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Increase in Use of Medical Radiation and US Medical Imaging Volumes | Antioxidants Prevent DNA Damage from Radiation
Increase in Use of Medical Radiation and US Medical Imaging Volumes | Antioxidants Prevent DNA Damage from Radiation
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Acute vs Elective Medical Imaging Exams and Cancer Risk  | Antioxidants Prevent DNA Damage from Radiation
Acute vs Elective Medical Imaging Exams and Cancer Risk | Antioxidants Prevent DNA Damage from Radiation
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Theory of Radiation Injury | Antioxidants Prevent DNA Damage from Radiation
Theory of Radiation Injury | Antioxidants Prevent DNA Damage from Radiation
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DNA Repair Complex - G H2AX and P53 with Evidence of Damage | Antioxidants Prevent DNA Damage from Radiation
DNA Repair Complex - G H2AX and P53 with Evidence of Damage | Antioxidants Prevent DNA Damage from Radiation
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Clinical Cancer Research | Antioxidants Prevent DNA Damage from Radiation
Clinical Cancer Research | Antioxidants Prevent DNA Damage from Radiation
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Specific Patients at Risk | Antioxidants Prevent DNA Damage from Radiation
Specific Patients at Risk | Antioxidants Prevent DNA Damage from Radiation
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Radiation Zones and Cataracts | Antioxidants Prevent DNA Damage from Radiation
Radiation Zones and Cataracts | Antioxidants Prevent DNA Damage from Radiation
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Radiation Cataractogenesis - Increase Risk of L Sided Brain Tumors | Antioxidants Prevent DNA Damage from Radiation
Radiation Cataractogenesis - Increase Risk of L Sided Brain Tumors | Antioxidants Prevent DNA Damage from Radiation
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Radiation Injury and Antioxidants | Antioxidants Prevent DNA Damage from Radiation
Radiation Injury and Antioxidants | Antioxidants Prevent DNA Damage from Radiation
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Antioxidants - Oral Prior to Radiation Exposure Preventing DNA Damage | Antioxidants Prevent DNA Damage from Radiation
Antioxidants - Oral Prior to Radiation Exposure Preventing DNA Damage | Antioxidants Prevent DNA Damage from Radiation
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Future Interventional Neuroradiologists Screenings for Mutations | Antioxidants Prevent DNA Damage from Radiation
Future Interventional Neuroradiologists Screenings for Mutations | Antioxidants Prevent DNA Damage from Radiation
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Transcript

Good morning. Thank you for allowing me to present by video this morning. I wish I was with you in person. I want to talk to you about the role of antioxidant as the method of decreasing DNA damage from medical radiation. This has been about 10 years work on my part. As you all know there's

being a significant increase in the use of medical radiation in society. In fact we deliver more dose to the population than any other source. There are about 80 million CT examinations per year in North America. 40 million mammograms 20

million nuclear medicine studies which whole blood pool radiation actually and they deliver more dose than any other form of medical radiation. And untold numbers of plain film and dental x-rays. There's an increased prevalence of

screening examinations for lung cancer and chest CT and virtual colonoscopy as well as mammography. The principal

source of radiation is elective scheduled medical imaging studies. But a significant proportion about thirty

percent if acute for acute trauma acute MI acute subarachnoid hemorrhage. The cancer risk from medical imaging is a function of age. The older you are when you're imaged the less likely you are to have a problem from DNA damage resulting in an

oncogenic issue because you die of something else. But if you're receiving a lot of radiation at a young age...say for example you have lymphoma when your child you get a lot of gallium scan...and you live for 70 years then the risk of a

secondary tumor as a result of the radiation received from medical imaging though it was justified at the time is significantly higher than the a risk for the CT scan delivered to an older

radiation cause DNA damage. Well an x-ray impinges upon...or ionizing radiation source impinges upon a water molecule and this water molecule is split into free radicals which bind to DNA. And this results in oxygen binding to that site

and resulting in an oxidative injury to the DNA. But we've worked on is the use of antioxidants as a method of collecting or scavenging the free radicals to decrease the likelihood of DNA damage occurring. Within ourselves we have DNA

repair mechanisms. Two of the most prevalent are H2alpha and p53. Patients with BRCA1 and 2 issues...the breast cancer inducing genes...have p53 mutation impairment and their ability to repair DNA damage is diminished. We can image

with immunofluorescent the activation of h2alpha and p53 repair mechanisms. And by being able to image with immuno- fluorescence...and on the right you see what it looks like...we can quantitate the degree of DNA damage. There is extensive

information that CT for example causes DNA breaks and it's been published in the Journal of Radiology. There's evidence that transluminal angioplasty in coronary or peripheral intervention cause DNA damage. There's evidence that the addition of contrast

material to a CT scan increases the number of DNA breaks by about thirty percent. There's evidence that nuclear medicine is associated with DNA breaks and DNA

getting chemotherapy...whether it be methotrexate

for an inflammatory spondylo- arthropathy or cisplatin chemotherapy doxorubicin for their oncology issues...that they when they have a CT have greater number of breaks because of their impaired

repairability than those who are not on chemotherapy. There is evidence of increased on oncogenesis or cancer risk associated with medical imaging radiation. And in the Canadian Medical Association Journal a very good paper

was published in 2011 showing that for every 10 millisieverts of radiation received for acute coronary intervention in MI there was a three percent increase in the risk of age and sex adjusted cancer.

I've recently published a review article in The Canadian Association of Radiologists Journal looking at MRI induced DNA damage. And is very interesting because it appears to be related not to the field strength but to the power of the

RF coils. And the mechanism of the DNA damage is different from the damage caused by CT. There are some unexpected groups who are considered radiation workers. Flight crews pilots stewardesses are considered radiation workers

because of the annual dose they receive related to altitude that they achieve from their professions. And in fact pilots and crews are limited in the number of transpolar routes they can take per year. The polar dose is greater than the more than

so the national level of flight. So if you get up to 20000 feet you don't get that much radiation. Get up to 30000 can get more you get the 40 thousand you start to get serious doses. You get 40000 over the North Pole. You get

more doses. So the frequent flyers in the room should be conscious of the fact that they're getting significant radiation dose from there multiple flights a year. In fact a pregnant stewardesses would be limited in the

number of flight she can take in the first trimester because of the dose that she receives. These papers are published by the FAA in radiation protection journals and in occupational

patients are at risk. Those who undergo high dose studies like cardiac PET CT. Patients who get contrast. Patients who get contrast who are on chemotherapy. Patients who are children with lymphoma who have multiple gallium scans and then live a long lives. Patients

with genetic mutations which impair their ability to repair DNA breaks induced by medical radiation. Some we know of BRCA 1 and 2. Others we tend not to think of like the retinoblastoma group who are very sensitive to medical

radiation. The founding fathers of radiology unfortunately suffered terrible fate from radiation injury. They stood in the x-ray beam as the patient was being imaged. We're all familiar with this image of Anna Rontgen...Conrad

Rontgen's wife hand and her wedding ring showing up. And unfortunately many of her...of the decendents of Rontgen are precursors suffered terrible deformity and death of the result of the ionizing radiation which their prolonged exposure to. Over

the last 70 years we as a field of interventionalists whether it be cardiology vascular surgeon radiology interventional neuroradiology seem to have forgotten that this happened to our forefathers. We expose ourselves to massive doses annually and we

don't bother to wear our badges so we don't know what happens to us. I noted

that I had no hair on the outside of my left leg one day and this triggered an interest in radiation damage that I was receiving professionally. This is

actually radiation dermatitis because my left leg was beside the x-ray tube. If you look at the distribution of dose our legs our left arm and our heads in particular get large doses because they're not

covered. We have a very high influence of cataracts as a profession. Thirty-eight percent of us will developed cataracts. These are posterior chamber cataracts. This is a different kind of cataract than is induced by age. Senile or age-related

cataracts are anterior or middle chamber cataracts in the lens. We get posterior chamber cataracts which is a form of onconeogenesis. And in a way it's the canary in the coal mine in this area of occupational risk. One of my recent

papers has been on this topic of looking at our progression of understanding. And the dose that we are allowed now annually receive to our lens has been reduced seven-fold in the last two years. This is a cross section of a lens. We

see the normal structure the cornea etc. And the posterior aspect of that lens is where our radiation-induced cataracts occur in thirty-eight percent of us. One my colleagues Vitor Pereira put together a beautiful study in

Geneva were he and his colleagues wore DLDs all over their bodies during interventions. And what was striking here with the dose to the left side of the head is six times higher than the dose to the right side of the head. This

correlates well with a paper demonstrating increased risk of left-sided brain tumors in interventional radiologists interventional cardiologists. In this paper of 31 interventional cardiologists

with brain tumors eighty-five percent were left-sided. The dose we receive is higher with the longer procedures. Cerebral embolization vertebroplasty etc... longer procedures have more dose

came home from work with a head full of thoughts about radiation injury and I went for a walk with my son. And it was just an example of how happenstance tends to be the source of invention sometimes. So Ronan and I

go out with Cora my dog and we were walking and we bumped into another dog and the owner of the other dog asked me what I did for a living and I told him I was a radiologist I did research. He asked what research I did and explained

to him that I was working on the issue of radiation injury and looking into antioxidants and he said I make antioxidant. It turns out this man was Ivan de Souza and he made an antioxidant called Urate. So we began

to use this in our experiments and initially we used an eyedropper essentially and took some peripheral mononuclear cells from pigs and radiated them in a cellar radiator and then applied topical antioxidant. And we found

we could decreased DNA breaks. Then we went on to feed the pig antioxidants and then radiate their blood and get a more in vivo type study and again we found we could decrease DNA breaks. Then we took the antioxidant ourselves and we found that

again we could decrease DNA breaks by pre- medicating with antioxidants. But the problem was this formulation made you slightly hypertensive. It was mainly uric acid and it wasn't a good thing to be taking. So we changed our formulation. I

happen to be visiting professor at Dalhousie Hniversity in Halifax Nova Scotia a wonderful beautiful place and I presented this work and they told me that they actually made antioxidants from apple skins. When you bite into an

apple it goes brown because of the oxidative effective of oxygen on the apple. And this is inhibited by quercetin in the apple. So we introduced this quercetin apple skin extract into our formulation which now consists of beta-carotene n-acetylcystine

Vitamin C and alpha lipoic acid and quercetin. We came up with the formulation that we made in a gel cap. You take it one hour prior to the procedure. I just

published this paper in the Journal of Vascular Interventional Radiology. Where

patients were pre-medicated and we were able to impair their DNA damage. So five patients undergoing a technitium MDP scan a bone scan were not pre-medicated. Blue is their pre-exposure dose. After the injection of

the bone scan technetium their breaks went up. We then pre-medicated a group of patients undergoing identical studies identical doses and having bone scans. And we could inhibit

or protect their DNA by a level which is so powerful that there is no statistical difference between the DNA breaks in their pre and post injection samples. So this was fascinating because this whole

blood radiation from technetium MDP over 4-6 hours and yet we could prevent the damage to the DNA from that radiation. Again in the spirit of happenstance one of my patients who makes paintballs asked me about my research and I told him what I

was doing. And he said so well you know a paintball is a gelcap. And I now also make Nyquil and Benadryl gelcaps I could make your formulation. So we got into a negotiation and they worked with us on mass producing our formulation for us.

And I went to visit and I discovered that their factory is actually on Kieran Street near the airport in Montreal Quebec. Gives you an example of how much synchronicity can be involved in these moments. Now not all of us are exposed to

equal risk. We know that women who have BRCA1 and 2 mutations are increased risk of ionizing radiation induced cancer. And they get mammograms perhaps alternating with...well they get MRI alternating with

mammograms for their breast cancer screening. We as radiologists I believe should be screened for mutations which impair our ability to repair our DNA from x-ray exposure. If you're Ashkenazi Jewish you have a two percent chance

whether you're male or female of having that BRCA 1 or 2 mutation. There are other syndromes that are familial which impair your ability to repair your DNA. And if you're going to go into a profession with a high exposure to radiation perhaps

that's not the healthiest thing for you to do. So we published this paper and whether or not interventional neuroradiology should screen for mutations that impair repairability in the Journal of Interventional Neuroradiology the last few months. I hope you found this

interesting. Thank you for allowing me to present in this fashion and just email me if any questions. Thank you.

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