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Development of a statewide hospital plan for radiologic emergencies.

Although general guidelines have been developed for triage of victims in the field and for hospitals to plan for a radiologic event, specific information for clinicians and administrators is not available for guidance in efficient management of radiation victims during their early encounter in the hospital. A consensus document was developed by staff members of four Connecticut hospitals, two institutions of higher learning, and the State of Connecticut Department of Environmental Protection and Office of Emergency Preparedness, with assistance of the American Society for Therapeutic Radiology and Oncology. The objective was to write a practical manual for clinicians (including radiation oncologists, emergency room physicians, and nursing staff), hospital administrators, radiation safety officers, and other individuals knowledgeable in radiation monitoring that would be useful for evaluation and management of radiation injury. The rationale for and process by which the radiation response plan was developed and implemented in the State of Connecticut are reviewed. Hospital admission pathways are described, based on classification of victims as exposed, contaminated, and/or physically injured. This manual will be of value to those involved in planning the health care response to a radiologic event.

Connecticut↗

Radiation exposure during anaesthetic practice.

With anaesthesia being administered more often outside of theatre in areas such as radiology suites, the occupational risk to anaesthetists from ionizing radiation may have increased. To determine radiation exposure from X-ray sources during normal anaesthetic practice, passive personal radiation monitoring devices were used to record the occupational exposure to radiation of 29 anaesthetists over a one calendar month period. Occupational whole body effective dose was calculated and extrapolated to give an estimated annual radiation exposure. Seven of the 29 anaesthetists recorded a dose that was higher than the minimum detectable limit. Extrapolating to estimate yearly doses, no anaesthetist would have approached the annual occupational dose limits for ionizing radiation. The maximum extrapolated annual whole body effective dose was 2.14 mSv, the Australian Recommendation and National Standard for occupational exposure being less than 20 mSv per year. The anaesthetist with the highest exposure would have exceeded the yearly recommended exposure limit for pregnant women (1 mSv). Even if they had worked all sessions in a radiation exposed environment, this person would not have exceeded the yearly annual occupational dose limits for ionizing radiation for non-pregnant staff provided they had worn a standard protective lead gown. The collar dose for this person was 7.08 mSv which may represent a significant risk to the thyroid if a protective lead collar was not worn. Although anaesthetists' radiation exposure is within acceptable limits, caution should be taken in rostering pregnant staff to anaesthetize where radiation exposure occurs, and all anaesthetists should routinely wear thyroid collars in such areas.

Anesthesiology↗

CNS cancers and radiation exposure: a case-control study among workers at two nuclear facilities.

A nested case-control study was conducted among workers employed in two nuclear facilities to investigate the possible association of primary CNS cancers with occupational exposure to radiation from external and internal sources. External radiation monitoring data from film badges were available for 27 cases and 90 matched controls. The radiation dose to the lung from internally deposited uranium was estimated for 47 cases and 120 matched controls from area and personnel monitoring data and was used in analyses in lieu of the brain dose. No association was observed between deaths from CNS cancers and exposure to ionizing radiation from external or internal sources. However, due to the small number of monitored subjects and low doses, a modest association could not be ruled out.

Adult↗

Time-course of radiation-induced chromosomal aberrations in tumor patients after radiotherapy.

PURPOSE: Radiation-induced chromosome aberrations are routinely used in biologic dosimetry to monitor radiation exposure. Translocations are considered stable aberrations with time after exposure. This study was performed to determine the temporal persistence of radiation-induced translocations during a 36-month period in therapeutically irradiated testicular seminoma patients who underwent partial body exposure (>10% of bone marrow). METHODS AND MATERIALS: Chromosome analyses were carried out in peripheral lymphocytes of 11 patients with testicular seminoma (n = 9), germinoma (n = 1), or follicular non-Hodgkin's lymphoma (n = 1). All patients received radiotherapy with photons from a linear accelerator; in 1 case, additional electron beams were used. Doses ranged from 26 Gy (seminoma) to 45 Gy (non-Hodgkin's lymphoma). None of the patients received chemotherapy. From each patient, blood samples were taken during the 36 months after irradiation at defined points. Chromosomal aberrations were scored after fluorescence in situ hybridization painting of chromosomes 1, 4, and 12 in combination with a pancentromeric probe. RESULTS: For 9 patients (7 with testicular seminoma, 1 with germinoma, and 1 with non-Hodgkin's lymphoma), a significant temporal decline of translocations, with a mean decline rate of 4.4% +/- 0.4% monthly, could be detected. Two testicular seminoma patients showed no temporal decline of aberration frequencies. CONCLUSION: Most partial body irradiated patients (9 of 11) showed a significant temporal decline of translocation frequencies during a 36-month period. Thus, reciprocal translocations after partial body irradiation cannot be regarded as stable over time. The temporal decline of aberration frequencies has to be taken into account for retrospective dose estimations.

Adult↗

Investigation of possible free-radical scavengers and metrics for radiation damage in protein cryocrystallography.

The introduction of highly intense wiggler and undulator beamlines has reintroduced the problem of X-ray radiation damage in protein crystals even at cryogenic temperatures. Several metrics for monitoring radiation damage are considered and unit-cell volume expansion is systematically investigated using crystals of three different types, but it is found to be too variable to be a useful metric. Radical scavengers of secondary radiation damage are investigated as possible mitigating agents. Styrene is found to be ineffective. A method of spectroscopically measuring the radiation damage with a microspectrophotometer was used and, in conjunction with crystallographic data, provided tentative but suggestive evidence for the efficacy of ascorbate as a free-radical scavenging agent in cryocooled hen egg-white lysozyme crystals.

Animals↗

Heterologous expression of the human cyclin-dependent kinase inhibitor p21Cip1 in the fission yeast, Schizosaccharomyces pombe reveals a role for PCNA in the chk1+ cell cycle checkpoint pathway.

Fission yeast cells expressing the human gene encoding the cyclin-dependent kinase inhibitor protein p21Cip1 were severely compromised for cell cycle progress. The degree of cell cycle inhibition was related to the level of p21Cip1 expression. Inhibited cells had a 2C DNA content and were judged by cytology and pulsed field gel electrophoresis to be in the G2 phase of the cell cycle. p21Cip1 accumulated in the nucleus and was associated with p34cdc2 and PCNA. Thus, p21Cip1 interacts with the same targets in fission yeast as in mammalian cells. Elimination of p34cdc2 binding by mutation within the cyclin-dependent kinase binding domain of p21Cip1 exaggerated the cell cycle delay phenotype. By contrast, elimination of PCNA binding by mutation within the PCNA-binding domain completely abolished the cell cycle inhibitory effects. Yeast cells expressing wild-type p21Cip1 and the mutant form that is unable to bind p34cdc2 showed enhanced sensitivity to UV. Cell cycle inhibition by p21Cip1 was largely abolished by deletion of the chk1+ gene that monitors radiation damage and was considerably enhanced in cells deleted for the rad3+ gene that monitors both DNA damage and the completion of DNA synthesis. Overexpression of PCNA also resulted in cell cycle arrest in G2 and this phenotype was also abolished by deletion of chk1+ and enhanced in cells deleted for rad3+. These results formally establish a link between PCNA and the products of the rad3+ and chk1+ checkpoint genes.

Amino Acid Sequence↗

Modeling photon output caused by backscattered radiation into the monitor chamber from collimator jaws using a Monte Carlo technique.

Dose per monitor unit in photon fields generated by clinical linear accelerators can be affected by the backscattered radiation into the monitor chamber from collimator jaws. Thus, it is necessary to account for the backscattered radiation in computing monitor unit setting for a treatment field. In this work, we investigated effects of the backscatter from collimator jaws based on Monte Carlo simulations of a clinical linear accelerator. The backscattered radiation scored within the monitor chamber was identified as originating either from the upper jaws (Y jaws), or from the lower jaws (X jaws). From the results of Monte Carlo simulations, ratios of the monitor-chamber-scored dose caused by the backscatter to the dose caused by the forward radiation, R(x,y), were modeled as functions of the individual X and Y jaw positions. The amount of the backscattered radiation for any field setting was then computed as a compound contribution from both the X and Y jaws. The dose ratios of R(x,y) were then used to calculate the change in photon output caused by the backscatter, Scb(x,y). Results of these calculations were compared with available measured data based on counting the electron pulses or charge from the electron target of an accelerator. Data from this study showed that the backscattered radiation contributes approximately 3% to the monitor-chamber-scored dose. A majority of the backscattered radiation comes from the upper jaws, which are located closer to the monitor chamber. The amount of the backscatter decreases approximately in a linear fashion with the jaw opening. This results in about a 2% increase of photon output from a 10 cm x 10 cm field to a 40 cm x 40 cm field. The off-axis location of the jaw opening does not have a significant effect on the magnitude of the backscatter. The backscatter effect is significant for monitor chambers using kapton windows, particularly for treatment fields using moving jaws. Applying the backscatter correction improves the accuracy of monitor-unit calculation using a model-based dose calculation algorithm such as the convolution method.

Algorithms↗

Exposure to cosmic radiation of British Airways flying crew on ultralonghaul routes.

British Airways has carried out radiation monitoring in Concorde for more than 20 years and has used a heuristic model based on data quoted by the National Aeronautics and Space Administration (NASA) to model radiation exposure in all longhaul fleets. From these data it has been calculated that no flight deck crew would exceed the control level of 6 mSv/y currently under consideration by regulatory authorities, which is three tenths of the occupational dose limit of 20 mSv/y recommended by the International Commission on Radiological Protection (ICRP). The model suggested that less than 4% of cabin crew based in Tokyo flying only between London and Japan could reach or exceed the 6 mSv/y level, based on a predicted effective dose rate of 7 microSv/h. To validate this calculation a sampling measurement programme was carried out on nine round trips flown by a Boeing 747-400 between London and Tokyo. The radiation field was measured with dosimeters used for routine personal monitoring (thermoluminescence dosimeters (TLDs) and polyallydiglycol carbonate neutron dosimeters). The limitations of the methodology are acknowledged, but the results indicate that the effective dose rate was 6 microSv/h which is consistent with the predicted effective dose rate of 7 microSv/h. This result, which is in accordance with other reported studies indicates that it is unlikely that any of the cabin crew based in Tokyo exceeded the 6 mSv/y level. In accordance with "as low as reasonably achievable" principles British Airways will continue to monitor flying crew routes and hours flown to ensure compliance.

Aerospace Medicine↗

Radiation exposure to patient and operator during radiofrequency ablation for supraventricular tachycardia.

BACKGROUND: Radiofrequency (RF) ablation has become the primary method of treatment for supraventricular tachycardia and often requires prolonged fluoroscopy times. AIM: To quantitate radiation exposure to patient and operator during RF ablation for supraventricular tachycardia. METHODS: Thermoluminescent dosemeters were used to monitor radiation at seven sites. Positions were: patient's thyroid, left scapula, T9 vertebra, right scapula and L4-L5 vertebra and the operator's thyroid and left hand. Monitoring was performed during 22 procedures. Of the patients studied 10 (45%) had atrioventricular junctional re-entry tachycardia (AVJRT) and 12 (55%) had accessory pathway tachycardia. RESULTS: The median fluoroscopy times (minutes) and inter-quartile ranges were 46 (39-65) for AVJRT, 55 (52-60) for left free wall accessory pathway (LFW), 107 (89-140) for septal and 166 (128-176) for RFW pathways. The mean radiation doses (mGy) to the chest wall were 50 for AVJRT, 47 for LFW, 87 for septal and 151 for RFW pathways. The mean radiation to the chest wall of the patient per case was found to be 3.9 times that reported for diagnostic cardiac catheterisation and 1.5 times that reported for angioplasty. CONCLUSIONS: Radiofrequency ablation is associated with significant irradiation of the patient and operator. All precautions should be taken to decrease this exposure. If eye irradiation is assumed to be equal to that to the thyroid, more than 45 procedures per month by a single operator (using ceiling-suspended lead glass shielding) may result in exceeding the recommended dose limit to the eye.

Adult↗

Adverse reproductive outcomes and occupational exposures among nurses: an investigation of multiple hazardous exposures.

1. The increasing numbers of pregnant women and women of childbearing age who are employed and exposed to hazardous substances pose occupational health concerns. 2. The findings of this study indicate the importance of not minimizing concern about exposure to radiation. Radiation monitoring should be implemented to a greater extent, and methods to measure low dose chronic radiation exposure should be developed. 3. Synergy between the adverse reproductive effects from multiple workplace factors among nurses, including but not limited to radiation, video display terminal use, and chemotherapeutic agents, warrants further evaluation.

Adolescent↗

Spore dosimetry of solar UV radiation: applications to monitoring of daily irradiance and personal exposure.

Environmental UV radiation can be quantified using spore dosimetry, which measures the inactivation of repair-deficient Bacillus subtilis spores dried on a membrane filter. The system exhibits highly selective sensitivity to UV radiation, not being affected by various environmental adversities, such as high and low temperature and humidity. Biologically-effective dose rate and cumulative dose of ambient radiation are measurable under various conditions at various places on the earth, including tropical, temperate, and polar sites. Applications to monitor the exposure at the surface of organisms including humans and plants have also been advanced.

Adult↗

Aspects of harmonisation of individual monitoring for external radiation in Europe: conclusions of a EURADOS action.

Following the publication of the EU Council Directive 96/29, EURADOS coordinated two working groups (WGs) for promoting the process of harmonisation on individual monitoring of occupationally exposed persons in Europe. An overview of the major findings of the second WG is presented. Information on the technical and quality standards and on the accreditation and approval procedures has been compiled. The catalogue of dosimetric services has been updated and extended. An overview of national regulations and standards for protection from radon and other natural sources in workplaces has been made, attempting to combine the results from individual monitoring for external, internal and workplace monitoring. A first status description of the active personal dosemeters, including legislative and technical information, and their implementation has been made. The importance of practical factors on the uncertainty in the dose measurement has been estimated. Even if a big progress has been made towards harmonisation, there is still work to be done.

Europe↗

Multicriteria relocation analysis of an off-site radioactive monitoring network for a nuclear power plant.

Due to increasing environmental consciousness in most countries, every utility that owns a commercial nuclear power plant has been required to have both an on-site and off-site emergency response plan since the 1980s. A radiation monitoring network, viewed as part of the emergency response plan, can provide information regarding the radiation dosage emitted from a nuclear power plant in a regular operational period and/or abnormal measurements in an emergency event. Such monitoring information might help field operators and decision-makers to provide accurate responses or make decisions to protect the public health and safety. This study aims to conduct an integrated simulation and optimization analysis looking for the relocation strategy of a long-term regular off-site monitoring network at a nuclear power plant. The planning goal is to downsize the current monitoring network but maintain its monitoring capacity as much as possible. The monitoring sensors considered in this study include the thermoluminescence dosimetry (TLD) and air sampling system (AP) simultaneously. It is designed for detecting the radionuclide accumulative concentration, the frequency of violation, and the possible population affected by a long-term impact in the surrounding area regularly while it can also be used in an accidental release event. With the aid of the calibrated Industrial Source Complex-Plume Rise Model Enhancements (ISC-PRIME) simulation model to track down the possible radionuclide diffusion, dispersion, transport, and transformation process in the atmospheric environment, a multiobjective evaluation process can be applied to achieve the screening of monitoring stations for the nuclear power plant located at Hengchun Peninsula, South Taiwan. To account for multiple objectives, this study calculated preference weights to linearly combine objective functions leading to decision-making with exposure assessment in an optimization context. Final suggestions should be useful for narrowing the set of scenarios that decision-makers need to consider in this relocation process.

Environmental Monitoring↗

A Monte Carlo program to calculate the exposure rate from airborne radioactive gases inside a nuclear reactor containment building.

A program was developed to calculate the exposure rate resulting from airborne gases inside a reactor containment building. The calculations were performed at the location of a wall-mounted area radiation monitor. The program uses Monte Carlo techniques and accounts for both the direct and scattered components of the radiation field at the detector. The scattered component was found to contribute about 30% of the total exposure rate at 50 keV and dropped to about 7% at 2000 keV. The results of the calculations were normalized to unit activity per unit volume of air in the containment. This allows the exposure rate readings of the area monitor to be used to estimate the airborne activity in containment in the early phases of an accident. Such estimates, coupled with containment leak rates, provide a method to obtain a release rate for use in offsite dose projection calculations.

Accidents↗

Surrogate tissue analysis: monitoring toxicant exposure and health status of inaccessible tissues through the analysis of accessible tissues and cells.

Genomics and proteomics have made it possible to define molecular physiology in exquisite detail, when tissues are accessible for sampling. However, many tissues are not accessible for human diagnostic evaluations or experimental studies, creating the need for surrogates that afford insight into exposures and effects in such tissues. Surrogate tissue analysis (STA) incorporating contemporary genomic and proteomic technologies may be useful in determining toxicant exposure and effect, or disease state, in target tissues at the pre- or early clinical stage. We present here a discussion of STA based on presentations given at the Society of Toxicology's 2003 annual meeting's "Innovations in Applied Toxicology" symposium. Speakers at the symposium (Box 1) discussed various potential applications of STA, including the use of peripheral blood lymphocytes (PBLs) as a source of genetic biomarkers to monitor radiation exposure; the use of gene expression analysis of PBLs and hair follicles as a means to monitor the impact of toxicants on inaccessible organs; the characterization of disease-associated gene signatures in peripheral blood mononuclear cells (PBMCs) of renal cell carcinoma (RCC) patients; the use of sperm RNA to determine genetic and environmental effects on sperm development in the testis; and the use of serum protein profiles to monitor the development and progression of various cancers. Also discussed are some of the challenges that must be overcome if the utility of STA is to be proven, and thus permit researchers to move this concept from the laboratory to the clinical environment.

Animals↗

Radiation protection concepts and quantities for the occupational exposure to cosmic radiation.

For the purposes of dose limitation and dose control, the harm, or detriment, of exposure to radiation is assessed by the quantity effective dose. Effective dose is evaluated by the application of factors to the averaged absorbed dose in the organs and tissues of the body. Radiation monitoring instruments are generally calibrated in terms of the quantity ambient dose equivalent which is defined in a simple spherical phantom. The relationship of these quantities is described. Requirements for the radiation protection of aircraft crew are given in the European Union Council Directive 96/29/EURATOM. There are requirements to assess the exposure of aircraft crew, to inform them of health risks, to reduce higher doses, and to control the dose to the fetus. There are no explicit dose limits, other than a dose objective to be applied to the exposure of the fetus, and no requirements for designation of areas or classification of workers. There are significant differences between the exposure condition of aircraft crew and workers in most other industries where there is occupational exposure to radiation. There are greater ranges of radiation types and energy, and there are different dose distributions and characteristics of the working populations. However, the field intensity is predictable and, with the exception of rare solar events, there is no risk of significant unexpected exposures. Dose assessment is anticipated to be by folding staff roster information with estimates of route doses, since there is little variability of dose rate within an aircraft. Route doses, which may be either an agreed average value for a given airport pairing and aircraft type, or be flight specific, will be closely linked to measured values. Requirements as to the accuracy of dose assessment should be applied which are broadly similar to those used in individual monitoring generally.

Aerospace Medicine↗

Initial symptoms of acute radiation syndrome in the JCO criticality accident in Tokai-mura.

A criticality accident occurred on September 30, 1999, at the uranium conversion plant in Tokai-mura (Tokai-village), Ibaraki Prefecture, Japan. When the criticality occurred, three workers saw a "blue-white glow," and a radiation monitor alarm was sounded. They were severely exposed to neutron and gamma-ray irradiation, and subsequently developed acute radiation syndrome (ARS). One worker reported vomiting within minutes and loss of consciousness for 10-20 seconds. This worker also had diarrhea an hour after the exposure. The other worker started to vomit almost an hour after the exposure. The three workers, including their supervisor, who had no symptoms at the time, were brought to the National Mito Hospital by ambulance. Because of the detection of gamma-rays from their body surface by preliminary surveys and decreased numbers of lymphocytes in peripheral blood, they were transferred to the National Institute of Radiological Sciences (NIRS), which has been designated as a hospital responsible for radiation emergencies. Dose estimations for the three workers were performed by prodromal symptoms, serial changes of lymphocyte numbers, chromosomal analysis, and 24Na activity. The results obtained from these methods were fairly consistent. Most of the data, such as the dose rate of radiation, its distribution, and the quality needed to evaluate the average dose, were not available when the decision for hematopoitic stem cell transplantation had to be made. Therefore, prodromal symptoms may be important in making decisions for therapeutic strategies, such as stem-cell transplantation in heavily exposed victims.

Amylases↗