Cumulative Effective Dose During Fluoroscopically Guided Interventions (FGI): Analysis of More Than 5000 FGIs in a Single European Center.

BACKGROUND: The number of fluoroscopically guided interventions (FGI) has increased significantly over time. However, little attention has been paid to possible stochastic radiation effects. The aim of this retrospective study was to investigate the number of patients who received cumulative effective doses over 100 mSv during FGI procedures. MATERIAL AND METHODS: Five thousand five hundred and fifty four classified FGI procedures were included. Radiation dose data, retrieved from an in-house-dose-management system, was analysed. Effective doses and cumulative effective doses (CED) were calculated. Patients who received a CED > 100 mSv were identified. Radiology reports, patient age, imaging and clinical data of these patients were used to identify reasons for CED ≥ 100 mSv. RESULTS: One Hundred and thirty two (41.1% female) of 3981 patients received a CED > 100 mSy, with a mean CED of 173.5 ± 84.5 mSv. Mean age at first intervention was 66.1 ± 11.7 years. 81 (61.4%) of 132 were older than 64 years, one patient was < 30 years. 110 patients received ≥ 100 mSv within one year (83.4%), through FGIs: EVAR, pelvic/mesenteric interventions (stent or embolization), hepatic interventions (chemoembolization, TIPSS), embolization of cerebral aneurysms or arterio-venous-malformations. CONCLUSIONS: Substantial CED may occur in a small but not ignorable fraction of patients (~ 3%) undergoing FGIs. Approximately 2/3rd of patients may most likely not encounter radiation-related stochastic effects due to life-threatening diseases and age at first treatment > 65 years but 1/3rd may. Patients undergoing more than one FGI (77%) carry a higher risk of accumulating effective doses > 100 mSv. Remarkably, 23% received a mean CED 162.2 ± 72.3 mSv in a single procedure.

[Individual dosimetry as an element of health prevention for employees exposed to ionizing radiation]. / Dozymetria indywidualna jako element profilaktyki zdrowotnej pracowników narazonych na promieniowanie jonizujace.

The paper presents the current radiation protection standards, in line with the recommendations of the International Commission on Radiological Protection (ICRP), and their evolution over the years based on new knowledge about the biological effects of ionizing radiation and the changing attitude of people to the accepted risk. The work takes into account in particular the role of the dose limit principle and individual dose measurements in activities aimed at health prevention of individual people occupationally exposed to ionizing radiation. Med Pr Work Health Saf. 2023;74(6):527-39.

ICRP PUBLICATION 152 Approved by the Commission in November 2021.

Radiation detriment is a concept developed by the International Commission on Radiological Protection to quantify the burden of stochastic effects from low-dose and/or low-dose-rate exposures to the human population. It is determined from the lifetime risks of cancer for a set of organs and tissues and the risk of heritable effects, taking into account the severity of the consequences. This publication provides a historical review of detriment calculation methodology since ICRP Publication 26, with details of the procedure developed in ICRP Publication 103, which clarifies data sources, risk models, computational methods, and rationale for the choice of parameter values. A selected sensitivity analysis was conducted to identify the parameters and calculation conditions that can be major sources of variation and uncertainty in the calculation of radiation detriment. It has demonstrated that sex, age at exposure, dose and dose-rate effectiveness factor, dose assumption in the calculation of lifetime risk, and lethality fraction have a substantial impact on radiation detriment values. Although the current scheme of radiation detriment calculation is well established, it needs to evolve to better reflect changes in population health statistics and progress in scientific understanding of radiation health effects. In this regard, some key parameters require updating, such as the reference population data and cancer severity. There is also room for improvement in cancer risk models based on the accumulation of recent epidemiological findings. Finally, the importance of improving the comprehensibility of the detriment concept and the transparency of its calculation process is emphasised.© 2022 ICRP. Published by SAGE.

Protección de embarazadas en radiología oral / Protection of pregnant women in oral radiology

Las radiografías dentales son necesarias para diagnosticar y hacer seguimiento de múltiples enfermedades orales. Sin embargo, debido a los conocidos efectos estocásticos de los rayos X dentales es imprescindible garantizar protección a los pacientes. Especial atención merecen las mujeres embarazadas por cuanto el feto es altamente vulnerable a la radiación, sobre todo enlas primeras semanas. Algunas recomendaciones de protección radiológica en esta población son: El uso de radiografías ha sido justificado; realizar el estudio 10 días después del inicio de la menstruación; informar del procedimiento a la embarazada a fin de evitar el miedo; optimizar el procedimiento (haz colimado, alto kVp, control manual de disparo, calibración regular etc.) y usar delantal plomado solo si las condiciones de optimización son insuficientes

Dental x-rays are necessary to diagnose and monitor multiple oral diseases. However, due to the well-known stochastic effects of dental X-rays, it is essential to guarantee patient protection. Pregnant women deserve special attention because the fetus is highly vulnerable to radiation, especially in the first weeks. Some recommendations for radiological protection in this population are the use of radiographs has been justified; conduct the study 10 days after the onset of menstruation; inform the pregnant woman about the procedure to avoid fear; optimize the procedure (collimated beam, high kVp, manual trip control, regular calibration etc.) and use a lead apron only if the optimization conditions are insufficient.

Radiation detriment calculation methodology: summary of ICRP Publication 152.

Radiation detriment is a concept to quantify the burden of stochastic effects from exposure of the human population to low-dose and/or low-dose-rate ionising radiation. As part of a thorough review of the system of radiological protection, the International Commission on Radiological Protection (ICRP) has compiled a report on radiation detriment calculation methodology as Publication 152. It provides a historical review of the detriment calculation with details of the procedure used in ICRP Publication 103. A selected sensitivity analysis was conducted to identify the parameters and calculation conditions that can be major sources of variation and uncertainty. It has demonstrated that sex, age at exposure, dose and dose-rate effectiveness factor, dose assumption in the lifetime risk calculation, and lethality fraction have a substantial impact on the calculated values of radiation detriment. Discussions are also made on the issues to be addressed and possible ways for improvement toward the revision of general recommendations. These include update of the reference population data and cancer severity parameters, revision of cancer risk models, and better handling of the variation with sex and age. Finally, emphasis is placed on transparency and traceability of the calculation, along with the need to improve the way of expressing and communicating the detriment.

Environmental and industrial developments in radiation cataractogenesis.

PURPOSE: This review discusses recent developments in our understanding of biological and physiological mechanisms underlying radiation cataractogenesis. The areas discussed include effects of low-dose exposures to the lens including potential relevance of non-targeted effects, the development of new personal-protective equipment (PPE) and standards in clinical and nuclear settings motivated by the updated ICRP recommendations to mitigate exposures to the lens of the eye. The review also looks at evidence from the field linking cataracts in birds and mammals to low dose exposures. CONCLUSIONS: The review suggests that there is evidence that cataractogenesis is not a tissue reaction (deterministic effect) but rather is a low dose effect which shows a saturable dose response relationship similar to that seen for non-targeted effects in general. The review concludes that new research is needed to determine the dose response relationship in environmental studies where field data are contradictory and lab studies confined to rodent models for human exposure studies.

Cytogenetic follow-up studies on humans with internal and external exposure to ionizing radiation.

Cells exposed to ionizing radiation have a wide spectrum of DNA lesions that include DNA single-strand breaks, DNA double-strand breaks (DSBs), oxidative base damage and DNA-protein crosslinks. Among them, DSB is the most critical lesion, which when mis-repaired leads to unstable and stable chromosome aberrations. Currently, chromosome aberration analysis is the preferred method for biological monitoring of radiation-exposed humans. Stable chromosome aberrations, such as inversions and balanced translocations, persist in the peripheral blood lymphocytes of radiation-exposed humans for several years and, therefore, are potentially useful tools to prognosticate the health risks of radiation exposure, particularly in the hematopoietic system. In this review, we summarize the cytogenetic follow-up studies performed by REAC/TS (Radiation Emergency Assistance Center/Training site, Oak Ridge, USA) on humans exposed to internal and external radiation. In the light of our observations as well as the data existing in the literature, this review attempts to highlight the importance of follow-up studies for predicting the extent of genomic instability and its impact on delayed health risks in radiation-exposed victims.

The use of dose quantities in radiological protection: ICRP publication 147 Ann ICRP 50(1) 2021.

The International Commission on Radiological Protection has recently published a report (ICRP Publication 147;Ann. ICRP50, 2021) on the use of dose quantities in radiological protection, under the same authorship as this Memorandum. Here, we present a brief summary of the main elements of the report. ICRP Publication 147 consolidates and clarifies the explanations provided in the 2007 ICRP Recommendations (Publication 103) but reaches conclusions that go beyond those presented in Publication 103. Further guidance is provided on the scientific basis for the control of radiation risks using dose quantities in occupational, public and medical applications. It is emphasised that best estimates of risk to individuals will use organ/tissue absorbed doses, appropriate relative biological effectiveness factors and dose-risk models for specific health effects. However, bearing in mind uncertainties including those associated with risk projection to low doses or low dose rates, it is concluded that in the context of radiological protection, effective dose may be considered as an approximate indicator of possible risk of stochastic health effects following low-level exposure to ionising radiation. In this respect, it should also be recognised that lifetime cancer risks vary with age at exposure, sex and population group. The ICRP report also concludes that equivalent dose is not needed as a protection quantity. Dose limits for the avoidance of tissue reactions for the skin, hands and feet, and lens of the eye will be more appropriately set in terms of absorbed dose rather than equivalent dose.

Human individual radiation sensitivity and prospects for prediction.

In the past few decades, it has become increasingly evident that sensitivity to ionising radiation is variable. This is true for tissue reactions (deterministic effects) after high doses of radiation, for stochastic effects following moderate and possibly low doses, and conceivably also for non-cancer effects such as cardiovascular disease, the causal pathway(s) of which are not yet fully understood. A high sensitivity to deterministic effects is not necessarily correlated with a high sensitivity to stochastic effects. The concept of individual sensitivity to high and low doses of radiation has long been supported by data from patients with certain rare hereditary conditions. However, these syndromes only affect a small proportion of the general population. More relevant to the majority of the population is the notion that some part of the genetic contribution defining radiation sensitivity may follow a polygenic model, which predicts elevated risk resulting from the inheritance of many low-penetrance risk-modulating alleles. Can the different forms of individual radiation sensitivities be inferred from the reaction of cells exposed ex vivo to ionising radiation? Can they be inferred from analyses of individual genotypes? This paper reviews current evidence from studies of late adverse tissue reactions after radiotherapy in potentially sensitive groups, including data from functional assays, candidate gene approaches, and genome-wide association studies. It focuses on studies published in 2013 or later because a comprehensive review of earlier studies was published previously in a report by the UK Advisory Group on Ionising Radiation.

[Stochastic effects of ionizing radiations]. / Gli effetti stocastici delle radiazioni ionizzanti.

OBJECTIVES: Stochastic effects induced by exposure to ionizing radiation rapresent a relevance radioprotection aspect. METHODS: Actually most of the information about radiation-induced oncogenic risk arise from the follow-up of the atomic bombs survivors (Life Span Study, LSS); at this information sources have been added over the last decades also data derived from medical, occupational and environmental studies conducted in various parts of the world and their contribution about number of cases and duration of follow-up period is of great relevance. These sources of information, in fact, provide important data related to very different exposure models compared to the historical of the LSS and closer to those who characterize the employment context in the last decades. RESULTS: Data from these studies seem to outline the evidence for which at the current occupational exposure levels significant ERR/Gy are observed only for lung cancer and for all haematological neoplasms with the exception of chronic lymphocytic leukemia.

Radiobiology in Cardiovascular Imaging.

The introduction of ionizing radiation in medicine revolutionized the diagnosis and treatment of disease and dramatically improved and continues to improve the quality of health care. Cardiovascular imaging and medical imaging in general, however, are associated with a range of radiobiologic effects, including, in rare instances, moderate to severe skin damage resulting from cardiac fluoroscopy. For the dose range associated with diagnostic imaging (corresponding to effective doses on the order of 10 mSv [1 rem]), the possible effects are stochastic in nature and largely theoretical. The most notable of these effects, of course, is the possible increase in cancer risk. The current review addresses radiobiology relevant to cardiovascular imaging, with particular emphasis on radiation induction of cancer, including consideration of the linear nonthreshold dose-response model and of alternative models such as radiation hormesis.

Overview of ICRP Committee 1: radiation effects.

This paper does not necessarily reflect the views of the International Commission on Radiological Protection. The author passed away on 13 November 2015.Committee 1 of the International Commission on Radiological Protection (ICRP) addresses issues pertinent to tissue reactions, risks of cancer and heritable diseases, radiation dose responses, effects of dose rate, and radiation quality. In addition, it reviews data on the effects of radiation on the embryo/fetus, genetic factors in radiation response, and uncertainties in providing judgements on radiation-induced health effects. Committee 1 advises the Main Commission on the biological basis of radiation-induced health effects, and how epidemiological, experimental, and theoretical data can be combined to make quantitative judgements on health risks to humans. The emphasis is on low radiation doses, in the form of detriment-adjusted nominal risk coefficients, where there are considerable uncertainties in terms of the biology and the epidemiology. Furthermore, Committee 1 reviews data from radiation epidemiology studies and publications on the molecular and cellular effects of ionising radiation relevant to updating the basis of the 2007 Recommendations published in ICRP Publication 103 This paper will provide an overview of the activities of Committee 1, the updated work of the Task Groups and Working Parties, and the future activities being pursued.

The Influence of Selected Fingerprint Enhancement Techniques on Forensic DNA Typing of Epithelial Cells Deposited on Porous Surfaces.

Fingerprints deposited at crime scene can be a source of DNA. Previous reports on the effects of fingerprint enhancement methods have focused mainly on fingermarks deposited in blood or saliva. Here, we evaluate the effects of fingerprint enhancement methods on fingerprints deposited on porous surfaces. We performed real-time quantification and STR typing, the results of which indicated that two methods (iodine fuming and 1,2-indanedione in ethyl acetate enhancement) had no effect on the quantity of DNA isolated and resultant STR alleles when compared to control samples. DNA quantities and allele numbers were lower for samples enhanced with silver nitrate and 1,2-indanedione in acetic acid when compared to control samples. Based on DNA quantity, quality, and observable stochastic effects, our data indicated that iodine fuming and 1,2-indanedione in ethyl acetate were the preferred options for the enhancement of fingerprints on porous surfaces.

International Commission on Radiological Protection Committee 1: current status and future directions.

Commission 1 of the International Commission on Radiological Protection considers the risk of induction of cancer and heritable disease (stochastic effects) together with the underlying mechanisms of radiation action. Committee 1 also considers the risks, severity, and mechanisms of induction of tissue/organ damage and developmental defects (deterministic effects). The Committee was significantly revamped in 2013 and last met in Abu Dhabi in October 2013. Committee 1 evaluated progress on two ongoing task groups: Task Group 64 'Cancer Risk from Alpha Emitters' and Task Group 75 'Stem Cell Radiobiology'. Following approval from the Main Commission, Committee 1 established two new task groups: Task Group 91 'Radiation Risk Inference at Low Dose and Low Dose Rate Exposure for Radiological Protection Purposes' and Task Group 92 'Terminology and Definitions'. This article presents a synopsis of the current status of Committee 1 and outlines the tasks that Committee 1 may undertake in the future.

Classification of radiation effects for dose limitation purposes: history, current situation and future prospects.

Radiation exposure causes cancer and non-cancer health effects, each of which differs greatly in the shape of the dose-response curve, latency, persistency, recurrence, curability, fatality and impact on quality of life. In recent decades, for dose limitation purposes, the International Commission on Radiological Protection has divided such diverse effects into tissue reactions (formerly termed non-stochastic and deterministic effects) and stochastic effects. On the one hand, effective dose limits aim to reduce the risks of stochastic effects (cancer/heritable effects) and are based on the detriment-adjusted nominal risk coefficients, assuming a linear-non-threshold dose response and a dose and dose rate effectiveness factor of 2. On the other hand, equivalent dose limits aim to avoid tissue reactions (vision-impairing cataracts and cosmetically unacceptable non-cancer skin changes) and are based on a threshold dose. However, the boundary between these two categories is becoming vague. Thus, we review the changes in radiation effect classification, dose limitation concepts, and the definition of detriment and threshold. Then, the current situation is overviewed focusing on (i) stochastic effects with a threshold, (ii) tissue reactions without a threshold, (iii) target organs/tissues for circulatory disease, (iv) dose levels for limitation of cancer risks vs prevention of non-life-threatening tissue reactions vs prevention of life-threatening tissue reactions, (v) mortality or incidence of thyroid cancer, and (vi) the detriment for tissue reactions. For future discussion, one approach is suggested that classifies radiation effects according to whether effects are life threatening, and radiobiological research needs are also briefly discussed.

Shared decision-making: is it time to obtain informed consent before radiologic examinations utilizing ionizing radiation? Legal and ethical implications.

Concerns about the possibility of developing cancer due to diagnostic imaging examinations utilizing ionizing radiation exposure are increasing. Research studies of survivors of atomic bomb explosions, nuclear reactor accidents, and other unanticipated exposures to similar radiation have led to varying conclusions regarding the stochastic effects of radiation exposure. That high doses of ionizing radiation cause cancer in humans is generally accepted, but the question of whether diagnostic levels of radiation cause cancer continues to be hotly debated. It cannot be denied that overexposure to ionizing radiation beyond a certain threshold, which has not been exactly determined, does generate cancer. This causes a dilemma: what should patients be informed about the possibility that a CT or similar examination might cause cancer later in life? At present, there is no consensus in the radiology community as to whether informed consent must be obtained from a patient before the patient undergoes a CT or similar examination. The author analyzes whether there is a legal duty mandating radiologists to obtain such informed consent but also, irrespective of the law, whether there an ethical duty that compels radiologists to inform patients of potential adverse effects of ionizing radiation. Over the past decade, there has been a noticeable shift from a benevolent, paternalistic approach to medical care to an autonomy-based, shared-decision-making approach, whereby patient and physician work as partners in determining what is medically best for the patient. Radiologists should discuss the benefits and hazards of imaging with their patients.

First generation stochastic gene episilencing (step1) model and applications to in vitro carcinogen exposure.

A novel first-generation stochastic gene episilencing (STEP1) model is introduced for quantitatively characterizing the probability of in vitro epigenetically silencing (episilencing) specific tumor-suppressor-microRNA (miRNA) genes by carcinogen exposure. Although the focus is mainly on in-vitro exposure of human cells to ionizing radiation, the mathematical formulations presented are general and can be applied to other carcinogens. With the STEP1 model, a fraction fj of the surviving target cells can have their tumor-suppressor-miRNA gene of type j silenced while the remaining fraction, 1 - fj , of the surviving cells do not undergo gene episilencing. Suppressor gene episilencing is assumed to arise as a Poisson process characterized with and exponential distribution of episilencing doses with mean dj . In addition to providing mathematical functions for evaluating the single-target-gene episilencing probability, functions are also provided for the multi-target-gene episilencing probability for simultaneously silencing of multiple tumor-suppressor-miRNA genes. Functional relationships are first developed for moderate doses where adaptive responses are unlikely and are then modified for low doses where adaptation can occur. Results apply to a specific follow-up time t after carcinogen exposure that exceeds the maximum time for the occurrence of an induced episilencing event.

Stochastic thresholds: a novel explanation of nonlinear dose-response relationships for stochastic radiobiological effects.

New research data for low-dose, low-linear energy transfer (LET) radiation-induced, stochastic effects (mutations and neoplastic transformations) are modeled using the recently published NEOTRANS(3) model. The model incorporates a protective, stochastic threshold (StoThresh) at low doses for activating cooperative protective processes considered to include presumptive p53-dependent, high-fidelity repair of nuclear DNA damage in competition with presumptive p53-dependent apoptosis and a novel presumptive p53-independent protective apoptosis mediated (PAM) process which selectively removes genomically compromised cells (mutants, neoplastic transformants, micronucleated cells, etc.). The protective StoThresh are considered to fall in a relatively narrow low-dose zone (Transition Zone A). Below Transition Zone A is the ultra-low-dose region where it is assumed that only low-fidelity DNA repair is activated along with presumably apoptosis. For this zone there is evidence for an increase in mutations with increases in dose. Just above Transition Zone A, a Zone of Maximal Protection (suppression of stochastic effects) arises and is attributed to maximal cooperation of high-fidelity, DNA repair/apoptosis and the PAM process. The width of the Zone of Maximal Protection depends on low-LET radiation dose rate and appears to depend on photon radiation energy. Just above the Zone of Maximal Protection is Transition Zone B, where deleterious StoThresh for preventing the PAM process fall. Just above Transition Zone B is a zone of moderate doses where complete inhibition of the PAM process appears to occur. However, for both Transition Zone B and the zone of complete inhibition of the PAM process, high-fidelity DNA repair/apoptosis are presumed to still operate. The indicated protective and deleterious StoThresh lead to nonlinear, hormetic-type dose-response relationships for low-LET radiation-induced mutations, neoplastic transformation and, presumably, also for cancer.