Radiological Exposure Research Articles

Application plan for radiological exposure model using virtual reality–based radiological exercise system

Abstract New exercise technology such as the virtual reality (VR)–based exercise system is required to meet soaring demand for target participants in exercises and to alleviate the difficulties in personnel mobilization through an alternative approach to the exercise system. In a previous study, event tree methodologies were introduced in setting up an exercise scenario of a VR-based radiological exercise system. In the scenario, the locations at which major events occur are rephrased as nodes, routes as paths, and public response actions as protective actions or contents of an exercise at individual locations. In the study, a model for estimating effective doses to the participants is proposed to evaluate the exercise system, using the effective dose rates at particular times and locations derived from a computer program. The effective dose received by a student when she/he follows a successful route is about a half of the dose received when she/he does not follow the exercise guide directions. In addition, elapsed time to finish an exercise when following a successful route is less than one-third of the time spent to finish an exercise when following the guide's directions.

Synergistic actions of FGF2 and bone marrow transplantation mitigate radiation-induced intestinal injury

Unwanted radiological or nuclear exposure remains a public health risk for which effective therapeutic countermeasures are lacking. Here, we evaluated the efficacy of fibroblast growth factor-2 (FGF2) in treating radiation-induced gastrointestinal syndrome (RIGS) incurred by lethal whole-body irradiation (WBI) when administered in conjunction with bone marrow transplantation (BMT). In vitro experiments indicated FGF2 treatment increased proliferation, reduced apoptosis, and upregulated AKT–GSK3β/β–catenin signaling in irradiated IEC-6 cells. We next established and analyzed mice cohorts consisting of sham irradiation (Group Sh); 12 Gy WBI (Group A); WBI with BMT (Group B); WBI with FGF2 treatment (Group F); and WBI with BMT and FGF2 treatment (Group BF). At 2 weeks post-irradiation, Group BF showed a dramatic increase in survival over all other groups. Intestinal epithelium of Group BF, but not Group B or F, showed augmented proliferation, decreased apoptosis, and preserved crypt numbers and morphology. Furthermore, Group BF maintained intestinal barrier function with minimal inflammatory disturbances in a manner comparable to Group Sh. In accordance, transcriptomic analyses showed significant upregulation of intestinal barrier and stem cell markers in Group BF relative to Groups A and B. Taken together, parenteral FGF2 synergizes with BMT to confer potent mitigation against RIGS.

Angiography vs transesophageal echocardiography-guided patent foramen ovale closure: A propensity score matched analysis of a two-center registry.

The purpose of this study is to compare the long-term outcomes of patent foramen ovale (PFO) closure using angiography or transesophageal echocardiography as procedural guidance. The interventional treatment is emerging as a safe and efficient option for patients with high likelihood of PFO-related cryptogenic stroke and high risk of recurrence. The "gold-standard" guidance technique remains an issue. Two cohorts of patients undergoing PFO closure for cryptogenic stroke in two catheterization laboratories of the same institution, using similar inclusion criteria but different guidance, were compared with propensity score matching. A total of 374 patients were enrolled, 161 in Angio-group and 213 in Echo-group. No difference was detected in the procedural complication rate. In Angio-group, radiological exposure (P=.001) and 6-month residual shunt (16.8% vs 8.0%, P=.015) were higher. After a mean follow-up of 41±30months, 28 patients (7.5%) presented any adverse event (death, recurrent cerebral ischemia, device-related complications, reintervention), with a higher rate in Angio-group (13.0% vs 3.3%, P=.001), mainly due to repeated percutaneous intervention (10.6% vs 1.4%, P=.001). The results were confirmed after propensity score matching (118patients/group). The rate of recurrent cerebral ischemia was 1.9% and was not significantly different in the two groups. Intra-procedural guidance and atrial septum aneurysm were independent predictors of the composite primary endpoint (OR 1.2, P=.016). The use of intra-procedural transesophageal echocardiography (TEE) guidance for PFO closure allows lower residual shunt rate, radiological exposure, and adverse events, mainly driven by a significant reduction in percutaneous reintervention.

Radiometric measurement of lignite coal and its by-products and assessment of the usability of fly ash as raw materials in Turkey

Abstract Lignite coal (LC) is a key energy source for electricity generation in Turkey. During lignite burning, huge amounts of fly ash (FA), bottom ash and slag are produced as by-products which contain radionuclides in the natural radioactive series of uranium and thorium, and radioactive potassium. These radionuclides may lead to radiological exposure of workers and the public and cause environmental problems. Therefore, finding diverse uses for the by-products in the construction sector and earthwork applications has considerable economic and environmental importance. In this study, the activity concentrations of 226Ra, 232Th and 40K in and radon emanating power (EP) and radon mass exhalation rate (EXRM) from LC, slag and FA obtained from the Kangal lignite-burning power plant with a power of 457 MWe were measured using gamma-ray spectroscopy. The major chemical components (SiO2, Al2O3, Fe2O3, CaO and MgO) of fly ash samples were analysed using an energy dispersive X-ray fluorescence spectrometer. The annual effective doses received by workers and members of the public were estimated using different scenarios specified in Radiation protection 122. The average activity concentrations of 226Ra, 232Th and 40K in LC, slag and FA samples were 187±21, 16±1 and 99±9 Bq kg−1, 620±18, 41±2 and 330±13 Bq kg−1, and 937±30, 38±2 and 272±17 Bq kg−1, respectively. The average values of EP and EXRM of the lignite, slag and FA samples were 8 %, 7 % and 10 %, and 0.1, 0.3 and 0.7 Bq kg−1 h−1, respectively. The highest average of the total annual effective dose is estimated at 153 μSv for members of the public and 74 μSv for workers, lower than the recommended annual limit of 1000 μSv.

Complex biliary stones management: cholangioscopy versus papillary large balloon dilation - a randomized controlled trial.

Background and study aims Endoscopic removal of biliary stones has high success rates, ranging between 85 % to 95 %. Nevertheless, some stones may be challenging and different endoscopic methods have evolved. Papillary large balloon dilation after sphincterotomy is a widely used technique with success rates ranging from 68 to 90 % for stones larger than 15 mm. Cholangioscopy allows performing lithotripsy under direct biliary visualization, either by laser or electrohydraulic waves, which have similar success rate (80 % – 90 %). However, there is no study comparing these 2 techniques. Patients and methods From April 2014 to June 2016, 100 patients were enrolled and randomized in 2 groups, using a non-inferiority hypothesis: cholangioscopy + electrohydraulic lithotripsy (group 1) and endoscopic papillary large balloon dilation (group 2). The main outcome was complete stone removal. Adverse events were documented. Mechanical lithotripsy was not performed. Failure cases had a second session with crossover of the methods. Results The mean age was 56 years. 74 (75.5 %) patients were female. The initial overall complete stone removal rate was 74.5 % (77.1 % in group 1 and 72 % in group 2, P > 0.05). After second session the overall success rate achieved 90.1 %. Procedure time was significantly lower in group 2, – 25.2 min (CI95 % – 12.48 to – 37.91). There were no significant differences regarding technical success rate, radiologic exposure and adverse events. Conclusion Single-operator cholangioscopy-guided lithotripsy and papillary large balloon dilation are effective and safe approaches for removing complex biliary stones.

Comments on “Radiation induced breast cancer risk in BRCA mutation carriers from low-dose radiological exposures: a systematic review”

Comments on “Radiation induced breast cancer risk in BRCA mutation carriers from low-dose radiological exposures: a systematic review”

Air Absorbed Dose Rate Measurements and External Dose Assessment by Car-Borne Survey in the Gold Mining Areas of Betare-Oya, Eastern-Cameroon

In order to assess radiological exposure of the public due to natural occurring radioactive materials from gold mining areas of Betare-Oya and vicinity, Eastern Cameroon, a preliminary study was carried out in 2015 for laboratory measurements of activity concentrations of primordial radionuclides. In terms of annual effective dose, results revealed a mean value of 0.34 mSv y-1. However, it was necessary to make air absorbed dose rate contour map for a detailed evaluation of external dose. For this purpose, a car-borne survey using a 3-in × 3-in NaI(Tl) scintillation spectrometer was carried out in Betare-Oya and vicinity. Absorbed dose rates in air ranged from 23 to 80 nGy h-1 with a mean value of 44 ± 7 nGy h-1. The average values of activity concentrations in soil of 40K, 238U and 232Th were 197 ± 21 Bq kg-1, 37 ± 13 Bq kg-1 and 32 ± 7 Bq kg-1 respectively. 232Th was found to be the main contributor to the absorbed dose rate in air from outdoor terrestrial radiation in the study areas with a mean value of 43%. External annual effective dose ranged from 0.17 to 0.60 mSv y-1 with a mean value of 0.33 ± 0.05 mSv y-1, in agreement with the result (0.34 mSv y-1) of the previous study performed in the same areas using gamma spectrometry in laboratory for radioactivity measurements in soil samples. This survey first and widely revealed an aspect of natural radiation exposures in soil mining areas of Eastern Cameroon.

Reply to the Comments on “Radiation induced breast cancer risk in BRCA mutation carriers from low-dose radiological exposures: a systematic review”

Reply to the Comments on “Radiation induced breast cancer risk in BRCA mutation carriers from low-dose radiological exposures: a systematic review”

35. Feasibility study of skin dose calculation with PCXMC 2.0, for rotational modes in interventional neuroradiology

Introduction Prolonged exposures in interventional radiology can lead to increased skin doses (Dskin) and to determinist side effects. The increasing frequency of Rotational mode (RM) acquisitions implies significant Dskin rises. The Dskin calculation method for a fluorography can be performed manually or with dedicated software. However, currently, such methods do not exist for RM. The aim of this study is to evaluate the feasibility of Dskin calculation with the PCXMC 2.0 Rotation software (STUK) for RM in interventional neuroradiology, then to validate this estimation by using a manual method combined with PCXMC use and fluorography. Methods This study is performed for an Allura Xper FD20/10 (Philips) system. The available RM are the XperCT (207°/rotation, 622 images) and the Propeller (240°/rotation, 122 images). For these acquisitions, mean dose is calculated by PCXMC for each organ, but this software is not able to obtain a reliable Dskin, which is averaged over the whole phantom skin. The objective is to determine the possible existence of a factor to convert mean organ dose during the acquisition to Dskin. Considering neuroradiology interventions, the mean brain dose (Dbrain) was chosen as convertible to Dskin for different points on the skin. Hence several measurements were carried out on an anthropomorphic ART phantom (Radiology Support Devices Inc.) with Thermo Luminescent Dosimeters (TLDs) which were calibrated at radiological energies and with a homogeneity below 5%. In a second phase, a manual calculation based method was created to estimate Dskin with a dedicated software which cannot consider RM: a trigonometric estimation was performed to evaluate the number of projections per rotation that could contribute to Dskin at each point. Fluorographies were then simulated on PCXMC for these points, based on each corresponding number of projections. Then, Dbrain for each fluorography was converted in RM Dskin. Experimental TLDs measurements were carried out in order to validate this method. Results For the XperCT, the posterior Dskin measured with TLDs is 34,53 mGy, 2,67 mGy for the Propeller. For these RM, the first Dskin estimations from Dbrain lead to the Dskin measured with TLDs within a 20% accuracy interval. Conclusion In addition to the Dskin determination with PCXMC for the two RM in interventional neuroradiology, its estimation with the fluorography conversion method seems possible.

34 A systematic literature review of the pre-hospital lessons identified following mass casualty deliberate bombing incidents

BackgroundSince the end of World War II, there has been an emergence of explosives used amongst civilian populations resulting in mass-casualty incidents. The development of pre-hospital medical systems, worldwide, has...

Medical and policy considerations for nuclear and radiation accidents, incidents and terrorism.

The purpose of this review is to address the increasing medical and public concern regarding the health consequences of radiation exposure, a concern shaped not only by fear of another Chernobyl or Fukushima nuclear power facility accident but also by the intentional use of a nuclear weapon, a radiological dispersion device, a radiological exposure device, or an improved nuclear device by rogue states such as North Korea and terrorist organizations such as Al Qaeda and ISIS. The United States has the medical capacity to respond to a limited nuclear or radiation accident or incident but an effective medical response to a catastrophic nuclear event is impossible. Dealing effectively with nuclear and radiation accidents or incidents requires diverse strategies, including policy decisions, public education, and medical preparedness. I review medical consequences of exposures to ionizing radiations, likely concomitant injuries and potential medical intervention. These data should help haematologists and other healthcare professionals understand the principles of medical consequences of nuclear terrorism. However, the best strategy is prevention.

Radiation induced breast cancer risk in BRCA mutation carriers from low-dose radiological exposures: a systematic review

The aim of this review paper is to clarify the radio-induced breast cancer (BC) risk in BRCA mutation carriers with a combined epidemiological and radiobiological comprehensive approach. A systematic literature search on PubMed (MEDLINE) and EMBASE was performed for articles published from January 1st, 2000 to June 15th, 2017 using dedicated key words as subject headings (MeSH) in three domains of research and evaluation: risk modeling, cohort-studies and ex-vivo radiation biology with epithelial non-tumoral human breast cells. Only eleven articles that meet the selection criteria could be retrieved. These articles are analyzed and discussed. This review, which includes all types of radiological breast exposures, shows an association between BC risk and low cumulative X-ray doses before age 30. There is no consistent data in this literature regarding the risk of BC from radiological exposure after age 30. Biological data point out strong indicators of radiation-induced genomic instability linked with carcinogenesis pathways. We conclude that the risk of radio-induced BC in BRCA mutation carriers depends on age at exposure and that repeated X-ray breast exposures such as mammography should be used very cautiously in these mutated patients.

Editorial Comment on: Radiation induced breast cancer risk in BRCA mutation carriers from low-dose radiological exposures: a systematic review

Editorial Comment on: Radiation induced breast cancer risk in BRCA mutation carriers from low-dose radiological exposures: a systematic review

Benefits of electroanatomic ablation of conventional cardiac arrhytmias: from fluoroscopy to zero X-ray mapping.

Electrophysiology procedures are traditionally performed under fluoroscopic guidance. Nowadays a growing interest in the radiation risk associated to these procedures has been cultivated, since radiation exposure has non-negligible stochastic and deterministic effects on health. A correlation between radiation exposure and lifetime malignancy effect is difficult to establish and the threshold of a completely safe exposure dose is unknown. Thus, electrophisiologists have become aware of the use of fluoroscopy and they have tried to use all the complementary imaging technologies available in order to reduce the radiological exposure. This review is aimed at evaluating the radiation exposure risk, both for the patients and the operators. We describe electroanatomical mapping systems and technologies, which allow the reduction of radiation exposure. We review the main literature based on different catheter ablation procedures with the use of the abovementioned technologies, specifically focusing on feasibility, safety, and radiation exposure. Finally, we highlight the necessity of increasing the radiological risk awareness among operators and cardiological scientific societies.

P2617Global radiological exposure of TAVI: an unresolved issue with potential drawbacks in low and intermediate risk patients

P2617Global radiological exposure of TAVI: an unresolved issue with potential drawbacks in low and intermediate risk patients

Uranium Mining and Norm in North America-Some Perspectives on Occupational Radiation Exposure.

All soils and rocks contain naturally occurring radioactive materials (NORM). Many ores and raw materials contain relatively elevated levels of natural radionuclides, and processing such materials can further increase the concentrations of naturally occurring radionuclides. In the U.S., these materials are sometimes referred to as technologically-enhanced naturally occurring radioactive materials (TENORM). Examples of NORM minerals include uranium ores, monazite (a source of rare earth minerals), and phosphate rock used to produce phosphate fertilizer. The processing of these materials has the potential to result in above-background radiation exposure to workers. Following a brief review of the sources and potential for worker exposure from NORM in these varied industries, this paper will then present an overview of uranium mining and recovery in North America, including discussion on the mining methods currently being used for both conventional (underground, open pit) and in situ leach (ISL), also referred to as In Situ Recovery (ISR), and the production of NORM materials and wastes associated with these uranium recovery methods. The radiological composition of the NORM products and wastes produced and recent data on radiological exposures received by workers in the North American uranium recovery industry are then described. The paper also identifies the responsible government agencies in the U.S. and Canada assigned the authority to regulate and control occupational exposure from these NORM materials.

Direct results of a prospective randomized study comparing ablation with the nMARQ catheter and the PVAC catheter used with and without a 3D system (MAPER 3D Study).

IntroductionOur aim was to compare in a prospective randomized study the safety, direct results and periprocedural data of ablation using an nMARQ catheter, a PVAC catheter used with the EnSite system, or a PVAC catheter only under fluoroscopy control.Material and methodsOne hundred two patients (70 male, 57 ±11 years) with atrial fibrillation (AF) were prospectively randomized to: group 1 – ablation performed with an nMARQ catheter and the CARTO 3 system; group 2 – a PVAC catheter used with the EnSite system; group 3 – ablation with a PVAC catheter without a 3D system.ResultsComplete isolation of 400/402 pulmonary veins (PV) (99.5%). Linear ablation was performed in 23 patients in group 1 (small distance between lines isolating PV), in 3 patients in group 2, in 1 patient in group 3. The superior vena cava was isolated in 1 patient, 9 patients, and 9 patients respectively. Duration of fluoroscopy and dose area product were significantly smaller in group 1 (6.5 ±2.9 min/808.8 ±393.9 cGy/cm2 vs. 13.6 ±5.6 min/1662.6 ±677.8 cGy/cm2 and 18.8 ±7.6 min/2327.9 ±975.5 cGy/cm2; p < 0.001). Procedure duration was shorter in group 1 (82.9 ±18.8 min vs. 101.2 ±19.6 min, p < 0.001 and 99.8 ±20.8 min, NS). Contrast injection was necessary in 2 patients in group 1, in 8 patients in group 2 and in all patients in group 3. Because nMARQ is a thermocool catheter, the volume of fluid injection was significantly greater (2348.5 ±543.5 ml vs. 1077.9 ±280.5 ml and 1076.5 ±375.6 ml, p < 0.001). There were no periprocedural deaths. We observed no cardiac tamponade, neurological complications and no atrioesophageal fistula during follow-up.ConclusionsThe lowest radiological exposure was observed during ablation performed with an nMARQ catheter. 3D systems reduced fluoroscopy duration and the necessity of contrast injection. The nMARQ catheter requires injection of a large volume of fluid.

Differential Motivations for Pursuing Diagnostic Radiology by Gender: Implications for Residency Recruitment

The purpose of this study is to determine how the motivations to pursue a career in radiology differ by gender. In addition, the influence of medical school radiology education will be assessed. Radiology applicants to our institution from the 2015-2016 interview season were offered an online survey in February 2016. Respondents scored the influence of 24 aspects of radiology on their decision to pursue radiology. Comparisons were made between male and female respondents. Respondents were also asked the type of medical school radiology education they received and to score the influence this experience had on their decision to pursue radiology. There were 202 total respondents (202/657) including 47 women and 155 men. Compared to men, the following factors had a more negative impact on women: flexible work hours (P = 0.04), work environment (P = 0.04), lifestyle (P = 0.04), impact on patient care (P = 0.05), high current debt load (P = 0.02), gender distribution of the field (P = 0.04), and use of emerging/advanced technology (P = 0.02). In contrast, women felt more favorably about the opportunities for leadership (P = 0.04) and research (P < 0.01). Dedicated radiology exposure was as follows: 20% (n = 20) none, 48% (n = 96) preclinical exposure, 55% (n = 111) elective rotation, and 18% (n = 37) core rotation. More intensive radiology exposure via a core rotation had a significantly positive impact on the decision to pursue radiology (P < 0.01). Male and female radiology applicants are motivated by different aspects of radiology, which may influence residency recruitment practices. In addition, more intensive radiology exposure has a net positive impact on the decision to pursue radiology.

Radiology Exposure in the Undergraduate Curriculum: A Medical Student Perspective on Quality and Opportunities for Positive Change

PurposeThis article is a continuation of a qualitative study designed to explore how radiology exposures can impact medical student opinions and perceptions of radiology and radiologists. We focused on: 1) conducting a radiology exposure inventory from the perspective of the medical student; 2) student evaluation of the quality of the radiology exposures and suggestions for positive change; and 3) development of a framework to address the needs of medical students as it relates to radiology education in the undergraduate medical curriculum. MethodsResearch methodology and design for this qualitative study were described in detail in a previous article by Visscher et al [1]. ResultsParticipants included 28 medical students; 18 were in medical school years 1 and 2 (preclerkship), and 10 were in years 3 and 4 (clerkship). Specific to the focus of this article, the data revealed 3 major findings: 1) multiple exposures to radiology exist, and they are received and valued differently depending on the medical student's stage of professional development; 2) medical students value radiology education and want their radiology exposure to be comprehensive and high quality; 3) Medical students have constructive suggestions for improving the quality of both formal and informal radiology exposures. ConclusionsPerforming a radiology exposure inventory from a medical student perspective is a useful way to explore how students receive and value radiology instruction. Medical students want a more comprehensive radiology education that can be summarized using the 5 C's of Radiology Education framework. The 5 C's (curriculum, coaching, collaborating, career and commitment) reflect medical students' desires to learn content that will support them in clinical practice, be supported in their professional development, and have the necessary information to make informed career decisions.

Dose assessment from chronic exposure to industrial NORM in iron ore processing

Radiological exposures due to naturally occurring radioactive material (NORM) can occur during a wide range of work-related activities in the mineral processing and chemical industries. However, evaluation of such exposures in industrial settings remains a difficult exercise owing inter alia to the large number of personnel, operations and plants affected; assumptions that often have to be made concerning the actual duration and frequency of exposures; the complex chemistry and radioactive disequilibria involved and typically, the paucity of historical data. In our study, the challenges associated with assessing chronic exposure to fugitive dust enriched in 210Pb and 210Po and the determination of the associated internal dose by inhalation and ingestion are described by reference to a case study undertaken at an iron ore sintering plant between June 2013 and July 2015. The applicability of default dose coefficients and biokinetic models provided by the International Commission for Radiological Protection was verified by combining air and dust monitoring with information on the characteristics of the aerosols and in-vitro solubility experiments. The disparity between particulate matter 100 microns or less in diameter (PM100), particulate matter 10 microns or less in diameter (PM10) and 210Pb/210Po activity concentrations observed over the different monitoring campaigns and sampling locations confirmed that use positional short-term monitoring surveys to extrapolate intake over a year was not appropriate and could lead to unrealistic intake and dose figures. Personal air sampling is more appropriate for estimating the dose in such situations, though it is not always practical and may collect insufficient quantities of material for radiochemical analysis; this is an important constraint when dealing with low specific activity materials.