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Joseph Yeboah Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, NC, USA Abstract: The ultimate goal of cardiovascular risk prediction is to identify individuals in the population to whom the application or administration of current proven lifestyle modifications and medicinal therapies will result in reduction in cardiovascular disease events and minimal adverse effects (net benefit to society). The use of cardiovascular risk prediction tools dates back to 1976 when the Framingham coronary heart disease risk score was published. Since then a lot of novel risk markers have been identified and other cardiovascular risk prediction tools have been developed to either improve or replace the Framingham Risk Score (FRS). In 2013, the new atherosclerotic cardiovascular disease risk estimator was published by the American College of Cardiology and the American Heart Association to replace the FRS for cardiovascular risk prediction. It is too soon to know the performance of the new atherosclerotic cardiovascular disease risk estimator. The risk-benefit ratio for preventive therapy (lifestyle modifications, statin +/− aspirin) based on cardiovascular disease risk assessed using the FRS is unknown but it was assumed to be a net benefit. Should we also assume the risk-benefit ratio for the new atherosclerotic cardiovascular disease risk estimator is also a net benefit? Keywords: risk prediction, prevention, cardiovascular disease

Institutions in the education, research and industrial sectors in Ghana are quite few in comparison to the medical sector. Occupational exposure to radiation in the education, research and industrial sectors in Ghana have been analysed for a 10 y period between 2000 and 2009, by extracting dose data from the database of the Radiation Protection Institute, Ghana Atomic Energy Commission. Thirty-four institutions belonging to the three sectors were monitored out of which∼65 % were in the industrial sector. During the 10 y study period, monitored institutions ranged from 18 to 23 while the exposed workers ranged from 246 to 156 between 2000 and 2009. Annual collective doses received by all the exposed workers reduced by a factor of 2 between 2000 and 2009. This is seen as a reduction in annual collective doses in education/research and industrial sectors by∼39 and∼62 %, respectively, for the 10 y period. Highest and least annual collective doses of 182.0 man mSv and 68.5 man mSv were all recorded in the industrial sector in 2000 and 2009, respectively. Annual average values for dose per institution and dose per exposed worker decreased by 49 and 42.9 %, respectively, between 2000 and 2009. Average dose per exposed worker for the 10 y period was least in the industrial sector and highest in the education/research sector with values 0.6 and 3.7 mSv, respectively. The mean of the ratio of annual occupationally exposed worker (OEW) doses for the industrial sector to the annual OEW doses for the education/research sector was 0.67, a suggestion that radiation protection practices are better in the industrial sector than they are in the education/research sector. Range of institutional average effective doses within the education/research and industrial sectors were 0.059–6.029, and 0.110–2.945 mSv, respectively. An average dose per all three sectors of 11.87 mSv and an average dose per exposed worker of 1.12 mSv were realised for the entire study period. The entire study period had 187 instances in which exposed workers received individual annual doses >1 mSv, with exposed workers in the education/research sector primarily receiving most of this individual dose. [ABSTRACT FROM PUBLISHER]

Occupational exposure to radiation in medical practice in Ghana has been analysed for a 10-y period between 2000 and 2009. Monitored dose data in the medical institution in Ghana from the Radiation Protection Institute's database were extracted and analysed in terms of three categories: diagnostic radiology, radiotherapy and nuclear medicine. One hundred and eighty medical facilities were monitored for the 10-y period, out of which ∼98 % were diagnostic radiology facilities. Only one nuclear medicine and two radiotherapy facilities have been operational in the country since 2000. During the 10-y study period, monitored medical facilities increased by 18.8 %, while the exposed workers decreased by 23.0 %. Average exposed worker per entire medical institution for the 10-y study period was 4.3. Annual collective dose received by all the exposed workers reduced by a factor of 4 between 2000 and 2009. This is seen as reduction in annual collective doses in diagnostic radiology, radiotherapy and nuclear medicine facilities by ∼76, ∼72 and ∼55 %, respectively, for the 10-y period. Highest annual collective dose of 601.2 man mSv was recorded in 2002 and the least of 142.6 man mSv was recorded in 2009. Annual average values for dose per institution and dose per exposed worker decreased by 79 and 67.6 %, respectively between 2000 and 2009. Average dose per exposed worker for the 10-y period was least in radiotherapy and highest in diagnostic radiology with values 0.14 and 1.05 mSv, respectively. Nuclear medicine however recorded average dose per worker of 0.72 mSv. Correspondingly, range of average effective doses within the diagnostic radiology, radiotherapy and nuclear medicine facilities were 0.328–2.614, 0.383–0.728 and 0.448–0.695 mSv, respectively. Throughout the study period, an average dose per medical institution of 3 mSv and an average dose per exposed worker of 0.69 mSv were realised. Exposed workers in diagnostic radiology primarily received most of the individual annual doses >1 mSv. The entire study period had 705 instances in which exposed workers received individual annual doses >1 mSv. On thermoluminescent dosemeter (TLD) return rates, facilities in Volta and Eastern Regions recorded highest return rates of 94.3 % each. Ashanti Region recorded the least TLD return rate with 76.7 %. [ABSTRACT FROM PUBLISHER]

Investigation of the optimization of protection of occupational exposed workers (OEWs) in Ghana had been carried out on the three practices in the country, namely medical applications, industrial radioisotope applications and research and education from 2002 to 2007. Mean annual effective dose and collective effective dose were estimated from dosimetry records from the Radiation Protection Institute of those occupationally exposed from 2002 to 2007. The mean annual effective dose estimated for about 650 OEWs per year ranged from 0.42 to 0.68 mSv compared with a global value of 0.5 mSv estimated by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR 2008 Report). This implies that efforts should still be made to institute as low as reasonably achievable culture in most practices in Ghana even though trend of doses incurred was low. The collective effective dose for this same period estimated ranged from 0.26 to 0.47 man Sv. A reference monetary value of the man sievert was estimated using the human capital approach for each year from 2002 to 2009; it ranged from 172 to 22 US $ per man Sv, which provided a basis for estimating the cost of averting a unit collective effective dose of 1 man Sv. This value could not be used for quantitative optimization since the range of mean annual effective dose estimated was below 1 mSv. [ABSTRACT FROM PUBLISHER]

The results of studies carried out on public exposure contribution from naturally occurring radioactive materials (NORMS) in two open-pit mines in the Western and Ashanti regions of Ghana are reported. The studies were carried out under International Atomic Energy Agency-supported Technical Co-operation Project GHA/9/005. Measurements were made on samples of water, soil, ore, mine tailings and air using gamma spectrometry. Solid-state nuclear track detectors were used for radon concentration measurements. Survey was also carried out to determine the ambient gamma dose rate in the vicinity of the mines and surrounding areas. The effective doses due to external gamma irradiation, ingestion of water and inhalation of radon and ore dusts were calculated for the two mines. The average annual effective dose was found to be 0.30 ± 0.06 mSv. The result was found to be within the levels published by other countries. The study provides a useful information and data for establishing a comprehensive framework to investigate other mines and develop guidelines for monitoring and control of NORMS in the mining industry and the environment as a whole in Ghana. [ABSTRACT FROM PUBLISHER]

Radiation dose to organs of 100 adult patients undergoing lumbar spine (LS) radiography at a University Hospital have been assessed. Free in air kerma measurement using an ionization chamber was used for the patient dosimetry. Organ and effective dose to the patients were estimated using PCXMC (version 1.5) software. The organs that recorded significant dose due to LS radiography were lungs, stomach, liver, adrenals, kidney, pancreas, spleen, galbladder, and the heart. It was observed that the stomach recorded the highest dose (48.2 ± 1.2 μGy) for LS anteroposterior (AP). The spleen also recorded the highest dose (41.2 ± 0.5 μGy) for LS lateral (LAT). The mean entrance surface air kerma (ESAK) of LS LAT (122.2 μGy) was approximately twice that of LS AP (76.3 μGy), but the effective dose for both examinations were approximately the same (LS LAT = 8.6 μSv and LS AP = 10.4 μSv). The overall stochastic health effect of radiation to patients due to LS radiography in the University Hospital is independent of the projection of the examination (AP or LAT).

The article discusses various potential biomarkers that have been found in a study for improving the classification of stages of cardiovascular disease including coronary artery calcium scoring, brachial flow-mediated dilation and high-sensitivity C-reactive protein.