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Table 2.Iii.1. Fissionable Isotopes1
FISSIONABLE ISOTOPES Charles P. Blair Last revised: 2012 “While several isotopes are theoretically fissionable, RANNSAD defines fissionable isotopes as either uranium-233 or 235; plutonium 238, 239, 240, 241, or 242, or Americium-241. See, Ackerman, Asal, Bale, Blair and Rethemeyer, Anatomizing Radiological and Nuclear Non-State Adversaries: Identifying the Adversary, p. 99-101, footnote #10, TABLE 2.III.1. FISSIONABLE ISOTOPES1 Isotope Availability Possible Fission Bare Critical Weapon-types mass2 Uranium-233 MEDIUM: DOE reportedly stores Gun-type or implosion-type 15 kg more than one metric ton of U- 233.3 Uranium-235 HIGH: As of 2007, 1700 metric Gun-type or implosion-type 50 kg tons of HEU existed globally, in both civilian and military stocks.4 Plutonium- HIGH: A separated global stock of Implosion 10 kg 238 plutonium, both civilian and military, of over 500 tons.5 Implosion 10 kg Plutonium- Produced in military and civilian 239 reactor fuels. Typically, reactor Plutonium- grade plutonium (RGP) consists Implosion 40 kg 240 of roughly 60 percent plutonium- Plutonium- 239, 25 percent plutonium-240, Implosion 10-13 kg nine percent plutonium-241, five 241 percent plutonium-242 and one Plutonium- percent plutonium-2386 (these Implosion 89 -100 kg 242 percentages are influenced by how long the fuel is irradiated in the reactor).7 1 This table is drawn, in part, from Charles P. Blair, “Jihadists and Nuclear Weapons,” in Gary A. Ackerman and Jeremy Tamsett, ed., Jihadists and Weapons of Mass Destruction: A Growing Threat (New York: Taylor and Francis, 2009), pp. 196-197. See also, David Albright N 2 “Bare critical mass” refers to the absence of an initiator or a reflector. -
Institute for Clinical and Economic Review
INSTITUTE FOR CLINICAL AND ECONOMIC REVIEW FINAL APPRAISAL DOCUMENT BRACHYTHERAPY & PROTON BEAM THERAPY FOR TREATMENT OF CLINICALLY-LOCALIZED, LOW-RISK PROSTATE CANCER December 22, 2008 Senior Staff Daniel A. Ollendorf, MPH, ARM Chief Review Officer Julia Hayes, MD Lead Decision Scientist Pamela McMahon, PhD Sr. Decision Scientist Steven D. Pearson, MD, MSc President, ICER Associate Staff Michelle Kuba, MPH Sr. Technology Analyst Angela Tramontano, MPH Research Assistant © ICER, 2008 1 CONTENTS About ICER .................................................................................................................................. 3 Acknowledgments ...................................................................................................................... 4 Executive Summary .................................................................................................................... 5 Evidence Review Group Deliberation.................................................................................. 15 ICER Integrated Evidence Rating.......................................................................................... 21 Evidence Review Group Members........................................................................................ 24 Appraisal Overview.................................................................................................................. 28 Background ............................................................................................................................... -
Californiachoice® Small Group Advantage PPO Three-Tier Hospital Network
CaliforniaChoice® Small Group Advantage PPO three-tier hospital network With the CaliforniaChoice Advantage PPO plans, you have a choice of tiers (or levels) of hospitals to visit. Tier one hospitals offer the greatest savings to you. Tier two hospitals have the second best level of savings. Tier three hospitals — or out-of-network hospitals — offer the least out-of-pocket savings, but you’ll still be covered. Keep in mind that the tier levels aren’t based on the quality of care given at each hospital. They’re based on which hospitals have shown they’re better able to give quality care that’s also cost effective. Our three-tier levels* are: }}Tier 1 — PPO network hospitals with lower-negotiated hospital reimbursement rates. }}Tier 2 — the remaining PPO network hospitals. }}Tier 3 — non-network hospitals. * The tier levels are not based on the quality of care given at each hospital. Instead, each level stands for the hospitals that show 19685CABENABC 08/15 the best use of health care dollars. CaliforniaChoice® Small Group Advantage PPO three-tier hospital network Here is a list of the Tier-1 and Tier-2 hospitals included in the network. Any hospital not listed is considered out of network. Hospital County Tier St Rose Hospital Alameda 1 Alameda Hospital Alameda 1 Children’s Hospital Oakland Alameda 2 Valleycare Medical Center Alameda 2 Washington Hospital Alameda 2 Sutter Amador Health Center Pioneer 1 Sutter Amador Health Center Plymouth 1 Sutter Amador Hospital Amador 1 Oroville Hospital & Medical Center Butte 1 Feather River Hospital -
Access+ HMO 2021Network
Access+ HMO 2021Network Our Access+ HMO plan provides both comprehensive coverage and access to a high-quality network of more than 10,000 primary care physicians (PCPs), 270 hospitals, and 34,000 specialists. You have zero or low copayments for most covered services, plus no deductible for hospitalization or preventive care and virtually no claims forms. Participating Physician Groups Hospitals Butte County Butte County BSC Admin Enloe Medical Center Cohasset Glenn County BSC Admin Enloe Medical Center Esplanade Enloe Rehabilitation Center Orchard Hospital Oroville Hospital Colusa County Butte County BSC Admin Colusa Medical Center El Dorado County Hill Physicians Sacramento CalPERS Mercy General Hospital Mercy Medical Group CalPERS Methodist Hospital of Sacramento Mercy Hospital of Folsom Mercy San Juan Medical Center Fresno County Central Valley Medical Medical Providers Inc. Adventist Medical Center Reedley Sante Community Physicians Inc. Sante Health Systems Clovis Community Hospital Fresno Community Hospital Fresno Heart and Surgical Hospital A Community RMCC Fresno Surgical Hospital San Joaquin Valley Rehabilitation Hospital Selma Community Hospital St. Agnes Medical Center Glenn County Butte County BSC Admin Glenn Medical Center Glenn County BSC Admin Humboldt County Humboldt Del Norte IPA Mad River Community Hospital Redwood Memorial Hospital St. Joseph Hospital - Eureka Imperial County Imperial County Physicians Medical Group El Centro Regional Medical Center Pioneers Memorial Hospital Kern County Bakersfield Family Medical -
NUREG-1350, Vol. 31, Information
NRC Figure 31. Moisture Density Guage Bioshield Gauge Surface Detectors Depth Radiation Source GLOSSARY 159 GLOSSARY Glossary (Abbreviations, Definitions, and Illustrations) Advanced reactors Reactors that differ from today’s reactors primarily by their use of inert gases, molten salt mixtures, or liquid metals to cool the reactor core. Advanced reactors can also consider fuel materials and designs that differ radically from today’s enriched-uranium dioxide pellets within zirconium cladding. Agreement State A U.S. State that has signed an agreement with the U.S. Nuclear Regulatory Commission (NRC) authorizing the State to regulate certain uses of radioactive materials within the State. Atomic energy The energy that is released through a nuclear reaction or radioactive decay process. One kind of nuclear reaction is fission, which occurs in a nuclear reactor and releases energy, usually in the form of heat and radiation. In a nuclear power plant, this heat is used to boil water to produce steam that can be used to drive large turbines. The turbines drive generators to produce electrical power. NUCLEUS FRAGMENT Nuclear Reaction NUCLEUS NEW NEUTRON NEUTRON Background radiation The natural radiation that is always present in the environment. It includes cosmic radiation that comes from the sun and stars, terrestrial radiation that comes from the Earth, and internal radiation that exists in all living things and enters organisms by ingestion or inhalation. The typical average individual exposure in the United States from natural background sources is about 310 millirem (3.1 millisievert) per year. 160 8 GLOSSARY 8 Boiling-water reactor (BWR) A nuclear reactor in which water is boiled using heat released from fission. -
Security of Supply of Medical Radioisotopes - a Clinical View Dr Beverley Ellis Consultant Radiopharmacist
Security of Supply of Medical Radioisotopes - a clinical view Dr Beverley Ellis Consultant Radiopharmacist Nuclear Medicine Centre Manchester University NHS Foundation Trust Nuclear Medicine § Approx 35 million clinical radionuclide imaging procedures worldwide § Globally 2nd most common imaging technique after CT (higher than MR) 20 million in USA 9 million in Europe 3 million in Japan 3 million in rest of the world Approx 700, 000 nuclear medicine procedures per year in UK Myocardial Perfusion - Ischaemia Stress Stress SA Rest Stress VLA Rest Stress HLA Rest Rest Tc-99m Bone Scans Normal Metastases Mo-99/Tc-99m Generator Supply Tc-99m Radiopharmaceutical Production Mo-99 Shortages Design of Clinical Services to Reduce Tc-99m Use § Optimisation of generator management – Efficiency savings – Delivery and extraction schedules – Patient scheduling § Improved communication – Customers – Suppliers § Improved software – gamma cameras – Produce comparable quality images using less radioactivity Global Situation § OECD/Nuclear Energy Agency (NEA) – Set up High Level Group (HLG-MR) in 2009 – Security of supply of Mo-99 and Tc-99m – Established 6 principles e.g. full cost recovery and outage reserve capacity – Issued a series of publications Global Situation § AIPES (Association of Imaging Producers & Equipment supplies) (Now called Nuclear Medicine Europe) – Support coordination of research reactor schedules Global Situation § Increased Mo-99 Production Capacity – Mo-99 suppliers – acquire additional capacity to cover shortfalls (Outage -
Trends in Targeted Prostate Brachytherapy: from Multiparametric MRI to Nanomolecular Radiosensitizers
Nicolae et al. Cancer Nano (2016) 7:6 DOI 10.1186/s12645-016-0018-5 REVIEW Open Access Trends in targeted prostate brachytherapy: from multiparametric MRI to nanomolecular radiosensitizers Alexandru Mihai Nicolae1, Niranjan Venugopal2 and Ananth Ravi1* *Correspondence: [email protected] Abstract 1 Odette Cancer Centre, The treatment of localized prostate cancer is expected to become a significant Sunnybrook Health Sciences Centre, 2075 Bayview Ave, problem in the next decade as an increasingly aging population becomes prone to Toronto, ON M4N3M5, developing the disease. Recent research into the biological nature of prostate cancer Canada has shown that large localized doses of radiation to the cancer offer excellent long- Full list of author information is available at the end of the term disease control. Brachytherapy, a form of localized radiation therapy, has been article shown to be one of the most effective methods for delivering high radiation doses to the cancer; however, recent evidence suggests that increasing the localized radiation dose without bound may cause unacceptable increases in long-term side effects. This review focuses on methods that have been proposed, or are already in clinical use, to safely escalate the dose of radiation within the prostate. The advent of multiparametric magnetic resonance imaging (mpMRI) to better identify and localize intraprostatic tumors, and nanomolecular radiosensitizers such as gold nanoparticles (GNPs), may be used synergistically to increase doses to cancerous tissue without the -
Review of Outpatient Brachytherapy Medicare Payments to Carolinas Medical Center
DEPARTMENT OF HEALTH & HUMAN SERVICES OFFICE OF INSPECTOR GENERAL Office of Audit Services, Region IV 61 Forsyth Street, SW, Suite 3T41 Atlanta, GA 30303 February 6, 2012 Report Number: A-04-11-06135 Ms. Suzanne Freeman Divisional President Carolinas Medical Center P.O. Box 32861 Charlotte, NC 28232-2861 Dear Ms. Freeman: Enclosed is the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), final report entitled Review of Outpatient Brachytherapy Medicare Payments to Carolinas Medical Center. We will forward a copy of this report to the HHS action official noted on the following page for review and any action deemed necessary. The HHS action official will make final determination as to actions taken on all matters reported. We request that you respond to this official within 30 days from the date of this letter. Your response should present any comments or additional information that you believe may have a bearing on the final determination. Section 8L of the Inspector General Act, 5 U.S.C. App., requires that OIG post its publicly available reports on the OIG Web site. Accordingly, this report will be posted at http://oig.hhs.gov. If you have any questions or comments about this report, please do not hesitate to call me, or contact Andrew Funtal, Audit Manager, at (404) 562-7762 or through email at [email protected]. Please refer to report number A-04-11-06135 in all correspondence. Sincerely, /Lori S. Pilcher/ Regional Inspector General for Audit Services Enclosure Page 2 – Ms. Suzanne Freeman Direct Reply to HHS Action Official: Nanette Foster Reilly Consortium Administrator Consortium for Financial Management & Fee for Service Operations Centers for Medicare & Medicaid Services 601 East 12th Street, Room 235 Kansas City, Missouri 64106 Department of Health and Human Services OFFICE OF INSPECTOR GENERAL REVIEW OF OUTPATIENT BRACHYTHERAPY MEDICARE PAYMENTS TO CAROLINAS MEDICAL CENTER Daniel R. -
Radiation Quick Reference Guide Recommend Contacting Your State Fusion Center
Domestic Nuclear Detection Office If you encounter something suspicious follow your specific local protocols. Radiation Quick Reference Guide Recommend contacting your state fusion center. DNDO is available 24/7 to assist at 1-877-DNDO-JAC / 1-877-363-6522 JAC Information Line 202-254-7179 Email: [email protected] Nuclear Concerns/ Threats 1. Nuclear Weapon - a device that releases nuclear energy in an ex- Isotopes of Concern for use in RDDs - with common uses plosive manner. Uses Highly Enriched Uranium (HEU) and/or 1. Cobalt-60 – cancer treatment, level/ Plutonium. density gauge, teletherapy, radiography, 2. Improvised Nuclear Device (IND) - a nuclear weapon fabricated food sterilization/irradiation, by a terrorist organization or rogue nation. brachytherapy 2. Iridium-192 – Radiography/non- destructive testing, flaw detection, brachy- therapy “cancer seed”, skin cancer Cobalt 60 sources Uranium “superficial” brachytherapy Plutonium 3. Uranium a. Uranium exists naturally in the earth’s crust. Of the different “isotopes” of uranium, U-235 is the one required to produce a Iridium sentinel and nuclear weapon. gamma camera b. Natural uranium contains a small amount of U-235 (<1%) which Cesium Seeds must be separated in complex extraction processes to create HEU. The predominant uranium isotope is U-238. 3. Cesium-137 - Gauge/level gauge, industrial radiography, brachyther- c. Highly Enriched Uranium (HEU) refers to uranium usable in weap- apy/teletherapy, well logging/density gauges ons due to its enrichment in U-235. 4. Strontium-90 – Radioisotope thermoelectric generator (RTG), fis- d. Approximately 25 kg of HEU is required for a nuclear weapon. sion product, industrial gauges, medical treatment e. -
High Dose-Rate Brachytherapy of Localized Prostate Cancer Converts
Open access Original research J Immunother Cancer: first published as 10.1136/jitc-2020-000792 on 24 June 2020. Downloaded from High dose- rate brachytherapy of localized prostate cancer converts tumors from cold to hot 1,2,3 1 1 1 Simon P Keam , Heloise Halse, Thu Nguyen, Minyu Wang , Nicolas Van Kooten Losio,1 Catherine Mitchell,4 Franco Caramia,3 David J Byrne,4 Sue Haupt,2,3 Georgina Ryland,4 Phillip K Darcy,1,2 Shahneen Sandhu,5 2,4 2,3 6 1,2 Piers Blombery, Ygal Haupt, Scott G Williams, Paul J Neeson To cite: Keam SP, Halse H, ABSTRACT organized immune infiltrates and signaling changes. Nguyen T, et al. High dose- rate Background Prostate cancer (PCa) has a profoundly Understanding and potentially harnessing these changes brachytherapy of localized immunosuppressive microenvironment and is commonly will have widespread implications for the future treatment prostate cancer converts tumors immune excluded with few infiltrative lymphocytes and of localized PCa, including rational use of combination from cold to hot. Journal for low levels of immune activation. High- dose radiation radio- immunotherapy. ImmunoTherapy of Cancer 2020;8:e000792. doi:10.1136/ has been demonstrated to stimulate the immune system jitc-2020-000792 in various human solid tumors. We hypothesized that localized radiation therapy, in the form of high dose- INTRODUCTION ► Additional material is rate brachytherapy (HDRBT), would overcome immune Standard curative- intent treatment options published online only. To view suppression in PCa. for localized prostate cancer (PCa) include please visit the journal online Methods To investigate whether HDRBT altered prostate radical prostatectomy or radiotherapy.1 (http:// dx. -
The Supply of Medical Isotopes
The Supply of Medical Isotopes AN ECONOMIC DIAGNOSIS AND POSSIBLE SOLUTIONS The Supply of Medical Isotopes AN ECONOMIC DIAGNOSIS AND POSSIBLE SOLUTIONS The Supply of Medical Isotopes AN ECONOMIC DIAGNOSIS AND POSSIBLE SOLUTIONS This work is published under the responsibility of the Secretary-General of the OECD. The opinions expressed and arguments employed herein do not necessarily reflect the official views of OECD member countries. This document, as well as any data and any map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. Please cite this publication as: OECD/NEA (2019), The Supply of Medical Isotopes: An Economic Diagnosis and Possible Solutions, OECD Publishing, Paris, https://doi.org/10.1787/9b326195-en. ISBN 978-92-64-94550-0 (print) ISBN 978-92-64-62509-9 (pdf) The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law. Photo credits: Cover © Yok_onepiece/Shutterstock.com. Corrigenda to OECD publications may be found on line at: www.oecd.org/about/publishing/corrigenda.htm. © OECD 2019 You can copy, download or print OECD content for your own use, and you can include excerpts from OECD publications, databases and multimedia products in your own documents, presentations, blogs, websites and teaching materials, provided that suitable acknowledgement of OECD as source and copyright owner is given. -
A Review of Rectal Toxicity Following Permanent Low Dose-Rate Prostate Brachytherapy and the Potential Value of Biodegradable Rectal Spacers
Prostate Cancer and Prostatic Disease (2015) 18, 96–103 © 2015 Macmillan Publishers Limited All rights reserved 1365-7852/15 www.nature.com/pcan REVIEW A review of rectal toxicity following permanent low dose-rate prostate brachytherapy and the potential value of biodegradable rectal spacers ME Schutzer1, PF Orio2, MC Biagioli3, DA Asher4, H Lomas1 and D Moghanaki1,5 Permanent radioactive seed implantation provides highly effective treatment for prostate cancer that typically includes multidisciplinary collaboration between urologists and radiation oncologists. Low dose-rate (LDR) prostate brachytherapy offers excellent tumor control rates and has equivalent rates of rectal toxicity when compared with external beam radiotherapy. Owing to its proximity to the anterior rectal wall, a small portion of the rectum is often exposed to high doses of ionizing radiation from this procedure. Although rare, some patients develop transfusion-dependent rectal bleeding, ulcers or fistulas. These complications occasionally require permanent colostomy and thus can significantly impact a patient’s quality of life. Aside from proper technique, a promising strategy has emerged that can help avoid these complications. By injecting biodegradable materials behind Denonviller’s fascia, brachytherpists can increase the distance between the rectum and the radioactive sources to significantly decrease the rectal dose. This review summarizes the progress in this area and its applicability for use in combination with permanent LDR brachytherapy. Prostate Cancer and Prostatic Disease (2015) 18, 96–103; doi:10.1038/pcan.2015.4; published online 17 February 2015 A BRIEF HISTORY OF LOW DOSE-RATE PROSTATE demonstrated an 82% 8-year bPFS for 1444 patients treated with BRACHYTHERAPY radioactive seed implant for low-risk disease;4 (2) a series by Originally described in 1917, low dose-rate (LDR) prostate Taira et al.