An investigation by the Maryland Department of Health and Mental Hygiene confirmed that an isotope contamination case was an isolated incident (see link below). What was extraordinary was the way local and state agencies put the pieces of the puzzle together.
Health officials in one Maryland county's communicable disease unit were notified on Nov. 12, 2004, about a case of acute hepatitis C. During an interview, the patient mentioned knowing someone similarly diagnosed at a different hospital. Their spouses worked together, and the two had met Oct. 15 at a clinic for a nuclear stress test, according to the DHMH report released on Monday.
An examination of clinic records revealed a third person whose hep C was reported to the county on Nov. 11. Coincidence was beginning to seem unlikely, according to the report. A further scrutiny of records showed that the three patients with confirmed hepatitis - and five others tested at the clinic on Oct. 15 - had been injected with doses of technetium-99m-labeled sestamibi prepared from the same pharmacy.
As the investigation focused on the pharmacy, the DHMH sent statewide alerts, requesting prompt entry of cases into the Maryland Electronic Reporting and Surveillance System. No other cases resulted from this effort. The DHMH and the Centers for Disease Control and Prevention began testing employees at the clinic and the pharmacy. These tests were negative.
Local and state officials expanded their investigation to other clinics that had received doses of the radionuclide drawn from the same lot number. In all, 16 cases in three different counties were found. An analysis of potential risk factors occurring at the time of incubation found individual cases of blood transfusion, renal dialysis, and surgery. But the only true commonality was that each had received a cardiac stress test on Oct. 15, 2004.
The pharmacy investigation revealed a number of procedural practices that could result in cross-contamination. A review of the records showed that the donor of labeled leukocytes, compounded on Oct. 15, had previously been diagnosed with hepatitis C. Genetic testing further revealed the donor's viral RNA to be genotype 1a, which matched 12 of 16 outbreak cases where the viral genotype could be determined.
Because of the time lag of a month between infection and initial outbreak, physical evidence at the pharmacy was minimal. Nonetheless, officials pieced together a convincing picture of the likelihood of the source of contamination.
The fact that the first patient interviewed by the DHMH could tell officials about a friend similarly diagnosed was a lucky stroke. After that, however, the investigation proceeded deliberately, with good coordination between the various governmental agencies, follow-up of leads, and analysis along the way of the available evidence.
For more information from the Diagnostic Imaging archives:
Contaminated radioisotopes cause hepatitis C infections
Comment: Serendipity and footwork each play a role in investigation
An investigation by the Maryland Department of Health and Mental Hygiene confirmed that an isotope contamination case was an isolated incident (see link below). What was extraordinary was the way local and state agencies put the pieces of the puzzle together.
An investigation by the Maryland Department of Health and Mental Hygiene confirmed that an isotope contamination case was an isolated incident (see link below). What was extraordinary was the way local and state agencies put the pieces of the puzzle together.
Health officials in one Maryland county's communicable disease unit were notified on Nov. 12, 2004, about a case of acute hepatitis C. During an interview, the patient mentioned knowing someone similarly diagnosed at a different hospital. Their spouses worked together, and the two had met Oct. 15 at a clinic for a nuclear stress test, according to the DHMH report released on Monday.
An examination of clinic records revealed a third person whose hep C was reported to the county on Nov. 11. Coincidence was beginning to seem unlikely, according to the report. A further scrutiny of records showed that the three patients with confirmed hepatitis - and five others tested at the clinic on Oct. 15 - had been injected with doses of technetium-99m-labeled sestamibi prepared from the same pharmacy.
As the investigation focused on the pharmacy, the DHMH sent statewide alerts, requesting prompt entry of cases into the Maryland Electronic Reporting and Surveillance System. No other cases resulted from this effort. The DHMH and the Centers for Disease Control and Prevention began testing employees at the clinic and the pharmacy. These tests were negative.
Local and state officials expanded their investigation to other clinics that had received doses of the radionuclide drawn from the same lot number. In all, 16 cases in three different counties were found. An analysis of potential risk factors occurring at the time of incubation found individual cases of blood transfusion, renal dialysis, and surgery. But the only true commonality was that each had received a cardiac stress test on Oct. 15, 2004.
The pharmacy investigation revealed a number of procedural practices that could result in cross-contamination. A review of the records showed that the donor of labeled leukocytes, compounded on Oct. 15, had previously been diagnosed with hepatitis C. Genetic testing further revealed the donor's viral RNA to be genotype 1a, which matched 12 of 16 outbreak cases where the viral genotype could be determined.
Because of the time lag of a month between infection and initial outbreak, physical evidence at the pharmacy was minimal. Nonetheless, officials pieced together a convincing picture of the likelihood of the source of contamination.
The fact that the first patient interviewed by the DHMH could tell officials about a friend similarly diagnosed was a lucky stroke. After that, however, the investigation proceeded deliberately, with good coordination between the various governmental agencies, follow-up of leads, and analysis along the way of the available evidence.
For more information from the Diagnostic Imaging archives:
Contaminated radioisotopes cause hepatitis C infections
Newsletter
Stay at the forefront of radiology with the Diagnostic Imaging newsletter, delivering the latest news, clinical insights, and imaging advancements for today’s radiologists.
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For patients who had coronary CTA for acute chest pain, emerging research found no significant association between plaque burden grades with CAD-RADS 2.0 and cardiac events.
The Reading Room Podcast: Current Insights on Recent Research About Radiation-Induced Cancers with CT Scans, Part 2
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Study: Photon-Counting CT Reduces Radiation Dosing by More than 40 Percent in Kids with Congenital Heart Disease
For pediatric patients with congenital heart disease, new research showed that cardiac PCCT yielded comparable signal-to-noise and contrast-to-noise ratios to energy-integrating detector CT at over a 43 percent lower dose length product.
The Reading Room Podcast: Current Insights on Recent Research About Radiation-Induced Cancers with CT Scans, Part 1
In a new podcast, Mahadevappa Mahesh, MS, Ph.D., and Joseph Cavallo, M.D., share their perspectives on recently published research looking at projections for future radiation-induced cancers from computed tomography (CT) scans.
Study Shows Enhanced Diagnosis of Coronary Artery Stenosis with Photon-Counting CTA
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FDA Expands Approval of MRI-Guided Ultrasound Treatment for Patients with Parkinson’s Disease
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CCTA Study: Plaque Burden Offers No Prognostic Benefit for Predicting Cardiac Events in Patients with Acute Chest Pain
For patients who had coronary CTA for acute chest pain, emerging research found no significant association between plaque burden grades with CAD-RADS 2.0 and cardiac events.
The Reading Room Podcast: Current Insights on Recent Research About Radiation-Induced Cancers with CT Scans, Part 2
In a second part of a new podcast episode on recently published research on projected radiation-induced cancers from computed tomography (CT) scans, Mahadevappa Mahesh, MS, Ph.D., and Joseph Cavallo, M.D., offer current perspectives on cardiac CT dosing, AI advances and the importance of teamwork in ensuring appropriate dosing for CT.
Study: Photon-Counting CT Reduces Radiation Dosing by More than 40 Percent in Kids with Congenital Heart Disease
For pediatric patients with congenital heart disease, new research showed that cardiac PCCT yielded comparable signal-to-noise and contrast-to-noise ratios to energy-integrating detector CT at over a 43 percent lower dose length product.
The Reading Room Podcast: Current Insights on Recent Research About Radiation-Induced Cancers with CT Scans, Part 1
In a new podcast, Mahadevappa Mahesh, MS, Ph.D., and Joseph Cavallo, M.D., share their perspectives on recently published research looking at projections for future radiation-induced cancers from computed tomography (CT) scans.
Study Shows Enhanced Diagnosis of Coronary Artery Stenosis with Photon-Counting CTA
In a new study comparing standard resolution and ultra-high resolution modes for patients undergoing coronary CTA with photon-counting detector CT, researchers found that segment-level sensitivity and accuracy rates for diagnosing coronary artery stenosis were consistently > 89.6 percent.
FDA Expands Approval of MRI-Guided Ultrasound Treatment for Patients with Parkinson’s Disease
For patients with advanced Parkinson’s disease, the expanded FDA approval of the Exablate Neuro platform allows for the use of MRI-guided focused ultrasound in performing staged bilateral pallidothalamic tractotomy.