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Wickramasinghe SU, Ramanathan V, Sarasanandarajah S, De Zoyza M, Paranamana R. Occupational dose measurement in interventional cardiology practice. RADIATION PROTECTION DOSIMETRY 2024; 200:629-639. [PMID: 38555495 DOI: 10.1093/rpd/ncae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
Ensuring the safety of healthcare workers in interventional cardiology necessitates effective monitoring of occupational radiation exposure. This study aims to assess the accuracy of the over-apron single dosimetric approach compared with double dosimetric methods and explore the relationship between under-apron and over-apron doses. This investigation showed that the prescribed annual dose constraint of 20 mSv year-1 was not exceeded by the maximum annual occupational doses determined by dosimetric algorithms, which were 0.13 ± 0.02, 0.15 ± 0.02 and 0.27 ± 0.04 mSv, respectively. The study demonstrated excellent statistically significant correlations among single and double dosimetric algorithms and between direct under-apron and over-apron doses. Consequently, single dosimetric algorithms could effectively estimate doses for double dosimetric algorithms, highlighting the limited added value of under-apron measurements. These findings significantly impact the practice of interventional cardiology in Sri Lanka, playing a crucial role in enhancing radiation protection measures.
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Affiliation(s)
| | - Vijitha Ramanathan
- Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Sivananthan Sarasanandarajah
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
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Engström A, Isaksson M, Larsson PA, Lundh C, Båth M. Lead aprons and thyroid collars: to be, or not to be? JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:031516. [PMID: 37678246 DOI: 10.1088/1361-6498/acf76f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/07/2023] [Indexed: 09/09/2023]
Abstract
Wearing lead aprons and thyroid collars for long periods of time has a subjective component: to balance the effective dose reduction with the effort of carrying a heavy load. Occupational radiation exposure has decreased dramatically in the last century within the health care system. During the same period the use of lead aprons and thyroid collars has also gone up. Therefore, a question that may be raised is: how safe is safe enough? In order to promote stakeholder involvement, the aim of the present study was to investigate staff's experience of discomforts associated with wearing lead aprons and thyroid collars for long periods of time, and also to investigate staff's willingness to tolerate personal dose equivalent (expressed as radiation dose) and the corresponding increase in future cancer risk to avoid wearing these protective tools. A questionnaire was developed and given to staff working in operating or angiography rooms at Skaraborg Hospital in Sweden. The results from the 245 respondents showed that 51% experienced bothersome warmth, 36% experienced fatigue and 26% experienced ache or pain that they believed was associated with wearing lead aprons. One third of the respondents would tolerate a personal dose equivalent of 1 mSv per year to avoid wearing lead aprons, but only a fifth would tolerate the corresponding increase in future cancer risk (from 43% to 43.2%). In conclusion, discomforts associated with wearing lead aprons and thyroid collars for long periods of time are common for the staff using them. At the same time, only a minority of the staff would tolerate a small increase in future cancer risk to avoid wearing them. The present study gives an example of stakeholder involvement and points at the difficulties in making reasonable decisions about the use of these protective tools.
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Affiliation(s)
- Andreas Engström
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Department of Radiology, Skaraborg Hospital, Region Västra Götaland, Skövde, SE-541 85, Sweden
| | - Mats Isaksson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
| | - Per-Anders Larsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Surgery, Skaraborg Hospital, Region Västra Götaland, Skövde, SE-541 85, Sweden
- Department of Research and Development, Skaraborg Hospital, Region Västra Götaland, SE-541 85 Skövde, Sweden
| | - Charlotta Lundh
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, SE-413 45, Sweden
| | - Magnus Båth
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, SE-413 45, Sweden
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Boice JD, Cohen SS, Mumma MT, Howard SC, Yoder RC, Dauer LT. Mortality among medical radiation workers in the United States, 1965-2016. Int J Radiat Biol 2023; 99:183-207. [PMID: 34731066 DOI: 10.1080/09553002.2021.1967508] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Estimates of radiation risks following prolonged exposures at low doses and low-dose rates are uncertain. Medical radiation workers are a major component of the Million Person Study (MPS) of low-dose health effects. Annual personal dose equivalents, HP(10), for individual workers are available to facilitate dose-response analyses for lung cancer, leukemia, ischemic heart disease (IHD) and other causes of death. MATERIALS AND METHODS The Landauer, Inc. dosimetry database identified 109,019 medical and associated radiation workers first monitored 1965-1994. Vital status and cause of death were determined through 2016. Mean absorbed doses to red bone marrow (RBM), lung, heart, and other organs were estimated by adjusting the recorded HP(10) for each worker by scaling factors, accounting for exposure geometry, the energy of the incident photon radiation, sex of the worker and whether an apron was worn. There were 4 exposure scenarios: general radiology characterized by low-energy x-ray exposure with no lead apron use, interventional radiologists/cardiologists who wore aprons, nuclear medicine personnel and radiation oncologists exposed to high-energy photon radiation, and other workers. Standardized mortality ratio (SMR) analyses were performed. Cox proportional hazards models were used to estimate organ-specific radiation risks. RESULTS Overall, 11,433 deaths occurred (SMR 0.60; 95%CI 0.59,0.61), 126 from leukemia other than chronic lymphocytic leukemia (CLL), 850 from lung cancer, and 1654 from IHD. The mean duration of monitoring was 23.7 y. The excess relative rate (ERR) per 100 mGy was estimated as 0.10 (95% CI -0.34, 0.54) for leukemia other than CLL, 0.15 (0.02, 0.27) for lung cancer, and -0.10 (-0.27, 0.06) for IHD. The ERR for lung cancer was 0.16 (0.01, 0.32) among the 55,218 male workers and 0.09 (-0.19, 0.36) among the 53,801 female workers; a difference that was not statistically significant (p-value = 0.23). CONCLUSIONS Medical radiation workers were at increased risk for lung cancer that was higher among men than women, although this difference was not statistically significant. In contrast, the study of Japanese atomic bomb survivors exposed briefly to radiation in 1945 found females to be nearly 3 times the radiation risk of lung cancer compared with males on a relative scale. For medical workers, there were no statistically significant radiation associations with leukemia excluding CLL, IHD or other specific causes of death. Combining these data with other cohorts within the MPS, such as nuclear power plant workers and nuclear submariners, will enable more precise estimates of radiation risks at relatively low cumulative doses.
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Affiliation(s)
- John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
| | | | - Michael T Mumma
- International Epidemiology Institute, Rockville, MD, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara C Howard
- ORISE Health Studies Program, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | | | - Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Koterov AN, Tukov AR, Ushenkova LN, Kalinina MV, Biryukov AP. Average Accumulated Radiation Doses for Global Nuclear Workers: Low Doses, Low Effects, and Comparison with Doses for Medical Radiologists. BIOL BULL+ 2022. [DOI: 10.1134/s106235902212007x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Yoder RC, Dauer LT, Balter S, Boice JD, Grogan HA, Mumma MT, Passmore CN, Rothenberg LN, Vetter RJ. Dosimetry for the study of medical radiation workers with a focus on the mean absorbed dose to the lung, brain and other organs. Int J Radiat Biol 2022; 98:619-630. [PMID: 30451566 PMCID: PMC9465996 DOI: 10.1080/09553002.2018.1549756] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The reconstruction of lifetime radiation doses for medical workers presents special challenges not commonly encountered for the other worker cohorts comprising the Million Worker Study. METHODS The selection of approximately 175,000 medical radiation workers relies on using estimates of lifetime and annual personal monitoring results collected since 1977. Approaches have been created to adjust the monitoring results so that mean organ absorbed doses can be estimated. RESULTS Changes in medical technology and practices have altered the radiation exposure environments to which a worker may have been exposed during their career. Other temporal factors include shifts in regulatory requirements that influenced the conduct of radiation monitoring and the changes in the measured dose quantities. CONCLUSIONS The use of leaded aprons during exposure to lower energy X rays encountered in fluoroscopically based radiology adds complexity to account for the shielding of the organs located in the torso when dosimeters were worn over leaded aprons. Estimating doses to unshielded tissues such as the brain and lens of the eye become less challenging when dosimeters are worn at the collar above the apron. The absence of leaded aprons in the higher energy photon settings lead to a more straightforward process of relating dosimeter results to mean organ doses.
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Affiliation(s)
| | | | | | - John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA;,Vanderbilt Epidemiology Center, Division of Epidemiology Department of Medicine, Vanderbilt-Ingram Cancer Center Vanderbilt University Medical Center, Nashville, TN, USA
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Dauer LT, Woods M, Miodownik D, Serencsits B, Quinn B, Bellamy M, Yoder C, Liang X, Boice JD, Bernstein J. Cohort profile - MSK radiation workers: a feasibility study to establish a deceased worker sub-cohort as part of a multicenter medical radiation worker component in the million person study of low-dose radiation health effects. Int J Radiat Biol 2022; 98:593-599. [PMID: 30810447 PMCID: PMC7147486 DOI: 10.1080/09553002.2019.1587194] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The National Council on Radiation Protection and Measurements (NCRP) is coordinating an expansive epidemiologic effort entitled the Million Person Study of Low-Dose Radiation Health Effects (MPS). Medical workers constitute the largest occupational radiation-exposed group whose doses are typically received gradually over time. METHODS A unique opportunity exists to establish an Institutional Review Board/Privacy Board (IRB/PB) approved, retrospective feasibility sub-cohort of diseased Memorial Sloan Kettering Cancer Center (MSK) medical radiation workers to reconstruct occupational/work history, estimate organ-specific radiation absorbed doses, and review existing publicly available records for mortality from cancer (including leukemia) and other diseases. Special emphasis will be placed on dose reconstruction approaches as a means to provide valid organ dose estimates that are as accurate and precise as possible based on the available data, and to allow proper evaluation of accompanying uncertainties. Such a study that includes validated dose measurements and information on radiation exposure conditions would significantly reduce dose uncertainties and provided greatly improved information on chronic low-dose risks. RESULTS The feasibility sub-cohort will include deceased radiation workers from MSK who worked during the nearly seventy-year timeframe from 1946 through 2010 and were provided individual personal radiation dosimetry monitors. A feasibility assessment focused on obtaining records for about 25-30,000 workers, with over 124,000 annual doses, including personnel/work histories, specific dosimetry data, and appropriate information for epidemiologic mortality tracing will be conducted. MSK radiation dosimetry measurements have followed stringent protocols complying with strict worker protection standards in order to provide accurate dose information for radiation workers that include detailed records of work practices (including specific task exposure conditions, radiation type, energy, geometry, personal protective equipment usage, badge position, and missed doses), as well as recorded measurements. These dose measurements have been ascertained through a variety of techniques that have evolved over the years, from film badges to thermoluminescent dosimetry technology to optically stimulated luminescent methodologies. It is expected that individual total doses for the sub-cohort will have a broad range from <10 mSv to > =1000 mSv. CONCLUSIONS MSK has pioneered the use of novel radiation diagnostic and therapeutic approaches over time (including initial work with x-rays, radium, and radon), with workplace safety in mind, resulting in a variety of radiation worker exposure scenarios. The results of this feasibility sub-cohort of deceased radiation workers, and associated lessons learned may potentially be applied to an expanded multicenter study of about 170,000 medical radiation worker component of the MPS.
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Affiliation(s)
- Lawrence T. Dauer
- Radiology & Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghan Woods
- Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Miodownik
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian Serencsits
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian Quinn
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Xiaolin Liang
- Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA;,Vanderbilt Epidemiology Center, Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonine Bernstein
- Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Lee D, Lee WJ, Jin YW, Kim J, Park S, Park S, Seo S. Estimation of the historical radiation dose of Korean radiation workers, 1961-1983. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:1005-1017. [PMID: 34587594 DOI: 10.1088/1361-6498/ac2b8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
Accurate dosimetry plays a key role in evaluating the radiation-induced health risks of radiation workers. The National Dose Registry in Korea contains the dose records of radiation workers in nuclear-related occupations since 1984. Thus, radiation doses for workers before 1984 are often sparse or missing. This study aimed to estimate the historical radiation dose before 1984 for radiation workers in Korea based on dose reconstruction models. The dose reconstruction models were derived from the nationwide self-administered questionnaire survey and the personal badge doses for workers in the cohort of the Korean Radiation Worker Study. The mean estimated annual doses between 1984 and 2016 from the dose reconstruction model were 4.67-0.6 mSv, which closely matched the reported doses of 4.51-0.43 mSv. The mean estimated annual doses between 1961 and 1983 based on the exposure scenarios developed by factors associated with radiation doses ranged from 11.08 to 4.82 mSv. The mean estimated annual doses of individuals in the cohort from 1961 to 1983 ranged from 11.15 to 4.88 mSv. Although caution needs to be exercised in the interpretation of these estimations due to uncertainty owed to the nature of extrapolation beyond the range of observed data, this study offers a sense of the radiation doses for workers during Korea's early period of radiation-related activities, which can be a useful piece of information for radiation-induced health risk assessments.
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Affiliation(s)
- Dalnim Lee
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Young Woo Jin
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Jiyeong Kim
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Soojin Park
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Sunhoo Park
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Songwon Seo
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
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Boice JD, Quinn B, Al-Nabulsi I, Ansari A, Blake PK, Blattnig SR, Caffrey EA, Cohen SS, Golden AP, Held KD, Jokisch DW, Leggett RW, Mumma MT, Samuels C, Till JE, Tolmachev SY, Yoder RC, Zhou JY, Dauer LT. A million persons, a million dreams: a vision for a national center of radiation epidemiology and biology. Int J Radiat Biol 2021; 98:795-821. [PMID: 34669549 PMCID: PMC10594603 DOI: 10.1080/09553002.2021.1988183] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Epidemiologic studies of radiation-exposed populations form the basis for human safety standards. They also help shape public health policy and evidence-based health practices by identifying and quantifying health risks of exposure in defined populations. For more than a century, epidemiologists have studied the consequences of radiation exposures, yet the health effects of low levels delivered at a low-dose rate remain equivocal. MATERIALS AND METHODS The Million Person Study (MPS) of U.S. Radiation Workers and Veterans was designed to examine health effects following chronic exposures in contrast with brief exposures as experienced by the Japanese atomic bomb survivors. Radiation associations for rare cancers, intakes of radionuclides, and differences between men and women are being evaluated, as well as noncancers such as cardiovascular disease and conditions such as dementia and cognitive function. The first international symposium, held November 6, 2020, provided a broad overview of the MPS. Representatives from four U.S. government agencies addressed the importance of this research for their respective missions: U.S. Department of Energy (DOE), the Centers for Disease Control and Prevention (CDC), the U.S. Department of Defense (DOD), and the National Aeronautics and Space Administration (NASA). The major components of the MPS were discussed and recent findings summarized. The importance of radiation dosimetry, an essential feature of each MPS investigation, was emphasized. RESULTS The seven components of the MPS are DOE workers, nuclear weapons test participants, nuclear power plant workers, industrial radiographers, medical radiation workers, nuclear submariners, other U.S. Navy personnel, and radium dial painters. The MPS cohorts include tens of thousands of workers with elevated intakes of alpha particle emitters for which organ-specific doses are determined. Findings to date for chronic radiation exposure suggest that leukemia risk is lower than after acute exposure; lung cancer risk is much lower and there is little difference in risks between men and women; an increase in ischemic heart disease is yet to be seen; esophageal cancer is frequently elevated but not myelodysplastic syndrome; and Parkinson's disease may be associated with radiation exposure. CONCLUSIONS The MPS has provided provocative insights into the possible range of health effects following low-level chronic radiation exposure. When the 34 MPS cohorts are completed and combined, a powerful evaluation of radiation-effects will be possible. This final article in the MPS special issue summarizes the findings to date and the possibilities for the future. A National Center for Radiation Epidemiology and Biology is envisioned.
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Affiliation(s)
- John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Brian Quinn
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Armin Ansari
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Steve R. Blattnig
- National Aeronautics and Space Administration Langley Research Center, Hampton, VA, USA
| | - Emily A. Caffrey
- Radian Scientific, LLC, Huntsville, AL, and Risk Assessment Corporation, Neeses, SC, USA
| | - Sarah S. Cohen
- EpidStrategies, a division of ToxStrategies, Inc, Cary, NC, USA
| | | | - Kathryn D. Held
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Derek W. Jokisch
- Francis Marion University, Florence, SC, USA
- Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | | | - Michael T. Mumma
- Vanderbilt University School of Medicine, Nashville, TN, USA
- International Epidemiology Institute, Rockville, MD, USA
| | | | | | | | | | - Joey Y. Zhou
- United States Department of Energy, Gaithersburg, MD, USA
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Mettler FA, Guiberteau MJ. Occupational Exposure in General Radiology and Nuclear Medicine: A Changing Target. Radiology 2021; 300:613-614. [PMID: 34156304 DOI: 10.1148/radiol.2021211104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fred A Mettler
- From the Department of Radiology, University of New Mexico School of Medicine, 2211 Lomas Blvd NE, Albuquerque, NM 87106 (F.A.M.); and 619 Northumberland Rd, Austin, Tex (M.J.G.)
| | - Milton J Guiberteau
- From the Department of Radiology, University of New Mexico School of Medicine, 2211 Lomas Blvd NE, Albuquerque, NM 87106 (F.A.M.); and 619 Northumberland Rd, Austin, Tex (M.J.G.)
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Villoing D, Borrego D, Preston DL, Alexander BH, Rose A, Salasky M, Linet MS, Lee C, Kitahara CM. Trends in Occupational Radiation Doses for U.S. Radiologic Technologists Performing General Radiologic and Nuclear Medicine Procedures, 1980-2015. Radiology 2021; 300:605-612. [PMID: 34156301 DOI: 10.1148/radiol.2021204501] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Occupational doses to most medical radiation workers have declined substantially since the 1950s because of improvements in radiation protection practices. However, different patterns may have emerged for radiologic technologists working with nuclear medicine because of the higher per-procedure doses and increasing workloads. Purpose To summarize annual occupational doses during a 36-year period for a large cohort of U.S. radiologic technologists and to compare dose between general radiologic technologists and those specializing in nuclear medicine procedures. Materials and Methods Annual personal dose equivalents (referred to as doses) from 1980 to 2015 were summarized for 58 434 (62%) participants in the U.S. Radiologic Technologists (USRT) cohort who responded to the most recent mailed work history survey (years 2012-2014) and reported never regularly performing interventional procedures. Doses were partitioned according to the performance of nuclear medicine (yes or no, frequency, procedure type) by calendar year. Annual dose records were described by using summary statistics (eg, median and 25th and 75th percentiles). Results Median annual doses related to performance of general radiologic procedures decreased from 0.60 mSv (interquartile range [IQR], 0.10-1.9 mSv) in 1980 to levels below the limits of detection by 2015, whereas annual doses related to performance of nuclear medicine procedures remained relatively high during this period (median, 1.2 mSv; IQR, 0.12-3.0 mSv). Higher median annual doses were associated with more frequent (above vs below the median) performance of diagnostic nuclear medicine procedures (≥35 vs <35 times per week; 1.6 mSv [IQR, 0.30-3.3 mSv] and 0.9 mSv [IQR, 0.10-2.6 mSv]). Higher and more variable annual doses were associated with more frequent performance of cardiac nuclear medicine (≥10 times per week) and PET (nine or more times per week) examinations (median, 1.6 mSv [IQR, 0.30-2.2 mSv] and 2.2 mSv [IQR, 0.10-4.6 mSv], respectively). Conclusion Annual doses to U.S. radiologic technologists performing general radiologic procedures declined during a 36-year period. However, consistently higher and more variable doses were associated with the performance of nuclear medicine procedures, particularly cardiac nuclear medicine and PET procedures. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Mettler and Guiberteau in this issue.
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Affiliation(s)
- Daphnée Villoing
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - David Borrego
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Dale L Preston
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Bruce H Alexander
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - André Rose
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Mark Salasky
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Martha S Linet
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Choonsik Lee
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
| | - Cari M Kitahara
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850 (D.V., D.B., A.R., M.S.L., C.L., C.M.K.); Hirosoft International, Eureka, Calif (D.L.P.); Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minn (B.H.A.); Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colo (B.H.A.); and Landauer, Glenwood, Ill (M.S.)
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11
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Lee WJ, Ko S, Bang YJ, Choe SA, Choi Y, Preston DL. Occupational radiation exposure and cancer incidence in a cohort of diagnostic medical radiation workers in South Korea. Occup Environ Med 2021; 78:876-883. [PMID: 34039756 PMCID: PMC8606456 DOI: 10.1136/oemed-2021-107452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
Objectives We investigated the association between protracted low-dose ionising radiation and the risk of cancer in medical radiation workers, the largest group of workers with occupational radiation exposures. Methods Data of all South Korean diagnostic medical radiation workers enrolled at the National Dose Registry during 1996–2011 were merged with the death and cancer incidence data until 31 December 2017. SIRs, relative risks and excess relative risks (ERRs) for cancer were calculated to quantify the radiation dose–response relationship using Poisson regression models. Results A total of 3392 first primary cancer cases were identified among 93 920 diagnostic medical radiation workers. The mean cumulative badge dose in the cohort was 7.20 mSv. The ERRs for solid cancer with a 5-year lag and haematopoietic cancers with a 2-year lag for all workers were 0.15 per 100 mGy (95% CI −0.20 to 0.51) and 0.09 per 100 mGy (95% CI −2.02 to 2.20), respectively. The ERRs for cancers did not significantly vary by job title, different lag years or after excluding thyroid and lung cancers. Sensitivity analyses restricted to workers employed for at least 1 year, or who were employed in or after 1996, or who had exposure to a cumulative badge dose of 1 mSv or more showed similar results. Conclusions Occupational radiation doses were not significantly associated with cancer incidence among South Korean diagnostic medical radiation workers. However, cautious interpretation of ERRs is needed due to the limitations of short follow-up and low cumulative radiation doses.
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Affiliation(s)
- Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Seulki Ko
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Ye Jin Bang
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yeongchull Choi
- Seoul Workers' Health Center, Ewha Womans University, Seoul, South Korea
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12
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Use of Biological Dosimetry for Monitoring Medical Workers Occupationally Exposed to Ionizing Radiation. RADIATION 2021. [DOI: 10.3390/radiation1020009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Medical workers are the largest group exposed to man-made sources of ionizing radiation. The annual doses received by medical workers have decreased over the last several decades, however for some applications, like fluoroscopically guided procedures, the occupational doses still remain relatively high. Studies show that for some procedures the operator and staff still use insufficient protective and dosimetric equipment, which might cause an underestimation of medical exposures. Physical dosimetry methods are a staple for estimating occupational exposures, although due to the inconsistent use of protection measures, an alternative method such as biological dosimetry might complement the physical methods to achieve a more complete picture. Such methods were used to detect exposures to doses as low as 0.1 mSv/year, and could be useful for a more accurate assessment of genotoxic effects of ionizing radiation in medical workers. Biological dosimetry is usually based on the measurement of the effects present in peripheral blood lymphocytes. Although some methods, such as chromosome aberration scoring or micronucleus assay, show promising results, currently there is no one method recognized as most suitable for dosimetric application in the case of chronic, low-dose exposures. In this review we decided to evaluate different methods used for biological dosimetry in assessment of occupational exposures of medical workers.
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Lee WJ, Bang YJ, Cha ES, Kim YM, Cho SB. Lifetime cancer risks from occupational radiation exposure among workers at interventional radiology departments. Int Arch Occup Environ Health 2020; 94:139-145. [PMID: 32894336 DOI: 10.1007/s00420-020-01569-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Interventional medical radiation workers represent an under-studied population worldwide, although they receive relatively high occupational radiation doses. This study aimed to estimate the lifetime cancer risk from occupational radiation exposure among workers at interventional radiology departments. METHODS A field survey of interventional medical workers in nationwide branches of the Korean Society of Interventional Radiology was conducted in 2017. Organ-specific radiation doses were estimated using national dose registry data and conversion coefficients provided by the International Commission on Radiological Protection. Lifetime attributable risk (LAR) and lifetime fractional risk (LFR) were calculated based on realistic exposure scenarios using a radiation risk assessment tool. RESULTS LARs from occupational radiation exposure until the age of retirement for all cancers combined were 338 (90.3-796.1), 121 (33.5-288.7), and 156 (41.1-390.6) per 100,000 individuals for male radiologists, male radiologic technologists, and female nurses, respectively. LFR for all cancers combined ranged from 0.22% (0.06-0.53) to 0.63% (0.17-1.47). Regarding the organ site, the highest LAR and LFR among all groups were observed for thyroid cancer. CONCLUSION This study provides timely evidence of potential cancer burden from the current levels of occupational radiation exposure among workers at interventional radiology departments. The risks varied by occupational groups, and workers, particularly interventional radiologists, need to be carefully monitored for radiation.
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Affiliation(s)
- Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
| | - Ye Jin Bang
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Young Min Kim
- Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Sung Bum Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
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14
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Chartier H, Fassier P, Leuraud K, Jacob S, Baudin C, Laurier D, Bernier MO. Occupational low-dose irradiation and cancer risk among medical radiation workers. Occup Med (Lond) 2020; 70:476-484. [DOI: 10.1093/occmed/kqaa130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Medical workers are the largest group of workers occupationally exposed to low doses of ionizing radiation (IR) worldwide.
Aims
This review presents all the cohorts of medical workers exposed in the world and summarizes cancer risks associated with radiation exposure in this population.
Methods
Epidemiological studies on health professionals exposed to IR published from 1975 to 2019 were reviewed. Strength of evidence was assessed according to the modified Royal College of General Practitioners three-star system.
Results
Among the 16 epidemiological studies focusing on cancers from 11 cohorts among medical staff exposed to radiation, higher risks of cancer were observed for pre-1950 exposure and for medical workers who performed fluoroscopically guided interventional procedures or radionuclides procedures compared to those who did not. However, strength of evidence supporting the associations remains moderate as several methodological limits including the lack of dosimetry data, lifestyle factors and recent updates may obscure the link between medical occupational exposure and cancer occurrence.
Conclusions
Excess risk of cancer is suspected for high and former exposures. The more highly exposed professions, i.e. interventional physicians and nuclear medicine workers, should be monitored carefully. Collaborative projects aiming to increase the quantity and quality of information of the studied populations would be a key point
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Affiliation(s)
- H Chartier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
- Percy Hospital, Radiological Protection Service of the Armed Forces (SPRA), Clamart, France
| | - P Fassier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - K Leuraud
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - S Jacob
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - C Baudin
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - D Laurier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - M-O Bernier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
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15
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Kim J, Seo S, Lee DN, Park S, Im KJ, Park S, Jin YW. OCCUPATIONAL EXPOSURE CHARACTERISTICS AND FACTORS ASSOCIATED WITH RADIATION DOSES AMONG KOREAN RADIATION WORKERS. RADIATION PROTECTION DOSIMETRY 2020; 189:106-113. [PMID: 32090270 DOI: 10.1093/rpd/ncaa019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 11/22/2019] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
This study identified occupational factors associated with radiation exposure in Korea. Survey data of 16 037 workers from 2016 to 2017, including lifestyle factors and occupational characteristics, were combined with the National Dose Registry. Higher average annual doses were observed in groups exhibiting health risk factors such as body mass index (BMI) and smoking. Average annual doses also differed according to occupational characteristics, including average daily working hours, use of radiation protection gear, calendar year of hiring and employment status. Moreover, the influence of different factors on radiation dose differed with occupations. In industrial radiography and nuclear power plants, average daily working hours were the most important factor determining worker radiation doses. In other occupations, such as education, industry and research, calendar year of hiring and duration of employment were the most important factors. This research indicates the need to consider the specific work procedures of occupations to determine exposure variations between or within facilities.
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Affiliation(s)
- Jiyeong Kim
- Laboratory of Low Dose Risk Assessment, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea
| | - Songwon Seo
- Laboratory of Low Dose Risk Assessment, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea
| | - Dal Nim Lee
- Laboratory of Low Dose Risk Assessment, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea
| | - Soojin Park
- Laboratory of Low Dose Risk Assessment, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea
| | - Ki-Jung Im
- Radiation Safety Division, Korea Foundation of Nuclear Safety, 49 Daewangpangyo-ro, 644 Beon-gil, Bundang-gu, Seongnam-si, South Korea
| | - Sunhoo Park
- Laboratory of Low Dose Risk Assessment, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea
| | - Young Woo Jin
- Laboratory of Low Dose Risk Assessment, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea
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Daniels RD, Kendall GM, Thierry-Chef I, Linet MS, Cullings HM. Strengths and Weaknesses of Dosimetry Used in Studies of Low-Dose Radiation Exposure and Cancer. J Natl Cancer Inst Monogr 2020; 2020:114-132. [PMID: 32657346 PMCID: PMC7667397 DOI: 10.1093/jncimonographs/lgaa001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A monograph systematically evaluating recent evidence on the dose-response relationship between low-dose ionizing radiation exposure and cancer risk required a critical appraisal of dosimetry methods in 26 potentially informative studies. METHODS The relevant literature included studies published in 2006-2017. Studies comprised case-control and cohort designs examining populations predominantly exposed to sparsely ionizing radiation, mostly from external sources, resulting in average doses of no more than 100 mGy. At least two dosimetrists reviewed each study and appraised the strengths and weaknesses of the dosimetry systems used, including assessment of sources and effects of dose estimation error. An overarching concern was whether dose error might cause the spurious appearance of a dose-response where none was present. RESULTS The review included 8 environmental, 4 medical, and 14 occupational studies that varied in properties relative to evaluation criteria. Treatment of dose estimation error also varied among studies, although few conducted a comprehensive evaluation. Six studies appeared to have known or suspected biases in dose estimates. The potential for these biases to cause a spurious dose-response association was constrained to three case-control studies that relied extensively on information gathered in interviews conducted after case ascertainment. CONCLUSIONS The potential for spurious dose-response associations from dose information appeared limited to case-control studies vulnerable to recall errors that may be differential by case status. Otherwise, risk estimates appeared reasonably free of a substantial bias from dose estimation error. Future studies would benefit from a comprehensive evaluation of dose estimation errors, including methods accounting for their potential effects on dose-response associations.
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Affiliation(s)
- Robert D Daniels
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Gerald M Kendall
- Cancer Epidemiology Unit, NDPH, University of Oxford, Oxford, UK
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Harry M Cullings
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
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Adliene D, Griciene B, Skovorodko K, Laurikaitiene J, Puiso J. Occupational radiation exposure of health professionals and cancer risk assessment for Lithuanian nuclear medicine workers. ENVIRONMENTAL RESEARCH 2020; 183:109144. [PMID: 32028181 DOI: 10.1016/j.envres.2020.109144] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Reconstruction and analysis of low doses received by the occupationally exposed medical radiation workers, especially nuclear medicine staff dealing with radioisotopes may significantly contribute to the understanding of radiation impact on individuals, assess and predict radiation related risks for the development of cancer or other specific diseases. METHODS A pool of 2059 annual effective doses corresponding to 272 job's positions occupied by nuclear medicine and radiology workers for a certain time period over 26 years in five Lithuanian hospitals was investigated in order to analyze the occupational exposure tendencies to medical staff. Requested data, measured in terms of whole body dose, personal dose equivalent Hp(10), was obtained from the National Register of Sources of Ionizing Radiation and Occupational Exposure. Considering that nuclear medicine staff is dealing with open sources/radioisotopes, doses to extremities, Hp(0.07), were measured using thermoluminescent dosimeters (TLD) of LiF:Mg, Ti type. Lifetime risk estimations for the development of specific cancer (thyroid cancer and leukemia) for exposed radiation workers were performed using risk models included in BEIR VII report (BEIR VII, 2006). The conservative assessment of the thyroid exposure was performed using RadRAT 4.1.1 tool. RESULTS Doses to radiology technologists and radiology nurses were found to be highest over the years. However, their annual doses never exceeded dose limit of 20 mSv and were following the same decreasing tendency as the doses of other personnel. There was no increase of doses to nuclear medicine staff observed after installation of two new PET/CT machines, indicating increased radiation protection culture and application of relevant technical and protective measures by the staff. Measured fingertip doses were 2-3 times higher than the hand doses measured with TLD ring and were dependent on the type and frequency of the nuclear medicine examination procedure and on the type and activity of isotopes used for examination. CONCLUSIONS For the first time, retrospective dose evaluation for the cohort of medical radiation workers was performed in the country. It enabled estimation of lifetime attributable risk for the development of two cancer types: thyroid and leukemia cancer among occupationally exposed medical radiation staff. Projected risk was low, ~10-5, however it was found that the risk of thyroid cancer for female staff was 5.7 times higher than for the males. Obtained results will be used for the predictive assessment of possible radiation induced health effects to occupationally exposed medical radiation workers.
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Affiliation(s)
- D Adliene
- Kaunas University of Technology, Kaunas, Lithuania.
| | - B Griciene
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - K Skovorodko
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; State Research Institute the Center for Physical Sciences and Technology, Vilnius, Lithuania
| | | | - J Puiso
- Kaunas University of Technology, Kaunas, Lithuania
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18
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Lee WJ, Preston DL, Cha ES, Ko S, Lim H. Thyroid cancer risks among medical radiation workers in South Korea, 1996-2015. Environ Health 2019; 18:19. [PMID: 30857541 PMCID: PMC6413450 DOI: 10.1186/s12940-019-0460-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/01/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Thyroid cancer rates, especially among children, are known to be increased by radiation exposure. However, little is known about the impact of chronic low-dose radiation exposure on thyroid cancer risk in adulthood. This study examined radiation effects on thyroid cancer rates as well as an overall evaluation of thyroid cancer risk among medical radiation workers. METHODS Data on all diagnostic medical radiation workers enrolled in the national dosimetry registry between 1996 and 2011 were linked with the cancer registry data through 2015. Standardized incidence ratios (SIRs) were used to compare the observed cancer incidence rates in this population to those for the general population while internal comparisons were used to estimate relative risks (RRs) for occupational history and excess relative risks (ERRs) were used to quantify the radiation dose-response relationship. RESULTS Overall, 827 thyroid cancer cases were reported among 93,922 medical radiation workers. Thyroid cancer SIRs were significantly higher than expected for both men (SIR 1.72, 95% confidence interval [CI] 1.53 to 1.91) and women (SIR 1.18, 95% CI 1.08 to 1.28). However, RRs for thyroid cancer by job title and duration of employment showed no particular pattern among diagnostic medical radiation workers. There were no indications of a significant dose effect on thyroid cancer rates for either men (ERR/100 mGy 0.07, 95% CI -0.38 to 0.53) or women (ERR/100 mGy -0.13, 95% CI -0.49 to 0.23). The findings were similar for different job titles or when limited to workers employed for at least one year. CONCLUSIONS While thyroid cancer incidence rates among Korean medical radiation workers were somewhat higher than those in the general population, there was no significant evidence that this increase was associated with occupational radiation dose. Additional follow-up together with consideration of other risk factors should provide useful information on thyroid cancer rates in this cohort.
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Affiliation(s)
- Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
| | | | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Seulki Ko
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Hyeyeun Lim
- Environmental Health Center, Asan Medical Center, Seoul, South Korea
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Abstract
PURPOSE The study of low dose and low-dose rate exposure is of immeasurable value in understanding the possible range of health effects from prolonged exposures to radiation. The Million Person Study (MPS) of low-dose health effects was designed to evaluate radiation risks among healthy American workers and veterans who are more representative of today's populations than are the Japanese atomic bomb survivors exposed briefly to high-dose radiation in 1945. A million persons were needed for statistical reasons to evaluate low-dose and dose-rate effects, rare cancers, intakes of radioactive elements, and differences in risks between women and men. METHODS AND MATERIALS The MPS consists of five categories of workers and veterans exposed to radiation from 1939 to the present. The U.S. Department of Energy (DOE) Health and Mortality study began over 40 years ago and is the source of ∼360,000 workers. Over 25 years ago, the National Cancer Institute (NCI) collaborated with the U.S. Nuclear Regulatory Commission (NRC) to effectively create a cohort of nuclear power plant workers (∼150,000) and industrial radiographers (∼130,000). For over 30 years, the Department of Defense (DoD) collected data on aboveground nuclear weapons test participants (∼115,000). At the request of NCI in 1978, Landauer, Inc., (Glenwood, IL) saved their dosimetry databases which became the source of a cohort of ∼250,000 medical and other workers. RESULTS Overall, 29 individual cohorts comprise the MPS of which 21 have been or are under active study (∼810,000 persons). The remaining eight cohorts (∼190,000 persons) will be studied as resources become available. The MPS is a national effort with critical support from the NRC, DOE, National Aeronautics and Space Administration (NASA), DoD, NCI, the Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency (EPA), Landauer, Inc., and national laboratories. CONCLUSIONS The MPS is designed to address the major unanswered question in radiation risk understanding: What is the level of health effects when exposure is gradual over time and not delivered briefly. The MPS will provide scientific understandings of prolonged exposure which will improve guidelines to protect workers and the public; improve compensation schemes for workers, veterans and the public; provide guidance for policy and decision makers; and provide evidence for or against the continued use of the linear nonthreshold dose-response model in radiation protection.
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Affiliation(s)
- John D Boice
- a National Council on Radiation Protection and Measurements , Bethesda , MD , USA.,b Department of Medicine, Division of Epidemiology , Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center , Nashville , TN , USA
| | | | - Michael T Mumma
- d International Epidemiology Institute , Rockville , MD , USA
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Kim S, Chang L, Mosher E, Lee C, Lee C. A feasibility study to reduce misclassification error in occupational dose estimates for epidemiological studies using body size-dependent computational phantoms. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2019; 3:83-88. [PMID: 31773069 PMCID: PMC6879178 DOI: 10.1109/trpms.2018.2847227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the epidemiological study on the health effects of participants in the United States Radiologic Technologists (USRT) study, organ dosimetry was performed based on surveys and literature reviews. To convert dosimeter readings to organ doses, organ dose coefficients were adopted. However, the existing dose coefficients were derived from computational human phantoms with ICRP reference height and weight not accounting for the variation in body size. We first calculated preliminary body size-dependent organ dose coefficients using selected body size-dependent phantoms combined with Monte Carlo radiation transport method. We then tested the accuracy of these body-size dependent coefficients against the ICRP 74 reference size coefficients in comparison with five individual-specific organ dose coefficients computed from computed tomography (CT) image-based anatomical models of five adult males with different body sizes also using Monte Carlo methods. The reference size dose coefficients overall underestimate the patient-specific dose coefficients by up to 51%. Body size-dependent phantoms overall provided more accurate organ dose coefficients for the five patients. In case of the esophagus, the dose underestimation of 51% in the comparison with the reference phantom was reduced to 7%. The results confirm that potential dosimetric misclassification caused by using reference size phantom-based dose coefficients can be resolved by using the body size-dependent dose coefficients.
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Affiliation(s)
- Sarah Kim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850
| | - Lienard Chang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850
- Department of Radiation Safety and Imaging Physics, Houston Methodist Hospital, Houston, TX 77030
| | - Elizabeth Mosher
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850
| | - Choonik Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850
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Chang LA, Borrego D, Lee C. Body-weight dependent dose coefficients for adults exposed to idealised external photon fields. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:1441-1453. [PMID: 30375363 PMCID: PMC6376489 DOI: 10.1088/1361-6498/aae66e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In epidemiological investigations of cancer risk from occupational exposure, it is important to obtain an organ-specific dose for each cohort member for accurate risk analysis. To date, dose conversion coefficients, which convert physical dose measurement to organ dose, are only available for individuals with reference body size, which can differentially bias the estimated organ dose depending on the body mass index of cohort members. In the current study, we calculated the organ dose coefficients applicable to adult males and females with various body weights by using the Monte Carlo radiation transport technique combined with a library of body size-dependent hybrid computational phantoms exposed in six idealised irradiation geometries. We adapted the eight adult male phantoms, 175 cm tall with weights of 60, 70, 80, 90, 100, 110, 120 and 130 kg, and the nine adult female phantoms, 165 cm tall with weights of 50, 60, 70, 80, 90, 100, 110, 120 and 130 kg. The radiation transport was simulated using MCNPX 2.7 Monte Carlo code. Phantoms were irradiated by external photon fields in anterior posterior (AP), posterior-anterior, right and left lateral, rotational, and isotropic geometries. The results showed that the 60 kg adult male phantom shows 1.33-, 1.43-, 1.44- and 1.52-fold greater dose coefficients for the lungs, heart, stomach, and liver, respectively, than the 120 kg adult male phantom at 0.1 MeV in AP geometry. We derived exponential correlation between organ dose coefficients and body weight to facilitate calculation of organ dose coefficients for a given weight. The comprehensive organ dose coefficients and exponential regression model can be used to estimate more accurate organ dose for individuals of the two genders with various body weights exposed to external photon radiation.
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Affiliation(s)
- Lienard A. Chang
- Department of Radiation Safety and Imaging Physics, Houston Methodist Hospital, Houston, TX 77030
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850
| | - David Borrego
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850
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Villoing D, Kitahara CM, Passmore C, Simon SL, Yoder RC. Photon energy readings in OSL dosimeter filters: an application to retrospective dose estimation for nuclear medicine workers. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:1053-1063. [PMID: 29916399 PMCID: PMC6169304 DOI: 10.1088/1361-6498/aacd64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This work investigates the applicability of using data from personal monitoring dosimeters to assess photon energies to which medical workers were exposed. Such determinations would be important for retrospective assessments of organ doses to be used in occupational radiation epidemiology studies, particularly in the absence of work history or other information regarding the energy of the radiation source. Monthly personal dose equivalents and filter ratios under two different metallic filters contained in the Luxel+® dosimeter were collected from Landauer, Inc. from 19 nuclear medicine (NM) technologists employed by three medical institutions, the institution A only performing traditional NM imaging (primarily using 99m Tc) and institutions B and C also performing positron emission tomography (PET, using 18F). Calibration data of the Luxel+® dosimeter for various xray spectra were used to establish ranges of filter ratios from 1.1 to 1.6 for 99m Tc and below 1.1 for 18F. Median filter ratios were 1.33 (Interquartile range (IQR), 0.15) for institution A, 1.08 (IQR, 0.16) for institution B, and 1.08 (IQR, 0.14) for institution C. The distributions of these filter ratios were statistically-significantly different between the institution A only performing traditional NM imaging and institutions B and C also performing PET imaging. In this proof-of-concept study, filter ratios from personal monitoring dosimeters were used to assess differences in photon energies to which NM technologists were exposed. Dosimeters from technologists only performing traditional NM procedures mostly showed Al/Cu filter ratios above 1.2, those likely performing only PET in a particular month had filter ratios below 1.1, and those which showed filter ratios between 1.1 and 1.2 likely came from technologists rotating between traditional NM and PET imaging in the same month. These results suggest that it is possible to distinguish technologists who only worked with higher-energy procedures versus those who only worked with other types of NM procedures.
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Affiliation(s)
- Daphnée Villoing
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States of America
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Choi Y, Shil Cha E, Jin Bang Y, Ko S, Ha M, Lee C, Jin Lee W. ESTIMATION OF ORGAN DOSES AMONG DIAGNOSTIC MEDICAL RADIATION WORKERS IN SOUTH KOREA. RADIATION PROTECTION DOSIMETRY 2018; 179:142-150. [PMID: 29106680 PMCID: PMC6257005 DOI: 10.1093/rpd/ncx239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/02/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
This study aimed to estimate the radiation organ doses from occupational exposure in 94 396 Korean medical radiation workers. Data on badge doses (i.e. personal dose equivalent at 10 mm) between 1996 and 2011 obtained from a national dosimetry registry, survey data from 2012 to 2013, and organ dose conversion coefficients provided by the International Commission on Radiological Protection (ICRP) were used for the estimation. The highest mean cumulative badge doses (26.87 mSv) were observed in radiologists, followed by radiologic technologists (15.96 mSv). Male workers exhibited higher mean cumulative badge doses, across occupational groups. The estimated organ doses showed similar trends with those of badge doses. Organs located outside the apron's coverage such as the thyroid showed higher mean organ doses than those protected by the apron. Our findings could contribute to future radiation epidemiologic studies to investigate health effects from occupational radiation exposure in Korea.
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Affiliation(s)
- Yeongchull Choi
- Department of Preventive Medicine, Korea University College of Medicine,
Seoul, Korea
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine,
Seoul, Korea
| | - Ye Jin Bang
- Department of Preventive Medicine, Korea University College of Medicine,
Seoul, Korea
| | - Seulki Ko
- Department of Preventive Medicine, Korea University College of Medicine,
Seoul, Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine,
Cheonan, Korea
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute,
National Institutes of Health, Shady Grove, MD, USA
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine,
Seoul, Korea
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Ko S, Chung HH, Cho SB, Jin YW, Kim KP, Ha M, Bang YJ, Ha YW, Lee WJ. Occupational radiation exposure and its health effects on interventional medical workers: study protocol for a prospective cohort study. BMJ Open 2017; 7:e018333. [PMID: 29248885 PMCID: PMC5778344 DOI: 10.1136/bmjopen-2017-018333] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Although fluoroscopically guided procedures involve a considerably high dose of radiation, few studies have investigated the effects of radiation on medical workers involved in interventional fluoroscopy procedures. Previous research remains in the early stages and has not reached a level comparable with other occupational studies thus far. Furthermore, the study of radiation workers provides an opportunity to estimate health risks at low doses and dose rates of ionising radiation. Therefore, the objectives of this study are (1) to initiate a prospective cohort study by conducting a baseline survey among medical radiation workers who involve interventional fluoroscopy procedures and (2) to assess the effect of occupational radiation exposure and on the overall health status through an in-depth cross-sectional study. METHODS AND ANALYSIS Intervention medical workers in Korea will be enrolled by using a self-administered questionnaire survey, and the survey data will be linked with radiation dosimetry data, National Health Insurance claims data, cancer registry and mortality data. After merging these data, the radiation organ dose, lifetime attributable risk due to cancer and the risk per unit dose will be estimated. For the cross-sectional study, approximately 100 intervention radiology department workers will be investigated for blood tests, clinical examinations such as ultrasonography (thyroid and carotid artery scan) and lens opacity, the validation of badge dose and biodosimetry. ETHICS AND DISSEMINATION This study was reviewed and approved by the institutional review board of Korea University (KU-IRB-12-12-A-1). All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations, and a report will be submitted to the relevant public health authorities in the Korea Centers for Disease Control and Prevention to help with the development of appropriate research and management policies.
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Affiliation(s)
- Seulki Ko
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
- Graduate School of Public Health, Korea University, Seoul, South Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Sung Bum Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Young Woo Jin
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, Yongin, South Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonam, South Korea
| | - Ye Jin Bang
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
- Graduate School of Public Health, Korea University, Seoul, South Korea
| | - Yae Won Ha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
- Graduate School of Public Health, Korea University, Seoul, South Korea
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Gray JM, Rasanayagam S, Engel C, Rizzo J. State of the evidence 2017: an update on the connection between breast cancer and the environment. Environ Health 2017; 16:94. [PMID: 28865460 PMCID: PMC5581466 DOI: 10.1186/s12940-017-0287-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/17/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND In this review, we examine the continually expanding and increasingly compelling data linking radiation and various chemicals in our environment to the current high incidence of breast cancer. Singly and in combination, these toxicants may have contributed significantly to the increasing rates of breast cancer observed over the past several decades. Exposures early in development from gestation through adolescence and early adulthood are particularly of concern as they re-shape the program of genetic, epigenetic and physiological processes in the developing mammary system, leading to an increased risk for developing breast cancer. In the 8 years since we last published a comprehensive review of the relevant literature, hundreds of new papers have appeared supporting this link, and in this update, the evidence on this topic is more extensive and of better quality than that previously available. CONCLUSION Increasing evidence from epidemiological studies, as well as a better understanding of mechanisms linking toxicants with development of breast cancer, all reinforce the conclusion that exposures to these substances - many of which are found in common, everyday products and byproducts - may lead to increased risk of developing breast cancer. Moving forward, attention to methodological limitations, especially in relevant epidemiological and animal models, will need to be addressed to allow clearer and more direct connections to be evaluated.
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Affiliation(s)
- Janet M. Gray
- Department of Psychology and Program in Science, Technology, and Society, Vassar College, 124 Raymond Avenue, Poughkeepsie, NY 12604-0246 USA
| | - Sharima Rasanayagam
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Connie Engel
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Jeanne Rizzo
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
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Till JE, Beck HL, Grogan HA, Caffrey EA. A review of dosimetry used in epidemiological studies considered to evaluate the linear no-threshold (LNT) dose-response model for radiation protection. Int J Radiat Biol 2017; 93:1128-1144. [DOI: 10.1080/09553002.2017.1337280] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kim MJ, Cha ES, Ko Y, Chun BC, Lee WJ. Reliability of self-reported questionnaire on occupational radiation practices among diagnostic radiologic technologists. Am J Ind Med 2017; 60:377-385. [PMID: 28262972 DOI: 10.1002/ajim.22704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to assess the reliability of a self-reported questionnaire on occupational radiation practices among radiologic technologists. METHODS We enrolled 941 participants who had repeatedly completed the questionnaire from the 2012-2013 radiologic technologists' health study in South Korea. We used percentage agreement, kappa statistics, and intraclass correlation coefficient (ICC) to assess the reliability of responses on work practices. RESULTS Overall agreement for ever-never diagnostic radiation procedures was high (87.5-97.5%), and κ values indicated substantial agreement (0.66-0.86) in all procedures except cephalometric and intraoral radiography. For the information of year of work start and working duration, high agreement was obtained (ICC: 0.99 and 0.98, respectively). However, use of a worn dosimeter and of personal protective equipment showed only moderate to substantial agreement. CONCLUSIONS Self-reported information on working practices regarding radiation exposure in radiologic technologists was reliable enough for epidemiologic studies. Am. J. Ind. Med. 60:377-385, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Moon Jung Kim
- Graduate School of Public Health; Korea University; Seoul South Korea
| | - Eun Shil Cha
- Department of Preventive Medicine; Korea University College of Medicine; Seoul South Korea
| | - Yousun Ko
- Department of Radiology; Seoul National University Bundang Hospital; Gyeonggi-do South Korea
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology; Seoul National University; Seoul South Korea
| | - Byung Chul Chun
- Graduate School of Public Health; Korea University; Seoul South Korea
- Department of Preventive Medicine; Korea University College of Medicine; Seoul South Korea
| | - Won Jin Lee
- Graduate School of Public Health; Korea University; Seoul South Korea
- Department of Preventive Medicine; Korea University College of Medicine; Seoul South Korea
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Breast cancer risk and protracted low-to-moderate dose occupational radiation exposure in the US Radiologic Technologists Cohort, 1983-2008. Br J Cancer 2016; 115:1105-1112. [PMID: 27623235 PMCID: PMC5117787 DOI: 10.1038/bjc.2016.292] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/29/2016] [Accepted: 08/09/2016] [Indexed: 11/08/2022] Open
Abstract
Background: Although high-dose ionising radiation is associated with increased breast cancer risks, the association with protracted low-dose-rate exposures remains unclear. The US Radiologic Technologist study provides an opportunity to examine the association between low-to-moderate dose radiation and breast cancer incidence and mortality. Methods: One thousand nine hundred and twenty-two self-reported first primary cancers were diagnosed during 1983–2005 among 66 915 female technologists, and 586 breast cancer deaths occurred during 1983–2008 among 83 538 female cohort members. Occupational breast dose estimates were based on work histories, historical data, and, after the mid-1970s, individual film badge measurements. Excess relative risks were estimated using Poisson regression with birth cohort stratification and adjustment for menopause, reproductive history, and other risk factors. Results: Higher doses were associated with increased breast cancer incidence, with an excess relative risk at 100 mGy of 0.07 (95% confidence interval (CI): -0.005 to 0.19). Associations were strongest for technologists born before 1930 (excess relative risk at 100 mGy=0.16; 95% CI: 0.03–0.39) with similar patterns for mortality among technologists born before 1930. Conclusions: Occupational radiation to the breast was positively associated with breast cancer risk. The risk was more pronounced for women born before 1930 who began working before 1950 when mean annual doses (37 mGy) were considerably higher than in later years (1.3 mGy). However, because of the uncertainties and possible systematic errors in the occupational dose estimates before 1960, these findings should be treated with caution.
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Drozdovitch V, Chumak V, Kesminiene A, Ostroumova E, Bouville A. Doses for post-Chernobyl epidemiological studies: are they reliable? JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:R36-R73. [PMID: 27355439 PMCID: PMC9426290 DOI: 10.1088/0952-4746/36/3/r36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
On 26 April 2016, thirty years will have elapsed since the occurrence of the Chernobyl accident, which has so far been the most severe in the history of the nuclear reactor industry. Numerous epidemiological studies were conducted to evaluate the possible health consequences of the accident. Since the credibility of the association between the radiation exposure and health outcome is highly dependent on the adequacy of the dosimetric quantities used in these studies, this paper makes an effort to overview the methods used to estimate individual doses and the associated uncertainties in the main analytical epidemiological studies (i.e. cohort or case-control) related to the Chernobyl accident. Based on the thorough analysis and comparison with other radiation studies, the authors conclude that individual doses for the Chernobyl analytical epidemiological studies have been calculated with a relatively high degree of reliability and well-characterized uncertainties, and that they compare favorably with many other non-Chernobyl studies. The major strengths of the Chernobyl studies are: (1) they are grounded on a large number of measurements, either performed on humans or made in the environment; and (2) extensive effort has been invested to evaluate the uncertainties associated with the dose estimates. Nevertheless, gaps in the methodology are identified and suggestions for the possible improvement of the current dose estimates are made.
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Affiliation(s)
- Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Vadim Chumak
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | | | | | - André Bouville
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Retired
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Choi Y, Kim J, Lee JJ, Jun JK, Lee WJ. Reconstruction of Radiation Dose Received by Diagnostic Radiologic Technologists in Korea. J Prev Med Public Health 2016; 49:288-300. [PMID: 27744670 PMCID: PMC5066420 DOI: 10.3961/jpmph.16.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/18/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives Diagnostic medical radiation workers in Korea have been officially monitored for their occupational radiation doses since 1996. The purpose of this study was to design models for reconstructing unknown individual radiation doses to which diagnostic radiation technologists were exposed before 1996. Methods Radiation dose reconstruction models were developed by using cross-sectional survey data and the personal badge doses of 8167 radiologic technologists. The models included calendar year and age as predictors, and the participants were grouped into six categories according to their sex and facility type. The annual doses between 1971 and 1995 for those who were employed before 1996 were estimated using these models. Results The calendar year and age were inversely related to the estimated radiation doses in the models of all six groups. The annual median estimated doses decreased from 9.45 mSv in 1971 to 1.26 mSv in 1995, and the associated dose variation also decreased with time. The estimated median badge doses from 1996 (1.22 mSv) to 2011 (0.30 mSv) were similar to the measured doses (1.68 mSv to 0.21 mSv) for the same years. Similar results were observed for all six groups. Conclusions The reconstruction models developed in this study may be useful for estimating historical occupational radiation doses received by medical radiologic technologists in Korea.
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Affiliation(s)
- Yeongchull Choi
- Department of Preventive Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jaeyoung Kim
- Department of Preventive Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jung Jeung Lee
- Department of Preventive Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Rajaraman P, Doody MM, Yu CL, Preston DL, Miller JS, Sigurdson AJ, Freedman DM, Alexander BH, Little MP, Miller DL, Linet MS. Cancer Risks in U.S. Radiologic Technologists Working With Fluoroscopically Guided Interventional Procedures, 1994-2008. AJR Am J Roentgenol 2016; 206:1101-8; quiz 1109. [PMID: 26998721 PMCID: PMC10986158 DOI: 10.2214/ajr.15.15265] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The purpose of this study was to examine risks of cancer incidence and mortality among U.S. radiation technologists performing or assisting with fluoroscopically guided interventional procedures. SUBJECTS AND METHODS A nationwide prospective cohort of 90,957 radiologic technologists, who responded to a 1994-1998 survey that collected information on whether they had ever worked with fluoroscopically guided interventional procedures, was followed through completion of a subsequent cohort survey during 2003-2005 (for cancer incidence) or December 31, 2008 (for cancer mortality). Sex-adjusted hazard ratios (HRs) and 95% CIs were calculated by use of Cox proportional hazards models for incidence and mortality from all cancers other than nonmelanoma skin cancer and for specific cancer outcomes in participants who reported ever performing fluoroscopically guided interventional procedures compared with technologists who never performed these procedures. RESULTS The analysis showed an approximately twofold increased risk of brain cancer mortality (HR, 2.55; 95% CI, 1.48-4.40) and modest elevations in incidence of melanoma (HR, 1.30; 95% CI, 1.05-1.61) and in breast cancer incidence (HR, 1.16; 95% CI, 1.02-1.32) but not mortality (HR, 1.07; 95% CI, 0.69-1.66) among technologists who performed fluoroscopically guided interventional procedures compared with those who never performed these procedures. Although there was a small suggestive increase in incidence of all cancers combined, excluding nonmelanoma skin cancers (HR, 1.08; 95% CI, 1.00-1.17), mortality from all cancers combined, excluding nonmelanoma skin cancers, was not elevated (HR, 1.00; 95% CI, 0.88-1.14). We similarly observed no elevated risk of cancers of the thyroid, skin other than melanoma, prostate, lung, or colon and rectum or of leukemia that was not chronic lymphocytic leukemia among workers who performed fluoroscopically guided interventional procedures. CONCLUSION We observed elevated risks of brain cancer, breast cancer, and melanoma among technologists who performed fluoroscopically guided interventional procedures. Although exposure to low-dose radiation is one possible explanation for these increased risks, these results may also be due to chance or unmeasured confounding by nonradiation risk factors. Our results must be confirmed in other studies, preferably with individual radiation dose data.
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Affiliation(s)
- Preetha Rajaraman
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Rockville, MD 20892-9778, MD, USA
- Center for Global Health, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Rockville, MD 20892-9778, MD, USA
| | - Michele M. Doody
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Rockville, MD 20892-9778, MD, USA
| | - Chu Ling Yu
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Rockville, MD 20892-9778, MD, USA
| | | | | | - Alice J. Sigurdson
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Rockville, MD 20892-9778, MD, USA
| | - D. Michal Freedman
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Rockville, MD 20892-9778, MD, USA
| | - Bruce H. Alexander
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Mark P. Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Rockville, MD 20892-9778, MD, USA
| | - Donald L. Miller
- Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Martha S. Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Rockville, MD 20892-9778, MD, USA
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Sun Z, Inskip PD, Wang J, Kwon D, Zhao Y, Zhang L, Wang Q, Fan S. Solid cancer incidence among Chinese medical diagnostic x-ray workers, 1950-1995: Estimation of radiation-related risks. Int J Cancer 2016; 138:2875-83. [PMID: 26860236 DOI: 10.1002/ijc.30036] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 11/07/2022]
Abstract
The objective of this study was to estimate solid cancer risk attributable to long-term, fractionated occupational exposure to low doses of ionizing radiation. Based on cancer incidence for the period 1950-1995 in a cohort of 27,011 Chinese medical diagnostic X-ray workers and a comparison cohort of 25,782 Chinese physicians who did not use X-ray equipment in their work, we used Poisson regression to fit excess relative risk (ERR) and excess absolute risk (EAR) dose-response models for incidence of all solid cancers combined. Radiation dose reconstruction was based on a previously published method that relied on simulating measurements for multiple X-ray machines, workplaces and working conditions, information about protective measures, including use of lead aprons, and work histories. The resulting model was used to estimate calendar year-specific badge dose calibrated as personal dose equivalent (Sv). To obtain calendar year-specific colon doses (Gy), we applied a standard organ conversion factor. A total of 1,643 cases of solid cancer were identified in 1.45 million person-years of follow-up. In both ERR and EAR models, a statistically significant radiation dose-response relationship was observed for solid cancers as a group. Averaged over both sexes, and using colon dose as the dose metric, the estimated ERR/Gy was 0.87 (95% CI: 0.48, 1.45), and the EAR was 22 per 10(4)PY-Gy (95% CI: 14, 32) at age 50. We obtained estimates of the ERR and EAR of solid cancers per unit dose that are compatible with those derived from other populations chronically exposed to low dose-rate occupational or environmental radiation.
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Affiliation(s)
- Zhijuan Sun
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.,Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter D Inskip
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jixian Wang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Deukwoo Kwon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD.,University of Miami School of Medicine Silvestre Comprehensive Cancer Center, Miami, FL
| | - Yongcheng Zhao
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Liangan Zhang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Qin Wang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Saijun Fan
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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Drozdovitch V, Brill AB, Callahan RJ, Clanton JA, DePietro A, Goldsmith SJ, Greenspan BS, Gross MD, Hays MT, Moore SC, Ponto JA, Shreeve WW, Melo DR, Linet MS, Simon SL. Use of radiopharmaceuticals in diagnostic nuclear medicine in the United States: 1960-2010. HEALTH PHYSICS 2015; 108:520-37. [PMID: 25811150 PMCID: PMC4376015 DOI: 10.1097/hp.0000000000000261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
To reconstruct reliable nuclear medicine-related occupational radiation doses or doses received as patients from radiopharmaceuticals over the last five decades, the authors assessed which radiopharmaceuticals were used in different time periods, their relative frequency of use, and typical values of the administered activity. This paper presents data on the changing patterns of clinical use of radiopharmaceuticals and documents the range of activity administered to adult patients undergoing diagnostic nuclear medicine procedures in the U.S. between 1960 and 2010. Data are presented for 15 diagnostic imaging procedures that include thyroid scan and thyroid uptake; brain scan; brain blood flow; lung perfusion and ventilation; bone, liver, hepatobiliary, bone marrow, pancreas, and kidney scans; cardiac imaging procedures; tumor localization studies; localization of gastrointestinal bleeding; and non-imaging studies of blood volume and iron metabolism. Data on the relative use of radiopharmaceuticals were collected using key informant interviews and comprehensive literature reviews of typical administered activities of these diagnostic nuclear medicine studies. Responses of key informants on relative use of radiopharmaceuticals are in agreement with published literature. Results of this study will be used for retrospective reconstruction of occupational and personal medical radiation doses from diagnostic radiopharmaceuticals to members of the U.S. radiologic technologists' cohort and in reconstructing radiation doses from occupational or patient radiation exposures to other U.S. workers or patient populations.
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Affiliation(s)
- Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD 20892
| | - Aaron B. Brill
- Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN
| | | | | | | | | | | | - Milton D. Gross
- Nuclear Medicine and Radiation Service, Department of Veterans Affairs Health System, Ann Arbor, MI
| | | | | | | | | | - Dunstana R. Melo
- Center for Countermeasures against Radiation, Lovelace Respiratory Research Institute, Albuquerque, NM
| | - Martha S. Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD 20892
| | - Steven L. Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD 20892
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Bouville A, Toohey RE, Boice JD, Beck HL, Dauer LT, Eckerman KF, Hagemeyer D, Leggett RW, Mumma MT, Napier B, Pryor KH, Rosenstein M, Schauer DA, Sherbini S, Stram DO, Thompson JL, Till JE, Yoder C, Zeitlin C. Dose reconstruction for the million worker study: status and guidelines. HEALTH PHYSICS 2015; 108:206-20. [PMID: 25551504 PMCID: PMC4854640 DOI: 10.1097/hp.0000000000000231] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The primary aim of the epidemiologic study of one million U.S. radiation workers and veterans [the Million Worker Study (MWS)] is to provide scientifically valid information on the level of radiation risk when exposures are received gradually over time and not within seconds, as was the case for Japanese atomic bomb survivors. The primary outcome of the epidemiologic study is cancer mortality, but other causes of death such as cardiovascular disease and cerebrovascular disease will be evaluated. The success of the study is tied to the validity of the dose reconstruction approaches to provide realistic estimates of organ-specific radiation absorbed doses that are as accurate and precise as possible and to properly evaluate their accompanying uncertainties. The dosimetry aspects for the MWS are challenging in that they address diverse exposure scenarios for diverse occupational groups being studied over a period of up to 70 y. The dosimetric issues differ among the varied exposed populations that are considered: atomic veterans, U.S. Department of Energy workers exposed to both penetrating radiation and intakes of radionuclides, nuclear power plant workers, medical radiation workers, and industrial radiographers. While a major source of radiation exposure to the study population comes from external gamma- or x-ray sources, for some of the study groups, there is a meaningful component of radionuclide intakes that requires internal radiation dosimetry assessments. Scientific Committee 6-9 has been established by the National Council on Radiation Protection and Measurements (NCRP) to produce a report on the comprehensive organ dose assessment (including uncertainty analysis) for the MWS. The NCRP dosimetry report will cover the specifics of practical dose reconstruction for the ongoing epidemiologic studies with uncertainty analysis discussions and will be a specific application of the guidance provided in NCRP Report Nos. 158, 163, 164, and 171. The main role of the Committee is to provide guidelines to the various groups of dosimetrists involved in the MWS to ensure that certain dosimetry criteria are considered: calculation of annual absorbed doses in the organs of interest, separation of low and high linear-energy transfer components, evaluation of uncertainties, and quality assurance and quality control. It is recognized that the MWS and its approaches to dosimetry are a work in progress and that there will be flexibility and changes in direction as new information is obtained with regard to both dosimetry and the epidemiologic features of the study components. This paper focuses on the description of the various components of the MWS, the available dosimetry results, and the challenges that have been encountered. It is expected that the Committee will complete its report in 2016.
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Affiliation(s)
- André Bouville
- National Cancer Institute (retired), 9609 Medical Center Drive, Room 7E590, MSC 9778, Rockville, MD, 20850, Telephone: 240-276-7416, Fax: 240-276-7840
| | | | - John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, Maryland
| | | | - Larry T. Dauer
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | | | - Bruce Napier
- Pacific Northwest National Laboratory, Richland, Washington
| | - Kathy H. Pryor
- Pacific Northwest National Laboratory, Richland, Washington
| | | | - David A. Schauer
- National Council on Radiation Protection and Measurements, Bethesda, Maryland
| | | | | | | | - John E. Till
- Risk Assessment Corporation, Neeses, South Carolina
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Simon SL, Preston DL, Linet MS, Miller JS, Sigurdson AJ, Alexander BH, Kwon D, Yoder RC, Bhatti P, Little MP, Rajaraman P, Melo D, Drozdovitch V, Weinstock RM, Doody MM. Radiation organ doses received in a nationwide cohort of U.S. radiologic technologists: methods and findings. Radiat Res 2014; 182:507-28. [PMID: 25361400 PMCID: PMC4406479 DOI: 10.1667/rr13542.1] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this article, we describe recent methodological enhancements and findings from the dose reconstruction component of a study of health risks among U.S. radiologic technologists. An earlier version of the dosimetry published in 2006 used physical and statistical models, literature-reported exposure measurements for the years before 1960, and archival personnel monitoring badge data from cohort members through 1984. The data and models previously described were used to estimate annual occupational radiation doses for 90,000 radiological technologists, incorporating information about each individual's employment practices based on a baseline survey conducted in the mid-1980s. The dosimetry methods presented here, while using many of the same methods as before, now estimate 2.23 million annual badge doses (personal dose equivalent) for the years 1916-1997 for 110,374 technologists, but with numerous methodological improvements. Every technologist's annual dose is estimated as a probability density function to reflect uncertainty about the true dose. Multiple realizations of the entire cohort distribution were derived to account for shared uncertainties and possible biases in the input data and assumptions used. Major improvements in the dosimetry methods from the earlier version include: A substantial increase in the number of cohort member annual badge dose measurements; Additional information on individual apron usage obtained from surveys conducted in the mid-1990s and mid-2000s; Refined modeling to develop lognormal annual badge dose probability density functions using censored data regression models; Refinements of cohort-based annual badge probability density functions to reflect individual work patterns and practices reported on questionnaires and to more accurately assess minimum detection limits; and Extensive refinements in organ dose conversion coefficients to account for uncertainties in radiographic machine settings for the radiographic techniques employed. For organ dose estimation, we rely on well-researched assumptions about critical exposure-related variables and their changes over the decades, including the peak kilovoltage and filtration typically used in conducting radiographic examinations, and the usual body location for wearing radiation monitoring badges, the latter based on both literature and national recommendations. We have derived organ dose conversion coefficients based on air-kerma weighting of photon fluences from published X-ray spectra and derived energy-dependent transmission factors for protective lead aprons of different thicknesses. Findings are presented on estimated organ doses for 12 organs and tissues: red bone marrow, female breast, thyroid, brain, lung, heart, colon, ovary, testes, skin of trunk, skin of head and neck and arms, and lens of the eye.
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Affiliation(s)
- Steven L. Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Martha S. Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Alice J. Sigurdson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bruce H. Alexander
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Deukwoo Kwon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Parveen Bhatti
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark P. Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Preetha Rajaraman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Dunstana Melo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Michele M. Doody
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Drozdovitch V, Brill AB, Mettler FA, Beckner WM, Goldsmith SJ, Gross MD, Hays MT, Kirchner PT, Langan JK, Reba RC, Smith GT, Bouville A, Linet MS, Melo DR, Lee C, Simon SL. Nuclear medicine practices in the 1950s through the mid-1970s and occupational radiation doses to technologists from diagnostic radioisotope procedures. HEALTH PHYSICS 2014; 107:300-10. [PMID: 25162420 PMCID: PMC4147674 DOI: 10.1097/hp.0000000000000107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Data on occupational radiation exposure from nuclear medicine procedures for the time period of the 1950s through the 1970s is important for retrospective health risk studies of medical personnel who conducted those activities. However, limited information is available on occupational exposure received by physicians and technologists who performed nuclear medicine procedures during those years. To better understand and characterize historical radiation exposures to technologists, the authors collected information on nuclear medicine practices in the 1950s, 1960s, and 1970s. To collect historical data needed to reconstruct doses to technologists, a focus group interview was held with experts who began using radioisotopes in medicine in the 1950s and the 1960s. Typical protocols and descriptions of clinical practices of diagnostic radioisotope procedures were defined by the focus group and were used to estimate occupational doses received by personnel, per nuclear medicine procedure, conducted in the 1950s to 1960s using radiopharmaceuticals available at that time. The radionuclide activities in the organs of the reference patient were calculated using the biokinetic models described in ICRP Publication 53. Air kerma rates as a function of distance from a reference patient were calculated by Monte Carlo radiation transport calculations using a hybrid computational phantom. Estimates of occupational doses to nuclear medicine technologists per procedure were found to vary from less than 0.01 μSv (thyroid scan with 1.85 MBq of administered I-iodide) to 0.4 μSv (brain scan with 26 MBq of Hg-chlormerodin). Occupational doses for the same diagnostic procedures starting in the mid-1960s but using Tc were also estimated. The doses estimated in this study show that the introduction of Tc resulted in an increase in occupational doses per procedure.
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Affiliation(s)
- Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda MD 20892
| | - Aaron B. Brill
- Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37232
| | - Fred A. Mettler
- Radiology and Nuclear Medicine Service, New Mexico VA Health Care System, 1501 San Pedro Blvd SE, Albuquerque, NM 87108
| | - William M. Beckner
- National Council on Radiation Protection and Measurements, Bethesda, MD
- Retired
| | - Stanley J. Goldsmith
- New York Presbyterian Hospital, Weill Cornell Medical Center, Starr 2-21, Nuclear Med Department, 525 East 68th St., New York, NY 10065
| | - Milton D. Gross
- Nuclear Medicine and Radiation Service, Department of Veterans Affairs Health System, 2215 Fuller Road, Ann Arbor, MI 48105
| | | | - Peter T. Kirchner
- National Institute of Biomedical Imaging and Biomedical Engineering, NIH, DHHS, 6707 Democracy Blvd, Bethesda, MD 20892
| | - James K. Langan
- Johns Hopkins University Medical Center, Baltimore, MD 21287
- Deceased
| | - Richard C. Reba
- Department of Radiology and Imaging Sciences, NIH Clinical Center, 10 Center Dr., Bethesda, MD 20892
| | - Gary T. Smith
- Departments of Nuclear Medicine, Tennessee Valley Healthcare System, Department of Veterans Affairs, 1310 24th Avenue South, Nashville, TN 37212
| | - André Bouville
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda MD 20892
- Retired
| | - Martha S. Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda MD 20892
| | - Dunstana R. Melo
- Institute of Radiation Protection and Dosimetry, Av Salvador Allende S/N, Recreio dos Bandeirantes, Rio de Janeiro, RJ 22780-160 Brazil
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda MD 20892
| | - Steven L. Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda MD 20892
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37
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Little MP, Kwon D, Doi K, Simon SL, Preston DL, Doody MM, Lee T, Miller JS, Kampa DM, Bhatti P, Tucker JD, Linet MS, Sigurdson AJ. Association of chromosome translocation rate with low dose occupational radiation exposures in U.S. radiologic technologists. Radiat Res 2014; 182:1-17. [PMID: 24932535 DOI: 10.1667/rr13413.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Chromosome translocations are a well-recognized biological marker of radiation exposure and cancer risk. However, there is uncertainty about the lowest dose at which excess translocations can be detected, and whether there is temporal decay of induced translocations in radiation-exposed populations. Dosimetric uncertainties can substantially alter the shape of dose-response relationships; although regression-calibration methods have been used in some datasets, these have not been applied in radio-occupational studies, where there are also complex patterns of shared and unshared errors that these methods do not account for. In this article we evaluated the relationship between estimated occupational ionizing radiation doses and chromosome translocation rates using fluorescent in situ hybridization in 238 U.S. radiologic technologists selected from a large cohort. Estimated cumulative red bone marrow doses (mean 29.3 mGy, range 0-135.7 mGy) were based on available badge-dose measurement data and on questionnaire-reported work history factors. Dosimetric assessment uncertainties were evaluated using regression calibration, Bayesian and Monte Carlo maximum likelihood methods, taking account of shared and unshared error and adjusted for overdispersion. There was a significant dose response for estimated occupational radiation exposure, adjusted for questionnaire-based personal diagnostic radiation, age, sex and study group (5.7 translocations per 100 whole genome cell equivalents per Gy, 95% CI 0.2, 11.3, P = 0.0440). A significant increasing trend with dose continued to be observed for individuals with estimated doses <100 mGy. For combined estimated occupational and personal-diagnostic-medical radiation exposures, there was a borderline-significant modifying effect of age (P = 0.0704), but little evidence (P > 0.5) of temporal decay of induced translocations. The three methods of analysis to adjust for dose uncertainty gave similar results. In summary, chromosome translocation dose-response slopes were detectable down to <100 mGy and were compatible with those observed in other radiation-exposed populations. However, there are substantial uncertainties in both occupational and other (personal-diagnostic-medical) doses that may be imperfectly taken into account in our analysis.
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Affiliation(s)
- Mark P Little
- a Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland 20892
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38
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Liu JJ, Freedman DM, Little MP, Doody MM, Alexander BH, Kitahara CM, Lee T, Rajaraman P, Miller JS, Kampa DM, Simon SL, Preston DL, Linet MS. Work history and mortality risks in 90 268 US radiological technologists. Occup Environ Med 2014; 71:819-35. [DOI: 10.1136/oemed-2013-101859] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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39
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Bigelow AM, Smith G, Clark JM. Catheter Ablation Without Fluoroscopy: Current Techniques And Future Direction. J Atr Fibrillation 2014; 6:1066. [PMID: 27957068 DOI: 10.4022/jafib.1066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 11/10/2022]
Abstract
Background: Catheter ablation is the treatment of choice for most forms of SVT. Traditionally, fluoroscopy has been the primary tool for visualizing catheter position. However, newer, 3-dimensional mapping technologies offer multiple options for minimizing fluoroscopy use. We review our 8 year experience of a zero-fluoroscopy approach using the Ensite system, and discuss our current techniques. Methods: From January 2006 to October 2013, we performed 524 catheter ablation procedures with a zero-fluoroscopy approach. The Ensite system was used exclusively. Early in the study, NavX mode was employed. In the later time period, Velocity mode was used. The Ensite system allowed easy access to all right sided arrhythmias. For left sided arrhythmias, TEE was added to aid with transseptal puncture. Results: Reviewing 524 consecutive procedures, mean age was 14 years (range 7 weeks to 65 years). Mean weight was 60.7 kg (range 3 to 174 kg). Mean procedure time was 142 minutes (range 42 - 402 minutes). There were no complications. Twenty -five patients required the use of fluoroscopy, mostly as part of simultaneous diagnostic or interventional cath procedures. There was only one instance in which fluoroscopy was used when not anticipated at the start of the procedure. With this data available, and seeing that fluoroscopy is rarely needed unexpectedly, we hypothesized that catheter ablation no longer requires a traditional cath lab. We present our early approach to ablation outside the catheterization lab. Conclusions: Three dimensional mapping systems can eliminate fluoroscopy use in virtually all routine ablation procedures. As technology improves, ablation procedures will shift beyond the traditional cath lab.
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Affiliation(s)
- Amee M Bigelow
- Akron Children's Hospital, Department of Pediatrics, Akron OH
| | - Grace Smith
- Akron Children's Hospital, The Heart Center, Division of Pediatric Cardiology, Akron, OH
| | - John M Clark
- Akron Children's Hospital, The Heart Center, Division of Pediatric Cardiology, Akron, OH
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40
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Neta G, Rajaraman P, Berrington de Gonzalez A, Doody MM, Alexander BH, Preston D, Simon SL, Melo D, Miller J, Freedman DM, Linet MS, Sigurdson AJ. A prospective study of medical diagnostic radiography and risk of thyroid cancer. Am J Epidemiol 2013; 177:800-9. [PMID: 23529772 DOI: 10.1093/aje/kws315] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although diagnostic x-ray procedures provide important medical benefits, cancer risks associated with their exposure are also possible, but not well characterized. The US Radiologic Technologists Study (1983-2006) is a nationwide, prospective cohort study with extensive questionnaire data on history of personal diagnostic imaging procedures collected prior to cancer diagnosis. We used Cox proportional hazard regressions to estimate thyroid cancer risks related to the number and type of selected procedures. We assessed potential modifying effects of age and calendar year of the first x-ray procedure in each category of procedures. Incident thyroid cancers (n = 251) were diagnosed among 75,494 technologists (1.3 million person-years; mean follow-up = 17 years). Overall, there was no clear evidence of thyroid cancer risk associated with diagnostic x-rays except for dental x-rays. We observed a 13% increase in thyroid cancer risk for every 10 reported dental radiographs (hazard ratio = 1.13, 95% confidence interval: 1.01, 1.26), which was driven by dental x-rays first received before 1970, but we found no evidence that the relationship between dental x-rays and thyroid cancer was associated with childhood or adolescent exposures as would have been anticipated. The lack of association of thyroid cancer with x-ray procedures that expose the thyroid to higher radiation doses than do dental x-rays underscores the need to conduct a detailed radiation exposure assessment to enable quantitative evaluation of risk.
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Affiliation(s)
- Gila Neta
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA.
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41
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Gerstenblith MR, Rajaraman P, Khaykin E, Doody MM, Alexander BH, Linet MS, Freedman DM. Basal cell carcinoma and anthropometric factors in the U.S. radiologic technologists cohort study. Int J Cancer 2012; 131:E149-55. [PMID: 21989791 PMCID: PMC3873091 DOI: 10.1002/ijc.26480] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 09/22/2011] [Indexed: 11/11/2022]
Abstract
Basal cell carcinoma (BCC) is the most common cancer in Caucasian populations. Although several risk factors are well-established, including ultraviolet radiation (UVR) sensitivity and exposure, few studies have examined anthropometric measures and BCC. Using Cox proportional hazards regression analysis, we prospectively investigated the relationship between height, weight and body mass index (BMI) and BCC in 58,213 Caucasian participants (11,631 men and 46,582 women) from the United States Radiological Technologists cohort. This analysis was limited to participants who were cancer-free at baseline. The baseline questionnaire provided self-reported anthropometric factors and the subsequent questionnaire collected skin cancer susceptibility factors, lifetime UVR exposure derived from residential and personal UVR exposure (time outdoors) and health outcomes. During 509,465 person-years of follow-up, we identified 2,291 BCC cases (486 men; 1,805 women). BCC risk increased with increasing height, and decreased with increasing weight and BMI in both sexes, even after adjusting for UVR susceptibility factors and exposures. For BMI categories: <25 (reference); 25-<30; 30-<35 and ≥ 35 kg m(-2) , multivariate hazard ratios (HR) in women were: 1.00; 0.74 (95% CI = 0.66-0.83); 0.67 (0.56-0.81) and 0.57 (0.44-0.74), respectively, p-trend ≤ 0.0001. Risks were similar in men. The inverse association between BMI and BCC was unaffected by controlling for sun-related exposures. Nevertheless, it may at least partly reflect residual UVR confounding. Further research with more detailed sun exposure data, including clothing patterns, would help clarify the relationship between BMI and BCC.
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Affiliation(s)
- Meg R Gerstenblith
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
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Kim KP, Miller DL, Berrington de Gonzalez A, Balter S, Kleinerman RA, Ostroumova E, Simon SL, Linet MS. Occupational radiation doses to operators performing fluoroscopically-guided procedures. HEALTH PHYSICS 2012; 103:80-99. [PMID: 22647920 PMCID: PMC3951010 DOI: 10.1097/hp.0b013e31824dae76] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In the past 30 y, the numbers and types of fluoroscopically-guided (FG) procedures have increased dramatically. The objective of the present study is to provide estimated radiation doses to physician specialists, other than cardiologists, who perform FG procedures. The authors searched Medline to identify English-language journal articles reporting radiation exposures to these physicians. They then identified several primarily therapeutic FG procedures that met specific criteria: well-defined procedures for which there were at least five published reports of estimated radiation doses to the operator, procedures performed frequently in current medical practice, and inclusion of physicians from multiple medical specialties. These procedures were percutaneous nephrolithotomy (PCNL), vertebroplasty, orthopedic extremity nailing for treatment of fractures, biliary tract procedures, transjugular intrahepatic portosystemic shunt creation (TIPS), head/neck endovascular therapeutic procedures, and endoscopic retrograde cholangiopancreatography (ERCP). Radiation doses and other associated data were abstracted, and effective dose to operators was estimated. Operators received estimated doses per patient procedure equivalent to doses received by interventional cardiologists. The estimated effective dose per case ranged from 1.7-56 μSv for PCNL, 0.1-101 μSv for vertebroplasty, 2.5-88 μSv for orthopedic extremity nailing, 2.0-46 μSv for biliary tract procedures, 2.5-74 μSv for TIPS, 1.8-53 μSv for head/neck endovascular therapeutic procedures, and 0.2-49 μSv for ERCP. Overall, mean operator radiation dose per case measured over personal protective devices at different anatomic sites on the head and body ranged from 19-800 (median = 113) μSv at eye level, 6-1,180 (median = 75) μSv at the neck, and 2-1,600 (median = 302) μSv at the trunk. Operators' hands often received greater doses than the eyes, neck, or trunk. Large variations in operator doses suggest that optimizing procedure protocols and proper use of protective devices and shields might reduce occupational radiation dose substantially.
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Affiliation(s)
- Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, Gyeonggi-do, Republic of Korea.
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43
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Linet MS, Slovis TL, Miller DL, Kleinerman R, Lee C, Rajaraman P, Berrington de Gonzalez A. Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin 2012; 62:75-100. [PMID: 22307864 PMCID: PMC3548988 DOI: 10.3322/caac.21132] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The 600% increase in medical radiation exposure to the US population since 1980 has provided immense benefit, but increased potential future cancer risks to patients. Most of the increase is from diagnostic radiologic procedures. The objectives of this review are to summarize epidemiologic data on cancer risks associated with diagnostic procedures, describe how exposures from recent diagnostic procedures relate to radiation levels linked with cancer occurrence, and propose a framework of strategies to reduce radiation from diagnostic imaging in patients. We briefly review radiation dose definitions, mechanisms of radiation carcinogenesis, key epidemiologic studies of medical and other radiation sources and cancer risks, and dose trends from diagnostic procedures. We describe cancer risks from experimental studies, future projected risks from current imaging procedures, and the potential for higher risks in genetically susceptible populations. To reduce future projected cancers from diagnostic procedures, we advocate the widespread use of evidence-based appropriateness criteria for decisions about imaging procedures; oversight of equipment to deliver reliably the minimum radiation required to attain clinical objectives; development of electronic lifetime records of imaging procedures for patients and their physicians; and commitment by medical training programs, professional societies, and radiation protection organizations to educate all stakeholders in reducing radiation from diagnostic procedures.
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Affiliation(s)
- Martha S Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7238, USA.
| | - Thomas L Slovis
- Chief, Pediatric Radiology, Department of Radiology, Children's Hospital of Michigan, Detroit, MI
| | - Donald L Miller
- Acting Chief, Diagnostic Devices Branch, Division of Mammography Quality and Radiation Program Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD
| | - Ruth Kleinerman
- Epidemiologist, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Choonsik Lee
- Investigator, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Preetha Rajaraman
- Investigator, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Amy Berrington de Gonzalez
- Senior Investigator, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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Simon SL. Organ-specific external dose coefficients and protective apron transmission factors for historical dose reconstruction for medical personnel. HEALTH PHYSICS 2011; 101:13-27. [PMID: 21617389 PMCID: PMC3964780 DOI: 10.1097/hp.0b013e318204a60a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
While radiation absorbed dose (Gy) to the skin or other organs is sometimes estimated for patients from diagnostic radiologic examinations or therapeutic procedures, rarely is occupationally-received radiation absorbed dose to individual organs/tissues estimated for medical personnel; e.g., radiologic technologists or radiologists. Generally, for medical personnel, equivalent or effective radiation doses are estimated for compliance purposes. In the very few cases when organ doses to medical personnel are reconstructed, the data is usually for the purpose of epidemiologic studies; e.g., a study of historical doses and risks to a cohort of about 110,000 radiologic technologists presently underway at the U.S. National Cancer Institute. While ICRP and ICRU have published organ-specific external dose conversion coefficients (DCCs) (i.e., absorbed dose to organs and tissues per unit air kerma and dose equivalent per unit air kerma), those factors have been published primarily for mono-energetic photons at selected energies. This presents two related problems for historical dose reconstruction, both of which are addressed here. It is necessary to derive conversion factor values for (1) continuous distributions of energy typical of diagnostic medical x-rays (bremsstrahlung radiation), and (2) energies of particular radioisotopes used in medical procedures, neither of which are presented in published tables. For derivation of DCCs for bremsstrahlung radiation, combinations of x-ray tube potentials and filtrations were derived for different time periods based on a review of relevant literature. Three peak tube potentials (70 kV, 80 kV, and 90 kV) with four different amounts of beam filtration were determined to be applicable for historic dose reconstruction. The probabilities of these machine settings were assigned to each of the four time periods (earlier than 1949, 1949-1954, 1955-1968, and after 1968). Continuous functions were fit to each set of discrete values of the ICRP/ICRU mono-energetic DCCs and the functions integrated over the air-kerma weighted photon fluence of the 12 defined x-ray spectra. The air kerma-weighted DCCs in this work were developed specifically for an irradiation geometry of anterior to posterior (AP) and for the following tissues: thyroid, breast, ovary, lens of eye, lung, colon, testes, heart, skin (anterior side only), red bone marrow (RBM), and brain. In addition, a series of functional relationships to predict DT Ka-1 values for RBM dependent on body mass index [BMI (kg m-2) ≡ weight per height] and average photon energy were derived from a published analysis. Factors to account for attenuation of radiation by protective lead aprons were also developed. Because lead protective aprons often worn by radiology personnel not only reduce the intensity of x-ray exposure but also appreciably harden the transmitted fluence of bremsstrahlung x-rays, DCCs were separately calculated for organs possibly protected by lead aprons by considering three cases: no apron, 0.25 mm Pb apron, and 0.5 mm Pb apron. For estimation of organ doses from conducting procedures with radioisotopes, continuous functions of the reported mono-energetic values were developed, and DCCs were derived by estimation of the function at relevant energies. By considering the temporal changes in primary exposure-related parameters (e.g., energy distribution), the derived DCCs and transmission factors presented here allow for more realistic historical dose reconstructions for medical personnel when monitoring badge readings are the primary data on which estimation of an individual's organ doses are based.
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Affiliation(s)
- Steven L Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Neta G, Brenner AV, Sturgis EM, Pfeiffer RM, Hutchinson AA, Aschebrook-Kilfoy B, Yeager M, Xu L, Wheeler W, Abend M, Ron E, Tucker MA, Chanock SJ, Sigurdson AJ. Common genetic variants related to genomic integrity and risk of papillary thyroid cancer. Carcinogenesis 2011; 32:1231-7. [PMID: 21642358 DOI: 10.1093/carcin/bgr100] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
DNA damage is an important mechanism in carcinogenesis, so genes related to maintaining genomic integrity may influence papillary thyroid cancer (PTC) risk. Candidate gene studies targeting some of these genes have identified only a few polymorphisms associated with risk of PTC. Here, we expanded the scope of previous candidate studies by increasing the number and coverage of genes related to maintenance of genomic integrity. We evaluated 5077 tag single-nucleotide polymorphisms (SNPs) from 340 candidate gene regions hypothesized to be involved in DNA repair, epigenetics, tumor suppression, apoptosis, telomere function and cell cycle control and signaling pathways in a case-control study of 344 PTC cases and 452 matched controls. We estimated odds ratios for associations of single SNPs with PTC risk and combined P values for SNPs in the same gene region or pathway to obtain gene region-specific or pathway-specific P values using adaptive rank-truncated product methods. Nine SNPs had P values <0.0005, three of which were in HDAC4 and were inversely related to PTC risk. After multiple comparisons adjustment, no SNPs remained associated with PTC risk. Seven gene regions were associated with PTC risk at P < 0.01, including HUS1, ALKBH3, HDAC4, BAK1, FAF1_CDKN2C, DACT3 and FZD6. Our results suggest a possible role of genes involved in maintenance of genomic integrity in relation to risk of PTC.
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Affiliation(s)
- Gila Neta
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health/DHHS, 6120 Executive Boulevard, Rockville, MD 20852-7244, USA.
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Bhatti P, Yong LC, Doody MM, Preston DL, Kampa DM, Ramsey MJ, Ward EM, Edwards AA, Ron E, Tucker JD, Sigurdson AJ. Diagnostic X-ray examinations and increased chromosome translocations: evidence from three studies. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2010; 49:685-92. [PMID: 20602108 PMCID: PMC3075914 DOI: 10.1007/s00411-010-0307-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 06/07/2010] [Indexed: 05/28/2023]
Abstract
Controversy regarding potential health risks from increased use of medical diagnostic radiologic examinations has come to public attention. We evaluated whether chromosome damage, specifically translocations, which are a potentially intermediate biomarker for cancer risk, was increased after exposure to diagnostic X-rays, with particular interest in the ionizing radiation dose-response below the level of approximately 50 mGy. Chromosome translocation frequency data from three separately conducted occupational studies of ionizing radiation were pooled together. Studies 1 and 2 included 79 and 150 medical radiologic technologists, respectively, and study 3 included 83 airline pilots and 50 university faculty members (total = 155 women and 207 men; mean age = 62 years, range 34-90). Information on personal history of radiographic examinations was collected from a detailed questionnaire. We computed a cumulative red bone marrow (RBM) dose score based on the numbers and types of X-ray examinations reported with 1 unit approximating 1 mGy. Poisson regression analyses were adjusted for age and laboratory method. Mean RBM dose scores were 49, 42, and 11 for Studies 1-3, respectively (overall mean = 33.5, range 0-303). Translocation frequencies significantly increased with increasing dose score (P < 0.001). Restricting the analysis to the lowest dose scores of under 50 did not materially change these results. We conclude that chromosome damage is associated with low levels of radiation exposure from diagnostic X-ray examinations, including dose scores of approximately 50 and lower, suggesting the possibility of long-term adverse health effects.
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Affiliation(s)
- Parveen Bhatti
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Schonfeld SJ, Bhatti P, Brown EE, Linet MS, Simon SL, Weinstock RM, Hutchinson AA, Stovall M, Preston DL, Alexander BH, Doody MM, Sigurdson AJ. Polymorphisms in oxidative stress and inflammation pathway genes, low-dose ionizing radiation, and the risk of breast cancer among US radiologic technologists. Cancer Causes Control 2010; 21:1857-66. [PMID: 20711808 PMCID: PMC3076104 DOI: 10.1007/s10552-010-9613-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Ionizing radiation, an established breast cancer risk factor, has been shown to induce oxidative damage and chronic inflammation. Polymorphic variation in oxidative stress and inflammatory-mediated pathway genes may modify radiation-related breast cancer risk. METHODS We estimated breast cancer risk for 28 common variants in 16 candidate genes involved in these pathways among 859 breast cancer cases and 1,083 controls nested within the US Radiologic Technologists cohort. We estimated associations between occupational and personal diagnostic radiation exposures with breast cancer by modeling the odds ratio (OR) as a linear function in logistic regression models and assessed heterogeneity of the dose-response across genotypes. RESULTS There was suggestive evidence of an interaction between the rs5277 variant in PTGS2 and radiation-related breast cancer risk. The excess OR (EOR)/Gy from occupational radiation exposure = 5.5 (95%CI 1.2-12.5) for the GG genotype versus EOR/Gy < 0 (95%CI < 0-3.8) and EOR/Gy < 0 (95%CI < 0-14.8) for the GC and CC genotypes, respectively, (p (interaction) = 0.04). The association between radiation and breast cancer was not modified by other SNPs examined. CONCLUSIONS This study suggests that variation in PTGS2 may modify the breast cancer risk from occupational radiation exposure, but replication in other populations is needed to confirm this result.
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Affiliation(s)
- Sara J Schonfeld
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, 6120 Executive Blvd MSC 7238, Bethesda, MD 20892, USA.
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Linet MS, Kim KP, Miller DL, Kleinerman RA, Simon SL, Berrington de Gonzalez A. Historical review of occupational exposures and cancer risks in medical radiation workers. Radiat Res 2010; 174:793-808. [PMID: 21128805 DOI: 10.1667/rr2014.1] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Epidemiological studies of medical radiation workers have found excess risks of leukemia, skin and female breast cancer in those employed before 1950 but little consistent evidence of cancer risk increases subsequently. Occupational radiation-related dose-response data and recent and lifetime cancer risk data are limited for radiologists and radiologic technologists and lacking for physicians and technologists performing fluoroscopically guided procedures. Survey data demonstrate that occupational doses to radiologists and radiologic technologists have declined over time. Eighty mostly small studies of cardiologists and fewer studies of other physicians reveal that effective doses to physicians per interventional procedure vary by more than an order of magnitude. For medical radiation workers, there is an urgent need to expand the limited information on average annual, time-trend and organ doses from occupational radiation exposures and to assess lifetime cancer risks of these workers. For physicians and technologists performing interventional procedures, more information about occupational doses should be collected and long-term follow-up studies of cancer and other serious disease risks should be initiated. Such studies will help optimize standardized protocols for radiologic procedures, determine whether current radiation protection measures for medical radiation workers are adequate, provide guidance on cancer screening needs, and yield valuable insights on cancer risks associated with chronic radiation exposure.
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Affiliation(s)
- Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20892-7238, USA.
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Dauer LT, Brooks AL, Hoel DG, Morgan WF, Stram D, Tran P. Review and evaluation of updated research on the health effects associated with low-dose ionising radiation. RADIATION PROTECTION DOSIMETRY 2010; 140:103-136. [PMID: 20413418 DOI: 10.1093/rpd/ncq141] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
While radiation health risks at low doses have traditionally been estimated from high-dose studies, we have reviewed recent literature and concluded that the mechanisms of action for many biological endpoints may be different at low doses from those observed at high doses; that acute doses <100 mSv may be too small to allow epidemiological detection of excess cancers given the background of naturally occurring cancers; that low-dose radiation research should use holistic approaches such as systems-based methods to develop models that define the shape of the dose-response relationship; and that these results should be combined with the latest epidemiology to produce a comprehensive understanding of radiation effects that addresses both damage, likely with a linear effect, and response, possibly with non-linear consequences. Continued research is needed to understand how radiobiology and epidemiology advances should be used to effectively model radiation worker risks.
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Affiliation(s)
- Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Bhatti P, Doody MM, Rajaraman P, Alexander BH, Yeager M, Hutchinson A, Burdette L, Thomas G, Hunter DJ, Simon SL, Weinstock RM, Rosenstein M, Stovall M, Preston DL, Linet MS, Hoover RN, Chanock SJ, Sigurdson AJ. Novel breast cancer risk alleles and interaction with ionizing radiation among U.S. radiologic technologists. Radiat Res 2010; 173:214-24. [PMID: 20095854 PMCID: PMC2922870 DOI: 10.1667/rr1985.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
As genome-wide association studies of breast cancer are replicating findings and refinement studies are narrowing the signal location, additional efforts are necessary to elucidate the underlying functional relationships. One approach is to evaluate variation in risk by genotype based on known breast carcinogens, such as ionizing radiation. Given the public health concerns associated with recent increases in medical radiation exposure, this approach may also identify potentially susceptible subpopulations. We examined interaction between 27 newly identified breast cancer risk alleles (identified within the NCI Cancer Genetic Markers of Susceptibility and the Breast Cancer Association Consortium genome-wide association studies) and occupational and medical diagnostic radiation exposure among 859 cases and 1083 controls nested within the United States Radiologic Technologists cohort. We did not find significant variation in the radiation-related breast cancer risk for the variant in RAD51L1 (rs10483813) on 14q24.1 as we had hypothesized. In exploratory analyses, we found that the radiation-associated breast cancer risk varied significantly by linked markers in 5p12 (rs930395, rs10941679, rs2067980 and rs4415084) in the mitochondrial ribosomal protein S30 (MRPS30) gene (P(interaction) = 0.04). Chance, however, may explain these findings, and as such, these results need to be confirmed in other populations with low to moderate levels of radiation exposure. Even though a complete understanding of the way(s) in which these variants may increase breast cancer risk remains elusive, this approach may yield clues for further investigation.
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Affiliation(s)
- Parveen Bhatti
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
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