A Review of Healthcare Failure Mode and Effects Analysis (HFMEA) in Radiotherapy.

This paper presents a review of risk analyses in radiotherapy (RT) processes carried out by using Healthcare Failure Mode Effect Analysis (HFMEA) methodology, a qualitative method that proactively identifies risks to patients and corrects medical errors before they occur. This literature review was performed to provide an overview of how to approach the development of HFMEA applications in modern RT procedures, comparing recently published research conducted to support proactive programs to identify risks. On the basis of the reviewed literature, the paper suggests HFMEA shortcomings that need to be addressed.

ON-FIELD EVALUATION OF OPERATOR LENS PROTECTIVE DEVICES IN INTERVENTIONAL RADIOLOGY.

The recent publication of the Euratom Directive 2013/59, adopting the reduction of eye lens dose limits from 150 to 20 mSv y-1, calls for the development of new tools and methodologies for evaluating the eye lens dose absorbed by the medical staff involved in interventional radiology practices. Moreover, the effectiveness of the protective devices, like leaded glasses, which can be employed for radiation protection purposes, must be tested under typical exposure scenarios. In this work, eye lens dose measurements were carried out on an anthropomorphic phantom simulating a physician bound to perform standard interventional neuroradiology angiographic procedures. The correlation between eye lens doses, in terms of Hp(0.07), and the equivalent dose [again in terms of Hp(0.07)] monthly measured with thermoluminescent dosemeters placed above the lead apron at the chest level was studied, in the presence and in the absence of different types of leaded glasses.

Concentrations of 90Sr in the tooth tissues 60 years after intake: results of TL measurements and applications for Techa River dosimetry.

This article focuses on the study of (90)Sr in the tooth tissues of Techa riverside residents 60 years after intake. The Techa River was contaminated by radioactive wastes in the 1950s. Contamination of the river system, including water, bottom sediment, floodplain soil, and grass, depended on the distance from the source of releases. Therefore, the average (90)Sr intake was different in different settlements located downstream the river. An additional factor influencing (90)Sr accumulation in the teeth is the rate of tissue mineralization at the time of intake which depended on the donor's age at the time of releases. Measurements of (90)Sr concentration in various dental tissues (enamel, crown, and root dentin) of 166 teeth were performed about 60 years after the main intake using the method of thermoluminescence passive beta detection. The paper presents the current levels of tooth tissue contamination, and the tooth-to-tooth variability of (90)Sr concentration in tooth tissues was assessed for the tissues which were matured at the time of massive liquid radioactive waste releases into the Techa River. A model describing the expected levels of (90)Sr in matured dental tissues depending on age and intake has been elaborated for the population under study. The results obtained will be used for calculation of internal dose in enamel and for interpretation of tooth doses measured by means of the electron paramagnetic resonance method, among the population of the Techa River region.

Review of retrospective dosimetry techniques for external ionising radiation exposures.

The current focus on networking and mutual assistance in the management of radiation accidents or incidents has demonstrated the importance of a joined-up approach in physical and biological dosimetry. To this end, the European Radiation Dosimetry Working Group 10 on 'Retrospective Dosimetry' has been set up by individuals from a wide range of disciplines across Europe. Here, established and emerging dosimetry methods are reviewed, which can be used immediately and retrospectively following external ionising radiation exposure. Endpoints and assays include dicentrics, translocations, premature chromosome condensation, micronuclei, somatic mutations, gene expression, electron paramagnetic resonance, thermoluminescence, optically stimulated luminescence, neutron activation, haematology, protein biomarkers and analytical dose reconstruction. Individual characteristics of these techniques, their limitations and potential for further development are reviewed, and their usefulness in specific exposure scenarios is discussed. Whilst no single technique fulfils the criteria of an ideal dosemeter, an integrated approach using multiple techniques tailored to the exposure scenario can cover most requirements.

Inventory and geochemical host phases of natural radionuclides in tin mining materials from Nigeria.

On the Nigerian Jos Plateau tin mining is extensively carried out in open pit style. Several types of materials occurring there (raw materials, waste, and soil) were analysed radiometrically. The geochemical host phases of the natural radionuclides were determined by a sequential extraction procedure according to the European BCR standard. It was found that especially easily mobilisable (228)Ra must be taken into consideration as a radioactive contaminant for the mining area.

Uranium and thorium in soils, mineral sands, water and food samples in a tin mining area in Nigeria with elevated activity.

The activity concentrations of uranium and thorium have been determined in soils and mineral sands from the Nigerian tin mining area of Bisichi, located in the Jos Plateau, and from two control areas in Nigeria (Jos City and Akure) using high-purity germanium detectors (HPGe). High resolution sector field inductively coupled plasma mass spectroscopy (HR-SF-ICP-MS) was used to determine uranium and thorium in liquids and foodstuffs consumed locally in the mining area. The activities of uranium and thorium measured in the soils and mineral sands from Bisichi ranged from 8.7 kBq kg(-1) to 51 kBq kg(-1) for (238)U and from 16.8 kBq kg(-1) to 98 kBq kg(-1) for (232)Th, respectively. These values were significantly higher than those in the control areas of Jos City and Akure and than the reference values reported in the literature. They even exceeded the concentrations reported for areas of high natural radioactive background. Radionuclide concentrations in samples of the local foodstuffs and in water samples collected in Bisichi were found to be higher than UNSCEAR reference values. The results reveal the pollution potential of the mining activities on the surrounding areas.

Thermoluminescence dating of a mikveh in Ichenhausen, Germany.

A vaulted basement found at the rabbi's residential house which was oriented according to the requirements of a mikveh has created a controversy in the architectural history of the Ichenhausen Synagogue (Germany). The rabbi's residential house is known to have been built in 1781 during the replacement of the old Synagogue that had existed since 1687. However, the architectural documents concerning the residential house did not contain any information about either the presence or the construction of the mikveh in the basement. Three bricks collected from the northern, eastern and southern walls of the vaulted basement of the rabbi's residence were dated using the thermoluminescence method to find out if the mikveh belongs to the old Synagogue or was built during the construction of the residence. The archaeological dose was assessed using multi-aliquot regenerative and additive dose techniques using quartz extracted from bricks. The age calculations were based on the assessment of annual dose rate in quartz by taking into account the possible variations of water content in bricks. The TL dates of the bricks were found to vary between 1797+/-11 and 1772+/-16 for dry and water saturated environments, respectively. The TL results ruled out the possibility that the walls of the mikveh belong to the former Synagogue.

Measurement techniques for tracer kinetic studies with stable isotopes of zirconium.

Biokinetic models are used in radiation protection to assess internal radiation doses. Experiments with stable isotopes as tracers can be performed to obtain characteristic parameters of these models. Two methods for the measurement of zirconium isotopes in human biological samples are presented--thermal ionisation mass spectrometry (TIMS) and proton nuclear activation analysis (PNA). Descriptions include sample preparation, operating conditions, relative uncertainties and method detection limits as well as important properties of both methods.

Determination of dose rates from natural radionuclides in dental materials.

Different types of materials used for dental prosthetics restoration, including feldspathic ceramics, glass ceramics, zirconia-based ceramics, alumina-based ceramics, and resin-based materials, were investigated with regard to content of natural radionuclides by means of thermoluminescence beta dosimetry and gamma spectrometry. The gross beta dose rate from feldspathic and glass ceramics was about ten times higher than the background measurement, whereas resin-based materials generated negligible beta dose rate, similarly to natural tooth samples. The specific activity of uranium and thorium was significantly below the levels found in the period when addition of uranium to dental porcelain materials was still permitted. The high-beta dose levels observed in feldspathic porcelains and glass ceramics are thus mainly ascribable to (40)K, naturally present in these specimens. Although the measured values are below the recommended limits, results indicate that patients with prostheses are subject to higher dose levels than other members of the population. Alumina- and zirconia-based ceramics might be a promising alternative, as they have generally lower beta dose rates than the conventional porcelain materials. However, the dosimetry results, which imply the presence of inhomogeneously distributed clusters of radionuclides in the sample matrix, and the still unsuitable structural properties call for further optimization of these materials.

The use of alpha-Al2O3:C in Risø OSL single grains attachment system for assessing the spatial dose rate distribution due to incorporation of 90Sr in human teeth.

The possibility of using a single grain OSL attachment system developed by the Risø National Laboratory (Roskilde, Denmark) for assessing the spatial distribution of radionuclides incorporated in human tissues was investigated. Detectors containing arrays of single grains of alpha-Al2O3)C powder (Landauer Inc., USA) were prepared using aluminium discs (diameter 9.7 mm), which can accommodate 100 single grains in 0.3 mm holes positioned in a 10 x 10 grid. The luminescence and dosimetric properties of each grain were investigated by exposing the detectors to uniform photon radiation fields. After the characterisation of the detectors, the systems were tested to assess the spatial dose rate distribution because of 90Sr incorporated in a tooth sample extracted from an inhabitant of the Techa River region.

Limits of thermoluminescence dosimetry using quartz extracted from recent building materials in urban settlements.

The luminescence of quartz extracted from recently fired building material is known to detect doses of few mGy and can be successfully employed in the case of large scale radiation exposures due to nuclear accidents or terrorist acts. One brick and two tiles (50-80 years range) collected from an urban settlement were used to test the realistic minimum detectable dose limits of retrospective luminescence dosimetry. Independent methods like alpha counting, beta dosimetry, gamma spectrometry and flame photometry were used for the annual dose assessment. Two approaches were employed for the evaluation of the total accrued dose: regenerative dose and additive dose. The former allows the assessment of doses due to anthropogenic sources of radiation as low as approximately 12 mGy by using 10-year-old samples, but it can be applied only in samples showing no sensitisation. The latter can be applied to any sample, however, the related uncertainty is higher and minimum detectable anthropogenic dose in young samples amounts to 20 mGy.

Isothermal decay studies of intermediate energy levels in quartz.

The recent interest in the thermoluminescence of quartz extracted from unfired building materials, such as mortar and concrete for dose reconstruction applications, led to the requirement of an accurate determination of the lifetime of the intermediate glow peaks in this mineral. The prediction of the lifetimes of these peaks is helpful in establishing the likely time range within which retrospective measurements can be carried out. These peaks, corresponding to intermediate energy levels, occur in the glow curve in the temperature range 150-250 degrees C (heating rate 2 degrees C/s). Lifetimes of 720+/-70 days and 580+/-70 years (at a temperature of 15 degrees C) were derived for the two main peaks placed in the glow curve at approximately 150 degrees C and 200 degrees C, respectively, using the isothermal decay technique. These results as well as the estimated values of the trap parameters (thermal activation energy and frequency factor) have been compared with the data already available in the literature.

Influence of the chemical form on the plasma clearance of ruthenium in humans.

The radioisotopes of ruthenium (103Ru and 106Ru) are abundant fission products and represent a radiological risk for the population in case of nuclear accidents. Few biokinetic studies have been performed on humans up to now and consequently the current model recommended by ICRP for ruthenium is derived mainly by extrapolation from animal data. The stable isotope 101Ru and proton activation analysis have been used to study the biokinetics of Ru in blood plasma samples taken during 8 studies in three healthy volunteers. The results obtained demonstrated that complexed Ru (in the form of citrate Ru(IV) complexes) is cleared from blood plasma very rapidly (characteristic half time of 17+/-2 min), while inorganic Ru remains longer in the systemic circulation, and is transferred to other organs and/or excreted with a biological half time of 23+/-2h. Good reproducibility of the clearance curves indicated no evidence of inter- or intra-individual variability when the same Ru solution was injected in repeated experiments to different subjects.

Stable tracer investigations in humans for assessing the biokinetics of ruthenium and zirconium radionuclides.

The interest in the biokinetics of ruthenium and zirconium in humans is justified by the potential radiological risk represented by their radionuclides. Only a few data related to the biokinetics of ruthenium and zirconium in humans are available and, accordingly, the biokinetic models currently recommended by the ICRP for these elements are mainly based on data from animal experiments. The use of stable isotopes as tracers, coupled with a proper analytical technique (nuclear activation analysis with protons) for their determination in biological samples, represents an ethically acceptable methodology for biokinetic investigations, being free from any radiation risk for the volunteer subjects. In this work, the results obtained in eight biokinetic investigations for ruthenium, conducted on a total of three healthy volunteers, and six for zirconium, performed on a total of three subjects, are presented and compared to the predictions of the ICRP models.

A re-evaluation of the biokinetics of zirconium in humans.

There is much interest in understanding the biokinetics of zirconium in humans due to the potential radiological risk represented by the radionuclide 95Zr and by its daughter 95Nb. Despite the significance of zirconium, few data are available on the actual biokinetics of zirconium in humans. Accordingly the biokinetic model currently recommended by ICRP for this element is based mainly on data from animal experiments. In this study, the use of the stable isotopes 90Zr and 96Zr as tracers has enabled the conduct of 6 biokinetic investigations in 3 healthy volunteers. These studies have provided new valuable information about intestinal absorption and kinetics in blood plasma of zirconium and have been used for the set-up of a more realistic compartmental model with possible applications for dosimetric purposes.

Regional dependence of urinary uranium baseline levels in non-exposed subjects with particular reference to volunteers from Northern Italy.

Knowledge of the level of natural uranium (U) in the human body is fundamental in order to estimate the potentially hazardous incorporation in accidentally exposed subjects. A constant monitoring of exposed workers needs reliable reference baseline values, which can be determined by measuring the U concentration in urine. ICPMS has proven to be a fast, reliable and highly sensitive technique for this purpose. Non-uniformity in the distribution of U levels in various regions and differences in dietary habits account for the significant regional variations of U concentration in urine in non-exposed subjects. In this paper, the determination of daily uranium urinary excretion levels in a group of 12 non-exposed subjects from Northern Italy is presented and compared to data present in the published literature and to values obtained in a larger group of German volunteers. The urinary U output values observed in the Italian subset are generally higher than the corresponding levels measured in other groups. This could be the result of a higher intake of U from liquids, as assessed by the determination of U concentration in drinking waters.

Kinetics of systemic ruthenium in human blood using a stable tracer.

The biokinetics of ruthenium after oral and intravenous administration has been investigated in two human subjects using the stable isotope 101Ru as a tracer. Tracer concentrations in blood plasma have been determined using activation analysis with protons. The results presented here prove that the stable tracer technique is a valuable tool for obtaining relevant information about the biokinetics of ruthenium in humans. From these pilot studies, it may be argued that the clearance of systemic ruthenium from plasma is significantly slower than the predictions of the biokinetic model currently recommended by the International Commission on Radiological Protection (ICRP). The experimental data for the orally administered tracer, which reflect the gastrointestinal absorption process, differ from the curve derived from the ICRP model, suggesting that the uptake into the systemic circulation may be lower than predicted. On the basis of these preliminary data, investigations on a larger number of subjects with improvements in the experimental design are scheduled.