Key outcome summaries of the scientific programme of the IRPA15 congress.

This special issue of JRP includes a selection of research papers and review articles presented at the 15th Congress of the International Radiation Protection Association (IRPA15) as chosen by the scientific committee. All invited journal contributions are suitably expanded beyond the initial conference presentations to meet the criteria for a full journal article and include (a) presentation within a comprehensive radiological protection context and (b) additional data/interpretation. Published contributions address a wide spectrum of scientific topics and concepts to further develop the radiation protection (RP) system. They are based on scientific evidence and available experience in a wide spectrum of applications of the protection system. The IRPA is the international voice of the RP profession. It promotes excellence in RP by providing benchmarks of good practice, enhancing professional competence, and encourages the application of the highest standards of professional conduct, skills and knowledge for the benefit of individuals and society. Within the overarching theme of the conference 'Bridging RP Culture and Science-Widening Public Empathy' IRPA15 provided an invaluable opportunity to discuss and strengthen the relations between RP culture and science, and share developing scientific knowledge and related experience in RP among members of the scientific community, between representatives of key international organizations, including ICRP, IAEA, WHO, and NEA but also with the public. Some discussions focused on the rationale of available RP programmes and priorities, with an opportunity to identify and further develop key scientific issues of the current RP system as well as key processes for the interaction between members of the scientific community and society. The scientific programme of IRPA15 included eight topics and four thematic areas. The topical areas were: Underpinning Science; Dosimetry and Measurement; the System of Protection; Standards and Regulation; Practical Implementation-Medical Sector, as well as Industry and Research; Emergency Preparedness and Response; Existing Exposures and Non-ionizing Radiation. The thematic areas addressed were: Ethics; Communication and Public Understanding; RP Culture; Human Capital and Competency.

Adaptive Manufacturing for Healthcare During the COVID-19 Emergency and Beyond.

During the COVID-19 pandemic, global health services have faced unprecedented demands. Many key workers in health and social care have experienced crippling shortages of personal protective equipment, and clinical engineers in hospitals have been severely stretched due to insufficient supplies of medical devices and equipment. Many engineers who normally work in other sectors have been redeployed to address the crisis, and they have rapidly improvised solutions to some of the challenges that emerged, using a combination of low-tech and cutting-edge methods. Much publicity has been given to efforts to design new ventilator systems and the production of 3D-printed face shields, but many other devices and systems have been developed or explored. This paper presents a description of efforts to reverse engineer or redesign critical parts, specifically a manifold for an anaesthesia station, a leak port, plasticware for COVID-19 testing, and a syringe pump lock box. The insights obtained from these projects were used to develop a product lifecycle management system based on Aras Innovator, which could with further work be deployed to facilitate future rapid response manufacturing of bespoke hardware for healthcare. The lessons learned could inform plans to exploit distributed manufacturing to secure back-up supply chains for future emergency situations. If applied generally, the concept of distributed manufacturing could give rise to "21st century cottage industries" or "nanofactories," where high-tech goods are produced locally in small batches.

Pseudogout of the transverse atlantal ligament: an unusual cause of cervical myelopathy.

BACKGROUND: Calcium pyrophosphate dihydrate deposition in the cervical spine is infrequently symptomatic. This is especially true at the craniocervical junction and upper cervical spine. CASE REPORT: A 70-year-old previously healthy woman presented with a progressive cervical myelopathy of four months duration. RESULTS: Examination revealed sensorimotor findings consistent with an upper cervical myelopathy. Radiological studies (plain radiographs, computed tomography, and magnetic resonance imaging) revealed C1-2 instability, and a well-defined extradural 3 cm x 1 cm retro-odontoid mass causing spinal cord compression. Transoral resection of the mass was performed followed by posterior C1-2 stabilization. Histological examination of the mass confirmed calcium pyrophosphate dihydrate deposition. Follow-up examination showed marked clinical and radiological improvement. CONCLUSION: Although uncommon, calcium pyrophosphate dihydrate deposition disease should be considered in the differential diagnosis of extradural mass lesions in the region of the odontoid.

Anterior occiput to axis screw fixation: part II: a biomechanical comparison with posterior fixation techniques.

STUDY DESIGN: This biomechanical study used flexibility testing on fresh-frozen human cadaveric specimens (occiput to C3) and compared the range of motion and neutral zone for three occipitocervical fixation techniques. OBJECTIVES: To contrast the stabilization provided by a new technique of anterior occipitocervical screw fixation with two other commonly used posterior occipitocervical fixation techniques. SUMMARY OF BACKGROUND DATA: There are no published reports describing this novel technique of anterior occipitocervical screw fixation. METHODS: Six human occipitocervical spine specimens were mounted in a custom-designed, spine-testing machine that applied a pure moment in flexion-extension, lateral bending, and axial rotation. The specimens were tested intact, after an odontoid osteotomy with capsular injury, and after each of three fixation methods: posterior wiring, posterior plate fixation with C1-C2 transarticular screws, and finally with anterior occipitocervical screws. Intervertebral motion was measured with an optoelectronic measurement system, and the range of motion and neutral zone were the kinematic variables measured and used for analysis. RESULTS: In flexion and extension testing, the posterior plate with transarticular screws provided greater stabilization than posterior wiring or anterior occipitocervical screws. In lateral bending and rotation, the anterior screws were similarly effective to the posterior plate, both of which were more effective than posterior wiring. CONCLUSION: The anterior screw fixation technique was as effective as a posterior plate with transarticular screws in stabilizing between the occiput and C2 in axial rotation and lateral bending. In extension and flexion, the anterior screw technique was not as effective as a posterior plate with transarticular screws in providing stability.

Anterior occiput-to-axis screw fixation: part I: a case report, description of a new technique, and anatomical feasibility analysis.

STUDY DESIGN: A case report of anterior screw fixation from the axis to the occiput is described, as is the surgical technique. The pertinent anatomy is described with a radiographic assessment of the feasibility, safety, and general applicability of this technique. OBJECTIVES: To describe a novel technique of anterior occipitocervical fixation and the pertinent anatomy. SUMMARY OF BACKGROUND DATA: In unique clinical situations where posterior fixation techniques may not be possible or may have already failed, an anterior screw fixation technique may add stability to further attempts at obtaining a posterior arthrodesis. METHODS: A case report is presented, followed by a detailed description of the surgical technique. Ten normal cervical spines had radiographs and computed tomography scans with reformats reviewed to determine screw entry points, target points, and proposed screw trajectories. Following screw insertion in eight fresh frozen human cadaver spine specimens, dissection verified screw location relative to structures at risk. RESULTS: The ideal entry point is located caudal to the C2 superior facet joint in line with the medial third of the C2 superior facet. The screw is directed 25 degrees posteriorly in the sagittal plane and 15 degrees laterally in the coronal plane. The screw tip is located in the posterolateral third of the occipital condyle. Anatomic variation is considerable and makes this technique inadvisable in up to 20% of cases. Structures at risk include the vertebral artery and the hypoglossal nerve. CONCLUSIONS: This new technique of anterior fixation of the atlas to the occiput is feasible and safe if meticulous surgical planning is performed.