Metrology for radiation protection: a new European network in the foundation phase

Abstract. More than 23 million workers worldwide are occupationally exposed to ionizing radiation and all people in the world are exposed to environmental radiation. The mean exposure, that is the mean annual dose of per person, is dominated by medical applications and exposure to natural sources. Due to recent developments in healthcare, e.g. the increasing application of ionising radiation in medical imaging with relative high doses like CT, and modern high dose applications (for example CT angiography), the exposure due to medical application has risen. Additionally, the changes in living conditions increase the exposure to natural radioactivity also: More living time is spent in buildings or in an urban environment, which causes higher exposure to Naturally Occurring Radioactive Materials (NORM) in building materials and higher exposure to radon. The level of radon activity concentration in buildings is far higher than in the environment (outdoor). This effect is often amplified by modern energy-efficient buildings which reduce the air exchange and thus increase the radon indoor activity concentration. In summary both medical application of ionizing radiation and natural sources are responsible for the increase of the mean annual exposure of the population. The accurate measurement of radiation dose is key to ensuring safety but there are two challenges to be faced: First, new standards and reference fields are needed due to the rapid developments in medical imaging, radiotherapy and industrial applications. Second, direct communication channels are needed to ensure that information on best practice in measurements reaches effectively and quickly the people concerned. It is therefore necessary to allow for an international exchange of information on identified problems and solutions. Consequently, a European Metrology Network (EMN) for radiation protection under the roof of EURAMET is in the foundation phase. This network EMN for Radiation Protection is being prepared by the project EMPIR 19NET03 supportBSS. The project aims to prepare this EMN by addressing this issue through the identification of stakeholder research needs and by implementing a long-term ongoing dialogue between stakeholders and the metrology community. The EMN will serve as a unique point of contact to address all metrological needs related to radiation protection and it will relate to all environmental processes where ionising radiation and radionuclides are involved. A Strategic Research Agenda and two roadmaps are in development, covering the metrology needs of both the Euratom Treaty and the EU Council Directive 2013/59/EURATOM pinning down the basic safety standards for protection against the dangers arising from exposure to ionizing radiation. Furthermore, long-term knowledge sharing, and capacity building will be supported and a proposal for a sustainable joint European metrology infrastructure is under way. This will significantly strengthen the radiation protection metrology and support radiation protection measures. The final goal of the network project is a harmonised, sustainable, coordinated and smartly specialised infrastructure to underpin the current and future needs expressed in the European regulations for radiation protection.

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Enlargement of cerebrospinal fluid spaces in long-term benzodiazepine abusers

Psychological Medicine ◽

10.1017/s0033291700000660 ◽

1987 ◽

Vol 17 (4) ◽

pp. 869-873 ◽

Cited By ~ 37

Author(s):

C. Schmauss ◽

J.-C. Krieg

Keyword(s):

Low Dose ◽

Matched Control ◽

Control Group ◽

High Dose ◽

Withdrawal Therapy ◽

The Mean ◽

Dose Dependent ◽

Dose Dependent Effect ◽

Age And Sex

SynopsisIn 17 benzodiazepine (BDZ) dependent in-patients a CT scan was performed before initiation of withdrawal therapy. The evaluation of the ventricular to brain ratio (VBR) by standardized and computerized measurements revealed significantly higher mean VBRs for both high-and low-dose BDZ-dependent patients compared to the mean VBR of an age- and sex-matched control group. In addition, the mean VBR of high-dose BDZ-dependent patients (N = 8) was significantly higher than the mean VBR of low-dose BDZ-dependent patients (N = 9). This difference could not be accounted for by the age of the patients or duration of BDZ-dependency and, therefore, suggests a dose-dependent effect of BDZs on the enlargement of internal CSF-spaces. On the other hand, higher values for the width of external CSF-spaces were found to be related to increasing age of the patients and duration of BDZ-dependency.

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Costs per Treatment Phase for AML Patients Receiving High-Dose Chemoterapy in Sweden

Blood ◽

10.1182/blood-2019-127957 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2154-2154

Author(s):

Emma Hernlund ◽

Josefine Redig ◽

Åsa Rangert Derolf ◽

Bjorn Paulsson ◽

Martin Höglund ◽

...

Keyword(s):

Complete Remission ◽

Resource Use ◽

Treatment Phase ◽

High Dose ◽

Curative Intent ◽

Swedish Cancer Registry ◽

The Mean ◽

Mean Cost ◽

First Admission

Introduction: AML affects all ages with an incidence rate of 5 per 100,000, but is much more frequent in older population. The overall lifetime risk of AML is estimated to be 0.5-1%. Long-term overall survival in younger (age < 60 years) is about 50%, but much worse among older population. Although AML therapy is one of the most resource-intensive cancer treatments, there are few estimates of the resource use and economic burden by treatment phase. Methods: This study was a retrospective database study performed on Swedish national data. Adult patients (age ≥18 years) diagnosed with AML in Sweden between 2007 and 2015 were identified in the Swedish Cancer Registry, along with vital status. Data on resource use were collected from national registers for inpatient- and outpatient specialized care and prescribed drugs. Information on diagnostics and treatment was accessed from the Swedish national AML Registry (SwAMLR). Data on sick leave (SL) and early retirement (ER) came from the Swedish Social Insurance Agency (absent days costed with the mean salary in Sweden). Hospital care resource use was costed using diagnosis-related group (DRG) remunerations, and include cost of inpatient drugs. The mean cost from the defined start of the treatment phase until the end of the treatment phase was divided by the mean number of days for the corresponding treatment phase to estimate the mean cost per day. The defined treatment phases were restricted to a maximum of 5 years. All costs are represented in US$. Results: Of the 2,954 patients identified in the Swedish Cancer Registry, 1,772 patients with a median age of 64 years were identified in the SwAMLR as fit for receiving high-dose chemotherapy . Of these, 1,243 were recorded with both curative intent of treatment and dates for achieving complete remission. Mean costs from the first AML-related hospital admission until the date of complete remission amount to $27,244. The mean number of days for the corresponding period were 45.16, resulting in a mean cost per day of $603 from first admission to first complete remission. The corresponding cost per day for patients recorded with curative intent but no complete remission (n=428) are $494. Time was counted from first AML-related admission until 90 days after first admission, or SCT or death, whichever occurred first. Costs after complete remission to either relapse, SCT, death or re-induction (n=1,237) amount to $50,793 for a mean of 438.63 days ($116/day). This treatment phase includes long-term survivors, whereas the costs from SCT, relapse or re-induction are not included. From relapse to death, the total cost is almost twofold for patients with re-induction (n=350) compared to palliative treatment (n=254). Cost per day amount to $179 for patients with palliative treatment and $256 for patients with re-induction treatment, respectively. The cost per day from date of SCT to death (n=511) is estimated to $192, incurred over a long period of time (mean number of days 844.02). The age of transplant recipients ranged between 18-71 years, with a median of 52 years. Conclusions: Costs of AML up to remission are feasible to estimate through DRG-costing methods, and studies have shown these costs are intense. Indeed this study shows that the highest cost per day is observed from first admission to complete remission. In addition results from our study show that there are high costs incurred also in the long-term, i.e. after remission. Of the included treatment phases the total cost from date of SCT to death is the largest, amounting to over $160,000. Approximately 20% are due to SL/ER, which is the second largest cost component after inpatient costs accounting for 60% of the total costs. Table. Disclosures Hernlund: ICON: Employment. Redig:ICON: Employment. Paulsson:Novartis: Employment. Vertuani:Novartis: Employment.

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Conceptual Approach to Creating a Complex System of Radiation Protection in the Conditions of Influence of High-Dose Fields of Ionizing Radiation

Medical Radiology and radiation safety ◽

10.12737/1024-6177-2019-64-6-25-30 ◽

2019 ◽

Vol 64 (6) ◽

pp. 25-30

Author(s):

V. Solov'ev ◽

Andrey Bushmanov ◽

V. Zorin ◽

M. Grachev

Keyword(s):

Complex System ◽

Ionizing Radiation ◽

Radiation Protection ◽

Lumbar Vertebrae ◽

Human Operator ◽

Professional Activity ◽

High Dose ◽

Conceptual Approach ◽

Red Bone Marrow ◽

Important Place

The general approaches and criteria for substantiating the complex system of radiation protection (RP) of a human operator in the conditions of work in high-dose fields of ionizing radiation are considered. When planning work in such conditions, it is advisable to consider a set of measures of an organizational, technical and medical nature. Each activity has its measures own limits to reduce the dose load on the human operator or the development of adverse effects of radiation, and in some cases only a combination of them can give a certain protective effect, allowing to carry out the necessary activities in such conditions. If an operator works in mobile technical facilities (for example, a bulldozer, a caterpillar all-terrain vehicle, a helicopter, etc.) an important place is occupied by the issue of strengthening the technical component of the RP, primarily by engineering the design of additional shield elements. The biomedical rationale for the optimality of such protection is givenensuring maximum protection of vital organs, in the first place, red bone marrow, a significant volume of which is concentrated in the bones in the lumbar vertebrae, sacrum and pelvis. Several examples of the performance of professional activity of operator in the conditions of high-dose ionizing radiation fields and an expert evaluation of the limiting capabilities of the technical and medical component of the integrated RP are considered.

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RADIOLOGICAL ASSESSMENT OF IONIZING RADIATION IMPACT ON THE TERRESTRIAL NON-HUMAN BIOTA IN LITHUANIA

Journal of Environmental Engineering and Landscape Management ◽

10.3846/16486897.2015.1043305 ◽

2015 ◽

Vol 23 (4) ◽

pp. 295-301 ◽

Cited By ~ 1

Author(s):

Marina KONSTANTINOVA ◽

Nina PROKOPČIUK ◽

Arūnas GUDELIS ◽

Donatas BUTKUS

Keyword(s):

Ionizing Radiation ◽

Nuclear Power ◽

Activity Concentration ◽

Assessment Tool ◽

Natural Radionuclides ◽

Soil Layer ◽

Software Application ◽

Dose Rates ◽

Top Soil

The quantitative assessment of radionuclides transfer to non-human biota using their activity concentration ratios is required for models of predictive doses of ionizing radiation. Based on long-term data regarding activity concentration of radionuclides in the top soil layer of the entire territory of Lithuania, and with the help of ERICA Assessment Tool – a software application that calculates dose rates to selected biota, we estimated the radiological impact on the terrestrial non-human biota with special emphasis on the protected areas located in the vicinity of Ignalina Nuclear Power Plant (INPP). Estimated total dose rates of artificial radionuclides – after-Chernobyl 137Cs and 90Sr as well as discharged by INPP – and natural radionuclides, such as 238U and 232Th, were found to be less than ERICA screening value of 10 μGy h–1.

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A survey of methadone prescribing at an inner-city drug service and a comparison with national data

Psychiatric Bulletin ◽

10.1192/pb.27.5.167 ◽

2003 ◽

Vol 27 (05) ◽

pp. 167-170 ◽

Cited By ~ 3

Author(s):

John Dunn

Keyword(s):

Inner City ◽

Methadone Maintenance ◽

Clinical Implications ◽

High Dose ◽

National Data ◽

Methadone Dose ◽

National Surveys ◽

Time In Treatment ◽

The Mean

Aims and Method Surveys suggest that UK drug services under-prescribe methadone to opiate-dependent patients. This study investigated methadone prescribing for 169 patients on long-term methadone at a specialist drug service. Results The mean methadone dose for patients on maintenance was 65.8 mg, and 67.7% were taking 50 mg or more. Mean doses in relation to methadone formulation varied substantially: mixture 57.4 mg, tablets 81.8 mg and ampoules 113.0 mg. These figures are higher than those reported from national surveys. The proportion of urine screens positive for illicit opiates was inversely related both to methadone dose and length of time in treatment. Clinical Implications This survey shows the levels of methadone prescribing at an inner-city drug service and gives support to the effectiveness of high-dose methadone maintenance.

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Assessment of the Knowledge of CT Scanner Operators on the Use of Dose Reduction Software Called Automatic Exposure Control (AEC) During a CT Scan

10.21203/rs.3.rs-754054/v1 ◽

2021 ◽

Author(s):

Eddy Fotso Kamdem ◽

Odette Ngano Samba ◽

Serge Abogo ◽

Joshua Tambe ◽

Jean Claude Mballa Amougou ◽

...

Keyword(s):

Medical Imaging ◽

Ionizing Radiation ◽

Dose Reduction ◽

Radiation Protection ◽

Ct Scanner ◽

Wrong Answer ◽

Public And Private ◽

Potential Risks ◽

Radiology Technicians ◽

Public And Private Hospitals

Abstract Objectif : Evaluate the knowledge of medical imaging technicians on the use of dose reduction software and the concept of patient radiation protection.Materials and methods : Descriptive and analytical transversal study from January 1 to December 1, 2020, conducted in the radiology and medical imaging services of Cameroon's public and private hospitals with a CT scanner. It was the first study on this topic that was conducted in Cameroon. This study was conducted from a questionnaire distributed to all medical imaging technicians in 10 country hospitals relating to the notions of dose reduction software and patient radiation protection.Results: 80 questionnaires were distributed and analyzed. The average age of medical imaging technicians was 30 years old. There were 32 women and 48 men. Most of the medical imaging technicians worked in private centers (n = 6). 75% of medical imaging technicians had been in practice for more than 5 years. 75% of medical imaging technicians gave the wrong answer regarding the use of dose reduction software. Finally, only a third of the practitioners had received training in patient radiation protection.Conclusion : Although the majority of medical imaging technicians declares to take into account the dangers related to ionizing radiation during examinations, a broader dissemination of patient radiation protection training and the use of dose reduction software, particularly during the initial curriculum. Radiology technicians could be one of the solutions to improve the knowledge of hospital practitioners in patient radiation protection. However, the use of ionizing radiation, however, need to know and take into account the potential risks of radio-induced cancer linked to high X-ray doses.

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Results of the Largest Study on Post-Transplant-Lymphoproliferations (PTLDs) of the Central Nervous System (CNS) in the Rituximab Era: A Surprising Overrepresentation of Kidney Transplantations, Key Importance of Methotrexate (Mtx), Cytarabine (AraC) and Radiotherapy (RX) for Long Term Survival and Low Impact of Rituximab (R)

Blood ◽

10.1182/blood.v112.11.3614.3614 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3614-3614 ◽

Cited By ~ 2

Author(s):

Sylvain Choquet ◽

Stefan Oertel ◽

Ioannis Anagnostopoulos ◽

Hanno Riess ◽

Madalina Uzunov ◽

...

Keyword(s):

Overall Survival ◽

University Hospital ◽

High Dose ◽

Solid Organ ◽

Cns Involvement ◽

Term Survival ◽

Long Term Survival ◽

The Mean ◽

The Impact

Abstract Background: PTLD is a rare and severe complication of solid organ and hematopoetic stem cell transplantation and CNS localizations are well known to be associated with an unfavourable outcome. Published data on PTLD with CNS involvement (CNS-PTLDs) are nearly inexistent and the impact of rituximab is unknown. Methods: We performed a retrospective analysis on CNS-PTLDs in two centres, the Pitié salpêtrière university hospital in Paris, France, and the Charité university hospital in Berlin, Germany, in order to have an homogeneous way to handle these diseases and to avoid biases of large national registers. PTLDs with extra-CNS localization were excluded. While attitudes for diagnosis, staging and initial immunosuppression diminution were identical, one centre largely used intravenous (iv) rituximab and radiotherapy while the other preferred high dose chemotherapy. The Pitié Salpêtrière series of 72 PTLD patients without CNS involvement served as a control population to identify specific disease characteristics of primary CNS-PTLD. Results: 24 patients with CNS-PTLD (median age 55y) have been analyzed and compared to the non-CNS PTLD group (table I). The mean follow-up of patients alive is 5 years. Primary CNS-PTLD are clearly of late onset (mean 1366 days after transplantation) with only 3/24 patients diagnosed within the first year after transplantation. There was a significant overrepresentation of renal allografts in the CNS-PTLD group as compared to PTLDs without CNS involvement, (75% vs 29%). Primary CNS-PTLDs were always of B-cell phenotype and tumors were EBV positive in 88% of cases. Treatment of primary CNS-PTLDs consisted of chemotherapy (CT) alone with high dose (HD) Mtx and/or HD AraC in 8 cases, intrathecal (it) Mtx only in 1 case and it single agent rituximab in 1 case. Rituximab has been used in combination with CT in 2 cases. Radiotherapy (RX) was used at a mean dose of 30 Gy in combination with CT in 6 patients, and in combination with rituximab in 6 patients. The overall survival of patients suffering from primary CNS-PTLD was 180 days, but some patients obtained sustained complete remissions (CR) and 11 survived more than one year [395d – 3965d]. Eight patients are alive at the time of analysis, 9 died of PTLD progression and 2 by early sepsis. The mean DFS is 1456 days. Among the 13 patients obtaining a CR, only one relapsed 6 years after his first PTLD diagnosis in an extra CNS form. Five patients died, 3 by sudden death (d60, d408, d671), one by cerebral toxoplasmosis (d703) and one by sepsis (d91). Among patients with long term survival, 5 have been treated with CT alone, 3 by RX +/− R and 3 with combined CT-RX. The role of rituximab in primary CNS-PTLD is still unclear, as only 4/9 patients treated with rituximab achieved survival, all the more so since it as been always used but once in association. Concusion: Primary CNS-PTLD is a specific entity inside the PTLD family, with a high representation of kidney grafts and EBV positive tumors. As in immunocompetent patients, long survival is possible, especially with HD CT with or without RX. The impact of rituximab seems to be reduced. CNS-PTLD Non CNS PTLD n 24 72 Age (years) 55 47 Sex ratio (M/F) 12/12 49/72 Delay from transplantation 1366 days 830 Kidney transplantation 75% (18/24) 29% Monomorphic/polymorphic 86% (19/22) 68% B phenotype 100% (24/24) 90% EBV positive (tumor) 88% (21/24) 71% ECOG > 2 33% (7/21) 14% (18/70) Overall survival 180 days 372 days Table1: comparison between primary CNS-PTLD and non CNS-PTLD

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High-dose desvenlafaxine in outpatients with major depressive disorder

CNS Spectrums ◽

10.1017/s1092852912000508 ◽

2012 ◽

Vol 17 (3) ◽

pp. 121-130 ◽

Cited By ~ 4

Author(s):

James M. Ferguson ◽

Karen A. Tourian ◽

Gregory R. Rosas

Keyword(s):

Major Depressive Disorder ◽

Adverse Events ◽

Depressive Disorder ◽

Dose Range ◽

Term Treatment ◽

High Dose ◽

Major Depressive ◽

Long Term Treatment ◽

The Mean

ObjectiveThis study investigated the safety and efficacy of long-term treatment with high-dose desvenlafaxine (administered as desvenlafaxine succinate) in major depressive disorder (MDD).MethodsIn this multicenter, open-label study, adult outpatients with MDD aged 18–75 were treated with flexible doses of desvenlafaxine (200–400 mg/d) for ≤ 1 year. Safety assessments included monitoring of treatment-emergent adverse events (TEAEs), patient discontinuations due to adverse events, electrocardiograms, vital signs, and laboratory determinations. The primary efficacy measure was mean change from baseline in the 17-item Hamilton Rating Scale for Depression [HAM-D(17)] total score.ResultsThe mean daily desvenlafaxine dose range over the duration of the trial was 267–356 mg (after titration). The most frequent TEAEs in the safety population (n = 104) were nausea (52%) and headache (41%), dizziness (31%), insomnia (29%), and dry mouth (27%). All TEAEs were mild or moderate in severity. Thirty-four (33%) patients discontinued from the study because of TEAEs; nausea (12%) and dizziness (9%) were the most frequently cited reasons. The mean change in HAM-D(17) total score for the intent-to-treat population (n = 99) was −9.9 at the last on-therapy visit in the last-observation-carried-forward analysis and −14.0 at month 12 in the observed cases analysis.ConclusionHigh-dose desvenlafaxine (200–400 mg/d) was generally safe and effective in the long-term treatment of MDD.

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EURAMED’s vision on medical radiation protection (research)

Annals of the ICRP ◽

10.1177/0146645318759621 ◽

2018 ◽

Vol 47 (3-4) ◽

pp. 152-158 ◽

Cited By ~ 2

Author(s):

C. Hoeschen

Keyword(s):

Radiation Protection ◽

Research Agenda ◽

Medical Application ◽

Ionising Radiation ◽

Strategic Research ◽

Reduce Radiation Exposure ◽

Medical Radiation ◽

Set Up ◽

Areas Of Interest ◽

First World

While many areas of radiation protection have formed so-called ‘platforms’ in Europe which provide strategic research agendas for their areas of interest, this did not happen for a long while for medical exposure, which is the application of ionising radiation that causes the greatest man-made exposure, at least in first world countries. Finally, in 2015, a European medical radiation protection strategic research agenda was set up, and a corresponding platform was launched in 2016. This was named ‘EURAMED’ – the European Alliance for Medical Radiation Protection Research. In its strategic research agenda, EURAMED defined its vision for medical radiation protection and the corresponding research needed. Five major topics were identified, ranging from measurements of medical application-related parameters such as exposures and image quality and radiation biology aspects relevant for medical applications to individual optimisation strategies, to optimal use of techniques and harmonisation of practises, and finally to justification of the use of ionising radiation in medicine, all based on sufficient infrastructures for quality assurance. The ultimate goal is to reduce radiation exposure and risk individually for patients and staff by interdisciplinary research between clinicians, physicists, and engineers. Therefore, it is essential that the results are translated into clinical practice.

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Have Progestin Related and Sporadic High Grade Meningiomas the Same Natural History?

10.21203/rs.3.rs-680956/v1 ◽

2021 ◽

Author(s):

Antoine Devalckeneer ◽

Rabih Aboukais ◽

Maxime Faisant ◽

Philippe Bourgeois ◽

Vannod-Michel Quentin ◽

...

Keyword(s):

Gamma Knife Radiosurgery ◽

Intracranial Meningioma ◽

High Dose ◽

High Grade ◽

Long Term Outcome ◽

Nomegestrol Acetate ◽

Grade Ii ◽

The Mean

Abstract Introduction: High grade progestin related meningiomas have been reported in recent series but we found no previous study describing their long-term outcome. Our study aimed to evaluate patients operated on for high grade intracranial meningioma and who underwent long term exposure to high dose of cyproterone acetate, nomegestrol acetate and chlormadinone acetate.Methods: Our study retrospectively included 9 patients with high grade progestin related intracranial meningioma between December 2006 and December 2020. In each patient, clinico-radiological follow-up was performed every 6 months after diagnosis and treatment withdrawal recommendation. Results: The mean progestative exposure was 11.4 years. Edema existence or absence of cleft sign on MRI were the key factors for surgical indication. All patients underwent surgery. Ajduvant radiotherapy was indicated in 1 patient, and Gamma Knife Radiosurgery was proposed in 2 other patients for a second location of mengioma. 6 patients harbored a grade II chordoïd meningioma subtype with 100% PR expression and 3 patients a grade II atypical meningioma subtype with lower PR expression. The mean follow-up was 7.1 years and none of the 9 patients presented with a recurrence.Conclusion: Patients with Grade II progestin related meningiomas have less tumor recurrence after surgery than patients with sporadic high grade meningomas, especially after progestin withdrawal. The presence/ appearance of peri-meningioma edema and the absence of cleft sign before volumetric change should suggest the existence of an underlying high grade meningioma. In these cases, surgical resection may immediately be considered and adjuvant radiotherapy should be reserved for proven recurrence cases.

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