RADIATION: MEDICAL DIAGNOSTIC USES

Use of radiologic procedures in diagnosis now contributes a significant dose of ionizing radiation to our population. Whether this presents a real risk to the health of the present and future population cannot be determined with certainty from evidence available at this time. Hence, it appears proper to keep the dose to every patient as low as practical consistent with good medical practice. The average dose can be significantly reduced by having more physicians apply the known techniques for minimizing the exposure to the patient.The medical profession has a direct professional concern for the actual or potential risk of damage resulting from the radiation that patients are exposed to during diagnostic x-ray procedures, since these procedures constitute the largest single man-made source of genetically significant radiation our population is now exposed to.It is important to distinguish two distinctly different types of radiation effects—somatic effect, in which the damage affects the health of the person irradiated, and genetic effect that is capable of producing constitutional defects in future progeny over many generations.     

Genomic damage in children accidentally exposed to ionizing radiation: a review of the literature

During the last decade, our knowledge of the mechanisms by which children respond to exposures to physical and chemical agents present in the environment, has significantly increased. Results of recent projects and programmes focused on children's health underline a specific vulnerability of children to environmental genotoxicants. Environmental research on children predominantly investigates the health effects of air pollution while effects from radiation exposure deserve more attention. The main sources of knowledge on genome damage of children exposed to radiation are studies performed after the Chernobyl nuclear plant accident in 1986. The present review presents and discusses data collected from papers analyzing genome damage in children environmentally exposed to ionizing radiation. Overall, the evidence from the studies conducted following the Chernobyl accident, nuclear tests, environmental radiation pollution and indoor accidental contamination reveals consistently increased chromosome aberration and micronuclei frequency in exposed than in referent children. Future research in this area should be focused on studies providing information on: (a) effects on children caused by low doses of radiation; (b) effects on children from combined exposure to low doses of radiation and chemical agents from food, water and air; and (c) specific effects from exposure during early childhood (radioisotopes from water, radon in homes). Special consideration should also be given to a possible impact of a radiochemical environment to the development of an adaptive response for genomic damage. Interactive databases should be developed to provide integration of cytogenetic data, childhood cancer registry data and information on environmental contamination. The overall aim is to introduce timely and efficient preventive measures, by means of a better knowledge of the early and delayed health effects in children resulting from radiation exposure.     

X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging

X-ray fluoroscopy is widely used for image guidance during cardiac intervention. However, radiation dose in these procedures can be high, and this is a significant concern, particularly in pediatric applications. Pediatrics procedures are in general much more complex than those performed on adults and thus are on average four to eight times longer¹. Furthermore, children can undergo up to 10 fluoroscopic procedures by the age of 10, and have been shown to have a three-fold higher risk of developing fatal cancer throughout their life than the general population^2,3.We have shown that radiation dose can be significantly reduced in adult cardiac procedures by using our scanning beam digital x-ray (SBDX) system⁴-- a fluoroscopic imaging system that employs an inverse imaging geometry^5,6 (Figure 1, Movie 1 and Figure 2). Instead of a single focal spot and an extended detector as used in conventional systems, our approach utilizes an extended X-ray source with multiple focal spots focused on a small detector. Our X-ray source consists of a scanning electron beam sequentially illuminating up to 9,000 focal spot positions. Each focal spot projects a small portion of the imaging volume onto the detector. In contrast to a conventional system where the final image is directly projected onto the detector, the SBDX uses a dedicated algorithm to reconstruct the final image from the 9,000 detector images.For pediatric applications, dose savings with the SBDX system are expected to be smaller than in adult procedures. However, the SBDX system allows for additional dose savings by implementing an electronic adaptive exposure technique. Key to this method is the multi-beam scanning technique of the SBDX system: rather than exposing every part of the image with the same radiation dose, we can dynamically vary the exposure depending on the opacity of the region exposed. Therefore, we can significantly reduce exposure in radiolucent areas and maintain exposure in more opaque regions. In our current implementation, the adaptive exposure requires user interaction (Figure 3). However, in the future, the adaptive exposure will be real time and fully automatic.We have performed experiments with an anthropomorphic phantom and compared measured radiation dose with and without adaptive exposure using a dose area product (DAP) meter. In the experiment presented here, we find a dose reduction of 30%.     

Electromagnetic fields and epidemiology: An overview inspired by the fourth course at the International School of Bioelectromagnetics

The fourth course at the International School of Bioelectromagnetics addressed various aspects of the epidemiology of exposure to electromagnetic fields (EMF). In this overview, inspired by the lectures and the discussions among participants, we summarize current knowledge on exposure to EMF and disease risk, with emphasis on studies of use of mobile phones and brain tumours and exposure to power lines and childhood leukaemia. Sources of bias and error hamper straightforward conclusions in some areas and, in order to move forward, improvements in study design and exposure assessment are necessary. The scientific evidence available to date on possible long‐term effects from exposure to ELF and RF fields is not strong enough to revise current protection limits based on the known acute effects of such exposures. Precautionary measures may be considered to reduce ELF exposure of children or exposure to RF during mobile phone use, keeping in mind that it is unclear whether they involve any preventive benefit. Possible health effects from mobile phone use in adults and in children should be investigated further by prospective epidemiological studies with improved exposure assessment and brain tumour incidence rates should be monitored. Further studies on the relation between childhood leukaemia and ELF magnetic fields would be worthwhile if they focus on heavily exposed groups and attempt to minimize possible selection bias. In conclusion, epidemiological studies conducted with appropriate diligence can play a key role in finding the answers. Bioelectromagnetics 30:511–524, 2009. © 2009 Wiley‐Liss, Inc.     

Mouse Spermatozoa in High Concentrations of Glycerol: Chemical Toxicity vs Osmotic Shock at Normal and Reduced Oxygen Concentrations

The cryobiological preservation of mouse spermatozoa has presented difficulties in the form of poor motilities or irreproducibility. We have identified several likely underlying problems. One is that published studies have used concentrations of the cryoprotectant glycerol that are substantially lower (0.3 M) than the ∼1 M concentrations that are optimal for most cells. Another may arise from the known high susceptibility of mouse sperm to free radical damage. We have identified two contributors to damage from higher concentrations of glycerol, namely, chemical toxicity proportional to concentration and exposure time and osmotic damage arising from too rapid an addition and removal of the glycerol. When toxicity is minimized by restricting the exposure time to 1 or 5 min and osmotic shock is minimized by adding and removing the glycerol stepwise, relatively high percentages of the sperm survive contact with 0.8 M glycerol. Free-radical damage in mouse sperm is known to be proportional to the oxygen concentration. We have determined the consequences of reducing the oxygen to <3% of atmospheric by the use of a bacterial membrane preparation, Oxyrase. Oxyrase reduced damage from centrifugation and substantially reduced damage from osmotic shock; however, it did not significantly reduce glycerol toxicity.     

THE SHOE-FITTING FLUOROSCOPE AS A RADIATION HAZARD

Tests of direct beam intensity and stray radiation from shoe-fitting fluoroscopes indicate wide variability of exposure of patrons and salesmen, with some exposures far in excess of standards proposed for safe use of the apparatus.The principal potential danger is interference with bone growth in children as a result of careless use or uncontrolled dosage of x-ray. Although less likely, there is also some possibility of excessive exposure of shoe salesmen in exceptional circumstances.The growing probability of increasing use of ionizing radiations warrants vigorous governmental control or possibly elimination of procedures of questionable merit which involve public risk.     

TrackBeam, a simple tool for estimating potential exposure to the solar beam underneath tree canopies

A simple tool, TrackBeam, for rapid in situ estimates of potential exposure to the solar beam of objects underneath tree canopies is presented, tested and demonstrated to be useful in insect conservation studies. The tool can be used whenever accurate data on sun exposure is of use e.g., in ecological studies of saproxylic insects. TrackBeam draws upon the principles behind the analysis of hemispherical photographs but its use is much less dependent on the weather at the time of sampling. It may be used for detecting canopy openings in directions corresponding to the solar path. Based on this, periods of time with potential beam exposure and/or the proportion of sky that is not obscured by canopy for objects such as dead wood may be estimated. The results of using TrackBeam compares well between operators and with the corresponding results of analysed hemispherical photographs. Results are presented which show that TrackBeam was successfully used to characterise the habitat light requirements of the saproxylic beetle Melanotus castanipes (Coleoptera: Elateridae).     

Theoretical models for estimating dose-effect relationships after combined exposure to cytotoxicants

Two classes of dose-effect models for cell killing (additive damage and independent effects) are developed under alternative hypotheses about the damage that leads to cell death. Generalized models, along with specific models for cell killing after exposure to a specific cytotoxicant, are used to make predictions about the effects of sequential or simultaneous exposure to different cytotoxicants. It is demonstrated that with the additive damage models developed one can adequately account for the combined effects of the cytotoxicants considered. Theoretical results are presented which suggest that after simultaneous exposure of cells to low total doses (<0.1 Gy) of different ionizing radiations, use of the conventional relative biological effectiveness approach to predict cell killing risks is unnecessary; cell killing risks can adequately be determined by assuming the effects of the different radiations to be independent. Also, for simultaneous exposure of cells to total doses of different radiations much larger than 0.1 Gy, use of the conventional RBE approach to arrive at cell killing risk could lead to overestimation of the risk.     

Epidemiological study of sun exposure and visual field damage in children in Primorsko-Goranska County--the risk factors of earlier development of macular degeneration

The aim of this study was to examine the possible harmful effects of solar exposure on visual field damage in children living in Primorsko-Goranska County. Our previous work has shown noxious influence on visual field in children with anamnesis long term exposure to sunlight. This is an extended study, including children in Novi Vinodolski and Gorski kotar. We measured possible defect in isopteric visual field and macular-meridian thresholds. In the area of island of Rab these changes were the biggest, subsequently is Novi Vinodolski and at least Gorski kotar with the smallest range of eye complicates according to exposure to sunlight. These damages correlate with the areas of great solar emission. Damages in periphery isopters of visual field have shown the characteristics of periphery defect invagination, while increased macular thresholds in complete visual field was from 5 to 15Asb. We can conclude that there is direct connection between increased sunlight and long-term exposure to sunlight on one side, and on the other side, damages of retinal perception. Increased sun exposure may represent very important factors in early occurrence and develop of Age-Related Macular Degeneration (AMD). It is recommended the children protection in summer months, as well as taking derivates of vitamin A and antioxidants. Nowadays, AMD is one of the most important causes of damaged visual field, pretend to be national problem if we don't use the adequate prevention. World Health Organization has to begin with prevention of AMD, including these risk factors.     

Acute skin sun damage in children and its consequences in adults

Children spend more time outdoors than adults and there is compelling evidence that childhood is a particularly vulnerable time for the photocarcinogenic effects of the sun. The negative effects of solar radiation are accumulated during the entire lifetime; however 80% of total lifetime sun exposure is taking place before the age of 18 years. Child skin is more sensitive than adult skin because natural defense mechanisms are not fully developed. A short exposure to midday sun will result in sunburns. Epidemiologic studies show a higher incidence of malignant melanoma in persons with a history of sunburns during childhood and adolescence. Sun exposure among infants and pre-school children is largely dependent on the discretion of adult care providers. Sun protective habits of mothers may predict the level of sun exposure in children. It is very important to transfer the knowledge and positive habits of proper sun protection to children. The purpose of sun-safety behavior is not to avoid outdoor activities, but rather to protect the skin from detrimental sun effects. Proper sun protection of children includes protection from excessive sun exposure, sunburns and other forms of skin damage caused by sun, which may lead to the future development of skin cancers. This paper reviews acute skin reactivity to sun in childhood and adolescence that causes damage in skin structure and function and produces undesirable chronic changes in adults.     

Damage to Biological Samples Caused by the Electron Beam during Electron Microscopy

A new method has been developed which measures directly the beam damage suffered by biological specimens in the electron microscope. This method involves the use of radioautography to measure specific radioactivity of labeled specimens, either exposed or unexposed to the beam. Using this technique, it has been found that macromolecular samples such as ribosomes and R17 virions are severely damaged during standard electron microscopic operations: from 15 to 40% of the mass of the sample may be lost in a 30 sec exposure to the beam.     

Historical review of occupational exposures and cancer risks in medical radiation workers

Epidemiological studies of medical radiation workers have found excess risks of leukemia, skin and female breast cancer in those employed before 1950 but little consistent evidence of cancer risk increases subsequently. Occupational radiation-related dose-response data and recent and lifetime cancer risk data are limited for radiologists and radiologic technologists and lacking for physicians and technologists performing fluoroscopically guided procedures. Survey data demonstrate that occupational doses to radiologists and radiologic technologists have declined over time. Eighty mostly small studies of cardiologists and fewer studies of other physicians reveal that effective doses to physicians per interventional procedure vary by more than an order of magnitude. For medical radiation workers, there is an urgent need to expand the limited information on average annual, time-trend and organ doses from occupational radiation exposures and to assess lifetime cancer risks of these workers. For physicians and technologists performing interventional procedures, more information about occupational doses should be collected and long-term follow-up studies of cancer and other serious disease risks should be initiated. Such studies will help optimize standardized protocols for radiologic procedures, determine whether current radiation protection measures for medical radiation workers are adequate, provide guidance on cancer screening needs, and yield valuable insights on cancer risks associated with chronic radiation exposure.     

Radiation Protection in Canada: Part VII. The Role of Industrial Hygiene in the Field of Radiation Protection

The main emphasis of a provincial radiation protection program is on ionizing radiation produced by machines, although assistance is given to the Federal Radiation Protection Division in its program relating to radioactive substances. The basis for the Saskatchewan program of radiation protection is the Radiological Health Act 1961. An important provision of the Act is annual registration of radiation equipment. The design of the registration form encourages a “do-it-yourself” radiation and electrical safety inspection.Installations are inspected every two years by a radiation health officer. Two hundred and twenty-one deficiencies were found during inspection of 224 items of radiation equipment, the commonest being failure to use personal film badges. Insufficient filtration of the beam, inadequate limitation of the beam, and unnecessary exposure of operators were other common faults.Physicians have a responsibility to weigh the potential advantages against the hazards when requesting radiographic or fluoroscopic procedures.     

Effect of blue light‐emitting diode light and antioxidant potential in a somatic cell

Light is an indispensable part of routine laboratory work in which conventional light is generally used. Light‐emitting diodes (LEDs) have come to replace conventional light, and thus could be a potent target in biomedical studies. Since blue light is a major component of visible light wavelength, in this study, using a somatic cell from the African green monkey kidney, we assessed the possible consequences of the blue spectra of LED light in future animal experiments and proposed a potent mitigation against light‐induced damage. COS‐7 cells were exposed to blue LED light (450 nm) and the growth and deoxyribonucleic acid (DNA) damage were assessed at different exposure times. A higher suppression in cell growth and viability was observed under a longer period of blue LED light exposure. The number of apoptotic cells increased as the light exposure time was prolonged. Reactive oxygen species (ROS) generation was also elevated in accordance to the extension of light exposure time. A comparison with dark‐maintained cells revealed that the upregulation of ROS by blue LED light plays a significant role in causing cellular dysfunction in DNA in a time‐dependent manner. In turn, antioxidant treatment has been shown to improve cell growth and viability under blue LED light conditions. This indicates that antioxidants have potential against blue LED light‐induced somatic cell damage. It is expected that this study will contribute to the understanding of the basic mechanism of somatic cell death under visible light and maximize the beneficial use of LED light in future animal experiments.     

A method for assessing alternative effects functions that uses simulation with EMDEX data

A method for evaluating a variety of alternative biologically plausible effects functions through the use of simulation studies conducted on personal-monitor exposure data is described. Using magnetic field time series collected with EMDEX instruments, we demonstrate how the method can be used to explore (1) how the outputs from various effects functions simulations compare to the results obtained by assuming that effects are proportional to time average field strength; (2) how the results of epidemiological studies might be used to assess the relative likelihood that each of the alternative effects functions describes biological reality; and (3) how the results might be used to assess possible health risks. Although the available data are sufficient to demonstrate the general method, they are not yet sufficient to support actual discrimination among possible alternatives. The arguments on the use of the method are for illustrative purposes only. © 1995 Wiley-Liss, Inc.     

Nasal bone hemangiomas: a review of clinical, radiologic, and operative experience

A case of hemangioma of the nasal bones is reported. Clinical and radiologic findings, including CT scan, are presented and the literature reviewed. Although rare, the lesion often has a characteristic clinical and radiologic presentation that can be recognized preoperatively. CT scanning is helpful in defining tumor characteristics and extent. Surgery appears curative in most cases without significant disfigurement. For smaller lesions, bone graft of the defect appears unnecessary and the presence of intact periosteum may actually contribute to regeneration of normal bone.     

A Caution for Monte Carlo Risk Assessment of Long Term Exposures based on Short-Term Exposure Study Data

Monte Carlo risk assessments commonly take as input empirical or parametric exposure distributions from specially designed exposure studies. The exposure studies typically have limited duration, since their design is based on statistical and practical factors (such as cost and respondent burden). For these reasons, the exposure period studied rarely corresponds to the biologic exposure period, which we define as the time at risk that is relevant for quantifying exposure that may result in health effects. Both the exposure period studied and the biologic exposure period will often differ from the exposure interval used in a Monte Carlo analysis. Such time period differences, which are often not accounted for, can have dramatic effects on the ultimate risk assessment. When exposure distributions are right skewed and/or follow a lognormal distribution, exposure will usually be overestimated for percentiles above the median by direct use of exposure study empirical data, since biologic exposure periods are generally longer than the exposure periods in exposure assessment studies. We illustrate the effect that biologic exposure time period and response error can have on exposure distributions, using soil ingestion as an example. Beginning with variance components from lognormally distributed soil ingestion estimates, we illustrate the effect of different modeling assumptions, and the sensitivity of the resulting analyses to these assumptions. We develop a strategy for determining appropriate exposure input distributions for soil ingestion, and illustrate this using data on soil ingestion in children.     

Diagnostic irradiation of women during the reproductive period.

The date of onset of the last menstrual period should be given on radiographic requisitions for all women of reproductive age. Every effort should be made to avoid unnecessary irradiation of any woman who might be pregnant. Radiation damage in the first 2 weeks of pregnancy, however, should be "all or none", resulting in either a miscarriage or a normal child. Diagnostic radiology procedures are not indications for therapeutic abortion. Ultrasound has now replaced ionizing radiation in most examinations of the fetus and placenta. Pelvimetry should be done only when the decision to do a cesarean section hinges on precise knowledge of measurements of the bony pelvis. On the rare occasion when a radiograph of the fetus is necessary the woman should be prone for the examination. All such examinations are best ordered after consultation with a radiologist. Radiography of distant areas with the beam directed away from the woman''s abdomen can be done without concern at any stage of pregnancy.     

Investigation of viability of plant tissue in the environmental scanning electron microscopy

The advantages of environmental scanning electron microscopy (ESEM) make it a suitable technique for studying plant tissue in its native state. There have been few studies on the effects of ESEM environment and beam damage on the viability of plant tissue. A simple plant tissue, Allium cepa (onion) upper epidermal tissue was taken as the model for study. The change of moisture content of samples was studied at different relative humidities. Working with the electron beam on, viability tests were conducted for samples after exposure in the ESEM under different operating conditions to investigate the effect of electron beam dose on the viability of samples. The results suggested that without the electron beam, the ESEM chamber itself can prevent the loss of initial moisture if its relative humidity is maintained above 90%. With the electron beam on, the viability of Allium cepa (onion) cells depends both on the beam accelerating voltage and the electron dose/unit area hitting the sample. The dose can be controlled by several of the ESEM instrumental parameters. The detailed process of beam damage on cuticle-down and cuticle-up samples was investigated and compared. The results indicate that cuticular adhesion to the cell wall is relatively weak, but highly resistant to electron beam damage. Systematic study on the effect of ESEM operation parameters has been done. Results qualitatively support the intuitive expectations, but demonstrate quantitatively that Allium cepa epidermal cells are able to be kept in a hydrated and viable state under relevant operation condition inside ESEM, providing a basis for further in situ experiments on plant tissues.     

Use of a 15 k gene microarray to determine gene expression changes in response to acute and chronic methylmercury exposure in the fathead minnow Pimephales promelas Rafinesque

This study describes the use of a 15 000 gene microarray developed for the toxicological model species, Pimephales promelas , in investigating the impact of acute and chronic methylmercury exposures in male gonad and liver tissues. The results show significant differences in the individual genes that were differentially expressed in response to each treatment. In liver, a total of 650 genes exhibited significantly ( P < 0·05) altered expression with greater than two-fold differences from the controls in response to acute exposure and a total of 267 genes were differentially expressed in response to chronic exposure. A majority of these genes were downregulated rather than upregulated. Fewer genes were altered in gonad than in liver at both timepoints. A total of 212 genes were differentially expressed in response to acute exposure and 155 genes were altered in response to chronic exposure. Despite the differences in individual genes expressed across treatments, the functional categories that altered genes were associated with showed some similarities. Of interest in light of other studies involving the effects of methylmercury on fish, several genes associated with apoptosis were upregulated in response to both acute and chronic exposures. Induction of apoptosis has been associated with effects on reproduction seen in the previous studies. This study demonstrates the utility of microarray analysis for investigations of the physiological effects of toxicants as well as the time-course of effects that may take place. In addition, it is the first publication to demonstrate the use of this new 15 000 gene microarray for fish biology and toxicology.