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JACC. Cardiovascular Imaging Dec 2016The introduction of ionizing radiation in medicine revolutionized the diagnosis and treatment of disease and dramatically improved and continues to improve the quality... (Review)
Review
The introduction of ionizing radiation in medicine revolutionized the diagnosis and treatment of disease and dramatically improved and continues to improve the quality of health care. Cardiovascular imaging and medical imaging in general, however, are associated with a range of radiobiologic effects, including, in rare instances, moderate to severe skin damage resulting from cardiac fluoroscopy. For the dose range associated with diagnostic imaging (corresponding to effective doses on the order of 10 mSv [1 rem]), the possible effects are stochastic in nature and largely theoretical. The most notable of these effects, of course, is the possible increase in cancer risk. The current review addresses radiobiology relevant to cardiovascular imaging, with particular emphasis on radiation induction of cancer, including consideration of the linear nonthreshold dose-response model and of alternative models such as radiation hormesis.
Topics: Cardiovascular Diseases; Cardiovascular System; Diagnostic Imaging; Dose-Response Relationship, Radiation; Humans; Predictive Value of Tests; Radiation Dosage; Radiation Exposure; Radiation Injuries; Risk Assessment; Risk Factors; Stochastic Processes
PubMed: 27931527
DOI: 10.1016/j.jcmg.2016.09.012 -
Clinical Oncology (Royal College of... Apr 2016Our acceptance of exposure to radiation is somewhat schizophrenic. We accept that the use of high doses of radiation is still one of the most valuable weapons in our...
Our acceptance of exposure to radiation is somewhat schizophrenic. We accept that the use of high doses of radiation is still one of the most valuable weapons in our fight against cancer, and believe that bathing in radioactive spas is beneficial. On the other hand, as a species, we are fearful of exposure to man-made radiation as a result of accidents related to power generation, even though we understand that the doses are orders of magnitude lower than those we use everyday in medicine. The 70th anniversary of the detonation of the atomic bombs in Hiroshima and Nagasaki was marked in 2015. The 30th anniversary of the Chernobyl nuclear power plant accident will be marked in April 2016. March 2016 also sees the fifth anniversary of the accident at the Fukushima nuclear power plant. Perhaps now is an opportune time to assess whether we are right to be fearful of the effects of low doses of radiation, or whether actions taken because of our fear of radiation actually cause a greater detriment to health than the direct effect of radiation exposure.
Topics: Age Factors; Background Radiation; Chernobyl Nuclear Accident; Dose-Response Relationship, Radiation; Fukushima Nuclear Accident; Humans; Neoplasms, Radiation-Induced; Nuclear Warfare; Radiation Dosage; Radiation Effects; Radiation Exposure; Radioactive Hazard Release; Radiotherapy; Risk Assessment
PubMed: 26880062
DOI: 10.1016/j.clon.2016.01.007 -
JACC. Cardiovascular Imaging Mar 2017Cardiovascular imaging plays a central role in the diagnosis and treatment of cardiovascular disease. Recently, increased emphasis has been placed on quality in... (Review)
Review
Cardiovascular imaging plays a central role in the diagnosis and treatment of cardiovascular disease. Recently, increased emphasis has been placed on quality in cardiovascular imaging, and it is becoming a central priority for various stakeholders, including patients, physicians, and payers. The changing health care landscape and associated challenges imposed on cardiac imagers, including reductions in reimbursement and growing need for pre-authorization, have also helped bring quality metrics to the forefront. Continuous quality improvement initiatives provide the framework for the team of physicians, technical staff members, administrators, and other health care professionals to deliver high-quality care. Efforts to improve quality in cardiac imaging have started to form the foundation for numerous research studies in this arena, and although few in number, randomized control trials have begun to emerge. This review highlights quality improvement studies focusing on appropriate use education, reporting, and radiation dose reduction in cardiovascular imaging.
Topics: Cardiac Imaging Techniques; Cardiovascular Diseases; Clinical Trials as Topic; Evidence-Based Medicine; Humans; Patient Safety; Predictive Value of Tests; Prognosis; Quality Improvement; Quality Indicators, Health Care; Radiation Dosage; Radiation Exposure; Research Design; Risk Factors; Unnecessary Procedures
PubMed: 28279386
DOI: 10.1016/j.jcmg.2016.12.004 -
Drug Discovery Today Jan 2021High doses of total-body or partial-body radiation exposure can result in a life-threatening acute radiation syndrome as manifested by severe morbidity. Entolimod... (Review)
Review
High doses of total-body or partial-body radiation exposure can result in a life-threatening acute radiation syndrome as manifested by severe morbidity. Entolimod (CBLB502) is effective in protecting against, and mitigating the development of, the hematopoietic and gastrointestinal subsyndromes of the acute radiation syndrome in rodents and nonhuman primates. Entolimod treatment reduces radiation-induced apoptosis and accelerates the regeneration of progenitors in radiation-damaged tissues. The drug has been evaluated clinically for its pharmacokinetics (PK), toxicity, and biomarkers. The US Food and Drug Administration (FDA) has granted investigational new drug, fast-track, and orphan drug statuses to entolimod. Its safety, efficacy, and animal-to-human dose conversion data allowed its progression with a pre-emergency use authorization application submission.
Topics: Acute Radiation Syndrome; Animals; Drug Development; Humans; Peptides; Radiation Exposure; Radiation-Protective Agents
PubMed: 33065293
DOI: 10.1016/j.drudis.2020.10.003 -
European Journal of Vascular and... Nov 2022Radiation cataract has been observed at lower doses than previously thought, therefore the annual limit for equivalent dose to the eye lens has been reduced from 150 to...
OBJECTIVE
Radiation cataract has been observed at lower doses than previously thought, therefore the annual limit for equivalent dose to the eye lens has been reduced from 150 to 20 mSv. This study evaluated radiation exposure to the eye lens of operators working in a hybrid operating room before and after implementation of a dose reduction program.
METHODS
From April to October 2019, radiation exposure to the first operator was measured during all consecutive endovascular procedures performed in the hybrid operating room using BeOSL H(3) eye lens dosimeters placed both outside and behind the lead glasses (0.75 mm lead equivalent). Measured values were compared with data from a historic control group from the same hospital before implementation of the dose reduction program.
RESULTS
A total of 181 consecutive patients underwent an endovascular procedure in the hybrid operating room. The median unprotected eye lens dose (outside lead glasses) of the main operator was 0.049 mSv for endovascular aortic repair (EVAR) (n = 30), 0.042 mSv for thoracic endovascular aortic repair (TEVAR) (n = 23), 0.175 mSv for complex aortic fenestrated or branched endovascular procedures (F/BEVAR; n = 15), and 0.042 mSv for peripheral interventions (n = 80). Compared with the control period, EVAR had 75% lower, TEVAR 79% lower, and F/BEVAR 55% lower radiation exposure to the unprotected eye lens of the first operator. The lead glasses led to a median reduction in the exposure to the eye lens by a factor of 3.4.
CONCLUSION
The implementation of a dose reduction program led to a relevant reduction in radiation exposure to the head and eye lens of the first operator in endovascular procedures. With optimum radiation protection measures, including a ceiling mounted shield and lead glasses, more than 440 EVARs, 280 TEVARs, or 128 FEVARs could be performed per year before the dose limit for the eye lens of 20 mSv was reached.
Topics: Humans; Operating Rooms; Radiation Dosage; Occupational Exposure; Radiation Exposure; Endovascular Procedures; Lens, Crystalline
PubMed: 35760276
DOI: 10.1016/j.ejvs.2022.06.016 -
GeroScience Dec 2023The Wake Forest nonhuman primate (NHP) Radiation Late Effects Cohort (RLEC) is a unique and irreplaceable population of aging NHP radiation survivors which serves the... (Review)
Review
The Wake Forest nonhuman primate (NHP) Radiation Late Effects Cohort (RLEC) is a unique and irreplaceable population of aging NHP radiation survivors which serves the nation's need to understand the late effects of radiation exposure. Over the past 16 years, Wake Forest has evaluated > 250 previously irradiated rhesus macaques (Macaca mulatta) that were exposed to single total body irradiation (IR) doses of 1.14-8.5 Gy or to partial body exposures of up to 10 Gy (5% bone marrow sparing) or 10.75 Gy (whole thorax). Though primarily used to examine IR effects on disease-specific processes or to develop radiation countermeasures, this resource provides insights on resilience across physiologic systems and its relationship with biological aging. Exposure to IR has well documented deleterious effects on health, but the late effects of IR are highly variable. Some animals exhibit multimorbidity and accumulated health deficits, whereas others remain relatively resilient years after exposure to total body IR. This provides an opportunity to evaluate biological aging at the nexus of resilient/vulnerable responses to a stressor. Consideration of inter-individual differences in response to this stressor can inform individualized strategies to manage late effects of radiation exposure, and provide insight into mechanisms underlying systemic resilience and aging. The utility of this cohort for age-related research questions was summarized at the 2022 Trans-NIH Geroscience Interest Group's Workshop on Animal Models for Geroscience. We present a brief review of radiation injury and its relationship to aging and resilience in NHPs with a focus on the RLEC.
Topics: Humans; Animals; Macaca mulatta; Models, Animal; Radiation Exposure; Radiation Injuries
PubMed: 37188889
DOI: 10.1007/s11357-023-00812-7 -
Bioelectromagnetics Jan 2020Wireless wearable and implantable devices are continuing to grow in popularity, and as this growth occurs, so too does the need to consider the safety of such devices.... (Review)
Review
Wireless wearable and implantable devices are continuing to grow in popularity, and as this growth occurs, so too does the need to consider the safety of such devices. Wearable and implantable devices require the transmitting and receiving of electromagnetic waves near and through the body, which at high enough exposure levels may damage proximate tissues. The specific absorption rate (SAR) is the quantity commonly used to enumerate exposure levels, and various national and international organizations have defined regulations limiting exposure to ensure safe operation. In this paper, we comprehensively review dosimetric studies reported in the literature up to the year 2019 for wearables and implants. We discuss antenna designs for wearables and implants as they relate to SAR values and field and thermal distributions in tissue, present designs that have made steps to reduce SAR, and then review SAR considerations as they relate to applied devices. As compared with previous review papers, this paper is the first review to focus on dosimetry aspects relative to wearable and implantable devices. Bioelectromagnetics. 2020;41:3-20 © 2019 The Authors. Bioelectromagnetics published by Wiley Periodicals, Inc.
Topics: Electromagnetic Fields; Humans; Muscle, Skeletal; Prostheses and Implants; Radiation Exposure; Radiometry; Temperature; Wearable Electronic Devices; Wireless Technology
PubMed: 31854006
DOI: 10.1002/bem.22240 -
The Iowa Orthopaedic Journal 2020The risks of radiation exposure in orthopaedic surgery have become a topic of increasing interest in the setting of widespread fluoroscopy use and concern for an...
BACKGROUND
The risks of radiation exposure in orthopaedic surgery have become a topic of increasing interest in the setting of widespread fluoroscopy use and concern for an increased prevalence of breast cancer among female orthopaedic surgeons. The aim of this national study of 31 female orthopaedic surgeons was to achieve a deeper understanding of fluoroscopic use in the OR and its associated exposure to radiation, by comparing female orthopaedic trauma and arthroplasty surgeons.
METHODS
A total of 31 surgeons wore dosimeters for 10 operating days each to track cumulative radiation exposure. Surgeons were not asked to modify their practice in any way, with no requirement that the operating days had to be chosen with the knowledge that fluoroscopy would be used. Participants were also asked to fill out a form at the end of each day, detailing the number of cases that day, the number of hours spent in the OR, and the total amount of time using fluoroscopy.
RESULTS
Trauma surgeons received significantly higher radiation doses in the OR (p=0.01) and reported longer use of fluoroscopy (p<0.001). Trauma surgeons also spent more time per day in the OR and had more cases per day compared to arthroplasty surgeons, but this difference was not significant. Radiation dose penetrating through protective equipment remained minimal.
CONCLUSION
Although the female trauma surgeons in the study operated longer and performed more procedures per day, the higher radiation exposure was best explained by the amount of time fluoroscopy is used in the OR. The fluoroscopic times in this study therefore may be a useful self-assessment tool for attending trauma and arthroplasty surgeons. Awareness of these differences will hopefully increase an individual surgeon's mindfulness toward the length of fluoroscopy use in each case, regardless of orthopaedic subspecialty..
Topics: Female; Fluoroscopy; Humans; Occupational Exposure; Orthopedic Surgeons; Physicians, Women; Radiation Exposure; United States
PubMed: 32742202
DOI: No ID Found -
Journal of Radiation Research Nov 2023Notably, the growing use of radionuclear technology, especially in diagnostic and therapeutic procedures involving radiation exposure, raises concerns about the health... (Meta-Analysis)
Meta-Analysis
Notably, the growing use of radionuclear technology, especially in diagnostic and therapeutic procedures involving radiation exposure, raises concerns about the health effects of radiation. Although epidemiological studies have provided strong evidence for elevated thyroid cancer risk after radiation exposure in childhood, the risk of thyroid cancer associated with adult exposure remains to be investigated. We conducted a systematic review and meta-analysis of relevant studies on the risk of developing thyroid cancer after radiation exposure in adulthood. The PubMed and Web of Science databases were used to select eligible articles. After screening, a total of 15 studies were identified in which estimates of the standardized incidence ratio (SIR) and the relative risk (RR) of thyroid cancer were available in 8 and 11 studies, respectively. The overall SIR estimated by the random effects model was 2.19 [95% confidence interval (CI), 1.54, 3.10]. Cochran's Q test showed significant heterogeneity in the SIRs (Q = 178, P < 0.0001). The overall RR at 10 mGy was 1.0038 (95% CI, 0.9991, 1.0085), with no significant heterogeneity (Q = 9.30, P = 0.5041). The total SIR, as well as that from each study, indicated a statistically significant excess, which could be related to screening bias. Radiation-related thyroid cancer risk was elevated in a few studies; however, the overall estimate of the RR at 10 mGy was not significant. This study demonstrates no strong epidemiological evidence for the risk of thyroid cancer in radiation exposure during adulthood; however, further research is needed.
Topics: Humans; Adult; Risk; Neoplasms, Radiation-Induced; Thyroid Neoplasms; Radiation Exposure
PubMed: 37816676
DOI: 10.1093/jrr/rrad073 -
Health Physics Mar 2016The health risks to humans and non-human biota exposed to low dose ionizing radiation remain ambiguous and are the subject of intense debate. The need to establish risk... (Review)
Review
The health risks to humans and non-human biota exposed to low dose ionizing radiation remain ambiguous and are the subject of intense debate. The need to establish risk assessment standards based on the mechanisms underlying low-level radiation exposure has been recognized by regulatory agencies as critical to adequately protect people and to make the most effective use of national resources. Here, the authors briefly review evidence showing that the molecular and biochemical changes induced by low doses of radiation differ from those induced by high doses. In particular, an array of redundant and inter-related mechanisms act in both prokaryotes and eukaryotes to restore DNA integrity following exposures to relatively low doses of sparsely ionizing radiation. Furthermore, the radiation-induced protective mechanisms often overcompensate and minimize the mutagenic potential of the byproducts of normal oxidative metabolism. In contrast to adaptive protection observed at low doses of sparsely ionizing radiation, there is evidence that even a single nuclear traversal by a densely ionizing particle track can trigger harmful effects that spread beyond the traversed cell and induce damaging effects in the nearby bystander cells. In vivo studies examining whether exposure to low dose radiation at younger age modulates the latency of expression of age-related diseases such as cancer, together with studies on the role of genetic susceptibility, will further illuminate the magnitude of risk of exposure to low dose radiation.
Topics: Animals; DNA Damage; Dose-Response Relationship, Radiation; Evidence-Based Medicine; Humans; Models, Biological; Oxidative Stress; Radiation Exposure; Radiation Injuries; Radiation, Ionizing; Risk Assessment
PubMed: 26808874
DOI: 10.1097/HP.0000000000000450