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Radiation - friend or foe? Presidential address to Ulster Medical Society 4th October 2012.

Spence R - Ulster Med J (2014)

View Article: PubMed Central - PubMed

Affiliation: Professor of Surgery and Consultant Surgeon, Belfast Trust, Centre for Medical Education, Queen's University Belfast, Mulhouse Building Grosvenor Road, Belfast BT12 6BA.

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In Ulster - the importance of X-rays was quickly realised on 9 July 1896 (only 6 months after Roentgen's announcement) at a medical staff meeting in the Old Belfast Royal Hospital in Frederick Street... He did many X-rays in his home in Mount Charles and in 1911 had a formal darkroom and new X-ray equipment in the hospital... The therapeutic use of X-rays followed quickly from the discovery and a lady with cancer of the breast was treated in 1896. (fig 5) Advances followed rapidly - Marie and Pierre Curie identified radium - discovered in 1896 and published in 1898... Radium paint, which fluoresced, was everywhere! However, the same workers who painted radium paint developed a mysterious and profound anaemia and osteonecrosis... Marie Curie, herself died from radiation induced aplastic anaemia... The American physicist, Thorson, first found the direct relationship between exposure to X-rays and side effects – he deliberately exposed his left index finger to an X-ray tube for 30 minutes per day, for 3 days, developing swelling, erythema and pain... With these, and other advances in radiation therapy it is now estimated that two-thirds of the 1.5 million new cancer cases diagnosed annually in USA - will undergo some form of radiation therapy... Despite careful planning, including the use of radio-sensitisers, radio-protectants, non-cancerous cells are affected resulting in many clinical side effects - from fatigue, and depression, to secondary malignancy such as breast cancer in women who have had mantle radiotherapy for lymphoma when young... While the management of the adverse effects of radiation therapy is not ideal, many treatment strategies are in practice... Therefore, with the huge amount of literature both published and on the internet including the standard oncology text books such as DeVita, there is great awareness in the public, the press and medical profession of the benefits and side effects of radiation therapy in the 21 century... The comprehensive Lancet paper of De Gonzalez from a decade ago looking at 15 countries (including UK) estimated cumulative cancer risk due to diagnostic X-rays... The dose of radiation during EVAR procedures may be close to that during coronary angiography which is highest of all (16.0mSv - equivalent to 800 chest X-rays. (fig 14) Similar data have been shown in USA and Europe... Recent debate centres around - ‘what should patients be told’,... Informed consent is not required in the UK for routine imaging, outwith interventional radiology, but should patients be told of the potential benefits of a particular scan (versus adverse effects).

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CT coronary angiogram (of the author!) following cardiac bypass
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fig14: CT coronary angiogram (of the author!) following cardiac bypass

Mentions: Preoperative CT is essential for the placement of the stent, to determine the vascular anatomy105. After the procedure stenting CT was performed, in earlier series, at 1, 3 and 12 months postoperatively and annually thereafter (EVAR I, II, 2005). The patient is, therefore, exposed to significant CT radiation106. One series from Belfast of 320 elective patients undergoing EVAR found a mean screening time of 29.4 mins ± 23.3 minutes and a radiation dose during the procedure of 13.4 ± 8.6 mSv. During the first postoperative year follow-up CT scans exposed the patients to 24.0mSv, and then 8.0mSv in subsequent years. Abdominal X-rays added a further 1.8mSv per year. This adds up to substantial radiation with subsequent long term carcinogenic risks107. (fig 13) Of course many of these patients are elderly, but younger patients with aortic aneurysm are not uncommon and this radiation dose may be clinically relevant in these patients in years to come. The dose of radiation during EVAR procedures may be close to that during coronary angiography which is highest of all (16.0mSv - equivalent to 800 chest X-rays108. (fig 14)


Radiation - friend or foe? Presidential address to Ulster Medical Society 4th October 2012.

Spence R - Ulster Med J (2014)

CT coronary angiogram (of the author!) following cardiac bypass
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4255836&req=5

fig14: CT coronary angiogram (of the author!) following cardiac bypass
Mentions: Preoperative CT is essential for the placement of the stent, to determine the vascular anatomy105. After the procedure stenting CT was performed, in earlier series, at 1, 3 and 12 months postoperatively and annually thereafter (EVAR I, II, 2005). The patient is, therefore, exposed to significant CT radiation106. One series from Belfast of 320 elective patients undergoing EVAR found a mean screening time of 29.4 mins ± 23.3 minutes and a radiation dose during the procedure of 13.4 ± 8.6 mSv. During the first postoperative year follow-up CT scans exposed the patients to 24.0mSv, and then 8.0mSv in subsequent years. Abdominal X-rays added a further 1.8mSv per year. This adds up to substantial radiation with subsequent long term carcinogenic risks107. (fig 13) Of course many of these patients are elderly, but younger patients with aortic aneurysm are not uncommon and this radiation dose may be clinically relevant in these patients in years to come. The dose of radiation during EVAR procedures may be close to that during coronary angiography which is highest of all (16.0mSv - equivalent to 800 chest X-rays108. (fig 14)

View Article: PubMed Central - PubMed

Affiliation: Professor of Surgery and Consultant Surgeon, Belfast Trust, Centre for Medical Education, Queen's University Belfast, Mulhouse Building Grosvenor Road, Belfast BT12 6BA.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

In Ulster - the importance of X-rays was quickly realised on 9 July 1896 (only 6 months after Roentgen's announcement) at a medical staff meeting in the Old Belfast Royal Hospital in Frederick Street... He did many X-rays in his home in Mount Charles and in 1911 had a formal darkroom and new X-ray equipment in the hospital... The therapeutic use of X-rays followed quickly from the discovery and a lady with cancer of the breast was treated in 1896. (fig 5) Advances followed rapidly - Marie and Pierre Curie identified radium - discovered in 1896 and published in 1898... Radium paint, which fluoresced, was everywhere! However, the same workers who painted radium paint developed a mysterious and profound anaemia and osteonecrosis... Marie Curie, herself died from radiation induced aplastic anaemia... The American physicist, Thorson, first found the direct relationship between exposure to X-rays and side effects – he deliberately exposed his left index finger to an X-ray tube for 30 minutes per day, for 3 days, developing swelling, erythema and pain... With these, and other advances in radiation therapy it is now estimated that two-thirds of the 1.5 million new cancer cases diagnosed annually in USA - will undergo some form of radiation therapy... Despite careful planning, including the use of radio-sensitisers, radio-protectants, non-cancerous cells are affected resulting in many clinical side effects - from fatigue, and depression, to secondary malignancy such as breast cancer in women who have had mantle radiotherapy for lymphoma when young... While the management of the adverse effects of radiation therapy is not ideal, many treatment strategies are in practice... Therefore, with the huge amount of literature both published and on the internet including the standard oncology text books such as DeVita, there is great awareness in the public, the press and medical profession of the benefits and side effects of radiation therapy in the 21 century... The comprehensive Lancet paper of De Gonzalez from a decade ago looking at 15 countries (including UK) estimated cumulative cancer risk due to diagnostic X-rays... The dose of radiation during EVAR procedures may be close to that during coronary angiography which is highest of all (16.0mSv - equivalent to 800 chest X-rays. (fig 14) Similar data have been shown in USA and Europe... Recent debate centres around - ‘what should patients be told’,... Informed consent is not required in the UK for routine imaging, outwith interventional radiology, but should patients be told of the potential benefits of a particular scan (versus adverse effects).

Show MeSH