Interest in nuclear power as a cleaner and alternative energy source is increasing in many countries. Despite the relative safety of nuclear power, large-scale disasters such as the Fukushima Daiichi (Japan) and Chernobyl (Ukraine) meltdowns are a reminder that emergency preparedness and safety should be a priority. In an emergency situation, there is a need to balance the tension between a rapid response, preventing harm, protecting communities, and safeguarding workers and responders. The first line of defense for workers and responders is personal protective equipment (PPE), but the needs vary by situation and location. Better understanding this is vital to inform PPE needs for workers and responders during nuclear and radiological power plant accidents and emergencies.

The aim of this study was to identify and describe the PPE used by different categories of workers and responders during nuclear and radiological power plant accidents and emergencies.

A systematic literature review format following the PRISMA 2020 guidelines was utilized. Databases SCOPUS, PubMed, EMBASE, INSPEC, and Web of Science were used to retrieve articles that examined the PPE recommended or utilized by responders to nuclear radiological disasters at nuclear power plants (NPPs).

The search terms yielded 6,682 publications. After removal of duplicates, 5,587 sources continued through the systematic review process. This yielded 23 total articles for review, and five articles were added manually for a total of 28 articles reviewed in this study. Plant workers, decontamination or decommissioning workers, paramedics, Emergency Medical Services (EMS), emergency medical technicians, military, and support staff were the categories of responders identified for this type of disaster. Literature revealed that protective suits were the most common item of PPE required or recommended, followed by respirators and gloves (among others). However, adherence issues, human errors, and physiological factors frequently emerged as hinderances to the efficacy of these equipment in preventing contamination or efficiency of these responders.

If worn correctly and consistently, PPE will reduce exposure to ionizing radiation during a nuclear and radiological accident or disaster. For the best results, standardization of equipment recommendations, clear guidelines, and adequate training in its use is paramount. As fields related to nuclear power and nuclear medicine expand, responder safety should be at the forefront of emergency preparedness and response planning.

Identification of paediatric coronary artery abnormalities is challenging. We studied whether coronary artery CT angiography can be performed safely and reliably in children.

Retrospective analysis of consecutive coronary CT angiography scans was performed for image quality and estimated radiation dose. Both factors were assessed for correlation with electrocardiographic-gating technique that was protocoled on a case-by-case basis, radiation exposure parameters, image noise artefact parameters, heart rate, and heart rate variability.

Sixty scans were evaluated, of which 96.5% were diagnostic for main left and right coronaries and 91.3% were considered diagnostic for complete coronary arteries. Subjective image quality correlated significantly with lower heart rate, increasing patient age, and higher signal-to-noise ratio. Estimated radiation dose only correlated significantly with choice of electrocardiographic-gating technique with median doses as follows: 2.42 mSv for electrocardiographic-gating triggered high-pitch spiral technique, 5.37 mSv for prospectively triggered axial sequential technique, 3.92 mSv for retrospectively gated technique, and 5.64 mSv for studies which required multiple runs. Two scans were excluded for injection failure and one for protocol outside the study scope. Five non-diagnostic cases were attributed to breathing motion, scanning prior to peak contrast enhancement, or scan acquisition during the incorrect portion of the R-R interval.

Diagnostic-quality coronary CT angiography can be performed reliably with a low estimated radiation exposure by tailoring each scan protocol to the patient’s body habitus and heart rate. We propose coronary CT angiography is a safe and effective diagnostic modality for coronary artery abnormalities in children.

This study was aimed to evaluate the outcomes of patients with large (>2 cm in great diameter) vestibular schwannomas (VSs) treated with hypofractionated stereotactic radiotherapy (HFSRT) compared to small (<2 cm) ones and the impact of debulking surgery prior to radiation for large VSs.

Fifty-nine patients with VSs treated with HFSRT (25 Gy in 5 fractions) were evaluated by tumour size and surgical status. Patients were divided based on tumour size: small VSs (n = 42) and large VSs (n = 17). The large group was further divided into the groups of pre-treatment debulking surgery (n = 8) and no surgery (n = 9). Rates of tumour control, brainstem necrosis and neurologic dysfunction were assessed following treatment. Pre-surgical magnetic resonance imaging (MRI) were used to generate hypothetical HFSRT plans to compare the effect of debulking surgery on dosimetry. Normal tissue complication probability (NTCP) modelling was performed to compare toxicity probabilities with and without surgical debulking in large VSs.

There was no statistical difference of tumour control rate between small and large VSs with 100% for small tumours and 94·1% for large tumours (p = 0·12), respectively. In large VSs patient, the tumour control rate of HFSRT was 100% (8/8) for surgically debulked patients and 89% (8/9) for non-surgically debulked patients (p = 0·35). There were no patients who experienced brainstem necrosis or progression of facial and trigeminal nerve symptoms after HFSRT in the entire groups of patients. Surgical debulking large VSs did not change the maximum point dose of brainstem (p = 0·98), but significantly decreased volumes of VSs and changed the minimum dose to the hottest 0·5 cc of tumour (p = 0·016) as well as the volume receiving at least 23 Gy (p = 0·023). NTCP modelling revealed very low rates (average < 1%) of brainstem toxicity with or without surgical debulking, but there was a significant difference favoring surgery (p < 0·05).

HFSRT is a safe and effective treatment for both small and large VSs and is a viable option for patients with large VSs who cannot undergo surgery, if NTCP of pre-debulking HFSRT dosimetry is lower.