Assessment of an Emergency Medicine System for Radiation Accidents in Korea: A State Survey of the Workers Involved the Medical Response to Radiation Accidents.

Radiation emergency medicine systems are operated around the world to provide special care for the injured that require immediate medical attention in accidents. The objective of this survey was to evaluate people's perception of those who design the emergency medical plan for radiation accidents and those who supervise it in Korea. A questionnaire survey was conducted on the people involved in a regulatory system for medical response in a radiation emergency. Of 150 survey recipients, 133 (88.7%) completed the survey, including 92 workers and 41 inspectors. The respondents expressed the view that the national emergency medical plan is prepared above the average level using a Likert-style scale of 1 to 5 (mean = 3.55, SD = 0.74). Interestingly, using the Mann-Whitney U test, it could be shown that inspectors evaluated the emergency medical system for radiation accidents more strictly in all of the questions than the licensee workers, especially on radiation medical emergency preparedness (p = 0.004) and the governmental regulatory policy for radiation safety (p = 0.007). For a more efficient system of radiation emergency medicine, licensee workers prioritized the workforce, whereas inspectors favored laws and regulations for safety. The survey results show different perspectives between inspectors and licensee workers, which stem from the actual properties of each occupational role in the regulatory system for radiation medical emergency. These data could be utilized for communication and interaction with relevant people to improve the medical response preparedness against radiation accidents.

Transfusion of γ-irradiated blood components to individuals does not compromise the cytogenetic dose assessment.

Most blood components for transfusions are irradiated ex vivo to prevent transfusion-associated graft-versus-host disease (TA-GvHD); this irradiation can potentially affect the cytogenetic dose assessment of patients showing acute radiation syndrome (ARS) with bone marrow suppression or acute anaemia. Whole blood samples from five donors were irradiated with 0, 10 or 25 Gy γ-rays. The mitotic activity of each cultured blood sample was measured by calculating the mitotic index. A dicentric chromosome assay was used to evaluate the chromosomal aberrations and absorbed dose of blood lymphocytes. Mitogenic activity and scorable metaphase spreads were significantly decreased in the blood samples irradiated with 10 and 25 Gy (p < 0.001). Moreover, a significant increase in the mean scores of all types of chromosomal aberrations in the 10 Gy γ-irradiated samples was observed, with the estimated dose being 11.3 Gy (95% CI: 10.67-11.95 Gy); however, we were unable to estimate the exposure dose in the 25 Gy γ-irradiated samples due to a limited number of scorable metaphase spreads. The mitotic index of the 25 Gy γ-irradiated whole blood samples was significantly suppressed by more than 4-log fold. Thus, in the present study, we evaluated the effects of recommended radiation doses in γ-irradiated transplantation blood components using cytogenetic dosimetry. These results suggest that the partial transfusion of blood components to patients with ARS or acute anaemia did not compromise the estimation of the exposure dose using cytogenetic dosimetry.

Assessment of working environment and personal dosimeter-wearing compliance of industrial radiographers based on chromosome aberration frequencies.

Industrial radiographers are exposed to relatively higher doses of radiation than other radiation-exposed workers in South Korea. The objective of our study was to investigate the impact of specific occupational conditions on chromosome aberration frequency and evaluate dosimeter-wearing compliance of industrial radiographers in Korea. We studied individual and occupational characteristics of 120 industrial radiographers working in South Korea and evaluated the frequency of dicentrics and translocations in chromosomes to estimate radiation exposure. The association between working conditions and chromosome aberration frequencies was assessed by Poisson regression analysis after adjusting for confounding factors. Legal personal dosimeter-wearing compliance among workers was investigated by correlation analysis between recorded dose and chromosome aberration frequency. Daily average number of radiographic films used in the last six months was associated with dicentrics frequency. Workers performing site radiography showed significantly higher translocation frequency than those working predominantly in shielded enclosures. The correlation between chromosome aberration frequency and recorded dose was higher in workers in the radiography occupation since 2012 (new workers) than other veteran workers. Our study found that site radiography could affect actual radiation exposure to workers. Controlling these working conditions and making an effort to improve personal dosimeter-wearing compliance among veteran workers as well as new workers may be necessary to reduce radiation exposure as much as possible in their workplace.

PRACTICAL METHODS FOR INTERNAL DOSE ASSESSMENT FOR RADIOIODINE INTAKE AFTER THYROID BLOCKING: CLASSIFICATION OF DEGREE OF BLOCKAGE AND DETERMINATION OF INSENSITIVE MEASUREMENT POINT.

Iodine thyroid blocking (ITB) suppresses the uptake of iodine to the thyroid and reduces internal doses after radioiodine intake; however, its disturbance of thyroid biokinetics causes considerable uncertainty in the use of dosimetric data intended for assessment of unblocked normal thyroid. To more accurately assess internal dose after ITB, practical dosimetry methods were proposed that consider the ITB effect in a dosimetric manner. A method using the ratio of urine excretion to thyroid retention activity was proposed to retrospectively determine individual-specific ITB levels; bioassay functions and dose coefficients corresponding to ITB levels were calculated separately using the latest biokinetic model and fundamental data. Moreover, insensitive measurement points of time, which led to similar results regardless of ITB level, were determined based on the dose per unit content. Proposed insensitive points for inhalation of vapour forms and particulate forms, respectively, were 1.5 days and 2 days after exposure.

Internal Dose Assessment after 131I-Iodide Misadministration in a Patient With Incompletely Blocked Thyroid Uptake: Personalized Internal Dose Assessment by Estimating Individual-Specific Biokinetics.

In July 2017, a medical accident occurred in South Korea, in which I-iodide solution was misadministered to the wrong patient. Although the International Commission on Radiological Protection provided internal dose coefficients for iodine for blocked thyroid, they were not reliable enough for determining the dose to the patient (whose thyroid uptake was incompletely blocked) due to a discrepancy in biokinetics. Therefore, a personalized dose assessment was performed to derive the individual-specific dose coefficients for the patient. Initially, the thyroid biokinetics of the patient were statistically clarified by fitting bioassay monitoring results and the corresponding predicted bioassay values, which were calculated repeatedly for varying iodine transfer rates in an iodine biokinetic model. After determining the transfer rate for the patient, the individual-specific dose coefficients were then calculated in accordance with latest recommendations of the International Commission on Radiological Protection. According to the individual-specific biokinetics, the 24 h thyroid uptake fraction of iodine was estimated as 0.52%. The thyroid absorbed dose of the patient was evaluated as 21.2 Gy, which differed greatly (by about 9 Gy) from the dose evaluated simply using the reference data for blocked thyroid uptake. The personalized dose assessment carried out for the patient not only reduced considerable uncertainties in the internal dose calculation, but also improved the reliability of the calculated internal dose by adopting the latest dosimetric data, including specific absorbed fraction values based on voxel phantoms. Through the dose assessment of the patient, the methodology of personalized dose assessment considering individual-specific biokinetics was developed.

Counting Efficiencies Determined by Monte Carlo Methods for In Vivo Measurement of 131I Activity in Thyroid.

The counting efficiencies obtained using a physical neck phantom are typically used in the measurement of I activity in the thyroid. It is well known, however, that the geometrical discrepancies between the physical neck phantom and the anatomy of the subject can significantly influence the counting efficiencies. Thus, it is necessary to consider the anatomical characteristics of individuals if we need to accurately determine the activity of I in the thyroid. This study aims to produce individualized counting efficiencies for thyroid measurement, considering the age, sex, and overlying tissue thickness of the subject being measured by Monte Carlo simulation. Simulations were performed using a series of computational human phantoms of different ages and sexes. The difference in counting efficiencies, depending on the age and sex of the phantom, were found to range from -26 to 3% for the phantoms and monitoring systems considered in the present study. The overlying tissue thickness of the computational phantoms was also modified to find the relationship between the counting ratio of the 80.2 and 364 keV gammas from I and the overlying tissue thickness. The equations for estimating the overlying tissue thickness of a subject were then derived from the relationships between counting ratios and overlying tissue thickness. Finally, in the present study, a set of equations representing the variation in counting efficiencies for the 364 keV peak as a function of the overlying tissue thickness were derived, which can be used to determine individualized counting efficiencies for the subject being measured. These individualized counting efficiencies considering the overlying tissue thickness given a subject's age and sex can provide accurate estimates of I activity for internal dosimetry.

Epithelial cell shape change of Drosophila as a biomonitoring model for the dose assessment of environmental radiation.

Inevitable exposure to ionizing radiation from natural and human-made sources has been increasing over time. After nuclear disasters, such as the Fukushima accident, the public concerns on health risk of radiation exposure because of radioactive contamination of the environment have increased. However, it is very difficult to assess the biological effects of exposure caused by environmental radiation. A reliable and rapid bioassay to monitor the physiological effects of radiation exposure is therefore needed. Here, we quantitatively analyzed the changes in cell shape in Drosophila epidermis after irradiation as a model for biomonitoring of radiation. Interestingly, the number of irregularly shaped epithelial cells was increased by irradiation in a dose-dependent manner. A dose-response curve constructed with the obtained data suggests that the measurement of the number of irregular shaped cell in the epidermis is useful for the assessment of radiation dose. In addition, a comparison of the variation in the different samples and the data scored by different observers showed that our evaluation for cellular morphology was highly reliable and accurate and would, therefore, have immense practical application. Overall, our study suggests that detection of morphological changes in the epithelial cells is one of the efficient ways to quantify the levels of exposure to radioactive radiation from the environment.

Measurement and Simulation of the Counting Efficiency of a Whole-body Counter Using a BOMAB Phantom Inserted with Rod Sources Containing Mixed Radionuclides.

The examination of internal contamination is important for providing an adequate medical response during a radiological emergency. A whole-body counting system can assess gamma-emitting radionuclides in a human body when monitoring internal contamination. It is necessary to calibrate whole-body counting systems by using a calibration phantom, such as a Bottle Manikin Absorption phantom, to properly assess internal contamination. However, the total weight of the Bottle Manikin Absorber phantom is high, and there can be leakage of radioactive sources, which are disadvantages of using such a phantom. This study proposes a calibration phantom that is designed to overcome these disadvantages. The proposed phantom consists of rod sources that are inserted in each part of the phantom. The counting efficiency of the rod-source-inserted calibration phantom was acquired using a Monte Carlo simulation method, but the results were evaluated by comparing the experimental efficiencies with those of a conventional Bottle Manikin Absorption phantom by using two commercial whole-body counting systems (stand-up type and bed type). The efficiency curve of the rod-source-inserted phantom matched well that of the conventional calibration phantom. The relative deviation between the efficiencies of the conventional Bottle Manikin Absorption phantom and the proposed calibration phantom in both whole-body counting systems was less than 11%, and the total weight of the phantom was also reduced. These results suggest that the proposed phantom can be manipulated more easily and replace the conventional Bottle Manikin Absorption calibration phantom for these two types of whole-body counting systems.

ASSESSMENT OF BODY POTASSIUM LEVEL BY GENDER AND AGE IN KOREAN ADULT GROUP.

Most internal radiation dose resulting from natural radionuclides is due to radon and radioactive potassium. Total body potassium (TBK) in human body may vary by ethnic group, gender and age. The objective of this study was to measure TBK and body potassium concentration in Korean subjects. Body potassium concentrations of the subjects were measured with a whole-body counter for 283 adult males and 181 adult females. Average TBK value and body potassium level were 111.2 g and 1.5 g kg-1 for males, while for females they were 71.7 g and 1.4 g kg-1. TBK increased with increasing body weight. Body potassium level per body weight was inversely proportional to age in both genders. The annual effective doses due to 40K in the human body of Korean population were calculated to be 0.15 and 0.13 mSv for males and females, respectively.

Estimation of counting efficiencies of a portable NaI detector using Monte Carlo simulation for thyroid measurement following nuclear accidents.

Radioiodine can be released in nuclear accidents and can cause internal contamination of the thyroid gland in members of the public. For population monitoring in radiation emergencies, measurement of counting efficiency is very important to accurately determine thyroid activity. Here, we estimate the counting efficiencies of a portable NaI detector using Monte Carlo simulations. Two different types of neck phantoms and a 7.62 cm long by 7.62 cm diameter NaI detector were modeled and the counting efficiencies were calculated depending on the thyroid size and distance from the neck phantom to the detector. We found that distance is a more important parameter than thyroid size. The optimal distance of the NaI detector from the neck surface was determined to be greater than 12 cm, beyond which the counting efficiency was not affected by thyroid size.

Is the Linear No-Threshold Dose-Response Paradigm Still Necessary for the Assessment of Health Effects of Low Dose Radiation?

Inevitable human exposure to ionizing radiation from man-made sources has been increased with the proceeding of human civilization and consequently public concerns focus on the possible risk to human health. Moreover, Fukushima nuclear power plant accidents after the 2011 East-Japan earthquake and tsunami has brought the great fear and anxiety for the exposure of radiation at low levels, even much lower levels similar to natural background. Health effects of low dose radiation less than 100 mSv have been debated whether they are beneficial or detrimental because sample sizes were not large enough to allow epidemiological detection of excess effects and there was lack of consistency among the available experimental data. We have reviewed an extensive literature on the low dose radiation effects in both radiation biology and epidemiology, and highlighted some of the controversies therein. This article could provide a reasonable view of utilizing radiation for human life and responding to the public questions about radiation risk. In addition, it suggests the necessity of integrated studies of radiobiology and epidemiology at the national level in order to collect more systematic and profound information about health effects of low dose radiation.

The radiologic technologists' health study in South Korea: study design and baseline results.

PURPOSE: To describe the study design, methods, and baseline results of a prospective cohort of radiologic technologists which we have initiated in South Korea. METHODS: The cohort participants were enrolled through a self-administered questionnaire survey administered from April 2012 to May 2013. Survey data were linked with radiation dosimetry, a cancer registry, and health insurance data by personal identification numbers. A nationwide representative survey was also conducted using a stratified random sampling design with face-to-face interviews. RESULTS: A total of 12,387 radiologic technologists were enrolled, which accounted for approximately 63% of all diagnostic radiologic technologists working in South Korea. For nationwide survey, 585 workers were interviewed using the detailed questionnaire, and buccal cells were also collected by scraping the inside of the cheek. The majority of study subjects were under 50-year-old and male workers. The average annual effective dose of radiation declined both men (from 2.75 to 1.43 mSv) and women (from 1.34 to 0.95 mSv) over the period of 1996-2011. A total of 99 cancers (66 cancers in men and 33 in women) were reported from 1992 to 2010. The standardized incidence ratio of all cancer combined was significantly lower in men (SIR = 0.75, 95% CI 0.58-0.96) than general population, but the ratios for thyroid cancer were significantly higher than expected among both men and women. CONCLUSIONS: This cohort provides comprehensive information on work activities and health status of diagnostic radiologic technologists. In addition, the nationwide representative sample provides unique opportunities compared with previous radiologic technologist studies.