Results and analysis of examination doses for paediatric CT procedures based on a nationwide survey in China.

OBJECTIVE: To report the results of a dose survey conducted across 31 provinces in mainland China from 2017 to 2018 and to analyse the dose level to determine the national diagnostic reference levels (DRLs) for paediatric CT procedures. METHODS: At least ten patients for each age group (0- < 1, 1- < 5, 5- < 10, 10- < 15 years) and each procedure (head, chest and abdomen) for each CT scanner were selected from four to eight hospitals in each province. The dose information (CTDIvol and DLP) was collected from the HIS or RIS-PACS systems. The median values in each CT scanner were considered the representative dose values for the paediatric patients in CT scanning. The national DRLs were estimated based on the 75th percentile distribution of the median values. RESULTS: A total of 24,395 patients and 319 CT scanners were investigated across 262 hospitals. For paediatric CT scanning in 4 different age groups, the median (P50) and the 75th percentile (P75) of CTDIvol and DLP for each scanning procedure were calculated and reported. National DRLs were then proposed for each procedure and age group. CONCLUSION: The dose level of CT scanning for children in mainland China was reported for the first time. The DRLs for paediatric CT in the present study are similar to those in some Asian countries but higher than those in European countries. CLINICAL RELEVANCE STATEMENT: The paediatric CT is an extensively used tool in diagnosing paediatric disease; however, children are more sensitive to radiation. Establishing the diagnostic reference level of paediatric CT examination is necessary to reduce the dose of CT in children and promote the optimisation of medical exposure. KEY POINTS: • The DRLs for 3 paediatric CT procedures (head, chest and abdomen) and 4 age groups (0- < 1, 1- < 5, 5- < 10, 10- < 15 years) were proposed in mainland China first time. • The examination parameter and dose for children need to be further optimised in China, especially to lower the tube voltage in paediatric CT.

ATM and TP53 polymorphisms modified susceptibility to radiation-induced lens opacity in natural high background radiation area, China.

Purpose: A population-based case-control study was conducted in Yangjiang and Enping areas in South China to assess whether the risk of lens opacity induced by natural high background radiation exposure is modulated by polymorphisms of ATM and TP53.Materials and methods: A total of 133 cases who were diagnosed with cortical and posterior subcapsular (PSC) opacity were recruited, and 419 healthy controls were selected through counter-matching in terms of radiation status. Genomic DNA from all the participants was genotyped with the Illumina platform for four single nucleotide polymorphisms of ATM (rs189037, rs373759, and rs4585) and TP53 (rs1042522). The cumulative lens dose received during the entire life was estimated based on annual indoor and outdoor radiation doses and gender- and age-specific occupancy factors. Non-conditional logistic regression was performed to calculate odds ratio (OR) and 95% confidence intervals (95% CI).Results:ATM rs189037 and TP53 rs1042522 were significantly related to cortical and PSC opacity. The risk of opacity was higher when individuals carried the A allele of ATM rs189037 and C allele of TP53 rs1042522, compared with GG genotype. ATM rs189037 A allele carriers (AG/AA) and TP53 rs1042522 C allele carriers (CG/CC) combined with a cumulative lens dose of 100 mGy or higher showed statistically significant opacity risks (OR = 5.51, 95% CI: 1.47-20.66; OR = 2.69, 95% CI: 1.10-6.60).Conclusion: The A allele of ATM rs189037 and C allele of TP53 rs1042522 increased the risk of lens opacity induced by radiation. These polymorphisms in ATM and TP53 might modify the risk of cortical and PSC opacity induced by chronic and prolonged low-dose radiation.

Estimation of the occupational exposure dose for medical diagnostic X-ray workers in Jiangsu, China, using a retrospective dosimetry method.

Medical diagnostic X-ray workers are one occupational group that has exposure to continuous low doses of external radiation over their working lifetimes. Current ICRP recommendations [ICRP. Recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Ann ICRP 1991;21 (1-3)] state that there is no threshold of stochastic effects induced by radiation exposure such as carcinogenicity or genetic defects, and that the frequency of the effects is proportional to the amount of exposure to low levels of radiation, which is measured by radiation dose. In order to determine the dose information for this special occupational group over their working lifetimes (focusing particularly on workers exposed before 1985, when there was no personal dose monitoring), a sampling survey of the occupational history for these workers was conducted and an occupational history database was established. Using the database and retrospective dosimetry method of Zhang et al. (A retrospective dosimetry method for occupational dose for Chinese medical diagnostic X-ray workers. Radiat Prot Dosimetry 1998;77:69-72), the annual occupational exposure dose for medical diagnostic X-ray personnel working between 1950 and 2011 was computerized. Some annual dose results estimated using the proposed method were numerically in good agreement with the monitoring results. The average of the annual dose for these medical workers peaked during the mid-1950s and then declined, reaching very low levels by the 1990s and remaining at those levels thereafter. The trend in the annual dose is similar to that reported by earlier studies by Zielinski et al. (Health outcomes of low-dose ionizing radiation exposure among medical workers: a cohort study of the Canadian national dose registry of radiation workers. Int J Occup Med Environ Health 2009;22:149-56). The dose calculated by the retrospective dosimetry method can truly indicate the degree of the workers' exposure in their medical X-ray diagnostic work.

Individual Monitoring and Occupational Dose Record Management in China: History, Current Status and Perspectives.

This review paper presents an overview of individual monitoring, as well as the national dose register and dose record management of radiation workers in China. Progress has recently been made on the individual monitoring of radiation workers. A critical analysis of current status and problems in individual monitoring is also presented and necessary future research on individual monitoring, such as the monitoring technology in the form of the ring dosimeters and eye lens dosimeters, is suggested.

Necessity of Internal Monitoring for Nuclear Medicine Staff in a Large Specialized Chinese Hospital.

This work intends to quantify the risk of internal contaminations in the nuclear medicine staff of one hospital in Henan province, China. For this purpose, the criteria proposed by the International Atomic Energy Agency (IAEA) to determine whether it is necessary to conduct internal individual monitoring was applied to all of the 18 nuclear medicine staff members who handled radionuclides. The activity of different radionuclides used during a whole calendar year and the protection measures adopted were collected for each staff member, and the decision as to whether nuclear medicine staff in the hospital should be subjected to internal monitoring was made on the basis of the criteria proposed by IAEA. It is concluded that for all 18 members of the nuclear medicine staff in the hospital, internal monitoring is required. Internal exposure received by nuclear medicine staff should not be ignored, and it is necessary to implement internal monitoring for nuclear medicine staff routinely.

Nested Case-control Study of Occupational Radiation Exposure and Breast and Esophagus Cancer Risk among Medical Diagnostic X Ray Workers in Jiangsu of China.

Medical diagnostic X-ray workers are one occupational group that expose to the long-term low-dose external radiation over their working lifetime, and they may under risk of different cancers. This study aims to determine the relationship between the occupational X-ray radiation exposure and cancer risk among these workers in Jiangsu, China. We conducted Nested case-control study to investigate the occupational X-ray radiation exposure and cancer risk. Data were collected through self-administered questionnaire, which includes but not limits to demographic data, personal behaviors and family history of cancer. Retrospective dose reconstruction was conducted to estimate the cumulative doses of the x-ray workers. Inferential statistics, t-test and 2 tests were used to compare the differences between each group. We used the logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) of cancer by adjusting the age, gender. All 34 breast cancer cases and 45 esophageal cancer cases that detected in a cohort conducted among health workers between 1950~2011 were included in this presented study, and 158 cancer-free controls were selected by frequency-matched (1:2). Our study found that the occupational radiation exposure was associated with a significantly increased cancer risk compared with the control, especially in breast cancer and esophageal cancer (adjusted OR=2.90, 95% CI: 1.19-7.04 for breast cancer; OR=4.19, 95% CI: 1.87-9.38 for esophageal cancer, and OR=3.43, 95% CI: 1.92-6.12 for total cancer, respectively). The occupational X-ray radiation exposure was associated with increasing cancer risk, which indicates that proper intervention and prevention strategies may be needed in order to bring down the occupational cancer risk.

Cytogenetic analysis of peripheral blood lymphocytes, many years after exposure of workers to low-dose ionizing radiation.

The present study aims to measure chromosomal aberrations and micronuclei in peripheral blood lymphocytes from 25 subjects exposed to 0.10-0.33 Gy external or internal irradiation 32-41 years ago using conventional cytogenetic analysis methods. The frequencies of total chromosome-type aberrations and micronucleus significantly increased in the exposed group compared with that in age-matched control group (p<0.001); chromatid-type aberrations showed no difference between the two groups (p>0.05). When exposed subjects were divided into two groups based on exposure dose, higher levels of dicentric plus translocation frequencies were observed in the ≥0.15 Gy dose group compared with those in the <0.15 Gy dose group, though the difference was not significant. Borderline association between exposure dose and dicentric frequency was detected in the exposed group (r=0.358; p=0.079). These results suggest that the genotoxic effects of ionizing radiation remain in subjects exposed to low-dose radiation even decades after exposure.

Radiation dose in the thyroid and the thyroid cancer risk attributable to CT scans for pediatric patients in one general hospital of China.

OBJECTIVE: To quantify the radiation dose in the thyroid attributable to different CT scans and to estimate the thyroid cancer risk in pediatric patients. METHODS: The information about pediatric patients who underwent CT scans was abstracted from the radiology information system in one general hospital between 1 January 2012 and 31 December 2012. The radiation doses were calculated using the ImPACT Patient Dosimetry Calculator and the lifetime attributable risk (LAR) of thyroid cancer incidence was estimated based on the National Academies Biologic Effects of Ionizing Radiation VII model. RESULTS: The subjects comprised 922 children, 68% were males, and received 971 CT scans. The range of typical radiation dose to the thyroid was estimated to be 0.61-0.92 mGy for paranasal sinus CT scans, 1.10-2.45 mGy for head CT scans, and 2.63-5.76 mGy for chest CT scans. The LAR of thyroid cancer were as follows: for head CT, 1.1 per 100,000 for boys and 8.7 per 100,000 for girls; for paranasal sinus CT scans, 0.4 per 100,000 for boys and 2.7 per 100,000 for girls; for chest CT scans, 2.2 per 100,000 for boys and 14.2 per 100,000 for girls. The risk of thyroid cancer was substantially higher for girls than for the boys, and from chest CT scans was higher than that from head or paransal sinus CT scans. CONCLUSIONS: Chest CT scans caused higher thyroid dose and the LAR of thyroid cancer incidence, compared with paransal sinus or head CT scans. Therefore, physicians should pay more attention to protect the thyroid when children underwent CT scans, especially chest CT scans.

Radioactivity of drinking-water in the vicinity of nuclear power plants in China based on a large-scale monitoring study.

The public concern for radioactivity of drinking-water has been increasing in recent years after the rapid development of nuclear power plants, and especially after the Fukushima nuclear accident. In this study, the radioactivity of water samples collected in the vicinity of nuclear facilities from seven provinces in China was measured and an average annual equivalent effective dose derived from drinking-water ingestion was calculated. The results showed that, in winter and spring, the activities of gross α and ß ranged from 0.009 Bq/L to 0.200 Bq/L and from 0.067 Bq/L to 0.320 Bq/L, respectively. While, in summer and autumn, the activities of gross a and ß varied from 0.002 Bq/L to 0.175 Bq/L and from 0.060 Bq/L to 0.334 Bq/L. Our results indicated that the gross a and ß activities in these measured water samples were below the WHO recommended values (0.5 Bq/L for gross α and 1.0 Bq/L for gross ß) and the annual equivalent effective dose derived from drinking-water ingestion was at a safe level.