COMPREHENSIVE RADIATION AND HYGIENIC MONITORING IN POPULATION OF THE RIVNE OBLAST RADIOLOGICALLY CONTAMINATED TERRITORIES. / KOMPLEKSNYI RADIATsIINO/GIGIIeNIChNYI MONITORYNG MEShKANTsIV RADIOAKTYVNO ZABRUDNENYKh TERYTORII RIVNENS'KOÏ OBLASTI U 2020 r.

OBJECTIVE: The key factors identification in radiation dose formation in population of radiologically contaminatedareas of Rivne oblast in the current period of accident through comprehensive radiation and hygienic monitoring inreference settlements in 2020 and estimation of their impact on dose formation were the study objectives. MATERIALS AND METHODS: Comprehensive radiation and hygienic monitoring of settlements in Rivne oblast(province) was provided in Stare Selo, Vezhytsia, Perekhodychi, and Drozdyn villages of Rokytne district, where thehighest radiation doses were registered after the ChNPP accident. Studies were conducted in September 2020.Measurements (n=696, 318 adults, and 378 children) were performed using the whole body counters (WBC) to deter-mine the internal radiation doses. The 48 samples of milk, 45 samples of potatoes and vegetables, and 35 samplesof wild products were collected in local farms and measured for the 137Cs and 90Sr content. Residents of the studiedsettlements (n=229, 140 adults, and 89 children) were interviewed about the levels of consumption of staple food-stuffs. External radiation doses were evaluated in all the studied settlements. Mathematical, dosimetric, and radio-chemical methods were applied. RESULTS AND CONCLUSIONS: Annual effective radiation doses of the Rivne oblast population in 2020 were formedmainly due to internal radiation ones that not exceeded 1.24 mSv · year-1 in adults and 0.65 mSv · year-1 in childrenagainst the RCT criterion of 1 mSv · year-1. Further 1.2-1.9-fold decrease in the annual internal radiation doses vs.the results of WBC-monitoring in autumn of 2017 was registered in the surveyed settlements. The latter confirmeda time pattern of radiation levels gradual reduction at the current stage of Chornobyl accident since 2011. Intakeof 137Cs with milk and wild mushrooms, which traditionally occupy a significant part of diet in the Rivne Polissya areaand have consistently high levels of radioactive cesium contamination, remains a key factor of internal radiationdose forming in residents of the surveyed settlements of Rivne oblast.

High filtration in interventional practices reduces patient radiation doses but not always scatter radiation doses.

OBJECTIVES: In fluoroscopy-guided interventional practices, new dose reduction systems have proved to be efficient in the reduction of patient doses. However, it is not clear whether this reduction in patient dose is proportionally transferred to operators' doses. This work investigates the secondary radiation fields produced by two kinds of interventional cardiology units from the same manufacturer with and without dose reduction systems.Methods:Data collected from a large sample of clinical procedures over a 2-year period (more than 5000 procedures and 340,000 radiation events) and the DICOM radiation dose structured reports were analysed. RESULTS: The average cumulative Hp(10) per procedure measured at the C-arm was similar for the standard and the dose reduction systems (452 vs 476 µSv respectively). The events analysis showed that the ratio Hp(10)/KAP at the C-arm was (mean ± SD) 5 ± 2, 10 ± 4, 14 ± 4 and 14 ± 6 µSv·Gy-1·cm-2 for the beams with no added filtration, 0.1, 0.4 and 0.9 mm Cu respectively and suggested that the main cause for the increment of the ratio Hp(10)/KAP vs the "standard system" is the use of higher beam filtration in the "dose reduction" system. CONCLUSION: Dose reduction systems are beneficial to reduce KAP in patients and their use should be encouraged, but they may not be equally effective to reduce occupational doses. Interventionalists should not overlook their own personal protection when using new technologies with dose reduction systems. ADVANCES IN KNOWLEDGE: Dose reduction technology in interventional systems may increase scatter dose for operators. Personal protection should not be overlooked with dose reduction systems.

What is the point of innovation in patient dose monitoring?

The Medical Futurist says that radiology is one of the fastest growing and developing areas of medicine, and therefore this might be the speciality in which we can expect to see the largest steps in development. So why do they think that, and does it apply to dose monitoring? The move from retrospective dose evaluation to a proactive dose management approach represents a serious area of research. Indeed, artificial intelligence and machine learning are consistently being integrated into best-in-class dose management software solutions. The development of clinical analytics and dashboards are already supporting operators in their decision-making, and these optimisations - if taken beyond a single machine, a single department, or a single health network - have the potential to drive real and lasting change. The question is for whom exactly are these innovations being developed? How can the patient know that their scan has been performed to the absolute best that the technology can deliver? Do they know or even care how much their lifetime risk for developing cancer has changed post examination? Do they want a personalised size-specific dose estimate or perhaps an individual organ dose assessment to share on Instagram? Let's get real about the clinical utility and regulatory application of dose monitoring, and shine a light on the shared responsibility in applying the technology and the associated innovations.

Registry of Buildings With Transformer Stations as a Basis for Epidemiological Studies on Health Effects of Extremely Low-Frequency Magnetic Fields.

Buildings with indoor transformer stations may serve as a basis for improved epidemiological studies on the health effects of extremely low-frequency magnetic fields (ELF MFs). Previous studies have shown that ELF MF exposure can be adequately assessed based on the fact that MF levels are high in apartments directly above transformers. In this paper, we describe the creation of a registry of Finnish residential buildings with built-in transformer stations and discuss its usability in epidemiological studies. Information obtained from electric utilities and building blueprints were used to identify 677 buildings in which an apartment was located above or adjacent to a transformer station. All apartments in these buildings were classified into exposure categories based on their location in relation to the transformer. Residential histories of these buildings were obtained from the Population Register Centre. Out of the 287,668 individuals who have resided in the buildings, 9,126 of them have resided in an apartment located directly above a transformer station. All information was collected without contacting residents, thus avoiding selection bias. The registry can be linked with data from high-quality nationwide registries to confirm or challenge the reported associations of ELF MF exposure and diseases such as cancer, miscarriage, and Alzheimer's disease. Bioelectromagnetics. 2020;41:34-40 © 2019 Bioelectromagnetics Society.

CR10-A PUBLIC DATABASE OF COSMIC RADIATION MEASUREMENTS AT AVIATION ALTITUDES OF ABOUT 10 KM.

Long-term measurements using silicon radiation spectrometer Liulin on board commercial aircraft have been performed since 2001; results were put into a new database, which covers more than 4500 flights with more than 130 000 measurements. Methodology and tools were developed to normalize the data with respect to latitude and altitude and thus enable comparison with other radiation detectors and with model calculations. This capability is demonstrated using data from the neutron monitor at Lomnický stít. Instead of providing data files for individual measurement period, two software solutions are delivered. First is a web-based user interface for visualizing and downloading arbitrary time window of interest from the database hosted at http://cr10.odz.ujf.cas.cz. The second is a set of interactive Python notebooks available at GitHub. Those implement the calibration, normalization and visualization methods-so the outputs can be tailored to user needs. The software and data are provided under GNU/CC license.

Trends and Distribution Analysis of Occupational Exposure From Medical Practices in China (2010-2016).

Occupational exposure to ionizing radiation from medical practices in China has been collected for a 7 y period between 2010 and 2016 from roughly 220 individual monitoring service providers through the Chinese Registry of Radiation Workers. Statistical dose distributions and characteristic tendencies are presented based on the evaluation in terms of six occupational categories. A reduction can be seen in average annual effective dose for interventional radiology, nuclear medicine, diagnostic radiology, radiotherapy, dental radiology, and others by 52%, 47%, 46%, 34%, 69%, and 31%, respectively, for the 7 y period. More than 94.5% of radiation workers received annual doses less than the public dose limit (1 mSv) in 2016. Workers engaged in nuclear medicine and interventional radiology activities were found to receive relatively more dose than the other fields of practice. Diagnostic radiology makes the dominant contribution of 68% to the collective effective dose of 73,641.3 person mSv received by 211,613 radiation workers in medical practices in 2016. The observation of workers in medical practices receiving well below the recommended occupational dose limit (20 mSv) could be a result of an improvement in radiation protection practices in the medical field in China. However, it is still necessary to control and manage the workplace and radiation workers to avoid unnecessary exposures, in particular for the workers engaged in nuclear medicine and interventional radiology activities.

The Level of Compliance With the Use of Personal Radiation Monitoring Devices by Qualified Radiographers at Provincial Hospitals in the Tshwane District Area.

When researchers accompanied radiography students during their work integrated learning, it was observed that there is non-compliance with regards the use of personal radiation monitoring devices by radiographers in the Radiology Departments at Provincial hospitals in the Tshwane district area. The aim of this research study was to identify the level of compliance with the use of radiation monitoring devices by radiographers. A quantitative descriptive study method was used, and the data collection tool was questionnaires that were hand delivered to all settings. The sample size of radiographers was 96, and consent was received from 61 participants. The data was collated in a Microsoft Excel® spreadsheet, and the variables were statistically analyzed for frequencies and percentages. The Fisher's exact test was used for association to answer the level of compliance and management of the radiation monitoring device. Results showed compliance of radiographers in the wearing of radiation monitoring devices but inconsistency as to where the radiation monitoring device should be worn. A lack of awareness about policies from the Radiation Board was also noted.

Indoor radon in Spanish workplaces. A pilot study before the introduction of the European Directive 2013/59/Euratom.

OBJECTIVE: To explore whether there is a possible problem regarding indoor radon concentration surpassing the new European Directive 2013/59/Euratom threshold in Spanish workplaces. We also aim to find out whether radon concentration might be associated with certain characteristics of workplaces. METHOD: We performed a cross-sectional study to measure indoor radon concentrations in Spanish workplaces including five different sectors (education, public administration, the health sector, the tourist sector and the private sector). To be measured, the workplace should be occupied permanently by at least one worker. Alpha-track type radon detectors were placed for at least three months and read at the Galician Radon Laboratory at the University of Santiago de Compostela. A descriptive analysis was performed on radon distribution by sector, building characteristics and number of workers affected. RESULTS: We faced enormous difficulties in finding volunteers for this study. Galicia and Madrid had the highest number of measurements. Of a total of 248 measurements, 27% had concentrations above 300 Bq/m3. Median radon concentration was 251 Bq/m3 in Galicia, followed by Madrid, with 61.5 Bq/m3. Forty-six percent of the workplaces measured in Galicia had radon concentrations higher than 300 Bq/m3 followed by 10.6% in Madrid. Nineteen percent of all workers were exposed to more than 300 Bq/m3 and 6.3% were exposed to radon concentrations higher than 500 Bq/m3. CONCLUSION: Indoor radon exposure might be a relevant problem in Spanish workplaces and the number of affected workers could be high. The prevalence of workers exposed to high radon concentrations probably depends on the geographical area.

Estimation of Seasonal Correction Factors for Indoor Radon Concentrations in Korea.

Long-term exposure to high radon concentration exerts pathological effects and elicits changes in respiratory function, increasing an individual's risk of developing lung cancer. In health risk assessment of indoor radon, consideration of long-term exposure thereto is necessary to identify a relationship between indoor radon exposure and lung cancer. However, measuring long-term indoor radon concentration can be difficult, and a statistical model for predicting mean annual indoor radon concentrations may be readily applicable. We investigated the predictability of mean annual radon concentrations using national data on indoor radon concentrations throughout the spring, summer, fall, and winter seasons in Korea. Indoor radon concentrations in Korea were highest in the winter and lowest in the summer. We derived seasonal correction and seasonal adjustment factors for each season based on the method proposed by previous study. However, these factors may not be readily applicable unless measured in a specific season. In this paper, we separate seasonal correction factors for each month of the year (new correction factors) based on correlations between indoor radon and meteorological factors according to housing type. To evaluate the correction factors, we assessed differences between estimated and measured mean annual radon concentrations. Roughly 97% of the estimated values were within ±40 Bq/m³ of actual measured values in detached houses, and roughly 85⁻87% of the estimated values were within ±40 Bq/m³ of the measured values in other residences. In most cases, the seasonal correction factors and the new correction factors had slightly better agreement than the seasonal adjustment factor. For predicting mean annual radon concentrations, the seasonal correction factors or seasonal adjustment factors can be of use when actual measurements of indoor radon concentrations for a specific season are available. Otherwise, the new correction factors may be more readily applicable.

Radiocaesium transfer and radiation exposure of frogs in Fukushima Prefecture.

The International Commission on Radiological Protection has proposed an environmental assessment framework. This includes ionising radiation exposure assessment for different frog life-stages, but radiocaesium transfer parameters are unavailable. We collate data from the Fukushima Prefecture (contaminated by the Fukushima accident) and estimate radiocaesium concentration ratio (CRwo-water) values for tadpoles and adult frogs, presenting the largest available amphibian CRwo-water dataset. In total, 513 adult frogs and 2540 tadpoles were analysed in 62 and 59 composite samples respectively. Results suggest that equilibrium was reached between water and amphibian radiocaesium activity concentrations circa one-year after the accident. Radiocaesium transfer to tadpoles was higher than to adult frogs. Dose rates were estimated for different life-stages and species in both the aquatic and terrestrial environment. Estimated dose rates to adults and tadpoles were typically similar because external exposure dominated for both organisms; frogspawn dose rates were estimated to be orders of magnitude lower than other life-stages. For the two sites assessed, which were outside of the most contaminated areas of the Fukushima Prefecture, estimated dose rates were below those anticipated to present a risk to wildlife populations; it is likely that dose rates in more contaminated areas were in excess of some effects benchmark values.

AUTOMATIC ACQUISITION OF CT RADIATION DOSE DATA: USING THE DIAGNOSTIC REFERENCE LEVEL FOR RADIATION DOSE OPTIMIZATION.

The present work describes that we try to construct a system that collects dose information that performed CT examination from multiple facilities and unified management. The results of analysis are compared with other National diagnostic reference level (DRL), and the results are fed back to each facility and the cause of the abnormal value is investigated for dose optimization. Medical information collected 139 144 tests from 33 CT devices in 13 facilities. Although the DRL of this study is lower than that of Japan DRL, it was higher than the DRL of each country. When collecting all the examination, it is thought that the variation of the dose due to the error other than the intended imaging site is large. In future, we should continue to collect information in order to DRL renewal and we also think that it is desirable to collect information on physique and detailed scan region as well.

Effect of Radiological Countermeasures on Subjective Well-Being and Radiation Anxiety after the 2011 Disaster: The Fukushima Health Management Survey.

After the Fukushima Daiichi Nuclear Power Station accident in 2011, concerns about radiation exposure and decline in subjective well-being have been reported. To tackle these problems, various countermeasures in relation to radiation have been implemented. In this study, we comprehensively evaluated the effects of radiological countermeasures on subjective well-being (e.g., satisfaction with life (SWL) and emotional well-being) and radiation anxiety, through a questionnaire survey targeting Fukushima residents (N = 1023). Propensity scores matching was applied to evaluate significant effects of radiological countermeasures on subjective well-being and radiation anxiety. Among the radiological countermeasures, thyroid examination, whole body counter, and air dose monitoring showed the highest proportions of participation, utilization, and useful evaluation, suggesting a high degree of public attention focused on these countermeasures. The basic survey was associated with significant increases in SWL and self-rated health (SH). Thyroid examination was significantly associated with not only a reduction in radiation anxiety but also an increase of emotional stress, suggesting the importance of careful design of system and detailed communication. Food inspection was associated with deterioration in SH. Those who utilized explanatory meetings showed increases in sadness, worry, and radiation anxiety, indicating that additional attention is required of the experts and authorities involved in explanatory meetings.

Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring.

PURPOSE: Radiation safety and protection are a key component of fluoroscopy-guided interventions. We hypothesize that providing weekly personal dose feedback will increase radiation awareness and ultimately will lead to optimized behavior. Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions. MATERIALS AND METHODS: Medical staff (physicians and technicians, n = 27) involved in fluoroscopy-guided interventions were equipped with electronic personal dose meters (PDMs). Procedure dose data including the dose area product and effective doses from PDMs were prospectively monitored for each consecutive procedure over an 8-month period (n = 1082). A personalized feedback form was designed displaying for each staff individually the personal dose per procedure, as well as relative and cumulative doses. This study consisted of two phases: (1) 1-5th months: Staff did not receive feedback (n = 701) and (2) 6-8th months: Staff received weekly individual dose feedback (n = 381). An anonymous evaluation was performed on the feedback and occupational dose. RESULTS: Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04-0.50) µSv/Gy cm2 versus (phase 2) 0.08 (0.02-0.24) µSv/Gy cm2, p = 0.002]. CONCLUSION: Personalized dose feedback increases radiation awareness and safety and can be provided to staff involved in fluoroscopy-guided interventions.

Towards a Long-Term Strategy for Voluntary-Based Internal Radiation Contamination Monitoring: A Population-Level Analysis of Monitoring Prevalence and Factors Associated with Monitoring Participation Behavior in Fukushima, Japan.

Following Japan's 2011 Fukushima nuclear incident, we assessed voluntary-based monitoring behavior in Minamisoma City-located 10-40 km from the Fukushima nuclear plant-to inform future monitoring strategies. The monitoring in Minamisoma included occasional free of charge internal-radiation-exposure measurements. Out of around 70,000 individuals residing in the city before the incident, a total of 45,788 residents (female: 52.1%) aged ≥21 were evaluated. The monitoring prevalence in 2011-2012 was only 30.2%, and this decreased to 17.9% in 2013-2014. Regression analyses were performed to estimate factors associated with the monitoring prevalence and participation behavior. The results show that, in comparison with the age cohort of 21-30 years, the cohort of 71-80 and ≥81 years demonstrated significantly lower monitoring prevalence; female residents had higher monitoring prevalence than male residents; those who were living in evacuation zones at the time of the incident had higher monitoring prevalence than those who lived outside any of the evacuation zones; for those living outside Fukushima and neighboring Prefectures post-incident monitoring prevalence decreased significantly in 2013-2014. Our findings inform the discussion on the concepts of radiation risk perception and accessibility to monitoring and societal decision-making regarding the maintenance of the monitoring program with low monitoring prevalence. We also stress the possibility that the monitoring can work both to check that internal contamination levels are within acceptable limits, and as a risk communication tool, alleviating individuals' concern and anxiety over radiation contamination.

[Factors affecting exposure level for medical staff during orthopedic procedures under fluoroscopic control]. / Czynniki wplywajace na poziom narazenia personelu medycznego podczas zabiegów ortopedycznych pod kontrola fluoroskopii.

BACKGROUND: Extended control of staff exposure in interventional radiology has been legally required over the last few years. This is determined by a number of factors, including the type of procedure, technical conditions and methodology. In orthopedic procedures fluoroscopy is used to control surgical reconstructions. An influence of particular factors on the registered values of doses received by the members of medical team performing osteosynthesis for limb fractures is presented in this paper. MATERIAL AND METHODS: Doses received by individual interventional team members performing specific functions, operator, assisting physicians and scrub nurse, during a series of the procedures were measured. Each person was equipped with 4 dosimetric tools, containing thermoluminescent dosimeters, to measure the equivalent doses for the eyes, hand skin and the neck (outside the shield) and to evaluate effective doses. The investigations were performed in operational theatres of 3 hospitals in Lódz. RESULTS: The equivalent doses per one procedure for the eyes and hand skin of the operator were 0.029-0.073 mSv and 0.366-1.604 mSv, respectively. Significantly higher doses were noted during the procedures of intramedullary osteosynthesis, especially for the operator. An average age and body mass index (BMI) of patients treated in the monitored hospitals did not differ statistically. CONCLUSIONS: Based on the dosimetric measurements the following conclusions can be drawn: in orthopedic procedures of interventional radiology (IR) the exposure of the staff is mostly determined by the type of procedure and more precisely by its complexity and by the optimized use of X-ray unit, including pulsed fluoroscopy. It is also revealed that the operator is the most exposed person in the interventional team. Med Pr 2017;68(1):75-83.

The assessment of the ionizing radiation dose received by patients during some diagnostic X-ray examinations carried out on the basis of the working procedures in the health care entities

Background: X-ray examination is a popular and universally used injury and disease diagnostic method. A distinctive X ray examination feature is that it can be done quickly which is extremely important in case of the need for rapid diagnosis of patients in life threatening condition. Another advantage of the X-ray examinations is also relatively low cost of carry. However, X-ray examination involve adverse health effects. During the examination the patient is subjected to ionizing radiation that might have impact on his health. Objective: The aim of this study has been to determine and assess the size of the entrance surface doses (ESD) received by patients during selected X-ray examinations performed on the basis of the medical working procedures available in healthcare entities in Masovian Voivodeship in Poland. Materials and Method: The examinations were conducted for 71 X-ray units located in the Masovian Voivodeship. Measurements of doses received by the patients were based on our own validated test methods. Results: It was found that the range applied to the high voltage in healthcare entities does not always coincide with the values specified in the standard procedures. It was found in the skull projection radiography AP and LAT that the recorded values were from range 60 to 82 kV (the average value of 74 kV) while in accordance with a standard procedure they should be in the range from 65 to 75 kV. Only in case of cervical spine radiography in the AP projection, the LAT exposure conditions were matching with the standard obligatory procedures in Poland. The consequence of selecting exposure conditions are significant differences in the size of the doses the patient receive during the same medical procedures. The greatest range of ESD doses was found during radiography of the thoracic spine in the projection AP and LAT. The projection LAT measured values were in the range of 523 to 10550 µGy (average value 2175 µGy). Conclusions: It is necessary to update immediately the standard procedures and to develop detailed guidelines for the preparation of working procedures in X-ray rooms.

Analysis of Radiation Doses and Dose Reduction Strategies During Cerebral Digital Subtraction Angiography.

OBJECTIVE: Adverse effects of increased use of cerebral digital subtraction angiography (DSA) include radiation-induced skin reactions and increased risk of malignancy. This study aimed to identify a method for reducing radiation exposure during routine cerebral DSA. METHODS: A retrospective review of 138 consecutive adult patients who underwent DSA with a biplane angiography system (Artis Zee, Siemens, Germany) from September 2015 to February 2016 was performed. In January 2016, the dose parameter was reset by the manufacturer from 2.4 µGy to 1.2 µGy. Predose (group 1) and postdose parameter reduction (group 2) groups were established. Angiograms and procedure examination protocols were reviewed according to patient age, gender, and diagnosis and angiography techniques were reviewed on the basis of the following radiation dose parameters: fluoroscopy time, reference point air kerma (Ka,r; in mGy), and kerma-area product (PKA; in µGym2). RESULTS: The mean Ka,r values in groups 1 and 2 were 1841.5 mGy and 1274.8 mGy, respectively. The mean PKA values in groups 1 and 2 were 23212.5 µGym2 and 14854.0 µGym2, respectively. Ka,r and PKA values were significantly lower in group 2 compared with group 1 (P < 0.001). Among individual factors, young age was a determining factor for reduced fluoroscopy time (P < 0.001), Ka,r (P = 0.047), and PKA (P = 0.022). CONCLUSIONS: Increased awareness of radiation risks, as well as the establishment of strategies to reduce radiation dose, led to lower radiation doses for DSA. The use of appropriate examinations and low-dose parameters in fluoroscopy contributed significantly to the radiation dose reductions.

Characterizing and Mapping of Exposure to Radiofrequency Electromagnetic Fields (20-3,000 Mhz) in Chengdu, China.

With radiofrequency exposure caused by electronic applications increasing, some members of the public are worrying about potential health risks. In this paper, methods of performing large-scale radiofrequency exposure evaluation are described. All studied sites were divided into three categories: commercial-area, residential-urban, and residential-rural. Then a series of site investigations were conducted on a car-mounted system in the years 2014 and 2015, aiming to characterize electric field exposure from 12 different radiofrequency sources. The results indicate that the studied environment is safe as indicated by exposure below guidelines and standards. The highest exposure measured in the 2 y of monitoring was from an FM source, 316.23 mV m. Telecommunication sources dominate exposure, contributing the most power density (65-90%). Meanwhile, intergroup differences are discussed and summarized. The spatial distributions of FM and GSM1800 exposure are demonstrated on a map. This study describes an approach for the assessment of the spatiotemporal pattern of radiofrequency exposures in Chengdu and facilitates the identification of any sources causing exposure above relevant guidelines and standards.

Radon and Thoron In-air Occupational Exposure Study within Selected Wine Cellars of the Western Cape (South Africa) and Associated Annual Effective Doses.

This is the first known study of exposure of Rn (radon) and secondarily Rn (thoron) in-air activity concentrations assessed within nine selected wine cellars in four wine districts of the Western Cape (South Africa) and the associated annual occupational effective doses. E-PERM electret ion chambers (EIC) and RAD-7 α-detectors were used to perform these measurements. The radon in-air levels ranged from 12 ± 4 Bq m to 770 ± 40 Bq m within the nine selected wine cellars. Eight of the nine wine cellars (excluding results from cellar w-6) had a median radon in-air activity concentration of 48 ± 8 Bq m. Continuous thoron in-air activity concentration levels were also measured near an internal granite wall of the wine cellar w-6 (barrel room), where peak levels of up to 1,520 ± 190 Bq m and an average of 680 ± 30 Bq m were observed. The occupational annual effective dose due to radon and decay progeny exposure in-air within the selected wine cellars ranged from 0.08 ± 0.03 mSv to 4.9 ± 0.3 mSv with a median of 0.32 ± 0.04 mSv (Tmax = 2,000 h). The annual effective dose within the wine cellar (w-6) ranged up to a maximum of 2.5 ± 0.4 mSv (Tmax = 2000 h) due to exposure to thoron and decay progeny. In general, most of the wines cellars pose negligible associated health risk to personnel due to ionizing radiation exposure from the inhalation of radon and progeny. Under certain conditions (proximity and exposure time), caution should be exercised at wine cellar w-6 because of elevated thoron in-air levels.

The Henri Mondor Procedure of Morbidity and Mortality Review Meetings: Prospective Registration of Clinical, Dosimetric, and Individual Radiosensitivity Data of Patients With Severe Radiation Toxicity.

PURPOSE: After radiation therapy (RT), various radiation-induced toxicities can develop in about one-fourth of patients. An international interest in using morbidity and mortality rates to monitor the quality of care and integrate morbidity and mortality review (MMR) meetings into organizations' governance processes has arisen. We report the first results of patients included in our MMR procedure that included biological assays for individual intrinsic radiosensitivity (IIRS). METHODS AND MATERIALS: Twenty-three patients were prospectively included in the MMR database. Twenty-two were evaluable for IIRS. Prostate (n=10) and breast (n=8) cancers were the most frequent disease types. The total dose delivered, determined according to the type of disease, ranged from 30 to 74 Gy. Our MMR procedure requires strict criteria: patients with unresolved toxicity of grade 3 or higher with availability of clinical (photographic) data, IIRS results obtained from skin biopsy assays, treatment modalities, and follow-up data. The RT technique and dosimetry were reviewed. RESULTS: Our prospective registration of toxicities showed mainly rectitis, occurring in 7 cases, and skin toxicities, occurring in 9. Of the 7 patients with rectitis, 5 received 66 Gy of post-prostatectomy RT with V50 (rectum volume receiving 50 Gy) ranging from 45% to 75% and a mean maximal dose of 66.5 Gy. For dermatitis and cystitis, the mean maximal doses were in the range of classical constraints without any overdosage or dose heterogeneity. No errors were found in the review of treatment planning and positioning. Conversely, all the patients were considered biologically as radiosensitive with genomic instability and ATM (ataxia telangiectasia mutated)-dependent DNA double-strand break repair impairments. CONCLUSIONS: The MMR review of files allowed clear answers for patients on the relationship between clinical events and their IIRS. Our procedure has allowed education of all our staff to monitor, identify, and document clinical, physical, and biological aspects of radiation-induced toxicities. Thus we recommend the introduction of the MMR procedure in RT departments.