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      The “As Low As Reasonably Achievable” (ALARA) principle: a brief historical overview and a bibliometric analysis of the most cited publications

      Radioprotection
      EDP Sciences

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          Abstract

          The “As Low As Reasonably Achievable” (ALARA) principle is largely followed in the radiology field. The current article provided a historical overview on the evolution and development of the ALARA principle and its related concepts. Meanwhile, the scientific impact of papers dealing with the ALARA principle was largely unknown. The current study aimed to identify the body of literature dealing with the ALARA principle, which of them were cited the most, and which of their references were cited the most. The Web of Science database hosted by Clarivate Analytics was accessed. Relevant papers were identified and analyzed. The search identified 979 relevant publications. Six journals ( Health Physics, Pediatric Radiology, Radiation Protection Dosimetry, Transactions of the American Nuclear Society, Fusion Engineering and Design, and American Journal of Roentgenology) have accounted for nearly one-fifth of these publications. The most cited publications and references mainly related to two patient groups, children and pregnant women. It is important to adhere to the ALARA principle whenever a decision is made to irradiate a patient, because the exact effect of radiation on the patient health is not yet totally understood and predictable.

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          Most cited references30

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          The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk.

          Increased use of computed tomography (CT) in pediatrics raises concerns about cancer risk from exposure to ionizing radiation. To quantify trends in the use of CT in pediatrics and the associated radiation exposure and cancer risk. Retrospective observational study. Seven US health care systems. The use of CT was evaluated for children younger than 15 years of age from 1996 to 2010, including 4 857 736 child-years of observation. Radiation doses were calculated for 744 CT scans performed between 2001 and 2011. Rates of CT use, organ and effective doses, and projected lifetime attributable risks of cancer. RESULTS The use of CT doubled for children younger than 5 years of age and tripled for children 5 to 14 years of age between 1996 and 2005, remained stable between 2006 and 2007, and then began to decline. Effective doses varied from 0.03 to 69.2 mSv per scan. An effective dose of 20 mSv or higher was delivered by 14% to 25% of abdomen/pelvis scans, 6% to 14% of spine scans, and 3% to 8% of chest scans. Projected lifetime attributable risks of solid cancer were higher for younger patients and girls than for older patients and boys, and they were also higher for patients who underwent CT scans of the abdomen/pelvis or spine than for patients who underwent other types of CT scans. For girls, a radiation-induced solid cancer is projected to result from every 300 to 390 abdomen/pelvis scans, 330 to 480 chest scans, and 270 to 800 spine scans, depending on age. The risk of leukemia was highest from head scans for children younger than 5 years of age at a rate of 1.9 cases per 10 000 CT scans. Nationally, 4 million pediatric CT scans of the head, abdomen/pelvis, chest, or spine performed each year are projected to cause 4870 future cancers. Reducing the highest 25% of doses to the median might prevent 43% of these cancers. The increased use of CT in pediatrics, combined with the wide variability in radiation doses, has resulted in many children receiving a high-dose examination. Dose-reduction strategies targeted to the highest quartile of doses could dramatically reduce the number of radiation-induced cancers.
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            Radiation exposure and pregnancy: when should we be concerned?

            The potential biological effects of in utero radiation exposure of a developing fetus include prenatal death, intrauterine growth restriction, small head size, mental retardation, organ malformation, and childhood cancer. The risk of each effect depends on the gestational age at the time of exposure, fetal cellular repair mechanisms, and the absorbed radiation dose level. A comparison between the dose levels associated with each of these risks and the estimated fetal doses from typical radiologic examinations lends support to the conclusion that fetal risks are minimal and, therefore, that radiologic and nuclear medicine examinations that may provide significant diagnostic information should not be withheld from pregnant women. The latter position is advocated by the International Commission on Radiological Protection, National Council on Radiation Protection, American College of Radiology, and American College of Obstetrics and Gynecology. However, although the risks are small, it is important to ensure that radiation doses are kept as low as reasonably achievable. RSNA, 2007
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              Detecting the historical roots of research fields by reference publication year spectroscopy (RPYS)

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                Author and article information

                Contributors
                Journal
                Radioprotection
                Radioprotection
                EDP Sciences
                0033-8451
                1769-700X
                April 2019
                May 13 2019
                April 2019
                : 54
                : 2
                : 103-109
                Article
                10.1051/radiopro/2019016
                5bc87112-9c5c-4c51-b26a-c1231fbd73c6
                © 2019

                https://www.edpsciences.org/en/authors/copyright-and-licensing

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