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Chauhan V, Beaton D, Tollefsen KE, Preston J, Burtt JJ, Leblanc J, Hamada N, Azzam EI, Armant O, Bouffler S, Azimzadeh O, Moertl S, Yamada Y, Tanaka IB, Kaiser JC, Applegate K, Laurier D, Garnier-Laplace J. Radiation Adverse Outcome pathways (AOPs): examining priority questions from an international horizon-style exercise. Int J Radiat Biol 2024:1-14. [PMID: 38718325 DOI: 10.1080/09553002.2024.2348072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/14/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE The Organisation for Economic Co-operation and Development (OECD) Adverse Outcome Pathway (AOP) Development Programme is being explored in the radiation field, as an overarching framework to identify and prioritize research needs that best support strengthening of radiation risk assessment and risk management strategies. To advance the use of AOPs, an international horizon-style exercise (HSE) was initiated through the Radiation/Chemical AOP Joint Topical Group (JTG) formed by the OECD Nuclear Energy Agency (NEA) High-Level Group on Low Dose Research (HLG-LDR) under the auspices of the Committee on Radiological Protection and Public Health (CRPPH). The intent of the HSE was to identify key research questions for consideration in AOP development that would help to reduce uncertainties in estimating the health risks following exposures to low dose and low dose-rate ionizing radiation. The HSE was conducted in several phases involving the solicitation of relevant questions, a collaborative review of open-ended candidate questions and an elimination exercise that led to the selection of 25 highest priority questions for the stated purpose. These questions were further ranked by over 100 respondents through an international survey. This final set of questions was judged to provide insights into how the OECD's AOP approach can be put into practice to meet the needs of hazard and risk assessors, regulators, and researchers. This paper examines the 25 priority questions in the context of hazard/risk assessment framework for ionizing radiation. CONCLUSION By addressing the 25 priority questions, it is anticipated that constructed AOPs will have a high level of specificity, making them valuable tools for simplifying and prioritizing complex biological processes for use in developing revised radiation hazard and risk assessment strategies.
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Affiliation(s)
- Vinita Chauhan
- Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Danielle Beaton
- Isotopes, Radiobiology and Environment Directorate, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Knut Erik Tollefsen
- Norwegian Institute for Water Research (NIVA), Oslo, Norway
- Centre for Environmental Radioactivity, Norwegian University of Life Sciences (NMBU), Ås, Norway
| | - Julian Preston
- Office of Air and Radiation, Radiation Protection Division, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Julie J Burtt
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Julie Leblanc
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Chiba, Japan
| | - Edouard I Azzam
- Isotopes, Radiobiology and Environment Directorate, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Olivier Armant
- Institut de Radioprotection Et de Sûreté Nucléaire (IRSN), PSE-ENV/SERPEN/LECO, Cadarache, France
| | | | - Omid Azimzadeh
- Federal Office of Radiation Protection, Oberschleissheim, Germany
| | - Simone Moertl
- Federal Office of Radiation Protection, Oberschleissheim, Germany
| | - Yutaka Yamada
- Department of Radiation Effects Research, Institute for Radiological Science, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Ignacia B Tanaka
- Department of Radiobiology, Institute for Environmental Sciences, Aomori, Japan
| | | | - Kimberly Applegate
- Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, USA (retired)
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay aux Roses, France
| | - Jacqueline Garnier-Laplace
- On secondment from IRSN to the Committee on Radiological Protection and Public Health's secretariat, Paris, France
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2
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Frush DP, Vassileva J, Brambilla M, Mahesh M, Rehani M, Samei E, Applegate K, Bourland J, Ciraj-Bjenlac O, Dahlstrom D, Gershan V, Gilligan P, Godthelp B, Hjemly H, Kainberger F, Mikhail-Lette M, Holmberg O, Paez D, Schrandt S, Valentin A, Van Deventer T, Wakeford R. Recurrent medical imaging exposures for the care of patients: one way forward. Eur Radiol 2024:10.1007/s00330-024-10659-x. [PMID: 38592419 DOI: 10.1007/s00330-024-10659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/17/2023] [Accepted: 01/23/2024] [Indexed: 04/10/2024]
Abstract
Medical imaging is both valuable and essential in the care of patients. Much of this imaging depends on ionizing radiation with attendant responsibilities for judicious use when performing an examination. This responsibility applies in settings of both individual as well as multiple (recurrent) imaging with associated repeated radiation exposures. In addressing the roles and responsibilities of the medical communities in the paradigm of recurrent imaging, both the International Atomic Energy Agency (IAEA) and the American Association of Physicists in Medicine (AAPM) have issued position statements, each affirmed by other organizations. The apparent difference in focus and approach has resulted in a lack of clarity and continued debate. Aiming towards a coherent approach in dealing with radiation exposure in recurrent imaging, the IAEA convened a panel of experts, the purpose of which was to identify common ground and reconcile divergent perspectives. The effort has led to clarifying recommendations for radiation exposure aspects of recurrent imaging, including the relevance of patient agency and the provider-patient covenant in clinical decision-making. CLINICAL RELEVANCE STATEMENT: An increasing awareness, generating some lack of clarity and divergence in perspectives, with patients receiving relatively high radiation doses (e.g., ≥ 100 mSv) from recurrent imaging warrants a multi-stakeholder accord for the benefit of patients, providers, and the imaging community. KEY POINTS: • Recurrent medical imaging can result in an accumulation of exposures which exceeds 100 milli Sieverts. • Professional organizations have different perspectives on roles and responsibilities for recurrent imaging. • An expert panel reconciles differing perspectives for addressing radiation exposure from recurrent medical imaging.
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Affiliation(s)
- Donald Paul Frush
- Department of Radiology, Duke University Medical Center, Durham, NC, 27705, USA.
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Marco Brambilla
- Department of Medical Physics, University Hospital of Novara, Novara, Italy
| | - Mahadevappa Mahesh
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Madan Rehani
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Ehsan Samei
- Department of Radiology, Duke University Medical Center, Durham, NC, 27705, USA
| | | | - John Bourland
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Vesna Gershan
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Paddy Gilligan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Barbara Godthelp
- Authority for Nuclear Safety and Radiation Protection, The Hague, The Netherlands
| | - Hakon Hjemly
- International Society of Radiographers and Radiological Technologists, London, UK
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Suz Schrandt
- ExPPect, Founder & CEO, and Patients for Patient Safety US, Champion (Affiliate, WHO PFPS Network), Arlington, VA, USA
| | - Andreas Valentin
- Department of Internal Medicine With Cardiology & Intensive Care Medicine Clinic Donaustadt Vienna Health Care Group, Vienna, Austria
| | | | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
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3
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Oliveira Bernardo M, Karout L, Morgado F, Ebrahimian S, Sarmet Santos A, Amorim C, Muniz Filho H, Moscatelli A, Francisco Muglia V, Schroeder H, Moulin Sales D, Gandolpho Henschel R, Giovanni Valese B, Kiipper F, Cesar Cavalcanti P, Lucena R, Jornada T, de Paula V, Zago M, Varella R, Anes M, Márcio Alves Pinheiro A, Claúdio de Moura Carvalho L, Santana de Melo Tapajos J, Antonio de Almeida F, Applegate K, Paulo G, Roberto Costa P. Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study. Eur J Radiol 2023; 169:111191. [PMID: 37976761 DOI: 10.1016/j.ejrad.2023.111191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Diagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based - DRL(DRLCI) and clinical indication - AD (ADCI) for adult CT in Brazil. METHODS The prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test. RESULTS In majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection. CONCLUSIONS There was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.
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Affiliation(s)
| | - Lina Karout
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Shadi Ebrahimian
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA.
| | | | - Clarissa Amorim
- Complexo Hospitalar de Niterói, Niterói, Rio de Janeiro, Brazil.
| | | | | | - Valdair Francisco Muglia
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Henrique Schroeder
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | | | | | | | | | | | - Ronaldo Lucena
- Unimed Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Tiago Jornada
- Hospital das Clínicas de Recife, Recife, Pernambuco, Brazil.
| | - Valnir de Paula
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Marcel Zago
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ricardo Varella
- Hospital Unimed de Vitória, Vitória, Espírito Santo, Brazil.
| | - Mauricio Anes
- Hospital das Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | | | | | | | - Kimberly Applegate
- University of Kentucky College of Medicine, Department of Radiology, Lexington, KY, USA.
| | - Graciano Paulo
- Escola Superior de Tecnologia da Saúde do Instituto Politécnico de Coimbra, Coimbra, Portugal.
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4
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Rühm W, Cho K, Larsson CM, Wojcik A, Clement C, Applegate K, Bochud F, Bouffler S, Cool D, Hirth G, Kai M, Laurier D, Liu S, Romanov S, Schneider T. Vancouver call for action to strengthen expertise in radiological protection worldwide. Radiat Environ Biophys 2023; 62:175-180. [PMID: 37097458 DOI: 10.1007/s00411-023-01024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/25/2023] [Indexed: 05/18/2023]
Abstract
Ionising radiation has been used for over a century for peaceful purposes, revolutionising health care and promoting well-being through its application in industry, science, and medicine. For almost as long, the International Commission on Radiological Protection (ICRP) has promoted understanding of health and environmental risks of ionising radiation and developed a protection system that enables the safe use of ionising radiation in justified and beneficial practices, providing protection from all sources of radiation. However, we are concerned that a shortage of investment in training, education, research, and infrastructure seen in many sectors and countries may compromise society's ability to properly manage radiation risks, leading to unjustified exposure to or unwarranted fear of radiation, impacting the physical, mental, and social well-being of our peoples. This could unduly limit the potential for research and development in new radiation technologies (healthcare, energy, and the environment) for beneficial purposes. ICRP therefore calls for action to strengthen expertise in radiological protection worldwide through: (1) National governments and funding agencies strengthening resources for radiological protection research allocated by governments and international organisations, (2) National research laboratories and other institutions launching and sustaining long-term research programmes, (3) Universities developing undergraduate and graduate university programmes and making students aware of job opportunities in radiation-related fields, (4) Using plain language when interacting with the public and decision makers about radiological protection, and (5) Fostering general awareness of proper uses of radiation and radiological protection through education and training of information multipliers. The draft call was discussed with international organisations in formal relations with ICRP in October 2022 at the European Radiation Protection Week in Estoril, Portugal, and the final call announced at the 6th International Symposium on the System of Radiological Protection of ICRP in November 2022 in Vancouver, Canada.
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Affiliation(s)
- W Rühm
- Helmholtz Centre Munich, German Research Centre for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
| | - K Cho
- Korea Institute of Nuclear Safety, Yuseong, 114, Daejeon, 34142, Korea
| | - C-M Larsson
- Australian Radiation Protection and Nuclear Safety Agency, 619 Lower Plenty Road, Yallambie, VIC, 3085, Australia
| | - A Wojcik
- Centre for Radiation Protection Research, Stockholm University, Svante Arrheniusväg 20C, 106 91, Stockholm, Sweden
- Institute of Biology, Jan Kochanoski University, 25-406, Kielce, Poland
| | - C Clement
- International Commission on Radiological Protection, 280 Slater Street, Ottawa, ON, K1P 5S9, Canada
| | - K Applegate
- University of Kentucky College Medicine, 800 Rose Street MN 150, Lexington, KY, 40506, USA
| | - F Bochud
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Rue du Grand-Pré 1, 1007, Lausanne, Switzerland
| | - S Bouffler
- Radiation Protection Sciences Division, UK Health Security Agency, Didcot, OX11 0RQ, Oxon, UK
| | - D Cool
- International Commission on Radiological Protection, 280 Slater Street, Ottawa, ON, K1P 5S9, Canada
| | - G Hirth
- Australian Radiation Protection and Nuclear Safety Agency, 619 Lower Plenty Road, Yallambie, VIC, 3085, Australia
| | - M Kai
- Nippon Bunri University, 1727 Ichigi, Ōita, 870-0397, Japan
| | - D Laurier
- Institut de Radioprotection et de Sûreté Nucléaire, BP 17-92262 Fontenay-aux-Roses Cedex, 31 Avenue de la Division Leclerc , 92260, Fontenay-aux-Roses, Île-de-France, France
| | - S Liu
- China Institute of Atomic Energy, 275 (1), Beijing, 102413, People's Republic of China
| | - S Romanov
- Southern Urals Biophysics Institute, Ozyorsk, Chelyabinsk Region, Russian Federation
| | - T Schneider
- Nuclear Protection Evaluation Centre, 28, rue de la Redoute, 92260, Fontenay aux Roses, France
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5
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Burtt JJ, Leblanc J, Randhawa K, Ivanova A, Rudd MA, Wilkins R, Azzam EI, Hecker M, Horemans N, Vandenhove H, Adam-Guillermin C, Armant O, Klokov D, Audouze K, Kaiser JC, Moertl S, Lumniczky K, Tanaka IB, Yamada Y, Hamada N, Al-Nabulsi I, Preston J, Bouffler S, Applegate K, Cool D, Beaton D, Tollefsen KE, Garnier-Laplace J, Laurier D, Chauhan V. Radiation Adverse Outcome Pathways (AOPs) are on the Horizon: Advancing Radiation Protection through an International Horizon-Style Exercisewe. Int J Radiat Biol 2022; 98:1763-1776. [PMID: 36067511 DOI: 10.1080/09553002.2022.2121439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Purpose: The Adverse Outcome Pathway (AOP) framework, a systematic tool that can link available mechanistic data with phenotypic outcomes of relevance to regulatory decision-making, is being explored in areas related to radiation risk assessment. To examine the challenges including the use of AOPs to support the radiation protection community, an international horizon-style exercise (HSE) was initiated through the Organisation for Economic Co-operation and Development Nuclear Energy Agency High-Level Group on Low Dose Research Radiation/Chemical AOP Joint Topical Group (JTG). The objective of the HSE was to facilitate the collection of ideas from a range of experts, to short-list a set of priority research questions that could, if answered, improve the description of the radiation dose-response relationship for low dose/dose-rate exposures, as well as reduce uncertainties in estimating the risk of developing adverse health outcomes following such exposures.Materials and methods: The HSE was guided by an international steering committee (SC) of radiation risk experts. In the first phase, research questions were solicited on areas that can be supported by the AOP framework, or challenges on the use of AOPs in radiation risk assessment. In the second phase, questions received were refined and sorted by the SC using a best-worst scaling (BWS) method. During a virtual 3-day workshop, the list of questions was further narrowed. In the third phase, an international survey of the broader radiation protection community led to an orderly ranking of the top questions.Results: Of the 271 questions solicited, 254 were accepted and categorized into 9 themes. These were further refined to the top 25 prioritized questions. Among these, the higher ranked questions will be considered as 'important' to drive future initiatives in the low dose radiation protection community. These included questions on the ability of AOPs to delineate responses across different levels of biological organization, and how AOPs could be applied to address research questions on radiation quality, doses or dose-rates, exposure time patterns and deliveries, and uncertainties in low dose/dose-rate effects. A better understanding of these concepts is required to support the use of the AOP framework in radiation risk assessment.Conclusion: Through dissemination of these results and considerations on next steps, the JTG will address select priority questions to advance the development and use of AOPs in the radiation protection community. The major themes observed will be discussed in the context of their relevance to areas of research that support the system of radiation protection.
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Affiliation(s)
- Julie J Burtt
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Julie Leblanc
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Kristi Randhawa
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Addie Ivanova
- Directorate of Environmental and Radiation Protection and Assessment, Canadian Nuclear Safety Commission, Ottawa, Canada
| | | | - Ruth Wilkins
- Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Edouard I Azzam
- Isotopes, Radiobiology and Environment Directorate, Canadian Nuclear Laboratories, Chalk River, Ontario, Canada
| | - Markus Hecker
- School of Environment and Sustainability, University of Saskatchewan, Saskatchewan, Canada
| | - Nele Horemans
- Biosphere Impact Studies, Belgian Nuclear Research Center (SCK CEN), Boeretang 200, 2400 Mol, Belgium
| | - Hildegarde Vandenhove
- Environment, Health and Safety, Belgian Nuclear Research Centre (SCK CEN), Boeretang 200, 2400 Mol, Belgium
| | - Christelle Adam-Guillermin
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Olivier Armant
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Dmitry Klokov
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Karine Audouze
- Université Paris Cité, T3S, Inserm UMRS 1124, Paris, France
| | - Jan Christian Kaiser
- Helmholtz Zentrum Munchen, Deutsches Forschungszentrum fur Gesundheit und Umwelt (GMBH) Neuherberg, Germany
| | - Simone Moertl
- Federal Office for Radiation Protection, 85764 Neuherberg, Germany
| | - Katalin Lumniczky
- National Public Health Centre, Unit of Radiation Medicine, Budapest, Albert Florian u. 2-6, 1097, Hungary
| | - Ignacia B Tanaka
- Department of Radiobiology, Institute for Environmental Sciences, 1-7, Ienomae, Obuchi, Rokkasho, Kamikita, Aomori, 039-3212, Japan
| | - Yutaka Yamada
- Department of Radiation Effects Research, National Institute of Radiological Sciences, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
| | - Isaf Al-Nabulsi
- US Department of Energy, Office of Domestic and International Health Studies, Office of Health and Safety, Office of Environment, Health Safety and Security, Washington, DC. USA
| | - Julian Preston
- Office of Air and Radiation, Radiation Protection Division, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Simon Bouffler
- UK Health Security Agency, Chilton, Didcot, Oxfordshire, UK
| | - Kimberly Applegate
- University of Kentucky College of Medicine, Department of Radiology, Lexington, KY, USA (retired)
| | | | - Danielle Beaton
- Isotopes, Radiobiology and Environment Directorate, Canadian Nuclear Laboratories, Chalk River, Ontario, Canada
| | - Knut Erik Tollefsen
- Norwegian Institute for Water Research (NIVA), Økernveien 94, N-0579, Oslo, Norway.,Centre for Environmental Radioactivity, Norwegian University of Life Sciences (NMBU), PO box 5003, N-1432 Ås, Norway
| | - Jacqueline Garnier-Laplace
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France.,On secondment from IRSN to the Committee on Radiological Protection and Public Health's secretariat, France
| | - Dominique Laurier
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Vinita Chauhan
- Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
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6
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Klokov D, Applegate K, Badie C, Brede DA, Dekkers F, Karabulutoglu M, Le Y, Rutten EA, Lumniczky K, Gomolka M. International expert group collaboration for developing an adverse outcome pathway for radiation induced leukaemia. Int J Radiat Biol 2022; 98:1802-1815. [PMID: 36040845 DOI: 10.1080/09553002.2022.2117873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The concept of the adverse outcome pathway (AOP) has recently gained significant attention as to its potential for incorporation of mechanistic biological information into the assessment of adverse health outcomes following ionizing radiation (IR) exposure. This work is an account of the activities of an international expert group formed specifically to develop an AOP for IR-induced leukaemia. Group discussions were held during dedicated sessions at the international AOP workshop jointly organized by the MELODI (Multidisciplinary European Low Dose Initiative) and the ALLIANCE (European Radioecology Alliance) associations to consolidate knowledge into a number of biological key events causally linked by key event relationships and connecting a molecular initiating event with the adverse outcome. Further knowledge review to generate a weight of evidence support for the Key Event Relationships (KERs) was undertaken using a systematic review approach. CONCLUSIONS An AOP for IR-induced acute myeloid leukaemia was proposed and submitted for review to the OECD-curated AOP-wiki (aopwiki.org). The systematic review identified over 500 studies that link IR, as a stressor, to leukaemia, as an adverse outcome. Knowledge gap identification, although requiring a substantial effort via systematic review of literature, appears to be one of the major added values of the AOP concept. Further work, both within this leukaemia AOP working group and other similar working groups, is warranted and is anticipated to produce highly demanded products for the radiation protection research community.
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Affiliation(s)
- Dmitry Klokov
- Laboratory of Experimental Radiotoxicology and Radiobiology, Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | - Kimberly Applegate
- Department of Radiology, University of Kentucky College of Medicine (retired), Lexington, KY, USA
| | - Christophe Badie
- Cancer Mechanisms and Biomarkers group, Department of Radiation Effects, Radiation, Chemical and Environmental, UK Health Security Agency, Oxfordshire, United Kingdom
| | - Dag Anders Brede
- Centre for Environmental Radioactivity (CERAD), Faculty of Environmental Sciences and Natural Resource Management (MINA), Norwegian University of Life Sciences (NMBU), Norway
| | - Fieke Dekkers
- Mathematical Institute, Utrecht University, Utrecht, The Netherlands.,Netherlands National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Melis Karabulutoglu
- Cancer Mechanisms and Biomarkers group, Department of Radiation Effects, Radiation, Chemical and Environmental, UK Health Security Agency, Oxfordshire, United Kingdom
| | | | - Eric Andreas Rutten
- Cancer Mechanisms and Biomarkers group, Department of Radiation Effects, Radiation, Chemical and Environmental, UK Health Security Agency, Oxfordshire, United Kingdom
| | - Katalin Lumniczky
- Radiation Biology, Federal Office for Radiation Protection BfS, Oberschleißheim, Germany
| | - Maria Gomolka
- Unit of Radiation Medicine, Department of Radiobiology and Radiohygiene, National Public Health Centre, Budapest, Hungary
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7
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Rehani MM, Applegate K, Bodzay T, Heon Kim C, Miller DL, Ali Nassiri M, Chul Paeng J, Srimahachota S, Srinivasa S, Takenaka M, Terez S, Vassileva J, Zhuo W. Accounting for radiation exposure from previous CT exams while deciding on the next exam: What do referring clinicians think? Eur J Radiol 2022; 155:110468. [PMID: 35973303 DOI: 10.1016/j.ejrad.2022.110468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/11/2022] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To obtain clinicians' views of the need to account for radiation exposure from previous CT scans and the advisability of a regulatory mechanism to control the number of CT scans for an individual patient. METHODS A convenience survey was conducted by emailing a link to a three-question electronic survey to clinicians in many countries, mostly through radiology and radiation protection contacts. RESULTS 505 responses were received from 24 countries. 293 respondents (58%) understand that current regulations do not limit the number of CT scans that can be prescribed for a single patient in a year. When asked whether there should be a regulation to limit the number of CT scans that can be prescribed for a single patient in one year, only a small fraction (143, 28%) answered 'No', 182 (36%) answered 'Maybe' and 166 (33%) answered 'Yes'. Most respondents (337; 67%) think that radiation risk should form part of the consideration when deciding whether to request a CT exam. A minority (138; 27%) think the decision should be based only on the medical indication for the CT exam. Comparison among the 4 countries (South Korea, Hungary, USA and Canada) with the largest number of respondents indicated wide variations in responses. CONCLUSIONS A majority of the surveyed clinicians consider radiation risk, in addition to clinical factors, when prescribing CT exams. Most respondents are in favor of, or would consider, regulation to control the number of CT scans that could be performed on a patient annually.
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Affiliation(s)
- Madan M Rehani
- Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Tamás Bodzay
- Traumatology, Dr. Manninger Jenő Trauma Center, Budapest, Hungary
| | - Chi Heon Kim
- Neurosurgery, Seoul National University College of Medicine, South Korea
| | - Donald L Miller
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, USA
| | | | - Jin Chul Paeng
- Nuclear Medicine, Seoul National University College of Medicine, South Korea
| | - Suphot Srimahachota
- Cardiovascular Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | | | - Mamoru Takenaka
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Sera Terez
- Radiology Clinic and Nuclear Medicine, University of Szeged, Hungary
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Weihai Zhuo
- Medical Physics, Institute of Radiation Medicine, Fudan University, China
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Rühm W, Clement C, Cool D, Laurier D, Bochud F, Applegate K, Schneider T, Bouffler S, Cho K, Hirth G, Kai M, Liu S, Romanov S, Wojcik A. Summary of the 2021 ICRP workshop on the future of radiological protection. J Radiol Prot 2022; 42:023002. [PMID: 35417898 DOI: 10.1088/1361-6498/ac670e] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/13/2022] [Indexed: 06/14/2023]
Abstract
The International Commission on Radiological Protection (ICRP) has embarked on a process to review and revise the current System of Radiological Protection ('the System'). To stimulate discussion, the ICRP published two open-access articles: one on aspects of the System that might require review, and another on research that might improve the scientific foundation of the System. Building on these articles, the ICRP organized a Workshop on the Future of Radiological Protection as an opportunity to engage in the review and revision of the System. This digital workshop took place from 14 October-3 November 2021 and included 20 live-streamed and 43 on-demand presentations. Approximately 1500 individuals from 100 countries participated. Based on the subjects covered by the presentations, this summary is organized into four broad areas: the scientific basis, concepts and application of the System; and the role of the ICRP. Some of the key topics that emerged included the following: classification of radiation-induced effects; adverse outcome pathway methodologies; better understanding of the dose-response relationship; holistic and reasonable approaches to optimization of protection; radiological protection of the environment; ethical basis of the System; clarity, consistency and communication of the System; application of the System in medicine and application of the principles of justification and optimization of protection.
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Affiliation(s)
- W Rühm
- Helmholtz Centre Munich, German Research Centre for Environmental Health, Ingolstaedter Landstraße 1, D-85764 Neuherberg, Germany
| | - C Clement
- International Commission on Radiological Protection, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada
| | - D Cool
- International Commission on Radiological Protection, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada
| | - D Laurier
- Institut de radioprotection et de Sûreté Nucléaire, BP 17-92262 Fontenay-aux-Roses Cedex, 31 avenue de la Division Leclerc, 92260 Fontenay-aux-Roses, Île-de-France, France
| | - F Bochud
- Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, CH-1011 Lausanne, Switzerland
| | - K Applegate
- University of Kentucky College Medicine, 800 Rose Street MN 150, Lexington, KY 40506, United States of America
| | - T Schneider
- Nuclear Protection Evaluation Centre, 28, rue de la Redoute, F-92260 Fontenay aux Roses, France
| | - S Bouffler
- Radiation Protection Science Division, UK Health Security Agency, Didcot, Oxon OX11 0RQ, United Kingdom
| | - K Cho
- Korea Institute of Nuclear Safety, PO Box 114, Yuseong, Daejeon 305-338, Republic of Korea
| | - G Hirth
- Australian Radiation Protection and Nuclear Safety Agency, PO Box 655, Miranda, NSW 1490, Australia
| | - M Kai
- Nippon Bunri University, 1727 Ichigi, Ōita 870-0397, Japan
| | - S Liu
- China Institute of Atomic Energy, PO Box 275 (1), Beijing CN-102413, People's Republic of China
| | - S Romanov
- Southern Urals Biophysics Institute, Ozyorsk, Chelyabinsk Region, Russia
| | - A Wojcik
- Centre for Radiation Protection Research, Stockholm University, Svante Arrheniusväg 20C, 106 91 Stockholm, Sweden
- Institute of Biology, Jan Kochanoski University, 25-406 Kielce, Poland
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9
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Vassileva J, Applegate K, Paulo G, Vano E, Holmberg O. Strengthening radiation protection education and training of health professionals: conclusions from an IAEA meeting. J Radiol Prot 2022; 42:011504. [PMID: 34875639 DOI: 10.1088/1361-6498/ac40e9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/06/2021] [Indexed: 06/13/2023]
Abstract
In March 2021 the International Atomic Energy Agency (IAEA) organised an online Technical Meeting on Developing Effective Methods for Radiation Protection Education and Training of Health Professionals with attendance of 230 participants representing 66 Member States and 24 international organizations, professional bodies and safety alliances. By means of a pre-meeting survey, presentations by experts, topical panel discussions and post-meeting feedback to the meeting summary, the meeting identified strengths, common weaknesses and possible solutions and actions for improving radiation protection education and training of health professionals. Available guidelines and resources for radiation protection training were also reviewed. The meeting discussion resulted in a strong consensus for the need of: (a) international guidance on education and training in radiation protection and safety for health professionals, (b) an international description of minimum standards of initial and ongoing competence and qualification in radiation protection for relevant professional groups, considering the available recommendations at international and regional levels. The proposed actions include provisions for train-the-trainer credentialing and facility training accreditation, balance betwee the online and face-to-face training, improved on-the job training, as well as improved inclusion in training programmes of aspects related to application of new technologies, ethical aspects, development of communication skills, and use of software tools for improving justification and optimisation. The need for making the ongoing training practical, applicable, and useful to the trainee was highlighted. The international consultation initiated by the IAEA was appreciated as a good approach to understand and promote coordination and collaboration at all levels, for best results in education and training in radiation protection of health professionals. Implementing such a holistic approach to education and training in radiation protection would contribute towards qualification and competence of health professionals needed to ensure application of high standards for quality and safety in medical uses of ionizing radiation.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Kimberly Applegate
- University of Kentucky College of Medicine, Lexington, KY, United States of America (retired)
| | - Graciano Paulo
- Medical Imaging and Radiotherapy Unit, ESTESC-Coimbra Health School, Instituto Politécnico de Coimbra, Coimbra, Portugal
| | - Eliseo Vano
- Radiology Department, Complutense University and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
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Clement C, Rühm W, Harrison J, Applegate K, Cool D, Larsson CM, Cousins C, Lochard J, Bouffler S, Cho K, Kai M, Laurier D, Liu S, Romanov S. Keeping the ICRP recommendations fit for purpose. J Radiol Prot 2021; 41:1390-1409. [PMID: 34284364 DOI: 10.1088/1361-6498/ac1611] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/20/2021] [Indexed: 05/23/2023]
Abstract
The International Commission on Radiological Protection (ICRP) has embarked on a review and revision of the system of Radiological Protection that will update the 2007 general recommendations in ICRPPublication 103. This is the beginning of a process that will take several years, involving open and transparent engagement with organisations and individuals around the world. While the system is robust and has performed well, it must adapt to address changes in science and society to remain fit for purpose. The aim of this paper is to encourage discussions on which areas of the system might gain the greatest benefit from review, and to initiate collaborative efforts. Increased clarity and consistency are high priorities. The better the system is understood, the more effectively it can be applied, resulting in improved protection and increased harmonisation. Many areas are identified for potential review including: classification of effects, with particular focus on tissue reactions; reformulation of detriment, potentially including non-cancer diseases; re-evaluation of the relationship between detriment and effective dose, and the possibility of defining detriments for males and females of different ages; individual variation in the response to radiation exposure; heritable effects; and effects and risks in non-human biota and ecosystems. Some of the basic concepts are also being considered, including the framework for bringing together protection of people and the environment, incremental improvements to the fundamental principles of justification and optimisation, a broader approach to protection of individuals, and clarification of the exposure situations introduced in 2007. In addition, ICRP is considering identifying where explicit incorporation of the ethical basis of the system would be beneficial, how to better reflect the importance of communications and stakeholder involvement, and further advice on education and training. ICRP invites responses on these and other areas relating to the review of the System of Radiological Protection.
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Affiliation(s)
- C Clement
- International Commission on Radiological Protection, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada
| | - W Rühm
- Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
| | - J Harrison
- Oxford Brookes University, Faculty of Health and Life Sciences, OX3 0BP Oxford, United Kingdom
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, OX11 0RQ Didcot, Oxon, United Kingdom
| | - K Applegate
- University of Kentucky College of Medicine, 800 Rose Street MN 150, Lexington, KY 40506, United States of America (retired)
| | - D Cool
- Electric Power Research Institute, Charlotte, NC, United States of America
| | - C-M Larsson
- Australian Radiation Protection and Nuclear Safety Agency, PO Box 655, Miranda, NSW 1490, Australia
| | - C Cousins
- International Commission on Radiological Protection, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada
| | - J Lochard
- Nagasaki University, 1-14 Bunkyomachi, Nagasaki 852-8521, Japan
| | - S Bouffler
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, OX11 0RQ Didcot, Oxon, United Kingdom
| | - K Cho
- Korea Institute of Nuclear Safety, PO Box 114, Yuseong, Daejeon 305-338, Korea
| | - M Kai
- Nippon Bunri University, 1727 Ichigi, Ōita 870-0397, Japan
| | - D Laurier
- Institut de radioprotection et de Sûreté Nucléaire, BP 17-92262 Fontenay-aux-Roses Cedex, 31 avenue de la Division Leclerc, 92260 Fontenay-aux-Roses, Île-de-France, France
| | - S Liu
- China Institute of Atomic Energy, PO Box 275 (1), Beijing CN-102413, People's Republic of China
| | - S Romanov
- Southern Urals Biophysics Institute, Ozyorsk, Chelyabinsk region, Russia
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11
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Laurier D, Rühm W, Paquet F, Applegate K, Cool D, Clement C. Areas of research to support the system of radiological protection. Radiat Environ Biophys 2021; 60:519-530. [PMID: 34657188 PMCID: PMC8522113 DOI: 10.1007/s00411-021-00947-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/05/2021] [Indexed: 05/07/2023]
Abstract
This document presents the ICRP's updated vision on "Areas of Research to Support the System of Radiological Protection", which have been previously published in 2017. It aims to complement the research priorities promoted by other relevant international organisations, with the specificity of placing them in the perspective of the evolution of the System of Radiological Protection. This document contributes to the process launched by ICRP to review and revise the System of Radiological Protection that will update the 2007 General Recommendations in ICRP Publication 103.
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Affiliation(s)
- D Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
| | - W Rühm
- Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany.
| | - F Paquet
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Cadarache, France
| | - K Applegate
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - D Cool
- International Commission on Radiological Protection (ICRP) Vice-Chair, Charlotte, NC, USA
| | - C Clement
- International Commission on Radiological Protection (ICRP), Ottawa, ON, Canada
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12
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Bochud F, Cantone MC, Applegate K, Coffey M, Damilakis J, Del Rosario Perez M, Fahey F, Jesudasan M, Kurihara-Saio C, Le Guen B, Malone J, Murphy M, Reid L, Zölzer F. Ethical aspects in the use of radiation in medicine: update from ICRP Task Group 109. Ann ICRP 2020; 49:143-153. [PMID: 32777956 DOI: 10.1177/0146645320929630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Whereas scientific evidence is the basis for recommendations and guidance on radiological protection, professional ethics is critically important and should always guide professional behaviour. The International Commission on Radiological Protection (ICRP) established Task Group 109 to advise medical professionals, patients, families, carers, the public, and authorities about the ethical aspects of radiological protection of patients in the diagnostic and therapeutic use of radiation in medicine. Occupational exposures and research-related exposures are not within the scope of this task group. Task Group 109 will produce a report that will be available to the different interested parties for consultation before publication. Presently, the report is at the stage of a working document that has benefitted from an international workshop organised on the topic by the World Health Organization. It presents the history of ethics in medicine in ICRP, and explains why this subject is important, and the benefits it can bring to the standard biomedical ethics. As risk is an essential part in decision-making and communication, a summary is included on what is known about the dose-effect relationship, with emphasis on the associated uncertainties. Once this theoretical framework has been presented, the report becomes resolutely more practical. First, it proposes an evaluation method to analyse specific situations from an ethical point of view. This method allows stakeholders to review a set of six ethical values and provides hints on how they could be balanced. Next, various situations (e.g. pregnancy, elderly, paediatric, end of life) are considered in two steps: first within a realistic, ethically challenging scenario on which the evaluation method is applied; and second within a more general context. Scenarios are presented and discussed with attention to specific patient circumstances, and on how and which reflections on ethical values can be of help in the decision-making process. Finally, two important related aspects are considered: how should we communicate with patients, family, and other stakeholders; and how should we incorporate ethics into the education and training of medical professionals?
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Affiliation(s)
- F Bochud
- IRA Lausanne University Hospital, Rue du Grand-Pré 1, CH-1007 Lausanne, Switzerland; e-mail:
| | | | | | | | | | | | - F Fahey
- Boston Children's Hospital, USA
| | - M Jesudasan
- WHO Global Network of Patients for Patient Safety, Malaysia
| | - C Kurihara-Saio
- National Institute for Quantum and Radiological Sciences and Technology, Japan
| | - B Le Guen
- International Radiation Protection Association, France
| | | | - M Murphy
- WHO Global Network of Patients for Patient Safety, Ireland
| | - L Reid
- Dalhousie University, Canada
| | - F Zölzer
- University of South Bohemia, Czech Republic
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13
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Abstract
Waardenburg syndrome (WS) is a rare genetic disorder secondary to neural crest cell developmental abnormalities. It is predominantly described as an auditory–pigmentary syndrome with diverse patient presentation, typically involving congenital sensorineural hearing loss and pigmentation abnormalities of the skin, hair, and iris. Other developmental abnormalities that may be associated with this syndrome are Hirschsprung's disease and a myriad of cardiovascular congenital defects. We present a case of a young girl with WS who found to have a persistent left superior vena cava (PLSVC) draining into the coronary sinus. The prevalence of PLSVC is increased in patients with chromosomal and genetic abnormalities. However, we are the first to report its presence in association with WS while discussing the challenges that may arise during central venous catheter placement in patients with PLSVC.
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Affiliation(s)
- Driss Raissi
- Department of Radiology, University of Kentucky, Kentucky, USA
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Krupinski EA, Chung A, Applegate K, DeSimone AK, Tridandapani S. Impact of Patient Photographs on Radiologists' Visual Search of Chest Radiographs. Acad Radiol 2016; 23:953-60. [PMID: 27161208 DOI: 10.1016/j.acra.2016.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/05/2016] [Accepted: 04/08/2016] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES To increase detection of mislabeled medical imaging studies, evidence shows it may be useful to include patient photographs during interpretation. This study examined how inclusion of photographs impacts visual search. MATERIALS AND METHODS Ten radiologists participated. Average age was 43.00 years and average years Board-certified was 9.70, with 2 residents, 1 general, 2 abdominal, 4 cardiothoracic, and 1 pediatric radiologist. They viewed 21 portable chest radiographs with and without a simultaneously acquired photograph of the patient while visual search was recorded. Their task was to note placement of lines and tubes. RESULTS Presence of the photograph reduced the number of fixations (chest radiograph only mean 98.68; chest with photograph present 80.81; photograph 10.59; p < 0.0001) and total dwell (chest radiograph only mean 30.84 seconds; chest radiograph with photograph present 25.68; photograph 3.93; p < 0.0001) on the chest radiograph as a result of periodically looking at the photograph. Overall viewing time did not increase with addition of the photograph because time not spent on the radiograph was spent on the photograph. On average, readers scanned from the radiograph to the photographs about four times during search. Men and non-cardiothoracic radiologists spent significantly more time scanning all the images, including the photographs. Average preference for having photographs was 6.10 on a 0-10 scale, and neck and chest were preferred as areas to include in the photograph. CONCLUSION Photographs may help with certain image interpretation tasks and may help personalize the reading experience for radiologists without increasing interpretation time.
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Affiliation(s)
- Elizabeth A Krupinski
- Department of Medical Imaging, University of Arizona, 1609 N Warren Bldg 211 Tucson, AZ 85724; Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia.
| | - Alex Chung
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia
| | - Kimberly Applegate
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia
| | - Ariadne K DeSimone
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia
| | - Srini Tridandapani
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia; School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia
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Filev PD, Mittal PK, Tang X, Duong PA, Wang X, Small WC, Applegate K, Moreno CC. Increased Computed Tomography Dose Due to Miscentering With Use of Automated Tube Voltage Selection: Phantom and Patient Study. Curr Probl Diagn Radiol 2015; 45:265-70. [PMID: 26810714 DOI: 10.1067/j.cpradiol.2015.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/08/2015] [Indexed: 11/22/2022]
Abstract
The purpose of the article is to determine if miscentering affected dose with use of automated tube voltage selection software. An anthropomorphic phantom was imaged at different table heights (centered in the computed tomography [CT] gantry, and -6, -3, +3, and +5.7cm relative to the centered position). Topogram magnification, tube voltage selection, and dose were assessed. Effect of table height on dose also was assessed retrospectively in human subjects (n = 50). When the CT table was positioned closer to the x-ray source, subjects appeared up to 33% magnified in topogram images. When subjects appeared magnified in topogram images, automated software selected higher tube potentials and tube currents that were based on the magnified size of the subject rather than the subject׳s true size. Table height strongly correlated with CT dose index (r = 0.98, P < 0.05) and dose length product (r = 0.98, P < 0.05) in the phantom study. Transverse dimension in the topogram highly correlated with dose in human subjects (r = 0.75-0.87, P <0.05). Miscentering results in increased dose due to topogram magnification with automated voltage selection software.
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Affiliation(s)
- Peter D Filev
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Pardeep K Mittal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Xiangyang Tang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Phuong-Anh Duong
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Xiaojing Wang
- Biostatistics Shared Core Resource at Winship Cancer Institute, Atlanta, GA
| | - William C Small
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Kimberly Applegate
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
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Applegate K. Image Gently: A campaign to promote radiation protection for children worldwide. SA J Radiol 2015. [DOI: 10.4102/sajr.v19i2.919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
With the goal of raising awareness and developing stakeholder educational tools for the appropriate imaging of children, the Image Gently campaign was launched in 2007. This campaign is a product of a multidisciplinary alliance with international representation which now numbers nearly 100 medical and dental professional societies and organisations, and includes regulatory organisations. The alliance focuses on increasing awareness and developing education materials that support the protection of children worldwide from unnecessary radiation in medicine. The alliance members work with agencies and regulatory bodies to improve standards and measures that are specific to children. The campaign has produced open source modules for all stakeholders regarding CT, fluoroscopy, nuclear medicine, interventional radiology, digital radiography and dental imaging. The philosophy of the Image Gently steering committee is to collaborate, to share information freely, to keep messaging simple and to commit to lifelong learning. Many healthcare practitioners may not understand how to decrease children’s radiation exposure; the goal of Image Gently is to increase all stakeholders’ understanding of both the benefits and the risks and to encourage radiation reduction strategies. This article summarises the rationale and goals of the global campaign to date.
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Travis LB, Ng AK, Allan JM, Pui CH, Kennedy AR, Xu XG, Purdy JA, Applegate K, Yahalom J, Constine LS, Gilbert ES, Boice JD. Second malignant neoplasms and cardiovascular disease following radiotherapy. Health Phys 2014; 106:229-246. [PMID: 24378498 DOI: 10.1097/hp.0000000000000013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Second malignant neoplasms (SMNs) and cardiovascular disease (CVD) are among the most serious and life-threatening late adverse effects experienced by the growing number of cancer survivors worldwide and are due in part to radiotherapy. The National Council on Radiation Protection and Measurements (NCRP) convened an expert scientific committee to critically and comprehensively review associations between radiotherapy and SMNs and CVD, taking into account radiobiology; genomics; treatment (i.e., radiotherapy with or without chemotherapy and other therapies); type of radiation; and quantitative considerations (i.e., dose-response relationships). Major conclusions of the NCRP include: (1) the relevance of older technologies for current risk assessment when organ-specific absorbed dose and the appropriate relative biological effectiveness are taken into account and (2) the identification of critical research needs with regard to newer radiation modalities, dose-response relationships, and genetic susceptibility. Recommendation for research priorities and infrastructural requirements include (1) long-term large-scale follow-up of extant cancer survivors and prospectively treated patients to characterize risks of SMNs and CVD in terms of radiation dose and type; (2) biological sample collection to integrate epidemiological studies with molecular and genetic evaluations; (3) investigation of interactions between radiotherapy and other potential confounding factors, such as age, sex, race, tobacco and alcohol use, dietary intake, energy balance, and other cofactors, as well as genetic susceptibility; (4) focusing on adolescent and young adult cancer survivors, given the sparse research in this population; and (5) construction of comprehensive risk prediction models for SMNs and CVD to permit the development of follow-up guidelines and prevention and intervention strategies.
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Affiliation(s)
- Lois B Travis
- *Rubin Center for Cancer Survivorship and Department of Radiation Oncology, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; †Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and the Dana-Farber Cancer Institute, Boston, MA; ‡Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK; §Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; and the University of Tennessee Health Science Center, Memphis, TN; **Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA; ††Nuclear Engineering and Engineering Physics Program, Rensselaer Polytechnic Institute, Troy, NY; ‡‡Department of Radiation Oncology, University of California at Davis, Davis, CA; §§Department of Radiology, Emory University, Atlanta, GA; ***Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY; †††Division ofCancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; ‡‡‡National Council on Radiation Protection and Measurements, Bethesda, MD, and the Department of Medicine, Vanderbilt University, Nashville, TN
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18
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Applegate K, Stayman J. MO-A-134-01: Computed Tomography 1: Iterative Reconstruction and Imaging Gently (or, Squeezing the Most Out of Every Photon and the Benefit of Doing So). Med Phys 2013. [DOI: 10.1118/1.4815219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Vassileva J, Rehani MM, Applegate K, Ahmed NA, Al-Dhuhli H, Al-Naemi HM, Al Suwaidi JS, Arandjic D, Beganovic A, Benavente T, Dias S, El-Nachef L, Faj D, Gamarra-Sánchez ME, Aguilar JG, Gershan V, Gershkevitsh E, Gruppetta E, Hustuc A, Ivanovic S, Jauhari A, Kharita MH, Kharuzhyk S, Khelassi-Toutaoui N, Khosravi HR, Kostova-Lefterova D, Kralik I, Liu L, Mazuoliene J, Mora P, Muhogora W, Muthuvelu P, Nikodemova D, Novak L, Pallewatte AS, Shaaban M, Shelly E, Stepanyan K, Teo ELHJ, Thelsy N, Visrutaratna P, Zaman A, Zontar D. IAEA survey of paediatric computed tomography practice in 40 countries in Asia, Europe, Latin America and Africa: procedures and protocols. Eur Radiol 2012; 23:623-31. [PMID: 22940731 DOI: 10.1007/s00330-012-2639-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 07/25/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To survey procedures and protocols in paediatric computed tomography (CT) in 40 less resourced countries. METHODS Under a project of the International Atomic Energy Agency, 146 CT facilities in 40 countries of Africa, Asia, Europe and Latin America responded to an electronic survey of CT technology, exposure parameters, CT protocols and doses. RESULTS Modern MDCT systems are available in 77 % of the facilities surveyed with dedicated paediatric CT protocols available in 94 %. However, protocols for some age groups were unavailable in around 50 % of the facilities surveyed. Indication-based protocols were used in 57 % of facilities. Estimates of radiation dose using CTDI or DLP from standard CT protocols demonstrated wide variation up to a factor of 100. CTDI(vol) values for the head and chest were between two and five times those for an adult at some sites. Sedation and use of shielding were frequently reported; immobilisation was not. Records of exposure factors were kept at 49 % of sites. CONCLUSION There is significant potential for improvement in CT practice and protocol use for children in less resourced countries. Dose estimates for young children varied widely. This survey provides critical baseline data for ongoing quality improvement efforts by the IAEA.
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Affiliation(s)
- Jenia Vassileva
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
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21
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Lynn R, Walsh N, Lei M, Applegate K, Convery D, Guerrero-Urbano T. EP-1164 FIXED FIELD IMRT, VMAT AND TOMOTHERAPY TECHNIQUES FOR HNSCC: A DOSIMETRIC AND VOLUMETRIC COMPARISON. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71497-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Travis LB, Ng AK, Allan JM, Pui CH, Kennedy AR, Xu XG, Purdy JA, Applegate K, Yahalom J, Constine LS, Gilbert ES, Boice JD. Second malignant neoplasms and cardiovascular disease following radiotherapy. J Natl Cancer Inst 2012; 104:357-70. [PMID: 22312134 PMCID: PMC3295744 DOI: 10.1093/jnci/djr533] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 11/21/2011] [Accepted: 11/30/2011] [Indexed: 12/29/2022] Open
Abstract
Second malignant neoplasms (SMNs) and cardiovascular disease (CVD) are among the most serious and life-threatening late adverse effects experienced by the growing number of cancer survivors worldwide and are due in part to radiotherapy. The National Council on Radiation Protection and Measurements (NCRP) convened an expert scientific committee to critically and comprehensively review associations between radiotherapy and SMNs and CVD, taking into account radiobiology; genomics; treatment (ie, radiotherapy with or without chemotherapy and other therapies); type of radiation; and quantitative considerations (ie, dose-response relationships). Major conclusions of the NCRP include: 1) the relevance of older technologies for current risk assessment when organ-specific absorbed dose and the appropriate relative biological effectiveness are taken into account and 2) the identification of critical research needs with regard to newer radiation modalities, dose-response relationships, and genetic susceptibility. Recommendation for research priorities and infrastructural requirements include 1) long-term large-scale follow-up of extant cancer survivors and prospectively treated patients to characterize risks of SMNs and CVD in terms of radiation dose and type; 2) biological sample collection to integrate epidemiological studies with molecular and genetic evaluations; 3) investigation of interactions between radiotherapy and other potential confounding factors, such as age, sex, race, tobacco and alcohol use, dietary intake, energy balance, and other cofactors, as well as genetic susceptibility; 4) focusing on adolescent and young adult cancer survivors, given the sparse research in this population; and 5) construction of comprehensive risk prediction models for SMNs and CVD to permit the development of follow-up guidelines and prevention and intervention strategies.
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MESH Headings
- Adult
- Age of Onset
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/etiology
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/etiology
- Cardiovascular Diseases/genetics
- Cardiovascular Diseases/prevention & control
- Child
- Confounding Factors, Epidemiologic
- Dose-Response Relationship, Radiation
- Female
- Genetic Predisposition to Disease
- Heart Block/epidemiology
- Heart Block/etiology
- Humans
- Incidence
- Male
- Myocardial Infarction/epidemiology
- Myocardial Infarction/etiology
- Neoplasms/radiotherapy
- Neoplasms, Radiation-Induced/epidemiology
- Neoplasms, Radiation-Induced/etiology
- Neoplasms, Radiation-Induced/genetics
- Neoplasms, Radiation-Induced/prevention & control
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/prevention & control
- Polymorphism, Genetic
- Radiotherapy/adverse effects
- Radiotherapy/methods
- Radiotherapy Dosage
- Radiotherapy, Adjuvant/adverse effects
- Radiotherapy, Conformal/adverse effects
- Radiotherapy, Conformal/methods
- Radiotherapy, Intensity-Modulated
- Risk Assessment
- Risk Factors
- SEER Program
- Stroke/epidemiology
- Stroke/etiology
- Survivors/statistics & numerical data
- United States/epidemiology
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Affiliation(s)
- Lois B Travis
- Rubin Center for Cancer Survivorship and Department of Radiation Oncology, James P. Wilmot Cancer Center, University of Rochester Medical Center, 265 Crittenden Blvd, CU 420318, Rochester, NY 14642, USA.
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23
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Hodgson D, Convery D, Greener A, Misson-Yates S, Thomas C, Footman M, Applegate K, Harrison L. 1403 poster DOSIMETRIC COMMISSIONING OF A MONTE CARLO MODEL IN THE ELEKTA MONACO TREATMENT PLANNING SYSTEM. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Hodgson D, Convery D, Greener A, Misson-Yates S, Thomas C, Harrison L, Applegate K, Footman M. Dosimetric Commissioning of Elekta CMS Monaco ® v2.03 Treatment Planning System at Guy's & St Thomas'. Clin Oncol (R Coll Radiol) 2011. [DOI: 10.1016/j.clon.2011.01.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Qayed M, Thompson A, Applegate K, Haight A, Chiang KY, Horan J. The Updated Schwartz Formula As A Screening Test For Abnormal Kidney Function Prior To Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Llapur CJ, Martínez TM, Coates C, Tiller C, Wiebke JL, Li X, Applegate K, Coxson HO, Tepper RS. Lung structure and function of infants with recurrent wheeze when asymptomatic. Eur Respir J 2008; 33:107-12. [PMID: 18715876 DOI: 10.1183/09031936.00106607] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Infants with recurrent wheeze have repeated episodes of airways obstruction; however, relatively little is known about the structure and function of their lungs when not symptomatic. The current authors evaluated whether infants with recurrent wheeze have smaller airway lumens or thickened airway walls, as well as decreased airway function. High-resolution computed tomography images 1 mm thick were obtained at three anatomic locations at an elevated lung volume and at functional residual capacity. Forced expiratory flows were also measured in subjects with recurrent wheeze. Airway lumen, wall areas and lung tissue density were not significantly different for recurrent wheeze (n = 17) and control (n = 14) subjects; however, subjects with recurrent wheeze had lower forced expiratory flows than predicted. Similar findings were obtained when subjects were grouped by exposure to tobacco smoke. These findings indicate that infants with recurrent wheeze, as well as exposure to tobacco smoke, have lower airway function when not symptomatic. The lower forced expiratory flows may result from a degree of airway narrowing that could not be resolved with the methodology employed or from other mechanisms, such as more collapsible airways or decreased pulmonary elastic recoil.
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Affiliation(s)
- C J Llapur
- Department of Paediatric Pulmonology and Critical Care, Indiana University Medical Center, Indianapolis, IN, USA
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27
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Affiliation(s)
- Geetika Khanna
- Department of Radiology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, USA.
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28
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Applegate K. Pregnancy screening of adolescents and women before radiologic testing: does radiology need a national guideline? J Am Coll Radiol 2007; 4:533-6. [PMID: 17660116 DOI: 10.1016/j.jacr.2007.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Indexed: 11/17/2022]
Abstract
Ionizing radiation has known teratogenic and cancer risks to fetuses. Policies for radiation exposure of pregnant patients during imaging tests in radiology departments vary widely and may or may not be in fully written form. No national guideline exists for how individual radiologists or radiology departments should protect fetuses from ionizing radiation exposure. With the rapid increase in the use of radiologic testing in general, particularly computed tomography, more adolescents and women undergo computed tomographic imaging and may unintentionally expose their fetuses. A national discussion within radiology organizations is needed to understand the advantages and disadvantages in the development of a national guideline for screening women of childbearing age for pregnancy before any procedures using ionizing radiation are performed. Given the increased public concern and increased use of radiologic testing, such a national guideline would improve consumer satisfaction and safety.
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Affiliation(s)
- Kimberly Applegate
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Abstract
We are currently seeing increasing opportunities to improve patient care with computed tomography (CT). At the same time, we are challenged to use this technology wisely. In particular, we are being asked to balance the benefits against the risks, chiefly those of ionizing radiation. To do this, we must have a foundation from which to determine the relative risks. This foundation necessarily must be composed of several components. First, it is important to understand the patterns of use and increasing application of CT, particularly multidetector CT. In addition, it is helpful to be familiar with measures of radiation pertinent to CT and the doses provided by this modality. This foundation then provides a context in which to discuss the issue of low-dose radiation and cancer risk as well as potential changes in CT practice guidelines and regulation. It is with an understanding of these issues that radiologists and other radiology personnel can participate in an informed discussion with referring physicians and patients and continue to optimize the practice of CT.
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Affiliation(s)
- Donald P Frush
- Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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30
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Dunnick NR, Applegate K, Arenson R, Levin D. Training for the future of radiology: a report of the 2005 Intersociety Conference. J Am Coll Radiol 2007; 3:319-24. [PMID: 17412074 DOI: 10.1016/j.jacr.2006.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Indexed: 11/26/2022]
Abstract
The field of radiology has expanded dramatically and now encompasses a broad range of imaging examinations and image guided procedures. These imaging technologies are powerful tools which provide valuable information, and combining modalities further enhances their value. The changes our imaging technologies have brought bring into question our training methods, especially the value of the clinical year prior to entering radiology. As the quality of our health care systems is being challenged, demonstration of both quality processes and outcomes are needed. Maintenance of Certification, which demonstrates continuing learning and practice improvement, has become an important part of a radiologist's quality credentials.
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31
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Williams MB, Krupinski EA, Strauss KJ, Breeden WK, Rzeszotarski MS, Applegate K, Wyatt M, Bjork S, Seibert JA. Digital radiography image quality: image acquisition. J Am Coll Radiol 2007; 4:371-88. [PMID: 17544139 DOI: 10.1016/j.jacr.2007.02.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Indexed: 11/28/2022]
Abstract
This article on digital radiography image acquisition is the first of two articles written as part of an intersociety effort to establish image quality standards for digital and computed radiography. The topic of the other paper is digital radiography image processing and display. The articles were developed collaboratively by the ACR, the American Association of Physicists in Medicine, and the Society for Imaging Informatics in Medicine. Increasingly, medical imaging and patient information are being managed using digital data during acquisition, transmission, storage, display, interpretation, and consultation. Data management during each of these operations has a direct impact on the quality of patient care. These articles describe what is known to improve image quality for digital and computed radiography and make recommendations on optimal acquisition, processing, and display. The practice of digital radiography is a rapidly evolving technology that will require the timely revision of any guidelines and standards. This document provides a basis for the technologies available today in clinical practice and may be useful in guiding the future clinical practice of digital radiography.
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Affiliation(s)
- Mark B Williams
- Department of Radiology, University of Virginia, Charlottesville, Va, USA
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32
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Krupinski EA, Williams MB, Andriole K, Strauss KJ, Applegate K, Wyatt M, Bjork S, Seibert JA. Digital radiography image quality: image processing and display. J Am Coll Radiol 2007; 4:389-400. [PMID: 17544140 DOI: 10.1016/j.jacr.2007.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Indexed: 11/29/2022]
Abstract
This article on digital radiography image processing and display is the second of two articles written as part of an intersociety effort to establish image quality standards for digital and computed radiography. The topic of the other paper is digital radiography image acquisition. The articles were developed collaboratively by the ACR, the American Association of Physicists in Medicine, and the Society for Imaging Informatics in Medicine. Increasingly, medical imaging and patient information are being managed using digital data during acquisition, transmission, storage, display, interpretation, and consultation. The management of data during each of these operations may have an impact on the quality of patient care. These articles describe what is known to improve image quality for digital and computed radiography and to make recommendations on optimal acquisition, processing, and display. The practice of digital radiography is a rapidly evolving technology that will require timely revision of any guidelines and standards.
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33
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McGarvey CK, Applegate K, Lee ND, Sokol DK. False-positive metaiodobenzylguanidine scan for neuroblastoma in a child with opsoclonus-myoclonus syndrome treated with adrenocorticotropic hormone (acth). J Child Neurol 2006; 21:606-10. [PMID: 16970854 DOI: 10.1177/08830738060210070801] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the case of a 2-year-old girl with opsoclonus-myoclonus syndrome treated with chronic adrenocorticotropic hormone (ACTH) in which a metaiodobenzylguanidine scan showed abnormal radiotracer uptake in the left adrenal gland region, interpreted as the site of an occult neuroblastoma. As this finding was not corroborated by previous or subsequent metaiodobenzylguanidine scans or by computed tomography (CT) or magnetic resonance imaging (MRI), we attribute the finding to being a false-positive result from adrenal hyperplasia owing to chronic use of ACTH and not to neuroblastoma. Metaiodobenzylguanidine scintigraphy is an extremely important nuclear medicine examination tool used for the evaluation and staging of pediatric neuroblastoma. We highlight the need for cautious interpretation of metaiodobenzylguanidine as a screening tool for neuroblastoma in patients treated with ACTH.
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Affiliation(s)
- Cynthia K McGarvey
- Department of Neurology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis 46202, USA
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34
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Staser JA, Alam T, Applegate K. Calcified pulmonary thromboembolism in a child with sickle cell disease: value of multidetector CT in patients with acute chest syndrome. Pediatr Radiol 2006; 36:561-3. [PMID: 16708206 DOI: 10.1007/s00247-006-0161-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Revised: 02/17/2006] [Accepted: 03/02/2006] [Indexed: 02/02/2023]
Abstract
The incidence of pulmonary embolism in children is not clearly known, but is believed to be low. Risk factors for pulmonary thromboembolism include central venous catheter, malignancy, surgery, infection, trauma, and congenital hypercoagulable disorders. Children with sickle cell disease are prothrombotic and are at an increased risk of thromboembolism. The incidence of this event is unknown because these children are often not thoroughly imaged. We report here a case of a calcified pulmonary thromboembolism in a child with sickle cell disease and emphasize the use of multidetector CT in detection of pulmonary thromboembolism in children with sickle cell disease.
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Affiliation(s)
- Jonathan A Staser
- Department of Radiology, Indiana University Medical Center, Indianapolis, IN 46202-5200, USA
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35
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Blake ME, Oates ME, Applegate K, Kuligowska E. Proposed program guidelines for pregnant radiology residents: a project supported by the American Association for Women Radiologists and the Association of Program Directors in Radiology. Acad Radiol 2006; 13:391-401. [PMID: 16488851 DOI: 10.1016/j.acra.2005.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Revised: 10/07/2005] [Accepted: 10/07/2005] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES Written institutional policies governing radiation exposure and work responsibilities for pregnant radiology residents are not uniform and often are nonexistent. Standardized program guidelines would allow residents and program directors alike to prepare for a resident pregnancy with objectivity and consistency. MATERIALS AND METHODS The American Association for Women Radiologists (AAWR) launched a task force to revisit guidelines for the protection of pregnant residents from radiation exposure during training. We conducted two surveys of the Association of Program Directors in Radiology (APDR) membership. Survey 1 was designed to learn about existing program and institutional policies and to assess the need for and interest in standardized guidelines that would address radiation exposure and work responsibilities for pregnant radiology residents. Based on those responses, we drafted a set of program guidelines incorporating policies contributed by responding program directors. Our follow-up APDR survey, survey 2, was conducted to determine opinions and acceptance of the drafted program guidelines. Each survey was analyzed by using a proportion of means test. RESULTS Fifty-five of 156 program director APDR members (35%) responded to survey 1. Only half the respondents had formal written policies at their respective institutions. Review of submitted policies showed widely divergent opinions about appropriate policies for pregnant radiology residents. Most (34/52; 75%) supported the development of standardized guidelines. In survey 2, 38/73 responding APDR members (53%) offered their opinions and comments on our drafted guidelines. Approximately 90% agreement was catalogued on 13 of 18 items (72%); a majority (>60%) agreed on all points, even the most controversial points concerning fluoroscopy. CONCLUSION A minority of radiology residency programs have written policies addressing pregnancy during training. With expressed support from a majority of responding program directors, we have developed and present here proposed program guidelines for pregnant radiology residents to serve as a framework for radiology residents and program directors alike.
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Affiliation(s)
- Meghan E Blake
- Department of Radiology, Boston University Medical Center, 88 East Newton St, Boston, MA 02118, USA.
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36
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Potterton VK, Ruan S, Sunshine JH, Applegate K, Cypel Y, Forman HP. Why don’t female medical students choose diagnostic radiology? A review of the current literature. J Am Coll Radiol 2004; 1:583-90. [PMID: 17411657 DOI: 10.1016/j.jacr.2004.02.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
While the number of women entering medical schools is approaching 50% nationally, women continue to be underrepresented in a number of specialties including diagnostic radiology. While diagnostic radiology has many characteristics that might be desirable to women, such as reasonable call hours, flexible scheduling, and high salaries, women still do not choose diagnostic radiology as a career. This article examines the literature to discern possible reasons for why women are entering diagnostic radiology at a lower rate. We address trends among women in academic medicine, which resemble trends among women in diagnostic radiology, and examine the effects of gender and socialization in medical school on specialty choices among women. The current literature suggests a constellation of factors may be responsible for the gender differences in diagnostic radiology. We suggest that further research is needed to elucidate why women do not seem to be choosing diagnostic radiology as frequently as one might predict based on the lifestyle of diagnostic radiologists and the numbers of women currently entering medical school. Once these reasons are made clear, it will be possible for residency program directors and medical schools to ensure that women are making informed specialty choices, whatever those choices may be.
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Affiliation(s)
- Victoria K Potterton
- Yale University School of Medicine, Department of Diagnostic Radiology, New Haven, Connecticut 06510, USA.
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37
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Katz DS, Wagner HJ, Grampp S, Miller TT, Frush DP, Peh WCG, Applegate K. The RSNA Editorial Fellowship: editorial fellows' perspective. Radiology 2003; 226:309-11. [PMID: 12563120 DOI: 10.1148/radiol.2262021234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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38
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39
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Affiliation(s)
- L Mahajan
- Department of Pediatric Gastroenterology and Nutrition, The Cleveland Clinic Foundation, Ohio 44195, USA
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40
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Applegate K, Connolly LP, Treves ST. Neuroblastoma presenting clinically as hip osteomyelitis: a "signature" diagnosis on skeletal scintigraphy. Pediatr Radiol 1995; 25 Suppl 1:S93-6. [PMID: 8577566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
At their initial emergency room presentation, four children were thought to have hip osteomyelitis. Skeletal scintigraphy, however, demonstrated multiple areas of abnormal tracer uptake in the bones in all four, and in three there was abnormal uptake in a soft tissue abdominal mass. The skeletal scintigraphic findings promptly led to the correct diagnosis of neuroblastoma.
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Affiliation(s)
- K Applegate
- Division of Nuclear Medicine, Department of Radiology, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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41
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Affiliation(s)
- K Applegate
- Department of Radiology, Children's Hospital, Boston, MA 02115, USA
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42
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Parad RB, Applegate K, Doubilet PM, Fishman SJ, Estroff JA. Occult fetal bowel obstruction: ileal atresia presenting in a newborn infant after normal antenatal sonography. J Ultrasound Med 1995; 14:161-163. [PMID: 8568964 DOI: 10.7863/jum.1995.14.2.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- R B Parad
- Department of Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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43
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Gallinaro R, Cheadle WG, Applegate K, Polk HC. The role of the complement system in trauma and infection. Surg Gynecol Obstet 1992; 174:435-40. [PMID: 1570624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The complement system is an important immediate host defense mechanism after trauma, extensive burn injury and after invasion by microbial pathogens. Massive complement activation, however, seems to be detrimental and may contribute further to the disease process and eventually to multiple organ failure or the septic state. In clinical situations in which complement is damaging, the logical therapy should be, if at all possible, the removal of the activated complement components from the circulation. However, much of the protein is attached to the membrane and effective locally, so prevention of the enzymatic cascade may be more appropriate. There has been little progress in manipulating the complement system to effectively alter such disease processes caused by the clinical situations and there is an important need for further research in the field.
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Affiliation(s)
- R Gallinaro
- Department of Surgery, University of Louisville School of Medicine, Kentucky 40292
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44
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Chen C, Applegate K, King WC, Glomset JA, Norum KR, Gjone E. A study of the small spherical high density lipoproteins of patients afflicted with familial lecithin: cholesterol acyltransferase deficiency. J Lipid Res 1984; 25:269-82. [PMID: 6726080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We studied the effects of the lecithin:cholesterol acyltransferase reaction on the size and composition of the small spherical high density lipoproteins of patients afflicted with familial lecithin:cholesterol acyltransferase deficiency. We isolated these lipoproteins by preparative ultracentrifugation and rate zonal ultracentrifugation, determined their diameter by gradient gel electrophoresis, and then calculated their composition by relating measurements of their lipid and apolipoprotein content to particle volume. Our results revealed lipoprotein particles 6.0-6.2 nm in diameter that contained approximately 2 molecules of apolipoprotein A-I, 37-38 molecules of phospholipid, 3-9 molecules of unesterified cholesterol, 1-2 molecules of cholesteryl ester, and 1-2 molecules of triacylglycerol. Upon being incubated with lecithin:cholesterol acyltransferase and a source of additional unesterified cholesterol, these lipoproteins increased in content of total cholesterol and in particle size to form discrete lipoprotein products 6.6-8.6 nm in diameter. The increase in size occurred despite a net decrease in product unesterified cholesterol and phospholipid and though the net change in total lipid volume was small. Moreover, specific product lipoproteins, isolated by rate zonal ultracentrifugation, contained an increased amount of apolipoprotein A-I. These results seem best explained by a process involving lecithin:cholesterol acyltransferase-induced particle rearrangement reactions. The possibility that a similar process normally occurs in vivo deserves to be explored.
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Glomset JA, Applegate K, Forte T, King WC, Mitchell CD, Norum KR, Gjone E. Abnormalities in lipoproteins of d < 1.006 g/ml in familial lecithin:cholesterol acyltransferase deficiency. J Lipid Res 1980; 21:1116-27. [PMID: 7462807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Studies of different sized lipoproteins of d < 1.006 g/ml from patients with familial lecithin:cholesterol acyltransferase deficiency have yielded new evidence of abnormalities in this lipoprotein class. Lipoproteins of all sizes contain high amounts of unesterified cholesterol, low amounts of total protein, and particularly low amounts of apolipoproteins C-II and C-III. Lipoproteins 60 nm in diameter or larger include particles that show a notched appearance upon electron microscopy, and contain a) a high combined volume of phospholipid, unesterified cholesterol, and protein; b) high amounts of cholesteryl ester and apolipoproteins C-I and E, and c) two major tetramethylurea-insoluble proteins that can be separated by electrophoresis in the presence of sodium dodecylsulfate. In contrast, lipoproteins that are 40 nm in diameter or less appear to contain low amounts of cholesteryl ester, normal amounts of apolipoproteins C-I and E, and a single tetramethylurea-insoluble protein the size of that in control lipoproteins. Since these abnormalities occur in the lipoproteins of four different patients from four different families, they are probably effects of the enzyme deficiency. Most, however, appear to arise indirectly because in vitro experiments published earlier indicate that few are reversed by incubation in the presence of the enzyme and patient high density lipoproteins.
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Glomset JA, Applegate K, Forte T, King WC, Mitchell CD, Norum KR, Gjone E. Abnormalities in lipoproteins of d < 1.006 g/ml in familial lecithin:cholesterol acyltransferase deficiency. J Lipid Res 1980. [DOI: 10.1016/s0022-2275(20)34773-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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