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PubMed2002

[Optimal intravascular brachytherapy: safety and radiation protection, reliability and precision guaranteed by guidelines, recommendations and regulatory requirements].

BACKGROUND: The success of intravascular brachytherapy relies entirely on the interdisciplinary approach. Interventional cardiologists, radiation oncologists and medical physicists must form a team from day 1. All members of the team need special knowledge and regular training in the field of vascular radiation therapy. Optimization of intravascular brachytherapy requires the use of standardized methods of dose specification, recording and reporting. This also implies using standardized methods of source calibration in terms of absorbed dose to water and having methods for simple internal control of the dosimetric quantities of new or replaced sources. Guidance is offered by international recommendations (AAPM TG 60, DGMP Report 16, NCS and EVA GEC-ESTRO). LEGAL REQUIREMENTS FOR RADIATION PROTECTION--WHAT'S NEW?: In Europe, new legal requirements on radiation protection issues have to be fulfilled. For Germany, the revised "Strahlenschutzverordnung" has been released recently. Nearly all organizational and medical processes are affected. For intravascular brachytherapy, several changes of requirements have to be considered. However, to follow these requirements does not cause serious problems. DGMP REPORT 16: GUIDELINES FOR MEDICAL PHYSICAL ASPECTS OF INTRAVASCULAR BRACHYTHERAPY: Evaluation of clinical results by comparison of intravascular brachytherapy treatment parameters is possible only if the prescribed dose and the applied dose distribution are reported clearly, completely and uniformly. The DGMP guidelines thus recommend to prescribe the dose to water at the system related reference point PRef at 2 mm radial distance for intracoronary application (and at 5 mm for peripheral vessels). The mean dose at 1 mm tissue depth (respectively at 2 mm) should be reported in addition. To safely define the planning target volume from the injured length, safety margins of at least 5 mm (10 mm) have to be taken into account on both ends. Safety margins have also to be considered for multisegmental treatment, to omit underdosage. IVUS based localization will support precise planning, avoid a geographic miss and edge effects and will allow for later evaluation. These DGMP recommendations are also included in the EVA GEC ESTRO recommendations and in the draft for an up-date of the AAPM TG 60 report. CONCLUSION: Medical physical quality management of intravascular brachytherapy is a necessary condition for optimal and safe treatment. Procedures, devices, and sources should fulfill the same degree of precision and safety as common in radiotherapy.

Brachytherapy↗
PubMed1988

Prospects for new information relevant to radiation protection from studies of experimental animals.

The theory underlying radiation protection was developed from studies of people, laboratory animals, tissues, cells and macromolecules. Data on people were obtained from opportunistic studies of individuals previously exposed to radiation. Rarely has it been possible to conduct prospective studies of people exposed to known quantities of radiation, which sharply restricts the nature of questions that they can address. In contrast, studies using laboratory animals and simpler biological systems can be designed to address specific questions, using controlled exposure conditions. In-vitro research with macromolecules, cells and tissues leads to understanding normal and disease processes in isolated biological components. Studies of the intact animals provide opportunities to study in vivo interactive mechanisms observed in vitro and their role in development of radiation-induced diseases such as cancer. In the future, studies of intact animals should prove increasingly valuable in linking new knowledge at the subanimal level with the more fragmentary information obtained from direct observations on people. This will provide insight into important issues such as (a) effects of low-level radiation exposures, (b) mechanism of cancer induction at high versus low radiation doses, and (c) influence of factors such as nutrition and exposure to chemicals on radiation-induced cancer. This presentation describes strategies for conducting and integrating results of research using macromolecules, cells, tissues, laboratory animals and people to improve our understanding of radiation-induced cancer. It will also emphasize the problems encountered in studies at all levels of biological organization when the disease is observed in low "excess incidence" long after exposure to the toxicant.

Animals↗
PubMed2002

Piloting a new radiation protection program strategy: rewarding compliance rather than sanctioning non-compliance.

In an attempt to improve compliance with historically problematic radiation protection program requirements, a novel incentive program was created in cooperation with a major vendor of biomedical research products. Researchers using radioisotopes that placed orders from a partnering vendor were afforded an added price discount if verified by the institutional radiation safety program to be in compliance with laboratory contamination survey requirements. The program, piloted for a period of 1 y, resulted in a total institutional savings of approximately $2,200 and a 27% improvement in compliance with targeted objectives when compared with previous years. Feedback from pilot participants was extremely positive, as the program served to shift the perception of the radiation protection program from one that sanctions non-compliance to one that rewards compliance. The relative success of the pilot program suggests that the approach may be broadly applicable both within radiation safety programs and other safety-related settings as well.

Cooperative Behavior↗
PubMed1994

Re-evaluation of a radiation protection cost benefit analysis study in brachytherapy.

Cost benefit analysis has been in use for many years as a method for making a comparison between the costs of radiation protection and the benefits of reduced radiation exposure. It is advocated by the International Commission on Radiological Protection (ICRP) and the National Radiological Protection Board (NRPB) has given more specific advice relating to the value of the man Sv to be used in the calculation of cost benefit. The purpose of this study is to investigate the changes in the NRPB advice over the last 10 years by correcting all figures for inflation and applying them to a particular radiation protection example. The example employed is a previously published case of the introduction of afterloading brachytherapy equipment at the Christie Hospital, Manchester. It has been shown that for this specific example the NRPB advice at one time led to a large cost benefit, at another time it led to a large cost deficit and later still it again gives a large cost benefit. Application of cost benefit analysis to decision making in radiation protection is therefore shown to be in need of further investigation and clarification before it can be used with confidence.

Brachytherapy↗
PubMed2006

Dosimetric issues in radiation protection of radiotherapy patients.

As life expectancy increases, thanks to improving general medical practices, cancer treatments for the ageing population become evermore necessary. Radiation therapy is increasingly a treatment of choice, promoted by continuing improvements in dose delivery technologies. Some techniques, collectively referred to as intensity-modulated radiation therapy, are encountering widespread acceptance and implementation, promoted by reports of superior tumour control and reduced toxicity. However, these new techniques pose new challenges in terms of radiation protection of patients, as they cause a more extensive low-dose exposure of normal tissues compared with conventional radiation therapy. The related dosimetric challenges and the methods available to tackle them are reviewed in this paper, which also emphasises the need for standard radiation protection dosimetry procedures so that information may be consistently gathered for a comparative evaluation of the different treatment modalities.

Adolescent↗
PubMed1988

H.M. Parker lecture. Radiation protection standards: a historical perspective.

The historical development of radiation standards limiting exposure to people is given in this paper. Since its purpose was to provide information to the public, the number of units is limited to two, and mathematical expressions are avoided. Emphasis is placed on the role of the National Council on Radiation Protection and Measurements and the International Commission on Radiological Protection rather than on regulations because the recommendations of these groups have played a strong part in the formulation of regulations.

Government Agencies↗
PubMed1999

[Radioiodine therapy of Graves' disease--quality assurance and radiation protection].

Radioiodine (I-131) is used successfully since more than 50 years for treatment of hyperthyroidism in Graves' disease. In the USA, more than half of the patients with a Graves' hyperthyroidism are treated primarily with radioiodine, whereas in Europe the frequency is less than a quarter of the patients. In Germany consensus could be achieved, the antithyroid drugs are indicated in patients with manifest hyperthyroidism to induce euthyroidism before radioiodine treatment. Typical indications for radioiodine treatment are: Treatment with antithyroid drugs without success for more than one year, drug-incompatibility and increased risk for surgery. In relation to the radiation dose applied, hyperthyroidism is eliminated after radioiodine treatment; in 80-100% of the patients the incidence of hypothyroidism ranges between 50 and 100%. In Germany, for reasons of quality assurance and radiation protection, radioiodine treatment is carried out in hospitals with wards equipped with radiation protection facilities; fractionated treatment with radioiodine is not allowed. Due to recent changes in radiation protection regulations, patients can be dismissed earlier from the wards than before; the mean duration of stay could be decreased from 10-12 to 3-4 days. Radioiodine treatment is safe and has only few side effects. However, patients have to be followed-up for life. Considering the cost-benefit-relation, radioiodine treatment has advantages especially in patients with small goiters as compared to surgery.

Graves Disease↗
PubMed2001

Results of a Division of Radiation Protection scrap yard exercise.

For years the Division of Radiation Protection (DRP) has participated in exercises, which are required by the Federal Emergency Management Agency (FEMA) to demonstrate our ability to deal with an accident at a nuclear power plant. These demonstrations are defined by objectives and are structured such that they offer little opportunity to practice for real-world radiological events in the exercise. Since real-world radiological incidents do occur throughout the year, this exercise was designed to be as realistic as possible. A scrap yard incident was chosen as the most probable type of event. The exercise was conducted on May 5 and 6, 1999.

Decontamination↗
PubMed2001

Mechanistic bases for modelling space radiation risk and planning radiation protection of astronauts.

The approaches generally adopted for planning radiation protection in ground-based facilities cannot be applied straightforward for astronaut protection in space. Indeed in such extreme conditions, modelling methods and shielding design must be based on a detailed mechanistic knowledge of the peculiar astronauts irradiation conditions. Great help can derive from mechanistic modelling, generally aimed to better understand the intermediate steps leading from the initial energy depositions to different biological endpoints, up to organ and organism level. In the present work, criteria will be illustrated for using mechanistic approaches in developing practical tools for astronauts radioprotection, once the external field and the interaction cross sections with the spacecraft walls are known; particular attention will be given to the treatment of mixed fields. Techniques for integrating into condensed-history codes stochastic information provided by event-by-event simulations will be presented.

Aerospace Medicine↗