Unintended and accidental medical radiation exposures in radiology: guidelines on investigation and prevention

This paper sets out guidelines for managing radiation exposure incidents involving patients in diagnostic and interventional radiology. The work is based on collation of experiences from representatives of international and national organizations for radiologists, medical physicists, radiographers, regulators, and equipment manufacturers, derived from an International Atomic Energy Agency Technical Meeting. More serious overexposures can result in skin doses high enough to produce tissue reactions, in interventional procedures and computed tomography, most notably from perfusion studies. A major factor involved has been deficiencies in training of staff in operation of equipment and optimization techniques. The use of checklists and time outs before procedures commence, and dose alerts when critical levels are reached during procedures can provide safeguards to reduce risks of these effects occurring. However, unintended and accidental overexposures resulting in relatively small additional doses can take place in any diagnostic or interventional X-ray procedure and it is important to learn from errors that occur, as these may lead to increased risks of stochastic effects. Such events may involve the wrong examinations, procedural errors, or equipment faults. Guidance is given on prevention, investigation and dose calculation for radiology exposure incidents within healthcare facilities. Responsibilities should be clearly set out in formal policies, and procedures should be in place to ensure that root causes are identified and deficiencies addressed. When an overexposure of a patient or an unintended exposure of a foetus occurs, the foetal, organ, skin and/or effective dose may be estimated from exposure data. When doses are very low, generic values for the examination may be sufficient, but a full assessment of doses to all exposed organs and tissues may sometimes be required. The use of general terminology to describe risks from stochastic effects is recommended rather than calculation of numerical values, as these are misleading when applied to individuals

Measurements of eye lens doses in interventional cardiology using OSL and electronic dosemeters

The purpose of this paper is to test the appropriateness of OSL and electronic dosemeters to estimate eye lens doses at interventional cardiology environment. Using TLD as reference detectors, personal dose equivalent was measured in phantoms and during clinical procedures. For phantom measurements, OSL dose values resulted in an average difference of 215% vs. TLD. Tests carried out with other electronic dosemeters revealed differences up to +/- 20% versus TLD. With dosemeters positioned outside the goggles and when TLD doses were > 20 mu Sv, the average difference OSL vs. TLD was 29%. Eye lens doses of almost 700 mu Sv per procedure were measured in two cases out of a sample of 33 measurements in individual clinical procedures, thus showing the risk of high exposure to the lenses of the eye when protection rules are not followed. The differences found between OSL and TLD are acceptable for the purpose and range of doses measured in the survey.Postprint (published version

Suppressed superconductivity in ultrathin Mo2N films due to pair-breaking at the interface

A strong disorder characterized by a small product of the Fermi vector kF and the electron mean free l drives superconductors towards insulating state. Such disorder can be introduced by making the films very thin. Here, we present 3-nm Mo2N film with k_F*l ~ 2 with a resistive superconducting transition temperature Tc = 2 K heavily suppressed in comparison with the bulk Tc. Superconducting density of states (DOS) with smeared gap-like peaks and in-gap states, so called Dynes DOS, is observed by the low temperature tunneling spectroscopy despite a sharp resistive transition. By scanning tunneling microscope the spectral maps are obtained and related to the surface topography. The maps show a spatial variation of the superconducting energy gap on the order of 20 % which is not accidental but well correlates with the surface corrugation: protrusions reveal larger gap, smaller spectral smearing and smaller in-gap states. In agreement with our previous measurements on ultrathin MoC films we suggest that the film-substrate interface introducing the local pair-breaking is responsible for the observed effects and generally for the suppression of the superconductivity in these ultrathin films.Comment: Manuscript with 3 Figure

Disorder- and magnetic field-tuned fermionic superconductor-insulator transition in MoN thin films. Transport and STM studies

Superconductor-insulator transition (SIT) driven by disorder and transverse magnetic field has been investigated in ultrathin MoN films by means of transport measurements and scanning tunneling microscopy and spectroscopy. Upon decreasing thickness, the homogeneously disordered films show increasing sheet resistance Rs, shift of the superconducting transition Tc to lower temperatures with the 3 nm MoN being the last superconducting film and thinner films already insulating. Fermionic scenario of SIT is evidenced by applicability of the Finkelsteins model, by the fact that Tc and the superconducting gap are coupled with a constant ratio, and by the spatial homogeneity of the superconducting and electronic characteristics. The logarithmic anomaly found in the tunneling spectra of the non-superconducting films is further enhanced in increased magnetic field due to the Zeeman spin effects driving the system deeper into the insulating state and pointing also to fermionic SIT.Comment: Manuscript (6 Figures) including Supplemental Materials (7 Figures

The Biological Role of Vitamins in Athletes’ Muscle, Heart and Microbiota

Physical activity, combined with adequate nutrition, is considered a protective factor against cardiovascular disease, musculoskeletal disorders, and intestinal dysbiosis. Achieving optimal performance requires a significantly high energy expenditure, which must be correctly supplied to avoid the occurrence of diseases such as muscle injuries, oxidative stress, and heart pathologies, and a decrease in physical performance during competition. Moreover, in sports activities, the replenishment of water, vitamins, and minerals consumed during training is essential for safeguarding athletes’ health. In this scenario, vitamins play a pivotal role in numerous metabolic reactions and some muscle biochemical adaptation processes induced by sports activity. Vitamins are introduced to the diet because the human body is unable to produce these micronutrients. The aim of this review is to highlight the fundamental role of vitamin supplementation in physical activity. Above all, we focus on the roles of vitamins A, B6, D, E, and K in the prevention and treatment of cardiovascular disorders, muscle injuries, and regulation of the microbiome

Digital chest radiography: an update on modern technology, dose containment and control of image quality

The introduction of digital radiography not only has revolutionized communication between radiologists and clinicians, but also has improved image quality and allowed for further reduction of patient exposure. However, digital radiography also poses risks, such as unnoticed increases in patient dose and suboptimum image processing that may lead to suppression of diagnostic information. Advanced processing techniques, such as temporal subtraction, dual-energy subtraction and computer-aided detection (CAD) will play an increasing role in the future and are all targeted to decrease the influence of distracting anatomic background structures and to ease the detection of focal and subtle lesions. This review summarizes the most recent technical developments with regard to new detector techniques, options for dose reduction and optimized image processing. It explains the meaning of the exposure indicator or the dose reference level as tools for the radiologist to control the dose. It also provides an overview over the multitude of studies conducted in recent years to evaluate the options of these new developments to realize the principle of ALARA. The focus of the review is hereby on adult applications, the relationship between dose and image quality and the differences between the various detector systems

Practice of ALARA in the pediatric interventional suite

As interventional procedures have become progressively more sophisticated and lengthy, the potential for high patient radiation dose has increased. Staff exposure arises from patient scatter, so steps to minimize patient dose will in turn reduce operator and staff dose. The practice of ALARA in an interventional radiology (IR) suite, therefore, requires careful attention to technical detail in order to reduce patient dose. The choice of imaging modality should minimize radiation when and where possible. In this paper practical steps are outlined to reduce patient dose. Further details are included that specifically reduce operator exposure. Challenges unique to pediatric intervention are reviewed. Reference is made to experience from modern pediatric interventional suites. Given the potential for high exposures, the practice of ALARA is a team responsibility. Various measures are outlined for consideration when implementing a quality assurance (QA) program for an IR service