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German Medical Science : GMS E-journal 2022Radioactive material and ionising radiation play a central role in medical diagnostics and therapy. The benefit of ionising radiation is opposed by the risk of... (Review)
Review
Radioactive material and ionising radiation play a central role in medical diagnostics and therapy. The benefit of ionising radiation is opposed by the risk of irreparable damage of the human organism. This risk, especially for developing malign neoplasms, has particularly been investigated in the population surviving the atomic bombing of Hiroshima and Nagasaki, but also increasingly in persons with occupational or medical exposure to ionising radiation. We conducted a systematic search for publications in English and German in relevant databases in March 2016. Retrievals were screened by two independent reviewers. We included examinations using imaging procedures with ionising radiation. The assessment of methodological quality was done concerning representativeness, risk of bias, and further limitations, and reporting quality was assessed using the RECORD checklist. The systematic searches identified seven cross-sectional, one register, and four cohort studies. An increase in collective effective doses analogue to the increase of computed tomography (CT) examinations could be observed. An increased risk of brain tumours in children after exposition to head CT and by an increase of the number of examinations was shown. For children with predisposing factors, an increased risk of tumours of the central nerve system, leukemia, and lymphoma was found. Furthermore, a general risk for malign neoplasms or haemoblastoma, and a specific risk for lymphoma after CT examinations of different parts of the body could be observed. Taking into consideration a mostly unclear representativeness of studies and an unclear or high risk of bias as well as lack of comparability due to different research questions, the validity of results is limited. The risk of bias due to a large number of reference sources must be reduced in studies leading to realistic estimates of collective radiation doses. The risk of CT-induced radiation exposure for children should be investigated by further studies with a follow-up of at least ten years.
Topics: Child; Cross-Sectional Studies; Humans; Radiation Exposure; Radiography; Tomography, X-Ray Computed; X-Rays
PubMed: 35465642
DOI: 10.3205/000308 -
Aging Nov 2020Radiation-induced skin injury (RSI) refers to a frequently occurring complication of radiation therapy. Nearly 90% of patients having received radiation therapy... (Review)
Review
Radiation-induced skin injury (RSI) refers to a frequently occurring complication of radiation therapy. Nearly 90% of patients having received radiation therapy underwent moderate-to-severe skin reactions, severely reducing patients' quality of life and adversely affecting their disease treatment. No gold standard has been formulated for RSIs. In the present study, the mechanism of RSI and topical medications was discussed. Besides, this study can be referenced for clinicians to treat RSIs to guide subsequent clinical medicine.
Topics: Administration, Cutaneous; Animals; Apoptosis; Dermatologic Agents; Fibrosis; Humans; Occupational Exposure; Radiation Exposure; Radiodermatitis; Radiotherapy; Severity of Illness Index; Skin; Treatment Outcome
PubMed: 33202382
DOI: 10.18632/aging.103932 -
Nature Medicine Dec 2023Over one million European children undergo computed tomography (CT) scans annually. Although moderate- to high-dose ionizing radiation exposure is an established risk...
Over one million European children undergo computed tomography (CT) scans annually. Although moderate- to high-dose ionizing radiation exposure is an established risk factor for hematological malignancies, risks at CT examination dose levels remain uncertain. Here we followed up a multinational cohort (EPI-CT) of 948,174 individuals who underwent CT examinations before age 22 years in nine European countries. Radiation doses to the active bone marrow were estimated on the basis of body part scanned, patient characteristics, time period and inferred CT technical parameters. We found an association between cumulative dose and risk of all hematological malignancies, with an excess relative risk of 1.96 (95% confidence interval 1.10 to 3.12) per 100 mGy (790 cases). Similar estimates were obtained for lymphoid and myeloid malignancies. Results suggest that for every 10,000 children examined today (mean dose 8 mGy), 1-2 persons are expected to develop a hematological malignancy attributable to radiation exposure in the subsequent 12 years. Our results strengthen the body of evidence of increased cancer risk at low radiation doses and highlight the need for continued justification of pediatric CT examinations and optimization of doses.
Topics: Humans; Child; Adolescent; Young Adult; Adult; Radiation Dosage; Neoplasms, Radiation-Induced; Hematologic Neoplasms; Radiation Exposure; Tomography, X-Ray Computed
PubMed: 37946058
DOI: 10.1038/s41591-023-02620-0 -
Nihon Hoshasen Gijutsu Gakkai Zasshi 2022
Topics: Radiation Exposure; Radiation Dosage
PubMed: 36403968
DOI: 10.6009/jjrt.2022-2115 -
BMJ (Clinical Research Ed.) Aug 2023To evaluate the effect of protracted low dose, low dose rate exposure to ionising radiation on the risk of cancer.
OBJECTIVE
To evaluate the effect of protracted low dose, low dose rate exposure to ionising radiation on the risk of cancer.
DESIGN
Multinational cohort study.
SETTING
Cohorts of workers in the nuclear industry in France, the UK, and the US included in a major update to the International Nuclear Workers Study (INWORKS).
PARTICIPANTS
309 932 workers with individual monitoring data for external exposure to ionising radiation and a total follow-up of 10.7 million person years.
MAIN OUTCOME MEASURES
Estimates of excess relative rate per gray (Gy) of radiation dose for mortality from cancer.
RESULTS
The study included 103 553 deaths, of which 28 089 were due to solid cancers. The estimated rate of mortality due to solid cancer increased with cumulative dose by 52% (90% confidence interval 27% to 77%) per Gy, lagged by 10 years. Restricting the analysis to the low cumulative dose range (0-100 mGy) approximately doubled the estimate of association (and increased the width of its confidence interval), as did restricting the analysis to workers hired in the more recent years of operations when estimates of occupational external penetrating radiation dose were recorded more accurately. Exclusion of deaths from lung cancer and pleural cancer had a modest effect on the estimated magnitude of association, providing indirect evidence that the association was not substantially confounded by smoking or occupational exposure to asbestos.
CONCLUSIONS
This major update to INWORKS provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality based on some of the world's most informative cohorts of radiation workers. The summary estimate of excess relative rate solid cancer mortality per Gy is larger than estimates currently informing radiation protection, and some evidence suggests a steeper slope for the dose-response association in the low dose range than over the full dose range. These results can help to strengthen radiation protection, especially for low dose exposures that are of primary interest in contemporary medical, occupational, and environmental settings.
Topics: Humans; United States; Cohort Studies; Neoplasms, Radiation-Induced; Radiation Dosage; Radiation, Ionizing; Industry; United Kingdom; Occupational Exposure; Occupational Diseases; Radiation Exposure
PubMed: 37586731
DOI: 10.1136/bmj-2022-074520 -
Cardiovascular Journal of Africa 2021
Topics: Humans; Radiation Exposure; Radiation Protection
PubMed: 34710212
DOI: 10.5830/CVJA-2021-052 -
Pediatric Radiology Apr 2023Paediatric computed tomography (CT) imaging has always been associated with challenges. Although the technical background of CT imaging is complex, it is worth... (Review)
Review
Paediatric computed tomography (CT) imaging has always been associated with challenges. Although the technical background of CT imaging is complex, it is worth considering the baseline aspects of radiation exposure to prevent unwanted excess radiation in paediatric patients. In this review, we discuss the most relevant factors influencing radiation exposure, and provide a simplified and practical approach to optimise paediatric CT.
Topics: Child; Humans; Radiation Dosage; Tomography, X-Ray Computed; Radiation Exposure
PubMed: 36333494
DOI: 10.1007/s00247-022-05526-0 -
Deutsches Arzteblatt International Mar 2023Computed tomography (CT) studies are requested by specialists from most medical disciplines and play a vital role in the diagnosis and treatment of patients. It follows... (Review)
Review
BACKGROUND
Computed tomography (CT) studies are requested by specialists from most medical disciplines and play a vital role in the diagnosis and treatment of patients. It follows that physicians of all specialties should possess basic knowledge of computed tomography, its proper use, and the radiation exposure associated with it.
METHODS
This review is based on publications retrieved by a selective search of the literature.
RESULTS
Approximately 12 million CT studies are carried out in Germany each year, and the trend is rising. Approximately 9% of all diagnostic studies involving ionizing radiation are CT studies. On average, more than 60% of the collective effective dose due to medical radiation exposure is attributable to CT. There are two types of radiation effects caused by ionizing radiation: sto - chastic and deterministic. The additional, individual relative lifetime cancer mortality risk due to ionizing radiation with wholebody exposure at a low single dose is estimated at 5% per sievert. Radiation exposure from CT studies of the head and trunk, e.g. of a patient with polytrauma, corresponds to an additional lifetime cancer mortality risk of approximately 0.1% at an effective dose of approximately 20 millisievert.
CONCLUSION
The radiation exposure due to CT, and the risks to which patients are subjected by it, have become more important with greater use of CT. Technical advances, targeted dose monitoring, and analyses of dose data can help identify areas where improvement is necessary, in furtherance of the overriding goal of lowering patients' radiation exposure while preserving adequate image quality.
Topics: Humans; Radiation Dosage; Risk Assessment; Neoplasms, Radiation-Induced; Radiation Exposure; Tomography, X-Ray Computed
PubMed: 36633449
DOI: 10.3238/arztebl.m2022.0395 -
RoFo : Fortschritte Auf Dem Gebiete Der... Jul 2021The exposure of a pregnant woman to X-rays is an event that can cause uncertainty for all concerned. This review provides guidance on how to assess such a situation... (Review)
Review
BACKGROUND
The exposure of a pregnant woman to X-rays is an event that can cause uncertainty for all concerned. This review provides guidance on how to assess such a situation and how to determine the dose to the unborn child. In general, the use of X-rays in pregnant women in radiology should be avoided. If possible, alternatives should be used, or examinations postponed to a time after the pregnancy. This review gives a summary of the procedure for determining the radiation exposure of a pregnant woman.
METHOD
Based on the previous report of 2002 and the literature on prenatal radiation exposure published thereafter, the DGMP/DRG report on the procedure for the assessment of prenatal radiation exposure was adapted to the current state of science and technology.
RESULTS
Typically, only relatively low radiation exposures of less than 20 mSv occur for the unborn child in X-ray diagnostics in the vast majority of cases. At these dose level the additional risk of damage to the embryo or fetus caused by the radiation is low and therefore only a rough conservative estimate using tabulated values are made. Only in a few types of examination (CT and interventional radiology) higher doses values might occur in the uterus. Instead of dose estimates (step 1 in the two-step model) in these cases the calculation of dose (step 2) are required and further action by the physician may be necessary.
CONCLUSIONS
During the assessment, it is useful to initially use simple conservative estimation procedures to quickly determine whether a case falls into this large group less than 20 mSv, where there is a very low risk to the unborn child. If this is the case, the pregnant woman should be informed immediately by the doctor who performed the examination/treatment. This avoids a psychological burden on the patient. The DGMP/DRG report suggests a relatively simple, clearly structured procedure with advantages for all parties involved (physician, medical physics experts, MTRA and patient).
KEY POINTS
· The DGMP/DRG report on prenatal radiation exposure describes the procedure for calculating radiation exposures and the associated risks for the unborn child.. · Using the two-step model, only a simple assessment based on the first step is necessary for most prenatal radiation exposures.. · With the given tables it is possible to estimate individual risks for the unborn child taking into account the radiation exposure.. · Only in the rare case that the first estimate results in a uterine dose larger 20 mSv a more accurate calculation is necessary..
CITATION FORMAT
· Fiebich M, Block A, Borowski M et al. Prenatal radiation exposure in diagnostic and interventional radiology. Fortschr Röntgenstr 2021; 193: 778 - 786.
Topics: Dose-Response Relationship, Radiation; Female; Fetus; Humans; Pregnancy; Radiation Dosage; Radiation Exposure; Radiology, Interventional
PubMed: 33327031
DOI: 10.1055/a-1313-7527 -
Yonsei Medical Journal Jul 2019Radon is a naturally occurring radioactive material that is formed as the decay product of uranium and thorium, and is estimated to contribute to approximately half of... (Review)
Review
Radon is a naturally occurring radioactive material that is formed as the decay product of uranium and thorium, and is estimated to contribute to approximately half of the average annual natural background radiation. When inhaled, it damages the lungs during radioactive decay and affects the human body. Through many epidemiological studies regarding occupational exposure among miners and residential exposure among the general population, radon has been scientifically proven to cause lung cancer, and radon exposure is the second most common cause of lung cancer after cigarette smoking. However, it is unclear whether radon exposure causes diseases other than lung cancer. Media reports have often dealt with radon exposure in relation to health problems, although public attention has been limited to a one-off period. However, recently in Korea, social interest and concern about radon exposure and its health effects have increased greatly due to mass media reports of high concentrations of radon being released from various close-to-life products, such as mattresses and beauty masks. Accordingly, this review article is intended to provide comprehensive scientific information regarding the health effects of radon exposure.
Topics: Health; Humans; Neoplasms, Radiation-Induced; Radiation Exposure; Radon
PubMed: 31250572
DOI: 10.3349/ymj.2019.60.7.597