Prevent Radiation Exposure Research Articles

Knowledge and perception of pharmacists and patients on the use of radiopharmaceuticals in disease management

Introduction: Nuclear medicine services, though still an emerging area in the field of medicine in Nigeria, have not been optimally utilised, possibly due to a lack of awareness by health workers. This study evaluated the knowledge and awareness of pharmacists and patients regarding radiopharmaceutical use in disease management. Methods: In this cross-sectional survey in southwest Nigeria, online self-administered and interviewer-administered structured questionnaires were used to collect data on the knowledge and perception of radiopharmaceuticals from 343 pharmacists and 67 ambulatory patients. The influence of the participant’s socio-demographic characteristics on the knowledge of radiopharmaceuticals scores was assessed with Man-Whitney U and Kruskal Wallis tests at p < 0.05. Results: The study found that 191 (55.7%) pharmacists and 75 (98.7%) patients had good knowledge of radiopharmaceuticals, while 70 (21.3%) pharmacists knew radiopharmaceuticals are regulated as radioactive substances and drugs. Most patients, 47 (61.8%), knew how to prevent radiation exposure to others, and 68 (89.5%) believed radiopharmaceuticals would help disease management. Conclusion: Pharmacists and patients have good knowledge of the use of radiopharmaceuticals. Pharmacists’ knowledge was influenced by the state of practice and prior knowledge of radiopharmaceuticals, while the number of clinics attended influenced patients’ knowledge.

Evaluation of shielding thickness in the radio-diagnostic facility of Turai Yaradua Maternity and Children Hospital Katsina, Katsina State, Nigeria

The medical application of radiation can induce radio-biological effects which makes it necessary to ensure some safety precautions, of which, room shielding is one of those safety measures. The aim of this study was to assess the lead wall lining thickness of the radio-diagnostic room of Turai Yaradua Maternity and Children Hospital Katsina. The required lead wall lining thickness was estimated using NCRP 147 formulations. The measured area of the radio-diagnostic room was 39.44 m2. The maximum required lead thickness values were estimated as 1.1 mm and 0.8 mm for erect and supine radiographic positions, respectively, while, the installed lead wall lining thickness was 2 mm. The area monitoring revealed that there was no leakage radiation. Though, the shielding was adequate and there was no leakage radiation, it is however recommended that the radiation workers maintain maximum distance, minimum exposure time and use shielding barrier in order to ensure minimal occupational radiation exposure. Periodic area monitoring is also encouraged in order to prevent radiation exposure of the members of the public.

Ultrasonography for Determining Endotracheal Tube Tip Position in Very Low Birth Weight Infants.

This study aims to investigate the feasibility of USG in confirming the endotracheal tube site and compare it with chest X-rays in very low birth weight infants. A chest X-ray and thorax ultrasonography processes are started as soon as the infant is intubated. Endotracheal tube place is evaluated with ultrasonography and noted, and with chest X-ray and time elapsed in these two processes are noted. The correlation between these two methods was calculated. While endotracheal tubes are visualized with 100% success, there was a significant correlation between the measures of endotracheal tube-carina distances (r = .979, P > .001). In addition, ultrasonography was six times faster than chest X-ray interpretation (USG; 4.6 ± 1.8min vs CXR; 29.6 ± 9.0min, P < .001). Ultrasonography is a feasible and faster method for determining endotracheal tube place in very low birth weight infants and may prevent radiation exposure in neonatal intensive care units.

Fiducial marker position affects target volume in stereotactic lung irradiation.

PurposeReal‐time tracking systems of moving respiratory targets such as CyberKnife, Radixact, or Vero4DRT are an advanced robotic radiotherapy device used to deliver stereotactic body radiotherapy (SBRT). The internal target volume (ITV) of lung tumors is assessed through a fiducial marker fusion using four‐dimensional computed tomography (CT). It is important to minimize the ITV to protect normal lung tissue from exposure to radiation and the associated side effects post SBRT. However, the ITV may alter if there is a change in the position of the fiducial marker with respect to the tumor. This study investigated the relationship between fiducial marker position and the ITV in order to prevent radiation exposure of normal lung tissue, and correct target coverage.Materials and methodsThis study retrospectively reviewed 230 lung cancer patients who received a fiducial marker for SBRT between April 2015 and September 2021. The distance of the fiducial marker to the gross tumor volume (GTV) in the expiratory (d ex) and inspiratory (d in) CT, and the ratio of the ITV/V(GTVex), were investigated.ResultsUpon comparing each lobe, although there was no significant difference in the d diff and the ITV/V(GTVex) between all lobes for d ex < 10 mm, there was significant difference in the d diff and the ITV/V(GTVex) between the lower and upper lobes for d ex ≥ 10 mm (p < 0.05). Moreover, there was significant difference in the d diff and the ITV/V(GTVex) between d ex ≥10 mm and d ex < 10 mm in all lung regions (p < 0.05).ConclusionThe ITV that had no margin from GTVs increased when d ex was ≥10 mm for all lung regions (p < 0.05). Furthermore, the increase in ITV tended to be greater in the lower lung lobe. These findings can help decrease the possibility of adverse events post SBRT, and correct target coverage.

Serum Immune-Inflammation Index Assessment in the Patients with Ulcerative Colitis.

Radiologic and endoscopic diagnostic methods are used to determine disease activity in ulcerative colitis (UC). In order for endoscopic procedures to be invasive and to prevent radiation exposure, especially in young people, studies have been carried out frequently to determine a simple, fast, and reliable activity marker with laboratory methods. Our aim in this study is to determine the usefulness of serum immune-inflammatory index as a noninvasive marker of activation in patients with ulcerative colitis. A total of 82 consecutive patients treated with a diagnosis of ulcerative colitis were included in the study. The disease activation was assessed using the Mayo endoscopic subscore. The site of involvement was grouped into two as left colitis and extensive colitis. Patients were divided into two groups as those who had active disease based on clinical and endoscopic findings and those who were in remission. C-reactive protein (CRP) levels, platelets, neutrophils, and lymphocytes were recorded in all participants. The systemic immune-inflammation index (SII) and CRP values were compared between UC patients with active disease or remission. The correlations between CRP, SII, and Mayo endoscopic subscores were analyzed. In addition, ROC curve analysis for SII was performed to determine the cut-off value, sensitivity, and specificity in determining ulcerative colitis activity. The value of SII was significantly higher in the active group than the remission group (respectively, 1497 ± 1300 and 495 ± 224, p < 0.001). In the correlation analysis, a significant correlation was found between SII and Mayo subscore. In ROC curve analysis, SII was found to be significantly effective in determining activity in ulcerative colitis patients. For 0.860 area under the curve, the sensitivity was 68.1% and the specificity was 91.2% at a cut-off value of 781.5. SII is significantly higher in patients with active ulcerative colitis than those in remission. It shows promise for use as a noninvasive marker of active ulcerative colitis.

CAN ULTRASOUND ALONE SUFFICE IN THE EVALUATION OF ACUTE ABDOMEN IN ADULTS – A COMPARATIVE COMPUTED TOMOGRAPHY VERSUS ULTRASOUND (HOSPITAL BASED) STUDY

OBJECTIVE The objective of this study was to study the role of ultrasound and computed tomography in evaluation of acute abdomen and to assess whether ultrasound alone will sufce in majority situations, so that radiation exposure may be minimized. MATERIALS AND METHODS This institutional review board approved prospective observational study comprised of 50 adult patients attending the emergency department for non-traumatic acute abdominal pain less than 3 days of duration. The radiological evaluation with US and CT scan (Non contrast and contrast enhanced) of abdomen was done at radiology department of Sharda hospital. The exclusion criteria were trauma and pregnancy. The equipments used were Ultrasound with color Doppler PHILIPS EPIQ 7G and CT Scan - GE Optima 660 - 128 slice CT Scanner with slice thickness of 0.6 mm. RESULTS The overall sensitivity of US was 74% and that of CT was 96.15% with insignicant difference (p value – 0.018). Also, the sensitivity of US compared to CT in diagnosing common etiologies of acute abdomen namely acute cholecystitis, acute appendicitis, intestinal obstruction, pancreatitis and ureteric calculi sensitivity did not differ signicantly. CT was necessary only in patients with retro-caecal appendicitis, bowel obstruction cases for dening the transition point and in patients with pancreatitis to obtain the CT Severity index. CONCLUSION We propose that US should remain the primary imaging modality in all patients of acute abdomen in order to prevent radiation exposure, especially as it was found to have a sensitivity comparable to CT, in majority of the clinical situations. Moreover, it is a more cost-effective investigation. Therefore, CT should be reserved only for the minority of clinical situations where US is signicantly inconclusive.

Transthoracic echocardiography monitoring during atrial septal defect and ventricular septal defect device closures using a three-dimensional printed transducer holder.

Transthoracic echocardiography (TTE) is noninvasive but can only be performed intermittently during fluoroscopy. In a prior study, we created a transducer holder device to allow for hemodynamic monitoring in the intensive care unit. The current study is the first instance of the use of a three-dimensional (3D)-printed TTE transducer holder, which is easily customized and personalized to a previous transducer holder at relatively low cost and short production time, to enable continuous TTE monitoring during device closure of an atrial septal defect (ASD) and ventricular septal defect (VSD). There were 14 ASD patients and 9 VSD patients scheduled to undergo device closure. The study's real-time TTE monitoring was performed by using a 3D-printed transducer holder over the course of the entire implantation procedure. There were 23 patients who successfully underwent septal closures using the 3D-printed holder that enabled real-time images over the entire procedure. The median duration for real-time TTE guidance was 15 minutes for the ASD and 36 minutes for the VSD and the median fluoroscopy time was 11 minutes for the ASD and 30 minutes for the VSD. One migrating VSD occluder and one case of aortic regurgitation after occluder deployment were noted by real-time TTE monitoring during the procedure. Our novel 3D-printed transducer holder can provide transesophageal echocardiography-like real-time imaging during device closure of an ASD and a VSD and may become a new alternative method in ASD and VSD closures. It can also prevent radiation exposure for the intervention team who would otherwise need to perform TTE during live fluoroscopy.

Ultrasound guidance for transforaminal percutaneous endoscopic lumbar discectomy may prevent radiation exposure: A case report.

BACKGROUNDPercutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH). Repeated fluoroscopy, with more than 30 shots on average, is inevitable to ensure its accuracy and safety. However, exposure to X-rays may pose a threat to human health. We herein report a case of ultrasound (US)-assisted PELD in two levels of LDH to explore a new possibility that can reduce the radiation dose during puncture and cannulation in PELD.CASE SUMMARYA 38-year-old man with low back pain and left leg pain for more than 7 years came to our clinic, his symptoms had aggravated for 1 month, and he was diagnosed with L3-4 and L4-5 disc herniations. He received US-guided PELD with good results: His straight leg elevation increased from 40 to 90 degrees after PELD, and his visual analog scale (VAS) and Oswestry Disability Index scores both significantly decreased immediately and 6 mo after PELD. With the guidance of US, he received only two shots of fluoroscopy (fluoroscopic time: 4.4 s; radiation dose: 3.98 mGy). To our knowledge, this is the first case of US-guided puncture and cannulation of PELD for LDH at two levels.CONCLUSIONUS could be used to guide PELD and has the potential to largely reduce radiation than traditional X-ray guidance.

Lead poisoning risk assessment of radiology workers using lead shields

Purpose: Lead containing dust may be present on the exterior surfaces of shields used to prevent radiation exposure. We determined whether use of lead shields poses an exposure risk for radiology personnel.Methods: We collected hand dustwipe and blood samples from 58 Radiology Department employees of an academic hospital. Samples were analyzed for lead content by atomic absorption spectroscopy. Results were compared between lead apron users (46) and nonusers (12).Results: Hand dustwipe lead was undetectable (<3 µg/sample) in all cases. Blood lead levels ranged from 0–3 µg/dL.Conclusions: In this study of Radiology Department workers, we did not find an increased risk of lead contamination on their hands or in their blood. Although our sample size is small, we conclude that lead poisoning is unlikely to occur with high frequency in lead shield users.

Using high-fidelity simulation to teach fundamental principles of cardiac catheterisation to pharmacy students.

Pharmacy students often find the pathophysiology and treatment of comorbid heart conditions challenging to understand. The objective of this study is to evaluate the impact of a cardiac catheterisation lab simulation on pharmacy students' knowledge related to cardiology and critical care pharmacotherapy. Third-year pharmacy students at the University of South Florida completed a high-fidelity cardiac catheterisation simulation. Specific aspects within the activity involved review of clinical parameters and images during catheterisation, identification of access points for catheter insertion, review of the types of stents available and associated pharmacotherapeutic considerations, and discussion of protective measures to prevent radiation exposure. Students completed knowledge-based presimulation and postsimulation assessments regarding these aspects of cardiac catheterisation. All students (n=111, 100%) completed the presimulation and postsimulation assessments. There was an increase in knowledge after the simulation, which was statistically significant in five out of nine questions, P<0.001. Based on course evaluations, students believed this activity enhanced their learning and ability to apply the material due to the close alignment and timing with their acute coronary syndrome lectures and the critical care module in the Pharmacotherapeutics course. Participation in the simulation improved students' knowledge related to cardiology pharmacotherapy and associated acute procedures.

Role of Ultrasound in the Diagnosis of Adnexal Torsion

Ovarian torsion refers to the complete or partial rotation of the ovary on its ligamentous supports, often resulting in impedance of its blood supply. It is one of the most common gynecologic emergencies and may affect females of all ages. The fallopian tube often twists along with the ovary; when this occurs, it is referred to as adnexal torsion. Prompt diagnosis is important to preserve ovarian and/or tubal function and to prevent other associated morbidity. However, making the diagnosis can be challenging because the symptoms are relatively nonspecific. Case report and literature review. A 53-year-old female denied any systemic disease before. She was suffered from lower back pain for one month. Severe lower abdomen cramping attacked suddenly thus she was sent to emergency room. Transabdominal ultrasound showed a huge mass over lower abdomen, and a right adnexa mass torsion was proved after emergency operation. This case illustrates transabdominal ultrasound can be used in diagnosis of adnexal mass torsion, especially in childbearing age woman who is not sure about pregnancy. This could prevent radiation exposure accompanied with more advanced image examination.

Modeling the effectiveness of shielding in the earth-moon-mars radiation environment using PREDICCS: five solar events in 2012

Radiation in the form of solar energetic particles (SEPs) presents a severe risk to the short-term health of astronauts and the success of human exploration missions beyond Earth’s protective shielding. Modeling how shielding mitigates the dose accumulated by astronauts is an essential step toward reducing these risks. PREDICCS (Predictions of radiation from REleASE, EMMREM, and Data Incorporating the CRaTER, COSTEP, and other SEP measurements) is an online tool for the near real-time prediction of radiation exposure at Earth, the Moon, and Mars behind various levels of shielding. We compare shielded dose rates from PREDICCS with dose rates from the Cosmic Ray Telescope for the Effects of Radiation (CRaTER) onboard the Lunar Reconnaissance Orbiter (LRO) at the Moon and from the Radiation Assessment Detector (RAD) on the Mars Science Laboratory (MSL) during its cruise phase to Mars for five solar events in 2012 when Earth, MSL, and Mars were magnetically well connected. Calculations of the accumulated dose demonstrate a reasonable agreement between PREDICCS and RAD ranging from as little as 2% difference to 54%. We determine mathematical relationships between shielding levels and accumulated dose. Lastly, the gradient of accumulated dose between Earth and Mars shows that for the largest of the five solar events, lunar missions require aluminum shielding between 1.0 g cm−2 and 5.0 g cm−2 to prevent radiation exposure from exceeding the 30-day limits for lens and skin. The limits were not exceeded near Mars.

How Occupational Health can Contribute in a Disaster and What We should Prepare for the Future—Lessons Learned through Support Activities of a Medical School at the Fukushima Daiichi Nuclear Power Plant in Summer 2011

A nuclear accident occurred at the Fukushima Daiichi Nuclear Power Plant of Tokyo Electric Power Company (TEPCO) as a result of a mega-earthquake and tsunami in March, 2011. A large number of workers were engaged in response and recovery operations under a complex structure of involved companies. They were exposed not only to radiation but also to other health hazards. TEPCO implemented programs to prevent radiation exposure, but had no effective systems for managing the other health risks and few occupational health (OH) professionals contributed to the health risk management. The University of Occupational and Environmental Health (UOEH), Japan, dispatched physicians to a quake-proof building at the plant to provide first-aid services from mid-May, 2011, and took a strategic approach to protecting workers from existing health risks. UOEH presented recommendations on OH systems and preventive measures against heat stress to the Government and TEPCO. The Ministry of Health, Labour, and Welfare issued guidelines to TEPCO and contractors. TEPCO implemented a comprehensive program against heat stress according to the guidelines and in cooperation with UOEH. As a result, we successfully prevented severe heat illness during summer 2011. From our experiences, we believe that the following recommendations should be considered: (1) the role of OH and the participation of experts should be defined in emergency response plans; (2) regulations should allow the national government and main companies involved to lead safety and health initiatives for all workers at disaster sites; and (3) OH professionals, response manuals and drills should be organized at a national level.

Treatment Delays Using an Automated Afterloading Low-Dose-Rate Brachytherapy System

Low-dose-rate (LDR) brachytherapy is an integral treatment modality in radiation oncology. Clinical efficacy is based on experience with manual source loading and continuous dose delivery. With remote afterloading technology, sources may be loaded and unloaded during the treatment course to prevent radiation exposure to nursing staff members and visitors. The aim of this study was to investigate treatment interruptions in terms of frequency and duration as well as extension of the overall treatment time period. The potential clinical impact of treatment interruptions was also considered. The treatment records of 20 patients who underwent brachytherapy in the Indiana University Department of Radiation Oncology administered with a Selectron LDR remote afterloader were reviewed. Results were tabulated and analysis performed with respect to 1) the number of interruptions, 2) delay time, 3) delay time (T(d)) as a function of total implant time (T), 4) the time of day that each interruption occurred, and 5) the time in minutes of each individual interruption. The mean number of interruptions was 44.9 per patient, (range, 24-76), with a mean prescription implantation duration of 45.7 hours and a mean actual treatment time of 51.2 hours resulting in a mean interruption time of 6.4 minutes per treatment hour. The number of interruptions was standardized and divided by the number of prescribed dose in grays, translating to 1.2 to 3.7 interruptions per gray delivered, with a mean of 1.6, resulting in an average T(d) of 11.21% (range, 7.35%-17.12%). Significant interruptions are frequent using remote afterloading LDR techniques, reducing the effective dose rate. Careful monitoring of such interruptions is warranted.

A sonography assisted technique for the removal of a femoral interlocking nail – a technical note

BackgroundOpen methods for removal of femoral interlocking nails involve an incision (up to 10 cm) over the trochanter to find the tip of the nail. The distal locking screws are some times difficult to palpate and an incision (up to about 5 cm) is often needed for exposure. Intra-operative fluoroscopy is often used as an adjunct technique to minimize the surgical wound. However, patients and surgeons are exposed to a radiation hazard. Sonography can provide a real-time and efficient alternative to fluoroscopy.MethodsSonography of soft tissue has been established to identify a foreign body. A metallic implant has a hyperechoic image; therefore, we can identify the correct position of the screws preoperatively and intraoperatively.ResultsWe have developed a technique using sonography and minimal incisions for the removal of a femoral interlocking nail. The proximal wound is 2.5 cm in length and the wound is 0.5 cm in length for each distal locking screw.ConclusionThe sonography can be used to minimize the length of incision and prevent radiation exposure in the removal of intramedullary femoral nails.

Radiation safety considerations with therapeutic 90Y Zevalin.

ABSTRACT Radioimmunotherapy with the 90Y-labeled Zevalin radioimmunoconjugate is a new and promising modality in cancer treatment that combines the targeting power of monoclonal antibodies with the cytotoxicity of localized radiation. 90Y is a pure beta emitter, with different physical characteristics than traditional therapeutic radionuclides such as 131I. It is important that radiation safety professionals understand the characteristics of this radionuclide so that effective radiation safety procedures can be implemented with the Zevalin regimen. Because 90Y is a pure beta emitter, the Zevalin regimen is routinely administered as an outpatient procedure and is administered by using plastic shielding. Once the radioimmunoconjugate has been administered, the risk of radiation exposure to healthcare workers and family members is minimal. The primary route of biologic elimination of 90Y Zevalin is through the urinary system, with approximately 7% of the total activity administered eliminated over the course of 1 wk. Standard universal precautions, which should already be in place in healthcare facilities, should be sufficient to prevent radiation exposure to personnel working with patients who have been treated with Zevalin. Written radiation safety instructions for patients are not required, but basic instructions to the patient and his or her family may help further minimize the risk of radiation exposure and help alleviate patient and family concerns.

3340 Assessment of radiation exposure during ercp and the efficacy of the shielding board.

Background : Recently, exposure time of radiation during ERCP seems to be increasing because of the development of therapeutic procedures using ERCP such as endoscopic sphincterotomy and endoscopic stenting. However, little consideration is given to the need for protection radiation exposure. Methods :We determined the radiation dose in 12 sessions with radiation dose counter on the chest and the back outside the protective gowns, and on the chest inside the gowns during ERCP. Then, with the shielding board, the dose was assessed with in the same manner in 13 sessions. Results : Without the shielding board, mean radiation dose per 10 minutes' fluoroscopy were 44.6 μSv at the chest outside the gowns, 77.4 μSv at the back outside the gowns, and 25.4 μSv at the chest inside the gowns. With the board, radiation dose at each parts was below the scale. Conclusion : 1) The radiation dose during ERCP is at a high level, and fluoroscopy time should be much more limited. 2) The shielding board reduced the radiation dose at the both of the chest and the back effectively. It seems to be efficient to prevent radiation exposure. 3) Because the back receive a higher dose than the chest, when not using the shielding board, operators should wear the protective gowns wrapping around the body, especially the spine, to protect from radiation. Background : Recently, exposure time of radiation during ERCP seems to be increasing because of the development of therapeutic procedures using ERCP such as endoscopic sphincterotomy and endoscopic stenting. However, little consideration is given to the need for protection radiation exposure. Methods :We determined the radiation dose in 12 sessions with radiation dose counter on the chest and the back outside the protective gowns, and on the chest inside the gowns during ERCP. Then, with the shielding board, the dose was assessed with in the same manner in 13 sessions. Results : Without the shielding board, mean radiation dose per 10 minutes' fluoroscopy were 44.6 μSv at the chest outside the gowns, 77.4 μSv at the back outside the gowns, and 25.4 μSv at the chest inside the gowns. With the board, radiation dose at each parts was below the scale. Conclusion : 1) The radiation dose during ERCP is at a high level, and fluoroscopy time should be much more limited. 2) The shielding board reduced the radiation dose at the both of the chest and the back effectively. It seems to be efficient to prevent radiation exposure. 3) Because the back receive a higher dose than the chest, when not using the shielding board, operators should wear the protective gowns wrapping around the body, especially the spine, to protect from radiation.

ITER plant layout and site services

The ITER site has not yet been determined. Nevertheless, to develop a construction plan and a cost estimate, it is necessary to have a detailed layout of the buildings, structures and outdoor equipment integrated with the balance of plant service systems prototypical of large fusion power plants. These services include electrical power for magnet feeds and plasma heating systems, cryogenic and conventional cooling systems, compressed air, gas supplies, demineralized water, steam and drainage. Nuclear grade facilities are provided to handle tritium fuel and activated waste, as well as to prevent radiation exposure of workers and the public. To prevent interference between services of different types and for efficient arrangement of buildings, structures and equipment within the site area, a plan was developed which segregated different classes of services to four quadrants surrounding the tokamak building, placed at the approximate geographical centre ofthe site. The locations of the buildings on the generic site were selected to meet all design requirements at minimum total project cost. A similar approach was used to determine the locations of services above, at and below grade. The generic site plan can be adapted to the site selected for ITER without significant changes to the buildings or equipment. Some rearrangements may be required by site topography, resulting primarily in changes to the length of services that link the buildings and equipment.