Annotated Bibliography: Radiology: medical exposure of radiation to patients and link to cancer.

This document is an accumulation of annotated bibliographies of medical journals spanning from 2008-2013, because the medical field values research that has occurred in the last five years. It is intended as an overview of a conversation that is common within the radiology discourse community. Overall the information is presented in a very subjective manner were various forms of articles such as case studies and patient analysis were gathered solely from medical journals accessed through the University of Central Florida library database not only to add credibility to the various physicians and researchers, but to provide a common accessible source for future users of this document. Commonalitys throughout most of the journals is the need for patients and doctors to be more aware of radiation exposure (i.e. CT imaging), because its not the imaging that is damaging, it is a about repetitious exposure to the ions of radiation which is commonly ignored, and could potentially get stimulated somewhere within the body to form a carcinoma. In addition throughout the article the need to reduce radiation was cohesive as they preferred to use other methods, because not only are they better for the patitent,but

Krystal Bowen English 1102 March 15,2013

they are also cheaper. The goal of this was to give anyone who is not a physician or a researcher the ability to learn more about the potential risk of repeated radiation exposure and its correlation to cancer so that they have the ability to educate themselves and take control of their health. In addition, anyone who is not a

professional should also discuss their procedures and recovery process with a licensed physician before making any drastic changes. A Siountas, et al. Radiation Exposure to Patients and Radiologist During Interventional Procedures. Radiation Protection Dosmetry 147. 1-2(n.d) :86-89. Science Citation Index. 21 Feb. 2013 The authors, researchers of the AHEPA General Hospital for angiography or angioplasty conducted a case study where they tested 32 patients are assigned to two physicians who control their exposure to radiation. To uncover the overall exposure that the patients, and physicians had been exposed to during medical procedures, they used a software programs to calculate absorbed doses and weighed the tissue samples as an identifying factor of exposure. In this experiment each patients has a physician who was randomly assigned, in order to allow the data to be representative of only the lens exposure. Throughout the case study they used the Niklason formula to calculate the data, which did correlate to the total, DAP that led to validity of this study because it produce the most accurate and applicable data. J Damilakis, et al. "Thyroid Exposure To Scattered Radiation And Associated Second Cancer Risk From Paediatric Radiotherapy For Extracranial Tumours." Radiation Protection Dosimetry 152.4 (n.d.): 317-322. Science Citation Index. Web. 4 Mar. 2013. This case study was conducted under the head of Faculty of Medicine for the University of Crete in which they attempt to estimate the impact of scattered thyroid dosage, and its applicable risk to cancer due to extended radiotherapy

exposure for extra-cranial tumors during childhood. The purpose of this study was to uncover more about the effects of scattered radiation on thyroid carcinoma due to limited material on the subject; despite being a common consequence of radiotherapy treatment that helps with prior childhood cancer. This case study was conducted on two anthropomorphic phantoms (plastic shells in the proper anatomical shape) that represents the common 5 and 10-year-old pediatric patient. Despite the lack of real patients they were able to simulate all of the tissues in addition to the bones, spinal cord, spinal discs, lung, brain, sinus, trachea, and bronchial cavity. Also to minimize bias the bone tissues matched age related density and expose them equally to the same amount of radiation exposure a typical patient would experience. They concluded that it is possible to reduce that thyroid dosage is they properly place the lead shield over the neck in order to reduce exposure. This is important because now they have found away to reduce it; it can be implemented which would result in a decrease of exposure for patients. KY Gulenchyn, et al. "Radiation Doses Originating From Diagnostic Procedures During The Treatment And Follow-Up Of Children And Adolescents With Malignant Lymphoma." Journal Of Radiological Protection 31.1 (n.d.): 83-93. Science Citation Index. Web. 8 Mar. 2013. Pediatric patients with malignant lymphoma will undergo a malignant diagnostic procedure that involves them being expose to ionizing radiation. In addition to that some will also be introduced to more radiation has the go through radiotherapy. Despite that these therapeutic radiation exposures being prescribed

its effect in children patients are still unknown. Overall the average effective dose was 518 mSv patients with the Hodgkin Lymphoma and 309 3mSv for those non Hodgkin Lymphoma patients. While the maximum dose was 1.7Sv.In the end the researchers under the Department of Nuclear Medicine came to the conclusion that the burden caused by the diagnostic imaging procedures performed routinely in children were considerable for there to only be 40% survival. Overall what accumulated in the in the most cumulative effective doses are CTs and GA scans. Ngaile, JE, P Msaki, and R Kazema. "Patient-Size-Dependent Radiation Dose Optimisation Technique For Abdominal Ct Examinations." Radiation Protection Dosimetry148.2 (n.d.): 189-201. Science Citation Index. Web. 6 Mar. 2013. Under the Directorate of Radiation, Tanzania Atomic Energy Commission a study was conducted in which they attempted to minimize a patients dose distributed to them as the underwent abdominal CT examinations. They performed this study with the use of cylindrical phantoms while using standard scanning methods followed up with selected combination of scanning parameters. Internet software accessible in both scanners allowed for the image noises to go through the phantom images so that they can be seen. The energy is then released to the x-ray detector were the result from the measurement of CT dose index is compared to atmosphere that is corrected for tempering of the phantom materials. In the end the results concluded that it can be reduced by 82% for a smaller phantom relative standard milliampere seconds, although the detector signals can be reduced by 93% for smaller relative to the amount of energy dispersed when they scanned using the standard format. In the end they revealed that with the use object-

specific scanning parameter on the studies performed, phantoms off various diameter could reduce incident radiation to a small size object by a significant amount in order to obtain the same image quality required for a standard object. Racadio, JM. "Controlling Radiation Exposure During Interventional Procedures In Childhood Cancer Patients." Pediatric Radiology 39.(n.d.): S71-S73.Science Citation Index. Web. 6 Mar. 2013. The head of the Department of Pediatric of Interventional Radiology discusses the various procedures that cancer patients go through over the period of their illness that results in them commonly having higher risk of radiation exposure than average paiteints. Radiologists have the ability to reduce the risk of exposure, which includes limiting the use of radiation if possible during interventional procedures, and they could also document it. In addition radiologist are somewhat obligated to hold staff radiation safety educational programs, because they are exposed to small amounts of it daily. Overall radiologist should be aware and consistently using procedures tat reduce further exposure in order to be preventive. This is important because it introduces that there are other people at risk for exposure other that the patients and automatically comes up with a solution to reduce the risk. Scaife, ER, and MD Rollins. "Managing Radiation Risk In The Evaluation Of The Pediatric Trauma Patient." Seminars In Pediatric Surgery 19.4 (n.d.): 252256. Science Citation Index. Web. 8 Mar. 2013. From the Division of Pediatric Surgery, University of Utah tried to decipher whether radiation correlates to cancer in patients. A common diagnostic tool is the

computed tomography scan. Typically children require evaluation for significant trauma will get a CT scan, but there are no guidelines or assessment to measure impact. Yet the question arises whether the liberal attitude towards children is appropriate because of the casual approach of exposing them to radiation due scans. In recent years people have become more aware and concerned over the radiation exposure delivered to kids through the imaging process. Resulting in a national campaign that promotes imaging gently. Despite whether or not the correlation is there it is something that physicians and patients should bother be aware of and document there dosage and scan. This is important because this is the first time this conversation has left its community and tried to become a part of mainstream through advertisement which educate the patients, forcing them to discuss there healthcare with there physicians. Seidenbusch, MC, and K Schneider. "Radiation Exposure Of Children In Pediatric Radiology - Part 1: Referral Criteria And X-Ray Examination Frequencies At A University Children's Hospital Between 1976 And 2003." Rofo-Fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren180.5 (n.d.): 410-422. Science Citation Index. Web. 7 Mar. 2013. Under the supervision of a pediatric oncologist they analyzed x-ray examinations performed in a universitys childrens hospital collecting in the database since 1976. Thirty years of collected in the database from all age groups; newborns to adolescent. The database now has all of a basic patients personal data. The analysis and preparation of this database was comprised of various algorithms. Childhood x-ray frequency and fluoroscopic examinations per patients has

suddenly changed over the last 30 years. In addition we were able to see that newborns and infants were higher compared to the other age groups. Overall the number of patients who has high number x-ray examinations decreased in the past years, proving that doctors are using preventative methods. This serves as a database to document patients e-rays diagnostics as well as for follow up and epidemiological studies. S Simoneaux, et al. "What Physicians Think About The Need For Informed Consent For Communicating The Risk Of Cancer From Low-Dose Radiation." Pediatric Radiology39.9 (n.d.): 917-925. Science Citation Index. Web. 7 Mar. 2013. Under The National Institute of Environmental Health Sciences, which is a subsidiary of Food and Drug Administration did a study to determine if patients should be given informed consent forms in order to communicate the risks of radiation-induced cancer due to radiation based imaging. A physician typically tends to be unaware of whether patients are knowledgeable of cancer risk from radiation-based imagings. Despite that they believe that informed consent for communication the risks should only be between patients undergoing radiation based imaging. This is important because it poses a question that is asked in the dialogue. Who should know the risk? T Inoue, et al. "Evaluation Of The Risk Of Radiation Exposure From New 18FDG PET/CT Plans Versus Conventional X-Ray Plans In Patients With Pediatric Cancers."Annals Of Nuclear Medicine 24.4 (n.d.): 261-267.Science Citation Index. Web. 4 Mar. 2013.

Under the Division of Cancer Screening, Research Center for Cancer the researchers attempted to evaluate the possibility of integrating positron emission tomography/ computed tomography against conventional imaging techniques in order to decrease radiation exposure in young patients while comparing it to the shortening of the life expectancy index. For this study they use the national average for a 10-year-old Japanese child which has a height of b140 cm and a weight of 35kg and then they evaluated the ten major pediatric cancers;( brain tumor, soft tissue, sarcoma, osteosarcoma, germ cell tumor, hepatoblastoma, neuroblastoma, retinoblastoma, Wilms tumor, leukemia and malignant lymphoma). The overall test was comprised of a PET scanner and a 16-section CT scanner, with the CT scan they scanned from the skull vertex through the pelvis using the standardized protocol. After the completion of the study they concluded that the effective dose in PET/CT plan of care was dramatically lower than CI plan. Wakeford,Richard. The Risk of Childhood Lukemia Following Exposure to Ionising Radiation. Journal of the Radiological Protection 33.1(n.f.): 1-25. Biological Abstract 1969-Present. Web. Feb. 24.2013 The researchers at Dalton Nuclear Institute, The University of Manchester Has analyzed the data collected from follow-up of the Japanese atomic bomb survivors, and has seen a correlation that has linked childhood leukemia and its sensitivity to induction by ionizing radiation. There is an excess relative risk (ERR) of being expressed as a temporal wave since exposure time. This pattern has been generally conrmed by studies of children treated with radiotherapy. A

recent large case-control study of radiation and childhood leukemia has found evidence of raised risks following low-level exposure. These ndings indicate that an ERR/Sv for childhood leukemia of ~50, which is derived from risk models centered around the Japanese atomic-bomb survivors, is roughly valid to low dose-rate exposure circumstances

Ronald M. Stewart, et al. "Pediatric Radiation Exposure During The Initial Evaluation For Blunt Trauma."Journal Of Trauma Injury Infection And Critical Care70.3 (n.d.): 724-730. Biological Abstracts 1969 - Present. Web. 1 Mar. 2013. According to researchers at The University of Texas Health Science Center the increased use of computed tomography (CT) scans for checkup of blunt force trauma has caused an overall increased dosage of radiation in

patients. Radiation dose is magnified in children due to body size, and making them more vulnerable to the long-term carcinogenic effects of radiation. There purpose for this research is to measure radiation dosage received in pediatric patients who have blunt trauma during first CT evaluation to determine whether those doses exceed doses traditionally linked with an increased risk of thyroid cancer. A study of patients from ages 0 years to 17 years conducted over a 6month period was used to collect the data. Dosimeters were placed on their necks, chests, and groin before each CT scanning in order to measure their surface radiation in order to collect the data. Study of the patients fell within the dose range associated with an increased risk of thyroid cancer and while the bodys effective doses fell within an increased risk of all cancers.

William Hollingworth, et al. "Radiation Exposure From Pediatric Head CT: A BiInstitutional Study." Pediatric Radiology 39.10 (2009): 1059-1065. Academic Search Premier. Web. 6 Mar. 2013. Under the leadership of the head of the Department of Pediatrics of Harborview Medical Center they examined the radiation dose from head CTs in children in a trauma center at a regional childrens hospital. With a random sample of 240 children ranging from; 0-3,4-9.10-14 years of age from the hospital were compared with a comparable cohort. All of the children had underwent at least a minimum of one head CT scan without enhancement. Using the PACS and Department of Radiology Information System were used to estimate an average dose and to reduce bias they equated for a lifetime of potential attributed risks of cancer incidence was estimated using Biologic Effects of Ionizing Radiation report. In the end the radiation dose from children with head CTs was defined by the normalized ED tend to be the highest in children and varied significantly.