Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

NOTE The report of the Committee without its annexes appears as Official Records of the General Assembly, Sixty-third Session, Supplement No. 46. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. The country names used in this document are, in most cases, those that were in use at the time the data were collected or the text prepared. In other cases, however, the names have been updated, where this was possible and appropriate, to reflect political changes. Scientific Annexes Annex A. Medical radiation exposures Annex B. Exposures of the public and workers from various sources of radiation INTROdUCTION 1. In the course of the research and development for and the application of atomic energy and nuclear technologies, a number of radiation accidents have occurred. Some of these accidents have resulted in significant health effects and occasionally in fatal outcomes. The application of technologies that make use of radiation is increasingly widespread around the world. Millions of people have occupations related to the use of radiation, and hundreds of millions of individuals benefit from these uses. Facilities using intense radiation sources for energy production and for purposes such as radiotherapy, sterilization of products, preservation of foodstuffs and gamma radiography require special care in the design and operation of equipment to avoid radiation injury to workers or to the public. Experience has shown that such technology is generally used safely, but on occasion controls have been circumvented and serious radiation accidents have ensued. 2. Reviews of radiation exposures from accidents have been presented in previous UNSCEAR reports. The last report containing an exclusive chapter on exposures from accidents was the UNSCEAR 1993 Report [U6]. 3. This annex is aimed at providing a sound basis for conclusions regarding the number of significant radiation accidents that have occurred, the corresponding levels of radiation exposures and numbers of deaths and injuries, and the general trends for various practices. Its conclusions are to be seen in the context of the Committee's overall evaluations of the levels and effects of exposure to ionizing radiation. 4. The Committee's evaluations of public, occupational and medical diagnostic exposures are mostly concerned with chronic exposures of …

sources and effects of ionizing radiation

Importance Increased use of computed tomography (CT) in pediatrics raises concerns about cancer risk from exposure to ionizing radiation. Objectives To quantify trends in the use of CT in pediatrics and the associated radiation exposure and cancer risk. Design Retrospective observational study. Setting Seven US health care systems. Participants The use of CT was evaluated for children younger than 15 years of age from 1996 to 2010, including 4 857 736 child-years of observation. Radiation doses were calculated for 744 CT scans performed between 2001 and 2011. Main Outcomes and Measures Rates of CT use, organ and effective doses, and projected lifetime attributable risks of cancer. Results The use of CT doubled for children younger than 5 years of age and tripled for children 5 to 14 years of age between 1996 and 2005, remained stable between 2006 and 2007, and then began to decline. Effective doses varied from 0.03 to 69.2 mSv per scan. An effective dose of 20 mSv or higher was delivered by 14% to 25% of abdomen/pelvis scans, 6% to 14% of spine scans, and 3% to 8% of chest scans. Projected lifetime attributable risks of solid cancer were higher for younger patients and girls than for older patients and boys, and they were also higher for patients who underwent CT scans of the abdomen/pelvis or spine than for patients who underwent other types of CT scans. For girls, a radiation-induced solid cancer is projected to result from every 300 to 390 abdomen/pelvis scans, 330 to 480 chest scans, and 270 to 800 spine scans, depending on age. The risk of leukemia was highest from head scans for children younger than 5 years of age at a rate of 1.9 cases per 10 000 CT scans. Nationally, 4 million pediatric CT scans of the head, abdomen/pelvis, chest, or spine performed each year are projected to cause 4870 future cancers. Reducing the highest 25% of doses to the median might prevent 43% of these cancers. Conclusions and Relevance The increased use of CT in pediatrics, combined with the wide variability in radiation doses, has resulted in many children receiving a high-dose examination. Dose-reduction strategies targeted to the highest quartile of doses could dramatically reduce the number of radiation-induced cancers.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/1696279/poi130056.pdf

The Use of Computed Tomography in Pediatrics and the Associated Radiation Exposure and Estimated Cancer Risk

Recent technologic advances have markedly enhanced the clinical applications of computed tomography (CT). While the benefits of CT exceed the harmful effects of radiation exposure in patients, increasing radiation doses to the population have raised a compelling case for reduction of radiation exposure from CT. Strategies for radiation dose reduction are difficult to devise, however, because of a lack of guidelines regarding CT examination and scanning techniques. Various methods and strategies based on individual patient attributes and CT technology have been explored for dose optimization. It is the purpose of this review article to outline basic principles of CT radiation exposure and emphasize the need for CT radiation dose optimization based on modification of scanning parameters and application of recent technologic innovations.

Strategies for CT radiation dose optimization.

Purpose— The purpose of this statement is to review the literature on childhood stroke and to provide recommendations for optimal diagnosis and treatment. This statement is intended for physicians ...

/pdf/management-of-stroke-in-infants-and-children-a-scientific-21glewj7ma.pdf

Management of Stroke in Infants and Children A Scientific Statement From a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young

on helical CT are greater than the risk of the radiation dose, technical factors should be adjusted to minimize the radiation dose. This adjustment is the responsibility of the radiologist supervising the examination. Little attention has been given to the technical parameters that can be adjusted to reduce the radiation dose associated with CT. In this perspective, we review the adaptations made to our helical CT protocols with the intention of reducing the radiation dose to pediatric patients. We hope that by calling attention to the issue of reducing radiation exposure in the pediatric population, these adaptations will be implemented for helical CT in pediatric and general imaging departments. Two parameters that can be adjusted easily and that have a profound effect on radiation dose are tube current and pitch.

/pdf/minimizing-radiation-dose-for-pediatric-body-applications-of-g3fc5a4vbc.pdf

Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large Children's Hospital.

Background CT deep learning reconstruction (DLR) algorithms have been developed to remove image noise. How the DLR affects image quality and radiation dose reduction has yet to be fully investigated. Purpose To investigate a DLR algorithm's dose reduction and image quality improvement for pediatric CT. Materials and Methods DLR was compared with filtered back projection (FBP), statistical-based iterative reconstruction (SBIR), and model-based iterative reconstruction (MBIR) in a retrospective study by using data from CT examinations of pediatric patients (February to December 2018). A comparison of object detectability for 15 objects (diameter, 0.5-10 mm) at four contrast difference levels (50, 150, 250, and 350 HU) was performed by using a non-prewhitening-matched mathematical observer model with eye filter (d'NPWE), task transfer function, and noise power spectrum analysis. Object detectability was assessed by using area under the curve analysis. Three pediatric radiologists performed an observer study to assess anatomic structures with low object-to-background signal and contrast to noise in the azygos vein, right hepatic vein, common bile duct, and superior mesenteric artery. Observers rated from 1 to 10 (worst to best) for edge definition, quantum noise level, and object conspicuity. Analysis of variance and Tukey honest significant difference post hoc tests were used to analyze differences between reconstruction algorithms. Results Images from 19 patients (mean age, 11 years ± 5 [standard deviation]; 10 female patients) were evaluated. Compared with FBP, SBIR, and MBIR, DLR demonstrated improved object detectability by 51% (16.5 of 10.9), 18% (16.5 of 13.9), and 11% (16.5 of 14.8), respectively. DLR reduced image noise without noise texture effects seen with MBIR. Radiologist ratings were 7 ± 1 (DLR), 6.2 ± 1 (MBIR), 6.2 ± 1 (SBIR), and 4.6 ± 1 (FBP); two-way analysis of variance showed a difference on the basis of reconstruction type (P < .001). Radiologists consistently preferred DLR images (intraclass correlation coefficient, 0.89; 95% CI: 0.83, 0.93). DLR demonstrated 52% (1 of 2.1) greater dose reduction than SBIR. Conclusion The DLR algorithm improved image quality and dose reduction without sacrificing noise texture and spatial resolution. © RSNA, 2020 Online supplemental material is available for this article.

Improving Image Quality and Reducing Radiation Dose for Pediatric CT by Using Deep Learning Reconstruction.

The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50–70%), lateral condylar (17–34%), and medial epicondylar fractures (10%), with fractures of the proximal radius (including but not limited to fractures of the radial neck) being relatively uncommon (5–10%). Our experience at a large children’s hospital suggests a different distribution. Our goals were (1) to ascertain the frequency of different elbow fracture types in a large pediatric population, and (2) to determine which fracture types were occult on initial radiographs but detected on follow-up. Review of medical records identified 462 children, median age 6 years and interquartile range for age of 4–8 years (range 0.8–18 years), who were diagnosed with elbow fractures at our institution over a 10-month period. Initial and follow-up radiographs were reviewed in blinded fashion independently by two experienced pediatric musculoskeletal radiologists to identify fracture types on initial and follow-up radiographs. The most common fractures included supracondylar (n = 258, 56%), radial neck (n = 80, 17%), and lateral condylar (n = 69, 15%). Additional fractures were seen on follow-up exams in 32 children. Of these, 25 had a different fracture type than was identified on initial radiographs. The most common follow-up fractures were olecranon (n = 23, 72%), coronoid process (n = 4, 13%) and supracondylar (n = 3, 9%). Olecranon fractures were significantly more common on follow-up radiographs than they were on initial radiographs (n = 33, 7%; P < .0001). Twenty-six children had more than one fracture type on the initial radiograph. The most common fracture combinations were radial neck with olecranon (n = 9) and supracondylar with lateral condylar (n = 9). Supracondylar fractures are the most frequent elbow fracture seen initially, followed by radial neck, lateral condylar, and olecranon fractures in a distribution different from what has been historically described. The relatively high frequency of olecranon fractures detected on follow-up speaks to their potentially occult nature. Careful attention to these areas is warranted in children with initially normal radiographs.

Pediatric elbow fractures: a new angle on an old topic

OBJECTIVE. T2 relaxation times on MRI are sensitive to the configuration of cartilage collagen and continually increase during aging in adults. In children, T2 relaxation times increase as a result of cartilage microstructure changes in early inflammatory arthritis. The purpose of this study was to determine age- and sex-related differences in T2 mapping of the patellar cartilage in children and adolescents during normal skeletal maturation. MATERIALS AND METHODS. Ninety-seven subjects (age range, 5–22 years; 51 females and 46 males; mean age, 14.3 and 13.7 years, respectively) without patellofemoral instability or inflammatory arthritis were included. All subjects underwent 1.5-T knee MRI with T2 mapping. The mean T2 relaxation time and thickness of the patellar cartilage were documented for each MRI examination. Skeletal maturation was determined by physeal patency (open; or closed or closing) on MRI. The associations between T2 relaxation times, cartilage thickness, sex, age, and physeal patency were a...

https://www.ajronline.org/doi/pdfplus/10.2214/AJR.13.11327

Age and Sex Dependency of Cartilage T2 Relaxation Time Mapping in MRI of Children and Adolescents

In children and young adults, SPECT/CT is ideally suited for assessment of the spectrum of pars abnormalities but can also aid in identifying other causes of low back pain.

Christopher G. Anton

Papers

Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large Children's Hospital.

Improving Image Quality and Reducing Radiation Dose for Pediatric CT by Using Deep Learning Reconstruction.

Pediatric elbow fractures: a new angle on an old topic

Age and Sex Dependency of Cartilage T2 Relaxation Time Mapping in MRI of Children and Adolescents

Spondylolysis and Beyond: Value of SPECT/CT in Evaluation of Low Back Pain in Children and Young Adults