Assessment of cancer risk and radiological effects from 210Po and 210Pb with consumption of wild medicinal herbal plants

BACKGROUND

Plants' raw materials can accumulate chemical elements, including radioisotopes, to some extent and reflect the region they grow in. Due to their high environmental content and toxicity, natural radionuclides - polonium 210Po and lead 210Pb are the most dangerous radioisotopes for human health.

METHODS

70 raw medicinal herbal materials from 54 popular wild-growing medicinal plant species, most of them included in the European Pharmacopoeia, were collected across three regions. In 210 samples, the activity concentrations of 210Po and 210Pb were determined, and their radiotoxicity and cancer risk were calculated.

RESULTS

The results of 210Po and 210Pb activities measured in herbal raw material were from 0.12 mBq g-1 dry weight in the fruits of the common chestnut (Aesculus hippocastanum) to 19.7 mBq g-1 dw in herb of ground elder (Aegopodium podagraria) for 210Po, while for 210Pb ranged from 0.16 mBq g-1 dw to 34.3 mBq g-1 dw in the same plants. There were statistically significant differences between 210Po and 210Pb content in leaves, herbs, flowers, and fruit. The studies indicated that the estimated annual effective radiation dose from Polish medicinal herbs consumption was low, ranging 0.03-105 µSv from 210Po and 0.02-98.2 µSv from 210Pb, while the risk of cancer morbidity and mortality ranged from 10-5 to 10-9.

CONCLUSIONS

Consumption of the tested medicinal herbs is safe from the radiological point of view and, based on the predictions related to the calculated risk of cancer, should not increase the probability of its occurrence.

On 210Po and 210Pb in algae diet supplements - The assessed radiation hazard of aquatic superfoods

Algae are believed to give health benefits. However, the studies showed they contain toxic elements, including radionuclides, and may affect human health. The study presents the values of activity concentrations of ²¹⁰Po and ²¹⁰Pb in the algae supplements available worldwide for adults. The activity concentrations (Bq/kg dw) ranged from 0.07 to 14.5 (²¹⁰Po) and from 0.06 to 8.48 (²¹⁰Pb). Also, the effective radiation doses and the cancer risk from ²¹⁰Po and ²¹⁰Pb decay ingested with analyzed algal supplements have been assessed. The highest values of annual effective doses have been estimated for ²¹⁰Po in the recommended portion of Spirulina (Arthrospira platensis) from China (59.7 μSv/year) and Diatomaceous earth from the USA (50.4 μSv/year). The cancer morbidity and mortality risk ranged from 10^-4 to 10^-8. The study indicated the activity concentrations of ²¹⁰Po and ²¹⁰Pb were low, and algae supplements for human consumption could be considered safe food.

Effective radiation dose of skeletal surveys performed for suspected physical abuse

BACKGROUND

A skeletal survey is an important diagnostic tool for patients presenting with suspected physical abuse. A relatively recent change in guidelines for skeletal surveys by the Royal College of Radiologists (RCR) in 2017 has led to more initial and follow-up images for these patients, which would be expected to have led to an increase in effective radiation dose.

OBJECTIVE

To estimate the effective dose following the change in guidelines and to ascertain the difference between doses before and after the change in guidelines.

MATERIALS AND METHODS

Data were collected retrospectively on children younger than 3 years old referred for skeletal surveys for suspected physical abuse at a tertiary paediatric centre. A Monte Carlo radiation patient dose simulation software, PCXMC v 2.0.1, was used to estimate the effective dose, expressed in millisieverts (mSv).

RESULTS

Sixty-eight children underwent skeletal surveys for suspected physical abuse. The total estimated effective dose for skeletal surveys with the previous RCR guidelines was found to be 0.19 mSv. For initial skeletal surveys with the current RCR guidelines, the estimated effective radiation dose was 0.19 mSv. Eighteen children had both initial and follow-up skeletal surveys as indicated by the current RCR guidelines, with an estimated effective total radiation dose of 0.26 mSv.

CONCLUSION

Skeletal surveys deliver a relatively low estimated effective radiation dose equivalent to 1 month of United Kingdom background radiation, with no significant change in dose following the change in guidelines. Therefore, the benefits of having a skeletal survey outweigh the main radiation risk. However, accurate data regarding the radiation dose are important for clinicians consenting parents/guardians for imaging in suspected physical abuse.

Bolete mushroom Boletus bainiugan from Yunnan as a reflection of the geographical distribution of 210Po, 210Pb and uranium (234U, 235U, 238U) radionuclides, their intake rates and effective exposure doses

This pioneering study aimed to determine the activity concentrations of ²¹⁰Po, ²¹⁰Pb and uranium (²³⁴U, ²³⁵U, ²³⁸U) radionuclides in fruit bodies of wild bolete Boletus bainiugan Dentinger and to estimate its edible safety, which may give scientific evidence for the consumption of this species. The analyses were performed using alpha spectrometer after digestion, exchange resins separation and deposition. Measurement data were analysed and interpolation maps reflecting ²¹⁰Po, ²¹⁰Pb and uranium (²³⁴U, ²³⁵U, ²³⁸U) geographical distribution in Yunnan province (China) were presented. In addition, from the perspective of food safety, the possible related effective radiation dose to mushrooms consumers were estimated. The results indicated that ²¹⁰Po, ²¹⁰Pb and uranium (²³⁴U, ²³⁵U, ²³⁸U) radionuclides contents in B. bainiugan were significantly different with respect to geographical distribution, and their possible intake in a part of the region was considerably higher. A very interesting observation was done according to the values of ²³⁵U/²³⁸U activity ratio indicating the occurrence of uranium faction from the global fallout of nuclear weapon tests.

Uranium (234U, 238U) and thorium (230Th, 232Th) in mushrooms of genus Leccinum and Leccinellum and the potential effective ionizing radiation dose assessment for human

Evaluated has been bioconcentration potential by fungi and risk to human consumers from exposure to natural long-lived radioactive uranium (²³⁴U, ²³⁸U) and thorium (²³⁰Th, ²³²Th) sequestered in stems, caps and the whole fruiting bodies by mushrooms of the genus Leccinum and Leccinellum. Edible species in the study were collected from boreal forests in the northern regions of Poland and investigated: red-capped scaber (Leccinum aurantiacum), orange oak bolete (Leccinum aurantiacum var. quercinum), foxy bolete (Leccinum vulpinum), slate bolete (Leccinum aurantiacum var. duriusculum) and hazel bolete (Leccinellum pseudoscabrum). The study showed the species accumulated uranium (²³⁴U, ²³⁸U) and thorium (^230Th, ²³²Th) form soil to some degree but the calculated values of the bioconcentration factor were below 1. The evaluation showed that Leccinum and Leccinellum mushrooms can contribute to annual effective radiation dose maximally at about 0.9 μSv. Hence, consumption of these mushrooms might increase the annual effective ionizing radiation dose received by a human, while the exposure is considered low from the toxicological point of view even if eaten at elevated amounts.

Distribution of 239,240Pu in marine products from the seas around the Korean Peninsula after the Fukushima nuclear power plant accident

In March 2011, an earthquake caused the shutdown of the active reactors at the Fukushima Daiichi Nuclear Power Plant (NPP), with the succeeding tsunami resulting in the release of radioactively contaminated water into the adjacent Japanese coastal waters. Marine biota selected from various trophic levels were collected in Korean coastal waters throughout 2014 and 2015 and their plutonium levels were measured to evaluate the radioactive contamination levels in the marine organisms that constitute the primary seafood diet in the Republic of Korea (ROK). The results showed that the activity concentrations of ^239,240Pu in plankton, macroalgae, mollusks, crustaceans, and cephalopods ranged from 13 to 58, 0.64 to 0.80, 0.94 to 5.40, 0.06 to 0.50, and 0.26 mBq kg^-1 of wet weight (w.w.), respectively. The activity concentrations of ^239,240Pu measured in the muscles of fish varied from 0.09 to 0.30 mBq kg^-1 (w.w.), relatively low values compared to those in other groups regardless of fish species, size, and sampling area. The concentration characteristics of ^239,240Pu in the various organs in the respective marine products revealed that the internal organs showed higher concentrations than the muscle or skin (or exoskeleton). The highest concentration of ^239,240Pu was measured in the viscera of an abalone, which had an activity concentration of 6.31 mBq kg^-1 (w.w.). The concentration factors (CFs) in the >300-μm fraction of plankton and in anchovy, shrimp, and mackerel ranged 67-84% of the International Atomic Energy Agency (IAEA)-recommended values, although the CF in macroalgae was much lower at approximately 5% of IAEA values, suggesting a wide range of ^239,240Pu CF in macroalgae. The mean transfer factor (TF) between macroalgae (0.6-0.8 mBq kg^-1) and abalone (5.4 mBq kg^-1) was estimated to be 7.5, implying that effective Pu transfer occurred between the two species. These figures equate to annual effective doses of ^239,240Pu to Koreans through consumption of macroalgae, shellfish, and fish of 1.8 × 10^-6, 1.4 × 10^-6, and 7.1 × 10^-7 mSv yr^-1, respectively, and a total dose of 3.9 × 10^-6 mSv yr^-1, values that are negligible compared to the annual effective dose limit of 1 mSv yr^-1.

Isotopes of 210Po and 210Pb in Hazel bolete (Leccinellum pseudoscabrum) - bioconcentration, distribution and related dose assessment

The hazel bolete Leccinellum pseudoscabrum (Kallenb.) Mikšík 2017 specimens and beneath soil layer (0-10 cm) have been examined on the occasion of ²¹⁰Po and ²¹⁰Pb activity concentrations, the nuclide bioaccumulation potential by species and distribution in fruit bodies. Mushrooms and forest soils came from six geographically distant locations in the northern and central parts of Poland. The threat to humans from ²¹⁰Po and ²¹⁰Pb contained in mushrooms has been also assessed. The absolute values of the ²¹⁰Po radioactivity, respectively, in caps and stems of fruit bodies were in the range 0.74 ± 0.06-8.59 ± 0.36 Bq kg^-1 dry biomass and from 0.81 ± 0.06-8.23 ± 0.37 Bq kg^-1 dry biomass, while the values of the ²¹⁰Pb radioactivity in caps and stems were in the range 0.61 ± 0.04-6.33 ± 0.22 Bq kg^-1 dry biomass and 0.83 ± 0.04-4.59 ± 0.24 Bq kg^-1 dry biomass, respectively. A potential related effective dose assessment showed that mushrooms L. pseudoscabrum can contribute at 0.89-10.3 μSv kg^-1 db from ²¹⁰Po decay and 0.42-4.37 μSv kg^-1 db from ²¹⁰Pb decay.

Implementation of Intraoperative Computed Tomography for Deep Brain Stimulation: Pitfalls and Optimization of Workflow, Accuracy, and Radiation Exposure

OBJECTIVE

Deep brain stimulation (DBS) is an effective treatment for movement disorders. Stereotactic electrode placement can be guided by intraoperative imaging, which also allows for immediate intraoperative quality control. This article is about implementation and refining a workflow applying intraoperative computed tomography (iCT) for DBS.

METHODS

Eighteen patients underwent DBS with bilateral implantation of directional electrodes applying a 32-slice movable computed tomography scanner in combination with microelectrode recording.

RESULTS

iCT led to a significant decrease in overall procedural time, despite performing multiple scans. In 3 of the initial 5 cases, iCT caused an adjustment of the final electrodes demonstrating the learning curve and the necessity to integrate road mapping for the exchange of microelectrode to final electrode. Implementation of low-dose computed tomography protocols added microelectrode iCT to the refined workflow, resulting in an intraoperative adjustment of a trajectory in 1 patient. Low-dose protocols lowered the total effective dose to 1.15 mSv, that is, a reduction by a factor of 3.5 compared to a standard non-iCT DBS procedure, despite repeated iCTs. Intraoperative lead detection based on final iCT revealed a radial error of 1.04 ± 0.58 mm and a vector error of 2.28 ± 0.97 mm compared to the preoperative planning, adjusted by the findings of microelectrode recording.

CONCLUSIONS

iCT can be easily integrated into the surgical workflow resulting in an overall efficient time-saving procedure. Repeated intraoperative scanning ensures reliable electrode placement, although low-dose scanning protocols prevent extensive radiation exposure. iCT of microelectrodes is feasible and led to the adjustment of 1 electrode.

210Po and 210Pb in forest mushrooms of genus Leccinum and topsoil from northern Poland and its contribution to the radiation dose

Wild growing mushrooms are traditional food items for man and also an important source of nutrients for small and big wildlife. Nevertheless, they can be species - specifically vulnerable for contamination with heavy metals and radionuclides. We studied a less known phenomenon of accumulation of highly toxic, the alpha-radiation emitter such as ²¹⁰Po and the beta emitter ²¹⁰Pb by three Leccinum mushrooms: orange oak bolete L. aurantiacum (Bull.) Gray (previous name Leccinum aurantiacum var. quercinum Pilát), foxy bolete L. vulpinum Watling and slate bolete L. duriusculum (Schulzer ex Kalchbr.) Singer. Fungal and soil materials were collected from areas of a different geochemical composition in the northern regions of Poland. In parallel evaluated was the risk to human consumer due to possible intake of ²¹⁰Po and ²¹⁰Pb with a mushroom meal. Results showed a heterogeneous distribution of ²¹⁰Po and ²¹⁰Pb activity concentrations within caps and stipes of fruiting bodies. Overall activity concentration for whole dried fungi material ranged from 0.59 ± 0.38 to 3.2 ± 0.2 Bq ²¹⁰Po kg^-1 and from 0.45 ± 0.04 to 3.1 ± 0.2 Bq ²¹⁰Pb kg^-1. Evaluation showed that Leccinum mushrooms consumed by locals in typical quantity of 0.5 kg (dry biomass) can contribute into annual effective radiation dose at 0.90-3.81 μSv from ²¹⁰Po decay and 0.31-2.14 μSv from ²¹⁰Pb decay, which is a small portion of the annual effective radiation dose of ²¹⁰Po and ²¹⁰Pb for human inhabiting the northern regions of Poland.

Low-radiation and high image quality coronary computed tomography angiography in “real-world” unselected patients

AIM

To determine the radiation dose and image quality in coronary computed tomography angiography (CCTA) using state-of-the-art dose reduction methods in unselected “real world” patients.

METHODS

In this single-centre study, consecutive patients in sinus rhythm underwent CCTA for suspected coronary artery disease (CAD) using a 320-row detector CT scanner. All patients underwent the standard CT acquisition protocol at our institute (Morriston Hospital) a combination of dose saving advances including prospective electrocardiogram-gating, automated tube current modulation, tube voltage reduction, heart rate reduction, and the most recent novel adaptive iterative dose reconstruction 3D (AIDR3D) algorithm. The cohort comprised real-world patients for routine CCTA who were not selected on age, body mass index, or heart rate. Subjective image quality was graded on a 4-point scale (4 = excellent, 1 = non-diagnostic).

RESULTS

A total of 543 patients were included in the study with a mean body weight of 81 ± 18 kg and a pre-scan mean heart rate of 70 ± 11 beats per minute (bpm). When indicated, patients received rate-limiting medication with an oral beta-blocker followed by additional intravenous beta-blocker to achieve a heart rate below 65 bpm. The median effective radiation dose was 0.88 mSv (IQR, 0.6-1.4 mSv) derived from a Dose Length Product of 61.45 mGy.cm (IQR, 42.86-100.00 mGy.cm). This also includes what we believe to be the lowest ever-reported radiation dose for a routine clinical CCTA (0.18 mSv). The mean image quality (± SD) was 3.65 ± 0.61, with a subjective image quality score of 3 (“good”) or above for 93% of patient CCTAs.

CONCLUSION

Combining a low-dose scan protocol and AIDR3D with a 320-detector row CT scanner can provide high quality images at exceptionally low radiation dose in unselected patients being investigated for CAD.

Intraoperative computed tomography as reliable navigation registration device in 200 cranial procedures

BACKGROUND

Registration accuracy is a main factor influencing overall navigation accuracy. Standard fiducial- or landmark-based patient registration is user dependent and error-prone. Intraoperative imaging offers the possibility for user-independent patient registration. The aim of this paper is to evaluate our initial experience applying intraoperative computed tomography (CT) for navigation registration in cranial neurosurgery, with a special focus on registration accuracy and effective radiation dose.

METHODS

A total of 200 patients (141 craniotomy, 19 transsphenoidal, and 40 stereotactic burr hole procedures) were investigated by intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Registration accuracy was measured by at least three skin fiducials that were not part of the registration process.

RESULTS

Automatic registration resulted in high registration accuracy (mean registration error: 0.93 ± 0.41 mm). Implementation of low-dose scanning protocols did not impede registration accuracy (registration error applying the full dose head protocol: 0.87 ± 0.36 mm vs. the low dose sinus protocol 0.72 ± 0.43 mm) while a reduction of the effective radiation dose by a factor of 8 could be achieved (mean effective radiation dose head protocol: 2.73 mSv vs. sinus protocol: 0.34 mSv).

CONCLUSION

Intraoperative CT allows highly reliable navigation registration with low radiation exposure.

210Po and 210Pb bioaccumulation and possible related dose assessment in parasol mushroom (Macrolepiota procera)

Presented are results of a study on accumulation and distribution of 210Po and 210Pb in the fruitbodies of parasol mushroom (Macrolepiota procera) and risk to human consumer due to exposure from highly radiotoxic decay particles emitted by both radionuclides. Mushrooms were collected from 16 forested places in central and northern regions of Poland. Activity concentrations of 210Po and 210Pb were determined after radiochemical separation of nuclides and subsequent measurement using validated method and alpha spectrometer. Results showed on spatially heterogeneous distribution of the 210Po and 210Po activity concentrations in M. procera and two interpolation maps were prepared. Activity concentrations of nuclides in dried caps of M. procera were in the range from 3.38 ± 0.41 to 16.70 ± 0.33 Bq∙210Po ∙kg-1 and from 5.11 ± 0.21 to 13.42 ± 0.30 Bq∙210Pb ∙kg-1. Consumption of M. procera foraged in central and northern Poland should not contribute significantly to the annual effective radiation doses from 210Po and 210Pb due to amount of both nuclides accumulated by fungus in caps.

Emergency preparedness for the accidental release of radionuclides from the Uljin Nuclear Power Plant in Korea

Site specific radionuclide dispersion databases were archived for the emergency response to the hypothetical releases of ¹³⁷Cs from the Uljin nuclear power plant in Korea. These databases were obtained with the horizontal resolution of 1.5 km in the local domain centered the power plant site by simulations of the Lagrangian Particle Dispersion Model (LPDM) with the Unified Model (UM)-Local Data Assimilation Prediction System (LDAPS). The Eulerian Dispersion Model-East Asia (EDM-EA) with the UM-Global Data Assimilation Prediction System (UM-GDAPS) meteorological models was used to get dispersion databases in the regional domain. The LPDM model was performed for a year with a 5-day interval yielding 72 synoptic time-scale cases in a year. For each case hourly mean near surface concentrations, hourly mean column integrated concentrations, hourly total depositions for 5 consecutive days were archived by the LPDM model in the local domain and by the EDM-EA model in the regional domain of Asia. Among 72 synoptic cases in a year the worst synoptic case that showed the highest mean surface concentration averaged for 5 days in the LPDM model domain was chosen to illustrate the emergency preparedness to the hypothetical accident at the site. The simulated results by the LPDM model with the ¹³⁷Cs emission rate of the Fukushima nuclear power plant accident for the first 5-day period were found to be able to provide prerequisite information for the emergency response to the early phase of the accident whereas those of the EDM-EA model could provide information required for the environmental impact assessment of the accident in the regional domain. The archived site-specific database of 72 synoptic cases in a year could have a great potential to be used as a prognostic information on the emergency preparedness for the early phase of accident.

Injured Children Receive Twice the Radiation Dose at Nonpediatric Trauma Centers Compared With Pediatric Trauma Centers

BACKGROUND

Use of cranial CT scans in children has been increasing, in part due to increased awareness of sports-related concussions. CT is the largest contributor to medical radiation exposure, a risk factor for cancer. Long-term cancer risks of CT scans can be two to three times higher for children than for adults because children are more radiosensitive and have a longer lifetime in which to accumulate exposure from multiple scans.

STUDY AIM

To compare the radiation exposure injured children receive when imaged at nonpediatric hospitals (NPHs) versus pediatric hospitals.

METHODS

Injured children younger than 18 years who received a CT scan at a referring hospital during calendar years (CYs) 2010 and 2013 were included. Patient-level factors included demographics, mode of transportation, and Injury Severity Score, and hospital-level factors included region of state, radiology services, and hospital type and size. Our primary outcome of interest was the effective radiation dose.

RESULTS

Four hundred eighty-seven children were transferred to the pediatric trauma center during CYs 2010 and 2013, with a median age of 7.2 years (interquartile range 5-13). The median effective radiation dose received at NPHs was twice that received at the pediatric trauma center (3.8 versus 1.6 mSv, P < .001). Results were confirmed in independent and paired analyses, after controlling for mode of transportation, emergency department disposition, level of injury severity, and at the NPH trauma center level, hospital type, size, region, and radiology services location.

CONCLUSION

NPHs have the potential to substantially reduce the medical radiation received by injured children. Pediatric CT protocols should be considered.

Patient knowledge regarding radiation exposure from spinal imaging

BACKGROUND CONTEXT

Spine surgeons employ a high volume of imaging in the diagnosis and evaluation of spinal pathology. However, little is known regarding patients' knowledge of the radiation exposure associated with these imaging techniques.

PURPOSE

To characterize spine patients' knowledge regarding radiation exposure from various imaging modalities.

STUDY DESIGN/SETTING

A cross-sectional survey study.

PATIENT SAMPLE

One hundred patients at their first clinic visit with a single spine surgeon at an urban institution.

OUTCOME MEASURES

The primary outcome was patient estimate of radiation dose for various common spinal imaging modalities as compared with true dose.

METHODS

An electronic survey was administered to all new patients before their first appointment with a single spinal surgeon. The survey asked patients to estimate how many chest x-rays (CXRs) worth of radiation were equivalent to various common spinal imaging modalities. Patient estimates were compared to true effective radiation doses determined from the literature. The survey also asked patients whether they would consider avoiding types of imaging modalities out of concern for excessive radiation exposure.

RESULTS

Patients accurately approximated the radiation associated with two views of the cervical spine, with a median estimate of 3.5 CXRs, compared with an actual value of 4.7 CXRs. However, patients underestimated the dose for computed tomography (CT) scans of the cervical spine (2.0 CXRs vs. 145.3 CXRs), two views of the lumbar spine (3.0 CXRs vs. 123.3 CXRs), and CT scans of the lumbar spine (2.0 CXRs vs. 638.3 CXRs). The majority of patients believed that there is at least some radiation exposure associated with magnetic resonance imaging (MRI). The percent of patients who would consider forgoing imaging recommend by their surgeon out of concern for radiation exposure was 14% for x-rays, 13% for CT scans, and 9% for MRI.

CONCLUSION

These results demonstrate a lack of patient understanding regarding radiation exposure associated with common spinal imaging techniques. These data suggest that patients might benefit from increased counseling and/or educational materials regarding radiation exposure before undergoing diagnostic imaging of the cervical or lumbar spine.

Determination of 210Po and 210Pb in red-capped scaber (Leccinum aurantiacum): bioconcentration and possible related dose assessment

The paper presents the studies on ²¹⁰Po and ²¹⁰Pb activity determination in red-capped scaber (Leccinum aurantiacum (Bulliard) Gray) collected in northern Poland. The aims of the studies were to determine ²¹⁰Po and ²¹⁰Pb content in analyzed mushrooms, evaluate the bioconcentration levels, and estimate possible related annual effective radiation dose to mushrooms consumers. The activities of ²¹⁰Po and ²¹⁰Pb in red-capped scaber were un-uniform and depended on sampling sites. But ²¹⁰Po and ²¹⁰Pb activity concentrations did not reflect their concentrations in topsoil. The results showed that the consumption of analyzed mushrooms should not increase significantly the total effective radiation dose from ²¹⁰Po and ²¹⁰Pb decay.

Measurements of tunnel placements after anterior cruciate ligament reconstruction--A comparison between CT, radiographs and MRI

BACKGROUND

A non-anatomic placement of the femoral and tibial tunnels may affect outcome in anterior cruciate ligament (ACL) reconstructions. Tunnel placements are validated with varying imaging modalities. We compared measurements of tunnel placements between radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) in a clinical setting, assessed the reliability and aimed to decide on a possible "gold standard".

METHODS

All patients who had undergone at least two of three modalities, radiographs, MRI and CT, after ACL reconstruction between January 2011 and June 2013 were included. Two radiologists measured tunnel placements according to a standardized protocol. Interobserver agreement was assessed with intraclass correlation coefficients (ICC), the intermodality differences with Bland-Atman plots. Radiation data for CT studies were collected.

RESULTS

Forty-six CTs, 45 radiographs and 30 MRIs were reviewed. Femoral inter-observer agreement for radiographs was ICC=0.64, for CT ICC=0.86 and for MRI ICC = 0.75. Tibial inter-observer agreement for radiographs was ICC=0.92, for CT-mip ICC=0.91, for CT and MRI ICC = 0.87. No intermodality differences between the femoral measurements were observed. In the tibia, there were differences between radiographs and CT (-3.9%), radiographs-MRI (-3.6%), CT-CT mip (3.2%) and CTmip-MRI (-3.1%). The effective radiation doses varied between 0.025 and 0.045 mSv, mean and median was 0.033 mSv.

CONCLUSION

There were differences in the tibial measurements between summation and single slice images. Only 3D-CT depicted the femoral tunnel in both directions. CT was consistently reliable in both femoral and tibial measurements. Effective radiation dose from CT was lower than previously reported. CT can safely be used in routine clinical practice to evaluate tunnel placements after ACL reconstruction.

Determination of (210)Po in calcium supplements and the possible related dose assessment to the consumers

The aim of this pioneer study was to investigate the most popular calcium supplements as a potential additional source of polonium (210)Po in human diet. The analyzed calcium pharmaceutics contained organic or inorganic calcium compounds; some from natural sources as mussels' shells, fish extracts, or sedimentary rocks. The objectives of this research were to investigate the naturally occurring (210)Po activity concentrations in calcium supplements, find the correlations between (210)Po concentration in medicament and calcium chemical form, and calculate the effective radiation dose connected to analyzed calcium supplement consumption. As results showed, (210)Po concentrations in natural origin calcium supplements (especially sedimentary rocks) were higher than the other analyzed. Also the results of (210)Po analysis obtained for inorganic forms of calcium supplements were higher. The highest (210)Po activity concentrations were determined in mineral tablets made from sedimentary rocks: dolomite and chalk - 3.88 ± 0.22 and 3.36 ± 0.10 mBq g(-1) respectively; while the lowest in organic calcium compounds: calcium lactate and calcium gluconate - 0.07 ± 0.02 and 0.17 ± 0.01 mBq g(-1). The annual effective radiation doses from supplements intake were estimated as well. The highest annual radiation dose from (210)Po taken with 1 tablet of calcium supplement per day was connected to sample made from chalk - 2.5 ± 0.07 μSv year(-1), while the highest annual radiation dose from (210)Po taken with 1 g of pure calcium per day was connected to dolomite - 12.7 ± 0.70 μSv year(-1).

The open fontanelle: a window to less radiation

INTRODUCTION

Over the years, there has been increasing awareness of the radiation doses from medical investigation and treatment modalities and the long-term effect of this radiation. In no other patient population is this more of an issue than in the paediatric population who are more radiosensitive and have a longer life span in which to express any negative effects of radiation. In children under the age of one, the anterior fontanelle is an acoustic window to intracranial structures allowing for the use of cranial ultrasound (CRUSS) instead of CT.

AIM

To determine the pattern of CT and Cranial ultrasound used in patients aged one or younger with shunt treated hydrocephalus.

METHODS

A retrospective review of patients who had a shunt inserted before the age of one and their imaging. Effective radiation doses were calculated for those who had CT scans.

RESULTS

One hundred thirty-five patients were included with 227 CTs and 124 CRUSS conducted. In the follow-up period after shunt insertion, 92 patients had CTs while 14 were followed with CRUSS and 51 patients required a shunt revision before the age of one. The average effective radiation dose per scan was 2.76 mSv.

CONCLUSION

Children with an open fontanelle and shunt can be followed reliably with CRUSS in order to reduce their exposure to radiation.