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Miller DL, Balter S. NCRP commentary no. 33-recommendations for stratification of equipment use and radiation safety training for fluoroscopy. J Radiol Prot 2024; 44:023001. [PMID: 38636477 DOI: 10.1088/1361-6498/ad4042] [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] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/18/2024] [Indexed: 04/20/2024]
Abstract
National Council on Radiation Protection and Measurements Commentary No. 33 'Recommendations for Stratification of Equipment Use and Radiation Safety Training for Fluoroscopy' defines an evidence-based, radiation risk classification for fluoroscopically guided procedures (FGPs), provides radiation-related recommendations for the types of fluoroscopes suitable for each class of procedure, and indicates the extent and content of training that ought to be provided to different categories of facility staff who might enter a room where fluoroscopy is or may be performed. For FGP, radiation risk is defined by the type and likelihood of radiation hazards that could be incurred by a patient undergoing a FGP. The Commentary also defines six training groups of facility staff based on their role in the fluoroscopy room. The training groups are based on a combination of job descriptions and the procedures in which these individuals might be involved. The Commentary recommends the extent and content of training that should be provided to each of these training groups. It also provides recommendations on training formats, training frequency, and methods for demonstrating that the learner has acquired the necessary knowledge.
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Affiliation(s)
- Donald L Miller
- U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - Stephen Balter
- Columbia University, New York, NY, United States of America
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Bazyka DA, Lytvynenko OO, Litvinenko OO. INFLUENCE OF IONIZING RADIATION ON THE DEVELOPMENT OF BREAST CANCER. Probl Radiac Med Radiobiol 2023; 28:22-48. [PMID: 38155113 DOI: 10.33145/2304-8336-2023-28-22-48] [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] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Indexed: 12/30/2023]
Abstract
Breast cancer (BC) is one of the urgent problems of health care, which is due to a constant trend of growth. One of the risk factors for the development of breast cancer is ionizing radiation (IR). Numerous epidemiological and experimental studies have shown the high sensitivity of the mammary gland (MG) to this factor. Consideration of models of absolute and relative risks of the occurrence of radio-induced tumors of the MG in irradiated persons showed the importance of such factors as age at the time of irradiation, multiplicity. frequency of exposure, dose level and concomitant non-neoplastic diseases of the mammary and thyroid gland (TG). Excess radiation-induced cases of cervical cancer were found among irradiated women after the atomic bombings of Hiroshima and Nagasaki.Epidemiological features of the development of breast cancer under the influence of IV are presented in detail, which is one of the environmental factors involved in the formation of the modern carcinogenic situation. In con-nection with the significant sensitivity of the MG to the carcinogenic effect of IR, this form of neoplasms attracted special attention after the Chornobyl accident. The effect of small doses of radiation after the Chornobyl disaster led to a wave-like change in the incidence of breast cancer in certain periods of the year, and the radiation-induced incidence of this pathology can occur spontaneously.
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Affiliation(s)
- D A Bazyka
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - O O Lytvynenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
| | - O O Litvinenko
- Nonprofit Organization National Cancer Institute of Ministry of Health of Ukraine, 33/43 Julia Zdanovska Str., Kyiv, 03022, Ukraine
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Zhukovsky M, Onishchenko A. Paracelsian 'Bergsucht' - lung cancer or radiation-induced fibrosis? Int J Radiat Biol 2023; 100:399-410. [PMID: 37930055 DOI: 10.1080/09553002.2023.2276916] [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: 07/07/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Assessment of absorbed doses on organs and tissues of miners during radon exposure in the Schneeberg mines in the sixteenth century and calculation of the probability of occurrence of radiation-induced lung cancer and lung fibrosis, considering the life expectancy characteristic and the absence of smoking. MATERIALS AND METHODS The expected radon concentration at the Schneeberg mines has been estimated using published data. Modeling of the accumulation of radon in the working tunnels of mine workings was carried out using the RESRAD-Build 4.0, based on the radium concentration in soil and geometric parameters of the mining tunnel from the engravings in Agricola's book. The dynamics of radionuclides in the human body were performed using the WinAct software in accordance with data from ICRP Publications 130 and 137. The values of absorbed doses on the tissues of the respiratory tract were obtained using the IDAC 2.1 program. Several models based on the epidemiology of uranium miners have been used to calculate radiation risks from radon exposure. The probability of male survival at birth and the age-specific frequency of spontaneous lung cancer not associated with radiation for miners of the sixteenth century (nonsmoking men aged 20-40 years) were estimated to properly calculate the radiation risks. RESULTS The expected radon concentration in the Schneeberg mines was assessed in the range of 75-100 kBq m-3. The average value of the equilibrium factor was estimated as 0.49 ± 0.03. The annual exposure of miners to radon decay products was assessed as 125-165 WLM year-1. The annual values of absorbed doses to different sections of the respiratory tract were calculated, the maximum absorbed doses of α-radiation are formed on the bronchial and bronchiolar regions of the lungs (2.23 Gy year-1). The deterministic effects as radiation fibrosis of the lungs with 10 years of experience in the mines of Schneeberg have a probability of occurrence from 60 to 100%. All the models used for radiation risk assessments showed that the lifetime risk of developing lung cancer for nonsmoking Schneeberg miners is many times lower than the risk of developing deterministic radiation effects. In contrast, for the smoking cohort of miners in the nineteenth century lung cancer become the dominant cause of death. CONCLUSIONS The deterministic radiation effects of Schneeberg miners in sixteenth century, exposed to extremely high levels of radon, such as radiation pneumosclerosis or pulmonary fibrosis, are more likely than the development of radiation-induced lung cancer.
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Qari LY, Homsi NJ, AlMadani TM, Jamal DM, Badr FF. An Assessment of the Public's Perceptions of Radiation Exposure and Risk Associated With Dental Radiographs: A Cross-Sectional Study. Cureus 2023; 15:e47879. [PMID: 38034156 PMCID: PMC10684028 DOI: 10.7759/cureus.47879] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Ionizing radiation exposure is an ever-present part of the dental diagnostic process. A public concern often exists due to the misunderstanding of the stochastic effects of dental X-rays. This information can be difficult to explain to the patient since many patients are apprehensive about the subject matter. OBJECTIVE This article aims to assess the public's knowledge of radiation exposure and estimate the general concern or apprehension about these diagnostic imaging modalities in an effort to understand and therefore ensure patient reassurance during treatment. METHOD A questionnaire was conducted asking adults between the ages of 18 to 74 in Jeddah, Saudi Arabia questions pertaining to radiation risk. RESULTS There were 105 respondents; 21.9% showed concerns toward dental imaging, while 20% were skeptical. approximately 74% of respondents believed there was a limit to the amount of radiation exposure a patient could receive for diagnostic purposes, while only eight percent correctly identified that there was no set limit. Only 21.9% knew that a breastfeeding mother could have dental X-rays if need be; 33.3% understood that ionizing radiation from an intra-oral dental X-ray caused less exposure than natural background radiation from a return flight from Jeddah to Dammam. Conclusions: Patients are not aware of ionizing radiation exposure equivalencies between different imaging modalities. A more effective approach to convey exposure risk would be relating the radiation doses to natural background radiation as comparators.
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Affiliation(s)
- Lyan Y Qari
- Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Najwa J Homsi
- Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | | | - Duaa M Jamal
- Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Fatma F Badr
- Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
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Huettenbrink C, Hitzl W, Distler F, Ell J, Ammon J, Pahernik S. Personalized Prediction of Patient Radiation Exposure for Therapy of Urolithiasis: An Application and Comparison of Six Machine Learning Algorithms. J Pers Med 2023; 13:jpm13040643. [PMID: 37109029 PMCID: PMC10146849 DOI: 10.3390/jpm13040643] [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: 03/10/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
The prediction of radiation exposure is an important tool for the choice of therapy modality and becomes, as a component of patient-informed consent, increasingly important for both surgeon and patient. The final goal is the implementation of a trained and tested machine learning model in a real-time computer system allowing the surgeon and patient to better assess patient's personal radiation risk. In summary, 995 patients with ureterorenoscopy over a period from May 2016 to December 2019 were included. According to the suggestions based on actual literature evidence, dose area product (DAP) was categorized into 'low doses' ≤ 2.8 Gy·cm2 and 'high doses' > 2.8 Gy·cm2 for ureterorenoscopy (URS). To forecast the level of radiation exposure during treatment, six different machine learning models were trained, and 10-fold crossvalidated and their model performances evaluated in training and independent test samples. The negative predictive value for low DAP during ureterorenoscopy was 94% (95% CI: 92-96%). Factors influencing the radiation exposure were: age (p = 0.0002), gender (p = 0.011), weight (p < 0.0001), stone size (p < 0.000001), surgeon experience (p = 0.039), number of stones (p = 0.0007), stone density (p = 0.023), use of flexible endoscope (p < 0.0001) and preoperative stone position (p < 0.00001). The machine learning algorithm identified a subgroup of patients of 81% of the total sample, for which highly accurate predictions (94%) were possible allowing the surgeon to assess patient's personal radiation risk. Patients without prediction (19%), the medical expert can make decisions as usual. Next step will be the implementation of the trained model in real-time computer systems for clinical decision processes in daily practice.
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Affiliation(s)
- Clemens Huettenbrink
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Wolfgang Hitzl
- Team Biostatistics and Publication of Clinical, Research and Innovation Management (RIM), Trial Studies, Paracelsus Medical University, 5020 Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Florian Distler
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Jascha Ell
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Josefin Ammon
- Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Sascha Pahernik
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
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Kamen J, Abraham E, Perricelli D, Price S, Golduber R. The Gap in Insurance Liability for Blood and Research Gamma Irradiators. Health Phys 2023; 124:231-243. [PMID: 36705917 PMCID: PMC9940840 DOI: 10.1097/hp.0000000000001660] [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] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 06/18/2023]
Abstract
ABSTRACT In 2019, a federal contractor accidently breached a 2,900 Ci 137 Cs sealed source while decommissioning it from a University of Washington research building, releasing a single digit curie of its contents. This event contaminated 13 people as well as all seven floors of the research building, which housed the radiation source. Estimates for clean-up costs and lost revenue exceeded $150 million. The magnitude of this cost prompted licensees in possession of such radioactive sources to question whether their insurance coverage is adequate to cover a large-scale incident and if coverage for such exposure even exists. In this article, we identify potential gaps in commercially available insurance policies by evaluating and assessing associated risks, damages, and accountability. While insurance can mitigate the expense associated with remediation, it is unlikely that sufficient limits would exist to fully protect healthcare institutions from direct financial liability in the event that their radioactive sources are implicated in a nuclear, chemical, biological, or radiological (NCBR) (sometimes called CBRN in other literature) mass contamination event. This paper seeks to outline how the risks and liability to healthcare institutions having such gamma irradiators can be reduced significantly by removing them rather than seeking to insure against the cost of remediation in the event of a leak and/or mass contamination. As such, licensees are encouraged to check their policies for the correct coverage and make sure any coverage restriction is removed from their policies. In addition, licensees are also encouraged to explore financial incentives offered by the US government programs to not only dispose of their present gamma irradiator sources at no cost but also to provide financial support to replace them with alternative technologies.
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Affiliation(s)
- Jacob Kamen
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elana Abraham
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Sarah Price
- Alliance Insurance Services, Inc., Houston, TX
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Earl VJ, Potter AOG, Perdomo AA. Effective doses for common paediatric diagnostic general radiography examinations at a major Australian paediatric hospital and the communication of associated radiation risks. J Med Radiat Sci 2023; 70:30-39. [PMID: 36453696 PMCID: PMC9977658 DOI: 10.1002/jmrs.632] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/24/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Health professionals in paediatric medical imaging are routinely required to communicate radiation risks to carers and patients. Effective dose alone cannot be used to specify and communicate the radiation risk for an individual as risks are dependent on many factors including age and patient sex. In this study, we estimated typical effective doses for 20 commonly performed paediatric general radiography examinations using the weight-based imaging protocols employed at a major Australian specialist paediatric hospital. Effective doses were used to estimate and categorise associated age-based stochastic risks with commonly used risk terminology to facilitate communication of risk. METHODS Paediatric protocols for common general radiography examinations and World Health Organization 50th percentile weight-for-age data for females and males aged up to 18 years were used to estimate typical effective doses using Monte Carlo software and lifetime risk of cancer incidence using published data. Results were used to determine standardised levels of risk using the Calman risk model. RESULTS Effective doses, corresponding lifetime risk of cancer incidence and level of risk category from 20 general radiography examinations for paediatric patients were calculated and presented for ease of communication. Doses ranged from <0.001 mSv (negligible risk) to 1.6 mSv (low risk). CONCLUSION Typical effective doses from common paediatric general radiography examinations, the associated lifetime risk of cancer incidence and level of risk have been established for our institution. This can be used to convey risks to health professionals, patients and carers in ways that are easy to understand and compare with other everyday risks.
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Affiliation(s)
- Victoria J. Earl
- Department of Medical ImagingThe Royal Children's HospitalParkvilleVictoriaAustralia,Department of Medical ImagingThe Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Amanda O. G. Potter
- Department of Medical ImagingThe Royal Children's HospitalParkvilleVictoriaAustralia
| | - Amanda A. Perdomo
- Department of Medical ImagingThe Royal Children's HospitalParkvilleVictoriaAustralia
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Garg M, Karami V, Moazen J, Kwee T, Bhalla AS, Shahbazi-Gahrouei D, Shao YJ. Radiation Exposure and Lifetime Attributable Risk of Cancer Incidence and Mortality from Low- and Standard-Dose CT Chest: Implications for COVID-19 Pneumonia Subjects. Diagnostics (Basel) 2022; 12. [PMID: 36553050 DOI: 10.3390/diagnostics12123043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
Since the novel coronavirus disease 2019 (COVID-19) outbreak, there has been an unprecedented increase in the acquisition of chest computed tomography (CT) scans. Nearly 616 million people have been infected by COVID-19 worldwide to date, of whom many were subjected to CT scanning. CT exposes the patients to hazardous ionizing radiation, which can damage the genetic material in the cells, leading to stochastic health effects in the form of heritable genetic mutations and increased cancer risk. These probabilistic, long-term carcinogenic effects of radiation can be seen over a lifetime and may sometimes take several decades to manifest. This review briefly describes what is known about the health effects of radiation, the lowest dose for which there exists compelling evidence about increased radiation-induced cancer risk and the evidence regarding this risk at typical CT doses. The lifetime attributable risk (LAR) of cancer from low- and standard-dose chest CT scans performed in COVID-19 subjects is also discussed along with the projected number of future cancers that could be related to chest CT scans performed during the COVID-19 pandemic. The LAR of cancer Incidence from chest CT has also been compared with those from other radiation sources, daily life risks and lifetime baseline risk.
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Andriulevičiūtė I, Skovorodko K, Adlienė D, Bielinis A, Laurikaitienė J, Gricienė B. Assessment of extremity exposure to technologists working manually with 99mTc-labelled radiopharmaceuticals and with an automatic injection system for 18F-FDG. J Radiol Prot 2022; 42:031510. [PMID: 35973412 DOI: 10.1088/1361-6498/ac89f9] [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] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
The hands of nuclear medicine (NM) personnel involved in radiopharmaceutical preparation and administration can receive significant radiation doses. The dose distribution across the hand is nonuniform and the Hp(0.07) doses obtained by an individual passive ring dosimeter do not always present a real situation. The aim of this study was to assess the extremity exposure of NM workers working with99mTc-labelled radiopharmaceuticals and with an automatic IRIDE (COMECER, Italy)18F-FDG injection system. Hp(0.07) doses were measured using calibrated thermoluminescent dosimeters-100 (TLD-100) and were read by a RIALTO TLD (NE Technology) reader. It was found that the most exposed parts of the hand during work with18F and99mTc radionuclides are the fingertips of the thumb, index finger and middle finger. The maximum fingertip doses were 1.3-2.4 times higher compared with the doses from the typical monitoring position (base of the middle finger of the dominant hand). When working with99mTc, the average hand doses were relatively high, i.e. 0.17 ± 0.04 and 0.37 ± 0.13 mSv Gbq-1for the left and the right hand, respectively, during preparation, and 58 ± 20 and 53 ± 13µSv GBq-1for the left and the right hand, respectively, during administration of99mTc labelled radiopharmaceuticals. Meanwhile, the lowest doses were found for hands during administration of18F-FDG (average hand dose 28 ± 13µSv GBq-1for the left hand and 28 ± 7µSv GBq-1for the right hand), which shows the advantages of automated injection/infusion systems, thus implementation of automatic infusion/injection in hospitals could be an expedient way to optimize Hp(0.07) doses to NM workers.
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Affiliation(s)
| | - Kirill Skovorodko
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Center for Physical Sciences and Technology (FTMC), Vilnius, Lithuania
| | | | | | | | - Birutė Gricienė
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Vilnius University, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius, Lithuania
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Klein L, Liu C, Steidel J, Enzmann L, Knaup M, Sawall S, Maier A, Lell M, Maier J, Kachelrieß M. Patient-specific radiation risk-based tube current modulation for diagnostic CT. Med Phys 2022; 49:4391-4403. [PMID: 35421263 DOI: 10.1002/mp.15673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/25/2021] [Revised: 03/11/2022] [Accepted: 03/29/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Modern CT scanners use automatic exposure control (AEC) techniques, such as tube current modulation (TCM), to reduce dose delivered to patients while maintaining image quality. In contrast to conventional approaches that minimize the tube current time product of the CT scan, referred to as mAsTCM in the following, we herein propose a new method referred to as riskTCM which aims at reducing the radiation risk to the patient by taking into account the specific radiation risk of every dose-sensitive organ. METHODS For current mAsTCM implementations, the mAs-product is used as a surrogate for the patient dose. Thus they do not take into account the varying dose sensitivity of different organs. Our riskTCM framework assumes that a coarse CT reconstruction, an organ segmentation and an estimation of the dose distribution can be provided in real time, e.g. by applying machine learning techniques. Using this information riskTCM determines a tube current curve that minimizes a patient risk measure, e.g. the effective dose, while keeping the image quality constant. We retrospectively applied riskTCM to 20 patients covering all relevant anatomical regions and tube voltages from 70 kV to 150 kV. The potential reduction of effective dose at same image noise is evaluated as a figure of merit and compared to mAsTCM and to a situation with a constant tube current referred to as noTCM. RESULTS Anatomical regions like the neck, thorax, abdomen and the pelvis benefit from the proposed riskTCM. On average, a reduction of effective dose of about 23 % for the thorax, 31 % for the abdomen, 24 % for the pelvis, and 27% for the neck have been evaluated compared to today's state-of-the-art mAsTCM. For the head, the resulting reduction of effective dose is lower, about 13 % on average compared to mAsTCM. CONCLUSIONS With a risk-minimizing tube current modulation, significant higher reduction of effective dose compared to mAs-minimizing tube current modulation is possible. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Laura Klein
- Division of X-Ray Imaging and CT, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Physics and Astronomy, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Chang Liu
- Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Steidel
- Division of X-Ray Imaging and CT, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Physics and Astronomy, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Lucia Enzmann
- Division of X-Ray Imaging and CT, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Physics and Astronomy, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Michael Knaup
- Division of X-Ray Imaging and CT, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Sawall
- Division of X-Ray Imaging and CT, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Lell
- Department of Radiology and Nuclear Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg
| | - Joscha Maier
- Division of X-Ray Imaging and CT, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc Kachelrieß
- Division of X-Ray Imaging and CT, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Callen-Kovtunova J, McKenna T, Steinhauser G. What's better for our health? Conducting protective actions during a nuclear emergency or accepting a certain radiation dose? J Radiol Prot 2022; 42:021516. [PMID: 35263727 DOI: 10.1088/1361-6498/ac5bde] [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] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
The threat caused by ionising radiation has resulted in the establishment of strict radiation protection guidelines. This is especially true for severe nuclear power plant (NPP) accident scenarios, which may involve the release of significant amounts of ionising radiation. However, we believe that the fine balance between the benefit of a certain protective action (e.g. evacuation) and its risks is not always accounted for properly. Deaths and mental health problems have been associated with protective actions (e.g. evacuation) implemented in the response to the Fukushima Daiichi (NPP) accident in 2011. The protective actions were implemented consistent with international recommendations, to reduce radiation-induced health effects, even though the off-site effective doses were too low to indicate that there would be any discernible radiation-induced health effects. In this paper, we will provide a first step for the development of tools to evaluate the risk of protective actions versus the radiation-induced health risk. Over 50 papers were selected as useful from more than 600 reviewed papers to characterise the health impact of protective actions taken during different emergencies (including, technical and natural emergencies). An analysis was performed comparing the radiation-induced health effects averted by protective actions with the health effects associated with the protective actions. We concentrated our analysis on deaths and mental health problems associated with protective actions compared with the inferred radiation-induced deaths averted by the protective actions. Our analysis is stated in terms of absolute risk (cases per 1000) of health effects to allow for a direct comparison. It indicates that taking protective actions consistent with dose criteria typically used in many countries could result in more excess deaths than the inferred radiation-induced deaths prevented, as well as resulting in mental health problems. We identified that residents of facilities for long stays and the elderly are particularly vulnerable and a significant number of the deaths among the general public are associated with a lack of emergency preparedness provisions.
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Affiliation(s)
- J Callen-Kovtunova
- Leibniz University Hannover, Institute of Radioecology and Radiation Protection, Herrenhäuser Str. 2, 30419 Hannover, Germany
| | - T McKenna
- Retired (International Atomic Energy Agency/ U.S. Nuclear Regulatory Commission), Vienna, Austria
| | - G Steinhauser
- Leibniz University Hannover, Institute of Radioecology and Radiation Protection, Herrenhäuser Str. 2, 30419 Hannover, Germany
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Covington MF, Mrose HE, Brown M. At Which Mean Glandular Dose Does the Benefit of Breast Cancer Deaths Averted Equal the Risk of Lives Lost to Screening From Radiation-induced Malignancy for Mammography With and Without Tomosynthesis? J Breast Imaging 2022; 4:25-30. [PMID: 38422413 DOI: 10.1093/jbi/wbab087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/19/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To estimate benefit-to-radiation-risk mean glandular dose (MGD) equivalence values for screening mammography, defined as the yearly MGD (over a 10-year period) at which the estimated benefit of mammography in terms of deaths averted equals the estimated risk of lives lost to screening due to radiation exposure (a benefit-to-risk ratio of 1). METHODS Benefit-to-risk ratios were calculated as the ratio of breast cancer deaths averted and lives lost to screening over 10-year intervals starting at age 40 for mammography and tomosynthesis using previously published methodology. The MGD values at which estimated benefit equals risk were tabulated. RESULTS The MGD values at which benefit-to-risk equivalence points were met for digital screening mammography are 63 milligray (mGy) (ages 40-49), 88 mGy (ages 50-59), 176 mGy (ages 60-69), and 336 mGy (ages 70-79). The MGD values that met benefit-to-risk equivalence for screening tomosynthesis plus digital mammography or synthetic mammography are 80 mGy (ages 40-49), 111 mGy (ages 50-59), 224 mGy (ages 60-69), and 427 mGy (ages 70-79). CONCLUSION Cutoff MGD values at which the estimated benefit from screening equals the estimated risk are well above standard screening MGD exposures. Care is necessary to ensure that threshold values are not exceeded during a screening exam, particularly for women ages 40-49 years old when using digital mammography plus tomosynthesis (due to an approximate doubling of dose per exam that will more readily exceed cutoff MGD values) and when many additional views are obtained.
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Affiliation(s)
- Matthew F Covington
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
- Huntsman Cancer Institute Center for Quantitative Cancer Imaging, Salt Lake City, UT, USA
| | - Helen E Mrose
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
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Čeliković I, Pantelić G, Vukanac I, Krneta Nikolić J, Živanović M, Cinelli G, Gruber V, Baumann S, Quindos Poncela LS, Rabago D. Outdoor Radon as a Tool to Estimate Radon Priority Areas-A Literature Overview. Int J Environ Res Public Health 2022; 19:662. [PMID: 35055485 DOI: 10.3390/ijerph19020662] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 02/01/2023]
Abstract
Doses from the exposure to outdoor radon are typically an order of magnitude smaller than those from indoor radon, causing a greater interest on investigation of the latter for radiation protection issues. As a consequence, assessment of radon priority areas (RPA) is mainly based on indoor radon measurements. Outdoor radon measurements might be needed to guarantee a complete estimation of radiological risk and may help to improve the estimation of RPA. Therefore, authors have analysed the available literature on outdoor radon to give an overview of outdoor radon surveys and potential correlation with indoor radon and estimation of RPA. The review has shown that outdoor radon surveys were performed at much smaller scale compared to indoor radon. Only a few outdoor radon maps were produced, with a much smaller density, covering a larger area, and therefore putting doubt on the representativeness of this data. Due to a large variety of techniques used for outdoor radon measurements and requirement to have detectors with a high sensitivity and resistance to harsh environmental conditions, a standardised measurement protocol should be derived. This is no simple endeavour since there are more applications in different scientific disciplines for outdoor radon measurements compared to indoor radon.
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Sakoda A, Nomura N, Kuroda Y, Kono T, Naito W, Yoshida H. Review of engagement activities to promote awareness of radiation and its associated risk amongst the Japanese public before and after the Fukushima Daiichi Nuclear Power Plant accident. J Radiol Prot 2021; 41:1258-1287. [PMID: 34816800 DOI: 10.1088/1361-6498/ac2678] [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] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
Following the Fukushima Daiichi Nuclear Power Plant accident in 2011, many radiation experts directly experienced a vast gap between ideal and real public understanding (PU) of radiation in risk communication. Therefore, this study collated and reviewed information about PU activities for radiation and its risk that six Japanese academic societies-which seem to be socially neutral expert communities-related to radiation and radiation risk conducted before and after the accident. Activities these radiation-related societies provided to the general public were discussed from the following perspectives: (a) difficulties in two-way communication due to resources, motivation and public interest and concerns; (b) balance between academic research and PU activities; (c) academic societies' building trust with the public while ensuring member experts' neutrality and independence; and (d) discussions among academic societies to prepare for public engagement. We hope that this paper encourages experts and academic societies in radiation protection to hold more national and international discussions about their roles in public communication and outreach.
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Affiliation(s)
- Akihiro Sakoda
- Ningyo-toge Environmental Engineering Centre, Japan Atomic Energy Agency, 1550 Kamisaibara, Kagamino-cho, Tomata-gun, Okayama 708-0698, Japan
| | - Naoki Nomura
- Department of Applied Nuclear Technology, Fukui University of Technology, 3-6-1 Gakuen, Fukui-city, Fukui pref 910-8505, Japan
| | - Yujiro Kuroda
- Department of Prevention and Care Science, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan
- Centre for Integrated Science and Humanities, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Takahiko Kono
- Sector of Fukushima Research and Development, Japan Atomic Energy Agency, 7-1 Omachi, Taira, Iwaki-shi, Fukushima 970-8026, Japan
| | - Wataru Naito
- Research Institute of Science for Safety and Sustainability, National Institute of Advanced Industrial Science and Technology, 16-1 Onogawa, Tsukuba-shi, Ibaraki 305-8569, Japan
| | - Hiroko Yoshida
- Radioisotope Research and Education Centre, Graduate School of Pharmaceutical Sciences, Tohoku University, 6-3 Aoba, Aramaki, Aoba-ku, Sendai-shi, Miyagi 980-8578, Japan
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Yoshida H, Coates R. IRPA practical guidance for engagement with the public on radiation and risk. J Radiol Prot 2021; 41:S181-S188. [PMID: 34265753 DOI: 10.1088/1361-6498/ac14d6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/25/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
The International Radiation Protection Association, IRPA, promotes the worldwide enhancement of professional competence, radiation protection (RP) culture and practice by providing benchmarks of good practice, as well as encouraging the application of the highest standards of professional conduct, skills and knowledge for the benefit of individuals and society. Enhancing public understanding of radiation and risk is highlighted by experiences from past emergencies, including the accident at Tokyo Electric Power Company's (TEPCO) Fukushima Daiichi Nuclear Power Plant in 2011 and the following post-disaster recovery, as one of the most important challenges, and this challenge is common across almost all public interfaces regarding radiation and risk. To this end IRPA has been continuing a Task Group activity for Public Understanding since 2013. After a series of workshops in various regions of the world, the IRPA draft guidance was developed and issued for consultation of the Associate Societies in 2019. Through these processes, IRPA received a lot of helpful comments and suggestions. IRPA finally published 'Practical Guidance for Engagement with the Public on Radiation and Risk' on the IRPA website in October 2020. The objective of the guidance is two-fold. Firstly, it is to enthuse all of us in our profession to become more active public advocates for RP. Secondly, it is to provide information, experiences and techniques to help us to become more effective and comfortable in this challenging task. This paper provides a key summary of the published IRPA guidance.
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Affiliation(s)
- H Yoshida
- Tohoku University, 6-3 Aoba, Aramaki, Aoba-ku, Sendai 980-8578, Japan
- International Radiation Protection Association (IRPA)
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Winford E, Bharija A. Referring physician perspective on how to handle frequent use of CT imaging. J Radiol Prot 2021; 41:597-600. [PMID: 34161937 DOI: 10.1088/1361-6498/ac0df3] [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] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
The increasing use of computed tomography (CT) and other relatively high radiation dose exams in a recurrent manner result in radiation risks to individual patients. Recent studies have provided alarming information not only to the radiological community but also to referring physicians. We, as referring physicians, are often implicated in the overuse of imaging. However, a recent paper rightfully summarized the situation that despite the best use of available clinical decision support system for prescribing an imaging exam at a major hospital in the USA, many patients were found to have high cumulative doses. Motivated by the cue provided by the paper in this very journal, we decided to come forward with a possible solution taking the example of the drug prescription system that we routinely use. We provide a template to translate prescription drug monitoring program to ionising radiation imaging. We suggest that all body CT exams should be monitored at an individual, prescriber, and institution level for frequency of use. Furthermore, there should be radiation risk stratification of an individual patient based on the cumulative radiation burden in recent years. Further, an individual's radiation risk-stratified in different risk levels should be available for use by the referring/ordering clinicians at the point of care. Finally, we feel distanced by the use of multiple scary radiation dose quantities in different imaging modalities and would prefer as simple a metric as 'milligram.'
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Affiliation(s)
- Elliott Winford
- Massachusetts General Hospital, Boston, MA, United States of America
| | - Ankur Bharija
- Medicine Department Stanford University School of Medicine, Stanford, CA, United States of America
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17
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Otsuka S, Arai T, Wagatsuma K, Sugawara Y, Horikawa D, Sasagase K, Yoshikawa K. [Risk Communication of Radiation Exposure for Diagnosis: A Questionnaire Survey]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:691-699. [PMID: 34305055 DOI: 10.6009/jjrt.2021_jsrt_77.7.691] [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: 11/11/2022]
Abstract
PURPOSE We investigated how a radiologic technologist explains to a patient about the risk of radiation exposure involved by the radiological examination. METHODS In this institutional review board-approved, cross-sectional study, an online questionnaire link was emailed to 650 radiological technologists who are members of the National Hospital Kanto Koshinetsu Radiological Technologist Association. The questions to survey risk communication included the ideal and reality explanation for radiation exposure to patients, the respondent's educational background, and years of experience. Statistical analysis was performed using the Kruskal-Wallis test and Bonferroni correction as a multiple comparison test. RESULTS Among the 650 radiological technologists, 245 (37.7%) completed the online questionnaire. The most common response was to compare and convey the doses of radiation during examination and background radiation when asked by a patient about risk. In the cross-analysis, the Kruskal-Wallis test showed no significant difference in what was explained according to educational background. According to years of experience, a significant difference in the content was found about explanation of the risk to patients. CONCLUSIONS We clarified the actual condition of risk communication related to the exposure in radiological examinations. In the future, development of risk communication is expected by improving the knowledge and information of "risk" and giving explanations requested by patients.
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Affiliation(s)
- Shun Otsuka
- Department of Radiology, Center Hospital of the National Center for Global Health and Medicine
| | | | - Kei Wagatsuma
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology.,School of Allied Health Sciences, Kitasato University
| | - Yasuharu Sugawara
- Department of Radiology, Center Hospital of the National Center for Global Health and Medicine
| | - Daisuke Horikawa
- Department of Radiology, Center Hospital of the National Center for Global Health and Medicine
| | - Kazu Sasagase
- Department of Radiology, Center Hospital of the National Center for Global Health and Medicine
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Matsumoto H, Shimada Y, Nakamura AJ, Usami N, Ojima M, Kakinuma S, Shimada M, Sunaoshi M, Hirayama R, Tauchi H. Health effects triggered by tritium: how do we get public understanding based on scientifically supported evidence? J Radiat Res 2021; 62:557-563. [PMID: 33912931 PMCID: PMC8273802 DOI: 10.1093/jrr/rrab029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/23/2021] [Indexed: 06/12/2023]
Abstract
The Commission for 'Corresponding to Radiation Disaster of the Japanese Radiation Research Society' formulated a description of potential health effects triggered by tritium. This was in response to the issue of discharging water containing tritium filtered by the Advanced Liquid Processing System (ALPS), generated and stored in Fukushima Daiichi Nuclear Power Station after the accident. In this review article, the contents of the description, originally provided in Japanese, which gives clear and detailed explanation about potential health effects triggered by tritium based on reliable scientific evidence in an understandable way for the public, were summarized. Then, additional information about biochemical or environmental behavior of organically bound tritium (OBT) were summarized in order to help scientists who communicate with general public.
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Affiliation(s)
- Hideki Matsumoto
- Department of Experimental Radiology and Health Physics, University of Fukui School of Medical Sciences, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Yoshiya Shimada
- Institute for Environmental Sciences, Rokkasho-mura, Kamikita-gun, Aomori 039-3212, Japan
| | - Asako J Nakamura
- Department of Biological Sciences, Faculty of Science, Ibaraki University, 2-1-1 Bunkyo, Mito, Ibaraki 310-8512, Japan
| | - Noriko Usami
- Photon Factory, Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - Mitsuaki Ojima
- Department of Environmental Health Sciences, Oita University of Nursing and Health Sciences, Oita 870-1201, Japan
| | - Shizuko Kakinuma
- Department of Radiation Effects Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba 263-8555, Japan
| | - Mikio Shimada
- Laboratory for Advanced Nuclear Energy, Institute of Innovative Research, Tokyo Institute of Technology, 2-12-1, Oookayaka, Meguro-ku, Tokyo 152-8550, Japan
| | - Masaaki Sunaoshi
- Department of Radiation Effects Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba 263-8555, Japan
| | - Ryoichi Hirayama
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba 263-8555, Japan
| | - Hiroshi Tauchi
- Corresponding author. Hiroshi Tauchi, Ph.D., Department of Biological Sciences, Faculty of Science, Ibaraki University, Bunkyo 2-1-1, Mito, Ibaraki 310-8512 Japan. Phone +81-29-228-8383 / Fax +81-29-228-8403;
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Suliman II, Alsafi K. Radiological Risk to Human and Non-Human Biota Due to Radioactivity in Coastal Sand and Marine Sediments, Gulf of Oman. Life (Basel) 2021; 11:549. [PMID: 34208166 DOI: 10.3390/life11060549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022] Open
Abstract
Natural and 137Cs radioactivity in coastal marine sediment samples was measured using gamma spectrometry. Samples were collected at 16 locations from four beaches along the coastal area of Muscat City, Gulf of Oman. Radioactivity in beach sand was used to estimate the radiological risk parameters to humans, whereas the radioactivity in marine sediments was used to assess the radiological risk parameters to non-human biota, using the ERICA Tool. The average radioactivity concentrations (Bqkg−1) of 226Ra, 232Th, 40K, 210Pb and 137Cs in sediments (sand) were as follows: 16.2 (16.3), 34.5(27.8), 54.7 (45.6), 46.8 (44.9) and 0.08 (0.10), respectively. In sand samples, the estimated average indoor (Din) and outdoor (Dout) air absorbed dose rates due to natural radioactivity were 49.26 and 27.4 and the total effective dose (AEDTotal; µSvy−1) ranged from 150.2 to 498.9 (average: 275.2). The measured radioactivity resulted in an excess lifetime cancer risk (ELCR) in the range of 58–203 (average: 111) in and an average gonadal dose (AGD; µGy.y−1) ranged from 97.3 to 329.5 (average: 181.1). Total dose rate per marine organism ranged from 0.035 µGy h−1 (in zooplankton) to 0.564 µGy h−1 (in phytoplankton). The results showed marine sediments as an important source of radiation exposure to biota in the aquatic environment. Regular monitoring of radioactivity levels is vital for radiation risk confinement. The results provide an important radiological risk profile parameter to which future radioactivity levels in marine environments can be compared.
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20
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Earl VJ, Baker LJ, Perdomo AA. Effective doses and associated age-related risks for common paediatric diagnostic nuclear medicine and PET procedures at a large Australian paediatric hospital. J Med Imaging Radiat Oncol 2021; 66:7-13. [PMID: 34110081 DOI: 10.1111/1754-9485.13257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/28/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Effective dose alone cannot be used to specify and communicate the radiation risk for an individual as risks are dependent on many factors including age and gender. There are limited published data regarding age-specific effective doses and the associated lifetime risk of developing cancers for paediatrics. In this study, we have estimated the typical effective doses for six commonly performed paediatric nuclear medicine and positron emission tomography (PET) studies at the Royal Children's Hospital, Melbourne, Australia. Effective doses were used to estimate and categorise associated stochastic risks with commonly used risk terminology. METHODS Paediatric protocols for common nuclear medicine and PET studies and the World Health Organization (WHO) 50th percentile weight-for-age data for females and males aged up to 18 years were used to estimate typical organ and effective doses using ICRP dosimetric tables for radiopharmaceuticals and lifetime risk of cancer incidence using BEIR VII Phase 2 report data. Results were used to determine standardised levels of risk. RESULTS Organ doses, effective doses, corresponding lifetime risk of cancer incidence and level of risk category from six common nuclear medicine and PET studies for paediatric patients were calculated and presented for ease of communication. CONCLUSION Typical effective doses from common paediatric nuclear medicine and PET studies and the associated lifetime risk of cancer incidence and level of risk have been established for our institution. This can be used to convey risks to health professionals, patients and carers in ways that are easy to understand and compare with other everyday risks.
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Affiliation(s)
- Victoria J Earl
- Department of Medical Imaging, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Luke J Baker
- Department of Medical Imaging, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Amanda A Perdomo
- Department of Medical Imaging, The Royal Children's Hospital, Melbourne, Victoria, Australia
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21
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Abstract
The ALARA (an acronym for 'as low as reasonably achievable') principle, keeping the likelihood of incurring exposure, the number of people exposed and the magnitude of their individual doses 'as low as reasonably achievable, taking into account economic and societal factors', is at the core of radiation protection. For many decades the principle has been an area of continuous development, with recent work highlighting the importance of engaging not only with the decision-makers in the ALARA process but all stakeholders who may incur an exposure. This paper considers a particular case study in which the dredging of non-hazardous sediment in the United Kingdom near a now decommissioned nuclear power station raised substantial public concern about radiological exposure. This turned what was a straightforward construction activity into a complex public engagement and reassurance task, at a significant cost disproportionate to the level of radiological risk. This paper highlights the key lessons learnt from the case study, including not only the importance of engaging the public as part of the ALARA process but also of considering the societal impact arising from stress and concerns if misinformation is allowed to promulgate. A discussion is included on the need to underpin any engagement with a clear plan, including pre-engagement, implementation and reinforcement of messages. In addition, the role of the radiation protection professional is considered in ensuring that all stakeholders are informed, so that ultimately they can come to their own decision on what is safe.
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Affiliation(s)
- P A Bryant
- The Society for Radiological Protection, DS009 Dartington Hall, Devon TQ9 6EN, United Kingdom
- EDF Energy, Bridgewater House, Bristol BS1 6BX, United Kingdom
- Department of Physics, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom
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Giaccardi M, Anselmino M, Del Greco M, Mascia G, Paoletti Perini A, Mascia P, De Ferrari GM, Picano E. Radiation awareness in an Italian multispecialist sample assessed with a web-based survey. Acta Cardiol 2021; 76:307-311. [PMID: 32228163 DOI: 10.1080/00015385.2020.1733303] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/24/2022]
Abstract
INTRODUCTION The awareness of radiation doses and risks, also during interventional cardiology procedures, is essential today in order to apply the risk-benefit assessment and to reinforce the principles of justification and optimisation in clinical practice. METHODS A voluntary survey with 10 questions and multiple-choice answers was run on a popular cardiology website (www.cardiolink.it) independently by a scientific publisher, in order to evaluate the contemporary level of radiation awareness in a multi-speciality sample of physicians in Italy. RESULTS One thousand eight hundred and sixty-one physicians completed the test. The survey showed good results since both prescribers and practitioners (mostly cardiologists) working in Italy are largely aware of the cancer and non-cancer risks of medical radiation use, regardless of their subspecialty background. CONCLUSION Physicians are largely aware of the cancer and non-cancer risks of medical radiation use, regardless of their subspecialty background. However, there is still broad space for improvement; in the future, the awareness of radiation risk is a prerequisite to create a culture of respect for radiation hazard and a commitment to minimise exposure and maximise protection.
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Affiliation(s)
- Marzia Giaccardi
- Department of Internal Medicine, Cardiology and Electrophysiology Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Matteo Anselmino
- Department of Medical Sciences, Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| | | | - Giuseppe Mascia
- Department of Internal Medicine (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Paoletti Perini
- Department of Internal Medicine, Cardiology and Electrophysiology Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Paola Mascia
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Gaetano Maria De Ferrari
- Department of Medical Sciences, Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
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Abstract
This manuscript reviews the recent evidence obtained in lung cancer screening with low dose spiral CT-scan (LDSCT) and focuses on the issues associated with its implementation in Europe. After a review of the magnitude of the lung cancer toll in lives, disease and Euro’s, the recently released data of the major lung cancer screening trials are reviewed and mirrored with the results of the US National Lung Screening Trial (NLST), comparing their strengths and weaknesses and areas of future research. The specific barriers and hurdles to be addressed for widely implementing this population screening in European countries are discussed, with special emphasis on the issues of inclusion of smokers, smoking cessation interventions, radiation injury and capacity planning. The pros and cons of including current smokers will be addressed together with the issue which is the better smoking cessation intervention. A medical physicist’s view on radiation exposure and quality control will address concerns about radiation induced cancers. The downstream effects of a LDSCT screening program on the capacity of CT-scans, radiologists, thoracic surgeons and radiation oncologists will follow. An estimated roadmap for the future is sketched with the expected role of all key stakeholders. This roadmap reflects the opinion leader’s reflections as expressed in a number of discussions with European health authorities, taking place as part of the recently released European Beating Cancer plan.
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Affiliation(s)
- Jan P van Meerbeeck
- Department of Pulmonology & Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium.,Antwerp University, Antwerp, Belgium
| | - Caro Franck
- Department of Medical Imaging, Antwerp University Hospital, Edegem, Belgium
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Mousavi Aghdam M, Crowley Q, Rocha C, Dentoni V, Da Pelo S, Long S, Savatier M. A Study of Natural Radioactivity Levels and Radon/Thoron Release Potential of Bedrock and Soil in Southeastern Ireland. Int J Environ Res Public Health 2021; 18:ijerph18052709. [PMID: 33800209 PMCID: PMC7967442 DOI: 10.3390/ijerph18052709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/28/2022]
Abstract
Radon (222Rn) and thoron (220Rn) account for almost two-thirds of the annual average radiation dose received by the Irish population. A detailed study of natural radioactivity levels and radon and thoron exhalation rates was carried out in a legislatively designated “high radon” area, as based on existing indoor radon measurements. Indoor radon concentrations, airborne radiometric data and stream sediment geochemistry were collated, and a set of soil samples were taken from the study area. The exhalation rates of radon (E222Rn) and thoron (E220Rn) for collected samples were determined in the laboratory. The resultant data were classified based on geological and soil type parameters. Geological boundaries were found to be robust classifiers for radon exhalation rates and radon-related variables, whilst soil type classification better differentiates thoron exhalation rates and correlated variables. Linear models were developed to predict the radon and thoron exhalation rates of the study area. Distribution maps of radon and thoron exhalation rates (range: E222Rn [0.15–1.84] and E220Rn [475–3029] Bq m−2 h−1) and annual effective dose (with a mean value of 0.84 mSv y−1) are presented. For some parts of the study area, the calculated annual effective dose exceeds the recommended level of 1 mSv y−1, illustrating a significant radiation risk. Airborne radiometric data were found to be a powerful and fast tool for the prediction of geogenic radon and thoron risk. This robust method can be used for other areas where airborne radiometric data are available.
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Affiliation(s)
- Mirsina Mousavi Aghdam
- Department of Civil and Environmental Engineering and Architecture, University of Cagliari, 09123 Cagliari, Italy;
- Department of Geology, School of Natural Sciences, Trinity College, D02PN40 Dublin, Ireland;
- Correspondence:
| | - Quentin Crowley
- Department of Geology, School of Natural Sciences, Trinity College, D02PN40 Dublin, Ireland;
| | - Carlos Rocha
- Biogeochemistry Research Group, School of Natural Sciences, Trinity College, D02PN40 Dublin, Ireland; (C.R.); (M.S.)
| | - Valentina Dentoni
- Department of Civil and Environmental Engineering and Architecture, University of Cagliari, 09123 Cagliari, Italy;
| | - Stefania Da Pelo
- Department of Chemical and Geological Sciences, University of Cagliari, 09042 Cagliari, Italy;
| | - Stephanie Long
- Environmental Protection Agency of Ireland, D14YR62 Dublin, Ireland;
| | - Maxime Savatier
- Biogeochemistry Research Group, School of Natural Sciences, Trinity College, D02PN40 Dublin, Ireland; (C.R.); (M.S.)
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Pavlenko TO, Serdiuk AM, Operchuk AP, Aksenov MV, Fryziuk MA, Tarasiuk OY, Fedorenko OV, Mykhailenko OV. EXPOSURE LEVELS OF UKRAINIAN POPULATION IN THE CONTEXT OF AN ACTION PLAN TO REDUCE INDOOR RADON LEVELS. Probl Radiac Med Radiobiol 2020; 25:220-229. [PMID: 33361837 DOI: 10.33145/2304-8336-2020-25-220-229] [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: 03/12/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To analyze and evaluate the available information to indoor radon concentration in the context of theimplementation of the radon action plan. METHODS OBJECT OF STUDY indoor radon-222 in dwellings by area and corresponding radiation risks of the population. Measurements were performed using passive track radonometry. The exposure time of the radonometers is atleast 30 days during heating season. Radiation risk calculations were performed according to the dose coefficientsand mathematical models of the ICRP. RESULTS It was found that for the whole country, reference level 300 Bq/m3 (radon gas) is exceeded in 16 % ofcases. It was found that geometric mean of radon gas levels was 120 Bq/m3 and varies from 35 to 265 Bq/m3 bydifferent area, namely the difference between radon levels in different territories of the country can be up to 7.5times. Variability of radon levels at the district level is also significant. It was found, radon activity concentrationdiffering by almost 10 times by districts with lognormal distribution and a geometric mean of 75 Bq/m3. The analy-sis of radiation risks of the population has established that estimated annual number of lung cancer deaths due toradon in Ukraine is almost 8,900 cases; and а direct economic loss for the country are estimated at more than $450 million a year. CONCLUSIONS Surveys of radon levels demonstrated significant variation in radon concentrations between different regions. For the whole country, reference level (300 Bq/m3) is exceeded on above 16 % of the dwellings, butpercentage of exceeding varies from 0.1 to 43.0 % by different area. Information on indoor radon concentrationsin almost a third of the country is non-available. For an effective implementation of the Action plan, it makes sense to introduce radon risk mapping.
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Affiliation(s)
- T O Pavlenko
- State Institution «O.M. Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», 50 Popudrenka St., Kyiv, 02094, Ukraine
| | - A M Serdiuk
- State Institution «O.M. Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», 50 Popudrenka St., Kyiv, 02094, Ukraine
| | - A P Operchuk
- State institution «Public health center of the Ministry of health of Ukraine», 41 Yaroslavska St., Kyiv, 04071, Ukraine
| | - M V Aksenov
- State Institution «O.M. Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», 50 Popudrenka St., Kyiv, 02094, Ukraine
| | - M A Fryziuk
- State Institution «O.M. Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», 50 Popudrenka St., Kyiv, 02094, Ukraine
| | - O Ye Tarasiuk
- State Institution «O.M. Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», 50 Popudrenka St., Kyiv, 02094, Ukraine
| | - O V Fedorenko
- State Institution «O.M. Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», 50 Popudrenka St., Kyiv, 02094, Ukraine
| | - O V Mykhailenko
- State Institution «O.M. Marzieiev Institute for Public Health of the National Academy of Medical Sciences of Ukraine», 50 Popudrenka St., Kyiv, 02094, Ukraine
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Gawlitza J, Henzler T, Trinkmann F, Nekolla E, Haubenreisser H, Brix G. COPD Imaging on a 3rd Generation Dual-Source CT: Acquisition of Paired Inspiratory-Expiratory Chest Scans at an Overall Reduced Radiation Risk. Diagnostics (Basel) 2020; 10:E1106. [PMID: 33352939 PMCID: PMC7765937 DOI: 10.3390/diagnostics10121106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 01/08/2023] Open
Abstract
As stated by the Fleischner Society, an additional computed tomography (CT) scan in expiration is beneficial in patients with chronic obstructive pulmonary disease (COPD). It was thus the aim of this study to evaluate the radiation risk of a state-of-the-art paired inspiratory-expiratory chest scan compared to inspiration-only examinations. Radiation doses to 28 organs were determined for 824 COPD patients undergoing routine chest examinations at three different CT systems-a conventional multi-slice CT (MSCT), a 2nd generation (2nd-DSCT), and 3rd generation dual-source CT (3rd-DSCT). Patients examined at the 3rd-DSCT received a paired inspiratory-expiratory scan. Organ doses, effective doses, and lifetime attributable cancer risks (LAR) were calculated. All organ and effective doses were significantly lower for the paired inspiratory-expiratory protocol (effective doses: 4.3 ± 1.5 mSv (MSCT), 3.0 ± 1.2 mSv (2nd-DSCT), and 2.0 ± 0.8 mSv (3rd-DSCT)). Accordingly, LAR was lowest for the paired protocol with an estimate of 0.025 % and 0.013% for female and male patients (50 years) respectively. Image quality was not compromised. Paired inspiratory-expiratory scans can be acquired on 3rd-DSCT systems at substantially lower dose and risk levels when compared to inspiration-only scans at conventional CT systems, offering promising prospects for improved COPD diagnosis.
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Affiliation(s)
- Joshua Gawlitza
- Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, 66424 Homburg, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68159 Mannheim, Germany;
| | - Frederik Trinkmann
- Pulmonology and Critical Care Medicine, Thoraxklinik at University Hospital Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), 69115 Heidelberg, Germany;
- Department of Biomedical Informatics of the Heinrich-Lanz-Center, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 69115 Heidelberg, Germany
| | - Elke Nekolla
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, 91465 Neuherberg, Germany; (E.N.); (G.B.)
| | | | - Gunnar Brix
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, 91465 Neuherberg, Germany; (E.N.); (G.B.)
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Ria F, Fu W, Chalian H, Abadi E, Segars PW, Fricks R, Khoshpouri P, Samei E. A comparison of COVID-19 and imaging radiation risk in clinical patient populations. J Radiol Prot 2020; 40:10.1088/1361-6498/abbf3b. [PMID: 33027775 PMCID: PMC9757494 DOI: 10.1088/1361-6498/abbf3b] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/16/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023]
Abstract
The outbreak of coronavirus SARS-COV2 affected more than 180 countries necessitating fast and accurate diagnostic tools. Reverse transcriptase polymerase chain reaction (RT-PCR) has been identified as a gold standard test with Chest CT and Chest Radiography showing promising results as well. However, radiological solutions have not been used extensively for the diagnosis of COVID-19 disease, partly due to radiation risk. This study aimed to provide quantitative comparison of imaging radiation risk versus COVID risk. The analysis was performed in terms of mortality rate per age group. COVID-19 mortality was extracted from epidemiological data across 299, 004 patients published by ISS-Integrated surveillance of COVID-19 in Italy. For radiological risk, the study considered 659 Chest CT performed in adult patients. Organ doses were estimated using a Monte Carlo method and then used to calculate Risk Index that was converted into an upper bound for related mortality rate following NCI-SEER data. COVID-19 mortality showed a rapid rise for ages >30 years old (min: 0.30%; max: 30.20%), whereas only four deaths were reported in the analysed patient cohort for ages <20 years old. The rates decreased for radiation risk across age groups. The median mortality rate across all ages for Chest-CT and Chest-Radiography were 0.007% (min: 0.005%; max: 0.011%) and 0.0003% (min: 0.0002%; max: 0.0004%), respectively. COVID-19, Chest Radiography, and Chest CT mortality rates showed different magnitudes and trends across age groups. In higher ages, the risk of COVID-19 far outweighs that of radiological exams. Based on risk comparison alone, Chest Radiography and CT for COVID-19 care is justified for patients older than 20 and 30 years old, respectively. Notwithstanding other aspects of diagnosis, the present results capture a component of risk consideration associated with the use of imaging for COVID. Once integrated with other diagnostic factors, they may help inform better management of the pandemic.
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Affiliation(s)
- Francesco Ria
- Carl E. Ravin Advanced Imaging Labs and Clinical Imaging Physics Group, Duke University Health System, 2424 Erwin Road, Suite 302, Durham, NC 27710, United States of America
| | - Wanyi Fu
- Carl E. Ravin Advanced Imaging Labs, Duke University Health System, 2424 Erwin Road, Suite 302, Durham, NC 27710, United States of America
| | - Hamid Chalian
- Radiology Department, Duke University Health System, 2301 Erwin Road, Durham, NC 27710, United States of America
| | - Ehsan Abadi
- Carl E. Ravin Advanced Imaging Labs, Duke University Health System, 2424 Erwin Road, Suite 302, Durham, NC 27710, United States of America
| | - Paul W Segars
- Carl E. Ravin Advanced Imaging Labs, Duke University Health System, 2424 Erwin Road, Suite 302, Durham, NC 27710, United States of America
| | - Rafael Fricks
- Carl E. Ravin Advanced Imaging Labs, Duke University Health System, 2424 Erwin Road, Suite 302, Durham, NC 27710, United States of America
- Department of Veterans Affairs, 508 Fulton St, Durham, NC 27705, United States of America
| | - Pegah Khoshpouri
- Radiology Department, Duke University Health System, 2301 Erwin Road, Durham, NC 27710, United States of America
| | - Ehsan Samei
- Carl E. Ravin Advanced Imaging Labs, Clinical Imaging Physics Group, Medical Physics Graduate Program, Departments of Radiology, Physics, Biomedical Engineering, and Electrical and Computer Engineering, Duke University, 2424 Erwin Road, Suite 302, Durham, NC 27710, United States of America
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Abstract
In this article, the authors focus on the importance of the zero X-ray ablation approach in electrophysiology. Radiation exposure related to conventional transcatheter ablation carries small but non-negligible stochastic and deterministic effects on health. Non-fluoroscopic mapping systems can significantly reduce, or even completely avoid, radiological exposure. The zero X-ray approach determines potential clinical benefits in terms of reduction of ionising radiation exposure, as well as safe technical advantages. The use of this method can result in similar outcomes when compared to the conventional fluoroscopic technique. These results are achieved without altering the duration, or compromising the effectiveness and safety, of the procedure. The zero X-ray ablation approach is a feasible and safe alternative to fluoroscopy, which is often only used in selected cases for troubleshooting. The non-fluoroscopic approach is considered a milestone for cancer prevention in ablation procedures.
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Affiliation(s)
- Giuseppe Mascia
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Marzia Giaccardi
- Department of Internal Medicine, Azienda USL Toscana Centro, Florence, Italy
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Cahoon EK, Zhang R, Simon SL, Bouville A, Pfeiffer RM. Projected Cancer Risks to Residents of New Mexico from Exposure to Trinity Radioactive Fallout. Health Phys 2020; 119:478-493. [PMID: 32881740 PMCID: PMC7497483 DOI: 10.1097/hp.0000000000001333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Accepted: 06/15/2020] [Indexed: 05/30/2023]
Abstract
The Trinity nuclear test, conducted in 1945, exposed residents of New Mexico to varying degrees of radioactive fallout. Companion papers in this issue have detailed the results of a dose reconstruction that has estimated tissue-specific radiation absorbed doses to residents of New Mexico from internal and external exposure to radioactive fallout in the first year following the Trinity test when more than 90% of the lifetime dose was received. Estimated radiation doses depended on geographic location, race/ethnicity, and age at the time of the test. Here, these doses were applied to sex- and organ-specific risk coefficients (without applying a dose and dose rate effectiveness factor to extrapolate from a population with high-dose/high-dose rates to those with low-dose/low-dose rates) and combined with baseline cancer rates and published life tables to estimate and project the range of radiation-related excess cancers among 581,489 potentially exposed residents of New Mexico. The total lifetime baseline number of all solid cancers [excluding thyroid and non-melanoma skin cancer (NMSC)] was estimated to be 183,000 from 1945 to 2034. Estimates of ranges of numbers of radiation-related excess cancers and corresponding attributable fractions from 1945 to 2034 incorporate various sources of uncertainty. We estimated 90% uncertainty intervals (UIs) of excess cancer cases to be 210 to 460 for all solid cancers (except thyroid cancer and NMSC), 80 to 530 for thyroid cancer, and up to 10 for leukemia (except chronic lymphocytic leukemia), with corresponding attributable fractions ranging from 0.12% to 0.25%, 3.6% to 20%, and 0.02% to 0.31%, respectively. In the counties of Guadalupe, Lincoln, San Miguel, Socorro, and Torrance, which received the greatest fallout deposition, the 90% UI for the projected fraction of thyroid cancers attributable to radioactive fallout from the Trinity test was estimated to be from 17% to 58%. Attributable fractions for cancer types varied by race/ethnicity, but 90% UIs overlapped for all race/ethnicity groups for each cancer grouping. Thus, most cancers that have occurred or will occur among persons exposed to Trinity fallout are likely to be cancers unrelated to exposures from the Trinity nuclear test. While these ranges are based on the most detailed dose reconstruction to date and rely largely on methods previously established through scientific committee agreement, challenges inherent in the dose estimation, and assumptions relied upon both in the risk projection and incorporation of uncertainty are important limitations in quantifying the range of radiation-related excess cancer risk.
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Affiliation(s)
- Elizabeth K. Cahoon
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rui Zhang
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Steven L. Simon
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Kaiser JC, Misumi M, Furukawa K. Biologically-based modeling of radiation risk and biomarker prevalence for papillary thyroid cancer in Japanese a-bomb survivors 1958-2005. Int J Radiat Biol 2020; 97:19-30. [PMID: 32573332 DOI: 10.1080/09553002.2020.1784488] [Citation(s) in RCA: 4] [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: 12/31/2022]
Abstract
PURPOSE Thyroid cancer of papillary histology (PTC) is the dominant type in radio-epidemiological cohorts established after nuclear accidents or warfare. Studies on post-Chernobyl PTC and on thyroid cancer in the life span study (LSS) of Japanese a-bomb survivors consistently revealed high radiation risk after exposure during childhood and adolescence. For post-Chernobyl risk assessment overexpression of the CLIP2 gene was proposed as molecular biomarker to separate radiogenic from sporadic PTC. Based on such binary marker a biologically-based risk model of PTC carcinogenesis has been developed for observational Chernobyl data. The model featured two independent molecular pathways of disease development, of which one was associated with radiation exposure. To gain credibility the concept for a mechanistic risk model must be based on general biological features which transcend findings in a single cohort. The purpose of the present study is therefore to demonstrate portability of the model concept by application to PTC incidence data in the LSS. By exploiting the molecular two-path concept we improve the determination of the probability of radiation causing cancer (POC). MATERIALS AND METHODS The current analysis uses thyroid cancer incidence data of the LSS with thyroid cancer diagnoses and papillary histology (n = 292) from the follow-up period between 1958 and 2005. Risk analysis was performed with both descriptive and biologically-based models. RESULTS Judged by goodness-of-fit all applied models described the data almost equally well. They yielded similar risk estimates in cohorts post-Chernobyl and LSS. The preferred mechanistic model was selected by biological plausibility. It reflected important features of an imperfect radiation marker which are not easily addressed by descriptive models. Precise model predictions of marker prevalence in strata of epidemiological covariables can be tested by molecular measurements. Application of the radiation-related molecular pathway from our preferred model in retrospective risk assessment decreases the threshold dose for 50% POC from 0.33 (95% confidence interval (CI) 0.18; 0.64) Gy to 0.04 (95% CI 0.01; 0.19) Gy for females and from 0.43 (95% CI 0.17; 1.84) Gy to 0.19 (95% CI 0.05; 1.00) Gy for males. These improvements are still not sufficient to separate radiation-induced from sporadic PTC cases at very low doses <0.015 Gy typical for the Fukushima accident. CONCLUSIONS Successful application of our preferred mechanistic model to LSS incidence data confirms and improves the biological two-path concept of radiation-induced PTC. Model predictions suggest further molecular validation studies to consolidate the basis of biologically-based risk estimation.
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Affiliation(s)
- Jan Christian Kaiser
- Helmholtz Zentrum München, Institute of Radiation Medicine, Oberschleißheim, Germany
| | - Munechika Misumi
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
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Abstract
This article describes radiation doses and cancer risks of digital breast imaging technologies used for breast cancer detection. These include digital mammography (DM), digital breast tomosynthesis (DBT), and newer technologies such as contrast-enhanced digital or spectral mammography (CEM), whole-breast computed tomography, breast-specific gamma imaging (BSGI), molecular breast imaging (MBI), and positron emission mammography (PEM). This article describes the basis for radiation risk estimates, compares radiation doses and risks, and provides benefit-to-radiation-risk ratios for different breast imaging modalities that use ionizing radiation. Current x-ray-based screening modalities such as DM and DBT have small to negligible risks of causing radiation-induced cancers in women of normal screening age. Possible new screening modalities such as CEM have similar small cancer risks. Potential screening modalities that involve radionuclide injection such as BSGI, MBI, and PEM have significantly higher cancer risks unless efficient detection systems and reduced administered doses are used. Benefit-to-radiation-risk estimates are highly favorable for screening with DM and other modalities having comparable (or higher) cancer detection rates and comparably low radiation doses.
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Affiliation(s)
- R Edward Hendrick
- University of Colorado School of Medicine, Department of Radiology, Aurora, CO
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Ozgun N, Serin HM, Cansu A, Cansu A. The Importance of Neurological Examination for the Indication of Computed Tomography of the Brain in Pediatric Emergency Room. Sisli Etfal Hastan Tip Bul 2020; 54:227-30. [PMID: 32617064 DOI: 10.14744/SEMB.2018.80457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/17/2018] [Indexed: 02/03/2023]
Abstract
Objectives: In this study, records of the children who underwent Computed Tomography of the Brain (CTB) were reviewed to increase the awareness of pediatricians to protect patients from radiation, whether CTB was used with right indications or if it was determinative for diagnosis. Methods: In total, in this study, 342 cases applied to our Pediatric Emergency Polyclinic between January 2005-December 2010 were retrospectively evaluated regarding complaints at admission, neurological examination and CTB results. The sensitivity and specificity of the neurological examination in detecting the CTB pathology was determined. Results: The results were normal in 319 of the 342 cases with CBT and abnormal in 23, out of which abnormal CTB results were only in three (0.99%) of the 301 patients with normal neurological examination results and in 20 (48.8%) of 41 patients with abnormal neurological examination results. The difference between the two groups was statistically significant (p=0.001). The sensitivity and specificity of the neurological examination in detecting CTB pathology were 87% and 94%, respectively. Conclusion: Detailed neurological examination of the patients in the pediatric emergency department has a key role in determining the indications for CTB. Clinical follow-up should guide neuroradiological imaging in children with normal results of the neurological examination.
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Chew SY, Ang IWL, Lim DXY, Tan MQS, Wee ZY. Assessment of knowledge and perceptions of medical radiation among caregivers and adolescent patients in the paediatric emergency department. Singapore Med J 2020; 62:582-587. [PMID: 32349196 DOI: 10.11622/smedj.2020071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/18/2022]
Abstract
INTRODUCTION This study aimed to assess understanding of the potential risks associated with medical imaging among caregivers and adolescent patients in a paediatric emergency department (PED) in Singapore. METHODS A prospective convenience sample survey was performed involving adolescents and caregivers presenting to our PED from December 2015 to May 2016. The questionnaire examined demographic data, knowledge of imaging procedures and radiation risks, and expectations regarding information provided about medical radiation. RESULTS A total of 349 questionnaires were returned (caregivers 82.5%, adolescents 17.5%). A mean of 6.2 ± 2.4 (out of 11) questions were correctly answered. Those who had tertiary education fared better than those who did not (36.4% vs. 17.2% scoring above the mean, p = 0.001). Age, gender, history of previous imaging and imaging performed during the visit did not affect the score. Two-thirds of the participants did not associate medical radiation with any negative lifetime risk of cancers or know that different scans entailed differing amounts of radiation. Most were unaware that the radiation dose in medical imaging is adjusted to a child's size. Among patients who underwent imaging, 90.1% received explanations on the need for scans, and 26.5% were informed of the risks involved. Almost all participants wished to be informed of imaging indications and risks. More preferred to learn this from physicians (75.6%) or technicians (51.6%) rather than through educational pamphlets (34.4%) or Internet resources (22.9%). CONCLUSION Awareness regarding medical radiation needs to be improved in our patient population. A mismatch exists between caregiver expectations and the actual procedure of disclosure of the risk associated with radiation.
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Affiliation(s)
- Su Yah Chew
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Ivy Wei Ling Ang
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Desiree Xin Ying Lim
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Zi Ying Wee
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abstract
OBJECTIVE. The purposes of this study were to determine organ and effective doses and to estimate the risk of exposure-induced cancer death (REID) associated with coronary CT angiography (CCTA) examinations. SUBJECTS AND METHODS. CCTA examinations were performed in three stages: calcium score, monitoring, and cardiac phases for all patients. Effective dose was calculated using two methods. The first was based on the scanner-derived dose-length product, and the second entailed use of an organ and effective dose calculator software application. Organ doses were calculated on the basis of the tissue weighting factors of International Commission on Radiation Protection report 103. REID values were assessed with a cancer risk estimator software application. RESULTS. The study included 185 patients (95 men, 90 women). For women, breast doses were high at 52.04 ± 14.08 mGy. The mean effective dose in the women was greater than that in the men (24.05 vs 16.30 mSv, p < 0.05). The mean REID values in patients undergoing CCTA with a 64-MDCT scanner were 13.4 per 10,000 men (1 in 746) and 19.6 per 10,000 women (1 in 508). The REID values were considerably higher for the younger women. CONCLUSION. The results of this study will help referring physicians justify requesting CCTA examinations by considering their benefits for diagnosis on the one hand and awareness of the risk of radiation-induced cancer on the other. In the case of CCTA scans that are properly justified by clinical indication, patients and physicians should not be concerned about the radiation risks.
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Abstract
The USA Defense Threat Reduction Agency provided data in 2014 on the health status, including cancer, of the 4,843 sailors on the nuclear-powered United States Ship (USS) Ronald Reagan over the 2.55-year period from May 12, 2011 to Dec 31, 2013. Also provided were data on a matched control group of 65,269 US Navy personnel. Examination of the control population relative to the US national data gives a relative risk for all malignancies of RR = 9.2 (95% CI 8.48 < 9.2 < 9.96). The result suggests a significant cancer risk associated with serving on a nuclear-powered ship, one which is not predicted by the science underlying current radiation protection legislation.
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Affiliation(s)
- Christopher Busby
- Environmental Research SIA, 1117 Latvian Academy of Sciences, Riga, Latvia
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Alreshidi MN, Alshubrmi D, Alreshidi F, Soliman K, Alrashidi I. Knowledge about imaging modalities, risks, and protection in radiology among medical students at the University of Hail. Avicenna J Med 2020; 10:15-21. [PMID: 32110545 PMCID: PMC7015000 DOI: 10.4103/ajm.ajm_49_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim The aim of this study was to evaluate awareness and knowledge about radiation risks and safety principles among medical students at the College of Medicine, University of Hail, Hail, Saudi Arabia, in their clinical years. Materials and Methods In this cross-sectional study, an anonymous electronic questionnaire was sent to 174 randomly selected students in clinical years 4-6. The questionnaire contained 38 questions. The respondents' answers to these questions were used to classify them according to their demographic characteristics and to evaluate their knowledge about common imaging modalities, radiation risks, and safety measures. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 22. Results Seventy-five (51.7%) of 145 respondents were female and 70 (48.3%) were male. Fifty-five respondents (37.9%) were in year 4, 38 (26.2%) were in year 5, and 52 (35.9%) were in year 6. The mean score for knowledge about common imaging modalities was 4.10 ± 2.030 of 10, that for knowledge about the risks of radiation was 3.17 ± 1.954 (range, 0-8) of 13, and that for knowledge about radiation protection measures was low at 0.79 ± 0.922 (range, 0-4) of 8. Overall, there was an improvement in knowledge about the imaging modalities and the risks of radiation as the number of clinical years increased (P = 0.000), but it was still unsatisfactory. Conclusion The results of this study indicate that the medical students at the University of Hail have very limited knowledge about radiation risks and safety measures. These findings highlight the need for urgent action to improve students' knowledge of these topics.
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Affiliation(s)
| | - Dalal Alshubrmi
- College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Fayez Alreshidi
- Assistant professor, Department of Family and Community Medicine, College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Khaled Soliman
- Consultant medical Physicist, Medical Physics Department, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim Alrashidi
- Interventional Radiologist, Radiology, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
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Takahashi I, Cologne J, Haruta D, Yamada M, Takahashi T, Misumi M, Fujiwara S, Matsumoto M, Kihara Y, Hida A, Ohishi W. Association Between Prevalence of Peripheral Artery Disease and Radiation Exposure in the Atomic Bomb Survivors. J Am Heart Assoc 2019; 7:e008921. [PMID: 30486720 PMCID: PMC6405541 DOI: 10.1161/jaha.118.008921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Past reports suggested that total‐body irradiation at 0.5 to 1.0 Gy could be responsible for atherosclerosis. Peripheral artery disease (PAD) is a manifestation of systematic atherosclerosis. Whether the consequences of a low‐to‐moderate dose of radiation include increased risk of PAD remains to be determined. The purpose of this study was to examine the association between radiation exposure and prevalence of PAD among Japanese atomic bomb survivors. Methods and Results Radiation exposure from the atomic bombing was assessed in 3476 participants (41.1% men, mean age 74.8 years with SD 6.4 years) with a cross‐sectional survey in 2010 to 2014. Left‐ and right‐side ankle‐brachial indexes and upstroke time (UT) were obtained using oscillometric VP‐2000. PAD was defined as an ankle‐brachial index of 1.0 or less or a prior history related to revascularization. UT was considered a sensitive marker of early‐stage PAD. Association between radiation exposure and PAD or UT was assessed using multivariable regression analyses with adjustment for potential confounding factors. Of 3476 participants, 79 (2.3%) were identified as having prevalent PAD. Multivariate logistic regression analysis indicated that radiation dose was unrelated to PAD prevalence (odds ratio, 0.83; 95% confidence interval [0.57‐1.21]). UT appeared to increase with radiation dose, but the increase was not statistically significant (1.09 ms/Gy; 95% confidence interval [−0.17 to 2.36]). Conclusions We found no clear association of radiation dose with PAD, but it remains to be determined whether UT is associated with radiation dose.
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Affiliation(s)
- Ikuno Takahashi
- 1 Department of Clinical Studies Radiation Effects Research Foundation (RERF) Hiroshima Japan
| | - John Cologne
- 2 Department of Statistics Radiation Effects Research Foundation (RERF) Hiroshima Japan
| | - Daisuke Haruta
- 3 Department of Clinical Studies Radiation Effects Research Foundation (RERF) Nagasaki Japan
| | - Michiko Yamada
- 1 Department of Clinical Studies Radiation Effects Research Foundation (RERF) Hiroshima Japan
| | - Tetsuya Takahashi
- 4 Department of Clinical Neuroscience and Therapeutics Hiroshima University Hiroshima Japan
| | - Munechika Misumi
- 2 Department of Statistics Radiation Effects Research Foundation (RERF) Hiroshima Japan
| | - Saeko Fujiwara
- 1 Department of Clinical Studies Radiation Effects Research Foundation (RERF) Hiroshima Japan.,6 Hiroshima Atomic-bomb Casualty Council Hiroshima Japan
| | - Masayasu Matsumoto
- 4 Department of Clinical Neuroscience and Therapeutics Hiroshima University Hiroshima Japan.,7 Japan Community Health care Organization Hoshigaoka Medical Center Osaka Japan
| | - Yasuki Kihara
- 5 Department of Cardiovascular Medicine Hiroshima University Hiroshima Japan
| | - Ayumi Hida
- 3 Department of Clinical Studies Radiation Effects Research Foundation (RERF) Nagasaki Japan
| | - Waka Ohishi
- 1 Department of Clinical Studies Radiation Effects Research Foundation (RERF) Hiroshima Japan
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Fukunaga H, Yokoya A, Taki Y, Butterworth KT, Prise KM. Precision Radiotherapy and Radiation Risk Assessment: How Do We Overcome Radiogenomic Diversity? TOHOKU J EXP MED 2019; 247:223-235. [PMID: 30971620 DOI: 10.1620/tjem.247.223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/18/2022]
Abstract
Precision medicine is a rapidly developing area that aims to deliver targeted therapies based on individual patient characteristics. However, current radiation treatment is not yet personalized; consequently, there is a critical need for specific patient characteristics of both tumor and normal tissues to be fully incorporated into dose prescription. Furthermore, current risk assessment following environmental, occupational, or accidental exposures to radiation is based on population effects, and does not account for individual diversity underpinning radiosensitivity. The lack of personalized approaches in both radiotherapy and radiation risk assessment resulted in the current situation where a population-based model, effective dose, is being used. In this review article, to stimulate scientific discussion for precision medicine in both radiotherapy and radiation risk assessment, we propose a novel radiological concept and metric - the personalized dose and the personalized risk index - that incorporate individual physiological, lifestyle-related and genomic variations and radiosensitivity, outlining the potential clinical application for precision medicine. We also review on recent progress in both genomics and biobanking research, which is promising for providing novel insights into individual radiosensitivity, and for creating a novel conceptual framework of precision radiotherapy and radiation risk assessment.
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Affiliation(s)
- Hisanori Fukunaga
- Centre for Cancer Research and Cell Biology, Queen's University Belfast
| | - Akinari Yokoya
- Tokai Quantum Beam Science Center, National Institutes for Quantum and Radiological Science and Technology
| | - Yasuyuki Taki
- Institute of Development, Aging and Cancer, Tohoku University
| | | | - Kevin M Prise
- Centre for Cancer Research and Cell Biology, Queen's University Belfast
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Sugiyama H, Misumi M, Brenner A, Grant EJ, Sakata R, Sadakane A, Utada M, Preston DL, Mabuchi K, Ozasa K. Radiation risk of incident colorectal cancer by anatomical site among atomic bomb survivors: 1958-2009. Int J Cancer 2019; 146:635-645. [PMID: 30873589 PMCID: PMC6916284 DOI: 10.1002/ijc.32275] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/14/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022]
Abstract
Radiation effects on colorectal cancer rates, adjusted for smoking, alcohol intake and frequency of meat consumption and body mass index (BMI) by anatomical subsite (proximal colon, distal colon and rectum) were examined in a cohort of 105,444 atomic bomb survivors. Poisson regression methods were used to describe radiation‐associated excess relative risks (ERR) and excess absolute rates (EAR) for the 1958–2009 period. There were 2,960 first primary colorectal cancers including 894 proximal, 871 distal and 1,046 rectal cancers. Smoking, alcohol intake and BMI were associated with subsite‐specific cancer background rates. Significant linear dose–responses were found for total colon (sex‐averaged ERR/Gy for 70 years old exposed at age 30 = 0.63, 95% confidence interval [CI]: 0.34; 0.98), proximal [ERR = 0.80, 95% CI: 0.32; 1.44] and distal colon cancers [ERR = 0.50, 95% CI: 0.04; 0.97], but not for rectal cancer [ERR = 0.023, 95% CI: −0.081; 0.13]. The ERRs for proximal and distal colon cancers were not significantly different (p = 0.41). The ERR decreased with attained age for total colon, but not for proximal colon cancer, and with calendar year for distal colon cancer. The ERRs and EARs did not vary by age at exposure, except for decreasing trend in EAR for proximal colon cancer. In conclusion, ionizing radiation is associated with increased risk of proximal and distal colon cancers. The ERR for proximal cancer persists over time, but that for distal colon cancer decreases. There continues to be no indication of radiation effects on rectal cancer incidence in this population. What's new? Increasing radiation dose is associated with elevated colon cancer incidence among atomic bomb survivors. Questions remain, however, about differences in radiation‐related increases in risk by anatomical subsite, particularly the proximal and distal colon and the rectum. In this study, analyses of radiation and colorectal cancer risk for Japanese atomic bomb survivors in the Life Span Study cohort show that ionizing radiation is associated specifically with elevated risk of proximal and distal colon cancers. Adjustment for body mass index and lifestyle factors had little effect on radiation risk estimates. No association was found between radiation exposure and rectal cancer.
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Affiliation(s)
- Hiromi Sugiyama
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Munechika Misumi
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Alina Brenner
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Eric J Grant
- Radiation Effects Research Foundation, Hiroshima, Japan
| | - Ritsu Sakata
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Atsuko Sadakane
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Mai Utada
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | | | - Kiyohiko Mabuchi
- Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, National Cancer Institute, Rockville, MD, USA
| | - Kotaro Ozasa
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
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Abstract
Every day, health physicists and physicians are expected to communicate effectively with concerned people, but rarely (if ever) are they given training on how to effectively communicate. In an age of social media, this paper presents the relevance of teachings from an ancient Greek philosopher. Aristotle's Rhetoric is still considered one of the most influential works on persuasive messaging. He puts the onus of effective communications on the people with the "true" and "just" information to communicate that information clearly to the audience. By communicating with intention-using the persuasive appeals of ethos, pathos, logos, and storytelling-radiation professionals can speak to their expertise in radiation science, while adapting their instructions, presentations, and communication styles to meet the needs of each type of audience: from scientists to concerned citizens, from doctors to first responders, and beyond.
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Abstract
Background Fluoroscopic guidance is routinely utilized during hip arthroscopic surgery. Previous studies have shown that the C-arm orientation can significantly affect radiation exposure for both the surgeon and the patient during orthopaedic procedures. However, this has not been previously assessed for hip arthroscopic surgery. Hypothesis Using an inverted C-arm during hip arthroscopic surgery will reduce radiation exposure to the patient and surgeon. Study Design Descriptive laboratory study. Methods A simulation study measured scatter radiation during hip arthroscopic surgery performed in the supine position under fluoroscopic guidance with an anthropomorphic pelvic phantom on a radiolucent operating table. Radiation exposure tested 2 different C-arm orientations: standard and inverted. Testing was performed at 6 locations corresponding to the patient, surgeon's neck, surgeon's waist, surgical technician, anesthesiologist, and radiology technician. Statistical analysis was performed using univariate and multivariate analyses assessing radiation exposure between the C-arm orientations. A risk calculation for carcinogenesis was performed based on reported radiation dosages. Results Radiation exposure (in mGy/min) was more than 100-fold higher for the patient compared with the surgeon in both C-arm orientations. The inverted C-arm orientation resulted in a 2.48-fold decrease in patient radiation exposure when compared with the standard orientation (10.8 mGy/min vs 26.8 mGy/min, respectively). There was a small but significant increase in surgeon radiation exposure in the inverted orientation compared with the standard orientation (0.072 vs 0.067 mGy/min, respectively). The patient's carcinogenesis risk was decreased 2.64-fold with the inverted orientation compared with the standard orientation (1.4 × 10-5 vs 3.7 × 10-5, respectively). Conclusion The inverted C-arm orientation resulted in a 2.48-fold decrease in patient radiation exposure with a 2.64-fold decrease in the carcinogenesis risk compared with the standard orientation. Inadvertently, the inverted orientation provided a 9-cm increase in the surgeon's working area. Our data supported the clinical utilization of the inverted C-arm orientation during hip arthroscopic surgery to minimize patient radiation exposure. Although there was a minimal but significant increase in surgeon radiation exposure with the inverted orientation, we believe that this is negligible when incorporated with standard leaded protective equipment as contrasted with the significant dose reduction for the patient as well as the decreased risk of carcinogenesis and hereditary disorders. Clinical Relevance Patients undergoing hip arthroscopic surgery routinely acquire radiation exposure during the use of the C-arm. Measures to minimize radiation via the inverted C-arm orientation will decrease the unnecessary risk to the patient while continuing to allow for optimal treatment.
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Affiliation(s)
- Nischal Nadig
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | | | - Edward Mottern
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - John Bojescul
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Terry Mueller
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
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Hirshfeld JW, Ferrari VA, Bengel FM, Bergersen L, Chambers CE, Einstein AJ, Eisenberg MJ, Fogel MA, Gerber TC, Haines DE, Laskey WK, Limacher MC, Nichols KJ, Pryma DA, Raff GL, Rubin GD, Smith D, Stillman AE, Thomas SA, Tsai TT, Wagner LK, Samuel Wann L, Januzzi JL, Afonso LC, Everett B, Hernandez AF, Hucker W, Jneid H, Kumbhani D, Edward Marine J, Morris PB, Piana RN, Watson KE, Wiggins BS. 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging-Best Practices for Safety and Effectiveness, Part 1: Radiation Physics and Radiation Biology: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways Developed in Collaboration With Mended Hearts. Catheter Cardiovasc Interv 2018; 92:203-221. [PMID: 30160013 DOI: 10.1002/ccd.27660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The stimulus to create this document was the recognition that ionizing radiation-guided cardiovascular procedures are being performed with increasing frequency, leading to greater patient radiation exposure and, potentially, to greater exposure for clinical personnel. Although the clinical benefit of these procedures is substantial, there is concern about the implications of medical radiation exposure. The American College of Cardiology leadership concluded that it is important to provide practitioners with an educational resource that assembles and interprets the current radiation knowledge base relevant to cardiovascular procedures. By applying this knowledge base, cardiovascular practitioners will be able to select procedures optimally, and minimize radiation exposure to patients and to clinical personnel. Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness is a comprehensive overview of ionizing radiation use in cardiovascular procedures and is published online. To provide the most value to our members, we divided the print version of this document into 2 focused parts. Part I: Radiation Physics and Radiation Biology addresses the issue of medical radiation exposure, the basics of radiation physics and dosimetry, and the basics of radiation biology and radiation-induced adverse effects. Part II: Radiological Equipment Operation, Dose-Sparing Methodologies, Patient and Medical Personnel Protection covers the basics of operation and radiation delivery for the 3 cardiovascular imaging modalities (x-ray fluoroscopy, x-ray computed tomography, and nuclear scintigraphy) and will be published in the next issue of the Journal.
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Kocher DC, Apostoaei AI, Hoffman FO, Trabalka JR. Probability Distribution of Dose and Dose-Rate Effectiveness Factor for use in Estimating Risks of Solid Cancers From Exposure to Low-Let Radiation. Health Phys 2018; 114:602-622. [PMID: 29697512 PMCID: PMC5922807 DOI: 10.1097/hp.0000000000000838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Indexed: 05/17/2023]
Abstract
This paper presents an analysis to develop a subjective state-of-knowledge probability distribution of a dose and dose-rate effectiveness factor for use in estimating risks of solid cancers from exposure to low linear energy transfer radiation (photons or electrons) whenever linear dose responses from acute and chronic exposure are assumed. A dose and dose-rate effectiveness factor represents an assumption that the risk of a solid cancer per Gy at low acute doses or low dose rates of low linear energy transfer radiation, RL, differs from the risk per Gy at higher acute doses, RH; RL is estimated as RH divided by a dose and dose-rate effectiveness factor, where RH is estimated from analyses of dose responses in Japanese atomic-bomb survivors. A probability distribution to represent uncertainty in a dose and dose-rate effectiveness factor for solid cancers was developed from analyses of epidemiologic data on risks of incidence or mortality from all solid cancers as a group or all cancers excluding leukemias, including (1) analyses of possible nonlinearities in dose responses in atomic-bomb survivors, which give estimates of a low-dose effectiveness factor, and (2) comparisons of risks in radiation workers or members of the public from chronic exposure to low linear energy transfer radiation at low dose rates with risks in atomic-bomb survivors, which give estimates of a dose-rate effectiveness factor. Probability distributions of uncertain low-dose effectiveness factors and dose-rate effectiveness factors for solid cancer incidence and mortality were combined using assumptions about the relative weight that should be assigned to each estimate to represent its relevance to estimation of a dose and dose-rate effectiveness factor. The probability distribution of a dose and dose-rate effectiveness factor for solid cancers developed in this study has a median (50th percentile) and 90% subjective confidence interval of 1.3 (0.47, 3.6). The harmonic mean is 1.1, which implies that the arithmetic mean of an uncertain estimate of the risk of a solid cancer per Gy at low acute doses or low dose rates of low linear energy transfer radiation is only about 10% less than the mean risk per Gy at higher acute doses. Data were also evaluated to define a low acute dose or low dose rate of low linear energy transfer radiation, i.e., a dose or dose rate below which a dose and dose-rate effectiveness factor should be applied in estimating risks of solid cancers.
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Affiliation(s)
- David C Kocher
- *Oak Ridge Center for Risk Analysis, Inc., 102 Donner Drive, Oak Ridge, TN 37830; †Deceased
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Hirshfeld JW, Ferrari VA, Bengel FM, Bergersen L, Chambers CE, Einstein AJ, Eisenberg MJ, Fogel MA, Gerber TC, Haines DE, Laskey WK, Limacher MC, Nichols KJ, Pryma DA, Raff GL, Rubin GD, Smith D, Stillman AE, Thomas SA, Tsai TT, Wagner LK, Wann LS. 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging-Best Practices for Safety and Effectiveness, Part 1: Radiation Physics and Radiation Biology: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2018; 71:2811-2828. [PMID: 29729876 DOI: 10.1016/j.jacc.2018.02.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Hirshfeld JW, Ferrari VA, Bengel FM, Bergersen L, Chambers CE, Einstein AJ, Eisenberg MJ, Fogel MA, Gerber TC, Haines DE, Laskey WK, Limacher MC, Nichols KJ, Pryma DA, Raff GL, Rubin GD, Smith D, Stillman AE, Thomas SA, Tsai TT, Wagner LK, Wann LS. 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2018; 71:e283-e351. [PMID: 29729877 DOI: 10.1016/j.jacc.2018.02.016] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Rühm W, Azizova T, Bouffler S, Cullings HM, Grosche B, Little MP, Shore RS, Walsh L, Woloschak GE. Typical doses and dose rates in studies pertinent to radiation risk inference at low doses and low dose rates. J Radiat Res 2018; 59:ii1-ii10. [PMID: 29432579 PMCID: PMC5941142 DOI: 10.1093/jrr/rrx093] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 07/25/2017] [Revised: 09/06/2017] [Accepted: 02/05/2018] [Indexed: 05/20/2023]
Abstract
In order to quantify radiation risks at exposure scenarios relevant for radiation protection, often extrapolation of data obtained at high doses and high dose rates down to low doses and low dose rates is needed. Task Group TG91 on 'Radiation Risk Inference at Low-dose and Low-dose Rate Exposure for Radiological Protection Purposes' of the International Commission on Radiological Protection is currently reviewing the relevant cellular, animal and human studies that could be used for that purpose. This paper provides an overview of dose rates and doses typically used or present in those studies, and compares them with doses and dose rates typical of those received by the A-bomb survivors in Japan.
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Affiliation(s)
- Werner Rühm
- Institute of Radiation Protection, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Tamara Azizova
- Southern Urals Biophysics Institute (SUBI), Ozyorskoe Shosse 19, 456780, Ozyorsk, Chelyabinsk Region, Russian Federation
| | - Simon Bouffler
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England (PHE), Chilton, Didcot OX11 ORQ, UK
| | - Harry M Cullings
- Radiation Effects Research Foundation, 5–2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Bernd Grosche
- Federal Office for Radiation Protection, Ingolstädter Landstr. 1, 85764 Oberschleißheim, Germany
| | - Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892-9778, USA
| | - Roy S Shore
- New York University School of Medicine, 650 First Ave., New York, NY 10016, USA
| | - Linda Walsh
- Medical Physics Group, Department of Physics, Science Faculty, University of Zürich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland
| | - Gayle E Woloschak
- Departments of Radiation Oncology, Radiology, and Cell and Molecular Biology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, 300 E. Superior St., Tarry 4-760, Chicago, IL 60611, USA
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Sato A, Lyamzina Y. Diversity of Concerns in Recovery after a Nuclear Accident: A Perspective from Fukushima. Int J Environ Res Public Health 2018; 15:E350. [PMID: 29462905 PMCID: PMC5858419 DOI: 10.3390/ijerph15020350] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 11/16/2022]
Abstract
Since the 2011 Fukushima nuclear accident, tremendous resources have been devoted to recovery, and the Japanese Government is gradually lifting evacuation orders. However, public concerns remain prevalent, affecting some people's return to a normal life and threatening their well-being. This study reviews government reports, academic papers, newspaper articles and conference presentations with the aim of obtaining a better understanding of issues which relate to radiation concerns in the recovery process in the aftermath of the accident. It looks extensively at: (1) the current status of the post-accident operations and existing radiation issues in Fukushima, and (2) approaches taken to engage the public during recovery from five previous comparable nuclear and radiological events: Three Mile Island, Buenos Aires (RA-2 facility), Chernobyl, Goiânia and Tokai-mura. The findings indicate that the limitations and emerging challenges of the current recovery operations cause concerns about radiation exposure in various aspects of day-to-day life. Past experiences suggest that long-term management that take a holistic and cohesive approach is critical for restoration of sustainable livelihoods and for social re-integration. Not only actual risks but also public perceptions of risks should be carefully assessed and addressed in the process of environmental remediation.
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Affiliation(s)
- Akiko Sato
- United Nations University Institute for the Advanced Study of Sustainability, Tokyo 150-8925, Japan.
| | - Yuliya Lyamzina
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan.
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Abstract
The Global Solar UV Index was developed as an easy-to-understand measure of the amount of biologically-effective ambient solar ultraviolet radiation (UVR) at different locations on the earth's surface. Over the past few years, questions have been raised about the global applicability of the UV Index, about the evidence base for exposure risk thresholds and related protective measures, and about whether the overall impact of the UV Index could be improved with modifications. An international workshop was organized by several organizations, including the World Health Organization, to assess if current evidence was sufficiently strong to modify the UV Index and to discuss different ways it might be improved in order to influence sun-protective behavior. While some animal research suggests there may be no threshold effect, the relative importance of sub-erythemal doses of sunlight in causing skin cancer in humans remains unknown. Evidence suggests that regular use of sunscreen can prevent skin cancer and that sunglasses are an effective method of protecting the eyes from solar UVR. The UV Index as a risk communication tool continues to be useful for raising awareness and to support sun-protection behavior. Although there was agreement that guidance on the use of the UV Index could be improved, the workshop participants identified that strong health outcome-based human evidence would be needed as the basis for a revision. For the UV Index to be relevant in as many countries as possible, it should continue to be adapted to suit local conditions.
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Affiliation(s)
- Peter Gies
- *Australian Radiation Protection and Nuclear Safety Agency, 619 Lower Plenty Road, Yallambie, Victoria, Australia; †Radiation Programme, Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland; ‡International Commission on Non-Ionizing Radiation Protection, 85764 Oberschleissheim, Germany; QIMR Berghofer Medical Research Institute 300 Herston Road, Herston, Queensland, Australia and CRUK Manchester Institute, University of Manchester, Wilmslow Road, Manchester, UK; §Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, Australia
| | - Emilie van Deventer
- *Australian Radiation Protection and Nuclear Safety Agency, 619 Lower Plenty Road, Yallambie, Victoria, Australia; †Radiation Programme, Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland; ‡International Commission on Non-Ionizing Radiation Protection, 85764 Oberschleissheim, Germany; QIMR Berghofer Medical Research Institute 300 Herston Road, Herston, Queensland, Australia and CRUK Manchester Institute, University of Manchester, Wilmslow Road, Manchester, UK; §Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, Australia
| | - Adèle C. Green
- *Australian Radiation Protection and Nuclear Safety Agency, 619 Lower Plenty Road, Yallambie, Victoria, Australia; †Radiation Programme, Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland; ‡International Commission on Non-Ionizing Radiation Protection, 85764 Oberschleissheim, Germany; QIMR Berghofer Medical Research Institute 300 Herston Road, Herston, Queensland, Australia and CRUK Manchester Institute, University of Manchester, Wilmslow Road, Manchester, UK; §Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, Australia
| | - Craig Sinclair
- *Australian Radiation Protection and Nuclear Safety Agency, 619 Lower Plenty Road, Yallambie, Victoria, Australia; †Radiation Programme, Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland; ‡International Commission on Non-Ionizing Radiation Protection, 85764 Oberschleissheim, Germany; QIMR Berghofer Medical Research Institute 300 Herston Road, Herston, Queensland, Australia and CRUK Manchester Institute, University of Manchester, Wilmslow Road, Manchester, UK; §Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, Australia
| | - Rick Tinker
- *Australian Radiation Protection and Nuclear Safety Agency, 619 Lower Plenty Road, Yallambie, Victoria, Australia; †Radiation Programme, Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland; ‡International Commission on Non-Ionizing Radiation Protection, 85764 Oberschleissheim, Germany; QIMR Berghofer Medical Research Institute 300 Herston Road, Herston, Queensland, Australia and CRUK Manchester Institute, University of Manchester, Wilmslow Road, Manchester, UK; §Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, Australia
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Abstract
OBJECTIVE Recent articles discussing cases of brain cancer in interventionalists have raised concerns regarding the hazards of occupational exposure to ionizing radiation. We review the basics of radiation dose and the potential radiation effects, particularly as they pertain to the operator. Then we present the data regarding the risk of each type of radiation effect to the fluoroscopy operator and staff, with special attention on cancer induction, radiation-induced cataracts, and the pregnant operator. CONCLUSION Although the evidence overwhelmingly shows that exposure to higher doses of radiation carries a risk of cancer and tissue reactions, the risks of chronic exposure to low-level radiation are less clear. Many studies examining occupational exposure to radiation fail to show an increased risk of stochastic effects of radiation, but the positive results raise concern that the studies are underpowered to consistently detect the small risk. The lack of information in these studies about radiation doses and adherence to radiation protection further confound their interpretation. Large prospective studies of populations with occupational exposure to low-level radiation might clarify this issue. More clearly established are the risks of radiation to the fetus and the risk of cataracts in interventional cardiologists and interventional radiologists. Interventionalists can mitigate these risks by following established radiation safety practices.
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Donnellan E, Masri A, Johnston DR, Pettersson GB, Rodriguez LL, Popovic ZB, Roselli EE, Smedira NG, Svensson LG, Griffin BP, Desai MY. Long-Term Outcomes of Patients With Mediastinal Radiation-Associated Severe Aortic Stenosis and Subsequent Surgical Aortic Valve Replacement: A Matched Cohort Study. J Am Heart Assoc 2017; 6:JAHA.116.005396. [PMID: 28476874 PMCID: PMC5524090 DOI: 10.1161/jaha.116.005396] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Cardiac disease after mediastinal radiotherapy for thoracic malignancy (chest radiotherapy [XRT]) often manifests as progressive aortic stenosis. In patients with XRT‐induced severe aortic stenosis undergoing surgical aortic valve replacement (SAVR), we sought to: (1) study long‐term survival and compare these patients with a matched cohort undergoing SAVR during the same time frame; and (2) identify potential predictors of long‐term mortality. Methods and Results We studied patients with symptomatic severe aortic stenosis undergoing SAVR at our institution, of which there were 172 mediastinal XRT patients (63±13 years, 62% women) matched in a 1:1 fashion (based on age, sex, time of surgery, and aortic valve area) with 172 non‐XRT patients (comparison group). Baseline clinical and postoperative data were obtained. Society of Thoracic Surgeons score was calculated and mortality was recorded. In the XRT group, the median Society of Thoracic Surgeons score was 4% (interquartile range 2–13), while mean left ventricular ejection fraction, left ventricular stroke volume index, and mean aortic valve gradient were 54±11%, 38±14 mL/m2, and 39±11 mm Hg, respectively. In the entire cohort, 27% and 34% of patients underwent concomitant coronary artery bypass grafting and aortic surgery at the time of SAVR, respectively. Thirty‐day/in‐hospital deaths occurred in 4 (2%) patients in the XRT group and 0 patients in the comparison group. At 6±3 years of follow‐up, on matched group analysis, there were 95 (28%) deaths (83 [48%] in the XRT group versus 12 [7%] in the comparison group (log‐rank 89, P<0.001). On multivariable Cox survival analysis, in the whole cohort, higher Society of Thoracic Surgeons score (hazard ratio, 1.14; 95% CI, 1.03–1.26) and mediastinal XRT (hazard ratio, 8.12; 95% CI, 4.26–15.64) were associated with increased longer‐term mortality (both P<0.01). Conclusions In patients with severe aortic stenosis undergoing SAVR, patients with prior mediastinal XRT have significantly worse longer‐term survival versus a matched cohort.
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Affiliation(s)
- Eoin Donnellan
- Centers for Radiation Heart Disease and Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Ahmad Masri
- Centers for Radiation Heart Disease and Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Douglas R Johnston
- Centers for Radiation Heart Disease and Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Gosta B Pettersson
- Centers for Radiation Heart Disease and Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - L Leonardo Rodriguez
- Centers for Radiation Heart Disease and Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Zoran B Popovic
- Centers for Radiation Heart Disease and Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Eric E Roselli
- Centers for Radiation Heart Disease and Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Nicholas G Smedira
- Centers for Radiation Heart Disease and Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Lars G Svensson
- Centers for Radiation Heart Disease and Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Brian P Griffin
- Centers for Radiation Heart Disease and Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Milind Y Desai
- Centers for Radiation Heart Disease and Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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