Are Online Simulations for Radiation Emergency Medical Preparedness Less Effective in Teaching Than Face-to-Face Simulations?

OBJECTIVE: The study clarified differences in understanding and satisfaction between face-to-face and online training on radiation emergency medical preparedness (REMP) training. METHODS: The training was held at Hirosaki University between 2018 and 2022, with 46 face-to-face participants and 25 online participants. RESULTS: Face-to-face training was significantly more understandable than online for the use of the Geiger counter (P < 0.05), but the educational effect of virtual reality (VR) was not significantly different from the actual practice. For the team exercise of taking care of the victims, online resulted in a significantly higher understanding (P < 0.05). CONCLUSIONS: Interactive exercises can be done online with equipment sent to learners, and VR is also as effective. The use of videos was more effective for first-timers to learn the practical process from a bird's-eye view, especially for team-based medical procedures.

Long-Term Analysis of Internal Exposure Dose-Reduction Effects by Food Regulation and Food Item Contribution to Dose after the Fukushima Daiichi Nuclear Power Plant Accident.

Over 10 years have passed since the Fukushima Daiichi Nuclear Power Plant accident. This study verifies the efficacy of longitudinal regulation on internal exposure doses and analyzes food group contributions to radiation doses using accumulated monitoring test results. The committed effective doses in 10,000 virtual persons from fiscal year (FY) 2012 to 2021, with and without regulation, were estimated as products of radioactivity concentrations randomly sampled from the test results, food intake, and dose coefficient. The distributed values of food intake rather than a mean value in dose estimation were assumed to reflect food intake variations and avoid underestimation of internal exposure doses for high-intake consumers. Furthermore, the ingestion of radioactive cesium from the calculation was analyzed per food group. The 95th percentile of the internal exposure dose (the dose of a "representative person") was less than 1 mSv/year in both FYs. The regulation effect was substantial in FY 2012, and no noticeable difference in radiation doses was found between the regulation and no regulation conditions after FY 2016. Internal exposure doses decreased until approximately FY 2016 and then remained constant. It was also shown that not only radioactivity concentration but also food intake is a major factor affecting cesium intake. In summary, it was confirmed that Japan had ensured food safety regarding radioactive materials.

Evaluation of Data-Driven Respiration Gating in Continuous Bed Motion in Lung Lesions.

Respiration gating is used in PET to prevent image quality degradation due to respiratory effects. In this study, we evaluated a type of data-driven respiration gating for continuous bed motion, OncoFreeze AI, which was implemented to improve image quality and the accuracy of semiquantitative uptake values affected by respiratory motion. Methods: 18F-FDG PET/CT was performed on 32 patients with lung lesions. Two types of respiration-gated images (OncoFreeze AI with data-driven respiration gating, device-based amplitude-based OncoFreeze with elastic motion compensation) and ungated images (static) were reconstructed. For each image, we calculated SUV and metabolic tumor volume (MTV). The improvement rate (IR) from respiration gating and the contrast-to-noise ratio (CNR), which indicates the improvement in image noise, were also calculated for these indices. IR was also calculated for the upper and lower lobes of the lung. As OncoFreeze AI assumes the presence of respiratory motion, we examined quantitative accuracy in regions where respiratory motion was not present using a 68Ge cylinder phantom with known quantitative accuracy. Results: OncoFreeze and OncoFreeze AI showed similar values, with a significant increase in SUV and decrease in MTV compared with static reconstruction. OncoFreeze and OncoFreeze AI also showed similar values for IR and CNR. OncoFreeze AI increased SUVmax by an average of 18% and decreased MTV by an average of 25% compared with static reconstruction. From the IR results, both OncoFreeze and OncoFreeze AI showed a greater IR from static reconstruction in the lower lobe than in the upper lobe. OncoFreeze and OncoFreeze AI increased CNR by 17.9% and 18.0%, respectively, compared with static reconstruction. The quantitative accuracy of the 68Ge phantom, assuming a region of no respiratory motion, was almost equal for the static reconstruction and OncoFreeze AI. Conclusion: OncoFreeze AI improved the influence of respiratory motion in the assessment of lung lesion uptake to a level comparable to that of the previously launched OncoFreeze. OncoFreeze AI provides more accurate imaging with significantly larger SUVs and smaller MTVs than static reconstruction.

Construction of a Phantom for Image Quality Evaluation in PET/MRI System.

Background: There is no phantom for image quality test in magnetic resonance imaging combined with positron emission tomography systems (PET/MRI systems). In MRI, radioactive water phantom containing 2-deoxy-2-[F-18] fluoro-D-glucose (18F-FDG) cannot be used due to the dielectric effect. Even for phantoms filled with MR-available solutions, the source current of the RF coil is strongly disturbed as the diameter of the phantom increases. Stable MR images require proper phantom size and solution selection. Previous reports have not provided these details. Other than that, few existing phantoms evaluate negative signals such as N-13 ammonia (13N-NH3). We created a phantom for PET/MRI system for image quality test. Methods: The phantom for the PET/MRI system was assembled in two portions. One portion is a signal part containing 18F-FDG radioactive water. The other portion is filled with polyvinyl alcohol glue to construct MRI image to generate µ-map. The glue part is allowed to rewrite the table position overlaps with the first layer, and attenuation correction is performed. Signals are set as positive (4 times and twice higher than background radioactivity) and negative (no radioactivity) columns with different sizes (15 mm φ and 7 mm φ). The PET images with X-ray computed tomography-based attenuation correction (CT-AC) and MRI-AC were evaluated by %-contrasts, variation and uniformity. Results: The %-contrasts of the positive shallow signals with PET/magnetic resonance (MR) and PET/CT were 41.8% and 45.4%, respectively. And it of the positive deep signals with PET/MR and PET/CT were 40.7% and 44.9%. On the other hand, the %-contrasts of the negative shallow signals with PET/MR and PET/CT were 62.3% and 65.6%, respectively. And it of the negative deep signals with PET/MR and PET/CT were 60.7% and 63.7%. Moreover, the % Nj index of uniformity was 2.0% on PET/MRI images and 0.34% on PET/CT images. For negative signals that assume a decrease in myocardial blood flow, The image quality of MR-AC was almost the same as that of CT-AC. Consistency between the images after CT-AC and MR-AC correction were confirmed, and in particular, a stable MR-AC µ-map was obtained in the phantom study. Conclusion: The suggested prototype phantom for generating µ-map is reasonable and useful for evaluating PET/MRI image quality, based on the present standard.

Longitudinal Verification of Post-Nuclear Accident Food Regulations in Japan Focusing on Wild Vegetables.

Focusing on the importance of wild vegetables for local residents, this study aims to validate the effects of food regulations under the current criteria (e.g., 100 Bq/kg for general foods) established approximately a year after the Fukushima Dai-ichi Nuclear Power Plant accident. Over 2,500,000 monitoring tests were performed under the criteria until fiscal year (FY) 2020. We estimated changes in internal exposure dose using test results. The effective dose was estimated using the radioactive concentration randomly sampled from the results, food intake, and dose conversion factor. As a new attempt, dose estimation reflecting the intake of wild vegetables that may have irreplaceable value for local residents was conducted. The median, 95th, and 99th percentile of the estimated dose without reflecting the wild vegetables' intake were 0.0485, 0.183, and 10.6 mSv/year, respectively, in the estimation with all test results (no regulation) and 0.0431, 0.0786, and 0.236 mSv/year, respectively, in the estimation with results within the standard limits (regulated) in FY2012. These doses decreased with time. Although estimated doses with or without the reflection of wild vegetables' intake were similar, estimation that is more plausible is possible, particularly for a high percentile, by reflecting the wild vegetables' intake. Radiation doses (regulated) were significantly less than 1 mSv/year in different FYs. In Japan, food regulation measures benefit food safety.

Training of Medical Responders to Nuclear Disaster: Hybrid Program in the COVID-19 Pandemic.

OBJECTIVE: The spread of COVID-19 has made it difficult to provide training in medical treatment in a radiation disaster. In this study, we will examine the effects and challenges of using a hybrid approach that combines online and face-to-face components. METHODS: A total of 5 face-to face and 25 online medical staff participated in the training program. This program was conducted by using multiple cameras for live coverage, while protective clothing and decontamination kits had been sent in advance to the participants so that they could experience face-to-face and online learning at the same time. RESULTS: Participants reported a high level of satisfaction and achievement with the style of delivery. They also experienced problems such as fatigue due to long hours, and dissatisfaction with the debriefing. CONCLUSIONS: In designing new online training, it is necessary to consider the quantity and content of the program, and to take participant fatigue into consideration.

Measurements and future projections of Gd-based contrast agents for MRI exams in wastewater treatment plants in the Tokyo metropolitan area.

Large amounts of Gd-based contrast agents are used in magnetic resonance imaging (MRI) that are then excreted in urine. These agents are subsequently discharged into the environment because they are difficult to remove by usual sewage treatment techniques. In this study, changes of the Gd anomaly during wastewater treatment processes were determined by analyzing wastewater samples and the possibility for future prediction of the changes was evaluated based on the relationship between the Gd anomaly and the number of MRI devices in use. After the wastewater treatment processes, the values of final effluent were increased 1.8 times compared to those of influent, and the Gd anomaly of effluent had a positive correlation to the number of MRI devices. The finding suggested that the changes of environmental impact were predictable based on the number of MRI devices.

[The Method for Estimation of Radiation Dose of Eye Lens Covered by Radiation Protection Glasses Using Personal Dosimeter for Trunk of the Body and X-ray Shielding Material].

PURPOSE: Radiation protection glasses is a useful tool for dose reduction of eye lens. However, the method to evaluate the dose of eye lens, which is covered with radiation protection glasses in actual radiation management situation, has not been established. We invented the easy-to-use procedure to estimate the dose of eye lens inside of radiation protection glasses for occupationally exposed person using an X-ray shielding material and an additional personal dosimeter for trunk of the body. The objective of this study was to evaluate the feasibility of the new method. METHODS: The radiation field in interventional radiology (IR) was reconstructed. A personal dosimeter was set to the eye position and neck position of medical staff phantom. Each dosimeter was covered by radiation protection glasses or X-ray shielding material, and the 1 cm or 70 mm dose equivalent quantity in the neck position was compared to the 3 mm dose equivalent quantity in the eye position. RESULTS: The dose equivalent quantity measured inside of X-ray shielding material in the neck position was similar to that of inside radiation protection glasses. Thus, the X-ray attenuation by radiation protection glasses was able to be simulated using the X-ray shielding material. CONCLUSION: It was suggested that the dose of eye lens inside of radiation protection glasses could be easily estimated by covering the conventional personal dosimeter for trunk of the body with the X-ray shielding material.

Achievements of true whole-body imaging using a faster acquisition of the lower extremities in variable-speed continuous bed motion.

Variable-speed continuous bed motion 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT), a reliable imaging technique, allows setting the bed motion speed for arbitrary sections of the body. The purpose of this study was to evaluate the relationship between the PET image quality and the bed speed following shortening of the scanning time for the lower extremities to achieve whole-body acquisition optimization of the examination time. Four sets of images were created by editing four-phase dynamic whole-body PET/CT images acquired at a bed speed of 6 and 14 mm/s in the trunk and lower extremities, respectively. The signal-to-noise ratio (SNR) was calculated using regions of interest in the liver, gluteus muscles, thigh, and lower legs, and the relationship between the bed speed and the SNR was assessed. The number of patients with findings in the lower extremities among 967 cases was evaluated. Based on this relationship between the SNR and bed motion speed, it is reasonable to increase the speed of the lower extremities by up to three times that of the trunk. The findings from whole-body FDG-PET imaging revealed that the number of patients with detected lesions in the lower extremities was 6.6% (64/967), bone metastases were found in 2.6%, soft lesions in 1.8%, and inflammation in 2.3%. Images of the lower extremities, which have a better SNR than the trunk, can be acquired at a faster bed speed using the variable-speed continuous bed motion PET.

Estimation of Effect of Radiation Dose Reduction for Internal Exposure by Food Regulations under the Current Criteria for Radionuclides in Foodstuff in Japan Using Monitoring Results.

This study examined the effect of food regulations under the current criteria (e.g., 100 Bq/kg for general foods) established approximately a year after the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident. Foods are monitored to ensure that foods exceeding the standard limit are not distributed; ~300,000 examinations per year have been performed especially since FY2014. This study comprehensively estimated the internal exposure dose resulting from the ingestion of foods containing radioactive cesium using the accumulated monitoring results. Committed effective dose was conservatively calculated as the product of the radioactive concentration randomly sampled from test results, food intake, and dose coefficient. The median, 95th, and 99th percentile of the dose were 0.0479, 0.207, and 10.6 mSv/y, respectively, in the estimation with all test results (without regulation), and 0.0430, 0.0790, and 0.233 mSv/y, respectively, in the estimation with results within the standard limits (with regulation) in FY2012. In FY2016, the dose with and without regulation were similar, except for high percentile, and those doses were significantly smaller than 1 mSv/y, which was adopted as the basis for the current criteria. The food regulation measures implemented in Japan after the FDNPP accident have been beneficial, and food safety against radionuclides has been ensured.

[Relationship between CT Numbers and Artifacts Obtained Using CT-based Attenuation Correction of PET/CT].

PURPOSE: The aim of this study was to clarify the artifacts that occurred in the non-activity signal with computed tomography (CT)-based attenuation correction (CTAC) error due to image misregistration. METHODS: We used a cylindrical phantom containing a test tube with a diameter of 15 mm as the non-activity signal part. Positron emission tomography (PET) images were acquired for 30 minutes using the phantom with water in the non-activity signal part and 18F-fluoro-2-deoxy-d-glucose (18F-FDG) (5.3 kBq/ml) in the background area. CT scanning was performed by replacing the water with contrast agents at different dilutions to obtain arbitrary CT numbers (-1000 to 1000). The PET images were attenuation-corrected individually by the CT images in which the CT number of the non-activity signal part had changed. The relationship between the CT numbers and the CTAC artifact was determined by measuring the PET value in the non-activity signal part of the PET images and comparing Ci. RESULTS: As the CT number of the CT images increased, Ci of the artifact increased. The CT number and Ci had a correlation of y=1.48x+2.86×103 (R2 =0.99) when CTAC was performed in units of CT numbers above 0 for PET data of water (0 HU) and a correlation of y=3.15x+6.26×103 (R2 =0.97) when CTAC was performed in units of CT numbers below 0 for PET data of air (-1000 HU). Although the original CT image was air, the artifacts due to CTAC errors with different Hounsfield units showed larger changes. In particular, positive artifacts were recognized in the PET images after CTAC depending on the Hounsfield units. CONCLUSIONS: When the CT number was different from the original in CTAC, the PET value was different. CTAC should be performed with caution as there may be image misregistration.

Time-related study on external exposure dose of 2-deoxy-2-[F-18]fluoro-D-glucose PET for workers' safety.

Time-course study of individual dose equivalents of 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography (18F-FDG PET) was conducted in different hospital workers, and the daily work duties were analyzed. For the measurements, a semiconductor dosimeter was used. The values at intervals of 1 min and 1 h, the monthly cumulative and daily cumulative doses, and trend graphs were acquired with dedicated software and displayed on the reader. The following radiation workers with duties involving maximum external exposure work were included: doctors making diagnoses (4.8 µSv/procedure), nurses removing injection needles (3.1 µSv/procedure), pharmacists performing quality control tests (2.9 µSv/procedure), nuclear medicine technologists assisting patient positioning (6.5 µSv/procedure), and cyclotron engineers performing daily checks (13.4 µSv/procedure). The results of analysis of daily work duties revealed the influencing factors of external exposure dose. To reduce the external exposure dose, investigators should shorten the patient's contact time with the 18F-FDG source or patient tracer.

Relationship between tumor volume and quantitative values calculated using two-dimensional bone scan images.

The bone scan index (BSI) is calculated from a whole-body bone scan image; it shows the tumor burden in bone as a percentage of total skeletal mass. It has been used to determine the prognosis and to assess treatment effects; however, little has been reported on whether the BSI calculated using a two-dimensional image can accurately evaluate the three-dimensional spread in tumor volume. We investigated the relationship between tumor volume and BSI using Monte Carlo simulation (MCS). We simulated a gamma camera and constructed a voxel phantom based on an anthropomorphic phantom computed tomography (CT) image and gamma rays emitted from each part according to technetium-99m-labeled methylene diphosphonate (99mTc-MDP) uptake (bone 1, soft tissue 0.2, tumor 2-32). We constructed bone scan images from the obtained counts and analyzed them using the BSI calculation software. The BSI increased with increased tumor uptake (two- to 32-fold). However, there was not always a significant difference between change in BSI and tumor uptake of eight times or greater than that of bone. When BSI was calculated with a tumor having an uptake of four-to-eight times higher than that of bone, the BSI was consistent with tumor volume, but decreased to about half the tumor volume when tumors were in the thoracic spine (Th-spine) segment. The BSI can be a good indicator of tumor volume in most segments, even though it is affected by the tumor's 99mTc-MDP uptake. Nevertheless, values calculated from the Th-spine should be interpreted carefully.

Development of a double-stranded siRNA labelling method by using 99mTc and single photon emission computed tomography imaging.

In vivo biodistribution of small interfering RNAs (siRNAs) is important to develop them for medical use. Therefore, novel single photon emitter-labelled siRNA was prepared by using diethylenetriamine-N,N,N',N″,N″-pentaacetic acid (DTPA) and poly(A) polymerase, and subsequently, real-time analysis of siRNA trafficking was performed by using single photon emission computed tomography (SPECT). This study aimed at assessing the use of 99mTc-radiolabelled siRNA targeting lacZ to detect lacZ expression in vivo. siRNA targeting lacZ was radiolabelled with 99mTc by using the bifunctional chelator DTPA, and the labelling efficiency and specific activity were determined. The probe stability in RNaseA was assessed. SPECT imaging was performed in mice overexpressing the lacZ gene in the liver. Radiolabelled siRNA remained highly stable in RNaseA solution at 37 °C. In SPECT imaging, significant 99mTc accumulation in the liver was observed in mice overexpressing the lacZ gene. 99mTc-labelled lacZ siRNA shows ß-galactosidase-specific accumulation and appears promising for the visualisation of lacZ expression in vivo. Our labelled siRNA should be deliverable to specific regions overexpressing the target gene.

A simulation study for estimating scatter fraction in whole-body 18F-FDG PET/CT.

Whereas Monte Carlo (MC) simulation is widely utilized in estimation of the scatter component, a simulation model which can calculate the scatter fraction (SF) of each patient is needed for making an accurate image quality assessment for clinical PET images based on the noise equivalent count. In this study, an MC simulation model was constructed which can calculate the SF for various phantoms. We utilized the Geant4 toolkit based on MC simulation to make a model of a PET scanner with a scatter phantom, and SFs calculated with this model were compared with the SF (SFconstant: 44%) measured with use of an actual PET scanner. Additionally, the SF values for an anthropomorphic phantom were calculated from its voxel phantom. Furthermore, we evaluated the impact on the SF due to the difference in the source distribution inside the phantom. The SF calculated from the scatter phantom in the MC simulation was 44%, the same as the SFconstant value. The average SF for the anthropomorphic phantom was 41%, but there was a maximum of 14 percentage points difference between each scan range, and the maximum difference in the SF was 8 percentage points for the difference in the source distribution. We constructed an MC simulation model which can calculate SFs for various phantoms. The SF was confirmed to be affected significantly by the source distribution. We judged that the actually measured SFconstant obtained from the PET scanner with the scatter phantom was not suitable for the assessment of the quality of all patient images.