The story behind the story, or there's lemonade in the water cooler today.
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Health Physics↗
Biomedical subjects
Ken Miller
Publications and source records attributed to Ken Miller.
Risk-informed, performance-based inspections at medical facilities.
During the past couple of years, radiation safety professionals have observed a significant change with regard to the inspection philosophy of regulators. The NRC and many Agreement State agencies have implemented a performance-based, risk-informed approach for inspecting medical Radiation Safety Programs. This new, less prescriptive approach originates from the necessity to produce safety benefits commensurate with their cost to the industry and still maintain health and safety performance. While compliance with regulatory requirements is important, regulatory agencies have been focusing on areas that provide greater safety benefit, such as protecting the radiation worker, members of the general public and the environment. This paper discusses simple and practical measures that may assist licensees in preparing for performance-based, risk informed inspections.
Employee Performance Appraisal↗
Lessons learned in preparing to receive large numbers of contaminated individuals.
Traditionally, medical radiation emergency plans have provided for the receipt and care of a limited number of individuals, usually no more than two or three at any given time. Large numbers of contaminated, uninjured individuals cannot be effectively handled in the emergency departments (EDs) of hospitals as they present a risk of forcing the ED to close because of contamination and they divert ED personnel away from patients needing medical attention. Alternative locations and plans for handling large numbers of contaminated but otherwise uninjured patients must be considered. Such plans developed at the Penn State Hershey Medical Center (HMC) during the 1979 accident at the Three Mile Island Nuclear Power Plant (TMI) were resurrected post 9/11 and used there in developing and upgrading plans and capabilities for handling large numbers of contaminated, uninjured individuals.
Disaster Planning↗
Health physics considerations in medical radiation emergencies.
Preplanning and organization can facilitate the health physics response in the event of a medical radiation emergency. Anticipating the needs will allow for advanced assembly of needed information and supplies that would be useful in effectively responding to such events. Annual training of emergency care providers and an easy to read and understand poster will be of great benefit in guiding personnel until health physics arrives. Major events also need consideration, in advance, as they will place additional demands on health physics.
Disaster Planning↗
Recent experiences with shielding a PET/CT facility.
Since the photon energy of positron emitting radionuclides is significantly higher than the maximum kVp of diagnostic x rays, designing a shielding plan for a PET/CT imaging facility requires careful consideration of future workloads and potential occupancy of surrounding spaces. The shielding calculations can be done by hand or with the aid of available software. In calculating the shielding, specific considerations arise. Some of these are presented as a checklist of things to consider when preparing to calculate the shielding required for a PET/CT facility.
Environmental Exposure↗
Potential dose to nuclear medicine technologists from 99mTc-DTPA aerosol lung studies.
Air sampling performed during 190 Tc-labeled DTPA aerosol lung ventilation studies indicated that the maximum airborne concentration to which the nuclear medicine technologists might be exposed was 7.1 x 10(-1) Bq mL(-1) (1.9 x 10(-5) microCi mL(-1)). If a single technologist performed ALL the aerosol studies, at this maximum airborne concentration, based on the Annual Limit on Intake (ALI), the resulting dose equivalents could be either 1 mSv (100 mrem) to the lungs or 0.1 mSv (10 mrem) to the total body. However, the procedures are shared by the technical staff, the times of exposure are represented by only a fraction of the overall procedure time, and the average airborne concentrations were found to be more than an order of magnitude lower than the maximum. This resulted in a projected average annual dose equivalent of 7.0 x 10(-3) mSv (0.7 mrem) to the lungs or 7.0 x 10(-4) mSv (0.07 mrem) to the whole body from the performance of these procedures.
Aerosols↗
Identification of proteins separated by one-dimensional sodium dodecyl sulfate/polyacrylamide gel electrophoresis with matrix-assisted laser desorption/ionization ion trap mass spectrometry; comparison with matrix-assisted laser desorption/ionization time-of-flight mass fingerprinting.
Digests from ten gel bands containing low abundance proteins were analyzed by both matrix-assisted laser desorption/ionization ion trap (MALDI-IT) and matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) methods. MALDI-TOF techniques were able to identify only one protein from all 10 gel bands, while MALDI-IT identified eight proteins from the same 10 bands. The ability to perform MS/MS experiments with a MALDI-IT instrument leads to protein identifications based on both peptide molecular mass and sequence information, and is much less prone to errors and uncertainties introduced by peptide fingerprinting methodologies in which protein identification is based on peptide molecular masses alone.
Amino Acid Sequence↗
Acute inhalation injury.
The lungs can be an efficient means for the absorption of inhaled toxicants, resulting in airway and pulmonary injury or systemic toxicity. Although a few specific antidotes exist for inhaled toxicants, the syndrome of acute inhalation injury and clinical therapeutics are linked by common pathways of pathophysiology. Understanding the mechanisms of inhalation injury and occupation- or situation-specific toxicants can simplify the decision-making process for the out-of-hospital emergency responder and the emergency physician when confronted with a patient and the myriad of potential inhaled toxicants.
Acute Disease↗
Assessment of the effects of holding time and temperature on Escherichia coli densities in surface water samples.
Escherichia coli is a routinely used microbiological indicator of water quality. To determine whether holding time and storage conditions had an effect on E. coli densities in surface water, studies were conducted in three phases, encompassing 24 sites across the United States and four commonly used monitoring methods. During all three phases of the study, E. coli samples were analyzed at time 0 and at 8, 24, 30, and 48 h after sample collection. During phase 1, when 4 degrees C samples were evaluated by Colilert or by placing a membrane onto mFC medium followed by transfer to nutrient agar containing 4-methylumbelliferyl-beta-D-glucuronide (mFC/NA-MUG), three of four sites showed no significant differences throughout the 48-h study. During phase 2, five of seven sites showed no significant difference between time 0 and 24 h by membrane filtration (mFC/NA-MUG). When evaluated by the Colilert method, five of seven sites showed no significant difference in E. coli density between time 0 and 48 h. During phase 3, 8 of 13 sites showed no significant differences in E. coli densities between time 0 and the 48-h holding time, regardless of method. Based on the results of these studies, it appears that if samples are held below 10 degrees C and are not allowed to freeze, most surface water E. coli samples analyzed by commonly used methods beyond 8 h after sample collection can generate E. coli data comparable to those generated within 8 h of sample collection. Notwithstanding this conclusion, E. coli samples collected from surface waters should always be analyzed as soon as possible.
Bacteriological Techniques↗
Variability in the American Society of Anesthesiologists Physical Status Classification Scale.
The American Society of Anesthesiologists (ASA) Physical Status (PS) Classification is used worldwide by anesthesia providers as an assessment of the preoperative physical health of patients. This score also has been used in policy-making, performance evaluation, resource allocation, and reimbursement of anesthesia services and frequently is cited in clinical research. The purpose of this study was to assess interrater reliability and describe sources of variability among anesthesia providers in assigning ASA PS scores. A questionnaire with 10 hypothetical patients scenarios was given to 70 anesthesia providers who were asked to assign ASA PS scores in each scenario and to provide rationale for their decisions. The data were summarized and stratified according to nurse anesthetist or anesthesiologist and military or nonmilitary anesthesia providers. We hypothesized there would be no difference between any of the anesthesia provider groups in assignment of ASA PS scores. A lack of interrater reliability in assigning ASA PS scores was demonstrated. There were no significant differences between the anesthesia provider groups. There was no correlation between ASA PS scoring and years practicing or any of the other demographic variables. Several sources of variability were identified: smoking, pregnancy, nature of the surgery, potential difficult airway, and acute injury.
Anesthesiology↗
Our way of life has changed forever.
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Disaster Planning↗
Success and complication rates with prehospital placement of an esophageal-tracheal combitube as a rescue airway.
INTRODUCTION: Previous studies have proven the success of the Esophageal-Tracheal Combitube (ETC) as a primary airway, but not as a rescue airway. OBJECTIVE: The object of this study was to observe success and complication rates of paramedic placement of an ETC as a rescue airway, and to compare success rates with endotracheal tube (ETT) intubation. The primary outcome indicator was placement with successful ventilation. Complication rates, esophageal placement, and return of spontaneous circulation (ROSC) were secondary measures. METHODS: A retrospective review of the records of patients who had ETC attempts by Emergency Medical Services (EMS) was conducted for a period of three years. Complications were defined a priori. The ETC is used primarily as rescue airway for a failed attempt at an endotracheal tube (ETT) intubation. A control group for ETT placements was drawn from the EMS quality assurance (QA) database for the same period. RESULTS: Esophageal-Tracheal Combitube insertion was attempted on 162 patients, of which, 113 (70%) were successful, 46 (28%) failed, and the outcome of three (2%) was not recorded. Inability to place the ETC occurred in 29 (18%) patients, and accounted for 48% (22/46) of failures. The use of the ETC caused dental trauma in one patient, and one placement of the ETC was related to the onset of subcutaneous emphysema. Blood in the ETC from active upper gatrointestinal bleeding occurred in nine patients (6%), and four tubes (3%) became dislodged en route to the hospital. The apriori complication rate was 44/162 (27%). Inability to determine placement of the ETC due to emesis from both ports occurred in 21 cases. Combining these problems with the apriori complications, the overall rate was 40% (65/162). Esophageal-Tracheal Combitube location was noted in a subset of 90 charts, of which, 76 (84%) were esophageal, and 14 (16%) were tracheal. Thirteen of 126 (10%) patients in cardiac arrest had return of spontaneous circulation (ROSC) in the field after placement of the ETC. An ETT was attempted in 128 control patients, of which, 107 (84%) were successful, 21 (16%) failed (odds ratio (OR) for ETT vs. ETC = 2.1; 95% CI = 1.12-3.86). CONCLUSION: Despite a low ROSC rate, the complication and success rates of ETC are acceptable for a rescue airway device. Tracheal placement of the Combitube is uncommon, but requires fail-safe discrimination. Similar to previous reports, the success ratio for ETT was greater than for the ETC.
California↗