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Costa de Castro M, Toroi P, Kortesniemi M, Lindholm C, Pinto M, Rinaldi L, Tietäväinen A, Tikkanen J, Živanović M. Impact of the measurement conditions and compression paddle on mammography dosimeter response. Phys Med 2024; 123:103405. [PMID: 38870645 DOI: 10.1016/j.ejmp.2024.103405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/08/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024] Open
Abstract
The effect of mammography measurement conditions was investigated to evaluate their impact on measurement uncertainties in clinical practice. The most prominent physical X-ray beam quantities i.e., - air kerma, half-value layer, and X-ray tube voltage - were examined by measuring the response of two ionization chambers and six X-ray multimeters (XMMs) of different models. Measurements were performed using several anode/filter combinations and both with and without the compression paddle in the X-ray beam. Maximum differences of higher than 6 % were found for all quantities when the dosimeter displayed value was compared with the reference value or the variation within the clinical anode/filter combinations Mo/Mo and Mo/Rh were considered. The study showed that the calibration procedure with the W/Al anode/filter combination was reliable only for ionization chambers, and the response of XMMs varies in such a way that the calibration coefficient cannot be predicted between various measurement conditions used in calibration and clinical practices. XMM calibrations are typically performed without a compression paddle in the beam, and the response of the XMM changes when radiation quality is slightly altered. If XMM specific data is not available, based on this study, an additional uncertainty of 2 % (k = 1) could be used as a typical estimate, at least for air kerma measurements. XMMs should be used for clinical measurements in mammography only with correct settings. If the correct settings are not available, the XMMs should not be used or used only with extreme caution.
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Affiliation(s)
| | - Paula Toroi
- STUK - Radiation and Nuclear Authority, Jokiniemenkuja 1, 01370 Vantaa, Finland; HUS HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, Finland.
| | - Mika Kortesniemi
- HUS HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Carita Lindholm
- STUK - Radiation and Nuclear Authority, Jokiniemenkuja 1, 01370 Vantaa, Finland
| | - Massimo Pinto
- ENEA-INMRI, Istituto Nazionale di Metrologia delle Radiazioni Ionizzanti, Via Anguillarese 301, 00123 Santa Maria di Galeria, (RM), Italy
| | - Luigi Rinaldi
- ENEA-INMRI, Istituto Nazionale di Metrologia delle Radiazioni Ionizzanti, Via Anguillarese 301, 00123 Santa Maria di Galeria, (RM), Italy
| | - Aino Tietäväinen
- STUK - Radiation and Nuclear Authority, Jokiniemenkuja 1, 01370 Vantaa, Finland
| | - Joonas Tikkanen
- STUK - Radiation and Nuclear Authority, Jokiniemenkuja 1, 01370 Vantaa, Finland
| | - Miloš Živanović
- Vinca Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11351 Vinča, Belgrade, Serbia
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Tollens F, Baltzer PA, Froelich MF, Kaiser CG. Economic evaluation of breast MRI in screening - a systematic review and basic approach to cost-effectiveness analyses. Front Oncol 2023; 13:1292268. [PMID: 38130995 PMCID: PMC10733447 DOI: 10.3389/fonc.2023.1292268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background Economic evaluations have become an accepted methodology for decision makers to allocate resources in healthcare systems. Particularly in screening, where short-term costs are associated with long-term benefits, and adverse effects of screening intermingle, cost-effectiveness analyses provide a means to estimate the economic value of screening. Purpose To introduce the methodology of economic evaluations and to review the existing evidence on cost-effectiveness of MR-based breast cancer screening. Materials and methods The various concepts and techniques of economic evaluations critical to the interpretation of cost-effectiveness analyses are briefly introduced. In a systematic review of the literature, economic evaluations from the years 2000-2022 are reviewed. Results Despite a considerable heterogeneity in the reported input variables, outcome categories and methodological approaches, cost-effectiveness analyses report favorably on the economic value of breast MRI screening for different risk groups, including both short- and long-term costs and outcomes. Conclusion Economic evaluations indicate a strongly favorable economic value of breast MRI screening for women at high risk and for women with dense breast tissue.
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Affiliation(s)
- Fabian Tollens
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Pascal A.T. Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Clemens G. Kaiser
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Abstract
INTRODUCTION Thermography offers a non-invasive radiation-free methodology for diagnostic imaging and temperature measurement, but the extent of the current application is unclear, as is the level of evidence for each use case. Moreover, population-based thermographic reference values for diagnostic purposes are nearly unknown. The aim of this scoping review is to identify patient populations and diseases in which thermography is applied, cataloguing of technical and environmental modalities, investigation of the existence of specific reference data and finally exploration of gaps and future tasks. METHODS AND ANALYSIS PubMed, Cochrane Database of Systematic Reviews and CENTRAL, Embase, Web of Science and OpenGrey are to be searched using pretested suitable search strategies, with no language restriction, but abstracts should be available in English or German and articles should not have been published before 2000. This limited time frame is due to the rapid technological progress, which makes it necessary to exclude reports based on outdated technology. The literature found will be selected on the basis of previously defined inclusion and exclusion criteria. Subsequently, relevant data will be extracted from the included references into a predesigned table. The selection and extraction process will be conducted by two researchers independently. The report of the results will be according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The entire review process will follow the Joanna Briggs Institute approach. The scoping review protocol is registered at the Open Science Framework. ETHICS AND DISSEMINATION Ethical approval is not required for this work, but ethical medicine also obliges us to carefully consider diagnostic alternatives and compare them with current standards. The dissemination of the results will take place in a variety of ways. First and foremost through publication in an open access journal, but also through conference proceedings. In addition, this scoping review will serve to open up new research foci with regard to thermography.
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Affiliation(s)
- Dorothea Kesztyüs
- Department of Medical Informatics, Georg-August-University Göttingen, University Medical Center, Göttingen, Niedersachsen, Germany
| | - Sabrina Brucher
- Department of Medical Informatics, Georg-August-University Göttingen, University Medical Center, Göttingen, Niedersachsen, Germany
- Institute for Distance Learning, Technical University of Applied Sciences, Berlin, Germany
| | - Tibor Kesztyüs
- Department of Medical Informatics, Georg-August-University Göttingen, University Medical Center, Göttingen, Niedersachsen, Germany
- Institute for Distance Learning, Technical University of Applied Sciences, Berlin, Germany
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Opportunities for Early Cancer Detection: The Rise of ctDNA Methylation-Based Pan-Cancer Screening Technologies. EPIGENOMES 2022; 6:epigenomes6010006. [PMID: 35225958 PMCID: PMC8883983 DOI: 10.3390/epigenomes6010006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
The efficiency of conventional screening programs to identify early-stage malignancies can be limited by the low number of cancers recommended for screening as well as the high cumulative false-positive rate, and associated iatrogenic burden, resulting from repeated multimodal testing. The opportunity to use minimally invasive liquid biopsy testing to screen asymptomatic individuals at-risk for multiple cancers simultaneously could benefit from the aggregated diseases prevalence and a fixed specificity. Increasing both latter parameters is paramount to mediate high positive predictive value—a useful metric to evaluate a screening test accuracy and its potential harm-benefit. Thus, the use of a single test for multi-cancer early detection (stMCED) has emerged as an appealing strategy for increasing early cancer detection rate efficiency and benefit population health. A recent flurry of these stMCED technologies have been reported for clinical potential; however, their development is facing unique challenges to effectively improve clinical cost–benefit. One promising avenue is the analysis of circulating tumour DNA (ctDNA) for detecting DNA methylation biomarker fingerprints of malignancies—a hallmark of disease aetiology and progression holding the potential to be tissue- and cancer-type specific. Utilizing panels of epigenetic biomarkers could potentially help to detect earlier stages of malignancies as well as identify a tumour of origin from blood testing, useful information for follow-up clinical decision making and subsequent patient care improvement. Overall, this review collates the latest and most promising stMCED methodologies, summarizes their clinical performances, and discusses the specific requirements multi-cancer tests should meet to be successfully implemented into screening guidelines.
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Microwave Imaging in Breast Cancer - Results from the First-In-Human Clinical Investigation of the Wavelia System. Acad Radiol 2022; 29 Suppl 1:S211-S222. [PMID: 34364762 DOI: 10.1016/j.acra.2021.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES Microwave Breast Imaging (MBI) is an emerging non-ionising technology with the potential to detect breast pathology. The investigational device considered in this article is a low-power electromagnetic wave MBI prototype that demonstrated the ability to detect dielectric contrast between tumour phantoms and synthetic fibroglandular tissue in preclinical studies. Herein, we evaluate the MBI system in the clinical setting. The capacity of the MBI system to detect and localise breast tumours in addition to benign breast pathology is assessed. Secondly, the safety profile and patient experience of this device is established. MATERIALS AND METHODS Female patients were recruited from the symptomatic unit to 1 of 3 groups: Biopsy-proven breast cancers (Group-1), unaspirated cysts (Group-2) and biopsy-proven benign breast lesions (Group-3). Breast Density was determined by Volpara VDM (Volumetric Density Measurement) Software. MBI, radiological, pathological and histological findings were reviewed. Subjects were surveyed to assess patient experience. RESULTS A total of 25 patients underwent MBI. 24 of these were included in final data analysis (11 Group-1, 8 Group-2 and 5 Group-3). The MBI system detected and localised 12 of 13 benign breast lesions, and 9 out of the 11 breast cancers. This included 1 case of a radiographically occult invasive lobular cancer. No device related adverse events were recorded. 92% (n = 23) of women reported that they would recommend MBI imaging to other women. CONCLUSION The MBI system detected and localized the majority of breast lesions. This modality may have the potential to offer a non-invasive, non-ionizing and painless adjunct to breast cancer diagnosis. Further larger studies are required to validate the findings of this study.
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Hooshmand S, Reed WM, Suleiman ME, Brennan PC. A review of screening mammography: The benefits and radiation risks put into perspective. J Med Imaging Radiat Sci 2021; 53:147-158. [PMID: 34969620 DOI: 10.1016/j.jmir.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION/BACKGROUND In medical imaging a benefit to risk analysis is required when justifying or implementing diagnostic procedures. Screening mammography is no exception and in particular concerns around the use of radiation to help diagnose cancer must be addressed. METHODS The Medline database and various established reports on breast screening and radiological protection were utilised to explore this review. RESULTS/DISCUSSION The benefit of screening is well argued; the ability to detect and treat breast cancer has led to a 91% 5-year survival rate and 497 deaths prevented from breast cancer amongst 100,000 screened women. Subsequently, screening guidelines by various countries recommend annual, biennial or triennial screening from ages somewhere between 40-74 years. Whilst the literature presents different perspectives on screening younger and older women, the current evidence of benefit for screening women <40 and ≥75 years is currently not strong. The radiation dose and associated risk delivered to each woman for a single examination is dependent upon age, breast density and breast thickness, however the average mean glandular dose is around 2.5-3 mGy, and this would result in 65 induced cancers and 8 deaths per 100,000 women over a screening lifetime from 40-74 years. This results in a ratio of lives saved to deaths from induced cancer of 62:1. CONCLUSION Therefore, compared to the potential mortality reduction achievable with screening mammography, the risk is small.
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Affiliation(s)
- Sahand Hooshmand
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia.
| | - Warren M Reed
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
| | - Mo'ayyad E Suleiman
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
| | - Patrick C Brennan
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
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Hendrick RE. Radiation Doses and Risks in Breast Screening. JOURNAL OF BREAST IMAGING 2020; 2:188-200. [PMID: 38424982 DOI: 10.1093/jbi/wbaa016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 03/02/2024]
Abstract
This article describes radiation doses and cancer risks of digital breast imaging technologies used for breast cancer detection. These include digital mammography (DM), digital breast tomosynthesis (DBT), and newer technologies such as contrast-enhanced digital or spectral mammography (CEM), whole-breast computed tomography, breast-specific gamma imaging (BSGI), molecular breast imaging (MBI), and positron emission mammography (PEM). This article describes the basis for radiation risk estimates, compares radiation doses and risks, and provides benefit-to-radiation-risk ratios for different breast imaging modalities that use ionizing radiation. Current x-ray-based screening modalities such as DM and DBT have small to negligible risks of causing radiation-induced cancers in women of normal screening age. Possible new screening modalities such as CEM have similar small cancer risks. Potential screening modalities that involve radionuclide injection such as BSGI, MBI, and PEM have significantly higher cancer risks unless efficient detection systems and reduced administered doses are used. Benefit-to-radiation-risk estimates are highly favorable for screening with DM and other modalities having comparable (or higher) cancer detection rates and comparably low radiation doses.
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Affiliation(s)
- R Edward Hendrick
- University of Colorado School of Medicine, Department of Radiology, Aurora, CO
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Comstock CE, Gatsonis C, Newstead G, Snyder BS, Gareen IF, Bergin JT, Rahbar H, Sung JS, Jacobs C, Harvey JA, Nicholson MH, Ward RC, Holt J, Prather A, Miller KD, Schnall MD, Kuhl CK. Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women With Dense Breasts Undergoing Screening. JAMA 2020; 323:746-756. [PMID: 32096852 PMCID: PMC7276668 DOI: 10.1001/jama.2020.0572] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Improved screening methods for women with dense breasts are needed because of their increased risk of breast cancer and of failed early diagnosis by screening mammography. OBJECTIVE To compare the screening performance of abbreviated breast magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT) in women with dense breasts. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study with longitudinal follow-up at 48 academic, community hospital, and private practice sites in the United States and Germany, conducted between December 2016 and November 2017 among average-risk women aged 40 to 75 years with heterogeneously dense or extremely dense breasts undergoing routine screening. Follow-up ascertainment of cancer diagnoses was complete through September 12, 2019. EXPOSURES All women underwent screening by both DBT and abbreviated breast MRI, performed in randomized order and read independently to avoid interpretation bias. MAIN OUTCOMES AND MEASURES The primary end point was the invasive cancer detection rate. Secondary outcomes included sensitivity, specificity, additional imaging recommendation rate, and positive predictive value (PPV) of biopsy, using invasive cancer and ductal carcinoma in situ (DCIS) to define a positive reference standard. All outcomes are reported at the participant level. Pathology of core or surgical biopsy was the reference standard for cancer detection rate and PPV; interval cancers reported until the next annual screen were included in the reference standard for sensitivity and specificity. RESULTS Among 1516 enrolled women, 1444 (median age, 54 [range, 40-75] years) completed both examinations and were included in the analysis. The reference standard was positive for invasive cancer with or without DCIS in 17 women and for DCIS alone in another 6. No interval cancers were observed during follow-up. Abbreviated breast MRI detected all 17 women with invasive cancer and 5 of 6 women with DCIS. Digital breast tomosynthesis detected 7 of 17 women with invasive cancer and 2 of 6 women with DCIS. The invasive cancer detection rate was 11.8 (95% CI, 7.4-18.8) per 1000 women for abbreviated breast MRI vs 4.8 (95% CI, 2.4-10.0) per 1000 women for DBT, a difference of 7 (95% CI, 2.2-11.6) per 1000 women (exact McNemar P = .002). For detection of invasive cancer and DCIS, sensitivity was 95.7% (95% CI, 79.0%-99.2%) with abbreviated breast MRI vs 39.1% (95% CI, 22.2%-59.2%) with DBT (P = .001) and specificity was 86.7% (95% CI, 84.8%-88.4%) vs 97.4% (95% CI, 96.5%-98.1%), respectively (P < .001). The additional imaging recommendation rate was 7.5% (95% CI, 6.2%-9.0%) with abbreviated breast MRI vs 10.1% (95% CI, 8.7%-11.8%) with DBT (P = .02) and the PPV was 19.6% (95% CI, 13.2%-28.2%) vs 31.0% (95% CI, 17.0%-49.7%), respectively (P = .15). CONCLUSIONS AND RELEVANCE Among women with dense breasts undergoing screening, abbreviated breast MRI, compared with DBT, was associated with a significantly higher rate of invasive breast cancer detection. Further research is needed to better understand the relationship between screening methods and clinical outcome. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02933489.
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Affiliation(s)
| | - Constantine Gatsonis
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Bradley S. Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ilana F. Gareen
- Department of Epidemiology and the Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Habib Rahbar
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Janice S. Sung
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Jenifer A. Harvey
- University of Virginia Cancer Center, Charlottesville, Virginia, USA
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Chang TY, Lai KJ, Tu CY, Wu J. Three-layer heterogeneous mammographic phantoms for Monte Carlo simulation of normalized glandular dose coefficients in mammography. Sci Rep 2020; 10:2234. [PMID: 32042071 PMCID: PMC7010737 DOI: 10.1038/s41598-020-59317-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/27/2020] [Indexed: 12/15/2022] Open
Abstract
Normalized glandular dose (DgN) coefficients obtained using homogeneous breast phantoms are commonly used in breast dosimetry for mammography. However, glandular tissue is heterogeneously distributed in the breast. This study aimed to construct three-layer heterogeneous mammographic phantoms (THEPs) to examine the effect of glandular distribution on DgN coefficient. Each layer of THEPs was set to 25%, 50%, or 75% glandular fraction to emulate heterogeneous glandular distribution. Monte Carlo simulation was performed to attain mean glandular dose (MGD) and air kerma at 22-36 kVp and W/Al, W/Rh, and W/Ag target-filter combinations. The heterogeneous DgN coefficient was calculated as functions of the mean glandular fraction (MGF), breast thickness, tube voltage, and half-value layer. At 50% MGF, the heterogeneous DgN coefficients for W/Al, W/Rh, and W/Ag differed by 40.3%, 36.7%, and 31.2%. At 9-cm breast thickness, the DgN values of superior and inferior glandular distributions were 25.4% higher and 29.2% lower than those of uniform distribution. The proposed THEPs can be integrated with conventional breast dosimetry to consider the heterogeneous glandular distribution in clinical practice.
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Affiliation(s)
- Tien-Yu Chang
- Department of Radiology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Kuan-Jen Lai
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Yuan Tu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
- Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Jay Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
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Kizina K, Stolte B, Totzeck A, Bolz S, Fleischer M, Mönninghoff C, Guberina N, Oldenburg D, Forsting M, Kleinschnitz C, Hagenacker T. Clinical Implication of Dosimetry of Computed Tomography- and Fluoroscopy-Guided Intrathecal Therapy With Nusinersen in Adult Patients With Spinal Muscular Atrophy. Front Neurol 2019; 10:1166. [PMID: 31787921 PMCID: PMC6856637 DOI: 10.3389/fneur.2019.01166] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/15/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Spinal muscular atrophy (SMA) is a genetic disorder that leads to progressive tetraparesis. Nusinersen is the first approved drug for the treatment of SMA and is administered via intrathecal injections. Neuromyopathic scoliosis and spondylodesis can impede lumbar punctures, thus necessitating the use of radiological imaging. Furthermore, dosimetry of this potentially lifelong therapy should be supervised. Methods: Fluoroscopy-assisted or computed tomography (CT)-guided intrathecal injections of nusinersen were performed in adult patients with SMA type 2 and 3. The mean effective dose was compared in patients with and without spondylodesis as well as in those with SMA type 2 and 3. The dosimetry was analyzed in relation to the motor function evaluated with the Revised Upper Limb module (RULM) score and the Hammersmith Functional Motor Scale-Expanded (HFMSE) score. Results: Fifteen patients with SMA type 2 and 3 underwent radiological imaging-assisted intrathecal injections. The mean effective dose per CT-guided injection per patient was 2.59 (±1.67) mSv (n = 12). The mean dose area product (DAP) per fluoroscopy-guided injection per patient was 200.48 (±323.67) μGym2 (n = 3). With increase in the number of injections, the effective dose (r = −0.23) (p < 0.05) and the DAP (r = −0.09) (p > 0.05) decreased. The mean effective dose in 4 patients without spinal fusion (SMA type 2) was 1.39 (±0.51) mSv, whereas that in 8 patients with spondylodesis (SMA type 2 and 3) was 3.21 (±1.73) mSv. The mean effective dose in 5 SMA type 2 patients with spondylodesis was 2.68 (±1.47) mSv (n = 5) and in 3 SMA type 3 patients was 4.00 (±1.82) mSv. Dosimetry did not show significant correlation with the clinical severity of the disease (RULM score: r = −0.045, p > 0.05 and HFMSE score: r = −0.001, p > 0.05). Conclusions: In SMA type 2 and 3 patients undergoing radiological imaging-assisted injections, the effective dose and DAP decreased during therapy with nusinersen. The mean effective dose in patients with spondylodesis was higher than that in patients without spondylodesis. Dosimetry should be monitored carefully in order to detect and prevent unnecessary radiation exposure.
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Affiliation(s)
- Kathrin Kizina
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Benjamin Stolte
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Andreas Totzeck
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Saskia Bolz
- Department of Neurology, University Hospital Essen, Essen, Germany
| | | | - Christoph Mönninghoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Denise Oldenburg
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - Tim Hagenacker
- Department of Neurology, University Hospital Essen, Essen, Germany
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Bremer D, Lüdecke D, von dem Knesebeck O. Social Relationships, Age and the Use of Preventive Health Services: Findings from the German Ageing Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214272. [PMID: 31689892 PMCID: PMC6862648 DOI: 10.3390/ijerph16214272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 01/01/2023]
Abstract
This paper investigates the associations between social relationships, age and the use of preventive health services among German adults. Data stem from the German Ageing Survey (10,324 respondents). The use of preventive health services was assessed by asking for regular use of flu vaccination and cancer screening in the past years. Predictors of interest were structural (having a partner, size of the social network) and functional aspects of social relationships (perceived informational support) and age. Logistic regression models were used to measure the associations between preventive health services use and these predictors. Self-perceived health, gender and education were considered as covariates. Having a partner (OR = 1.20, 95% CI: 1.07-1.34) and perceived informational support (OR = 1.38, 95% CI: 1.13-1.69) were associated with a higher probability of getting flu vaccination regularly over the past years. Informational support (OR = 1.42, 95% CI: 1.17-1.72) and having a partner (OR = 1.57, 95% CI: 1.41-1.75) were positively associated with regular cancer screening over the past years. Associations between the size of the social network and use of preventive health services were not statistically significant. Associations between the use of preventive health services and social relationships varied by age. Structural and functional aspects of social relationships may support preventive health behavior. To increase preventive health behavior and the use of preventive health services, it is necessary to integrate information on social relationships into routine care and to strengthen sources of social support.
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Affiliation(s)
- Daniel Bremer
- Department of Medical Psychology & Center for Health Care Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Daniel Lüdecke
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
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