Radiation doses and diagnostic reference levels for common CT scans in adults in Northwest region of Iran.

This study aims to estimate organ dose and cancer risks, establish region-specific diagnostic reference levels (DRLs), and determine achievable doses (ADs) for common CT procedures in adults in the northwest of Iran. Effective and organ doses were estimated using VirtualDoseCT software in a sample of 480 adult patients who underwent head, sinus, chest, and abdomen-pelvis (AP) CT scans. The guidelines provided by the BEIR VII report were utilized to estimate cancer risks. Effective and organ doses for specific procedures were determined, with the highest mean organ dose being observed in the brain during head CT examinations, with a value of 54.02 mGy. It was observed that the lungs in chest examinations and the colon in AP examinations had the highest risk of cancer, with rates of 30.72 and 21.37 per 100,000 persons, respectively. Higher cancer risk values were generally exhibited by females compared to males. The DRLs for common CT examinations were established as follows: Head CT (CTDIvol 41 mGy, DLP 760 mGy cm), Sinus CT (CTDIvol 16 mGy, DLP 261 mGy cm), Chest CT (CTDIvol 8 mGy, DLP 287 mGy cm), and AP CT (CTDIvol 9 mGy, DLP 508 mGy cm). Significant variations in dose distribution among facilities were identified, indicating the need for optimization. The study highlights the importance of minimizing radiation exposure to critical organs and promoting patient safety in CT examinations. The establishment of region-specific DRLs and ADs can help optimize radiation doses and reduce cancer risks for patients.

The cardioprotective effects of nano-curcumin against doxorubicin-induced cardiotoxicity: A systematic review.

Although the chemotherapeutic drug, doxorubicin, is commonly used to treat various malignant tumors, its clinical use is restricted because of its toxicity especially cardiotoxicity. The use of curcumin may alleviate some of the doxorubicin-induced cardiotoxic effects. Especially, using the nano-formulation of curcumin can overcome the poor bioavailability of curcumin and enhance its physicochemical properties regarding its efficacy. In this study, we systematically reviewed the potential cardioprotective effects of nano-curcumin against the doxorubicin-induced cardiotoxicity. A systematic search was accomplished based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the identification of all relevant articles on "the role of nano-curcumin on doxorubicin-induced cardiotoxicity" in the electronic databases of Scopus, PubMed, and Web of Science up to July 2021. One hundred and sixty-nine articles were screened following a predefined set of inclusion and exclusion criteria. Ten eligible scientific papers were finally included in the present systematic review. The administration of doxorubicin reduced the body and heart weights of mice/rats compared to the control groups. In contrast, the combined treatment of doxorubicin and nano-curcumin increased the body and heart weights of animals compared with the doxorubicin-treated groups alone. Furthermore, doxorubicin could significantly induce the biochemical and histological changes in the cardiac tissue; however, coadministration of nano-curcumin formulation demonstrated a pattern opposite to the doxorubicin-induced changes. The coadministration of nano-curcumin alleviates the doxorubicin-induced cardiotoxicity through various mechanisms including antioxidant, anti-inflammatory, and antiapoptotic effects. Also, the cardioprotective effect of nano-curcumin formulation against doxorubicin-induced cardiotoxicity was higher than free curcumin.

Patterns and trends of population radiation exposure and projected the risk of exposure-induced death from gamma camera examinations in Yazd Province.

INTRODUCTION: The use of nuclear medicine examinations as imaging modalities has recently increased. This study aimed to assess the radiation dose delivered to patients from common diagnostic nuclear medicine examinations and estimate the risk of exposure-induced death (REID). In addition, the frequency of nuclear medicine procedures were evaluated from 2015-2018. MATERIALS AND METHODS: The data were collected from adult patients who had undergone cardiac, skeletal, renal, lacrimal, and thyroid imaging. For each patient, the effective dose was calculated using dose conversion factors, and REID was estimated using PCXMC. The frequency of examinations between 2015 and 2018 was obtained from the hospital information system (HIS). RESULTS: The highest estimated effective dose was attributed to the scans of myocardial stress (8.09 ± 1.28 mSv), myocardial rest (5.59 ± 1.27 mSv), and thyroid imaging (3.93 ± 0.55 mSv). In addition, cardiac stress examination had the highest REID values for solid cancers (212.5 ± 67.5) and bone scans had the highest REID values for leukemia (11.5 ± 2.5). A large increase in the number of myocardial perfusion scans was a significant contributor to an increase in collective effective dose from 23.37 man-Sv in 2015 to 49.47 man-Sv in 2018, a compound annual growth rate (CAGR) of 26%. CONCLUSION: Although the annual frequency and per capita effective dose of nuclear medicine procedures in Yazd Province increased continuously, they were comparably lower than those reported for other countries. Despite this, the cancer risks of nuclear medicine scans at the individual level are negligible (around 0.01% excess fatal cancer risk), yet the increasing tendency for these examinations could be of concern.

ESTIMATION OF DIAGNOSTIC REFERENCE LEVELS AND ACHIEVABLE DOSES FOR PEDIATRIC PATIENTS IN COMMON COMPUTED TOMOGRAPHY EXAMINATIONS: A MULTI-CENTER STUDY.

This study was conducted to determine first local diagnostic reference levels (DRLs) and achievable doses (ADs) for pediatric patients during the most common computed tomography (CT) procedures in Yazd province. The DRL was obtained based on volume CT dose index (CTDIvol) and dose length product (DLP) for four various age groups of children. Data were collected from the most commonly performed pediatric CT scans, including abdomen-pelvis, chest, brain and sinus examinations, at six high-loaded institutes. The patients' data (766 no.) in terms of CTDIvol and DLP were obtained from four age groups: ≤1-, 1-5-, 5-10- and 10-15-y-old. The 75th percentiles of CTDIvol and DLP were considered as DRL values and the 50th percentiles were described as ADs for those parameters. Consequently, the acquired DRLs were compared with other national and international published values. The DRLs in terms of CTDIvol for abdomen-pelvis, chest, brain and sinus examinations were 3, 8, 9 and 10 mGy; 4, 5, 5 and 5 mGy; 25, 28, 29 and 38 mGy; and 23, 24, 26 and 27 mGy for four different age groups of ≤1-, 1-5-, 5-10- and 10-15-y-old, respectively. The DRL values in terms of DLP were 75, 302, 321 and 342 mGy.cm; 109, 112, 135 and 170 mGy.cm, 352, 355, 360 and 481 mGy.cm; and 206, 211, 228 and 245 mGy.cm, respectively, for the mentioned age groups. In this study, the DRL and AD values in the brain examination were greater among the other studied regions. The DRL plays a critical role in the optimization of radiation doses delivered to patients and in improving their protection. This study provides the local DRLs and ADs for the most common pediatric CT scanning in Yazd province to create optimum situation for the clinical practice.

The role of melatonin on radiation-induced pneumonitis and lung fibrosis: A systematic review.

PURPOSE: Pneumonitis and lung fibrosis, as the most common compliances of lung irradiation, can affect the quality of life. The use of radio-protective agents can ameliorate these injuries. This study aimed to review the potential protective role of melatonin in the treatment of radiation-induced Pneumonitis and lung fibrosis. METHODS: The current systematic study was conducted based on PRISMA guidelines to identify relevant literature on " the effect of melatonin on radiation-induced pneumonitis and lung fibrosis" in the electronic databases of Web of Science, Embase, PubMed, and Scopus up to January 2021. Eighty-one articles were screened in accordance with the inclusion and exclusion criteria of the study. Finally, eight articles were included in this systematic review. RESULTS: The finding showed that the lung irradiation-induced pneumonitis and lung fibrosis. The co-treatment with melatonin could alleviate these compliances through its anti-oxidant and anti-inflammatory actions. Melatonin through upregulation of some enzymes such as catalase, superoxide dismutase, glutathione, NADPH oxidases 2 and 4, dual oxidases 1 and 2, and also downregulation of malondialdehyde reduced oxidative stress following lung radiation. Moreover, melatonin through its anti-inflammatory effects, can attenuate the increased levels of nuclear factor kappa B, tumor necrosis factor alpha, transforming growth factor beta 1, SMAD2, interleukin (IL)-4, IL-4 receptor-a1 (IL4ra1), and IL-1 beta following lung radiation. The histological damages induced by ionizing radiation were also alleviated by co-treatment with melatonin. CONCLUSION: According to the obtained results, it was found that melatonin can have anti-pneumonitis and anti-fibrotic following lung irradiation.

A comparison of skin dose estimation between thermoluminescent dosimeter and treatment planning system in prostatic cancer: A brachytherapy technique.

Aims: This study aimed to compare the skin dose calculated by treatment planning system (TPS) and measured with thermoluminescent dosimeters (TLDs) in brachytherapy of prostatic cancer to show the skin TLD dosimetry as an appropriate quality assurance procedure for TPS dose calculations. Methods: The skin dose of 15 patients with prostatic cancer treated by high dose rate brachytherapy technique was assessed by two types of TLD dosimeters (GR-200 and TLD-100). The TLDs were placed on the patient's skin at three different points (anterior, left, and right) using five TLDs for each point. The dose values of TLDs and TPS were compared using paired t-test and the percentages of difference were reported. Results: There was a good agreement between TPS calculations and TLDs measurements for both of the GR-200 and TLD-100 dosimeters. The mean skin dose values for anterior, left, and right points were 65.06±21.88, 13.88±4.1, and 10.05±4.39 cGy, respectively, for TPS. These values were 65.70±23.2, 14.51±4.3, and 10.54±5 cGy for GR-200, and 64.22±23.5, 13.43±4.4, and 9.99±4.1 cGy for TLD-100, respectively. Conclusion: The TPS skin dose calculations in brachytherapy of prostatic cancer had a good agreement with the TLD-100 and GR-200 measurements at the three different points on patients' skin. TLD-100 had lower differences with TPS calculations compared to GR-200. Relevance for Patients: The outcome of this research shows that for people with prostatic cancer, TPS can estimate accurately the skin dose of different points including anterior, left, and right in brachytherapy technique.

Evaluating the radioprotective effect of single dose and daily oral consumption of green tea, grape seed, and coffee bean extracts against gamma irradiation.

INTRODUCTION: The aim of this study was to investigate and compare the radio-protective effect of green tea, grape seed, and coffee bean extracts in different oral consumption methods in mice. MATERIALS AND METHODS: In this experimental-quantitative study 150 mice in 15 equally sized groups were used. For each extract, two groups received 200 mg/kg of herbal extracts' combination for 7 and 30 consecutive days before irradiation, and one group received 800 mg/kg of the extract 2 h before irradiation (3 Gy gamma-rays of Co-60). The similar groups were classified to receive a combination of the plant extracts (green tea, grape seed, and coffee bean). Irradiation without consuming plant extract (irradiated group), and a control group were also devised. Alkaline comet and micronucleus assays were used to investigate the radioprotective effect on mice blood and bone marrow cells, respectively. RESULTS: Consumption of all plant extracts significantly decreased the radiation damage to blood and bone marrow cells, compared to the irradiated group (p < 0.01), with grape seed extract showing higher protective effect. Continuous daily oral consumption (one week/month) showed a significant higher radioprotective effect compared to single consumption (p < 0.05). Continuous consumption of the combination of the extracts showed a higher radio-protection in comparison to each of the plant extracts (p < 0.03). CONCLUSIONS: The radioprotective effect of continuous consumption (for one week/month) of the plant extracts was greater than single dose. In continuous consumption protocols, we found the synergetic property and higher radioprotective effect of the plant extract combination compared to each one.

The radioprotective effects of alpha-lipoic acid on radiotherapy-induced toxicities: A systematic review.

PURPOSE: Radiation therapy is one of the main cancer treatment modalities applied in 50-70% of cancer patients. Despite the many advantages of this treatment, such as non-invasiveness, organ-preservation, and spatiotemporal flexibility in tumor targeting, it can lead to complications in irradiated healthy cells/tissues. In this regard, the use of radio-protective agents can alleviate radiation-induced complications. This study aimed to review the potential role of alpha-lipoic acid in the prevention/reduction of radiation-induced toxicities on healthy cells/tissues. METHODS: A systematic search was performed following PRISMA guidelines to identify relevant literature on the "role of alpha-lipoic acid in the treatment of radiotherapy-induced toxicity" in the electronic databases of Web of Science, Embase, PubMed, and Scopus up to January 2021. Based on the inclusion and exclusion criteria of the present study, 278 articles were screened. Finally, 29 articles were included in this systematic review. RESULTS: The obtained results showed that in experimental in vivo models, the radiation-treated groups had decreased survival rate and body weight compared to the control groups. It was also found that radiation can induce mild to severe toxicities on gastrointestinal, circulatory, reproductive, central nervous, respiratory, endocrine, exocrine systems, etc. However, the use of alpha-lipoic acid could alleviate the radiation-induced toxicities in most cases. This radio-protective agent exerts its effects through mechanisms of anti-oxidant, anti-apoptosis, anti-inflammatory, and so on. CONCLUSION: According to the obtained results, it can be mentioned that co-treatment of alpha-lipoic acid with radiotherapy ameliorates the radiation-induced toxicities in healthy cells/tissues.

Estimating the whole-body effective dose and health risks as well as introducing a new easy method for eye lens dosimetry in interventional cardiology procedures.

This study aimed to introduce a new method for eye lens thermo-luminescent dosimetry and also estimate the dose associated with induced cancer risk due to the ionizing radiation exposure received by physicians and other staff cooperating in interventional cardiology (IC) procedures. The measurements were performed with six TLDs (thermoluminescent dosimeters): four TLDs for eye lens dosimetry (2 positioned on respiratory/surgical mask under the eye region as the new method; and 2 near the outside border of the eye as the common method) and two TLDs for whole-body dosimetry. Whole-body doses were used to calculate the cancer risks induced by IC procedures. The results of the new proposed method for eye lens dosimetry were similar to common TLD positioning (mean differences <5%) and mask displacement had no significant effect on eye dose measurement in our new method. Our proposed method for eye lens dosimetry is simpler and more comfortable compared to the common method and it can be used as an alternative method without using TLD holders to monitor lens dose for IC workers wearing masks during the procedure. The estimated excess cancer incidence risk induced by IC procedures was 29.58 ± 5.71 and 46.68 ± 7.77 (per 100000 individuals) for men and women, respectively.

Investigating the radioprotective effect of sesamol oral consumption against gamma irradiation in mice by micronucleus and alkaline comet assays.

INTRODUCTION: Ionizing radiations induce damage to the bone marrow and blood cells. The aim of this study was to investigate the radioprotective effect of sesamol oral consumption on mice bone marrow and peripheral blood cells using micronuclei and alkaline comet assay. MATERIALS AND METHODS: This experimental-quantitative study was performed on 50 mice in 5 equal groups. One group received 50 mg/kg of sesamol for 7 consecutive days and another group received 100 mg/kg of this extract 2 h before irradiation (3 Gy gamma-rays of Cobalt-60). Irradiation without consuming sesamol and sesamol without irradiation were applied in other groups. Micronucleus and alkaline comet assays were used to measure the DNA damages in bone marrow and peripheral blood cells. The data were statistically compared using one-way ANOVA, and Tukey HSD test. RESULTS: In comparison with the only-irradiated group, oral consumption of sesamol 2 h and 7 days before irradiation decreased remarkably micro-nucleated normochromatid erythrocytes (mnNCE) as 54.5% and 70.4% (P < 0.0001), and micro-nucleated nucleated polychromatid erythrocytes (mnPCE) as 49% and 66% (P < 0.001), respectively. Furthermore, the number of PCE/NCE ratio increased as 47% and 83.6% (P < 0.0001) compared to the irradiated group. The percentage of DNA in tail and apoptotic comets decreased significantly with oral consumption of sesamol (daily or single dose) compared to the irradiated group (P < 0.005). These variations were greater in 7-day continuous pre-irradiation method. CONCLUSION: Sesamol as a radioprotector can reduce the effects of gamma irradiation on mice bone marrow and blood cells. The daily oral consumption of this extract is more effective in comparison with the single consumption before irradiation.

Radiation dose and risk of exposure-induced death associated with common computed tomography procedures in Yazd Province.

PURPOSE: This survey was conducted to evaluate the radiation dose delivered to the patients through different CT procedures along with its corresponding risks in Yazd province. METHOD: Data for the five most common procedures were collected from six institutions from September 2017. The effective dose for each patient was estimated by ImpactDose software. The risk of exposure-induced death (REID) was calculated by coupling the BEIR VII model and ICRP 103 data for the Asian population. RESULTS: The median effective doses for the five most common procedures, in descending order, were as follows: 5.19 mSv for abdomen-pelvis, 3.30 mSv for routine chest, 3.00 mSv for chest HRCT, 0.76 mSv for Brain and 0.47 mSv for sinus. Averaged over all the procedures, the ratio of maximum to minimum of effective dose was 90-fold. The highest associated risk was tied to high-resolution CT scans for women which was estimated to be 1 exposure-induced death related to 2096 scans performed on a 20-year old patient. CONCLUSION: The estimated effective doses for all the procedures except sinus were comparably low, however, the variations among patient doses, even for a given procedure, were substantially high, indicating that further optimization processes need to be undertaken. Moreover, it was estimated that approximately 2000 scans of abdomen-pelvis performed on 20 year-old women could result in 1 radiation-induced cancer death, which in large scales may cause drastic health issues. In this regard, several approaches, one of which is the implementation of DRLs, can be suggested to reduce the collective dose from CT scans.

ESTABLISHMENT OF LOCAL DIAGNOSTIC REFERENCE LEVELS FOR COMMON PROCEDURES OF COMPUTED TOMOGRAPHY IN YAZD PROVINCE.

OBJECTIVE: The aim of this study was to propose first established diagnostic reference levels (DRLs) in computed tomography (CT) for adults, based on volume-averaged CTDI and dose length product (DLP) metrics in Yazd Province. MATERIALS AND METHODS: Six multislice CT scanners located at diverse areas of Yazd Province and seven common procedures were selected for the present study. For each procedure, at least twenty patients 18 years and older were sampled at each institution. For each patient, dose report data and scan parameters as well as patient's information were abstracted from picture archiving and communication system. RESULTS: Proposed DRLs in terms of computed tomography dose index (mGy) and DLP (mGy.cm) were as follows: brain (42, 527), sinus (25, 220), neck (14, 264), abdomen-pelvis (11, 295), routine chest (8, 247), CT pulmonary angiogram (32, 261) and chest HRCT (11, 455), respectively, slightly lower compared to other investigations. CONCLUSION: The proposed DRLs in this study should be considered as the local DRLs for the seven most common adult CT examinations in Yazd province so as to optimize the patient dose while maintaining acceptable image quality for the clinical task.

Diagnostic value of fecal calprotectin in patient with ulcerative colitis.

BACKGROUND: Ulcerative colitis (UC) is characterized by recurrent episodes of inflammation limited to the mucosal layer of the colon. Calprotectin is a zinc and calcium binding protein derived from neutrophils and monocytes. It is easily detectable in tissue samples, body fluids, and stools, which makes it a potentially valuable marker of inflammation. The aim of the current study is to evaluate the value of fecal calprotectin (FC) as a marker of disease activity in patients with UC. METHODS: Seventy three eligible subjects underwent ileocolonoscopy and multiple biopsies were obtained from different parts of the colon and terminal ileum. All patients underwent blood and stool sampling as well as an interview to assess the disease severity utilizing ulcerative colitis activity index (UCAI), subjectively. The diagnostic value of the FC in comparison with Mayo disease activity index as the gold standard technique, was then evaluated. RESULTS: Mean FC level increased linearly according to Mayo disease activity index (r=0.44, p<0.001) and was significantly different between levels of Mayo disease activity index (p=0.003). In multivariate analysis, Mayo disease activity index, positive CRP and ESR were associated with FC level. FC level > 21.4 ng/ml was able to discriminate between active and inactive phases of UC according to Mayo disease activity index>2 with 72.3% sensitivity and 73.1% specificity. The combination of FC > 21.4 ng/ml and UCAI score of 7 had a 46.8% sensitivity and 88% specificity to diagnose Mayo disease activity index >2. Furthermore, FC level <21.4 ng/ml in combination with UCAI score of <3 showed a highly considerable specificity of 98% to discriminate the remission phase of UC (Mayo disease activity index <2), although with a low sensitivity (31%). CONCLUSION: FC appears to be a non-invasive biomarker with moderate accuracy to discriminate the active phase of inflammatory bowel disease (IBD). The value of FC especially in combination with UCAI is highly considerable to rule out the Mayo disease activity index >2.