Cumulative Effective Dose and Cancer Risk of Pediatric Population in Repetitive Whole-Body Scan Using Dual-Energy X-Ray Absorptiometry

Communicating Relative Radiation Doses for Plain Radiographs in Pediatric Dermatology

Plain radiographs are occasionally indicated in pediatric dermatology, and caregivers expect providers ordering such studies to counsel about the associated radiation exposure. We reviewed possible indications for plain radiographs in pediatric dermatology and assessed estimated effective radiation doses of these studies. We compared these estimates to natural background equivalent radiation time and estimated equivalent radiation exposure during international flight times. Although exact radiation dosages will vary by institutional and individual patient factors, we hope that these estimates will provide useful figures to counsel patients and caregivers about the low associated radiation dosages of plain radiographs to facilitate shared decision making.

Comparing Bioelectrical Impedance Analysis, Air Displacement Plethysmography, and Dual-Energy X-Ray Absorptiometry for Body Composition in Pediatric Obesity

BACKGROUND

Body composition analysis is crucial in clinical practice, yet few methods are suitable for pediatric patients, and data on young children with obesity are limited.

METHODS

This study measured body fat percentage (BFP), fat mass (FM), and fat-free mass (FFM) in 26 pediatric patients with obesity (BMI: 35.6±6.9 kg/m2), using two bioelectrical impedance analysis (BIA) devices (TANITA and BIACORPUS), and the results were compared to those of the gold-standard dual-energy X-ray absorptiometry (DXA). Additionally, air displacement plethysmography (BODPOD) was compared with DXA, and all methods were evaluated against each other.

RESULTS

Significant differences were observed between all methods and parameters (p < 0.05). For example, Bland-Altman analysis for BFP identified differences between BIACORPUS and DXA (mean: -3.5%; 95% limits of agreement: -16.7% to 9.8%) and between TANITA and DXA (mean: -3.1%; 95% limits of agreement: -12.2% to 6.1%). These differences can be regarded as clinically relevant, especially when considering the 95% limits of agreement. Further, moderate differences between BODPOD and DXA were identified, which could be clinically relevant (mean: 2.1%; 95% limits of agreement: -4.2% to 8.5%).

CONCLUSIONS

TANITA was the most comparable BIA method to the gold standard, DXA. Therefore, TANITA is recommended for assessing body composition in young patients with obesity to monitor therapy progress in clinical settings. When using BODPOD as an alternative to DXA, caution is warranted since we found relevant differences between both methods.

Application and prospect of metabolomics in the early diagnosis of osteoporosis: a narrative review

This paper reviews the application of metabolomics in the early diagnosis of osteoporosis in recent years. The authors searched electronic databases for the keywords "metabolomics", "osteoporosis" and "biomarkers", then analyzed the relationship between functional markers and osteoporosis using categorical summarization. Lipid metabolism, amino acid metabolism and energy metabolism are closely related to osteoporosis development and can become early diagnostic markers of the condition. However, the existing studies in metabolomics suffer from varying application methods, difficulty in identifying isomers, small study cohorts and insufficient research on metabolic mechanisms. Consequently, it is important for future research to focus on broadening and standardizing the scope of the application of metabolomics. High-quality studies on a large scale should also be conducted while promoting the early diagnosis of osteoporosis in a more precise, comprehensive and sensitive manner.

Estimation of skeletal muscle mass in 4-year-old children using the D3-creatine dilution method

BACKGROUND

Given limited experience in applying the creatine-(methyl-D3) (D3Cr) dilution method to measure skeletal muscle mass (SMM) in young children, the feasibility of deployment in a fielding setting and performance of the method was assessed in a cohort of 4-year-old children in Dhaka, Bangladesh.

METHODS

Following D3Cr oral dose (10 mg) administration, single fasting urine samples were collected at 2-4 days (n = 100). Twenty-four-hour post-dose collections and serial spot urine samples on days 2, 3 and 4 were obtained in a subset of participants (n = 10). Urinary creatine, creatinine, D3Cr and D3-creatinine enrichment were analyzed by liquid chromatography-tandem mass spectrometry. Appendicular lean mass (ALM) was measured by dual-energy x-ray absorptiometry and grip strength was measured by a hand-held dynamometer.

RESULTS

SMM was measured successfully in 91% of participants, and there were no adverse events. Mean ± SD SMM was greater than ALM (4.5 ± 0.4 and 3.2 ± 0.6 kg, respectively). Precision of SMM was low (intraclass correlation = 0.20; 95% CI: 0.02, 0.75; n = 10). Grip strength was not associated with SMM in multivariable analysis (0.004 kg per 100 g of SMM; 95% CI: -0.031, 0.038; n = 91).

CONCLUSIONS

The D3Cr dilution method was feasible in a community setting. However, high within-child variability in SMM estimates suggests the need for further optimization of this approach.

IMPACT

The D3-creatine (D3Cr) stable isotope dilution method was considered a feasible method for the estimation of skeletal muscle mass (SMM) in young children in a community setting and was well accepted among participants. SMM was weakly associated with both dual-energy x-ray absorptiometry-derived values of appendicular lean mass and grip strength. High within-child variability in estimated values of SMM suggests that further optimization of the D3Cr stable isotope dilution method is required prior to implementation in community research settings.

Radiation exposure in multiple hereditary exostoses: A retrospective review

Background

Exposure to ionizing radiation in patients with Multiple Hereditary Exostoses (MHE) is inevitable and necessary for the diagnosis and treatment of MHE. Radiation exposure has many potentially dangerous consequences, including the increased risk of developing cancer. This is especially concerning in the pediatric patient population since children are more likely to develop adverse effects from radiation than adults. This study aimed to quantify radiation exposure over a five-year period among patients diagnosed with MHE since such information is not currently available in the literature.

Methods

Diagnostic radiographs, computed tomography (CT) scans, nuclear medicine studies, and intraoperative fluoroscopy exposures were analyzed for radiation exposure in 37 patients diagnosed with MHE between 2015 and 2020.

Results

Thirty-seven patients with MHE underwent 1200 imaging studies, 976 of which were related to MHE and 224 unrelated to MHE. The mean estimated MHE cumulative radiation dose per patient was 5.23 mSv. Radiographs related to MHE contributed the most radiation. Patients from the ages of 10- to 24-years-old received the most imaging studies and exposure to ionizing radiation, especially compared to those under age 10 (P = 0.016). The 37 patients also received a total of 53 surgical-excision procedures, with a mean of 1.4 procedures per person.

Conclusions

MHE patients are exposed to increased levels of ionizing radiation secondary to serial diagnostic imaging, with those ages 10-24 years old being exposed to significantly higher doses of radiation. Because pediatric patients are more sensitive to radiation exposure and are at an overall higher risk, the use of radiographs should always be justified in those patients.

Bone Health in Children with Rheumatic Disorders: Focus on Molecular Mechanisms, Diagnosis, and Management

Bone is an extremely dynamic and adaptive tissue, whose metabolism and homeostasis is influenced by many different hormonal, mechanical, nutritional, immunological and pharmacological stimuli. Genetic factors significantly affect bone health, through their influence on bone cells function, cartilage quality, calcium and vitamin D homeostasis, sex hormone metabolism and pubertal timing. In addition, optimal nutrition and physical activity contribute to bone mass acquisition in the growing age. All these factors influence the attainment of peak bone mass, a critical determinant of bone health and fracture risk in adulthood. Secondary osteoporosis is an important issue of clinical care in children with acute and chronic diseases. Systemic autoimmune disorders, like juvenile idiopathic arthritis, can affect the skeletal system, causing reduced bone mineral density and high risk of fragility fractures during childhood. In these patients, multiple factors contribute to reduce bone strength, including systemic inflammation with elevated cytokines, reduced physical activity, malabsorption and nutritional deficiency, inadequate daily calcium and vitamin D intake, use of glucocorticoids, poor growth and pubertal delay. In juvenile arthritis, osteoporosis is more prominent at the femoral neck and radius compared to the lumbar spine. Nevertheless, vertebral fractures are an important, often asymptomatic manifestation, especially in glucocorticoid-treated patients. A standardized diagnostic approach to the musculoskeletal system, including prophylaxis, therapy and follow up, is therefore mandatory in at risk children. Here we discuss the molecular mechanisms involved in skeletal homeostasis and the influence of inflammation and chronic disease on bone metabolism.

Medical Device Development for Children and Young People-Reviewing the Challenges and Opportunities

Development of specific medical devices (MDs) is required to meet the healthcare needs of children and young people (CYP). In this context, MD development should address changes in growth and psychosocial maturation, physiology, and pathophysiology, and avoid inappropriate repurposing of adult technologies. Underpinning the development of MD for CYP is the need to ensure MD safety and effectiveness through pediatric MD-specific regulations. Contrary to current perceptions of limited market potential, the global pediatric healthcare market is expected to generate around USD 15,984 million by 2025. There are 1.8 billion young people in the world today; 40% of the global population is under 24, creating significant future healthcare market opportunities. This review highlights a number of technology areas that have led to successful pediatric MD, including 3D printing, advanced materials, drug delivery, and diagnostic imaging. To ensure the targeted development of MD for CYP, collaboration across multiple professional disciplines is required, facilitated by a platform to foster collaboration and drive innovation. The European Pediatric Translational Research Infrastructure (EPTRI) will be established as the European platform to support collaboration, including the life sciences industrial sector, to identify unmet needs in child health and support the development, adoption, and commercialization of pediatric MDs.

Individual Calculation of Effective Dose and Risk of Malignancy Based on Monte Carlo Simulations after Whole Body Computed Tomography

Detailed knowledge about radiation exposure is crucial for radiology professionals. The conventional calculation of effective dose (ED) for computed tomography (CT) is based on dose length product (DLP) and population-based conversion factors (k). This is often imprecise and unable to consider individual patient characteristics. We sought to provide more precise and individual radiation exposure calculation using image based Monte Carlo simulations (MC) in a heterogeneous patient collective and to compare it to phantom based MC provided from the National Cancer Institute (NCI) as academic reference. Dose distributions were simulated for 22 patients after whole-body CT during Positron Emission Tomography-CT. Based on MC we calculated individual Lifetime Attributable Risk (LAR) and Excess Relative Risk (ERR) of cancer mortality. ED_MC was compared to ED_DLP and ED_NCI. ED_DLP (13.2 ± 4.5 mSv) was higher compared to ED_NCI (9.8 ± 2.1 mSv) and ED_MC (11.6 ± 1.5 mSv). Relative individual differences were up to -48% for ED_MC and -44% for ED_NCI compared to ED_DLP. Matching pair analysis illustrates that young age and gender are affecting LAR and ERR significantly. Because of these uncertainties in radiation dose assessment automated individual dose and risk estimation would be desirable for dose monitoring in the future.