Radiation protection perspective to recurrent medical imaging: what is known and what more is needed?

2021 ◽  
pp. 20210477
Author(s):  
Jenia Vassileva ◽  
Ola Holmberg
Keyword(s):  
Radiation Protection ◽  
Current Knowledge ◽  
Clinical History ◽  
Patient Specific ◽  
Individual Radiosensitivity ◽  
Dose Saving ◽  
End Stage ◽  
Future Work ◽  
Standardised Patient

This review summarises the current knowledge about recurrent radiological imaging and associated cumulative doses to patients. The recent conservative estimates are for around 0.9 million patients globally who cumulate radiation doses above 100 mSv, where evidence exists for cancer risk elevation. Around one in five is estimated to be under the age of 50. Recurrent imaging is used for managing various health conditions and chronic diseases such as malignancies, trauma, end-stage kidney disease, cardiovascular diseases, Crohn’s disease, urolithiasis, cystic pulmonary disease. More studies are needed from different parts of the world to understand the magnitude and appropriateness. The analysis identified areas of future work to improve radiation protection of individuals who are submitted to frequent imaging. These include access to dose saving imaging technologies; improved imaging strategies and appropriateness process; specific optimisation tailored to the clinical condition and patient habitus; wider utilisation of the automatic exposure monitoring systems with an integrated option for individual exposure tracking in standardised patient-specific risk metrics; improved training and communication. The integration of the clinical and exposure history data will support improved knowledge about radiation risks from low doses and individual radiosensitivity. The radiation protection framework will need to respond to the challenge of recurrent imaging and high individual doses. The radiation protection perspective complements the clinical perspective, and the risk to benefit analysis must account holistically for all incidental and long-term benefits and risks for patients, their clinical history and specific needs. This is a step toward the patient-centric health care.

scholarly journals Incomplete Restoration of Homeostatic Shear Stress Within Arteriovenous Fistulae

2012 ◽  
Vol 135 (1) ◽  
Author(s):  
Patrick M. McGah ◽  
Daniel F. Leotta ◽  
Kirk W. Beach ◽  
R. Eugene Zierler ◽  
Alberto Aliseda
Keyword(s):  
3D Ultrasound ◽  
Patient Specific ◽  
Shear Stresses ◽  
Arteriovenous Fistulae ◽  
Vessel Remodeling ◽  
Mechanical Homeostasis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hemodynamic Simulations

Arteriovenous fistulae are surgically created to provide adequate access for dialysis patients suffering from end-stage renal disease. It has long been hypothesized that the rapid blood vessel remodeling occurring after fistula creation is, in part, a process to restore the mechanical stresses to some preferred level, i.e., mechanical homeostasis. We present computational hemodynamic simulations in four patient-specific models of mature arteriovenous fistulae reconstructed from 3D ultrasound scans. Our results suggest that these mature fistulae have remodeled to return to ‘‘normal’’ shear stresses away from the anastomoses: about 1.0 Pa in the outflow veins and about 2.5 Pa in the inflow arteries. Large parts of the anastomoses were found to be under very high shear stresses >15 Pa, over most of the cardiac cycle. These results suggest that the remodeling process works toward restoring mechanical homeostasis in the fistulae, but that the process is limited or incomplete, even in mature fistulae, as evidenced by the elevated shear at or near the anastomoses. Based on the long term clinical viability of these dialysis accesses, we hypothesize that the elevated nonhomeostatic shear stresses in some portions of the vessels were not detrimental to fistula patency.

Emerging Therapy-Related Kidney Disease

2009 ◽  
Vol 133 (2) ◽  
pp. 268-278
Author(s):  
Lois J. Arend ◽  
Tibor Nadasdy
Keyword(s):  
Kidney Disease ◽  
Renal Injury ◽  
Recent Literature ◽  
Renal Toxicity ◽  
Kidney Injury ◽  
Clinical History ◽  
Drug Induced ◽  
Stage Renal Disease ◽  
End Stage

Abstract Context.—Many new therapies have emerged within the last 5 to 10 years to treat a variety of conditions. Several of these have direct or indirect renal toxicities that may go undiagnosed without careful attention of the pathologist to a patient's clinical history, particularly the addition of new medications or treatments. Objective.—To discuss patterns of renal injury resulting from medications or therapeutic regimens that have been introduced within the last 10 years. Recognition of these patterns may allow the pathologist to alert the attending clinician to a possible drug-induced renal injury and prevent further deterioration of renal function and possible chronic kidney disease. Data Sources.—A review of recent literature and unpublished observations of case-derived material. Conclusions.—A number of newer therapies have emerged as agents of renal toxicity, producing a variety of pathologic changes in the kidney. The outcome can be acute or chronic glomerular, tubular, interstitial, and/or vascular injury. Some drugs will result in irreversible changes and end-stage renal disease, whereas many of the alterations can be reversed with removal of the offending agent, avoiding potential long-term kidney injury.

Developing Training Tools for Clinicians in LICs: A Qualitative Investigation of the Patient Factors That Influence Prosthetic Prescription

2020 ◽  
Author(s):  
Michael Walker ◽  
Pratima Saravanan ◽  
Jessica Menold
Keyword(s):  
Activity Level ◽  
Patient Specific ◽  
Specific Information ◽  
Material Resources ◽  
Health History ◽  
Medical Infrastructure ◽  
Lower Income Countries ◽  
Future Work

Abstract A prosthesis is a replacement limb that must be functionally sound, comfortably fit, durable, and aesthetically pleasing. Difficulty in prescription is further amplified by each patient’s unique needs and the variability within patient data. The clinician’ s education and prior training is critical in effectively navigating the wealth of patient specific information needed to prescribe a prosthesis and rehabilitation plan that increases the likelihood of long-term patient success. Education and training significantly vary, however, from country to country, and in Lower Income Countries (LIC) a lack of formalized prosthetic training contributes to a lower quality of life for resident amputees. Prosthetists and technicians in LICs face further challenges due to a lack of material resources and formal medical infrastructure. This study was motivated to understand the types of patient information that influence decision-making strategies during prosthetic prescription and compare strategies across expert and novice groups. The results of this study suggest that salient factors are different between each clinician group and is influenced by the complexity of the patients’ case. Activity level of the amputee influenced novices’ prescription, whereas amputee’s motivation, insurance, and health history influenced experts’ prosthetic prescription. Future work exploring the utility of complimentary or supplemental prescription tools, particularly for prosthetists in LICs, is discussed.

Frequency of Gastrointestinal Diseases in Patients with End-Stage Renal Disease Treated with Long Term Dialysis

2018 ◽  
Vol 2 (2) ◽  
pp. 105-112
Author(s):  
Lutfi Zylbeari ◽  
Zamira Bexheti ◽  
Gazmend Zylbeari ◽  
Ferizate Haxhirexha ◽  
Kastriot Haxhirexha
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Gastrointestinal Diseases ◽  
Stage Renal Disease ◽  
End Stage

The effects of long-term vigorous endurance exercise on the coronary arteries

2019 ◽  
Vol 67 (2) ◽  
Keyword(s):  
Endurance Training ◽  
Coronary Atherosclerosis ◽  
Calcium Score ◽  
The Other ◽  
Disease Phenotype ◽  
Male Athletes ◽  
Artery Disease ◽  
Future Work ◽  
Summary Data

Moderate endurance training is known to improve cardiovascular risk factors, and prolongs life expectancy. On the other hand, there has been some discussion whether “too much” exercise might have a contrarious effect by accelerating coronary atherosclerosis. The goal of this review was to evaluate the current literature on the effects of long-term vigorous endurance training on the coronary vasculature. In summary, data point to an increased calcium score, and a higher burden of atherosclerotic plaque in male athletes compared to sedentary controls. However, the plaques found in athletes were more prone to be calcified. The pathogenesis and clinical relevance of this athlete coronary artery disease phenotype remains incompletely understood and represents an area of important future work.

The effects of long-term vigorous endurance exercise on the coronary arteries

2019 ◽  
Vol 67 (2) ◽  
Keyword(s):  
Endurance Training ◽  
Coronary Atherosclerosis ◽  
Calcium Score ◽  
The Other ◽  
Disease Phenotype ◽  
Male Athletes ◽  
Artery Disease ◽  
Future Work ◽  
Summary Data

Moderate endurance training is known to improve cardiovascular risk factors, and prolongs life expectancy. On the other hand, there has been some discussion whether “too much” exercise might have a contrarious effect by accelerating coronary atherosclerosis. The goal of this review was to evaluate the current literature on the effects of long-term vigorous endurance training on the coronary vasculature. In summary, data point to an increased calcium score, and a higher burden of atherosclerotic plaque in male athletes compared to sedentary controls. However, the plaques found in athletes were more prone to be calcified. The pathogenesis and clinical relevance of this athlete coronary artery disease phenotype remains incompletely understood and represents an area of important future work.

Positive Emotion in Generalized Anxiety Disorder

2019 ◽  
pp. 297-311
Author(s):  
Ilana Seager ◽  
Douglas S. Mennin ◽  
Amelia Aldao
Keyword(s):  
Anxiety Disorder ◽  
Positive Affect ◽  
Generalized Anxiety Disorder ◽  
Positive Emotion ◽  
Behavioral Therapy ◽  
Generalized Anxiety ◽  
Emotional Dysfunction ◽  
Wide Range ◽  
Future Work

Generalized anxiety disorder (GAD) is a debilitating condition characterized by excessive, pervasive, uncontrollable, and paralyzing worries about a wide range of future situations. Individuals with this condition frequently find themselves stuck in worry and tension cycles in futile attempts at reducing uncertainty and increasing control. GAD has been associated with substantial impairments in functioning and reduced quality of life. GAD remains poorly understood, and the long-term efficacy and end-state functioning resulting from treatment are weaker compared to other anxiety disorders. Some treatments (e.g., emotion regulation therapy, acceptance-based behavioral therapy) have improved efficacy, partly by targeting emotional dysfunction. Basic psychopathology research has focused on identifying the role of negative affect in GAD, so little is known about how positive affect is experienced and regulated in this disorder. This is particularly important in light of the overlap of this condition with major depressive disorder, which is characterized by low or suppressed positive emotion. Developing such an understanding is essential to further improve the efficacy of emotion-based treatments. This chapter reviews current and future directions in the study of positive affect in GAD. The chapter reviews the nascent research on positive affect and GAD, then illustrates dimensions of future work.

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