BackgroundConsiderable effort has been expended on tobacco control strategies in the United States since the mid-1950s. However, we have little quantitative information on how changes in smoking behaviors have impacted lung cancer mortality. We quantified the cumulative impact of changes in smoking behaviors that started in the mid-1950s on lung cancer mortality in the United States over the period 1975–2000.MethodsA consortium of six groups of investigators used common inputs consisting of simulated cohort-wise smoking histories for the birth cohorts of 1890 through 1970 and independent models to estimate the number of US lung cancer deaths averted during 1975–2000 as a result of changes in smoking behavior that began in the mid-1950s. We also estimated the number of deaths that could have been averted had tobacco control been completely effective in eliminating smoking after the Surgeon General’s first report on Smoking and Health in 1964.ResultsApproximately 795 851 US lung cancer deaths were averted during the period 1975–2000: 552 574 among men and 243 277 among women. In the year 2000 alone, approximately 70 218 lung cancer deaths were averted: 44 135 among men and 26 083 among women. However, these numbers are estimated to represent approximately 32% of lung cancer deaths that could have potentially been averted during the period 1975–2000, 38% of the lung cancer deaths that could have been averted in 1991–2000, and 44% of lung cancer deaths that could have been averted in 2000.ConclusionsOur results reflect the cumulative impact of changes in smoking behavior since the 1950s. Despite a large impact of changing smoking behaviors on lung cancer deaths, lung cancer remains a major public health problem. Continued efforts at tobacco control are critical to further reduce the burden of this disease.

Fluoroscopy guided interventions, such as transjugular intrahepatic portosystemic shunt (TIPS) procedures, can results in relatively high radiation doses to patients and staff. The purpose of this study was to evaluate the possible benefit of dedicated fluoroscopy exposure factors in the reduction of doses. Doses to patients and staff were measured during fluoroscopy-guided TIPS procedures in two Dutch university hospitals. Patient doses were calculated from dose-area product (DAP) measurements, entrance beam dimensions and DAP conversion factors. Staff doses were measured outside lead aprons using electronic personal dosemeters. Average patient entrance skin dose (ESD) rate during fluoroscopy was 49 mGy min-1 (13 cases, average fluoroscopy duration 32 min) in one hospital, and 6 mGy min-1 (10 cases, average fluoroscopy duration 50 min) in the other. Estimated staff effective dose per procedure was 28 microSv average in the first hospital compared with 4 microSv average in the other. The use of dedicated fluoroscopy exposure factors, with a relatively high tube voltage and lower tube current resulted in a significant dose reduction for patient and staff in this type of radiological intervention.

Performance on the Rey‐Auditory Verbal Learning (R‐AVL) and Rey‐Osterrieth Complex Figure Design (R‐O CFD) tests was examined in patients (N = 94) with dementia of the Alzheimer's type (DAT) and closed head injury (CHI). On the R‐AVL, DAT patients demonstrated considerably greater impairment than CHI patients, along with a flat learning/retention curve that showed negligible improvement with repeated trials, recency effects only, and an excessive number of word intrusions (confabulation) on the recognition trial. CHI patients demonstrated both a recency and primacy effect along with improvement over repeated trials (positive slope learning curve). Both groups demonstrated impairment R‐O CFD recall; the DAT group again displayed substantially greater copying and recall deficits. Clinical guidelines are given for the use of the R‐AVL and R‐O CFD for these two patient populations.

Effective dose is an important quantity in relation to assessment of radiation risk. Organ and effective doses to paediatric patients undergoing diagnostic and therapeutic heart catheterization procedures can be assessed by combining relatively simple measurements, e.g. of dose-area product (DAP), and calculated dose conversion factors (DCF). This also holds for the radiation dose to the hospital staff, e.g. the cardiologist. Monte Carlo (MC) simulation of radiation transport in mathematical anthropomorphic phantoms is used to obtain the DCFs, which strongly depend on beam quality and geometrical parameters. The performance of a dedicated fast MC code (PCXMC) for patient dosimetry is compared with that of a more elaborate general purpose MC code (MCNP). Resulting organ doses sometimes may differ considerably, partly due to phantom differences. While MCNP uses separate male and female mathematical phantoms, PCXMC uses a hermaphrodite. However, both codes yield effective doses that agree rather well, so PCXMC can be used for convenience. The MCNP code is used to calculate the effective dose to the cardiologist exposed to radiation scattered from the patient. Without protective clothing, effective dose per procedure to the cardiologist is at least two orders of magnitude lower than that to the patient. The effectiveness of various types and thickness of protective clothing has been evaluated for one view of one cardiac catheterization. The results of the calculations do not contradict experimental studies from the literature. MC simulation may serve as a useful tool to improve the accuracy of estimating occupational effective dose from personal dose monitors.

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