Comparison of Mean Glandular Dose between Full-Field Digital Mammography and Digital Breast Tomosynthesis

Early detection of breast cancer is diagnosed using mammography, the gold standard in breast screening. However, its increased use also provokes radiation-induced breast malignancy. Thus, monitoring and regulating the mean glandular dose (MGD) is essential. The purpose of this study was to determine MGD for full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in the radiology department of a single centre. We also analysed the exposure factors as a function of breast thickness. A total of 436 patients underwent both FFDM and DBT. MGD was auto calculated by the mammographic machine for each projection. Patients’ data included compressed breast thickness (CBT), peak kilovoltage (kVp), milliampere-seconds (mAs) and MGD (mGy). Result analysis showed that there is a significant difference in MGD between the two systems, namely FFDM and DBT. However, the MGD values in our centre were comparable to other centres, as well as the European guideline (<2.5 mGy) for a standard breast. Although DBT improves the clinical outcome and quality of diagnosis, the risk of radiation-induced carcinogenesis should not be neglected. Regular quality control testing on mammography equipment must be performed for dose monitoring in women following a screening mammography in the future.

Kajian pemantauan dosis neutron terhadap pekerja radiasi pada pengoperasian Linac dengan energi foton ≥ 10 MV

The use of Linac for radiotherapy is starting to use a lot of high-energy photons of 10 MV; in addition, some use 15 MV for patient therapy in routine use, there is also the use of 6 MV. The purpose of this study is to obtain an overview and information of the neutron dose that has the potential to provide additional doses for radiation workers operating the Linac 10 MV aircraft. Based on the Regulation of the Head of BAPETEN No. 3 of 2013, Article 48 paragraph (2) states that in the operation of Linac with X-ray photon energies above 10 MV, must coat the shield wall with a neutron-absorbing material. The statement follows the IAEA-TecDoc 1891 that neutrons will have the potential to have a significant radiological impact on workers if routinely operated at energies above 10 MV, so must consider protection for workers. The results of a survey from 27 hospitals, obtained information through filling out questionnaires and discussions and validated with B@LIS Pendora, it found that the trend of annual doses received by each profession in the operation of Linac 6 MV, 10 MV, and 15 MV was less than one mSv, only partially small worker dose that is above one mSv (above the 90th percentile). This study concluded that the presence of neutrons in Linacs up to 10 MV was deemed not to have a significant radiological impact on workers. The recommended criteria/mechanism for monitoring worker neutron doses in Linacs up to 10 MV could be based on if the safety study results obtained a dose received by workers 1.5 mSv/year. Then, there is no need to monitor the neutron dose. If the measurement results of exposure to neutron and gama radiation around the Linac space are 7.5 microSv/hour, there is no need for neutron monitoring. In Linacs above 10 MV, if the annual effective dose is 1.5 mSv/year, there is no need to monitor the dose of special neutron personnel. Still, routine radiation exposure monitoring may be considered every two years. Keywords: Neutron Dose, Radiation Worker, Linac, Dose Monitoring.

Diagnostic reference levels in digital mammography: A systematic review

Diagnostic reference levels (DRLs) in digital mammography (DM) serve as a useful benchmark for dose monitoring and optimization, allowing comparison amongst countries, institutions and mammography units. A systematic review of DRLs in DM, published in 2014, reported a lack of consistent and internationally accepted protocol in DRLs establishment, thereby resulting in wide variations in methodologies which complicates comparability between studies. In 2017, the International Commission of Radiation Protection (ICRP) published additional guidelines and recommendations to provide clarity in the protocol used in DRLs establishment. With the continuing evolvement of technology, optimization of examinations and updates in guidelines and recommendations, DRLs should be revised at regular intervals. This systematic review aims to provide an update and identify a more consistent protocol in the methodologies used to establish DRLs. Searches were conducted through Web of Science, PubMed-MEDLINE, ScienceDirect, CINAHL and Google Scholar, which resulted in 766 articles, of which 19 articles were included after screening. Relevant data from the included studies were summarized and analyzed. While the additional guidelines and recommendations have provided clarifications in the methodologies used in DRLs establishment, such as data source (i.e., the preference to use data derived from patient instead of phantoms to establish DRLs), protocol (i.e., stratification of DRLs by compressed breast thickness and detector technology, and the use of median value for DRLs quantity instead of mean) and percentiles used to establish DRLs (i.e., set at the 75th percentile with a minimum sample size of 50 patients), other differences such as the lack of a standard dose calculation method used to estimate mean glandular dose continues to complicate comparisons between studies and different DM systems. This systematic review update incorporated the updated guidelines and recommendations from ICRP which will serve as a useful resource for future research efforts related to DRLs, dose monitoring and optimization.

Exploring population pharmacokinetic models in patients treated with vancomycin during continuous venovenous haemodiafiltration (CVVHDF)

Background Therapeutic antibiotic dose monitoring can be particularly challenging in septic patients requiring renal replacement therapy. Our aim was to conduct an exploratory population pharmacokinetic (PK) analysis on PK of vancomycin following intermittent infusion in critically ill patients receiving continuous venovenous haemodiafiltration (CVVHDF); focussing on the influence of dialysis-related covariates. Methods This was a retrospective single-centre tertiary level intensive care unit (ICU) study, which included patients treated concurrently with vancomycin and CVVHDF between January 2015 and July 2016. We extracted clinical, laboratory and dialysis data from the electronic healthcare record (EHR), using strict inclusion criteria. A population PK analysis was conducted with a one-compartment model using the PMetrics population PK modelling package. A base structural model was developed, with further analyses including clinical and dialysis-related data to improve model prediction through covariate inclusion. The final selected model simulated patient concentrations using probability of target attainment (PTA) plots to investigate the probability of different dosing regimens achieving target therapeutic concentrations. Results A total of 106 vancomycin dosing intervals (155 levels) in 24 patients were examined. An acceptable 1-compartment base model was produced (Plots of observed vs. population predicted concentrations (Obs–Pred) R2 = 0.78). No continuous covariates explored resulted in a clear improvement over the base model. Inclusion of anticoagulation modality and vasopressor use as categorical covariates resulted in similar PK parameter estimates, with a trend towards lower parameter estimate variability when using regional citrate anti-coagulation or without vasopressor use. Simulations using PTA plots suggested that a 2 g loading dose followed by 750 mg 12 hourly as maintenance dose, commencing 12 h after loading, is required to achieve adequate early target trough concentrations of at least 15 mg/L. Conclusions PTA simulations suggest that acceptable trough vancomycin concentrations can be achieved early in treatment with a 2 g loading dose and maintenance dose of 750 mg 12 hourly for critically ill patients on CVVHDF.

Ensuring hemodialysis adequacy by dialysis dose monitoring with UV spectroscopy analysis of spent dialyzate

Introduction: Patients’ session-to-session variation has been shown to influence outcomes, making critical the monitoring of dialysis dose in each session. The aim of this study was to detect the intra-patient variability of blood single pool Kt/V as measured from pre-post dialysis blood urea and from the online tool Adimea®, which measures the ultraviolet absorbance of spent dialyzate. Methods: This open, one-armed, prospective non-interventional study, evaluates patients on bicarbonate hemodialysis or/and on hemodiafiltration. Dialysis was performed with B. Braun Dialog+ machines equipped with Adimea®. In the course of the prospective observation, online monitoring with Adimea® in each session was established without the target warning function being activated. A sample size of 97 patients was estimated. Results: A total of 120 patients were enrolled in six centers in China (mean age 51.5 ± 12.2 years, 86.7% males, 24.2% diabetics). All had an AV-fistula. The proportion of patients with blood Kt/V < 1.20 at baseline was 48.3%. During follow-up with Adimea®, the subgroup with Kt/V > 1.20 at baseline remains at the same adequacy level for more than 90% of the patients. Those with a Kt/V < 1.20 at baseline, showed a significant increase of Kt/V to 60% of the patients reaching the adequacy level >1.20. The coefficient of variation for spKt/V as evaluated by Adimea® was 9.6 ± 3.4%, not significantly different from the 9.6 ± 8.6% as blood Kt/V taken at the same time. Conclusion: Online monitoring of dialysis dose by Adimea® improves and maintains dialysis adequacy. Implementing online monitoring by Adimea into daily practice moves the quality of dialysis patient care a significant step forward.

Patient dose monitoring using exposure index against body mass index level on chest X-ray examination

The image quality factor is not merely a matter of whether the image is repeated or not, but also has a wide range of information and also has to maintain the protection method for the patient is the reception of the dose due to radiographic action. So it is necessary to monitor the patient's dose using the EI value. The factors that determine the EI value are the exposure factor and the thickness of the object or BMI (Body Mass Index). Exposure factors (kV and mAs) are factors that have been commonly used as patient dose monitoring, where the tube voltage is a component that changes more often with a relatively constant tube current. The study used data on patients with Thoracic examination at the age of 20-65 years which were then categorized into BMI. The analysis was carried out on the EI value contained in the radiographic image. The results showed that BMI in the normal, Light Grade Fat (LGF), Heavy Grade Fat (HGF) categories, respectively, the EI values were 1562, 1679, and 1955 for the female sex, and 1266, 1600, and 1821 for the male gender. Significantly (P?0.05) the EI value showed difference between female and male sexes.

CT-scan patient dose monitoring on thorax examination in general hospital Sanjiwani Gianyar

Currently, in the world of medicine, the use of medical devices is very important. Along with the development of technology, the need for imaging in radio diagnostics is getting higher. This can be seen from the increasing trend of using medical devices by experts that are tailored to the needs of patients. The progress of radiological examination is growing rapidly with the use of radiation sources, one of which is by using a CT-Scan (Computed Tomography Scanning). The use of CT-Scans must be monitored to ensure the protection and safety of workers, patients, and the public. Protection requirements that must be met in the use of radiation are optimization of radiation protection and safety. The optimization of radiation protection is determined from the diagnostic guide level or the Indonesian Diagnostic Reference Level (I-DRL). The data used in this study is a chest contrast examination with the category of adults (15 years and over). From the CT-Scan irradiation, the CTDIVol and DLP values ??were determined in the 3rd quartile (Q3=75 percentile).

General radiographic patient dose monitoring using conformity test data

Currently, the Nuclear Energy Supervisory Agency (BAPETEN) is actively guiding users or license holders related to patient protection against radiation hazards or often referred to as radiation protection and safety on medical exposure. Protection against medical exposure became a big issue when the mandatory compliance test on X-ray equipment for diagnostic and interventional radiology was introduced. In addition, license holders through their medical practitioners are also required to use the level of medical exposure guidelines. While PERKA BAPETEN No. 9, 2011 concerning the Suitability Test of Diagnostic and Interventional Radiology X-Ray device, states that one of the test parameters that directly affect the patient's radiation dose and determine the feasibility of operating the X-Ray device to the patient is information on the dose or rate of radiation dose received by the patient. Monitoring doses with Entrance Surface Air Kerma (ESAK) or what is often referred to as ESD (entrance surface dose) using suitability conformity test data starting from 50,60,70,80,90 and 100 kVp with 20 mAs at SID 100 meters. The results of the research on the value of ESAK was 0.049 mGy, an ESAK value that still met the national I-DRL value from BAPETEN Regulation No. 1211/K/V/2021.

Evaluation of subcutaneous daratumumab injections in the ambulatory care setting

Introduction Subcutaneous daratumumab is non-inferior to intravenous daratumumab for the treatment of multiple myeloma and significantly reduced incidence of systemic reactions. However, manufacturer for subcutaneous daratumumab has not provided guidance regarding optimal methods for monitoring for hypersensitivity reactions following subcutaneous daratumumab administration. Methods A retrospective analysis was performed in two cohorts of patients who received at least two doses of subcutaneous daratumumab for the treatment of plasma cell disorders: patients with previous exposure to intravenous daratumumab (dara-exposed) and patients without history of intravenous daratumumab (dara-naïve). The primary outcome was incidence of systemic and injection-site reactions following first dose of subcutaneous daratumumab. Secondary analysis included time to systemic and injection-site reactions, grading of adverse reaction, and incidence of second systemic reaction. Results Thirty-one patients were dara-naïve and 49 patients were dara-exposed. Differences in incidence of systemic (dara-naïve: 9.7% vs dara-exposed: 6.1%, p = 0.67) and injection-site reactions (dara-naïve: 12.9% vs dara-exposed: 14.3%, p = 0.99) did not reach statistical significance. Difference in median time to systemic reaction (dara-naïve: 3 h vs dara-exposed: 12 h, p = 0.18) was clinically important but did not reach statistical significance. Median time to injection-site reactions (dara-naïve: 6 h vs dara-exposed: 24 h, p = 0.03) was shorter in the dara-naïve cohort. No clinically meaningful difference was observed for incidence of second systemic reaction. Conclusion Most reactions were mild and did not require medical intervention. Following first subcutaneous daratumumab dose, monitoring for 3 h for dara-naïve patients and no monitoring time for dara-exposed patients for hypersensitivity reactions may be a safe and reasonable practice.