Subtle excess in lifetime cancer risk related to CT scanning in Spanish young people

Background: CT scan is a life-saving medical diagnostic tool, entailing higher levels of ionising radiation exposure than conventional radiography, which may result in an increase in cancer risk, particularly in children. Information about the use and potential health effects of CT scan imaging among young people in Spain is scarce. Objective: This paper aims to estimate the number of radiation-related cancer cases which can be expected due to the use of CT scanning in Spanish children and young adults in a single year (2013). Methods: The 2013 distribution of number and types of CT scans performed in young people was obtained for Catalonia and extrapolated to the whole Spain. Organ doses were estimated based on the technical characteristics of 17,406 CT examinations extracted from radiology records. Age and sex-specific data on cancer incidence and life tables were obtained for the Spanish population. Age and sex-specific risk models developed by the Committee on Health Risks of Exposure to Low Levels of Ionizing Radiations (BEIR VII) and Berrington de Gonzalez were used, together, with the dose estimates to derive the lifetime attributable risks of cancer in Spain due to one year of CT scanning and project the number of future cancer cases to be expected. Results: In 2013, 105,802 CT scans were estimated to have been performed in people younger than age 21. It was estimated that a total of 168.6 cancer cases (95% CrI: 30.1-421.1) will arise over life due to the ionising radiation exposure received during these CTs. Lifetime attributable risks per 100,000 exposed patients were highest for breast and lung cancer. The largest proportion of CTs was to the head and neck and hence the highest numbers of projected cancer cases were of thyroid and oral cavity/pharynx. Conclusions: Despite the undeniable medical effectiveness of CT scans, this risk assessment suggests a small excess in cancer cases which underlines the need for justification and optimisation in paediatric scanning. Given the intrinsic uncertainties of these risk projection exercises, care should be taken when interpreting the predicted risks

Trends and patterns in the use of computed tomography in children and young adults in Catalonia — results from the EPI-CT study

Background Although there are undeniable diagnostic benefits of CT scanning, its increasing use in paediatric radiology has become a topic of concern regarding patient radioprotection. Objective To assess the rate of CT scanning in Catalonia, Spain, among patients younger than 21 years old at the scan time. Materials and methods This is a sub-study of a larger international cohort study (EPI-CT, the International pediatric CT scan study). Data were retrieved from the radiological information systems (RIS) of eight hospitals in Catalonia since the implementation of digital registration (between 1991 and 2010) until 2013. Results The absolute number of CT scans annually increased 4.5% between 1991 and 2013, which was less accentuated when RIS was implemented in most hospitals. Because the population attending the hospitals also increased, however, the rate of scanned patients changed little (8.3 to 9.4 per 1,000 population). The proportions of patients with more than one CT and more than three CTs showed a 1.51- and 2.7-fold increase, respectively, over the 23 years. Conclusion Gradual increases in numbers of examinations and scanned patients were observed in Catalonia, potentially explained by new CT scanning indications and increases in the availability of scanners, the number of scans per patient and the size of the attended population.Supported in part by the Seventh Framework Programme from the European Community (Grant agreement no: 269912) and the Consejo de Seguridad Nuclear

Water vapour in the atmosphere of a transiting extrasolar planet

Copyright © 2007 Nature Publishing GroupWater is predicted to be among the most abundant (if not the most abundant) molecular species after hydrogen in the atmospheres of close-in extrasolar giant planets ('hot Jupiters'). Several attempts have been made to detect water on such planets, but have either failed to find compelling evidence for it or led to claims that should be taken with caution. Here we report an analysis of recent observations of the hot Jupiter HD 189733b (ref. 6) taken during the transit, when the planet passed in front of its parent star. We find that absorption by water vapour is the most likely cause of the wavelength-dependent variations in the effective radius of the planet at the infrared wavelengths 3.6 mum, 5.8 mum (both ref. 7) and 8 mum (ref. 8). The larger effective radius observed at visible wavelengths may arise from either stellar variability or the presence of clouds/hazes. We explain the report of a non-detection of water on HD 189733b (ref. 4) as being a consequence of the nearly isothermal vertical profile of the planet's atmosphere

Patient-specific 3D printed soft models for liver surgical planning and hands-on training

Background: Pre-surgical simulation-based training with three-dimensional (3D) models has been intensively developed in complex surgeries in recent years. This is also the case in liver surgery, although with fewer reported examples. The simulation-based training with 3D models represents an alternative to current surgical simulation methods based on animal or ex vivo models or virtual reality (VR), showing reported advantages, which makes the development of realistic 3D-printed models an option. This work presents an innovative, low-cost approach for producing patient-specific 3D anatomical models for hands-on simulation and training. Methods: The article reports three paediatric cases presenting complex liver tumours that were transferred to a major paediatric referral centre for treatment: hepatoblastoma, hepatic hamartoma and biliary tract rhabdomyosarcoma. The complete process of the additively manufactured liver tumour simulators is described, and the different steps for the correct development of each case are explained: (1) medical image acquisition; (2) segmentation; (3) 3D printing; (4) quality control/validation; and (5) cost. A digital workflow for liver cancer surgical planning is proposed. Results: Three hepatic surgeries were planned, with 3D simulators built using 3D printing and silicone moulding techniques. The 3D physical models showed highly accurate replications of the actual condition. Additionally, they proved to be more cost-effective in comparison with other models. Conclusions: It is demonstrated that it is possible to manufacture accurate and cost-effective 3D-printed soft surgical planning simulators for treating liver cancer. The 3D models allowed for proper pre-surgical planning and simulation training in the three cases reported, making it a valuable aid for surgeons.The research undertaken in this paper has been partially funded by the QuirofAM project (Exp. COMRDI16-1-0011) co-financed by the European Union through the European Regional Development Fund FEDER with the support of ACCIÓ-Generalitat de Catalunya 2014–2020.Peer ReviewedPostprint (published version

Valoración mediante resonancia magnética de la deformidad glenohumeral y cambios morfológicos musculares en la parálisis braquial obstétrica : modelo experimental en rata y correlación con la clínica humana o de lo experimental en rata y correlación con la clínica humana

Introducción: El desequilibrio de la musculatura del hombro resultante de la lesión nerviosa secundaria a la parálisis braquial obstétrica puede provocar una contractura en rotación interna del hombro, una retroversión de la glenoides y una subluxación de la cabeza humeral asociadas a una hipoplasia articular glenohumeral. Algunos estudios experimentales han demostrado similitudes entre el plexo braquial de rata y del humano. El objetivo principal del presente trabajo es analizar la idoneidad de un modelo preclínico de anomalías en el hombro de rata secundarias a parálisis braquial obstétrica utilizando la imagen por RM como herramienta fundamental en su valoración. Material y métodos: 1. Estudio de un modelo experimental de PBO en 43 neonatos de ratas con valoración mediante resonancia magnética de alto campo 2. Estudio de correlación clínico-radiológica en 15 niños con PBO no recuperada valorados mediante resonancia magnética. Resultados Un 87% de las ratas presentaron una marcha anómala con pérdida de rotación externa media de 56º. En el modelo clínico la pérdida de rotación externa pasiva fue de 67º. Se demostró una ligera anteversión glenoidea en el hombro afecto (4º) en el modelo experimental y una retroversión media de -22º en el grupo clínico. El PCHA no mostró diferencias significativas entre ambos hombros en el modelo experimental. El ángulo bicipital demostró cambios significativos tanto en el modelo experimental (-6,6º) como en el grupo clínico (-26º). El área de la cabeza humeral del hombro afecto fue un 19% menor en el modelo experimental y un 14% menor en el grupo clínico. El área del músculo subescapular e infraespinoso del hombro afecto fueron un 52% y un 46% menor en el modelo experimental y un 40% y un 26% menor en el grupo clínico, respectivamente. Conclusiones: La resonancia magnética es válida en un modelo preclínico experimental en ratas, demuestra una pérdida de volumen de los músculos subescapular e infraespinoso y esta se correlaciona con la limitación en la rotación externa pasiva en la exploración física. El modelo preclínico de PBO experimental en el neonato de rata no reproduce las anomalías características de la displasia glenohumeral.Introduction: The unbalanced shoulder muscles resulting from nerve injuries secondary to brachial plexus injury (BPI) can cause a shoulder internal rotation contraction, glenoid retroversion and subluxation and hypoplasia of the humeral head. Experimental studies have demonstrated similarities between the rat brachial plexus and humans. Material and Methods: 1. We performed High field MRI studies in 43 rat neonates with a surgically induced BPI evaluating muscular and glenohumeral changes in the shoulder. 2. Clinical and radiological MRI correlation in 15 children with not recovered BPI. Results An 87% of the rats had an abnormal march and loss of external rotation (56º). The passive external rotation loss in the clinical model was 67º. We found a slight glenoid anteversion (+4º) in the affected shoulder of the rats, and a moderate glenoid retroversion (-22º) in the affected shoulder in children. The PHHA did not show significant differences between both shoulders in the experimental model. The bicipital angle demonstrated significant differences between the two shoulders, both in the experimental rat model (-6,6º) and children (-26º). The area of the humeral head in the affected shoulder was a 19% smaller in the experimental model and a 14% smaller in children. The area of subescapular and infraspinous muscles of the affected shoulder were 52% and 46% lower in the experimental rat model and 40% and 26% smaller in children, respectively. Conclusions: MRI is valid in a BPI experimental preclinical model in rats. In our experimental study the loss of subscapularis and infrespinosus muscles correlated with a limited external passive rotation in the shoulder. Our experimental preclinical model of BPI in rats do not reproduce the glenohumeral dysplasia that can be seen in children with BPI

Multiparametric MRI evaluation of bone sarcomas in children

Abstract Osteosarcoma and Ewing sarcoma are the most common bone sarcomas in children. Their clinical presentation is very variable depending on the age of the patient and tumor location. MRI is the modality of choice to assess these bone sarcomas and has an important function at diagnosis and also for monitoring recurrence or tumor response. Anatomic sequences include T1- and T2-weighted images and provide morphological assessment that is crucial to localize the tumor and describe anatomical boundaries. Multiparametric MRI provides functional information that helps in the assessment of tumor response to therapy by using different imaging sequences and biomarkers. This review manuscript illustrates the role of MRI in osteosarcoma and Ewing sarcoma in the pediatric population, with emphasis on a functional perspective, highlighting the use of diffusion-weighted imaging and dynamic contrast-enhanced MRI at diagnosis, and during and after treatment

De lege Julia ambitus : acroasis inaugularis praecedens pro-docturae gradum

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