Cost-risk-benefit analysis in diagnostic radiology with special reference to the application of referral guidelines.

Cost-risk-benefit analysis has been applied to protection of the patient in diagnostic radiology with special reference to the application of referral guidelines. The analysis presented has extended previous work in this field to provide a theoretical framework that encompasses key factors that need to be considered in the optimisation of patient protection from both diagnostic and radiation risks. The fraction of patients whose symptoms do not meet criteria contained in the referral guidelines and, therefore, for whom an X-ray examination is not indicated has been termed the selectivity of the guidelines. Also included are the detriments arising from rejected or repeated examinations as well as the levels of patient dose employed in order to achieve given levels of true and false diagnostic outcomes. A comprehensive framework for optimisation is outlined and its relationship to justification discussed.

Design, manufacture and deployment of a low-cost area radiation monitoring system using Raspberry Pi computers and open-source software.

Monitoring of background radiation levels in radiopharmaceutical laboratories is a key tool in minimising dose to workers. Retrofitting area monitoring systems in an existing laboratory can be disruptive and prohibitively expensive. We set out to develop a flexible low-cost area monitoring system utilising the power of inexpensive single board computers and open-source software. A complete system has been developed which includes local and remote real-time display with local warning, dose rate logging and automated plotting and backup of results from over 20 individual monitors connected via wifi.

Use of health economics in the development of a national radon control strategy in Ireland.

A health economics evaluation of different radon intervention strategies was undertaken including the incorporation of prevention into new buildings, the incorporation of potential remedial measures into new buildings and remediation of existing buildings. The analysis shows that (1) the incorporation of prevention into new houses at the time of construction is generally more cost effective than remediation of existing houses and (2) that the cost effectiveness of programmes aimed at encouraging householders to test and remediate their houses may be poor if they are not undertaken within the context of coherent radon reduction strategy. The results of this evaluation were used to identify the most cost-effective radon interventions in an Irish context in support of the development of a National Radon Control Strategy.

Radiology stewardship and quality improvement: the process and costs of implementing a CT radiation dose optimization committee in a medium-sized community hospital system.

PURPOSE: The aims of this study were to measure the effectiveness of a multidisciplinary CT dose optimization committee and estimate its costs and to describe a radiation stewardship quality improvement initiative in one CT department at a medium-sized community hospital system that used a participatory design committee methodology. METHODS: A CT dose optimization committee was conceived, funded, and formed, consisting of the following stakeholders: radiologists, technologists, consultant medical physicists, and an administrator. Volume CT dose index (CTDIvol) and repeat rate were monitored for 1 month, for one scan type, during which iterative protocol adjustments were made through committee interaction. Effects on repeat rate and CTDIvol were quantified and benchmarked against national diagnostic reference levels after retrospective medical record review of 100 consecutive patients before and after the intervention. Labor hours were reported and wage resources estimated. RESULTS: Over 3 months, the committee met in person twice and exchanged 128 e-mails in establishing a process for protocol improvement and measurement of success. Repeat rate was reduced from 13% (13 of 100) to 0% (0 of 100). Scans meeting the ACR reference level for CTDIvol (75 mGy) improved by 34% (38 of 100 before, 51 of 100 after; Fisher's exact 2-tailed P = .09), and those meeting ACR pass/fail criterion (80 mGy) improved by 29% (58 of 100 before, 75 of 100 after; Fisher's exact 2-tailed P = .01). Committee evolution and work, and protocol development and implementation, required 57 person-hours, at an estimated labor cost of $12,488. CONCLUSIONS: An efficient process was established as a proof of concept for the use of a multidisciplinary committee to reduce patient radiation dose, repeat rate, and variability in image quality. The committee and process ultimately improved the quality of patient care, fostered a culture of safety and ongoing quality improvement, and calculated costs for such an endeavor.

Optimization of radiation protection for the control of occupational exposure in Ghana.

Investigation of the optimization of protection of occupational exposed workers (OEWs) in Ghana had been carried out on the three practices in the country, namely medical applications, industrial radioisotope applications and research and education from 2002 to 2007. Mean annual effective dose and collective effective dose were estimated from dosimetry records from the Radiation Protection Institute of those occupationally exposed from 2002 to 2007. The mean annual effective dose estimated for about 650 OEWs per year ranged from 0.42 to 0.68 mSv compared with a global value of 0.5 mSv estimated by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR 2008 Report). This implies that efforts should still be made to institute as low as reasonably achievable culture in most practices in Ghana even though trend of doses incurred was low. The collective effective dose for this same period estimated ranged from 0.26 to 0.47 man Sv. A reference monetary value of the man sievert was estimated using the human capital approach for each year from 2002 to 2009; it ranged from 172 to 22 US $ per man Sv, which provided a basis for estimating the cost of averting a unit collective effective dose of 1 man Sv. This value could not be used for quantitative optimization since the range of mean annual effective dose estimated was below 1 mSv.

[Ecological and economic approaches to removing radioactively dangerous objects from service].

The paper considers major ecological and economic problems when removing radiation dangerous objects from service and rehabilitating the areas, which require their solution: the absence of specific guidelines for ranking the contaminated lands exposed to radioactive and chemical pollution from the potential risk to the population and environment; no clear criteria for ceasing area rehabilitation works; radiation exposure levels for the population living in the areas after rehabilitation; allowable levels of residual specific activity, and levels of heavy metals in soil, surface and underground water and bed sediment. The cost such works is the most important and decisive problem. A decision-making algorithm consisting of three main blocks: organizational-technical, engineering, geological and medicoecological measures is proposed to solve managerial, economic, and scientific problems.

Commercial devices measuring UV radiation: a good choice for the public?

Commercial devices measuring UV radiation are available on the market at affordable prices. This work presents the response of six commercial devices in comparison to UV index measurements and in relation to the guidelines provided by the INTERSUN programme. Taking everything into account, overestimated or non-standard data, and ambiguous or incomplete information was found. Instead of using these gadgets, people should refer to official information and advice provided by health and weather services.

Comparison between UV index measurements performed by research-grade and consumer-products instruments.

Ultraviolet radiation (UVR) exposure, skin cancer and other related diseases are not just subjects of scientific literature. Nowadays, these themes are also discussed on television, newspapers and magazines for the general public. Consequently, the interest in prevention of sun overexposure is increasing, as the knowledge of photoprotection methods and UVR levels. The ultraviolet index (UVI) is a well-known tool recommended by the World Health Organization to avoid harmful effects of UV sunlight. UVI forecasts are provided by many national meteorological services, but local UVI measurements can provide a more realistic and appropriate evaluation of UVR levels. Indeed, as scientific instruments are very expensive and difficult to manipulate, several manufacturers and retail shops offer cheap and simple non-scientific instruments for UVI measurements, sometimes included in objects of everyday life, such as watches, outfits and hand-held instruments. In this work, we compare measurements provided by several commercial non-scientific instruments with data provided by a Bentham spectrometer, a very accurate sensor used for UV measurements. Results show that only a few of the instruments analyzed provide trustworthy UVI measurements.

Cost-effectiveness of countermeasures against radon in the Czech Republic: preliminary report.

The cost-effectiveness of remedial and preventive countermeasures against indoor radon in the frame of the Czech Radon Programme is preliminarily estimated, resulting in 72 700 CZK and 194 000 CZK per y of life gained by remediation and prevention, respectively, (exchange rate approximately 28 CZK/EUR).

[The use of computer system in the introduction of countermeasures in agriculture after the Chernobyl accident].

In the development of strategies for countermeasures aimed at the rehabilitation of contaminated areas, essential is to identify criteria for assessing their effectiveness and factors influencing the priority of the criteria chosen. A method is suggested for assessing effectiveness of countermeasures in agriculture based on a multicriterium analysis of radiologic, economic, regulatory and socio-psychological indicators characterizing the use of countermeasures. Rating of countermeasures strategies is presented depending on financing of works on the rehabilitation of the Chernobyl affected areas.

Determination and use of the monetary values of the averted person-sievert for use in radiation protection decisions in Hungary.

The monetary value of the averted dose is a key element in the implementation of the optimization principle both in radiation praxis and intervention. The main concept of this principle is to select options so as to maintain exposures at a reasonable level. The feature of this concept is to look for the minimal total cost, i.e., the sum of the costs of protection and health detriment. In its publications, ICRP emphasized the need for developing models which also take into account the "subjective" aspects of health detriment in the optimization process, such as the perception of risk by individuals and the need to put more emphasis on equity in the distribution of individual doses. This paper proposes a modified alpha-value model based on CEPN's model (Centre d'Etude sur L'Evaluation de la Protection dans le Domaine Nucleaire) to put more emphasis on recently published considerations about the smaller effects of the portion of collective dose derived from small doses. The parameters of the monetary value of unit collective dose averted, which is a key element of this type of model, can be estimated by means of approaches like human capital (HC) and willingness to pay (WTP) from the point of view of economic theories. The present study summarizes the results achieved by WTP among the radiation specialists mainly from the Paks Nuclear Power Plant, Hungary. The aim of the effort was to determine the value of a statistical life and the monetary value of a unit person-sievert associated with averted occupational exposure due to ionizing radiation. To apply the WTP method, a questionnaire has been prepared on the basis of the one introduced by CEPN in the late 1990's. The investigations show that the value of US$6,200 person-Sv(-1) seems to be acceptable for the alphabase-value for the occupational situation in Hungary in 1999. WTP assessments should be applied with caution since the economic level of the country, the workplace surveyed, and the computational methods affect the results. In addition, achieving a high level safety culture must rely on international cooperation both from the theoretical and practical viewpoints, and international markets affect the associated costs. Therefore the monetary requirements cannot always be assessed solely on a national basis.

Radon and lung cancer: a cost-effectiveness analysis.

OBJECTIVES: This study examined the cost-effectiveness of general and targeted strategies for residential radon testing and mitigation in the United States. METHODS: A decision-tree model was used to perform a cost-effectiveness analysis of preventing radon-associated deaths from lung cancer. RESULTS: For a radon threshold of 4 pCi/L, the estimated costs to prevent 1 lung cancer death are about $3 million (154 lung cancer deaths prevented), or $480,000 per life-year saved, based on universal radon screening and mitigation, and about $2 million (104 lung cancer deaths prevented), or $330,000 per life-year saved, if testing and mitigation are confined to geographic areas at high risk for radon exposure. For mitigation undertaken after a single screening test and after a second confirmatory test, the estimated costs are about $920,000 and $520,000, respectively, to prevent a lung cancer death with universal screening and $130,000 and $80,000 per life-year for high risk screening. The numbers of preventable lung cancer deaths are 811 and 527 for universal and targeted approaches, respectively. CONCLUSIONS: These data suggest possible alternatives to current recommendations.