Assessment of natural radioactivity in the RCC building materials used in the valley region of Manipur, India.

An assessment of radioactivity concentration of reinforced cement concrete types of house was conducted in the valley region of Manipur, India. The average radioactivity concentration of 226Ra, 232Th, and 40K of portland cements are 39 (range: 32-52) Bqkg-1, 36 (range: 22-62) Bqkg-1, and 1812 (1254-2424) Bqkg-1; for concrete are 36 (range: 26-45) Bqkg-1, 65 (range: 45-86) Bqkg-1, and 660 (639-681) Bqkg-1; for sand are 45 (30-61) Bqkg-1, 114 (range: 55-212) Bqkg-1, and 1859 (range: 1413-2232) Bqkg-1; and for bricks are 30 (range: 24-37) Bqkg-1, 148 (range:79-184) Bqkg-1, and 1444 (range: 1093-2103) Bqkg-1, respectively. The annual effective dose was observed with an average value of 1.9 (range: 0.9-3.3) mSvy-1. However, gamma index was observed with an average value of 1.1 (range: 0.5-2.0).

Distribution of some natural and artificial radionuclides in soil from the city of Bitola (Macedonia) and its environs.

The aim of the study is a thorough investigation of the radioactivity level in soils of the town of Bitola (Macedonia) and its environs. Topsoil samples collected from 58 locations within a 5 × 5 km grid were analysed. Serving as a screening, gross alpha and beta activity measurements were performed using gas-flow proportional counter. Gamma-spectrometric measurements revealed the presence of three natural (40K, 226Ra, 232Th) and one artificial radionuclide (137Cs) in the samples. The activity concentrations of these radionuclides were consistent with the results of similar studies in neighbouring areas. Spatial distribution maps and factor analyses have revealed that the activity concentrations of the natural radionuclides are strongly influenced by geology and have no significant influence from human activities. A correlation of 137Cs activity concentrations with terrain elevation was also observed. The aim of the study is a thorough investigation of the radioactivity level in soils of the town of Bitola (Macedonia) and its environs. Topsoil samples collected from 58 locations within a 5 × 5 km grid were analysed. Serving as a screening, gross alpha and beta activity measurements were performed using gas-flow proportional counter. Gamma-spectrometric measurements revealed the presence of three natural (40K, 226Ra, 232Th) and one artificial radionuclide (137Cs) in the samples. The activity concentrations of these radionuclides were consistent with the results of similar studies in neighbouring areas. Spatial distribution maps and factor analyses have revealed that the activity concentrations of the natural radionuclides are strongly influenced by geology and have no significant influence from human activities. A correlation of 137Cs activity concentrations with terrain elevation was also observed.

Survival outcomes of radium-223 therapy for metastatic castration-resistant prostate cancer following national health insurance reimbursement in Taiwan.

BACKGROUND: Radium-223 dichloride (Ra-223) prolongs overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC) with symptomatic bone metastases. However, there is considerable variation in outcomes among individuals. We aimed to evaluate the prognostic determinants associated with patient survival following National Health Insurance (NHI) reimbursement for Ra-223 therapy in Taiwan. METHODS: Patients with mCRPC who underwent Ra-223 treatment at Taipei Veterans General Hospital were retrospectively enrolled. Each intravenous Ra-223 dose was administered at 55 kBq/kg at 4-week intervals. Clinical outcomes were obtained from medical records; potential prognostic factors for survival were assessed. Kaplan-Meier analysis was used to generate cumulative survival curves; between-group differences were evaluated using the Chi-squared test. Statistical significance was set at p < 0.05. RESULTS: Seventy-six patients underwent Ra-223 therapy; 62 patients received NHI reimbursement and the remainder self-paid. Fifty patients (65.8%) completed six cycles of treatment; 26 (34.2%) received 1 to 5 cycles. Mortality occurred in 47 patients. Factors significantly associated with survival included ≤five bone metastases ( p = 0.0018), baseline prostate-specific antigen (PSA) ≤36 ng/mL ( p = 0.0004), baseline alkaline phosphate (ALP) <115 U/L ( p = 0.0007), and baseline hemoglobin (Hb) >12 g/dL ( p = 0.0029). Patients who completed six cycles of treatment achieved significantly higher OS compared to those who did not ( p < 0.0001). There has been a 4.4-fold increase in the number of patients since reimbursement began; there was no significant difference in OS between patients who received NHI reimbursement and those who self-paid. CONCLUSION: Administration of Ra-223 demonstrates considerable potential to extend the survival of patients with mCRPC. Survival outcomes may be influenced by various prognostic factors. However, no significant difference in OS was observed subsequent to reimbursement of Ra-223 therapy for mCRPC through the NHI system in Taiwan.

The first investigation on the radiotoxicity risks associated with ingesting radium in drinking water from the Oujda Region-Morocco and some bottled mineral waters.

Drinking water is essential to human life. However, it can be polluted by various factors, including radioactive substances such as radon 222Rn and radium 226Ra. Therefore, the determination of their concentrations is important for public health. The aim of this work is to measure the concentration of 226Ra in samples of tap, natural spring and well water taken from different sources in the eastern region of Morocco, as well as in a few samples of bottled mineral water. We used an AlphaGUARD detector with an AlphaKit accessory and an RTM1688-2 to carry out measurements of radon in secular equilibrium with radium. The got results show that the 226Ra activity is less than 0.104 ± 0.023 Bq/L, the Annual Effective Dose (AED)) for adults and children is less than 29.1 ± 4.7 µSv.y-1and 123.8 ± 4.7 µSv.y-1 for infants. The chemical toxicity risk evaluated using the Lifetime Average Daily Dose (LADD) was found less than 0.23 ± 0.05 µgkg-1day-1. The obtained results are reasonable in relation to international guidelines, and do not present any radiological hazard to consumers that could be attributed to the radium and radon in the analyzed water samples.

Research methods for seawater intrusion in China and recommendations for novel radium-radon technologies.

Seawater intrusion has been a globally significant environmental issue. This paper comprehensively reviews and highlights the research methods of seawater intrusion in China, recommending the potential application of novel radioactive radium-radon isotopes. Geochemical and geophysical techniques have been extensively utilized in studying seawater intrusion in China, including methods such as hydrochemical analysis, groundwater level observations, geophysical survey techniques, and isotope tracing. The former three methodologies boast a lengthier historical application in seawater intrusion field, while the radium-radon tools in isotope tracing, as newcomers, can specifically indicate crucial scientific questions such as seawater intrusion rates, salt groundwater age, water-rock reactions, and preferential flow dynamics. However, it is imperative to acknowledge the limitations inherent in the utilization of radium-radon tools within the realm of seawater intrusion research, as with any other methodologies. Strategic integration of radium-radon tools with other methodologies will propel advancements in the investigation of seawater intrusion in China. While the primary focus is on research methods in China, insights gained from novel radium-radon tools could have broader value for seawater intrusion research and coastal management globally.

The Radium triplet 226Ra, 228Ra, 224Ra in saline deep water - a valuable information source.

The occurrence of enhanced concentration of the radium triplet 226Ra, 228Ra and 224Ra is a frequently observed property of highly saline anoxic deep water as used e.g. in geothermal plants. In the present study we develop a model to explain the observed activity levels in the brines. The model considers processes at the rock-fluid interface of the aquifer like alpha recoil, sorption and surface precipitation and is implemented by means of a Monte Carlo simulation. The outcomes of the simulations indicate the dominating role of fine-grained constituents of the reservoir rock, e.g. claystone with enhanced specific activities of the natural decay chains. Mass fractions of such material in the order of a few percent are sufficient to result in radium fluid concentrations >1 Bq l-1. Also a generally valid relation between the Th/U ratio in the aquifer rock and the 228Ra/226Ra activity ratio in the fluid was found. This link improves the agreement between radium fluid data and the mean Th/U ratio of the Earth's crust. The 224Ra/228Ra fluid ratios reflect the transport time from the location of last radium release to the sampling point. The model findings were applied to a well investigated aquifer used in a geothermal plant in the North German Basin. An eight component system of the aquifer rock was established as the basis for the simulation of the radium concentrations in the deep fluid. The comparison between simulation and fluid analyses revealed a degree of radium sorption of about 50 %, which is necessary to match the model's results with the measurements. On the other hand, the 228Ra/226Ra fluid ratio of the brine was well reproduced by the simulation, showing the suitability of the model even in complex heterogeneous reservoirs. From the 224Ra/228Ra fluid ratios a transition from pore-to fracture-guided transport < 10 m distance from the production well is suggested. Precipitates from such deep fluids occurring after changes of the thermodynamic conditions are able to accumulate radium isotopes in Ba/Sr-sulphate phases. The time dependence of the radioactive disequilibrium between 226Ra, 228Ra and its child 228Th in such scales is described by a mathematical model and is applied to two different uptake models. Based on this approach, age determinations on precipitates found in different components of a geothermal plant are conducted. They reveal the triggering of scale formation due to modifications in the plant. The results are suitable for drawing conclusions about the operation of the system, which result in a reduction in the amount of scale and a reduction in downtimes.

Leaching behaviour of 226Ra from uranium tailings and adsorption behaviour in geotechnical medias.

The leaching process of uranium tailings is a typical water-rock interaction. The release of 226Ra from uranium tailings depends on the nuclides outside the intrinsic properties of uranium tailings on the one hand, and is influenced by the water medium on the other. In this paper, a uranium tailings repository in southern China was used as a research object, and uranium tailings at different depths were collected by drilling samples and mixed to analyze the 226Ra occurrence states. Static dissolution leaching experiments of 226Ra under different pH conditions, solid-liquid ratio conditions, and ionic strength conditions were carried out, and the adsorption and desorption behaviours of 226Ra in five representative stratigraphic media were investigated. The results show that 226Ra has a strong adsorption capacity in representative strata, with adsorption distribution coefficient Kd values ranging from 1.07E+02 to 1.29E+03 (mL/g) and desorption distribution coefficients ranging from 4.97E+02 to 2.71E+03 (mL/g), but the adsorption is reversible. The 226Ra in uranium tailings exists mainly in the residual and water-soluble states, and the release of 226Ra from uranium tailings under different conditions is mainly from the water-soluble and exchangeable state fractions. Low pH conditions, low solid-liquid ratio conditions and high ionic strength conditions are favourable to the release of 226Ra from uranium tailings, so the release of 226Ra from uranium tailings can be reduced by means of adjusting the pH in the tailings and setting up a water barrier. The results of this research have important guiding significance for the management of existing uranium tailings ponds and the control of 226Ra migration in groundwater, which is conducive to guaranteeing the long-term safety, stability and sustainability of uranium mining sites.

Navigating through the coordination preferences of heavy alkaline earth metals: Laying the foundations for 223Ra- and 131/135mBa-based targeted alpha therapy and theranostics of cancer.

The clinical success of [223Ra]RaCl2 (Xofigo®) for the palliative treatment of bone metastases in patients with prostate cancer has highlighted the therapeutic potential of α-particle emission. Expanding the applicability of radium-223 in Targeted Alpha Therapy of non-osseous tumors is followed up with significant interest, as it holds the potential to unveil novel treatment options in the comprehensive management of cancer. Moreover, the use of barium radionuclides, like barium-131 and -135m, is still unfamiliar in nuclear medicine applications, although they can be considered as radium-223 surrogates for imaging purposes. Enabling these applications requires the establishment of chelators able to form stable complexes with radium and barium radionuclides. Until now, only a limited number of ligands have been suggested and these molecules have been primarily inspired by existing structures known for their ability to complex large metal cations. However, a systematic inspection of chelators specifically tailored to Ra2+ and Ba2+ has yet to be conducted. This work delves into a comprehensive investigation of a series of small organic ligands, aiming to unveil the coordination preferences of both radium-223 and barium-131/135m. Electronic binding energies of both metal cations to each ligand were theoretically computed via Density Functional Theory calculations (COSMO-ZORA-PBE-D3/TZ2P), while thermodynamic stability constants were experimentally determined for Ba2+-ligand complexes by potentiometry, NMR and UV-Vis spectroscopies. The outcomes revealed malonate, 2-hydroxypyridine 1-oxide and picolinate as the most favorable building blocks to design multidentate chelators. These findings serve as foundation guidelines, propelling the development of cutting-edge radium-223- and barium-131/135m-based radiopharmaceuticals for Targeted Alpha Therapy and theranostics of cancer.

Radioactivity and elemental oxidation composition in soil from Yangjiang, a high background natural radiation area, China.

Soil is an important source and medium of radionuclides, and the content of radioactivity in soil is crucial for radiological impact evaluation. In this study, twenty soil samples in the high background natural radiation area of Yangjiang, China were collected and analyzed for 226Ra, 232Th, 40K and 137Cs concentrations in order to evaluate the radiological health risk in the area. Results showed that the average activity concentrations of 226Ra, 232Th and 40K are 66 Bq/kg, 109 Bq/kg and 211 Bq/kg, respectively. The calculated radiological parameters of radium equivalent activity (Raeq), absorbed dose rate (D), annual effective dose equivalent (AEDE), internal and external hazard indices (Hin and Hex) show a large variation at different sampling sites. Additionally, the elemental oxidation composition and 40K/K mass ratio in the soil were analyzed to further augment the background information of the high background radiation area in Yangjiang.

Efficacy of Combination Therapy With Radium-223 and Enzalutamide in Castration-resistant Prostate Cancer With Bone Metastases.

BACKGROUND/AIM: Radium-223 therapy has been reported to improve prognosis in patients with castration-resistant prostate cancer (CRPC) and bone metastases. Occasionally, radium-223 and androgen receptor signaling inhibitors (ARSIs) are used in combination for disease control, but the efficacy of this combination is unclear. This study assessed the efficacy of the addition of enzalutamide in patients treated with radium-223. PATIENTS AND METHODS: We included patients with CRPC and bone metastases who were treated with radium-223 at our institution. Patients were assigned to the enzalutamide combination group or non-combination group. We compared progression-free survival (PFS), overall survival (OS), and the completion rate of radium-223 between the two groups. RESULTS: In total, 39 patients with CRPC were included in this retrospective study. The median follow-up duration was 8.8 months. The enzalutamide combination and non-combination groups included 22 (56.4%) and 17 patients (43.6%), respectively. Median PFS was 11.3 months [95% confidence interval (CI)=3.9-19.9] in the combination group, versus 3.0 months (95%CI=1.9-5.5) in the non-combination group (p=0.004). Median OS did not significantly differ between the groups. The radium-223 completion rate was higher in the combination group than in the non-combination group (72.7% vs. 35.3%, p=0.026). CONCLUSION: The combined use of enzalutamide with radium-223 therapy improved PFS and treatment completion rates in patients with CRPC and bone metastases. This combination may be associated with a more favorable prognosis.

Increase of prostate-specific antigen doubling time predicts survival in metastatic castration-resistant prostate cancer patients undergoing radium therapy.

OBJECTIVE: Radium-223 (Ra-223) is an important treatment modality for bone-dominant metastatic castration-resistant prostate cancer (mCRPC). However, there is currently a lack of effective markers to monitor treatment response during treatment. We aim to investigate the response in prostate-specific antigen doubling time (PSADT) as a potential marker for assessing Ra-223 treatment in mCRPC patients. METHODS: We retrospectively collected data from mCRPC patients who underwent radium treatment at our institution between August 2020 and June 2023. Prostate-specific antigen (PSA) measurements prior to treatment and during treatment were collected. Baseline PSADT was calculated from PSA measurements prior to Ra-223 treatment; interim PSADT was calculated from PSA measurements before Ra-223 treatment and prior to the fourth course injection. Overall survival was calculated from the start of treatment to the date of death. Univariable and multivariable analysis using the Cox proportional hazards model were performed to examine the association of factors with overall survival. RESULTS: We included 35 patients from our institution, with a median overall survival of 13.3 months. Eighteen (51.4%) completed all six courses of treatment. PSA dynamic response (interim PSADT > baseline PSADT or decreased PSA) was observed in 20 patients. Overall survival was associated with a PSA dynamic response (HR = 0.318, 95% CI 0.133-0.762, p = 0.010) when compared to patients without response. CONCLUSIONS: Dynamic changes in PSADT were associated with survival in mCRPC patients receiving radium therapy. Comparing interim and baseline PSADT could serve as a valuable marker for determining treatment benefits.

ISIT-QA: In Silico Imaging Trial to Evaluate a Low-Count Quantitative SPECT Method Across Multiple Scanner-Collimator Configurations for 223Ra-Based Radiopharmaceutical Therapies.

Personalized dose-based treatment planning requires accurate and reproducible noninvasive measurements to ensure safety and effectiveness. Dose estimation using SPECT is possible but challenging for alpha (α)-particle-emitting radiopharmaceutical therapy (α-RPT) because of complex γ-emission spectra, extremely low counts, and various image-degrading artifacts across a plethora of scanner-collimator configurations. Through the incorporation of physics-based considerations and skipping of the potentially lossy voxel-based reconstruction step, a recently developed projection-domain low-count quantitative SPECT (LC-QSPECT) method has the potential to provide reproducible, accurate, and precise activity concentration and dose measures across multiple scanners, as is typically the case in multicenter settings. To assess this potential, we conducted an in silico imaging trial to evaluate the LC-QSPECT method for a 223Ra-based α-RPT, with the trial recapitulating patient and imaging system variabilities. Methods: A virtual imaging trial titled In Silico Imaging Trial for Quantitation Accuracy (ISIT-QA) was designed with the objectives of evaluating the performance of the LC-QSPECT method across multiple scanner-collimator configurations and comparing performance with a conventional reconstruction-based quantification method. In this trial, we simulated 280 realistic virtual patients with bone-metastatic castration-resistant prostate cancer treated with 223Ra-based α-RPT. The trial was conducted with 9 simulated SPECT scanner-collimator configurations. The primary objective of this trial was to evaluate the reproducibility of dose estimates across multiple scanner-collimator configurations using LC-QSPECT by calculating the intraclass correlation coefficient. Additionally, we compared the reproducibility and evaluated the accuracy of both considered quantification methods across multiple scanner-collimator configurations. Finally, the repeatability of the methods was evaluated in a test-retest study. Results: In this trial, data from 268 223RaCl2 treated virtual prostate cancer patients, with a total of 2,903 lesions, were used to evaluate LC-QSPECT. LC-QSPECT provided dose estimates with good reproducibility across the 9 scanner-collimator configurations (intraclass correlation coefficient > 0.75) and high accuracy (ensemble average values of recovery coefficients ranged from 1.00 to 1.02). Compared with conventional reconstruction-based quantification, LC-QSPECT yielded significantly improved reproducibility across scanner-collimator configurations, accuracy, and test-retest repeatability ([Formula: see text] Conclusion: LC-QSPECT provides reproducible, accurate, and repeatable dose estimations in 223Ra-based α-RPT as evaluated in ISIT-QA. These findings provide a strong impetus for multicenter clinical evaluations of LC-QSPECT in dose quantification for α-RPTs.

A pioneering study of the radiological mapping in the world's largest mangrove forest (the Sundarbans) and implications for the public and environment.

Coastal Mangroves are facing growing threats due to the harmful consequences of human activities. This first-ever detailed study of natural radioactivity in soil samples collected from seven tourist destinations within the Sundarbans, the world's largest mangrove forest, was conducted using HPGe gamma-ray spectrometry. Although the activity levels of 226Ra (11 ± 1-44 ± 4 Bq/kg) and 232Th (13 ± 1-68 ± 6 Bq/kg) generally align with global averages, the concentration of 40K (250 ± 20-630 ± 55 Bq/kg) was observed to surpass the worldwide average primarily due to factors like salinity intrusion, fertilizer application, agricultural runoff, which suggests the potential existence of potassium-rich mineral resources near the study sites. The assessment of the hazard parameters indicates that the majority of these parameters are within the recommended limits. The soil samples do not pose a significant radiological risk to the nearby population. The results of this study can establish important radiological baseline data before the Rooppur Nuclear Power Plant begins operating in Bangladesh.

Alpha and Beta Radiation for Theragnostics.

Targeted radionuclide therapy (TRT) has significantly evolved from its beginnings with iodine-131 to employing carrier molecules with beta emitting isotopes like lutetium-177. With the success of Lu-177-DOTATATE for neuroendocrine tumors and Lu-177-PSMA-617 for prostate cancer, several other beta emitting radioisotopes, such as Cu-67 and Tb-161, are being explored for TRT. The field has also expanded into targeted alpha therapy (TAT) with agents like radium-223 for bone metastases in prostate cancer, and several other alpha emitter radioisotopes with carrier molecules, such as Ac-225, and Pb-212 under clinical trials. Despite these advancements, the scope of TRT in treating diverse solid tumors and integration with other therapies like immunotherapy remains under investigation. The success of antibody-drug conjugates further complements treatments with TRT, though challenges in treatment optimization continue.

Radioactivity from oil and gas produced water accumulated in freshwater mussels.

Legacy disposal of oil and gas produced water (OGPW) to surface water has led to radium contamination in streambed sediment creating a long-term radium source. Increased radium activities pose a potential health hazard to benthic organisms, such as freshwater mussels, as radium is capable of bioaccumulation. This project quantifies the impact of OGPW disposal on adult freshwater mussels, Eurynia dilatata, which were examined along the Allegheny River adjacent to a centralized waste treatment facility (CWT) that historically treated and then discharged OGPW. Radium isotopes (226Ra and 228Ra) were measured in streambed sediment, mussel soft tissue, and mussel hard shell collected upstream, at the outfall, 0.5 km downstream, and 5 km downstream of the CWT. Total radium activity was significantly higher (p < 0.05) in mussel tissue (mean = 3.44 ± 0.95 pCi/g), sediment (mean = 1.45 ± 0.19 pCi/g), and hard shell (mean = 0.34 ± 0.11 pCi/g) samples 0.5 km downstream than background samples collected upstream (mean = 1.27 ± 0.24; 0.91 ± 0.09; 0.10 ± 0.02 pCi/g respectively). Mussel shells displayed increased 226Ra activities up to 5 km downstream of the original discharge. Downstream soft tissue and hard shell 87Sr/86Sr ratios, as well as hard shell metal/calcium (e.g., Na/Ca; K/Ca; Mg/Ca) and 228Ra/226Ra ratios demonstrated trends towards values characteristic of Marcellus OGPW. Combined, this study demonstrates multiple lines of evidence for radium retention and bioaccumulation in freshwater mussels resulting from exposure to Marcellus OGPW.

A comprehensive value-based method for new nuclear medical service pricing: with case study of radium [223Ra] bone metastases treatment.

IMPORTANCE: Innovative nuclear medicine services offer substantial clinical value to patients. However, these advancements often come with high costs. Traditional payment strategies do not incentivize medical institutes to provide new services nor determine the fair price for payers. A shift towards a value-based pricing strategy is imperative to address these challenges. Such a strategy would reconcile the cost of innovation with incentives, foster transparent allocation of healthcare resources, and expedite the accessibility of essential medical services. OBJECTIVE: This study aims to develop and present a comprehensive, value-based pricing model for new nuclear medicine services, illustrated explicitly through a case study of the radium [223Ra] treatment for bone metastases. In constructing the pricing model, we have considered three primary value determinants: the cost of the new service, associated service risk, and the difficulty of the service provision. Our research can help healthcare leaders design an evidence-based Fee-For-Service (FFS) payment reference pricing with nuclear medicine services and price adjustments. DESIGN, SETTING AND PARTICIPANTS: This multi-center study was conducted from March 2021 to February 2022 (including consultation meetings) and employed both qualitative and quantitative methodologies. We organized focus group consultations with physicians from nuclear medicine departments in Beijing, Chongqing, Guangzhou, and Shanghai to standardize the treatment process for radium [223Ra] bone metastases. We used a specially designed 'Radium Nuclide [223Ra] Bone Metastasis Data Collection Form' to gather nationwide resource consumption data to extract information from local databases. Four interviews with groups of experts were conducted to determine the add-up ratio, based on service risk and difficulty. The study organized consultation meeting with key stakeholders, including policymakers, service providers, clinical researchers, and health economists, to finalize the pricing equation and the pricing result of radium [223Ra] bone metastases service. MAIN OUTCOMES AND MEASURES: We developed and detailed a pricing equation tailored for innovative services in the nuclear medicine department, illustrating its application through a step-by-step guide. A standardized service process was established to ensure consistency and accuracy. Adhering to best practice guidelines for health cost data analysis, we emphasized the importance of cross-validation of data, where validated data demonstrated less variation. However, it required a more advanced health information system to manage and analyze the data inputs effectively. RESULTS: The standardized service of radium [223Ra] bone metastases includes: pre-injection assessment, treatment plan, administration, post-administration monitoring, waste disposal and monitoring. The average duration for each stage is 104 min, 39 min, 25 min, 72 min and 56 min. A standardized monetary value for medical consumables is 54.94 yuan ($7.6), and the standardised monetary value (medical consumables cost plus human input) is 763.68 yuan ($109.9). Applying an agreed value add-up ratio of 1.065, the standardized value is 810.19 yuan ($116.9). Feedback from a consultation meeting with policymakers and health economics researchers indicates a consensus that the pricing equation developed was reasonable and well-grounded. CONCLUSION: This research is the first study in the field of nuclear medicine department pricing methodology. We introduce a comprehensive value-based nuclear medical service pricing method and use radium[223Ra] bone metastases treatment pricing in China as a case study. This study establishes a novel pricing framework and provides practical instructions on its implementation in a real-world healthcare setting.

Microbially formed Mn(IV) oxide as a novel adsorbent for removal of Radium.

Radioactivity of Ra isotopes in natural waters is of serious concern. Control of 226Ra concentrations in tailings ponds, which store waste from U ore extraction processes, is an important issue in mill tailings management. In this study, we tested microbially formed Mn(IV) oxide as an adsorbent for removal of Ra in water treatment. Biogenic Mn(IV) oxide (BMO) was prepared using a Mn(II)-oxidizing fungus, Coprinopsis urticicola strain Mn-2. First, adsorption experiments of Sr and Ba, as surrogates for Ra, onto BMO were conducted in aqueous NaCl solution at pH 7. Distribution coefficients for Ba and Sr were estimated to be ∼106.5 and ∼104.3 mL/g, respectively. EXAFS analysis indicated that both Sr and Ba adsorbed in inner-sphere complexes on BMO, suggesting that Ra would adsorb in a similar way. From these findings, we expected that BMO would work effectively in removal of Ra from water. Then, BMO was applied to remove Ra from mine water collected from a U mill tailings pond. Just 7.6 mg of BMO removed >98% of the 226Ra from 3 L of mine water, corresponding to a distribution coefficient of 107.4 mL/g for Ra at pH ∼7. The obtained value was convincingly high for practical application of BMO in water treatment. At the same time, the high distribution coefficient indicates that Mn(IV) oxide can be an important carrier and host phase of Ra in the environment.

Evaluation of two-dimensional total bone uptake (2D-TBU) and bone scan index (BSI) extracted from active bone metastatic burden on the bone scintigraphy in patients with radium-223 treatment.

OBJECTIVE: Radium-223 is a first alpha-emitting radionuclide treatment for metastatic castration-resistant prostate cancer (mCRPC) patients with bone metastases. Although the spread-based bone scan index (BSI) and novel index of the intensity-based two-dimensional total bone uptake (2D-TBU) from bone scintigraphy may provide useful input in radium-223 treatment, they have not been evaluated in detail yet. This study aimed to fill this gap by evaluating BSI and 2D-TBU in patients treated with radium-223. METHODS: Twenty-seven Japanese patients with mCRPC treated with radium-223 were retrospectively analyzed. The patients were evaluated via blood tests and bone scans at baseline and 3 cycles intervals of treatment. BSI and 2D-TBU were analyzed via VSBONE BSI in terms of correlations, response to radium-223 treatment, association with treatment completion, and the Kaplan-Meier survival analysis was performed. RESULTS: Nineteen patients (70.4%) completed six cycles of radium-223 treatment, whereas eight patients (29.6%) did not complete the treatment regimen. A significant difference in baseline BSI and 2D-TBU was observed between these groups of patients. Both BSI and 2D-TBU were highly correlated (r = 0.96, p < 0.001). Univariate analysis showed an association between radium-223 completion in median BSI and 2D-TBU values (p = 0.015) and completion percentage differences (91.7% vs. 45.5%; p = 0.027). The Kaplan-Meier product limit estimator showed that the median overall survival was 25.2 months (95% CI 14.0-33.6 months) in the completion group and 7.5 months (95% CI 3.3-14.2 months) in the without completion group (p < 0.001). The overall survival based on median cutoff levels showed a significant difference in 2D-TBU (p = 0.007), but not in BSI (p = 0.15). CONCLUSIONS: The 2D-TBU may offer advantages over BSI in classifying patients towards radium-223 treatment based on the degree of progression of bone metastases. This study supports the importance of preliminary assessment of bone metastasis status using BSI and 2D-TBU extracted from VSBONE BSI for radium-223 treatment decisions.

Randomized Phase II Study Evaluating the Addition of Pembrolizumab to Radium-223 in Metastatic Castration-resistant Prostate Cancer.

The checkpoint immunotherapeutic pembrolizumab induces responses in a small minority of patients with metastatic castration-resistant prostate cancer (mCRPC). Radium-223 (R223) may increase immunogenicity of bone metastases and increase pembrolizumab (P) activity. In a randomized phase II study, we assessed the effect of R223+P compared with R223 on tumor immune infiltration, safety, and clinical outcomes in patients with mCRPC. The primary endpoint was differences in CD4+ and CD8+ T-cell infiltrate in 8-week versus baseline bone metastasis biopsies; secondary endpoints were safety, radiographic progression-free survival (rPFS), and overall survival (OS). Of the 42 treated patients (29 R223+P, 13 R223), 18 R223+P and 8 R223 patients had evaluable paired tumor biopsies. Median fold-change of CD4+ T cells was -0.7 (range: -9.3 to 4.7) with R223+P and 0.1 (-11.1 to 3.7) with R223 (P = 0.66); for CD8+ T cells, median fold-change was -0.6 (-7.4 to 5.3) with R223+P and -1.3 (-3.1 to 4.8) with R223 (P = 0.66). Median rPFS and OS was 6.1 (95% confidence interval: 2.7-11.0) and 16.9 months [12.7-not reached (NR)], respectively, with R223+P and 5.7 (2.6-NR) and 16.0 (9.0-NR), respectively, with R223. Although R223+P was well tolerated with no unexpected toxicity, the combination did not improve efficacy. High-dimensional flow cytometry demonstrated minimal immune modulation with R223, whereas R223+P induced CTLA-4 expression on circulating CD4+ T cells. Clinical responders possessed lower circulating frequencies of Ki67+ T and myeloid cells at baseline and higher circulating frequencies of TIM-3+ T and myeloid cells by week 9. Although R223+P did not induce T-cell infiltration into the tumor microenvironment, exhaustion of induced peripheral T-cell immune responses may dampen the combination's clinical activity.

A numerical model for the prediction of radon flux from uranium mill tailings at Jaduguda, India.

Solid process fine waste or tailings of a uranium mill is a potential source of release of radiologically significant gaseous radon (222Rn). A number of variables such as radium (226Ra) content, porosity, moisture content, and tailings density can affect the extent of emanation from the tailings. Further, if a cover material is used for remediation purposes, additional challenges due to changes in the matrix characteristics in predicting the radon flux can be anticipated. The uranium mill tailings impoundment systems at Jaduguda have been in use for the long-term storage of fine process waste (tailings). A pilot-scale remediation exercise of one of the tailings ponds has been undertaken with 30 cm soil as a cover material. For the prediction of the radon flux, a numerical model has been developed to account for the radon exhalation process at the remediated site. The model can effectively be used to accommodate both the continuous and discrete variable inputs. Depth profiling and physicochemical characterization for the remediated site have been done for the required input variables of the proposed numerical model. The predicted flux worked out is well below the reference level of 0.74 Bq m-2 s-1 IAEA (2004).