Radiation Induced Lung Injury: Prediction, Assessment and Management

Giridhar, Prashanth,Mallick, Supriya,Rath, Goura Kishore,Julka, Pramod Kumar Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.7

Radiation induced lung injury has long been considered a treatment limiting factor for patients requiring thoracic radiation. This radiation induced lung injury happens early as well as late. Radiation induced lung injury can occur in two phases viz. early (< 6 months) when it is called radiation pneumonitis and late (>6 months) when it is called radiation induced lung fibrosis. There are multiple factors that can be patient, disease or treatment related that predict the incidence and severity of radiation pneumonitis. Radiation induced damage to the type I pneumocytes is the triggering factor to initiate such reactions. Over the years, radiation therapy has witnessed a paradigm shift in radiation planning and delivery and successfully reduced the incidence of lung injury. Radiation pneumonitis is usually a diagnosis of exclusion. Steroids, ACE inhibitors and pentoxyphylline constitute the cornerstone of therapy. Radiation induced lung fibrosis is another challenging aspect. The pathophysiology of radiation fibrosis includes continuing inflammation and microvascular changes due to pro-angiogenic and profibrogenic stimuli resembling those in adult bronchiectasis. General supportive management, mobilization of airway secretions, anti-inflammatory therapy and management of acute exacerbations remains the treatment option. Radiation induced lung injury is an inevitable accompaniment of thoracic radiation.

방사선조사와 cis-dichorodiammineplatinum(Ⅱ)가 흰쥐의 심근에 미치는 효과에 관한 실험적 연구

이경자(Kyung Ja Lee) 대한방사선종양학회 1994 Radiation Oncology Journal Vol.12 No.3

Purpose : The study was designed to investigate the effect of cis-dichorodiammineplatinum(Ⅱ)(cis-DDP) on the radiation-induced cardiomyopathy in the rat. Materials and Methods : The myocardial damage was assessed by histopathologic changes. In radiation alone group radiation dose ranged from 10-40 Gy X-ray in a single dose and in combined group cis-dichorodiammineplatinum(Ⅱ) at a dose of 6mg/kg was given intraperitoneally immediately after irradiation of same dose with X-ray alone group. Results : The early changes by radiation included congestion, inflammatory cell infiltrations and fibrosis in myocardial interstitium with focal myocardial necrosis,, which was noted in 10 Gy group. Myocardial fibrosis was increased by increasing dose of radiation but myocardial necrosis was not proportional to radiation dose cis-DDP alone group showed minimal degeneration of myocardium with surrounded by inflammatory cell infiltrations. In combined group, myocardial fibrosis in 10 Gy group were similar to radiation alone group, but 30 Gy and 40 Gy groups showed severer changes. Electron microscopic examination showed disruption of Z-band and edema of mitochondria with decreased matrix density in 20 Gy radiation group which were severer in 40 Gy radiation group. Combined group showed endothelial changes and disruption of Z-band worse than radiation alone group as well as increased connective tissue which was considered as a hallmark of late change in radiation-induced heart disease. Conclusion : This results showed minimal enhancement of the radiation-induced cardiomyopathy in rats by cis-DDP.

자궁경부암 환자에 있어서 방사선 치료에 의해 자궁경·질 도말 표본에 나타난 세포 변화에 관한 연구

박성혜,김인선,백승룡,박효숙,박노원 대한병리학회 1988 Journal of Pathology and Translational Medicine Vol.22 No.3

Analysis of Trends in Dose through Evaluation of Spatial Dose Rate and Surface Contamination in Radiation-Controlled Area and Personal Exposed Dose of Radiation Worker at the Korea Institute of Radiological and Medical Sciences (KIRAMS)

Lee, Bu Hyung,Kim, Sung Ho,Kwon, Soo Il,Kim, Jae Seok,Kim, Gi-sub,Park, Min Seok,Park, Seungwoo,Jung, Haijo Korean Society of Medical Physics 2016 의학물리 Vol.27 No.3

As the probability of exposure to radiation increases due to an increase in the use of radioisotopes and radiation generators, the importance of a radiation safety management field is being highlighted. We intend to help radiation workers with exposure management by identifying the degree of radiation exposure and contamination to determine an efficient method of radiation safety management. The personal exposure doses of the radiation workers at the Korea Institute of Radiological & Medical Sciences measured every quarter during a five-year period from Jan. 1, 2011 till Dec. 31, 2015 were analyzed using a TLD (thermoluminescence dosimeter). The spatial dose rates of radiation-controlled areas were measured using a portable radioscope, and the level of surface contamination was measured at weekly intervals using a piece of smear paper and a low background alpha/beta counter. Though the averages of the depth doses and the surface doses in 2012 increased from those in 2011 by about 14%, the averages were shown to have decreased every year after that. The exposure dose of 27 mSv in 2012 increased from that in 2011 in radiopharmaceutical laboratories and, in the case of the spatial dose rate, the rate of decrease in 2012 was shown to be similar to the annual trend of the whole institute. In the case of the surface contamination level, as the remaining radiation-controlled area with the exception of the I-131 treatment ward showed a low value less than $1.0kBq/m^2$, the annual trend of the I-131 treatment ward was shown to be similar to that of the entire institute. In conclusion, continuous attention should be paid to dose monitoring of the radiation-controlled areas where unsealed sources are handled and the workers therein.

A Discussion for Alteration of the Radiation Issues Based on the Clipping Analyses of Radiation Articles Reported in Korea

김주연,윤돌미,유지엽,박태진 대한방사선방어학회 2016 방사선방어학회지 Vol.41 No.2

Background: Radiation accidents having occurred in recent containing the accident in Fukushima nuclear power plants of Japan were resulted to the increase in some public concern, anxiety and confusion for radiation or nuclear safety. The public anxiety for radiation is not being decreased though the announcements done in radiation research institutes in Korea. Therefore, this study aims at providing an effective system for radiation publicity to the public members by the clipping analysis for the radiation articles reported in the media. And, the relation between those radiation issues and the radiation perception to the public members is analyzed. Materials and Methods: The radiation articles reported by them in 2013 and 2014 have been collected, and they are then classified with the article characteristic, field and tendency. Classified articles have been reviewed by dividing as two year. The 210 articles have been compared for their tendencies, characteristics and fields by year reported, and their characteristic comparison by reported year are then reviewed. Results and Discussion: Though the frequency that the radiological accidents have occurred in worldwide is far low compared to the accidental frequencies occurred in the general industrial fields, the radiation perception is being still deteriorated because of its special problem, which is defined as exposure, contamination or radioactivity, about radiation. The basic principles for radiation communication were suggested for preventing some unnecessary misunderstanding due to the variation of understanding for radiation issues. Conclusion: It is necessary to perform a variety of strategies for the publicity in improving the radiation perception, to build a relationship with the press or the media and then to consistently interact with them. Radiation communication must be performed by radiation experts or complete charge department, and must be consistently performed and be taken predictable patterns.

흰쥐 장에서 Cis-Diammine Dichloro Platinum(Ⅱ)의 방사선손상에 대한 효과

이경자,이정식 梨花女子大學校 醫科大學 醫科學硏究所 1995 EMJ (Ewha medical journal) Vol.18 No.4

목적 : 흰쥐의 복부에 방사선조사와 cis-DDP를 투여하여 소장과 대장의 조직학적 소견을 토대로 하여 cis-DDP가 장관에서 방사선손상에 미치는 영향을 관찰 한다. 방법 : 흰쥐의 복부에 방사선조사군(6~10 Gy), cia-DDP(2.5mg/kg)투여군, 방사선조사와 cis-DDP 병행군으로 분류하였다. 방사선조사군은 전복부에 선형가속기를 이용하여 단일조사하고 cis-DDP투여군은 복강내 1회 주입하였다. 병행군은 방사선조사 전 30분에 cis-DDP투여군과 방사선조사 직후 cis-DDP투여군으로 분류하며 cis-DDP는복강내 주입하였다 실험완료 후 30일에 동물은 개복하여소장과 대장의 조직학적 소견을 광학현미경과 전자현미경으로 비교 관찰하였다. 결과 : 소장에서 cis-DDP단독군은 점막에 경도의 염증세포침윤과 국소적인 괴사가 관찰되었다. 방사선조사 단독군에서 점막의 괴사는 8 Gy, 방사선 조사와 cia-DDP병행군의 6 Gy에서 관찰되었다. 점막하조직의 섬유화는 방사선조사 단독군은 10 Gy, 방사선조사 전 cis-DDP 투여군은8 Gy, 방사선조사 후 cis-DDP 투여군은 6 Gy에서 나타나기 시작하였으며 근층의 괴사는 3군 모두 8 Gy에서 관찰되었다 소장에서 점막하조직의 섬유화를 정량적 종말점으로 하여 증강율은 방사선조사 전 cis-DDP투여군은1.67, 방사선조사 후 cis-DDP 투여군은 1.25이었다 대장에서 점막하조직의 섬유화는 방사선조사 단독군과 방사선조사 후 cis-DDP투여군의 8 Gy에서 관찰되었으며 방사선조사 전 cis-DDP투여군의 6 Gy에서 관찰되었으며 점막하조직의 섬유화를 정량적 종말점으로 하여 증강율은방사선조사 전 cis-DDP 투여군은 1.33, 방사선조사 후투여군은 1.0이었다. 결론 : 점막하조직의 섬유화를 정량적 종말점으로 하여 증강율이 소장에서 방사선조사 전 cis-DDP투여군은 1.67, 방사선조사 후 cis-DDP투여군은 1.25이었다. 대장에서 증강율은 방사선조사 전 cis-DDP투여군은 1.33, 방사선조사후 cis-DDP투여군은 1.0이었다. Cis-DDP는 소장과 대장에서 방사선의 효과를 증강시키며 특히 cis-DDP를 방사선조사 전에 투여한 경우 방사선손상이 증가되었다. 0bjective : This experimental study was performed for evaluate the effects of cis-di-amminedichloroplatinum(Ⅱ) (cis-DDP) on the radiation injury of rat bowel by histopathologic changes. Method and materials : Rats were exposed to entire abdomen by a single doses of X-ray(6-10 Gy) without or witn cis-DDP(2.5mg/kg). Rats were divided into 3 groups such as radiationalone, cis-DDP alone and combined group. In combined group, cis-DDP was given 30minutes before or immediately after irradiation. Results : Cis-DDP induced the inflammatory cell infiltrations with focal necrosis of the mucosa in the small bowel and no abnormal change in the large bowel. In radiation alone group,mucosal necrosis, subrnucosal fibrosis and muscular necrosis were prominent changes in smallbowel and submucosal fibrosis in the large bowel. The submucosal fibrosis in the small bowelwas appealed in 10 Gy of radiation alone group and 8 Gy of cis-DDP infusion after radiationand 6 Gy of cis-DDP infusion before radiation of combined group. In the large bowel, submucosal fibrosis was noted in 8 Gy of radiation alone group and 8 Gy of cis-DDP infusion after radiation and 6 Gy of cis-DDP infusion before radiation of combined group. In the smallbowel, the enhancement ratio was 1.67 in a group of cis-DDP infusion before radiation and 125 in a group of cis-DDP infusion after radiation as the end point was the submucosal fibrosis,In the large bowel, the enhancement ratio was 1.33 in a group of cis-DDP infusion before radiation and 1.0 in a cup of cis-DDP infusion after radiation as e end point was e submucosal fibrosis. Conclusion : This study suggested that cis-DDP enhance the radiation effect in the small andlarge bowel especially when cis-DDP was infused before radiation.

의료용 선형 가속기 종류에 따른 방사선 치료기법에 대한 분석

김염재 ( Young Jae Kim ),동경래 ( Kyung Rae Dong ),여화연 ( Hwa Yeon Yeo ) 조선대학교 공학기술연구원 2012 공학기술논문지 Vol.5 No.3

The use of radiation therapy continues today as a treatment for cancer in radiation therapy devices. This study will be focused on the characteristics of medical radiation devices for the radiation oncology field. Clinac IX was developed or validated by Varian; it was com­bined with Intensity modulated Radiation Therapy (lMRT), Image-Guided Radiation Therapy (lGRT), and on board imaging that allow us to provide our patients with advanced radiation ther­apy. Varian Clinac IX linear accelerators capable of imaging cancerous tumor treatment areas during the actual process of radiation treatment, a process known a linage-Guided Radiation Therapy, or IMRT. Artiste CT Vision developed by Simens IMRT and IGRT. CT is able to pre­cise location of the internal organs in the cancer patients. Novalis TXTM is radiation treatment machine; the Novalis TxTM can treat many different types of cancer. Treatment table (Cauch)`s movement was wider than other devices. However, it has the disadvantage that it is more expensive than other device. Tomotherapy treatment equipment is likely to IMRT, IGRT treatment technique. However, before treatment it causes unnecessary patient exposure to radiation. As a result all the equipment studied here most1y available treatment techniques. Thus, when the introduction of new radiation therapy equipment in the hospital, which is imple­mented based on the treatment technique cost and patient care.

Radiation Safety and Education in the Applicants of the Final Test for the Expert of Pain Medicine

( Pyong Eun Park ),( Jung Min Park ),( Joo Eun Kang ),( Jae Hun Cho ),( Suk Ju Cho ),( Jae Hun Kim ),( Woo Seog Sim ),( Yong Chul Kim ) 대한통증학회 2012 The Korean Journal of Pain Vol.25 No.1

Background: The C-arm fluoroscope is known as the most important equipment in pain interventions. This study was conducted to investigate the completion rate of education on radiation safety, the knowledge of radiation exposure, the use of radiation protection, and so on. Methods: Unsigned questionnaires were collected from the 27 pain physicians who applied for the final test to become an expert in pain medicine in 2011. The survey was composed of 12 questions about the position of the hospital, the kind of hospital, the use of C-arm fluoroscopy, radiation safety education, knowledge of annual permissible radiation dose, use of radiation protection, and efforts to reduce radiation exposure. Results: In this study, although most respondents (93%) had used C-arm fluoroscopy, only 33% of the physicians completed radiation safety education. Even though nine (33%) had received education on radiation safety, none of the physicians knew the annual permissible radiation dose. In comparing the radiation safety education group and the no-education group, the rate of wearing radiation-protective glasses or goggles and the use of radiation badges or dosimeters were significantly higher in the education group. However, in the use of other protective equipment, knowledge of radiation safety, and efforts to reduce radiation exposure, there were no statistical differences between the two groups. Conclusions: The respondents knew very little about radiation safety and had low interest in their radiation exposure. To make the use of fluoroscopy safer, additional education, as well as attention to and knowledge of practices of radiation safety are required for pain physicians. (Korean J Pain 2012; 25: 16-21)

방사선 종사자 근무 분야별 피폭에 관한 검토

윤철호(Chul-Ho Yoon),윤석환(Seok-Hwan Yoon),최준구(Jun-Gu Choi) 대한방사선과학회(구 대한방사선기술학회) 2008 방사선기술과학 Vol.31 No.3

  본 논문은 2006. 1. 1~12. 31(1년)까지 방사선 종사자 근무분야별 피폭에 관하여 서울시내 3차 의료기관인 A, B, C병원의 방사선 분야 종사자 방사선 피폭선량에 대한 분석 결과, 다음과 같은 결론을 얻었다.<BR>  1. 방사선 종사자 근무분야별 피폭은 심혈관조영실이 1.41 mSv로서 제일 많았고, 방사선종양학과는 0.64 mSv로서 제일 낮았다.<BR>  2. 방사선 종사자 근무분야별 피폭선량은 시술건수에 비례하였다.<BR>  3. 방사선 종사자 근무분야별 시술건수 당 피폭선량은 심혈관조영실 근무자가 많았고, 영상의학과 근무자는 적은 것으로 나타났다.<BR>  4. 방사선 종사자 근무분야별 피폭선량 순위는 심혈관조영실, 핵의학과, 영상의학과, 방사선종양학과의 순이었다.<BR>  이상과 같은 결과로 볼 때, 국제방사선방어위원회(ICRP) 권고안 범위이내이므로 병원 방사선 종사자들의 피폭에 따른 유해는 없는 것으로 판단되었다.   Radiation dose to radiologists working at three hospitals in Seoul was investigated from Jan 1, 2006 to Dec. 31, 2006. The results are as follows.<BR>  First, radiation dose to radiologists at a cardiac angiography room was measured as 1.41 mSv, the highest while radiation dose to radiologists at a department of radiation oncology was measured as 0.64 mSv, the lowest.<BR>  Second, radiation dose proves to be in direct proportion to the number of X-ray treatment.<BR>  Third, as for the radiation dose in X-ray treatments, radiologists in cardiac angiography room are exposed to the largest amount of radiation while radiologists in diagnostic radiology department are exposed to the smallest amount of radiation.<BR>  Last, radiation dose at a cardiac angiography room is the largest and is followed by nuclear medicine, diagnostic radiology, and radiation oncology departments in order.<BR>  According to ICRP, exposure less than 20 mSv per year is highly recommended while radiation dose is allowed as long as it is ranged less than 50 mSv per year or 100 mSv within a 5-year period. Taking into account the results, radiation exposure does not do any harm to radiologists at any related departments in Korean hospitals because the dose per year is less than 1.60 mSv.

응급의학과 의사의 방사선 피폭에 대한 인지도 조사

오상훈,최세민,이미진,박규남,최승필,김영민,소병학,김한준,조영순,홍태용 대한응급의학회 2008 대한응급의학회지 Vol.19 No.5

Purpose: Emergency physicians (EPs) are exposed to radiation in the emergency department (ED). However, EPs are not followed with dosimeter measurements of radiation exposure because of the common belief that EPs have a low exposure to radiation. This study was performed to investigate the recognition of EPs’ level of radiation exposure. Methods: Data were collected from direct interviews with questionnaires administered at five ED’s medical conference from November, 2007 to March, 2008. One hundred and twenty-one EPs were surveyed with questionnaires. The questionnaires consisted of six items on the patient characteristics, rate of radiation exposure, recognition of radiation exposure, knowledge of radiation exposure, patient exposure, and education. Some questions were graded on a five point Likert scale. The average and standard deviation were calculated. Results: There were 58.3% of the EPs that reported that they were exposed to portable X-rays more than three times per day; 58.8% of the answers showed that the EPs did not escape from exposure to the portable X-rays. For 87.3% of the EPs, they did not wear lead aprons during the portable X-rays. There were 51.1% of answers that severely underestimated the radiation dose from a CT. The recognition and knowledge of radiation exposure among ED residents increased as there level of training increased, but this was not the case for the board certified emergency physicians (p=0.016). The radiation exposure to the patients was not accurately estimated by EP scores, regardless of their level of experience. Conclusion: The lack of knowledge and recognition of the exposure to radiation by EPs expose them and their patients to potentially dangerous levels of radiation that might increase their lifetime cancer risk. We recommend that EPs should be educated regarding their radiation exposure as well as their patients and followed by dosimeter evaluations to minimize radiation exposure.