Evaluation of diagnostic parameters from parotid and submandibular dynamic salivary glands scintigraphy and unstimulated sialometry in Sjögren's syndrome.

Our aim was to validate eight scintigraphic salivary gland (SG) parameters, as diagnostic parameters in patients with Sjögren's syndrome (SS). We used the standardized stimulated dynamic salivary gland scintigraphy (DSGS) protocol and correlated this with the unstimulated whole sialometry (UWS) functions. The DSGS and UWS tests meeting the European and the USA diagnostic classification criteria for SS were applied in twenty patients and in ten normal controls. The DSGS tests were performed 60min after the intravenous (i.v.) injection of 370MBq of technetium-99m-pertechnetate ((99m)TcO(-)4) and after per os stimulation with a 0.5g tablet of ascorbic acid administered 40min after the injection. Using time-activity curves, eight different parameters were calculated for each parotid gland (PG) and each submandibular salivary gland (SMG): a) time at maximum counts (Tmax), b) time at minimum counts (Tmin), c) maximum accumulation (MA), d) accumulation velocity (AV), e) maximum secretion (MS), f) maximum stimulated secretion (MSS), g) stimulated secretion velocity (SSV), and h) uptake ratio (UR). Values of UWS below 2.5mL/15min, were considered abnormal. All these parameters, as for the PG, showed significant abnormality in SS patients (P<0.001), especially of the secretion function. All SMG parameters also showed a significant abnormality (P<0.001), but especially of the accumulation function. There was a greater impairment of the above parameters in SMG than in PG in the SS patients. Sensitivity of the standardized DSGS was 100%, specificity 80%, negative prognostic value 100%, and positive prognostic value 91%. Sensitivity of UWS was 75%. In conclusion, this paper suggested that the best diagnostic parameters for the SS patients were those of: a) the maximum secretion, b) the maximum stimulated secretion for both the parotid and the submandibular glands, c) maximum accumulation and d) accumulation velocity of submandibular glands. The times at maximum and at minimum counts were non diagnostic.

Patient dose measurements in diagnostic radiology procedures in Montenegro.

It was the aim of the study presented here to estimate for the first time patient dose levels in conventional diagnostic radiology in Montenegro. Measurements of patient dose in terms of entrance surface air kerma (ESAK) and kerma-area product (KAP) were performed on at least 10 patients for each examination type, in each of five randomly selected health institutions in Montenegro, so that a total of 872 patients for 16 different examination categories were included in the survey (817 patients for 1049 radiographies and 55 fluoroscopy patients). Exposure settings and individual data were recorded for each patient. Mean, median and third quartile values ESAK of patient doses are reported. The estimated mean ESAK values obtained are as follows: 4.7 mGy for pelvis anteroposterior (AP), 4.5 mGy for lumbar spine AP, 7.8 mGy for lumbar spine lateral (LAT), 3.1 mGy for thoracic spine AP and 4.3 mGy for thoracic spine LAT. When compared with the European diagnostic reference values, the mean ESAK for all studied examination types are found to be below the reference levels, except in chest radiography. Mean ESAK values for chest radiography are 0.9 mGy for posteroanterior (PA) projection and 2.0 mGy for LAT. The results exhibit a wide range of variation. For fluoroscopy examinations, the total KAP was measured. The mean KAP value per procedure for barium meal is found to be 22 Gy cm(2), 41 Gy cm(2) for barium enema and 19 Gy cm(2) for intravenous urography. Broad dose ranges for the same types of examinations indicate the necessity of applying practice optimisation in diagnostic radiology and establishment of national diagnostic reference levels.

Effective dose estimation and lifetime cancer mortality risk assessment from exposure to Chernobyl 137Cs on the territory of Belgrade City and the region of Vojvodina, Serbia.

PURPOSE: The purpose of this paper is to determine the activity concentrations of radionuclide (137)Cs in soil samples on the territory of Belgrade and the province of Vojvodina. Also, the lifetime cancer mortality risk from external exposure during 1 year is assessed, and the effective dose is estimated. METHODS: Eighty eight soil samples were collected from 30 uncultivated locations in Belgrade, and 30 soil samples were collected from 10 locations in the province of Vojvodina. Activity concentrations were measured using an HPGe detector. Using dose conversion factors taken from "EPA Federal Guidance Report 12," annual effective doses from external sources were estimated. The lifetime cancer mortality risk was assessed using cancer risk coefficients taken from "EPA Federal Guidance Report 13." RESULTS: Activity concentrations of (137)Cs for the territory of Belgrade are in the range of 2.07-89.1 Bq/kg with a mean value of 23.77 Bq/kg; the estimated annual effective doses are in the range of 0.41-17.5 nSv with a mean value of 4.67 nSv, and assessed lifetime cancer mortality risks, normalized on 100,000 inhabitants, are in the range 0.2-9.5 × 10(-5) with a mean value 2.5 × 10(-5). Activity concentrations of (137)Cs for the province of Vojvodina are in the range of 2.73-18.9 Bq/kg with a mean value of 8.57 Bq/kg; estimated annual effective doses are in the range of 0.54-3.71 nSv with a mean value of 1.68 nSv, and assessed lifetime cancer mortality risks, normalized on 100,000 inhabitants, are in the range of 0.3-2.0 × 10(-5) with a mean value 0.9 × 10(-5). CONCLUSION: Receiving doses are low from (137)Cs radionuclides occurring in soil, according to the linear no-threshold approach; the risk for cancer development exists but is very small.

Cancer risk assessment after exposure from natural radionuclides in soil using Monte Carlo techniques.

PURPOSE: The purpose of this paper is to assess fatal cancer risk after external and internal (inhalation and ingestion) exposure from natural radionuclides in soil like (238)U, (232)Th, (40)K, and (226)Ra on the territory of Bela Crkva, Serbia. Although receiving doses are low from sources like natural radionuclides in soil, because of stochastic effects of ionizing radiation, risk for developing cancer exists and can be quantified. METHODS: Concentrations of radionuclides from 80 soil samples are measured using HPGe detector. Fatal cancer risk is assessed from calculated ambient dose rate in the target organs of body due to external and internal exposure. Monte Carlo simulations are used to obtain conversion factors which are required to calculate absorbed dose rate in target organs. RESULTS AND DISCUSSION: Assessed cancer risk for (238)U in the case of both inhalation and ingestion exposure is from 1.11 × 10(-6) to 24 × 10(-6) for minimal and maximal activity in soil samples, from 1.02 × 10(-6) to 23.3 × 10(-6) for exposure to (226)Ra, from 1.89 × 10(-6) to 50.3 × 10(-6) for exposure to (232)Th, and from 0.265 × 10(-6) to 9.83 × 10(-6) for exposure to (40)K. Overall risk from (40)K as external and internal source is from 0.8 × 10(-6) to 31.9 × 10(-6). Calculated cancer risks from both inhalation and ingestion exposure could be related to all tissues that are on the way of distribution of particles within the body but especially to deposition sites in the body. CONCLUSION: Assessed risks for fatal cancer development from inhaled and ingested natural radionuclides originating in soil are not increased.

Influence of occupational exposure to low-dose ionizing radiation on the plasma activity of superoxide dismutase and glutathione level.

BACKGROUND/AIM: During exposure to low-level doses (LD) of ionizing radiation (IR), the most of harmful effects are produced indirectly, through radiolysis of water and formation of reactive oxygen species (ROS). The antioxidant enzymes--superoxide dismutase (SOD): manganese SOD (MnSOD) and copper-zinc SOD (CuZnSOD), as well as glutathione (GSH), are the most important intracellular antioxidants in the metabolism of ROS. Overproduction of ROS challenges antioxidant enzymes. The aim of this study was to examine if previous exposure to low doses of IR induces adaptive response by means of stimulation of intracellular antioxidant defense system. METHODS: We investigated a group of medical workers occupationally exposed to IR (n = 44), 29 male and 15 female. The controls (n = 33) consisted of medical workers not exposed to IR, 23 male and 10 female. The examinees from both groups worked in the same environment and matched in crucial characteristics. All measurements were performed by a calibrated thermoluminiscent dosimeter type CaF2:Mn. SOD activity and GSH content were measured spectrophotometrically in the plasma of both groups of medical workers. Half of each blood sample was irradiated by 2Gy of gamma radiation, dose-rate 0.45 Gy/min, and the distance from the source of 74 cm. RESULTS: The dosimetry results indicate that occupational doses were very low. Our results confirmed significantly higher SOD activity in the exposed vs. unexposed workers (p < 0.00006). SOD activity after irradiation of blood samples failed to show a significant difference between the exposed workers and the controls (p = 0.905), even the difference in each group before and after the irradiation was significant. In blood samples of the exposed workers expression of enzymes after the irradiation, was not as high as in the controls, or even in the case of the exposed in nuclear medicine personnel, SOD activity was decreased. There were no significant differences in the content of GSH between the groups. CONCLUSION: Our results pointed out that occupational exposure to low doses of IR compromised mitochondrial function. During occupational exposure, the activity of antioxidant enzymes was increased as a protection against the increased production of ROS. After high-dose irradiation dysfunction of mitochondrial system was noticed, suggesting the break-down of antioxidant defense and failure of an adaptive response. Therefore, the "chronic oxidative stress" might reduce antioxidant defense in the case of accidental exposure to high doses of IR. It could indirectly increase the incidence of some other "free radicals' diseases" in occupationally exposed personnel.

The Monte Carlo SRNA-VOX code for 3D proton dose distribution in voxelized geometry using CT data.

This paper describes the application of the SRNA Monte Carlo package for proton transport simulations in complex geometry and different material compositions. The SRNA package was developed for 3D dose distribution calculation in proton therapy and dosimetry and it was based on the theory of multiple scattering. The decay of proton induced compound nuclei was simulated by the Russian MSDM model and our own using ICRU 63 data. The developed package consists of two codes: the SRNA-2KG, which simulates proton transport in combinatorial geometry and the SRNA-VOX, which uses the voxelized geometry using the CT data and conversion of the Hounsfield's data to tissue elemental composition. Transition probabilities for both codes are prepared by the SRNADAT code. The simulation of the proton beam characterization by multi-layer Faraday cup, spatial distribution of positron emitters obtained by the SRNA-2KG code and intercomparison of computational codes in radiation dosimetry, indicate immediate application of the Monte Carlo techniques in clinical practice. In this paper, we briefly present the physical model implemented in the SRNA package, the ISTAR proton dose planning software, as well as the results of the numerical experiments with proton beams to obtain 3D dose distribution in the eye and breast tumour.

[Occupational exposure to ionizing radiation and the occurrence of cataract]. / Profesionalna ekspozicija jonizujucem zracenju i katarakta.

Radiation cataract is one of ensuing effects of ionizing radiation, since its threshold dose under which it does not occur, and above which it shows dose dependency, has been observed. Clinical course of radiation cataract is identical for all the types of ionizing radiation and is very typical. Minimal dose for progressive cataract formation is determined by the type of radiation, i.e., its relative biological efficacy, dose, and the duration of the exposure period. Theoretically, threshold dose existence does not exclude the incidence of cataract formation under significantly smaller doses, as well. The aim of this study was to analyze the incidence of cataract formation among the medical staff professionally exposed to ionizing radiation. Neither of the diagnosed cataracts had typical morphology, nor was the correlation established between the dose, exposure time, and the cataract formation. All the diagnosed cataracts were described as premature, and therefore ionizing radiation was considered as a co-factor in premature cataract formation in the examined groups.