The document discusses the benefits and risks of medical radiation exposure in children. It finds that chest X-rays were the most common radiological exam performed on children in hospitals, even when over 50% provided no diagnostic benefit. The absorbed radiation doses for children were three to four times higher than reference values. Improving hospital protocols could help optimize exams and lower unnecessary radiation exposure for patients.
Assessment of Entrance Skin Dose in routine x-ray examinations of chest, skul...IOSR Journals
It is assumed that children are more susceptible to the effects of ionizing radiation and so deserves
special attention. Entrance skin doses (ESD) and Effective dose (E) to pediatric patients were estimated during
chest, skull, abdomen and pelvis examination in five Nigeria hospitals using DoseCal software. The mean ESD
for Chest (PA) in age range 1 – 5 in the five hospitals (H1 – H5) were 70, 139, 130, 105 and 111μGy,
respectively. The median ESD values in all the examinations were compared with the NRPB and EC reference
level and were found to be lower except for Chest PA and Chest Lateral examinations. The mean effective doses
were compared with those found in literature and were found to be comparable. Data shows that there is
variation in the result of the ESD obtained and so adherence to guidelines should be demonstrated
One example of how Clinical Cancer Registry level data can review practice va...Cancer Institute NSW
We examined the possible utility of using Cancer Institute NSW Clinical Cancer Registry data by examining one contentious issue in radiation oncology as an example. Increasing evidence has been published about the safety and efficacy of hypofractionated radiotherapy, in comparison with standard fractionation, in early, node-negative breast cancer.
Introducing VESPIR: a new open-source software to investigate CT ventilation ...Cancer Institute NSW
Computed tomography ventilation imaging (CTVI) is an exciting new functional lung imaging modality enabling functionally adaptive lung cancer radiotherapy treatments. In 2015, this became clinical reality with the first patient treatment performed in the US. Unfortunately the development of new CTVI workflows in the clinic can be challenging, due to the requisite advanced four-dimensional (4D) image processing. To overcome this, we have developed VESPIR (VEntilation via Scripted Pulmonary Image Registration), a user-friendly software toolkit to help streamline the end-to-end validation of CTVI workflows in the clinic.
Curative lung radiotherapy has historically been hampered by inadequate imaging techniques. Conventional CT provides poor information regarding tumour shape, size and motion throughout the patient’s breathing cycle. Consequently lung radiotherapy techniques have been characterised by excessively large targets to ensure the actual tumour receives the intended treatment.
Assessment of Entrance Skin Dose in routine x-ray examinations of chest, skul...IOSR Journals
It is assumed that children are more susceptible to the effects of ionizing radiation and so deserves
special attention. Entrance skin doses (ESD) and Effective dose (E) to pediatric patients were estimated during
chest, skull, abdomen and pelvis examination in five Nigeria hospitals using DoseCal software. The mean ESD
for Chest (PA) in age range 1 – 5 in the five hospitals (H1 – H5) were 70, 139, 130, 105 and 111μGy,
respectively. The median ESD values in all the examinations were compared with the NRPB and EC reference
level and were found to be lower except for Chest PA and Chest Lateral examinations. The mean effective doses
were compared with those found in literature and were found to be comparable. Data shows that there is
variation in the result of the ESD obtained and so adherence to guidelines should be demonstrated
One example of how Clinical Cancer Registry level data can review practice va...Cancer Institute NSW
We examined the possible utility of using Cancer Institute NSW Clinical Cancer Registry data by examining one contentious issue in radiation oncology as an example. Increasing evidence has been published about the safety and efficacy of hypofractionated radiotherapy, in comparison with standard fractionation, in early, node-negative breast cancer.
Introducing VESPIR: a new open-source software to investigate CT ventilation ...Cancer Institute NSW
Computed tomography ventilation imaging (CTVI) is an exciting new functional lung imaging modality enabling functionally adaptive lung cancer radiotherapy treatments. In 2015, this became clinical reality with the first patient treatment performed in the US. Unfortunately the development of new CTVI workflows in the clinic can be challenging, due to the requisite advanced four-dimensional (4D) image processing. To overcome this, we have developed VESPIR (VEntilation via Scripted Pulmonary Image Registration), a user-friendly software toolkit to help streamline the end-to-end validation of CTVI workflows in the clinic.
Curative lung radiotherapy has historically been hampered by inadequate imaging techniques. Conventional CT provides poor information regarding tumour shape, size and motion throughout the patient’s breathing cycle. Consequently lung radiotherapy techniques have been characterised by excessively large targets to ensure the actual tumour receives the intended treatment.
UOG Journal Club August 2013
Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results
J. L. Alcázar, L. Díaz, P. Flórez, S. Guerriero and M. Jurado
Link to the article (open access):
onlinelibrary.wiley.com/doi/10.1002/uog.12440/abstract
Advances in automatic tuberculosis detection in chest x ray imagessipij
Tuberculosis (TB) is very dangerous and rapidly spread disease in the world. In the investigating cases for
suspected tuberculosis (TB), chest radiography is not only the key techniques of diagnosis based on the
medical imaging but also the diagnostic radiology. So, Computer aided diagnosis (CAD) has been popular
and many researchers are interested in this research areas and different approaches have been proposed
for the TB detection and lung decease classification. In this paper, the medical background history of TB
decease in chest X-rays and a survey of the various approaches in TB detection and classification are
presented. The literature in the related methods is surveyed papers in this research area until now 2014.
Only a small percentage of cancer patients are good candidates for proton therapy. Yet, for the right patients, proton therapy can reduce radiation exposure to healthy tissue. To help you make the best care decisions, this slide deck offers information to help you identify those of cancer patients best treated with proton therapy.
Defining and assessing a delineation uncertainty margin for modern radiotherapyCancer Institute NSW
The implementation of image-guided technology and progressively conformal techniques in modern radiotherapy for the treatment of cancer, ensure the planned distribution of dose is well matched to the clinician-defined target volume. However, this precision relies on the target volume including all malignant tissue, with delineation uncertainty resulting in potential normal tissue toxicities and insufficient dose to the cancer. Methods need to be implemented to minimise delineation uncertainty, and subsequently improve local control and patient outcomes.
A distributed data mining network infrastructure for Australian radiotherapy ...Cancer Institute NSW
Routine electronic storage of medical records and imaging is becoming standard practice in radiotherapy. There is immense potential to utilise this increasingly diverse data resource as an evidence base for decision support systems for cancer prognosis and subsequent personalised treatment decisions.
My thoughts on the challenges in pediatric radiology in India today. I have discussed the current status and the future prospects and offered possible solutions as well. This was the Dr. Arcot Gajaraj oration that I delivered at the X Annual Conference of the Indian Society of Pediatric Radiology (ISPR) in Chandigarh on 29th September, 2012.
The experience of survival following Blood and Marrow Transplant in NSW, Aust...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many experience significant late morbidity and mortality.
Weight loss among patients with Head and Neck Cancer at St Vincent's Hospital...Cancer Institute NSW
Patients with Squamous cell carcinoma (SCC) of the Head and Neck (H&N) are often treated with curative intent using treatment protocols placing them at high risk of nutritional decline. Recently released COSA guidelines recommend that prophylactic enteral feeding should be considered for T4 upper aerodigestive tract tumours undergoing concurrent chemoradiotherapy. Evidence is yet to identify optimal method of nutrition intervention and timing across all tumour stages in this population.
UOG Journal Club August 2013
Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results
J. L. Alcázar, L. Díaz, P. Flórez, S. Guerriero and M. Jurado
Link to the article (open access):
onlinelibrary.wiley.com/doi/10.1002/uog.12440/abstract
Advances in automatic tuberculosis detection in chest x ray imagessipij
Tuberculosis (TB) is very dangerous and rapidly spread disease in the world. In the investigating cases for
suspected tuberculosis (TB), chest radiography is not only the key techniques of diagnosis based on the
medical imaging but also the diagnostic radiology. So, Computer aided diagnosis (CAD) has been popular
and many researchers are interested in this research areas and different approaches have been proposed
for the TB detection and lung decease classification. In this paper, the medical background history of TB
decease in chest X-rays and a survey of the various approaches in TB detection and classification are
presented. The literature in the related methods is surveyed papers in this research area until now 2014.
Only a small percentage of cancer patients are good candidates for proton therapy. Yet, for the right patients, proton therapy can reduce radiation exposure to healthy tissue. To help you make the best care decisions, this slide deck offers information to help you identify those of cancer patients best treated with proton therapy.
Defining and assessing a delineation uncertainty margin for modern radiotherapyCancer Institute NSW
The implementation of image-guided technology and progressively conformal techniques in modern radiotherapy for the treatment of cancer, ensure the planned distribution of dose is well matched to the clinician-defined target volume. However, this precision relies on the target volume including all malignant tissue, with delineation uncertainty resulting in potential normal tissue toxicities and insufficient dose to the cancer. Methods need to be implemented to minimise delineation uncertainty, and subsequently improve local control and patient outcomes.
A distributed data mining network infrastructure for Australian radiotherapy ...Cancer Institute NSW
Routine electronic storage of medical records and imaging is becoming standard practice in radiotherapy. There is immense potential to utilise this increasingly diverse data resource as an evidence base for decision support systems for cancer prognosis and subsequent personalised treatment decisions.
My thoughts on the challenges in pediatric radiology in India today. I have discussed the current status and the future prospects and offered possible solutions as well. This was the Dr. Arcot Gajaraj oration that I delivered at the X Annual Conference of the Indian Society of Pediatric Radiology (ISPR) in Chandigarh on 29th September, 2012.
The experience of survival following Blood and Marrow Transplant in NSW, Aust...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many experience significant late morbidity and mortality.
Weight loss among patients with Head and Neck Cancer at St Vincent's Hospital...Cancer Institute NSW
Patients with Squamous cell carcinoma (SCC) of the Head and Neck (H&N) are often treated with curative intent using treatment protocols placing them at high risk of nutritional decline. Recently released COSA guidelines recommend that prophylactic enteral feeding should be considered for T4 upper aerodigestive tract tumours undergoing concurrent chemoradiotherapy. Evidence is yet to identify optimal method of nutrition intervention and timing across all tumour stages in this population.
Secondary Malignancy after Treatment of Prostate Cancer. Radical Prostatectom...asclepiuspdfs
Background: This study aims to determine whether the treatment of locally confined prostate cancer (PCa) with external radiotherapy (EBRT) increases the risk to develop secondary malignancies (SM) compared to radical prostatectomy (RPE). Materials and Methods: Data from patients who were treated curatively with RPE or EBRT from 2010 to 2018 and who did not have distant metastases, previous malignancy, or previous treatment with radiotherapy or chemotherapy at the time of diagnosis were reviewed to determine the incidence of SM over a median follow-up period of 47 months (range 12–96 months). Regression models were used to correlate the clinicopathological factors with the incidence of SM.
Assessment of Health Care Workers Knowledge, Attitude and Practices of Radiat...ijtsrd
Radiological doses are low and the chances of long time effect is minimal, but it should be kept as low as reasonably achievable. Therefore health workers especially Doctors requesting for imaging must be well trained in deciding when medical imaging should be carried out and should also have accurate knowledge of the associated risk involved. This can only be achieved if a proper knowledge and safety practice is adhered to. A cross sectional study to investigate the level of health workers knowledge, about radiation safety and their attitude towards radiation safety was carried out. A self administered questionnaire for radiation safety was sent to a purposive sample of 174 Health workers at a Specialist Hospital, in Jos, Plateau State, Nigeria. 169 questionnaires were filled and return by participant responsive rate 97.1 . The sample include 8 Radiologist, 72 Nurses, 3 Oncologist, 49 Clinicians, 26 Technicians and 11 Surgeons. Majority of the participants have never attain any radiation safety related training 76 . Radiologist and oncologist who were more frequently expose to ionizing radiation, their knowledge was not far better than the other health workers. The general knowledge score ranges from 5.9 to 60.9 , with a low score among nurses and surgeons. The most alarming was the applicability and convenience of radiation protection policies and procedure. Adherence to safety precaution practices was mostly violated by participants, especially nurses and surgeons, but they attributed it to the poor application of protective measures during performing the procedures. The investigation concluded that Health workers in a Specialist Hospital, Jos Plateau State, Nigeria have fair knowledge, negative attitude and poor safety practices towards radiation safety policies and precautions. Chenko G. Y. Nimchang | Ndam Moses Ponsel | Manset W. E. | Songden S. D "Assessment of Health Care Workers Knowledge, Attitude and Practices of Radiation Safety at a Specialist Hospital, Jos, Plateau State, Nigeria" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-6 , October 2022, URL: https://www.ijtsrd.com/papers/ijtsrd46452.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/46452/assessment-of-health-care-workers-knowledge-attitude-and-practices-of-radiation-safety-at-a-specialist-hospital-jos-plateau-state-nigeria/chenko-g-y-nimchang
Paul Coplan, VP, Johnson & Johnson_mHealth IsraelLevi Shapiro
Pesentation, October 19th, 2021: What’s Next in RWE for Medical Devices: The Art of the Possible. Presented by Paul Coplan, ScD, MBA, FISPE, Vice President, Med Device Epidemiology and RWD Sciences, Johnson & Johnson; Adjunct Professor, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine; Fellow of the International Society of Pharmacoepidemiology
- Why RWE is Important for Medical Devices: Challenges with Clinical Trials of Medical Devices (Blinding, Surgeon skill/technique, Hospital process, Product modifications, Long term Follow up, Enrolment challenges)
- Types of Real-World Data Sources (Complaints like MAUDE, Eudramed and Company Databases, Hospital Databases, Electronic Health Records, Claims, Registries, Patient surveys, Surgeon surveys, PROs, Patient Preferences, wearables, sensors, social media, Surgical videos, device generated data, radiographic images)
- FDA CDRH Report on RWE Examples for Regulatory Decisions
- J&J Med Device Epidemiology & Real-World Data Sciences
- US National Evaluation System for Health Technology (NEST)
- RWE for Safety Assessments: Cobalt in Implants and at Work and Risk of Cancer
- Summary of Cobalt Exposure and All-Site Cancer Risk, by Study Type
- Comparative Effectiveness Studies Using RWE
- Summary
a. Use of RWE is important to benefit patients globally and enhance the safety and innovation of medical devices
b. Regulators are interested in using RWE for regulatory decisions but data quality and evidence needs to be regulatory grade
c. NEST has been a useful forum to advance the use of RWE for regulatory decisions in the US
d. RWE can be used for safety assessments, regulatory decisions, comparative effectiveness research, and R&D of products
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
Current literature on dental radiology was reviewed in order to seek justification for radiological protection of patients in dental radiography, to explore the different factors affecting patient dose and to derive practical guidance on how to achieve radiological protection of patients in dentistry. Individual doses incurred in dental radiology are in general relatively low, however it is generally accepted that there is no safe level of radiation dose and that no matter how low the doses received are, there is a mathematical probability of an effect. Hence appropriate patient protection measures must be instituted to keep the exposures as low as reasonably achievable (ALARA). The literature review demonstrated that there is considerable scope for significant dose reductions in dental radiology using the techniques of optimization of protection.
Most dental professionals are not convinced of the need for regulatory control of dental radiography practice. They believe doses are too low to warrant regulatory control and consequently patient protective measures. This study shows that individual doses in dental radiology are relatively low. However, there is no safe level of radiation dose and that no
matter how low the doses received are, there is a
mathematical probability of an effect. Consequently, appropriate patient protection measures must be instituted to keep exposures as low as reasonably achievable (ALARA).
An Audit of the Management and Associated Contextual Correlates of Clinical P...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Evidence TableEvidence TablePICOT Question
[Insert here]APA Source Reference
(Include the DOI or URL. Use the source URL, not the library link.) Indicate: Peer Reviewed,
Clinical Guideline, or
Best Practice GuidelineAim, Hypothesis,
or Research QuestionConceptual or
Theoretical FrameworkResearch Design/MethodologyMeasurement
MethodSample Population
or SettingResearch Variables Data AnalysisFindingsGaps in ResearchSignificant Findings from a Critical Appraisal of the Evidence
(level, quality of the evidence)Good QuotesAdditional NotesEnd of Worksheet
Role of Clinical Trial Participation in Cancer Research: Barriers,
Evidence, and Strategies
Joseph M. Unger, Ph.D.1, Elise Cook, M.D.2, Eric Tai, M.D.3, and Archie Bleyer, M.D.4
1Fred Hutchinson Cancer Research Center, Seattle, Washington
2The University of Texas MD Anderson Cancer Center, Houston, Texas
3Centers for Disease Control and Prevention, Atlanta, Georgia
4St Charles Health System, Quality Department, Bend, Oregon
OVERVIEW
Fewer than 1 in 20 adult cancer patients enroll in cancer clinical trials. But although barriers to
trial participation have been the subject of frequent study, the rate of trial participation has not
changed substantially over time. Barriers to trial participation are structural, clinical, and
attitudinal, and differ according to demographic and socioeconomic factors. In this paper, we
characterize the nature of cancer clinical trial barriers, and we consider global and local strategies
for reducing barriers. We also consider the specific case of adolescents with cancer, and show that
the low rate of trial enrollment in this age group strongly correlates with limited improvements in
cancer population outcomes compared to other age groups. Our analysis suggests that a clinical
trial system that enrolls patients at higher rates produces treatment advances at a faster rate and
corresponding improvements in cancer population outcomes. Viewed in this light, the issue of
clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor.
Fewer barriers to trial participation would allow trials to be completed more quickly and would
improve the generalizability of trial results. Moreover, increased accrual to trials is important to
patients, since trials provide patients the opportunity to receive the newest treatments. In an era of
increasing emphasis on a treatment decision-making process that incorporates the patient
perspective, the opportunity for patients to choose trial participation for their care is vital.
INTRODUCTION
The path from initial development of a new cancer drug to diffusion of the new therapy into
the cancer treatment community relies, crucially, on clinical trials, which represent the final
step in evaluating the efficacy of new therapeutic approaches for malignancy. It has been
repeatedly estimated that <5% of adult cancer patients enroll in cancer clinical trials.1,2
...
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Surgical Site Infections, pathophysiology, and prevention.pptx
Benefit vs[1][1][2][1]. risk in children's exposure to radiation for medical diagnosis purposes
1. BENEFIT VS. RISK IN CHILDREN’S EXPOSURE TO RADIATION FOR MEDICAL DIAGNOSIS
PURPOSES
Elena Dădulescu, Ioana Şorop, Daniela Mossang, Corina Pera, E. Pătru, D. Bondari, I. Prejbeanu
Abstract: The increasing and diversified access to the medical diagnosis using ionizing radiation sources and other
epidemiologic studies drew atention to international organizations about the long term risk of developing cancer produced
by exposure to ionizing radiation. Medical exposure to ionizing radiation in childhood requires special caution because
children represent the age group with the highest radiosensibility, and therefore the risk of cancer is 2-3 times greater
compared to the adult. The risk is determined partly by the child’s anatomical, pathological, biochemical and physiological
peculiarities and partly by their increased life expectancy. In order to assess the potential risk among the child population,
we considered the physiological developement of breast, gonades and the largest distribution of the bone marow in the
skeleton. The great number of exposures, the inappropriate use of physical parameters of the radiological equipament, their
performances, lead to great entrance surface doses in the patients.
For this reason, it is becoming increasingly important to guarantee to the patient the fact that the medical diagnosis with
ionizing radiation is not associated with great risks due to irradiation. The present study was conducted in the Anesthesia
and Intensive Care Department (ATI) and in the Pediatric Department in the County Dolj Hospital (2005-2007), following
the frequency and distribution of radiological examinations and the entrance surface dosese for patients in the most
important radiological exaninations. We found out that the chest X-ray exams were the first in all age groups, even though
more than 50% had no diagnostic benefit whatsoever. The absorbed doses by the children were three to four times greater
than the reference values. That’s why we need hospital work protocols which might represent a better instrument to improve
the clinical system and the patient medical care.
Key words: medical exposure, entrance surface dose, reference levels
Elena Dadulescu: MD, Student PhD Faculty of Medicine Craiova, The Authority of Public Health Dolj, Laboratory of
Ionizing Radiation Hygiene ;liricv@yahoo.com
Ioana Sorop: physicist, Student PhD Faculty of Physics Bucharest; The Authority of Public Health Dolj, Laboratory of
Ionizing Radiation Hygiene; liricv@yahoo.com
Daniela Mossang: Assistant Professor Faculty of Physics, Student PhD Faculty of Physics Bucharest; The Authority of
Public Health Dolj, Laboratory of Ionizing Radiation Hygiene; liricv@yahoo.com
Corina Pera: medical physicist, County Hospital Resita
Dan Bondari: MD, Assistant Professor, Student PhD Faculty of Medicine Craiova UMF
Emilia Patru: MD, Associated Professor ;UMF Craiova
Ileana Prejbeanu: MD, Associated Professor ;UMF Craiova
2. Introduction
It has been a long time since the use of radiation sources for diagnostic purposes first proved their benefits. The
increasing and diversified access to these sources, as well as the developed epidemiologic studies, have drawn attention to
international organizations, regarding the long term risk to develop cancer due to exposure to ionizing radiation [2]. For this
reason, the patient’s right to a minimal exposure to ionizing radiation is becoming increasingly important so as to ensure the
lowest risk possible. Medical exposure to ionizing radiation in all children age groups requires increased caution because
they represent the category of patients with the highest radio sensibility, and therefore the risk of cancer is 2-3 times greater
compared to the adult [7, 8]. This risk is determined partly by the child’s anatomical, pathological, biochemical and
physiological peculiarities and partly by their increased life expectancy. During the medical observation of newborns and
small children, frequent radiological investigations, especially chest and abdomen, are performed. On the other hand, those
who present clinical complications, require longer hospitalization, which can take even several months, which can increase
the number of X-ray examinations. Every exposure means a new radiation dose for the child [1, 19]. The increased number
of exposures, misuse of physical parameters of the radiological equipment and its technology may lead to high entrance
surface doses at the patient [9, 10]. It is necessary to know the present trends of the absorbed doses by patients during
radiological examinations in every medical section. This represents a guide for optimizing the patient’s radioprotection so as
to minimize the risks involved [13].
Material and method
The present study was conducted in the Anesthesia and Intensive Care Department (ATI) and in the Pediatric
Department in the county hospital, between 2005-2007. The study has two main directions: on the one hand, it describes the
frequency and distribution of radiological exams, and on the other hand, it estimates entrance surface doses for patients who
have been exposed during the most important medical procedures. The radiological examinations are conducted with two
types of equipment:
mobile X-ray unit, Polymobile 10 Type with a total filtering of 3.4mm Al
fix X-ray unit, ELTEX 400 type with a total filtering of 2.5mm Al
The physical parameters are measured with a multifunctional measuring instrument which tests the quality of type
RMI-242 radiological systems, with a flat ionization chamber with a volume of 51cc and a standard phantom.
The statistic evaluation was made using a Student Test comparing the obtained average values for the entry surface dose
with the reference values [14].
Results and discussions
1. Frequency of radiological examinations in the ATI department
Table 1. Frequency of radiological examinations on years and type of procedure
Graph 1. Frequency of radiological examinations on years and type of procedure
A slight variation of the frequency of the radiological exam can be observed during the three years assessed. The
obvious decrease in 2007 can be attributed to a better collaboration between doctors who requested the procedures, and
practitioners regarding the standards of medical exposure to ionizing radiation.
2. Number of children that have undergone a radiological exam out of the total of newborns
3. Graph 2. The number of newborns that have been radiologically examined out of the total number of new-born
babies
Out of the 8785 newborns in the studied period, 9.8% had at least one radiological exam. The average number of
radiological exams conducted on a single child is 1.8, the highest number of radiological exams being 9.
3. the distribution of the radiological examinations in the pediatric department, sorted by age and procedures
Table 2. Frequency of radiological examinations
Graph 3. Frequency of radiological examinations
The largest number of chest X-rays is conducted on the 0 - 3 age group, the value dropping significantly in the
subsequent age groups. One of the causes could be the much more varied pathology of this age group, but also the doctors’
habit of repeating the clinical exams more than once before the treatment shows any improvement.
4. Ratio between the number of chest X-rays performed and the confirmed examinations
Table 3. Ratio between the number of chest X-rays performed and the confirmed examinations
Graph 4. Ratio between the number of chest X-rays performed and the confirmed examinations
Besides the fact that the number of chest X-rays is extremely high in comparison to other procedures, the percentage of
confirmed examinations is mostly below 50%.
5. Comparing the used kilo-voltage values to the reference values for chest X-rays
Graph 5. Kilo-voltage
For all age groups, excepting that of 12-15, the kilo-voltage values used surpasses the recommended values for a chest
X-ray, which are between 60 and 80kV
6. The average entrance surface doses values for the children in ATI and the comparison with the reference
values specified in the Order no. 285/79/2002 of the Ministry of Health and Family and of the president of the
National Committee for the Nuclear Activities Control regarding the radioprotection of people in the event of the
medical exposures to ionizing radiations.
Table 4. The entrance surface doses
Graph 6. The entrance surface doses
For chest X-ray, the value of the entrance surface dose is the highest compared to the other two types of exams and 1.08
times higher than the reference values. For other examination types there are no reference values whatsoever.
7. Average values of the entrance surface doses per exam type and age groups for the children in the pediatric
department and the comparison with the reference values
Table 5. Average values of the entrance surface doses per exam type and age groups for the children in the
pediatric department and the comparison with the reference values
It has been observed that one exposure of a 5 year old child determined 4 times greater chest irradiation values, 3 times
greater for two exposures and 2 times greater in the pelvic area, compared to the reference values. Values close to the
reference values have been found for the skull X-ray.
The values of the Student Test point out statistically significant differences for the chest and pelvic X-rays (p<0.001)
and statistically insignificant ones for the skull X-rays (p>0.05). For other types of procedures reference values are not
specified [16, 19].
Conclusions
4. 1. Of all investigations, chest X-ray is ranked first in all age groups, even though more than 50% had no diagnostic
benefit whatsoever. Therefore, “better” can easily become “worse”, if neglecting that any radiation dosage may be harmful
and may have long term repercussions, considering the very high latency of the effects inflicted by the ionizing radiation
[17].
2. The radiological equipment used in Children’s ATI and also in the Pediatric Departments are not designed
purposely for pediatric radiology. In addition, it does not comply with the standards regarding technical parameters, which
ultimately may have a crucial impact on the radiation dose received by the patient [3, 4].
3. In order to gather correct diagnostic information, a crucial part is played by the quality of the radiography, strongly
linked to the previously mentioned parameters [5, 15].
4. The doses absorbed by the children (three or four times greater than the reference values) can be explained by the
use of low kilo-voltage (which implies the use of ‘soft” X-ray fascicles, associated with the release of higher doses), the
values of this physical parameter in the 0 - 11 age group being below the recommended values [6, 7, 12].
5. In the case of newborns, the most worrying aspect is not the dose the child is exposed to, but the fact that clinical
X-rays are repeated during hospitalization. This leads to cumulative doses, which are likely to increase during the
newborn’s childhood [18].
6. To reduce the exposure of the child to radiation, it’s important that the medical staff have special training regarding
the anatomy and physiology of the child, and that the medical care takes place in a friendly environment [17, 12].
7. Hospital protocols may improve the healthcare system and ultimately lead to a better care for the patient [11].
8. Every clinician will have to be aware of his responsibility as well as the collective responsibility to ensure the
quality of the medical act.
All these suggestions, if followed, could lead to the decrease of ineffective investigations, and particularly to decreasing
the radiation doses per patient.
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[10] Lindskoug B.A., Exposure parameters in x-ray diagnosis of children, infants and the newborns. Radiation
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[11] Martin C.J., Darragh C.L., McKenzie G.A., et. al., Implementation of a program for reduction of radiographic
doses and results achieved through increases in tube potential. Br. J Radiology 1993; 66(783):228-33;
[12] Mooney R., Thomas P.S., Dose reduction in a pediatric X-ray department following optimization of
radiographic technique. Br J Radiology 1998; 7 (848):852-60;
[13] Picano E., Sustainability of medical imaging, BMJ 2004, 328:578-580;
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532-533;
[15] Regulla D., Eder H., Patient exposures in medical X-ray imaging in Europe. Radiation Protection Dosimetry,
2005, pg.11-25;
[16] Schreiner - Karoussou A, Back C, Harpes N (eds), Practical Implementation of the Medical Exposure
Directive ( 97/43) in Luxembourg with special reference to diagnostic reference level, Radiological Protection of
Patient in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy, 2001, 1: 403 – 406;
[17] Scripcaru Gh., Bioetica între ştiinţele vieţii şi drepturile omului, Revista Română de Bioetică, vol. 1, nr.2,
2008, pg. 2;
[18] Stern.S, Tucker S, Gagne RM (eds), Estimated Benefits of Proposed Amendments to the FDA Radiation-
Safety Standard for Diagnostic Y- Ray Equipment, Science Across the Boundaries, February, 2001, pg.1-27;
[19] Tschurlovits M., A proposal to prove compliance of ESD with EU – Guideline, Radiological Protection of
Patient in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy, 2001, 1:407 – 410;
[20] Wraith C.M., Martin C.J., Stockdale E.J., et. al., An investigation into techniques reducing doses from neo-
natal radiographic examinations, Br. J Radiology 1995, 68(814):1074-82.