A multiscale approach for the study of x-ray radiation effects in paediatric patients subjected to interventional cardiology procedures

Maria Souli, Agapi Ploussi, Ellas Spyratou, Ioannis Seimenis


Purpose: Paediatric dosimetry requires a patient-spe- cific approach due to the long-life expectancy and high radiosensitivity of children. The main aim of the current study was to study physical and biological dosimetric characteristics, as well as the effect of x-ray radiation on the biochemical properties of lymphocytes in paediatric patients who underwent interventional cardiology (IC) procedures.

Materials and Methods: A total of 10 paediatric pa- tients who underwent IC procedures with a biplane angi- ographic system was enrolled in the study. Physical do- simetry was performed by converting dose-area-product to effective dose with the use of appropriate k-factors taking into account patient’s body size. Peripheral blood samples were collected from each patient before and im- mediately after the IC procedure. Biodosimetry, for the detection of radiation-induced DNA damage, was based on the assessment of the protein biomarker γ-H2AX. Furthermore, biomechanical properties of unirradiated and irradiated lymphocytes were evaluated using atomic force spectroscopy.

Results: Effective doses (EDs) estimated for the stud- ied cases ranged from 0.6 to 16.7 mSv. Immunofluores- cence microscopy detected a small increase in γ-H2AX


paediatric dosimetry, γ-H2AX, biodosimetry, elastic modulus, atomic force spectroscopy

Full Text:



Hart D, Wall BF, Hiller MC, et al. Frequency and collective dose for medical and dental X-ray examinations in the UK, 2008. Health Protection Agency 2010, HPA-CRCE-012.

Tsapaki V, Ahmed N, AlSuwaidi JS, et al. Radiation exposure to patients during IR procedures in 20 countries. Initial IAEA project results. AJR Am J Roentgenol 2009; 193(2): 559-569.

Ait-Ali L, Andreassi MG, Foffa I, et al. Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart 2010; 96(4): 269-274.

Nikitaki Z, Vladimir, Ν, Mavragani ΙV, et al. Non-DSB clustered DNA lesions. Does theory colocalize with the experiment? Rad Phys Chem 2016; 128: 26-35.

Löbrich M, Shibata A, Beucher A, et al. γH2AX foci analysis for monitoring DNA double-strand break repair: Strengths, limitations and optimization. Cell Cycle 2010; 9(4): 662-669.

Redon CE, Dickey JS, Bonner WM, et al. γ-H2AX as a biomarker of DNA damage induced by ionizing radiation in human peripheral blood lymphocytes and artificial skin. Adv Space Res 2009; 43(8): 1171-1178.

Rogakou EP, Pilch DR, Orr AH, et al. DNA double-stranded breaks induce histone H2AX phosphorylation on serine 139. J Biol Chem 1998; 273(10): 5858-5868.

Dragovich MA, Genemaras K, Dailey HL, et al. Dual regulation of L-Selectin-mediated leukocyte adhesion by endothelial surface glycocalyx. Cell Mol Bioeng 2017; 10: 102-113.

Vicente-Manzanares M, Sánchez-Madrid F. Role of the cytoskeleton during leukocyte responses. Ιmmunology 2004; 4: 110-122.

Alexandrova A, Antonova N. Rheological and mechanical aspects of leukocytes motion and adhesion. Series on Biomechanics 2012; 27: 74-79.

Wautier JL, Schmid-Schonbein GW, Nash GB, et al. Measurement of leukocyte rheology in vascular disease: clinical rationale and methodology. Clin Hemorheol Microcirc 1999; 21: 7-24.

Evans EA. Bending elastic modulus of red blood cell membrane derived from buckling instability in micropipette aspiration tests. Biophys J 1983; 43: 27-30.

Bransky A, Korin N, Nemirovski Y, et al. An automated cell analysis sensing system based on a microfabricated rheoscope for the study of red blood cells physiology. Biosens Bioelectron 2006; 22: 165-169.

Li Y, Wenb C, Xiea H, Ye A, et al. Mechanical property analysis of stored red blood cell using optical tweezers. Colloids Surf B Biointerfaces 2009; 70: 169-173.

Spyratou E, Dilvoi M, Patatoukas G, et al. Probing the effects of ionizing radiation on Young’s modulus of human erythrocytes cytoskeleton using atomic force microscopy. J Med Phys 2019; (2): 113-117.

Cappella B, Dietler G. Force-distance curves by atomic force microscopy. Surf Sci Rep 1999; 34: 1-104.

Thomas G, Burnham NA, Camesano TA, et al. Measuring the mechanical properties of living cells using atomic force microscopy. J Vis Exp 2013; 76: e50497.

Schmidt PWE, Dance DR, Skinner CL, et al. Conversion factors for the estimation of effective dose in paediatric cardiac angiography. Phys Med Biol 2000; 45: 3095-3107.

Hutter JL, Bechhoefer J. Calibration of atomic-force microscope tips. Rev Sci Instrum 1993; 64: 1868-1873.

Sneddon IN. The relation between load and penetration in the axisymmetric Boussines q problem for a punch of arbitrary profile. Int J Eng Sci 1965; 3: 47-56.

Heylmann, D, Rodel F, Kindler T, et al. Radiation sensitivity of human and murine peripheral blood lymphocytes, stem and progenitor cells. Biochim Biophys Acta 2014; 1846(1): 121-129.

Beels L, Bacher K, De Wolf D, et al. gamma-H2AX foci as a biomarker for patient X-ray exposure in paediatric cardiac catheterization: are we underestimating radiation risks? Circulation 2009; 120(19): 1903-1909.

Rothkamm K, Balroop S, Shekhdar J, et al. Leukocyte DNA damage after multi-detector row CT: a quantitative biomarker of low-level radiation exposure. Radiology 2007; 242(1): 244-251.

Horn S, Barnard S, Rothkamm K. Gamma-H2AX-based dose estimation for whole and partial body radiation exposure. PLoS One 2011; 6(9): e25113.

Bonner WM, Redon CE, Dickey JS, et al. γH2AX and cancer. Nat Rev Cancer 2008; 8(12): 957-967.

Cai X, Cai J, Dong S, et al. Morphology and mechanical properties of normal lymphocyte and Jurkat revealed by atomic force microscopy. [Article in Chinese]. Sheng Wu Gong Cheng Xue Bao 2009; 25: 1107-1112.

Kuznetsova TG, Starodubtseva MN, Yegorenkov NI, et al. Atomic force microscopy probing of cell elasticity. Micron 2007; 38: 824-883.

DOI: http://dx.doi.org/10.36162/hjr.v5i1.335


  • There are currently no refbacks.