Abstract: Since the first Oxford Survey of Childhood Cancer’s results were published, people have become more aware of the risks associated with prenatal exposure from diagnostic x rays. As a result, it has since been the subject of many studies. In this review, the results of recent epidemiological studies are summarized. The current international guidelines for diagnostic x-ray examinations were compared to the review. All epidemiological studies starting from 2007 and all relevant international guidelines were included. Apart from one study that involved rhabdomyosarcoma, no statistically significant associations were found between prenatal exposure to x rays and the development of cancer during 2007–2020. Most of the studies were constrained in their design due to too small a cohort or number of cases, minimal x-ray exposure, and/or data obtained from the exposed mothers instead of medical reports. In one of the studies, computed tomography exposure was also included, and this requires more and longer follow-up in successive studies. Most international guidelines are comparable, provide risk coefficients that are quite conservative, and discourage abdominal examinations of pregnant women.
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Diagnostic reference levels (DRLs) for medical x-ray procedures are being implemented currently in the Netherlands. By order of the Dutch Healthcare Inspectorate, a survey has been conducted among 20 Dutch hospitals to investigate the level of implementation of the Dutch DRLs in current radiological practice. It turns out that hospitals are either well underway in implementing the DRLs or have already done so. However, the DRLs have usually not yet been incorporated in the QAsystem of the department nor in the treatment protocols. It was shown that the amount of radiation used, as far as it was indicated by the hospitals, usually remains below the DRLs. A procedure for comparing dose levels to the DRLs has been prescribed but is not Always followed in practice. This is especially difficult in the case of children, as most general hospitals receive few children. Health Phys. 108(4):462–464; 2015
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Introduction: The Netherlands does not have a national guideline for performing radiographic examinations on pregnant patients. Radiographic examination is a generic term for all examinations performed using ionizing radiation, including but not limited to radiographs, fluoroscopy and computed tomography. A pilot study amongst radiographers (Medical Radiation Technologists (MRTs)) showed that standardized practice of radiographic examinations on pregnant women is not evident between Radiology departments and that there is a need for a national guideline as the varying practice methods may lead to confusion and uncertainty amongst both patients and MRTs. Methods: Focus groups consisting of MRTs from several Radiology departments within the Netherlands were used to map ideas and requirements as to what should be included in the national guideline. Nine focus group sessions were organized with a total of 52 participants. Using a previous review (Wit, Fleur; Vroonland, Colinda; Bijwaard H. Pre-natal X-ray exposure and the risk of developing paediatric cancer; a systematic review of risk factors and a comparison of international guidelines. Health Physics 2021; 121 (3):225e233), the following key points were chosen as discussion topics for the focus group sessions: dose reduction, confirming pregnancy and risk communication. Results: Results showed that the participating MRTs did not agree on the use of lead aprons. That the national guideline should include standardized methods to adjust parameters to decrease radiation dose. Focus group participants find it difficult to ask a patient's pregnancy status, especially when dealing with relatively young and old (er) patients. When communicating the level of risk associated with a radiographic examination the participating MRTs would like to be able to use examples and comparisons, preferably by means of a multilingual website. Conclusion: A national guideline must include information on justification, available alternatives, dose reductions methods and confirmation of pregnancy requirements when fetal dose is a significant risk. Implications for practice: A national guideline ensures standardized practice can be implemented in Radiology departments, increasing clarity of the issues for both patients and MRTs.
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Abstract—A survey was conducted among 20 Dutch hospitals about radiation protection for interventional fluoroscopy. This was a follow-up of a previous study in 2007 that led to several recommendations for radiation protection for interventional fluoroscopy. The results indicate that most recommendations have been followed. However, radiation-induced complications from interventional procedures are still often not recorded in the appropriate register. Furthermore, even though professionals with appropriate training in radiation protection are usually involved in interventional procedures, this often is not the case when these procedures are carried out outside the radiology department. Although this involvement is not required by Dutch law, it is recommended to have radiation protection professionals present more often at interventional procedures. Further improvements in radiation protection for interventional fluoroscopy may come from a comparison of dose-reducing practices among hospitals, the introduction of diagnostic reference levels for interventional procedures, and a more thorough form of screening and follow-up of patients
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Abstract—A survey about radiation protection in pediatric radiology was conducted among 22 general and seven children’s hospitals in the Netherlands. Questions concerned, for example, child protocols used for CT, fluoroscopy and x-ray imaging, number of images and scans made, radiation doses and measures taken to reduce these, special tools used for children, and quality assurance issues. The answers received from 27 hospitals indicate that radiation protection practices differ considerably between general and children’s hospitals but also between the respective general and children’s hospitals. It is recommended that hospitals consult each other to come up with more uniform best practices. Few hospitals were able to supply doses that can be compared to the national Diagnostic Reference Levels (DRLs). The ones that could be compared exceeded the DRLs in one in five cases, which is more than was expected beforehand.
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Introduction: In the Netherlands, Diagnostic Reference Levels (DRLs) have not been based on a national survey as proposed by ICRP. Instead, local exposure data, expert judgment and the international scientific literature were used as sources. This study investigated whether the current DRLs are reasonable for Dutch radiological practice. Methods: A national project was set up, in which radiography students carried out dose measurements in hospitals supervised by medical physicists. The project ran from 2014 to 2017 and dose values were analysed for a trend over time. In the absence of such a trend, the joint yearly data sets were considered a single data set and were analysed together. In this way the national project mimicked a national survey. Results: For six out of eleven radiological procedures enough data was collected for further analysis. In the first step of the analysis no trend was found over time for any of these procedures. In the second step the joint analysis lead to suggestions for five new DRL values that are far below the current ones. The new DRLs are based on the 75 percentile values of the distributions of all dose data per procedure. Conclusion: The results show that the current DRLs are too high for five of the six procedures that have been analysed. For the other five procedures more data needs to be collected. Moreover, the mean weights of the patients are higher than expected. This introduces bias when these are not recorded and the mean weight is assumed to be 77 kg. Implications for practice: The current checking of doses for compliance with the DRLs needs to be changed. Both the procedure (regarding weights) and the values of the DRLs should be updated.
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Vibrational and structural properties of lead-free piezoelectric (1-x)Na0.5Bi0.5TiO3–xCaTiO3 (0 < x < 1.00) solid solutions have been investigated using Raman spectroscopy and X-ray diffraction. Different anomalies were detected and analyzed taking into consideration the phase transition from rhombohedral to orthorhombic phase at room temperature. All Raman bands were interpreted through the variation in the peak positions (frequency) and the corresponding half-widths at half maximum (HWHM) as a function of x. XRD used as a complementary technique to Raman spectroscopy, showed that the rhombohedral – orthorhombic phase transition went gradually through an intermediate phase consisting of a mixture of rhombohedral (R3c) and orthorhombic (Pnma) structures and that the fraction of orthorhombic phase increased with CT composition. The results show that the morphotropic phase boundary (MPB) is located between 0.09 and 0.15.
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Patients scheduled for a magnetic resonance imaging (MRI) scan sometimes require screening for ferromagnetic Intra Orbital Foreign Bodies (IOFBs). To assess this, they are required to fill out a screening protocol questionnaire before their scan. If it is established that a patient is at high risk, radiographic imaging is necessary. This review examines literature to evaluate which imaging modality should be used to screen for IOFBs, considering that the eye is highly sensitive to ionising radiation and any dose should be minimised.Method: Several websites and books were searched for information, these were as follows: PubMed, Science Direct, Web of Knowledge and Google Scholar. The terms searched related to IOFB, Ionising radiation, Magnetic Resonance Imaging Safety, Image Quality, Effective Dose, Orbits and X-ray. Thirty five articles were found, several were rejected due to age or irrelevance; twenty eight were eventually accepted. Results: There are several imaging techniques that can be used. Some articles investigated the use of ultrasound for investigation of ferromagnetic IOFBs of the eye and others discussed using ComputedTomography (CT) and X-ray. Some gaps in the literature were identified, mainly that there are no articles which discuss the lowest effective dose while having adequate image quality for orbital imaging.Conclusion: X-ray is the best method to identify IOFBs. The only problem is that there is no research which highlights exposure factors that maintain sufficient image quality for viewing IOFBs and keep the effective dose to the eye As Low As Reasonably Achievable (ALARA).
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Background: A positive association between obesity based on body mass index (BMI) and periodontitis has been reported. Fat tissue-related systemic inflammation acts as the link to periodontal comorbidities of obesity. However, the BMI is unable to distinguish fat and fat-free tissues. More precise measures are required to evaluate body composition, including fat and fat-free tissues. This study aimed to determine the sex differences in the association between dual-energy x-ray absorptiometry (DXA)-measured body composition (i.e., fat mass and muscle mass) and phenotypes with periodontitis. Methods: Cross-sectional data of 3892 participants from the National Health and Nutrition Examination Survey (NHANES) study 2011‒2014 were analyzed. Adiposity indices (fat mass index [FMI] and percentage body fat [%BF]) and muscle mass index (MMI) were calculated. The participants were categorized by the quintiles of FMI, MMI, and %BF. Body composition phenotypes were categorized as: low adiposity-low muscle (LA-LM), low adiposity-high muscle (LA-HM), high adiposity-low muscle (HA-LM), or high adiposity-high muscle (HA-HM), respectively. Periodontitis was defined by the CDC/AAP (Centers for Disease Control and Prevention/American Academy of Periodontology) criteria. Multivariable logistic regression analysis was conducted, stratified by sex. We further adjusted for white blood cell (WBC) counts in the sensitivity analysis. Results: Restricted cubic splines revealed non-linear associations between body composition indices and periodontitis risk. Women with a higher FMI (odds ratio for Q5 vs. Q1 [ORQ5vs1] = 1.787, 95% confidence interval: 1.209–2.640) or %BF (ORQ5vs1 = 2.221, 1.509–3.268) had increased odds of periodontitis. In addition, women with HA-LM phenotype were more likely to develop periodontitis (OR = 1.528, 1.037–2.252). Interestingly, the WBC count, a systemic inflammatory biomarker, attenuated these associations. No statistically significant associations were found in men. Conclusions: The association between DXA-measured body composition and phenotypes with periodontitis differs per sex. Only in women higher adiposity indices and HA-LM phenotype were associated with an increased risk of periodontitis.
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Rationale: Diagnosis of sarcopenia in older adults is essential for early treatment in clinical practice. Bio-electrical impedance analysis (BIA) may be a valid means to assess appendicular lean mass (ALM) in older adults, but limited evidence is available. Therefore, we aim to evaluate the validity of BIA to assess ALM in older adults.Methods: In 215 community dwelling older adults (age ≥ 55 years), ALM was measured by BIA (Tanita MC-780; 8-points) and compared with dual-energy X-ray absorptiometry (DXA, Hologic Discovery A) as reference. Validity for assessing absolute values of ALM was evaluated by: 1) bias (mean difference), 2) percentage of accurate predictions (within 5% of DXA values), 3) individual error (root mean squared error (RMSE), mean absolute deviation), 4) limits of agreement (Bland-Altman analysis). For diagnosis of low ALM, the lowest quintile of ALM by DXA was used (below 21.4 kg for males and 15.4 for females). Sensitivity and specificity of detecting low ALM by BIA were assessed.Results: Mean age of the subjects was 71.9 ± 6.4, with a BMI of 25.8 ± 4.2 kg/m2, and 70% were females. BIA slightly underestimated ALM compared to DXA with a mean bias of -0.6 ± 0.2 kg. The percentage accurate predictions was 54% with RMSE 1.6 kg and limits of agreements −3.0 to +1.8 kg. Sensitivity was 79%, indicating that 79% of subjects with low ALM according to DXA also had low ALM with the BIA. Specificity was 90%, indicating that 90% of subjects with ‘no low’ ALM according to DXA also had ‘no low’ ALM with the BIA.Conclusions: This comparison showed a poor validity of BIA to assess absolute values of ALM, but a reasonable sensitivity and specificity to diagnose a low level of ALM in community-dwelling older adults in clinical practice.Disclosure of interest: None declared.
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