[Detoxification after use of new psychoactive substances purchased online]. / Avrusning etter bruk av nye rusmidler fra internett.

Background: The knowledge base on new psychoactive substances (NPS) is generally limited. This introduces new challenges and increased unpredictability in substance abuse treatment. Case presentation: A man in his thirties was submitted to detoxification after reportedly using flubromazolam, a high potency designer benzodiazepine, which he had purchased on the dark web. Extensive drug testing of serum, urine and hair, and the remains in a dropper bottle delivered by the patient, did not reveal flubromazolam or possible metabolites, but did reveal several common drugs of abuse, and 8-aminoclonazolam, a metabolite of clonazolam, another designer benzodiazepine sold on the dark web. The detoxification was uncomplicated. An excessive treatment protocol based on the patient's information, involving high preparedness and increased resources, both clinically and analytically, turned out to be unnecessary. Interpretation: The drug use and clinical course in this case proved to be more common than the unit prepared for. The case history illustrates both the challenges with users of NPS and the general unpredictability in substance abuse treatment.

Gamma radiation at a human relevant low dose rate is genotoxic in mice.

Even today, 70 years after Hiroshima and accidents like in Chernobyl and Fukushima, we still have limited knowledge about the health effects of low dose rate (LDR) radiation. Despite their human relevance after occupational and accidental exposure, only few animal studies on the genotoxic effects of chronic LDR radiation have been performed. Selenium (Se) is involved in oxidative stress defence, protecting DNA and other biomolecules from reactive oxygen species (ROS). It is hypothesised that Se deficiency, as it occurs in several parts of the world, may aggravate harmful effects of ROS-inducing stressors such as ionising radiation. We performed a study in the newly established LDR-facility Figaro on the combined effects of Se deprivation and LDR γ exposure in DNA repair knockout mice (Ogg1(-/-)) and control animals (Ogg1(+/-)). Genotoxic effects were seen after continuous radiation (1.4 mGy/h) for 45 days. Chromosomal damage (micronucleus), phenotypic mutations (Pig-a gene mutation of RBC(CD24-)) and DNA lesions (single strand breaks/alkali labile sites) were significantly increased in blood cells of irradiated animals, covering three types of genotoxic activity. This study demonstrates that chronic LDR γ radiation is genotoxic in an exposure scenario realistic for humans, supporting the hypothesis that even LDR γ radiation may induce cancer.

Quality assurance in radiotherapy on a national level; experience from Norway: the KVIST initiative.

BACKGROUND AND PURPOSE: In radiotherapy (RT), there are high requirements for quality assurance (QA) in all the steps of the process. Development of QA systems are demanding in terms of financial and human resources. A national QA programme (KVIST) has been established in Norway to facilitate implementation of QA activity on hospital level. METHOD: The KVIST organisation comprises the KVIST team, the reference group (RG) and the working groups (WGs). The KVIST team is multidisciplinary and are employed in permanent positions. The RG acts as an advisory body for the KVIST team in defining and ranking the priority of projects. Relevant national QA projects are identified in collaboration with the RG, and WGs are established to carry out the various projects. RESULT: Several national consensus documents have been prepared by the various WGs. Systems for incident handling and activity reporting have been established and clinical audits have been implemented in Norwegian RT. Guidelines for RT of various diagnoses have also been prepared in collaboration with National Cancer groups. CONCLUSION: The KVIST programme has been very well acknowledged in the Norwegian RT community. It has succeeded in creating a positive attitude towards QA and improved the communication between centres and the various professions.

Comparison of high-dose-rate (192)Ir source strength measurements using equipment with traceability to different standards.

PURPOSE: According to the American Association of Physicists in Medicine Task Group No. 43 (TG-43) formalism used for dose calculation in brachytherapy treatment planning systems, the absolute level of absorbed dose is determined through coupling with the measurable quantity air-kerma strength or the numerically equal reference air-kerma rate (RAKR). Traceability to established standards is important for accurate dosimetry in laying the ground for reliable comparisons of results and safety in adoption of new treatment protocols. The purpose of this work was to compare the source strength for a high-dose rate (HDR) (192)Ir source as measured using equipment traceable to different standard laboratories in Europe and the United States. METHODS AND MATERIALS: Source strength was determined for one HDR (192)Ir source using four independent systems, all with traceability to different primary or interim standards in the United States and Europe. RESULTS: The measured HDR (192)Ir source strengths varied by 0.8% and differed on average from the vendor value by 0.3%. Measurements with the well chambers were 0.5% ± 0.1% higher than the vendor-provided source strength. Measurements with the Farmer chamber were 0.7% lower than the average well chamber results and 0.2% lower than the vendor-provided source strength. All of these results were less than the reported source calibration uncertainties (k=2) of each measurement system. CONCLUSIONS: In view of the uncertainties in ion chamber calibration factors, the maximum difference in source strength found in this study is small and confirms the consistency between calibration standards in use for HDR (192)Ir brachytherapy.

Calibration of reference KAP-meters at SSDL and cross calibration of clinical KAP-meters.

INTRODUCTION: In the summer of 2007 the secondary standard dosimetry laboratory (SSDL) in Norway established a calibration service for reference air-kerma product meter (KAP-meter). The air-kerma area product, P(KA), is a dosimetric quantity that can be directly related to the patient dose and used for risk assessment associated with different x-ray examinations. The calibration of reference KAP-meters at the SSDL gives important information on parameters influencing the calibration factor for different types of KAP-meters. The use of reference KAP-meters calibrated at the SSDL is an easy and reliable way to calibrate or verify the P(KA) indicated by the x-ray equipment out in the clinics. MATERIAL AND METHODS: Twelve KAP-meters were calibrated at the SSDL by use of the substitution method at five diagnostic radiation qualities (RQRs). RESULTS: The calibration factors varied from 0.94 to 1.18. The energy response of the individual KAP-meters varied by a total of 20% between the different RQRs and the typical chamber transmission factors ranged from 0.78 to 0.91. DISCUSSION: It is important to use a calibrated reference KAP-meter and a harmonised calibration method in the P(KA) calibration in hospitals. The obtained uncertainty in the P(KA) readings is comparable with other calibration methods if the information in the calibration certificate is correct used, corrections are made and proper positioning of the KAP-chamber is performed. This will ensure a reliable estimate of the patient dose and a proper optimisation of conventional x-ray examinations and interventional procedures.

Effects of chronic gamma irradiation on reproduction in the earthworm Eisenia fetida (Oligochaeta).

Eisenia fetida were exposed continuously to (60)Co gamma radiation during two generations (F(0) and F(1)). Adult F(0) reproduction capacity (i.e., number of cocoons produced, hatchability and number of F(1) hatchlings) in controls and at five dose rates (0.18, 1.7, 4, 11 and 43 mGy/h) was measured over a 13-week exposure period. Survival, growth and sexual maturation of F(1) hatchlings were observed for 11 weeks. F(1) adults were exposed for a further 13 weeks to determine their reproduction capacity. There was no radiation-induced effect on the cocoon production rate in either F(0) or F(1). For F(0), hatchability of cocoons produced during the first 4 weeks was reduced to 60% at 43 mGy/h (98% in controls), and none of the cocoons produced at 5-13 weeks hatched. At 11 mGy/h the cocoon hatchability was reduced to 25% at 9-13 weeks. In addition, the number of hatchlings per hatched cocoon was reduced at 11 and 43 mGy/h. Correspondingly, at these dose rates, the total number of F(1) hatchlings per adult F(0) was significantly lower than in the control. This number was also reduced at 4 mGy/h, but the effect was of borderline significance. For adult F(1), the hatchability of cocoons at 11 mGy/h was reduced to 45-69% during the 13-week exposure period. The number of hatchlings (F(2)) per cocoon and the total number of F(2) individuals produced was also reduced. However, and in contrast to the results observed for F(0), hatchability increased with time, suggesting a possible acclimatization or adaptation of the F(1) individuals. In conclusion, chronic irradiation reduced the reproduction capacity of E. fetida, but extensive exposure periods (13 weeks) were needed for these effects to be expressed. The lowest dose rates at which an effect was observed were 4 mGy/h in F(0) and 11 mGy/h in F(1).