Responsible Radionuclide Cancer Care.

The landscape of nuclear oncology is rapidly changing. The advent of molecular radionuclide theranostics, multidisciplinary tumor board decision making, artificial intelligence and radiomics interpretation of diagnostic imaging, evolution of pharmacogenomics prediction of tumor response, and regulatory requirements for prospective individual dosimetry are just some of the elements which are broadening the essence of physician responsibility. The burgeoning knowledge base essential for mastering the emergent technologies, and their profound effect on moral philosophic aspects of provision of cancer care, are challenging. The new relationship of the theranostic nuclear physician with respect to shared care of the individual patient, particularly with regard to transparency, accountability, and responsibility for targeted radionuclide diagnosis and therapy of cancer, will be explored in this update.

The future of ICRP: towards a centenary and beyond.

The International Commission on Radiological Protection (ICRP) has been in existence for 87 y, since its establishment in 1928. It remains a leading authority in radiological protection, and its role is to provide recommendations and guidance on all aspects of protection against ionising radiation. The published recommendations of ICRP form the basis of radiation safety standards worldwide. Modernisation of the organisation in recent years has led to new initiatives and changes. These have included writing a strategic plan and code of ethics for the first time. Elections for committee membership have been through open nominations, a process which will shortly be repeated for the membership in the next term, commencing on 1 July 2017. Biennial symposia started in 2011, and the success of the first two symposia has secured this venture as a regular part of the ICRP calendar. ICRP has also revised its method of working with other organisations by establishing 'special liaison organisation' status. This has improved collaboration with the ever-expanding number of organisations working in radiological protection, with whom it is important that ICRP has essential links. ICRP is also looking to review its legal basis and governing documents in the future, in order to ensure that best practices are being followed as ICRP evolves. In addition, the strategic plan will be reviewed and updated regularly. Other ways of working with organisations will be considered to further strengthen engagement with the wider radiological protection community. ICRP aims to make its publications available at low or no cost, and to produce both a plain language overview of the system of radiological protection and a summary of the recommendations. These activities will require additional financial resources, and ICRP has embarked on a fundraising campaign to support such efforts. ICRP can be proud of its history of maintaining its independence and preserving the wide respect earned over many years. Despite long traditions, ICRP has evolved and will continue to do so to perform as a more modern organisation as it heads towards a centenary and beyond.

Overview of radiation dose to patients from medical X-ray examinations in Nigeria.

OBJECTIVES: Medical Imaging accounts for the largest radiation exposure of population from artificial sources of radiation. The radiation dose rcceivedby patients from iedicail x-ray examinations in Nigeria has shown large variations within and among diagnostic centers for similar examinations. This could be traced to lack of imaging protocols and on avalability of local/national diagnostic reference, levels. Hence, the need to assess the trend of radiation doseto patients from radiological practice in Nigeria. Methocls:Entrance surface doses(ESDs) reported by, Nigerian authors for common x-ray examinations from 2000 - 2014 were extracted from articles published in peer reviewed journals, analyzed and compared with ifiternationally recommended Diagnostic Reference Levels (DkLs). RESULTS: Among x-ray examinations, skull accounted for 32% followed by chest (22%), lumbar spine (13%), abdomen (12%), pelvis (8%), extremitics(8%), thorax and cervical spine(5%). The range of mean ESDs reported for various projections of x-ray examination are chest (2.28 - 3.70 mGy); Abdomen (4.42 - 7.22 mGy); Skull (3.81 - 5.19 mGy); Pelvis (5.93 mGy); Lumbar spine (5.73 - 10.98 mGy); Thorax (0.96 - 1.85 mGy); Cervical spine (1.45 - 1.49mGy) and Extremitics (0.31 -0.49 mGy). In this study, it was found that the mean ESDs received by patients from chest, skull and pelvis ex'aminations were higher than the published DRLs for similar x-ray examinations. CONCLUSION: The results of this study showed that to harmonize radiation protection of patients and improve radiological practice in Nigeria there is need for development of comprehensive national diagnostic reference levels.

A systems approach to evaluating ionizing radiation: six focus areas to improve quality, efficiency, and patient safety.

Ionizing radiation is an essential component of the care process. However, providers and patients may not be fully aware of the risks involved, the level of ionizing radiation delivered with various procedures, or the potential for harm through incidental overexposure or cumulative dose. Recent high-profile incidents demonstrating the devastating short-term consequences of radiation overexposure have drawn attention to these risks, but applicable solutions are lacking. Although various recommendations and guidelines have been proposed, organizational variability challenges providers to identify their own practical solutions. To identify potential failure modes and develop solutions to preserve patient safety within a large, national healthcare system, we assembled a multidisciplinary team to conduct a comprehensive analysis of practices surrounding the delivery of ionizing radiation. Workgroups were developed to analyze existing culture, processes, and technology to identify deficiencies and propose solutions. Six focus areas were identified: competency and certification; equipment; monitoring and auditing; education; clinical pathways; and communication and marketing. This manuscript summarizes this comprehensive, multidisciplinary, and systemic analysis of risk and provides examples to illustrate how these focus areas can be used to improve the use of ionizing radiation. The proposed solutions, once fully implemented, may advance patient safety and care.

[ANALYSIS OF RADIATION IN THE DEPLOYMENT OF MILITARY UNITS OF THE MINISTRY OF DEFENSE OF UKRAINE].

There were observed radiation hazardous objects and zone of possibie rauioactive contaminationof the area with military units, and also possibility of influence of adverse factors (radiation) on the human organism. There is also available characteristic of Ukrainian nuclear Powers, number of population, that lives on the area with different pollution degree.

[Status and development prospects of radiological health in the Navy].

More than 7.5 thousands of people work as military and civilian personnel and have an access to a lot of sources of ionizing radiation on ships and vessels, at coastal units and institutions of the Navy. This fact determines the importance of radiation safety and medical preventive measures on naval fleets. The article analyses the state of radiation-hygienic measures, outlines the conceptual basis for the development of radiation hygiene in the Navy. Substantiated reconstruction tasks effectiveness of health control and state sanitary and epidemiological supervision of radiation safety, provides information about the optimal set of instruments for radiation monitoring equipment radiobiological laboratories and centres of state sanitary and epidemiological supervision at various levels.

Expert assessment of preventive measures in the zone of guaranteed voluntary resettlement.

OBJECTIVE: An expert evaluation of preventive measures focused on population health maintenance in the zone of guaranteed voluntary resettlement taking into account the limitations of the provisions of certain articles of the Law of Ukraine on the clean-up of the Chornobyl disaster aftermath. MATERIALS AND METHODS: The research survey was applied using a peer review method. The three-level (national, regional, district) expert workgroup was involved been employed within recovery of the Chornobyl disaster aftermath. Professional experience of minimum 10 years, corresponding profile and current position were the requirements for selection. A simple streamlining the values of paired or consistent comparison was applied on the primary empirical data. RESULTS: The arrangements made in recent years by the Cabinet of Ministers of Ukraine and ministries engaged in clean-up and recovery from the Chornobyl nuclear power plant accident are ineffective. Costs from the Fund for the implementation of measures to clean-up the consequences of the Chornobyl disaster and social protection are reduced. There is no consensus among experts regarding some constraint of an action of certain articles of the Law of Ukraine "On the status and social protection of citizens affected by the Chornobyl disaster" on the principles of social protection and healthcare of the population living in contaminated areas. CONCLUSIONS: In addressing the social and health consequences of the Chornobyl disaster the Verkhovna Rada of Ukraine just for a long time has passes no amendment to the legislation on the subject. At that there are several restrictions in force for a large number of articles of the existing laws that were adopted in 1991. The mentioned above exacerbates social strain and destroys the "citizen-state relationship". The extreme need has emerged in a comprehensive public review of existing laws with involvement of multidisciplinary group of experts to a "round table" to justify the draft laws.

[Health consequences in overexposed persons after the Chernobyl accident: basic resume and unsolved problems].

Data of researches of consequences for health after the Chernobyl accident in 1986 are generalized. Consequences for health of these groups and principles of the further supervision over them are estimated. The increasing of leukemia among the reasons attracts attention.

[Modern possibilities of therapeutic aid in the time of mass sanitary losses of radiation profile].

Modern concept of medical-prophylactic measures in the time of mass radiation affection is presented in the present article. Moreover the past changes in organization-regular structure of medical service of the Armed Forces of the Russian Federation and appearance of new time-board equipment were taken into account. Recommendations about the rendering of all types of therapeutic aid on all stages of medical evacuation--first, premedical, medical assistance, qualified and specialized--are given.

[Promising directions of optimization of providing radiological safety in large-scale treatment-and-preventive institutions].

The article contains results of fulfilled studies that allowed finding main features of radiology safety, working out academic and research recommendations to perfect radiology safety in treatment-and-preventive institutions (TPI) and creating a method of calculation of authorized staffing needed by radiological safety services. It was established that the following actions are least fulfilled: radiation control, organization of radiation safety education, authorization for work with ionizing radiation both for military men and civil staff, maintenance of documentation. We suggest that promising direction of optimization of providing radiological safety in large-scale TPI is the following: allotment of special structure that will provide comprehensive fulfillment of regulatory documents demands, it may be, e. g. radiological safety service.

[Improvement of the organization of oncological aid under conditions of specific technogenic load on the population].

Social and economic disbenifits due to mortality from malignant neoplasms were estimated taking into account the losses of man-years of work, mean life expectancy for the sick, losses from temporary disablement and invalidization caused by malignancies, and the cost of oncological aid. The study was based at an area in Uzbekistan subjected to pollution by industrial wastes from an uranium-extracting enterprise. A special purpose-oriented program has been elaborated for the correction of oncological aid currently provided to the workers of the Navoi mining and metallurgical works and the local population. Its implementation resulted in a 13% reduction of standardized mortality from malignant neoplasm in 2004 compared with 1999 and another 24% in 2009. The disbenefit prevented by the reduction of mortality at active ages is estimated at 60,6 mln rubles.

[Contemporary topics on organizing sanitary and radiologic control over using X-rays in medical establishments].

Preventive medicine specialists face goals of creating hygienic measures considering contemporary conditions of using ionizing radiation in medicine.

[Trends in activities of ICRP].

International Commission for Radiological Protection (ICRP) consists of main commission (MC) and 4 committees. Committee 3 (C3) deals with radiological protection in medicine, which is chaired by Prof. Fred Mettler. The C3 has been actively producing reports and recommendations applying ICRP recommendation 1990 (Pub.90) to daily practices of radiology. Those publications include "pregnancy and medical radiation", "avoidance of radiation injuries in IVR", etc.. The main commission has been dealing with two important subjects. The one is "new recommendation at the start of the 21st century" the other is "protection of environments and ecology". Two task groups are preparing drafts recommendations for those subjects, which will be discussed in MC to be held in October 2002.

The Center for Devices and Radiological health: an update.

At a recent medical device conference, Dr. David Feigal, the Director of the Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) stated that one-third of the CDRH staff will retire in five years. This is only one of many challenges that the Center faces.This article discusses key factors shaping current FDA device policies and programmes, the CDRH strategic plan, the continuing importance of the standards programme, and CDRH harmonisation activities.