Objective To investigate the basic situation of nuclear medicine diagnostic and treatment institutions in Shanghai, understand the development level and distribution characteristics of nuclear medicine in Shanghai, and assess the current status of nuclear medicine development in Shanghai. Methods Using questionnaires, on-site verification, and retrieval of information system records, a survey was carried out on nuclear medicine department staff, equipment, and personal radiation exposure levels of workers in Shanghai. Results As of December 2023, there were 48 nuclear medicine diagnostic and treatment institutions in Shanghai, including 32 (66.7%) tertiary hospitals. Of these, 24 (50%) hospitals performed ¹³¹I therapy, and 9 (18.8%) hospitals conducted ¹³¹I treatment for thyroid cancer. There were 681 nuclear medicine radiation workers, with an average annual effective dose from external radiation of 0.54 mSv. There were 137 pieces of nuclear medicine equipment, including 56 SPECT/CT, 42 PET/CT, 8 PET/MRI, 25 thyroid function meters, and 6 cyclotrons. In 2023, the total radioactivity of radionuclides used in Shanghai was 1.2 × 10⁸ MBq, with 3.4 × 10⁷ MBq of ¹⁸F, 7.4 × 10⁷ MBq of ^99mTc, and 1.2 × 10⁷ MBq of ¹³¹I. The total annual number of nuclear medicine diagnostic and treatment procedures performed was 247 826 and the application frequency was 10.0 procedures per thousand population. Conclusion Clinical nuclear medicine in Shanghai has developed rapidly, achieving the Level I healthcare standard as defined in the UNSCEAR 2008 report. Enhancing occupational protection for radiation workers is a critical issue that requires particular attention in the next phase of development.

Background With the widespread application of ionizing radiation technology in non-medical fields, the number of non-medical radiation workers has steadily increased over the years. Individual dose monitoring serves as a crucial measure to safeguard the occupational health of non-medical radiation workers, as it can accurately identify occupational health risks and optimize radiation protection strategies. Objective To analyze the individual monitoring data of radiation workers from partial non-medical sectors in Shanghai from 2016 to 2023, to obtain the status of occupational radiation exposure and to provide a reference basis for non-medical radiation hygiene supervision and protection management. Methods The study subjects consisted of radiation workers from non-medical institutions in Shanghai who recieved individual dose monitoring at a Class-A radiation health technical service institution between 2016 and 2023. Under the Specifications for individual monitoring of occupational external exposure (GBZ 128-2019), thermoluminescence dosimetry was used for measuring personal dose equivalent, H_p(10), of various occupations encompassing industrial irradiation, industrial radiography, radioisotope production, accelerator operation, other industrial applications, education, and veterinary medicine. Kruskal-Wallis H test was used for comparison among multiple groups, Bonferroni method was adopted for pairwise comparison, and Mann-Kendall test was conducted for trend analysis to analyze the per-capita annual effective dose and its variation over time across different occupational categories of radiation workers. Results A total of 13728 person-times of non-medical radiation workers were monitored from 2016 to 2023, accumulating a collective effective dose of 3025.69 person-mSv. The per-capita annual effective dose M(P₂₅, P₇₅) was 0.14(0.08, 0.25) mSv. There were statistically significant differences in the per-capita annual effective dose of radiation workers in different years (H=874.826, P< 0.05). Similarly, significant variations were identified among various occupational categories (H=115.569, P< 0.05). Among them, the per-capita annual effective dose of radiological workers engaged in the production of radioactive isotopes was the highest, at 0.21(0.14, 0.32) mSv, followed by those in veterinary medicine, at 0.17 (0.11, 0.61) mSv; the difference between these two groups was not statistically significant (Z=1.231, P > 0.05), but both were significantly higher than those in other occupational categories (Z=3.913, 9.761, P<0.05). The veterinary medicine category had the highest proportion of monitored individuals with annual effective dose exceeding 1 mSv to the total number of monitored individuals(NR₁), reaching 17.12%, and the industrial radiography category showed the highest proportion of workers exposed to more than the annual investigation level 5 mSv to the total number of monitored individuals (NR₅), at 0.16%. Conclusion From 2016 to 2023, the overall individual doses of some non-medical radiation workers in Shanghai remain low, indicating well-controlled radiation levels in workplaces and low exposure risks. It is necessary to focus on radiation workers engaged in radioisotope production, veterinary medicine and industrial radiography.

Objective:To understand the radiation protecton awareness of clinical staff for patients, and to provide strategies and suggestions for promoting the justification of medical exposure.Methods:From June to September 2023, 1 430 physicians or technicians from 10 tertiary hospitals, 9 secondary hospitals and 8 primary hospitals in Shanghai were selected by multi-stage stratified random sampling method to conduct a questionnaire survey about radiation-related cognition through a combination of offline and online survey. The contents of the questionnaire included the characteristics of the respondents, the training of radiation protection, the self-awareness of patients on radiation protection, the actual cognition of the basic knowledge of ionizing radiation, the cognition of the dose caused by different types of the radiological examinations, and the ways to access knowledge of ionizing radiation. SPSS software was used for statistical analysis.Results:A total of 1 229 valid questionnaires were received, of which 82.10% respondents belonged to the clinical department and 17.90% belonged to the radiology department. 58.37% of the respondents in clinical department have received radiation-related training, and 98.64% in radiology department have done so. The overall mastery of radiation protection-related knowledge in radiology department was better than in clinical department, and the difference was statistically significant ( χ2=39.58, P<0.05). Most of the respondents tended to underestimate the radiation dose to patients from CT scans, and the proportion of the respondents who underestimated the CT doses to different sites was all greater than 45%. Logistic regression analysis showed that the contributing factors affecting radiation protection cognition are a combination of technical titles, radiation protection training to a varing degree, the level of medical institutions and their majors (95% CI of the OR values did not include 1, χ2=5.66-28.26, P<0.05). Conclusions:Most clinical staff have realized the importance of controlling the radiation dose in radiological examinations, but there is less understanding of the dose magnitude caused by different radiological examinations. Education and training are the best way to improve the awareness of ionizing radiation. Radiation protection training should be integrated into general medical education or standardized training for physicians.

【Objective】 To explore the effectiveness of using donor plasma reinfusion to flush the leukoreduction system (LRS) chamber during the final reinfusion phase with the Trima Accel automated blood collection system in preventing the reduction of CD4+ and CD8+ T lymphocytes. 【Methods】 A longitudinal and cross-sectional study was designed. CD4+ count<200 cells/μL and CD8+ count<125 cells/μL were considered as the criteria for deficiency. Eighteen first-time platelet donors were followed up. The lymphocyte count was measured at 0, 3-6 and 7-14 times of blood donation in the last 300 days. 170 healthy blood donors who have not donated blood were selected as the control group. According to the cut-off point(October 2021), 88 blood donors who mainly used automatic blood collection system to donate platelet apheresis in the last 365 days(median blood donation times ≥17.5)were divided into three groups(A, B and C)and blood samples were obtained. The time for Groups A, B and C started donating platelet apheresis were as follows: Group A: before October 2019, Group B: from October 2019 to September 2021, Group C: after October 2021. Blood samples were analyzed to obtain blood counts including CD4 + and CD8 + T lymphocytes. Blood samples were analyzed to obtain blood cell counts including CD4+ and CD8+ T lymphocytes. Through a comparative analysis, this study aimed to determine if there are any statistical differences in the detection indices between the follow-up groups with varying frequencies of blood donation, the control group, and groups A, B, and C. This approach was employed to infer the efficacy of donor plasma reinfusion in flushing the leukoreduction system (LRS) chamber for preventing the decline of CD4+ and CD8+ T lymphocytes. 【Results】 Eighteen first-time blood donors who were converted to regular platelet apheresis donors did not show a decrease of CD4 + and CD8 + T lymphocytes in the 5 th and 11 th blood donation (median number of blood donation), and there was no significant difference between the above indexes and those in the 0 th blood donation. Among the previous frequent blood donors, the CD4+ and CD8+ T lymphocyte counts in Group B and Group C are both higher than the standard value, showing no statistical difference from the control group. Among regular blood donors, the CD4+ and CD8+ T lymphocyte counts in groups B and C were higher than the criteria values, and had no statistical difference compared to the control group.The CD4+ T lymphocyte count in Group A was normal, with only one donor in Group A having a CD8+ T lymphocyte count below 125 cells/μL. This donor has donated 281 times of platelet apheresis, and the group he belongs to has started blood donation 2-21 years(median of 5 years) before the adjustment of reinfusion mode. The CD4+ and CD8+ T lymphocyte counts in Group A showed significant differences compared to the control group, with median counts (Group A/Control Group) of 359/521 and 257/372, respectively, P<0.001. In Group A, 0%(0/35) had a CD4+ count below 200 cells/μL, and 2.85%(1/35) of donors had a CD8+ count below 125 cells/μL, which was far lower than the proportion of CD4+ and CD8+ T cell deficiency found in regular apheresis donors by John M. Gansner and Mahboubeh Rahmani. The study showed that the adjustment of the plasma reinfusion mode did not further reduce the T lymphocyte counts in blood donors, but instead further restored the T lymphocyte counts in regular blood donors. This indicated that after the adjustment of plasma reinfusion mode, blood donors might not have lost CD4+ and CD8+ T lymphocytes during blood donation, or only lost a small amount, and can recover even if they donate platelet apheresis frequently. 【Conclusion】 Trima Accel automated blood collection system has a good effect on preventing CD4 + and CD8 + T lymphocytes from being reduced by flushing the LRS chamber with donor plasma.

ObjectiveTo analyze the individual monitoring results of the radiation workers in Shanghai’s Jing’an District from 2017 to 2023, to assess the occupational protection status as well as to offer scientific references for enhancing occupational health and radiation safety, and to provide support for health education initiatives targeting radiation workers. MethodsRadiation workers from several medical institutions in Jing’an District from 2017 to 2023 were selected as the subjects for this study. The individual dose of occupational external radiation exposure was monitored by using thermoluminescence dosimeters. Continuous data of seven years were statistically analyzed using SPSS 20.0. ResultsFrom 2017 to 2023, the annual collective effective dose for radiation workers in Jing’an District was 329.53 person·mSv, with an average individual annual effective dose of 0.17 mSv, and the median individual annual effective dose was 0.12 mSv. There were statistically significant differences in the individual annual effective doses across different years (H=277.131, P<0.05). The individual doses varied significantly among different levels of medical institutions (H=46.097, P<0.05), with tertiary institutions having the lowest median individual dose of 0.09 mSv, which was significantly lower than those at primary, secondary, and ungraded institutions (P<0.05). The median annual effective dose in males was lower than that in females, showing a statistically significant difference (Z=-3.438, P<0.05). There were significant differences in the individual annual effective doses among different occupational categories (H=150.727, P<0.05), with nuclear medicine workers experiencing the highest median annual dose of 0.56 mSv. ConclusionFrom 2017 to 2023, the individual dose of radiation workers in medical institutions in Jing’an District of Shanghai remained at a low level, reflecting the effective measures of radiation protection facilities in workplaces in Jing’an District, but particular attention should be given to radiological workers in nuclear medicine and workers in primary medical institutions.

ObjectiveTo explore the intervention effect and molecular mechanism of Dabufei decoction in Dunhuang formula combined with cisplatin on Lewis lung adenocarcinoma-bearing mice. MethodFifty C57BL/6J mice were used， with 10 randomly assigned to the blank group （without modeling）， and 40 subcutaneously inoculated with Lewis cells to establish a Lewis lung adenocarcinoma-bearing mouse model. These 40 mice were randomly divided into the following four groups （with 10 mice in each group）： Model group （equal volume of physiological saline）， cisplatin group （5 mg·kg^-1）， Dabufei decoction group （14.35 g·kg^-1·d^-1）， and Dabufei decoction combined with cisplatin group （Dabufei decoction 14.35 g·kg^-1·d^-1 + cisplatin 5 mg·kg^-1）. Each group was treated continuously for 14 days. The general condition of the mice was observed， body weight changes were recorded， and the tumor inhibition rate， spleen index， and thymus index were calculated. Peripheral blood white blood cell （WBC）， platelet （PLT）， and hemoglobin （HGB） were detected by routine blood tests. Flow cytometry was used to detect the expression of CD4⁺CD25⁺FoxP3⁺ regulatory T cells （Treg） and natural killer （NK） cells in the spleen. Western blot and real-time quantitative polymerase chain reaction （Real-time PCR） were used to determine the expression of proteins and mRNA related to the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway in tumor tissues. ResultCompared with the blank group， the model group showed decreased body weight （P<0.05）， spleen index， and thymus index （P<0.05）， decreased percentage of NK cells in the spleen （P<0.05）， increased percentage of Treg cells （P<0.05）， and decreased counts of WBC， PLT， and HGB （P<0.05）. Compared with the model group， the Dabufei decoction group exhibited significant tumor growth inhibition， increased body weight， and reduced tumor weight （P<0.05）， increased percentage of NK cells （P<0.05）， decreased proportion of Treg cells （P<0.05）， and increased counts of WBC， PLT， and HGB （P<0.05）. In the cisplatin group， tumor growth was significantly inhibited， body weight significantly decreased （P<0.05）， and tumor weight significantly reduced （P<0.05）. The spleen index and thymus index decreased （P<0.05）， and the percentage of Treg cells significantly decreased （P<0.05）. The counts of WBC， PLT， and HGB significantly decreased （P<0.05）. In the Dabufei decoction combined with cisplatin group， tumor growth was significantly inhibited， and tumor weight significantly reduced （P<0.05）. The levels of phosphorylated PI3K， Akt， and mTOR proteins and mRNA in tumor tissues were significantly reduced in all medication groups （P<0.05）. Compared with the cisplatin group， the Dabufei decoction combined with cisplatin group showed significantly inhibited tumor growth， reduced tumor weight （P<0.05）， increased body weight （P<0.05）， increased spleen index and thymus index （P<0.05）， increased percentage of NK cells （P<0.05）， decreased percentage of Treg cells （P<0.05）， significantly increased counts of WBC， PLT， and HGB （P<0.05）， and reduced levels of phosphorylated PI3K， Akt， and mTOR and their mRNA （P<0.05）. ConclusionDabufei decoction combined with cisplatin has a synergistic effect with reduced toxicity， effectively regulating immune function， increasing the proportion of NK cells， reducing the proportion of Treg cells， improving bone marrow suppression， and downregulating the PI3K/Akt/mTOR signaling pathway to inhibit tumor growth in Lewis lung adenocarcinoma-bearing mice.

Background Individual monitoring of occupational external exposure is an essential part of the occupational health management of radiation workers, and is an important basis for the evaluation of individual absorbed dose and the diagnosis of occupational radiation diseases. Continuous participation of monitoring service providers in intercomparison is a fundamental quality assurance for routine monitoring, which can identify problems and improve them in time. Objective Taking the Laboratory of Radiation Protection in Shanghai Institute of Preventive Medicine as an example, to evaluate the performance of an individual occupational external dose monitoring system in the laboratory, identify influencing factors of the monitoring results, and provide a basis for improving the quality of daily monitoring by analyzing the process and results of a national intercomparison of individual dose monitoring. Methods According to the Testing criteria of personnel dosimetry performance for external exposure (GBZ 207-2016), and the relevant requirements of Class II (photon) inspection, a total of 20 groups of blind sample dosimeters were measured for four consecutive years from 2018 to 2021. The radiation energy source of each group was identified, and related personal dose equivalent H_p(10), the uncertainty of measurement results, and the deviation between the reported value and the reference value were calculated. The national intercomparison process and results of individual dose monitoring were also analyzed. Results The energy sources of the blind samples in the tested laboratory for four years were N100 or Cs-137. The reported dose values of the blind samples were 0.57-4.61 mSv, the combined uncertainties were 0.043-0.365 mSv, the expanded uncertainties (k=2) were 0.09-0.73 mSv, and the relative expanded uncertainties (k=2) were 13.8%-16.4%. The single-group performance ∣P_i∣ of 20 sets of blind samples in the four years was ≤0.10, the yearly comprehensive performance of 5 sets of blind samples was ≤0.10, and the yearly Q score of the test report was >15 points. The laboratory achieved excellent results in the national intercomparison of individual dose monitoring in four consecutive years, except the Q value not reaching full score. Conclusion The laboratory exhibits standardized data processing of individual dose monitoring, generates accurate and reliable results, and meets the requirements of relevant national standards; but it should continue to participate in the national intercomparison of individual dose monitoring, strengthen the angular response research of energy identified dosimeter, improve the monitoring ability of low-dose X-rays, analyze the key points of reducing the uncertainty of measurement results, and continuously improve the monitoring ability.

Objective:To construct back propagation (BP) neural network model to predict the dose required for 131I therapy for hyperthyroidism and to calculate the personalized dose plan for patients. Methods:A complete set of data of patients treated for hyperthyroidism radioaiodine was collected from the nuclear medicine departments of several medical colleges in Shanghai, including history, examination result, treatment course, etc. As a result, a prediction model was established. The predicated result for BP neural network, radial basis function (RBF) neural network and Support Vector Machine (SVM) were compared by means of small sample data. The optimal model was selected to predict administrated dose and to finally test the accuracy of the model.Results:The average errors in BP neural network, RBF neural network and SVM model based on small samples were 5.53%, 7.09% and 9.64%, respectively. After comparison, BP neural network was selected to build the prediction model. 30 cases of data were selected by random sampling to verify the BP neural network. The mean error, mean square error, minimum error and maximum error of the prediction result were 7.22%, 0.053, 0.57% and 13.78%, respectively.Conclusions:In this study, a neural network prediction method was proposed to provide a more accurate dose for patients in need of radioiodine therap for hyperthyroidism, and to reduce the possibility of radiation damage or the unsatisfactory therapeutic effect caused by insufficient dose. It has clinical practical significance in providing the reference for clinicians to evaluate the administrated dose.

Objective:To investigate the characteristics of diagnostic radiology and the situation of repeated examinations at medical institutions of Jinshan district, and put forward strategies and suggestions for the correct guidance on and reasonable applications of various medical exposures.Methods:The cases data on radiological examinations at medical institutions in Jinshan district, obtained in 2017 from Shanghai Municipal Health Commission Information Center Platform, was used to describe the characteristics of population distribution of patients, examination types, examination areas, diagnosed diseases, number of repeated examinations and the result of radiological examinations.Results:The main types of radiological examinations in Jinshan district were the CT scans and the conventional X-ray diagnosis, accounted respectively for 53.2% and 44.7% of the total radiological examinations. The radiological examinations were mainly performed on household registration (77.3%). The number of radiological examinations on males was close to on females, with examination frequency of 49.4% for males and 50.1% for females. The greatest frequency of radiological examinations was found in the age group older than 41 years, accounting for 77.1% of CT scans and 65.2% of the conventional X-ray diagnosis. The main examination sites of the CT scans at Jinshan medical institutions were chest (32.8%), abdomen (19.4%), brain (16.1%) and spine (11.4%), and for the conventional X-ray diagnosis were chest (43.2%) and limbs (39.6%). The main departments applying for radiological examinations are surgery (39.7%) and medicine (27.1%). The numbers of radiological examinations are, respectively, diseases of the respiratory system (19.8%), the injury, poisoning and some other consequences of external causes (15.8%), and the diseases of musculoskeletal system and connective tissue (15.8%). The positive rate of the conventional X-ray diagnosis was 53.1%, and the positive rate of CT scans was 73.5%. The conventional X-ray diagnosis and CT scans contributed higher specific rates of repeated examinations, accounting for 9.3% and 7.9% of the total of such type examination, respectively.Conclusions:CT scans in Jinshan district accounted for more than half of the total frequency of radiological examinations, therefore, interventions should be imposed on certain types of phycians and patients types.

Objective To investigate dose parameters in computed tomography (CT) scanning of common body parts inall public medical institutions in Shanghai, China, and analyze the dose distribution of CT scanning among adult subjects in Shanghai, and to provide a basis for establishing the diagnostic reference levels of CT scanning in Shanghai. Methods We selected at least one medical institution with CT services each from all 16 districts of Shanghai. In each medical institution, a piece of CT equipment with qualified annual inspection was sampled to investigate the doses to subjects in head, chest, abdomen, and lumbar spine scanning. We collected the basic information of the subjects, CT scanning parameters, volumetric CT dose index (CTDI_vol), and dose length product (DLP). Results The scanning data of 1475 subjects were obtained. The 75th percentiles of the CTDI_vol of the head, chest, abdomen, and lumbar spine were 57 mGy, 11 mGy, 16 mGy, and 23 mGy, respectively. The 75th percentiles of the DLP were 862 mGy·cm, 361 mGy·cm, 593 mGy·cm, and 550 mGy·cm, respectively. Conclusion CTDI_vol and DLP differed significantly at different body parts, and also differed greatly at the same body parts. The DLP of men was slightly higher than that of women.