Annals of the ICRP. A report of: doses to infants from ingestion of radionuclides in mothers' milk

Assessment of radioactivity level and associated radiological hazard in fertilizer from Dhaka

Miners, factory workers, traders, end-users, and foodstuff consumers all run the risk of encountering health hazards derived from the presence of elevated levels of radiation in fertilizers, as these groups often come into direct or indirect contact with fertilizers as well as raw materials throughout various linked processes such as mineral extractions, fertilizer production, agricultural practices. A total of 30 samples of various kinds of fertilizer produced in different factories in Dhaka megacity were analyzed to quantify the concentrations of primordial radionuclides using HPGe detector. Among the analyzed samples, average (range) concentration of 40K was found to be 9920 ± 1091 (8700 ± 957-11,500 ± 1265), 9100 ± 1001 (8600 ± 946-9600 ± 1056), 2565 ± 282 (2540 ± 279-2590 ± 285), and 3560 ± 392 (2620 ± 288-4500 ± 495) Bq/kg in the samples of Muriate of Potash Fertilizer, Sulphate of Potash Fertilizer, Humic Acid Fertilizer, and NPKS Fertilizer, respectively. Elevated concentration of 226Ra was found in Triple Super Phosphate Fertilizer with a mean (range) of 335 ± 37 (290 ± 32-380 ± 42) Bq/kg. The higher activity of 40K can be linked to the greater levels of elemental potassium in phosphate fertilizer. Elevated concentrations of radionuclides may also result from variations in chemical processes as well as the local geology of the mining areas where the raw materials were extracted for fertilizer production. Numerous fertilizer brands surpass prescribed limits for various hazardous parameters, presenting significant health risks to factory workers, farmers, and consumers of agricultural products. This study provides baseline information on the radioactivity of fertilizers, which could be used to develop mitigation methods, establish national fertilizer usage limits, justify regulatory frameworks, and raise public awareness of fertilizer overuse. The findings of the study could potentially help to explore the impact of fertilizer on the food chain.

mRNA and small RNA gene expression changes in peripheral blood to detect internal Ra-223 exposure

PURPOSE

Excretion analysis is the established method for detection of incorporated alpha-emitting radionuclides, but it is laborious and time consuming. We sought a simplified method in which changes in gene expression might be measured in human peripheral blood to detect incorporated radionuclides. Such an approach could be used to quickly determine internal exposure in instances of a radiological dispersal device or a radiation accident.

MATERIALS AND METHODS

We evaluated whole blood samples from five patients with castration-resistant prostate cancer and multiple bone metastases (without visceral or nodal involvement), who underwent treatment with the alpha emitting isotope Radium-223 dichloride (Ra-223, Xofigo^®). Patients received about 4 MBq per cycle and, depending on survival and treatment tolerance, were followed for six months. We collected 24 blood samples approximately monthly corresponding to treatment cycle.

RESULTS

Firstly, we conducted whole genome screening of mRNAs (mRNA seq) and small RNAs (small RNA seq) using next generation sequencing in one patient at eight different time points during all six cycles of Ra-223-therapy. We identified 1900 mRNAs and 972 small RNAs (222 miRNAs) that were differentially up- or down-regulated during follow-up after the first treatment with Ra-223. Overall candidate RNA species inclusion criteria were a general (≥|2|-fold) change or with peaking profiles (≥|5|-fold) at specific points in time. Next we chose 72 candidate mRNAs and 101 small RNAs (comprising 29 miRNAs) for methodologic (n = 8 samples, one patient) and independent (n = 16 samples, four patients) validation by qRT-PCR. In total, 15 mRNAs (but no small RNAs) were validated by methodologic and independent testing. However, the deregulation occurred at different time points, showing a large inter-individual variability in response among patients.

CONCLUSIONS

This proof of concept provides support for the applicability of gene expression measurements to detect internalized alpha-emitting radionuclides, but further work is needed with a larger sample size. While our approach has merit for internal deposition monitoring, it was complicated by the severe clinical condition of the patients we studied.

Absence of Detectable Radionuclides in Breast Milk in Sendai, Japan in 2012 Even by High-Sensitivity Determination: Estimated Dose among Infants after the Fukushima Nuclear Disaster

The aim of this study was to estimate radionuclide levels in breast milk and the transferred dose to their infants in Sendai (100 km from Fukushima), Japan after the 2011 Fukushima nuclear disaster. Radionuclide concentrations were analyzed in 101 specimens of breast milk collected in 2012. Median values for minimum detectable activities were 0.39, 0.34, 1.1, 1.89, and 17.1 Bq/kg for ¹³⁷Cs, ¹³⁴Cs, ¹³¹I, ^110mAg, and ⁴⁰K, respectively. Only radionuclides from ⁴⁰K were detected. To estimate potential exposure and radiocesium dose, we assumed that the samples contained each minimum detectable activity level. The mean minimum detectable activity concentrations (standard deviation) of ¹³⁷Cs and ¹³⁴Cs were 0.42 (0.15) and 0.37 (0.14) Bq/kg, respectively. Means of estimated dietary intakes of ¹³⁷Cs and ¹³⁴Cs among infants were 0.35 (0.12) and 0.31 (0.11) Bq/day, respectively. The committed effective doses of radiocesium in infants aged 3 and 12 months via breastmilk were estimated at 5.6 (2.1) and 3.3 (1.2) μSv/year, respectively. Dietary intakes of ¹³⁷Cs and ¹³⁴Cs in breastfeeding mothers were back-calculated at 1.9 (0.71) and 1.7 (0.65) Bq/day, respectively. The study verified no discernible exposure to radionuclides among infants. The most conservative estimates were below the Japanese internal exposure limit of 1 mSv/year.

Radiological impacts in Life Cycle Assessment. Part I: General framework and two practical methodologies

To date, impacts of ionising radiations have been largely disregarded in Life Cycle Assessment (LCA). This omission can be linked to the lack of a standard and comprehensive framework for including the effects of radionuclides alongside other emissions from industrial processes. Drawing on a recent review of Radiological Impact Assessment methodologies for LCA studies, this article proposes an overarching framework for integrating impacts of radionuclides in the Impact Assessment phase of LCA. From this framework, two alternative methodologies have been derived. They differ mainly in the way transport and dispersion of radionuclides in the environment are modelled: UCrad represents the first-of-its-kind compartment-type methodology for radionuclides, whereas the alternative Critical Group Methodology (CGM) has been adapted from standard Risk Assessment practices. Characterisation factors for a range of emitted species have been calculated using both methodologies and compared with those obtained from the Human Health Damages methodology, which is the only approach to radiological impacts yet implemented in LCA. For both UCrad and CGM the results are in general agreement with the Human Health Damages methodology, but UCrad gives factors closer to those obtained by the CGM approach. UCrad represents a major step towards incorporating ionising radiation impacts in LCIA. A subsequent paper will explore quantitatively the main differences between the UCrad and CGM methodologies.

A model for estimating the total absorbed dose to the thyroid in Swedish inhabitants following the Chernobyl Nuclear Power Plant accident: implications for existing international estimates and future model applications

The time-integrated absorbed dose to the thyroid gland in the years after a fallout event can indicate the potential excess number of thyroid cancers among young individuals after a radionuclide release. Typical mean values of the absorbed dose to the thyroid have been calculated previously using reported data on radioiodine obtained from air sampling and dairy milk surveys in Sweden after the Chernobyl fallout, not including the contribution from ¹³⁴Cs and ¹³⁷Cs. We have developed a model for Swedish conditions taking these additional dose contributions into account. Our estimate of the average time-integrated absorbed dose to the thyroid, D _th,tot, during the first 5 years after fallout ranged from 0.5-4.1 mGy for infants and from 0.3-3.3 mGy for adults. The contribution to D _th,tot from ¹³¹I through inhalation and milk consumption varied considerably among different regions of Sweden, ranging from 9%-79% in infants, and from 4%-58% in adults. The external irradiation and exposure from the ingestion of ^134,137Cs in foodstuffs accounted for the remaining contributions to D _th,tot (i.e. up to 96% for adults). These large variations can be explained by the highly diverse conditions in the regions studied, such as different degrees of fractionation between wet and dry deposition, different grazing restrictions on dairy cattle, and differences in ^134,137Cs transfers through food resulting from differences in the local fallout. It is our conclusion that the main contribution to D _th,tot from nuclear power plant fallout in areas subjected to predominantly wet deposition will be from external exposure from ground deposition, followed by internal exposure from contaminated food containing the long-lived fission product ¹³⁷Cs and the neutron-activated fission product ¹³⁴Cs. The contribution from ^134,137Cs to the thyroid absorbed dose should thus be taken into account in future epidemiological studies.

Japanese Food Data Challenge the Claimed Link between Fukushima's Releases and Recently Observed Thyroid Cancer Increase in Japan

Internal, high-dose exposure with radioiodine is known to increase the risk for thyroid cancer in children and adolescents. Ingestion of contaminated food is generally regarded a dominant route of internal exposure. We analyzed the huge data set of the post-Fukushima food monitoring campaign and deployed a conservative model for the estimation of the doses to the general public in a worst-case scenario. Our data suggest that the committed equivalent ingestion doses to the thyroids of the affected Japanese public, even in the utmost conservative approach, remained below the limit on ingestion of radioiodine in foodstuffs and beverages of 50 mSv (as thyroid equivalent dose). This level of 50 mSv is also the intervention level for the administration of stable iodine, mainly after inhalation. Our study hence suggests that, based on the food data, the internal exposure of Japanese residents was too low to cause a statistically discernible increase in thyroid cancer, even if the contribution from inhalation is taken into account. The data also indicate that the governmental efforts in the food monitoring campaign were successful and cut the thyroid doses to the public by a factor of approximately 3 compared to a scenario without any monitoring.

Implementation of iodine biokinetic model for interpreting I-131 contamination in breast milk after the Fukushima nuclear disaster

After the accident at the Fukushima Daiichi Nuclear Power Plant run by Tokyo Electric Power Company in 2011, breast milk samples obtained from volunteers living in Fukushima and neighboring prefectures were examined and small amounts of I-131 (2.2–36.3 Bq/kg) were detected in some samples. In this work, the I-131 concentrations in breast milk from nursing mothers in Ibaraki prefecture were calculated based on the iodine biokinetic model during lactation together with time-variable intake scenarios by inhalation of ambient air and ingestion of tap water, using the authors’ code. The calculated I-131 concentrations in breast milk generally agreed with those measured for the volunteers. Based on the results, thyroid equivalent doses to breast-fed infants were estimated for each place of residence of the volunteers on the assumption that these infants consumed 800 ml of breast milk every day, resulting in 10–11 mSv for Mito and Kasama cities and 1.1–1.8 mSv for Tsukuba and Moriya cities. It was suggested that breast milk consumption could be a major contributor to internal dose of breast-fed infants in areas with mild I-131 pollution; however, further studies considering personal behavior surveys would be necessary to estimate individual doses.

Experience in retake analysis for digital mammography at a university hospital

Data from one digital mammograph (flat detector active area of 19.2 × 23 cm(2)) were collected over a 1-year period using locally developed software in order to evaluate retakes, their rates, their causes and the possible measures to reduce their occurrence. Among them, 7.1 % of the images were marked as repetitions, and in 16 % of the studies, at least one image was repeated. When evaluating causes of retakes, the primary cause was incorrect positioning (49 %), closely followed by additional retakes in cases of large breasts (44 %). When dealing with large breasts and using a small flat panel, additional images were necessary to fully visualise the breast, and as a consequence, some breast regions received repeated radiation exposure. Moreover, a small detector increases retakes in breasts slightly wrongly positioned. To try and reduce the retake rate, it is important to plan training sessions based on images selected from the retake analysis.

Super-resolution variable-dose imaging in digital radiography: quality and dose reduction with a fluoroscopic flat-panel detector

PURPOSE

Super-resolution (SR) image processing produces a high-resolution image from a series of low-resolution images. The aim of this study was to evaluate SR-images based on fluoroscopic flat-detector (FD) acquisition at different frame rates.

METHODS

Fluoroscopic FD-sequences with 20 frames were obtained with varying pulse frequencies of (1) a line pair resolution phantom; (2) a low-contrast resolution phantom, and (3) a human knee specimen. Super-resolution digital radiographs (SR-Radiographs) were generated from each sequence. Variable-dose images were simulated by constructing SR-Radiographs using 6 and 12 frames from the corresponding fluoroscopic sequence. "Single Shot" and Computed Radiography (CR) images were obtained for comparison based on dynamic range and sharpness of bone detail structures. Patient-derived SR-Radiographic images were constructed to demonstrate clinical examples.

RESULTS

The spatial resolution of SR-radiographs obtained at 12.5 frames per second (fps) and 6 fps were comparable with CR and "Single Shot" images, providing ~3.5 line pairs per mm (l p/mm). Similarly, low-contrast resolution of SR-radiographs obtained at 12.5, 6, and 30 fps were equivalent to CR and "Single Shot" images. The human knee specimen SR-radiograph obtained using 12 FD images at 12.5 fps was superior to a CR image in overall image quality, with a dose reduction of 75%. Variable-dose SR-radiographic simulations suggest a dose saving potential of 90-95% when using 6 FD images at 12.5 fps or 6 fps, respectively.

CONCLUSIONS

The phantom testing images and simulation results demonstrate that diagnostic quality SR-radiographic images of skeletal extremities can be synthesized using a flat-panel detector system designed primarily for angiography. SR-images obtained with substantially reduced radiation dose are feasible, and this technology may improve digital radiography for pediatric, neonatal radiography, or mammography applications. Further testing is needed to validate super-resolution techniques in other body regions and for different flat-detector systems.

Cost and cost-effectiveness of digital mammography compared with film-screen mammography in Australia

OBJECTIVE

A systematic review assessed the relative safety and effectiveness of digital mammography compared with film-screen mammography. This study utilised the evidence from the review to examine the economic value of digital compared with film-screen mammography in Australia.

METHODS

A cost-comparison analysis between the two technologies was conducted for the overall population for the purposes of breast cancer screening and diagnosis. In addition, a cost-effectiveness analysis was conducted for the screening subgroups where digital mammography was considered to be more accurate than film-screen mammography.

RESULTS

Digital mammography in a screening setting is $11 more per examination than film-screen mammography, and $36 or $33 more per examination in a diagnostic setting when either digital radiography or computed radiography is used. In both the screening and diagnostic settings, the throughput of the mammography system had the most significant impact on decreasing the incremental cost/examination/year of digital mammography.

CONCLUSION

Digital mammography is more expensive than film-screen mammography. Whether digital mammography represents good value for money depends on the eventual life-years and quality-adjusted life-years gained from the early cancer diagnosis.

IMPLICATIONS

The evidence generated from this study has informed the allocation of public resources for the screening and diagnosis of breast cancer in Australia.

Diagnosis and treatment of polonium poisoning

OBJECTIVES

Interest in the clinical toxicology of (210)polonium ((210)Po) has been stimulated by the poisoning of Alexander Litvinenko in 2006. This article reviews the clinical features, diagnosis, and treatment of acute radiation syndrome (ARS) resulting from the ingestion of (210)Po. PHYSICAL CHARACTERISTICS: (210)Po is a high-energy alpha-emitter (radioactive half-life 138 days) that presents a radiation hazard only if taken into the body, for example, by ingestion, because of the low range of alpha particles in biological tissues. As a result, external contamination does not cause radiation sickness.

TOXICOKINETICS

Ingested (210)Po is concentrated initially in red blood cells and then the liver, kidneys, spleen, bone marrow, gastrointestinal (GI) tract, and gonads. (210)Po is excreted in urine, bile, sweat, and (possibly) breath and is also deposited in hair. After ingestion, unabsorbed (210)Po is present in the faeces. The elimination half-life in man is approximately 30-50 days. In the absence of medical treatment, the fatal oral amount is probably in the order of 10-30 microg.

CLINICAL PRESENTATION

If the absorbed dose is sufficiently large (e.g., >0.7 Gy), (210)Po can cause ARS. This is characterized by a prodromal phase, in which nausea, vomiting, anorexia, lymphopenia, and sometimes diarrhea develop after exposure. Higher radiation doses cause a more rapid onset of symptoms and a more rapid reduction in lymphocyte count. The prodromal phase may be followed by a latent phase during which there is some clinical improvement. Subsequently, the characteristic bone marrow (0.7-10 Gy), GI (8-10 Gy), or cardiovascular/central nervous system syndromes (>20 Gy) develop, with the timing and pattern of features dependent on the systemic dose. The triad of early emesis followed by hair loss and bone marrow failure is typical of ARS. Those patients who do not recover die within weeks to months, whereas in those who survive, full recovery can take many months.

INVESTIGATION AND DIAGNOSIS

Serial blood counts are important for assessing the rate of reduction in lymphocyte counts. Chromosome analysis, especially the dicentric count, may establish radiation effects and provides an estimation of dose. The diagnosis of (210)Po poisoning is established by the presence of (210)Po in urine and faeces and the exclusion of other possible causes. In the absence of a history of exposure, diagnosis is very difficult as clinical features are similar to those of much more common conditions, such as GI infections and bone marrow failure caused, for example, by drugs, other toxins, or infections.

MANAGEMENT

Good supportive care is essential and should be directed at controlling symptoms, preventing infections but treating those that do arise, and transfusion of blood and platelets as appropriate. Gastric aspiration or lavage may be useful if performed soon after ingestion. Chelation therapy is also likely to be beneficial, with research in animals suggesting reduced retention in the body and improvements in survival, although increased activity in some radiosensitive organs has also been reported with some chelating agents. Dimercaprol (British Anti-Lewisite) (with penicillamine as an alternative) is currently recommended for (210)Po poisoning, but animal models also indicate efficacy for 2,3,-dimercapto-1-propanesulfonic acid, meso-dimercaptosuccinic acid, or N,N -dihydroxyethylethelene-diamine-N,N -bis-dithiocarbamate.

CONCLUSIONS

Internal contamination with (210)Po can cause ARS, which should be considered in patients presenting initially with unexplained emesis, followed later by bone marrow failure and hair loss.

Radiation protection in Australia: a thirty year perspective

This review charts the changes in radiation protection philosophy, regulation and practice over the thirty year period 1977-2007. During this time there have been substantial changes both internationally and in Australia. Medical physicists have been involved, and continue to be involved, in all aspects of radiation protection in medicine at a national, State and hospital level.

Prevention of high-dose-rate brachytherapy accidents. ICRP Publication 97

High-dose-rate brachytherapy is a rapidly growing technique (HDR) that has been replacing low-dose-rate (LDR) procedures over the last few years in both industrialised and developing countries. It is estimated that about 500,000 procedures (administration of treatment) are performed by HDR units annually. LDR equipment has been discontinued by many manufacturers over the last few years, leaving HDR brachytherapy as the major alternative. HDR brachytherapy techniques deliver a very high dose, of the order of 1.6-5.0 Gy/min, so mistakes can lead to under- or overdosage with the potential for clinical adverse effects. More than 500 HDR accidents (including one death) have been reported along the entire chain of procedures from source packing to delivery of dose. Human error has been the prime cause of radiation events. In the present report, the International Commission on Radiological Protection concludes that many accidents could have been prevented if staff had had functional monitoring equipment and paid attention to the results. Since iridium has relatively short half-life, the HDR sources need to be replaced approximately every 4 months. Over 10,000 HDR sources are transported annually, with the resultant potential for accidents; therefore, appropriate procedures and regulations must be observed. A number of specific recommendations on procedures and equipment are given in this report. The need for an emergency plan and for practising emergency procedures is stressed. The possibility of loss or theft of sources must be kept in mind. A collaborating team of specifically trained personnel following quality assurance (QA) procedures is necessary to prevent accidents. Maintenance is indispensable component of QA; external audits of procedures re-enforce good and safe practice, and identify potential causes of accidents. QA should include peer review of cases. Accidents and incidents should be reported and the lessons learned should be shared with other users to prevent similar mistakes.