A coherent framework for non-ionizing radiation protection

A coherent and overarching framework for health protection from non-ionizing radiation does not currently exist. Instead, many governments maintain different compliance needs targeting only some non-ionizing radiation exposure situations. An international framework developed by the World Health Organization would promote a globally consistent approach for the protection of people from non-ionizing radiation. Designed based on decades of practical experience the framework provides guidance on establishing clear national health and safety objectives and how they should be achieved. It supports multisectoral action and engagement by providing a common language and systematic approach for managing non-ionizing radiation. The framework should allow governments to respond to policy challenges on how to achieve effective protection of people, especially in a world that is rapidly deploying new non-ionizing radiation technologies. In this paper the concepts and key features are presented that underpin the framework for non-ionizing radiation protection, including examples of implementation.

Exposure Worry: The Psychological Impact of Perceived Ionizing Radiation Exposure in British Nuclear Test Veterans

Potential psychological issues faced by British nuclear test veterans have been under-researched. This study assessed the prevalence of clinically relevant anxiety in British nuclear test veterans and aimed to explore experiences of worry and the broader psychological impact of the British nuclear weapons testing programme. The Geriatric Anxiety Inventory (Short-Form) was completed by 89 British nuclear test veterans (33.7% met the criteria for clinically relevant anxiety). Nineteen veterans then participated in semi-structured interviews. Thematic analysis of the data generated three themes. The first theme highlighted how worry was relevant only in a few cases (four) generally regarding their grandchildren’s health, but the guilt in those who perceive responsibility for family health conditions also appeared to be a pertinent issue. The second theme highlighted the anger towards authorities resulting from perceived negligence and deception. The third theme highlighted the relevance of how certain life events across the life course influence the potential psychological impact. This study suggests that guilt must be considered in (potentially) exposed individuals whose family members experience health conditions, which may exacerbate distress. It also suggests the importance that authorities ensure transparency when dealing with any radiological exposure scenario to reduce the potential for anger.

Radiation and public health

The electromagnetic spectrum encompasses frequencies that range from above approximately 1020 hertz (Hz) for ionizing radiation at the high end of the spectrum to static fields and power frequencies of 50–60 Hz at the low end. In order of decreasing frequency, the spectrum comprises gamma-rays, X-rays, ultraviolet radiation, visible light, infrared radiation, microwaves, radio waves and extremely low frequency electric and magnetic fields (ELF EMF). This chapter reviews sources and health effects of human exposure to radiation within the electromagnetic spectrum, and for ionizing radiation exposure to subatomic particles, as well as reviewing policies for limiting human exposure where appropriate.

The Role of Ultrasonography in the Diagnosis and Decision Algorithm for the Management of Pneumothorax after Transbronchial Lung Cryobiopsy

<b><i>Background:</i></b> Pneumothorax is one of the main complications of transbronchial lung cryobiopsy (TBLC). Chest ultrasound (CUS) is a radiation-free alternative method for pneumothorax detection. <b><i>Objective:</i></b> We tested CUS diagnostic accuracy for pneumothorax and assessed its role in the decision algorithm for pneumothorax management. Secondary objectives were to evaluate the post-procedure pneumothorax occurrence and risk factors. <b><i>Methods:</i></b> Eligible patients underwent TBLC, followed by chest X-ray (CXR) evaluation 2 h after the procedure, as our standard protocol. Bedside CUS was performed within 30 min and 2 h after TBLC. Pneumothorax by CUS was defined by the absence of lung sliding and comet-tail artefacts and confirmed with the stratosphere sign on M-mode. Pneumothorax size was determined through lung point projection on CUS and interpleural distance on CXR and properly managed according to clinical status. <b><i>Results:</i></b> Sixty-seven patients were included. Nineteen pneumothoraces were detected at 2 h after the procedure, of which 8 (42.1%) were already present at the first CUS evaluation. All CXR-detected pneumothoraces had a positive CUS detection. There were 3 discordant cases (κ = 0.88, 95% CI: 0.76–1.00, <i>p</i> &#x3c; 0.001), which were detected by CUS but not by inspiration CXR. We calculated a specificity of 97.5% (95% CI: 86.8–99.9) and a sensitivity of 100% (95% CI: 87.2–100) for CUS. Pneumothorax rate was higher when biopsies were taken in 2 lobes and if histology had pleural representation. Final diagnosis was achieved in 79.1% of patients, with the most frequent diagnosis being hypersensitivity pneumonitis. Regarding patients with large-volume pneumothorax needing drainage, the rate of detection was similar between CUS and CRX. <b><i>Conclusion:</i></b> CUS can replace CXR in detecting the presence of pneumothorax after TBLC, and the lung point site can reliably indicate its size. This useful method optimizes time spent at the bronchology unit and allows immediate response in symptomatic patients, helping to choose optimal treatment strategies, while preventing ionizing radiation exposure.

Skin Manifestations after Ionizing Radiation Exposure: A Systematic Review

Morphological and functional skin alterations secondary to the action of ionizing radiation are well documented. In addition to its application in the medical field, ionizing radiation represents a public health problem for diagnostic and therapeutic purposes due to the potential risk of exposure to unexpected events, such as nuclear accidents or malicious acts. With regard to the use of ionizing radiations in the medical field, today, they constitute a fundamental therapeutic method for various neoplastic pathologies. Therefore, the onset of adverse skin events induced by radiation represents a widespread and not negligible problem, affecting 95% of patients undergoing radiotherapy. A systematic literature search was performed from July 2021 up to August 2021 using PubMed, Embase, and Cochrane databases. Articles were screened by title, abstract and full text as needed. A manual search among the references of the included papers was also performed. This systematic review describes the various skin reactions that can arise following exposure to ionizing radiation and which significantly impact the quality of life, especially in cancer patients.

Squamous Cell Carcinoma (SCC) and Chronic Radiation Dermatitis Associated with Childhood Ionizing Radiation Exposure: Case Report with Review of the Literature

Introduction: Squamous cell carcinoma (SCC) is one of the most common types of skin cancer in Caucasians, but the role played by ionizing radiation (IR) exposure in its etiology is unclear. Case Presentation: This study presents a patient with SCC, actinic keratoses, and radiation dermatitis of the feet with a distant history of IR exposure from a shoe-fitting fluoroscope. It is likely the fluoroscope’s IR contributed to the etiology of these manifestations. Conclusions: Patients with a history of repeated IR exposure, particularly from older, unregulated sources such as a shoe-fitting fluoroscope, should be monitored with a high index of suspicion for skin cancer and other related problems.