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February 5, 2008

This is from the front page of today's The Sudbury Star, of Ontario, Canada.

See full text of this story via the web version of this article.

Dec 13, 2007/b>

The isotopes storm

Nordion, which supplies about 50 percent of the world's medical isotopes, has been hard hit by the shutdown of the Chalk River nuclear plant in Ontario, which has been off line since November. The Canadian government on Wednesday ordered the reactor be restarted immediately and resume operations for 120 days. The company said the reactor would be up to full production within about a week and it would "turn supply around quickly." The company said it now expects to be able to ship the isotopes to customers sooner than the early to mid-January date it provided last week. Nordion is a division of MDS Inc.

Brian Bapty, an analyst at Raymond James Ltd in Vancouver, British Columbia, discussed the possibility of lasting fallout from the incident if U.S. customers start looking elsewhere for their medical isotope supplies. Bapty said there has been calls in recent years to produce the isotopes in the United States and these calls got louder during the Chalk River shutdown. He asked "Does this inspire a competitive landscape? Does this inspire a new competitor into the mix?"

Ref: Scott Anderson (Reuters - Toronto, Canada), "MDS hit from isotopes delay less than expected", Reuters, Dec 13, 2007 2:11 PM EST

March 27, 2006

* California - pharmacy used wrong shielding - 1 R/hr package

* New Hampshire - medical misadministration - wrong isotope - 5.2 rem

January 20, 2006

* Connecticut - technologists didn't need physician order to give 4.1 mCi I-131 to patient sent for diagnostic whole-body scan

* Louisiana - lung brachytherapy catheter 15 cm shy - 750 cGy

January 2, 2006

* CT scans are replacing treadmill stress tests; New technology detects clogged arteries better than the older methods
Bob Lamendola, South Florida Sun-Sentinel/Charlotte Observer (NC)

A new generation of X-ray CT scans that appeared in the past two years can detect clogged heart arteries more accurately than older methods, doctors say, and can detect the most lethal types of blockages, which don't show up on stress tests. Since 2001, when CT scans were improved to the point that they could make clear images of the heart, the number of cardiac CTs has climbed to more than 1 million per year nationwide -- and is rising -- compared with 10 million stress tests and 2.2 million angiograms.

Boca Raton salesman Norman Levi, 62, said he may owe his life to a CT scan. Levi felt chest pain while walking his dog -- frightening for a man whose parents died without warning from first-time heart attacks. A stress test was inconclusive. His doctor suggested heartburn pills. No help. Later, a CT scan found the culprit: a 90 percent blockage in an artery. "The CT scan saw something the stress test didn't find," Levi said. And it was done within minutes, without surgery. Doctors injected Levi with dye, made a 20-second X-ray scan with a CT and reaped dozens of detailed, computerized images of his heart and vessels.

Stress tests use sound waves or radioactive dye to measure blood flow to the heart while the patient is resting or exercising. If a problem is found, patients usually get an angiogram. Doctors make an incision at the groin, thread a thin tube through an artery, inject dye and examine the blood vessels with an X-ray. They can see if the flow of blood is being blocked in an artery narrowed by plaque, deposits of soft or hardened fat caused by cholesterol. But there's a hitch in this approach. "Half of the people who have heart attacks never have narrowing of the blood vessels. Something else is going on," said Dr. Claudio Smuclovisky, a CT specialist at South Florida Imaging in Boca Raton. Doctors now know that plaque doesn't just bulge inward into the vessel, it bulges outward, undetectable to stress tests and angiograms. Plaque is dangerous not just because it blocks the artery but because it ruptures, prompting the body to form big clots that block the vessel. Outward bulges are more the more dangerous type. Studies show about 70 percent of those with outward bulges have heart attacks vs. 30 percent of those with inward bulges. CT scans can see the outward bulges. "If the stress test is negative, the doctor is going to tell you that you're fine. Well, maybe not," said Dr. Michael Yue-Hua Shen, a heart imaging specialist at the Cleveland Clinic in Weston, Fla. "With the CT, we can see the plaque. We can be more aggressive in treating it." "CT is better than anything we have now that is non-invasive," Shen said. "This is where we're going in the future."

CT scans have another advantage: They are not invasive. One percent of angiograms -- also called cardiac catheterizations -- cause complications such as stroke, internal bleeding, anesthesia reactions and, in about 1 in 1,000 cases, death.

Yet some cardiology and imaging specialists still question the value of CT scans for heart disease. Dr. Roger Blumenthal, director of preventive cardiology at Johns Hopkins University, said angiograms still have a bit better resolution than CT in measuring blockages, especially ones hardened by calcium. Stress tests will never fade away, some specialists say, because they better measure the heart at work. "You're never going to have any one test taking over the landscape," Martin said.

Dr. Edward Martin at the Oklahoma Heart Institute in Tulsa favors MRIs, saying the accuracy is nearly as good and the image is created by non-damaging magnetic beams instead X-rays. Even fans of CT heart scans say they expose patients to too much radiation to be used as a routine screening test for healthy people. The scan delivers 8 to 12 millisievert of radiation, about three times the exposure we get annually from nature. A stress test using nuclear dye is about the same; an angiogram is a little less. "The radiation risk from CT is significant," Shen said.

Proponents of heart CTs predict rapid growth of new uses and wider acceptance. Most insurers now cover CT heart scans if deemed medically needed by the doctor. Cardiologists are using CTs to decide whether patients with borderline heart problems need to undergo angiograms, about one-quarter of which find no heart disease. Doctors said CT scans at $700 to $1,000 each can spare thousands of people from the risk and expense of angiograms, costing $5,000 to $15,000.

A May study in the Journal of the American Medical Association found heart CTs as accurate as angiograms, catching 87 to 99 percent of blockages in German heart patients. Cardiologist Seth Baum in Boca Raton is among a growing number using CT scans to decide whether a patient needs to take cholesterol drugs, which can damage the liver. Scans have found patients deemed to be at low risk for heart disease who have dangerous plaque and need to be on medication, Baum said, as well as higher-risk patients who are free of plaque and can stick with safer therapy such as niacin. "If you're 40 and with elevated cholesterol but no heart disease on the CT, it might be wise to keep you off the medication and just put you on diet and exercise," said radiologist Smuclovisky, who took himself off cholesterol drugs after a clean CT. Shen's team in Weston scanned 77 heart patients as part of a study being prepared. They found dangerous plaque in 48 percent of those rated low risk based on family history, cholesterol and other factors. About 20 percent of the patients had enough plaque to justify starting medication, Shen said.

November 13, 2005

* MRIs are called magnets for patient injuries
Marie McCullough, Knight Ridder/Indianapolis Star

Health professionals prize magnetic resonance imaging (MRI) for its ability to provide detailed, three-dimensional pictures of soft tissues such as the brain, without the potentially harmful effects of X-rays or nuclear scans. Considering that the US now has about 10,000 MRI machines that produce 20 million scans a year, the technology is remarkably safe, said radiologist Manuel Kanal, the University of Pittsburgh Medical Center's director of MR services. On the other hand, no one knows exactly how safe. A poll of 105 organizations participating in a dial-in seminar oganized by a nonprofit health services research firm (ECRI) in September found that nearly 60 percent have had MRI "incidents," including projectiles, burns and interference with implants. Most such incidents are not reported to the Food and Drug Administration, because reporting is voluntary and varies -- just like safety practices. An ECRI analysis of the FDA's database found 389 MRI-related incidents from 1995 through May 2005, including eight deaths.

For example, it's not supposed to happen, but it's well-documented: A metal object gets into a room with a magnetic resonance imaging machine, then gets pulled into the maw of the giant magnet. Chairs, intravenous drug poles, mop buckets, laundry carts, ladders, even the tines of an electric forklift. And safety experts say the chances for error are growing. More patients have implantable electric devices -- pacemakers, defibrillators, cochlear implants, vagal nerve stimulators -- that can be disrupted by an MRI. The scanners are becoming ever more powerful and are being used in new ways, such as guiding invasive treatment. Patients are also getting fatter, making it tougher to prevent burns caused by touching the inside of the machine.

* REVIEW: Radiologic-Pathologic Correlations from Head to Toe: Understanding the Manifestations of Disease
Usha A. Joseph, MD, Journal of Nuclear Medicine

This is a quite complimentary review of what Dr. Joseph calls "a unique global, collaborative effort by more than 60 authors from Europe and the United States, most of whom are experts, leaders, and respected teachers in their fields. The book is a comprehensive, easily readable, and well-written compilation to assist busy radiologists with difficult cases in their daily practice. The 7 chapters are logically organized into anatomic regions starting with the head and neck and progressing down to the chest, gastrointestinal, and urogenital regions, in addition to separate chapters on musculoskeletal and breast imaging, providing both a practical and a systematic approach to disease diagnosis. Each chapter covers the relevant pathology and associated radiographic abnormalities of major disease categories, focusing extensively on neoplasms, tumors, infection, and inflammation. There are 794 figures with 1,863 separate illustrations, 599 of which are in color, and 38 tables. Each disease category is organized under the headings "Definitions," "Pathology," "Clinical Findings," "Relevant Radiographic Study," and "Findings." These topics are discussed fairly comprehensively but without unnecessary or excessive details, thus helping one to better understand a radiologic abnormality by a thorough knowledge of the pathologic basis of the disease... I found this well-written, richly illustrated, comprehensive medical review combining whole-body imaging with relevant gross and microscopic findings to be easy to read and understand. It will be a timely, valuable, and welcome addition to my personal medical library."


Barnes and Noble offers significant discount on this book

October 7, 2005

* nuclear medicine research - federal funding is in jeopardy, sez Rep. Moran

September 26, 2005

Experimental nuclear medicine technique successful in identifying heart attack hours after pain has subsided

The Oct 4 issue of Circulation, a medical journal published by American Heart Association, will include a paper by Dilsizian et al. describing tests of a new method of identifying myocardial ischemia long after the pain has stopped and blood flow to the heart has returned to normal. The new technique would hold significant advantage over present practice in that no treadmill stress test, or stress-inducing drugs, need be used. The study involved 32 patients who had been identified as potential myocardial ischemia victims and diagnosed using treadmill stress test. Later, but in all cases within 30 hours of the chest pain, the new "at rest" technique was tried. Over 90% agreement between the methods was found (95% confidence interval was 75% to 98% for 10-minute wait after injection and 79% to 99% for 30-minute wait. The reserchers conclude that ischemic memory can be successfully identified via metabolic imaging with BMIPP.

[Source: Vasken Dilsizian et al., "Metabolic Imaging With -Methyl-p-[123I]-Iodophenyl-Pentadecanoic Acid Identifies Ischemic Memory After Demand Ischemia", Circulation 2005, doi:10.1161/CIRCULATIONAHA.104.530428 (Published online before print September 26, 2005)]

October 21, 2004

* Florida - radioactive sources put under cushion of boss' chair; criminal investigation (Naples)

* Louisiana - wrong patient given xenon scan (28 mRad - Tulane U)

September 3, 2004

* Doctors, Patients Caught in Global Security Web; Medical Isotopes More Frequently Denied International Shipment
IAEA Staff Report

Industry representatives have told the IAEA of increasing difficulties in delivering lifesaving isotopes that require urgent international transport. The incidence of delays and denials is growing worldwide, although there are no global statistics. Some airlines have policies against carrying any radioactive material. In other instances, a country«s regulatory controls may make it very difficult for the airlines to meet needed requirements, creating bottlenecks that have effectively blocked shipments. In cases involving isotopes with short half lives - such as iodine used to treat and detect thyroid tumours - it is rendered useless, or if it has missed the flight and gets on another one, its use is more limited. "If an airline or other transport provider refuses to take a shipment, or is unable to take a shipment, then this increases the prospect of someone missing a cancer treatment," Mr. Michael Wangler, IAEA Unit Head, Safety of Transport of Radioactive Materials Unit, said. "There is a risk that if more airlines do deny, particularly where few airlines serve key regions, then this does raise a serious issue. It potentially means that medical clinics and hospitals in specific areas are at risk from being denied essential medical supplies," Mr. Wangler said. IAEA staff has drafted "Guidance for the Import and Export of Radioactive Sources" to help minimize delays and denials. The Board of Governors is expected to vote on whether to accept the draft guidance at their meeting this month.
[a pdf version of the draft guidance is available here.

* Georgia - I-131 misadministration (100 mCi vs 33 mCi), Riverdale

April 1, 2004

Nordion seeks easing of US HEU export restriction to keep reliable supply of medical isotopes

MDS Nordion is the world's biggest producer of medical isotopes used to diagnose and treat disease -- it sells more more than $300 million worth annually. The Canadian company has long been working to convert it's isotope production facilities from high-enriched uranium (HEU) to low-enriched uranium (LEU) targets. In 1992, the US enacted an antiproliferation law which requires the operator of an HEU-fueled reactor must be working toward conversion in order to be eligible to receive U.S. HEU.

Nordion has decided that their conversion plan is too expensive and will disrupt operations for too long a period. The company asked in vain for U.S. financial assistance, and is currently reassesing their approach rather than working on implementing an particular conversion plan. The Nuclear Control Institute has urged NRC to reject further export of HEU to Nordion, noting that "Recent information indicates that at least since September 2003, Nordion has ceased all cooperation, work and intention towards converting the Maple facilities from HEU targets to LEU targets." The controversy may be resolved by the U.S. Congress -- the "Burr amendment" to the energy bill which is supported by the Council on Radiopharmaceuticals & Radionuclides.

Refs: Daniel Horner (Platts-Washington), "Nordion headed for 'showdown' with U.S.?", Nuclear Fuel, v29 n6, March 15, 2004, p. 1; and Bert Hill (The Ottawa Citizen), "MDS Nordion caught in war of words: U.S. lobby seeks halt of uranium shipments to Kanata firm", Ottawa Citizen, April 1, 2004, p. D1]

March 22, 2004

* California - 17 mCi Sr-90 eye applicator source missing again (Loma Linda Med Ctr)

March 13, 2004

* New Jersey - prostate patient required second implant as swelling caused underexposure (Hoboken)

March 11, 2004

* Virginia - possible overexposure of hospital patient (UVA-Charlottesville)

* Ohio - brain tumor patient 24% underdose (Cleveland Clinic Foundation)

* Connecticut - up to 10 uCi spilled on I-84 in courier vehicle crash (West Hartford)

March 10, 2004

* New Jersey - prostate patient records seemed to show that he received 5000 rad instead of 10,000; but further review showed the I-125 seed implant went as planned

* Massachusetts - VA hospital sent something radioactive in clean waste shipment; alarmed landfill monitor

March 3, 2004

* Oklahoma - syringe broke when pig knocked over (28 mCi I-131 spill inside glovebox)

February 17, 2004

* Tennessee - spill at pharmacy (97 mCi I-131, Chattanooga)

January 3, 2004

CT scan dose mentally debilitating for very young children

Researchers at Sweden's Karolinska Institute reanalysed data from more than 2,000 infants who had been treated with radiation for a benign birthmark condition between 1930 and 1959. When the boys were inducted into the Swedish army at age 18 or 19, significant differences in logical reasoning and learning ability appeared, compared with those who had not had radiation treatment. Another indication of their capacities was reflected in their high-school attendance levels. While 32 per cent of boys who had not been irradiated around the brain attended high school, only 17 per cent of those who received the highest dosages did.

"The average dose to the brain over a year was equivalent to a single CT scan today," Prof. Hall said [Per Hall, an epidemiologist for the Karolinska who was the lead author on the study]. "And normally two CT scans are performed if a child comes in with a minor trauma." As a consequence, the authors of the study, appearing in yesterday's issue of the British Medical Journal, are calling for greater caution on the part of doctors prescribing CT scans for children.

[Ref: The Canadian Press, "CT scan has debilitating effect on brains of children: study", Portage Daily Graphic (Manitoba, Canada), January 3, 2004, p. 18]

The study involved 3094 men who had received radiation therapy before the age of 18 months between 1930 and 1959 for minor birthmarks called haemangioma. At the ages of 18 and 19, the intellectual capacity of the men was tested and their attendance at high school recorded. The proportion of boys who attended high school fell as the amounts of radiation they were exposed to on the front and back of the brain increased. Those exposed to head irradiation were 50 per cent less likely to go on to higher education, with one in three boys not exposed to head X-rays attending secondary school compared with one in six of those who had. Boys who had received head X-rays were less able at intelligence tests showing learning ability and logical reasoning.

[Ref: Jenny Hope, "Head X-rays may stunt a child's brain power", Courier Mail (Queensland, Australia), January 3, 2004, p. 13]

Hall et al. study is first that shows mental debilitation at these doses in otherwise healthy kids

It was already known that children treated with radiation for life-threatening cancers often did not reach their full intellectual potential, but it was hard to separate the effects of the therapy from the effects of the disease itself, said Professor Hall. The new study demonstrated for the first time the effects of radiation in healthy children. "The risks and benefits of CT scans in minor head trauma need re-evaluating," wrote the research leader, Per Hall, in the British Medical Journal this week.

[Ref: Julie Robotham (Medical Editor, Sydney Morning Herald), "Toddler CT Scans May Cause Brain Damage", Sydney Morning Herald, January 3, 2004, p. 3]

CT scans - pressures for unnecessary use

Professor Hall said the use of CT scans had become sloppy. "They are routinely used for minor cases of head trauma, possibly for legal and financial considerations, because we have not been aware of the potential risks and this practice needs to be re-evaluated," he said.

[Ref: Jenny Hope, "Head X-rays may stunt a child's brain power", Courier Mail (Queensland, Australia), January 3, 2004, p. 13]

Parents or GPs sometimes press Australian hospitals to perform the CT scans on children with relatively trivial bumps, so the Swedish findings serve as a reminder to doctors to only perform them with good reason, says Andrew Maclean, a council member of the Australasian College for Emergency Medicine.

Dr Maclean said: "CT scanners are more widely available than they used to be. You can potentially get [a scan] a lot more easily . . . There is also medico-legal pressure, of not wanting to miss things [for fear of being sued]. They [children] may get a scan when clinically it's not necessary."

[Ref: Julie Robotham (Medical Editor, Sydney Morning Herald), "Toddler CT Scans May Cause Brain Damage", Sydney Morning Herald, January 3, 2004, p. 3]

Hall et al study may be underestimating the 1939-1950 era doses

Dr Antony [Jayne Antony, a neurologist from the Children's Hospital at Westmead] said it was impossible to calculate retrospectively the precise radiation doses absorbed by the Swedish men, so the comparison between their therapy and CT scans might not be valid.

[Ref: Julie Robotham (Medical Editor, Sydney Morning Herald), "Toddler CT Scans May Cause Brain Damage", Sydney Morning Herald, January 3, 2004, p. 3]

Hall et al. findings may apply to older children, too

Professor Hall said the findings were alarming. He said they were based on children who had head X-rays before the age of 18 months. But he feared there might be damaging effects even in older children.

[Ref: Jenny Hope, "Head X-rays may stunt a child's brain power", Courier Mail (Queensland, Australia), January 3, 2004, p. 13]

December 22, 2003

* Texas - P-32 source wire discovered leaking upon return from hospital (Guidant Corp)

December 12, 2003

* Philadelphia PA - hospital sent 1 mCi sulfur-35 vial to landfill

August 18, 2003

* Illinois - intravascular brachytherapy source retraction problem - 25% excess dose to patient (Rush North Medical Center, Skokie IL)

August 1, 2003

* BREAST CANCER: Risk higher for young women with Hodgkin disease treated with radiation
Cancer Weekly,ÊAugust 5, 2003, p. 26 (subscription required) --
A study by Travis et al. in the July 23/30, 2003 issue of the Journal of the American Medical Association analyzed the risk of breast cancer among 3,817 women diagnosed with Hodgkin disease (HD) at age 30 or younger (between June 1965 and December 1994) and provided estimates of relative and absolute excess risk in terms of radiation dose delivered to the breast and the number of alkylating-agent (certain types of drugs that inhibit cell division and growth and are used to treat some cancers) cycles. In an international part of the investigation, the researchers studied 105 patients with HD who developed breast cancer and matched them with 266 patients with HD but without breast cancer. "A radiation dose of 4 Gy or more delivered to the breast was associated with a 3.2-fold increased risk, compared with the risk in patients who received lower doses and no alkylating agents. Risk increased to 8-fold with a dose of more than 40 Gy. Radiation risk did not vary appreciably by age at exposure or reproductive history. Increased risks persisted for 25 or more years following radiotherapy", the study concludes.

Treatment with alkylating agents alone resulted in a reduced risk (40%) of breast cancer, and combined alkylating agents and radiotherapy in a 1.4-fold increased risk. Risk of breast cancer decreased with increasing number of alkylating agent cycles. Risk also was low (60% reduced risk) among women who received 5 Gy or more delivered to ovaries compared with those who received lower doses.

"Despite our quantification of this serious late effect," the paper concludes, "it is clear that the major gains and successes in the treatment of HD greatly outweigh the treatment-related risks of breast cancer and other late sequelae. Given current modifications in approaches to radiotherapy, in the future late effects should have less impact on the lives of women with HD. In the interim, for current survivors of HD, the high risk of radiation-associated breast cancer, which in our study did not diminish at the highest doses or in the longest follow-up, suggests the need for programs of clinician and patient awareness, lifetime surveillance, and possible prevention strategies."

Joachim Yahalom, MD, of Memorial Sloan-Kettering Cancer Center, New York, wrote, in an accompanying commentary, that the "results reported by Travis et al. clearly demonstrate the influence of radiation dose on the risk of breast cancer. Within the range of doses that have been used in the past, more radiation translates into a higher risk of developing breast cancer. This information, as well as data from earlier publications, supports the notion that 'lower is better' as long as the radiation dose used augments the cure rate for HD... The pendulum of therapy for HD that has swung from wide-field, full-dose radiation alone to full-dose chemotherapy and no radiation is likely to settle in the middle, providing a safer cure for Hodgkin disease by using brief chemotherapy and reduced radiation. The efficacy of this strategy already has been demonstrated, but determination of potential long-term toxicity will require more time."

July 21, 2003

* Pennsylvania - prostrate cancer therapy misadministration - many implanted seeds out of place

* Ohio - underdose during sinus tumor treatment at James Cancer Ctr

July 14, 2003

* Missouri - patient underdose due to leak from syringe at Washington U Hospital

July 9, 2003

NRC doesn't want to make the professional certification boards irrelevant to the question of whether or not someone is qualified to be a regulatorily significant person (that's nuclear.com's phrase, BTW). On June 30, representatives of several such boards and other stakeholders attended a most interesting meeting at NRC HQ on a proposed rule being developed on the matter. Here's a couple of documents related to that meeting released today by NRC:

* Medical training & experience - NRC's proposed rule 10CFR35: Issue briefing by NMSS' Roger Broseus

* Medical training & experience - NRC's proposed rule 10CFR35: Meeting summary (May 20, 2003)

June 27, 2003

* Illinois - hospital administered 10.8 mCi thyroid dose to wrong patient in Barrington

June 5, 2003

Sen. Enzi et al decry lack of regulation of radiological medical staff
13 States do not require licensure of any kind for persons who perform or plan medical imaging examinations and radiation therapy treatments;
... 37 States license, regulate, or register radiographers;
... 28 States license radiation therapists;
... 22 States license nuclear medicine technologists;
... 8 States license or require board certification of medical physicists; and
... no States regulate or license medical dosimetrists.
See Sen. Enzi's statement upon presenting the bill.

May 16, 2003

Radiation oncology services - UK blue ribbon panel report almost ready

In the UK, the Expert Review Group on Radiation Oncology Services was established by Health minister to examine the appropriate future development of radiotherapy services. The group has conducted a national assessment of needs for radiotherapy services having regard to the demography and epidemiology of cancer and the gaps in current service provision. It is anticipated that the report will be published shortly. [Source: Jamie O'Keefe, "Radiotherapy report 'latest'", Munster Express (Ireland), May 16, 2003]

May 14, 2003

Radiation therapy no longer automatic disqualifier for giving blood

Chemotherapy and radiation therapy for cancer treatment are no longer reasons to defer blood donation, according to Cascade Regional Blood Service. If you have been turned down as a blood donor because of a cancer diagnosis, you may qualify to donate again, depending on your diagnosis. Donors with superficial skin cancers or melanoma that has been removed and documented as localized only can donate. Cervical cancer patients who have been released from their doctor's care may also be able to donate blood - as well as others who have been cancer-free for five years. If you have been deferred indefinitely as a donor because of a cancer diagnosis, contact your local blood bank for information about being a blood donor. [Source: Debbie Cafazzo, "Some cancer patients can give blood", Tacoma News Tribune, May 14, 2003]