Search

Abstract Background The clinical translation of positron emission tomography (PET) radiotracers for cancer management presents complex challenges. We have developed consensus-based recommendations for preclinical and clinical assessment of novel and established radiotracers, applied to image different cancer types, to improve the standardisation of translational methodologies and accelerate clinical implementation. Methods A consensus process was developed using the RAND/UCLA Appropriateness Method (RAM) to gather insights from a multidisciplinary panel of 38 key stakeholders on the appropriateness of preclinical and clinical methodologies and stakeholder engagement for PET radiotracer translation. Panellists independently completed a consensus survey of 57 questions, rating each on a 9-point Likert scale. Subsequently, panellists attended a consensus meeting to discuss survey outcomes and readjust scores independently if desired. Survey items with median scores ≥ 7 were considered ‘required/appropriate’, ≤ 3 ‘not required/inappropriate’, and 4–6 indicated ‘uncertainty remained’. Consensus was determined as ~ 70% participant agreement on whether the item was ‘required/appropriate’ or ‘not required/not appropriate’. Results Consensus was achieved for 38 of 57 (67%) survey questions related to preclinical and clinical methodologies, and stakeholder engagement. For evaluating established radiotracers in new cancer types, in vitro and preclinical studies were considered unnecessary, clinical pharmacokinetic studies were considered appropriate, and clinical dosimetry and biodistribution studies were considered unnecessary, if sufficient previous data existed. There was ‘agreement without consensus’ that clinical repeatability and reproducibility studies are required while ‘uncertainty remained’ regarding the need for comparison studies. For novel radiotracers, in vitro and preclinical studies, such as dosimetry and/or biodistribution studies and tumour histological assessment were considered appropriate, as well as comprehensive clinical validation. Conversely, preclinical reproducibility studies were considered unnecessary and ‘uncertainties remained’ regarding preclinical pharmacokinetic and repeatability evaluation. Other consensus areas included standardisation of clinical study protocols, streamlined regulatory frameworks and patient and public involvement. While a centralised UK clinical imaging research infrastructure and open access federated data repository were considered necessary, there was ‘agreement without consensus’ regarding the requirement for a centralised UK preclinical imaging infrastructure. Conclusions We provide consensus-based recommendations, emphasising streamlined methodologies and regulatory frameworks, together with active stakeholder engagement, for improving PET radiotracer standardisation, reproducibility and clinical implementation in oncology.

Abstract Introduction Magnetic resonance imaging (MRI) is a rapidly evolving modality, generally considered safe due to lack of ionising radiation. While MRI technology and techniques are improving, many of the safety concerns remain the same as when first established. Patient thermal injuries are the most frequently reported adverse event, accounting for 59% of MRI incidents to the Food and Drug Administration (FDA). Surveys indicate many incidents remain unreported. Patient thermal injuries are preventable and various methods for their mitigation have been published. However, recommendations can be variable, fragmented and confusing. The aim of this systematic review was to synthesise the evidence on MRI safety and associated skin injuries and offer comprehensive recommendations for radiographers to prevent skin thermal injuries. Methods Four journal databases were searched for sources published January 2010–May 2023, presenting information on MRI safety and thermal injuries. Results Of 26,801 articles returned, after careful screening and based on the eligibility criteria, only 79 articles and an additional 19 grey literature sources were included (n = 98). Included studies were examined using thematic analysis to determine if holistic recommendations can be provided to assist in preventing skin burns. This resulted in three simplified recommendations: Remove any electrically conductive items Insulate the patient to prevent any conductive loops or contact with objects Communicate regularly Conclusion By implementing the above recommendations, it is estimated that 97% of skin burns could be prevented. With thermal injuries continuing to impact MRI safety, strategies to prevent skin burns and heating are essential. Assessing individual risks, rather than blanket policies, will help prevent skin thermal injuries occurring, improving patient care.

Abstract Future energy scenarios include both green and blue hydrogen, as both are needed to scale up decarbonized energy supply. A transition to renewable energy is predicted over time, but the urgency we are facing cannot be met by renewable energy alone. For blue hydrogen production, the overall greenhouse gas (GHG) emissions are primarily affected by emissions from natural gas production, processing, and transport (CO2 and methane), as well as process efficiency and carbon capture ratio. Few complete and updated analyses are available that cover the entire blue hydrogen value chain with the best available technology for process facilities, as well as the proper design, operation, and maintenance of all relevant systems and infrastructure. This paper analyses the GHG intensity of blue hydrogen, using recent data as well as input from technology providers on state‐of‐the‐art gas reforming technologies. Data are primarily based on natural gas production and transport in the North Sea Basin, with gas export from the Norwegian continental shelf to continental Europe or the United Kingdom, and with blue hydrogen production either in Norway or near pipeline landfall in the European Union or United Kingdom. Some data related to potential blue hydrogen production in the US Appalachian region are also given. The data show that the properly designed and operated value chains for blue hydrogen supply, with minimal emissions from natural gas supply and high carbon capture in hydrogen production, will give a major reduction in GHG emissions from energy end‐use. GHG footprint for end‐users based on blue hydrogen will typically be 80%–90% lower than for direct supply and use of natural gas.

Emission reductions in power generation for offshore oil and gas activities are key in order to reach climate targets in regions with this industry. This study presents a review of both established and immature low carbon power generation concepts, an analysis of their potential for greenhouse gas (GHG) emission reduction, and an evaluation of their offshore applicability. The potential for GHG emission reduction is quantified by estimating CO2 equivalent intensity for implementation on the Norwegian Continental Shelf. The offshore applicability is evaluated with emphasis on weight, infrastructure requirements, process heat availability, technical maturity, as well as health, safety, and environment (HSE). It is shown that power from shore is the only technically mature concept with potential for very high emission reductions (>95 %, provided that low GHG electric power is available). There are several alternative concepts under development that also can give significant emission reductions (>70 %), including fuel switching, CO2 capture and storage, and renewable power combined with energy storage. Combined cycle gas turbines and offshore wind power combined with gas turbines are technically mature and can achieve partial emission reductions (around 15–50 %, with the assumed system configurations). Other concepts offering partial emission reductions are under development, but do not show clear advantages over those already mentioned. It is pointed out that, to enable reaching the net zero emission targets, only efficiency improvements and power from shore are not enough, and there is a need to develop additional low emission technologies not yet on the market. The present study has compiled a large database of specifications for assessing low carbon power production concepts and proposes a methodology that is valuable in screening a large number of commercial and immature technologies.

Vaccines are essential to ensuring a nation’s health, wellbeing and prosperity. After the coronavirus pandemic commenced, the Australian Government introduced social restrictions to constrain virus transmission, seeing significant economic impacts. Reflecting the extraordinary circumstances, subsequent vaccination rollout forwent usual health technology assessment (HTA) processes, facilitating restrictions removal and leading to societal and economic recovery. However, in ‘usual’ circumstances, HTA may not consider such broader effects of vaccines, making it challenging for them to achieve timely funding. We used detailed modelling to compare economic impacts under continued lockdowns against population-wide vaccination rollout between January 2020 and June 2023 and examined global HTA vaccine evaluation methodologies and efforts to develop broader valuation approaches. Australian gross domestic product reduces by approximately AUD 395 billion with lockdowns. With vaccination rollout, this effect is approximately AUD 214bn, a positive incremental impact of AUD 181bn. Vaccination contributes to large estimated positive effects for tourism (AUD 28bn) and education (AUD 26bn) exports, employment (142,000 jobs) and government finances (AUD 259bn). Conversely, global HTA methods generally only consider direct patient health outcomes and healthcare system-related costs, with broader effects usually not impacting funding decisions. Our results suggest that recent efforts to propose broader HTA valuation frameworks warrant further policy consideration.

Bisphenol A is widely used in food and drinks packaging. There is evidence of associations between raised urinary bisphenol A (uBPA) and increased incidence of reported cardiovascular diagnoses.To estimate associations between BPA exposure and angiographically graded coronary atherosclerosis. 591 patients participating in The Metabonomics and Genomics in Coronary Artery Disease (MaGiCAD) study in Cambridgeshire UK, comparing urinary BPA (uBPA) with grades of severity of coronary artery disease (CAD) on angiography. Linear models were adjusted for BMI, occupational social class and diabetes status. Severe (one to three vessel) CAD was present in 385 patients, 86 had intermediate disease (n=86) and 120 had normal coronary arteries. The (unadjusted) median uBPA concentration was 1.28 ng/mL with normal coronary arteries, and 1.53 ng/mL with severe CAD. Compared to those with normal coronary arteries, uBPA concentration was significantly higher in those with severe CAD (OR per uBPA SD=5.96 ng/ml OR=1.43, CI 1.03 to 1.98, p=0.033), and near significant for intermediate disease (OR=1.69, CI 0.98 to 2.94, p=0.061). There was no significant uBPA difference between patients with severe CAD (needing surgery) and the remaining groups combined.BPA exposure was higher in those with severe coronary artery stenoses compared to those with no vessel disease. Larger studies are needed to estimate true dose response relationships. The mechanisms underlying the association remain to be established.