Spatial Variation Regularities of Cosmic Radiation and Evaluation of Exposure Doses to Aircrews

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Radiation Exposure to Patient and Staff in Hepatic Chemoembolization: Risk Estimation of Cancer and Deterministic Effects

The purpose of the study was to determine the risks of radiation-induced cancer and deterministic effects for the patient and staff in transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Sixty-five patients with HCC underwent the first cycle of TACE. Thermoluminescence dosemeters and conversion factors were used to measure surface doses and to calculate organ doses and effective dose. For the patient, the risk of fatal cancer and severe genetic defect was in the magnitude of 10⁻⁴ and 10⁻⁵, respectively. Five patients showed surface doses over the first lumbar vertebra exceeding 2000 mSv and 45 patients showed doses over the spine or the liver region above 500 mSv. The risk of fatal cancer and severe genetic defect for the radiologist and assistant was in the magnitude of 10⁻⁷ to 10⁻⁸. They could exceed the threshold for lens opacity in the case of more than 490 and 1613 TACE yearly for a period of many years, respectively. Radiation dose could lead to local transient erythema and/or local depression of hematopoiesis in many patients after TACE. For the radiologist and assistant, risk of fatal cancer and genetic defect and lens opacity might arise when they perform interventions such as TACE intensively.     

医学工作者的职业照射:剂量水平、辐射危害和个人剂量监测

辐射的医学应用是核能应用中最为活跃的领域,特别是近20年来介入放射学突飞猛进的发展,医学工作者是职业受照群体中增长最快的,也是最大的受照群体。由于辐射防护管理和培训的滞后,辐射防护意识和装备满足不了迅猛发展的需要,医学工作者(特别是介入放射学工作者)的职业性受照剂量较高,因此医学工作者是职业受照群体中最应受到关注的群体。为此,告诫职业受照的医学工作者,在用辐射技术造福于病人的同时,要关注自已的安全和健康,加强防护,接受完整的个人剂量监测。     

Occupational Exposure of the Eye Lens in Interventional Procedures: How to Assess and Manage Radiation Dose

Occupational exposure from interventional x-ray procedures is one of the areas in which increased eye lens exposure may occur. Accurate dosimetry is an important element to investigate the correlation of observed radiation effects with radiation dose, to verify the compliance with regulatory dose limits, and to optimize radiation protection practice. The objective of this work is to review eye lens dose levels in clinical practice that may occur from the use of ionizing radiation. The use of a dedicated eye lens dosimeter is the recommended methodology; however, in practice it cannot always be easily implemented. Alternatively, the eye lens dose could be assessed from measurements of other dosimetric quantities or other indirect parameters, such as patient dose. The practical implementation of monitoring eye lens doses and the use of adequate protective equipment still remains a challenge. The use of lead glasses with a good fit to the face, appropriate lateral coverage, and/or ceiling-suspended screens is recommended in workplaces with potential high eye lens doses.     

Perception of Radiation Exposure and Risk Among Patients,Medical Students,and Referring Physicians at a Tertiary Care Community Hospital

Background

It is important for physicians to be aware of the radiation doses as well as the risks associated with diagnostic imaging procedures that they are ordering.

Methods

A survey was administered to patients, medical students, and referring physicians from a number of specialties to determine background knowledge regarding radiation exposure and risk associated with commonly ordered medical imaging tests.

Results

A total of 127 patients, 32 referring physicians, and 30 medical students completed the survey. The majority of patients (92%) were not informed of the radiation risks associated with tests that they were scheduled to receive and had false perceptions about the use of radiation and its associated risks. Physicians and medical students had misconceptions about the use of ionizing radiation in a number of radiologic examinations; for example, 25% and 43% of physicians and medical students, respectively, were unaware that interventional procedures used ionizing radiation, and 28% of physicians were unaware that mammography used ionizing radiation. Computed tomographies and barium studies were thought to be associated with the least ionizing radiation among physicians.

Conclusion

There is a need for educating the public, medical students, and referring physicians about radiation exposure and associated risk so that (1) patients receiving multiple medical imaging tests are aware of the radiation that they are receiving and (2) physicians and future physicians will make informed decisions when ordering such tests to limit the amount of radiation that patients receive and to promote informed consent among patients.     

Radiation necrosis of the brain: Time of onset and incidence related to total dose and fractionation of radiation

Summary Clinical deterioration during or after brain irradiation may be due to progression of neoplasm or radiation induced necrosis of the neoplasm and/or of normal brain tissues, or a combination of all. Eight patients with histologically documented radiation induced lesions of the brain are included in this study. The radiation therapy included the fractional schedule, group A, who received 280 to 300 rads daily, to a total dose of 4500 to 5000 rads and weekly exposure did not exceed 900 rads. Group B patients were exposed to 850 rads, daily dose on day 1, 3, 21 and 23 to a total dose of 3400 rads. The incidence of radiation induced lesions of brain was 3.4% in patients group A and 8.7% in group B patients (without) statistical significance). The median time of onset of these lesions after completion of radiation therapy was significantly shorter in group B patients (8.5 months) as opposed to group A patients (21 months).     

Clinical Imaging Guidelines Part 2: Risks,Benefits, Barriers,and Solutions

A recent international meeting was convened by two United Nations bodies to focus on international collaboration on clinical appropriateness/referral guidelines for use in medical imaging. This paper, the second of 4 from this technical meeting, addresses barriers to the successful development/deployment of clinical imaging guidelines and means of overcoming them. It reflects the discussions of the attendees, and the issues identified are treated under 7 headings:■ Practical Strategy for Development and Deployment of Guidelines;■ Governance Arrangements and Concerns with Deployment of Guidelines;■ Finance, Sustainability, Reimbursement, and Related Issues;■ Identifying Benefits and Radiation Risks from Radiological Examinations;■ Information Given to Patients and the Public, and Consent Issues;■ Special Concerns Related to Pregnancy; and■ The Research Agenda.Examples of topics identified include the observation that guideline development is a global task and there is no case for continuing it as the project of the few professional organizations that have been brave enough to make the long-term commitment required. Advocacy for guidelines should include the expectations that they will facilitate: (1) better health care delivery; (2) lower cost of that delivery; with (3) reduced radiation dose and associated health risks. Radiation protection issues should not be isolated; rather, they should be integrated with the overall health care picture. The type of dose/radiation risk information to be provided with guidelines should include the uncertainty involved and advice on application of the precautionary principle with patients. This principle may be taken as an extension of the well-established medical principle of “first do no harm.”     

Assessment of the awareness of radiation protection and related concepts among nursing staff mainly working in diagnostic imaging units,cath-labs and operation theatres in Sri Lanka: A survey-based study

IntroductionThis study was carried out to evaluate the awareness of radiation protection, radiation types, medical imaging equipment and radiation effects among nurses for the first time in Sri Lanka. Since nurses are involved as direct caregivers in diagnostic and therapeutic radiography and radiation treatment procedures, they need to have a good understanding of the areas mentioned above.MethodsA self-administered questionnaire was used to collect data from 391 nurses working in hospitals, clinics, and other healthcare settings. Forwarded questions gathered the participants' demographic details and assessed their awareness of radiation protection, medical imaging equipment, radiation type and radiation effects. The average score per awareness area for each demographic characteristic was calculated based on the responses. Additionally, the percentage of participants who scored above 50 and 75 was calculated for each awareness area.ResultsThe majority were female participants (81.1%) and possessed a diploma in nursing (66.0%) with 10.8 years of average work experience. 92.3%, 74.7%, 69.8% and 22.3% of the participants scored more than 50 marks for the questions related to radiation protection, medical imaging equipment, radiation type and radiation effects, respectively. The level of nursing education and prior training in radiation protection significantly influenced all awareness areas, whereas participants with a graduate qualification in nursing and with prior radiation protection training scored the highest average marks.ConclusionBased on the scores obtained, the Sri Lankan nurses have satisfactory awareness of the essential concepts related to radiation types, medical imaging equipment and radiation protection. However, there is a significant lacking of awareness of radiation effects. This can be attributed to the fact that most participants did not have any formal training in radiation protection. The results implicate that proper training in radiation protection can significantly influence awareness of radiation protection and related concepts. Therefore, it is a timely requirement to initiate short awareness programs and continuing education programs on radiation protection for nurses working in specialised radiation units.Implications for practiceThe study suggests the necessity of initiating continuous education programs for nursing staff radiation protection to overcome the awareness gaps.     

DNA Repair: Relationship to Drug and Radiation Resistance,Metastasis and Growth Factors

Summary

DNA repair mechanisms are important for the recovery of both normal and malignant tissues from radiation and chemotherapy. Drug ‘resistance’ may merely reflect the similarity of cancer to normal tissues. Investigating the normal repair mechanisms by cloning human DNA repair genes will permit a much better comparison. Therapeutic inhibition of DNA repair may be possible with poly-ADP-ribose polymerase inhibitors. A differential effect may be obtained since less-differentiated cells have a higher poly-ADP-ribose polymerase activity. Clinical application of repair inhibitors can be achieved by using antimetabolites such as high-dose hydroxyurea which produces levels of 1–3 mmol litre ^?1/24 hours. The whole cell and tissue response to DNA damage is more complex than removal of adducts and joining strand breaks. DNA damage can result in an increase in growth-factor receptors, the release of soluble mediators that affect undamaged cells and stimulation of plasminogen activator. These changes may enhance growth and recovery as well as bypass or repair the damage. The generation of heterogeneity in a tumour population may be mediated by DNA rearrangements. Genetic instability is much higher in metastatic clones and a comparison of DNA strand-break repair in a metastatic and a non-metastatic line showed more rapid repair in the former. Aberrant use of DNA repair stimulated by growth factors may mediate tumour progression and heterogeneity as well as drug resistance.     

Thermal Ablation,Embolization, and Selective Internal Radiation Therapy Combined with Checkpoint Inhibitor Cancer Immunotherapy: Safety Analysis

PurposeTo describe interventional oncology therapies combined with immune checkpoint inhibitor (ICI) therapy targeting the programmed death 1 pathway in patients with different neoplasms.Materials and MethodsThis was a retrospective cohort study of patients who underwent tumor-directed thermal ablation, embolization, or selective internal radiation therapy (SIRT) between January 1, 2011, and May 1, 2019, and received anti–programmed death 1/PD-L1 agents ≤ 90 days before or ≤ 30 days after the interventional procedure. Immune-related adverse events (irAEs) and procedural complications ≤ 90 days after the procedure were graded according to the Common Terminology Criteria for Adverse Events version 5.0. The study included 65 eligible patients (49% female; age 63 years ± 11.1). The most common tumors were metastatic melanoma (n = 28) and non–small cell lung cancer (NSCLC) (n = 12). Patients underwent 78 procedures (12 patients underwent > 1 procedure), most frequently SIRT (35.9%) and cryoablation (28.2%). The most common target organs were liver (46.2%), bone (24.4%), and lung (9.0%). Most patients received ICI monotherapy with pembrolizumab (n = 30), nivolumab (n = 22), and atezolizumab (n = 6); 7 patients received ipilimumab and nivolumab.ResultsSeven (10.8%) patients experienced an irAE (71.4% grade 1–2), mostly affecting the skin. Median time to irAE was 33 days (interquartile range, 19–38 days). Five irAEs occurred in patients with melanoma, and no irAEs occurred in patients with NSCLC. Management required corticosteroids (n = 3) and immunotherapy discontinuation (n = 1); all irAEs resolved to grade ≤ 1. There were 4 intraprocedural and 32 postprocedural complications (77.8% grade < 3). No grade 5 irAEs and/or procedural complications occurred.ConclusionsNo unmanageable or unanticipated toxicities occurred within 90 days after interventional oncology therapies combined with ICIs.