Diagnostic reference levels in low- and middle-income countries: early "ALARAm" bells?

Background In 1996 the International Commission on Radiological Protection (ICRP) introduced diagnostic reference levels (DRLs) as a quality assurance tool for radiation dose optimization. While many countries have published DRLs, available data are largely from high-income countries. There is arguably a greater need for DRLs in low- and middle-income-countries (LMICs), where imaging equipment may be older and trained imaging technicians are scarce. To date, there has been no critical analysis of the published work on DRLs in LMICs. Such work is important to evaluate data deficiencies and stimulate future quality assurance initiatives. Purpose To review the published work on DRLs in LMICs and to critically analyze the comprehensiveness of available data. Material and Methods Medline, Scopus, and Web of Science database searches were conducted for English-language articles published between 1996 and 2015 documenting DRLs for diagnostic imaging in LMICs. Retrieved articles were analyzed and classified by geographical region, country of origin, contributing author, year of publication, imaging modality, body part, and patient age. Results Fifty-three articles reported DRLs for 28 of 135 LMICs (21%), reflecting data from 26/104 (25%) middle-income countries and 2/31 (6%) low-income countries. General radiography (n = 26, 49%) and computerized tomography (n = 17, 32%) data were most commonly reported. Pediatric DRLs (n = 14, 26%) constituted approximately one-quarter of published work. Conclusion Published DRL data are deficient in the majority of LMICs, with the paucity most striking in low-income countries. DRL initiatives are required in LMICs to enhance dose optimization.

Development of a universal medical X-ray imaging phantom prototype.

Diagnostic X-ray imaging depends on the maintenance of image quality that allows for proper diagnosis of medical conditions. Maintenance of image quality requires quality assurance programs on the various X-ray modalities, which consist of pro-jection radiography (including mobile X-ray units), fluoroscopy, mammography, and computed tomography (CT) scanning. Currently a variety of modality-specific phantoms are used to perform quality assurance (QA) tests. These phantoms are not only expensive, but suitably trained personnel are needed to successfully use them and interpret the results. The question arose as to whether a single universal phantom could be designed and applied to all of the X-ray imaging modalities. A universal phantom would reduce initial procurement cost, possibly reduce the time spent on QA procedures and simplify training of staff on the single device. The aim of the study was to design and manufacture a prototype of a universal phantom, suitable for image quality assurance in general X-rays, fluoroscopy, mammography, and CT scanning. The universal phantom should be easy to use and would enable automatic data analysis, pass/fail reporting, and corrective action recommendation. In addition, a universal phantom would especially be of value in low-income countries where finances and human resources are limited. The design process included a thorough investigation of commercially available phantoms. Image quality parameters necessary for image quality assurance in the different X-ray imaging modalities were determined. Based on information obtained from the above-mentioned investigations, a prototype of a universal phantom was developed, keeping ease of use and reduced cost in mind. A variety of possible phantom housing and insert materials were investigated, considering physical properties, machinability, and cost. A three-dimensional computer model of the first phantom prototype was used to manufacture the prototype housing and inserts. Some of the inserts were 3D-printed, others were machined from different materials. The different components were assembled to form the first prototype of the universal X-ray imaging phantom. The resulting prototype of the universal phantom conformed to the aims of a single phantom for multiple imag-ing modalities, which would be easy to use and manufacture at a reduced cost. A PCT International Patent Application No. PCT/IB2016/051165 has been filed for this technology.

Influence of sanitizers on the lipopolysaccharide toxicity of Escherichia coli strains cultivated in the presence of Zygosaccharomyces bailii.

The influence of sublethal concentrations of two sanitizers, liquid iodophor and liquid hypochlorite (LH), on the growth rates and toxicity of food-borne pathogenic Escherichia coli strains grown in the presence of spoilage yeast Zygosaccharomyces bailii was assessed. When grown in combination with Z. bailii both E. coli O113 and E. coli O26 exhibited slower growth rates, except when E. coli O113 was grown in combination with Z. bailii at 0.2% LH. The growth rate of Z. bailii was not impacted by the addition of the sanitizers or by communal growth with E. coli strains. LAL and IL-6 results indicated a decrease in toxicity of pure E. coli cultures with comparable profiles for control and sanitizer exposed samples, although the LAL assay proved to be more sensitive. Interestingly, pure cultures of Z. bailii showed increased toxicity measured by LAL and decreased toxicity measured by IL-6. LAL analysis showed a decrease in toxicity of both E. coli strains grown in combination with Z. bailii, while IL-6 analysis of the mixed cultures showed an increase in toxicity. The use of LAL for toxicity determination in a mixed culture overlooks the contribution made by spoilage yeast, thus demonstrating the importance of using the appropriate method for toxicity testing in mixed microbe environments.

In-house development of a neonatal chest simulation phantom.

The aim of the study was to design and construct an anatomical and radiological phantom of a neonatal chest for investigating image quality and patient entrance surface dose (ESD). The density, elemental composition, scatter, attenuation, and absorption characteristics of different possible substitute materials were compared to that of neonatal tissues for radiological equivalence. Availability and cost of possible substitute materials were also considered. The most optimal substitute materials were selected to represent neonatal muscle, bone, healthy or aerated and sick or collapsed lung. For anatomical equivalence, a computed tomography (CT) scan was performed on a neonatal cadaver. Dimensions of different organs and structures were measured with software measuring tools at different window and level settings. Simplifying assumptions, due to machining limitations, were made. The results were used to create scaled drawings, which were used to machine the structures of the phantom. The phantom was assembled in a layer-by-layer manner and was validated with region of interest (ROI) analyses. The neonatal chest simulation phantom was an acceptable simulation of a real neonatal chest based on ROI validation, with an overall deviation of 32.5%. The phantom was successfully used in our diagnostic radiology division for ESD and image quality investigations for chest anterior-posterior (AP) radiographs.

Isolation, identification and typification of Alicyclobacillus acidoterrestris and Alicyclobacillus acidocaldarius strains from orchard soil and the fruit processing environment in South Africa.

Alicyclobacillus acidoterrestris and Alicyclobacillus acidocaldarius are thermo-acidophilic, non-pathogenic, spore-forming bacteria that can survive the typical heat processing of fruit juices and concentrates. Bacterial endospores then germinate, grow and cause spoilage of acid food products. Species of Alicyclobacillus were isolated from orchard soil and a fruit concentrate production factory in South Africa. Preliminary identification of the isolates was based on morphological, biochemical and physiological properties. Identification at species level was done by PCR amplification using genus-specific primers and 16S ribosomal RNA (rRNA) gene sequencing. The majority of isolates belonged to the species A. acidoterrestris, but A. acidocaldarius was also isolated and identified. As far as we could determine, this is the first report of the isolation of A. acidoterrestris from wash water and soil outside a fruit processing plant, as well as the isolation of A. acidocaldarius from vinigar flies. The genotypic relatedness between strains of A. acidoterrestris and between strains of A. acidocaldarius was determined by RAPD-PCR. Sixteen isolates identified as A. acidoterrestris grouped into four clusters based on RAPD-PCR banding patterns, suggesting that they belong to at least four genotypic groups. Three isolateT:/PGN/ELSEVIER/YFMIC/web/00001155/s identified as A. acidocaldarius gave three unique banding patterns.

Isolation and identification of species of Alicyclobacillus from orchard soil in the Western Cape, South Africa.

Alicyclobacilli were isolated from orchard soil collected from an apple and pear farm in Elgin, Western Cape, South Africa. Morphological, biochemical and physiological characteristics of the isolates were used to presumptively classify them as belonging to the genus Alicyclobacillus. Strains were identified to species level by polymerase chain reaction (PCR) with genus-specific primers, and 16S ribosomal RNA (rRNA) gene sequencing. To our knowledge this is the first report on the isolation of Alicyclobacillus acidoterrestris and Alicyclobacillus acidocaldarius from orchard soil. The presence of these organisms in the soil suggests a possible source of contamination for the final fruit juice, concentrate or pulp.