Estimation of Effective Doses and Lifetime Risk of Exposure-induced Cancer Death in Pediatric CT Scans

Background: The increasing frequency of computed tomography (CT) scans for a range of purposes, particularly pediatrics, has raised concerns regarding the population's radiation exposure and subsequent chances of cancers. This study aimed to estimate the effective doses of pediatrics radiation and induced cancer risks from five most common CT scan procedures in Yazd Province, Iran.Methods: Data of pediatric patients from four age groups of ≤1, 1-5, 5-10, and 10-15 years old were retrospectively collected from 6 educational institutions located in diverse areas of Yazd Province. For each participant, the effective doses and REID (risk of exposure-induced death) rate were estimated by Impact Dose and PCXMC software, respectively. Then, the findings were reported by categorizing the patients regarding their effective diameter.Results: The effective doses and REID values did not show any significant differences among the studied age groups. The highest mean of effective dose was recorded for the scan of abdomen-pelvis (average ± standard deviation, 5.24±3.19 mSv) followed by chest (3.76±2.28 mSv), brain (1.25±1.07 mSv), and sinus (0.65±0.4 mSv) examinations. The highest REID was documented for chest scan (490±314 excess deaths in one million scans) followed by abdomen-pelvis procedure (404±280).Conclusion: The radiation doses delivered to the pediatric patients and the associated fatal cancer risk with common CT procedures were comparably in the same range of the previous studies. Our findings can represent an estimation of the radiation-induced risks of CT scans and can be used for extending the knowledge of clinicians and researchers

Mustard Gas Effects on Iranian Veterans After 20 Years as Shown on Chest High-resolution Computed Tomography: A Follow-up Study

Introduction: Mustard gas is a known chemical weapon that was used in the 1980-1988 Iran- Iraq War. It causes many health problems, including serious respiratory damage. In this study, we used high-resolution computed tomography to assess the pulmonary complications after 20 years of veterans of the Iran-Iraq War who were exposed to mustard gas. Materials and Methods: This was a follow-up study conducted on 200 Iranian veterans with a history of exposure to mustard gas at least 20 years previously. High-resolution computed tomography was performed on all veterans and was interpreted by two independent expert radiologists who were blinded to the study. The frequency of high-resolution computed tomography ndings was reported. Data were analyzed with statistical package for the social sciences version 20 software. Results:One hundred twenty veterans (60%) showed HRCT abnormalities. The most frequent high-resolution computed tomography ndings were diffuse hyper-aeration, 63 (52.5%); interstitial opacity, 50 (41.7%); parenchymal opacity, 26 (21.7%); bronchiectasis, 15 (12.5%); sub-pleural air trapping, 13 (10.8%); and local brosis, 10 (8.3%). Generally, lower lobes were more frequently affected. Conclusion: This study showed a high frequency of abnormal high-resolution computed tomography ndings in veterans who were exposed to mustard gas, and most abnormalities were irreversible. These ndings included diffuse hyper-aeration, interstitial opacity, parenchymal opacity, bronchiectasis, sub-pleural air trapping, and local brosis

Transient ischemic dilation as a diagnostic marker in myocardial perfusion SPECT protocols: a systematic review and meta-analysis

Abstract Background: Transient ischemic dilation (TID) measures left ventricle (LV) volume changes which can be associated with combination of myocardial and endocardial ischemia. Various stress methods, single photon emission computerized tomography (SPECT) imaging protocol, camera and software incite controversy on TID cut off. The purpose of this study was to evaluate the TID ratio in detection of coronary artery disease (CAD) categories in a systematic review and meta-analysis. Method: We conducted a systematic search of electronic databases (PubMed, Scopus, Embase and Web of Science) up to 1 January 2017. The reference lists of all included studies were searched for a higher accuracy. The search strategy was according a defined PICO as P: none, I: Transient ischemic dilation, O: Coronary Artery Diseases, C: Angiographies. Statistical analysis was done by Comprehensive meta-analysis software version 2 (CMA-2). Result: After study selection process, 7 studies were selected for data extraction. TID was studied from 1987. The sample size of included studies ranged between 86 and 545. The mean age of included patients varied between 58 and 69 years old. Ranges of TID in CAD categories were excluded. The pooled estimates of TID in single and dual pharmacological stress test in three CAD categories were calculated. Conclusion: Our findings show that more studies are needed to compare the TID variability. Although in this study meta-analysis was done and TID was summarized from studies but the software differences were ignored

Evaluation of hyperprolactinemia risk factors in infertile women referred to Yazd Infertility Center: A cross-sectional study

Background: Hyperprolactinemia is one of the most common causes of infertility in women. The prevalence of pituitary tumors is 25-30% among infertile participants with hyperprolactinemia. Objective: The aim of this study was to describe the causes of hyperprolactinemia in infertile women referred to Yazd Infertility Center. Materials and Methods: This cross-sectional study was conducted with 182 infertile women with hyperprolactinemia who were referred to Yazd Infertility Center from February 2018 to October 2019. Serum prolactin was assessed by the human prolactin ELISA kit according to the Padtan Gostar Isar protocol. The age, duration of infertility, causes of hyperprolactinemia, and type of infertility treatment were noted. The MRI findings were added. Results: The mean age of participants was 28.9 ± 0.36 yr and the prolactin level was 76 ± 8.97 ng/ml. The etiology of hyperprolactinemia among the study participants was 35 participants (19.2%) with pituitary adenoma, 47 participants (25.8%) with polycystic ovary syndrome, 14 participants (7.7%) with pituitary adenoma and polycystic ovary syndrome, and 86 participants (47.3%) with idiopathic hyperprolactinemia. The results of this study showed that there was no statistically significant difference between the mean prolactin levels in participants with different causes of hyperprolactinemia (p = 0.31). Conclusion: Idiopathic hyperprolactinemia and polycystic ovary syndrome are the most common reasons for hyperprolactinemia. Key words: Hyperprolactinemia, Infertility, PCOS

Factors Associated with Breast Cancer Screening Decision Stage among Women in Tehran, Iran.

BACKGROUND: Early detection through screening is the best method to reduce death due to breast cancer. It has been shown, having knowledge and generating positive attitudes, influences the decision of women to participate in the screening programs. The aim of this study was to identify the factors associated with breast cancer screening (BCS) and with an intention to have screening among women in Tehran, Iran. METHODS: A cross-sectional study was carried out from January to July 2011, among women who had attended to primary health-care centers in West Tehran using multi-stage sampling method. We invited 1,240 women sequentially to complete a self-administered survey questionnaire at the beginning of their visit; and 1,012 (82%) completed the survey. The questionnaire included, items drawn from the Preventive Health Model that assess socio-demographic background and perceptions about BCS. Multiple logistic regression analysis was performed to identify factors associated with screening and intention to do screening in the future. RESULTS: The mean age of subjects was 38.2 years. Women who perceived more screening efficacy (odd ratio [OR] =1.63; confidence interval [CI] 95%: 1.12-2.37) and fewer performance barriers (OR = 0.82; CI 95%: 0.68-0.97) were more likely to perform clinical breast exam in the future. The women who reported higher clinical breast exam self-efficacy (OR = 1.82; CI 95%: 1.39-2.37), mammography self-efficacy (OR = 1.31; CI 95%: 1.04-1.65), screening efficacy (OR = 1.53; CI 95%: 1.18-1.97), and family influence (OR = 1.27; CI 95%: 1.05-1.54), and those who reported fewer screening performance barriers (OR = 0.56; CI 95%: 0.48-0.67) were more likely to decide for carried out mammography in the future. Most respondents indicated that they intended to do clinical breast exam and mammography in the future (75.8% and 72.1% respectively). About 65% of women reported they would do both. CONCLUSIONS: We found that women\u27s intention to do BCS was very high and a comprehensive national program is needed to guide their intention. Among different demographic factors, the impact of education level on doing BCS was significant

The Normal Value of Tibial Tubercle Trochlear Groove Distance in Patients With Normal Knee Examinations Using MRI

Patellar instability is a multifactorial common knee pathology that has a high recurrence rate, and the symptoms continue and ultimately predispose the patient to chondromalacia and osteoarthritis. Tibial tuberosity-trochlear groove distance (TTTG) is very important in the assessment of patellofemoral joint instability. The purpose of this study was to report the normal value of TTTG in males and females in different age groups and to assess the reliability of MRI in measuring TTTG. All patients presenting with knee pain and normal examinations of the knee joint, with a normal MRI report, referring to Shahid Sadoughi hospital of Yazd, Iran, from April 2014 to September 2014, were included in the study. MR images were studied once by two radiologists and for the second time by one radiologist. Mean value of TTTG was reported for males and females and in three age groups. Intra- and inter-observer reliability was calculated. A total of 98 patients were eligible to evaluate during 6 months (68 male and 30 female). Mean TTTG was 10.9±2.5 mm in total, which was 10.8±2.8 mm and 11.3±2.3 mm in males and females, respectively (P>0.05). Mean TTTG in males ≤30 years, 30-50 years and, ≥51-year-old were 10.8±2.6 mm, 10.8±2.7 mm, and 10.8±2.6 mm, respectively; that was 12.1±3.4 mm, 11.4±1.9 mm, and 10.5±1.7 mm in females ≤30 years, 31-50 years and, ≥51-year-old, respectively (95% CI). The coefficient of variation was <10% for both intra- and interobserver analysis. The results of the present study showed no significant difference in TTTG value between males and females in different age groups. In addition, it demonstrated that MRI is a reliable method in assessment of TTTG and identified normal value for TTTG at 10.9±2.5 mm

Evaluation of diagnostic value of pelvic MRI in endometriosis in comparison with surgical findings: A cross-sectional study

Background: Endometriosis is a multifocal gynecologic disorder during the fertility period in women. Magnetic resonance imaging (MRI) is an important diagnostic modality for this disease and can either be used alone or along with transvaginal ultrasonography. Objective: This study aims to compare the accuracy of pelvis MRI in pelvic deep endometriosis with laparoscopic findings in women referred to Shahid Sadoughi hospital in one yr. Materials and Methods: This cross-sectional study was conducted on 40 women suspicious of endometriosis who referred to Shahid Sadoughi hospital, Yazd, Iran from November 2020-2021. Based on clinical findings and history, participants were referred to the imaging center for pelvic MRI. Finally, the results of MRI and diagnostic laparoscopy were compared with pathologic findings. Results: The sensitivity and specificity of MRI for pelvic endometriosis were 94.8% and 20%, respectively. Also, the positive predictive value and negative predictive value of MRI were 90.2% and 33.3%, respectively. Conclusion: Laparoscopy is still the gold standard of endometriosis diagnosis, but MRI with susceptibility-weighted imaging sequence is the best noninvasive diagnostic method. Key words: Deep infiltrating endometriosis, Magnetic resonance imaging, Diagnosis, Laparoscopy, Sensitivity, Specificity

Isquemia silenciosa detectada en la imagen de perfusión miocárdica en pacientes con antecedentes de revascularización: un estudio descriptivo-analítico

Antecedentes y objetivos: las enfermedades cardiovasculares son una de las causas más importantes de muerte en todo el mundo. La revascularización de la arteria coronaria es uno de los métodos no médicos más comunes para el tratamiento de enfermedades de la arteria coronaria. La reestenosis y la isquemia es la consecuencia más importante de la revascularización. Según la literatura reciente, hasta el 60% de los pacientes experimentan isquemia silenciosa después de la revascularización. Se informa que la imagen de perfusión miocárdica (IPM) es una buena modalidad en el diagnóstico de isquemia silenciosa. En este estudio, nuestro objetivo fue investigar la prevalencia de isquemia silenciosa detectada mediante IPM en pacientes con antecedentes de revascularización.Materiales y métodos: en este estudio analítico descriptivo, enrolamos a 340 pacientes asintomáticos remitidos para IPM al hospital Afshar o Shahid Sadoughi, Yazd, Irán, con antecedentes de revascularización. Los datos demográficos y el historial médico pasado de los pacientes junto con sus resultados de IPM se registraron en un cuestionario y los datos finalmente se analizaron utilizando el software SPSS 21.Resultados: esta población de estudio consta de 206 (60,6%) hombres y 134 (39,4%) mujeres con una edad media de 62,3±9,9, con un rango entre 35 y 86 años. Según nuestros resultados, solo el 40,6% de los pacientes tuvieron resultados normales de IPM y hubo una diferencia estadísticamente significativa entre el injerto de derivación de la arteria coronaria (IDAC) y la intervención coronaria percutánea (ICP) según la gravedad de la isquemia silenciosa.Conclusión: la prevalencia de isquemia silenciosa es alta en pacientes con antecedentes de revascularización, especialmente en pacientes con antecedentes de IDAC de edades comprendidas entre 50 y 70 años. Teniendo en cuenta la alta prevalencia de isquemia silenciosa, es lógico un seguimiento más cercano para los pacientes sometidos a revascularización coronaria para el diagnóstico temprano de reestenosis e isquemia

Correlation between neutrophil to lymphocyte ratio and coronary calcium score in CT angiography: NLR and coronary calcification

Background: cardiovascular diseases are the most common causes of death worldwide. Atherosclerosis is the most important etiology for cardiovascular diseases. Nowadays, atherosclerosis is defined as a chronic inflammatory disease. Among the most important inflammatory markers, WBC is said to be a risk factor for cardiovascular events and mortality. Among different WBC subtypes, neutrophil and thus neutrophil to lymphocyte ratio (NLR) is an important predictor for mortality and morbidity. Based on this, in this study we aimed to investigate the correlation between NLR and coronary artery calcification. Patients and methods: This research is a cross-sectional study of correlation type. A total of 353 consecutive patients were enrolled with stable angina referred to Afshar heart center for elective CT-angiography. Patients were divided into 4 groups based on NLR and the patients’ data was analyzed using SPPSS ver.26 software. Results: In this study a total of 353 patients were investigated which included 159 women and 194 men. The patients ages ranged between 19 and 80 and the average age was 53 years. We found a statistically significant difference in coronary calcium score (CCS) between patients in fourth quartile of NLR and other patients (P-Value<0.001). Spearman’s correlation test with r=0.420 and P-Value<0.001 indicated a positive correlation between NLR and CCS. Conclusion: Based on the results of present research its concluded that NLR is correlated with CCS and patients with NLR above 2.42 are in danger of higher risk of coronary artery calcification.Antecedentes: las enfermedades cardiovasculares son las causas más comunes de muerte en todo el mundo. La aterosclerosis es la etiología más importante para las enfermedades cardiovasculares. Hoy en día, la aterosclerosis se define como una enfermedad inflamatoria crónica. Entre los marcadores inflamatorios más importantes, se dice que el conteo sanguíneo completo (CSC) es un factor de riesgo para eventos cardiovasculares y mortalidad. En base a esto, en este estudio nuestro objetivo fue investigar la correlación entre la relación de neutrófilos a linfocitos (RNL) y la calcificación de la arteria coronaria. Pacientes y métodos: esta investigación es un estudio transversal correlacional. Un total de 353 pacientes consecutivos se inscribieron con angina estable remitidos al centro cardíaco Afshar para una angiografía por TC electiva. Los pacientes se dividieron en 4 grupos según RNL y los datos de los pacientes se analizaron utilizando el software SPPSS ver.26. Resultados: En este estudio se investigó un total de 353 pacientes que incluyeron 159 mujeres y 194 hombres. La edad promedio fue de 53 años. Encontramos una diferencia estadísticamente significativa en la puntuación de calcio coronario (PCC) entre pacientes en el cuarto cuartil de RNL y otros pacientes (valor P<0,001). La prueba de correlación de Spearman con r=0,420 y valor P<0,001 indicó una correlación positiva entre RNL y PCC. Conclusión: Con base en los resultados de la presente investigación, se concluyó que la RNL se correlaciona con PCC y los pacientes con RNL por encima de 2,42 tienen un mayor riesgo de calcificación de la arteria coronaria

Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy

Objective(s): Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right–sided cancer. Methods: To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring) were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT) to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions) over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol) was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. Results: A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed) and 36 patients with right-sided cancer (controls)] were enrolled. Dose-volume histogram (DVH) [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46). In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03) and anterolateral (17.1% versus 2.8%, P=0.049) walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS) of>3 was observed in twelve cases (34.3%), while in five of the controls (13.9%),(Odds ratio=1.3). There was no significant difference between the groups regarding left ventricular ejection fraction. Conclusion: The risk of radiation induced myocardial perfusion abnormality in patients treated with CRT on the left hemi thorax is not low. It is reasonable to minimize the volume of the heart being in the field of radiation employing didactic radiation planning techniques. Also it is advisable to screen these patients with MPI-SPECT, even if they are clinically asymptomatic, as early diagnosis and treatment of silent ischemia may change the outcome