Main Article Content
Cytogenetic testing, healthcare workers, occupational disease
Background: The aim of this study was to analyze the impact of low doses of ionizing radiation on healthcare workers using dosimeter data and several biomarkers of effects, and to asses the suitability of those tests. Methods: Data from the last medical examinations, obtained from the medical records of 148 employees were analysed. They were divided into three groups: nuclear medicine, interventional radiology and general radiology. The examination included hematological parameters and cytogenetical tests: unstable chromosomal aberrations (UCA) and micronucleus test (MNT). The received cumulative 5-year dose was calibrated into personal dose equivalents Hp(10). Results: A statistically significant difference was found between the groups in the UCAs (c2=6.634, p=0.036) with the highest UCA frequency in nuclear medicine. The ANOVA showed a statistically significant difference in the values of erythrocytes (F(2,140)=3.715, p=0.027), monocytes (F(2,127)=3.326, p=0.039) and platelets (F(2,135)=4.209, p=0.017), with higher erythrocytes and lower platelets in interventional radiology and lower monocytes in nuclear medicine, all with small effect size. The dose was significantly different among the groups (c2 =22,191; p<0.001). The nuclear medicine workers received a higher dose compared to interventional radiology (U=458, p<0.001) and general radiology (U=510.5, p<0.001). Conclusions: Nuclear medicine employees are at a higher risk of developing neoplastic and blood-related diseases due to consistent exposure to low doses of ionizing radiation. Results suggest that UCA test might be more suitable for detecting radiation-induced damage at low doses than MNT. Compulsory monitoring of the health status at periodic examinations is required to prevent occupational diseases, esp. among the nuclear medicine workers.
2. Milacic S: Diseases caused by ionizing radiation. In Vidaković A, Bulat P, Dzelajlija S. et al. (eds): Occupa-tional Medicine. Belgrade: KCS-Institute of Occupational Health and Radiological Protection “Dr Drago-mir Karajović”, 1997:621-643.
3. Milačić S. Chromosomal aberrations like biomarkers of exposition to ionizing radiation. Acta Clinica. 2005; 5:64-71.
4. Dertinger SD, Bemis JC, Phonethepswath S, et al. Reticulocyte and micro-nucleated reticulocyte re-sponses to gamma irradiation: effect of age. Mutat Res. 2009;675(1-2):77-80. Doi: 10.1016/j.mrgentox.2009.02.002
5. Ossetrova NI, Sandgren DJ, Gallego S, Blakely WF. Combined approach of hematological biomarkers and plasma protein SAA for improvement of radiation dose assessment triage in biodosimetry applications. Health Phys. 2010;98(2):204-208. Doi: 10.1097/HP.0b013e3181abaabf
6. Republic of Serbia. Rulebook on Determining Occupational Diseases. Belgrade, Serbia: Official Gazette of the Republic of Serbia, 2003: 05.
7. Joksić G. Cytogenetic methods for detecting internal contamination by radio-nuclides. Chemical Indus-try. 2001;556:273-276.
8. Milačić S. Chromosomal aberrations after exposure to low doses of ionizing radiation. J BUON. 2009;14(4):641-646.
9. Milačić S. Risk of occupational radiation-induced cataract in medical workers. Med Lav. 2009;100(3):178-186.
10. Milačić S. The incidence of malignant neoplasms in individuals working in the area of ionizing radiation in hospitals. J BUON. 2008;13:377-384.
11. Pernot E, Hall J, Baatout S, et al. Ionizing radiation biomarkers for potential use in epidemiological stud-ies. Mutat Res. 2012; 751(2):258-286. doi:10.1016/j.mrrev.2012.05.003
12. Bonassi S, Hagmar L, Strömberg U, et al. Chromosomal aberrations in lymphocytes predict human can-cer independently of exposure to carcinogens. European Study Group on Cytogenetic Biomarkers and Health. Cancer Res. 2000; 60(6): 1619-1625.
13. Zhang XX: Chromosome Instability. In Gersen SL, Keagle MB (eds): The Principles of Clinical Cytogenet-ics. Totowa: Humana Press, 2005: 347-363.
14. Djoković-Davidović J, Milovanović A, Milovanović J, et al. Analysis of chromosomal aberrations fre-quency, haematological parameters and received doses by nuclear medicine professionals. J BUON. 2016; 21(5):1307-1315.
15. Milačić S. Frequency of chromosomal lesions and damaged lymphocytes of workers occupationally ex-posed to X rays. Health Phys. 2005; 88(4):334-339. Doi: 10.1097/01.hp.0000149920.09402.1d
16. Seed TM, Fritz TE, Tolle DV, Jackson WE 3rd. Hematopoietic responses under protracted exposures to low daily dose gamma irradiation. Adv Space Res. 2002; 30(4):945-955. Doi: 10.1016/s0273-1177(02)00159-x
17. Republic of Serbia. Rulebook on Limits of Exposure to Ionizing Radiation and Measurements for As-sessment of the Exposure Levels. Belgrade, Serbia: Official Gazette of the Republic of Serbia, 2011; 86 and 2018; 50.
18. Republic of Serbia. Rulebook on the Preliminary and Periodical Medical Examinations of Employees at Workplaces with Elevated Risk. Belgrade, Serbia: Official Gazette of the Republic of Serbia, 2007; 120, 2008; 93 and 2017:53.
19. Republic of Serbia. Law on Radiation Protection and Nuclear Safety and Security. Belgrade, Serbia: Offi-cial Gazette of the Republic of Serbia, 2018; 95 and 2019:10.
20. Moorhead PS, Nowell PC, Mellman WJ, et al. Chromosome preparations of leukocytes cultured from hu-man peripheral blood. Exp Cell Res. 1960;20:613-616. Doi: 10.1016/0014-4827(60)90138-5
21. International Atomic Energy Agency. (2001). Cytogenetic Analysis for Radiation Dose Assessment—A Manual. Available on line at: https://www-pub.iaea.org/MTCD/Publications/PDF/TRS405_scr.pdf (Last Accessed 14.02.2023)
22. International Atomic Energy Agency. (2011). Cytogenetic Dosimetry: Applications in Preparedness for and Response to Radiation Emergencies. Available on line at: https://www-pub.iaea.org/MTCD/Publications/PDF/EPR-Biodosimetry%202011_web.pdf (Last Ac-cessed 14.02.2023)
23. Fenech M, Morley AA. Measurement of micronuclei in lymphocytes. Mutat Res. 1985;147(1-2):29-36. Doi: 10.1016/0165-1161(85)90015-9
24. Fenech M. Optimisation of micronucleus assays for biological dosimetry. Prog Clin Biol Res. 1991;372:373-386.
25. Đoković-Davidović, J. The analysis of the chromosomal aberrations frequency of the employees from different workplaces in the zone of ionizing radiation. Doctoral thesis, University of Belgrade, Belgrade, 26.9.2016.
26. Cardis E, Vrijheid M, Blettner M, et al. Risk of cancer after low doses of ionizing radiation: retrospective cohort study in 15 countries. BMJ. 2005; 331(7508):77. Doi: 10.1136/bmj.38499.599861.E0
27. Venneri L, Rossi F, Botto N, et al. Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report. Am Heart J. 2009;157(1):118-124. Doi: 10.1016/j.ahj. 2008.08.009
28. Cherednichenko O, Pilyugina A, Nuraliev S. Chronic human exposure to ionizing radiation: Individual variability of chromosomal aberration frequencies and G0 radiosensitivities. Mutat Res Genet Toxicol Environ Mutagen. 2022;873:503434. Doi: 10.1016/j.mrgentox. 2021.503434
29. Kim YJ, Lee JW, Cho YH, et al. Chromosome Damage in Relation to Recent Radiation Exposure and Radia-tion Quality in Nuclear Power Plant Workers. Toxics. 2022;10(2):94. Doi: 10.3390/toxics10020094
30. Baudin C, Bernier MO, Klokov D, Andreassi MG. Biomarkers of Genotoxicity in Medical Workers Ex-posed to Low-Dose Ionizing Radiation: Systematic Review and Meta-Analyses. Int J Mol Sci. 2021;22(14):7504. Doi: 10.3390/ijms22147504
31. Lalić H, Lekić A, Radosević-Stasić B. Comparison of chromosome aberrations in peripheral blood lym-phocytes from people occupationally exposed to ionizing and radiofrequency radiation. Acta Med Oka-yama. 2001;55(2):117-127. Doi: 10.18926/AMO/32005
32. Gutiérrez-Enríquez S, Ramón Y Cajal T, et al. Ionizing radiation or mitomycin-induced micronuclei in lymphocytes of BRCA1 or BRCA2 mutation carriers. Breast Cancer Res Treat. 2011;127(3):611-622. Doi: 10.1007/s10549-010-1017-6
33. Shen X, Chen Y, Li C, et al. Rapid and automatic detection of micronuclei in binucleated lymphocytes im-age. Sci Rep. 2022;12(1):3913. Doi: 10.1038/s41598-022-07936-4
34. Kliesch U, Danford N, Adler ID. Micronucleus test and bone-marrow chromosome analysis: a compari-son of 2 methods in vivo for evaluating chemically induced chromosomal alterations. Mutat Res. 1981;80(2):321-332. Doi: 10.1016/0027-5107(81)90105-6
35. Ropolo M, Balia C, Roggieri P, et al. The micronucleus assay as a biological dosimeter in hospital workers exposed to low doses of ionizing radiation. Mutat Res. 2012;747(1):7-13. Doi: 10.1016/j.mrgentox.2012.02.014
36. Pajic J, Rakic B, Rovcanin B, et al. Inter-individual variability in the response of human peripheral blood lymphocytes to ionizing radiation: comparison of the dicentric and micronucleus assays. Radiat Envi-ron Biophys. 2015;54(3):317-325. Doi: 10.1007/s00411-015-0596-3
37. Shahid S, Mahmood N, Nawaz Chaudhry M. Assessment of impacts of hematological parameters of chronic ionizing radiation exposed workers in hospitals. FUUAST Journal of Biology. 2014;4(2):135-146.