As Low As Reasonably Achievable Research Articles

OPTIMIZATION OF RADIATION PROTECTION IN PATIENTS THROUGH IMPLEMENTATION OF LOCAL DIAGNOSTIC REFERENCE LEVEL (DRL) IN PANORAMIC DENTAL EXAMINATION IN RADIOLOGY INSTALLATION OF PROF. DR. MARGONO SOEKARJO HOSPITAL

One of the principles of radiation protection is optimization. Optimization is done to make the dose received as low as reasonably achievable (ALARA) by considering economic and social factors. Implementation of radiation protection optimization can be done with dose management through the Local Diagnostic Reference Level (DRL). In recent years, the Nuclear Energy Regulatory Agency (BAPETEN) has set the Indonesian DRL value for several X-ray modalities, including dental panoramic. This study was motivated by panoramic patient dose audit data using the auto mode exposure factor, which operators often use. The method for determining the manual mode exposure factor is carried out by comparing the image quality of the current variations of 6.3 mA, 8 mA, 10 mA, 13 mA, and 16 mA with a fixed voltage of 66 kV and a time of 14.1 seconds. The local DRL value was obtained by comparing the dental panoramic auto mode measurements with manual mode using certain exposure factors according to the recommendations in the initial study using a head phantom. This study used 100 patient data with adult human criteria aged over 15. The results obtained from the initial study and questionnaires in manual mode were the values that had the highest CNR and SNR at a current variation of 10 mA. The exposure factor was then used to collect patient data. The local DRL value obtained for auto mode was 83.35 mGy cm2; in manual mode, it was 57.7 mGy cm2. Manual mode exposure factors in dental panoramic examinations affected the implementation of local DRL values with a decrease of 30.77% from auto mode. The use of manual mode in dental panoramic examinations significantly reduces the radiation dose received by patients, so the use of manual mode is one of the steps to optimize radiation protection. Keywords: Diagnostic Reference Level (DRL), optimization of radiation protection in patients, dental panoramic.

Assessing the Reliability of Postoperative Cross-Table Radiographs Compared to CT Scans for Measuring Acetabular Anteversion Angle Following Total Hip Arthroplasty.

This study aimed to evaluate acetabular anteversion following total hip arthroplasty (THA) using cross-table lateral radiographs and CT scans and to determine the reliability of cross-table lateral radiographs compared to computed tomography (CT) scans for measuring acetabular anteversion. We conducted a cross-sectional study of patients undergoing THA at Justice K.S. Hegde Charitable Hospital, Deralakatte, Mangalore, from January 2020 to June 2021. Radiographs are typically taken in both anteroposterior (AP) and lateral views after THA. However, for this study, a cross-table lateral view was used instead of the usual lateral radiograph to measure the angle of anteversion. The anteversion was calculated using the method described by Woo and Morrey. Additionally, CT scans were performed on all patients as part of the study protocol. The anteversion measured in these scans was compared to that in the cross-table radiographs to assess the latter's reliability for routine use. The risk of radiation exposure from CT scans was minimized by adhering to the ALARA (As Low as Reasonably Achievable) principle, with only axial sections of the acetabular cup being scanned. The results show that the radiographic acetabular anteversion and CT scan measurements have a mean difference of 0.3036. There is a positive correlation between these measurements. The p-value is not statistically significant (p=0.698). Therefore, the measurements are correlated with each other with a linear relationship (r=0.919). For anteversion measurements using the X-ray method, the mean was 27.16 degrees with a standard deviation of ±9.49. The median was 27.26 degrees, ranging from 10.27 to 42.58 degrees. In comparison, the CT method yielded a mean anteversion of 27.40 degrees with a standard deviation of ±8.50 degrees. The median was 27.64 degrees, ranging from 12.35 to 43.11 degrees. Cross-table lateral radiographs are a reliable and comparable method to CT scans for measuring acetabular anteversion following total hip arthroplasty.

Radiation Protection and Radiobiology

This study provides a comprehensive overview of the principles of radiation protection and radiobiology. It defines and classifies radiation, distinguishing between ionizing and non-ionizing radiation. The biological effects of radiation, with a particular emphasis on its impact on DNA and cellular structures, are examined in detail. The text specifies radiation-sensitive and radiation-resistant tissues and explains both deterministic and stochastic effects. Additionally, the discussion encompasses radioepidemiological information and the relationship between linear energy transfer and DNA damage. The article delineates the classification of radiation areas as either controlled or supervised. It offers an extensive overview of the safety and protection methods employed in radiation work, including the ALARA (As Low As Reasonably Achievable) principle, the use of personal protective equipment, and dosimeters. Furthermore, it explains the radiation protection methods utilized in radiology units and outlines the precautions that should be taken during pregnancy. The article also presents recommendations for reducing radiation exposure. Overall, this article serves as a valuable resource on radiation safety for radiation workers and the public, containing essential information on protection from the harmful effects of radiation and safe working practices.

Monte Carlo simulation analysis of radiation attenuation properties induced by arsenic accumulation in femur and tibia bones of rats exposed to sodium arsenite diet

PurposeThe study aims to investigate the effect of sodium arsenite (NaAsO2) on radiation permeability in biological tissues of rats, challenging existing literature claims about NaAsO2's influence on the density of bones. The motivation is determining whether exposure alters radiation permeability within a defined range of radiological energy. Should any changes be observed, radiation protection guidelines may necessitate the use of lower energy levels in imaging procedures involving such exposure. This consideration is vital for ensuring adherence to radiation safety standards, particularly in medical imaging, where minimizing patient and operator exposure to radiation is paramount. Materials and methodsIn this study, rats were divided into two groups: a control group and a NaAsO2-treated group. After the treatment period, these animals were euthanized to collect their femurs and tibias for further analysis. The elemental composition of these bones was then meticulously examined using Scanning Electron Microscopy (SEM), enhanced by Energy-dispersive X-ray Spectrometry (EDX). Monte Carlo Simulation codes of MCNP6 and PHITS 3.22 were used for investigate photon induced interactions. These powerful tools allowed us to assess the gamma-ray attenuation properties of the collected samples. For an accurate comparison and analysis, we referred to the NIST database using the WinXCom program. Furthermore, the study explored the effects of charged particles on the bone samples, employing the SRIM code for this purpose. This part of the research was crucial to understanding the interactions at a more detailed level. We calculated the photon attenuation parameters for radiological energies up to 0.5 MeV and also investigated the interactions of charged particles with energies as high as 15 MeV. ResultsIn groups treated with NaAsO2, while there is less reduction in mass attenuation coefficients, larger differences have been observed in linear attenuation coefficients. Notably, a decrease in the linear attenuation coefficient has been observed in the NaAs Tibia group. ConclusionThe application of sodium arsenite (NaAsO2) results in a reduction in the Linear Attenuation Coefficient, necessitating a detailed investigation to determine whether this decrease also affects the Hounsfield unit, in accordance with the ALARA (As Low As Reasonably Achievable) principle that guides radiation safety protocols.

In Vivo Demonstration of a Real-Time Temporal SNR Acoustic Output Adjustment Method.

This work proposes a novel method of temporal signal-to-noise ratio (SNR)-guided adaptive acoustic output adjustment and demonstrates this approach during in vivo fetal imaging. Acoustic output adjustment is currently the responsibility of sonographers, but ultrasound safety studies show recommended as low as reasonably achievable (ALARA) practices are inconsistently followed. This study explores an automated ALARA method that adjusts the mechanical index (MI) output, targeting imaging conditions matching the temporal noise perception threshold. A 28-dB threshold SNR is used as the target SNR, following prior work showing relevant noise quantities are imperceptible once this image data quality level is reached. After implementing adaptive output adjustment on a clinical system, the average MI required to achieve 28-dB SNR in an 11-volunteer fetal abdomen imaging test ranged from 0.17 to 0.26. The higher MI levels were required when imaging at higher frequencies. During tests with 20-s MI adjustment imaging periods, the degree of motion impacted the adaptive performance. For stationary imaging views, target SNR levels were maintained in 90% of SNR evaluations. When scanning between targets the imaging conditions were more variable, but the target SNR was still maintained in 71% of the evaluations. Given the relatively low MI recommended when performing MI adjustment and the successful adjustment of MI in response to changing imaging conditions, these results encourage adoption of adaptive acoustic output approaches guided by temporal SNR.

An Estimation of the Monetary Value of the Person-Sievert Useful for Occupational Radiological Protection within the Healthcare System of Sweden.

The As Low As Reasonably Achievable (ALARA) principle includes taking into account economic and societal factors. To consider these factors, decision-aiding techniques such as cost-benefit analysis were introduced by the International Commission on Radiological Protection (ICRP) 50 y ago. Over the years, developments in health economics have led to new ways of deriving the concept of a value of a statistical life (VSL), which now is influencing the monetary value assigned to a unit of collective dose for radiological protection purposes (the α value) used in cost-benefit analyses. The aim of the present study was to estimate an α value useful for occupational radiological protection within the healthcare system of Sweden. A survey based on the stated preference approach was developed and sent to staff who are exposed to ionizing radiation at their work in Region Västra Götaland (Sweden). The survey essentially contained two scenarios: the respondents' willingness to pay for measures against radon exposure at home and their willingness to accept compensation for x-ray exposure at work. Answers from 718 respondents were collected. In the sensitivity analysis of the survey, the overall median VSL based on the two scenarios was calculated to be $50 million (IQR $10 to 363 million). The corresponding α value was established to $1,600 person-mSv -1 ($2,100 person-mSv -1 if excess burden of taxes is excluded). The recommended α value is in the high end compared to other studies but within the interval of values being used by nuclear utilities today. The α value should be seen in the light of ICRP's recommendation about stakeholder involvement as an important part of the optimization process.

Commissioning of the first hospital-based PET radiopharmaceutical cyclotron in Greece: personnel dose assessment

The role of 18F–fluoro–deoxy–glucose in positron emission tomography (PET) imaging is well established in diagnosis and management of cancer patients. Installations of on-site self-shielded mini cyclotrons are increasing. The Dose on Demand Biomarker Generator BG-75 was installed at Metaxa Cancer Hospital, Greece, in May 2021 and is the first hospital-based PET radiopharmaceutical cyclotron in the country. Personnel expected external exposure was established during commissioning; internal exposure is not expected. Personnel dose was estimated with two methods: survey meter measurements in various locations combined with the time spent in each location, and direct measurement using electronic personal dosemeters. Gamma and neutron radiation readings outside the cyclotron vault were at background levels. Inside the cyclotron vault, the highest recorded radiation readings by the target were 18 μSv h−1 for both gammas and neutrons with cyclotron in operational mode; at one meter, the values were 5 μSv h−1 and 4 μSv h−1, respectively. The annual expected whole body dose per cyclotron operator is 0.6 mSv, and the respective extremity dose 16 mSv. The annual expected whole body and extremity dose for the radiochemist is 0.3 mSv and 25 mSv, respectively. The respective annual dose estimates for the medical physicists are < 1 mSv. The expected personnel doses are well below the regulatory limits and local as low as reasonably achievable (ALARA) levels. With experience and a robust ALARA program, personnel exposure could be further reduced.

Protocol optimization for functional cardiac CT imaging using noise emulation in the raw data domain.

Four-dimensional (4D) wide coverage computed tomography (CT) is an effective imaging modality for measuring the mechanical function of the myocardium. However, repeated CT measurement across a number of heartbeats is still a concern. A projection-domain noise emulation method is presented to generate accurate low-dose (mA modulated) 4D cardiac CT scans from high-dose scans, enabling protocol optimization to deliver sufficient image quality for functional cardiac analysis while using a dose level that is as low as reasonably achievable (ALARA). Given a targeted low-dose mA modulation curve, the proposed noise emulation method injects both quantum and electronic noise of proper magnitude and correlation to the high-dose data in projection domain. A spatially varying (i.e., channel-dependent) detector gain term as well as its calibration method were proposed to further improve the noise emulation accuracy. To determine the ALARA dose threshold, a straightforward projection domain image quality (IQ) metric was proposed that is based on the number of projection rays that do not fall under the non-linear region of the detector response. Experiments were performed to validate the noise emulation method with both phantom and clinical data in terms of visual similarity, contrast-to-noise ratio (CNR), and noise-power spectrum (NPS). For both phantom and clinical data, the low-dose emulated images exhibited similar noise magnitude (CNR difference within 2%), artifacts, and texture to that of the real low-dose images. The proposed channel-dependent detector gain term resulted in additional increase in emulation accuracy. Using the proposed IQ metric, recommended kVp and mA settings were calculated for low dose 4D Cardiac CT acquisitions for patients of different sizes. A detailed method to estimate system-dependent parameters for a raw-data based low dose emulation framework was described. The method produced realistic noise levels, artifacts, and texture with phantom and clinical studies. The proposed low-dose emulation method can be used to prospectively select patient-specific minimal-dose protocols for functional cardiac CT.

Synthesis of the European ALARA network 20th workshop ‘ALARA for interventional radiology and nuclear medicine’

The European as low as reasonably achievable(ALARA) network regularly organises workshops on topical issues in radiation protection (RP). The topic of the 20th workshop was: ‘ALARA for interventional radiology (IR) and nuclear medicine (NM)’. The objective was to examine the challenges faced when applying the optimisation principle (ALARA) in IR and NM and to consider how ALARA could be better implemented for patient and staff exposures. This memorandum provides a synthesis of the workshop sessions, and recommendations coming from the working groups discussion. Parallels are drawn with the recommendations arising from the 13th EAN workshop on ‘ALARA and the medical sector (2011)’ to consider how the optimisation challenges in IR and NM have evolved over the past decade. Current levels of exposure are presented along with operational practice and the challenges and opportunities for improvement, both in monitoring and practice. Whilst RP challenges remain, the application of ALARA appears more established in IR compared with experiences reported in 2011. The application of ALARA to emerging technologies in the NM setting is in need of further development to ensure that RP is considered at all stages in the development process of new radiopharmaceuticals. Besides the obvious technical and operational aspects, the importance of education and training, human factors and broadly the RP ‘culture’ were deemed fundamental to the success of the application of ALARA and where further emphasis is needed. All concerned parties, medical physics experts (MPEs), radiation protection experts, clinical staff, manufacturers and regulators have a role to play in the application of ALARA and this is discussed in the memorandum. Many of the recommendations from the 13th EAN workshop remain applicable today and overlap with the recommendations arising from the 20th workshop. This should prompt attention given that the use of IR and the development of novel radiopharmaceuticals for NM is only anticipated to increase with time.

Radiation Dose Optimization in Radiology: A Comprehensive Review of Safeguarding Patients and Preserving Image Fidelity.

Radiation dose optimization in radiology is a critical aspect of modern healthcare, aimed at balancing the necessity of diagnostic imaging with the imperative of patient safety. This comprehensive review explores the fundamental principles, techniques, and considerations in optimizing radiation dose to safeguard patients while preserving image fidelity. Beginning with acknowledging the inherent risks associated with medical radiation exposure, the review highlights strategies such as the As Low as Reasonably Achievable (ALARA) principle, technological advancements, and quality assurance measures to minimize radiation dose without compromising diagnostic accuracy. Regulatory guidelines and the importance of patient education and informed consent are also discussed. Through a synthesis of current knowledge and emerging trends, the review underscores the pivotal role of radiation dose optimization in radiology practice. Furthermore, it emphasizes the need for ongoing research and collaboration to advance dose reduction strategies, establish standards for radiation safety, and explore personalized dose optimization approaches. By prioritizing radiation dose optimization, healthcare providers can ensure the highest standards of patient care while minimizing potential risks associated with medical radiation exposure.

Radiation exposure of patients during endourological procedures.

Considering the existing gaps in the literature regarding patient radiation dose (RD) and its associated risks, a systematic review of the literature on RD was conducted, focusing on percutaneous nephrolithotomy (PCNL), extracorporeal shock wave lithotripsy (SWL), and ureteroscopy (URS). Two authors conducted a literature search on PubMed, Web of Science, and Google Scholar to identify studies on RD during endourological procedures. Two thousand two hundred sixty-six articles were screened. Sixty-five publications met the inclusion criteria using the PRISMA standards. RD was generally highest for PCNL, reaching levels up to 33mSv, 28,700 mGycm2, and 430.8mGy. This was followed by SWL, with RD reaching up to 7.32mSv, 13,082 mGycm2, and 142mGy. URS demonstrated lower RD, reaching up to 6.07mSv, 8920 mGycm2, and 46.99mGy. Surgeon experience and case load were inversely associated with RD. Strategies such as optimizing fluoroscopy settings, implementing ultrasound (US), and following the ALARA (As Low As Reasonably Achievable) principle minimized RD. This is the first systematic review analyzing RD, which was generally highest during PCNL, followed by SWL and URS. There is no specific RD limit for these procedures. Implementation of strategies such as optimizing fluoroscopy settings, utilizing US, and adhering to the ALARA principle proved effective in reducing RD. However, further research is needed to explore the factors influencing RD, assess their impact on patient outcomes, and establish procedure-specific reference levels for RD.

Radiation protection knowledge and practices among Moroccan dentists: A cross-sectional study

ObjectiveTo analyze the current status of knowledge and practices among the Moroccan dentists in the region of Rabat-Salé-Kenitra, towards radiation protection. MethodsThis is a cross-sectional study based on a questionnaire related to knowledge and practice regarding radiation protection of patients and dental staff from April to June 2022. The study sample included 325 dentists practicing in the Rabat-Salé-Kénitra region. The target population consisted of all dentists working in public, semi-public and private workplaces. Results96.6% of dentists were aware of radiation protection. However, nearly 35% were aware of ALARA (as low as reasonably achievable) principle and 73.9% thought that dental X-rays are harmful. 63.6%of subjects used digital image receptor. Only 16.7% of them used a film holder and more than 60% didn't follow the position and distance rule. The median knowledge score was 7 [5, 9], and there was a statistically significant difference according to dentist qualification (P ​= ​0.007), dental radiation protection continuous training (P ​< ​0.0001), age (P = ​0.007) and years of experience (P ​= ​0.039). The median practice score was 5 [4, 6] and there was a statically significance association according to workplace setting (P ​= ​0.001). There was a significant positive relationship between knowledge score and practice score (r ​= ​0.24, P<0.0001). Dentist qualification (OR 0.51, 95%CI: 0.27–0.94, P ​= ​0.03) and continuous training (OR 2.40, 95%CI: 1.47–3.93, P<0.0001) were significant predictors of knowledge, while workplace setting (OR 0.54, 95%CI: 0.32–0.93, P ​= ​0.027) and knowledge score (OR 1.24, 95%CI: 1.12–1.38, P<0.0001) were predictors of practices. ConclusionImproving dentists' knowledge of radiation protection measures and tools as well as dose reduction techniques could increase their safe practices in dental radiology.

Radiation exposure to the orthopedic surgeon-a dosimetric comparison of two mini C-arm fluoroscopy models: a pilot study.

Perform a cadaveric experimental pilot study to measure and compare potential radiation exposure to an orthopedic surgeon from 2 different-generation mini C-arm models during a simulated orthopedic surgery. 16 radiation dosimeters. Mock surgery setups were constructed with a canine cadaver thoracic limb and 2 different-generation mini C-arm models. Four radiation dosimeters were placed near the mini C-arm to mimic common locations of radiation exposure during image acquisition. One mini C-arm was placed in auto technique mode, and 100 static images were acquired. The dosimeters were replaced, and a 5-minute-long dynamic image was acquired. The same protocols were repeated for the second mini C-arm. The dosimetry badges were then submitted for radiation exposure quantification. All but 1 dosimeter had radiation exposure levels below the detectable limits of the dosimeter. The dosimeter closest to the primary x-ray beam of 1 mini C-arm during dynamic image acquisition had a reading of 1 mrem. Intraoperative radiation exposure from the mini C-arm is low, specifically to areas not protected by lead and in close proximity to the primary x-ray beam. That being said, surgeons should always practice the principles of ALARA (ie, as low as reasonably achievable) to minimize radiation exposure in the workplace.

Impact of Reducing Fluoroscopy Pulse Rate on Adult Modified Barium Swallow Studies

Modified Barium Swallow Studies (MBSS) are a critical part of the evaluation, treatment planning, and outcome assessment for persons with swallowing disorders. Since MBSSs use ionizing radiation with associated cancer risks, many clinicians have reduced radiation exposure by reducing the fluoroscopic pulse rate. However, by reducing pulse rate, we also decrease the temporal resolution of MBSSs which has been shown in pilot studies to significantly reduce diagnostic accuracy. Two hundred MBSSs from patients routinely undergoing MBSS as standard of care conducted at 30 pulses per second (pps) using the Modified Barium Swallow Study Impairment Profile (MBSImP™) standardized administration protocol were selected. A stratified sampling method ensured that a full range of swallowing impairments (etiology, type, and severity) was represented. Recordings were down sampled from 30 pps to 15, 7.5, and 4 pps. MBSSs were rated using the MBSImP components and Penetration–Aspiration Scale (PAS) score for each swallow. Percent agreement was calculated across raters for MBSImP and PAS scores by bolus type and volume. The Least-Squares Method was used for hypothesis testing. Statistically significant and clinically meaningful changes in scores of swallowing physiology and penetration/aspiration occurred when reducing pulse rate below 30pps. These changes were evident across bolus types and volumes. Given the impact on diagnostic accuracy and the low radiation risks to adults undergoing MBSSs, reducing pulse rate to 15pps or below is not aligned with the As Low As Reasonably Achievable (ALARA) principle and should not be used as a viable method to reduce radiation exposure from MBSSs.

Evaluation of organ dose using size-specific dose estimation (SSDE) and related cancer risk due to chest CT scan during the COVID-19 pandemic.

This study aimed to estimate lung and breast doses for individual patients using the size-specific dose estimate (SSDE) method, as well as calculating effective doses, in patients who underwent chest CT scans during the COVID-19 pandemic. Cancer risk incidence was estimated using excess relative risk (ERR), excess absolute risk (EAR), and lifetime attributable risk (LAR) models from the Biological Effects of Ionizing Radiation Report VII (BEIR-VII). Data from about 570 patients who underwent CT scans for COVID-19 screening were utilized for this study. Using the header of the CT images in a Python script, SSDE and effective dose were calculated for each patient. The SSDE obtained by water equivalent effective diameter (wSSDE) was considered as lung and breast dose, and applied in organ-specific cancer risk estimation. The mean wSSDE value for females (13.3mGy) was slightly higher than that for males (13.1mGy), but the difference was not statistically significant (P value=0.41). No significant differences were observed between males and females in terms of calculated EAR and ERR for lung cancer at 5 and 30years after exposure (P value=0.47, 0.46, respectively). Similarly, there was no significant difference in lung cancer LAR values between females and males (P value=0.48). The results also indicated a decrease in LAR values for both lung and breast cancers with increasing exposure age. In accordance with the ALARA (as low as reasonably achievable) principle, it is important for medical staff and the general public to consider the benefits of CT imaging in detecting such infections. Additionally, imaging medical physicists and CT scan experts should optimize imaging protocols and strike a balance between image quality for detecting abnormalities and radiation dose, all while adhering to the ALARA principle.

Optimization of the "Perth CT" Protocol for Preoperative Planning and Postoperative Evaluation in Total Knee Arthroplasty.

Background and Objectives: Total knee arthroplasty (TKA) has become the treatment of choice for advanced osteoarthritis. The aim of this paper was to show the possibilities of optimizing the Perth CT protocol, which is highly effective for preoperative planning and postoperative assessment of alignment. Materials and Methods: The cross-sectional study comprised 16 patients for preoperative planning or postoperative evaluation of TKA. All patients were examined with the standard and optimized Perth CT protocol using advance techniques, including automatic exposure control (AEC), iterative image reconstruction (IR), as well as a single-energy projection-based metal artifact reduction algorithm for eliminating prosthesis artifacts. The effective radiation dose (E) was determined based on the dose report. Imaging quality is determined according to subjective and objective (values of signal to noise ratio (SdNR) and figure of merit (FOM)) criteria. Results: The effective radiation dose with the optimized protocol was significantly lower compared to the standard protocol (p < 0.001), while in patients with the knee prosthesis, E increased significantly less with the optimized protocol compared to the standard protocol. No significant difference was observed in the subjective evaluation of image quality between protocols (p > 0.05). Analyzing the objective criteria for image quality optimized protocols resulted in lower SdNR values and higher FOM values. No significant difference of image quality was determined using the SdNR and FOM as per the specified protocols and parts of extremities, and for the presence of prothesis. Conclusions: Retrospecting the ALARA ('As Low As Reasonably Achievable') principles, it is possible to optimize the Perth CT protocol by reducing the kV and mAs values and by changing the collimation and increasing the pitch factor. Advanced IR techniques were used in both protocols, and AEC was used in the optimized protocol. The effective dose of radiation can be reduced five times, and the image quality will be satisfactory.

DETERMINATION OF GROSS ALPHA/BETA RADIOACTIVITY OF WATER SAMPLES AROUND MINING SITES, DANGE-SHUNI LGA, SOKOTO STATE

Mining activities in the Iullumeden (Sokoto) basin is often heard of due to its prominence in artisanal mode of ransacking the Earth in search of minerals and metal of high economic values. The unabated demand in the growing post-industrial era have decimated any health impact that could be borne by the inhabitants of the mining communities. Dange-Shuni is an enclave of this basin that was covered in a bid to determine the gross alpha and beta radioactivity in domestic water in and around mining points. Water samples were collected and analyzed via Hidex 300 SL system of Liquid Scintillation Counting from a systematic sampling of fifteen mining points. The results indicate that both the gross alpha and beta radioactivity concentrations were in elevation with about 80% and 85% above the global limits of 0.5 and 1.0 . The results are good reasons to work hard in order to bring dose of radioactivity exposure to the inhabitants to as low as reasonably achievable (ALARA) being a mandate of WHO.

Assessment of Radiation Exposure with Mandatory Two Fluoroscopic Views for Epidural Procedures

BACKGROUND: Various regulations and practice patterns develop on the basis of Local Coverage Determination (LCD), which are variably perceived as guidelines and/or mandated polices/ regulations. LCDs developed in 2021 and effective since December 2021 mandated a minimum of 2 views for final needle placement with contrast injection which includes both anteroposterior (AP) and lateral or oblique view. Radiation safety has been a major concern for pain physicians and multiple tools have been developed to reduce radiation dose, along with improvement in technologies to limit radiation exposure while performing fluoroscopically guided interventional procedures, with implementation of principles of As Low As Reasonably Achievable (ALARA). The mandated 2 views of epidural injections have caused concern among some physicians, because of the potential of increased exposure to ionizing radiation, despite application of various principles to minimize radiation exposure. Others, including policymakers are of the opinion that it reduces potential abuse and improves safety. OBJECTIVE: To assess variations in the performance of epidural procedures prior to the implementation of the new LCD compared with after the implementation of the new LCD by comparing time and dosage for all types of epidural procedures. STUDY DESIGN: A retrospective, case controlled, comparative evaluation of radiation exposure during epidural procedures in interventional pain management. SETTING: An interventional pain management practice and a specialty referral center in a private practice setting in the United States. METHODS: The study was performed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. The main outcome measure was radiation exposure time measured in seconds and dose measured in mGy-kG2 (milligray to kilogray squared per procedure). RESULTS: Changes in exposure and dose varied by procedural type and location. Exposure time in seconds increased overall by 21%, whereas radiation dose mGy-kG increased 133%. Fluoroscopy time increased most for lumbar interlaminar epidural injections of 43%, followed by 29% for cervical interlaminar epidural injections, 20% for caudal epidural injections, and 14% for lumbar transforaminal epidural injections. In contrast, highest increases were observed in the radiation dose mGy of 191% for caudal epidural injections, followed by 173% for lumbar interlaminar epidural injections, 113% for lumbar transforaminal epidural injections, and the lowest being cervical interlaminar epidural injections of 94%. This study also shows lesser increases for cervical interlaminar epidural injections because an oblique view is utilized rather than a lateral view resulting in a radiation dosage increase of 94% compared to overall increase of 133%, whereas the duration of time of 29% was higher than the overall combined duration of all procedures which only increased by 21%. LIMITATIONS: A retrospective evaluation utilizing the experience of a single physician. CONCLUSION: The results of this study showed significant increases in radiation exposure time and dosage; however, increase of dosage was overall 21% median Interquartile Range (IQR) compared to 133% of radiation dose median IQR. In addition, the results also showed variations for procedure, overall showing highest increases for lumbar interlaminar epidural injections for time (43%) and caudal epidural injections for dosage (191%). KEY WORDS: Spinal interventional procedures, cervical epidural injections, lumbar epidural injections, caudal epidural injections, lumbar transforaminal epidural injections, radiation exposure time, radiation dose

Is cross-sectional imaging necessary for fractures of the distal lower leg in children and adolescents: results of a nationwide survey.

In childhood and adolescence, cross-sectional imaging, most commonly computed tomography (CT), is often performed for advanced diagnosis of joint injuries of the distal lower leg and upper ankle. Due to radiation exposure, the need for CT remains controversial, as these injuries follow stereotypies and usually have a similar course. Alternatively, the performance of magnetic resonance imaging (MRI) is also discussed. Since radiation sensitivity at this young age is much higher than in adults, an effort must be to minimize radiation exposure according to as low as reasonably achievable (ALARA) principles. The aim of this survey is to evaluate the current procedure in Germany in the diagnosis of pediatric injuries of the distal lower leg and upper ankle. For data collection, a survey entitled "CT in fractures of the ankle joint in childhood and adolescence: subject of the survey are injuries between 8 and 15years of age" of the Section of Pediatric Traumatology in the German Association of Trauma Surgery was sent to all members via the distribution list of the German Society of Orthopedics and Traumatology and the distribution list of the German Society of Pediatric Surgery in a period from September 20, 2022-December 21, 2022. The survey included a total of 21 questions. Target groups were trauma and pediatric surgeons and orthopedic surgeons working in the hospital and in practice. A total of 525 participants took part in the survey: ultrasound diagnostics are used by almost 25% and the Ottawa Ankle Rules by over 50% always or in most cases. A conventional x-ray is always or most often used by over 90%. CT imaging is rarely used by 88.57%, mainly for surgical planning or analysis of fracture progression. 69.9% report that their radiology department uses a pediatric protocol for CT exams; 25.71% do not know if this is the case. MRI imaging is also used infrequently by 89.33%, mostly to identify associated injuries. Overall, CT imaging is chosen by 55.62% and MRI imaging by 35.24% as the sectional imaging modality for suspected fractures; 95.05% consider sectional imaging useful for a triplane fracture, 59.24% for a two-plane fracture, 41.71% for a Salter-Harris type III/IV injury, and 8% for a Salter-Harris type I/II injury. The survey showed that the conventional X-ray is still the gold standard. Interestingly, more than half of the respondents regularly use the Ottawa Ankle Rules, and diagnostics using ultrasound are also used by almost a quarter. Awareness of radiation protection in children exists, although a quarter of all participants do not know the extent to which their radiology department has a specific pediatric protocol for CT imaging. Cross-sectional imaging is performed on a regular basis. Regarding the actual extent of imaging, there is a clear divergence between theory and practice.

Indoor radon concentration levels in some selected offices at Ibrahim Badamasi Babangida University, Lapai, Nigeria and its attendant annual effective dose

Although radon concentrations in outdoor environments are generally low, the indoor concentrations can become appreciably high thereby affecting the indoor air quality and causing some severe health challenges. Thirty (30) offices from the ground floor and first floor of some buildings within Ibrahim Badamasi Babangida (IBB) University campus, Lapai Nigeria, were randomly selected for indoor radon concentration (CRn) measurement using RAD7 continuous radon monitor. Annual effective dose was also computed to determine the level of public exposure. The results showed that radon concentration values for all the offices on the ground floor ranged between 9.6±2.7 Bqm−3 and 90.7±8.1 Bqm−3, with mean value of 28.5±4.8 Bqm−3 while the range of radon concentration at first floor was 2.5±1.4 Bqm−3 - 80.4±7.5 Bqm−3. All the measured indoor radon concentration levels were less than the 100 Bqm−3 action level proposed by World Health Organization (WHO). Average annual absorbed dose for both ground and first floors were 0.36±0.06 mSvy−1 and 0.24±0.05 mSvy−1 respectively, with corresponding mean annual effective dose of 0.86±0.15 mSvy−1 and 0.58±0.11 mSvy−1 in sequence. These values were below the 1.0 mSvy−1 safety limit set for public. Although the results did not suggest any immediate exposure threat to the public, it is important that the University staffs are adequately informed of indoor radon levels and its attendant health hazards. Improved and adequate ventilation of all the office buildings is highly encouraged in order to keep the radon levels as low as reasonably achievable (ALARA).