Public Health England survey of eye lens doses in the UK medical sector.

The ICRP has recently recommended that the occupational exposure limit for the lens of the eye be reduced to 20 mSv in a year, averaged over defined periods of 5 years, with no single year exceeding 50 mSv. There has been concern amongst some groups of individuals, particularly interventional cardiologists and radiologists as well as relevant professional bodies, that implementation of these recommendations into UK law will adversely affect working patterns. However, despite a number of informative European studies, there is currently little UK dosimetry data available upon which judgements can effectively be based. In order to address this knowledge gap, Public Health England has carried out a small, targeted survey of UK lens doses to medical staff undertaking procedures likely to involve the highest levels of radiation exposure. Two out of a total of 61 individuals surveyed had projected annual doses which could be close to 20 mSv, measured outside lead glasses. Use of protective equipment was generally good; however, lead glasses were only used by 9 participants. The results of this survey suggest that compliance with the ICRP recommendations is likely to be possible for most individuals in the UK medical sector.

The role of F(18)-fluorodeoxyglucose positron emission tomography in guiding diagnosis and management in patients with known or suspected cardiac sarcoidosis.

Cardiac sarcoidosis (CS) has gained significant interest in recent years with the emergence of advanced imaging modalities such as MRI and F(18)-fluorodeoxyglucose-positron emission tomography (FDG-PET) as modalities to aid in the diagnosis of this condition. CS remains a difficult condition to diagnose, particularly in cases of isolated cardiac involvement and it can present with a broad spectrum of clinical syndromes. Furthermore, the appropriate management of these patients remains controversial. FDG-PET has a potential role not only in diagnosis of CS but also in directing further therapies, facilitating the decision to start immunosuppression and monitoring the response to it. In this article, we discuss when to consider FDG-PET, outline the current optimal patient preparation and scanning protocols and then, using case examples, discuss the use of FDG-PET in follow-up of patients with known or suspected CS. We also outline how PET can influence management decisions in these patients.

Age and gender effects on the extent of myocardial involvement in acute myocarditis: a cardiovascular magnetic resonance study.

OBJECTIVE: Based upon epidemiological studies, male gender and younger age are risk factors for developing fatal myocarditis. The impact of age and gender on myocardial injury pattern in acute myocarditis, however, is not well understood. In patients with clinically acute myocarditis, this study sought to characterise the relation between patient age and gender and the extent of myocardial involvement using cardiovascular magnetic resonance (CMR) imaging. CMR markers for oedema, inflammation and fibrosis defined myocardial involvement. DESIGN, SETTING AND PATIENTS: 65 patients (42 years old (SD 15), 41 male) with clinically acute myocarditis were assessed. Using standard methods, T2-weighted and contrast-enhanced T1-weighted (early and late enhancement) CMR images were acquired. T2 images were visually and quantitatively assessed for oedema. Early enhancement images were quantified for inflammation, as was regional fibrosis in late enhancement images. Data were analysed for groups of age (>40, <40 years) and gender. RESULTS: 62% of all patients had evidence of regional oedema, which was more prevalent in patients below 40 years of age (80.7% vs 51.3%, p<0.05), as was myocardial fibrosis (76.9% vs 48.7%, p<0.05). However, early enhancement was more frequently found in patients above 40 years (84.2% vs 61.5%, p<0.05). Men were twice as likely as women to demonstrate myocardial fibrosis (73.2 vs 37.5%, p<0.01). CONCLUSION: In patients with clinically acute myocarditis, myocardial fibrosis was more frequent in men and in patients younger than 40 years. Injury sustained in younger patients appears to be more regional and more severe, as indicated by a higher incidence of irreversible injury.

Experiences of a proactive IR(ME)R inspection in radiotherapy.

The Ionizing Radiation (Medical Exposure) Regulations 2000, IR(ME)R, apply to the safety of the patient referred for a medical exposure to ionizing radiation. In Scotland, the Scottish Executive (Department of Health) is responsible for carrying out inspections of compliance with these regulations. IR(ME)R specifically addresses issues concerned with Employer's duties, responsibilities of the Practitioner, Operator and Referrer, justification of individual medical exposures for diagnosis and treatment, optimization of all procedures, clinical audit and adequate training of all duty holders. A proactive IR(ME)R inspection of the Clinical Oncology Department, Raigmore Hospital, Inverness, was carried out in November 2001 by inspectors based at the Department of Health, London, and seconded by the Scottish Executive, Department of Health. The aim of the inspection was to assess the degree of compliance with the regulations. In this case study the experiences of a proactive inspection are described in detail and some of the important elements of implementing IR(ME)R in a department that operates an ISO 9000-2000 Quality Management System addressed. The identification of IR(ME)R Duty Holders' responsibilities is one important aspect which may be inadequately described by the existing Quality Management System documentation. Other key elements of the inspection include the methods of authorizing the justification, the importance of the treatment prescription sheets in the demonstration of compliance with IR(ME)R, patient identification and pregnancy questions and dose recording procedures. The integration of the standard operating procedures as described in Schedule 1 of the regulations is also important. Where the existing Quality Management System documentation is written to include the IR(ME)R requirements of duty holder's responsibilities and the allocation of all the important tasks, then there is no need to re-badge these documents for IR(ME)R purposes. IR(ME)R encourages departments to focus on the safety of the patient and to document good practice. In order to comply, departments will have to show evidence of optimization of their procedures and must address the clinical governance issues associated with delivery of treatment.