Perception of Orthopedics Surgeons about the Risks of Radiation Exposure in Fluoroscopy / Percepção de cirurgiões ortopédicos sobre os riscos da exposição à radiação na fluoroscopia

Abstract Objective The present study aims to understand the perceptions of orthopedists and traumatologists regarding the risk of exposure to ionizing radiation in fluoroscopy procedures. Methods An objective, structured, self-administered questionnaire with sociodemographic, professional, and occupational variables was developed, available through an invitation sent to orthopedist physicians whose contacts were made publicly available. Results A total of 141 questionnaires were answered and analyzed. Most respondents (99%) use fluoroscopy in their surgeries, and only 34.8% of the participants feel safe with the use of the equipment. It was observed that the knowledge about ionizing radiation is inadequate, because 22.6% of the participants are unaware of the type of radiation emitted in fluoroscopy and its biological effects. In addition, 52% of the participants did not know or do not understand the principles of radiological protection and their relationship with surgical practices. Conclusion We concluded that the radiological protection of most orthopedists in surgical procedures is inadequate, and initial and continued training programs of professionals are necessary, bringing health benefits to orthopedists and their patients.

Resumo Objetivo Este estudo visa compreender as percepções dos médicos ortopedistas e traumatologistas em relação ao risco da exposição à radiação ionizante nos procedimentos de fluoroscopia. Métodos Desenvolveu-se um questionário objetivo, estruturado, autoaplicável e com variáveis sociodemográficas, profissionais e ocupacionais, disponibilizado através de convite enviado a médicos ortopedistas cujos contatos estavam disponibilizados publicamente. Resultados Foram respondidos e analisados 141 questionários. A maioria dos respondentes (99%) utilizam a fluoroscopia em suas cirurgias, e apenas 34,8% dos participantes se sentem seguros com o uso do equipamento. Observou-se que o conhecimento sobre radiação ionizante é inadequado, pois 22,6% dos respondentes desconhecem o tipo de radiação emitida na fluoroscopia e seus efeitos biológicos. Além disso, 52% dos respondentes não conhecem ou não compreendem os princípios de proteção radiológica e suas relações com as práticas cirúrgicas. Conclusão Conclui-se que a proteção radiológica da maioria dos ortopedistas nos procedimentos cirúrgicos é inadequada e são necessários programas de formação inicial e continuada dos profissionais, trazendo benefícios para a saúde dos ortopedistas e de seus pacientes.

Actualización en fotoprotección / Update in photoprotection

Hoy en día entre las principales patologías por las que muchos pacientes acuden a servicios de dermatología suelen encontrarse las fotodermatosis o enfermedades de la piel causadas por exposición aguda o crónica a la radiación ultravioleta. Tal vez uno de los motivos de la elevada incidencia de estas enfermedades se debe al desarrollo de diferentes actividades cotidianas bajo el sol, sin la protección adecuada, ya que gran parte de la población todavía no ha tomado conciencia del daño que puede ocasionar el sol en la piel; en su papel como exacerbante de entidades como el lupus o diferentes cuadros de alergia; así como desencadenante del cáncer de piel. Al respecto cada año se producen más de 130.000 casos de melanoma en todo el mundo (estimaciones de la Organización Mundial de la Salud); y entre 2 a 3 millones de cánceres de piel que no son tipo melanoma. Mientras los cánceres de piel no-melanomas tienen fácil tratamiento quirúrgico y raramente son malignos; los melanomas (cánceres de piel por excesiva exposición a la radiación ultravioleta) son muy agresivos, los tratamientos no son muy eficaces a largo plazo, y la mortalidad es relativamente elevada. A lo anteriormente mencionado se suma la situación de confinamiento por la pandemia de COVID-19 debido a la cuál hemos estado en un periodo prolongado de baja exposición solar más larga de lo habitual, teniendo como consecuencia fisiopatológica bajos niveles de síntesis de vitamina D corporal, con un incremento en el riesgo de infecciones, incluida la del coronavirus. De igual manera procesos de protección solar como la melanogénesis dependientes del impacto de la radiación ultravioleta (UV) en la piel frenada por el mismo confinamiento, así como la reducción en la hiperqueratosis e hiperplasia epidérmica, como respuesta gradual de aclimatación lumínica de la piel, han traído como consecuencia un mayor daño por la mayor sensibilidad frente a las irradiancias solares más energéticas y agresivas (UV), con una piel sin período de adaptación, lo que podría repercutir a largo plazo en una mayor incidencia de cáncer de piel. De esta forma tenemos que considerar que en el periodo de confinamiento por la COVID-19 las medidas de foto protección habituales cobran especial importancia, por lo que es recomendable exposiciones solares directas, diarias, breves, para aumentar los niveles séricos de vitamina D3, además de lograr los beneficios que aportan la exposición solar a nuestro estado de ánimo, a través de la estimulación de neurotransmisores involucrados en los mecanismos de bienestar emocional(afectado también por el confinamiento). Por tales motivos el objetivo de la presente revisión será brindar una actualización en lo referente a tipos de fotoprotectores, su uso; y sobre las recomendaciones en foto prevención que deben inculcarse en nuestra población.

Algae Metabolites as an Alternative in Prevention and Treatment of Skin Problems Associated with Solar Radiation and Conventional Photo-protection

Abstract The histological structure and biochemistry of the skin is affected by solar radiation having adverse effects ranging from sunburns, premature aging that includes wrinkles, spots, dryness, and loss of collagen to cancer development. The skin has defense mechanisms to prevent damage caused by radiation, but when radiation exposure is excessive these mechanisms are not strong enough to protect the skin. The use of sunscreen is the most common practice of photo- protection. The active ingredients of these cosmetic protective formulations are generally from synthetic origin and have presented several drawbacks at the level of photo-stability, systemic absorption and can generate contact and photo-contact dermatitis. This review illustrates skin solar radiation problems, common sunscreen ingredients limitation and mentions how algae can be an alternative according to studies that have evaluated the photo-protective potential of extracts and compounds isolated by different techniques.

Ionizing Radiation Exposure in Children with Vesicoureteral Reflux: Should We Be Alarmed? / Exposición a radiacion ionizante en niños con reflujo vesicoureteral: Debemos preocuparnos?

Objectives Ionizing radiation imaging is commonly used for diagnosis and follow up in children with vesicoureteral reflux (VUR). We aim to measure the effective dose (mSv) in patients with VUR. Methods We reviewed our electronic database of patients under 8-years-old with VUR. Primary endpoint was to calculate the effective radiation dose (ED). Absolute frequencies and percentages were reported for global qualitative variables. This study conducted a logistic regression model to calculate the odds ratio for radiation exposure. Analysis was performed using STATA version 14.0 (StataCorp LLC, College Station, TX, EEUU). Results A total of 140 patients were found, 97 were assessed for eligibility. We included 59 patients in the final analysis. Mean age was 20 ± 17.9 months, 66% were females. Most cases of VUR were bilateral (44%) and high grade (93.4%). The lowest number of studies per patient was two, with a minimum radiation of 5.7 mSv. The highest radiation was estimated at 20.7 mSv corresponding to a total of five studies. Logistic regression showed that highest grades of VUR and age of first UTI episode were associated with higher ED (OR, 1.7; 95% CI, 0.87-3.31), (OR 1.02; 95% CI 0.97-1.07) respectively. A mean ED for children with VUR was estimated of 5.5 ± 3 mSv/year. Conclusion In our study, the children with VUR were exposed to 5.5 mSv/year without counting the natural background radiation, which is alarming, and we believe should raise awareness worldwide in how we are unnecessarily diagnosing indolent VUR cases and following patients.

Objetivos La imagenología por radiación ionizante es una herramienta usada frecuentemente para el diagnóstico y seguimiento de pacientes con reflujo vesicoureteral (RVU). El objetivo del presente trabajo es calcular la dosis estimada en milisieverts (mSv) de pacientes con RVU. Métodos Se realizó una revisión retrospectiva de todos los pacientes menores de 8 años con RVU. El objetivo principal fue calcular la dosis de radiación efectiva recibida por los pacientes con base en los estudios imagenológicos realizados hasta el momento de la revisión de la base de datos. Las frecuencias y porcentajes fueron reportados para las variables cualitativas. Se realizó una regresión logística para calcular la asociación de factores de riesgo con la exposición a radiación. El análisis estadístico fue realizado con el programa STATA versión 14.0 (StataCorp LLC, College Station, TX, EEUU). Resultados Se identificaron 140 patientes, de los cuales 97 fueron evaluados para coprobar su elegibilidad. En total, 59 pacientes fueron incluidos para el análisis final. La edad promedio de los pacientes fue de 20 ± 1,.9 meses, y 66% eran mujeres. La mayoría de casos fueron bilaterales (44%) y de alto grado (93,4%). El menor número de estudios realizados por paciente fue 2, con una dosis mínima de radiación acumulada de 5,7 mSv. La máxima radiación acumulada fue de 20,7 mSv, correspondiente a un total de 5 estudios. La regresión logística demostró que altos grados de reflujo y la edad a la cual tuvieron la primera infección se asociaban con mayores dosis de radiación efectiva (razón de probabilidades [RP]: 1.7; intervalo de confianza del 95% [IC95%]: 0,87­3,31), (RP: 1,02; IC95%: 0,97­1,07), respectivamente. Estimamos una dosis efectiva de radiación de 5,5 ± 3 mSv/año en nuestra población. Conclusión Nuestro estudio demuestra que pacientes con reflujo son expuestos a un promedio de 5,5 mSv/año sin contar la radiación de base a la que se exponen todos los humanos anualmente, lo cual resulta alarmante. Esto debe generar introspección al momento de evaluar pacientes con reflujo y evitar efectos a largo y mediano plazos.

Characterization of Geiger-Müller radiation detectors response at the University of Costa Rica's Cyclotron Facilities / Caracterización de la respuesta de detectores de radiación Geiger-Müller en el Ciclotrón de la Universidad de Costa Rica

To ensure a reliable verification of a radiation detector, the right parameters for this response verification must be determined and a specific characterization on the detectors of interest must be performed. These were the main pillars of this study, where four Geiger-Müller at the University of Costa Rica's Cyclotron Facilities' main laboratories were studied and characterized using a 137Cs source. First, a verification of the inverse-square law was performed to corroborate the correct measurement by the detectors as the distance from a 137Cs source to the detectors was varied using a new design for a positioner support to ensure repeatability. This verification yielded a potential fit curve with and equation D=670635 x-1.961 (error percentage of 1.95%) and an R2 value of 0.9836. Then, using combinations of copper plates of widths 1.0 mm and 2.0 mm as attenuators between the source and the detectors, the mass attenuation coefficient for copper was obtained only as a reference value for future calibrations of the detectors. The result for this value was 0.040 cm2 /g. The results obtained in this study and the method developed to achieve these results will serve as a base for calibrations of the detectors at these facilities, which will ensure the safety of the patients and personnel in this building.

Para asegurar respuesta correcta de un detector de radiación, se deben determinar los parámetros correctos para esta verificación y debe realizarse una caracterización específica de los detectores de interés. Estos fueron los pilares principales de este estudio, donde se estudiaron y caracterizaron 4 detectores Geiger-Müller en los laboratorios principales del Ciclotrón de la Universidad de Costa Rica utilizando una fuente radiactiva de 137Cs. Primero, se realizó una verificación de la ley del inverso-cuadrado para corroborar la medición correcta de los detectores según se varía la distancia entre la fuente de 137Cs al detector utilizando un diseño nuevo de un soporte posicionador para la fuente que asegura la repetibilidad entre experimentos. Esta verificación resultó en una curva de ajuste potencial de ecuación D=670635x-1,961 (porcentaje de error de 1,95%) y un valor de R2 de 0,9836. Luego, utilizando combinaciones de placas de cobre de espesores 1,0 mm y 2,0 mm como atenuadores entre la fuente y los detectores, se obtuvo el coeficiente de atenuación másico para el cobre como un valor de referencia para futuras calibraciones de los detectores. Este resultado fue de 0,040 cm2/g. Los resultados obtenidos en esta investigación y el método desarrollado para lograr estos resultados servirán como una base para una futura confirmación metrológica calibraciones de los detectores en estos laboratorios, lo cual colaborará con la seguridad y protección radiológica de pacientes y trabajadores en este edificio.

Estimated exposure of spine surgeons to radiation / Estimativa da exposição de cirurgiões de coluna vertebral à radiação / Estimativa de la exposición de cirujanos de columna vertebral a la radiación

ABSTRACT Objective To estimate the amount of radiation received and accumulated in the bodies of two surgeons, one being the responsible surgeon and the other the assistant, performing spine surgery procedures over a period of 25 years. Methods Seventy-two spinal surgeries were performed during a seven-month period and the radiation loads were measured in both surgeons. The measurement of radiation was captured in fluoroscopy in anteroposterior and lateral incidences. The surgeon and the assistant used two dosimeters, one in the cervical region protecting the thyroid and the other on the lead apron in the genital region. The radioactive loads were measured in millisieverts and the accumulated charges were recorded monthly in both regions of the body in the two surgeons for seven months and the means for the work periods (1, 5, 10, 15, 20 and 25 years) were estimated. Results It was observed that in the surgeon the average accumulated radiation loads were 131.9% and 176.92% higher than those of the assistant in the cervical and genital regions, respectively. Conclusion While the use of X-rays is indispensable in routine orthopedic surgery, we have to consider the development of techniques of protection, rigor and discipline in the use of safety materials for surgeons. Preventive exposure reduction measures such as using thyroid protection equipment and turning the head away from the patient during fluoroscopy, among others, should be mandatory to promote less radiation exposure. Level of evidence II; Comparative prospective study.

RESUMO Objetivo Estimar a quantidade de radiação recebida e acumulada no corpo de dois cirurgiões, durante período de 25 anos de trabalho, sendo um o cirurgião responsável e outro, assistente, nos procedimentos de cirurgia da coluna vertebral. Métodos Foram realizadas 72 cirurgias de coluna vertebral em um período de sete meses, e as cargas de radiação foram medidas nos dois cirurgiões. A medição da radiação foi captada em fluoroscópio nas incidências anteroposterior e de perfil. O cirurgião e o auxiliar utilizaram dois dosímetros, sendo um na região cervical protegendo a tireoide e outro sobre o avental de chumbo, na região genital. As cargas radioativas foram medidas em milisievert e as cargas acumuladas foram registradas mensalmente em ambas as regiões do corpo nos dois cirurgiões, durante sete meses, foram estimadas as médias no período (1, 5, 10, 15, 20 e 25 anos) de trabalho. Resultados Observou-se que no cirurgião as médias das cargas de radiação acumulada foram 131,9% e 176,92% superiores às do assistente nas regiões cervical e genital, respectivamente. Conclusão Enquanto o uso dos raios X for indispensável na rotina da cirurgia ortopédica, há de se considerar o desenvolvimento de técnicas de proteção, rigor e disciplina no uso materiais de segurança para os cirurgiões. Medidas preventivas de redução da exposição, como uso de equipamento para proteção da tireoide e girar a cabeça para se afastar do paciente durante a fluoroscopia, entre outras, devem ser obrigatórias para promover menor exposição à radiação. Nível de evidência II; Estudo prospectivo comparativo.

RESUMEN Objetivo Estimar la cantidad de radiación recibida y acumulada en el cuerpo de dos cirujanos, durante 25 años de trabajo, siendo uno el cirujano responsable y el otro, asistente, en los procedimientos de cirugía de columna vertebral. Métodos Se realizaron 72 cirugías de columna vertebral en un período de siete meses, y las cargas de radiación fueron medidas en los dos cirujanos. La medición de la radiación fue captada en fluoroscopio en las incidencias anteroposterior y de perfil. El cirujano y el auxiliar usaron dos dosímetros, siendo uno en la región cervical protegiendo la tiroides y otro sobre el delantal de plomo, en la región genital. Las cargas radiactivas se midieron en milisievert, y las cargas acumuladas se registraron mensualmente en ambas regiones del cuerpo, en los dos cirujanos, durante siete meses, y se estimaron los promedios durante el período (1, 5, 10, 15, 20 y 25 años) de trabajo. Resultados Se observó que en el cirujano los promedios de las cargas de radiación acumulada fueron de 131,9% y 176,92% superiores a las del asistente en las regiones cervical y genital, respectivamente. Conclusión Mientras el uso de rayos X sea indispensable en la rutina de la cirugía ortopédica, hay que considerar el desarrollo de técnicas de protección, rigor y disciplina en el uso de materiales de seguridad para los cirujanos. Las medidas preventivas de reducción de la exposición, como uso de equipamiento para protección de la tiroides y girar la cabeza para alejarse del paciente durante la fluoroscopia, entre otras, deben ser obligatorias para promover menor exposición a la radiación. Nivel de evidencia II; Estudio prospectivo comparativo.

Safety of the effective radiation dose received during stroke hospitalization / Segurança da dose de radiação efetiva recebida durante internação por acidente vascular cerebral

Abstract Background Neuroimaging is widely used for diagnosis and treatment of stroke. However, little is known about whether the radiation doses received by patients comply with international safety guidelines. Objectives The aim of this study was to evaluate the effective radiation dose received while in hospital for stroke and analyze its safety according to current guidelines. Methods This cross-sectional study included 109 patients who were hospitalized and diagnosed with ischemic stroke. The National Institutes of Health Stroke Scale was used to evaluate stroke severity, the Bamford clinical classification was used for topography, and the TOAST classification was used for etiology. The computed tomography dose index and size-specific dose estimates were used to calculate the effective radiation dose (ERD) received while in hospital. A Mann-Whitney test was used to compare the ERD received by thrombolysed and non-thrombolysed patients. Non-parametric statistics were used to analyze the data with a 95% confidence interval. Results During the study period, the median ERD received was 10.9 mSv. Length of stay was not associated with radiation exposure. No differences were demonstrated in ERD according to stroke etiology or Bamford clinical classification. Patients who had CT perfusion (only or in addition to CT or angiotomography) received the highest ERD (46.5 mSv) and the difference compared to those who did not (10.8 mSv) was statistically significant (p<0.001). No differences were found in the ERD between thrombolysed and non-thrombolysed patients. There was no correlation between ERD while in hospital and stroke severity. Conclusions According to the current national guidelines, the protocol for examining images at our stroke unit is safe in terms of the ERD received by the patient while in hospital. There was no difference in the ERD received by patients stratified by thrombolytic treatment or stroke severity.

Resumo Contexto A neuroimagem é amplamente utilizada para o diagnóstico e tratamento do acidente vascular cerebral (AVC). No entanto, pouco se sabe se a dose de radiação recebida nesses exames está de acordo com as diretrizes internacionais de segurança. Objetivos O objetivo deste estudo foi avaliar a dose de radiação efetiva (DRE) durante a hospitalização por AVC. Métodos Trata-se de estudo transversal com 109 pacientes hospitalizados com diagnóstico de AVC isquêmico. A gravidade do AVC foi avaliada pela National Institutes of Health Stroke Scale, a topografia pela classificação clínica de Bamford e a etiologia pelo Trial of ORG 10172 in Acute Stroke Treatment (TOAST). O índice de dose recebida no exame de tomografia computadorizada (TC) e as estimativas de dose específicas foram usados ​​para calcular a DRE recebida durante a hospitalização. O teste de Mann-Whitney foi utilizado para comparar a DRE recebida por pacientes trombolisados ​​e não trombolisados. Estatísticas não paramétricas foram utilizadas para analisar os dados. Resultados Durante o período do estudo, a DRE foi de 10,9 mSv. O tempo de internação não foi associado à exposição à radiação. Nenhuma diferença foi demonstrada na DRE de acordo com a etiologia e classificação clínica de Bamford. Os pacientes que fizeram perfusão (isolada, associada à TC ou angiotomografia) receberam a maior DRE (46,5 mSv) em comparação aos que não fizeram (10,8 mSv), sendo estatisticamente significativo (p <0,001). Não foram encontradas diferenças na DRE entre pacientes trombolisados e não trombolisados. Não houve correlação entre a DRE durante a hospitalização com a gravidade do AVC. Conclusões De acordo com as atuais diretrizes nacionais, o protocolo de exame de imagens na unidade de AVC é seguro em relação à DRE recebido pelo paciente durante a internação. Não houve diferença na DRE dos pacientes de acordo com o tratamento trombolítico e a gravidade do AVC.

Padronizando a Exposição à Radiação durante o Cateterismo Cardíaco em Crianças com Cardiopatia Congênita: Dados de um Registro Multicêntrico Brasileiro / Standardizing Radiation Exposure during Cardiac Catheterization in Children with Congenital Heart Disease: Data from a Multicenter Brazilian Registry

Resumo Fundamento Nos últimos anos, o recente aumento no número de procedimentos intervencionistas tem resultado em crescente preocupação em relação à exposição radiológica por pacientes e equipe médica. A avaliação da exposição dos níveis de radiação em crianças é difícil devido à grande variabilidade no peso corporal. Portanto, os valores de referência de radiação não estão bem definidos para essa população. Objetivos Avaliar e validar a razão do produto dose-área (DAP) em relação ao peso corporal como uma medida de referência de radiação em cateterismos cardíacos em crianças. Métodos Estudo multicêntrico observacional com dados do Registro Brasileiro de Cateterismo Cardíaco em Cardiopatias Congênitas (CHAIN) de março de 2013 a junho de 2014. Os critérios de inclusão foram: pacientes <18 anos submetidos a procedimentos hemodinâmicos para cardiopatia congênita, com DAP devidamente registrado. Foram considerados diferenças estatísticas significativas os valores de p < 0,05. Resultados Este estudo avaliou 429 pacientes com idade e peso medianos de 50 (10, 103) meses e 15 (7, 28) kg, respectivamente. O DAP mediano foi de 742,2 (288,8, 1.791,5) μGy.m2. Houve uma boa correlação entre o DAP e o produto peso/tempo de fluoroscopia (rs=0,66). Não foi observada diferença estatisticamente significativa na relação DAP/peso entre procedimentos terapêuticos e diagnósticos. Houve ampla variação da relação DAP/peso entre os procedimentos terapêuticos (p<0.001). Conclusões A proporção DAP/peso é a medida mais simples e aplicável para avaliar a exposição radiológica em uma população pediátrica. Apesar da escassa literatura disponível, as doses obtidas no presente estudo foram semelhantes àquelas encontradas anteriormente. Estudos de validação e comparação são importantes na avaliação do impacto de estratégias para redução da exposição radiológica nessa população. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background In recent years the increasing number of interventional procedures has resulted in growing concerns regarding radiation exposure for patients and staff. The evaluation of radiation exposure in children is difficult due to the great variability in body weight. Therefore, reference levels of radiation are not well defined for this population. Objectives To study and validate the ratio of dose-area product (DAP) to patient weight as a reference measurement of radiation for hemodynamic congenital heart disease procedures in children. Methods This observational multicenter study uses data obtained from a Brazilian registry of cardiac catheterization for congenital heart disease from March 2013 to June 2014. Inclusion criteria were all patients aged <18 years old undergoing hemodynamic procedures for congenital heart disease, with recorded DAP doses. P-value < 0.05 was considered as statistically significant. Results This study evaluated 429 patients with median age and weight of 50 (10, 103) months and 15 (7, 28) kg, respectively. Median DAP was 742.2 (288.8, 1,791.5) μGy.m2. There was a good correlation between DAP and weight-fluoroscopic time product(rs=0.66). No statistically significant difference was observed in DAP/weight ratio between therapeutic and diagnostic procedures. There was a wide variation in the DAP/weight ratio among the therapeutic procedures (p<0.001). Conclusions The DAP/weight ratio is the simplest and most applicable measurement to evaluate radiation exposure in a pediatric population. Although there is limited literature available, the doses obtained in the present study were similar to those previously found. Ongoing research is important to evaluate the impact of strategies to reduce radiation exposure in this population (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Niveles de Referencia para Diagnóstico en Procedimientos Radiológicos Dentales: Una Guía Práctica / Diagnostic Reference Levels in Dental Radiological Procedures: A Practical Guide

RESUMEN: Las exposiciones médicas con radiación ionizante son actualmente la principal fuente de exposición a la radiación artificial a nivel global, entre ellas, los exámenes dentales corresponden a uno de los más frecuentes. Para prevenir dosis innecesariamente altas a los pacientes durante estas exposiciones, la Comisión Internacional de Protección Radiológica (ICRP) recomienda la utilización de Niveles de Referencia para Diagnóstico (DRLs), como una herramienta efectiva de ayuda a la optimización de la protección radiológica en la exposición médica de pacientes. Dado que la legislación de Chile aún no ha incorporado el uso de los DRLs, el presente trabajo de revisión tuvo como objetivo analizar la publicación N° 135 de la ICRP para generar un documento que sirva de guía para los odontólogos, explicando de manera didáctica y en un lenguaje sencillo, pero técnico, los principales aspectos a tener en cuenta para establecer los DRLs en procedimientos de radiología dental.

SUMMARY: Currently exposure to ionizing radiation is currently the main source of exposure to artificial radiation worldwide, with dental examinations being one of the most frequent events. In order to prevent exposure of unnecessarily high doses in patients, the International Commission on Radiological Protection (ICRP) recommends the use of Diagnostic Reference Levels (DRLs), as an effective tool to help maximize protection from radiation during medical exposure of patients. Given that the Chilean legislation has not yet incorporated the use of DRLs, the purpose of this study was to analyze publication N° 135 of the ICRP to generate a document, to serve as a guide for dentists, didactically outlining in simple but technical language, the main aspects to consider when establishing DRLs in dental radiology procedures.

The effect of low dose ionizing radiation exposure on dynamic thiol-disulfide homeostasis and ischemia modified albumin levels: an observational study / Efeito da exposição à radiação ionizante de baixa dose na homeostase dinâmica de tiol-dissulfeto e níveis de albumina modificada por isquemia: estudo observacional

Abstract Background: The primary objective of this study was to investigate the effect of low dose ionizing radiation exposure on thiol/disulfide homeostasis and ischemia modified albumin levels. The secondary objective is to compare thiol/disulfide homeostasis and ischemia modified albumin levels among the personnel exposed to low dose ionizing radiation in anesthesia application areas, in and out of the operation room. Methods: The study included a total of 90 volunteers aged between 18 and 65 years old, with 45 personnel working in a setting with potential for radiation exposure (Exposed Group) and 45 personnel in a setting without radiation exposure (Control Group). Their native thiol, total thiol, disulphide, albumine and IMA levels were measured. Exposed group included personnel who were exposed to radiation outside the operating room - Operation room (−) Group and inside the operating room - Operation room (+) Group. Results: Albumin, native and total thiol levels were significantly lower in the participants exposed to radiation in the anesthesia application area; no statistically significant difference was found in terms of disulfide and ischemia modified albumin levels. In the Operation room (−) Group exposed to radiation, native thiol and total thiol values were significantly lower compared to the Operation room (+) Group. Conclusion: Awareness of being in danger of oxidative stress should be established in personnel exposed to radiation in the anesthesia application area following low dose ionizing radiation exposure, and the necessary measures should be taken.

Resumo Justificativa: O objetivo principal do estudo foi investigar o efeito de exposição à radiação ionizante de baixa dose nos níveis de homeostase tiol/dissulfeto e de albumina modificada por isquemia. O objetivo secundário foi comparar os níveis de homeostase tiol/dissulfeto e albumina modificada por isquemia entre indivíduos expostos à radiação ionizante de baixa dose nas áreas de procedimentos anestésicos, dentro e fora da sala de cirurgia. Método: O estudo incluiu um total de 90 voluntários com idades entre 18 e 65 anos, 45 profissionais que trabalhavam em ambiente de exposição potencial a radiação (Grupo Exposto) e 45 profissionais que trabalhavam em ambiente sem exposição à radiação (Grupo Controle). Foram medidos os níveis de tiol nativo, tiol total, dissulfeto, albumina e albumina modificada por isquemia. O Grupo Exposto era constituído por profissionais expostos a radiação fora da sala de cirurgia - Grupo sala de cirurgia (-) e na sala de cirurgia - Grupo sala de cirurgia (+). Resultados: Os níveis de albumina, tiol nativo e total foram significantemente mais baixos nos participantes expostos à radiação em área de realização de anestesia, e nenhuma diferença estatisticamente significante foi encontrada para os níveis de dissulfeto e albumina modificada por isquemia. No Grupo exposto sala de cirurgia (-), os valores de tiol nativo e tiol total foram significantemente mais baixos quando comparados ao Grupo sala de cirurgia (+). Conclusões: Os profissionais expostos à radiação em área de realização de anestesia devem ser conscientizados quanto ao perigo do estresse oxidativo após exposição à radiação ionizante de baixa dose e medidas cabíveis devem ser instituídas.

Evaluation of Glucosamine Effect Against Heart and Brain Damage Induced by Y-radiation or Aluminium Chloride in Female Rats

Abstract Glucosamine is known as anti-inflammatory, antioxidant and as neuroprotective as well as using to treat many of diseases. This work aimed to investigate the remedial effect of glucosamine (20mg/kg b.wt) against the damage induced by a single dose of γ-radiation (8Gy) or aluminium chloride (AlCl3) (100mg/kg b.wt) in the heart and brain tissues of female rats. Serum aspartate aminotransferase (AST), cholesterol, triglycerides (TGs), LDH and creatine kinase (CPK) were measured. Moreover, gene expression of amyloid protein precursor (APP) and seladin-1 were estimated in the brain tissue. Also, acetylcholinesterase activity (AChE) and p-tau protein expression were estimated in brain homogenate. Metallothioneine (MT) was estimated in the heart and brain tissues. Heart and brain histopathological examination was performed. Irradiation significantly decreased serum AST, CPK and LDH, as well as MT levels in heart and brain tissues. Also, gene expression of seladin-1 decreased. On the other hand, irradiation significantly increased serum TGs level and brain AchE activity, tau protein, and β-amyloid percursor (APP). AlCl3 administration (21 days) induced disturbance in most of the estimated parameters, especially AST, TGs, and MT. Glucosamine treatment with irradiation or AlCl3 improved most of the measured parameters. In addition, histopathological examination confirmed the biochemical results. In conclusion: Glucosamine could be used to improve the heart and brain damages induced by γ-radiation exposure or AlCl3.

Factors affecting fluoroscopy time during percutaneous nephrolithotomy: Impact of stone volume distribution in renal collecting system

ABSTRACT Purpose: To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time. Materials and Methods: Data from 102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fluoroscopy time. Results: The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fluoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 (75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent predictors of fluoroscopy time during percutaneous nephrolithotomy. Conclusions: The distribution of the stone burden volume in the pelvicalyceal system is a significant predictor for prolonged fluoroscopy time during percutaneous nephrolithotomy. Measures to decrease FT could be beneficial in patients with a high ASV-to-RCSV ratio for precise preoperative planning.

Non-use of sunscreen among adults and the elderly in southern Brazil

Abstract Background One of the main prevention methods against skin cancer is the use of sunscreen; however, incidence of this disease has not declined despite prevention campaigns. Objective Investigate the prevalence of non-use of sunscreen and its associated factors. Method A population-based cross-sectional study with individuals aged 18 years or over living in the urban area. Conducted between April and July of 2016. Participants were interviewed about socioeconomic, demographic, and behavioral questions. Non-use of sunscreen was considered as the outcome. For multivariate analysis, Poisson regression with robust adjustment for variance was used. Results Among the 1300 participants, prevalence of non-use of sunscreen was 38.2% (95% CI: 34.6-41.8). The variables independently associated with the outcome were male sex, older age, brown or black skin color, lower income, fewer years of education, no physical activity in leisure time, no medical consultations in the last year, and self-perception of health as regular or poor. Study limitations The prevalence may be underestimated by reports of more use of sunscreen than actually used, which could increase the figure in the outcome. Conclusion It was estimated that about four out of ten adults and elderly do not use sunscreen in this sample. Prevention strategies are needed to advance health policy and ensure that sun protection options are easily accessible.

Development and validation of an instrument to assess the knowledge of general practitioners and pediatricians about photoprotection and solar radiation

Abstract Background The knowledge of general practitioners about photoprotection is unknown. Objectives To develop and validate an instrument to evaluate the knowledge of general practitioners and pediatricians about photoprotection, gauging the knowledge of these professionals. Methods The study followed the steps: (1) Literature identification and item elaboration related to the theme; (2) Content validation; (3) Apparent validation; (4) Construct validation: internal consistency analysis and discriminatory analysis; (5) Reliability analysis. In Step 4, the instrument was applied to 217 general practitioners and pediatricians who worked in the host city of the study; the scores were compared with dermatologists scores. Results The final instrument had 41 items and showed satisfactory internal consistency (Cronbach's alpha = 0.780), satisfactory reproducibility and good test-retest reliability (good-to-excellent kappa statistic in more than 60% of items). The discriminatory analysis registered a mean score of 54.1 points for dermatologists and 31.1 points for generalists and pediatricians, from a total of 82 possible points, representing a statistically significant difference (p < 0.001). Generalists and pediatricians demonstrated an understanding of the relationship between excessive sun exposure and skin cancer, but they revealed lack of technical information necessary for their professional practice. Study limitations The instrument evaluates only knowledge, without evaluating the conduct of the participants. Conclusion The results show that the instrument has good internal consistency and good reproducibility. It could be useful in the identification of general practitioners and pediatricians knowledge gaps on the subject, for the subsequent development of training and educational strategies.

Incidencia de la exposición a los rayos X en cirugías de columna / Incidence of X-rays exposure in spinal surgeries

Introducción: El control radioscópico intraoperatorio es una práctica cada vez más frecuente, que no está libre de eventos adversos para el personal de la salud. Objetivos: Conocer la tasa de uso de radioscopia en la cirugía vertebral, reconocer las medidas de control, evaluar la asimilación del cirujano a los elementos de protección y analizar los eventos adversos en estos profesionales. Materiales y Métodos: Se envió, por correo electrónico, a cirujanos espinales, una encuesta de 17 preguntas de opciones múltiples. Resultados: Se recibieron 55 encuestas. El 87% se dedicaba a la columna, en más del 60% de sus prácticas. El arco en C es el método más utilizado para el control final, en forma pulsátil. Solo el 31% controla el tiempo real. El delantal plomado de una pieza es el método más utilizado, pero se desconoce cuándo se debe reemplazar. La mitad utiliza más de un elemento. Siete casos de trastornos visuales, 5 patologías tiroideas, 3 dermatitis y 2 casos de infertilidad. Tres cirujanos fueron operados por nódulos tiroideos, cataratas o neoplasia. Conclusiones: El control radioscópico intraoperatorio es una práctica frecuente en la cirugía espinal. El delantal plomado de una pieza es el método más utilizado y, muchas veces, se lo combina, pero se desconoce cuándo se deben renovar los plomados. Uno de cada tres cirujanos presentaron las patologías evaluadas y 3, cirugías relacionadas. Así queda en evidencia la protección y el control escasos que existen en los cirujanos especialistas, acompañados de una falta de protocolización que deja a la deriva este control. Nivel de Evidencia: IV

Background: Intraoperative radiographic control (IRC) is an increasingly common practice, but it causes certain adverse events for healthcare providers. Objectives: To measure the use of fluoroscopy in spinal surgery, recognize control measures, evaluate assimilation of protection elements by surgeons, and analyze adverse events for spinal surgeons. Materials and Methods: A survey of 17 multiple-choice questions was e-mailed to spinal surgeons. Results: 55 surveys were answered. More than 60% of surgeons were spinal surgeons. The C-arm is the most widely used machine for final control by pulsating X-rays. Real-time controls are carried out in 31% of cases. One-piece leaded aprons are the most commonly used method, but it is unknown when they should be replaced. Half of the respondents uses more than one protection element. There were seven cases of vision changes, 5 of thyroid disorders, 3 of dermatitis, and 2 of infertility. Three surgeons required surgery for thyroid nodules, cataracts or neoplasm. Conclusions: IRC is a common practice in spinal surgery. One-piece leaded aprons are the most commonly used method and they are often combined with other elements, but it is not known when aprons must be replaced. One in 3 surgeons suffered from the studied conditions, and there were 3 related surgeries. Lack of adequate protection and control is a reality for specialist surgeons, together with a lack of protocols, making this an unregulated issue. Level of Evidence: IV

Prevalance of papillary thyroid carcinoma among patients underwent thyroidectomy and its relative relation to medical Z-Ray exposure

Background: The papillary thyroid carcinoma is the most common cancer among well-differentiated thyroid carcinoma. Exposure to environmental radiation adn edical X-Ray can be considered as an iportant risk factor. The aim of the study to evaluate the prevalence of papillary thyroid carcinoma among patients underwent thyroidetomy and the possible relation to X-Ray exposure. Patient and methods: A prospective clinically randomized trial was conducted in the department of surgery in Diwaniyah Teaching Hospital during the period from February 2016 to October 2018 on 432 patients with goiter from those 62 patients proved to be papillary thyroid carcinoma. Results: out of 432 patients with goiter underwent thyroidectomy 62 patients proved to be papillary carcinoma, female was 49 (79 %), and male was 13 (21%) with solitary thyroid nodule predominant (61.3%) the radiation exposure is higgly significant in patients proved to be papillary thyrid carcinoma about (85.48%), the FNAC sensitivity was low about 37%. There were 14 patients re-explored either for remnant thyroid tissue in 11 or neck disection in 3 patients. Only there patients presented with occult papillary thyroid carcinoma. Conclusion: Papillary thyroid carcinoma is the most common thyroid malignancy with salient increased incidence and female predominant in this region. X-ray exposure carries a significant risk factor for thyroid malignancy. However, further national clinical studies recommended confirming the results