Sources and types of solid wastes [10].
\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"Milestone",originalUrl:"/media/original/124"}},components:[{type:"htmlEditorComponent",content:'
Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
\n\nThis achievement solidifies IntechOpen’s place as a pioneer in Open Access publishing and the home to some of the most relevant scientific research available through Open Access.
\n\nWe are so proud to have worked with so many bright minds throughout the years who have helped us spread knowledge through the power of Open Access and we look forward to continuing to support some of the greatest thinkers of our day.
\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"10888",leadTitle:null,fullTitle:"Dietary Fibers",title:"Dietary Fibers",subtitle:null,reviewType:"peer-reviewed",abstract:"Dietary fibers have been identified as a food ingredient of importance due to their ability to act on the gut microbiome. The health benefits of dietary fibers have been numerous and not just limited to this alone. Since time immemorial, dietary fibers are identified as playing a significant role in the normalization of bowel movements and also helping control blood glucose and cholesterol levels, as well as control weight gain. The book provides fundamental knowledge on dietary fibers as well as shares insights and updates on their health benefits. The chapters have been written by experts in these two areas and it is hoped that the profits from going through the content are substantial",isbn:"978-1-83969-636-7",printIsbn:"978-1-83969-635-0",pdfIsbn:"978-1-83969-637-4",doi:"10.5772/intechopen.95197",price:100,priceEur:109,priceUsd:129,slug:"dietary-fibers",numberOfPages:94,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"341227ed81a866eb05390bc26f2e5ad7",bookSignature:"Viduranga Y. Waisundara",publishedDate:"January 7th 2022",coverURL:"https://cdn.intechopen.com/books/images_new/10888.jpg",numberOfDownloads:896,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:1,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:1,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 4th 2021",dateEndSecondStepPublish:"April 1st 2021",dateEndThirdStepPublish:"May 31st 2021",dateEndFourthStepPublish:"August 19th 2021",dateEndFifthStepPublish:"October 18th 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science\nand Technology from the Department of Chemistry, National\nUniversity of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013.\nShe relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the\nNational Institute of Fundamental Studies from April 2013 to\nOctober 2016. She was a senior lecturer on a temporary basis at the Department of\nFood Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is\ncurrently Deputy Principal of the Australian College of Business and Technology –\nKandy Campus, Sri Lanka. She is also the Global Harmonization Initiative (GHI)",institutionString:"Australian College of Business & Technology",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"13",totalChapterViews:"0",totalEditedBooks:"11",institution:{name:"Kobe College",institutionURL:null,country:{name:"Japan"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"323",title:"Food and Nutrition",slug:"food-and-nutrition"}],chapters:[{id:"79444",title:"Introductory Chapter: The Basics of Dietary Fibers",doi:"10.5772/intechopen.101468",slug:"introductory-chapter-the-basics-of-dietary-fibers",totalDownloads:126,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Kanchana Samarasinghe, Chamodya R. Dharmadasa and Viduranga Y. Waisundara",downloadPdfUrl:"/chapter/pdf-download/79444",previewPdfUrl:"/chapter/pdf-preview/79444",authors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara"},{id:"320764",title:"B.Sc.",name:"Kanchana",surname:"Samarasinghe",slug:"kanchana-samarasinghe",fullName:"Kanchana Samarasinghe"},{id:"437009",title:"Ms.",name:"Chamodya R.",surname:"Dharmadasa",slug:"chamodya-r.-dharmadasa",fullName:"Chamodya R. Dharmadasa"}],corrections:null},{id:"78644",title:"Psyllium: A Source of Dietary Fiber",doi:"10.5772/intechopen.99372",slug:"psyllium-a-source-of-dietary-fiber",totalDownloads:268,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Dietary fiber is commonly known as roughage. Fibers are mostly present in vegetables, whole grain, nuts, legumes, and fruits. This is an indigestible part of the food obtained by plants. It includes polysaccharides such as cellulose, hemicellulose, pectic substances, mucilages, gums and lignin as well. Dietary fiber has beneficial physiological effect on health, so it is included in daily diet to decrease occurrence of several diseases. In this sequence, this chapter describes about the dietary fiber, psyllium commonly known as Isabgol which is prepared from the seed of the Plantago ovata Forsk (Psyllium ispaghula). Psyllium is hydrophilic mucilloid, has the capacity to absorb water and increases in volume while absorbing water. Psyllium consists of mixed viscous polysaccharide in which about 35% soluble and 65% insoluble polysaccharides (cellulose, hemicellulose, and lignin) are present. This can be used as gelling, food thickener, emulsifying and stabilizing agents in some food products. Psyllium is a natural biopolymer which has high quantity of hemicelluloses consist of xylan backbone connected with arabinose, galacturonic acid and rhamnose units. Since last many years it is being used as therapeutic agent in several diseases like chronic constipation, inflammation of mucous membrane of GIT tract, duodenal ulcers, piles or diarrohoea etc. It may be source of renewable and biodegradable polymer.",signatures:"Ranu Agrawal",downloadPdfUrl:"/chapter/pdf-download/78644",previewPdfUrl:"/chapter/pdf-preview/78644",authors:[{id:"353397",title:"Dr.",name:"Ranu",surname:"Agrawal",slug:"ranu-agrawal",fullName:"Ranu Agrawal"}],corrections:null},{id:"77526",title:"Dietary Fiber and Dyslipidemia",doi:"10.5772/intechopen.98838",slug:"dietary-fiber-and-dyslipidemia",totalDownloads:124,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Fibers are abundantly found in vegetables, fruit, beans, cereals, seeds, and tubers. Beans and seeds, alongside prevailing as both of the fiber sources, are the sources of vegetable protein as well. Whereas tubers are a carbohydrate source, which people deem as a staple food. Fiber intake in diets, particularly soluble fibers, has the ability to produce gel in the intestines, inhibiting glucose and cholesterol absorption. Dietary fibers have the ability to bind bile salts in the digestive tract, and disturbed bile reabsorption will stimulate bile synthesis in the liver. Dyslipidemia has a significant role in systemic responses and inflammation in adipose tissues. Inflammation can increase intestinal permeability and adipose tissues. Dyslipidemic management is carried out by altering lifestyles, intervening in suitable diets to reduce LDL levels, and increasing HDL levels. The degree of compliance with diet interventions is seminal to ensure successful dyslipidemic management.",signatures:"I. Gusti Ayu Nyoman Danuyanti and Z.S. Ahmad Fahrurrozi",downloadPdfUrl:"/chapter/pdf-download/77526",previewPdfUrl:"/chapter/pdf-preview/77526",authors:[{id:"354351",title:"Dr.",name:"I. Gusti Ayu Nyoman",surname:"Danuyanti",slug:"i.-gusti-ayu-nyoman-danuyanti",fullName:"I. Gusti Ayu Nyoman Danuyanti"},{id:"420432",title:"Mr.",name:"Z.S.",surname:"Ahmad Fahrurrozi",slug:"z.s.-ahmad-fahrurrozi",fullName:"Z.S. Ahmad Fahrurrozi"}],corrections:null},{id:"78373",title:"Suitability of Fruits and Vegetables for Provision of Daily Requirement of Dietary Fiber Targets",doi:"10.5772/intechopen.99689",slug:"suitability-of-fruits-and-vegetables-for-provision-of-daily-requirement-of-dietary-fiber-targets",totalDownloads:130,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The risk factors associated with low dietary fiber intake and the synergy with its role in colon prebiotic activity has stimulated a re-awakening in the scientific research. Dietary fiber intake has reduced all over the world, and so it has been labelled as a major shortfall nutrient of important in public health. Changes in lifestyle and improved standard of living have affected the diet of consumers in so many ways. Observation of these facts have spurred a special interest in the search for functional foods that contains essential nutrients like dietary fiber whose nutritional value improves the health of the consumer, enhances their physical and mental state and prevent lifestyle diseases. Fruits and vegetables are a modest source of total dietary fiber with nutrients such as vitamins, minerals, and phytochemicals, including polyphenols, which provide support for their biological plausibility and enhance their health benefits. This chapter therefore reviews existing literature on the utilization of fruits and vegetables as rich sources of fiber; their fiber concentration, their appropriateness in meeting the adequate fiber intake for daily consumption and their overlapping roles as a fiber source and as nutraceuticals.",signatures:"Oluwafunmilayo Dorcas Adegbaju, Gloria Aderonke Otunola and Anthony Jide Afolayan",downloadPdfUrl:"/chapter/pdf-download/78373",previewPdfUrl:"/chapter/pdf-preview/78373",authors:[{id:"355270",title:"Dr.",name:"Oluwafunmilayo",surname:"Dorcas Adegbaju",slug:"oluwafunmilayo-dorcas-adegbaju",fullName:"Oluwafunmilayo Dorcas Adegbaju"},{id:"428761",title:"Dr.",name:"Gloria Aderonke",surname:"Otunola",slug:"gloria-aderonke-otunola",fullName:"Gloria Aderonke Otunola"},{id:"428762",title:"Dr.",name:"Anthony Jide",surname:"Afolayan",slug:"anthony-jide-afolayan",fullName:"Anthony Jide Afolayan"}],corrections:null},{id:"77957",title:"Prebiotic Dietary Fibers for Weight Management",doi:"10.5772/intechopen.99421",slug:"prebiotic-dietary-fibers-for-weight-management",totalDownloads:128,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"While all prebiotics are accepted as dietary fibers, not all dietary fibers are accepted as prebiotics. Fructo-oligosaccharides and galacto-oligosaccharides are significant prebiotic dietary fibers related with the regulation of weight management. They, selectively stimulate the growth of bifidobacteria and lactobacillus, thus help to modulate gut microbiota. Since bifiodobacteria population are responsible for energy scavenging they are playing a vital role in the weight management. In addition, prebiotics fermented to short chain fatty acids by gut microbiota, whose presence in the large intestine is responsible for many of the metabolic effects and prevent metabolic diseases such as obesity. Short chain fatty acids via different mechanisms also stimulate satiety hormones such as GLP-1 and PYY, and shift glucose and lipid metabolism. To conclude, prebiotic dietary fibers beneficially impact the gut microbiota thus can be effective on regulation of weight management. There is a need for further clinical trials to explain more comprehensively the effects of dietary prebiotics on weight management.",signatures:"Ceren Gezer and Gözde Okburan",downloadPdfUrl:"/chapter/pdf-download/77957",previewPdfUrl:"/chapter/pdf-preview/77957",authors:[{id:"218599",title:"Associate Prof.",name:"Ceren",surname:"Gezer",slug:"ceren-gezer",fullName:"Ceren Gezer"},{id:"420502",title:"Dr.",name:"Gözde",surname:"Okburan",slug:"gozde-okburan",fullName:"Gözde Okburan"}],corrections:null},{id:"78325",title:"Signaling Pathways Associated with Metabolites of Dietary Fibers Link to Host Health",doi:"10.5772/intechopen.99586",slug:"signaling-pathways-associated-with-metabolites-of-dietary-fibers-link-to-host-health",totalDownloads:120,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Food is a basic requirement for human life and well-being. On the other hand, diet is necessary for growth, health and defense, as well as regulating and assisting the symbiotic gut microbial communities that inhabit in the digestive tract, referred to as the gut microbiota. Diet influences the composition of the gut microbiota. The quality and quantity of diet affects their metabolism which creates a link between diet. The microorganisms in response to the type and amount of dietary intake. Dietary fibers, which includes non-digestible carbohydrates (NDCs) are neither neither-digested nor absorbed and are subjected to bacterial fermentation in the gastrointestinal tract resulting in the formation of different metabolites called SCFAs. The SCFAs have been reported to effect metabolic activities at the molecularlevel. Acetate affects the metabolic pathway through the G-protein-coupled receptor (GPCR) and free fatty acid receptor2 (FFAR2/GPR43) while butyrate and propionate transactivate the peroxisome proliferator-activated receptors (PPARγ/NR1C3) and regulate the PPARγ target gene Angptl4 in colonic cells of the gut. The NDCs via gut microbiota dependent pathway regulate glucose homeostasis, gut integrity and hormone by GPCR, NF-kB, and AMPK-dependent processes. In this chapter, we will focus on dietary fibers, which interact directly with gut microbes and lead to the production of metabolites and discuss how dietary fiber impacts gut microbiota ecology, host physiology, and health and molecule mechanism of dietary fiber on signaling pathway that linked to the host health.",signatures:"Kavita Rani, Jitendra Kumar, Sonia Sangwan, Nampher Masharing, Murli Dhar Mitra and H.B. 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Lewis",slug:"elfed-lewis",email:"Elfed.Lewis@ul.ie",position:null,institution:{name:"University of Limerick",institutionURL:null,country:{name:"Ireland"}}},{id:"259703",title:"Dr.",name:"Dinesh Babu",middleName:null,surname:"Duraibabu",fullName:"Dinesh Babu Duraibabu",slug:"dinesh-babu-duraibabu",email:"dineshbabu.duraibabu@ul.ie",position:null,institution:{name:"University of Limerick",institutionURL:null,country:{name:"Ireland"}}},{id:"269578",title:"Dr.",name:"Gabriel",middleName:null,surname:"Leen",fullName:"Gabriel Leen",slug:"gabriel-leen",email:"Gabriel.Leen@ul.ie",position:null,institution:{name:"University of Limerick",institutionURL:null,country:{name:"Ireland"}}},{id:"269579",title:"M.Sc.",name:"Fintan",middleName:null,surname:"McGuinness",fullName:"Fintan McGuinness",slug:"fintan-mcguinness",email:"Fintan.McGuinness@ul.ie",position:null,institution:{name:"University of Limerick",institutionURL:null,country:{name:"Ireland"}}},{id:"269580",title:"Dr.",name:"Gerard",middleName:null,surname:"Dooly",fullName:"Gerard Dooly",slug:"gerard-dooly",email:"Gerard.Dooly@ul.ie",position:null,institution:{name:"University of Limerick",institutionURL:null,country:{name:"Ireland"}}}]}},chapter:{id:"63471",slug:"review-of-liquid-filled-optical-fibre-based-temperature-sensing",signatures:"Fintan McGuinness, Gabriel Leen, Elfed Lewis, Gerard Dooly, Daniel Toal\nand Dinesh Babu Duraibabu",dateSubmitted:"May 22nd 2018",dateReviewed:"August 1st 2018",datePrePublished:"November 5th 2018",datePublished:"April 24th 2019",book:{id:"8271",title:"Applications of Optical Fibers for Sensing",subtitle:null,fullTitle:"Applications of Optical Fibers for Sensing",slug:"applications-of-optical-fibers-for-sensing",publishedDate:"April 24th 2019",bookSignature:"Christian Cuadrado-Laborde",coverURL:"https://cdn.intechopen.com/books/images_new/8271.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"220902",title:"Dr.",name:"Christian",middleName:null,surname:"Cuadrado-Laborde",slug:"christian-cuadrado-laborde",fullName:"Christian Cuadrado-Laborde"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"27036",title:"Dr.",name:"Daniel",middleName:null,surname:"Toal",fullName:"Daniel Toal",slug:"daniel-toal",email:"daniel.toal@ul.ie",position:null,institution:{name:"University of Limerick",institutionURL:null,country:{name:"Ireland"}}},{id:"85846",title:"Prof.",name:"Elfed",middleName:null,surname:"Lewis",fullName:"Elfed Lewis",slug:"elfed-lewis",email:"Elfed.Lewis@ul.ie",position:null,institution:{name:"University of Limerick",institutionURL:null,country:{name:"Ireland"}}},{id:"259703",title:"Dr.",name:"Dinesh Babu",middleName:null,surname:"Duraibabu",fullName:"Dinesh Babu Duraibabu",slug:"dinesh-babu-duraibabu",email:"dineshbabu.duraibabu@ul.ie",position:null,institution:{name:"University of Limerick",institutionURL:null,country:{name:"Ireland"}}},{id:"269578",title:"Dr.",name:"Gabriel",middleName:null,surname:"Leen",fullName:"Gabriel Leen",slug:"gabriel-leen",email:"Gabriel.Leen@ul.ie",position:null,institution:{name:"University of Limerick",institutionURL:null,country:{name:"Ireland"}}},{id:"269579",title:"M.Sc.",name:"Fintan",middleName:null,surname:"McGuinness",fullName:"Fintan McGuinness",slug:"fintan-mcguinness",email:"Fintan.McGuinness@ul.ie",position:null,institution:{name:"University of Limerick",institutionURL:null,country:{name:"Ireland"}}},{id:"269580",title:"Dr.",name:"Gerard",middleName:null,surname:"Dooly",fullName:"Gerard Dooly",slug:"gerard-dooly",email:"Gerard.Dooly@ul.ie",position:null,institution:{name:"University of Limerick",institutionURL:null,country:{name:"Ireland"}}}]},book:{id:"8271",title:"Applications of Optical Fibers for 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\r\n\tThis book seeks to provide scientific information related to the importance of how Health and Educational Success relate and supplement each other. Starting from the development of programs in the Higher Education Sector, Drawing up mechanisms to implement the programs, and further reviewing those programs. The importance of upskilling the Health Professionals is also important because they will have graduated from the drawn programs therefore, it is important that their skills improved from time to time so that they can be able to offer relevant care. Additionally, the receiver of care who are patients and communities also must be provided with relevant Health Education which aligns to programs that were crafted. Importance of continuously subjecting these programs to Quality Assurance measures is important to be sure that the programs are implemented as they were approved by Accreditation Professional bodies. Health and Educational Success will lead to healthy living.
",isbn:"978-1-80356-147-9",printIsbn:"978-1-80356-146-2",pdfIsbn:"978-1-80356-148-6",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"a0117b7a325926daecd4d712c1574142",bookSignature:"Dr. Thifhelimbilu Irene Ramavhoya, Dr. Takalani Edith Mutshatshi and Prof. Tebogo Maria Mothiba",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11482.jpg",keywords:"Quality Assurance, Monitoring, Evaluation, Tertiary Education, Health, Non-Communicable, Diseases, Health Education, Retraining, Training Programmes, Framework, Health Professionals",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 1st 2022",dateEndSecondStepPublish:"March 1st 2022",dateEndThirdStepPublish:"April 30th 2022",dateEndFourthStepPublish:"July 19th 2022",dateEndFifthStepPublish:"September 17th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"5 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"A researcher and educator, acting as an operational manager at the Department of Health, Limpopo University, also affiliated with North-West University, University of South Africa, and the University of Pretoria. Dr. Ramavhoya is a Peer review member of Annals of a global health journal, a Member of the Senate committee with SG Lourence nursing college, and a Member of the HIV & AIDS Publication group.",coeditorOneBiosketch:"A senior lecturer at the University of Limpopo with experience in Health Care Sciences, previously affiliated with SANC, the University of South Africa, and the Garankuwa College of Nursing.",coeditorTwoBiosketch:"An active researcher with more than 100 publications in national and international journals such as Curationis, Health SA Gesondheid, and Journal of Nursing Management among others. Dr. Mothiba served the TREC as a nurse and became its Deputy Chairperson in 2019, was awarded five Vice-Chancellor’s Excellence Awards at the University of Limpopo(2013, 2016, 2019), and the Best Academic Achievement award from the University of Johannesburg in 2013.",coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"446660",title:"Associate Prof.",name:"Irene",middleName:null,surname:"Ramavhoya",slug:"irene-ramavhoya",fullName:"Irene Ramavhoya",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003JZt3rQAD/Profile_Picture_1641369636515",biography:"A highly skilled, innovative, proactive thinker with commendable vast experience in health care service delivery in clinical, educational, and managerial skills at the hospital, community, and educational health care setting. I worked as a professional nurse (clinical nurse practitioner for 12 years, acting as an operational manager for five years, and as a lecturer, this is my Sixth year (three at Limpopo College and this is my third year working at the University of Pretoria).",institutionString:"University of Limpopo",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Limpopo",institutionURL:null,country:{name:"South Africa"}}}],coeditorOne:{id:"345542",title:"Dr.",name:"Takalani",middleName:"Edith",surname:"Mutshatshi",slug:"takalani-mutshatshi",fullName:"Takalani Mutshatshi",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000033qJAFQA2/Profile_Picture_1639054888008",biography:"Senior Lecturer, Department of Nursing Science, University of Limpopo. Ph.D. Health Studies. Research niche areas include Health Service Management, General Nursing, Community Nursing, Occupational Health Nursing, and Child (Paediatric) Nursing. Member of DENOSA.",institutionString:"University of Limpopo",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Limpopo",institutionURL:null,country:{name:"South Africa"}}},coeditorTwo:{id:"335856",title:"Prof.",name:"Tebogo Maria",middleName:null,surname:"Mothiba",slug:"tebogo-maria-mothiba",fullName:"Tebogo Maria Mothiba",profilePictureURL:"https://mts.intechopen.com/storage/users/335856/images/system/335856.png",biography:"Introduction: My research career started at the University of Limpopo in July 2006. I facilitated Nursing Services Management, Nursing Dynamics and Research Methodology from undergraduate to postgraduate levels. Health Care Management was my major focus in completing a Bachelor of Curationis, Master of Nursing and PhD.\nResearch career, supervision and publications: I embraced my dual role as a nurse educator in knowledge management in research and capacity building as an academic at the University of Limpopo. As an academic for the last 15 years, I viewed knowledge management as the core area in (i) discovering knowledge on the quality of existing health systems with a focus on nurses and patients, (ii) building international partnerships for capacity building in knowledge management of self, students and peers (iii) strategies of knowledge management in patients with Non-Communicable (NCDs) and Communicable Diseases (CDs) (e.g. Diabetes & HIV/AIDS) in the communities of Limpopo Province. Spending 15 years in teaching was instrumental in building my research career, build capacity by supervising masters and PhD students, thus instilling the awareness of knowledge management in students to improve practice leading to provision of quality patient care. I have successfully supervised up to completion 25 Masters (males and females) and 7 doctoral candidates (all women and 5 working at University of Limpopo Faculty of Health Sciences. I am currently have 9 postgraduates assigned to me for masters and doctoral studies. This gives me hope that I am achieving my goals of mentoring women in academia. This also led me to co-author some of my 105 articles with masters and doctoral graduates along with research team members. To date I had published 9 book chapters of 7 of them in 2021 though 3 are still in press. \nResearch Projects: I was appointed as Deputy Project Leader from 2014 to 2020 for the VLIROUS Project 2 funded by Flemish Inter-University Council which included peers from Antwerp University in Belgium in which I supervised masters and doctoral students together with peers. This project was aimed at prevention and management of NCDs in the rural communities. I was a Deputy Principal Investigator, for a Swedish Forte and SAMRC for a collaborative project on Strengthening Maternal Health in Limpopo Province. This was aimed at improving maternal health service provision and debriefing of Midwives in Limpopo Province. I am also part of International Skin Integrity Research Group with University of Nottingham University in the UK. I am also a Co-Principal Investigator of Co-designing Community-based ICT’s Interventions to Enhance Maternal and Child Health in South Africa (CoMaCH) Project in partnership with four Universities in the UK, UL, WITS and HSRC.\nAchievement Awards: I have received five Vice Chancellor Research Excellence Awards in the University of Limpopo in 2013, 2016 and 2019. I was presented with the 'Top Academic Achiever Award” by the University of Johannesburg for my doctoral degree in 2014 October, and was allowed to join the Golden Key Honour Society. The Key is built on pillars of knowledge, capacity building and development of international research partnerships.\nResearch Rating: NRF C3 rated researcher\nIn conclusion, my academic career history Lecturer, senior lecturer 2006 July to 2014 July UL, 2014 August to date Professor, Research Professor FHS 2018 December to 2020 June, FHS Acting Executive Dean 2020 July to June 2021. Executive Dean FHS July 2021 to date.",institutionString:"University of Limpopo",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"4",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Limpopo",institutionURL:null,country:{name:"South Africa"}}},coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"23",title:"Social Sciences",slug:"social-sciences"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"429339",firstName:"Jelena",lastName:"Vrdoljak",middleName:null,title:"Ms.",imageUrl:"https://mts.intechopen.com/storage/users/429339/images/20012_n.jpg",email:"jelena.v@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"6942",title:"Global Social Work",subtitle:"Cutting Edge Issues and Critical Reflections",isOpenForSubmission:!1,hash:"222c8a66edfc7a4a6537af7565bcb3de",slug:"global-social-work-cutting-edge-issues-and-critical-reflections",bookSignature:"Bala Raju Nikku",coverURL:"https://cdn.intechopen.com/books/images_new/6942.jpg",editedByType:"Edited by",editors:[{id:"263576",title:"Dr.",name:"Bala",surname:"Nikku",slug:"bala-nikku",fullName:"Bala Nikku"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6926",title:"Biological Anthropology",subtitle:"Applications and Case Studies",isOpenForSubmission:!1,hash:"5bbb192dffd37a257febf4acfde73bb8",slug:"biological-anthropology-applications-and-case-studies",bookSignature:"Alessio Vovlas",coverURL:"https://cdn.intechopen.com/books/images_new/6926.jpg",editedByType:"Edited by",editors:[{id:"313084",title:"Dr.",name:"Alessio",surname:"Vovlas",slug:"alessio-vovlas",fullName:"Alessio Vovlas"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. 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\nGeneration of municipal solid waste, together with the high organic share present in solid waste and its often incorrect discarding, results in extensive ecological pollution, mainly based on the emission of gases that contribute to the greenhouse effect, such as methane (CH4) and carbon dioxide (CO2). Because of this environmental threat, municipal authorities are currently urged to implement techno-economic and political solutions of higher efficiency to manage the growing quantities of municipal solid waste [1].
\nThe lion’s share of municipal (mainly urban) solid waste consists of biodegradable matter, which plays a substantial role in greenhouse gas emissions in today’s cities all around the globe. According to the present state of knowledge, integrated solid waste management is the strategy of choice to manage this issue; such strategies, however, require improvement in order to handle the growing organic fractions of municipal solid discards. If accomplished in a smart manner, this can on the one hand contribute to the aspired reduction of greenhouse gas emissions, and, on the other hand, even potentially generate economic benefits. Hence, systems for sustainable management of municipal solid waste are auspicious and attractive objects of study to assess current consumption behavior in different global regions and to protect the natural environment.
\nGenerally, municipal solid waste gets disposed of in dumps and landfills as the most simple, convenient, inexpensive, and technologically less advanced method. Organic fractions as the major component of municipal solid waste undergo biodegradation under the anaerobic conditions prevailing in landfills, which consequently releases greenhouse gases as mentioned above [2].
\nReduction or complete abolition of environmental contamination becomes increasingly important, which intensifies the global efforts dedicated to develop novel strategies for gradually reducing the quantities of the biodegradable municipal solid wastes in landfills. The process toward reduction of organic pollution involves (i) source separated collection of organic fraction of municipal solid waste, which undergo compost production, (ii) organic waste incineration for energy production, and (iii) mechanical/biological processing to get a compostable material [3].
\nThis introduction chapter makes the reader familiar with the principles of municipal solid waste management, encompassing landfilling and recycling technologies; moreover, the composition of different types of municipal solid waste will be introduced. Based on this, the most feasible, promising, and realistic scenarios for municipal solid waste management are presented in order to provide a solid scientific background of these processes implemented or in development, and the factors needed to assess the sustainability of these processes in a critical and straightforward fashion by using innovative sustainable assessment tools [4].
\n“Municipal solid waste” is commonly understood as the waste accruing in a municipality. Most of this solid waste is generated without any segregation, and, therefore, it may be either harmful or harmless. In general, independent on the origin of municipal solid waste, its impact on the environment and different life forms affects pollution of air, water, and soil. Moreover, impact of municipal solid waste on land use, odors, and esthetic aspects has also accounted for holistic considerations of waste treatment systems.
\nIn principle, the human species is on top of any environmental pollution and consequently constitutes the major factor endangering nature’s biodiversity. Global population growth and increasing consumer demands, especially in strongly growing, emerging, and developing economies, have resulted in a large production increase worldwide. However, most industrial facilities have insufficient or completely lacking monitoring of their production processes in environmental terms, and often insufficient or inadequate facilities for management and treatment of waste. The global trend of rapid urban growth has further caused an increase of waste generation from private habitation sites and private and public service facilities; in addition, intensified construction and demolition activities are ongoing. As urban population density is generally very high all over the world, the daily consumption of goods and services is also high in urban areas. Additionally, the amounts of accruing municipal solid waste are also directly correlating with the economic status of the society in a given country [5].
\nMunicipal solid waste generation
Because of diverse shortcomings such as the lack of waste segregation already at the origin, insufficient treatment, scarce reuse, lacking recycling systems, and often inappropriate disposal, solid waste management still has various gaps in the management chain which need to be filled. Treatment of the organic waste fraction for energy and resource recovery changes its physical and chemical characteristics. In this context, the most important processing techniques encompass composting (aerobic treatment) or bio-methanogenesis (anaerobic treatment in biogas reactors). Composting through aerobic processing produces compost as a stable product, which is broadly utilized as manure and as soil fertilizer and soil conditioner.
\nDue to various reasons, composting facilities are used to a lower extent in large metropolitan cities. Prevalence of unsegregated waste and production of low-quality compost resulting in low end user acceptance are the two most important reasons for this underutilization. Bio-methanogenesis via microbiological activity under anaerobic conditions generates biogas rich in methane as the value component. In general, composting becomes feasible when a given waste contains high moisture and high organic content. Uncontrolled and arbitrary disposal of mixed waste including organic fractions that cause environmental problems such as land pollution and pollution of soil and aquatic environments due to leaching of waste components [7].
\nAn exemplary study assessing a new industrial process for mechanical-biological treatment of municipal solid waste reports that municipal solid waste received for treatment on the plant typically consists of, based on the dry mass, 9% of rejectable waste, 21% of fines (<20 mm) (mainly rejectables), 23% of paper and cardboard, and 15% of diverse plastic materials originating from petrochemistry. Such high content in plastics, paper, and cardboard is typical for the local situation (suburb of Mende, Lozère, France), where municipal solid waste is collected based only on a source separation of glass and complex residual waste, without separately collecting plastic, paper, and cardboards [8].
\nA classification of solid waste sources can be accomplished based on the following assumptions:
All solid waste produced within a municipality’s territory, independent on its physical and chemical nature and source of generation, is classified as “municipal solid waste” (Figure 1).
All economic activities create a given solid waste pattern.
Due to the fact that economic and consumers’ activities cause generation of solid waste, all these activities are considered sources of solid waste [9].
A hypothetical urban municipality and the geographic areas (1. Urban, 2. Industrial, 3. Rural) where solid waste is generated [
Private households, hotels, offices, stores, educational, and other institutions are causes of municipal solid waste generation. The lion’s share of solid waste encompasses organic (mainly food or horticulture) waste, cardboard, paper, plastics and other resins, textile rags, metal, and glass; in many cases, even demolition and construction debris is included in collected waste, in addition to certain quantities of precarious waste, such as batteries, electric light bulbs and fluorescent tubes, automotive parts, expired medicines and other pharmaceutical products, and diverse chemicals, e.g., cleaning and cosmetic products [10]. Hence, the main sources of solid waste are private households and the agricultural, industrial, construction, commercial, and institutional sectors. An assignment of different types of solid waste to their individual sources is shown in Table 1.
\nSource | \nTypical waste generators | \nTypes of solid wastes | \n
---|---|---|
Residential (private sector) | \nSingle and multifamily habitations | \nPaper, cardboard, food wastes, plastics, textile rags, leather, yard waste, glass, lignocelluloses (wood, grass, and lopping), metals, ashes (heating and tobacco products), special wastes (e.g., bulky items, white goods, electronic parts, batteries, car tires, waste oils), and diverse types of precarious household waste | \n
Industrial sector | \nLight and heavy manufacturing companies, fabrication, power and chemical plants, construction sites | \nHousekeeping waste, different packaging materials, food waste, construction and demolition materials, ashes, hazardous waste, and special waste | \n
Commercial sector | \nStores, markets, gastronomy, hotels, office buildings, etc. | \nPaper, cardboard, plastics, wood, food wastes, glass, metals, special wastes, and hazardous waste | \n
Institutional sector | \nSchools, universities, kindergartens, hospitals and other health and medical institutions, penitentiaries, government centers | \nSame as for the commercial sector | \n
Construction and demolition sector | \nNew construction sites, renovation sites, road rehabilitation, demolition of buildings | \nWood, steel, asphalt, cement, insulation materials, dirt, dust, etc. | \n
Municipal services | \nStreet cleaning, parks, landscaping, beaches, groves, playgrounds, sport facilities, other recreational areas, and wastewater treatment plants | \nStreet sweepings, landscape, tree- and bush trimmings, different waste accruing in parks, beaches, riversides, and other recreational area, sludge after flooding events | \n
Processing sector | \nHeavy and light manufacturing, chemical plants, (bio)refineries, power plants, mineral extraction and processing, joinery, and veneer works | \nIndustrial process waste, saw dust, scrap materials, off specification products, slag, and tailings | \n
All of the above should be included as “municipal solid waste” | \n||
Agro-industrial sector | \nFarms, crops, orchards, vineyards, dairies, feedlots, distilleries, rendering and animal processing industry, biodiesel industry, and bioethanol production | \nAgricultural wastes, spoiled food wastes, animal residues (slaughterhouse waste), hazardous wastes (e.g., pesticides, antibiotic residues), and crude glycerol | \n
Sources and types of solid wastes [10].
In parallel to the increase of population and economic activity, solid waste management is turning into a severe issue for almost all municipalities. Public health, odor disturbance, hazardous gas emissions, air pollution, or particulate matter formation are typical phenomena prevailing in urban regions. For smart management, municipal solid waste disposal requires proper environmental monitoring during the entire waste treatment chain from waste collection to its ultimate disposal, and, finally, a regular control of disposal sites is needed [11].
\nTo manage solid waste in an efficient fashion, the interrelationships of four functional elements have to be taken into account before a decision about an ultimate disposal strategy can be made. As reported by Shah [12], the first function element refers to the material generated at the source. Materials to which no more value is added are referred to and disposed as waste; quantity and nature of different types of waste are dependent on the waste source. The second function element encompassed the handling, separation, and storage at site of waste. In this context, waste has to be subjected toward separation before being placed into suitable storage containers. Paper, cardboard, packaging plastics, glass, ferrous metals, aluminum cans, and organic waste are those components, which typically are separated and stored individually. This step is crucial before moving to the next point. During the collection process, solid waste is picked up and placed into empty containers, which have separate compartments for recyclable materials [13]. Subsequently, the refuse collection staff collects the waste around the disposal centers manually before disposing it at the disposal sites. Figure 2 illustrates the individual steps involved from waste material generation at its source until the final functional element for ultimate waste disposal.
\nSchematic of solid waste management system [
A policy for proper waste management needs to be grounded on the principles of sustainable development, which considers the society’s refuse not only as rejects but also as a potential resource, which can undergo upgrading for potential value creation. In urban regions, appropriate solid waste management facilities are essential for, on the one hand, environmental management and protection and, on the other hand, for public health. Strategies and techniques for solving waste problems on a regional scale inevitably have a large number of possible solutions in order to be implemented in different areas, which are characterized by variable population densities, different life standard and life style, number of locations for waste management infrastructure, and number and types of protected landscape areas and other high value ecological sites. Environmentally benign waste management depends on various site-specific factors such as the composition of the waste, efficacy of waste collection at its source and of processing systems required to carry out different waste management techniques, feasibility of value-added material recovery from waste streams, emission standards to which waste management facilities are designed and operated, overall cost efficiency, and social performance of the community [7]. Due to this high complexity, municipal solid waste management has attracted a great deal of attention especially in countries with highly dynamic economic development such as India, a country that produces an estimated quantity of 50–600 million tons of municipal solid waste per year [7].
\nLife cycle assessment (LCA) is a process analytical tool recommended in many EU documents, e.g., the Directive 2008/98/EC on waste and certain other directives. LCA as a tool supports or enables the holistic consideration of the environmental impact of a new product or process already in its infancy, hence, during development [14]. As a quantitative measure, the Sustainable Process Index (SPI) allows to compare in a straightforward way the ecological footprint of products, processes, and systems based on the area required for completely embedding a process/system into the ecosphere [15]. Hence, LCA is a well-established tool, which nowadays is widely used to assess the environmental impact of product life cycles (“cradle-to-gate” or “cradle-to-grave”; the first refers only to production until the product leaving the factory’s gate, while latter involves also the waste disposal after a product’s life span), new technological processes, as well as waste management systems including waste treatment and processes for disposal, recycling, composting, or waste conversion for energy generation (biogas, thermal conversion in cogeneration plants). The evaluation of the existing situation of municipal solid waste management from an environmental, economic, and social perspective via a life cycle approach is an important first step prior to taking any decisions on the technologies to be selected, the policies to be developed, and the strategies to be followed for a nation [16].
\nThe considerable number of reported LCA computer models dedicated to municipal solid waste management, often resorting to the SPI quantification tool, emphasizes the applicability of LCA in issues related to municipal solid waste management systems. Typically, these models have been developed independently from each other and are often based on features and assumptions that are highly specific to the period, economic framework, and geographical conditions in which they were developed. This clearly emphasizes that the assessment of feasibility of a given solid waste management systems needs to be in accordance to the individually prevailing conditions in a specific city or region.
\nBecause of its low incidence, the risk of patient exposure to ionizing radiation is often underestimated—and underappreciated—as a patient safety (PS) threat across various healthcare settings. Consequently, the Joint Commission mandates that hospitals prepare for managing radiation-related risks in terms of protecting patients from unnecessary exposure, limiting any associated potential damage, monitoring the types and extent of radiation, and maintaining proficiency in decontamination procedures in cases of direct radioactive isotope contact [1, 2]. In terms of everyday healthcare facility functioning, there is a dual focus to ensure that radiation safety standards are met: (a) avoidance of unnecessary exposure including improper dosing and (b) assurance that radioactive material will be properly handled and disposed [2].
\nRegardless of the details or the mode of delivery, the intent of the treating team should always be the reduction in both short- and long-term radiation exposures [3]. It has been recommended by different organizations and authors that radiation exposure reduction (RER) efforts encompass both pre-procedural and procedural phases of treatment [4, 5]. The use of radiation for diagnostic or therapeutic indications (RDTI) has clear benefits when appropriately directed and supervised. However, serious errors, prolonged or repeated exposures, and lack of supervision can be associated with significant adverse consequences, including the risk of acute radiation sickness, malignancy, and death [6, 7, 8, 9, 10]. Table 1 [top section] lists the approximate incidence of adverse effects at various levels of radiation exposure (measured in Rads). In addition, comparative descriptions of alternative radiation units of measure are provided for the reader in the lower section of Table 1. The latter measure is intended to reduce the confusion often encountered due to multiple naming conventions in this area of science.
\nSide effect | \nFrequency | \nMinimum exposure amount (Rads) | \n
---|---|---|
Hyperpigmentation/erythema | \n>50% | \n50–200 | \n
Mild fatigue | \n>50% | \n50–200 | \n
Mild myelosuppression | \n>50% | \n50–200 | \n
Skin desquamation | \n<10% | \n100 | \n
Mild nausea/vomiting/diarrhea | \n<10% | \n100–400 | \n
Intractable vomiting/diarrhea | \n90% | \n>400 | \n
Comparison of alternative units of measure | \nConversion factor | \n
---|---|
1 Rad | \n0.01 Joule/kg; 0.01 Gray; 0.01 Sv | \n
1 Millirad | \n0.00001 Joule/kg; 0.00001 Gray; 0.00001 Sv | \n
1 Milligray; 1 Centigray; 1 Decigray; 1 Dekagray | \n0.1; 1; 10; 1000 Rads, etc. (respectively) | \n
1 Coulomb/kg | \n3876 Roentgen; 3875 Parker; 3875 Rep | \n
1 Millicoulomb/kg | \n3.876 Roentgen* | \n
1 Microcoulomb/kg | \n0.003876 Roentgen* | \n
1 Tissue Roentgen | \n1 Roentgen | \n
Approximate incidence of adverse effect at different radiation exposures measured in Rads.
kg = kilogram; Sv = Sievert; * = same applies for Parker and Rep units.
An important distinction must be made between radiation exposure and radioactive contamination. Radiation exposure refers to a person receiving energy in the form of waves or particles from an external source or from internal contamination [9, 10]. To prevent harm to the patient, the duration of exposure is carefully controlled. To prevent harm to the radiology technician, distance and shielding from source are employed [11, 12]. In contrast, a contaminated person has radioactive material on (or inside) the body secondary to ingestion, inhalation or deposition on the body surface. Thus, contamination can be classified as internal or external. Most patients exposed to radiation are not contaminated [13]. Radiation can be measured in SI unit Gray (Gy), which represents the absorption of one joule of radiation energy per kilogram of matter. In order to reflect the degree of radioactive contamination in human tissue, the unit of Sievert (Sv) us usually employed. The following clinical vignettes will illustrate both radiation exposure (#1) and contamination (#2 and #3). For the purposes of our chapter, the reader should be familiar with the three general types of radiation, including the associated energetic characteristics and shielding capacity (Table 2). In addition, various levels of radiation exposure (measured in millisieverts) including the typical associated contextual settings are shown in Figure 1.
\nType of radiation | \nPenetrating energy | \nPenetrating capacity in human body | \nShielding capacity | \n
---|---|---|---|
Alpha (α) | \nLow | \nEpidermis | \nDissipates in air | \n
Beta (β) | \nIntermediate | \nSoft tissue | \nSheet of paper | \n
Gamma (γ) | \nHigh | \nBones and organs | \nLead | \n
Types of ionizing radiation, with corresponding levels of penetration and preferred shielding characteristics.
Different levels of radiation exposure, measured in millisieverts (mSv) and the associated biological manifestations.
Over a period of months, numerous patients who underwent computed tomography (CT) perfusion scans of the brain at different hospitals across a wide geographic area reported vague complaints of oddly shaped patterns of unexpected hair loss. Reportedly, the mostly band-like areas of alopecia appeared within 1–2 weeks following each patient’s CT study. Some patients began complaining of new onset memory loss and/or difficulty keeping balance while walking. Given the unusual pattern of clinical signs and symptoms, as well as the isolated nature of occurrences, it took months before the connection was made between CT perfusion scans and what turned out to be significant radiation overdoses. When the true scope of the problem became evident, hundreds of patients were identified as having received approximately eight times the expected levels of radiation. It appeared that the root cause for the above occurrences may be faulty programming of CT scanner devices. A nationwide statement of caution was issued by the FDA, urging hospitals across the US to review institutional CT scan logs to check radiation dosage levels and data regarding applicable adherence to established dosing protocols [14, 15]. In response to the above events, the first state law in the US aimed at protecting patients from excessive radiation exposure during CT scans was signed into law by Gov. Arnold Schwarzenegger of California [16]. In addition to providing an accreditation mandate for CT scanners, the bill also requires that radiation dose be recorded on the scanned image in a patient’s medical record, and that radiation overdoses be reported to patients, treating physicians, and the state Department of Public Health [16].
\nIn 1987, improperly abandoned hospital radiation equipment in Goiania, Brazil, led to the contamination of a large number of people. During the post-incident review, it was discovered that an unused irradiation machine was left behind when a privately owned healthcare facility moved. The device was subsequently stolen by a group of young men who sold it to a scrap metal dealer. During the disassembly of the medical equipment, a broken capsule of the highly radioactive cesium-137 was accidentally smashed, along with its lead enclosure, liberating “shiny bluish dust which glowed in the dark” [17]. Unaware of the danger, numerous individuals associated with the scrap metal yard owner came into contact with the radioactive powder. The most seriously affected victims developed alopecia, cutaneous burns, vomiting and diarrhea. The governmental response was slow at first, due mainly to the lack of recognition of the magnitude and the urgency of the situation. Experts from the Soviet Union and the US were involved in the subsequent management and containment of the radioactive risk. The incident was thought to be the most serious of its kind at the time, with 240 documented cases of contamination, 20 hospitalizations, and 4 fatalities [17, 18].
\nIn 1992, an unexpected discovery of radioactive waste was made by a regional disposal company in Indiana, Pennsylvania [9, 19]. Subsequent investigation by the US National Regulatory Commission (NRC) found that in November of 1992, a local clinic in Indiana, Pennsylvania treated a patient with high-dose brachytherapy using an iridium-192 radioactive source [20]. It was determined that the treatment was not completed due to equipment-related issues. Unknown to the operators, the source wire became fractured and remained in the patient. Investigators discovered that the required radiation survey at the end of the treatment was not performed. The patient was discharged to a nursing home and died 5 days later. Unaware of the danger, nursing home staff removed the source-containing catheter and disposed of it as biohazardous waste [9]. The source was identified during routine radiation surveillance by the waste disposal company. In addition to being a contributor to the index patient’s death, more than 90 individuals may have been exposed to the radioactive material, with doses ranging from <0.05 to >2.55 rem [20].
\nDifficult to identify at the time of the initial exposure, radiation injury tends to present in a delayed fashion. Radiation injury also tends to be low on a typical differential diagnosis list as most cases tend to involve unintentional (and unrecognized) exposure. As demonstrated by our three vignettes, the uncommon occurrence of harmful medical radiation exposure (HMRE) can originate as a result of various types of PS error; both of omission and of commission [21]. In addition, radiation-related PS issues can result from lack of adequate oversight at both institutional level (e.g., absent safety procedures) and governmental level (e.g., lack of applicable laws, regulations, or enforcement) [9, 22, 23].
\nComplexities associated with HMRE prompted an important discussion regarding the nature and the content of the informed consent process, specifically as it relates to medical radiation exposure [24]. The true gravity of such considerations is exemplified by the known association between cumulative radiation exposure and the incremental risk of malignancy following repeated CT imaging episodes [25]. Moreover, compared to the adult population, the overall risk is significantly greater for pediatric patients [26].
\nTwo broad categories of clinical (e.g., biologic) effects of radiation, specific to the contexts of radiation therapy or accidental isotope exposure, include deterministic injuries and stochastic injuries. Deterministic injuries manifest as radiation-induced escalation of normal physiologic apoptosis resulting in increased death of essential cells with resultant tissue and organ dysfunction [27]. These types of injuries occur when large numbers of cells become damaged and, as a result, die immediately or shortly after irradiation [28]. Dermatoligic post-exposure injury can range from “local erythema” to “skin necrosis” [28]. Estimation of dosage is measured in the units of Gy, with 0–2 Gy associated with no biological effects; 2–5 Gy causing transient erythema (<2 weeks), followed by epilation (2–8 weeks) and recovery (6–52 weeks); 5–10 Gy associated with prolonged erythema (up to 8 weeks), epilation (2–8 weeks), and recovery (6–52 weeks); 10–15 Gy exposure causes transient erythema (<2 weeks), dry/moist desquamation (2–8 weeks), followed by permanent epilation (6–52 weeks) and finally atrophy (>40 weeks); and >15 Gy being associated with acute ulceration (<2 weeks), moist desquamation (2–8 weeks), dermal necrosis (6–52 weeks), and eventual surgery (>40 weeks) [28]. Table 3 outlines the above exposure levels in a systematized fashion.
\nRadiation dose (Gy) | \nPossible adverse reaction | \nTimeline | \n
---|---|---|
0–2 | \nNo effect | \n\n |
2–5 | \nTransient erythema | \n<2 weeks | \n
5–10 | \nProlonged erythema | \n<8 weeks | \n
10–15 | \nDry/moist desquamation leading to permanent epilation | \n2–8 weeks → 6–52 weeks | \n
>15 | \nAcute ulceration leading to desquamation and dermal necrosis | \n<2 weeks → 6–52 weeks | \n
Post-exposure deterministic injury shown with radiation dose in Gray units and the typical timeline associated with the appearance of adverse effects.
Stochastic effects manifest as cellular carcinogenesis and result from radiation induced mutations in genetic material of cells including germ cells [27]. For stochastic injuries, post-radiation damage becomes the key determinant of clinically apparent, usually long-term manifestation [28]. Such effects also depend on the type/activity of the isotope involved. More specifically, these kinds of injuries have a linear nonthreshold dose that may lead to radiation-induced malignancy and/or heritable genetic defects [28]. Estimation of dosage from radiologic studies utilizes the units of Sieverts (Sv), with procedures such as dual-isotope SPECT (24 mSv) and CT angiography (19 mSv), carrying the highest effective radiation doses [28]. Of note, victims of the Chernobyl disaster were exposed to a maximum radioactivity of 300–450 mSv/h within a 15 km radius. The individuals that had suffered from radiation are suspected to have received a minimum of 0.8–2 Gy (80–200 Rad) dose [28].
\nThe first line of ensuring safety is the presence of organizational policies and procedures pertaining to HMRE as well as the handling of radioisotope-containing medical materials, both at the departmental and institutional levels [29, 30, 31]. In addition to applicable policies and procedures that are harmonized to prevailing laws and regulations, organizations also employ radiation safety experts in the role of Radiation Safety Officer (or functional equivalent thereof) to ensure the maintenance of appropriate legal and procedural compliance [31, 32, 33]. Any HMRE events that are deemed reportable to appropriate local, regional, or national authorities are handled by the Radiation Safety Officer. In addition, employees who work around radiation equipment and/or interact with medical radioisotopes must wear radiation monitoring badges that help quantify levels of healthcare worker exposure [34, 35]. Some general considerations of how appropriate policies and procedures can help protect the well-being of both patients and healthcare workers include [7, 32, 36, 37, 38]:
In diagnostic radiography, the use of hardwired “safety prompts” helps facilitate double-checking of the expected radiation dosage; also, it is important to ensure the presence of appropriate warning lights, such as “X-ray in progress” and sufficiently labeled facilities with caution signs
Ensuring that the delivery process of therapeutic radiation is appropriately structured, including thorough planning, simulated application, and the presence of built-in cross-checks (e.g., two or more experts sign-off on the final therapeutic plan, including the physician, the physicist, and a dosimetrist)
Monitoring of cumulative monthly radiation exposure and limiting further exposure for those employees who exceeded established thresholds
Protocolized monitoring of medical waste for the presence of radioactivity, both at the site of origin (e.g., the hospital) and at the destination (e.g., landfill)
In the European Union and associated countries, the Euratom Treaty recommends that a patient examination and clinical justification are provided before a referral is made to a radiologist or a nuclear medicine expert. Moreover, nonionizing radiation is preferred whenever it will provide comparable information to that obtained by means of ionizing radiation [39]. For example, an ultrasound or magnetic resonance imaging (MRI) may provide the same desired information as a CT, without the need for ionizing radiation [40]. Additional safety enforcement strategies include: safety checklists to verify the patient and study being performed; radiation dose customization utilizing the patient’s weight, age, medical history, and intended body segment to be scanned/imaged; and decision support systems which provide ordering physicians an opportunity to answer questions regarding their patients and consider alternatives to ionizing diagnostics [40].
\nThe US Food and Drug Administration (FDA) has partnered with other organizations to promote education and communication regarding radiation safety to patients and medical professionals [41]. Among their resources, the FDA collaborated with the National Council on Radiation Protection and Measurement to communicate the risk of radiation exposure with patients, particularly imaging involving young children [41, 42]. The FDA advocates for patient and healthcare provider awareness via the Image Wisely and Image Gently radiation risk campaigns, as well as with the International Atomic Energy Agency’s “Radiation Protection of Patients” website [41, 43, 44]. The FDA has also advocated for patient and healthcare provider tools to reduce radiation exposure. One particular innovative safety tool is the “Patient Medical Imaging Record Card”, which was developed by the FDA in collaboration with Image Wisely [41, 43]. The card can be used to track patient imaging studies by date, type, and location to prevent unnecessary repeat ionizing radiation exposures [41]. Looking toward the future, this card would ideally be integrated into the patient’s electronic health record and stored in a nationally accessible database for healthcare providers, such as the Federal Data service Hub, which is established by the Affordable Care Act and backed by the Health and Human Services department [45].
\nThe US Nuclear Regulatory Commission was established with The Energy Reorganization Act of 1974 to license and regulate the civilian use of radioactive materials to protect public health and safety and the environment. It is in charge of overseeing nuclear reactors, security, and materials as well as radioactive waste. The commission sets rules and licensing, enforces those rules, evaluates facilities, and provides support and logistics for incident response. Some aspects of management and regulation of certain radioactive materials have been granted to Agreement States [46].
\nAlthough most individuals exposed to radiation contamination are not symptomatic, the consequences of such exposures tend to result in long-term sequelae [47, 48, 49, 50]. Providers should be aware of signs and symptoms of radiation injury so that such occurrences can be readily recognized, contained, and victims treated promptly [51, 52]. As demonstrated in our
Acute radiation syndrome (ARaS), unlike radiation injury, is a systemic entity that occurs very rarely in the healthcare setting. It usually involves some form of equipment failure, radioactive isotope release, criminal activity/theft, or inappropriate disposal of equipment or isotope(s) [9, 18, 19, 20, 55]. Because ARaS may be the only overt “manifestation” of a major radioactive breach, it is critical that it is promptly recognized, and that it leads to a thorough investigation into associated events. Symptoms of ARaS evolve over time in distinct phases. The duration of each phase and the time of its onset will be approximately inversely proportional to the dose [56]. An initial prodromal phase, with symptoms such as nausea, vomiting, weakness, and fatigue, typically develops within hours to days after exposure of the whole body to radiation exceeding 0.7 Gray (Gy). ARaS manifests most acutely and severely in the hematopoietic, gastrointestinal, and cardiovascular/neurovascular systems [27, 57]. Radiation-induced gastrointestinal manifestations of ARaS manifest as nausea, vomiting, and bloody diarrhea. Severe dermatological injury with burns, desquamation, epilation, and ulceration can occur after significant radiation exposure even in the absence of ARaS [58], as exemplified by our
Syndrome | \nHematopoietic | \nGastrointestinal | \nCardiovascular/neurovascular | \n
---|---|---|---|
Dose | \n>0.3–0.7 Gy | \n>6–10 Gy | \n>20–50 Gy | \n
Prodromal stage (minutes—2 days) | \nAnorexia, nausea/vomiting | \nAnorexia, severe nausea, vomiting, cramps, and diarrhea | \nExtreme nervousness and confusion, severe nausea, vomiting, watery diarrhea, loss of consciousness and burning sensation of the skin | \n
Latent stage | \nPatient appears well for 1–6 weeks | \nPatient appears and feels well for less than a week | \nPatient may return to partial functionality (often lasts less than several hours) | \n
Manifest illness stage | \nAnorexia, fever, and malaise Drop in all blood cell counts Primary cause of death is infection and hemorrhage Most deaths within a few months Survival rate is inversely proportional to dose | \nMalaise, anorexia, severe diarrhea, fever, dehydration, and electrolyte imbalance Death occurs within 2 weeks after exposure | \nWatery diarrhea, convulsions, and coma Onset occurs 5–6 hours after exposure Death occurs within 3 days of exposure | \n
Recovery | \nFull recovery for large percentage of patients from a few weeks to 2 years after exposure Death may occur in some individuals at 1.2 Gy The LD50/60 is 2.5 to 5 Gy | \nThe LD100 is about 10 Gy | \nNo recovery expected | \n
Acute radiation syndrome: most common manifestations [13].
The general principles of protection from radiation injury depend upon four factors: distance, time, shielding, and removal or containment of contamination [27]. When caring for potential radiation contaminated patients, healthcare personnel must minimize the duration of exposure to a source, maximize the distance from source, and establish effective shielding from the source. Identification of the presence of radioactive contamination on or within a patient mandates early removal/containment in order to forestall further damage and contamination [27]. In cases similar to the Goiania incident, hand-held Geiger counters must be utilized in order to focus on accurately identifying anatomic areas of contamination unique to each individual [1]. Substantial exposure of emergency responders and clinicians caring for potentially heavily contaminated patients may occur. Emergency medical services and clinicians must use caution and adhere to strict precautions for managing hazardous materials to prevent inadvertent contamination of themselves and others [27]. Personnel should wear radiation dosimeters, sealed in clear, airtight plastic bags, and worn outside the clothing to allow rapid assessment and early detection of contamination. Workers and work areas should undergo repeated surveillance with radiation detectors at appropriate intervals [1, 27].
\nIn cases of more significant exposure, ARaS manifests initially through the hematopoietic system as blood marrow tissues are highly radiosensitive [27]. Of all the components of hematopoiesis, circulating lymphocytes have the most radiosensitive cell lines and provides a useful laboratory tool to screen for the severity of the radiation sickness early in observation (Figure 2) [56]. After whole body exposure above 0.5 Gy, the rapid fall in lymphocyte number starts within hours, and the lymphocyte depletion is proportional to the dose between 1 and 10 Gy [56]. GM-CSF may be helpful for the recovery of the bone marrow function after clinically significant radiation exposure [57]. Lymphocyte depletion kinetics serves as the single best estimator of radiation exposure and clinical outcome [27]. A decrease in absolute lymphocyte levels may be observed at whole-body doses as low as 100 mSv, but clinically significant response may not be seen below 1–2 Sv. Depending on the absorbed dose, such changes can begin within hours of exposure, so it is recommended that an immediate complete blood count with differential is performed as a baseline and then every 6–12 hours thereafter for 2–3 days [27]. An elevated serum amylase provides a supplementary piece of information that may also be an early sign of serious radiation exposure involving the head and neck. The results of this test are nonspecific; however, and they may also reflect alcohol intake, a stress response, trauma to the face or abdomen, or other factors [27]. In addition, the presence of nausea and vomiting within several (usually around 4) hours of exposure may also be diagnostically helpful.
\nTime-dependent lymphocyte depletion kinetics following either severe or moderate radiation exposures. As early as 6–12 hours following exposure, there may be some indication of the severity of the exposure [
Similar to other toxicological phenomena, determining the potential harm of radiation exposure mandates consideration of three factors: dose of radiation exposure, tissue or surface area exposed, and duration of exposure. Whole body radiation exposure to 4 or 5 Sv (or Gy) imparts potentially lethal effects, while an extremity can tolerate several times that exposure [27]. General measures of radiation exposure (e.g., fluoroscopy time) have low utility and accuracy [28]. At this juncture, it is important to introduce the concept of KERMA, or “Kinetic Energy Released in Matter”, which is a measure of energy delivered (or dose) [28]. Air-KERMA is the KERMA measured in air (e.g., low scatter environment) [28]. More useful methods of determining radiation administered include: (a) total air-KERMA (exposure) at pre-specified reference point, (b) air-KERMA area product, and (c) peak skin dose or the maximum dose received by any local area of patient skin [28, 59]. See Figures 3
Timeline for post exposure injury for dosage of 2–5 Gy.
Timeline for post exposure injury for dosage of 10–15 Gy.
Timeline for post exposure injury for dosage >15 Gy.
A point of concern among care providers and parents is the risk of radiation exposure from medical imaging, especially in the pediatric population. Epidemiologic studies have shown that
Relative radiation level | \nAdult effective dose estimate range (mSv) | \nPediatric effective dose estimate range (mSv) | \nExample examinations | \n
---|---|---|---|
O | \n0 | \n0 | \nUltrasound; MRI | \n
☢ | \n<0.1 | \n<0.03 | \nChest X-ray; hand X-rays | \n
☢☢ | \n0.1–1 | \n0.03–0.3 | \nPelvis X-ray; mammography | \n
☢☢☢ | \n1–10 | \n0.3–3 | \nAbdomen CT; nuclear medicine bone scan | \n
☢☢☢☢ | \n10–30 | \n3–10 | \nAbdomen CT with and without contrast; whole body PET | \n
☢☢☢☢☢ | \n30–100 | \n10–30 | \nCTA chest abdomen pelvis with contrast; transjugular intrahepatic portosystemic shunt placement | \n
Relative radiation level designations along with associated effective adult and pediatric doses, as well as imaging examinations that correspond to said levels [65].
A typical CT scan of the head of a child carries an average dose of 2–2.5 millisieverts (mSv) of radiation. CT imaging of the chest and abdomen carries doses averaging 3–4 and 5–6 mSv, respectively. The actual dose administered differs from the more nebulous effective dose, as other factors make the amount of radiation exposure more meaningful in children than adults. The effective radiation doses received by children are about 50% higher than those received by adults for similar imaging studies due to smaller body sizes and radiation attenuation [66, 67]. Up to an age of 10, children are approximately three times more sensitive to radiation than adults, which is why longer life expectancy coupled with organ systems that are still developing disproportionately increases the relative burden of pediatric radiation exposure [67, 68, 69].
\nSeveral studies have attempted to answer questions regarding specific childhood cancer risks associated with radiation exposure. Two studies showed increased incidence of pediatric leukemia in children with medical radiation exposure; however, these studies used retrospective questionnaire data and their result as inconsistent with older data [70, 71]. Certain genetic phenotypes might make some children more sensitive to the effects of radiation and risk of acute lymphocytic leukemia [72]. Very limited data exist on CT-attributable risk of solid tumors in children. There is weak evidence regarding the association between radiation exposure and such occurrences (e.g., pediatric astrocytoma and Ewing’s sarcoma), but this connection is in no way definitive [60].
\nData regarding the lifetime risk of cancers appear to be more robust. A large retrospective cohort study reviewed >175,000 patients from the NHS registry in England [26]. The authors noted a positive association between dose of radiation from CT imaging and leukemia and brain tumors. They found relative risk of leukemia to be 3.18 in patients who received more than 30 mSv of cumulative radiation. Similarly, they found an increased relative risk of brain cancer to be 2.82 in pediatric patients who received cumulative dosing of 50 mSv or more [26]. The caveat to these data, however, is that these are rare cancers to begin with, thus the absolute relative risk increase is very small. Although the relative risk of brain cancer may nearly triple with significant cumulative radiation exposure, the absolute risk is still exceedingly small. Based on robust statistical models, for every 100,000 skull/brain CT scans in 5-year-old children, eight brain/central nervous system cancers and four cases of leukemia would result [73]. The same study estimates that 100,000 chest CT scans would lead to an excess of 31 thyroid cancers, 55 breast malignancies, and 1 leukemia case [73]. Consequently, the lifetime risk of cancers, although small, should be discussed with parents of children undergoing CT scanning. Although these studies are largely safe in children, unnecessary exposure to radiation should still be avoided, and diagnostic tests not utilizing ionizing radiation should be used whenever possible. The medical necessity of imaging should be weighed against the relatively small risk of harm when determining the appropriateness of these studies. Again, the greatest risk of cancer appears to exist when children are exposed to cumulative doses of radiation greater than 30–50 mSv.
\nAccording to the American College of Radiology, no single diagnostic X-ray study or procedure results in radiation exposure sufficient to threaten the well-being of the pregnant patient, the developing embryo, or the fetus [74]. In fact, diagnostic radiation exposures during pregnancy may be safer than the frequent concerns over
Literature suggesting that accrual of cumulative radiation exposures from diagnostic radiological studies, such as CT scans or fluoroscopy, over the course of patients’ lifetimes puts them at risk for the potential carcinogenic risks of radiation [83, 84]. One example here comes from the area of endovascular interventional procedures. Since the introduction of endovascular therapy in the late 1980s, there has been incredible growth in this group of procedural modalities. In fact, endovascular procedures have increased approximately 400% over the past decade [85]. The applicability and medical advancements of this form of therapy have revolutionized treatment of our patients. However, there has been an associated cost, including substantial risk of ionizing radiation exposure [86]. Some of the pioneers of endovascular therapy have succumbed to the deleterious consequence of ionizing radiation [87]. Radiation safety practices have made tremendous advances since the discovery of Roentgen’s X-rays over 120 years ago. Early practitioners were focused on patient outcomes and providing minimally invasive methods to treat complex disease processes. These sacrifices of early practitioners led to our awareness and knowledge that now allows us to perform truly remarkable treatments to benefit our patients. A number of very practical steps can be taken to reduce radiation exposure to patients, operators, and staff [88, 89]. Awareness itself can be an effective first step in reducing exposure. Once awareness of the problem exists, we can then work to educate and enact training and methodology to achieve maximal safety to our patients and ourselves. However, despite the available data, there remains a significant safety deficit. In 2014, a survey of US vascular surgery trainees found 45% had no formal radiation safety training, 74% were unaware of the radiation safety policy for pregnant females, 48% did not know their radiation safety officer’s contact information, and 43% were unaware of the acceptable yearly levels of radiation exposure [90]. However, an important observation was that the trainees who felt their attendings were applying ALARA techniques were much more likely to do so themselves. Therefore, it is incumbent on those of us providing training to the next generation of caregivers to set an example of excellence and expect the same from our trainees. Only by expecting excellence can we hope to achieve superior safety for our patients and ourselves.
\nAdvocates for radiation safety recommend exposing patients, especially children, to as little radiation as possible. This is embodied within the concept of “as low as reasonably achievable” (ALARA) in the context of radiation exposure [84]. As such, ALARA addresses the role for healthcare providers, particularly those caring for children, in reducing exposure to radiation while maintaining the reliability of the diagnostic radiology modality [91]. Multiple methods can be used to achieve ALARA including: adjusting the amount of radiation in the diagnostic study based on patient weight, considering alternative modalities such as sonography or magnetic resonance imaging, enhancing shielding with thyroid or breast shields, focusing on the suspicious area with focused or limited view diagnostic imaging, and discouraging repeat CT scan studies [91]. In one example, although noninvasive multi-slice cardiac-computed tomography angiography (CCTA) can accurately screen for coronary ischemia, its widespread utilization has generated concern because of potential diagnostic radiation exposure. Utilization of a radiation dose reduction program in concert with limiting the image acquisition window for CCTA has demonstrated marked reduction, more than 50%, in estimated radiation doses in a statewide registry without impairment of image quality [83]. In another example, appendicitis represents the most common disease process resulting in increased CT scan utilization in children over the last two decades. Clinical practice guidelines advocating for “abdominal sonography first” for the evaluation of appendicitis have demonstrated comparable diagnostic accuracy to CT scan imaging, while reducing CT scan utilization and thus radiation exposure [91]. The Pediatric Emergency Care Applied Research Network collaborative development of a clinical decision guideline for pediatric head trauma is another example of research helping to reduce the medical radiation footprint by reliably identifying patients at low risk for clinically important traumatic brain injuries, for whom CT can routinely be obviated [92].
\nCareful adherence to existing PS protocols, including active surveillance for any signs and/or symptoms of HMRE, is among the most important considerations for facilities/departments providing diagnostic and/or therapeutic radiation services [28]. In addition to direct radiation, the formation of X-ray image is inherently associated with some degree of “scattered radiation” that is the principal source of exposure to the patient and medical staff [28]. This “scatter” increases with both intensity of the X-ray beam and the size of the exposed field [28]. Any hospital employing medical radiation needs to have an infrastructure to support protocols for every step of the way throughout the application of said radiation including patient and healthcare worker safety, proper identification and dosing, and waste management of materials in order to prevent contamination.
\nThe power to harness ionizing radiation for medical uses has a history spanning more than a century. Although its positive impact on the modern-day prowess of the diagnostician is unquestionable, great care must be taken in order to not abuse this technology. Diagnostic imaging with ionizing radiation seems poised to be part of the medical armamentarium for the foreseeable future. Further research is required in all aspects of this field, including more efficient protocols for delivery, custom-tailoring therapy which takes into account the patients’ makeup, potential short-term and long-term harmful effects, the prediction and prevention of harm and better safeguards for dosimetry not only for patients but also for healthcare workers. Greater strides must be achieved in the realm of oversight and standardization of practice, as well as a comprehensive, nonpunitive reporting system for adverse events. A multidisciplinary approach from health physicists, radiation safety personnel, and clinicians is paramount for the management of contamination events and for the safe and accurate use of both diagnostic and therapeutic medical radiation. The key for this technology going forward is for education to be widespread among all levels of healthcare, from patients and their families to healthcare providers and policy makers. Research and public health information dissemination will go hand-in-hand throughout the next century of medical radiation use.
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Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:{name:"Medical University Plovdiv",country:{name:"Bulgaria"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. 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Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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