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Article: Updated Estimates of Radiation Risk for Cancer and Cardiovascular Disease: Implications for Cardiology Practice.

Picano, Eugenio / Vano, Eliseo

2024 Volume 13, Issue 7

Abstract: This review aims to furnish an updated assessment of the societal healthcare load, including cancer and cardiovascular disease resulting from diagnostic radiologic operations. The previously projected additional cancer risk of 0.9% in a United States ... ...

Abstract	This review aims to furnish an updated assessment of the societal healthcare load, including cancer and cardiovascular disease resulting from diagnostic radiologic operations. The previously projected additional cancer risk of 0.9% in a United States 2004 study referred to radiological conditions in 1996 with an X-ray exposure of 0.50 millisievert (mSv) per capita annually. Radiological exposure (radiology + nuclear medicine) has escalated to 2.29 mSv (2016) per capita per year. Low-dose exposures were previously assumed to have a lower biological impact, since they allow the DNA repair system to mitigate molecular damage. However, epidemiological data matured and disproved this assumption, as shown by updated cancer risk assessments derived from the World Health Organization 2013 and the German Institute of Radioprotection 2014 data. The risk of cardiovascular disease aligns within the same order of magnitude as cancer risk and compounds it, as shown by a comprehensive meta-analysis of 93 studies. The collective societal burden arising from the augmented risks of cancer and cardiovascular disease attributable to diagnostic radiology and nuclear medicine is higher than previously thought.
Language	English
Publishing date	2024-04-02
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13072066
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Article ; Online: Why is radiological protection different in medicine? Sievert Memorial Lecture.

Vano, Eliseo

Journal of radiological protection : official journal of the Society for Radiological Protection

2021 Volume 41, Issue 3

Abstract: There are many aspects of radiological protection in medicine that are different from other areas of activity using ionising radiation. In this paper, the author presents and justify some of these differences and highlight the reasons for and benefits of ...

Abstract	There are many aspects of radiological protection in medicine that are different from other areas of activity using ionising radiation. In this paper, the author presents and justify some of these differences and highlight the reasons for and benefits of this consideration for the medical field. It is important to understand the differences as we are all likely to be patients at some point in our lives and be exposed to ionising radiation for imaging procedures several times and, in some cases, for therapeutic indications. The work done by the International Commission on Radiological Protection and other international organisations to produce and recommend a consistent system of radiological protection in medicine for the safe use of ionising radiation in medical practices must be highlighted. We should understand why we do not apply dose limits and dose constraints to patients, as well as why we have three levels of justification when considering the use of ionising radiation for patients. We highlight the relevance of personalised radiation protection in parallel to personalised medical practice, and the importance of an integrated approach for occupational and patient protection, especially for interventional procedures. We also cover the differences between patients and volunteers in biomedical research, the importance of radiation safety in quality assurance programmes (including the consideration of unintended and accidental exposures) for some clinical practices, and the relevance of education and training in radiological protection for medical and health professionals and information on radiation risks for patients. Finally, the ethical issues with regard to the safe use of ionising radiation in medicine and the impact of new technology will be addressed.
MeSH term(s)	Biomedical Research ; Humans ; International Agencies ; Medicine ; Radiation Protection ; Radiation, Ionizing
Language	English
Publishing date	2021-08-18
Publishing country	England
Document type	Journal Article ; Lecture
ZDB-ID	639411-5
ISSN	1361-6498 ; 0952-4746
ISSN (online)	1361-6498
ISSN	0952-4746
DOI	10.1088/1361-6498/abffc5
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Article ; Online: Recurrent imaging procedures with ionising radiation on the same patient. Should we pay more attention?

Vano, Eliseo

Journal of radiological protection : official journal of the Society for Radiological Protection

2020 Volume 40, Issue 2, Page(s) E14–E17

MeSH term(s)	Humans ; International Agencies ; Neoplasms, Radiation-Induced/etiology ; Quality Control ; Radiation Dosage ; Radiation Protection ; Radiation, Ionizing ; Retreatment ; Risk Factors ; Tomography, X-Ray Computed
Language	English
Publishing date	2020-06-01
Publishing country	England
Document type	Editorial
ZDB-ID	639411-5
ISSN	1361-6498 ; 0952-4746
ISSN (online)	1361-6498
ISSN	0952-4746
DOI	10.1088/1361-6498/ab7fbb
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Article ; Online: Challenges for managing the cumulative effective dose for patients.

Vano, Eliseo

The British journal of radiology

2020 Volume 93, Issue 1116, Page(s) 20200814

Abstract: Notwithstanding that 100 mSv is not a threshold for radiation effects, cumulative effective dose (CED) for patients of ≥100 mSv derived from recurrent imaging procedures with ionising radiation has been recently the topic of several publications. The ... ...

Abstract	Notwithstanding that 100 mSv is not a threshold for radiation effects, cumulative effective dose (CED) for patients of ≥100 mSv derived from recurrent imaging procedures with ionising radiation has been recently the topic of several publications. The International Commission on Radiological Protection has alerted on the problems to use effective dose for risk estimation in individual patients but has accepted to use this quantity for comparison the relative radiation risks between different imaging modalities. A new International Commission on Radiological Protection document on the use of effective dose (including medicine), is in preparation. Recently published data on the number of patients with CED ≥100 mSv ranged from 0.6 to 3.4% in CT and around 4% in interventional radiology. The challenges to manage the existing situation are summarised. The main aspects identified are: 1) New technology with dose reduction techniques. 2) Refinements in the application of the justification and optimisation for these groups of patients. 3) Patient dose management systems with alerts on the cumulative high doses. 4) Education on the proper use of cumulative effective dose for referrers and practitioners including information for patients. 5) Future research programmes in radiation biology and epidemiology may profit the patient dose data from the groups with high cumulative dose values.
MeSH term(s)	Humans ; Radiation Dosage ; Radiation Protection/standards ; Radiography, Interventional/standards ; Tomography, X-Ray Computed/standards
Language	English
Publishing date	2020-09-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20200814
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Article ; Online: Understanding the Basis of Radiation Protection for Endovascular Procedures: Occupational and Patients.

Rial, Rodrigo / Vañó, Eliseo

EJVES vascular forum

2021 Volume 51, Page(s) 20–22

Abstract: Introduction: Some concepts of radiation protection are not well understood and must be refreshed periodically. The basic knowledge that a vascular surgeon must have about radiation protection for patients and staff is summarised.: Report: Diagnostic ...

Abstract	Introduction: Some concepts of radiation protection are not well understood and must be refreshed periodically. The basic knowledge that a vascular surgeon must have about radiation protection for patients and staff is summarised. Report: Diagnostic reference levels are a form of investigation into the medical exposure of patients during diagnostic and endovascular procedures that help to optimise them. Radiological quantities such as dose area product, also known as kerma area product and cumulative dose, are the most relevant to the patient. Equivalent dose, in mSv, determines the dose limits for staff. The effective dose (related to absorbed dose), also in mSv, represents the global risk of cancer and hereditary effects. For patient protection, the most important factors are fluoroscopy time, collimation, magnification, keeping the patient as near as possible to the image detector and as far as possible away from the tube, and trying to work in fluoroscope mode. Regarding occupational protection, distance, shielding, and dosimetry are the most important. Discussion: With the increased use of endovascular procedures, radiation protection is an issue that has grown in importance. Radiation protection is based on three principles: justification; optimisation; and dose limits. Every action focused on reducing a patient's radiation dose will also reduce the dose to staff. Basic principles such as "the further away the better", "always use a lead apron, thyroid protector, and lead glasses", and "do not forget to wear personal dosimeters" must be remembered at all times.
Language	English
Publishing date	2021-04-20
Publishing country	England
Document type	Journal Article
ISSN	2666-688X
ISSN (online)	2666-688X
DOI	10.1016/j.ejvsvf.2021.03.001
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Article ; Online: Protección radiológica en endoscopia.

Tchekmedyian, Asadur J / Dumonceau, Jean-Marc / Rosales Espizua, Francisco Javier / Ferreira Bicalho, Luciano Andrey / Vaño, Eliseo

Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru

2024 Volume 43, Issue 4, Page(s) 348–357

Abstract: Endoscopy has evolved from a purely diagnostic technique to a therapeutic procedure. This is possible in many cases thanks to the use of fluoroscopy, which entails exposure to ionizing radiation for both patients and the personnel involved. Endoscopic ... ...

Title translation	Radiation protection in endoscopy.
Abstract	Endoscopy has evolved from a purely diagnostic technique to a therapeutic procedure. This is possible in many cases thanks to the use of fluoroscopy, which entails exposure to ionizing radiation for both patients and the personnel involved. Endoscopic retrograde cholangiopancreatography (ERCP), which necessarily requires fluoroscopy, is classified by the Food and Drug Administration as an examination with a potential risk of triggering radiation induced injuries. This article reviews the biological effects of radiation, the types of radiological equipment used in ERCP, as well as the magnitudes and dosimetric units, to finally address the radio protection elements in the endoscopy room. The objective is to provide the reader with the information to be able to perform these procedures with the greatest radiological safety for both patients and occupationally exposed personnel.
MeSH term(s)	Humans ; Radiation Protection/methods ; Radiation Dosage ; Radiation Monitoring/methods ; Occupational Exposure/adverse effects ; Occupational Exposure/prevention & control ; Occupational Exposure/analysis ; Radiation Injuries/etiology ; Radiation Injuries/prevention & control ; Cholangiopancreatography, Endoscopic Retrograde/methods ; Fluoroscopy/methods
Language	Spanish
Publishing date	2024-01-16
Publishing country	Peru
Document type	Review ; English Abstract ; Journal Article
ZDB-ID	2058591-3
ISSN	1609-722X ; 1609-722X
ISSN (online)	1609-722X
ISSN	1609-722X
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Article ; Online: Uncertainties in occupational eye lens doses from dosimeters over the apron in interventional practices.

Sánchez, Roberto / Vañó, Eliseo / Fernández, José Miguel

Journal of radiological protection : official journal of the Society for Radiological Protection

2022 Volume 42, Issue 2

Abstract: It is relevant to estimate the uncertainties in the measurement of eye lens doses from a personal dosimeter over the protective apron without using additional dosimetry near the eyes. Additional dosimetry for interventionists represents a difficulty for ... ...

Abstract	It is relevant to estimate the uncertainties in the measurement of eye lens doses from a personal dosimeter over the protective apron without using additional dosimetry near the eyes. Additional dosimetry for interventionists represents a difficulty for routine clinical practice. This study analyses the estimated eye doses from dosimeter values taken at chest level over the apron and their uncertainties. Measurements of
MeSH term(s)	Humans ; Lens, Crystalline ; Occupational Exposure/analysis ; Radiation Dosage ; Radiation Dosimeters ; Radiation Protection ; Radiology, Interventional
Language	English
Publishing date	2022-02-23
Publishing country	England
Document type	Journal Article
ZDB-ID	639411-5
ISSN	1361-6498 ; 0952-4746
ISSN (online)	1361-6498
ISSN	0952-4746
DOI	10.1088/1361-6498/ac5187
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Article ; Online: Self-* Capabilities of Cloud-Edge Nodes: A Research Review.

S-Julián, Raúl / Lacalle, Ignacio / Vaño, Rafael / Boronat, Fernando / Palau, Carlos E

Sensors (Basel, Switzerland)

2023 Volume 23, Issue 6

Abstract: Most recent edge and fog computing architectures aim at pushing cloud-native traits at the edge of the network, reducing latency, power consumption, and network overhead, allowing operations to be performed close to data sources. To manage these ... ...

Abstract	Most recent edge and fog computing architectures aim at pushing cloud-native traits at the edge of the network, reducing latency, power consumption, and network overhead, allowing operations to be performed close to data sources. To manage these architectures in an autonomous way, systems that materialize in specific computing nodes must deploy self-* capabilities minimizing human intervention across the continuum of computing equipment. Nowadays, a systematic classification of such capabilities is missing, as well as an analysis on how those can be implemented. For a system owner in a continuum deployment, there is not a main reference publication to consult to determine what capabilities do exist and which are the sources to rely on. In this article, a literature review is conducted to analyze the self-* capabilities needed to achieve a self-* equipped nature in truly autonomous systems. The article aims to shed light on a potential uniting taxonomy in this heterogeneous field. In addition, the results provided include conclusions on why those aspects are too heterogeneously tackled, depend hugely on specific cases, and shed light on why there is not a clear reference architecture to guide on the matter of which traits to equip the nodes with.
Language	English
Publishing date	2023-03-08
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2052857-7
ISSN	1424-8220 ; 1424-8220
ISSN (online)	1424-8220
ISSN	1424-8220
DOI	10.3390/s23062931
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Article ; Online: Cloud-Native Workload Orchestration at the Edge: A Deployment Review and Future Directions.

Vaño, Rafael / Lacalle, Ignacio / Sowiński, Piotr / S-Julián, Raúl / Palau, Carlos E

Sensors (Basel, Switzerland)

2023 Volume 23, Issue 4

Abstract: Cloud-native computing principles such as virtualization and orchestration are key to transferring to the promising paradigm of edge computing. Challenges of containerization, operative models and scarce availability of established tools make a thorough ... ...

Abstract	Cloud-native computing principles such as virtualization and orchestration are key to transferring to the promising paradigm of edge computing. Challenges of containerization, operative models and scarce availability of established tools make a thorough review indispensable. Therefore, the authors have described the practical methods and tools found in the literature as well as in current community-led development projects, and have thoroughly exposed the future directions of the field. Container virtualization and its orchestration through Kubernetes have dominated the cloud computing domain, while major efforts have been recently recorded focused on the adaptation of these technologies to the edge. Such initiatives have addressed either the reduction of container engines and the development of specific tailored operating systems or the development of smaller K8s distributions and edge-focused adaptations (such as KubeEdge). Finally, new workload virtualization approaches, such as WebAssembly modules together with the joint orchestration of these heterogeneous workloads, seem to be the topics to pay attention to in the short to medium term.
Language	English
Publishing date	2023-02-16
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2052857-7
ISSN	1424-8220 ; 1424-8220
ISSN (online)	1424-8220
ISSN	1424-8220
DOI	10.3390/s23042215
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Article: Characteristics and Management of Patients with Alopecia Areata and Selected Comorbid Conditions: Results from a Survey in Five European Countries.

Vañó-Galván, Sergio / Egeberg, Alexander / Piraccini, Bianca Maria / Marwaha, Simran / Reed, Catherine / Johansson, Erin / Durand, Frederick / Bewley, Anthony

Dermatology and therapy

2024 Volume 14, Issue 4, Page(s) 1027–1037

Abstract: Introduction: Alopecia areata (AA) is an autoimmune condition that causes non-scarring hair loss and can impose a high psychosocial burden on patients. The presence of comorbid conditions may impact the management of AA in clinical practice. This ... ...

Abstract	Introduction: Alopecia areata (AA) is an autoimmune condition that causes non-scarring hair loss and can impose a high psychosocial burden on patients. The presence of comorbid conditions may impact the management of AA in clinical practice. This analysis aims to describe disease characteristics and management of AA in patients with concomitant atopic, autoimmune, and psychiatric comorbid conditions. Methods: Data were collected from the Adelphi Disease Specific Programme™, a cross-sectional survey of physicians and their adult patients with AA conducted in France, Germany, Italy, Spain, and the UK between October 2021 and June 2022. Patients' disease severity was based on physician's definition. Physician-reported data on demographics, AA clinical characteristics, comorbid conditions, and information related to AA therapies were analyzed. Analyses were descriptive. Results: Overall, 239 dermatologists provided data for 2083 patients, of which 558 patients (27%) had at least one atopic, autoimmune, or psychiatric comorbid conditions. The most common comorbid conditions were atopic dermatitis, autoimmune thyroid disease, and anxiety. The mean (standard deviation) patient age for the three comorbidity groups was 37.6 years (12.1) and 56% of the patients were women (n = 313). In the three comorbidity groups, 51%, 50%, and 55% of patients with atopic, autoimmune, and psychiatric comorbidities had severe AA with disease progression reported as worsening in 30%, 28%, and 30%, respectively, whereas in the group with no comorbidities, 37% were described as having severe AA and 21% getting worse. Scalp hair loss was the primary sign reported across the three groups of comorbid conditions (atopic, 91%; autoimmune, 91%; psychiatric, 88%). Patients with preselected comorbidities presented more frequently AA-related signs and symptoms beyond scalp hair loss than patients without comorbid conditions. These patients were also more likely to receive topical calcineurin inhibitors, topical immunotherapy, conventional systemic immunosuppressants, and oral Janus kinase inhibitors for the treatment of their AA. Conclusion: This analysis provided insights into the burden and management of AA in patients presenting with atopic, autoimmune, and psychiatric comorbid conditions in five European countries.
Language	English
Publishing date	2024-03-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2680284-3
ISSN	2190-9172 ; 2193-8210
ISSN (online)	2190-9172
ISSN	2193-8210
DOI	10.1007/s13555-024-01133-z
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