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Annals of the ICRP Dec 2020The International Commission on Radiological Protection (ICRP) developed effective dose as a quantity related to risk for occupational and public exposure. There was a...
The International Commission on Radiological Protection (ICRP) developed effective dose as a quantity related to risk for occupational and public exposure. There was a need for a similar dose quantity linked to risk for making everyday decisions relating to medical procedures. Coefficients were developed to enable the calculation of doses to organs and tissues, and effective doses for procedures in nuclear medicine and radiology during the 1980s and 1990s. Effective dose has provided a valuable tool that is now used in the establishment of guidelines for patient referral and justification of procedures, choice of appropriate imaging techniques, and providing dose data on potential exposure of volunteers for research studies, all of which require the benefits from the procedure to be weighed against the risks. However, the approximations made in the derivation of effective dose are often forgotten, and the uncertainties in calculations of risks are discussed. An ICRP report on protection dose quantities has been prepared that provides more information on the application of effective dose, and concludes that effective dose can be used as an approximate measure of possible risk. A discussion of the way in which it should be used is given here, with applications for which it is considered suitable. Approaches to the evaluation of risk and methods for conveying information on risk are also discussed.
Topics: Humans; International Agencies; Nuclear Medicine; Radiation Dosage; Radiation Protection
PubMed: 33147998
DOI: 10.1177/0146645320927849 -
European Radiology Aug 2022The terms "notifications" and "alerts" for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been... (Review)
Review
The terms "notifications" and "alerts" for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. Some interventional radiology societies as well as national authorities have also published dose notifications for fluoroscopy-guided interventional procedures. Notifications and alerts may also be useful for optimisation and to avoid unintended and accidental exposures. The main interest in using these values for high-dose procedures (CT and interventional) is to optimise imaging procedures, reducing the probability of stochastic effects and avoiding tissue reactions. Alerts in X-ray systems may be considered before procedures (as in CT), during procedures (in some interventional radiology systems), and after procedures, when the patient radiation dose results are known and processed. This review summarises the different uses of notifications and alerts to help in optimisation for CT and for fluoroscopy-guided interventional procedures as well as in the analysis of unintended and accidental medical exposures. The paper also includes cautions in setting the alert values and discusses the benefits of using patient dose management systems for the alerts, their registry and follow-up, and the differences between notifications, alerts, and trigger levels for individual procedures and the terms used for the collective approach, such as diagnostic reference levels. KEY POINTS: • Notifications and alerts on patient dose values for computed tomography (CT) and fluoroscopy-guided interventional procedures (FGIP) allow to improve radiation safety and contribute to the avoidance of radiation injuries and unintended and accidental exposures. • Alerts may be established before the imaging procedures (as in CT) or during and after the procedures as for FGIP. • Dose management systems should include notifications and alerts and their registry for the hospital quality programmes.
Topics: Fluoroscopy; Humans; Radiation Dosage; Radiation Protection; Radiography, Interventional; Radiology, Interventional; Tomography, X-Ray Computed
PubMed: 35294584
DOI: 10.1007/s00330-022-08675-w -
Journal of Medical Imaging and... Jun 2022This article presents the findings of phase three of a mixed-method study. Phases one and two explored South African radiographers' radiation protection intention and...
BACKGROUND
This article presents the findings of phase three of a mixed-method study. Phases one and two explored South African radiographers' radiation protection intention and practices and found that even though radiographers reported a high intention to perform radiation protection, varying practices were observed. Phase three of the study explored optimising radiation protection among radiographers in South Africa.
OBJECTIVE
The research objective guiding phase three of the study was to explore co-constructed change ideas to facilitate optimal radiation protection.
METHODS
A qualitative research approach using focus group interviews collected data from eight purposively selected radiography managers. The collected data was analysed using thematic analysis.
RESULTS
Two themes and related categories were identified. Radiographer managers defined radiation protection correctly and concurred that they observed suboptimal radiation protection practices. They attributed suboptimal practice with diminished stature of the radiographer within the healthcare team, ionising radiation being an unseen harm and radiographers' attitude. Radiography managers envisioned their ideal radiation protection environment and suggested ways to attain it. Among the suggestions was a strong collaboration between stakeholders, continuous education, research, national standardised policies, and radiography organisational structures.
CONCLUSION
To rectify suboptimal radiation protection, radiography managers co-constructed ideas to optimise radiation protection practices. Fundamental to change was healthcare organisations embedding radiation protection within their safety culture; thereby, all stakeholders would be invested in upholding the organisation-wide impetus. However, ultimately compliance and accountability is an individual choice.
Topics: Allied Health Personnel; Humans; Leadership; Radiation Protection; Radiography; South Africa
PubMed: 35367167
DOI: 10.1016/j.jmir.2022.03.007 -
Radiation and Environmental Biophysics May 2023Ionising radiation has been used for over a century for peaceful purposes, revolutionising health care and promoting well-being through its application in industry,... (Review)
Review
Ionising radiation has been used for over a century for peaceful purposes, revolutionising health care and promoting well-being through its application in industry, science, and medicine. For almost as long, the International Commission on Radiological Protection (ICRP) has promoted understanding of health and environmental risks of ionising radiation and developed a protection system that enables the safe use of ionising radiation in justified and beneficial practices, providing protection from all sources of radiation. However, we are concerned that a shortage of investment in training, education, research, and infrastructure seen in many sectors and countries may compromise society's ability to properly manage radiation risks, leading to unjustified exposure to or unwarranted fear of radiation, impacting the physical, mental, and social well-being of our peoples. This could unduly limit the potential for research and development in new radiation technologies (healthcare, energy, and the environment) for beneficial purposes. ICRP therefore calls for action to strengthen expertise in radiological protection worldwide through: (1) National governments and funding agencies strengthening resources for radiological protection research allocated by governments and international organisations, (2) National research laboratories and other institutions launching and sustaining long-term research programmes, (3) Universities developing undergraduate and graduate university programmes and making students aware of job opportunities in radiation-related fields, (4) Using plain language when interacting with the public and decision makers about radiological protection, and (5) Fostering general awareness of proper uses of radiation and radiological protection through education and training of information multipliers. The draft call was discussed with international organisations in formal relations with ICRP in October 2022 at the European Radiation Protection Week in Estoril, Portugal, and the final call announced at the 6th International Symposium on the System of Radiological Protection of ICRP in November 2022 in Vancouver, Canada.
Topics: Humans; Radiation Protection; Radiation, Ionizing; Canada; International Agencies
PubMed: 37097458
DOI: 10.1007/s00411-023-01024-5 -
RoFo : Fortschritte Auf Dem Gebiete Der... Apr 2019
Topics: European Union; Germany; Guideline Adherence; Health Physics; Humans; National Health Programs; Occupational Health; Radiation Injuries; Radiation Protection
PubMed: 30897660
DOI: 10.1055/a-0848-0096 -
International Journal of Environmental... Oct 2022The current geopolitical situation and the war on Ukraine's territory generate questions about the possible use of a nuclear weapon and create the need to refresh...
The current geopolitical situation and the war on Ukraine's territory generate questions about the possible use of a nuclear weapon and create the need to refresh emergency protective plans for the population. Ensuring the protection of public health is a national responsibility, but the problem is of international size and global scale. Radiological or nuclear disasters need suitable decision making at the right time, which determine large effective radiation protection activities to ensure public health is protected, reduce fatalities, radiation disease, and other effects. In this study, a simulation of a single nuclear weapon detonation with an explosion yield of 0.3 and 1 Mt was applied for a hypothetical location, to indicate the required decision making and the need to trigger protocols for the protection of the population. The simulated explosion was located in a city center, in a European country, for the estimation of the size of the effects of the explosion and its consequences for public health. Based on the simulation results and knowledge obtained from historical nuclear events, practical suggestions, discussion, a review of the recommendations was conducted, exacerbated by the time constraints of a public health emergency. Making science-based decisions should encompass clear procedures with specific activities triggered immediately based on confirmed information, acquired from active or/and passive warning systems and radiometric specific analysis provided by authorized laboratories. This study has the potential to support the preparedness of decision makers in the event of a disaster or crisis-related emergency for population health management and summarizes the strengths and weaknesses of the current ability to respond.
Topics: Decision Making; Disaster Planning; Nuclear Weapons; Public Health; Radiation Protection; Radioactive Hazard Release
PubMed: 36232066
DOI: 10.3390/ijerph191912766 -
Life Sciences in Space Research Jul 2015Cancer is an important long-term risk for astronauts exposed to protons and high-energy charged particles during travel and residence on asteroids, the moon, and other... (Review)
Review
Cancer is an important long-term risk for astronauts exposed to protons and high-energy charged particles during travel and residence on asteroids, the moon, and other planets. NASA's Biomedical Critical Path Roadmap defines the carcinogenic risks of radiation exposure as one of four type I risks. A type I risk represents a demonstrated, serious problem with no countermeasure concepts, and may be a potential "show-stopper" for long duration spaceflight. Estimating the carcinogenic risks for humans who will be exposed to heavy ions during deep space exploration has very large uncertainties at present. There are no human data that address risk from extended exposure to complex radiation fields. The overarching goal in this area to improve risk modeling is to provide biological insight and mechanistic analysis of radiation quality effects on carcinogenesis. Understanding mechanisms will provide routes to modeling and predicting risk and designing countermeasures. This white paper reviews broad issues related to experimental models and concepts in space radiation carcinogenesis as well as the current state of the field to place into context recent findings and concepts derived from the NASA Space Radiation Program.
Topics: Animals; Astronauts; Cosmic Radiation; Humans; Mice; Neoplasms; Occupational Exposure; Radiation Dosage; Radiation Injuries; Radiation Protection; Space Flight
PubMed: 26256633
DOI: 10.1016/j.lssr.2015.07.006 -
Anaesthesia Apr 2016In many orthopaedic operating rooms, anaesthesia providers routinely wear lead aprons for protection from radiation, but some studies have questioned whether this is... (Review)
Review
In many orthopaedic operating rooms, anaesthesia providers routinely wear lead aprons for protection from radiation, but some studies have questioned whether this is needed. We conducted a systematic review to identify studies that measured the amount of radiation that anaesthetists were exposed to in the orthopaedic operating room. Multiple studies have shown that at 1.5 m from the source of radiation, anaesthetists received no radiation, or amounts so small that a person would have to be present in an unreasonable number of operations to receive cumulative doses of any significance. Radiation doses at this distance were often at the limits of the sensitivity of the measuring dosimeter. We question the need to wear lead protection for anaesthesia providers who are routinely at 1.5 m or a greater distance from standard fluoroscopy units.
Topics: Anesthesia; Humans; Occupational Exposure; Operating Rooms; Orthopedics; Protective Clothing; Radiation Dosage; Radiation Monitoring; Radiation Protection
PubMed: 26874074
DOI: 10.1111/anae.13400 -
Medical Physics Aug 2022Proton imaging makes use of high-energy, low-intensity proton beams that fully traverse the patient and has been suggested to reduce range uncertainty in proton therapy....
BACKGROUND
Proton imaging makes use of high-energy, low-intensity proton beams that fully traverse the patient and has been suggested to reduce range uncertainty in proton therapy. Upright patient positioning with proton imaging is being considered for a fixed beam room of a new proton therapy facility currently under construction. Considering that the yield and energy spectrum of secondary radiation from high-energy proton beams is proton beam energy dependent, an assessment of radiation shielding at the energies required for proton imaging should be performed prior to use. Furthermore, NCRP 144 recommends that pion production be considered for proton energies greater than 300 MeV, which are not typically utilized for proton therapy but may be required for proton imaging.
PURPOSE
The purpose of this work was to determine whether proton treatment and imaging with an upright patient positioning system on a fixed beamline were acceptable from a radiation shielding perspective. This is the first report on radiation shielding assessment of proton imaging applications and includes consideration of pion production at the proton beam energy of 330 MeV.
METHODS
The Geant4 Monte Carlo toolkit was used for the radiation shielding assessment. The calculations consisted of the generation of secondary particle phase-space files by simulating the passage of high-energy proton beams in two target materials, and subsequent simulation of the secondary particles in the proton therapy facility geometry. Particle fluence was converted to operational and protection radiation safety quantities with a custom python script for assessment of instantaneous and annual doses, respectively.
RESULTS
The total yields of pions from a 330-MeV proton beam were many orders of magnitude less than that of neutrons and photons. Three-dimensional maps of ambient dose rate for a 330-MeV proton beam showed doses arising from secondary neutrons and photons far exceed those arising from pion production. Incorporating representative annual workloads into the calculation demonstrated that proton imaging doses outside the shielded area were negligible compared to those arising from proton therapy.
CONCLUSIONS
Pion production has a negligible impact on the radiation shielding of proton imaging at 330 MeV relative to neutron and photon production. Radiation shielding designed for proton therapy is adequate for high-energy proton imaging applications.
Topics: Humans; Monte Carlo Method; Neutrons; Proton Therapy; Protons; Radiation Dosage; Radiation Protection; Radiometry
PubMed: 35611603
DOI: 10.1002/mp.15727 -
Journal of the American College of... Feb 2023US physicians in multiple specialties who order or conduct radiological procedures lack formal radiation science education and thus sometimes order procedures of limited... (Review)
Review
US physicians in multiple specialties who order or conduct radiological procedures lack formal radiation science education and thus sometimes order procedures of limited benefit or fail to order what is necessary. To this end, a multidisciplinary expert group proposed an introductory broad-based radiation science educational program for US medical schools. Suggested preclinical elements of the curriculum include foundational education on ionizing and nonionizing radiation (eg, definitions, dose metrics, and risk measures) and short- and long-term radiation-related health effects as well as introduction to radiology, radiation therapy, and radiation protection concepts. Recommended clinical elements of the curriculum would impart knowledge and practical experience in radiology, fluoroscopically guided procedures, nuclear medicine, radiation oncology, and identification of patient subgroups requiring special considerations when selecting specific ionizing or nonionizing diagnostic or therapeutic radiation procedures. Critical components of the clinical program would also include educational material and direct experience with patient-centered communication on benefits of, risks of, and shared decision making about ionizing and nonionizing radiation procedures and on health effects and safety requirements for environmental and occupational exposure to ionizing and nonionizing radiation. Overarching is the introduction to evidence-based guidelines for procedures that maximize clinical benefit while limiting unnecessary risk. The content would be further developed, directed, and integrated within the curriculum by local faculties and would address multiple standard elements of the Liaison Committee on Medical Education and Core Entrustable Professional Activities for Entering Residency of the Association of American Medical Colleges.
Topics: Humans; Schools, Medical; Multimedia; Radiology; Curriculum; Radiation Protection
PubMed: 36130692
DOI: 10.1016/j.jacr.2022.08.010