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Cancer research  2008;68(21):8825-8831.
The U.S. population has nearly one radiographic examination per person per year and concern about cancer risks associated with medical radiation has increased. Radiologic technologists were surveyed to determine whether their personal cumulative exposure to diagnostic x-rays was associated with increased frequencies of chromosome translocations, an established radiation biomarker and possible intermediary suggesting increased cancer risk. Within a large cohort of U. S. radiologic technologists, 150 provided a blood sample for whole chromosome painting and were interviewed about past x-ray examinations. The number and types of examinations reported were converted to a red bone marrow (RBM) dose score with units that approximated 1 mGy. The relationship between dose score and chromosome translocation frequency was assessed using Poisson regression. The estimated mean cumulative RBM radiation dose score was 49 (range 0 – 303). After adjustment for age, translocation frequencies significantly increased with increasing RBM dose score with an estimate of 0.004 translocations per 100 cell equivalents per score unit (95% confidence interval 0.002 to 0.007; P < 0.001). Removing extreme values or adjustment for gender, cigarette smoking, occupational radiation dose, allowing practice x-rays while training, work with radioisotopes, and radiotherapy for benign conditions did not affect the estimate. Cumulative radiation exposure from routine x-ray examinations was associated independently with increased chromosome damage, suggesting the possibility of elevated long-term health risks, including cancer. The slope estimate was consistent with expectation based on cytogenetic experience and atomic bomb survivor data.
PMCID: PMC2586176  PMID: 18974125
Radiation exposure; diagnostic x-rays; chromosome translocations; FISH; risk factors
2.  Increased Frequency of Chromosome Translocations Associated with Diagnostic X-Ray Examinations 
Radiation research  2008;170(2):149-155.
Informative studies of cancer risks associated with medical radiation are difficult to conduct owing to low radiation doses, poor recall of diagnostic X rays, and long intervals before cancers occur. Chromosome aberrations have been associated with increased cancer risk and translocations are a known radiation biomarker. Seventy-nine U.S. radiologic technologists were selected for blood collection, and translocations were enumerated by whole chromosome painting. We developed a dose score to the red bone marrow for medical radiation exposure from X-ray examinations reported by the technologists that they received as patients. Using Poisson regression, we analyzed translocations in relation to the dose scores. Each dose score unit approximated 1 mGy. The estimated mean cumulative red bone marrow radiation dose score was 42 (range 1–265). After adjustment for age, occupational radiation, and radiotherapy for benign conditions, translocation frequencies significantly increased with increasing red bone marrow dose score with an estimate of 0.007 translocations per 100 CEs per score unit (95% CI, 0.002 to 0.013; P = 0.01). Chromosome damage has been linked with elevated cancer risk, and we found that cumulative radiation exposure from medical X-ray examinations was associated with increased numbers of chromosome translocations.
PMCID: PMC2766815  PMID: 18666821
Health physics  2011;101(1):13-27.
While radiation absorbed dose (Gy) to the skin or other organs is sometimes estimated for patients from diagnostic radiologic examinations or therapeutic procedures, rarely is occupationally-received radiation absorbed dose to individual organs/tissues estimated for medical personnel, e.g., radiologic technologists or radiologists. Generally, for medical personnel, equivalent or effective radiation doses are estimated for compliance purposes. In the very few cases when organ doses to medical personnel are reconstructed, the data is usually for the purpose of epidemiologic studies, e.g., a study of historical doses and risks to a cohort of about 110,000 radiologic technologists presently underway at the U.S. National Cancer Institute. While ICRP and ICRU have published organ-specific external dose conversion coefficients (DCCs), i.e., absorbed dose to organs and tissues per unit air kerma and dose equivalent per unit air kerma, those factors have been primarily published for mono-energetic photons at selected energies. This presents two related problems for historical dose reconstruction, both of which are addressed here. It is necessary to derive conversion factors values for (i) continuous distributions of energy typical of diagnostic medical x rays (bremsstrahlung radiation), and (ii) for energies of particular radioisotopes used in medical procedures, neither of which are presented in published tables. For derivation of DCCs for bremsstrahlung radiation, combinations of x-ray tube potentials and filtrations were derived for different time periods based on a review of relevant literature. Three peak tube potentials (70 kV, 80 kV, and 90 kV) with four different amounts of beam filtration were determined to be applicable for historic dose reconstruction. The probability of these machine settings were assigned to each of the four time periods (earlier than 1949, 1949-1954, 1955-1968, and after 1968). Continuous functions were fit to each set of discrete values of the ICRP/ICRU mono-energetic DCCs and the functions integrated over the air-kerma weighted photon fluence of the 12 defined x-ray spectra. The air kerma-weighted DCCs in this work were developed specifically for an irradiation geometry of anterior to posterior (AP) and for the following tissues: thyroid, breast, ovary, lens of eye, lung, colon, testes, heart, skin (anterior side only), red bone marrow (RBM), heart, and brain. In addition, a series of functional relationships to predict DT per Ka values for RBM dependent on body mass index [BMI (kg m−2) ≡ weight per height2] and average photon energy were derived from a published analysis. Factors to account for attenuation of radiation by protective lead aprons were also developed. Because lead protective aprons often worn by radiology personnel not only reduce the intensity of x-ray exposure but also appreciably harden the transmitted fluence of bremsstrahlung x rays, DCCs were separately calculated for organs possibly protected by lead aprons by considering three cases: no apron, 0.25 mm Pb apron, and 0.5 mm Pb apron. For estimation of organ doses from conducting procedures with radioisotopes, continuous functions of the reported mono-energetic values were developed and DCCs were derived by estimation of the function at relevant energies. By considering the temporal changes in primary exposure-related parameters, e.g., energy distribution, the derived DCCs and transmission factors presented here allow for more realistic historical dose reconstructions for medical personnel when monitoring badge readings are the primary data on which estimation of an individual's organ doses are based.
PMCID: PMC3964780  PMID: 21617389
4.  Increased frequency of chromosome translocations in airline pilots with long-term flying experience 
Chromosome translocations are an established biomarker of cumulative exposure to external ionising radiation. Airline pilots are exposed to cosmic ionising radiation, but few flight crew studies have examined translocations in relation to flight experience.
We determined the frequency of translocations in the peripheral blood lymphocytes of 83 airline pilots and 50 comparison subjects (mean age 47 and 46 years, respectively). Translocations were scored in an average of 1039 cell equivalents (CE) per subject using fluorescence in situ hybridisation (FISH) whole chromo-some painting and expressed per 100 CE. Negative binomial regression models were used to assess the relationship between translocation frequency and exposure status and flight years, adjusting for age, diagnostic x ray procedures, and military flying.
There was no significant difference in the adjusted mean translocation frequency of pilots and comparison subjects (0.37 (SE 0.04) vs 0.38 (SE 0.06) translocations/100 CE, respectively). However, among pilots, the adjusted translocation frequency was significantly associated with flight years (p = 0.01) with rate ratios of 1.06 (95% CI 1.01 to 1.11) and 1.81 (95% CI 1.16 to 2.82) for a 1- and 10-year incremental increase in flight years, respectively. The adjusted rate ratio for pilots in the highest compared to the lowest quartile of flight years was 2.59 (95% CI 1.26 to 5.33).
This data suggests that pilots with long-term flying experience may be exposed to biologically significant doses of ionising radiation. Epidemiological studies with longer follow-up of larger cohorts of pilots with a wide range of radiation exposure levels are needed to clarify the relationship between cosmic radiation exposure and cancer risk.
PMCID: PMC2608721  PMID: 19074211
5.  Chromosomal aberrations in human lymphocytes and fibroblasts after exposure to very low doses of high-LET radiation 
Journal of Radiation Research  2014;55(Suppl 1):i50-i51.
Purpose: The relationship between biological effects and low doses of radiation is still uncertain, especially for high-LET radiation exposures. Estimates of risk from exposure to low doses and low dose rates are often extrapolated from the Japanese atomic bomb survivor data using either linear or linear-quadratic models fitted to dose–response data. In this study, we determined the dose–response for chromosome damage after exposure to very low doses of high-LET radiation and assessed the radiation qualities of Fe, Si and Oxygen ions.
Materials and methods: Chromosomal aberrations (CA) were measured in human peripheral blood lymphocytes and normal skin fibroblasts after exposure to very low doses (0.01–0.20 Gy) of 77-MeV/u oxygen (LET = 55 keV/µm), 170-MeV/u 28Si (LET = 99 keV/µm), or 56Fe ions with energies of 600- or 450-MeV/u (LET = 180 or 195 keV/µm). These exposures included doses that, on average, produce fewer than one in five direct ion traversals per cell nucleus. Chromosomes were analyzed using the whole-chromosome fluorescence in situ hybridization (FISH) technique during the first cell division after irradiation, and CA were identified as either simple exchanges (translocations and dicentrics) or complex exchanges (involving more than two breaks in two or more chromosomes). The frequencies of CA in the painted chromosome(s) were evaluated as the ratio between aberrations scored and total cells analyzed. The dose–response for simple exchanges was assessed using a generalized linear model assuming binomial errors per number of chromosomes scored. The model coefficients were extrapolated to whole-genome equivalents. The linear dose–response denoted as the targete effects (TE) model considered the mean number of radiation tracks per cell. Two different non-targeted effect (NTE) models, P = P0 + αT + κ × I (NTE1), and P = P0 + αT (1 − e−T) + κe−T × I (NTE2), were compared with the simple linear model, P = P0 + αT. Akaike information criteria (AIC) and Bayes information criteria (BIC) were used to compare TE and NTE models for fitting chromosome aberrations in low dose range.
Results: Doses that on average produce more than one ion traversal per cell nucleus showed a linear dose–response for CA in both lymphocytes and fibroblasts. However, for doses that produce fewer than one tracks per cell in fibroblasts, O, Si and Fe particles showed a dose-independent response for CA that was significantly elevated relative to background frequencies. For fibroblasts the NTE model 2, P = P0 + αT (1 − e−T) + κe−T × I, showed improved fit to CA in low dose range compared with TE model or NTE1 model. For lymphocytes, tests of the various models were less clear with TE model optimal for Si and Fe while the NTE2 model optimal for O particles. When low-dose exposures were fractionated with 2-h intervals, increased frequencies of both simple and complex exchanges were observed. Nitric oxide scavenger reduced CA induced by low doses of high-LET irradiation. Inhibition of transforming growth factor-β receptor-1 reduced the frequency of simple exchanges.
Conclusions: The results show a non-linear dose–response for CA in fibroblasts after very low doses of high-LET exposure. Possible explanations for this could involve non-targeted effects due to aberrant cell signaling [ 1], perhaps involving nitric oxide and TGF-β, or could be due to delta-ray dose fluctuations [ 2] where CA are induced in cells that receive a significant dose from delta-rays emanating from the multiple ion tracks that do not directly traverse cell nuclei.
PMCID: PMC3941494
low dose; heavy ion; chromosome aberrations
6.  Risk of Cataract after Exposure to Low Doses of Ionizing Radiation: A 20-Year Prospective Cohort Study among US Radiologic Technologists 
American Journal of Epidemiology  2008;168(6):620-631.
The study aim was to determine the risk of cataract among radiologic technologists with respect to occupational and nonoccupational exposures to ionizing radiation and to personal characteristics. A prospective cohort of 35,705 cataract-free US radiologic technologists aged 24–44 years was followed for nearly 20 years (1983–2004) by using two follow-up questionnaires. During the study period, 2,382 cataracts and 647 cataract extractions were reported. Cigarette smoking for ≥5 pack-years; body mass index of ≥25 kg/m2; and history of diabetes, hypertension, hypercholesterolemia, or arthritis at baseline were significantly (p ≤ 0.05) associated with increased risk of cataract. In multivariate models, self-report of ≥3 x-rays to the face/neck was associated with a hazard ratio of cataract of 1.25 (95% confidence interval: 1.06, 1.47). For workers in the highest category (mean, 60 mGy) versus lowest category (mean, 5 mGy) of occupational dose to the lens of the eye, the adjusted hazard ratio of cataract was 1.18 (95% confidence interval: 0.99, 1.40). Findings challenge the National Council on Radiation Protection and International Commission on Radiological Protection assumptions that the lowest cumulative ionizing radiation dose to the lens of the eye that can produce a progressive cataract is approximately 2 Gy, and they support the hypothesis that the lowest cataractogenic dose in humans is substantially less than previously thought.
PMCID: PMC2727195  PMID: 18664497
cataract; radiation; technology, radiologic; x-rays
7.  Evaluation of radiation doses delivered in different chest CT protocols 
There are differences in the reference diagnostic levels for the computed tomography (CT) of the chest as cited in different literature sources. The doses are expressed either in weighted CT dose index (CTDIVOL) used to express the dose per slice, dose-length product (DLP), and effective dose (E). The purpose of this study was to assess the radiation dose used in Low Dose Computer Tomography (LDCT) of the chest in comparison with routine chest CT examinations as well as to compare doses delivered in low dose chest CT with chest X-ray doses.
CTDIVOL and DLP doses were taken to analysis from routine CT chest examinations (64 MDCT TK LIGHT SPEED GE Medical System) performed in 202 adult patients with FBP reconstruction: 51 low dose, 106 helical, 20 angio CT, and 25 high resolution CT protocols, as well as 19 helical protocols with iterative ASIR reconstruction. The analysis of chest X-ray doses was made on the basis of reports from 44 examinations.
Mean values of CTDIVOL and DLP were, respectively: 2.1 mGy and 85.1 mGy·cm, for low dose, 9.7 mGy and 392.3 mGy·cm for helical, 18.2 mGy and 813.9 mGy·cm for angio CT, 2.3 mGy and 64.4 mGy·cm for high resolution CT, 8.9 mGy. and 317.6 mGy·cm for helical ASIR protocols. Significantly lower CTDIVOL and DLP values were observed for low dose and high resolution CT versus the remaining CT protocols; doses delivered in CT ASIR protocols were also lower (80–81%). The ratio between medial doses in low dose CT and chest X-ray was 11.56.
Radiation dose in extended chest LDCT with parameters allowing for identification of mediastinal structures and adrenal glands is still much lower than that in standard CT protocols. Effective doses predicted for LDCT may exceed those used in chest X-ray examinations by a factor of 4 to 12, depending on LDCT scan parameters. Our results, as well as results from other authors, suggest a possibility of reducing the dose by means of iterative reconstruction. Efforts towards further dose reduction which would permit replacing chest X-ray with low dose CT in certain research screening projects should be encouraged.
PMCID: PMC3894921  PMID: 24454417
radiation safety; radiation protection; computed tomography (CT); chest CT; lung CT; low dose CT
8.  mBAND analysis of early and late damages in the chromosome of human lymphocytes after exposures to gamma rays and Fe ions 
Journal of Radiation Research  2014;55(Suppl 1):i87-i88.
Stable-type chromosome aberrations that survive multiple generations of cell division include translocation and inversions. An efficient method to detect an inversion is multi-color banding fluorescent in situ hybridization (mBAND) which allows identification of both inter- and intra-chromosome aberrations simultaneously. Post irradiation, chromosome aberrations may also arise after multiple cell divisions as a result of genomic instability. This study was aimed at investigating stable or late-arising chromosome aberrations in human lymphocytes induced after low- and high-LET radiation exposure.
Human lymphocytes were exposed in vitro to gamma ray doses of 2 or 4 Gy using a 137Cs source at a dose rate of 0.5 Gy/min. For high LET radiation, cells were exposed to Fe ions (600 MeV/nucleon) of 0.05, 0.5 or 1 Gy at NASA Space Radiation Laboratory (NSRL) at Brookhaven National Laboratory (BNL). Chromosomes were collected at 48 h which represented the first mitosis, and 7 and 14 days after irradiation using a premature chromosome condensation (PCC) technique as described previously [ 1]. Chromosome 3 was painted with the XCyte3 mBAND kit (MetaSystems), and intra- and inter-chromosomal aberrations were analyzed with the mBAND analysis system (MetaSystems).
With gamma irradiation, about half of the damages observed at first mitosis remained after 7- and 14-day culture, suggesting transmissibility of damages to the surviving progeny. With Fe ions irradiation, at the doses that produced similar frequencies of gamma-induced chromosome aberrations as observed at first mitosis, a significantly lower yield of aberrations remained at the same population doublings after Fe ion exposure. At these equitoxic doses, more complex-type aberrations were observed for Fe ions, indicating that Fe ion-induced initial chromosome damages are more severe and may lead to cell death.
Comparison of the number of breaks indicates that Fe ions produced three or more breaks in ∼20% of the damaged chromosome 3, whereas ∼10% or a less fraction of cells with three or more breaks in chromosome 3 were found after gamma ray exposures. Unlike gamma rays, increasing doses of Fe ions did not produce more breaks in a damaged chromosome 3, indicating that damages from Fe ions exposures were mostly due to the single track effect, in agreement with the results of Hada et al. [ 1, 2].
Increasing doses of exposure resulted in less fraction of chromosome break ends involved in intra-chromosomal exchange induced by either gamma rays or Fe ions in the first mitosis.
Interestingly, simple inversions in chromosome 3 were found in only the 7 and 14-day samples after 4 Gy gamma irradiation. It is not clear whether cells containing simple inversions had already progressed through the first cell division at 48 h, or the simple inversions were induced after the first cell division.
Detailed analysis of breaks participating in total chromosome exchanges within the first cell cycle post-irradiation revealed a common hot spot located in the 3p21 region, which is a known fragile site corresponding to Band 6 in the mBand analysis [ 2]. The breakpoint distribution in chromosomes collected at 7 days, but not at 14 days, post-irradiation appeared similar to the distribution in cells collected within the first cell cycle post-irradiation. The breakpoint distribution for human lymphocytes after radiation exposure was different from the previously published distribution for human mammary epithelial cells [ 2], indicating that interphase chromatin folding structures play a role in the distribution of radiation-induced breaks.
PMCID: PMC3941537
heavy ion; genomic instability; chromosome aberrations; mBAND
9.  Gene Expression Signatures That Predict Radiation Exposure in Mice and Humans 
PLoS Medicine  2007;4(4):e106.
The capacity to assess environmental inputs to biological phenotypes is limited by methods that can accurately and quantitatively measure these contributions. One such example can be seen in the context of exposure to ionizing radiation.
Methods and Findings
We have made use of gene expression analysis of peripheral blood (PB) mononuclear cells to develop expression profiles that accurately reflect prior radiation exposure. We demonstrate that expression profiles can be developed that not only predict radiation exposure in mice but also distinguish the level of radiation exposure, ranging from 50 cGy to 1,000 cGy. Likewise, a molecular signature of radiation response developed solely from irradiated human patient samples can predict and distinguish irradiated human PB samples from nonirradiated samples with an accuracy of 90%, sensitivity of 85%, and specificity of 94%. We further demonstrate that a radiation profile developed in the mouse can correctly distinguish PB samples from irradiated and nonirradiated human patients with an accuracy of 77%, sensitivity of 82%, and specificity of 75%. Taken together, these data demonstrate that molecular profiles can be generated that are highly predictive of different levels of radiation exposure in mice and humans.
We suggest that this approach, with additional refinement, could provide a method to assess the effects of various environmental inputs into biological phenotypes as well as providing a more practical application of a rapid molecular screening test for the diagnosis of radiation exposure.
John Chute and colleagues report that gene expression patterns in peripheral blood mononuclear cells from mice and humans reflect prior radiation exposure.
Editors' Summary
Everyone living on earth is constantly exposed to low levels of ionizing radiation—energy in the form of waves or particles that is powerful enough to strip electrons out of atoms and to break chemical bonds in important biomolecules. These low levels of ionizing radiation come from radioactive chemicals in the ground and cosmic rays, for example, and are relatively harmless. Occasionally, though, individuals are exposed to larger amounts of ionizing radiation, often as a result of medical tests and treatments but sometimes through the accidental or deliberate release of radioactive chemicals. These larger doses, which permanently damage or kill cells, can cause radiation sickness, a condition characterized by bone marrow failure, gut problems, susceptibility to bacterial infections, and other symptoms that develop days or months after exposure to ionizing radiation. Particularly large doses can be lethal but even moderate doses can increase an individual's risk of developing cancer later in life.
Why Was This Study Done?
Some of the effects of ionizing radiation can be reduced if suitable treatment is started immediately after exposure. Unfortunately, it takes several days to estimate the amount of ionizing radiation to which an individual has been exposed. It would be useful to measure personal exposures more quickly, especially in emergency situations where ideally doctors would be able to distinguish rapidly and accurately between the “worried well” and exposed individuals. As cells respond to irradiation by altering the expression of some genes, the researchers in this study investigated whether gene expression profiling (a molecular biology technique that catalogues all the genes expressed by a cell) can be used to define a set of gene expression changes—called a metagene—that differentiates between irradiated and non-irradiated cells.
What Did the Researchers Do and Find?
The researchers exposed mice to no ionizing radiation, a low dose that causes no medical problems, an intermediate dose that damages blood cells, or a lethal dose. Six hours later, they isolated blood cells from the mice, and catalogued which genes each sample expressed. Using this information, the researchers identified and validated metagenes that accurately distinguished between blood samples from non-irradiated and irradiated animals and between samples from animals exposed to different radiation doses. The researchers then developed a metagene for human radiation exposure using blood samples taken from patients before and after total body irradiation given as part of their medical treatment. This metagene correctly identified 18 of 20 pre-irradiation samples and 17 of 20 post-irradiation samples. Finally, the researchers tested whether the radiation metagenes developed in mice could distinguish between samples taken from irradiated and non-irradiated people. Although the high-dose mouse metagene correctly identified all of the samples from healthy donors as being non-irradiated, it correctly identified only two-thirds of the pre-irradiated samples from patients.
What Do These Findings Mean?
These findings indicate that metagenes can be generated that recognize different levels of radiation exposure in mice and people. In the mouse study a metagene was identified that correctly identified in all cases whether a sample came from a non-irradiated mouse or an animal exposed to the lowest dose of radiation. This result suggests that it might be possible to use a metagene to identify exposed individuals among thousands of “worried well” after a radiation emergency. First, however, the mouse and human metagenes identified here need to be refined to improve their accuracy and then validated in more people. The current high-dose mouse metagene may be bad at identifying non-irradiated patients, for example, because of gene expression changes that are a result of the patients' underlying disease or previous medical treatments. By studying additional patients, it might be possible to improve the accuracy of the metagene by taking these radiation-independent changes into account. Finally and more generally, these findings suggest that the metagene approach could be used to monitor people's exposure to other dangerous environmental agents.
Additional Information.
Please access these Web sites via the online version of this summary at
US Environmental Protection Agency offers information on understanding radiation and factsheets on ionizing radiation
MedlinePlus provides links to information on radiation exposure and pages on radiation sickness
US Centers for Disease Control and Prevention has information on emergency preparedness and response to radiation emergencies
Wikipedia has pages on ionizing radiation, radiation poisoning, and expression profiling (note that Wikipedia is a free online encyclopedia that anyone can edit)
PMCID: PMC1845155  PMID: 17407386
10.  Radiation awareness among radiology residents, technologists, fellows and staff: where do we stand? 
Insights into Imaging  2014;6(1):133-139.
To investigate and compare the knowledge of radiation dose and risk incurred in common radiology examinations among radiology residents, fellows, staff radiologists and technologists.
A questionnaire containing 17 multiple choice questions was administered to all residents, technologists, fellows and staff radiologists of the department of medical imaging through the hospital group mailing list.
A total of 92 responses was received. Mean score was 8.5 out of 17. Only 48 % of all participants scored more than 50 % correct answers. Only 23 % were aware of dose from both single-view and two-view chest X-ray; 50–70 % underestimated dose from common studies; 50–75 % underestimated the risk of fatal cancer. Awareness about radiation exposure in pregnancy is variable and particularly poor among technologists. A statistically significant comparative knowledge gap was found among technologists.
Our results show a variable level of knowledge about radiation dose and risk among radiology residents, fellows, staff radiologists and technologists, but overall knowledge is inadequate in all groups. There is significant underestimation of dosage and cancer risk from common examinations, which could potentially lead to suboptimal risk assessment and excessive or unwarranted studies posing significant radiation hazard to the patient and radiology workers.
Main Messages
• Knowledge of radiation dose and risk is poor among all radiology workers.
• Significant knowledge gap among technologists compared to residents, fellows and staff radiologists.
• Significant underestimation of radiation dose and cancer risk from common examinations.
PMCID: PMC4330233  PMID: 25412827
Radiation dose; Radiation risk; Residents; Technologists; Cancer risk; Questionnaire
11.  Personalized estimates of radiation dose from dedicated breast CT in a diagnostic population and comparison with diagnostic mammography 
Physics in medicine and biology  2013;58(22):10.1088/0031-9155/58/22/7921.
This study retrospectively analyzed the mean glandular dose (MGD) to 133 breasts from 132 subjects, all women, who participated in a clinical trial evaluating dedicated breast CT in a diagnostic population. The clinical trial was conducted in adherence to a protocol approved by institutional review boards and the study participants provided written informed consent. Individual estimates of mean glandular dose to each breast from dedicated breast CT was obtained by combining x-ray beam characteristics with estimates of breast dimensions and fibroglandular fraction from volumetric breast CT images, and using normalized glandular dose coefficients. For each study participant and for the breast corresponding to that imaged with breast CT, an estimate of the MGD from diagnostic mammography (including supplemental views) was obtained from the DICOM image headers for comparison. This estimate uses normalized glandular dose coefficients corresponding to a breast with 50% fibroglandular weight fraction. The median fibroglandular weight fraction for the study cohort determined from volumetric breast CT images was 15%. Hence, the MGD from diagnostic mammography was corrected to be representative of the study cohort. Individualized estimates of MGD from breast CT ranged from 5.7 mGy to 27.8 mGy. Corresponding to the breasts imaged with breast CT, the MGD from diagnostic mammography ranged from 2.6 to 31.6 mGy. The mean (± inter-breast SD) and the median MGD (mGy) from dedicated breast CT exam were 13.9±4.6 and 12.6, respectively. For the corresponding breasts, the mean (± inter-breast SD) and the median MGD (mGy) from diagnostic mammography were 12.4±6.3 and 11.1, respectively. Statistical analysis indicated that at the 0.05 level, the distributions of MGD from dedicated breast CT and diagnostic mammography were significantly different (Wilcoxon signed ranks test, p = 0.007). While the interquartile range and the range (maximum-minimum) of MGD from dedicated breast CT was lower than diagnostic mammography, the median MGD from dedicated breast CT was approximately 13.5% higher than that from diagnostic mammography. The MGD for breast CT is based on a 1.45 mm skin layer and that for diagnostic mammography is based on a 4 mm skin layer; thus, favoring a lower estimate for MGD from diagnostic mammography. The median MGD from dedicated breast CT corresponds to the median MGD from 4 to 5 diagnostic mammography views. In comparison, for the same 133 breasts, the mean and the median number of views per breast during diagnostic mammography were 4.53 and 4, respectively. Paired analysis showed that there was approximately equal likelihood of receiving lower MGD from either breast CT or diagnostic mammography. Future work will investigate methods to reduce and optimize radiation dose from dedicated breast CT.
PMCID: PMC3872967  PMID: 24165162
Computed tomography; Mammography; Breast CT; Radiation dose
12.  Airline Pilot Cosmic Radiation and Circadian Disruption Exposure Assessment from Logbooks and Company Records 
Annals of Occupational Hygiene  2011;55(5):465-475.
Objectives: US commercial airline pilots, like all flight crew, are at increased risk for specific cancers, but the relation of these outcomes to specific air cabin exposures is unclear. Flight time or block (airborne plus taxi) time often substitutes for assessment of exposure to cosmic radiation. Our objectives were to develop methods to estimate exposures to cosmic radiation and circadian disruption for a study of chromosome aberrations in pilots and to describe workplace exposures for these pilots.
Methods: Exposures were estimated for cosmic ionizing radiation and circadian disruption between August 1963 and March 2003 for 83 male pilots from a major US airline. Estimates were based on 523 387 individual flight segments in company records and pilot logbooks as well as summary records of hours flown from other sources. Exposure was estimated by calculation or imputation for all but 0.02% of the individual flight segments’ block time. Exposures were estimated from questionnaire data for a comparison group of 51 male university faculty.
Results: Pilots flew a median of 7126 flight segments and 14 959 block hours for 27.8 years. In the final study year, a hypothetical pilot incurred an estimated median effective dose of 1.92 mSv (absorbed dose, 0.85 mGy) from cosmic radiation and crossed 362 time zones. This study pilot was possibly exposed to a moderate or large solar particle event a median of 6 times or once every 3.7 years of work. Work at the study airline and military flying were the two highest sources of pilot exposure for all metrics. An index of work during the standard sleep interval (SSI travel) also suggested potential chronic sleep disturbance in some pilots. For study airline flights, median segment radiation doses, time zones crossed, and SSI travel increased markedly from the 1990s to 2003 (Ptrend < 0.0001). Dose metrics were moderately correlated with records-based duration metrics (Spearman’s r = 0.61–0.69).
Conclusions: The methods developed provided an exposure profile of this group of US airline pilots, many of whom have been exposed to increasing cosmic radiation and circadian disruption from the 1990s through 2003. This assessment is likely to decrease exposure misclassification in health studies.
PMCID: PMC3113148  PMID: 21610083
circadian disruption; cosmic radiation; exposure assessment; flight crew; pilots
13.  The status of Spain's dental practice following the European Union directive concerning radiological installations: 11 years on (1996–2007) 
Dentomaxillofacial Radiology  2010;39(8):468-474.
The aim of this study was to assess the influence of European Union legislation on dental radiology practice in Spain and the reduction in doses administered in dental radiological installations 11 years after its introduction.
A total of 19 079 official reports on dental surgeries from 16 Spanish autonomous regions published between 1996 and 2007 were studied. We analysed the physical characteristics of the X-ray units, anomalies, film processing, exposure times and mean radiation doses administered in clinical situations.
The dose applied to obtain a radiograph of an upper second molar had decreased by 37% up until 2007, the mean dose being 2.7 mGy, with 81.1% of installations using a dose of less than 4 mGy, with a reference dose for the 3rd quartile of 3.6 mGy. Of note was the incorporation of digital systems (50.1%), which are gradually replacing manual processing systems (45.3%). There were significant differences between the systems: direct digital radiology < indirect digital radiology = Insight = Ektaspeed = Ultraspeed (P < 0.001). In installations with digital systems, 6.3% used more than 4 mGy (20.5% with direct radiology and 3.2% with indirect radiology) and 7.4% a dose of less than 0.5 mGy, with a mean dose of 1.8 mGy and a reference dose for the 3rd quartile of 2.3 mGy.
There has been a gradual improvement in dental radiology practices; however, the incorporation of digital systems has not resulted in all the benefits hoped for, and mistakes are frequent. Besides the physical parameters that have been established, anatomical and clinical image quality criteria should be established to convince dentists of the real benefits of incorporating quality guarantee procedures in their practices.
PMCID: PMC3520208  PMID: 21062940
radiography, intraoral, dental; radiation dosage; radiology; dental film
14.  Paediatric CT scan usage and referrals of children to computed tomography in Germany-a cross-sectional survey of medical practice and awareness of radiation related health risks among physicians 
Computed tomography (CT) is a major source of ionizing radiation exposure in medical diagnostic. Compared to adults, children are supposed to be more susceptible to health risks related to radiation. The purpose of a cross-sectional survey among office-based physicians in Germany was the assessment of medical practice in paediatric CT referrals and to investigate physicians' knowledge of radiation doses and potential health risks of radiation exposure from CT in children.
A standardized questionnaire was distributed to all paediatricians and surgeons in two defined study areas. Furthermore, the study population included a random sample of general practitioners in the two areas. The questionnaire covered the frequency of referrals for paediatric CT examinations, the medical diagnoses leading to paediatric CT referrals, physicians' knowledge of radiation doses and potential health risks of radiation exposure from CT in children.
A total of 295 (36.4%) physicians responded. 59% of the doctors had not referred a child to CT in the past year, and approximately 30% referred only 1-5 children annually. The most frequent indications for a CT examination in children were trauma or a suspected cancer. 42% of the referrals were related to minor diagnoses or unspecific symptoms. The participants underestimated the radiation exposure due to CT and they overestimated the radiation exposure due to conventional X-ray examinations.
In Germany, the frequency of referrals of children to computed tomography is moderate. The knowledge on the risks from radiation exposure among office-based physicians in our sample varied, but there was a tendency to underestimate potential CT risks. Advanced radiological training might lead to considerable amendments in terms of knowledge and practice of CT referral.
PMCID: PMC3306200  PMID: 22364554
15.  Radiation exposure from CT in early childhood: a French large-scale multicentre study 
The British Journal of Radiology  2012;85(1009):53-60.
The increasing use of CT scans in the paediatric population raises the question of a possible health impact of ionising radiation exposure associated with CT scans. The aim of this study was to describe the pattern of CT use in early childhood.
In 14 major French paediatric radiology departments, children undergoing at least 1 CT scan before age 5, between 2000 and 2006, were included. For each examination, absorbed organ doses were calculated.
43% of the 27 362 children in the cohort were aged less than 1 year during their first exposure, with 9% being aged less than 1 month. The mean number of examinations per child was 1.6 (range 1–43). The examinations included: head in 63% of the cases, chest in 21%, abdomen and pelvis in 8% and others in 8%. Brain and eye lenses received the highest cumulative doses from head examinations, with mean organ dose values of 22 mGy (maximum 1107 mGy) and 26 mGy (maximum 1392 mGy), respectively. The mean cumulative effective dose was 3.2 mSv (range 0.1–189 mSv).
CT scan exposure in childhood is responsible for relatively high doses to radiosensitive organs. The rather large dose range according to the protocols used requires their optimisation. The cohort follow-up will study the risk of long-term radiation-induced cancer.
PMCID: PMC3473922  PMID: 22190749
16.  Evidence for Radiation Hormesis After In Vitro Exposure of Human Lymphocytes to Low Doses of Ionizing Radiation§ 
Dose-Response  2008;6(3):252-271.
Previous research has demonstrated that adding a very small gamma-ray dose to a small alpha radiation dose can completely suppress lung cancer induction by alpha radiation (a gamma-ray hormetic effect). Here we investigated the possibility of gamma-ray hormesis during low-dose neutron irradiation, since a small contribution to the total radiation dose from neutrons involves gamma rays. Using binucleated cells with micronuclei (micronucleated cells) among in vitro monoenergetic-neutron-irradiated human lymphocytes as a measure of residual damage, we investigated the influence of the small gamma-ray contribution to the dose on suppressing residual damage. We used residual damage data from previous experiments that involved neutrons with five different energies (0.22-, 0.44-, 1.5-, 5.9-, and 13.7-million electron volts [MeV]). Corresponding gamma-ray contributions to the dose were approximately 1%, 1%, 2%, 6%, and 6%, respectively. Total absorbed radiation doses were 0, 10, 50, and 100 mGy for each neutron source. We demonstrate for the first time a protective effect (reduced residual damage) of the small gamma-ray contribution to the neutron dose. Using similar data for exposure to gamma rays only, we also demonstrate a protective effect of 10 mGy (but not 50 or 100 mGy) related to reducing the frequency of micronucleated cells to below the spontaneous level.
PMCID: PMC2564764  PMID: 18846261
Gamma rays; X rays; Neutrons; Hormesis; Human Lymphocytes; Micronucleus
17.  Low-Dose Radiation Activates Akt and Nrf2 in the Kidney of Diabetic Mice: A Potential Mechanism to Prevent Diabetic Nephropathy 
Repetitive exposure of diabetic mice to low-dose radiation (LDR) at 25 mGy could significantly attenuate diabetes-induced renal inflammation, oxidative damage, remodeling, and dysfunction, for which, however, the underlying mechanism remained unknown. The present study explored the effects of LDR on the expression and function of Akt and Nrf2 in the kidney of diabetic mice. C57BL/6J mice were used to induce type 1 diabetes with multiple low-dose streptozotocin. Diabetic and age-matched control mice were irradiated with whole body X-rays at either single 25 mGy and 75 mGy or accumulated 75 mGy (25 mGy daily for 3 days) and then sacrificed at 1–12 h for examining renal Akt phosphorylation and Nrf2 expression and function. We found that 75 mGy of X-rays can stimulate Akt signaling pathway and upregulate Nrf2 expression and function in diabetic kidneys; single exposure of 25 mGy did not, but three exposures to 25 mGy of X-rays could offer a similar effect as single exposure to 75 mGy on the stimulation of Akt phosphorylation and the upregulation of Nrf2 expression and transcription function. These results suggest that single 75 mGy or multiple 25 mGy of X-rays can stimulate Akt phosphorylation and upregulate Nrf2 expression and function, which may explain the prevention of LDR against the diabetic nephropathy mentioned above.
PMCID: PMC3514845  PMID: 23227273
Ionizing radiation-associated breast cancer risk appears to be modified by timing of reproductive events such as age at radiation exposure, parity, age at first live birth, and age at menopause. However, potential breast cancer risk modification of low- to moderate radiation dose by polymorphic estrogen metabolism-related gene variants has not been routinely investigated. We assessed breast cancer risk of 12 candidate variants in 12 genes involved in steroid metabolism, catabolism, binding, or receptor functions in a study of 859 cases and 1083 controls within the US Radiologic Technologists (USRT) cohort. Using cumulative breast dose estimates from a detailed assessment of occupational and personal diagnostic ionizing radiation exposure, we investigated the joint effects of genotype on the risk of breast cancer. In multivariate analyses, we observed a significantly decreased risk of breast cancer associated with the CYP3A4 M445T minor allele (rs4986910, OR=0.3; 95% CI 0.1–0.9). We found a borderline increased breast cancer risk with having both minor alleles of CYP1B1 V432L (rs1056836, CC vs. GG, OR=1.2; 95% CI 0.9–1.6). Assuming a recessive model, the minor allele of CYP1B1 V432L significantly increased the dose-response relationship between personal diagnostic x-ray exposure and breast cancer risk, adjusted for cumulative occupational radiation dose (pinteraction=0.03) and had a similar joint effect for cumulative occupational radiation dose adjusted for personal diagnostic x-ray exposure (pinteraction=0.06). We found suggestive evidence that common variants in selected estrogen metabolizing genes may modify the association between ionizing radiation exposure and breast cancer risk.
PMCID: PMC2860373  PMID: 19214745
19.  No clinically relevant effect on cognitive outcomes after low-dose radiation to the infant brain: A population-based cohort study in Sweden 
Acta Oncologica (Stockholm, Sweden)  2014;53(9):1143-1150.
While the detrimental effects of cranial radiotherapy on the developing brain are well known, the effects on cognitive performance of low doses of ionizing radiation is less studied. We performed a population-based cohort study to determine whether low doses of ionizing radiation to the brain in infancy affects cognitive function later in life. Further we hypothesized that the dose to the hippocampus predicts cognitive late side effects better than the anterior or the posterior brain doses.
Material and methods
During 1950–1960 3860 boys were treated with radiation in Sweden for cutaneous hemangiomas before the age of 18 months. Of these, 3030 were analyzed for military test scores at the age of 18 years and 2559 for the highest obtained educational level.
Logical, spatial and technical test scores were not affected by increasing irradiation doses. The verbal test scores displayed a significant trend for decreasing scores with increasing doses to the hippocampus (p = 0.005). However, the absolute mean difference between the zero dose and the highest dose category (median 680 mGy) was very small, only 0.64 stanine points, and the significance was dependent on the highest dose category, containing few subjects. The educational level was not affected by brain irradiation. Overall, the hippocampal dose was a better predictor of late cognitive side effects than the doses to the anterior or the posterior brain. In conclusion, there was no decrease in logical, spatial and technical verbal or global test scores after ionizing radiation doses up to 250 mGy, but a subtle decrease in verbal test scores if the highest dose category was included (median 680 mGy). However, the clinical relevance of this decline in the highest dose group is questionable, since we could not find any effect on the highest obtained educational level.
PMCID: PMC4219853  PMID: 24697746
Health physics  2009;97(4):275-298.
Between 1986 and 1990, several hundred thousand workers, called “liquidators” or “clean-up workers”, took part in decontamination and recovery activities within the 30-km zone around the Chernobyl nuclear power plant in Ukraine, where a major accident occurred in April 1986. The Chernobyl liquidators were mainly exposed to external ionizing radiation levels that depended primarily on their work locations and the time after the accident when the work was performed. Because individual doses were often monitored inadequately or were not monitored at all for the majority of liquidators, a new method of photon (i.e. gamma and x-rays) dose assessment, called “RADRUE” (Realistic Analytical Dose Reconstruction with Uncertainty Estimation) was developed to obtain unbiased and reasonably accurate estimates for use in three epidemiologic studies of hematological malignancies and thyroid cancer among liquidators. The RADRUE program implements a time-and-motion dose reconstruction method that is flexible and conceptually easy to understand. It includes a large exposure rate database and interpolation and extrapolation techniques to calculate exposure rates at places where liquidators lived and worked within ~70 km of the destroyed reactor. The RADRUE technique relies on data collected from subjects’ interviews conducted by trained interviewers, and on expert dosimetrists to interpret the information and provide supplementary information, when necessary, based upon their own Chernobyl experience. The RADRUE technique was used to estimate doses from external irradiation, as well as uncertainties, to the bone-marrow for 929 subjects and to the thyroid gland for 530 subjects enrolled in epidemiologic studies. Individual bone-marrow dose estimates were found to range from less than one μGy to 3,300 mGy, with an arithmetic mean of 71 mGy. Individual thyroid dose estimates were lower and ranged from 20 μGy to 507 mGy, with an arithmetic mean of 29 mGy. The uncertainties, expressed in terms of geometric standard deviations, ranged from 1.1 to 5.8, with an arithmetic mean of 1.9.
PMCID: PMC2930607  PMID: 19741357
external dose; Chernobyl; liquidators; dose reconstruction; bone marrow; thyroid
21.  Comparison of RBE values of high- LET α-particles for the induction of DNA-DSBs, chromosome aberrations and cell reproductive death 
Various types of radiation effects in mammalian cells have been studied with the aim to predict the radiosensitivity of tumours and normal tissues, e.g. DNA double strand breaks (DSB), chromosome aberrations and cell reproductive inactivation. However, variation in correlations with clinical results has reduced general application. An additional type of information is required for the increasing application of high-LET radiation in cancer therapy: the Relative Biological Effectiveness (RBE) for effects in tumours and normal tissues. Relevant information on RBE values might be derived from studies on cells in culture.
To evaluate relationships between DNA-DSB, chromosome aberrations and the clinically most relevant effect of cell reproductive death, for ionizing radiations of different LET, dose-effect relationships were determined for the induction of these effects in cultured SW-1573 cells irradiated with gamma-rays from a Cs-137 source or with α-particles from an Am-241 source. RBE values were derived for these effects. Ionizing radiation induced foci (IRIF) of DNA repair related proteins, indicative of DSB, were assessed by counting gamma-H2AX foci. Chromosome aberration frequencies were determined by scoring fragments and translocations using premature chromosome condensation. Cell survival was measured by colony formation assay. Analysis of dose-effect relations was based on the linear-quadratic model.
Our results show that, although both investigated radiation types induce similar numbers of IRIF per absorbed dose, only a small fraction of the DSB induced by the low-LET gamma-rays result in chromosome rearrangements and cell reproductive death, while this fraction is considerably enhanced for the high-LET alpha-radiation. Calculated RBE values derived for the linear components of dose-effect relations for gamma-H2AX foci, cell reproductive death, chromosome fragments and colour junctions are 1.0 ± 0.3, 14.7 ± 5.1, 15.3 ± 5.9 and 13.3 ± 6.0 respectively.
These results indicate that RBE values for IRIF (DNA-DSB) induction provide little valid information on other biologically-relevant end points in cells exposed to high-LET radiations. Furthermore, the RBE values for the induction of the two types of chromosome aberrations are similar to those established for cell reproductive death. This suggests that assays of these aberrations might yield relevant information on the biological effectiveness in high-LET radiotherapy.
PMCID: PMC3127784  PMID: 21651780
22.  Increased apoptosis and DNA double-strand breaks in the embryonic mouse brain in response to very low-dose X-rays but not 50 Hz magnetic fields 
Journal of the Royal Society Interface  2014;11(100):20140783.
The use of X-rays for medical diagnosis is enhancing exposure to low radiation doses. Exposure to extremely low-frequency electromagnetic or magnetic fields is also increasing. Epidemiological studies show consistent associations of childhood leukaemia with exposure to magnetic fields but any causal relationship is unclear. A limitation in assessing the consequence of such exposure is the availability of sensitive assays. The embryonic neuronal stem and progenitor cell compartments are radiosensitive tissues. Using sensitive assays, we report a statistically significant increase in DNA double-strand break (DSB) formation and apoptosis in the embryonic neuronal stem cell compartment following in utero exposure to 10–200 mGy X-rays. Both endpoints show a linear response. We also show that DSB repair is delayed following exposure to doses below 50 mGy compared with 100 mGy. Thus, we demonstrate in vivo consequences of low-dose radiation. In contrast to these impacts, we did not observe any significant induction of DSBs or apoptosis following exposure to 50 Hz magnetic fields (100 or 300 µT). We conclude that any DSB induction by treatment with magnetic fields is lower than following exposure to 10 mGy X-rays. For comparison, certain procedures involving computed tomography scanning are equivalent to 1–5 mGy X-rays.
PMCID: PMC4191111  PMID: 25209403
low-dose radiation; extremely low-frequency electromagnetic fields; apoptosis; DNA double-strand breaks; DNA damage response
23.  Radiation dose evaluation in multidetector-row CT imaging for acute stroke with an anthropomorphic phantom 
The British Journal of Radiology  2010;83(996):1029-1041.
This study evaluated radiation dose and dose reduction in CT imaging for acute stroke. Radiation doses in three types of CT imaging (i.e. non-contrast-enhanced CT, CT perfusion (CTP) and CT angiography (CTA)) were measured with an in-phantom dosimetry system for 4-, 16- and 64-detector CT scanners in 5 hospitals. To examine the relationship between image quality and radiation dose in CTA, image contrast-to-noise ratio was evaluated. Doses to the brain, lens, salivary glands and local skin obtained with scan protocols in routine use were: 42–71 mGy, 30–88 mGy, 3.9–7.3 mGy and 40–97 mGy in non-contrast-enhanced CT; 41–75 mGy, 9.9–10 mGy, 1.5–2.1 mGy and 107–143 mGy in CTP; and 8.2–55 mGy, 26–69 mGy, 2.0–73 mGy and 32–72 mGy in CTA. For the combination of these CT examinations, on average a patient would receive 236 mGy for the maximum local skin dose and 4.2 mSv for the effective dose evaluated by the International Commission on Radiological Protection (ICRP) 103. Effective doses in CTP in this study were less than those obtained with representative protocols of Western countries. Average effective doses in each CT examination were not more than 1.5 mSv. The use of reduced kV and a narrow scan range would be effective in dose reduction of CTA and CTP, and intermittent scanning would be essential in CTP. Although lens and maximum local skin doses were far less than the thresholds for deterministic effects, since radiation risks would be increased in repeated CT examinations, efforts should be devoted to dose reduction in stroke CT examinations.
PMCID: PMC3473617  PMID: 21088088
24.  Little impact of tsunami-stricken nuclear accident on awareness of radiation dose of cardiac computed tomography: A questionnaire study 
BMC Research Notes  2013;6:170.
With the increased use of cardiac computed tomography (CT), radiation dose remains a major issue, although physicians are trying to reduce the substantial risks associated with use of this diagnostic tool. This study was performed to investigate recognition of the level of radiation exposure from cardiac CT and the differences in the level of awareness of radiation before and after the Fukushima nuclear plant accident.
We asked 30 physicians who were undergoing training in internal medicine to determine the equivalent doses of radiation for common radiological examinations when a normal chest X-ray is accepted as one unit; questions about the absolute radiation dose of cardiac CT data were also asked.
According to the results, 86.6% of respondents believed the exposure to be 1 mSv at most, and 93.3% thought that the exposure was less than that of 100 chest X-rays. This finding indicates that their perceptions were far lower than the actual amounts. Even after the occurrence of such a large nuclear disaster in Fukushima, there were no significant differences in the same subjects’ overall awareness of radiation amounts.
Even after such a major social issue as the Fukushima nuclear accident, the level of awareness of the accurate radiation amount used in 64-channel multidetector CT (MDCT) by clinical physicians who order this test was not satisfactory. Thus, there is a need for the development of effective continuing education programs to improve awareness of radiation from ionizing radiation devices, including cardiac CT, and emphasis on risk-benefit evaluation based on accurate knowledge during medical training.
PMCID: PMC3682884  PMID: 23631688
64-channel MDCT; Radiation dose; Questionnaires; Awareness
25.  Evaluation of Genotoxicity in Patients Subjected to Panoramic Radiography by Micronucleus Assay on Epithelial Cells of the Oral Mucosa 
Radiography is one of the most valuable diagnostic tools used in comprehensive dental care. Although there is no safe level of radiation exposure, the possible risk associated with exposure to radiation, must be elucidated. To date, a variety of assays have been proposed to assess the mutagenic potential of genotoxicants; however, these methods are typically laborious and time consuming. The aim of the present study was to evaluate the possible genotoxic effect of routinely used panoramic radiation exposure in exfoliated epithelial cells as measured by the formation of micronuclei and to compare the genotoxicity of X-rays on keratinized epithelial gingival cells and the nonkeratinized buccal epithelial cells.
Materials and Methods:
The study included 53 healthy individuals with a mean age of 25.21 ±12.67 years. Specimens of exfoliated epithelial cells were collected from patients subjected to panoramic radiography before and 10 days after radiation exposure. The cells were stained with Giemsa and evaluated for micronuclei by scoring 1000 cells per slide.
In our study, the genotoxic effect of radiation exposure from panoramic radiography showed a statistically significant increase in the MN frequency in buccal epithelial cells. A significant correlation was observed between the age of the subjects and micronuclei, although no such correlation was found between gender and micronuclei count.
MN test serves as a simple biomarker indicating the direct exposure to DNA damaging agents such as ionizing radiation, emphasizing great sensitivity even for exposure to low doses during radiation screening. Thus, panoramic dental radiography should be cautiously used only when necessary.
PMCID: PMC4037266  PMID: 24910676
Panoramic Radiography; Micronucleus Tests; Epithelial Cells; Ionizing Radiation

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