domingo, 27 de marzo de 2011

Radiation Dictionary


RADIATION EMERGENCIESRadiation Dictionary

On this page:

A

Absolute risk: the proportion of a population expected to get a disease over a specified time period. See also riskrelative risk.
Absorbed dose: the amount of energy deposited by ionizing radiation in a unit mass of tissue. It is expressed in units of joule per kilogram (J/kg), and called “gray” (Gy). For more information, see “Primer on Radiation Measurement” at the end of this document.
Activity (radioactivity): the rate of decay of radioactive material expressed as the number of atoms breaking down per second measured in units called becquerels or curies.
Acute exposure: an exposure to radiation that occurred in a matter of minutes rather than in longer, continuing exposure over a period of time. See alsochronic exposureexposurefractionated exposure.
Acute Radiation Syndrome (ARS): a serious illness caused by receiving a dose greater than 75rads of penetrating radiation to the body in a short time (usually minutes). The earliest symptoms are nausea, fatigue, vomiting, and diarrhea. Hair loss, bleeding, swelling of the mouth and throat, and general loss of energy may follow. If the exposure has been approximately 1,000 rads or more, death may occur within 2 – 4 weeks. For more information, see CDC’s fact sheet “Acute Radiation Syndrome” at emergency.cdc.gov/radiation/ars.asp.
Air burst: a nuclear weapon explosion that is high enough in the air to keep the fireball from touching the ground. Because the fireball does not reach the ground and does not pick up any surface material, the radioactivity in the fallout from an air burst is relatively insignificant compared with a surface burst. For more information, see Chapter 2 of CDC’s Fallout Report athttp://www.cdc.gov/nceh/radiation/fallout/falloutreport.pdf .
Alpha particle: the nucleus of a helium atom, made up of two neutrons and two protons with a charge of +2. Certain radioactive nuclei emit alpha particles. Alpha particles generally carry more energy than gamma or beta particles, and deposit that energy very quickly while passing through tissue. Alpha particles can be stopped by a thin layer of light material, such as a sheet of paper, and cannot penetrate the outer, dead layer of skin. Therefore, they do not damage living tissue when outside the body. When alpha-emitting atoms are inhaled or swallowed, however, they are especially damaging because they transfer relatively large amounts of ionizing energy to living cells. See also beta particlegamma rayneutronx-ray.
Ambient air: the air that surrounds us.
Americium (Am): a silvery metal; it is a man-made element whose isotopes Am-237 through Am-246 are all radioactive. Am-241 is formed spontaneously by the beta decay of plutonium-241. Trace quantities of americium are widely used in smoke detectors, and as neutron sources in neutron moisture gauges.
Atom: the smallest particle of an element that can enter into a chemical reaction.
Atomic number: the total number of protons in the nucleus of an atom.
Atomic mass unit (amu): 1 amu is equal to one twelfth of the mass of a carbon-12 atom.
Atomic mass number: the total number of protons and neutrons in the nucleus of an atom.
Atomic weight: the mass of an atom, expressed in atomic mass units. For example, the atomic number of helium-4 is 2, the atomic mass is 4, and the atomic weight is 4.00026.

B

Background radiation: ionizing radiation from natural sources, such as terrestrial radiation due toradionuclides in the soil or cosmic radiation originating in outer space.
Becquerel (Bq): the amount of a radioactive material that will undergo one decay (disintegration) per second. For more information, see “Primer on Radiation Measurement” at the end of this document.
Beta particles: electrons ejected from the nucleus of a decaying atom. Although they can be stopped by a thin sheet of aluminum, beta particles can penetrate the dead skin layer, potentially causing burns. They can pose a serious direct or external radiation threat and can be lethal depending on the amount received. They also pose a serious internal radiation threat if beta-emitting atoms are ingested or inhaledSee also alpha particlegamma rayneutronx-ray.
Bioassay: an assessment of radioactive materials that may be present inside a person’s body through analysis of the person’s blood, urine, feces, or sweat.
Biological Effects of Ionizing Radiation (BEIR) Reports: reports of the National Research Council's committee on the Biological Effects of Ionizing Radiation. For more information, seehttp://www.nap.edu/books/0309039959/html/.
Biological half-life: the time required for one half of the amount of a substance, such as a radionuclide, to be expelled from the body by natural metabolic processes, not counting radioactive decay, once it has been taken in through inhalation, ingestion, or absorption. See alsoradioactive half-lifeeffective half-life.

C

Carcinogen: a cancer-causing substance.
Chain reaction: a process that initiates its own repetition. In a fission chain reaction, a fissile nucleus absorbs a neutron and fissions (splits) spontaneously, releasing additional neutrons. These, in turn, can be absorbed by other fissile nuclei, releasing still more neutrons. A fission chain reaction is self-sustaining when the number of neutrons released in a given time equals or exceeds the number of neutrons lost by absorption in non-fissile material or by escape from the system.
Chronic exposure: exposure to a substance over a long period of time, possibly resulting in adverse health effects. See also acute exposurefractionated exposure.
Cobalt (Co): gray, hard, magnetic, and somewhat malleable metal. Cobalt is relatively rare and generally obtained as a byproduct of other metals, such as copper. Its most common radioisotope, cobalt-60 (Co-60), is used in radiography and medical applications. Cobalt-60 emits beta particlesand gamma rays during radioactive decay.
Collective dose: the estimated dose for an area or region multiplied by the estimated population in that area or region. For more information, see “Primer on Radiation Measurement” at the end of this document.
Committed dose: a dose that accounts for continuing exposures expected to be received over a long period of time (such as 30, 50, or 70 years) from radioactive materials that were deposited inside the body. For more information, see “Primer on Radiation Measurement” at the end of this document.
Concentration: the ratio of the amount of a specific substance in a given volume or mass of solution to the mass or volume of solvent.
Conference of Radiation Control Program Directors (CRCPD): an organization whose members represent state radiation protection programs. For more information, see the CRCPD website:http://www.crcpd.org.
Contamination (radioactive): the deposition of unwanted radioactive material on the surfaces of structures, areas, objects, or people where it may be external or internalSee alsodecontamination.
Cosmic radiation: radiation produced in outer space when heavy particles from other galaxies (nuclei of all known natural elements) bombard the earth. See also background radiation,terrestrial radiation.
Criticality: a fission process where the neutron production rate equals the neutron loss rate to absorption or leakage. A nuclear reactor is "critical" when it is operating.
Critical mass: the minimum amount of fissile material that can achieve a self-sustaining nuclearchain reaction.
Cumulative dose: the total dose resulting from repeated or continuous exposures of the same portion of the body, or of the whole body, to ionizing radiation. For more information, see “Primer on Radiation Measurement ” at the end of this document.
Curie (Ci): the traditional measure of radioactivity based on the observed decay rate of 1 gram of radium. One curie of radioactive material will have 37 billion disintegrations in 1 second. For more information, see “Primer on Radiation Measurement” at the end of this document.
Cutaneous Radiation Syndrome (CRS): the complex syndrome resulting from radiation exposure of more than 200 rads to the skin. The immediate effects can be reddening and swelling of the exposed area (like a severe burn), blisters, ulcers on the skin, hair loss, and severe pain. Very large doses can result in permanent hair loss, scarring, altered skin color, deterioration of the affected body part, and death of the affected tissue (requiring surgery). For more information, see CDC’s fact sheet “Acute Radiation Syndrome,” at emergency.cdc.gov/radiation/ars.asp.

D

Decay chain (decay series): the series of decays that certain radioisotopes go through before reaching a stable form. For example, the decay chain that begins with uranium-238 (U-238) ends in lead-206 (Pb-206), after forming isotopes, such as uranium-234 (U-234), thorium-230 (Th-230), radium-226 (Ra-226), and radon-222 (Rn-222).
Decay constant: the fraction of a number of atoms of a radioactive nuclide that disintegrates in a unit of time. The decay constant is inversely proportional to the radioactive half-life.
Decay products (or daughter products): the isotopes or elements formed and the particles and high-energy electromagnetic radiation emitted by the nuclei of radionuclides during radioactive decay. Also known as "decay chain products" or "progeny" (the isotopes and elements). A decay product may be either radioactive or stable. 

Decay, radioactive: disintegration of the nucleus of an unstable atom by the release of radiation.
Decontamination: the reduction or removal of radioactive contamination from a structure, object, or person.
Depleted uranium: uranium containing less than 0.7% uranium-235, the amount found in natural uranium. See also enriched uranium.
Deposition density: the activity of a radionuclide per unit area of ground. Reported as becquerelsper square meter or curies per square meter.
Deterministic effects: effects that can be related directly to the radiation dose received. The severity increases as the dose increases. A deterministic effect typically has a threshold below which the effect will not occur. See also stochastic effectnon-stochastic effect.
Deuterium: a non-radioactive isotope of the hydrogen atom that contains a neutron in its nucleusin addition to the one proton normally seen in hydrogen. A deuterium atom is twice as heavy as normal hydrogen. See also tritium.
Dirty bomb: a device designed to spread radioactive material by conventional explosives when the bomb explodes. A dirty bomb kills or injures people through the initial blast of the conventional explosive and spreads radioactive contamination over possibly a large area—hence the term “dirty.” Such bombs could be miniature devices or large truck bombs. A dirty bomb is much simpler to make than a true nuclear weapon. See also radiological dispersal device.
Dose (radiation): radiation absorbed by person’s body. Several different terms describe radiation dose. For more information, see “Primer on Radiation Measurement” at the end of this document.
Dose coefficient: the factor used to convert radionuclide intake to dose. Usually expressed as dose per unit intake (e.g., sieverts per becquerel).
Dose equivalent: a quantity used in radiation protection to place all radiation on a common scale for calculating tissue damage. Dose equivalent is the absorbed dose in grays times the quality factor. The quality factor accounts for differences in radiation effects caused by different types ofionizing radiation. Some radiation, including alpha particles, causes a greater amount of damage per unit of absorbed dose than other radiation. The sievert (Sv) is the unit used to measure dose equivalent. For more information, see “Primer on Radiation Measurement” at the end of this document.
Dose rate: the radiation dose delivered per unit of time.
Dose reconstruction: a scientific study that estimates doses to people from releases ofradioactivity or other pollutants. The dose is reconstructed by determining the amount of material released, the way people came in contact with it, and the amount they absorbed.
Dosimeter: a small portable instrument (such as a film badge, thermoluminescent dosimeter [TLD], or pocket dosimeter) for measuring and recording the total accumulated dose of ionizing radiation a person receives.
Dosimetry: assessment (by measurement or calculation) of radiation dose.

E

Effective dose: a dosimetric quantity useful for comparing the overall health affects of irradiationof the whole body. It takes into account the absorbed doses received by various organs and tissues and weighs them according to present knowledge of the sensitivity of each organ to radiation. It also accounts for the type of radiation and the potential for each type to inflict biologic damage. The effective dose is used, for example, to compare the overall health detriments of different radionuclides in a given mix. The unit of effective dose is the sievert (Sv); 1 Sv = 1 J/kg. For more information, see “Primer on Radiation Measurement” at the end of this document.
Effective half-life: the time required for the amount of a radionuclide deposited in a living organism to be diminished by 50% as a result of the combined action of radioactive decay and biologic elimination. See also biological half-lifedecay constantradioactive half-life.
Electron: an elementary particle with a negative electrical charge and a mass 1/1837 that of theproton. Electrons surround the nucleus of an atom because of the attraction between their negative charge and the positive charge of the nucleus. A stable atom will have as many electrons as it has protons. The number of electrons that orbit an atom determine its chemical properties.See also neutron.
Electron volt (eV): a unit of energy equivalent to the amount of energy gained by an electronwhen it passes from a point of low potential to a point one volt higher in potential.
Element: 1) all isotopes of an atom that contain the same number of protons. For example, the element uranium has 92 protons, and the different isotopes of this element may contain 134 to 148 neutrons. 2) In a reactor, a fuel element is a metal rod containing the fissile material.
Enriched uranium: uranium in which the proportion of the isotope uranium-235 has been increased by removing uranium-238 mechanically. See also depleted uranium.
Epidemiology: the study of the distribution and determinants of health-related states or events in specified populations; and the application of this study to the control of health problems.
Exposure (radiation): a measure of ionization in air caused by x-rays or gamma rays only. The unit of exposure most often used is the roentgenSee also contamination.
Exposure pathway: a route by which a radionuclide or other toxic material can enter the body. The main exposure routes are inhalationingestion, absorption through the skin, and entry through a cut or wound in the skin.
Exposure rate: a measure of the ionization produced in air by x-rays or gamma rays per unit of time (frequently expressed in roentgens per hour).
External exposure: exposure to radiation outside of the body.

F

Fallout, nuclear: minute particles of radioactive debris that descend slowly from the atmosphere after a nuclear explosion. For more information, see Chapter 2 of CDC’s Fallout Report athttp://www.cdc.gov/nceh/radiation/fallout/falloutreport.pdf .
Fissile material: any material in which neutrons can cause a fission reaction. The three primary fissile materials are uranium-233, uranium-235, and plutonium-239.
Fission (fissioning): the splitting of a nucleus into at least two other nuclei that releases a large amount of energy. Two or three neutrons are usually released during this transformation. See alsofusion.
Fractionated exposure: exposure to radiation that occurs in several small acute exposures, rather than continuously as in a chronic exposure.
Fusion: a reaction in which at least one heavier, more stable nucleus is produced from two lighter, less stable nuclei. Reactions of this type are responsible for the release of energy in stars or inthermonuclear weapons.

G

Gamma rays: high-energy electromagnetic radiation emitted by certain radionuclides when their nuclei transition from a higher to a lower energy state. These rays have high energy and a short wave length. All gamma rays emitted from a given isotope have the same energy, a characteristic that enables scientists to identify which gamma emitters are present in a sample. Gamma rays penetrate tissue farther than do beta or alpha particles, but leave a lower concentration of ions in their path to potentially cause cell damage. Gamma rays are very similar to x-raysSee alsoneutron.
Geiger counter: a radiation detection and measuring instrument consisting of a gas-filled tube containing electrodes, between which an electrical voltage but no current flows. When ionizing radiation passes through the tube, a short, intense pulse of current passes from the negative electrode to the positive electrode and is measured or counted. The number of pulses per second measures the intensity of the radiation field. Geiger counters are the most commonly used portable radiation detection instruments.
Genetic effects: hereditary effects (mutations) that can be passed on through reproduction because of changes in sperm or ova. See also teratogenic effectssomatic effects.
Gray (Gy): a unit of measurement for absorbed dose. It measures the amount of energy absorbed in a material. The unit Gy can be used for any type of radiation, but it does not describe the biological effects of the different radiations. For more information, see “Primer on Radiation Measurement” at the end of this document.

H

Half-life: the time any substance takes to decay by half of its original amount. See also biological half-lifedecay constanteffective half-liferadioactive half-life.
Health physics: a scientific field that focuses on protection of humans and the environment fromradiation. Health physics uses physics, biology, chemistry, statistics, and electronic instrumentation to help protect individuals from any damaging effects of radiation. For more information, see the Health Physics Society website: http://www.hps.org/.
High-level radioactive waste: the radioactive material resulting from spent nuclear fuel reprocessing. This can include liquid waste directly produced in reprocessing or any solid material derived from the liquid wastes having a sufficient concentration of fission products. Other radioactive materials can be designated as high-level waste, if they require permanent isolation. This determination is made by the U.S. Nuclear Regulatory Commission on the basis of criteria established in U.S. law. See also low-level wastetransuranic waste.
Hot spot: any place where the level of radioactive contamination is considerably greater than the area around it.

I

Ingestion: 1) the act of swallowing; 2) in the case of radionuclides or chemicals, swallowing radionuclides or chemicals by eating or drinking.
Inhalation: 1) the act of breathing in; 2) in the case of radionuclides or chemicals, breathing in radionuclides or chemicals.
Internal exposure: exposure to radioactive material taken into the body.
Iodine: a nonmetallic solid element. There are both radioactive and non-radioactive isotopes of iodine. Radioactive isotopes of iodine are widely used in medical applications. Radioactive iodine is a fission product and is the largest contributor to people’s radiation dose after an accident at a nuclear reactor.
Ion: an atom that has fewer or more electrons than it has protons causing it to have an electrical charge and, therefore, be chemically reactive.
Ionization: the process of adding one or more electrons to, or removing one or more electrons from, atoms or molecules, thereby creating ions. High temperatures, electrical discharges, ornuclear radiation can cause ionization.

Ionizing radiation:
 any radiation capable of displacing electrons from atoms, thereby producingions. High doses of ionizing radiation may produce severe skin or tissue damage. See also alpha particlebeta particlegamma rayneutronx-ray.
Irradiation: exposure to radiation.
Isotope: a nuclide of an element having the same number of protons but a different number ofneutrons.

K

Kiloton (Kt): the energy of an explosion that is equivalent to an explosion of 1,000 tons of TNT. One kiloton equals 1 trillion (1012) calories. See also megaton.

L

Latent period: the time between exposure to a toxic material and the appearance of a resultant health effect.
Lead (Pb): a heavy metal. Several isotopes of lead, such as Pb-210 which emits beta radiation, are in the uranium decay chain.
Lead Federal Agency (LFA): the federal agency that leads and coordinates the emergency response activities of other federal agencies during a nuclear emergency. After a nuclear emergency, the Federal Radiological Emergency Response Plan (FRERP, available athttp://www.fas.org/nuke/guide/usa/doctrine/national/frerp.htm) will determine which federal agency will be the LFA.
Local radiation injury (LRI): acute radiation exposure (more than 1,000 rads) to a small, localized part of the body. Most local radiation injuries do not cause death. However, if the exposure is from penetrating radiation (neutronsx-rays, or gamma rays), internal organs may be damaged and some symptoms of acute radiation syndrome (ARS), including death, may occur. Local radiation injury invariably involves skin damage, and a skin graft or other surgery may be required. See also CDC’s fact sheet “Acute Radiation Syndrome” atemergency.cdc.gov/radiation/ars.asp.
Low-level waste (LLW): radioactively contaminated industrial or research waste such as paper, rags, plastic bags, medical waste, and water-treatment residues. It is waste that does not meet the criteria for any of three other categories of radioactive waste: spent nuclear fuel and high-level radioactive wastetransuranic radioactive waste; or uranium mill tailings. Its categorization does not depend on the level of radioactivity it contains.

M

Megaton (Mt): the energy of an explosion that is equivalent to an explosion of 1 million tons of TNT. One megaton is equal to a quintillion (1018) calories. See also kiloton.
Molecule: a combination of two or more atoms that are chemically bonded. A molecule is the smallest unit of a compound that can exist by itself and retain all of its chemical properties.

N

Neoplastic: pertaining to the pathologic process resulting in the formation and growth of an abnormal mass of tissue.
Neutron: a small atomic particle possessing no electrical charge typically found within an atom'snucleus. Neutrons are, as the name implies, neutral in their charge. That is, they have neither a positive nor a negative charge. A neutron has about the same mass as a protonSee also alpha particlebeta particlegamma raynucleonx-ray.
Non-ionizing radiation: radiation that has lower energy levels and longer wavelengths thanionizing radiation. It is not strong enough to affect the structure of atoms it contacts but is strong enough to heat tissue and can cause harmful biological effects. Examples include radio waves, microwaves, visible light, and infrared from a heat lamp.
Non-stochastic effects: effects that can be related directly to the radiation dose received. The effect is more severe with a higher dose. It typically has a threshold, below which the effect will not occur. These are sometimes called deterministic effects. For example, a skin burn from radiation is a non-stochastic effect that worsens as the radiation dose increases. See alsostochastic effects.
Nuclear energy: the heat energy produced by the process of nuclear fission within a nuclear reactor or by radioactive decay.
Nuclear fuel cycle: the steps involved in supplying fuel for nuclear power plants. It can include mining, milling, isotopic enrichment, fabrication of fuel elements, use in reactors, chemical reprocessing to recover the fissile material remaining in the spent fuel, reenrichment of the fuel material refabrication into new fuel elements, and waste disposal.
Nuclear tracers: radioisotopes that give doctors the ability to "look" inside the body and observe soft tissues and organs, in a manner similar to the way x-rays provide images of bones. A radioactive tracer is chemically attached to a compound that will concentrate naturally in an organ or tissue so that an image can be taken.
Nucleon: a proton or a neutron; a constituent of the nucleus of an atom.
Nucleus: the central part of an atom that contains protons and neutrons. The nucleus is the heaviest part of the atom.
Nuclide: a general term applicable to all atomic forms of an element. Nuclides are characterized by the number of protons and neutrons in the nucleus, as well as by the amount of energy contained within the atom.

P

Pathways: the routes by which people are exposed to radiation or other contaminants. The three basic pathways are inhalationingestion, and direct external exposureSee also exposure pathway.
Penetrating radiation: radiation that can penetrate the skin and reach internal organs and tissues. Photons (gamma rays and x-rays), neutrons, and protons are penetrating radiations. However, alpha particles and all but extremely high-energy beta particles are not considered penetrating radiation.
Photon: discrete "packet" of pure electromagnetic energy. Photons have no mass and travel at the speed of light. The term "photon" was developed to describe energy when it acts like a particle (causing interactions at the molecular or atomic level), rather than a wave. Gamma raysand x-rays are photons.
Pitchblende: a brown to black mineral that has a distinctive luster. It consists mainly of urananite (UO2), but also contains radium (Ra). It is the main source of uranium (U) ore.
Plume: the material spreading from a particular source and traveling through environmental media, such as air or ground water. For example, a plume could describe the dispersal of particles, gases, vapors, and aerosols in the atmosphere, or the movement of contamination through an aquifer (For example, dilution, mixing, or adsorption onto soil).
Plutonium (Pu): a heavy, man-made, radioactive metallic element. The most important isotope is Pu-239, which has a half-life of 24,000 years. Pu-239 can be used in reactor fuel and is the primary isotope in weapons. One kilogram is equivalent to about 22 million kilowatt-hours of heat energy. The complete detonation of a kilogram of plutonium produces an explosion equal to about 20,000 tons of chemical explosive. All isotopes of plutonium are readily absorbed by the bones and can be lethal depending on the dose and exposure time.
Polonium (Po): a radioactive chemical element and a product of radium (Ra) decay. Polonium is found in uranium (U) ores.
Prenatal radiation exposure: radiation exposure to an embryo or fetus while it is still in its mother’s womb. At certain stages of the pregnancy, the fetus is particularly sensitive to radiation and the health consequences could be severe above 5 rads, especially to brain function. For more information, see CDC’s fact sheet, “Possible Health Effects of Radiation Exposure on Unborn Babies,” at emergency.cdc.gov/radiation/prenatal.asp.
Protective Action Guide (PAG): a guide that tells state and local authorities at what projected dose they should take action to protect people from exposure to unplanned releases ofradioactive material into the environment.
Proton: a small atomic particle, typically found within an atom's nucleus, that possesses a positive electrical charge. Even though protons and neutrons are about 2,000 times heavier than electrons, they are tiny. The number of protons is unique for each chemical element. See alsonucleon.

Q

Quality factor (Q): the factor by which the absorbed dose (rad or gray) is multiplied to obtain a quantity that expresses, on a common scale for all ionizing radiation, the biological damage (rem) to an exposed person. It is used because some types of radiation, such as alpha particles, are more biologically damaging internally than other types. For more information, see “Primer on Radiation Measurement” at the end of this document.

R

Rad (radiation absorbed dose): a basic unit of absorbed radiation dose. It is a measure of the amount of energy absorbed by the body. The rad is the traditional unit of absorbed dose. It is being replaced by the unit gray (Gy), which is equivalent to 100 rad. One rad equals the dose delivered to an object of 100 ergs of energy per gram of material. For more information, see “Primer on Radiation Measurement” at the end of this document.
Radiation: energy moving in the form of particles or waves. Familiar radiations are heat, light, radio waves, and microwaves. Ionizing radiation is a very high-energy form of electromagnetic radiation.
Radiation sickness: See also acute radiation syndrome (ARS), or the CDC fact sheet “Acute Radiation Syndrome,” at emergency.cdc.gov/radiation/ars.asp.
Radiation warning symbol: a symbol prescribed by the Code of Federal Regulations. It is a magenta or black trefoil on a yellow background. It must be displayed where certain quantities ofradioactive materials are present or where certain doses of radiation could be received.
Radioactive contamination: the deposition of unwanted radioactive material on the surfaces of structures, areas, objects, or people. It can be airborne, external, or internal. See alsocontaminationdecontamination.
Radioactive decay: the spontaneous disintegration of the nucleus of an atom.
Radioactive half-life: the time required for a quantity of a radioisotope to decay by half. For example, because the half-life of iodine-131 (I-131) is 8 days, a sample of I-131 that has 10 mCiof activity on January 1, will have 5 mCi of activity 8 days later, on January 9. See alsobiological half-lifedecay constanteffective half-life.
Radioactive material: material that contains unstable (radioactive) atoms that give off radiationas they decay.
Radioactivity: the process of spontaneous transformation of the nucleus, generally with the emission of alpha or beta particles often accompanied by gamma rays. This process is referred to as decay or disintegration of an atom.
Radioassay: a test to determine the amounts of radioactive materials through the detection ofionizing radiation. Radioassays will detect transuranic nuclides, uraniumfission and activation products, naturally occurring radioactive material, and medical isotopes.
Radiogenic: health effects caused by exposure to ionizing radiation.
Radiography: 1) medical: the use of radiant energy (such as x-rays and gamma rays) to image body systems. 2) industrial: the use of radioactive sources to photograph internal structures, such as turbine blades in jet engines. A sealed radiation source, usually iridium-192 (Ir-192) or cobalt-60 (Co-60), beams gamma rays at the object to be checked. Gamma rays passing through flaws in the metal or incomplete welds strike special photographic film (radiographic film) on the opposite side.
Radioisotope (radioactive isotope): isotopes of an element that have an unstable nucleus. Radioactive isotopes are commonly used in science, industry, and medicine. The nucleus eventually reaches a stable number of protons and neutrons through one or more radioactive decays. Approximately 3,700 natural and artificial radioisotopes have been identified.
Radiological or radiologic: related to radioactive materials or radiation. The radiological sciences focus on the measurement and effects of radiation.
Radiological dispersal device (RDD): a device that disperses radioactive material by conventional explosive or other mechanical means, such as a spray. See also dirty bomb.
Radionuclide: an unstable and therefore radioactive form of a nuclide.
Radium (Ra): a naturally occurring radioactive metal. Radium is a radionuclide formed by the decay of uranium (U) and thorium (Th) in the environment. It occurs at low levels in virtually all rock, soil, water, plants, and animals. Radon (Rn) is a decay product of radium.
Radon (Rn): a naturally occurring radioactive gas found in soils, rock, and water throughout the United States. Radon causes lung cancer and is a threat to health because it tends to collect in homes, sometimes to very high concentrations. As a result, radon is the largest source of exposure to people from naturally occurring radiation.
Relative risk: the ratio between the risk for disease in an irradiated population to the risk in an unexposed population. A relative risk of 1.1 indicates a 10% increase in cancer from radiation, compared with the "normal" incidence. See also riskabsolute risk.
Rem (roentgen equivalent, man): a unit of equivalent dose. Not all radiation has the same biological effect, even for the same amount of absorbed dose. Rem relates the absorbed dose in human tissue to the effective biological damage of the radiation. It is determined by multiplying the number of rads by the quality factor, a number reflecting the potential damage caused by the particular type of radiation. The rem is the traditional unit of equivalent dose, but it is being replaced by the sievert (Sv), which is equal to 100 rem. For more information, see “Primer on Radiation Measurement” at the end of this document.
Risk: the probability of injury, disease, or death under specific circumstances and time periods. Risk can be expressed as a value that ranges from 0% (no injury or harm will occur) to 100% (harm or injury will definitely occur). Risk can be influenced by several factors: personal behavior or lifestyle, environmental exposure to other material, or inborn or inherited characteristic known from scientific evidence to be associated with a health effect. Because many risk factors are not exactly measurable, risk estimates are uncertain. See also absolute riskrelative risk.
Risk assessment: an evaluation of the risk to human health or the environment by hazards. Risk assessments can look at either existing hazards or potential hazards.
Roentgen (R): a unit of exposure to x-rays or gamma rays. One roentgen is the amount of gamma or x-rays needed to produce ions carrying 1 electrostatic unit of electrical charge in 1 cubic centimeter of dry air under standard conditions.

S

Sensitivity: ability of an analytical method to detect small concentrations of radioactive material.
Shielding: the material between a radiation source and a potentially exposed person that reduces exposure.
Sievert (Sv): a unit used to derive a quantity called dose equivalent. This relates the absorbed dose in human tissue to the effective biological damage of the radiation. Not all radiation has the same biological effect, even for the same amount of absorbed dose. Dose equivalent is often expressed as millionths of a sievert, or micro-sieverts (µSv). One sievert is equivalent to 100 rem. For more information, see “Primer on Radiation Measurement” at the end of this document.
S.I. units: the Systeme Internationale (or International System) of units and measurements. This system of units officially came into being in October 1960 and has been adopted by nearly all countries, although the amount of actual usage varies considerably. For more information, see “Primer on Radiation Measurement” at the end of this document.
Somatic effects: effects of radiation that are limited to the exposed person, as distinguished fromgenetic effects, which may also affect subsequent generations. See also teratogenic effects.
Stable nucleus: the nucleus of an atom in which the forces among its particles are balanced. See also unstable nucleus.
Stochastic effect: effect that occurs on a random basis independent of the size of dose. The effect typically has no threshold and is based on probabilities, with the chances of seeing the effect increasing with dose. If it occurs, the severity of a stochastic effect is independent of the dose received. Cancer is a stochastic effect. See also non-stochastic effectdeterministic effect.
Strontium (Sr): a silvery, soft metal that rapidly turns yellow in air. Sr-90 is one of the radioactivefission materials created within a nuclear reactor during its operation. Stronium-90 emits beta particles during radioactive decay.
Surface burst: a nuclear weapon explosion that is close enough to the ground for the radius of the fireball to vaporize surface material. Fallout from a surface burst contains very high levels of radioactivity. See also air burst. For more information, see Chapter 2 of CDC’s Fallout Report athttp://www.cdc.gov/nceh/radiation/fallout/falloutreport.pdf .

T

Tailings: waste rock from mining operations that contains concentrations of mineral ore that are too low to make typical extraction methods economical.
Thermonuclear device: a “hydrogen bomb.” A device with explosive energy that comes fromfusion of small nuclei, as well as fission.
Teratogenic effect: birth defects that are not passed on to future generations, caused by exposure to a toxin as a fetus. See also genetic effectssomatic effects.
Terrestrial radiation: radiation emitted by naturally occurring radioactive materials, such asuranium (U), thorium (Th), and radon (Rn) in the earth.
Thorium (Th): a naturally occurring radioactive metal found in small amounts in soil, rocks, water, plants, and animals. The most common isotopes of thorium are thorium-232 (Th-232), thorium-230 (Th-230), and thorium-238 (Th-238).
Transuranic: pertaining to elements with atomic numbers higher than uranium (92). For example,plutonium (Pu) and americium (Am) are transuranics.
Tritium: (chemical symbol H-3) a radioactive isotope of the element hydrogen (chemical symbol H).See also deuterium.

U

Unstable nucleus: a nucleus that contains an uneven number of protons and neutrons and seeks to reach equilibrium between them through radioactive decay (i.e., the nucleus of a radioactive atom). See also stable nucleus.
UNSCEAR: United Nations Scientific Committee on the Effects of Atomic Radiation. See alsohttp://www.unscear.org/.
Uranium (U): a naturally occurring radioactive element whose principal isotopes are uranium-238 (U-238) and uranium-235 (U-235). Natural uranium is a hard, silvery-white, shiny metallic ore that contains a minute amount of uranium-234 (U-234).
Uranium mill tailings: naturally radioactive residue from the processing of uranium ore. Although the milling process recovers about 95% of the uranium, the residues, or tailings, contain severalisotopes of naturally occurring radioactive material, including uranium (U), thorium (Th), radium(Ra), polonium (Po), and radon (Rn).

W

Whole body count: the measure and analysis of the radiation being emitted from a person’s entire body, detected by a counter external to the body.
Whole body exposure: an exposure of the body to radiation, in which the entire body, rather than an isolated part, is irradiated by an external source.

X

X-ray: electromagnetic radiation caused by deflection of electrons from their original paths, or inner orbital electrons that change their orbital levels around the atomic nucleus. X-rays, likegamma rays can travel long distances through air and most other materials. Like gamma rays, x-rays require more shielding to reduce their intensity than do beta or alpha particles. X-rays and gamma rays differ primarily in their origin: x-rays originate in the electronic shell; gamma rays originate in the nucleusSee also neutron.

Primer on Radiation Measurement

In the aftermath of a radiological emergency the public will see radiation and its potential hazards described in many different and sometimes confusing ways. This primer is intended to help journalists and community leaders understand these terms.
Activity or radioactivity is measured by the number of atoms disintegrating per unit time. Abecquerel is 1 disintegration per second. A curie is 37 billion disintegrations per second, which is the number of disintegrations per second in 1 gram of pure radium. A disintegrating atom can emit a beta particle, an alpha particle, a gamma ray, or some combination of all these, so becquerels or curies alone do not provide enough information to assess the risk to a person from a radioactive source.
Disintegrating atoms emit different forms of radiation–—alpha particles, beta particles, gamma rays, or x-rays. As radiation moves through the body, it dislodges electrons from atoms, disrupting molecules. Each time this happens, the radiation loses some energy until it escapes from the body or disappears. The energy deposited indicates the number of molecules disrupted. The energy the radiation deposits in tissue is called the dose, or more correctly, the absorbed dose. The units of measure for absorbed dose are the gray (1 joule per kilogram of tissue) or the rad (1/100 of a gray). The cumulative dose is the total absorbed dose or energy deposited by the body or a region of the body from repeated or prolonged exposures.
Alpha particles, beta particles, gamma rays, and x-rays affect tissue in different ways. Alpha particles disrupt more molecules in a shorter distance than gamma rays. A measure of the biologic risk of the energy deposited is the dose equivalent. The units of dose equivalent are sieverts orrem. Dose equivalent is calculated by multiplying the absorbed dose by a quality factor.
Sometimes a large number of people have been exposed to a source of ionizing radiation. To assess the potential health effects, scientists often multiply the exposure per person by the number of persons and call this the collective dose. Collective dose is expressed as “person-rem” or “person-sieverts.”
Abbreviations for Radiation Measurements
When the amounts of radiation being measured are less than 1, prefixes are attached to the unit of measure as a type of shorthand. This is called scientific notation and is used in many scientific fields. The table below shows the prefixes for radiation measurement and their associated numeric notations.
PrefixEqual toHow Much Is That?AbbreviationExample
atto-1 X 10-18.000000000000000001 A aCi
femto-1 X 10-15.000000000000001 F fCi
pico-1 X 10-12.000000000001 p pCi
nano-1 X 10-9.000000001 n nCi
micro-1 X 10-6.000001 µ µCi
milli-1 X 10-3.001 m mCi
centi-1 X 10-2.01 c cSv
When the amount to be measured is 1,000 (i.e., 1 X 103) or higher, prefixes are attached to the unit of measure to shorten very large numbers (also scientific notation). The table below shows the prefixes used in radiation measurement and their associated numeric notations.
PrefixEqual toHow Much Is That?AbbreviationExample
kilo-1 X 1031000 k kCi
mega-1 X 1061,000,000 M MCi
giga-1 X 109100,000,000 G GBq
tera-1 X 1012100,000,000,000 T TBq
peta-1 X 1015100,000,000,000,000 P PBq
exa-1 X 1018100,000,000,000,000,000 E EBq
Health Effects of Radiation Exposure 
Exposure to radiation can cause two kinds of health effects. Deterministic effectsare observable health effects that occur soon after receipt of large doses. These may include hair loss, skin burns, nausea, or death. Stochastic effects are long-term effects, such as cancer. The radiation dose determines the severity of a deterministic effect and the probability of a stochastic effect.
The object of any radiation control program is to prevent any deterministic effects and minimize the risk for stochastic effects. When a person inhales or ingests a radionuclide, the body will absorb different amounts of that radionuclide in different organs, so each organ will receive a different organ dose. Federal Guidance Report 11 (FGR-11) from the Environmental Protection Agency (EPA) lists dose conversion factors for all radionuclides. This report can be downloaded from http://www.epa.gov/radiation/pubs.htm. The dose conversion factor for each organ is the number of rem delivered to that organ by each curie or becquerel of intake of a specific radioisotope.
External, Internal, and Absorbed Doses 
A person can receive an external dose by standing near a gamma or high-energy beta-emitting source. A person can receive an internal dose by ingesting or inhaling radioactive material. The external exposure stops when the person leaves the area of the source. The internal exposure continues until the radioactive material is flushed from the body by natural processes or decays.
A person who has ingested a radioactive material receives an internal dose to several different organs. The absorbed dose to each organ is different, and the sensitivity of each organ to radiation is different. FGR-11 assigns a different weighting factor to each organ. To determine a person’s risk for cancer, multiply each organ’s dose by its weighting factor, and add the results; the sum is the effective dose equivalent (“effective” because it is not really the dose to the whole body, but a sum of the relative risks to each organ; and “equivalent” because it is presented in rem or sieverts instead of rads or gray).
Committed and Total Effective Dose Equivalents 
When a person inhales or ingests a radionuclide, that radionuclide is distributed to different organs and stays there for days, months, or years until it decays or is excreted. The radionuclide will deliver a radiation dose over a period of time. The dose that a person receives from the time the nuclide enters the body until it is gone is the committed dose. FGR-11 calculates doses over a 50-year period and presents the committed dose equivalent for each organ plus thecommitted effective dose equivalent (CEDE).
A person can receive both an internal dose and an external dose. The sum of the committed effective dose equivalent (CEDE) and the external dose is called the total effective dose equivalent (TEDE).

Bibliography

Agency for Toxic Substances and Disease Registry Glossary [online]. [cited 2002 Aug 5] Available from URL: http://www.atsdr.cdc.gov/glossary.html.
Birky BK, Slaback LA, Schleien b. Handbook of Health Physics and Radiological Health 3rd Ed. Maryland: Williamson and Wilkins, 1998. Centers for Disease Control and Prevention. Public Health Emergency Preparedness and Response [online]. [cited 2002 Sep 3] Available from URL:emergency.cdc.gov.
Centers for Disease Control and Prevention. The Savannah River Site Dose Reconstruction Project Phase II: Source Term Calculation and Ingestion Pathway Data Retrieval April 30 2001, Glossary [online]. [cited Sep 12 2002]. Available from URL:http://www.cdc.gov/nceh/radiation/savannah/glossary.pdf .
Centers for Disease Control and Prevention and the National Cancer Institute. A Feasibility Study of the Health Consequences to the American Population from Nuclear Weapons Tests Conducted by the United States and Other Nations. Vol. 1, August 2001, Glossary: pp. 234–246.
Council for Foreign Relations. Terrorism: [online]. [cited 2002 Aug 28]. Available from URL:http://www.cfr.org/issue/135/terrorism.html .
Environmental Protection Agency. Radiation Information [online]. [cited 2002 Oct 1] Available from URL: http://www.epa.gov/rpdweb00/topics.html.
Federal Emergency Management Agency. Guide for All-Hazard Emergency Operations Planning: State and Local Guide (101) FEMA [online]. [cited 2002 Aug 7]. Available from URL:http://www.fema.gov/rrr/allhzpln6g.shtm .
Feiner F, Miller DG, Walker FW. Chart of the Nuclides 13th Ed. California: General Electric Corporation, 1983.
Friis R, Sellers T. Epidemiology for Public Health Practice 2nd Ed. Gaithersburg, Maryland: Aspen Publishers, Inc. 1999.
Institute of Medicine. Appendix K Glossary and Acronyms, Biological Threats and Terrorism: Assessing the Science and Response Capabilities: Workshop Summary. Washington, DC: National Academy Press: 2002: pp.275–286.
New Mexico Department of Public Safety. New Mexico Weapons of Mass Destruction Preparedness Glossary [online]. [cited 2002 Aug 5].
U.S. Department of Transportation. 2000 Emergency Response Guidebook [online]. [cited 2002 Aug 7]. Available from URL: http://transit-safety.volpe.dot.gov/training/Archived/EPSSeminarReg/CD/documents/EmerPrep/erg2000.pdf .

La ruleta rusa del cáncer y el tabaco


viernes 25 de marzo de 2011

La ruleta rusa del cáncer y el tabaco

Artículo tomado del blog Stem Cells:
Los científicos acaban de ganar otra batalla en la lucha contra el cáncer. En efecto, un equipo dirigido por Michael Stratton ha logrado decodificar el código genético completo de dos de los tipos de cánceres más comunes -de lapiel y de pulmón- en lo que se prevé seria elprimer paso para logra
El trabajo de Stratton ha permitido comprobar que en las células del cáncer de piel, también conocido como melanoma, existen unos 30.000 “errores genéticos”, generalmente producidos por las exposiciones prolongadas a las radiaciones solares. 
La mayoría de estos errores se encuentran en zonas del ADN queresultan inofensivas, pero -obviamente- algunos acaban provocando el cáncer.


En cuanto al cáncer de pulmón, el trabajo ha revelado la existencia de unos23.000 errores similares, la mayoría de los cuales tienen lugar comoconsecuencia de la inhalación de humo de cigarrillos. 
Para los expertos, basta el humo de unos 15 cigarrillos para que alguno de estos errores se produzca. 
La mayoría de las veces el cambio genético tiene lugar en una región del ADN que no “expresa” ningún cambio importante en la célula,pero en ocasiones termina desencadenando un cáncer de pulmón.



Como dice Stratton, se trata de “una verdadera ruleta rusa.” “La mayor parte del tiempo las mutaciones tienen lugar en zonas poco importantes del genoma, pero en otros casos, aciertan en los sitios que provocan cáncer”, continua Stratton.
r un revolucionario tratamiento contra esta enfermedad. En primer lugar, este trabajo permitirá detectar los tumores mucho antes a partir de un simple análisis de sangre, y en segundo, allanará el camino a nuevos productos farmacológicos."

La nota viene ampliada en Neoteo:
"Al dejar de fumar o al exponerse menos al sol, la gente reduce los riesgos de enfermarse simplemente haciendo descender la tasa de mutaciones no deseadas. Uno de los objetivos que persiguen los científicos involucrados en esta familia de proyectos es justamente determinar con exactitud cuáles son los “disparadores” que producen las mutaciones más peligrosas.
Tom Haswell, un profesional que hace 15 años que trabaja en el tema, cree que estas son “enormes noticias para los pacientes, ya que se trata de una esperanza cierta de que al menos para algunos tipos de cáncer existirán tratamientos efectivos dentro de pocos años”. Los expertos en cáncer de todo el mundo han manifestado su conformidad con el trabajo de Stratton. Es la primera vez que el genoma completo de una variedad de cáncer ha sido secuenciado, y lo mejor de todo es que otros tipos seguirán este camino pronto. El profesor Carlos Caldas, del Cancer Research Institute de Cambridge también ha expresado su alegría: “Como si fuesen verdaderos arqueólogos moleculares, estos investigadores han excavado a través de capas de información genética para descubrir la historia de la enfermedad de estos pacientes. Finalmente tenemos una imagen detallada de cómo los diferentes tipos de cáncer se desarrollan y, en última instancia, mejores herramientas para encontrar la manera adecuada de tratarlos y prevenirlos”, afirma. Sin dudas, son excelentes noticias"

  

¿No será más fácil dejar de fumar?

Practice Guidelines Website and Systematic Reviews Website


Clinical Practice Guidelines We Can Trust

Released:
March 23, 2011
Type:
Consensus Report
Topic:
Quality and Patient Safety
Activity:
Standards for Developing Trustworthy Clinical Practice Guidelines
Board:
Board on Health Care Services
When treating patients, doctors and other healthcare providers often are faced with difficult decisions and considerable uncertainty. They rely on the scientific literature, in addition to their knowledge, experience, and patient preferences, to inform their decisions. Clinical practice guidelines are statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Because of the large number of clinical practice guidelines available, practitioners and other guideline users find it challenging to determine which guidelines are of high quality. If guideline users had a mechanism to immediately identify high quality, trustworthy clinical practice guidelines, their health-related decision making would be improved—potentially improving both health care quality and health outcomes.
The U.S. Congress, through the Medicare Improvements for Patients and Providers Act of 2008, asked the IOM to undertake a study on the best methods used in developing clinical practice guidelines. The IOM developed eight standards for developing rigorous, trustworthy clinical practice guidelines (see the complete list of standards). To properly evaluate the effects of the standards on clinical practice guidelines development and health care quality and outcomes, the IOM encourages the Agency for Health Care Research and Quality to pilot-test the standards and assess their reliability and validity. While there always will be uncertainty in clinical practice, ensuring that clinicians have trustworthy guidelines will bring more evidence to bear on clinician and patient decision making.

Finding What Works in Health Care: Standards for Systematic Reviews

Released:
March 23, 2011
Type:
Consensus Report
Topics:
Biomedical and Health ResearchPublic HealthQuality and Patient Safety
Activity:
Standards for Systematic Reviews of Comparative Effectiveness Research
Board:
Board on Health Care Services
Healthcare decision makers—including clinicians and other healthcare providers—increasingly turn to systematic reviews for reliable, evidence-based comparisons of health interventions. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies. They can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. But the quality of systematic reviews varies; often the scientific rigor of the collected literature is not scrutinized or there are errors in data extraction and meta-analysis.
In the Medicare Improvement for Patients and Providers Act of 2008, Congress directed the IOM to develop standards for conducting systematic reviews. In this report, the IOM recommends standards for systematic reviews of the comparative effectiveness of medical or surgical interventions (see the list of the standards). The standards are meant to assure objective, transparent, and scientifically valid systematic reviews. The evidence base for how best to conduct systematic reviews is limited, and no set of standards is generally accepted or consistently applied. For example, there is little research on how to manage bias for individuals providing input into the systematic review, or on who should screen and select studies for the review. In developing its standards, the IOM relied on the current methodological evidence and guidance from respected organizations that produce systematic reviews. The IOM's standards address the entire systematic review process, from locating, screening, and selecting studies for the review, to synthesizing the findings (including meta-analysis) and assessing the overall quality of the body of evidence, to producing the final review report.


Ilustration

Finding What Works in Health Care: Standards for Systematic Reviews






Report Brief

Released:
3/23/2011
Download:
PDF

Finding What Works in Health Care: Standards for Systematic Reviews

Healthcare decision makers in search of reliable information comparing health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, and for professional medical societies and other organizations that develop clinical practice guidelines.
In the Medicare Improvement for Patients and Providers Act of 2008, Congress directed the Institute of Medicine (IOM) to develop standards for conducting systematic reviews and to develop standards for clinical practice guidelines, which are evidence-based recommendations for clinicians to use when treating patients. The IOM formed two distinct committees to respond to this charge, and each committee assessed the relevant evidence and considered expert guidance to develop the standards. This report,Finding What Works in Health Care: Standards for Systematic Reviews, recommends standards for systematic reviews of the comparative effectiveness of medical or surgical interventions (see a list of the standards).
Importance of Setting Standards for Systematic Reviews
The quality of systematic reviews is variable. Too often, the scientific rigor of the collected literature is not scrutinized or there are errors in data extraction and meta-analysis. Reporting biases present the greatest obstacle to collecting all relevant information on the effectiveness of an intervention. Research is important to individual decision making, whether it reveals benefits, harms, or lack of effectiveness of a health intervention. Thus, the systematic review should identify all of the studies—and all of the relevant data from the studies—that may pertain to the research question.
The task of identifying relevant research data is challenging. Although hundreds of thousands of research articles are indexed in bibliographic databases each year, a substantial proportion of effectiveness data are never published or are not easy to access. Moreover, it is well documented that published data may not represent all of the findings on an intervention’s effectiveness. Positive findings are more likely to be published than null or negative results.
In many cases, the users cannot determine the quality of a systematic review because the details of the review are so poorly documented. Additionally, many systematic reviews do not focus on questions that are important for real-world healthcare decisions, such as determining whether the benefits of taking a specific medication outweigh the risks.
Standards can improve the quality of systematic reviews, which will minimize the likelihood of clinicians coming to the wrong conclusions and ultimately making the wrong recommendation for treatment. The standards presented in this report—developed by the authoring committee—are meant to ensure objective, transparent, and scientifically valid systematic reviews. The need for establishing standards for systematic reviews was underscored in the health reform legislation The Patient Protection and Affordable Care Act of 2010, which created the nation’s first nonprofit Patient-Centered Outcomes Research Institute (PCORI).
Developing Standards for Systematic Reviews
The committee defines a “standard” as “a process, action, or procedure for performing systematic reviews that is deemed essential to producing scientifically valid, transparent, and reproducible results.”
Systematic reviews of comparative effectiveness research—a type of research that compares different treatment options for the same disease—can be narrow in scope and consist of simple comparisons, such as the effectiveness of one drug versus another. They also can address more complex questions, such as the comparative effectiveness of drugs versus surgery for a specific condition. The committee’s standards apply principally to publicly funded systematic reviews of comparative effectiveness research that focus specifically on treatments.
The evidence base for how best to conduct systematic reviews is limited, and no set of standards is generally accepted or consistently applied. For example, there is little research on how to manage bias for individuals providing input into the systematic review, or on who should screen and select studies for the review. In developing its standards, the committee relied on the current methodological evidence and guidance from respected organizations that produce systematic reviews. The committee’s standards address the entire systematic review process, from locating, screening, and selecting studies for the review, to synthesizing the findings (including meta- analysis) and assessing the overall quality of the body of evidence, to producing the final review report.
The standards are current “best practices”; they are not the last word. All of the recommended standards must be considered provisional, pending better empirical evidence about their scientific validity, feasibility, efficiency, and ultimate usefulness in healthcare decision making. The standards will be especially valuable for systematic reviews of high-stakes clinical questions with broad population impact, where the use of public funds to get the right answer justifies careful attention to the rigor of the systematic review. Individuals involved in systematic reviews should be thoughtful about all of the recommended standards and elements, using their best judgment if resources are inadequate to implement all of them, or if some seem inappropriate for the particular task or question at hand. Transparency in reporting the methods actually used and the reasoning behind the choices are among the most important of the standards recommended by the committee.
Improving the Quality of Systematic Reviews
The committee proposes a framework for improving the quality of the research that supports systematic reviews, including strategies for involving the right people, methods for conducting the systematic review, methods for synthesizing and evaluating evidence, and methods for communicating and using the results. Successful execution and effective use of a systematic review requires improving the science supporting the steps in the systematic review process.
In addition, the committee finds that the environment surrounding the development of systematic reviews lacks adequate funding and coordination—both of which are needed to conduct high-quality systematic reviews. Many organizations conduct systematic reviews, but typically they do not work together. The committee emphasizes the need for greater collaboration among stakeholder groups, including PCORI, government agencies, medical professional societies, researchers, and patient interest groups. Together, these groups have the potential to improve the rigor and transparency of systematic reviews, encourage standardization of methods and processes, set priorities for selection of clinical topics of interest to clinicians and patients, reduce unintentional duplication of efforts, and more effectively manage conflicts of interest.
Recommendations
The committee recommends that PCORI provide oversight and encourage coordination among Department of Health and Human Services (HHS) agencies to improve the research base and support the environment for systematic reviews. Improved coordination should include:
  • Developing training programs for researchers, users, consumers, and other stakeholders to encourage more effective and inclusive contributions to systematic reviews of comparative effectiveness research;
  • Systematically supporting research that advances the methods for designing and conducting systematic reviews of comparative effectiveness research;
  • Supporting research to improve the communication and use of systematic reviews of comparative effectiveness research in clinical decision making;
  • Developing effective coordination and collaboration between U.S. and international partners;
  • Developing a process to ensure that standards for systematic reviews of comparative effectiveness research are regularly updated to reflect current best practice; and
  • Using systematic reviews to inform priorities and methods for primary comparative effectiveness research.
Conclusion
Systematic reviews should be used to inform healthcare decision makers about what is known and not known about the effectiveness of health interventions. Patients expect that their doctors and other healthcare providers know what type of treatment to recommend. Yet the reality is that the evidence that informs current healthcare decisions often is incomplete and may be biased, and there are no standards in place to ensure that systematic reviews of the evidence are objective, transparent, and scientifically valid. Better-quality systematic reviews have the potential to improve the decisions made by clinicians, to better inform patient choice, and to provide a more trustworthy basis for decisions by payers and policy makers.

Report Brief for Practice Guidelines




Report at a Glance

Report Brief

Released:
3/23/2011
Download:
PDF

Clinical Practice Guidelines We Can Trust

Healthcare providers often are faced with difficult decisions and considerable uncertainty when treating patients. They rely on the scientific literature, in addition to their knowledge, skills, experience, and patient preferences, to inform their decisions. Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Rather than dictating a one-size-fits-all approach to patient care, clinical practice guidelines offer an evaluation of the quality of the relevant scientific literature and an assessment of the likely benefits and harms of a particular treatment. This information enables healthcare providers to proceed accordingly, selecting the best care for a unique patient based on his or her preferences.
The U.S. Congress, through the Medicare Improvements for Patients and Providers Act of 2008, asked the Institute of Medicine (IOM) to undertake a study on the best methods used in developing clinical practice guidelines. To ensure that organizations developing such guidelines have information on approaches that are objective, scientifically valid, and consistent, the IOM formed an expert committee. The committee developed eight standards for developing rigorous, trustworthy clinical practice guidelines.
Developing Trustworthy Guidelines
The Guidelines International Network database currently contains more than 3,700 clinical practice guidelines from 39 countries. Additionally, there are nearly 2,700 guidelines in the National Guidelines Clearinghouse (NGC), part of the Agency for Healthcare Research and Quality (AHRQ). Because of the large number of clinical practice guidelines available, guideline users, including practitioners, find it challenging to determine which guidelines are of high quality. If guideline users had a mechanism to immediately identify high quality, trustworthy clinical practice guidelines, their health-related decision making would be improved, potentially resulting in enhanced health care quality and outcomes. Likewise, a set of standards for trustworthy clinical guidelines would help developers create such guidelines, which, in turn, has the potential to improve healthcare decision making and health care quality and outcomes.
Most guidelines used today suffer from shortcomings in development. Dubious trust in guidelines is the result of many factors, including failure to represent a variety of disciplines in guideline development groups, lack of transparency in how recommendations are derived and rated, and omission of a thorough external review process. To be trustworthy, clinical practice guidelines should:
  • Be based on a systematic review of the existing evidence;
  • Be developed by a knowledgeable, multidisciplinary panel of experts and representatives from key affected groups;
  • Consider important patient subgroups and patient preferences, as appropriate;
  • Be based on an explicit and transparent process that minimizes distortions, biases, and conflicts of interest;
  • Provide a clear explanation of the logical relationships between alternative care options and health outcomes, and provide ratings of both the quality of evidence and the strength of recommendations; and
  • Be reconsidered and revised as appropriate when important new evidence warrants modifications of recommendations.
Additionally, as reflected in the committee’s standards for developing trustworthy clinical practice guidelines, guideline development groups optimally comprise members without conflict of interest. The committee recognizes that in some circumstances, a guideline development group may not be able to perform its work without members who have conflicts of interest—for example, relevant clinical specialists who receive a substantial portion of their incomes from services pertinent to the guideline. Therefore, the committee specifies that members of the guideline development group who have a conflict of interest should not represent more than a minority of the group.
The committee standards also emphasize that in making guideline recommendations, the guideline development group should provide a summary of relevant available evidence that describes the quality, quantity, and consistency of that aggregate evidence.
Setting Standards for Trustworthy Guidelines
The committee proposes eight standards for developing trustworthy guidelines. These standards reflect the latest literature, expert consensus, and public input. The committee recommends that all guidelines comply with these standards (see Standards document for more detailed information). The standards reflect best practices across the entire guideline development process, including attention to:
  • Establishing transparency;
  • Management of conflict of interest;
  • Guideline development group composition;
  • Clinical practice guideline–systematic review intersection;
  • Establishing evidence foundations for and rating strength of recommendations;
  • Articulation of recommendations;
  • External review; and
  • Updating.
The committee’s proposed standards have yet to be tested by clinical practice guideline developers and users to determine whether the standards produce unbiased, scientifically valid, and trustworthy clinical practice guidelines, and whether implementation of the clinical practice guidelines based on the committee’s standards improve health outcomes.
Promoting Adoption
To promote adoption of the standards, the committee recommends that the U.S. Department of Health and Human Services (HHS) create a mechanism to identify trustworthy guidelines. Such identification will serve three purposes: promote wider adoption of the IOM standards by developers since there will be an advantage to clinical practice guidelines publicly identified as trustworthy, provide users of clinical practice guidelines with an easy guide to identify guidelines that are trustworthy, and promote adoption of trustworthy clinical practice guidelines.
To affect quality of care and patient outcomes, implementers should ensure that trustworthy guidelines are made available to clinicians and health systems. Therefore, the committee recommends that implementers employ effective, multi-faceted strategies targeting both individuals and healthcare systems to promote adherence to trustworthy clinical practice guidelines. Increased adoption of electronic health records and computer-aided clinical decision support (CDS) will open new opportunities to rapidly promote clinical practice guidelines to healthcare providers and patients. To advance this goal, guideline developers should structure the format, vocabulary, and content of clinical practice guidelines to help ease the implementation of computer-aided CDS by end-users.
Evaluating Trustworthy Guidelines
It is important that the committee’s standards are properly evaluated. The committee encourages AHRQ to direct a portion of its research funds to pilot-test the standards, to assess their reliability and validity, and to evaluate the effects of the standards on clinical practice guideline development and health care quality and outcomes. While AHRQ is not directly involved in clinical practice guideline development, it does play a vital role in disseminating guidelines through its NGC. The committee recommends that AHRQ require the NGC to discontinue the inclusion of guidelines whose development is not sufficiently documented, and to prominently identify guidelines that reflect the committee’s proposed standards for trustworthiness.
Conclusion
Patients rely on healthcare providers for quality care and expect that those providers have the knowledge and expertise to make health-related decisions. Clinical practice guidelines can aid clinicians and patients alike in determining the best treatment options for a particular disease or condition. While there always will be uncertainty in clinical practice, ensuring that clinicians have trustworthy guidelines will bring more evidence to bear on clinician and patient decision making. Trustworthy guidelines hold the promise of improving health care quality and outcomes.