Radiological Protection in Veterinary Practice

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Comment

GENERAL

1.       Some data on availability of diagnostic and therapy veterinary methodologies and equipment  that involve ionizing radiation at global, regional, or national levels, should be provided

2.       Some information about existing educational practices on diagnostic or therapy modalities in veterinary, should be provided

3.        More information about the existing or  regulations, and gap(s) in this aspect should be provided.

4.       Wherever it is possible, examples should be provided from the veterinary practice, instead of human medicine.

149

Should be listed /defined   "standard radiological imaging" procedures. 

Usually, it is used “General Radiography procedures”.

162

“clinical practice” should be replaced by “in veterinary clinical practice”

473

“utero exposure – in the range of 50-100 mSv” likely should be   “50 – 100 mGy”

481

“radiogenic disease at low doses”

 It would be more appropriate to use the term “stochastic effects at low doses” as they are the most likely to occur at low doses and widely accepted term.

484

“Commission for humans” should be more specific, which commission?

527 - 528

“the possible particular sensitivity of the breast tissue in some stages of its preparing for lactation”

Should be support by reference.

530 – 531

“If the presence of the pregnant or possibly pregnant individual is deemed justified, and informed consent is given, then the exposure needs to be optimised”. This is not very correct, as the main purpose for “optimization of exposure” is to protect the patients/animal, not staff or handlers (caregivers).  In case of protection of the pregnant carer or comforter, the most appropriate term maybe “radiation protection measures need to be optimised”

552 - 553

“In humans, for most properly conducted diagnostic radiology procedures, doses typically do not exceed 20 mGy although interventional procedures involving the pelvis could be higher”. 

 It is important to be mentioned that these 20 mGy is the uterus’s dose

558 – 560

“Similar effects, risks, and management strategies apply to animal patients, particularly as a lot of evidence for teratogenic effects comes from animal studies, as mentioned above (Benjamin et al., 1998; Russell, 2013).   

This is not a correct sentence, or its place is not correct, as previously it was not mentioned anything about the teratogenic effects.

608

“Environmental exposure (that is, exposure to the living environment) is a fourth type of exposure”.

Following the previous categorization, should be added       “ ….. is a fourth type of exposure category”

704

Fig. 3.2.  Justification , Level 3   “ the particular application should be judged to do more good than harm to the individual patient” 

                                Should be:   “ the particular application should be judged to do more good than harm to the individual animal patient”

704

Fig 3.2   It should be added a tool for application of radiation protection of animals involved in research purposes

708 – 709

“Ionising radiation can be emitted from an unstable atom undergoing radioactive decay, as is the case with radiopharmaceuticals”

This is not very correct, as radiopharmaceuticals are not atoms, but molecules.  “..as in the case with radiopharmaceuticals which contains radioactive isotopes ”

739

“(PPE, e.g. gloves, lead, aprons) “        

  Should  be  “(PPE, e.g., lead gloves, lead aprons) “

750 – 753

“Where reasonably possible, maximising distance from a radiation source is a simple and  practical principle for dose reduction. The use of handling tools (e.g. tweezers, tongs) and hand  carts should be considered, along with working at ‘arm’s length’ and taking ‘one step back’ where

feasible (Fig. 3.4)”

Since, just in the previous sentence (747 – 749)  an interventional fluoroscopy modality was mentioned, a comment about distance keeping in this modality would be appropriate, as well.

764

“..to work at arm’s length or take a step back”  

     Using of idioms should be avoided

768 -770

Fig. 3.4     Representation of the inverse-square law. Doubling the distance from a point source of ionising radiation will reduce exposure by a factor of four, as the photons are spread over a larger distance. In  practice, this can often be accomplished by taking one step back.

1.        Caption should consist of one sentence, not of three.

2.       “as the photons are spread over a larger distance”      

This is not correct.  Exposure reduction (radiation intensity reduction) is because the initial radiation amount is spread over the larger  area. Double distance, quadruples area size, etc.

782 - 784

Fig. 3.5. Different radiation types have different abilities to pass through a material. © OpenStax licensed under a Creative Commons Attribution License 4.0. Download for free at http://cnx.org/contents/85abf193-2bd2-4908-8563-90b8a7ac8df6@12.2

 References should not be used in the Figure caption text

829

“Publication 138 (2018) ….”

Recommended citation: ICRP, 2018. Ethical foundations of the system of radiological protection. ICRP Publication 138. Ann. ICRP 47(1).

(ICRP)

842

“Justice, or the ensuring of social equity and fairness of decisions, relates directly to the principle of the application of dose limits”

This is not very clear

855 - 856

“(Beauchamp and Childress, 2019), which are emphasised in Publication 1XX (ICRP, 20XX)”

 Please, provide the correct citation.

897

“….having a plan for such accidents...”

Should be   “….having a plan for such incidents and accidents...”

996 – 997

“Mobile equipment may need to be checked more frequently than fixed installations.”

Please provide justification for this statement.

998

“(e.g., software, cameras in nuclear medicine, image monitors, etc.)”

So far, no protocols were developed for testing of postprocessing software(s). Software should be removed from the list.

1001 – 1002

“Additionally, mobile equipment is being marketed as ‘lighter’ because shielding has been reduced from, say, 6 kg to 4 kg.”

This is incomplete and not very correct statement.

Usually, in mobile units, employed generator and X-ray tube have less power, therefore the beam energy may be reduced, that needs  thinner tube housing layers.

1105

“6.1.1. Justification of medical procedures”

 Should be more appropriate  “6.1.1. Justification of medical exposure”

1116 - 1117

“Those completing the training should be able to perform imaging and quality control on equipment, as well as provide effective risk communication with owners and handlers of animals”

Consider making changes:   “ Those having completed the training on quality control on equipment, as well as provide effective risk communication with owners and handlers of animals   should be able to perform imaging”

1197

“…procedures or other nuclear technologies….”  

It would be more appropriate “.. procedures or other nuclear diagnostic or therapeutic modalities..”

1209 - 1210

“..CT-guided and other interventional procedures are increasingly performed in  veterinary medicine and could potentially result in deterministic effects…”

An additional information should be provided, such as:  “CT-guided and other interventional procedures are increasingly performed in

1210 veterinary medicine and could potentially result in deterministic effects, like skin tissue reactions”

1223

“interventional proceduralists”

If it is possible, replace the word “proceduralists”  as it is not typical for medical profession

1270

“..regular checks of equipment performance..”

This is not very correct. The name of regular tests  is  “routine performance testing “, as the equipment performance test is not performed regularly

1272 – 1274

“..However, since the specific  risks induced by radiation exposure in animals are not yet quantified, currently no guidance is available related to, for instance, animal specific DRLs.”

This is not correct.  DRLs are practical  tool for health professional and regulatory & inspection bodies to compare imaging procedures and to determine if the patient’s safety has been optimized.  In addition,  DRLs are not directly related to the risk.

1307 - 1309

“3) the person, after having received relevant information regarding potential risks, agrees to undergo some limited exposure (with a dose constraint of the order of a few µSv maximum) “

Reference should be provided.

1318 - 1320

“Prudence is highly relevant to the process of optimisation, consistent with other areas of  veterinary practice that use potentially harmful substances or principles; for example, if 50 mg of  a drug would suffice to obtain the desired clinical effect, it would not make sense to use 100 mg.”

This is not the most appropriate example. An example of set of exposure parameters and dose indices should be much more valuable.

1355

Please, consider the idea to add this type of warning sign, as well 

1376

“being exposed where the radiation field is highest, such as in the primary radiation beam.”

 Should be replaced with “….where radiation field has highest intensity ..”

1400 - 1401

“and that technical parameters are adequately  tailored to veterinary patients”

It would be more appropriate  “ exposure parameters”

1412

“in significantly increased leakage and scatter.”

Should be added:   “in significantly increased amount of leakage and scattered radiation”

1422 - 1423

“Optimisation measures for patient protection in diagnostic radiology, for the same image quality, should be discussed with the manufacturer and installation engineer…”

Should be add:  “Optimisation measures for patient protection in veterinary diagnostic radiology, for the same image

 quality, should be discussed with the manufacturer and installation engineer

1468 - 1469

“Nemanic et al. (2015) addressed the potential of lead shielding to reduce animal dose during elbow radiography in dogs”

This is not very correct. Having a high-attenuating material inside the primary beam can increase the exposure parameters (if AEC is applied) or /and reduce the image quality.  On the other hand, using a shield outside the primary beam is not productive.

1471

“..In  the latter study, doses up to 617.5 mGy were reported”

This is  not very correct.   Please check the reference and provide the correct dose parameter “..In  the latter study, peak skin doses or the doses at a reference point up to 617.5 mGy were reported”

1503

“for protecting workers from non-radioactive contaminants”

This is not very clear.

1537

“Martinez et al., 2014”

Please, check the reference.

1544-1546

“However, it may take several  days or even weeks before the dose rate emitted by the animal has fallen below the threshold values  for its release and it can return home (e.g. 3+ weeks in some countries following iodine therapy).

This statement should be checked (3+ weeks) , and a reference to be provided. Usually, the international standards recommend the dose rate level as criteria for patient release, not number of days.

1608 - 1609

“the architectural requirements of the building and rooms, in particular those where  radioactive sources will be stored, and ionising radiation will be applied”

Please consider language revision,   “… and ionizing radiation procedures will be applied.”

1610-1611

“…the optimal positioning of the equipment..”

Should be added    “the optimal positioning of the equipment and  animal..”

1638 - 1639

“ the IAEA- as a means to prevent the same or a similar event from happening in a comparable professional context elsewhere”

Please, consider providing the name of the IAEA platform (SAFRON, SAFRAD)

1644-1645

“Finally, doses to animals, staff, members of the public, and the environment, as applicable, should be monitored.”

Please, consider replacing “monitored” with “periodically assessed”.