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Biomedical subjects

F Fagnani

Publications and source records attributed to F Fagnani.

At least 19 recordsLinked to original sources

Definition and estimation of lifetime detriment from radiation exposures: principles and methods.

Although the lifetable methodology is a standard tool in epidemiology and risk assessment, there are a number of differences in the way it has been applied by various advisory committees that have attempted to estimate radiation risks. The most fundamental of these differences concerns the choice of parameter to be estimated: the "excess lifetime risk" is the difference in lifetime risks between exposed and unexposed populations; the "risk of exposure-induced death" is the lifetime risk of dying of a disease attributable to exposure. These two quantities are not the same, even at low doses. Although both quantities have some utility in risk assessment, the "risk of exposure-induced death" comes closer to capturing the total impact of exposure. Other differences between reported risk estimates include details of the calculations, the baseline rates and age distributions of the exposed population, the forms of the models for excess rates, handling of organ-specific doses, and the groupings of cancer sites. These issues are discussed theoretically and illustrated with comparisons of the BEIR V and UNSCEAR reports. Although the risk estimates from these two reports are similar for most cancer sites, it is shown that this happens to be the result of an approximate cancellation of a number of differences that could be quite large.

Environmental Exposure

Doses to patients from dental radiology in France.

In France, a national study was undertaken to estimate both dental radiology practices (equipment and activity) and the associated population collective dose. This study was done in two steps: A nationwide survey was conducted on the practitioner categories involved in dental radiology, and dosimetric measurements were performed on patients and on an anthropomorphic phantom by using conventional dental x-ray machines and pantomographic units. A total of 27.5 x 10(6) films were estimated to have been performed in 1984; 6% of them were pantomographic and 94% were conventional. Most of the organ doses measured for one intra-oral film were lower than 1 mGy (100 mrad); pantomogram dose values were generally higher than intra-oral ones. The collective effective dose equivalent figure was 2,000 person-Sv (2 x 10(5) person rem) leading to a per head dose equivalent of 0.037 mSv (3.7 mrem). The study allowed authors to identify ways to reduce the patient dose in France (e.g., implementing the use of long cone devices and controlling darkroom practices).

France

Doses to patients from diagnostic radiology in France.

Reported here are results of a 1982 national survey in France to establish the collective effective dose equivalent associated with the main types of radiological examinations practiced annually in this country (except nuclear medicine, C.T. scans, dental radiology and mass chest screening). This report describes the methodology followed in achieving dose measurements either on an anthropomorphic phantom or directly on the patient, and it highlights the importance of the radiological procedures (number of x-ray films, fluoroscopy screening time, etc.) on the patient organ doses. The estimated collective effective dose equivalent associated with these radiological practices is 86,000 person-Sv, i.e., an individual effective dose equivalent of 1.58 mSv y-1; the genetically significant dose figure is 0.29 mSv and the collective red bone marrow dose due to 45 million x-ray exams practiced in France (1982) is 40,300 person-Sv, i.e. 0.74 mSv per inhabitant.

Adult

[The financing of medico-technical activities. The example of a scanner in France (1986)].

To analyse the french methods for financing technical-medical activities as CT scanners, and to assess if they can face, or not, the management constraints of such activities a financial simulation has been executed. First, current expenditures are totalized (including depreciations and financial charges) with variations according to the number of examinations per year. Costs are classified especially according to fixed and variable charges: the weight of fixed charges, especially equipment charges, is the most significant. It's very high in yearly expenditures. Most, that involves a very fast decreasing cost with increasing number of procedures. Second, consequences of such accounts are analyzed: on private CT scanners, Payed with a charge per examination whatever would be the factor's cost; on public CT scanners, payed with an annual allowance; in this case charges equal receipts whatever would be the cost for a procedure. Third, a break point is defined; either the annual activity is higher: there would be an excedent; either it is lower: there would be a deficit. Then, those results are reported to CT-scanners activity's data in France (1986). After all, we discuss about financing systems themselves, and suggest a few hypothesis to explain those desadjustments between charges and their financing way.

Financial Management

Contrasted diffusion and the use of CT scanner equipment in France.

During the last 4 years, there has been a rapid catching-up in the distribution level of CT-scanners in France. In a survey of CT-scanner utilization, data from all machines operating in the PACA Region in 1986, showed that the mean activity was 6,080 examinations per machine. The co-existence of both private and public medicine led to different use of materiel (5,500 to 5,800 exams per machine in the public versus 8,600 in the private sector and a higher productivity in the profit-making establishments. This difference was not explained by procedural variations in carrying out the technique, which appeared to be similar and standardized everywhere, but probably reflected patient selection (80% of ambulatory patients in the private sector, 25 to 50% in PTH).

France

[The practice of x-ray computed tomography during a period of rapid growth. A survey on the Provence-Alpes-Côte d'Azur region in 1986].

From May to September 1986, a sample of 748 CT-scanner examinations, representative of the total annual activity, has been collected in Provence-Alpes-Côte d'Azur Region. The regional activity of CT-scanner has been estimated to 91,200 examinations in 1986 (total France: 628,500 in 1985) or 22.7 procedures per 1,000 inhabitants (total France: 11,4 in 1985). CT-scanner is now a routine diagnostic imaging device with an annualized average of 6,080 procedures per machine (5,770 in public sector and 8,415 in the for-profit private one). The mean effective utilization time for a machine in one year was 2,700 hours in a regional, public, teaching hospital (PTH) and 3,100 in private, for-profit establishment (PPE). The number of procedures per machine-use hour was 2,4 in PTH and 2.8 PPE. No procedural difference has been observed between the two sectors in carrying out the technique. CT-Scanner diffusion in the private for profit sector has meant: - an increase in the demand from general medical practionners (more than 1/4 examinations); - a larger range of indications concerning less serious health conditions.

France

[Collective radiation dosage due to radiodiagnostic practice in France in 1982. Methodology. 1].

This paper recalls the main concepts of dosimetry which are useful when assessing the collective dose to the patient from medical X-ray examinations. It describes the general protocol which has been followed in measuring dose associated to each x-ray exam (anthropomorphic phantom, in vivo measurement) and gives some results about the variations of parameters such as the mAs, the kVp and the fluoroscopy screening time. As far as the gonadal dose and the effective dose equivalent are concerned a first evaluation is given per type of examination carried out in France in 1982.

Film Dosimetry

[Collective irradiation caused by radio-diagnostic procedures in France in 1982. Results (2)].

This paper gives the most important results of the collective dose received by patients who undergoing diagnostic radiology examinations in France in 1982. It details, per each X-ray examination type, the collective organ dose associated with, and highlights the importance of the radiological procedures (number of X-ray films, fluoroscopy screening time) on the received patient doses. If one takes into account organs for which dosimetric measurements have been carried out, the collective effective dose equivalent per 10(6) inhabitants is 442 man-Sievert; the genetically significant dose reaches 0.295 mSv and finally the collective red bone marrow dose due to 45 million X-ray exams practiced in France (1982) is 40,300 man-Sievert i.e. 0.742 mSv. per inhabitant.

Female

[National survey of radiodiagnosis. Methodological aspects (1)].

A national sample of 386 radiological departments and offices representative of a total set of approximately 5 000 have been involved in a statistical survey during the years 81-82. This survey was first directed to the analysis of the production factors related to radiology (number and characteristics of facilities and equipment; medical and paramedical personnel, ...). The radiological activity has then been observed during one week (in June 82) through systematic questionnaires. The information collected on about 13 000 X-Ray examinations consists in characteristics of the population examined, the aims and results of examination, a technical description of procedures (number and size of films; projection; physical parameters, ...). This survey has excluded X-Ray routine examinations (occupational and others); dental examinations, isolated fluoroscopy and ultrasound practiced by physicians.

France

[National survey on radiodiagnosis. Personnel and equipment (2)].

The total projected number of units (including tables and potters) has been estimated at 16 325 in 1982, at the exclusion of radiological dental systems and unit exclusively devoted to mass X-Ray examinations. Almost half of this total equipment is located in public hospitals (including University hospitals), where the departments have a mean size which is markedly greater than the private sector (clinics and physicians' offices). One of the main feature of the French equipment is the high rate of remote controlled machines (almost 40%). The total labor forces involved directly in this activity has been estimated to 46 000; of which 14 580 are physicians (radiologists or not) and 18 680 are radiographers. The mean productivity, computed in annual mean number of examinations per person (medical and para-medical) is estimated at 1 000. These results are examined and compared throughout the different sectors (public and private; hospital, clinic and ambulatory care).

France

[National survey on radiodiagnosis. Comparative analysis of the activity of different sectors (3)].

The survey has estimated the global annual production of radiological procedures in France (1982) at 45,4 millions. The large public hospitals (including University hospitals) produce up to 42% of the total; the mean number of annual procedures by X-Ray unit being 4 000, in this sector. The private sector (including clinics and offices) has a production ratio between 2 350 and 2 800 annual procedures by X-Ray Unit; some type of examinations are over represented as compared with the public sector for example lumbar and dorsal spine and digestive. Specialized procedures such as vascular and neuro-radiological represent a quasi monopoly of the public sector. In term of economic behavior, some differences appear between the public and private sectors in the way to account for the procedures to the Social Security System. These are partly due to differences in the complexity of the procedures (for example in the case of abdomen, stomach and upper G.I., the latter being more often performed in hospitals) and to different medical practices (number of films; utilisation of divided films, etc.). The share of procedures executed under the responsibility of a radiologist yields 88% of the total.

France

[An estimation of the incidence of cerebrovascular accidents in France].

In the absence of epidemiological data concerning France, indirect assessment was undertaken of the incidence and prevalence of cerebrovascular accidents (CVA) at a national level. An international comparison of mortality data concerning diseases of the circulatory system was first made. This analysis reviewed the existence of a certain number of inherent difficulties in the use of available statistics. It is probable that a notable proportion, increasing with age, of cases of CVA, are situated in undefined causes. A similar phenomenon should be noted with regard to cardiac causes (changes in diagnostic practice in the case of ischemic heart disease). Furthermore, mortality data for CVA are very sensitive to the effect of the age and sex structures of the populations considered. Between the years 50 and 80, the absolute number of annual deaths by CVA roughly rose from 60 000 to 70 000 in France. However, after adjustment taking into account changes in numbers, age and sex and undetermined causes, there is a marked decrease in comparative levels (almost 40%). This decrease is of the same order of magnitude as that for mortality of circulatory system diseases taken overall, as well as that of general mortality. CVA remains the 3rd cause of death (in terms of numbers) but it is only in 8th place, in terms of loss of life expectancy. Taking as the reference the American National Survey of Stroke, using a certain number of hypotheses, it is possible to estimate the incidence of CVA in France. This gives an annual number of cases of the order of 140 000, including approximately 100 000 cases of initial CVA. The corresponding prevalence is estimated at 470 000 (mean numbers of individuals suffering one or more CVA).

Age Factors

Phosphofructokinase (PFK) deficiency due to a catalytically inactive mutant M-type subunit.

A case of M-type PFK deficiency due to the synthesis of a structurally abnormal and catalytically inactive M-subunit was reported. PFK activity was reduced (39% of normal) in red cells, normal in leukocytes and platelets, and absent in muscle. The red cell enzyme was not inhibited by antiserum to human muscle PFK and displayed normal biochemical properties (Km for ATP and fructose-6-phosphate, storage stability at +4 degrees C and -80 degrees C, optimum pH, electrophoretic pattern and molecular weight). The complete lack of PFK activity in muscle was confirmed on both histological preparations and muscle extracts. Double immunodiffusion analysis using an antinormal M-PFK serum revealed that the enzyme molecule was present and immunologically identical with normal, although it was catalytically inactive. The muscle abnormality was also confirmed by electromyography, ischemic exercise testing, histochemistry and electron microscopy. Moreover, PFK activity was investigated in myoblast cultures maintained up to 25 days, and it was found to be absent.

Erythrocytes

Aspartate aminotransferase and alanine aminotransferase activities in plasma: statistical distributions, individual variations, and reference values.

The determination of frequency value (percentile limits) and the classification of the different variation factors allow us to define more and more homogeneous subpopulations as we use these factors for sorting. Using as our study population those persons coming to the Centre for Preventive Medicine, we were able to: (a) Describe and measure the significance and importance of physiological variations or of variations attributed to age--the latter largely related only to excessive weight, which it seems to us is often the case. (b) Establish a classification for variation factors; the recapitulatory table should be useful to clinical chemists in helping physicians interpret a laboratory test result that falls within the zone of incertitude. (c) Suggest a preliminary group of reference values for healthy subjects, to be used in interpreting a laboratory test in this way.

Adolescent