Overdiagnosis and overimaging: an ethical issue for radiological protection

Aims and objectives: This study aimed to analyse the key factors that influence the overimaging using X-ray such as self-referral, defensive medicine and duplicate imaging studies and to emphasize the ethical problem that derives from it. Materials and methods: In this study, we focused on the more frequent sources of overdiagnosis such as the total-body CT, proposed in the form of screening in both public and private sector, the choice of the most sensitive test for each pathology such as pulmonary embolism, ultrasound investigations mostly of the thyroid and of the prostate and MR examinations, especially of the musculoskeletal system. Results: The direct follow of overdiagnosis and overimaging is the increase in the risk of contrast media infusion, radiant damage, and costs in the worldwide healthcare system. The theme of the costs of overdiagnosis is strongly related to inappropriate or poorly appropriate imaging examination. Conclusions: We underline the ethical imperatives of trust and right conduct, because the major ethical problems in radiology emerge in the justification of medical exposures of patients in the practice. A close cooperation and collaboration across all the physicians responsible for patient care in requiring imaging examination is also important, balancing possible ionizing radiation disadvantages and patient benefits in terms of care

Imaging of response to anti-angiogenic drugs

Les nouveaux traitements, comme les molécules antiangiogéniques, agissent sur des cibles spécifiques. Leur effet sur la taille tumorale est parfois absent ou retardé. De nouvelles techniques d’imagerie fonctionnelle s’intéressent à une caractéristique physiologique plutôt que la taille tumorale, et pourraient mettre en évidence des modifications en réponse au traitement apparaissant plus précocement. L’imagerie dynamique de la microcirculation suit la biodistribution d’un agent de contraste, et analyse la vascularisation tumorale. L’imagerie par résonance magnétique pondérée en diffusion permet de distinguer l’eau libre, de l’eau restreinte dans les tissus, reflétant la cellularité tumorale. L’imagerie par résonance magnétique par effet BOLD reflète l’oxygénation tissulaire en quantifiant le rapport déoxy/oxyhémoglobine. Les études testant ces techniques sont cependant préliminaires et nécessitent des études à grande échelle pour évaluer leur rôle dans la réponse aux traitements ciblés en oncologie.New therapies, such as anti-angiogenic drugs, target specific molecules. Their effect on tumor size is sometimes absent or delayed. New techniques of functional imaging do not detect changes in size, but rather a physiological characteristic, and could reveal changes in response to treatment which arise earlier. Dynamic contrast-enhanced (DCE) imaging follows the biodistribution of a contrast agent and analyzes tumor vascularization. Diffusion-weighted magnetic resonance imaging quantifies restriction to diffusion of water in tissues, reflecting tumor cellularity. BOLD magnetic resonance imaging reflects tissue oxygenation by quantifying the ratio between deoxygenated and oxygenated hemoglobin. Studies testing these techniques are still preliminary. It is therefore necessary to organize large scale studies to evaluate their potential role in response to targeted therapies in oncology

Medical applications of ionizing radiation and radiation protection for European patients, population and environment

Medical applications of ionising radiation (IR) represent a key component of the diagnosis and treatment of many diseases, guaranteeing efficient health care. The use of IR in medicine, the largest source of general population radiation exposure, is potentially associated with increased risk of cancer and non-cancer diseases, which needs to be evaluated to provide evidence-based input for risk-benefit considerations. Efforts are also needed to improve the safety and efficacy of medical applications through optimisation. The EC Euratom programme enhances research in medical radiation protection. The four complementary multidisciplinary projects presented here contribute to (1) improving knowledge on exposure and effects of diagnostic and therapeutic applications and (2) transferring results into clinical practice. The common aim is to optimise use for individual patients, enhance education and training, ensuring adherence to ethical standards, particularly related to technologies based on artificial intelligence. MEDIRAD, SINFONIA and HARMONIC focus on improving exposure estimation and studying the detrimental effects of diagnostic and therapeutic medical exposures in patients and staff using different endpoints. EURAMED rocc-n-roll brings together the results of the projects and the recommendations generated by them to build, in collaboration with the EU Radiation Protection research platforms, a strategic research agenda and a roadmap for research priorities

Education and training in radiation protection in Europe: an analysis from the EURAMED rocc-n-roll project

Background: A Strengths, weaknesses, opportunities and threats analysis was performed to understand the status quo of education and training in radiation protection (RP) and to develop a coordinated European approach to RP training needs based on stakeholder consensus and existing activities in the field. Fourteen team members represented six European professional societies, one European voluntary organisation, two international healthcare organisations and five professions, namely: Medical Physicists; Nuclear Medicine Physicians; Radiologists; Radiation Oncologists and Radiographers. Four subgroups analysed the “Strengths”, “Weaknesses”, “Opportunities” and “Threats” related to E&T in RP developed under previous European Union (EU) programmes and on the Guidelines on Radiation Protection Education and Training of Medical Professionals in the EU. Results: Consensus agreement identified four themes for strengths and opportunities, namely: (1) existing structures and training recommendations; (2) RP training needs assessment and education & training (E&T) model(s) development; (3) E&T dissemination, harmonisation, and accreditation; (4) financial supports. Weaknesses and Threats analysis identified two themes: (1) awareness and prioritisation at a national/global level and (2) awareness and prioritisation by healthcare professional groups and researchers. Conclusions: A lack of effective implementation of RP principles in daily practice was identified. EuRnR strategic planning needs to consider processes at European, national and local levels. Success is dependent upon efficient governance structures and expert leadership. Financial support is required to allow the stakeholder professional agencies to have sufficient resources to achieve a pan European radiation protection training network which is sustainable and accredited across multiple national domains.info:eu-repo/semantics/publishedVersio

Subclinical Left Ventricular Dysfunction Detected by Speckle-Tracking Echocardiography in Breast Cancer Patients Treated With Radiation Therapy:A Six-Month Follow-Up Analysis (MEDIRAD EARLY‐HEART study)

Copyright © 2022 Locquet, Spoor, Crijns, van der Harst, Eraso, Guedea, Fiuza, Santos, Combs, Borm, Mousseaux, Gencer, Frija, Cardis, Langendijk and Jacob. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Background: In the case of breast cancer (BC), radiotherapy (RT) helps reduce locoregional recurrence and BC-related deaths but can lead to cardiotoxicity, resulting in an increased risk of long-term major cardiovascular events. It is therefore of primary importance to early detect subclinical left ventricular (LV) dysfunction in BC patients after RT and to determine the dose-response relationships between cardiac doses and these events. Methods: Within the frame of the MEDIRAD European project (2017-2022), the prospective multicenter EARLY-HEART study (ClinicalTrials.gov Identifier: NCT03297346) included chemotherapy naïve BC women aged 40-75 years and treated with lumpectomy and adjuvant RT. Myocardial strain analysis was provided using speckle-tracking echocardiography performed at baseline and 6 months following RT. A global longitudinal strain (GLS) reduction >15% between baseline and follow-up was defined as a GLS-based subclinical LV dysfunction. Individual patient dose distributions were obtained using multi-atlas-based auto-segmentation of the heart. Dose-volume parameters were studied for the whole heart (WH) and left ventricle (LV). Results: The sample included 186 BC women (57.5 ± 7.9 years, 64% left-sided BC). GLS-based subclinical LV dysfunction was observed in 22 patients (14.4%). These patients had significantly higher cardiac exposure regarding WH and LV doses compared to patients without LV dysfunction (for mean WH dose: 2.66 ± 1.75 Gy versus 1.64 ± 0.96 Gy, p = 0.01). A significantly increased risk of subclinical LV dysfunction was observed with the increase in the dose received to the WH [ORs from 1.13 (V5) to 1.74 (Dmean); p <0.01] and to the LV [ORs from 1.10 (V5) to 1.46 (Dmean); p <0.01]. Based on ROC analysis, the LV-V5 parameter may be the best predictor of the short-term onset of subclinical LV dysfunction. Conclusion: These results highlighted that all cardiac doses were strongly associated with the occurrence of subclinical LV dysfunction arising 6 months after BC RT. Whether measurements of GLS at baseline and 6 months after RT combined with cardiac doses can early predict efficiently subclinical events occurring 24 months after RT remains to be investigated.The European Community’s Horizon 2020 Programme supported the EARLY-HEART study conducted in the frame of the MEDIRAD - Implications of Medical Low Dose Radiation Exposure - project spanning from 2017 to 2021 granted by the Euratom Research and Training Programme 2014-2014 under agreement No. 755523.info:eu-repo/semantics/publishedVersio

A paradigm shift in point-of-care imaging in low-income and middle-income countries

Summary: The concept of primary healthcare is now regarded as crucial for enhancing access to healthcare services in low-income and middle-income countries (LMICs). Technological advancements that have made many medical imaging devices smaller, lighter, portable and more affordable, and infrastructure advancements in power supply, Internet connectivity, and artificial intelligence, are all increasing the feasibility of POCI (point-of care imaging) in LMICs. Although providing imaging services at the same time as the clinic visit represents a paradigm shift in the way imaging care is typically provided in high-income countries where patients are typically directed to dedicated imaging centres, a POCI model is often the only way to provide timely access to imaging care for many patients in LIMCs. To address the growing burden of non-communicable diseases such as cancer and heart disease, bringing advanced imaging tools to the POCI will be necessary. Strategies tailored to the countries’ specific needs, including training, safety and quality, will be of the utmost importance