Assessment of fetal radiation exposure in pregnant women undergoing computed tomography and rotational angiography examinations for pelvic trauma.

This study aimed to assess fetal radiation exposure in pregnant women undergoing computed tomography (CT) and rotational angiography (RA) examinations for the diagnosis of pelvic trauma. In addition, this study aimed to compare the dose distributions between the two examinations. Surface and average fetal doses were estimated during CT and RA examinations using a pregnant phantom model and real-time dosemeters. The pregnant model phantom was constructed using an anthropomorphic phantom, and a custom-made abdominal phantom was used to simulate pregnancy. The total average fetal dose received by pregnant women from both CT scans (plain, arterial and equilibrium phases) and a single RA examination was ~60 mGy. Because unnecessary repetition of radiographic examinations, such as CT or conventional 2D angiography can increase the radiation risk, the irradiation range should be limited, if necessary, to reduce overall radiation exposure.

[Efficacy of L-shaped Shielding in Interventional Radiology by Transradial Approach and Consideration of Methods for Appropriate Use].

The present study investigated how effective an L-shaped shield was, depending on its position, in reducing a doctor's exposure to radiation during catheterization to access the transradial approach (TRA). The shield's effectiveness was evaluated by measuring the air kerma where the doctor stood under four conditions: with and without the shield, and with and without the shield in conjunction with conventional protection. To enable the shield to be positioned correctly in clinical practice, an illustrated instruction decal affixable to the shield's doctor-facing surface was produced, and the effectiveness of the decal was verified by means of a crossover test in which, as subjects of the study, different nurses set up the shield with and without the decal affixed to it. In the test, in which a human body phantom was used, the C-arm set at the PA angle, and the shield positioned 10 cm from the axilla of the phantom, the shield's effectiveness at 100 cm, 130 cm, and 160 cm above the floor where the doctor stood was 55%, 77%, and 47%, respectively. The effectiveness increased when the shield was positioned closer to the axilla. A significant difference in the positioning of the shield by the subjects was observed depending on whether or not the decal was affixed ( p<0.05, Wilcoxon signed-rank test), indicating that the use of the decal improved the positioning. It was concluded that, positioned correctly, the shield could effectively reduce the doctor's exposure to radiation during TRA.

Evaluation of radiation dose for inferior vena cava filter placement during pregnancy: A comparison of dosimetry and dose calculation software.

Numerous medical conditions are associated with pregnancy in women, including pulmonary thromboembolism, which can be fatal. An effective treatment of this condition is the positioning of an inferior vena cava filter (IVC-F) under the guidance of X-ray imaging. However, this procedure involves the risk of high radiation exposure to pregnant women and fetuses. Moreover, there are no published reports comparing the values of fetal dose, received during IVC-F placement in pregnant women, determined using dose calculation software and actual measurements. To address this issue, we compared the fetal radiation dose and entrance surface dose (ESD) for pregnant women for gestation periods of 6 and 9 months based on software calculations and actual measurements. The ESD and fetal doses were estimated for a pregnant woman for gestation periods of 6 and 9 months during IVC-F placement. For actual measurements, one pregnant model phantom was constructed using an anthropomorphic phantom, and two custom-made different-sized abdomen phantoms were used to simulate pregnancy. The custom-made abdomen phantoms were constructed using polyurethane. For software calculations, the software utilized a set of anatomically realistic pregnant patient phantoms. The ESD estimated using the software was consistent with the measured ESD, but the fetal dose estimations were more complicated due to fetal positioning. During fetal dose evaluation using software calculations, the user must carefully consider how much of the fetal length is in the irradiation field to prevent underestimation or overestimation. Despite the errors, the software can assist the user in identifying the magnitude of the dose approaching critical limits.

SIZE-specific dose estimate for lower-limb CT.

The Computed Tomography Dose Index (CTDI) is an indicator for dose management in computed tomography (CT), but has limited use for patient dosimetry. To evaluate the patient dose, the size-specific dose estimate (SSDE), reported by the American Association of Physics in Medicine task groups 204, 220, and 293, must be calculated by the CTDIvol(z) displayed on the CT console, and the conversion factor f(D(z)) from the effective diameter (DEff) or water equivalent diameter (Dw). However, no reports have verified the appropriateness of using the 320-mm diameter phantom for dose assessment in CT examinations involving the lower limbs. Therefore, we validated a new method for evaluating the SSDE(z) of the lower limbs, using two 160-mm diameter phantoms instead of the 320-mm diameter phantom. The CTDIvol(z) obtained from Monte Carlo (MC) simulation study was reliable because they were almost the same as obtained in a dosimetry study. The conversion factor f (D (zl.l.)) for the lower limbs was evaluated based on the CTDIvol(z) obtained by MC simulation performed using two polymethyl methacrylate cylinder phantoms of 160-mm diameter. The MC simulation was performed by the International Commission on Radiological Protection publication 135 reference adult phantom and was used to evaluate the absorbed dose of the pelvis, thighs, knees, and ankles. The dose showing the greatest difference was the thighs, which was 8.3 mGy (16%) lower than the absorbed dose. Thus, the SSDE (zl.l.) could be estimated from the [Formula: see text] displayed on the CT scanner console.

SIZE-SPECIFIC DOSE ESTIMATES IN FETAL COMPUTED TOMOGRAPHY.

During fetal computed tomography (CT) imaging, because of differences in the pregnancy period and scanning conditions, different doses of radiation are absorbed by the fetus. We propose a correction coefficient for determining the fetal size-specific dose estimate (SSDE) from the CT dose index (CTDI) displayed on the console at tube voltages of 80-135 kVp. The CTDIs corresponding to pregnant women and fetuses were evaluated using a Monte Carlo (MC) simulation, and the ratio of these CTDIs was defined as the Fetus-factor. When the effective diameter of a fetus was approximately 10 cm, the Fetus-factor was 1.0. The estimated pregnant SSDE was multiplied by the Fetus-factor to estimate the fetal SSDE, which was compared with the fetal dose obtained by the MC simulation of the image of the fetal CT examination. The fetal dose could be estimated with an error of 31.5% in fetal examinations conducted using helical CT.

Novel pregnant model phantoms for measurement of foetal radiation dose in x-ray examinations.

This study presents a comparison of novel pregnant model phantoms with a handmade phantom in terms of shape and radiation measurement points to determine which model is more suitable for measuring the foetal radiation dose during x-ray examinations. Novel pregnant model phantoms were constructed using an anthropomorphic phantom in combination with two differently-sized custom-made abdomen phantoms simulating pregnancy, which were constructed from a polyurethane resin. The size and shape of the polyurethane resin were designed based on abdominal sizes and shapes collected from the computed tomography examinations at 18 pregnant patients of one hospital. The handmade pregnant model phantom was constructed using an anthropomorphic phantom and a beach ball containing water. Compared with the handmade phantom, there were additional dose measurement points on the novel pregnant model phantoms. Our model phantoms improved upon the handmade phantom in terms of shape and radiation measurement points. We produced pregnant model phantoms that simulated the shapes and sizes of actual patients for the first time.

Extracellular mRNA transported to the nucleus exerts translation-independent function.

RNA in extracellular vesicles (EVs) are uptaken by cells, where they regulate fundamental cellular functions. EV-derived mRNA in recipient cells can be translated. However, it is still elusive whether "naked nonvesicular extracellular mRNA" (nex-mRNA) that are not packed in EVs can be uptaken by cells and, if so, whether they have any functions in recipient cells. Here, we show the entrance of nex-mRNA in the nucleus, where they exert a translation-independent function. Human nex-interleukin-1ß (IL1ß)-mRNA outside cells proved to be captured by RNA-binding zinc finger CCCH domain containing protein 12D (ZC3H12D)-expressing human natural killer (NK) cells. ZC3H12D recruited to the cell membrane binds to the 3'-untranslated region of nex-IL1ß-mRNA and transports it to the nucleus. The nex-IL1ß-mRNA in the NK cell nucleus upregulates antiapoptotic gene expression, migration activity, and interferon-γ production, leading to the killing of cancer cells and antimetastasis in mice. These results implicate the diverse actions of mRNA.

Fetal radiation dose of four tube voltages in abdominal CT examinations during pregnancy: A phantom study.

This study aimed to compare the dose and noise level of four tube voltages in abdominal computerized tomography (CT) examinations in different abdominal circumference sizes of pregnant women. Fetal radiation doses were measured with two anthropomorphic pregnant phantoms and real-time dosimeters of photoluminescence sensors using four tube voltages for abdominal CT. The noise level was measured at the abdomen of two anthropomorphic pregnant phantoms. In the large pregnant phantom, the mean fetal doses performed using 120 and 135 kV were statistically significantly lower than the lower tube voltages (P < 0.05). In the small pregnant phantom, the mean fetal dose performed by 100, 120, and 135 kV was significantly lower than the lowest tube voltage tested (P < 0.05). The ratios of the peripheral mean dose to the centric mean dose showed that the ratios of 80 kV were the highest and those for 135 kV were the lowest in both pregnant phantoms. The ratios of the peripheral mean dose to the centric mean dose decreased as the tube voltage increased. Compared with low tube voltages, high tube voltages such as 120 and 135 kV could reduce radiation doses to the fetus without compromising the image uniformity in abdominal CT examinations during pregnancy. On low tube voltage protocols, the dose near the maternal skin surface may be increased in large pregnant women because of reduced penetration of the x rays.

Proposed diagnostic reference levels for general radiography and mammography in Japan.

Diagnostic reference levels (DRLs 2015) in Japan were first published in 2017, on the Japan Network for Research and Information on Medical Exposures network. Medical facilities in Japan are now presumably reconsidering radiation doses at their facilities and approaching protection optimisation through the application of DRLs 2015. However, since more than 3 years have elapsed since publication, radiation doses received by patients in Japan may have diverged from DRLs 2015. We therefore undertook the present study. Based on our questionnaire survey implemented in 2017, we estimated the entrance skin dose (ESD) under general radiography fields and the mean glandular dose (MGD) under mammography, to compile a report on the doses received by patients under general radiography fields and mammography, and to propose new DRLs as replacements for DRLs 2015. Radiation doses under general radiography fields and mammography were estimated from the results of the 2017 questionnaire survey and applied to determine new DRLs at 75% values of dose distributions in general radiography fields and at 95% values of dose distributions in mammography. Among all the modes for general radiography fields and mammography, median ESD and MGD were significantly smaller with flat panel detector systems than with computed radiography systems. Comparison of the results with DRLs 2015 values showed a trend toward decreases in all imaging methods of the general radiography fields and mammography ranging from 5.0% (child chest radiography) to 31.7% (skull radiography). Moreover, responses showed that DRLs 2015 were recognised and used for comparison at many facilities. We have described the doses received by patients in general radiography fields and mammography in 2017 and proposed new DRLs as replacements for DRLs 2015. The DRLs we proposed for general radiography fields and mammography were determined to be lower than DRLs 2015 for all modes.

VOLUME CT DOSE INDEX AND DOSE-LENGTH PRODUCT VALUES ACCORDING TO FACILITY SIZE IN JAPAN.

The aim of this study was to investigate differences in volume computed tomography dose index (CTDIvol) and dose-length product (DLP) values according to facility size in Japan. A questionnaire survey was sent to 3000 facilities throughout Japan. Data from each facility were collected including bed number, computed tomography (CT) scan parameters employed and the CTDIvol and/or DLP values displayed on the CT scanner during each examination. The CTDIvol and DLP for 11 adult and 6 paediatric CT examinations were surveyed. Comparison of CTDIvol and DLP values of each examination according to facility size revealed key differences in CT dose between small and large facilities. This study highlights the importance of lowering the dose of coronary artery examination with contrast agent in smaller facilities and of lowering the dose of adult and paediatric head CT without contrast agent in larger facilities. The results of this study are valid in Japan.

OPTIMISATION OF SWALLOWING CT EXAMINATION: DOSE REDUCTION AND IMAGE QUALITY.

This study sought to optimise the swallowing computed tomography (SCT) scan protocol for use with the new wide-area detector-row CT (ADCT) scanner and to estimate patient dose in terms of the organ-absorbed dose and the effective dose. The conventional ADCT (ADCTViSION) and the new ADCT (ADCTGENESIS) scanner were compared using: (1) the organ-absorbed dose and the effective dose, with a phantom study, (2) the detailed organ-absorbed doses of the neck region, using a Monte Carlo simulation and (3) a relative visual quality analysis. The effective energy differed significantly between the ADCTViSION (50 keV) and the ADCTGENESIS (57 keV). The effective doses were 2.9 and 1.9 mSv, respectively. Compared with the ADCTViSION, the absorbed dose was reduced by 34% with the ADCTGENESIS. With the ADCTGENESIS, the tube current could be reduced from 40 to 30 mA. With the optimised scan protocol, a further 25% dose reduction can be achieved.

Diagnostic reference levels and achievable doses for common computed tomography examinations: Results from the Japanese nationwide dose survey.

OBJECTIVE:: To propose a new set of Japanese diagnostic reference levels (DRLs) and achievable doses (ADs) for 2017 and to verify the usefulness of Japanese DRLs (DRLs 2015) for CT, by investigating changes in the volume CT dose index (CTDIvol) from 2014 to 2017. METHODS:: Detailed information on the CT scan parameters used throughout Japan were obtained by questionnaire survey. The CTDIvol and dose-length product for the 11 commonest adult and 6 commonest paediatric CT examinations were surveyed and compared with 2014 data and DRLs 2015. RESULTS:: Evaluations of adult head (helical), and abdomen and pelvis without contrast agent, paediatric chest without contrast agent, and abdomen and pelvis without contrast agent showed a slightly lower mean CTDIvol in 2017 than in 2014 (t-test, p < 0.05). The interquartile range of CTDIvol for all 2017 examinations was lower than in 2014. CONCLUSIONS:: This study verified the lower mean, 75th percentile, and interquartile range by investigating changes in the CTDIvol from 2014 to 2017. The DRLs 2015 contributed to CT radiation dose reduction. ADVANCES IN KNOWLEDGE:: The widespread implementation of iterative reconstruction algorithms and low-tube voltage in CT scanners is likely to facilitate further reduction in the CT radiation dose used in Japan. Although radiological technologists may require further education on appropriate CTDIvol and DLP usage, the DRLs 2015 greatly contributed to the reduction of the CT radiation dose used in Japan.

[Survey of Recognition, Utilization, and Evaluation for Diagnostic Reference Levels in the Field of X-ray Computed Tomography].

A survey on recognition, utilization, and evaluation for diagnostic reference levels (DRLs) after establishing Japan DRLs 2015 in the field of X-ray computed tomography (CT) was conducted for members of Japanese Society of Radiological Technology using web-based questionnaire system. The survey consisted of provincial branches to which respondents belong, their occupation, years of professional experience, years of experience in X-ray CT section, recognition of DRLs, and utilization and evaluation of DRLs in the field of X-ray CT section. Each survey item had one to eight questions. A total of 369 members completed the questionnaire. Among them, 295 out of 369 (79.9%) members knew that DRLs were released in Japan. After establishing the DRLs, 226 of 330 (68.5%) and 123 of 319 (38.6%) members investigated the doses used for adult and pediatric CT at their facilities, respectively. Although 345 of 369 (93.5%) members answered that DRLs are necessary for the field of X-ray CT, only 142 of 369 (38.5%) members thought that the established DRLs are enough to use in the field of X-ray CT. The survey has clarified the current status of recognition, utilization, and evaluation for DRLs in the field of X-ray CT after establishing the DRLs in Japan.

Hepato-entrained B220+CD11c+NK1.1+ cells regulate pre-metastatic niche formation in the lung.

Primary tumours establish metastases by interfering with distinct organs. In pre-metastatic organs, a tumour-friendly microenvironment supports metastatic cells and is prepared by many factors including tissue resident cells, bone marrow-derived cells and abundant fibrinogen depositions. However, other components are unclear. Here, we show that a third organ, originally regarded as a bystander, plays an important role in metastasis by directly affecting the pre-metastatic soil. In our model system, the liver participated in lung metastasis as a leucocyte supplier. These liver-derived leucocytes displayed liver-like characteristics and, thus, were designated hepato-entrained leucocytes (HepELs). HepELs had high expression levels of coagulation factor X (FX) and vitronectin (Vtn) and relocated to fibrinogen-rich hyperpermeable regions in pre-metastatic lungs; the cells then switched their expression from Vtn to thrombospondin, both of which were fibrinogen-binding proteins. Cell surface marker analysis revealed that HepELs contained B220+CD11c+NK1.1+ cells. In addition, an injection of B220+CD11c+NK1.1+ cells successfully eliminated fibrinogen depositions in pre-metastatic lungs via FX Moreover, B220+CD11c+NK1.1+ cells demonstrated anti-metastatic tumour ability with IFNγ induction. These findings indicate that liver-primed B220+CD11c+NK1.1+ cells suppress lung metastasis.

SWALLOWING COMPUTED TOMOGRAPHY: DOSE ESTIMATION IN A PHANTOM STUDY CONDUCTED AT VARIOUS PATIENT RECLINING ANGLES.

Swallowing computed tomography (SCT) is a relatively new technique for the morphological and kinematic analyses of swallowing. However, no optimal scan protocols are available till date. We conducted the present SCT study to estimate the patient dose at various patient reclining positions. A RANDO phantom with a thermoluminescent dosemeter was placed on a hard Table board in a semi-reclining position at the centre and off-centre. According to predetermined scan protocols, irradiation was performed to acquire scanograms at reclining angles of 55° and 65°. The effective dose was the lowest at the centre 45° (3.8 mSv) reclining angle. Comparison between the off-centre (4.6 mSv at 55°, 6.8 mSv at 65°) and centre (4.5 mSv, 5.8 mSv) values suggested that the off-centre position is undesirable with regard to the patient dose. Accordingly, we believe that SCT methods must be revised on the basis of these factors.

Fetal dose conversion factor for fetal computed tomography examinations: A mathematical phantom study.

This study aimed to examine the relationship between fetal dose and the dose-length product, and to evaluate the impact of the number of rotations on the fetal doses and maternal effective doses using a 320-row multidetector computed tomography unit in a wide-volume mode. The radiation doses for the pregnant woman and the fetus were estimated using ImPACT CT Patient Dosimetry Calculator software for scan lengths ranging from 176 to 352 mm, using a 320-row unit in a wide-volume mode and an 80-row unit in a helical scanning mode. In the 320-row unit, the fetal doses in all scan lengths ranged from 3.51 to 6.52 mGy; the maternal effective doses in all scan lengths ranged from 1.05 to 2.35 mSv. In the 80-row unit, the fetal doses in all scan lengths ranged from 2.50 to 3.30 mGy; the maternal effective doses in all scan lengths ranged from 0.83 to 1.68 mSv. The estimated conversion factors from the dose-length product (mGy・cm) to fetal doses (mGy) for the 320-row unit in wide-volume mode and the 80-row unit in helical scanning mode were 0.06 and 0.05 (cm-1 ) respectively. While using a 320-row MDCT unit in a wide-volume mode, operators must take into account the number of rotations, the beam width as automatically determined by the scanner, the placement of overlap between volumetric sections, and the ratio of overlapping volumetric sections.

Nitrative DNA damage induced by carbon-black nanoparticles in macrophages and lung epithelial cells.

Carbon black (CB) is a nanomaterial used mainly in rubber products. Exposure to CB by inhalation causes malignant lung tumors in experimental animals. CB inhalation may cause chronic inflammation in the respiratory system, leading to carcinogenesis, but the mechanism remains unclear. Reactive oxygen and nitrogen species are generated from inflammatory and epithelial cells under inflammatory conditions, and resulting DNA damage may contribute to carcinogenesis. In this study, we performed immunocytochemistry to determine whether CB exposure induces formation of 8-nitroguanine (8-nitroG), a nitrative DNA lesion formed under inflammatory conditions, in RAW 264.7 macrophage and A549 lung epithelial cells. We compared the DNA-damaging effects of CB particles with primary diameter 56nm (CB56) and 95nm (CB95). Both types of CB induced 8-nitroG formation, mainly in the nucleus of RAW 264.7 and A549 cells, and CB95 tended to induce more 8-nitroG formation than did CB56. Flow cytometry revealed that CB95 generated larger amount of reactive oxygen species than did CB56 in RAW 264.7 cells. The Griess method showed that CB95 produced significantly larger amount of nitric oxide (NO) than did CB56. Flow cytometry showed that CB95 was more efficiently internalized into the cells than was CB56. The cellular uptake of CB and 8-nitroG formation in RAW 264.7 cells were reduced by monodansylcadaverine, an inhibitor of clathrin-mediated endocytosis, and by siRNA for Ctlc (clathrin heavy chain) gene. CB induces nitrative DNA damage in cultured cells, and clathrin-mediated endocytosis is involved, at least in part.

PATIENT EXPOSURE DURING PLAIN RADIOGRAPHY AND MAMMOGRAPHY IN JAPAN IN 1974-2014.

We investigated changes in the entrance skin dose (ESD) and the mean glandular dose (MGD) during plain radiography or mammography in Japan from 1974 to 2014. Surveys regarding the conditions used for plain radiography and mammography were performed throughout Japan in 1974, 1979, 1989, 1993, 1997, 2001, 2003, 2007, 2011 and 2014. The anatomical regions considered were categorised as follows: skull anteroposterior (AP), lumbar AP, lumbar lateral (LAT), pelvis (AP), ankle, chest posteroanterior (PA), Guthmann (lateral pelviography for pregnant women), infant hip joint and mammography. The doses for all anatomical regions decreased from 1974 to 1993. The MGD for mammography remained low from 1993 to 2014, and the ESDs for chest (PA) radiography trended upward. After the 2000s, the use of digital imaging increased in Japan. This is the first long-term study to examine changes in ESDs and MGDs in Japan.

Energy dependence and angular dependence of an optically stimulated luminescence dosimeter in the mammography energy range.

This study aimed to investigate the energy dependence and the angular dependence of commercially available optically stimulated luminescence (OSL) point dosimeters in the mammography energy range. The energy dependence was evaluated to calculate calibration factors (CFs). The half-value layer range was 0.31-0.60 mmAl (Mo/Mo 22-28 kV, Mo/Rh 28-32 kV, and W/Rh 30-34 kV at 2-kV intervals). Mo/Rh 28 kV was the reference condition. Angular dependence was tested by rotating the X-ray tube from -90° to 90° in 30° increments, and signal counts from angled nanoDots were normalized to the 0° signal counts. Angular dependence was compared with three tube voltage and target/filter combinations (Mo/Mo 26 kV, Mo/Rh 28 kV and W/Rh 32 kV). The CFs of energy dependence were 0.94-1.06. In Mo/Mo 26-28 kV and Mo/Rh 28-32 kV, the range of CF was 0.99-1.01, which was very similar. For angular dependence, the most deteriorated normalized values (Mo/Mo, 0.37; Mo/Rh, 0.43; and W/Rh, 0.58) were observed when the X-ray tube was rotated at a 90° angle, compared to 0°. The most angular dependences of ± 30°, 60°, and 90° decreased by approximately 4%, 14%, and 63% respectively. The mean deteriorated measurement 30° intervals from 0° to ± 30° was 2%, from ± 30° to ± 60° was 8%, and from ± 60° to ± 90° was 40%. The range of energy dependence in typical mammography energy range was not as much as that in general radiography and computed tomography. For accurate measurement using nanoDot, the tilt needs to be under 30°.

Software Development for Estimating the Conversion Factor (K-Factor) at Suitable Scan Areas, Relating the Dose Length Product to the Effective Dose.

We developed a k-factor-creator software (kFC) that provides the k-factor for CT examination in an arbitrary scan area. It provides the k-factor from the effective dose and dose-length product by Imaging Performance Assessment of CT scanners and CT-EXPO. To assess the reliability, we compared the kFC-evaluated k-factors with those of the International Commission on Radiological Protection (ICRP) publication 102. To confirm the utility, the effective dose determined by coronary computed tomographic angiography (CCTA) was evaluated by a phantom study and k-factor studies. In the CCTA, the effective doses were 5.28 mSv in the phantom study, 2.57 mSv (51%) in the k-factor of ICRP, and 5.26 mSv (1%) in the k-factor of the kFC. Effective doses can be determined from the kFC-evaluated k-factors in suitable scan areas. Therefore, we speculate that the flexible k-factor is useful in clinical practice, because CT examinations are performed in various scan regions.