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Casey RT, Hendriks E, Deal C, Waguespack SG, Wiegering V, Redlich A, Akker S, Prasad R, Fassnacht M, Clifton-Bligh R, Amar L, Bornstein S, Canu L, Charmandari E, Chrisoulidou A, Freixes MC, de Krijger R, de Sanctis L, Fojo A, Ghia AJ, Huebner A, Kosmoliaptsis V, Kuhlen M, Raffaelli M, Lussey-Lepoutre C, Marks SD, Nilubol N, Parasiliti-Caprino M, Timmers HHJLM, Zietlow AL, Robledo M, Gimenez-Roqueplo AP, Grossman AB, Taïeb D, Maher ER, Lenders JWM, Eisenhofer G, Jimenez C, Pacak K, Pamporaki C. International consensus statement on the diagnosis and management of phaeochromocytoma and paraganglioma in children and adolescents. Nat Rev Endocrinol 2024:10.1038/s41574-024-01024-5. [PMID: 39147856 DOI: 10.1038/s41574-024-01024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 08/17/2024]
Abstract
Phaeochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumours that arise not only in adulthood but also in childhood and adolescence. Up to 70-80% of childhood PPGL are hereditary, accounting for a higher incidence of metastatic and/or multifocal PPGL in paediatric patients than in adult patients. Key differences in the tumour biology and management, together with rare disease incidence and therapeutic challenges in paediatric compared with adult patients, mandate close expert cross-disciplinary teamwork. Teams should ideally include adult and paediatric endocrinologists, oncologists, cardiologists, surgeons, geneticists, pathologists, radiologists, clinical psychologists and nuclear medicine physicians. Provision of an international Consensus Statement should improve care and outcomes for children and adolescents with these tumours.
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Affiliation(s)
- Ruth T Casey
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
- Department of Endocrinology, Cambridge Cancer Centre and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Emile Hendriks
- Department of Paediatric Diabetes and Endocrinology, Cambridge Cancer Centre and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cheri Deal
- Endocrine and Diabetes Service, CHU Sainte-Justine and University of Montreal, Montreal, Québec, Canada
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Verena Wiegering
- University Children's Hospital, Department of Paediatric Hematology, Oncology and Stem Cell Transplantation, University of Würzburg, Würzburg, Germany
| | - Antje Redlich
- Paediatric Oncology Department, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - Scott Akker
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Rathi Prasad
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Martin Fassnacht
- Department of Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Roderick Clifton-Bligh
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Laurence Amar
- Université de Paris, Paris, France
- Hypertension Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Stefan Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Letizia Canu
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Centro di Ricerca e Innovazione sulle Patologie Surrenaliche, Azienda Ospedaliera Universitaria (AOU) Careggi, Florence, Italy
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Paediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | | | - Maria Currás Freixes
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO) and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Ronald de Krijger
- Princess Maxima Center for Paediatric Oncology, Utrecht, Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Luisa de Sanctis
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Antonio Fojo
- Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Amol J Ghia
- Department of Radiation Oncology, University Hospital of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Angela Huebner
- Department of Paediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
- Blood and Transplant Research Unit in Organ Donation and Transplantation, National Institute for Health Research, University of Cambridge, Cambridge, UK
| | - Michaela Kuhlen
- Paediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Charlotte Lussey-Lepoutre
- Service de médecine nucléaire, Inserm U970, Sorbonne université, Groupe hospitalier Pitié-Salpétrière, Paris, France
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR GOSH Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Naris Nilubol
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, Turin, Italy
| | - Henri H J L M Timmers
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Anna Lena Zietlow
- Clinical Child and Adolescent Psychology, Institute of Clinical Psychology and Psychotherapy, Department of Psychology, TU Dresden, Dresden, Germany
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO) and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Anne-Paule Gimenez-Roqueplo
- Université Paris Cité, PARCC, INSERM, Paris, France
- Service de Génétique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Ashley B Grossman
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
- Centre for Endocrinology, Barts and the London School of Medicine, London, UK
- ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Jacques W M Lenders
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Graeme Eisenhofer
- Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD, USA
| | - Christina Pamporaki
- Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Alhorani Q, Alkhybari E, Rawashdeh M, Sabarudin A, Latiff RA, Al-Ibraheem A, Vinjamuri S, Mohamad M. Revising and exploring the variations in methodologies for establishing the diagnostic reference levels for paediatric PET/CT imaging. Nucl Med Commun 2023; 44:937-943. [PMID: 37615527 DOI: 10.1097/mnm.0000000000001748] [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: 08/25/2023]
Abstract
PET-computed tomography (PET/CT) is a hybrid imaging technique that combines anatomical and functional information; to investigate primary cancers, stage tumours, and track treatment response in paediatric oncology patients. However, there is debate in the literature about whether PET/CT could increase the risk of cancer in children, as the machine is utilizing two types of radiation, and paediatric patients have faster cell division and longer life expectancy. Therefore, it is essential to minimize radiation exposure by justifying and optimizing PET/CT examinations and ensure an acceptable image quality. Establishing diagnostic reference levels (DRLs) is a crucial quantitative indicator and effective tool to optimize paediatric imaging procedures. This review aimed to distinguish and acknowledge variations among published DRLs for paediatric patients in PET/CT procedures. A search of relevant articles was conducted using databases, that is, Embase, Scopus, Web of Science, and Medline, using the keywords: PET-computed tomography, computed tomography, PET, radiopharmaceutical, DRL, and their synonyms. Only English and full-text articles were included, with no limitations on the publication year. After the screening, four articles were selected, and the review reveals different DRL approaches for paediatric patients undergoing PET/CT, with primary variations observed in patient selection criteria, reporting of radiation dose values, and PET/CT equipment. The study suggests that future DRL methods for paediatric patients should prioritize data collection in accordance with international guidelines to better understand PET/CT dose discrepancies while also striving to optimize radiation doses without compromising the quality of PET/CT images.
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Affiliation(s)
- Qays Alhorani
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Essam Alkhybari
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Saudi Arabia
| | - Mohammad Rawashdeh
- Radiologic Technology Program, Applied Medical Sciences College, Jordan University of Science and Technology, Irbid
| | - Akmal Sabarudin
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rukiah A Latiff
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - Sobhan Vinjamuri
- Department of Nuclear Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mazlyfarina Mohamad
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Lindberg JC, Archer D. Radiophobia: Useful concept, or ostracising term? PROGRESS IN NUCLEAR ENERGY 2022. [DOI: 10.1016/j.pnucene.2022.104280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shi HM, Sun ZC, Ju FH. Understanding the harm of low‑dose computed tomography radiation to the body (Review). Exp Ther Med 2022; 24:534. [PMID: 35911849 DOI: 10.3892/etm.2022.11461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hai-Min Shi
- Department of Gynecology and Obstetrics Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Zhi-Chao Sun
- Department of Medical Imaging, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Fang-He Ju
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310006, P.R. China
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Muhammad N, Karim M, Harun H, Rahman M, Azlan R, Sumardi N. The impact of tube current and iterative reconstruction algorithm on dose and image quality of infant CT head examination. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Three-dimensional oropharyngeal airway changes after facemask therapy using low-dose computed tomography: a clinical trial with a retrospectively collected control group. Prog Orthod 2021; 22:50. [PMID: 34939164 PMCID: PMC8695404 DOI: 10.1186/s40510-021-00391-3] [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: 08/11/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
Aims This study aimed to evaluate the short-term oropharyngeal airway volumetric changes in growing Class III maxillary-deficient patients treated by facemask without expansion compared with untreated Class III controls, using low-dose computed tomography. Methods Eighteen maxillary-deficient children (9 boys, nine girls) with a mean age of 7.81 ± 0.84 years were treated with maxillary bonded bite block and facemask (FM). Pre- (T1) and post-treatment (T2) low-dose CT images were acquired. Sixteen untreated Class III patients with a mean age of 7.03 ± 0.56 years had previously two low-dose CT scans within a one year of follow-up. Volumetric and minimal cross-sectional area measurements were obtained to assess the oropharyngeal airway changes. Quantitative mean, minimum, and maximum displacement of superimposed 3D models were estimated from a point-based analysis. Paired-samples t-tests were used for the intragroup comparisons, and an independent samples t-test and the Mann–Whitney U tests were carried out for the intergroup comparisons. Results A statistically significant increase in the total and retropalatal volumes oropharyngeal airway volume were observed in the control group (302.23 ± 345.58 and 145.73 ± 189.22 mm3, respectively). In the FM group, statistically significant increases in the total and retropalatal volumes were observed (738.86 ± 1109.37 mm3 and 388.63 ± 491.44 mm3, respectively). However, no statistically significant differences were found between the two groups, except for the maximum part analysis which was significantly greater in the FM group (p = 0.007). Conclusions FM therapy appeared to have no additional effects on the oropharyngeal airway other than those induced by growth.
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7
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Lopes MA, Coleman RR, Cremata EJ. Radiography and Clinical Decision-Making in Chiropractic. Dose Response 2021; 19:15593258211044844. [PMID: 34675758 PMCID: PMC8524714 DOI: 10.1177/15593258211044844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022] Open
Abstract
The concern over x-ray exposure risks can overshadow the potential benefit of radiography, especially in cases where manual therapy is employed. Spinal malalignment cannot be accurately visualized without imaging. Manual therapy and the load tolerances of injured spinal tissues raise different criteria for the use of x-rays for spinal disorders than in medical practice. Current regulatory bodies rely on radiography risk assessments based on Linear-No-Threshold (LNT) risk models. There is a need to consider radiography guidelines for chiropractic which are different from those for medical practice. Radiography practice guidelines are summaries dominated by frequentist interpretations in the analysis of data from studies. In contrast, clinicians often employ a pseudo-Bayesian form of reasoning during the clinical decision-making process. The overrepresentation of frequentist perspectives in evidence-based practice guidelines alter decision-making away from practical assessment of a patient's needs, toward an overly cautious standard applied to patients without regard to their risk/benefit likelihoods relating to radiography. Guidelines for radiography in chiropractic to fully assess the condition of the spine and spinal alignment prior to manual therapy, especially with high velocity, low amplitude spinal manipulation (HVLA-SM), should necessarily differ from those used in medical practice.
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Affiliation(s)
- Mark A. Lopes
- Gonstead Clinical Studies Society, Santa Cruz, CA, USA
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8
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He CQ, Mao L, Yao J, Zhao WC, Huang B, Hu N, Long DX. The Threshold Effects of Low-Dose-Rate Radiation on miRNA-Mediated Neurodevelopment of Zebrafish. Radiat Res 2021; 196:633-646. [PMID: 34399425 DOI: 10.1667/rade-20-00265.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/29/2021] [Indexed: 11/03/2022]
Abstract
The biological effects and regulatory mechanisms of low-dose and low-dose-rate radiation are still rather controversial. Therefore, in this study we investigated the effects of low-dose-rate radiation on zebrafish neurodevelopment and the role of miRNAs in radiation-induced neurodevelopment. Zebrafish embryos received prolonged gamma-ray irradiation (0 mGy/h, 0.1 mGy/h, 0.2 mGy/h, 0.4 mGy/h) during development. Neurodevelopmental indicators included mortality, malformation rate, swimming speed, as well as the morphology changes of the lateral line system and brain tissue. Additionally, spatiotemporal expression of development-related miRNAs (dre-miR-196a-5p, dre-miR-210-3p, dre-miR-338) and miRNA processing enzymes genes (Dicer and Drosha) were assessed by qRT-PCR and whole mount in situ hybridization (WISH). The results revealed a decline in mortality, malformation and swimming speed, with normal histological and morphological appearance, in zebrafish that received 0.1 mGy/h; however, increased mortality, malformation and swimming speed were observed, with pathological changes, in zebrafish that received 0.2 mGy/h and 0.4 mGy/h. The expression of miRNA processing enzyme genes was altered after irradiation, and miRNAs expression was downregulated in the 0.1 mGy/h group, and upregulated in the 0.2 mGy/h and 0.4 mGy/h groups. Furthermore, ectopic expression of dre-miR-210-3p, Dicer and Drosha was also observed in the 0.4 mGy/h group. In conclusion, the effect of low-dose and low-dose-rate radiation on neurodevelopment follows the threshold model, under the regulation of miRNAs, excitatory effects occurred at a dose rate of 0.1 mGy/h and toxic effects occurred at a dose rate of 0.2 mGy/h and 0.4 mGy/h.
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Affiliation(s)
- Chu-Qi He
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
| | - Liang Mao
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
| | - Jin Yao
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
| | - Wei-Chao Zhao
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
| | - Bo Huang
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
| | - Nan Hu
- Key Discipline Laboratory for National Defense for Biotechnology in Uranium Mining and Hydrometallurgy, University of South China, Hengyang, Hunan 421001, China
| | - Ding-Xin Long
- School of Public Health, University of South China, Hengyang 421001, PR China.,Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards, Hengyang, Hunan 421001, China
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Oakley PA, Betz JW, Harrison DE, Siskin LA, Hirsh DW. Radiophobia Overreaction: College of Chiropractors of British Columbia Revoke Full X-Ray Rights Based on Flawed Study and Radiation Fear-Mongering. Dose Response 2021; 19:15593258211033142. [PMID: 34421439 PMCID: PMC8375354 DOI: 10.1177/15593258211033142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 01/11/2023] Open
Abstract
Fears over radiation have created irrational pressures to dissuade radiography use within chiropractic. Recently, the regulatory body for chiropractors practicing in British Columbia, Canada, the College of Chiropractors of British Columbia (CCBC), contracted Pierre Côté to review the clinical use of X-rays within the chiropractic profession. A "rapid review" was performed and published quickly and included only 9 papers, the most recent dating from 2005; they concluded, "Given the inherent risks of radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine." The CCBC then launched an immediate review of the use of X-rays by chiropractors in their jurisdiction. Member and public opinion were gathered but not presented to their members. On February 4, 2021, the College announced amendments to their Professional Conduct Handbook that revoked X-ray rights for routine/repeat assessment and management of patients with spine disorders. Here, we highlight current and historical evidence that substantiates that X-rays are not a public health threat. We also point out critical and insurmountable flaws in the single paper used to support irrational and unscientific policy that discriminates against chiropractors who practice certain forms of evidence-based X-ray-guided methods.
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Affiliation(s)
| | | | | | | | | | - International Chiropractors Association Rapid Response Research Review Subcommittee
- Private Practice, Newmarket, ON, Canada
- Private Practice, Boise, ID, USA
- CBP NonProfit, Inc, Eagle, ID, USA
- Private Practice, Green Brook, NJ, USA
- Private Practice, Laurel, MD, USA
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Aldinc H, Gun C, Yaylaci S, Barbur E. Pediatric Minor Head Trauma: Factors Affecting the Anxiety of Parents. Clin Pediatr (Phila) 2021; 60:273-278. [PMID: 33884910 DOI: 10.1177/00099228211009678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Managing the anxiety of the parents of pediatric patients with head trauma is challenging. This study aimed to examine the factors that affect anxiety levels of parents whose children were admitted to the emergency department with minor head trauma. In this prospective study, the parents of 663 consecutive pediatric patients were invited to answer a questionnaire. Parents of 600 children participated in the study. The parents who believed they were provided sufficient information and who were satisfied with the service received had significantly more improvement in anxiety-related questions. Cranial X-ray assessment had a significantly positive impact on the anxiety of the parents, whereas cranial computed tomography and neurosurgery consultation did not. In assessing pediatric minor head trauma, cranial computed tomography imaging and neurosurgery consultation should not be expected to relieve the anxiety of the parents. However, adequately informing them and providing satisfaction are the factors that could lead to improvement.
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Affiliation(s)
- Hasan Aldinc
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Emergency Medicine, Istanbul, Turkey
| | - Cem Gun
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Emergency Medicine, Istanbul, Turkey
| | - Serpil Yaylaci
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Emergency Medicine, Istanbul, Turkey
| | - Erol Barbur
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
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11
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Frush DP, Sorantin E. Radiation use in diagnostic imaging in children: approaching the value of the pediatric radiology community. Pediatr Radiol 2021; 51:532-543. [PMID: 33743037 DOI: 10.1007/s00247-020-04924-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 08/19/2020] [Accepted: 11/30/2020] [Indexed: 01/15/2023]
Abstract
Medical imaging is foundational in the care of children, and much of the medical imaging province depends on ionizing radiation: radiography, fluoroscopy, CT and nuclear imaging. Many considerations for this imaging in children are distinct in the domains of appropriate radiation use, other factors that determine examination quality, the opportunities to engage and educate through networking, and the translation of research efforts. Given these needs, it is worth approaching the contributions and their impact by the pediatric radiology community, especially to the enhancement of this value in the care of children.
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Affiliation(s)
- Donald P Frush
- Pediatric Radiology, Duke University Medical Center, Room #2568, 40 Duke Medicine Circle, Red Zone, Duke South Box 3808, Durham, NC, 27710, USA.
| | - Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Graz, Austria
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12
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Van Gorp G, Lambrechts M, Jacobs R, Declerck D. Paediatric dentist's ability to detect and diagnose dental trauma using 2D versus 3D imaging. Eur Arch Paediatr Dent 2021; 22:699-705. [PMID: 33713318 DOI: 10.1007/s40368-021-00611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Visualisation of the third dimension has been reported to increase effectiveness of correctly diagnosing traumatic dental injuries. AIM To assess the ability of paediatric dentists to detect and diagnose Traumatic Dental Injuries (TDI) using two different imaging modalities, intraoral radiographs (2D) and CBCT scans (3D). In addition, observer's confidence regarding the obtained diagnosis, using either technique, was assessed. MATERIAL AND METHODS Both 2D and 3D images of 20 dental trauma cases in children were presented in random order to a panel of thirteen paediatric dentists. Observers received instructions for the screening of the images for radiographic findings related to dental trauma, using structured scoring sheets for 2D and 3D images. Observed data were compared to those recorded by two experienced benchmark observers. A ten-point scale was used for assessing observer's confidence regarding their final diagnosis using 2D versus 3D images. RESULTS Performance of individual observers showed wide variation. Statistical significance was reached for correctly detected and correctly diagnosed findings (p = 0.02), in favor of 3D. Most of the observers reported comparable confidence using 2D and 3D, two observers were more confident using 3D and one observer was more confident using 2D. CONCLUSIONS Paediatric dentist's ability to detect and diagnose findings in patients with TDI was higher on 3D images. Most observers showed a similar confidence score of their diagnostic performance both on 2D and on 3D.
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Affiliation(s)
- G Van Gorp
- Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, KU Leuven, University Hospitals Leuven, Kapucijnenvoer 7, PO box 7001, B-3000, Leuven, Belgium.
| | - M Lambrechts
- Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, KU Leuven, University Hospitals Leuven, Kapucijnenvoer 7, PO box 7001, B-3000, Leuven, Belgium
| | - R Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - D Declerck
- Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, KU Leuven, University Hospitals Leuven, Kapucijnenvoer 7, PO box 7001, B-3000, Leuven, Belgium
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Oakley PA, Harrison DE. Radiophobic Fear-Mongering, Misappropriation of Medical References and Dismissing Relevant Data Forms the False Stance for Advocating Against the Use of Routine and Repeat Radiography in Chiropractic and Manual Therapy. Dose Response 2021; 19:1559325820984626. [PMID: 33628151 PMCID: PMC7883173 DOI: 10.1177/1559325820984626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/14/2022] Open
Abstract
There is a faction within the chiropractic profession passionately advocating against the routine use of X-rays in the diagnosis, treatment and management of patients with spinal disorders (aka subluxation). These activists reiterate common false statements such as "there is no evidence" for biomechanical spine assessment by X-ray, "there are no guidelines" supporting routine imaging, and also promulgate the reiterating narrative that "X-rays are dangerous." These arguments come in the form of recycled allopathic "red flag only" medical guidelines for spine care, opinion pieces and consensus statements. Herein, we review these common arguments and present compelling data refuting such claims. It quickly becomes evident that these statements are false. They are based on cherry-picked medical references and, most importantly, expansive evidence against this narrative continues to be ignored. Factually, there is considerable evidential support for routine use of radiological imaging in chiropractic and manual therapies for 3 main purposes: 1. To assess spinopelvic biomechanical parameters; 2. To screen for relative and absolute contraindications; 3. To reassess a patient's progress from some forms of spine altering treatments. Finally, and most importantly, we summarize why the long-held notion of carcinogenicity from X-rays is not a valid argument.
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Armbruster M, Koliogiannis V. [The (severely) injured pregnant patient from the perspective of radiology]. Unfallchirurg 2020; 123:928-935. [PMID: 33064161 DOI: 10.1007/s00113-020-00885-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Trauma is one of the leading causes of mortality in pregnant women and significantly increases the likelihood of an unwanted termination of pregnancy. Particularly in severe trauma with an increased risk of significant maternal injuries, computed tomography (CT) remains the imaging modality of choice as it is comprehensively available, quick to carry out and has a high diagnostic accuracy in the detection and classification of life-threatening trauma-associated pathologies compared to other imaging techniques. Considering the radiation-associated risks, it is unlikely that a single, monophasic CT in the emergency trauma room will exceed the threshold of deterministic radiation damage; therefore, fetal malformations or fetal loss are not to be expected; however, there is a low stochastic risk for the delayed occurrence of radiation-induced cancer both for the child and the mother that can be considered small in comparison to missed or delayed diagnoses after severe trauma. Intravenous, nonionic iodinated contrast agents are not contraindicated during pregnancy and should be administered whenever their use would also be considered appropriate in a nonpregnant patient; however, unnecessary scans and, if possible, multiple contrast agent phases should be avoided in order to reduce radiation. Magnetic resonance imaging (MRI) has a major role in the subacute setting and constitutes an excellent problem solver for specific questions, such as the evaluation of discoligamentous injuries of the spine. Its use is deemed acceptable at any stage of pregnancy when the required information is considered important for the management of further treatment. Due to potential teratogenic effects of MRI contrast media containing gadolinium on the fetus, including an increased likelihood of fetal loss, they should only be administered with great caution and under strictly defined indications.
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Affiliation(s)
- M Armbruster
- Klinik und Poliklinik für Radiologie, LMU Klinikum München, Marchionistr. 15, 81377, München, Deutschland.
| | - V Koliogiannis
- Klinik und Poliklinik für Radiologie, LMU Klinikum München, Marchionistr. 15, 81377, München, Deutschland
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Oakley PA, Navid Ehsani N, Harrison DE. 5 Reasons Why Scoliosis X-Rays Are Not Harmful. Dose Response 2020; 18:1559325820957797. [PMID: 32963506 PMCID: PMC7488912 DOI: 10.1177/1559325820957797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Radiographic imaging for scoliosis screening, diagnosis, treatment, and management is the gold standard assessment tool. Scoliosis patients receive many repeat radiographs, typically 10-25 and as many as 40-50, equating to a maximum 50 mGy of cumulative exposure. It is argued this amount of radiation exposure is not carcinogenic to scoliosis patients for 5 main reasons: 1. Estimated theoretical cumulative effective doses remain below the carcinogenic dose threshold; 2. Scoliosis patient x-rays are delivered in serial exposures and therefore, mitigate any potential cumulative effect; 3. Linear no-threshold cancer risk estimates from scoliosis patient cohorts are flawed due to faulty science; 4. Standardized incidence/mortality ratios demonstrating increased cancers from aged scoliosis cohorts are confounded by the effects of the disease entity itself making it impossible to claim cause and effect resulting from low-dose radiation exposures from spinal imaging; 5. Children are not more susceptible to radiation damage than adults. Radiophobia concerns from patients, parents, and doctors over repeat imaging for scoliosis treatment and management is not justified; it adds unnecessary anxiety to the patient (and their parents) and interferes with optimal medical management. X-rays taken in the evidence-based management of scoliosis should be taken without hesitation or concern about negligible radiation exposures.
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Oakley PA, Harrison DE. X-Ray Hesitancy: Patients' Radiophobic Concerns Over Medical X-rays. Dose Response 2020; 18:1559325820959542. [PMID: 32994755 PMCID: PMC7503016 DOI: 10.1177/1559325820959542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
All too often the family physician, orthopedic surgeon, dentist or chiropractor is met with radiophobic concerns about X-ray imaging in the clinical setting. These concerns, however, are unwarranted fears based on common but ill-informed and perpetuated ideology versus current understanding of the effects of low-dose radiation exposures. Themes of X-ray hesitancy come in 3 forms: 1. All radiation exposures are harmful (i.e. carcinogenic); 2. Radiation exposures are cumulative; 3. Children are more susceptible to radiation. Herein we address these concerns and find that low-dose radiation activates the body's adaptive responses and leads to reduced cancers. Low-dose radiation is not cumulative as long as enough time (e.g. 24 hrs) passes prior to a repeated exposure, and any damage is repaired, removed, or eliminated. Children have more active immune systems; the literature shows children are no more affected than adults by radiation exposures. Medical X-rays present a small, insignificant addition to background radiation exposure that is not likely to cause harm. Doctors and patients alike should be better informed of the lack of risks from diagnostic radiation and the decision to image should rely on the best evidence, unique needs of the patient, and the expertise of the physician-not radiophobia.
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Oakley PA, Harrison DE. Death of the ALARA Radiation Protection Principle as Used in the Medical Sector. Dose Response 2020; 18:1559325820921641. [PMID: 32425724 PMCID: PMC7218317 DOI: 10.1177/1559325820921641] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022] Open
Abstract
ALARA is the acronym for "As Low As Reasonably Achievable." It is a radiation protection concept borne from the linear no-threshold (LNT) hypothesis. There are no valid data today supporting the use of LNT in the low-dose range, so dose as a surrogate for risk in radiological imaging is not appropriate, and therefore, the use of the ALARA concept is obsolete. Continued use of an outdated and erroneous principle unnecessarily constrains medical professionals attempting to deliver high-quality care to patients by leading to a reluctance by doctors to order images, a resistance from patients/parents to receive images, subquality images, repeated imaging, increased radiation exposures, the stifling of low-dose radiation research and treatment, and the propagation of radiophobia and continued endorsement of ALARA by regulatory bodies. All these factors result from the fear of radiogenic cancer, many years in the future, that will not occur. It has been established that the dose threshold for leukemia is higher than previously thought. A low-dose radiation exposure from medical imaging will likely upregulate the body's adaptive protection systems leading to the prevention of future cancers. The ALARA principle, as used as a radiation protection principle throughout medicine, is scientifically defunct and should be abandoned.
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Wu D, Wang G, Bian B, Liu Z, Li D. Benefits of Low-Dose CT Scan of Head for Patients With Intracranial Hemorrhage. Dose Response 2020; 19:1559325820909778. [PMID: 32214915 PMCID: PMC7065437 DOI: 10.1177/1559325820909778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/23/2019] [Accepted: 01/16/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: For patients with intracranial hemorrhage (ICH), routine follow-up computed tomography (CT) scans are typically required to monitor the progression of intracranial pathology. Remarkable levels of radiation exposure are accumulated during repeated CT scan. However, the effects and associated risks have still remained elusive. This study presented an effective approach to quantify organ-specific radiation dose of repeated CT scans of head for patients with ICH. We also indicated whether a low-dose CT scan may reduce radiation exposure and keep the image quality highly acceptable for diagnosis. Methods: Herein, 72 patients with a history of ICH were recruited. The patients were divided into 4 groups and underwent CT scan of head with different tube current–time products (250, 200, 150, and 100 mAs). Two experienced radiologists visually rated scores of quality of images according to objective image noise, sharpness, diagnostic acceptability, and artifacts due to physiological noise on the same workstation. Organ-/tissue-specific radiation doses were analyzed using Radimetrics. Results: In conventional CT scan group, signal to noise ratio (SNR) and contrast to noise ratio (CNR) of ICH images were significantly higher than those in normal brain structures. Reducing the tube current–time product may decrease the image quality. However, the predilection sites for ICH could be clearly identified. The SNR and CNR in the predilection sites for ICH were notably higher than other areas. The brain, eye lenses, and salivary glands received the highest radiation dose. Reducing tube current–time product from 250 to 100 mA can significantly reduce the radiation dose. Discussion: We demonstrated that low-dose CT scan of head can still provide reasonable images for diagnosing ICH. The radiation dose can be reduced to ∼45% of the conventional CT scan group.
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Affiliation(s)
- Dan Wu
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Gang Wang
- Department of Orthopedics, The Third Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Bingyang Bian
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Zhuohang Liu
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Dan Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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Shibata S, Shibamoto Y, Maehara M, Hobo A, Hotta N, Ozawa Y. Reasons for Undergoing CT During Childhood: Can CT-Exposed and CT-Naive Populations Be Compared? Dose Response 2020; 18:1559325820907011. [PMID: 32110172 PMCID: PMC7026821 DOI: 10.1177/1559325820907011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/22/2019] [Accepted: 01/16/2020] [Indexed: 12/20/2022] Open
Abstract
Several epidemiological studies suggested an increased risk of cancer and other tumors in individuals undergoing computed tomography (CT) examination during childhood; however, it was questioned whether the group undergoing CT was comparable to that not undergoing CT. To address this issue, we investigated the reasons for undergoing CT in 763 children aged 0 to 19 years in 2013. Their medical records were fully evaluated and symptoms, underlying conditions, reasons for CT, and clinical courses after CT were investigated. Among the 763 children, 66.1% underwent repeat CT after the first examination, and 19.3% underwent CT 8 times or more. Among all the examined children, 8.8% had cancer and 4.7% had cancer-prone conditions such as Down syndrome, tuberous sclerosis, and cirrhosis. Only 11.4% of the 763 children underwent CT because of trauma, and 32.2% of the children had some types of congenital anomaly. The rate of trauma decreased with an increase in the frequency of CT examinations. Since the incidence of congenital anomalies is below 2.5% in the general population, it was concluded that the population of children undergoing CT is completely different from that not undergoing CT. The 2 groups should not be compared.
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Affiliation(s)
- Shunsuke Shibata
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Megumi Maehara
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Ayano Hobo
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Naohide Hotta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Yoshiyuki Ozawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan
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Perez MD, Jeong SH, Raman S, Nowinski D, Wu Z, Redzwan SM, Velander J, Peng Z, Hjort K, Augustine R. Head-compliant microstrip split ring resonator for non-invasive healing monitoring after craniosynostosis-based surgery. Healthc Technol Lett 2020; 7:29-34. [PMID: 32190338 PMCID: PMC7067054 DOI: 10.1049/htl.2018.5083] [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: 11/13/2018] [Revised: 09/17/2019] [Accepted: 11/08/2019] [Indexed: 12/15/2022] Open
Abstract
A soft and highly directive, proximity-coupled split-ring resonator fabricated with a liquid alloy, copper and polydimethylsiloxane (PDMS) is presented. The same was designed for sensing osteogenesis of calvarial bone. As dielectric properties of bone grafts in ossifying calvarial defects should change during the osteogenesis process, devices like this could monitor the gradual transformation of the defect into bone by differentiating changes in the dielectric properties as shifts in the resonance frequency. Computational Software Technology (CST) Microwave Studio®-based simulation results on computational head models were in good agreement with laboratory results on head phantom models, which also included the comparison with an in-vivo measurement on the human head. A discussion based on an inductive reasoning regarding dynamics' considerations is provided as well. Since the skin elasticity of newborn children is high, stretching and crumpling could be significant. In addition, due to typical head curvatures in newborn children, bending should not be a significant issue, and can provide higher energy focus in the defect area and improve conformability. The present concept could support the development of soft, cheap and portable follow-up monitoring systems to use in outpatient hospital and home care settings for post-operative monitoring of bone healing after reconstructive surgical procedures.
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Affiliation(s)
- Mauricio David Perez
- Department of Engineering Sciences, The Angstrom Laboratory, Uppsala University, 751 21 Uppsala, Sweden
| | - Seung Hee Jeong
- Department of Engineering Sciences, The Angstrom Laboratory, Uppsala University, 751 21 Uppsala, Sweden
| | - Sujith Raman
- Department of Electronics and Instrumentation, Bharathiar University, Coimbatore, India
| | - Daniel Nowinski
- Department of Surgical Sciences, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Zhigang Wu
- Department of Engineering Sciences, The Angstrom Laboratory, Uppsala University, 751 21 Uppsala, Sweden
- State Key Laboratory of Digital Manufacturing and Equipment Technology, School of Mechanical Science & Engineering, Huazhong University of Science & Technology, Wuhan 430074, People's Republic of China
| | - Syaiful M.S. Redzwan
- Department of Engineering Sciences, The Angstrom Laboratory, Uppsala University, 751 21 Uppsala, Sweden
| | - Jacob Velander
- Department of Engineering Sciences, The Angstrom Laboratory, Uppsala University, 751 21 Uppsala, Sweden
| | - Zhiwei Peng
- School of Minerals Processing and Bioengineering, Central South University, Changsha, Hunan 410083, People's Republic of China
| | - Klas Hjort
- Department of Engineering Sciences, The Angstrom Laboratory, Uppsala University, 751 21 Uppsala, Sweden
| | - Robin Augustine
- Department of Engineering Sciences, The Angstrom Laboratory, Uppsala University, 751 21 Uppsala, Sweden
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21
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Postinfectious Bronchiolitis Obliterans in Children: Diagnostic Workup and Therapeutic Options: A Workshop Report. Can Respir J 2020; 2020:5852827. [PMID: 32076469 PMCID: PMC7013295 DOI: 10.1155/2020/5852827] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 12/23/2022] Open
Abstract
Bronchiolitis obliterans (BO) is a rare, chronic form of obstructive lung disease, often initiated with injury of the bronchiolar epithelium followed by an inflammatory response and progressive fibrosis of small airways resulting in nonuniform luminal obliteration or narrowing. The term BO comprises a group of diseases with different underlying etiologies, courses, and characteristics. Among the better recognized inciting stimuli leading to BO are airway pathogens such as adenovirus and mycoplasma, which, in a small percentage of infected children, will result in progressive fixed airflow obstruction, an entity referred to as postinfectious bronchiolitis obliterans (PIBO). The present knowledge on BO in general is reasonably well developed, in part because of the relatively high incidence in patients who have undergone lung transplantation or bone marrow transplant recipients who have had graft-versus-host disease in the posttransplant period. The cellular and molecular pathways involved in PIBO, while assumed to be similar, have not been adequately elucidated. Since 2016, an international consortium of experts with an interest in PIBO assembles on a regular basis in Geisenheim, Germany, to discuss key areas in PIBO which include diagnostic workup, treatment strategies, and research fields.
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22
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Muzaffar R, Koester E, Frye S, Alenezi S, Sterkel BB, Osman MM. Development of Simple Methods to Reduce the Exposure of the Public to Radiation from Patients Who Have Undergone 18F-FDG PET/CT. J Nucl Med Technol 2019; 48:63-67. [PMID: 31604894 DOI: 10.2967/jnmt.119.233296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/21/2019] [Indexed: 11/16/2022] Open
Abstract
At a time when reducing the radiation dose to patients and the public has become a major focus, we assessed the radiation exposure rate from patients after an 18F-FDG PET/CT scan and evaluated different interventions to reduce it. Methods: We enrolled 100 patients, divided into 2 groups. For both groups, the radiation dose rate was measured with an ionization survey meter immediately after the scan. For group 1, the patients then voided and their dose rate was measured again. For group 2, the patients waited 30 min before voiding, and we measured the dose rate before (group 2A) and after (group 2B) they voided. Results: In total, 74 of the 100 patients exceeded the 20 μSv/h (2 mR/h) threshold immediately after the scan. In group 1, the mean dose rate decreased by 20.0% from the postscan measurement, with 12 of 36 remaining at or above 20 μSv/h. In group 2A, the mean dose rate decreased by 23% from the postscan measurement, with 9 of 38 remaining at or above 20 μSv/h. In group 2B, the mean dose rate decreased by 35% from the postscan measurement, with 1 of 38 remaining at 20 μSv/h. Conclusion: Nearly 75% of patients undergoing an 18F-FDG PET/CT scan exceed 20 μSv/h when leaving the imaging facility. The most effective method to reduce radiation exposure was to have the patient void 30 min after the examination.
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Affiliation(s)
- Razi Muzaffar
- Division of Nuclear Medicine, Department of Radiology, Saint Louis University, Saint Louis, Missouri
| | - Elyse Koester
- Division of Nuclear Medicine, St. Louis University Hospital, SSM Health, St. Louis, Missouri
| | - Sarah Frye
- Medical Imaging and Radiation Therapeutics, Saint Louis University, St. Louis, Missouri; and
| | - Saud Alenezi
- Division of Nuclear Medicine, Department of Radiology, Saint Louis University, Saint Louis, Missouri
| | - Barbara B Sterkel
- Diagnostic Imaging Service VA, St. Louis Health Care System, Saint Louis, Missouri
| | - Medhat M Osman
- Division of Nuclear Medicine, Department of Radiology, Saint Louis University, Saint Louis, Missouri
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Gubbels CM, Werner JT, Oakley PA, Harrison DE. Reduction of thoraco-lumbar junctional kyphosis, posterior sagittal balance, and increase of lumbar lordosis and sacral inclination by Chiropractic BioPhysics ® methods in an adolescent with back pain: a case report. J Phys Ther Sci 2019; 31:839-843. [PMID: 31645816 PMCID: PMC6801338 DOI: 10.1589/jpts.31.839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022] Open
Abstract
[Purpose] To present the structural improvement of an excessive junctional thoracolumbar kyphosis and related biomechanical parameters in an adolescent. [Participant and Methods] A 16 year old female presented with chronic back pains. Radiographic assessment revealed excessive posterior sagittal balance and thoracolumbar kyphosis and reduced lumbar lordosis and sacral inclination. Chiropractic BioPhysics® technique including mirror image®, anterior thoracic translation and thoracolumbar hyperextension traction was performed as well as spinal manipulation and postural exercises over an 8-week period. [Results] After 24 in-office treatments and a daily home program the patient reported a minimization of back pains and a better mood. Follow-up X-rays demonstrated a 48 mm reduction of posterior sagittal balance, a 22° reduction of thoracolumbar kyphosis, an 11° increase in lumbar lordosis, and a 10° increase in sacral inclination. [Conclusion] This is the first case documenting the non-surgical reduction of excessive thoracolumbar junctional kyphosis and related biomechanical parameters in an adolescent. Precise analysis of radiologic assessment for adolescents presenting with back pains is advised and are safe for the screening of postural disorders. There is a growing evidence base for the Chiropractic BioPhysics® technique approach in the correction of lumbar spine disorders; more research is encouraged to further evaluate this unique treatment.
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Affiliation(s)
| | | | - Paul A. Oakley
- Private Practice: 11A-1100 Gorham Street, Newmarket, ON,
L3Y 8Y8, Canada
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24
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Oakley PA, Ehsani NN, Harrison DE. Repeat Radiography in Monitoring Structural Changes in the Treatment of Spinal Disorders in Chiropractic and Manual Medicine Practice: Evidence and Safety. Dose Response 2019; 17:1559325819891043. [PMID: 31839759 PMCID: PMC6900628 DOI: 10.1177/1559325819891043] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 12/18/2022] Open
Abstract
There is substantial evidence for normal relationships between spine and postural parameters, as measured from radiographs of standing patients. Sagittal balance, cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic tilt, and the more complex understanding of the interrelations between these essential components of normal stance have evolved to where there are known, established thresholds for normalcy. These spinal parameters are reliably measured from X-ray images and serve as goals of care in the treatment of spine and postural disorders. Initial and follow-up spinal imaging by X-ray is thus crucial for the practice of contemporary and evidence-based structural rehabilitation. Recent studies have demonstrated that improvement in the spine and posture by nonsurgical methods offers superior long-term patient outcomes versus conventional methods that only temporarily treat pain/dysfunction. Low-dose radiation from repeated X-ray imaging in treating subluxated patients is substantially below the known threshold for harm and is within background radiation exposures. Since alternative imaging methods are not clinically practical at this time, plain radiography remains the standard for spinal imaging. It is safe when used in a repeated fashion for quantifying pre-post spine and postural subluxation and deformity patterns in the practice of structural correction methods by chiropractic and other manual medicine practices.
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25
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A Nano-Dose Protocol For Cobb Angle Assessment in Children With Scoliosis: Results of a Phantom-based and Clinically Validated Study. Clin Spine Surg 2019; 32:E340-E345. [PMID: 31162186 DOI: 10.1097/bsd.0000000000000834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN This was a prospective validation study with technical notes. OBJECTIVE This study aimed to validate a new ultra-low-dose full-spine protocol for reproducible Cobb angle measurements-the "nano-dose" protocol. SUMMARY OF BACKGROUND DATA Scoliosis is a 3-dimensional (3D) deformity of the spine characterized by 3D clinical parameters. Nevertheless, 2D Cobb angle remains an essential and widely used radiologic measure in clinical practice. Repeated imaging is required for the assessment and follow-up of scoliosis patients. The resultant high dose of absorbed radiation increases the potential risk of developing radiation-induced cancer in such patients. Micro-dose radiographic imaging is already available in clinical practice, but the radiation dose delivered to the patient could be further reduced. METHODS An anthropomorphic child phantom was used to establish an ultra-low-dose protocol in the EOS Imaging System still allowing Cobb angle measurements, defined as nano-dose. A group of 23 consecutive children presenting for scoliosis assessment, 12 years of age or younger, were assessed with standard-dose or micro-dose and additional nano-dose full-spine imaging modalities. Intraobserver and interobserver reliability of determining the reliability of 2D Cobb angle measurements was performed. The dosimetry was performed in the anthropomorphic phantom to confirm theoretical radiation dose reduction. RESULTS A nano-dose protocol was established for reliable Cobb angle measurements. Dose area product with this new nano-dose protocol was reduced to 5 mGy×cm, corresponding to one sixth of the micro-dose protocol (30 mGy×cm) and <1/40th of the standard-dose protocol (222 mGy×cm). Theoretical dose reduction, for posteroanterolateral positioning was confirmed using phantom dosimetry. Our study showed good reliability and repeatability between the 2 groups. Cobb variability was <5 degrees from the mean using 95% confidence intervals. CONCLUSIONS We propose a new clinically validated nano-dose protocol for routine follow-up of scoliosis patients before surgery, keeping the radiation dose at a bare minimum, while allowing for reproducible Cobb angle measurements.
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Abstract
The mitochondrial enzyme succinate dehydrogenase (SDH) acts as a tumor suppressor. Biallelic inactivation of one of the genes encoding for SDH subunits (collectively named SDHx) leads to complete loss of the protein function and the development of diverse group of tumors. Pheochromocytomas-paragangliomas are the prime example of hereditary tumors caused by SDH deficiency. In this review, we discuss the roles of imaging examinations, and illustrate new insights into genotype-imaging phenotype relationships.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France
| | - Henri Timmers
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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27
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Ulyanenko S, Pustovalova M, Koryakin S, Beketov E, Lychagin A, Ulyanenko L, Kaprin A, Grekhova A, M Ozerova A, V Ozerov I, Vorobyeva N, Shegay P, Ivanov S, Leonov S, Klokov D, Osipov AN. Formation of γH2AX and pATM Foci in Human Mesenchymal Stem Cells Exposed to Low Dose-Rate Gamma-Radiation. Int J Mol Sci 2019; 20:E2645. [PMID: 31146367 PMCID: PMC6600277 DOI: 10.3390/ijms20112645] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022] Open
Abstract
DNA double-strand breaks (DSB) are among the most harmful DNA lesions induced by ionizing radiation (IR). Although the induction and repair of radiation-induced DSB is well studied for acute irradiation, responses to DSB produced by chronic IR exposures are poorly understood, especially in human stem cells. The aim of this study was to examine the formation of DSB markers (γH2AX and phosphorylated kinase ATM, pATM, foci) in human mesenchymal stem cells (MSCs) exposed to chronic gamma-radiation (0.1 mGy/min) in comparison with acute irradiation (30 mGy/min) at cumulative doses of 30, 100, 160, 240 and 300 mGy. A linear dose-dependent increase in the number of both γH2AX and pATM foci, as well as co-localized γH2AX/pATM foci ("true" DSB), were observed after an acute radiation exposure. In contrast, the response of MSCs to a chronic low dose-rate IR exposure deviated from linearity towards a threshold model, for γH2AX, pATM foci and γH2AX/pATM foci, with an indication of a "plateau". The state of equilibrium between newly formed DSB at a low rate during the protracted exposure time and the elimination of a fraction of DSB is proposed as a mechanistic explanation of the non-linear DSB responses following a low dose-rate irradiation. This notion is supported by the observation of the elimination of a substantial fraction of DSB 6 h after the cessation of the exposures. Our results demonstrate non-linear dose responses for γH2AX and pATM foci in human MSCs exposed to low dose-rate IR and showed the existence of a threshold, which may have implications for radiation protection in humans.
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Affiliation(s)
- Stepan Ulyanenko
- A. Tsyb Medical Radiological Research Centre-Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Koroleva 4, Obninsk 249030, Russia.
| | - Margarita Pustovalova
- State Research Center-Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow 123098, Russia.
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow 119991, Russia.
- Moscow Institute of Physics and Technology, Dolgoprudny 141700, Russia.
| | - Sergey Koryakin
- A. Tsyb Medical Radiological Research Centre-Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Koroleva 4, Obninsk 249030, Russia.
| | - Evgenii Beketov
- A. Tsyb Medical Radiological Research Centre-Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Koroleva 4, Obninsk 249030, Russia.
| | - Anatolii Lychagin
- A. Tsyb Medical Radiological Research Centre-Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Koroleva 4, Obninsk 249030, Russia.
| | - Liliya Ulyanenko
- A. Tsyb Medical Radiological Research Centre-Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Koroleva 4, Obninsk 249030, Russia.
| | - Andrey Kaprin
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow 125284, Russia.
| | - Anna Grekhova
- State Research Center-Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow 123098, Russia.
- Emanuel Institute for Biochemical Physics, Russian Academy of Sciences, Moscow 119991, Russia.
| | - Alexandra M Ozerova
- Faculty of Biology, Lomonosov Moscow State University, GSP-1, Leninskie Gory, Moscow 119991, Russia.
| | - Ivan V Ozerov
- State Research Center-Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow 123098, Russia.
| | - Natalia Vorobyeva
- State Research Center-Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow 123098, Russia.
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow 119991, Russia.
| | - Peter Shegay
- Center for Innovative Radiological and Regenerative Technologies of the Ministry of Health of the Russian Federation, Koroleva 4, Obninsk 249030, Russia.
| | - Sergey Ivanov
- A. Tsyb Medical Radiological Research Centre-Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Koroleva 4, Obninsk 249030, Russia.
| | - Sergey Leonov
- Moscow Institute of Physics and Technology, Dolgoprudny 141700, Russia.
- Institute of Cell Biophysics, Russian Academy of Sciences, Institutskaya St., 3, Pushchino 142290, Russia.
| | - Dmitry Klokov
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Andreyan N Osipov
- State Research Center-Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow 123098, Russia.
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow 119991, Russia.
- Moscow Institute of Physics and Technology, Dolgoprudny 141700, Russia.
- Center for Innovative Radiological and Regenerative Technologies of the Ministry of Health of the Russian Federation, Koroleva 4, Obninsk 249030, Russia.
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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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Bushberg JT. Uses of Effective Dose: The Good, the Bad, and the Future. HEALTH PHYSICS 2019; 116:129-134. [PMID: 30585952 DOI: 10.1097/hp.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Effective dose (E) is a risk-adjusted dosimetric quantity developed by the International Commission on Radiological Protection. It is a key metric for practical management of the risk of stochastic health effects in a comprehensive radiation protection program. The International Commission on Radiological Protection and others have emphasized repeatedly that E is not intended to represent an actual radiation dose and should not be used as a risk-related metric for a specific person or population. The cancer risk uncertainties in the low-dose range and the underlying approximations, simplifications, and sex- and age-averaging used in generating E make it unsuitable for this purpose. However, in practice, medical imaging professionals and authors of peer-reviewed medical publications frequently and incorrectly use E as a surrogate for whole-body dose in order to calculate cancer risk estimates for specific patients or patient populations. This frequent misuse has popularized E for uses for which it was neither designed nor intended. Alternatives to E have been proposed that attempt to account for known age and sex differences in radiation sensitivity. E has also been proposed as a general indicator for communicating radiation risk to patients, if its limitations are kept in mind. Forthcoming guidance from the International Commission on Radiological Protection will likely clarify if, when, and how some form of E may be used as a rough indicator of the risk of a stochastic effect, possibly with some modifications for the substantial variations in risk known to exist with respect to age, sex, and population group.
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Affiliation(s)
- Jerrold T Bushberg
- Associate Chairman, Department of Radiology, Clinical Professor of Radiology and Radiation Oncology, School of Medicine, University of California, Davis, 2315 Stockton Blvd., FSSB 2500, Sacramento, CA 95817
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Tufton N, Sahdev A, Drake WM, Akker SA. Can subunit-specific phenotypes guide surveillance imaging decisions in asymptomatic SDH mutation carriers? Clin Endocrinol (Oxf) 2019; 90:31-46. [PMID: 30303539 DOI: 10.1111/cen.13877] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/07/2018] [Accepted: 10/07/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE With the discovery that familial phaeochromocytoma and paraganglioma syndrome can be caused by mutations in each subunit of the succinate dehydrogenase enzyme (SDH), has come the recognition that mutations in the individual subunits have their own distinct natural histories. Increased genetic screening is leading to the identification of increasing numbers of, mostly asymptomatic, gene mutation carriers and the implementation of screening strategies for these individuals. Yet there is, to date, no international consensus regarding screening strategies for asymptomatic carriers. DESIGN A comprehensive PubMed search from 1/1/2000 to 28/2/2018 was undertaken using multiple search terms and subsequently a manual review of references in identified papers to identify all clinically relevant cases and cohorts. In this review, the accumulated, published experience of phenotype and malignancy risks of individual SDH subunits is analysed. Where possible screening results for asymptomatic SDH mutation carriers have been analysed separately to define the penetrance in asymptomatic carriers (asymptomatic penetrance). RESULTS The combined data confirms that "asymptomatic penetrance" is highest for SDHD and when there is penetrance, the most likely site to develop a PGL is head and neck (SDHD) and extra-adrenal abdominal (SDHB). However, the risk in SDHB carriers of developing HNPGL is also high (35.5%) and a PCC is low (15.1%), and in SDHD carriers there is a high risk of developing a PCC (35.8%) or abdominal PGL (9.4%) and a small, but significant risk at other sympathetic sites. The data suggest that the risk of malignant transformation is the same for both PCC and extra-adrenal abdominal PGLs (30%-35%) in SDHB carriers. In SDHD carriers, the risk of malignant transformation was highest in HNPGLs (7.5%) and similar for sympathetic sites (3.8%-5.2%). CONCLUSIONS Using this data, we suggest surveillance screening of asymptomatic carriers can be tailored to the underlying SDH subunit and review possible surveillance programmes.
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Affiliation(s)
- Nicola Tufton
- Department of Endocrinology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Centre for Endocrinology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anju Sahdev
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - William M Drake
- Department of Endocrinology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Centre for Endocrinology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Scott A Akker
- Department of Endocrinology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Centre for Endocrinology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Duncan JR, Lieber MR, Adachi N, Wahl RL. Reply: Radiation Dose Does Matter: Mechanistic Insights into DNA Damage and Repair Support the Linear No-Threshold Model of Low-Dose Radiation Health Risks. J Nucl Med 2018; 59:1780-1781. [DOI: 10.2967/jnumed.118.218321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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32
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Shibamoto Y, Nakamura H. Overview of Biological, Epidemiological, and Clinical Evidence of Radiation Hormesis. Int J Mol Sci 2018; 19:E2387. [PMID: 30104556 PMCID: PMC6121451 DOI: 10.3390/ijms19082387] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 12/19/2022] Open
Abstract
The effects of low-dose radiation are being increasingly investigated in biological, epidemiological, and clinical studies. Many recent studies have indicated the beneficial effects of low doses of radiation, whereas some studies have suggested harmful effects even at low doses. This review article introduces various studies reporting both the beneficial and harmful effects of low-dose radiation, with a critique on the extent to which respective studies are reliable. Epidemiological studies are inherently associated with large biases, and it should be evaluated whether the observed differences are due to radiation or other confounding factors. On the other hand, well-controlled laboratory studies may be more appropriate to evaluate the effects of low-dose radiation. Since the number of such laboratory studies is steadily increasing, it will be concluded in the near future whether low-dose radiation is harmful or beneficial and whether the linear-no-threshold (LNT) theory is appropriate. Many recent biological studies have suggested the induction of biopositive responses such as increases in immunity and antioxidants by low-dose radiation. Based on recent as well as classical studies, the LNT theory may be out of date, and low-dose radiation may have beneficial effects depending on the conditions; otherwise, it may have no effects.
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Affiliation(s)
- Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
| | - Hironobu Nakamura
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
- Department of Radiology, Saito Yukokai Hospital, Osaka 567-0085, Japan.
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33
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Fortner MO, Oakley PA, Harrison DE. Alleviation of chronic spine pain and headaches by reducing forward head posture and thoracic hyperkyphosis: a CBP ® case report. J Phys Ther Sci 2018; 30:1117-1123. [PMID: 30154612 PMCID: PMC6110208 DOI: 10.1589/jpts.30.1117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/15/2018] [Indexed: 12/14/2022] Open
Abstract
[Purpose] This case presents the reduction of both forward head posture and thoracic hyperkyphosis in a young male with chronic back pain and headaches by a comprehensive posture rehabilitation program as a part of Chiropractic BioPhysics® methods. [Participant and Methods] A 32 year old male presented with constant pain and headaches for seven years since he was involved in a work related injury. He had seen five different MDs, undergone multiple imaging tests, and received multiple prescriptions, thirteen steroid injections and was recommended for a spine surgery that he had denied. He was on long-term disability. Upon comprehensive posture and spine assessment, the patient had exaggerated forward head translation and thoracic hyperkyphosis. The patient was treated 36 times over 13-weeks with cervical and thoracic extension exercises, traction, and manipulation. [Results] After treatment the patient reported dramatic improvement in symptoms as indicated on valid disability questionnaires and substantial improvements in posture. [Conclusion] Posture-related pain and disability is not often addressed in allopathic medicine but substantial posture improvements are achievable in short time periods as this case illustrates. Poor postures in young patients should be corrected to avoid long-term consequences. Radiography as used in spinal rehabilitation is safe and reliable.
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Cardarelli JJ, Ulsh BA. It Is Time to Move Beyond the Linear No-Threshold Theory for Low-Dose Radiation Protection. Dose Response 2018; 16:1559325818779651. [PMID: 30013457 PMCID: PMC6043938 DOI: 10.1177/1559325818779651] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/18/2018] [Accepted: 05/01/2018] [Indexed: 02/03/2023] Open
Abstract
The US Environmental Protection Agency (USEPA) is the primary federal agency responsible for promulgating regulations and policies to protect people and the environment from ionizing radiation. Currently, the USEPA uses the linear no-threshold (LNT) model to estimate cancer risks and determine cleanup levels in radiologically contaminated environments. The LNT model implies that there is no safe dose of ionizing radiation; however, adverse effects from low dose, low-dose rate (LDDR) exposures are not detectable. This article (1) provides the scientific basis for discontinuing use of the LNT model in LDDR radiation environments, (2) shows that there is no scientific consensus for using the LNT model, (3) identifies USEPA reliance on outdated scientific information, and (4) identifies regulatory reliance on incomplete evaluations of recent data contradicting the LNT. It is the time to reconsider the use of the LNT model in LDDR radiation environments. Incorporating the latest science into the regulatory process for risk assessment will (1) ensure science remains the foundation for decision making, (2) reduce unnecessary burdens of costly cleanups, (3) educate the public on the real effects of LDDR radiation exposures, and (4) harmonize government policies with the rest of the radiation scientific community.
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35
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Duncan JR, Lieber MR, Adachi N, Wahl RL. Radiation Dose Does Matter: Mechanistic Insights into DNA Damage and Repair Support the Linear No-Threshold Model of Low-Dose Radiation Health Risks. J Nucl Med 2018; 59:1014-1016. [PMID: 29853652 DOI: 10.2967/jnumed.118.210252] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- James R Duncan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael R Lieber
- USC Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, California; and
| | | | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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36
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Oakley PA. Is early treatment for mild adolescent idiopathic scoliosis superior over the traditional 'watch & wait' approach? A case report with long-term follow-up. J Phys Ther Sci 2018; 30:680-684. [PMID: 29765179 PMCID: PMC5940471 DOI: 10.1589/jpts.30.680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/07/2018] [Indexed: 12/11/2022] Open
Abstract
[Purpose] To present a case of the complete correction of mild suspected adolescent
idiopathic scoliosis in support of the argument that early aggressive treatment is
superior to the traditional ‘watch & wait’ approach. [Subject and Methods] A
9-year-old female presented with a 14° thoracic curve indicative of early adolescent
idiopathic scoliosis. The parents consented to immediate and early treatment with the
SpineCor dynamic and corrective scoliosis brace. The brace was worn 20 hours per day and
check-ups were performed every three months. [Results] The patient achieved complete
correction of the thoracic curve within 9-months. The child was followed for 4.5 years
until she approached near cessation of skeletal growth (Risser sign grade 4) at the age of
14 years, 4-months. The patient’s spine remained straight throughout the follow-up.
[Conclusion] This report as well as others suggests that the SpineCor bracing system is a
unique and effective intervention for mild scoliosis. Further, this case illustrates an
ideal outcome and supports the argument that initiating treatment at the earliest
indication of suspected idiopathic scoliosis should offer superior outcomes versus the
traditional ‘watch & wait’ approach. Last, radiation exposures associated with
radiography for scoliosis treatment and management are negligible and not harmful.
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Affiliation(s)
- Paul A Oakley
- Private Practice: 11A-1100 Gorham Street, Newmarket, Ontario L3Y 8Y8, Canada
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Salerno S, Granata C, Trapenese M, Cannata V, Curione D, Rossi Espagnet MC, Magistrelli A, Tomà P. Is MRI imaging in pediatric age totally safe? A critical reprisal. Radiol Med 2018; 123:695-702. [PMID: 29725913 DOI: 10.1007/s11547-018-0896-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/20/2018] [Indexed: 12/11/2022]
Abstract
Current radiological literature is strongly focussed on radiation imaging risks. Indeed, given there is a small but actual augment in cancer risk from exposure to ionizing radiation in children, it is important to understand what the risk of alternative techniques could be. We retrospectively review literature data concerning possible MR imaging risks, focussing on the biological effects of MR, sedation and gadolinium compound risks when dealing with infant patients. The main concerns can be summarized in: (1) Biological effects of non-ionizing electromagnetic fields (EMF) employed-whose mechanisms of interaction with human tissues are polarization, induced current, and thermal heating, respectively. (2) Risks associated with noises produced during MRI examinations. (3) Hazards from ferromagnetic external and/or implanted devices-whose risk of being unintentionally brought inside MR room is higher in children than in adults. (4) Risks associated with sedation or general anaesthesia, essential problem in performing MR in very young patients, due to the exam long-lasting. (5) Risks related to gadolinium-based contrast agents, especially considering the newly reported brain deposition.
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Affiliation(s)
- Sergio Salerno
- Dipartimento di Diagnostica per Immagini, Policlinico Università degli Studi di Palermo, Via del Vespro 127, CAP 90127, Palermo, Italy.
| | - Claudio Granata
- UOC Radiologia - Ospedale Pediatrico Giannina Gaslini, Genoa, Italy
| | - Marco Trapenese
- Dipartimento di Energia, Ingegneria dell'Informazione e Modelli Matematici, Università degli Studi di Palermo, Palermo, Italy
| | - Vittorio Cannata
- Servizio Prevenzione e Protezione/Fisica Sanitaria, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Davide Curione
- Dipartimento Diagnostica per Immagini, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Andrea Magistrelli
- Dipartimento Diagnostica per Immagini, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Paolo Tomà
- Dipartimento Diagnostica per Immagini, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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Massalha S, Lugassi R, Raysberg E, Koskosi A, Lechtenberg G, Israel O, Kennedy JA. Evaluation of Staff Radiation Exposure during Transthoracic Echocardiography Close to Myocardial Perfusion Imaging. J Am Soc Echocardiogr 2018; 31:763-770. [PMID: 29625886 DOI: 10.1016/j.echo.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Transthoracic echocardiography (TTE) and myocardial perfusion imaging (MPI) are used in cardiac patients. In this study the radiation exposure of sonographers performing TTE following MPI was evaluated. METHODS Of 40 study patients, 30 underwent same-day 99mTc sestamibi MPI and TTE, while another 10 underwent only TTE. Patients who underwent both studies were divided into three groups: right-handed TTE performed by an echocardiographer and right- and left-handed TTE performed by a cardiac sonographer. Seven thermoluminescent radiation dosimeter badges monitored the forehead, wrists, anterolateral right and left chest, sternal notch, and umbilical region of each examiner. Group characteristics were compared. Radiation exposures were deemed positive if >0.1 mSv. RESULTS There were no statistical differences in patient weight and body mass index. The left-handed approach group had higher residual radioactivity (979 ± 73 vs 884 ± 73 MBq [P < .01] and 906 ± 81 MBq [P < .04]), but no statistical difference in duration of TTE, compared with the other two MPI groups. Radiation exposure was positive in the right anterolateral chest and hand (0.45 and 1 mSv, respectively) for the echocardiographer, the right anterolateral chest and wrist and umbilical region (0.59, 1.06, and 0.15 mSv, respectively) for the right-handed sonographer, and the left chest and hand (0.12 and 0.34 mSv, respectively) for the left-handed sonographer. Dosimeters indicated no radiation exposure in the TTE-only group. CONCLUSIONS Staff members performing TTE after MPI are exposed to radiation that might warrant monitoring. Altering study sequence, adopting a left-handed approach, and using other radiation-reducing techniques can minimize the degree of exposure.
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Affiliation(s)
- Samia Massalha
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.
| | - Rachel Lugassi
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Elyahu Raysberg
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Amjad Koskosi
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | | | - Ora Israel
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - John A Kennedy
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; Faculty of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel
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Oakley PA, Harrison DE. Radiophobia: 7 Reasons Why Radiography Used in Spine and Posture Rehabilitation Should Not Be Feared or Avoided. Dose Response 2018; 16:1559325818781445. [PMID: 30013456 PMCID: PMC6043928 DOI: 10.1177/1559325818781445] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/04/2018] [Accepted: 05/15/2018] [Indexed: 12/21/2022] Open
Abstract
Evidence-based contemporary spinal rehabilitation often requires radiography. Use of radiography (X-rays or computed tomography scans) should not be feared, avoided, or have their exposures lessened to decrease patient dose possibly jeopardizing image quality. This is because all fears of radiation exposures from medical diagnostic imaging are based on complete fabrication of health risks based on an outdated, invalid linear model that has simply been propagated for decades. We present 7 main arguments for continued use of radiography for routine use in spinal rehabilitation: (1) the linear no-threshold model for radiation risk estimates is invalid for low-dose exposures; (2) low-dose radiation enhances health via the body's adaptive response mechanisms (ie, radiation hormesis); (3) an X-ray with low-dose radiation only induces 1 one-millionth the amount of cellular damage as compared to breathing air for a day; (4) radiography is below inescapable natural annual background radiation levels; (5) radiophobia stems from unwarranted fears and false beliefs; (6) radiography use leads to better patient outcomes; (7) the risk to benefit ratio is always beneficial for routine radiography. Radiography is a safe imaging method for routine use in patient assessment, screening, diagnosis, and biomechanical analysis and for monitoring treatment progress in daily clinical practice.
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Siegel JA, Greenspan BS, Maurer AH, Taylor AT, Phillips WT, Van Nostrand D, Sacks B, Silberstein EB. The BEIR VII Estimates of Low-Dose Radiation Health Risks Are Based on Faulty Assumptions and Data Analyses: A Call for Reassessment. J Nucl Med 2018; 59:1017-1019. [PMID: 29475999 DOI: 10.2967/jnumed.117.206219] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/12/2018] [Indexed: 11/16/2022] Open
Abstract
The 2006 National Academy of Sciences Biologic Effects of Ionizing Radiation (BEIR) VII report is a well-recognized and frequently cited source on the legitimacy of the linear no-threshold (LNT) model-a model entailing a linear and causal relationship between ionizing radiation and human cancer risk. Linearity means that all radiation causes cancer and explicitly excludes a threshold below which radiogenic cancer risk disappears. However, the BEIR VII committee has erred in the interpretation of its selected literature; specifically, the in vitro data quoted fail to support LNT. Moreover, in vitro data cannot be considered as definitive proof of cancer development in intact organisms. This review is presented to stimulate a critical reevaluation by a BEIR VIII committee to reassess the validity, and use, of LNT and its derived policies.
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Affiliation(s)
| | - Bennett S Greenspan
- Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Alan H Maurer
- Temple University School of Medicine, Philadelphia, Pennsylvania
| | | | - William T Phillips
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Douglas Van Nostrand
- Nuclear Medicine Research, MedStar Health Research Institute, Washington, District of Columbia
| | - Bill Sacks
- U.S. Food and Drug Administration (retired), Green Valley, Arizona; and
| | - Edward B Silberstein
- Departments of Radiology and Medicine (emeritus), University of Cincinnati Medical Center, Cincinnati, Ohio
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41
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Siegel JA, Sacks B, Pennington CW, Welsh JS. Reply: DNA Repair After Exposure to Ionizing Radiation Is Not Error-Free. J Nucl Med 2018; 59:349. [DOI: 10.2967/jnumed.117.198804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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42
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Ionizing radiation from computed tomography versus anesthesia for magnetic resonance imaging in infants and children: patient safety considerations. Pediatr Radiol 2018; 48:21-30. [PMID: 29181580 DOI: 10.1007/s00247-017-4023-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/19/2017] [Accepted: 10/30/2017] [Indexed: 12/20/2022]
Abstract
In the context of health care, risk assessment is the identification, evaluation and estimation of risk related to a particular clinical situation or intervention compared to accepted medical practice standards. The goal of risk assessment is to determine an acceptable level of risk for a given clinical treatment or intervention in association with the provided clinical circumstances for a patient or group of patients. In spite of the inherent challenges related to risk assessment in pediatric cross-sectional imaging, the potential risks of ionizing radiation and sedation/anesthesia in the pediatric population are thought to be quite small. Nevertheless both issues continue to be topics of discussion concerning risk and generate significant anxiety and concern for patients, parents and practicing pediatricians. Recent advances in CT technology allow for more rapid imaging with substantially lower radiation exposures, obviating the need for anesthesia for many indications and potentially mitigating concerns related to radiation exposure. In this review, we compare and contrast the potential risks of CT without anesthesia against the potential risks of MRI with anesthesia, and discuss the implications of this analysis on exam selection, providing specific examples related to neuroblastoma surveillance imaging.
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43
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Shibamoto Y, Kamei Y, Kamei K, Tsuchiya T, Aoyama N. Continuous Low-Dose-Rate Irradiation Promotes Growth of Silkworms. Dose Response 2017; 15:1559325817735252. [PMID: 29051717 PMCID: PMC5639971 DOI: 10.1177/1559325817735252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 11/03/2022] Open
Abstract
To investigate the influence of low-dose-rate irradiation on the growth of silkworms, Bombyx mori, eggs of silkworms were randomly divided into 2 groups and were grown on either low-dose-radiation-emitting sheets or control sheets. On the radiation-emitting sheets, the dose rate was measured as 66.0 (4.3) μSv/h (mean [standard deviation]) by a Geiger-Müller counter for α, β, and γ rays and 3.8 (0.3) μSv/h by a survey meter for γ rays. The silkworms became larger when bred on the radiation-emitting sheets, and their body weight was about 25% to 37% heavier on day 42 to 49 after starting the experiment. Continuous low-dose-rate irradiation promoted the growth of silkworms. It should be further investigated whether this phenomenon could be utilized by the silk industry.
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Affiliation(s)
- Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya , Japan
| | - Yoshiaki Kamei
- Japan Regional Promotion Organization, Yasutomi-cho, Himeji , Japan
| | - Koichi Kamei
- Japan Regional Promotion Organization, Yasutomi-cho, Himeji , Japan
| | - Takahiro Tsuchiya
- Radiology Center, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan
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44
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Duncan JR, Lieber MR, Adachi N, Wahl RL. DNA Repair After Exposure to Ionizing Radiation Is Not Error-Free. J Nucl Med 2017; 59:348. [DOI: 10.2967/jnumed.117.197673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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45
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Fahey FH, Goodkind A, MacDougall RD, Oberg L, Ziniel SI, Cappock R, Callahan MJ, Kwatra N, Treves ST, Voss SD. Operational and Dosimetric Aspects of Pediatric PET/CT. J Nucl Med 2017; 58:1360-1366. [PMID: 28687601 DOI: 10.2967/jnumed.116.182899] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/05/2017] [Indexed: 01/04/2023] Open
Abstract
No consistent guidelines exist for the acquisition of a CT scan as part of pediatric PET/CT. Given that children may be more vulnerable to the effects of ionizing radiation, it is necessary to develop methods that provide diagnostic-quality imaging when needed, in the shortest time and with the lowest patient radiation exposure. This article describes the basics of CT dosimetry and PET/CT acquisition in children. We describe the variability in pediatric PET/CT techniques, based on a survey of 19 PET/CT pediatric institutions in North America. The results of the survey demonstrated that, although most institutions used automatic tube current modulation, there remained a large variation of practice, on the order of a factor of 2-3, across sites, pointing to the need for guidelines. We introduce the approach developed at our institution for using a multiseries PET/CT acquisition technique that combines diagnostic-quality CT in the essential portion of the field of view and a low-dose technique to image the remainder of the body. This approach leads to a reduction in radiation dose to the patient while combining the PET and the diagnostic CT into a single acquisition. The standardization of pediatric PET/CT provides an opportunity for a reduction in the radiation dose to these patients while maintaining an appropriate level of diagnostic image quality.
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Affiliation(s)
- Frederic H Fahey
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts .,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Alison Goodkind
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Robert D MacDougall
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Leah Oberg
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Sonja I Ziniel
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; and
| | - Richard Cappock
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Michael J Callahan
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - S Ted Treves
- Department of Radiology, Harvard Medical School, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephan D Voss
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
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