This work was funded by R21CA134819 (CH), T32CA009035 (SD),and P30CA006927 (Cancer Center Core Grant). The authors would like to thank Elizabeth Culnan for her assistance with participant recruitment, Lia Boyle, Eva Panigrahi, and Kate Menezes for their assistance in the development of procedures, and Jeanne Pomenti with her assistance with manuscript preparation. We also thank the journal reviewers for their helpful suggestions.

1. Preparing for UV Exposure
	<ol>
		<li>Explain to the participant how MED testing works ("I'm going to expose some skin on your arm to UV light over the course of about 20 min, and tomorrow, we're going to check that section of your skin in order to determine how sensitive you are to the light. You may experience a sunburn in the small areas that we expose to UV. If the sunburn is painful or bothers you, you can treat it like you would any other sunburn.")</li>
	 <li>Staff and participant should wear UV protective glasses.</li>
	 <li>The participant should be wearing a short-sleeved shirt or roll her sleeve up.</li>
	 <li>Have the participant put on a glove to protect the skin on her hand. </li>
	 <li>Remove the Daavlin patch1 backing on the left and right sides of the patch, and place it on the inner lower arm just adjacent to the glove, avoiding any existing skin blemishes.</li>
		<li>Cover any additional skin on the arm with the participant's shirt or other material.</li>
	 <li>Place the arm so that the holes in the patch will be exposed to the UV light source. No other skin should be exposed to the UV light.</li>
	 <li>Tell the participant she will feel warmth but her arm will not be burning during the test.</li>
	</ol>
	2. Conducting UV Exposure
	<ol>
		<li>Patch holes (e.g. 6) should be exposed to UV at intervals throughout the exposure period. </li>
	 <li>Start with hole 1 open.</li>
	 <li>Select the total duration of the exposure based on the manufacturer specifications for the light source and the participant's Fitzpatrick skin type I-VI (very fair to very dark; Fitzpatrick, 1988).2 Fairer skin is more likely to burn.</li>
	 <li>Set a timer for the total duration of exposure (e.g. 20 min). A second backup timer may also be used. Start the timer(s). </li>
	 <li>For example, open hole 2 after 2 min, open hole 3 after 4 min, open hole 4 after 8 min, open hole 5 after 12 min, and open hole 6 after 16 min. Thus, the skin UV exposure times will be 20 min for hole 1, 18 min for hole 2, 16 min for hole 3, 12 min for hole 4, 8 min for hole 5, and 4 min for hole 6.</li>
	 <li>In order to more easily identify the exposed areas after 24-48 hr, mark the skin exposed on the far edge of the first and last holes of the patch and ask the participant to not wash off the marks until after the skin is examined.</li>
	 <li>Have the participant remove the glove and patch.</li>
	 <li>Reiterate to the participant that the skin must be reexamined in 24-48 hr.</li>
	</ol>
	3. Assessing the MED
	<ol>
		<li>After 24-48 hr, examine the exposed areas of skin. Red or pink skin indicates erythema or burning. Erythemetous skin exposed to the shortest duration of UV is defined as the minimal erythema dose or MED.</li>
	 <li>Future exposures to UV should be for durations shorter than the MED to avoid burning.</li>
	 <li>If the areas of exposure are difficult to identify, you may want to put the patch back on using the marks to align with the exposed skin. This is also helpful if using a skin color measurement device such as a spectrophotometer. </li>
	 <li>Spectrophotometers provide measures of L* (darkness) and b* (hue). a* refers to the redness of the skin. A higher a* value indicates redder skin.</li>
	 <li>If using a skin color measurement device such as a spectrophotometer, place the spectrophotometer aperture in the center of the hole to be measured. </li>
	 <li>Measure each of the 6 exposure areas in numerical order and one unexposed area near the others for comparison. Try to measure the center of each hole but not a freckle or mole or other non-UV discolorations. Label each of the measurements. The measurement from the unexposed area should be labeled 0 min and be listed next to area 6 (the shortest exposure area - 4 min).</li>
	 <li>Increases in a* values should correspond with increases in UV exposure duration. Try re-measuring values that are not in corresponding order.</li>
	 <li>A 2.5 point difference in the a* of unexposed skin compared to exposed skin indicates a significant difference in redness, suggesting potential burning.</li>
	 <li>Add 2.5 to the lowest a* value. Anything at or above this value would be considered potentially burning. The lowest exposure time above this value is considered the MED.</li>
	</ol>

<ol>
	<li>Fitzpatrick, T. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+validity+and+practicality+of+sun-reactive+skin+types+I+through+VI.">The validity and practicality of sun-reactive skin types I through VI.</a> Archives of Dermatology. 124, 869-871 (1988).</li><li>Bodekaer, M., Akerstrom, U., Wulf, H. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accumulation+of+sunscreen+in+human+skin+after+daily+applications:+a+study+of+sunscreens+with+different+ultraviolet+radiation+filters.">Accumulation of sunscreen in human skin after daily applications: a study of sunscreens with different ultraviolet radiation filters.</a> Photodermatol. Photoimmunol. Photomed. 28, 127-132 (2012).</li><li>Kwon, I. H., Kwon, H. H., Na, S. J., Youn, J. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Could+colorimetric+method+replace+the+individual+minimal+erythemal+dose+(MED)+measurements+in+determining+the+initial+dose+of+narrow-band+UVB+treatment+for+psoriasis+patients+with+skin+phototype+III-V?.">Could colorimetric method replace the individual minimal erythemal dose (MED) measurements in determining the initial dose of narrow-band UVB treatment for psoriasis patients with skin phototype III-V?.</a> J. Eur. Acad. Dermatol. Venereol. , (2012).</li><li>Youn, J. I., Park, J. Y., Jo, S. J., Rim, J. H., Choe, Y. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+the+usefulness+of+skin+phototype+and+skin+color+as+the+parameter+of+cutaneous+narrow+band+UVB+sensitivity+in+psoriasis+patients.">Assessment of the usefulness of skin phototype and skin color as the parameter of cutaneous narrow band UVB sensitivity in psoriasis patients.</a> Photodermatol. Photoimmunol. Photomed. 19, 261-264 (2003).</li><li>Henriksen, M., Na, R., Agren, M. S., Wulf, H. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimal+erythema+dose+after+multiple+UV+exposures+depends+on+pre-exposure+skin+pigmentation.">Minimal erythema dose after multiple UV exposures depends on pre-exposure skin pigmentation.</a> Photodermatol. Photoimmunol. Photomed. 20, 163-169 (2004).</li><li>Kraemer, C. K., Menegon, D. B., Cestari, T. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Determination+of+the+minimal+phototoxic+dose+and+colorimetry+in+psoralen+plus+ultraviolet+A+radiation+therapy.">Determination of the minimal phototoxic dose and colorimetry in psoralen plus ultraviolet A radiation therapy.</a> Photodermatol. Photoimmunol. Photomed. 21, 242-248 (2005).</li><li>Sachdeva, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fitzpatrick+skin+typing:+applications+in+dermatology.">Fitzpatrick skin typing: applications in dermatology.</a> Indian J. Dermatol. Venereol. Leprol. 75, 93-96 (2009).</li><li>Webb, A. R., Kift, R., Berry, J. L., Rhodes, L. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+vitamin+D+debate:+translating+controlled+experiments+into+reality+for+human+sun+exposure+times.">The vitamin D debate: translating controlled experiments into reality for human sun exposure times.</a> Photochem. Photobiol. 87, 741-745 (2011).</li><li>Otman, S. G., Edwards, C., Gambles, B., Anstey, A. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+a+semiautomated+method+of+minimal+erythema+dose+testing+for+narrowband+ultraviolet+B+phototherapy.">Validation of a semiautomated method of minimal erythema dose testing for narrowband ultraviolet B phototherapy.</a> Br. J. Dermatol. 155, 416-421 (2006).</li><li>Taylor, D. K., Anstey, A. V., Coleman, A. J., Diffey, B. L., Farr, P. M., Ferguson, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+dosimetry+and+calibration+in+ultraviolet+radiation+therapy:+a+report+of+a+British+Photodermatology+Group+workshop.">Guidelines for dosimetry and calibration in ultraviolet radiation therapy: a report of a British Photodermatology Group workshop.</a> Br. J. Dermatol. 146, 755-763 (2002).</li></ol>

We have nothing to disclose.

Ultraviolet radiation (UV) therapy is sometimes used as a treatment for various common skin conditions, including psoriasis, acne, and eczema. The dosage of UV light is prescribed according to an individual's skin sensitivity, which is determined as a function of the individual's Fitzpatrick skin type I through VI (very fair to very dark).2 Human skin varies in its sensitivity to UV radiation because of varying degrees of skin pigmentation, thickness, and other factors. Thus, to establish the proper dosage of ...

minimal erythema dose (med) testing

Ultraviolet radiation (UV) therapy is sometimes used as a treatment for various common skin conditions, including psoriasis, acne, and eczema. The dosage of UV light is prescribed according to an individual's skin sensitivity. Thus, to establish the proper dosage of UV light to administer to a patient, the patient is sometimes screened to determine a minimal erythema dose (MED), which is the amount of UV radiation that will produce minimal erythema (sunburn or redness caused by engorgement of capillaries) of an individual's skin within a few hours following exposure. This article describes how to conduct minimal erythema dose (MED) testing. There is currently no easy way to determine an appropriate UV dose for clinical or research purposes without conducting formal MED testing, requiring observation hours after testing, or informal trial and error testing with the risks of under- or over-dosing. However, some alternative methods are discussed.

<img alt="Figure 1" fo:content-width="4in" fo:src="/files/ftp_upload/50175/50175fig1highres.jpg" src="/files/ftp_upload/50175/50175fig1.jpg" /> 
Figure 1. The four steps of conducting MED testing: preparing for UV exposure, conducting UV exposure, assessing the MED, and determining the MED.
<img alt="Figure 2" src="/files/ftp_upload/50175/50175fig2.jpg" />
<p class="jove_content" fo:keep-toget...

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Minimal Erythema Dose MED Testing

This article describes how to conduct minimal erythema dose (MED) testing in order to determine the lowest dose of ultraviolet radiation that will cause erythema (burning) when administered to an individual.

Minimal Erythema Dose (MED) Testing

Ultraviolet radiation (UV) therapy is  sometimes used as a treatment for various common skin conditions, including  psoriasis, acne, and eczema. The ...

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41.2K Views.  Fox Chase Cancer Center. This article describes how to conduct minimal erythema dose (MED) testing in order to determine the lowest dose of ultraviolet radiation that will cause erythema (burning) when administered to an individual.

Video: Minimal Erythema Dose MED Testing

Quantitative Autonomic Testing

Disorders associated with dysfunction of autonomic nervous system are quite common yet frequently unrecognized. Quantitative autonomic testing can be invaluable tool for evaluation of these disorders, both in clinic and research. There are number of autonomic tests, however, only few were validated clinically or are quantitative. Here, fully quantitative and clinically validated protocol for testing of autonomic functions is presented. As a bare minimum the clinical autonomic laboratory should have a tilt table, ECG monitor, continuous noninvasive blood pressure monitor, respiratory monitor and a mean for evaluation of sudomotor domain. The software for recording and evaluation of autonomic tests is critical for correct evaluation of data. The presented protocol evaluates 3 major autonomic domains: cardiovagal, adrenergic and sudomotor. The tests include deep breathing, Valsalva maneuver, head-up tilt, and quantitative sudomotor axon test (QSART). The severity and distribution of dysautonomia is quantitated using Composite Autonomic Severity Scores (CASS). Detailed protocol is provided highlighting essential aspects of testing with emphasis on proper data acquisition, obtaining the relevant parameters and unbiased evaluation of autonomic signals. The normative data and CASS algorithm for interpretation of results are provided as well.

Standardized, comprehensive and fully quantitative testing of autonomic functions is described. The autonomic tests consist of evaluation of all three major autonomic domains including cardiovagal, adrenergic and sudomotor. The severity and distribution of dysautonomia is quantitated using Composite Autonomic Severity Scores.

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For pediatric applications, dose savings with the SBDX system are expected to be smaller than in adult procedures. However, the SBDX system allows for additional dose savings by implementing an electronic adaptive exposure technique. Key to this method is the multi-beam scanning technique of the SBDX system: rather than exposing every part of the image with the same radiation dose, we can dynamically vary the exposure depending on the opacity of the region exposed. Therefore, we can significantly reduce exposure in radiolucent areas and maintain exposure in more opaque regions. In our current implementation, the adaptive exposure requires user interaction (Figure 3). However, in the future, the adaptive exposure will be real time and fully automatic.
We have performed experiments with an anthropomorphic phantom and compared measured radiation dose with and without adaptive exposure using a dose area product (DAP) meter. In the experiment presented here, we find a dose reduction of 30%.

We are developing a dynamic adaptive exposure technique using our scanning beam digital X-ray system. Rather than exposing an object uniformly, the exposure is adapted depending on the opacity of the object. Here we show an experiment on an anthropomorphic phantom that resulted in a dose saving of 30%.

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This article describes the process used by &#214;rebro University Hospital to produce double dose buffy coat platelet concentrates prepared from whole blood donations and treated with the INTERCEPT Blood System for pathogen inactivation. The in vitro quality of the final platelet units are evaluated over 7 days of storage.

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A Novel Application of Musculoskeletal Ultrasound Imaging

Ultrasound is an attractive modality for imaging muscle and tendon motion during dynamic tasks and can provide a complementary methodological approach for biomechanical studies in a clinical or laboratory setting. Towards this goal, methods for quantification of muscle kinematics from ultrasound imagery are being developed based on image processing. The temporal resolution of these methods is typically not sufficient for highly dynamic tasks, such as drop-landing. We propose a new approach that utilizes a Doppler method for quantifying muscle kinematics. We have developed a novel vector tissue Doppler imaging (vTDI) technique that can be used to measure musculoskeletal contraction velocity, strain and strain rate with sub-millisecond temporal resolution during dynamic activities using ultrasound. The goal of this preliminary study was to investigate the repeatability and potential applicability of the vTDI technique in measuring musculoskeletal velocities during a drop-landing task, in healthy subjects. The vTDI measurements can be performed concurrently with other biomechanical techniques, such as 3D motion capture for joint kinematics and kinetics, electromyography for timing of muscle activation and force plates for ground reaction force. Integration of these complementary techniques could lead to a better understanding of dynamic muscle function and dysfunction underlying the pathogenesis and pathophysiology of musculoskeletal disorders.

We describe a new ultrasound-based vector tissue Doppler imaging technique to measure muscle contraction velocity, strain and strain rate with sub-millisecond temporal resolution during dynamic activities. This approach provides complementary measurements of dynamic muscle function and could lead to a better understanding of mechanisms underlying musculoskeletal disorders.

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The current priority in breast cancer radiotherapy is to reduce cardiac doses without compromising target tissue coverage. The voluntary breath-hold technique described here is a simple, inexpensive solution to this problem and capable of being instituted widely without the need for specialized equipment.

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A highly reproducible model for myocardial infarction in mice with minimal invasive manipulations is described. The model can be easily performed, resulting in a high reproducibility and survival rate. Thus, the described model will reduce the number of required animals as requested by the 3R principle (Replacement, Refinement and Reduction).

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Minimal erythema dose (MED) testing is frequently used in clinical settings for determining the smallest amount of ultraviolet (UV) irradiation necessary to produce erythema (inflammatory reddening) on the surface of the skin. In this context, the MED is regarded as a key factor in determining starting doses for UV phototherapy for common skin conditions such as psoriasis and eczema. In research settings, MED testing also has potential to be a powerful tool for assessing within- and between-persons variation in inflammatory responses. However, MED testing has not been widely adopted for use in research settings, likely owing to a lack of published guidelines, which is a barrier to obtaining reproducible results from this assay. Also, protocols and equipment for establishing MED vary widely, making it difficult to compare results across laboratories. Here, we describe a precise and reproducible method to induce and measure superficial erythema using newly designed protocols and methods that can easily be adapted to other equipment and laboratory environments. The method described here includes detail on procedures that will allow extrapolation of a standardized dosage schedule to other equipment so that this protocol can be adapted to any UV radiation source.

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