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Objective:To investigate the application of diagnostic criteria for common occupational radiation-induced diseases to radiation workers, in order to provide a basis for the revision, publicity and standardization of the standards.Methods:Radiation workers were selected from 1 city, 7 provinces and 1 corporation by using cluster random sampling method from January 2021 to May 2021. Awareness of the criteria and the effects of ionizing radiation, and the suggestions for diagnostic works were investigated and analyzed.Results:A total of 2 839 radiation workers were investigated. There were differences in the awareness of different diagnostic criteria, the inclusions in complex diagnostic criteria, the materials required for applying for diagnosis, and the ways of knowing the diagnostic criteria( χ2=416.06, 2 924.14, 83.45, 895.67, 815.94, P<0.001). The correct understanding rates of deterministic effects and stochastic effects were 80.63% and 43.64%, respectively. The acceptance rates in applicable materials were 96.79% for occupational exposure history, 94.72% for occupational health monitoring records and 93.55% for individual monitoring of occupational exposure, respectively. Pre-employment training rate was 80.20%, on-job training rate was 81.19%, and untrained rate was 3.77%. The suggestions to the diagnosis of occupational radiation-induced diseases are to strengthen training, pay attention to individual monitoring, occupational health examination, and strengthen health supervision and law enforcement. Conclusions:Radiation workers have a low awareness rate of certain diagnostic standards and a high awareness rate of diagnostic procedures. Publicity and training of health effects of ionizing radiation and diagnostic criteria of occupational radiation-induced diseases should be strengthened. Diagnostic procedure should be optimized.
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There are differences and inconsistencies to some degree in the radioactive contamination control level of personnel′s body surface availiable in many national standards, thus puzzling the users. Therefore, it is proposed to compare the applicable scope, conditions and differences between relevant national standards, and combine with similar clinical nuclear medicine standards of radiological protection content to presevent recommendations on the contamination control level that should be correctly applied in an event of nuclear and radiological emergency. Based on the discussion of similar standards, the contaminated personnel with α of 0.04-10 Bq/cm 2 and β of 0.4-100 Bq/cm 2 are advised to be treated in the institutions with higher than secondary medical insititution. Both α econtamination control levels less than 0.04 Bq/cm 2 and β levels less than 0.4 Bq/cm 2 could be achivable, if fully decontaminated.
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Objective:To explore the optimization of tritium internal exposure monitoring and dose estimation for radiation workers at pressurized heavy water reactor nuclear power plants (PHWR NPPs).Methods:A total of 92 radiation workers at Candu-6 PHWR NPPs were observed to calculate the distribution of quenching index (tSIE). Ten samples with tSIE values ranging from 160 to 460 were selected to make the blank urine quenching curve. By comparing with the quenching curve accompined with the equipment, the optimization of correlationship of urine tritium measurement system was carried out. In estimating tritium internal radiation dose, the dose coefficient was optimized and adjusted by comparing the Canadian algorithm with the national standard algorithm. Dead time correction curve was drawn by means of heavy water simulation experiment diluting main heat transfer system.Results:Through the analysis and optimization of tritium internal dose estimation, the optimal dose coefficient was determined to be 4.8 and the quenching curve of blank urine sample was made. By comparison, it was found that the deviation was larger when tSIE<200, which confirmed the necessity of blank curve. When the tritium concentration in urine was higher than 2.4×10 4 Bq/ml, the urine sample needed to be diluted and then measured to correct the effect of death time. Conclusions:By optimizing both tritium internal exposure monitoring and dose estimation, not only the collective dose management can be improved, but also the unplanned tritium intake can be detected and treated in time, which plays an important role in ensuring the protection and safety of the radiation workers at PHWR NPPs.
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In April 2021, the Japanese government decided to discharge nuclear wastewater from the Fukushima Daiichi nuclear power plant into the sea, which aroused widespread concern all over the world. The radioactive substances in nuclear wastewater may affect the environment through the action of ocean circulation, groundwater or carbon cycle. In addition, it may expose people to the health effects of low-dose but long-term pollution once nuclear wastewater is discharged into the sea. Based on this, this paper discusses the possible global environmental impact of nuclear wastewater from a general perspective and illustrates its possible health effects as well as potential mental health problems from an individual perspective, and puts forward some suggestions on the issue of Fukushima nuclear wastewater discharge.
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Objective:To evaluate biological dose and retrospective biodosimetry of a case of large area back skin injury caused by suspected interventional procedure.Methods:Peripheral blood from the patient was collected at about 7 months after interventional procedure, and the chromosomal aberrations in peripheral blood cells were analyzed to evaluate the retrospective biodosimetry using the correction factor of dose estimation, Dolphin′s model and Qdr method, respectively. Results:Based on the amounts of semi-automated dic and manually detected dic plus ring, the whole-body average absorbed dose of the victim was estimated to be 0.68-0.95 Gy by four different dose response curves. Over dispersion of dic or dic plus ring was also detected, and the efficiency of dose assessment was obviously increased using dic semi-automatic detection. Based on three different retrospective biodosimetry models, the estimated average absorbed dose was further corrected to be between 1.80-2.86 Gy, which was consistent with clinical diagnosis of degree Ⅳ radiation skin injury.Conclusions:A case of suspected radiation skin injury was confirmed by chromosomal aberration analysis and it’s biodosimetry was reconstructed, suggesting that the unstable chromosomal aberration analysis may be applicable to assess the retrospective biodosimetry of non-uniform local radiation exposure.
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Objective:To carry out investigation and analysis of an extensive skin radiation injury to the back accidentally caused by interventional procedure and to explore the problems faced in the event with emphasis on avoiding the reoccurance of similar events in the future.Methods:The data were collected by consulting the patient′s detailed medical history, collecting and analyzing clinical diagnosis and treatment data, tracking and observing their clinical manifestations and signs. The patient′s peripheral blood samples were also collected, together with the biological dose estimated and the equipment data collected on the site of the interventional treatment hospital.Results:The whole body dose to the patient was estimated to be 0.95 Gy. The typical values of kerma rate of radiation incident on the body surface due to fluoroscopic procedures were 373.5 mGy/min in subtraction modality and 47.8 mGy/min in fluoroscopy modality, respectively. The annual effective dose to the interventional radiologist was 20.51 mSv due to his operation in long-time radiation exposure conditions, higher than 3.09 mSv for other interventional radiologists with similar workload in the same department. The whole body and local clinical manifestations of the patients were in line with radiation injury. No clear diagnosis has been obtained in several hospitals, nor can obvious treatment outcomes be obsevered.Conclusion:Combined with the biological dose estimation result and clinical manifestations, the case was diagnosed as degree Ⅳ skin radiation injury. Radiation injury is closely related to whether the operation is conducted according to the standard and the output dose of X-ray machine. Non-specialized hospitals should strengthen clinical diagnosis and treatment of radiation injury.
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Objective:To estimate the physical dose of an over exposed person working for industrial radiography.Methods:The main exposure parameters were obtained. The exposure duration was 8 min. The exposure pattern was external exposure by isotropic point radioactive source. The radioactive activity was 2.183 TBq. In the present calculation, the Chinese reference adult voxel phantom was used, and the Monte Carlo simulation was performed using the program based on the secondary development of Geant4 to obtain the absorbed dose of each part of the victim.Results:The dose distribution in the victim′s hands was obtained. The doses to most areas of the palm were 2-10 Gy, and the doses to the fingers were 10-20 Gy. The equivalent doses to 23 tissues or organs of the exposed person were estimated to be in the range of 0.012-0.207 Gy.Conclusions:The physical dose estimation method could evaluate rapidly the local dose distribution of the victim′s key exposed body parts, and thus provide an important reference for medical treatment.
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Objective:To investigate radiation-induced somatic mutations and variations and provide theoretical basis for clarifying radiation-induced genetic changes and long-term effects by whole-genome sequencing analysis of the genetic variations of the victim of the " 5.7" 192Ir radiation accident in Nanjing. Methods:Normal back skin tissue, irradiated bone and soft tissues, and peripheral blood were collected from the victim 2 047 days post-irradiation. DNA of these samples was extracted and sequenced with high-throughput genomics and analyzed by bioinformatics method. The genetic variations of between irradiated and normal tissues were compared.Results:Compared with normal back skin tissue, there are large amounts of genetic variations in the irradiated bone and soft tissues and peripheral blood, including base substitution (transition, transversion), small insertion, small deletion, copy number variation (gain, loss) and structure variation (large deletion, large duplication, inversion, intra-chromosomal translocation, inter-chromosomal translocation). There were 10 666 genetic variations in the irradiated bone and soft tissues and 11 233 genetic variations in peripheral blood, where thousands of genes were involved in. These variations occurred in the exons, introns, UTR′3, UTR′5, splicing sites, within 5 kb upstream of transcription initiation site, within 5 kb downstream of transcription termination site, ncRNA and intergenic region. All chromosomes had genetic variations.Conclusions:There were a large number of genetic variations in the irradiated tissues and blood of the victim at 2 047 days after irradiation, which may affect the body function and cause the long-term effects.
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Objective To explore radiation protection cognition and mental health status of the staff in the second level and lower hospitals of a certain city. Methods Design a questionnaire on radiation protection knowledge and conduct a mental health test. The content of the questionnaire includes 26 questions in 2 dimensions, including general personal information and radiation protection knowledge. Among them, there are 20 questions about radiation protection knowledge. the self-rating symptom scale (SCL-90) is selected for the mental health test, with a total of 90 questions. Results The average score of the radiation protection knowledge question survey was (13.62 ± 2.21) points. The accuracy is less than 60% 102 people (16.04%); 60%~79% 430 people (67.61%); ≥ 80% 104 people (16.35%). SCL90 test indicates that 38.99% (248/636) of radiation workers is poor in mental health, the scores of each main factor are higher than the national norm. Among them, the somatization, obsessive-compulsive symptoms, interpersonal sensitivity and anxiety of radiation workers were relatively significant, with statistical differences (P < 0.05). Conclusion The overall cognition level of radiation protection staff in primary hospitals of a certain city is very low, therefore, training and supervision need to be strengthened. There are still some radiation workers whose mental health is not good, and active psychological intervention measures should be taken.
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Tritium (3H) is an isotope of hydrogen. The main sources in the environment are natural tritium and artificial tritium.Artificially produced tritium appears as a by-product or a key fuel in the development of nuclear energy, and its release rate far exceeds that of natural tritium. The public's exposure to tritium in the environment is very low. Strategically speaking, the protection of tritium should focus on occupational exposure workers. This article briefly summarizes the nature, source, hazards, protection and pollution treatment of tritium, so that the public and radiation workers can understand relevant knowledge and do personal protection.
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Objective@#To evaluate the parabiotic tissue protection concept in the repairment of acute radiation-induced skin injury.@*Methods@#Seven patients(3 males and 4 females) with acute radiation injury treated in the Department of Plastic Surgery of the Second Affiliated Hospital of Soochow University from February 2014 to January 2018. The ages of patients ranged from 45 to 76 years. The wound areas include perineum and buttock (n=3), chest(n=2), and thigh(n=2). In the early stage, subregional " sandwich" surgical dressing was used to protect the probiotic tissue. Two months later, the necrotic tissue was clearly demarcated, the debridement was underwent, and the parabiotic tissue was preserved as far as possible. Vacuum sealing drainage(VSD)was applied to cover and soak wound with normal saline to moisturize the wound and promote the benign transformation of ecological tissue. Ten days later, the granulation grown well, and the skin flaps and myocutaneous flaps with good blood supply were designed to repair the wounds. The VSD device was continued to be used, to drain effusion under flap and promote the growth of cystic cavity granulation, with the purpose to promote blood supply of the skin flap, perform the final biological cleaning effect on the parabiotic tissue of the wound surface, promote the benign transformation of parabiotic tissue, and reduce the further necrosis.@*Results@#Seven patients with Ⅳ degree acute radiation-induced injury wounds were treated 6-10 weeks for surgery preparation, and 2-4 weeks for VSD-application after debridement. Except for part of flap was necrotized on 10th day after the first operation in one patient, all the other patients achieved satisfied outcome in a surgery. There was no further radiation-induced ulcer occurred during the 0.5-3 years of follow-up.@*Conclusions@#The concept of parabiotic tissue protection during preoperative, intraoperative and postoperative recovery phase can promote parabiotic tissue transformed to a good result after acute radiation injury, and reduce the size and depth of soft tissue necrosis, which can provide a good foundation for the secondary repair with flap and reduce complications.
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Objective@#To explore the treatment technique, occurrence and development patterns of such radiation injuries as in a major radiological accident in which a victim suffered mild bone marrow radiation sickness combined grade degree Ⅲ acute radiation induced skin injury, based on his dose estimation, clinical manifestations and disease treatments.@*Methods@#History inquiry in detail, earlier physical dose estimation and biological dose estimation were conducted in conjunction with analyzing the chromosome aberration of peripheral blood lymphocytes. The physical dose was estimated by Monte Carlo method.The systematic laboratory and imaging examination was performed to evaluate the condition. The comprehensive analysis was conducted to determine the diagnosis and treatment plan.@*Results@#At 3d after the exposure, "Ren" felt mild pain and discomfortable on the skin of the right index finger. The body of the right hand index finger was covered with blister at 21 d after exposure.The estimation of biological dose was 0.43 Gy (95%CI: 0.31-0.58 Gy), and the physical dose was estimated to be 36-164 Gy for each part of the right hand finger. The hematopoietic system, immune system and endocrine system were normal. The liver function index value was transiently increased. The liver damage resulted from the use of antibiotic-induced combined with the patient′s past medical history and admission examination result, and the relevant antibiotics were discontinued. The liver function returned to normal after liver protection treatment. At 22 d after irradiation, a right finger incision and decompression surgery were performed. The stem cells were extracted and implanted into the right index finger. After 59 days of hospitalization, there was no obvious discomfort in the body, and the right index finger recovered well, as well as the pain significantly relieved, and the knuckle activity was basically normal.@*Conclusions@#The patient with excessive radiation and grade Ⅲ acute radiation skin injury was successfully treated, and local application of autologous adipose-derived stem cell transplantation achieved good result .
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Objective To estimate the absorbed dose and effective dose to the examined adult patients during digital tomosynthesis and to provide reference data for radiation dosimetry.Methods The phantom experiments were grouped according to the examined site(main beam scanned site),and the data displayed in real time during digital tomosynthesis are used as conditions for the phantom experiments.The effective doses to the examined patients were estimated on the basis of phantom scanning and tissue-absorbed dose calculation.Results During digital tomosynthesis,the effective doses to the examined patients of various groups were 0.524 mSv for head,0.736 mSv for cervical spine,2.719 mSv for thoracic vertebra,1.810 mSv for chest,1.240 mSv for lumbar spine,2.317 mSv for abdomen and 2.316 mSv for pelvis,respectively.Conclusions During digital tomography,the highest value of effective doses was estimated to be 2.719 mSv in thoracic vertebra group,followed by abdominal group 2.317 mSv and pelvic group 2.316 mS,with the lowest 0.524 mSv in head group.The main factors influencing the effective dose include tube voltage,total mAs,irradiation field size,main beam irradiation range,and the number of tissues or organs in scanned range.
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Objective To investigate the safety and clinical value of using ExoSeal vascular closure device (VCD) in interventional management via antegrade femoral access.Methods Clinical and imaging data of 303 patients (316 affected limbs) who were received interventional procedure via antegrade femoral access closure were retrospectively analyzed.ExoSeal VCD (VCD group,n=127) and manual compression (MC group,n =176) were performed to make femoral artery puncture point hemostasis.The time of hemostasis,actual immobilization time,technical success rate and vascular related complications were recorded and compared between the two groups.Results In VCD group and MC group,the time of hemostasis were (3.68 ± 2.40) min and (18.32 ± 4.54) min,the actual immobilization time were (3.45±5.30) h and (10.44±14.68) h,the technical success rates were 98.52％ (133/135) and 93.92％ (170/181),and the complication rates were 2.22％ (3/135) and 8.84％ (16/181),respectively.There were statistically significant differences between two groups (all P＜0.05).In VCD group,there were 2 cases of subcutaneous hematomas,and 1 case of retroperitoneal hematoma.In MC group,there were 15 cases of subcutaneous hematomas and 1 case of acute thrombosis in the puncture side limb.Conclusion Regarding hemostasis of puncture site in interventional management via antegrade femoral access,the use of ExoSeal VCD is safe and effective.
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Objective To investigate the late effects induced by ionizing radiation and the rehabilitation treatment of local radiation injury by medical follow-up of the patient exposed to192 Ir at 5.7 accident in Nanjing,and to provide more experience for the treatments in the medical emergency of nuclear or radiological accident.Methods According to the history inquiry and physical examination of the patient in detail and the record of clinical symptoms and signs,the changes of the blood system,immune system,reproductive system,eyes,nervous system were systematically evaluated.The effects of rehabilitation treatment for the patient with lower limb dysfunction were also assessed.Results After the medical treatments of the patient,the hematopoietic immune system was restored,but the bone marrow aspiration still showed low bone marrow hyperplasia in right ilium.Meanwhile,the level of sex hormones was within the normal range,but semen examination showed sperm motility was 0.The radiation damage also occurred in the eye lens,retina and fundus.Howevcr,the psychological evaluation showed that the patient was stable and the right lower limb skin wound healing was well except for dysfunction and pain in some extent,which was relieved after the rehabilitation treatment.Conclusions The physiological function of the exposed victim with mild bone marrow type acute radiation sickness could be completely or partially restored after the clinical treatment in the early stage.
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Objective To investigate a dose response curve based on a genetic workstation with automatic analysis system of dicentric chromosome assay (DCA) for establishing a high speed dose estimation method.Methods Peripheral blood from three healthy volunteers was irradiated in vitro using 60Co γ-rays,and then lymphocytes were cultured and fixed on slides using the standard protocol for DCA.Dicentric chromosome in metaphase cells was analyzed automatically with the genetic workstation and confirmed manually,and the dose response curve of automated dicentric chromosome was fitted.Dicentric chromosome of another peripheral blood sample irradiated with different doses was manually analyzed to verify the accuracy of the above automated DCA.Results The yield of automated DCA was well fitted by an equation Y =0.018 06D2 + 0.012 79D + 0.000 489 1 with a correlation coefficient R2 =0.961.The biological dose of radiation could be accurately estimated by this dose response curve within a few minutes.Conclusions We had successfully established a new dosimetry method by analyzing dicentric chromesome automatically,which can save a lot of manual analysis time and hence has important significance for emergency rescue in nuclear accidents.
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With the continuously exploration,in recent years,further understanding of anatomical characteristics of the cervical pedicle brings great breakthrough in cervical pedicle screw implantation.In addition,pedicle screw implantation in cervical spine is considered as a technique with high safety and reliability,which can be widely used in cervical trauma fracture,cervical instability,degenerative,inflammatory,benign or malignant tumor,deformity and other neck diseases.Because of the tremendous differences between upper cervical spine (C1,C2) and lower cervical spine (C3-7) in anatomical morphology,cervical pedicle screw implantation in C1 and C2 differs from in lower cervical spine.Due to the similar structure of C3-7,pedicle screw implantation methods are based on the same principle and sharing a few points in common.The pedicle screw technique can be classified in two groups according to the practice methods:navigation technology and manual placement of cervical pedicle screw.Navigation nailing is considered as reliable,easy handing,and with clear operative vision,however,with disadvantages as complex procedures,highly cost operation equipment,and risk in navigation draft.Therefore,manual placement of pedicle screw is more reasonable and practical comparing with the former.In this study,it analyzed anatomical characteristics of lower cervical pedicle and the measurement of pedicle structure,discussed technique of manual placement of pedicle screw in lower cervical spine and biomechanical study of pedicle screw,and summed up the comparison of the advantages and disadvantages of current representative manual placement technology.
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Objective To investigate the clinical efficacy of lumbar-sacurm-iliac screws fixation in the treatment of complicated sacral fractures.Methods From January 2012 to October 2012,18 complicated sacrum fracture patients with unstable pelvic fractures and cauda equina dysfunctionwere retrospectively studied,which Gibbons score were all 4 points.Surgical treatment was performed by posterior lumbar-sacurm-iliac screw fixation combined with sacral decompression.The fixation stage can be extended to L4,S2 level by fracture.According to the patient's nerve injury and fracture displacement surgery sacral decompression and observation of nerve root injury.Ater full decompression,correct the vertical displacement and rotate the displacement,and then place the cross further fixed.The first 3 months after surgery,the patient reviewed once a month,3 months after the patient review once every six months.Results 18 patients underwent surgery for 2-21 d after injury,with an average of 10.2 d.The operation time is 150-240 min,an average of 180 min.Intraoperative blood loss of 600-2 000ml,an average of 1 100ml.The time of follow-up was 13-34 months,with an average of 23.4 months.Gibbons score averaged 4 points from preoperative to 2.78 points,the difference was statistically significant.Preoperative patients with an average angle of 42.89,postoperative 21.94,the difference was statistically significant.Postoperative Majeed scores averaged 64.5 points.Excellent in 3 cases,good in 3 cases,can be 7 cases,poor in 5 cases,excellent rate was 33.33％.Preoperative visual analogue scale (VAS) score averaged from 8.78 points before surgery to 2.22 points,this difference was statistically significant.The results of Tometta and Matto method were excellent in 5 cases,3 cases were good,7 cases were available,5 cases were poor,excellent and good rate was 44.44％.Conclusion Lumbarsacurm-iliac screw fixation in the treatment of complex sacral fractures can achieve a good reduction of fracture and attain satisfied nerve decompression,and more conducive to oatients faster and better recovery.
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Objective To provide nutritional supportive scheme for patients with radiation injury through the treatment of the one exposed to Nanjing 192Ir source accident.Methods The reasonable nutrition treatment scheme was made on the basis of dietary survey and nutritional index monitoring during clinical stages of the patient,including body weight,body mass index(BMI),biochemical indexes,electrolyte,etc.,as well as metabolic cart determination of resting energy expenditure (REE).Results Patient on admission (days 5 post-irradiated) weighing 42.5 kg,172 days after the first irradiated (the first skin grafting) fell to a minimum of 36 kg,then gradually rise,hen rose back to normal range on days 383 before discharge.Normal admission hemoglobin was 135 g/L,172 d after irradiated to a minimum of 54 g/L,normal discharge;when lymphocytes admission low as 0.5 × 109/L,58 days back to normal after exposure,172 days after irradiated down to 0.4 × 109/L.Serum albumin was normal admission 41.2 g/L,172 days after irradiated down to 25.3 g/L.The normal level of serum prealbumin was 0.22 g/L,248 days to a minimum of 0.04 g/L,the basic return to normal at discharge was 0.17 g/L.Admission normal liver function,bilirubin index slightly higher,the all in one parenteral nutrition after about 2.5 months later,bilirubin and liver function indicators were gradually increased,the adjusted treatment and nutrition liver and gallbladder and other gradually returned to normal after treatment.REE and the body weight were determined by metabolic cart on days 294,308 and 342 for the energy requirements.Conclusions For patient with radiation injury,appropriate nutrition therapy is a key method for the clinical treatment and rehabilitation,which can maintain the nutritional status of patients and improve clinical treatment.