Patient doses from medical examinations in Russia: 2009-2015.

The aim of this study was to evaluate adult patient doses in Russia in the context of patient protection. Effective doses from x-ray and nuclear medicine examinations were assessed using two approaches. The first was based on data collection performed by the authors in hospitals in St. Petersburg and other 17 Russian regions. The second approach was to assess mean doses through the collective dose estimated annually within the federal data bank ESKID. In 2015, 203 million examinations were conducted in Russia, i.e. 1.4 examinations per capita. The number of examinations has increased by 35% over the last 10 years. Patient doses from x-ray examinations are strongly dependent on the imaging modality. Mean dose increases by an order of magnitude with each x-ray modality from dental examinations (0.01-0.1 mSv) to radiography (0.1-1 mSv), fluoroscopy and CT (1-10 mSv) and to interventional examinations (more than 10 mSv). Mean doses for x-ray examinations are comparable with that of foreign countries. Scintigraphy examinations with 99mTc are associated with mean doses of 1-5 mSv. Mean doses from PET/CT whole body examinations are 15-25 mSv with similar contributions from CT and radiopharmaceuticals. In nuclear medicine, patient doses are lower compared to other countries. According to ESKID data the collective dose from medical exposure in Russia has decreased from 140 000 man-Sv in 2000 to 77 000 man-Sv in 2015. Medical exposure contributes about 13% into a total collective dose. The maximum contribution was from CT examinations, i.e. 45% in 2015. A range of mean doses between different hospitals was up to two orders of magnitude for radiography and one order of magnitude for CT. In interventional studies, the scatter of individual doses was significant. Significant variations in doses between hospitals and some regions indicate the potential for optimization with the focus on interventional examinations, CT and nuclear medicine examinations combined with CT.

INVESTIGATION OF PARTIAL VOLUME EFFECT IN DIFFERENT PET/CT SYSTEMS: A COMPARISON OF RESULTS USING THE MADEIRA PHANTOM AND THE NEMA NU-2 2001 PHANTOM.

Positron emission tomography combined with computed tomography (PET/CT) is a quantitative technique used for diagnosing various diseases and for monitoring treatment response for different types of tumours. However, the accuracy of the data is limited by the spatial resolution of the system. In addition, the so-called partial volume effect (PVE) causes a blurring of image structures, which in turn may cause an underestimation of activity of a structure with high-activity content. In this study, a new phantom, MADEIRA (Minimising Activity and Dose with Enhanced Image quality by Radiopharmaceutical Administrations) for activity quantification in PET and single photon emission computed tomography (SPECT) was used to investigate the influence on the PVE by lesion size and tumour-to-background activity concentration ratio (TBR) in four different PET/CT systems. These measurements were compared with data from measurements with the NEMA NU-2 2001 phantom. The results with the MADEIRA phantom showed that the activity concentration (AC) values were closest to the true values at low ratios of TBR (<10) and reduced to 50 % of the actual AC values at high TBR (30-35). For all scanners, recovery of true values became closer to 1 with an increasing diameter of the lesion. The MADEIRA phantom showed good agreement with the results obtained from measurements with the NEMA NU-2 2001 phantom but allows for a wider range of possibilities in measuring image quality parameters.

Russian practical guidance on radiological support for justification of X-ray and nuclear medicine examinations.

An important part of the justification process is assessment of the radiation risks caused by exposure of a patient during examination. The authors developed official national methodology both for medical doctors and sanitary inspectors called 'assessment of radiation risks of patients undergoing diagnostic examinations with the use of ionizing radiation'. The document addresses patients of various age groups and a wide spectrum of modern X-ray and nuclear medicine examinations. International scale of risk categorisation was implemented by the use of effective dose with account for age dependence of radiation risk. The survey of effective doses in radiology, including CT, mammography, and intervention radiology, and nuclear medicine, including single-photon emission tomography and positron emission tomography, for patients of various age groups from several regions of Russia was used for the risk assessment. The output of the methodology is a series of tables for each diagnostic technology with lists of examinations for three age groups (children/adolescents, adults and seniors) corresponding to various radiation risk categories.

Nuclear medicine examinations of children in Russia.

The number and specification of radionuclide examinations, administrated activity and effective doses were collected during 2011-13 for 4944 paediatric patients from 10 nuclear medicine (NM) departments of some Russian regions. The kidney examinations account for about 70 % of paediatric NM examinations in general hospitals. Diagnostics of all other organs contribute from 2 to 8 % each in the total number of paediatric examinations. Administrated activities of radiopharmaceuticals are approximately proportional to the child's age, and variations between different hospitals usually are within the factor of 3-4 and for some types of examination up to 10. The range of the effective dose due to paediatric NM examinations is roughly estimated as 2-6 mSv per examination, approximately the same as in adults. Some examinations (heart, thyroid, whole body) result in doses of younger children that are 2-3 times higher than the doses of adults. Effective doses in paediatric positron emission tomography (PET) diagnostics are in the range of 4-10 mSv per examination and are higher compared with the dose of adult patients. The application of combined radiodiagnostic technologies (single photon emission computer tomography with roentghen computer tomography [SPECT/CT] or PET with roetghen computer tomography [PET/CT]) increases the effective dose of patients by the factor of 1.5-2 for the skeleton or whole body examinations.

Release criteria for patients having undergone radionuclide therapy and criteria for their crossing the state border of the Russian Federation.

By means of a conservative dosimetry model, the values of operational radiological criteria for patients released from hospital--residual activity in a body and dose rate near the patient's body--are substantiated based on the effective dose limit of 5 mSv for persons helping the patient or living with him and 1 mSv for other adults and children. Two sets of operative criteria for radionuclides (125)I, (131)I, (153)Sm and (188)Re used in Russia for radionuclide therapy were derived. Release criteria for (125)I well differ from such values in other countries because in this work absorption of (125)I low-energy photon radiation in the patient was taken into account. When a patient having undergone radionuclide therapy crosses the frontier of Russia, high-sensitivity devices for radiation control at the custom can detect the patient. A simplified radiological assessment of the patient was suggested aimed at provision of radiation safety for patient companions in transport.

Measurements of long-term external and internal radiation exposure of inhabitants of some villages of the Bryansk region of Russia after the Chernobyl accident.

A Nordic-Soviet programme was initiated in 1990 to evaluate the external and internal radiation exposure of the inhabitants of several villages in the Bryansk region of Russia. This area was one of the number of areas particularly affected by the nuclear accident at the Chernobyl Nuclear Power Plant in 1986. Measurements were carried out yearly until 1998 and after that more irregularly; in 2000, 2006 and 2008 respectively. The effective dose estimates were based on individual thermoluminescent dosemeters and on in vivo measurements of the whole body content of (137)Cs (and (134)Cs during the first years of the programme). The decrease in total effective dose during the almost 2 decade follow-up was due to a continuous decrease in the dominating external exposure and a less decreasing but highly variable exposure from internal irradiation. In 2008, the observed average effective dose (i.e. the sum of external and internal exposure) from Chernobyl (137)Cs to the residents was estimated to be 0.3mSv y(-1). This corresponds to 8% of the estimated annual dose in 1990 and to 1% of the estimated annual dose in 1986. As a mean for the population group and for the period of the present study (2006-2008), the average yearly effective dose from Chernobyl cesium was comparable to the absorbed dose obtained annually from external exposure to cosmic radiation plus internal exposure to naturally occurring radionuclides in the human body. Our data indicate that the effective dose from internal exposure is becoming increasingly important as the body burdens of Chernobyl (137)Cs are decreasing more slowly than the external exposure. However, over the years there have been large individual variations in both the external and internal effective doses, as well as differences between the villages investigated. These variations and differences are presented and discussed in this paper.

Validation of 131I ecological transfer models and thyroid dose assessments using Chernobyl fallout data from the Plavsk district, Russia.

Within the project "Environmental Modelling for Radiation Safety" (EMRAS) organized by the IAEA in 2003 experimental data of (131)I measurements following the Chernobyl accident in the Plavsk district of Tula region, Russia were used to validate the calculations of some radioecological transfer models. Nine models participated in the inter-comparison. Levels of (137)Cs soil contamination in all the settlements and (131)I/(137)Cs isotopic ratios in the depositions in some locations were used as the main input information. 370 measurements of (131)I content in thyroid of townspeople and villagers, and 90 measurements of (131)I concentration in milk were used for validation of the model predictions. A remarkable improvement in models performance comparing with previous inter-comparison exercise was demonstrated. Predictions of the various models were within a factor of three relative to the observations, discrepancies between the estimates of average doses to thyroid produced by most participant not exceeded a factor of ten.

Validation of environmental transfer models and assessment of the effectiveness of countermeasures using data on (131)I releases from Chernobyl.

The studies undertaken by the (131)I Working Group, part of the International Atomic Energy Agency's EMRAS (Environmental Modelling for Radiation Safety) programme, were focused primarily on evaluating the predictive capability of environmental models. Particular emphasis was placed on applying models to evaluate the effectiveness of countermeasures.

Uncertainties in individual doses in a case-control study of thyroid cancer after the Chernobyl accident.

Individual radiation doses to the thyroid were reconstructed for 2239 subjects of a case-control study of thyroid cancer among young people that was carried out in regions of Belarus and Russia contaminated by radioactive fallout from the Chernobyl accident. Although the process of dose reconstruction provides a point estimate of each subject's dose, it is obvious that there is uncertainty associated with these dose calculations. The following main sources of uncertainty in the estimated individual doses were identified: (1) shared and unshared errors associated with parameters of the dosimetry model; and (2) unshared errors that are associated with the variability, reliability and ability of information from the personal interviews. Besides setting up proper distributions for the parameters of the dosimetry model, inter-individual correlations were also defined to take into account shared errors. By the application of Monte Carlo simulations, a set of approximately log-normally distributed thyroid doses was obtained for each subject; the geometric standard deviations of the distributions are found to vary among individuals from 1.7 to 3.7.

External and internal irradiation of a rural Bryansk (Russia) population from 1990 to 2000, following high deposition of radioactive caesium from the Chernobyl accident.

In 1990, a joint Nordic-Russian project was initiated in order to make independent estimations of the effective dose to selected groups of inhabitants in a highly contaminated area around the city of Novozybkov in the western Bryansk region of Russia. The inhabitants were living in six villages with initial contamination levels of (137)Cs between 0.9 and 2.7 MBq m(-2). Some villages had been decontaminated, others not. Both school children and adults participated in the study. The external irradiation of 100-130 inhabitants was determined during 1 month in September-October each year from 1990 to 2000 (except 1999), using individual thermoluminescent dosemeters. The body burden of (137,134)Cs was determined by in vivo measurements in about 500 inhabitants annually from 1991 to 2000, and for a subgroup also with analysis of the (137)Cs concentration in urine. The mean effective dose (E) from external and internal irradiation due to (137,134)Cs deposition varied between 2.5 and 1.2 mSv per year between 1990 and 2000. The total mean E decreased, on average, by 9% per year, while the mean external dose decreased by 16% per year. The dose rate from internal radiation decreased more slowly than the dose rate from external radiation, and also showed an irregular time variation. The contribution from the internal dose to the total E was 30-50%, depending on the village. Predictions for the long-term changes in the effective dose to people living in the areas are presented. The cumulated E for the 70 years following the accident was estimated to be about 90 mSv with the assumption that both internal and external dose decrease by 2% per year after year 2000. The highest E during a life-time received by single individuals living in the area may amount to around 500 mSv considering the individual variations in E.

Contributions of short-lived radioiodines to thyroid doses received by evacuees from the Chernobyl area estimated using early in vivo activity measurements.

A series of in vivo gamma spectrometric measurements of 65 people evacuated from Pripyat 1.5 days after the Chernobyl Nuclear Power Plant Unit 4 explosion was performed in St Petersburg, Russia, as early as 30 April 1986. The historical spectra and interviews were recently processed and the results used for thyroid dose estimation. Activities of 131I in thyroid and 132Te in lungs were determined easily; for estimation of 132I and 133I activities in thyroid, sophisticated methods of spectral processing were developed. According to thyroid measurement data, the mean ratio of 133I/131I activities (at the time of the accident) inhaled by residents of Pripyat was 2.0. The mean ratio of thyroid dose from 133I inhalation to that caused by 131I amounts to 0.3, which confirms the accuracy of dose estimates based on the evolution of the Chernobyl accident. The mean ratio of 132I activity in thyroid to that of 132Te in lungs was assessed from the human measurement data to be 0.2, which is in reasonable agreement with the metabolic properties of these radionuclides. The mean ratio of thyroid dose from 132I originating from 132Te deposited in lungs to the dose caused by 131I was 0.13 +/- 0.02 for Pripyat residents who did not take KI pills and 0.9 +/- 0.1 for persons who took KI pills. Thus, the contribution of short-lived radioiodines to total thyroid dose of Pripyat residents, which was on average 30% for persons who did not use stable iodine prophylaxis, and about 50% for persons who took KI pills on 26-27 April, should be accounted for in the assessment of thyroid health effects.

131I content in the human thyroid estimated from direct measurements of the inhabitants of Russian areas contaminated due to the Chernobyl accident.

The method of processing and the results of measurements of 131I content in the thyroids of Russian people performed in May-June 1986 are presented. The contribution of radiation from Cs radionuclides in the human body was taken into account in the processing of measurement data with an SRP-68-01 device. The greatest individual 131I content was found in the thyroids of inhabitants of the Bryansk region, up to 250-350 kBq, and in the Tula and Orel regions, up to 100 kBq. The average 131I thyroid activity in the middle of May 1986 reached 80 kBq for inhabitants of some settlements in the Bryansk region, 5-8 kBq in the Tula region and 5 kBq in the Orel region.

Long-term external radiation exposure of inhabitants in the western Bryansk region of Russia as a consequence of the Chernobyl accident.

The western Bryansk region in south-western Russia was highly contaminated with 137Cs and 134Cs due to the Chernobyl accident in 1986. In 1990, a joint Nordic-Russian project was initiated in order to make measurements and estimates of the absorbed doses to selected groups of inhabitants in this area. The participating individuals were living in small villages with contamination levels between 0.9 and 2.7 MBq m(-2). Only some villages had been decontaminated. Both school-children and adults participated in the study and the number of persons was between 100 and 130 each year, residing in 5 villages. Every year in September-October, from 1990 to 1998. we performed individual measurements of external absorbed doses, assessed with thermoluminescent (TL) dosemeters (LiF). The mean effective dose per year from external irradiation due to the Chernobyl accident of the inhabitants in the villages ranged between 0.8 and 2.9 mSv during the study period and decreased with an apparent half-time of 3.7-8.2 years, depending on village and group. The highest individual doses within one village were, on average higher by a factor of 3 than the mean value for that village. Under the conservative assumption of a decrease rate in the external effective dose of 2% per year after 1998, individuals in the most highly exposed village are assumed to receive a life-time effective dose of about 75 mSv (between 1986 and 2056) from external exposure to caesium radionuclides. The mean value for the villages under study was estimated to be around 65 mSv using the assumed rate of decrease.

Childhood exposure due to the Chernobyl accident and thyroid cancer risk in contaminated areas of Belarus and Russia.

The thyroid dose due to 131I releases during the Chernobyl accident was reconstructed for children and adolescents in two cities and 2122 settlements in Belarus, and in one city and 607 settlements in the Bryansk district of the Russian Federation. In this area, which covers the two high contamination spots in the two countries following the accident, data on thyroid cancer incidence during the period 1991-1995 were analysed in the light of possible increased thyroid surveillance. Two methods of risk analysis were applied: Poisson regression with results for the single settlements and Monte Carlo (MC) calculations for results in larger areas or sub-populations. Best estimates of both methods agreed well. Poisson regression estimates of 95% confidence intervals (CIs) were considerably smaller than the MC results, which allow for extra-Poisson uncertainties due to reconstructed doses and the background thyroid cancer incidence. The excess absolute risk per unit thyroid dose (EARPD) for the birth cohort 1971-1985 by the MC analysis was 2.1 (95% CI 1.0-4.5) cases per 10(4) person-year Gy. The point estimate is lower by a factor of two than that observed in a pooled study of thyroid cancer risk after external exposures. The excess relative risk per unit thyroid dose was 23 (95% CI 8.6-82) Gy(-1). No significant differences between countries or cities and rural areas were found. In the lowest dose group of the settlements with an average thyroid dose of 0.05 Gy the risk was statistically significantly elevated. Dependencies of risks on age-at-exposure and on gender are consistent with findings after external exposures.

[Assessment of oncogenic risk of the irradiation of the thyroid gland in humans]. / Otsenka onkogennogo riska oblucheniia shchitovidnoi zhelezy cheloveka.

The paper deals with one of the most urgent aspects of irradiation hygiene, namely assessment of risk for irradiation-induced cancers of the thyroid. A model is described to predict high mortality rates of thyroidal cancer in the population due to the catastrophe at the Chernobyl Atomic Power Station. With the model, life-time risk rates involving sex and age at the moment of irradiation, as well as an irradiation mode.

[Radiation of the thyroid during examination of patients with thyroid diseases using radioactive iodine]. / Obluchenie shchitovidnoi zhelezy, soprovozhdaiushchee obsledovanie patsientov s tireoidnymi zabolevaniiami s pomoshch'iu radioaktivnogo ioda.

Basing on 131I uptake functions in the thyroid of 109 patients irradiation doses of this organ were evaluated for persons with normal iodine metabolism and in the following diseases: hypothyrosis, moderate thyrotoxicosis, nodular toxic and nontoxic goiter, vegetative neurosis. Maximum tolerant doses of 123I, 125I, 131I and 132I are recommended for diagnostic examination of thyroid function and scanning of this organ.