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Occupational and Environmental Medicine Dec 2021We investigated the association between protracted low-dose ionising radiation and the risk of cancer in medical radiation workers, the largest group of workers with...
OBJECTIVES
We investigated the association between protracted low-dose ionising radiation and the risk of cancer in medical radiation workers, the largest group of workers with occupational radiation exposures.
METHODS
Data of all South Korean diagnostic medical radiation workers enrolled at the National Dose Registry during 1996-2011 were merged with the death and cancer incidence data until 31 December 2017. SIRs, relative risks and excess relative risks (ERRs) for cancer were calculated to quantify the radiation dose-response relationship using Poisson regression models.
RESULTS
A total of 3392 first primary cancer cases were identified among 93 920 diagnostic medical radiation workers. The mean cumulative badge dose in the cohort was 7.20 mSv. The ERRs for solid cancer with a 5-year lag and haematopoietic cancers with a 2-year lag for all workers were 0.15 per 100 mGy (95% CI -0.20 to 0.51) and 0.09 per 100 mGy (95% CI -2.02 to 2.20), respectively. The ERRs for cancers did not significantly vary by job title, different lag years or after excluding thyroid and lung cancers. Sensitivity analyses restricted to workers employed for at least 1 year, or who were employed in or after 1996, or who had exposure to a cumulative badge dose of 1 mSv or more showed similar results.
CONCLUSIONS
Occupational radiation doses were not significantly associated with cancer incidence among South Korean diagnostic medical radiation workers. However, cautious interpretation of ERRs is needed due to the limitations of short follow-up and low cumulative radiation doses.
Topics: Adult; Cohort Studies; Female; Health Personnel; Humans; Incidence; Male; Middle Aged; Neoplasms; Neoplasms, Radiation-Induced; Occupational Exposure; Radiation Exposure; Radiation, Ionizing; Republic of Korea
PubMed: 34039756
DOI: 10.1136/oemed-2021-107452 -
Journal of Vascular Surgery Jul 2022The objective of the present study was to evaluate radiation safety practices, radiation training, and radiation exposure among senior vascular residents and fellows in...
OBJECTIVE
The objective of the present study was to evaluate radiation safety practices, radiation training, and radiation exposure among senior vascular residents and fellows in Accreditation Council for Graduate Medical Education-accredited programs across the United States.
METHODS
Anonymous surveys were sent to all Accreditation Council for Graduate Medical Education program directors to be distributed to postgraduate year 4 to 7 vascular trainees for completion. The survey questions focused on program type (single vs multiple hospital site), familiarity with their radiation officer, formal radiation training, frequency of radiation feedback, use of safety equipment, and adherence to as low as reasonably achievable principles.
RESULTS
A total of 95 trainees responded (27% response rate). Of the 95 trainees, 49 (51.6%) had reported they had never met their radiation safety officer, 74 (77.9%) reported they had received formal radiation safety education, 50 (53%) reported receiving feedback regarding their monthly radiation exposure, and 24 (25%) reported never having received such feedback. All the findings were more common among the multiple hospital site program respondents.
CONCLUSIONS
It should be of significant concern that such a high number of trainees have been exceeding radiation exposure limits. Programs should strive to reduce radiation exposure through formal training, provision of safety equipment, modeling by attendings of adherence to as low as reasonably achievable principles, and timely feedback on radiation exposure.
Topics: Education, Medical, Graduate; Humans; Internship and Residency; Radiation Exposure; Surveys and Questionnaires; United States; Vascular Surgical Procedures
PubMed: 35065221
DOI: 10.1016/j.jvs.2021.12.080 -
Anatolian Journal of Cardiology Oct 2017We aimed to compare the operator and patient radiation exposure in standard projections during elective diagnostic coronary angiography procedures via transradial (TRA)...
OBJECTIVE
We aimed to compare the operator and patient radiation exposure in standard projections during elective diagnostic coronary angiography procedures via transradial (TRA) versus transfemoral (TFA) approaches.
METHODS
In this analytical cross-sectional study, a total of 202 consecutive patients who were candidates for diagnostic coronary angiography were randomized to undergo the procedure via TFA or TRA approaches (101 in each group). Patients with abnormal Allen test and history of coronary artery bypass surgery, valvular heart disease, and unsuccessful coronary angiography were excluded from the study. A single operator performed all of the procedures using a single angiography system. Patient and operator radiation exposure were measured using diamentor and an electronic personal dosimeter, respectively. Each procedure comprised a standardized sequence of projections including four standard views for the left coronary system and two standard views for the right coronary system.
RESULTS
Left anterior oblique (LAO) caudal (50°/30°) and right anterior oblique RAO (30°) projections were associated with the highest and lowest patient radiation exposure, respectively. The operator received a significantly higher radiation exposure in the TRA approach for LAO cranial (for both left and right coronary systems) and LAO caudal (for left coronary system) projections during coronary angiography compared with the TFA approach.
CONCLUSION
Though a similar amount of patient radiation exposure in each projection was observed among TFA and TRA groups; LAO cranial and LAO caudal projections were associated with a significantly higher operator radiation exposure in the TRA group. These findings need to be considered when choosing the optimal arterial approach for patients scheduled for coronary angiography.
Topics: Cardiologists; Coronary Angiography; Coronary Artery Disease; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Patients; Prospective Studies; Radiation Exposure
PubMed: 28777096
DOI: 10.14744/AnatolJCardiol.2017.7724 -
Journal of the National Cancer... Jul 2020A monograph systematically evaluating recent evidence on the dose-response relationship between low-dose ionizing radiation exposure and cancer risk required a critical... (Review)
Review
BACKGROUND
A monograph systematically evaluating recent evidence on the dose-response relationship between low-dose ionizing radiation exposure and cancer risk required a critical appraisal of dosimetry methods in 26 potentially informative studies.
METHODS
The relevant literature included studies published in 2006-2017. Studies comprised case-control and cohort designs examining populations predominantly exposed to sparsely ionizing radiation, mostly from external sources, resulting in average doses of no more than 100 mGy. At least two dosimetrists reviewed each study and appraised the strengths and weaknesses of the dosimetry systems used, including assessment of sources and effects of dose estimation error. An overarching concern was whether dose error might cause the spurious appearance of a dose-response where none was present.
RESULTS
The review included 8 environmental, 4 medical, and 14 occupational studies that varied in properties relative to evaluation criteria. Treatment of dose estimation error also varied among studies, although few conducted a comprehensive evaluation. Six studies appeared to have known or suspected biases in dose estimates. The potential for these biases to cause a spurious dose-response association was constrained to three case-control studies that relied extensively on information gathered in interviews conducted after case ascertainment.
CONCLUSIONS
The potential for spurious dose-response associations from dose information appeared limited to case-control studies vulnerable to recall errors that may be differential by case status. Otherwise, risk estimates appeared reasonably free of a substantial bias from dose estimation error. Future studies would benefit from a comprehensive evaluation of dose estimation errors, including methods accounting for their potential effects on dose-response associations.
Topics: Causality; Humans; Neoplasms, Radiation-Induced; Occupational Exposure; Radiation Exposure; Radiation, Ionizing; Radiometry
PubMed: 32657346
DOI: 10.1093/jncimonographs/lgaa001 -
Radiology May 2020
Topics: Humans; Nuclear Medicine; Radiation Exposure; United States
PubMed: 32186459
DOI: 10.1148/radiol.2020200200 -
American Journal of Speech-language... Aug 2019Purpose Clinicians are trained to rely on radiation exposure time as an indicator of patient radiation exposure in Videofluoroscopic Swallowing Studies (VFSSs). However,...
Purpose Clinicians are trained to rely on radiation exposure time as an indicator of patient radiation exposure in Videofluoroscopic Swallowing Studies (VFSSs). However, it has been shown in other medical uses of fluoroscopy that dose area product (DAP), the amount of radiation delivered to the patient, is a better indicator of overall patient radiation exposure than radiation exposure time. This study sought to understand the relationship of DAP in VFSSs with radiation exposure time and projection used (lateral vs. posterior-anterior [PA]). Method DAP, radiation exposure time, and projection were recorded in 200 adults undergoing clinically indicated VFSSs conducted in accordance with the Modified Barium Swallow Impairment Profile guidelines. Data were analyzed using Spearman correlation and related sample Wilcoxon test. Results DAP and radiation exposure time did not correlate significantly in the lateral or upper PA projections. DAP was significantly higher in the PA compared to lateral projection (p < .01); however, time was shorter in PA versus lateral (p < .01). The average mGy-cm per second was 7 for lateral projections, 14 for upper PA projections, 17 for middle PA projections, and 34 for lower PA projections. Conclusions Radiation exposure time and DAP do not strongly correlate across VFSSs. Specifically, this means that 1 patient can have a low radiation exposure time with a high DAP relative to another person with a higher radiation exposure time but a lower DAP. The results of this study question the common clinical practice of using time (specifically the 5-min indicator) as a threshold for radiation exposure during a VFSSs.
Topics: Aged; Cineradiography; Deglutition; Deglutition Disorders; Female; Humans; Male; Middle Aged; Radiation Dosage; Radiation Exposure; Retrospective Studies; Statistics, Nonparametric; Time Factors
PubMed: 31112653
DOI: 10.1044/2019_AJSLP-18-0271 -
Annals of Surgery Mar 2022The aims of this study were 3-fold: first, establish the level of radiation exposure experienced by the pediatric trauma patients; second, model the level of risk of...
OBJECTIVE
The aims of this study were 3-fold: first, establish the level of radiation exposure experienced by the pediatric trauma patients; second, model the level of risk of developing fatal carcinogenesis; and third, test whether pattern of injury was predictive of the level of exposure.
SUMMARY BACKGROUND DATA
There are certain conditions that cause children to be exposed to increased radiation, that is, scoliosis, where level of radiation exposure is known. The extent that children are exposed to radiation in the context of multiple traumas remains unclear.
METHODS
Patients below the age of 16 years and with an Injury Severity Score (ISS) ≥10, treated by a Major Trauma Center for the period January 2008 to December 2018 were identified. The following data were extracted for the year following the patient's injury: number, doses, and type of radiological examination.The sex and age of the patient was taken into account in the calculation of the risk of developing a carcinogenesis.
RESULTS
The median radiation dose of the 425 patients identified in the 12 months following injury, through both CT and radiographs, was 24.3 mSv. Modeling the predictive value of pattern of injury and other relevant clinical values, ISS was proportionately predictive of cumulative dose received.
CONCLUSION
A proportion of younger polytrauma patients were exposed to high levels of radiation that in turn mean an increased risk of carcinogenesis. However, the ISS, age, injury pattern, and length of hospital stay are predictive of both risks, enabling monitoring and patient advisement of the risks.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Male; Multiple Trauma; Neoplasms, Radiation-Induced; Radiation Exposure; Retrospective Studies; Risk Assessment
PubMed: 32740254
DOI: 10.1097/SLA.0000000000004204 -
Biomolecules Dec 2019Follow-up studies after the Chernobyl and Fukushima accidents have shown that Cs and I made up the major amount of harmful contaminants in the atmospheric dispersion and... (Review)
Review
Follow-up studies after the Chernobyl and Fukushima accidents have shown that Cs and I made up the major amount of harmful contaminants in the atmospheric dispersion and fallout. Other potential sources for such radionuclide exposure may be terrorist attacks, e.g., via contamination of drinking water reservoirs. A primary purpose of radionuclide mobilization is to minimize the radiation dose. Rapid initiation of treatment of poisoned patients is imperative after a contaminating event. Internal contamination with radioactive material can expose patients to prolonged radiation, thus leading to short- and long-term clinical consequences. After the patient's emergency conditions are addressed, the treating physicians and assisting experts should assess the amount of radioactive material that has been internalized. This evaluation should include estimation of the radiation dose that is delivered and the specific radionuclides inside the body. These complex assessments warrant the reliance on a multidisciplinary approach that incorporates regional experts in radiation medicine and emergencies. Regional hospitals should have elaborated strategies for the handling of radiation emergencies. If radioactive cesium is a significant pollutant, Prussian blue is the approved antidote for internal detoxification. Upon risks of radioiodine exposure, prophylactic or immediate treatment with potassium iodide tablets is recommended. Chelators developed from calcium salts have been studied for gastrointestinal trapping and enhanced mobilization after strontium exposure.
Topics: Cesium Radioisotopes; Ferrocyanides; Humans; Iodine Radioisotopes; Post-Exposure Prophylaxis; Potassium Iodide; Pre-Exposure Prophylaxis; Radiation Exposure; Radioactive Hazard Release
PubMed: 31835766
DOI: 10.3390/biom9120856 -
Neural Plasticity 2016Ionizing radiation is omnipresent. We are continuously exposed to natural (e.g., radon and cosmic) and man-made radiation sources, including those from industry but... (Review)
Review
Ionizing radiation is omnipresent. We are continuously exposed to natural (e.g., radon and cosmic) and man-made radiation sources, including those from industry but especially from the medical sector. The increasing use of medical radiation modalities, in particular those employing low-dose radiation such as CT scans, raises concerns regarding the effects of cumulative exposure doses and the inappropriate utilization of these imaging techniques. One of the major goals in the radioprotection field is to better understand the potential health risk posed to the unborn child after radiation exposure to the pregnant mother, of which the first convincing evidence came from epidemiological studies on in utero exposed atomic bomb survivors. In the following years, animal models have proven to be an essential tool to further characterize brain developmental defects and consequent functional deficits. However, the identification of a possible dose threshold is far from complete and a sound link between early defects and persistent anomalies has not yet been established. This review provides an overview of the current knowledge on brain developmental and persistent defects resulting from in utero radiation exposure and addresses the many questions that still remain to be answered.
Topics: Animals; Brain; Humans; Radiation Exposure; Radiation, Ionizing; Research; Risk; Survivors
PubMed: 27382490
DOI: 10.1155/2016/1243527 -
The Journal of Invasive Cardiology Nov 2023Previous studies show that the distal transradial approach (dTRA) is safe and effective for coronary angiography and percutaneous coronary intervention. However, the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Previous studies show that the distal transradial approach (dTRA) is safe and effective for coronary angiography and percutaneous coronary intervention. However, the effect of dTRA on radiation exposure in the catheterization laboratory has not been characterized. The authors analyzed the available literature to compare the radiation exposure associated with dTRA vs the traditional radial approach (TRA).
METHODS
A systematic review and meta-analysis of the scientific literature was conducted by using relevant terms to search the PubMed, Embase, and Cochrane Library databases from their inception until October 13, 2022, to identify randomized controlled trials (RCTs) comparing dTRA with TRA. The primary outcome was radiation exposure reported as fluoroscopy time, air kerma, or kerma-dose product. The standard mean difference (SMD) and its 95% confidence interval were used to summarize continuous variables. Random effect and meta-regression also were used for analyses.
RESULTS
Among 484 studies identified, 7 were RCTs, with a total of 3427 patients (1712 dTRA, 1715 TRA). No difference was found between dTRA and TRA in radiation exposure quantified as fluoroscopy time (SMD -0.10 [-0.36, 0.15], P=.43) or air kerma (SMD -0.31 [-0.74, 0.13], P=.17). The overall estimate favored lower kerma-area product in the TRA (SMD 0.19 [0.08, 0.30], P=.0006). Meta-regression showed no correlation between fluoroscopy time and year of publication.
CONCLUSIONS
Compared with TRA, dTRA was associated with significantly greater radiation exposure per the kerma-area product during interventional cardiology procedures, with no differences in fluoroscopy time and air kerma.
Topics: Humans; Coronary Angiography; Cardiac Catheterization; Randomized Controlled Trials as Topic; Percutaneous Coronary Intervention; Radiation Exposure; Radial Artery
PubMed: 37992334
DOI: 10.25270/jic/23.00206