Alpha radiation from polymetallic nodules and potential health risks from deep-sea mining.

In search for critical elements, polymetallic nodules at the deep abyssal seafloor are targeted for mining operations. Nodules efficiently scavenge and retain several naturally occurring uranium-series radioisotopes, which predominantly emit alpha radiation during decay. Here, we present new data on the activity concentrations of thorium-230, radium-226, and protactinium-231, as well as on the release of radon-222 in and from nodules from the NE Pacific Ocean. In line with abundantly published data from historic studies, we demonstrate that the activity concentrations for several alpha emitters are often higher than 5 Bq g-1 at the surface of the nodules. These observed values can exceed current exemption levels by up to a factor of 1000, and even entire nodules commonly exceed these limits. Exemption levels are in place for naturally occurring radioactive materials (NORM) such as ores and slags, to protect the public and to ensure occupational health and radiation safety. In this context, we discuss three ways of radiation exposure from nodules, including the inhalation or ingestion of nodule fines, the inhalation of radon gas in enclosed spaces and the potential concentration of some radioisotopes during nodule processing. Seen in this light, inappropriate handling of polymetallic nodules poses serious health risks.

Description of a transient proximal tubulopathy induced by amino acids perfusion in peptide receptor radionuclide therapy: A case report.

RATIONALE: Peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogs is a targeted internal radiotherapy method used to treat tumors expressing somatostatin receptors. Concomitant amino acids perfusion is systematically performed in order to inhibit the proximal tubular uptake of the radionuclide and thus prevent nephrotoxicity. PATIENT CONCERNS:: a 67-year-old woman with an intestinal neuroendocrine tumor with multiple lymphadenopathies and liver metastases. The patient displayed a carcinoid syndrome with flushes including facial erythrosis and paresthesia. During the treatment, the patient exhibited emesis and severe cramps. DIAGNOSIS: We describe incomplete proximal tubulopathy induced by an amino acid therapy with [177Lu]-DOTA0-Tyr3-octreotate, which was reversible after treatment discontinuation. This diagnosis relies on metabolic acidosis, hypophosphatemia due to renal loss, tubular proteinuria and generalized aminoaciduria. Serum creatinine remained stable during and after the procedure. INTERVENTIONS: PRRT with radiolabeled somatostatin analog ([177Lu]-DOTA0-Tyr3-octreotate). In order to prevent PRRT induced nephrotoxicity, we used a solution of 20 amino acids including 22 g/L Lysine and 16.8 g/L Arginine. Metoclopramide was successfully used to control vomiting. During the treatment and at the time of cramps, the blood sample showed hypophosphatemia at 0.3 mmol/L justifying intravenous phosphate supplementation. The cramps disappeared after this infusion. OUTCOMES: Hypophosphatemia with low TmPO4/GFR was observed as well as an increase in ß2-microglobulinuria, urinary polyclonal light chains, and amino aciduria involving all amino acids. All these disturbances disappeared the day after the treatment and there was no acute kidney injury after 5 PRRT sessions. Six months after PRRT discontinuation, the patient had neither renal failure nor proximal tubulopathy. Aminoacid induced tubulopathy involves the main ligands of the megalin receptor. It has recently been demonstrated that cilastatin is a megalin inhibitor in the proximal tubule and therefore could represent an attractive alternative to amino acids for this purpose. LESSONS: This case report is a description of a nephroprotective strategy in which partial, and transient tubulopathy is induced, in order to decrease proximal absorption of a tubulotoxic molecule. This little known strategy could be used to prevent proximal tubular injury caused by others megalin-mediated nephrotoxicity medication.

Pharmacological treatment of inhalation injury after nuclear or radiological incidents: The Chinese and German approach.

Inhalation injury is often associated with burns and significantly increases morbidity and mortality. The main toxic components of fire smoke are carbon monoxide, hydrogen cyanide, and irritants. In the case of an incident at a nuclear power plant or recycling facility associated with fire, smoke may also contain radioactive material. Medical treatments may vary in different countries, and in this paper, we discuss the similarities and differences in the treatments between China and Germany. Carbon monoxide poisoning is treated by 100% oxygen administration and, if available, hyperbaric oxygenation in China as well as in Germany. In addition, antidotes binding the cyanide ions and relieving the respiratory chain are important. Methemoglobin-forming agents (e.g., nitrites, dimethylaminophenol) or hydroxocobalamin (Vitamin B12) are options. The metabolic elimination of cyanide may be enhanced by sodium thiosulfate. In China, sodium nitrite with sodium thiosulfate is the most common combination. The use of dimethylaminophenol instead of sodium nitrite is typical for Germany, and hydroxocobalamin is considered the antidote of choice if available in cases of cyanide intoxications by fire smoke inhalation as it does not further reduce oxygen transport capacity. Systematic prophylactic use of corticosteroids to prevent toxic pulmonary edema is not recommended in China or Germany. Stable iodine is indicated in the case of radioiodine exposure and must be administered within several hours to be effective. The decorporation of metal radionuclides is possible with Ca (DTPA) or Prussian blue that should be given as soon as possible. These medications are used in both countries, but it seems that Ca (DTPA) is administered at lower dosages in China. Although the details of the treatment of inhalation injury and radionuclide(s) decorporation may vary, the general therapeutic strategy is very similar in China and Germany.

Visual acuity, oncologic, and toxicity outcomes with 103Pd vs. 125I plaque treatment for choroidal melanoma.

PURPOSE: To evaluate outcomes of choroidal melanoma patients treated with 125I or 103Pd plaque brachytherapy. METHODS AND MATERIALS: From 1993 to 2012, our institution treated 160 patients with 103Pd (56.1%) and 125 patients with 125I (43.9%) plaque brachytherapy. Tumor outcomes, visual acuity (VA), and toxicity were compared. Multivariate analyses (MVAs) and propensity score analysis were used to help address differences in baseline characteristics. RESULTS: Median followup was longer for 125I patients, 52.7 vs. 43.5 months (p < 0.01). At baseline, 103Pd patients had lower rates of VA worse than 20/200 (4.4% vs. 16%, p = 0.002), T3-T4 tumors (17.5% vs. 32.8%, p = 0.03), and transpupillary thermotherapy use (3.1% vs. 9.6%, p = 0.001). Both 103Pd and 125I provided >90% 3-year overall survival and >93% 5-year secondary enucleation-free survival. On MVA, radionuclide was not predictive for tumor outcomes. A higher percentage maintained vision better than 20/40 with 103Pd (63% vs. 35%, p = 0.007) at 3 years. MVA demonstrated 103Pd radionuclide (odds ratio [OR]: 2.12, p = 0.028) and tumor height ≤5 mm (OR: 2.78, p = 0.017) were associated with VA better than 20/40. Propensity score analysis matched 23 125I with 107 103Pd patients. 103Pd continued to predict better VA at 3 years (OR: 8.10, p = 0.014). On MVA for the development of VA worse than 20/200 or degree of vision loss, radionuclide was not significant. Lower rates of radiation retinopathy were seen with 103Pd than 125I (3 years: 47.3% vs. 63.9%, p = 0.016), with radionuclide significant in MVA. CONCLUSIONS: Both 125I and 103Pd achieve excellent tumor control. An increased probability of long-term VA better than 20/40 and reduced risk of radiation retinopathy is associated with 103Pd.

Renal Function Assessment During Peptide Receptor Radionuclide Therapy.

Theranostics labeled with Y-90 or Lu-177 are highly efficient therapeutic approaches for the systemic treatment of various cancers including neuroendocrine tumors and prostate cancer. Peptide receptor radionuclide therapy (PRRT) has been used for many years for metastatic or inoperable neuroendocrine tumors. However, renal and hematopoietic toxicities are the major limitations for this therapeutic approach. Kidneys have been considered as the "critical organ" because of the predominant glomerular filtration, tubular reabsorption by the proximal tubules, and interstitial retention of the tracers. Severe nephrotoxity, which has been classified as grade 4-5 based on the "Common Terminology Criteria on Adverse Events," was reported in the range from 0%-14%. There are several risk factors for renal toxicity; patient-related risk factors include older age, preexisting renal disease, hypertension, diabetes mellitus, previous nephrotoxic chemotherapy, metastatic lesions close to renal parenchyma, and single kidney. There are also treatment-related issues, such as choice of radionuclide, cumulative radiation dose to kidneys, renal radiation dose per cycle, activity administered, number of cycles, and time interval between cycles. In the literature, nephrotoxicity caused by PRRT was documented using different criteria and renal function tests, from serum creatinine level to more accurate and sophisticated methods. Generally, serum creatinine level was used as a measure of kidney function. Glomerular filtration rate (GFR) estimation based on serum creatinine was preferred by several authors. Most commonly used formulas for estimation of GFR are "Modifications of Diet in Renal Disease" (MDRD) equation and "Cockcroft-Gault" formulas. However, more precise methods than creatinine or creatinine clearance are recommended to assess renal function, such as GFR measurements using Tc-99m-diethylenetriaminepentaacetic acid (DTPA), Cr-51-ethylenediaminetetraacetic acid (EDTA), or measurement of Tc-99m-MAG3 clearance, particularly in patients with preexisting risk factors for long-term nephrotoxicity. Proximal tubular reabsorption and interstitial retention of tracers result in excessive renal irradiation. Coinfusion of positively charged amino acids, such as l-lysine and l-arginine, is recommended to decrease the renal retention of the tracers by inhibiting the proximal tubular reabsorption. Furthermore, nephrotoxicity may be reduced by dose fractionation. Patient-specific dosimetric studies showed that renal biological effective dose of <0Gy was safe for patients without any risk factors. A renal threshold value <28Gy was recommended for patients with risk factors. Despite kidney protection, renal function impairment can occur after PRRT, especially in patients with risk factors and high single or cumulative renal absorbed dose. Therefore, patient-specific dosimetry may be helpful in minimizing the renal absorbed dose while maximizing the tumor dose. In addition, close and accurate renal function monitoring using more precise methods, rather than plasma creatinine levels, is essential to diagnose the early renal functional changes and to follow-up the renal function during the treatment.

Modelling of Radiological Health Risks from Gold Mine Tailings in Wonderfonteinspruit Catchment Area, South Africa.

Mining is one of the major causes of elevation of naturally-occurring radionuclide material (NORM) concentrations on the Earth's surface. The aim of this study was to evaluate the human risk associated with exposure to NORMs in soils from mine tailings around a gold mine. A broad-energy germanium detector was used to measure activity concentrations of these NORMs in 66 soil samples (56 from five mine tailings and 10 from the control area). The RESidual RADioactivity (RESRAD) OFFSITE modeling program (version 3.1) was then used to estimate the radiation doses and the cancer morbidity risk of uranium-238 ((238)U), thorium-232 ((232)Th), and potassium-40 ((40)K) for a hypothetical resident scenario. According to RESRAD prediction, the maximum total effective dose equivalent (TEDE) during 100 years was found to be 0.0315 mSv/year at year 30, while the maximum total excess cancer morbidity risk for all the pathways was 3.04 × 10(-5) at year 15. The US Environmental Protection Agency considers acceptable for regulatory purposes a cancer risk in the range of 10(-6) to 10(-4). Therefore, results obtained from RESRAD OFFSITE code has shown that the health risk from gold mine tailings is within acceptable levels according to international standards.

Positive Influence of 177Lu PSMA-617 Therapy on Bone Marrow Depression Caused by Metastatic Prostate Cancer.

A 75-year-old man with castrate-resistant prostate cancer and increasing prostate-specific antigen (PSA) level developed severe bone marrow depression during Ra radionuclide therapy. Because of this, he was treated with Lu-PSMA in compassionate use for this not-yet-approved therapy. At the beginning of Lu-PSMA therapy, repeated blood transfusions (BT) were necessary. Six months after the last BT, after 3 cycles of Lu-PSMA, his blood count stabilized. He required no further BTs and his PSA level remained lowered.

Measurement of radioactivity levels and assessment of radioactivity hazards of soil samples in Karaman, Turkey.

In this study, the levels of the natural and artificial radioactivity in soil samples collected from surrounding of Karaman in Turkey were measured. Activity concentrations of the concerned radionuclides were determined by gamma-ray spectrometry using a high-purity germanium detector with a relative efficiency of 40 % at 1.332 MeV. The results obtained for the (238)U series ((226)Ra, (214)Pb and (214)Bi), (232)Th series ((228)Ac), (40)K and fission product (137)Cs are discussed. To evaluate the radiological hazard of radioactivity in samples, the radium equivalent activity (Raeq), the absorbed dose rate (D), the annual effective dose and the external (Hex) and internal hazard index (Hin) were calculated and presented in comparison with the data collected from different areas in the world and Turkey.

Determination of 234U/238U, 235U/238U and 236U/238U isotope ratios in urine using sector field inductively coupled plasma mass spectrometry.

Quantification of the isotopic composition of uranium in urine at low levels of concentration is important for assessing both military and civilian populations' exposures to uranium. However, until now there has been no convenient, precise method established for rapid determination of multiple uranium isotope ratios. Here, the authors report a new method to measure (234)U/(238)U, (235)U/(238)U and (236)U/(238)U. It uses solid-phase chelation extraction (via TRU columns) of actinides from the urine matrix, followed by measurement using a magnetic sector field inductively coupled plasma mass spectrometer (SF-ICP-MS-Thermo Element XR) equipped with a high-efficiency nebulizer (Apex PFA microflow) and coupled with a membrane desolvating nebulizer system (Aridus II™). This method provides rapid and reliable results and has been used successfully to analyse Certified Reference Materials.

Radiation safety considerations for the use of ²²³RaCl2 DE in men with castration-resistant prostate cancer.

The majority of patients with late stage castration-resistant prostate cancer (CRPC) develop bone metastases that often result in significant bone pain. Therapeutic palliation strategies can delay or prevent skeletal complications and may prolong survival. An alpha-particle based therapy, radium-223 dichloride (²²³RaCl2), has been developed that delivers highly localized effects in target areas and likely reduces toxicity to adjacent healthy tissue, particularly bone marrow. Radiation safety aspects were evaluated for a single comprehensive cancer center clinical phase 1, open-label, single ascending-dose study for three cohorts at 50, 100, or 200 kBq kg⁻¹ body weight. Ten patients received administrations, and six patients completed the study with 1 y follow-up. Dose rates from patients administered ²²³Ra dichloride were typically less than 2 µSv h⁻¹ MBq⁻¹ on contact and averaged 0.02 µSv h⁻¹ MBq⁻¹ at 1 m immediately following administration. Removal was primarily by fecal excretion, and whole body effective half-lives were highly dependent upon fecal compartment transfer, ranging from 2.5-11.4 d. Radium-223 is safe and straightforward to administer using conventional nuclear medicine equipment. For this clinical study, few radiation protection limitations were recommended post-therapy based on facility evaluations. Specific precautions are dependent on local regulatory authority guidance. Subsequent studies have demonstrated significantly improved overall survival and very low toxicity, suggesting that ²²³Ra may provide a new standard of care for patients with CRPC and bone metastases.

Assessment of indoor absorbed gamma dose rate from natural radionuclides in concrete by the method of build-up factors.

The specific absorbed gamma dose rates, originating from natural radionuclides in concrete, were calculated at different positions of a detection point inside the standard room, as well as inside an example room. The specific absorbed dose rates corresponding to a wall with arbitrary dimensions and thickness were also evaluated, and appropriate fitting functions were developed, enabling dose rate calculation for most realistic rooms. In order to make calculation simpler, the expressions fitting the exposure build-up factors for whole (238)U and (232)Th radionuclide series and (40)K were derived in this work, as well as the specific absorbed dose rates from a point source in concrete. Calculated values of the specific absorbed dose rates at the centre point of the standard room for (238)U, (232)Th and (40)K are in the ranges of previously obtained data.

Assessing the dose values received by patients during conventional radiography X-ray examinations and the technical condition of the equipment used for this purpose.

BACKGROUND: X-ray examination is associated with patient exposure to ionizing radiation. Dose values depend on the type of medical procedure used, the X-ray unit technical condition and exposure conditions selected. The aim of this study was to determine the dose value received by patients during certain conventional radiography X-ray examinations and to assess the technical condition of medical equipment used for this purpose. MATERIAL AND METHODS: The study covered the total number of 118 conventional diagnostic X-ray units located in the Masovian Voivodeship. The methodology used to assess the conventional diagnostic X-ray unit technical condition and the measurement of the radiation dose rate received by patients are based on test procedures developed by the Department of Radiation Protection and Radiobiology of the National Institute of Public Health - National Institute of Hygiene (Warszawa, Poland) accredited for compliance with PN-EN 17025 standard by the Polish Centre for Accreditation. RESULTS: It was found that 84.7% of X-ray units fully meet the criteria set out in the Polish legislation regarding the safe use of ionizing radiation in medicine, while 15.3% of the units do not meet some of them. The broadest dose value range was recorded for adult patients. Particularly, during lateral (LATl) lumbar spine radiography the recorded entrance surface dose (ESD) values ranged from 283.5 to 7827 µGy (mean: 2183.3 µGy). CONCLUSIONS: It is absolutely necessary to constantly monitor the technical condition of all X-ray units, because it affects population exposure to ionizing radiation. Furthermore, it is essential to raise radiographers' awareness of the effects that ionizing radiation exposure can have on the human body.

Bringing New PET drugs to clinical practice - a regulatory perspective.

The regulatory framework for radioactive drugs, in particular those used in positron emission tomography (PET) scans, has been gradually established since the release of the Food and Drug Administration Modernization Act in 1997. Various guidances specially tailored to accommodate special properties of PET drugs have been issued by the Food and Drug Administration (FDA) in order to ensure this valuable technology (i.e., PET molecular imaging) will continue to be available to patients and yet the safety and efficacy of PET drugs are well regulated so that public health will be protected. This article presents several key elements of this regulatory framework for PET drugs. New regulatory avenues proposed by the FDA to facilitate the research and development process to bring more new PET drugs to clinical practice, as well as to foster the opportunity of using "orphan" PET drugs in clinical practice are also discussed in this paper.

Response of ionization chamber based pocket dosimeter to beta radiation.

Quantitative estimate of the response of ionization chamber based pocket dosimeters (DRDs) to various beta sources was performed. It has been established that the ionization chamber based pocket dosimeters do not respond to beta particles having energy (Emax)<1 MeV and same was verified using (147)Pm, (85)Kr and (204)Tl beta sources. However, for beta particles having energy >1 MeV, the DRDs exhibit measureable response and the values are ~8%, ~14% and ~27% per mSv for natural uranium, (90)Sr/(90)Y and (106)Ru/(106)Rh beta sources respectively. As the energy of the beta particles increases, the response also increases. The response of DRDs to beta particles having energy>1 MeV arises due to the fact that the thickness of the chamber walls is less than the maximum range of beta particles. This may also be one of the reasons for disparity between doses measured with passive/legal dosimeters (TLDs) and DRDs in those situations in which radiation workers are exposed to mixed field of gamma photons and beta particles especially at uranium processing plants, nuclear (power and research) reactors, waste management facilities and fuel reprocessing plants etc. The paper provides the reason (technical) for disparity between the doses recorded by TLDs and DRDs in mixed field of photons and beta particles.

The analysis of plant-based raw materials of unknown origin.

Chosen aspects of the safety of use of several herbs received from National Medicines Institute, which came from smuggling, have been examined. The analysis has been conducted in three different aspects: (1) Possibilities of contamination of plant-based raw materials by metals of heavy elements (As, Cd, Cu, Cr, Pb). (2) Conscious smuggling of intoxicating preparation or narcotics in plant-based raw materials. (3) Radioactive contamination originating mostly from 137Cs isotope. To solve the problem, analytical methods of GFAAS and ICP-MS, X-ray diffraction and high-distributive spectrometry of gamma-radiation have been applied. Determined concentration of arsenic in all analyzed samples and the concentration of lead in one sample exceeded allowable concentration recommended by WHO. In analyzed materials, no presence of narcotics or radioactive contamination of 137Cs isotope has been detected.

Macro and trace mineral constituents and radionuclides in mushrooms: health benefits and risks.

This article reviews and updates data on macro and trace elements and radionuclides in edible wild-grown and cultivated mushrooms. A huge biodiversity of mushrooms and spread of certain species over different continents makes the study on their multi-element constituents highly challenging. A few edible mushrooms are widely cultivated and efforts are on to employ them (largely Agaricus spp., Pleurotus spp., and Lentinula edodes) in the production of selenium-enriched food (mushrooms) or nutraceuticals (by using mycelia) and less on species used by traditional medicine, e.g., Ganoderma lucidum. There are also attempts to enrich mushrooms with other elements than Se and a good example is enrichment with lithium. Since minerals of nutritional value are common constituents of mushrooms collected from natural habitats, the problem is however their co-occurrence with some hazardous elements including Cd, Pb, Hg, Ag, As, and radionuclides. Discussed is also the problem of erroneous data on mineral compounds determined in mushrooms.

[Regularities of lateral distribution of uranium and thorium decay series radionuclides in the anthropogenically changed soils from the area of radium production waste storage].

Cartographical investigations of the territory of radium production waste storage has shown some changes in lateral differentiation of radionuclides of uranium and thorium decay series to occur during 27 years (1981-2008). Those changes are caused mostly by flat denudation typical for fluvial terrace. At present radionuclides of uranium and thorium decay series are concentrated mostly in flood lands and relief depressions. At the same time, decrease in the radionuclide activity concentration in 0-20 cm soil layer is observed with changes in lateral distribution. Total stocks of 226Ra, 210Pb and 210Po within catena soils studied in the northern and southern parts of the waste storage decreased 3-6 times, 238U - 2 times, and did not significantly change in case of 232Th during 27 years. Nonetheless, most of the samples studied are referred to radioactive waste both according to Russian standards (SPORO-2002) and IAEA safety norms (IAEA, 2004).

The influence of multiple types of occupational exposure to radon, gamma rays and long-lived radionuclides on mortality risk in the French "post-55" sub-cohort of uranium miners: 1956-1999.

The adverse health effects of radon on uranium miners, especially on their lungs, are well documented, but few studies have considered the effects of other radiation exposures. This study examined the mortality risks associated with exposure to radon, external γ rays and long-lived radionuclides (LLR) in the French "post-55" sub-cohort, which includes uranium miners first employed between 1956 and 1990 for whom all three types of exposure were assessed individually. Exposure-risk relationships were estimated with linear excess relative risk models and a 5-year lag time. The post-55 sub-cohort includes 3377 miners, contributing 89,405 person-years, followed up through the end of 1999 with a mean follow-up of 26.5 years. Mean cumulative exposure was 17.8 WLM for radon, 54.7 mSv for γ rays, and 1,632 Bq.m(-3).h for LLR. Among the 611 deaths observed, 66 were due to lung cancer. Annual individual exposures were significantly correlated. Increased mortality was observed for lung cancer (SMR = 1.30; 95% CI: 1.01, 1.65) and for brain and central nervous system (CNS) cancer (SMR = 2.00; 95% CI: 1.09, 3.35). Cumulative exposure to radon, γ rays and LLR was associated only with a significant risk of lung cancer. These new results could suggest an association between lung cancer and exposure to γ rays and LLR. They must nonetheless be interpreted with caution because of the correlation between the types of exposure. The calculation of organ doses received by each of these exposures would reduce the collinearity.

Natural radionuclides in fish species from surface water of Bagjata and Banduhurang uranium mining areas, East Singhbhum, Jharkhand, India.

PURPOSE: To study the natural radionuclides in the freshwater fish samples around the uranium mining areas of Bagjata and Banduhurang, East Singhbhum, Jharkhand, India. MATERIALS AND METHODS: The naturally occurring radioisotopes of uranium, U(nat), consisting of (234)U, (235)U and (238)U; (226)Ra, (230)Th and (210)Po were analysed in the fish samples from the surface water of Bagjata and Banduhurang mining areas after acid digestion. The ingestion dose, concentration factor and excess lifetime cancer risk of the radionuclides were estimated. RESULTS: The geometric mean activity of U(nat), (226)Ra, (230)Th and (210)Po in the fish samples was found to be 0.05, 0.19, 0.29 and 0.95 Bq kg(-1)(fresh) (Becquerel per kilogram fresh fish), respectively, in the Bagjata mining area, while for Banduhurang mining area it was estimated to be 0.08, 0.41, 0.22 and 2.48 Bq kg(-1)(fresh), respectively. The ingestion dose was computed to be 1.88 and 4.16 µSvY(-1), respectively, for both the areas which is much below the 1 mSv limit set in the new International Commission on Radiological Protection (ICRP) recommendations. The estimation of the Concentration Factors (CF) reveal that the CF from water is greater than 1 l/kg(-1)in most of the cases while from sediment CF is less than 1. The excess individual lifetime cancer risk due to the consumption of fish was calculated to be 2.53 × 10(-5) and 6.48 × 10(-5), respectively, for Bagjata and Banduhurang areas, which is within the acceptable excess individual lifetime cancer risk value of 1 × 10(-4). CONCLUSION: The study confirms that current levels of radioactivity do not pose a significant radiological risk to freshwater fish consumers.

Tumor-related lipid exudation after plaque radiotherapy of choroidal melanoma: the role of Bruch's membrane rupture.

PURPOSE: To identify the risk factors predictive of development of tumor-related lipid exudation (TRLE) after plaque radiotherapy of posterior uveal melanoma. DESIGN: Case-control study. PARTICIPANTS: Cases included 294 patients with posterior uveal melanoma who had developed TRLE after plaque radiotherapy. Controls included 294 patients with posterior uveal melanoma who had not developed TRLE after plaque radiotherapy. Controls were matched with cases for age, gender, and initial tumor thickness. METHODS: Data were extracted from medical charts containing demographic, clinical, and treatment information. Detailed fundus drawings and color fundus photographs were reviewed for each patient. MAIN OUTCOME MEASURES: Tumor and ocular features of eyes with posterior uveal melanoma treated with plaque radiotherapy. RESULTS: Multivariate analysis identified Bruch's membrane rupture (P<0.001), serous retinal detachment (RD) before radiation (P< or =0.019), closer proximity to the optic disc and foveola (P = 0.004 and 0.013, respectively), greater tumor base (P = 0.035), failure to receive transpupillary thermotherapy (TTT) after radiation (P<0.001), and initial increase of serous RD after radiation (P<0.001) as significant risk factors predictive of development of TRLE after plaque radiotherapy of posterior uveal melanoma. Radiation dose at the tumor base correlated with maximum extent of TRLE (P = 0.003). The mean interval between plaque radiotherapy and onset of TRLE was 14 months (median, 11 months; range, 2-97 months), with 88% of cases developing TRLE within 2 years of radiation. The interval between the onset of TRLE and the first evidence of its regression was a mean of 33 months (median, 38 months; range, 2-194 months). CONCLUSIONS: Our study identified Bruch's membrane rupture as an important factor predisposing to development of TRLE after plaque radiotherapy of posterior uveal melanoma. Other predictive factors included serous RD before radiation, large tumor basal diameter, posterior tumor location, lack of adjunctive TTT, and early increase of serous RD after plaque radiotherapy.