Radiation-Induced Lens Opacities among Interventional Cardiologists: Retrospective Assessment of Cumulative Eye Lens Doses.

This study describes the retrospective lens dose calculation methods developed and applied within the European epidemiological study on radiation-induced lens opacities among interventional cardiologists. While one approach focuses on self-reported data regarding working practice in combination with available procedure-specific eye lens dose values, the second approach focuses on the conversion of the individual whole-body dose to eye lens dose. In contrast with usual dose reconstruction methods within an epidemiological study, a protocol is applied resulting in an individual distribution of possible cumulative lens doses for each recruited cardiologist, rather than a single dose estimate. In this way, the uncertainty in the dose estimate (from measurement uncertainty and variability among cardiologists) is represented for each individual. Eye lens dose and whole-body dose measurements have been performed in clinical practice to validate both methods, and it was concluded that both produce acceptable results in the framework of a dose-risk evaluation study. Optimal results were obtained for the dose to the left eye using procedure-specific lens dose data in combination with information collected on working practice. This method has been applied to 421 interventional cardiologists resulting in a median cumulative eye lens dose of 15.1 cSv for the left eye and 11.4 cSv for the right eye. From the individual cumulative eye lens dose distributions obtained for each cardiologist, maxima up to 9-10 Sv were observed, although with low probability. Since whole-body dose values above the lead apron are available for only a small fraction of the cohort and in many cases not for the entire working career, the second method has only been used to benchmark the results from the first approach. This study succeeded in improving the retrospective calculation of cumulative eye lens doses in the framework of radiation-induced risk assessment of lens opacities, but it remains dependent on self-reported information, which is not always reliable for early years. However, the calculation tools developed can also be used to make an assessment of the eye lens dose in current practice.

Skin dose rate conversion factors after contamination with radiopharmaceuticals: influence of contamination area, epidermal thickness and percutaneous absorption.

Skin contamination with radiopharmaceuticals can occur during biomedical research and daily nuclear medicine practice as a result of accidental spills, after contact with bodily fluids of patients or by inattentively touching contaminated materials. Skin dose assessment should be carried out by repeated quantification to map the course of the contamination together with the use of appropriate skin dose rate conversion factors. Contamination is generally characterised by local spots on the palmar surface of the hand and complete decontamination is difficult as a result of percutaneous absorption. This specific issue requires special consideration as to the skin dose rate conversion factors as a measure for the absorbed dose rate to the basal layer of the epidermis. In this work we used Monte Carlo simulations to study the influence of the contamination area, the epidermal thickness and the percutaneous absorption on the absorbed skin dose rate conversion factors for a set of 39 medical radionuclides. The results show that the absorbed dose to the basal layer of the epidermis can differ by up to two orders of magnitude from the operational quantity Hp(0.07) when using an appropriate epidermal thickness in combination with the effect of percutaneous absorption.

Mapping very low level occupational exposure in medical imaging: a useful tool in risk communication and decision making.

OBJECTIVES: The use of ionising radiation in medical imaging is accompanied with occupational exposure which should be limited by optimised room design and safety instructions. These measures can however not prevent that workers are exposed to instantaneous dose rates, e.g. the residual exposure through shielding or the exposure of discharged nuclear medicine patients. The latter elements are often questioned by workers and detailed assessment should give more information about the impact on the individual radiation dose. METHODS: Cumulated radiation exposure was measured in a university hospital during a period of 6 months by means of thermoluminescent dosimeters. Radiation exposure was measured at background locations and at locations where enhanced exposure levels are expected but where the impact on the individual exposure is unclear. RESULTS: The results show a normal distribution of the cumulated background radiation level. No enhanced cumulated radiation exposure which significantly differs from this background level could be found during the operation of intra-oral apparatus, during ultrasonography procedures among nuclear medicine patients and at operator consoles of most CT-rooms. CONCLUSIONS: This 6 months survey offers useful information about occupational low level exposure in medical imaging and the findings can be useful in both risk communication and decision making.

The introduction of automated dispensing and injection during PET procedures: a step in the optimisation of extremity doses and whole-body doses of nuclear medicine staff.

Significant staff exposure is generally expected during PET-and PET/CT applications. Whole-body doses as well as extremity doses are usually higher per procedure compared with SPECT applications. Dispensing individual patient doses and manual injection involves high extremity doses even when heavy weighted syringe shields are used. In some cases the external radiation causes an exposure to the fingertips of more than 500 mSv y(-1), which is the yearly limit. Whole-body doses per procedure are relatively lower compared with extremity doses and are generally spread over the entire procedure (Guillet, B., Quentin, P., Waultier, S., Bourrelly, M., Pisano, P. and Mundler, O. Technologist radiation exposure in routine clinical practice with 18F-FDG PET. J. Nucl. Med. Technol. 33, 175-179 (2005). Optimisation of the individual workload is often used to restrict staff doses, but many PET centres face the need for further optimisation to reduce the staff doses to an acceptable level. During this study the effect of the use of an automated dispensing and injection system for (18)FDG on whole-body doses and extremity doses was evaluated. Detailed dosimetric studies using thermoluminescent and direct ion storage dosimetry were carried out before and after the introduction of this system. The results show that the extremity doses can be reduced by more than 95 % up to a mean level of 10 muSv per handled GBq. At the same time, whole-body doses can be halved during injection of the tracer. This results in a dose reduction of 20 % during the entire procedure of injection, escorting and positioning. In this way, the study shows that with the use of automated dispensing and injection a considerable staff dose reduction can be obtained.

A study of the correlation between dose area product and effective dose in vascular radiology.

The purpose of the multi-centre study was to assess dose area product (DAP) and effective dose of patients undergoing angiography of the lower limbs in Belgium and to investigate the correlation between DAP and effective dose. DAP values were measured in 12 centres and compared with the national diagnostic reference levels (DRLs). The effective dose (E) was estimated by multiplying the DAP with case-specific conversion coefficients (CCs) that were calculated with Monte Carlo software MCNP5. As a model for the patient, a mathematical hermaphrodite phantom was used. Calculations showed that tube configurations and extra Cu filtration have a large influence on these CCs. Due to the use of Cu filtration, effective dose can be twice as high for comparable DAP values. Also the use of an over-couch tube configuration is a disadvantage when compared with the under-couch tube configuration. For centres working under-couch without the use of extra Cu-filtration, the DAP values correlate very well with effective dose (Spearman's rank correlation rho ; = 0.97). For these conditions, general CCs between DAP and E were calculated. They were 0.083 mSv Gy(-1) cm(-2) (ICRP 60) and 0.065 mSv Gy(-1) cm(-2) (ICRP 103).

Diagnostic reference levels in angiography and interventional radiology: a Belgian multi-centre study.

The purpose of this study was to determine diagnostic reference levels (DRLs) for common angiographic and interventional procedures in Belgium. Dose Area Product (DAP) measurements were performed on 21 systems, (13 angiography and 4 vascular surgery centres). Type of procedure, total DAP, patient weight and height were collected on a daily basis during 1 y. The 75th percentile of the distribution of DAP values was defined as DRL. Preliminary DRLs were calculated for the three most frequent procedures for the whole population, for a weight class of patients (65-80 kg) and normalised to the standard size patient. Among them, the DRL for angiography of the lower limbs (30% of the procedures) from the whole population was 74.6 and 63.2 Gycm2 for the size corrected. The mean DAP values of each room was then compared to these DRLs.

Personal dose monitoring in hospitals: global assessment, critical applications and future needs.

It is known that medical applications using ionising radiation are wide spread and still increasing. Physicians, technicians, nurses and others constitute the largest group of workers occupationally exposed to man-made sources of radiation. Many hospital workers are consequently subjected to routine monitoring of professional radiation exposures. in the university hospital, UZ Brussel, 600 out of 4000 staff members are daily monitored for external radiation exposures. The most obvious applications of ionising radiation are diagnostic radiology, diagnostic or therapeutic use of radionuclides in nuclear medicine and external radiation therapy or brachytherapy in radiotherapy departments. Other important applications also include various procedures in interventional radiology (IR), in vitro biomedical research and radiopharmaceutical production around cyclotrons. Besides the fact that many of the staff members, involved in these applications, are not measurably exposed, detailed studies were carried out at workplaces where routine dose monitoring encounters difficulties and for some applications where relatively high occupational exposures can be found. most of the studies are concentrated around nuclear medicine applications and IR. They contain assessments of both effective dose and doses at different parts of the body. The results contribute to better characterisation of the different workplaces in a way that critical applications can be identified. Moreover, conclusions point out future needs for practical routine dose monitoring and optimisation of radiation protection.

The use of extremity dosemeters in a hospital environment.

A general overview is given on the use of extremity dosemeters, their calibration, the units and phantoms to be used. One of the major applications of extremity dosemeters is to monitor the personnel in a hospital environment. In nuclear medicine, brachytherapy and interventional radiology (IR) skin doses to hands and legs can be substantial. Here, we report on two studies that are presently being undertaken in Belgium. The first one tries to map the dose distribution on the hands, in function of the manipulation in nuclear medicine. Some preliminary results are also given from a nationwide survey study for patient and personnel doses during IR and cardiology. The radiologists' hands, legs and forehead are monitored during a whole range of procedures in different hospitals.

Expression of SOCS genes in normal and leukemic human leukocytes stimulated by prolactin, growth hormone and cytokines.

To evaluate the possible role of the recently described family of suppressors of cytokine signaling (SOCS) factors in the human lympho-hemopoietic system, we have monitored SOCS factor expression, both constitutive and induced by either cytokines, prolactin (PRL) or growth hormone (GH), using polymerase chain reaction in normal and leukemic cells. CIS (cytokine-inducible SH2-containing protein), SOCS-2 and SOCS-3 were constitutively expressed in peripheral blood mononuclear leukocytes. SOCS-3 expression was enhanced by PRL or by IFN-gamma. In bone marrow cells and granulocytes, CIS expression was induced and SOCS-2 enhanced by IFN-gamma and by PRL. In tonsillar cells, CIS expression was increased and SOCS-2 was induced by IL-1beta, IL-6, PRL and GH. SOCS-3 expression was enhanced by IL-1beta. The expression of SOCS-7 was increased by IL-6, PRL and GH. In Raji B-lymphoma cells, the expression of SOCS-2 and SOCS-7 was enhanced by IL-1beta. In THP-1 myeloid leukemia cells pretreated with TPA (to induce receptors for IFN-gamma), IFN-gamma induced SOCS-2. Jurkat cells expressed more SOCS-2 when exposed to PRL. Original observations in this work include the first report on SOCS-7 induction by cytokines. Also our data shed new light on the possible involvement of PRL and GH in the cytokine network. These hormones could modulate the transduction of signals originating from receptors for various cytokines.

Human neutrophils express GH-N gene transcripts and the pituitary transcription factor Pit-1b.

Since GH stimulates the development and function of granulocytes, we investigated the expression of GH in granulocyte subsets. By immunocytochemistry, 25 +/- 7% of the human neutrophils were shown to express immunoreactive GH, whereas eosinophils were negative. Reversed transcription (RT)-PCR analysis demonstrated GH mRNA in neutrophils. Restriction analysis revealed that neutrophils express the GH-N gene but not the GH-V gene. Furthermore, we demonstrated by western blot analysis that neutrophils express an alternatively spliced variant of the pituitary transcription factor Pit-1, designated Pit-1b.

Increased IL-6 production and IL-6-mediated Ig secretion in murine host-vs-graft disease.

BALB/c mice neonatally injected with semiallogenic (A/J x BALB/c)F1 splenocytes develop a host-vs-graft (HVG) reaction between host T cells and donor B cells, resulting in hypergammaglobulinemia, splenomegaly, and increased serum levels of various autoantibodies. This syndrome is associated with a polyclonal activation of the donor-derived B cells. High serum levels of IL-6 were found in 4-wk-old mice undergoing HVG disease (mean +/- SEM, 132 +/- 93 as compared with 12 +/- 2 in control mice, p < 0.05). Also supernatants of spleen cell cultures from HVG mice contained increased levels of IL-6. In situ hybridization and cell depletion experiments demonstrated that host macrophages were responsible for this pathologic IL-6 secretion. The spontaneous in vitro production of autoreactive antibodies by donor B cells from HVG mice was further enhanced by adding human rIL-6, whereas addition of human rIL-1 beta, human rIL-2, murine rIL-4, murine rIL-5, or combinations of these cytokines had no effect. Finally, addition of blocking anti-IL-6 and anti-IL-6 receptor mAb markedly reduced hyper IgG1 production in cultures of spleen cells from HVG mice. These data suggest that an increased production of IL-6 by persistently stimulated host macrophages is involved in the activation of donor B cells leading to HVG disease.