy table than above. Yet interventionalists' lower legs are typically unshielded and table skirts are often positioned incorrectly. We sought to characterize the efficacy of the leg protector wraps (Leg Wraps, Burlington Medical Inc.) in reducing the radiation dose to the operator's lower leg during fenestrated and branched endovascular aneurysm repair (F-BEVAR). METHODS A prospective cohort study was performed evaluating the lower leg radiation dose reduction of one vascular surgeon during F/BEVAR using antimony/bismuth Enviro-Lite leg wraps (0.35 mm lead equivalency, 99.7% attenuation at 50 kVp; Burlington Medical, Hampton Roads, Virginia). Optically Stimulated Luminescence nanoDot detectors (microSTARii System, LANDAUER, Inc., Glenwood, Illinois) were placed over and under the left leg wrap at the anterior tibial tuberosity position to compare operator leg dose with and without this additional protection. The table-mounted lead skirt was used consistently in all cases. The nanoDot detectors were cross-calibrated with a survey meter (RaySafe X2 survey sensor, Fluke Biomedical, Cleveland, Ohio) by measuring scattered radiation at a position equivalent to an operator's mid-tibia while performing digital acquisitions of a 25-cm thick, 30 cm × 30 cm acrylic phantom with a Philips FD20 fluoroscope (Philips Healthcare, Best, The Netherlands) with the table skirt removed. The measured radiation doses were converted to a Hp (0.07) skin dose, assuming an RQR6 beam spectrum (IEC-61267). Paired Wilcoxon test was performed to identify significant attenuation of radiation exposure. RESULTS Leg dose measurements from 40 F-BEVARs were analyzed. The patients had a median (interquartile range) body mass index of 27 (24-32) kg/m2. Median procedure reference air kerma was 1,100 (728-1,601) mGy, kerma-area product was 127 (73-184) Gycm2, and fluoroscopy time was 69 (54-86) min. The median skin dose Hp (0.07) over the leg wraps (n = 40) was 54.2 (24-100) μSv and under the leg wraps (n = 40) was 2.7 μSv (1.0-5.8). The leg wraps attenuated the radiation dose by 95% (89-98%) (P < 0.001). The unprotected, Hp (0.07) per kerma-area product was determined to be 0.38 (0.30-0.55) μSv/Gycm2. CONCLUSIONS The 0.35-mm lead-equivalent leg wraps significantly decreased scattered radiation to the lower leg during F-BEVAR. Protective leg wraps should be recommended to operators performing complex fluoroscopically guided procedures.
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Affiliation(s)
- Bala Ramanan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Alejandro Pizano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey Guild
- Division of Medical Physics, Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa L Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Richardson KK, Ling W, Krager K, Fu Q, Byrum SD, Pathak R, Aykin-Burns N, Kim HN. Ionizing Radiation Activates Mitochondrial Function in Osteoclasts and Causes Bone Loss in Young Adult Male Mice. Int J Mol Sci 2022; 23:675. [PMID: 35054859 PMCID: PMC8775597 DOI: 10.3390/ijms23020675] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/13/2022] Open
Abstract
The damaging effects of ionizing radiation (IR) on bone mass are well-documented in mice and humans and are most likely due to increased osteoclast number and function. However, the mechanisms leading to inappropriate increases in osteoclastic bone resorption are only partially understood. Here, we show that exposure to multiple fractions of low-doses (10 fractions of 0.4 Gy total body irradiation [TBI]/week, i.e., fractionated exposure) and/or a single exposure to the same total dose of 4 Gy TBI causes a decrease in trabecular, but not cortical, bone mass in young adult male mice. This damaging effect was associated with highly activated bone resorption. Both osteoclast differentiation and maturation increased in cultures of bone marrow-derived macrophages from mice exposed to either fractionated or singular TBI. IR also increased the expression and enzymatic activity of mitochondrial deacetylase Sirtuin-3 (Sirt3)-an essential protein for osteoclast mitochondrial activity and bone resorption in the development of osteoporosis. Osteoclast progenitors lacking Sirt3 exposed to IR exhibited impaired resorptive activity. Taken together, targeting impairment of osteoclast mitochondrial activity could be a novel therapeutic strategy for IR-induced bone loss, and Sirt3 is likely a major mediator of this effect.
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Affiliation(s)
- Kimberly K. Richardson
- Center for Musculoskeletal Disease Research and Center for Osteoporosis and Metabolic Bone Diseases, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.R.); (W.L.); (Q.F.)
| | - Wen Ling
- Center for Musculoskeletal Disease Research and Center for Osteoporosis and Metabolic Bone Diseases, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.R.); (W.L.); (Q.F.)
| | - Kimberly Krager
- Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.); (R.P.); (N.A.-B.)
| | - Qiang Fu
- Center for Musculoskeletal Disease Research and Center for Osteoporosis and Metabolic Bone Diseases, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.R.); (W.L.); (Q.F.)
| | - Stephanie D. Byrum
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Rupak Pathak
- Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.); (R.P.); (N.A.-B.)
| | - Nukhet Aykin-Burns
- Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.); (R.P.); (N.A.-B.)
| | - Ha-Neui Kim
- Center for Musculoskeletal Disease Research and Center for Osteoporosis and Metabolic Bone Diseases, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (K.K.R.); (W.L.); (Q.F.)
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Mahajan A, NiveditaChakrabarty, Shukla S. A narrative review on radiation risk from imaging for COVID-19: Breaking the myths and the mithya. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dunn CJ, Changoor S, Issa K, Moore J, Moontasri NJ, Faloon MJ, Sinha K, Hwang KS, Ruoff M, Emami A. Cervical Computed Tomography Angiography Rarely Leads to Intervention in Patients With Cervical Spine Fractures. Global Spine J 2020; 10:992-997. [PMID: 32875840 PMCID: PMC7645098 DOI: 10.1177/2192568219885897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To evaluate the impact of computed tomography angiography (CTA) in the management of trauma patients with cervical spine fractures by identifying high-risk patients for vertebral artery injury (VAI), and evaluating how frequently patients undergo subsequent surgical/procedural intervention as a result of these findings. METHODS All trauma patients with cervical spine fractures who underwent CTA of the head and neck at our institution between January 2013 and October 2017 were identified. Patients were indicated for CTA according to our institutional protocol based on the modified Denver criteria, and included patients with cervical fractures on scout CT. Those with positive VAI were noted, along with their fracture location, and presence or absence of neurological deficit on physical examination. Statistical analysis was performed and odds ratios were calculated comparing the relationship of cervical spine fracture with presence of VAI. RESULTS A total of 144 patients were included in our study. Of those, 25 patients (17.4%) were found to have VAI. Two patients (1.4%) with VAI underwent subsequent surgical/procedural intervention. Of the 25 cervical fractures with a VAI, 20 (80%), were found to involve the upper cervical region (4.2 OR, 95% CI 1.5-12.0; P = .007). Of the 25 who had a VAI, 9 were unable to undergo reliable neurologic examination. Of the remaining 16 patients, 5 (31.3%) had motor or sensory deficits localized to the side of the VAI, with no other attributable etiology. CONCLUSIONS Cervical spine fractures located in the region of the C1-C3 vertebrae were more likely to have an associated VAI on CTA. VAI should also be considered in cervical trauma patients who present with neurological deficits not clearly explained by other pathology. Despite a finding of VAI, patients rarely underwent subsequent surgical or procedural intervention.
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Affiliation(s)
- Conor John Dunn
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Stuart Changoor
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Kimona Issa
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Jeffrey Moore
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Nancy J. Moontasri
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Michael Joseph Faloon
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, NJ, USA
- Department of Orthopaedic Surgery, Morristown Medical Center, Morristown, NJ, USA
| | - Kumar Sinha
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Ki Soo Hwang
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Mark Ruoff
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Arash Emami
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, NJ, USA
- Arash Emami, University Spine Center, 504 Valley Road, Suite 203, Wayne, NJ 07470, USA.
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Kendall GM, Bunch KJ, Stiller CA, Vincent TJ, Murphy MFG. Case-control study of paternal occupational exposures and childhood bone tumours and soft-tissue sarcomas in Great Britain, 1962-2010. Br J Cancer 2020; 122:1250-1259. [PMID: 32099095 PMCID: PMC7156690 DOI: 10.1038/s41416-020-0760-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/14/2020] [Accepted: 02/06/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This nationwide study investigated associations between paternal occupational exposure and childhood bone tumours and soft- tissue sarcomas. METHODS The UK National Registry of Childhood Tumours provided cases of childhood sarcomas born and diagnosed in Great Britain, 1962-2010. Control births, unaffected by childhood cancer, were matched on sex, birth period and birth registration sub-district. Fathers' occupations were assigned to one or more of 33 exposure groups and coded for occupational social class. RESULTS We analysed 5,369 childhood sarcoma cases and 5380 controls. Total bone tumours, total soft-tissue sarcomas and the subgroups osteosarcoma, rhabdomyosarcoma and Ewing Sarcoma Family of Tumours (ESFT) were considered separately. Significant positive associations were seen between rhabdomyosarcoma and paternal exposure to EMFs (odds ratio = 1.67, CI = 1.22-2.28) and also for ESFT and textile dust (1.93, 1.01-3.63). There were putative protective effects on total bone tumours of paternal dermal exposure to hydrocarbons, metal, metal working or oil mists. CONCLUSIONS Despite the large size and freedom from bias of this study, our results should be interpreted with caution. Many significance tests were undertaken, and chance findings are to be expected. Nevertheless, our finding of associations between ESFT and paternal exposure to textile dust may support related suggestions in the literature.
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Affiliation(s)
- Gerald M Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Kathryn J Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK
| | - Timothy J Vincent
- Formerly of Childhood Cancer Research Group, University of Oxford, Oxford, UK
| | - Michael F G Murphy
- Nuffield Department of Women's and Reproductive Health John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
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Zehra U, Bow C, Cheung JPY, Pang H, Lu W, Samartzis D. The association of lumbar intervertebral disc calcification on plain radiographs with the UTE Disc Sign on MRI. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1049-1057. [PMID: 28993894 DOI: 10.1007/s00586-017-5312-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/10/2017] [Accepted: 09/24/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE The pathogenesis and the clinical impact of disc calcification are not well known. Utilizing ultra-short time-to-echo (UTE) magnetic resonance imaging, the UTE Disc Sign (UDS) (i.e., hypo/hyper-intense disc band) was developed and found to be more significantly related to pain and disability than the conventional T2-weighted (T2W) MRI. It has been hypothesized that the UDS may represent mineralized deposits in the disc. The following study addressed the relationship between disc calcification on plain radiographs to that of the UDS on MRI. METHODS A cross-sectional study was performed on 106 Southern Chinese subjects (50% male; mean age 52.3 years). Standing lateral plain radiographs as well as T2W and UTE MRI of L1-S1 (n = 530 discs) were performed of all subjects. Lateral radiographs were used to localize disc calcification of the lumbar spine, T2W MRI was utilized to assess disc degeneration based on a defined grading scheme, and the UTE MRI was implemented to detect the UDS (hyper- or hypo-intense band across a disc). Disc degeneration and UDS scores were summed to represent cumulative scores. Subject demographics and disability profiles (Oswestry Disability Index: ODI) were obtained. RESULTS Disc calcification on plain radiographs was observed in 33.9% of subjects (55.5% males; mean age 54.3 years), whereas UDS was noted in 40.5% of subjects (51.1% males; mean age 55.0 years). Of these subjects, 66.6% calcification and 74.4% UDS occurred at the three lowest lumbar levels, while multilevel calcification and UDS involved 19.4 and 39.5%, respectively. 72.2% of subjects with plain radiographic disc calcification had corresponding UDS on UTE MRI (p < 0.001). Multilevel disc calcification on plain radiographs was associated with multilevel UDS (71.4%, p < 0.001). Both the number of calcified disc levels on plain radiographs and the number of UDS levels were also significantly and positively correlated with each other (r = 0.58, p < 0.001). Subjects with disc calcification and positive UDS as well as individuals with increased disc degeneration scores on T2 W MRI were significantly older (p < 0.05). The cumulative UDS score on UTE MRI significantly correlated with worse ODI scores (r = 0.31; p = 0.001), whereas cumulative disc calcification scores on plain radiographs did not (r = 0.15; p = 0.19). CONCLUSIONS This is the first study to compare the UDS on UTE MRI with disc calcification on plain radiographs. Disc calcification was correlated with the UDS on UTE, suggesting that the UDS may represent disc calcification. However, UTE MRI appears to be a more sensitive imaging modality in identifying subtle and unique disc changes that may not be revealed on plain radiographs or conventional MRI. This disconnect may rationalize the significant correlation of UTE with disability in comparison with the conventional imaging, further stressing its potential clinical importance.
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Affiliation(s)
- Uruj Zehra
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Cora Bow
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Henry Pang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - William Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China.
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Raz DJ, Clancy SL, Erhunmwunsee LJ. Surgical Management of the Radiated Chest Wall and Its Complications. Thorac Surg Clin 2017; 27:171-179. [PMID: 28363372 DOI: 10.1016/j.thorsurg.2017.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiation to the chest wall is common before resection of tumors. Osteoradionecrosis can occur after radiation treatment. Radical resection and reconstruction can be lifesaving. Soft tissue coverage using myocutaneous or omental flaps is determined by the quality of soft tissue available and the status of the vascular pedicle supplying available myocutaneous flaps. Radiation-induced sarcomas of the chest wall occur most commonly after radiation therapy for breast cancer. Although angiosarcomas are the most common radiation-induced sarcomas, osteosarcoma, myosarcomas, rhabdomyosarcoma, and undifferentiated sarcomas also occur. The most effective treatment is surgical resection. Inoperable tumors are treated with chemotherapy, with low response rates.
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Affiliation(s)
- Dan J Raz
- Division of Thoracic Surgery, City of Hope, MOB 2001B, 1500 East Duarte Road, Duarte, CA 91010, USA.
| | - Sharon L Clancy
- Division of Plastic Surgery, City of Hope, MOB 2001B, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Loretta J Erhunmwunsee
- Division of Thoracic Surgery, City of Hope, MOB 2001B, 1500 East Duarte Road, Duarte, CA 91010, USA
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Abstract
Sarcomas are rare malignancies of mesenchymal origin and are broadly divided into soft tissue sarcomas and bone sarcomas. The etiology of these tumors is largely unknown, and most sarcomas are sporadic. A small subset of sarcomas is associated with certain genetic syndromes and environmental factors. Ionizing radiation is the strongest environmental factor linked to sarcoma development.
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Affiliation(s)
- Jane Y C Hui
- Division of Surgical Oncology, Department of Surgery, University of Minnesota, 420 Delaware Street Southeast, Mayo Mail Code 195, Minneapolis, MN 55455, USA.
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Niwa O, Barcellos-Hoff MH, Globus RK, Harrison JD, Hendry JH, Jacob P, Martin MT, Seed TM, Shay JW, Story MD, Suzuki K, Yamashita S. ICRP Publication 131: Stem Cell Biology with Respect to Carcinogenesis Aspects of Radiological Protection. Ann ICRP 2016; 44:7-357. [PMID: 26637346 DOI: 10.1177/0146645315595585] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This report provides a review of stem cells/progenitor cells and their responses to ionising radiation in relation to issues relevant to stochastic effects of radiation that form a major part of the International Commission on Radiological Protection's system of radiological protection. Current information on stem cell characteristics, maintenance and renewal, evolution with age, location in stem cell 'niches', and radiosensitivity to acute and protracted exposures is presented in a series of substantial reviews as annexes concerning haematopoietic tissue, mammary gland, thyroid, digestive tract, lung, skin, and bone. This foundation of knowledge of stem cells is used in the main text of the report to provide a biological insight into issues such as the linear-no-threshold (LNT) model, cancer risk among tissues, dose-rate effects, and changes in the risk of radiation carcinogenesis by age at exposure and attained age. Knowledge of the biology and associated radiation biology of stem cells and progenitor cells is more developed in tissues that renew fairly rapidly, such as haematopoietic tissue, intestinal mucosa, and epidermis, although all the tissues considered here possess stem cell populations. Important features of stem cell maintenance, renewal, and response are the microenvironmental signals operating in the niche residence, for which a well-defined spatial location has been identified in some tissues. The identity of the target cell for carcinogenesis continues to point to the more primitive stem cell population that is mostly quiescent, and hence able to accumulate the protracted sequence of mutations necessary to result in malignancy. In addition, there is some potential for daughter progenitor cells to be target cells in particular cases, such as in haematopoietic tissue and in skin. Several biological processes could contribute to protecting stem cells from mutation accumulation: (a) accurate DNA repair; (b) rapidly induced death of injured stem cells; (c) retention of the DNA parental template strand during divisions in some tissue systems, so that mutations are passed to the daughter differentiating cells and not retained in the parental cell; and (d) stem cell competition, whereby undamaged stem cells outcompete damaged stem cells for residence in the niche. DNA repair mainly occurs within a few days of irradiation, while stem cell competition requires weeks or many months depending on the tissue type. The aforementioned processes may contribute to the differences in carcinogenic radiation risk values between tissues, and may help to explain why a rapidly replicating tissue such as small intestine is less prone to such risk. The processes also provide a mechanistic insight relevant to the LNT model, and the relative and absolute risk models. The radiobiological knowledge also provides a scientific insight into discussions of the dose and dose-rate effectiveness factor currently used in radiological protection guidelines. In addition, the biological information contributes potential reasons for the age-dependent sensitivity to radiation carcinogenesis, including the effects of in-utero exposure.
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Ozasa K. Epidemiological research on radiation-induced cancer in atomic bomb survivors. JOURNAL OF RADIATION RESEARCH 2016; 57 Suppl 1:i112-i117. [PMID: 26976124 PMCID: PMC4990102 DOI: 10.1093/jrr/rrw005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/11/2015] [Indexed: 05/13/2023]
Abstract
The late effects of exposure to atomic bomb radiation on cancer occurrence have been evaluated by epidemiological studies on three cohorts: a cohort of atomic bomb survivors (Life Span Study; LSS), survivors exposed IN UTERO : , and children of atomic bomb survivors (F1). The risk of leukemia among the survivors increased remarkably in the early period after the bombings, especially among children. Increased risks of solid cancers have been evident since around 10 years after the bombings and are still present today. The LSS has clarified the dose-response relationships of radiation exposure and risk of various cancers, taking into account important risk modifiers such as sex, age at exposure, and attained age. Confounding by conventional risk factors including lifestyle differences is not considered substantial because people were non-selectively exposed to the atomic bomb radiation. Uncertainty in risk estimates at low-dose levels is thought to be derived from various sources, including different estimates of risk at background levels, uncertainty in dose estimates, residual confounding and interaction, strong risk factors, and exposure to residual radiation and/or medical radiation. The risk of cancer in subjects exposed IN UTERO : is similar to that in LSS subjects who were exposed in childhood. Regarding hereditary effects of radiation exposure, no increased risk of cancers associated with parental exposure to radiation have been observed in the F1 cohort to date. In addition to biological and pathogenetic interpretations of the present results, epidemiological investigations using advanced technology should be used to further analyze these cohorts.
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Affiliation(s)
- Kotaro Ozasa
- Department of Epidemiology, Radiation Effects Research Foundation, 5-2 Hjiyama-koen, Minami-ku, Hiroshima, 732-0815, Japan
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Hendry JH, Niwa O, Barcellos-Hoff MH, Globus RK, Harrison JD, Martin MT, Seed TM, Shay JW, Story MD, Suzuki K, Yamashita S. ICRP Publication 131: Stem cell biology with respect to carcinogenesis aspects of radiological protection. Ann ICRP 2016; 45:239-52. [PMID: 26956677 DOI: 10.1177/0146645315621849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Current knowledge of stem cell characteristics, maintenance and renewal, evolution with age, location in 'niches', and radiosensitivity to acute and protracted exposures is reviewed regarding haematopoietic tissue, mammary gland, thyroid, digestive tract, lung, skin, and bone. The identity of the target cells for carcinogenesis continues to point to the more primitive and mostly quiescent stem cell population (able to accumulate the protracted sequence of mutations necessary to result in malignancy), and, in a few tissues, to daughter progenitor cells. Several biological processes could contribute to the protection of stem cells from mutation accumulation: (1) accurate DNA repair; (2) rapid induced death of injured stem cells; (3) retention of the intact parental strand during divisions in some tissues so that mutations are passed to the daughter differentiating cells; and (4) stem cell competition, whereby undamaged stem cells outcompete damaged stem cells for residence in the vital niche. DNA repair mainly operates within a few days of irradiation, while stem cell replications and competition require weeks or many months depending on the tissue type. This foundation is used to provide a biological insight to protection issues including the linear-non-threshold and relative risk models, differences in cancer risk between tissues, dose-rate effects, and changes in the risk of radiation carcinogenesis by age at exposure and attained age.
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Affiliation(s)
- J H Hendry
- Christie Medical Physics and Bioengineering, Christie Hospital NHS Foundation Trust and University of Manchester, Manchester M20 4BX, UK
| | - O Niwa
- Fukushima Medical University and Radiation Effects Research Foundation, Japan
| | - M H Barcellos-Hoff
- Radiation Oncology and Cell Biology, New York University School of Medicine, USA
| | - R K Globus
- Bone and Signaling Laboratory, Space Biosciences Research Branch, NASA Ames Research Center, USA
| | - J D Harrison
- Centre for Radiation, Chemical and Environmental Hazards, Health Protection Directorate, Public Health England, UK
| | - M T Martin
- Laboratoire de Genomique et Radiobiologie de la Kertinopoiese, CEA, France
| | | | - J W Shay
- Radiation Oncology, Simmons Cancer Center, University of Texas, Southwestern Medical Center, USA
| | - M D Story
- Radiation Oncology, Simmons Cancer Center, University of Texas, Southwestern Medical Center, USA
| | - K Suzuki
- Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Japan
| | - S Yamashita
- Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Japan
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Schreurs AS, Shirazi-Fard Y, Shahnazari M, Alwood JS, Truong TA, Tahimic CGT, Limoli CL, Turner ND, Halloran B, Globus RK. Dried plum diet protects from bone loss caused by ionizing radiation. Sci Rep 2016; 6:21343. [PMID: 26867002 PMCID: PMC4750446 DOI: 10.1038/srep21343] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/21/2016] [Indexed: 12/21/2022] Open
Abstract
Bone loss caused by ionizing radiation is a potential health concern for radiotherapy patients, radiation workers and astronauts. In animal studies, exposure to ionizing radiation increases oxidative damage in skeletal tissues, and results in an imbalance in bone remodeling initiated by increased bone-resorbing osteoclasts. Therefore, we evaluated various candidate interventions with antioxidant or anti-inflammatory activities (antioxidant cocktail, dihydrolipoic acid, ibuprofen, dried plum) both for their ability to blunt the expression of resorption-related genes in marrow cells after irradiation with either gamma rays (photons, 2 Gy) or simulated space radiation (protons and heavy ions, 1 Gy) and to prevent bone loss. Dried plum was most effective in reducing the expression of genes related to bone resorption (Nfe2l2, Rankl, Mcp1, Opg, TNF-α) and also preventing later cancellous bone decrements caused by irradiation with either photons or heavy ions. Thus, dietary supplementation with DP may prevent the skeletal effects of radiation exposures either in space or on Earth.
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Affiliation(s)
- A-S Schreurs
- Bone and Signaling Laboratory, Space Biosciences Division, NASA Ames Research Center
| | - Y Shirazi-Fard
- Bone and Signaling Laboratory, Space Biosciences Division, NASA Ames Research Center
| | - M Shahnazari
- Bone and Signaling Laboratory, Space Biosciences Division, NASA Ames Research Center
| | - J S Alwood
- Bone and Signaling Laboratory, Space Biosciences Division, NASA Ames Research Center
| | - T A Truong
- Bone and Signaling Laboratory, Space Biosciences Division, NASA Ames Research Center
| | - C G T Tahimic
- Bone and Signaling Laboratory, Space Biosciences Division, NASA Ames Research Center
| | - C L Limoli
- Department of Radiation Oncology, University of California Irvine
| | - N D Turner
- Department of Nutrition and Food Science, Texas A&M University
| | - B Halloran
- Department of Medicine, Division of Endocrinology, University of California San Francisco
| | - R K Globus
- Bone and Signaling Laboratory, Space Biosciences Division, NASA Ames Research Center
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Fabricant PD. CORR Insights(®): A Radiation Safety Training Program Results in Reduced Radiation Exposure for Orthopaedic Residents Using the Mini C-arm. Clin Orthop Relat Res 2016; 474:585-7. [PMID: 26645681 PMCID: PMC4709323 DOI: 10.1007/s11999-015-4657-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/24/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Peter D Fabricant
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Cheung JPY, Bow C, Samartzis D, Ganal-Antonio AKB, Cheung KMC. Clinical utility of ultrasound to prospectively monitor distraction of magnetically controlled growing rods. Spine J 2016; 16:204-9. [PMID: 26523963 DOI: 10.1016/j.spinee.2015.10.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/07/2015] [Accepted: 10/22/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Growing rods are commonly used for surgical treatment of skeletally immature patients with scoliosis, but require repeated surgeries for distractions and are fraught with complications. As an alternative, the use of magnetically controlled growing rods (MCGR) allows for more frequent non-invasive distractions to mimic normal growth. However, more plain radiographs are needed to monitor increased distraction frequency, thereby increasing ionizing radiation exposure to the developing child. The use of ultrasound, which emits no radiation, has been found in a cross-sectional study to be reliable in measuring MCGR distractions. PURPOSE The study aims to address the prospective clinical utility of ultrasound compared with plain radiographs for assessing MCGR distractions. STUDY DESIGN This is a prospective study. PATIENT SAMPLE The study includes patients with early-onset scoliosis undergoing distractions after MCGR implant. OUTCOME MEASURES The distraction length on plain radiographs and ultrasound was measured. METHODS This is a prospective study of patients treated with MCGR. Patients with both single- and dual-rod systems were included. Outpatient distractions were performed at monthly intervals, targeting 2 mm of distraction on each occasion. Assessment of distraction length was monitored by ultrasound at each visit; plain radiographs were taken every 6 months and were compared with ultrasound measurements. RESULTS Nine patients (5 female, 4 male), with a mean of 29 distractions (standard deviation [SD] ±14.3), were recruited. The mean distracted length per 6 months was 5.7 mm (SD ±3.6 mm) on plain radiographs and 5.2 mm (SD ±3.9 mm) on ultrasound for the concave rod, and 6.1 mm (SD ±3.6 mm) on plain radiographs and 5.9 mm (SD ±3.8 mm) on ultrasound for the convex rod. Excellent inter- and intra-rater reliabilities were observed for radiographic and ultrasound measurements. An excellent correlation was noted between the two imaging modalities (r=0.93; p<.0001). CONCLUSIONS This is the first prospective study to validate that ultrasound assessment of MCGR distraction lengths was highly comparable with that of plain radiographs. The present study has verified that ultrasound can be used to document length changes by distraction over time and that it had high clinical utility. Ultrasound can be a reliable alternative to plain radiographs, thereby avoiding radiation exposure and its potential detrimental sequelae in the developing child.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Cora Bow
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | | | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, China.
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Fan TM, Khanna C. Comparative Aspects of Osteosarcoma Pathogenesis in Humans and Dogs. Vet Sci 2015; 2:210-230. [PMID: 29061942 PMCID: PMC5644632 DOI: 10.3390/vetsci2030210] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/01/2015] [Accepted: 08/11/2015] [Indexed: 01/10/2023] Open
Abstract
Osteosarcoma (OS) is a primary and aggressive bone sarcoma affecting the skeleton of two principal species, human beings and canines. The biologic behavior of OS is conserved between people and dogs, and evidence suggests that fundamental discoveries in OS biology can be facilitated through detailed and comparative studies. In particular, the relative genetic homogeneity associated with specific dog breeds can provide opportunities to facilitate the discovery of key genetic drivers involved in OS pathogenesis, which, to-date, remain elusive. In this review, known causative factors that predispose to the development OS in human beings and dogs are summarized in detail. Based upon the commonalities shared in OS pathogenesis, it is likely that foundational discoveries in one species will be translationally relevant to the other and emphasizes the unique opportunities that might be gained through comparative scientific approaches.
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Affiliation(s)
- Timothy M Fan
- Department of Veterinary Clinical Medicine, Comparative Oncology Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61820, USA.
| | - Chand Khanna
- Tumor and Metastasis Biology Section, Pediatric Oncology Branch, Center for Clinical Research, The National Cancer Institute, Washington, DC 20004, USA.
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Thiagarajan A, Iyer NG. Radiation-induced sarcomas of the head and neck. World J Clin Oncol 2014; 5:973-981. [PMID: 25493233 PMCID: PMC4259957 DOI: 10.5306/wjco.v5.i5.973] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/28/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
With improved outcomes associated with radiotherapy, radiation-induced sarcomas (RIS) are increasingly seen in long-term survivors of head and neck cancers, with an estimated risk of up to 0.3%. They exhibit no subsite predilection within the head and neck and can arise in any irradiated tissue of mesenchymal origin. Common histologic subtypes of RIS parallel their de novo counterparts and include osteosarcoma, chondrosarcoma, malignant fibrous histiocytoma/sarcoma nitricoxide synthase, and fibrosarcoma. While imaging features of RIS are not pathognomonic, large size, extensive local invasion with bony destruction, marked enhancement within a prior radiotherapy field, and an appropriate latency period are suggestive of a diagnosis of RIS. RIS development may be influenced by factors such as radiation dose, age at initial exposure, exposure to chemotherapeutic agents and genetic tendency. Precise pathogenetic mechanisms of RIS are poorly understood and both directly mutagenizing effects of radiotherapy as well as changes in microenvironments are thought to play a role. Management of RIS is challenging, entailing surgery in irradiated tissue and a limited scope for further radiotherapy and chemotherapy. RIS is associated with significantly poorer outcomes than stage-matched sarcomas that arise independent of irradiation and surgical resection with clear margins seems to offer the best chance for cure.
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Stokes OM, O'Donovan EJ, Samartzis D, Bow CH, Luk KDK, Cheung KMC. Reducing radiation exposure in early-onset scoliosis surgery patients: novel use of ultrasonography to measure lengthening in magnetically-controlled growing rods. Spine J 2014; 14:2397-404. [PMID: 24486476 DOI: 10.1016/j.spinee.2014.01.039] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 12/20/2013] [Accepted: 01/17/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Magnetically-controlled growing rod (MCGR) technology has been reported for the treatment of early-onset scoliosis (EOS). Such technology allows for regular and frequent outpatient rod distractions without the need for additional surgery. However, pre- and postdistraction spine radiographs are required to verify the amount of lengthening. This increased exposure to ionizing radiation in developing children significantly increases their risk profile for radiation-induced cancer and noncancerous morbidity. PURPOSE This study addressed the first and novel application and reliability of the use of ultrasonography, that has no ionizing radiation exposure, as an alternative to plain radiographs in the visualizing and confirming of rod distractions. STUDY DESIGN A prospective study. PATIENT SAMPLE Six EOS patients who underwent surgical treatment with MCGRs were prospectively recruited. OUTCOME MEASURES Imaging measurements based on ultrasound and plain radiographs. METHODS All patients were imaged via ultrasound, ease of rod identification was established, and the reliability and reproducibility of optimal reference point selection assessed blindly by three individuals. The clinical algorithm, using ultrasound, was subsequently implemented. Plain radiographs served as controls. RESULTS Assessment of the rod's neck distance on ultrasound demonstrated a high degree of interrater reliability (a=0.99; p<.001). Intrarater reliability remained high on repeat measurements at different time intervals (a=1.00; p<.001). Satisfactory interrater reliability was noted when measuring the rod's neck (a=0.73; p=.010) and high reliability was noted in assessing the housing of the rod (a=0.85; p=.01) on plain radiographs. Under blinded conditions, 2 mm rod distraction measured on radiographs corresponded to 1.7 mm distraction on the ultrasound (standard deviation: 0.24 mm; p<.001). Subsequently, the clinical algorithm using ultrasound, instead of radiographs, has been successfully implemented. CONCLUSIONS This is the first study to report the use of a novel technique using noninvasive, nonionizing ultrasound to reliably document rod distractions in EOS patients. A high level of inter- and intrarater reliabilities were noted. More importantly, the use of ultrasonography may result in fewer whole spine radiographs from being taken in patients who have had MCGRs implanted for EOS; thereby decreasing their exposure to ionizing radiation and the potential risk of future radiation-induced diseases.
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Affiliation(s)
- Oliver M Stokes
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong, SAR China
| | - Elizabeth J O'Donovan
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong, SAR China
| | - Dino Samartzis
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong, SAR China
| | - Cora H Bow
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong, SAR China
| | - Keith D K Luk
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong, SAR China
| | - Kenneth M C Cheung
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong, SAR China.
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Shuaib W, Khan A, Mehta A, Arvind A, Hidalgo J. Utility of CT angiography in cervical spine trauma: analysis of radiation and cost. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0204.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Hamada N, Fujimichi Y. Classification of radiation effects for dose limitation purposes: history, current situation and future prospects. JOURNAL OF RADIATION RESEARCH 2014; 55:629-40. [PMID: 24794798 PMCID: PMC4100010 DOI: 10.1093/jrr/rru019] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 05/12/2023]
Abstract
Radiation exposure causes cancer and non-cancer health effects, each of which differs greatly in the shape of the dose-response curve, latency, persistency, recurrence, curability, fatality and impact on quality of life. In recent decades, for dose limitation purposes, the International Commission on Radiological Protection has divided such diverse effects into tissue reactions (formerly termed non-stochastic and deterministic effects) and stochastic effects. On the one hand, effective dose limits aim to reduce the risks of stochastic effects (cancer/heritable effects) and are based on the detriment-adjusted nominal risk coefficients, assuming a linear-non-threshold dose response and a dose and dose rate effectiveness factor of 2. On the other hand, equivalent dose limits aim to avoid tissue reactions (vision-impairing cataracts and cosmetically unacceptable non-cancer skin changes) and are based on a threshold dose. However, the boundary between these two categories is becoming vague. Thus, we review the changes in radiation effect classification, dose limitation concepts, and the definition of detriment and threshold. Then, the current situation is overviewed focusing on (i) stochastic effects with a threshold, (ii) tissue reactions without a threshold, (iii) target organs/tissues for circulatory disease, (iv) dose levels for limitation of cancer risks vs prevention of non-life-threatening tissue reactions vs prevention of life-threatening tissue reactions, (v) mortality or incidence of thyroid cancer, and (vi) the detriment for tissue reactions. For future discussion, one approach is suggested that classifies radiation effects according to whether effects are life threatening, and radiobiological research needs are also briefly discussed.
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Affiliation(s)
- Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 2-11-1 Iwado-kita, Komae, Tokyo 201-8511, Japan
| | - Yuki Fujimichi
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 2-11-1 Iwado-kita, Komae, Tokyo 201-8511, Japan
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Hagedorn JC, Emery SE, France JC, Daffner SD. Does CT Angiography Matter for Patients with Cervical Spine Injuries? J Bone Joint Surg Am 2014; 96:951-955. [PMID: 24897744 DOI: 10.2106/jbjs.m.00036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cervical injury can be associated with vertebral artery injury. This study was performed to determine the impact of computed tomography (CT) angiography of the head and neck on planning treatment of cervical spine fracture, if these tests were ordered appropriately, and to estimate cost and associated exposure to radiation and contrast medium. METHODS This retrospective review included all patients who underwent CT of the cervical spine and CT angiography of the head and neck from January 2010 to August 2011 at one institution. Patients were divided into those with and those without cervical spine fracture seen on CT of the cervical spine. We determined if the CT angiography of the head and neck was positive for vascular injury in the patients with a cervical fracture. Vascular injury treatment and alterations in surgical fracture treatment due to positive CT angiography of the head and neck were recorded. A scan was deemed appropriate if it had been ordered per established institutional protocol. RESULTS Of the 381 patients who underwent CT angiography of the head and neck, 126 had a cervical injury. Sixteen of the CT angiography studies were appropriately ordered for non-spinal indications, and twenty-three were inappropriately ordered. The CT angiography was positive for one patient for whom the imaging was off protocol and one for whom the indication was non-spinal. Nineteen patients had positive CT angiography of the head and neck; no patient underwent surgical intervention for a vascular lesion. Eleven patients underwent surgical intervention for a cervical fracture; the operative plan was changed because of vascular injury in one case. The CT angiography was positive for eleven of forty-eight patients who had sustained a C2 fracture; this group accounted for eleven of the nineteen positive CT angiography studies. Noncontiguous injuries occurred in nineteen patients; three had positive CT angiography of the head and neck. The approximate charge for the CT angiography was $3925, radiation exposure was approximately 4000 mGy/cm, and contrast-medium load was approximately 100 mL. CONCLUSIONS Positive CT angiography of the head and neck rarely altered surgical treatment of cervical spine injuries. This study supports the findings in the literature that C1-C3 spine injuries have an increased association with vertebral artery injury. CT angiography of the head and neck ordered off protocol had a low likelihood of being positive. Strict adherence to protocols for CT angiography of the head and neck can reduce costs and decrease unnecessary exposure to radiation and contrast medium. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- John C Hagedorn
- Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV 26506-9196. E-mail address for J.C. Hagedorn II:
| | - Sanford E Emery
- Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV 26506-9196. E-mail address for J.C. Hagedorn II:
| | - John C France
- Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV 26506-9196. E-mail address for J.C. Hagedorn II:
| | - Scott D Daffner
- Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV 26506-9196. E-mail address for J.C. Hagedorn II:
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Schwartz B, Benadjaoud MA, Cléro E, Haddy N, El-Fayech C, Guibout C, Teinturier C, Oberlin O, Veres C, Pacquement H, Munzer M, N'guyen TD, Bondiau PY, Berchery D, Laprie A, Hawkins M, Winter D, Lefkopoulos D, Chavaudra J, Rubino C, Diallo I, Bénichou J, de Vathaire F. Risk of second bone sarcoma following childhood cancer: role of radiation therapy treatment. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2014; 53:381-90. [PMID: 24419490 PMCID: PMC3996275 DOI: 10.1007/s00411-013-0510-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 12/23/2013] [Indexed: 05/16/2023]
Abstract
Bone sarcoma as a second malignancy is rare but highly fatal. The present knowledge about radiation-absorbed organ dose-response is insufficient to predict the risks induced by radiation therapy techniques. The objective of the present study was to assess the treatment-induced risk for bone sarcoma following a childhood cancer and particularly the related risk of radiotherapy. Therefore, a retrospective cohort of 4,171 survivors of a solid childhood cancer treated between 1942 and 1986 in France and Britain has been followed prospectively. We collected detailed information on treatments received during childhood cancer. Additionally, an innovative methodology has been developed to evaluate the dose-response relationship between bone sarcoma and radiation dose throughout this cohort. The median follow-up was 26 years, and 39 patients had developed bone sarcoma. It was found that the overall incidence was 45-fold higher [standardized incidence ratio 44.8, 95 % confidence interval (CI) 31.0-59.8] than expected from the general population, and the absolute excess risk was 35.1 per 100,000 person-years (95 % CI 24.0-47.1). The risk of bone sarcoma increased slowly up to a cumulative radiation organ absorbed dose of 15 Gy [hazard ratio (HR) = 8.2, 95 % CI 1.6-42.9] and then strongly increased for higher radiation doses (HR for 30 Gy or more 117.9, 95 % CI 36.5-380.6), compared with patients not treated with radiotherapy. A linear model with an excess relative risk per Gy of 1.77 (95 % CI 0.6213-5.935) provided a close fit to the data. These findings have important therapeutic implications: Lowering the radiation dose to the bones should reduce the incidence of secondary bone sarcomas. Other therapeutic solutions should be preferred to radiotherapy in bone sarcoma-sensitive areas.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Bone Neoplasms/chemically induced
- Bone Neoplasms/epidemiology
- Bone Neoplasms/etiology
- Child
- Child, Preschool
- Cohort Studies
- Dose-Response Relationship, Radiation
- Female
- Humans
- Infant
- Infant, Newborn
- Male
- Middle Aged
- Models, Statistical
- Neoplasms, Radiation-Induced/chemically induced
- Neoplasms, Radiation-Induced/epidemiology
- Neoplasms, Radiation-Induced/etiology
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/etiology
- Radiotherapy/adverse effects
- Radiotherapy Dosage
- Risk
- Sarcoma/chemically induced
- Sarcoma/epidemiology
- Sarcoma/etiology
- Survivors
- Young Adult
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Affiliation(s)
- Boris Schwartz
- Radiation Epidemiology Group, Unit 1018 INSERM, Institut Gustave Roussy, Rue Camille Desmoulins, 94805, Villejuif, France,
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24
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Hamada N. What are the intracellular targets and intratissue target cells for radiation effects? Radiat Res 2013; 181:9-20. [PMID: 24369848 DOI: 10.1667/rr13505.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Exactly a century after Röntgen's discovery of X rays, I entered a university to major in radiological sciences. At that time, I felt that, despite extensive use and indispensable roles of ionizing radiation in medicine and industry, many fascinating questions have yet to be answered concerning its biological mechanisms of action, and thus I decided to get into the field of radiation research. Fifteen years have passed since I started radiobiological studies in 1998, during which time various basic tenets I initially learned in my late teens and early twenties have been challenged by recent observations. Of these, this brief overview particularly focuses on the following five different albeit non mutually exclusive questions: (i) "Is nuclear DNA the only intracellular target for radiation effects?"; (ii) "What is the significance of delayed cell death in clonogenic survival?"; (iii) "Does an irradiated cell become a cancer cell?"; (iv) "Are cataracts tissue reactions?"; and (v) "Why is high-LET radiation biologically effective?".
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Affiliation(s)
- Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
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25
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Samartzis D, Nishi N, Cologne J, Funamoto S, Hayashi M, Kodama K, Miles EF, Suyama A, Soda M, Kasagi F. Ionizing radiation exposure and the development of soft-tissue sarcomas in atomic-bomb survivors. J Bone Joint Surg Am 2013; 95:222-9. [PMID: 23389785 DOI: 10.2106/jbjs.l.00546] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Very high levels of ionizing radiation exposure have been associated with the development of soft-tissue sarcoma. The effects of lower levels of ionizing radiation on sarcoma development are unknown. This study addressed the role of low to moderately high levels of ionizing radiation exposure in the development of soft-tissue sarcoma. METHODS Based on the Life Span Study cohort of Japanese atomic-bomb survivors, 80,180 individuals were prospectively assessed for the development of primary soft-tissue sarcoma. Colon dose in gray (Gy), the excess relative risk, and the excess absolute rate per Gy absorbed ionizing radiation dose were assessed. Subject demographic, age-specific, and survival parameters were evaluated. RESULTS One hundred and four soft-tissue sarcomas were identified (mean colon dose = 0.18 Gy), associated with a 39% five-year survival rate. Mean ages at the time of the bombings and sarcoma diagnosis were 26.8 and 63.6 years, respectively. A linear dose-response model with an excess relative risk of 1.01 per Gy (95% confidence interval [CI]: 0.13 to 2.46; p = 0.019) and an excess absolute risk per Gy of 4.3 per 100,000 persons per year (95% CI: 1.1 to 8.9; p = 0.001) were noted in the development of soft-tissue sarcoma. CONCLUSIONS This is one of the largest and longest studies (fifty-six years from the time of exposure to the time of follow-up) to assess ionizing radiation effects on the development of soft-tissue sarcoma. This is the first study to suggest that lower levels of ionizing radiation may be associated with the development of soft-tissue sarcoma, with exposure of 1 Gy doubling the risk of soft-tissue sarcoma development (linear dose-response). The five-year survival rate of patients with soft-tissue sarcoma in this population was much lower than that reported elsewhere.
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Affiliation(s)
- Dino Samartzis
- Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan.
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26
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Schwab JH, Springfield DS, Raskin KA, Mankin HJ, Hornicek FJ. What's new in primary bone tumors. J Bone Joint Surg Am 2012; 94:1913-9. [PMID: 23079883 DOI: 10.2106/jbjs.l.00955] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Joseph H Schwab
- Orthopaedic Oncology Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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27
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Burningham Z, Hashibe M, Spector L, Schiffman JD. The epidemiology of sarcoma. Clin Sarcoma Res 2012; 2:14. [PMID: 23036164 PMCID: PMC3564705 DOI: 10.1186/2045-3329-2-14] [Citation(s) in RCA: 378] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 04/18/2012] [Indexed: 12/12/2022] Open
Abstract
Sarcomas account for over 20% of all pediatric solid malignant cancers and less than 1% of all adult solid malignant cancers. The vast majority of diagnosed sarcomas will be soft tissue sarcomas, while malignant bone tumors make up just over 10% of sarcomas. The risks for sarcoma are not well-understood. We evaluated the existing literature on the epidemiology and etiology of sarcoma. Risks for sarcoma development can be divided into environmental exposures, genetic susceptibility, and an interaction between the two. HIV-positive individuals are at an increased risk for Kaposi's sarcoma, even though HHV8 is the causative virus. Radiation exposure from radiotherapy has been strongly associated with secondary sarcoma development in certain cancer patients. In fact, the risk of malignant bone tumors increases as the cumulative dose of radiation to the bone increases (p for trend <0.001). A recent meta-analysis reported that children with a history of hernias have a greater risk of developing Ewing's sarcoma (adjusted OR 3.2, 95% CI 1.9, 5.7). Bone development during pubertal growth spurts has been associated with osteosarcoma development. Occupational factors such as job type, industry, and exposures to chemicals such as herbicides and chlorophenols have been suggested as risk factors for sarcomas. A case-control study found a significant increase in soft tissue sarcoma risk among gardeners (adjusted OR 4.1, 95% CI 1.00, 14.00), but not among those strictly involved in farming. A European-based study reported an increased risk in bone tumors among blacksmiths, toolmakers, or machine-tool operators (adjusted OR 2.14, 95% CI 1.08, 4.26). Maternal and paternal characteristics such as occupation, age, smoking status, and health conditions experienced during pregnancy also have been suggested as sarcoma risk factors and would be important to assess in future studies. The limited studies we identified demonstrate significant relationships with sarcoma risk, but many of these results now require further validation on larger populations. Furthermore, little is known about the biologic mechanisms behind each epidemiologic association assessed in the literature. Future molecular epidemiology studies may increase our understanding of the genetic versus environmental contributions to tumorigenesis in this often deadly cancer in children and adults.
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Affiliation(s)
- Zachary Burningham
- Department of Family And Preventive Medicine, University of Utah, 2000 Circle of Hope, HCI-4245, Salt Lake City, UT, 84112, USA
| | - Mia Hashibe
- Department of Family And Preventive Medicine, University of Utah, 2000 Circle of Hope, HCI-4245, Salt Lake City, UT, 84112, USA
| | - Logan Spector
- Division of Epidemiology/Clinical Research, Department of Pediatrics and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Joshua D Schiffman
- Division of Pediatric Hematology/Oncology, Center for Children's Cancer Research, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Abstract
Posttraumatic radioulnar synostosis is a rare complication following fracture of the forearm and elbow. Risk factors for synostosis are related to the initial injury and surgical management of the fracture. Typically, patients present with complete loss of active and passive forearm pronation and supination. Evidence of bridging heterotopic bone between the radius and ulna can be seen on plain radiographs. Although nonsurgical management is sufficient in some cases, surgical excision is typically required. The timing of surgical intervention remains controversial. However, early resection between 6 and 12 months after the initial injury can be performed safely in patients with radiographic evidence of bony maturation. Surgical management consists of complete resection of the synostosis with optional interposition of biologic or synthetic materials to restore forearm rotation. A low recurrence rate can be achieved following primary radioulnar synostosis excision without the need for routine adjuvant prophylaxis.
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29
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Dowe JD, Hendel RC. Reducing Radiation Exposure from Cardiovascular Imaging Through Implementation of Appropriate Use Criteria. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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Fabricant PD, Berkes MB, Dy CJ, Bogner EA. Diagnostic medical imaging radiation exposure and risk of development of solid and hematologic malignancy. Orthopedics 2012; 35:415-20. [PMID: 22588399 DOI: 10.3928/01477447-20120426-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Limiting patients' exposure to ionizing radiation during diagnostic imaging is of concern to patients and clinicians. Large single-dose exposures and cumulative exposures to ionizing radiation have been associated with solid tumors and hematologic malignancy. Although these associations have been a driving force in minimizing patients' exposure, significant risks are found when diagnoses are missed and subsequent treatment is withheld. Therefore, based on epidemiologic data obtained after nuclear and occupational exposures, dose exposure limits have been estimated. A recent collaborative effort between the US Food and Drug Administration and the American College of Radiology has provided information and tools that patients and imaging professionals can use to avoid unnecessary ionizing radiation scans and ensure use of the lowest feasible radiation dose necessary for studies. Further collaboration, research, and development should focus on producing technological advances that minimize individual study exposures and duplicate studies. This article outlines the research used to govern safe radiation doses, defines recent initiatives in decreasing radiation exposure, and provides orthopedic surgeons with techniques that may help decrease radiation exposure in their daily practice.
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Affiliation(s)
- Peter D Fabricant
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York 10021, USA.
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31
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Riad S, Biau D, Holt GE, Werier J, Turcotte RE, Ferguson PC, Griffin AM, Dickie CI, Chung PW, Catton CN, O'sullivan B, Wunder JS. The clinical and functional outcome for patients with radiation-induced soft tissue sarcoma. Cancer 2011; 118:2682-92. [DOI: 10.1002/cncr.26543] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/01/2011] [Accepted: 08/02/2011] [Indexed: 11/12/2022]
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