Public health implications of medical diagnostic radiation exposure

Radiation from Computed Tomography (CT) is now the major contributor to population radiation dose. Despite controversy around the dose-effect relationship of radiation from CT, the linear non-threshold (LNT) theory is endorsed by many authorities, and constitutes the basis of cancer risk estimates. The purpose of this study was (1) a literature review of radiobiological theories, and methods of dose saving stategies in CT; (2) to highlight the importance of dose saving in CT, and to demonstrate how dose can be saved in a radiology department: Following a 40% reduction in reference X-ray tube current for a CT of the urinary tract, the effecitve dose and estimated lifetime attributable risk of incident cancer due to this CT in a group (n=103) were reduced by 37% and 38% in an age and sex-matched group respectively. The literature review showed that the public health implications of CT radiation exposure remain uncertain.Health StudiesM.A. (Public Health

Gastric adenocarcinoma causing biliary obstruction without ductal dilatation: a case report

Abstract Introduction Gastric adenocarcinoma is a known complication of partial gastrectomy. Jaundice from gastric adenocarcinoma usually occurs in the setting of hepatic nodal or parenchymal metastasis. This case demonstrates an unusual level of biliary obstruction from gastric adenocarcinoma. Case presentation An 84-year-old Caucasian man was diagnosed as having a new gastric adenocarcinoma at the level of the gastroenteric anastomosis of a prior Billroth II gastrectomy after presenting with painless jaundice. He had a non-dilated biliary tree on radiographic imaging despite evidence of large bile duct obstruction on liver biopsy. The obstruction was managed with endoscopic wire-guided stenting of the malignant tumor. Conclusions The unusual finding of a non-dilated biliary tree in the face of obstructive jaundice is likely to have resulted from the unusual post-surgical anatomy and hence distal level of obstruction. Endoscopic duodenal stenting is a novel method of managing obstructive jaundice in gastric adenocarcinoma