[Radiology and emergency medicine: pitfalls to avoid in traumatology]. / Radiologie en médecine d'urgence : pièges à éviter en traumatologie.

The management of trauma is a significant part of emergency medicine practice, in a context where the number of sports accidents is rising steadily every year, with a total of 430,000 people affected in Switzerland in 2023 according to the Swiss Accident Prevention Bureau. In addition to the physical examination, radiological assessment is a cornerstone of diagnosis. Radiology of the musculoskeletal system is the most frequently requested paraclinical examination in these situations. The consequences of not recognizing radiological lesions may result in short-term consequences (haemorrhagic or neurological injuries) or long-term consequences (chronic pain, functional impairment). We therefore present examples of "pitfalls in radiology" frequently encountered in our daily clinical practice, and the use of additional exams.

La traumatologie fait partie intégrante de la médecine d'urgence, ce d'autant plus que chaque année les accidents de sport augmentent, avec un total de 430 000 personnes touchées en Suisse en 2023 selon le Bureau suisse de prévention des accidents. Hormis l'examen clinique, le bilan radiologique est une pierre angulaire du diagnostic. La radiologie de l'appareil locomoteur est l'examen paraclinique le plus demandé dans ces situations. Les conséquences de la non-reconnaissance de lésions radiologiques peuvent engendrer des séquelles à court terme (lésions hémorragiques ou neurologiques) ou à long terme (douleur chronique, impotence fonctionnelle). Il nous semblait ainsi important de présenter quelques « pièges en radiologie ¼, fréquemment rencontrés dans notre pratique quotidienne, et les compléments nécessaires à la pose d'un diagnostic éclairé.

Leveraging the full expertise of radiographers for improved healthcare delivery.

The role of radiographers in healthcare has evolved significantly from operating imaging equipment to being essential in patient care and diagnosis. In Australia, radiographers play a crucial role in image interpretation, identifying and communicating significant findings to enhance patient outcomes. Preliminary image evaluation (PIE) allows radiographers to interpret images and ensure significant findings are noted, particularly in urgent situations, complementing diagnoses when radiologist reports are unavailable. Despite their potential, many radiographers lack empowerment, leading to delays and adverse patient outcomes. This underutilisation stems from a lack of support and systemic barriers. Radiographers, with their extensive expertise in imaging, are vital for ensuring patient safety and care quality. Policy changes are needed to integrate PIE into standard workflows, allowing radiographers to fully utilise their skills. Recognising and leveraging their expertise will enhance patient care, foster collaboration, and ensure radiographers contribute fully to the healthcare team, ultimately improving patient safety and care quality.

A survey of the radiation safety practices of veterinary practitioners during portable equine radiography in Ireland.

Veterinary practitioners and other personnel involved in the examination are exposed to ionizing radiation while performing portable radiographs on horses. An online survey was distributed to all Veterinary Council of Ireland-registered practices where the self-reported practice profile is at least 20% equine work. The survey contained questions relating to radiation safety training, protocols, personal dosimetry and lead protection usage, repeat exposures, sedation, and personnel roles during the examination. The aim of the survey was to document the current radiation safety practices of equine veterinary practitioners during portable radiography. The results showed that although adherence to guidance set out by the Environmental Protection Agency (EPA) is reasonably good, compliance rates can be improved. Personal dosemeter usage and repeat rate reduction could particularly benefit from further improvement. This is of the utmost importance in ensuring that occupational radiation exposure to veterinary practitioners is kept to an absolute minimum during their daily practice.

Perspective of radiography science - a document analysis of dissertations.

INTRODUCTION: The aim of this study was to clarify the perspective of radiography science as an academic discipline. A discipline can be studied by discovering the collective use of concepts, especially core concepts. We have previously identified the core concepts as clinical practices in radiography, radiographers' profession, safe and high-quality radiation use, and technology in radiography. The relationships between these concepts have not been studied previously. In order to clarify the perspective of radiography science we have investigated further the core concepts, their interrelationships and interdependencies. METHODS: Altogether, 53 dissertations meeting the inclusion criteria were selected for a qualitative document analysis. The data were first analysed deductively using an extraction matrix comprising four core concepts developed from previous studies, then relational statements were synthesised, and the statements were analysed semantically. RESULTS: Analysis revealed the bilateral interrelationships between the concepts and their dependencies. All the concepts were used within healthcare. The rationale for radiography science research was the clinical practice of radiography and the improvement of services in a complex environment as a part of patients' pathways. Safe and high-quality radiation use was investigated as a means to deliver optimal services. Technology was studied as being functional or a means to deliver services. The perspective of the discipline was seen as the combination of humanistic interaction with advanced technology, where safety and quality were a necessity. CONCLUSIONS: Defining core concepts and their interrelations clarifies the perspective of the discipline and gives radiography researchers a way to argue their viewpoint.

Barriers to radiographers' use of radiation safety principles: A qualitative perspective.

INTRODUCTION: To minimise the risks associated with ionising radiation, it is necessary for all staff involved to employ specific techniques to reduce radiation exposure of the patient. These techniques include using compression during examinations of the pelvic region and lumbar spine, using a gonad shield, and asking women if they are pregnant. However, some staff do not use these techniques consistently. Increasing compliance requires determining why staff are non-compliant. Thus, this study aims to qualitatively investigate why radiographers do not use these techniques. METHODS: This qualitative study is based on a cross-sectional electronic survey with open-ended questions. The data were analysed using an inductive qualitative content analysis with quantification of the findings. In total, 111 radiographers from 20 hospitals in Sweden participated. RESULTS: Three categories appear related to barriers that could obstruct the radiographer from using compression, gonad shields and asking about pregnancy: patient characteristics, interaction between the patient and the radiographer and issues related to the situation and examination. CONCLUSIONS: The barriers to not using radiation protection measures varied depending on the specific measure. However, the barriers were mainly related to the patient experiencing pain, communication difficulties and cultural reasons. In addition, the lack of adequate and user-friendly equipment was seen as a barrier to applying compression and using gonad shielding.

Diagnostic reference levels for the most frequent radiological examinations carried out in Brazil / Niveles de referencia diagnósticos para los exámenes radiológicos más frecuentes realizados en Brasil

OBJECTIVES: A large-scale survey of doses to patients undergoing the most frequent radiological examinations was carried out in health services in São Paulo (347 radiological exami nations per 1 000 inhabitants), the most populous Brazilian state. METHODS: A postal dosimetric kit with thermoluminescence dosimeters was used to evalu ate the entrance surface dose (ESD) to patients. A stratified sampling technique applied to the national health database furnished important data on the distribution of equipment and the an nual number of examinations. Chest, head (skull and sinus), and spine (cervical, thoracic, and lumbar) examinations were included in the trial. A total of 83 rooms and 868 patients were in cluded, and 1 415 values of ESD were measured. RESULTS: The data show large coefficients of variation in tube charge, giving rise to large variations in ESD values. Also, a series of high ESD values associated with unnecessary lo calizing fluoroscopy were detected. Diagnostic reference levels were determined, based on the 75th percentile (third quartile) of the ESD distributions. For adult patients, the diagnostic ref erence levels achieved are very similar to those obtained in international surveys. However, the situation is different for pediatric patients: the ESD values found in this survey are twice as large as the international recommendations for chest radiographs of children. CONCLUSIONS: Despite the reduced number of ESD values and rooms for the pediatric pa tient group, it is recommended that practices in chest examinations be revised and that specific national reference doses and image quality be established after a broader survey is carried out.

OBJETIVOS: Estudio a gran escala de las dosis aplicadas a pacientes sometidos a los exámenes radiológicos más frecuentes realizados en los servicios de salud de São Paulo (347 exámenes radiológicos por 1 000 habitantes), el estado más poblado de Brasil. MÉTODOS: Se empleó un sistema dosimétrico postal con dosímetros termoluminiscentes para evaluar la dosis en la superficie de entrada (DSE) de los pacientes. Se realizó un muestreo estratificado de la base de datos nacional de salud que aportó información importante sobre la distribución del equipamiento y el número de pruebas realizadas anualmente. El estudio abarcó los exámenes de tórax, cabeza (cráneo y senos paranasales) y columna vertebral (cervical, dorsal y lumbar). Se incluyeron 83 instalaciones y 868 pacientes; se obtuvieron 1 415 mediciones de DSE. RESULTADOS: Los resultados mostraron grandes coeficientes de variación en la carga del tubo, lo que originó variaciones considerables en las DSE. Además, se detectaron valores elevados de DSE asociados con fluoroscopias de localización innecesarias. Los niveles de referencia diagnósticos se determinaron a partir del percentil 75 (tres cuartiles) de las distribuciones de las DSE. Para pacientes adultos, los niveles de referencia diagnósticos alcanzados fueron muy similares a los obtenidos en estudios internacionales. No obstante, la situación fue diferente en los pacientes pediátricos: los valores de DSE obtenidos en este estudio fueron dos veces mayores que los recomendados internacionalmente para radiografías de tórax en niños. CONCLUSIONES: A pesar del reducido número de valores de DSE e instalaciones en el grupo de pacientes pediátricos, se recomienda revisar la práctica de estudios radiológicos de tórax y establecer referencias nacionales específicas para las dosis y la calidad de las imágenes, después de realizar un estudio más amplio.

Correlações técnicas e ocupacionais da radiologia intervencionista: [revisão] / Occupational and technical correlations of interventional radiology: [review]

A radiologia diagnóstica é a área da física médica relacionada ao uso de raios X para a obtenção de informações anatômicas e funcionais do corpo humano. As técnicas associadas a essa área utilizam tubos de raios X como fontes de radiação, filmes para o registro das informações, sistemas de monitoração por televisão e equipamentos que digitalizam as imagens utilizando computadores. Os equipamentos de fluoroscopia são considerados fontes artificiais de radiação ionizante e são utilizados para a realização de exames e procedimentos nas doenças vasculares. O objetivo deste estudo foi analisar criticamente os métodos de proteção em relação à radiação emitida pela fluoroscopia utilizados pelos profissionais que lidam com a radiologia intervencionista no ambiente hospitalar. Foi realizada uma análise crítica das atitudes de proteção tomadas pelos profissionais engajados nos procedimentos da radiologia intervencionista a partir da revisão bibliográfica realizada em livros-textos e em revistas periódicas indexadas no MEDLINE, nas línguas portuguesa, inglesa, francesa e espanhola, no período de 1966 a 2005, conforme os princípios e as normas de segurança de proteção radiológica norteadas pela Portaria 453/98 do Ministério da Saúde e a norma da Comissão Nacional de Energia Nuclear NN-3.01 do Ministério da Ciência e Tecnologia.

Diagnostic radiology is a field of physical medicine that uses X rays to obtain functional and anatomical information on the human body. The techniques associated to this area use X ray tubes as radiation sources, films to record information, and monitoring systems using television and computers for the digitalization of images. Fluoroscopic equipment is considered as artificial springs of ionizing radiation and is used in diagnostic exams and procedures of vascular illnesses. The objective of this study was to critically analyze the protection methods regarding the radiation emitted by fluoroscopy used by professionals dealing with interventional radiology in a hospital environment. An evaluation of protection methods adopted by professionals directly involved in procedures of interventional radiology was performed based on extensive literature review of textbooks and medical journals indexed on MEDLINE in Portuguese, English, French, and Spanish from 1966 to 2005. It is in accordance with the radiological protection security norms and regulations guided by Edict 453/98 of the Brazilian Department of Health and the National Commission of Nuclear Energy NN-3.01 of the Brazilian Department of Science and Technology.

Otimização dos parâmetros de exposição radiográfica através de método computacional para aquisição de imagens de boa qualidade para diagnóstico / A computer-aided method to optimize radiographic exposure parameters to acquire better quality images for diagnosis

Falhas na execução de uma imagem radiográfica ou durante o processamento dos filmes geram interpretações errôneas, repetição do exame, maior exposição dos pacientes à radiação, além de aumentar o tempo clínico e os custos. A seleção correta dos parâmetros de exposição radiográfica proporciona a aquisição de imagens radiográficas com contraste, nitidez, detalhes, densidade óptica e definição das estruturas anatômicas para a realização de laudos radiográficos confiáveis. Assim sendo, neste artigo é apresentado um método computacional que pode auxiliar na seleção dos parâmetros de exposição mais apropriados para um dado exame radiográfico. As densidades ópticas foram simuladas considerando a composição e a espessura dos tecidos da estrutura anatômica, as características do aparelho de raios  X e do sistema écran-filme e os parâmetros de exposição otimizados conforme regras encontradas na literatura. Cinco radiologistas experientes avaliaram imagens radiográficas adquiridas de simuladores antropomórficos com parâmetros de exposição sugeridos pelo método computacional desenvolvido e também parâmetros encontrados na literatura. Após analisarem o contraste (diferença de densidade óptica em áreas adjacentes) e a nitidez (presença de detalhes visíveis tais como linhas estruturais finas, bordas de tecidos ou estruturas de interesse diagnóstico), os radiologistas opinaram que as imagens adquiridas com os parâmetros de exposição sugeridos pelo método computacional proposto proporcionaram um bom diagnóstico. Além disso, os valores de densidade óptica medidos nas imagens radiográficas numa posição correspondente ao centro do campo de radiação também apresentaram uma boa correlação com aqueles calculados pelo método, em torno de 90%. Este método pode se tornar também um valioso recurso didático para treinamento de novos profissionais para o setor radiológico.

Radiographic images of good quality allow adequate diagnosis. However imperfections in the selection process of exposure parameters, or during the film processing, generate erroneous interpretations or exam repetition, resulting in major exposure of patients to the radiation, and increasing the clinical time and costs. This article presents a computer method that helps the choice of better exposure parameters. The optical densities had been simulated taking into account tissue composition and thickness of the anatomical structure, characteristics of the X-ray equipment and screen-film system, and radiographic exposure parameters optimized according to rules found in literature. Five experienced radiologists evaluated the radiographic images obtained from anthropomorphic phantoms with the exposure parameters suggested by proposed method (named MD), and also with others parameters found in literature. After analyzing the image contrast and sharpness, they declared that the MD images provide a good diagnosis. Besides, the optical density values measured in these radiographic images on the position corresponding to the center of radiation field presented a good agreement (correlation of 90%) with those values calculated by the proposed method. This method can also become a valuable didactic resource for training of new professionals for the radiological sector.

Conceptos actuales en la radiología basada en evidencias: revisión / A review of current concepts in evidence-based radiology

La medicina basada en evidencias (MBE) se fundamenta en un descubrimiento sistemático, evaluación crítica y utilización de la investigación actual publicada en la literatura médica, para la toma de decisiones referentes al cuidado de un paciente individual o políticas de salud. En la radiología (incluyendo sus ramas diagnóstica y terapéutica), los principios y práctica de una MBE han recibido atención limitada. En esta breve revisión, presentamos algunos conceptos básicos de cómo implementar una radiología basada en evidencias y los conceptos y etapas de la MBE y el metaanálisis con enfoque en la radiología basada en evidencias. Se identifican las aplicaciones de ésta en la práctica, la educación y la investigación, y las habilidades requeridas. La aplicación de los principios de la MBE en el diagnóstico por imagen facilita la interpretación de los estudios y sustenta una evaluación bien dirigida. Esta revisión será útil para radiólogos en cualquier etapa de su entrenamiento o desarrollo profesional, con el fin de estimular una práctica radiológica basada en evidencias, especialmente en países en desarrollo.

It has been noted that "Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough." Evidence-based medicine (EBM) is defined as the process of systematically finding, critically appraising, and using contemporary research published in the medical literature as a basis to make decisions regarding individual patient care and health care policy. In radiology, including its diagnostic and interventional aspects, the principles and practice of EBM have not been thoroughly studied. In this brief review article, we describe key aspects of evidence-based radiology (EBR), concepts and steps followed in EBM and meta-analysis. The skills required to practice EBR are identified, and the roles of EBR in radiologic practice, education, and research are discussed. The application of EBM principles to diagnostic imaging facilitates the interpretation of imaging studies and produces a sound and comprehensive radiologic evaluation. This review could be useful for radiologists and clinicians at any stage of their training or career. It encourages the practice of EBM and EBR especially in developing countries.

Proposta de um programa básico para a formação do médico residente em radiologia e diagnóstico por imagem / A proposal for a medical residency program in radiology and diagnostic imaging

OBJETIVO: Propor um modelo de programa para residência médica em radiologia e diagnóstico por imagem, com programa básico de treinamento teórico e de treinamento em serviço. MATERIAIS E MÉTODOS: O programa foi idealizado a partir de uma análise e revisão da literatura, com base nas recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem e da Comissão Nacional de Residência Médica, e tendo como modelo o programa do Conselho Americano de Regulamentação de Educação Médica para Graduados. RESULTADOS: A proposta foi desenvolvida para um programa de duração de três anos, dividido em módulos de subespecialidades ou métodos diagnósticos. Foram descritos os objetivos e especificadas as competências a serem alcançadas pelos médicos residentes. CONCLUSÃO: Mudanças no modelo de ensino-aprendizado se tornaram necessárias face ao crescente acúmulo de informações e o desenvolvimento tecnológico. A organização da aquisição de conhecimentos de forma hierarquizada, com um conteúdo programático básico, permite uma formação adequada do futuro especialista. Espera-se que esta proposta possa contribuir como subsídio para o aprimoramento dos programas de residência médica, permitindo a implementação de um modelo em âmbito nacional.

OBJECTIVE: To propose a model of a program of medical residence in radiology and diagnostic imaging comprising theoretical and practical training. MATERIALS AND METHODS: The program was based on a literature review and critical analysis, following recommendations from Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (Brazilian College of Radiology and Image Diagnosis) and Comissão Nacional de Residência Médica (National Commission for Medical Residency), and based on the program of Accreditation Council for Graduate Medical Education. RESULTS: The present proposal has been developed for a three-year-duration program divided into modules by subspecialties or diagnostic methods. Objectives have been described and targeted proficiencies specified. Evaluation models have been presented and discussed. CONCLUSION: Changes in the current teaching-learning model have become necessary because of the increasing information availability and fast technological development in the latest years. The hierarchical organization of the knowledge acquisition process with essential programmatic contents allows an appropriate education of the future specialist. It is anticipated that the present proposal may contribute to improve the medical residency programs, thus stimulating the implementation of a countrywide model.

Consideraciones sobre el uso de rayos X en la práctica médica convencional para la necesaria aplicación de normas básicas de seguridad / Considerations about the use of X-rays in the conventional medical practice for necesary aplication of basic security rules

The application maintained and increasing of the explorations with X-rays, consequence of significant development of the engineering together with evolved computacionals methodologies has allowed to reach to the great anatomical majority of locus where it seats the disease. The consequence immediate has been the increase of the exhibition of the patients to ionizing radiations. Different organizations, worried about the health publish, including with it to important societies of Radiology and also to tie international organizations directly related to the governments like the WHO and the OPS. They have emphasized the necessity to generateregulatory conducts destined to introduce the basic rules of the good medical practice. In our country a situation of smaller development in this particular area still persists. Contingencies experienced by general doctors in his professional practice in small town are described. Some situations derived from the use of conventional radiological procedures like mammography and axial computed tomography are presented commenting aspects that do necessary to prevent the doses that receive the patients in order to avoid the expression of stochasticor deterministic effects with high doses of radiation applied with medical intentions. General aspects of radiological procedures related to practices in pediatric patient emphasizing the conditions of increased risk for iatrogenic effects of radiation, particularly in those premature or new borns.

Por que reducir las dosis de radiacion en pediatria

Many reports have been publicated in the past few years orientate to reduce the irradiation dose in children. It was compared with survivors of the atomic bomb in Japan. The ones who received low doses, in order to the 10 to 50 mSv, levels that left inside of diagnostic radiology spectrum, and in asociation in a small but significant increase in the tumors incidence. The major radiosensibility of children, obligate us to take, the necessary measure to rationalize the use of ionization radiation in pediatric, in special the CT, wich is the method that gives the higher doses. This measures can be abridge to: 1. - Select properly the cases that are going to be benefit whit the method trough the pediatrician. 2.- Reduce the exposition factors. 3.- Direct the exam only to the specific study area. 4.- Except special cases, perform only single phase studies. 5. Protection for superficial organs. 6. Deliver information for parents and general public.

Múltiples trabajos se han publicado en los últimos años orientados a disminuir las dosis de irradiación en niños. La experiencia en sobrevivientes japoneses de la bomba atómica, que recibieron bajas dosis, dentro del espectro de la radiología diagnóstica, demostró que ellas se asocian a un pequeño, pero significativo aumento en la incidencia de tumores. El mayor efecto de las radiaciones en niños nos obliga a tomar medidas necesarias para racionalizar su uso especialmente el de la TC, método que aporta las mayores dosis. Estas medidas se pueden resumir en: 1.- Selección adecuada por parte del clínico de los casos que se van a beneficiar con el método. 2.- Disminuir los factores de exposición. 3.- Dirigir el examen sólo al área que es necesario estudiar. 4.- Salvo excepciones, realizar estudios de TC monofásicos. 5.- Protección de órganos superficiales. 6.- Instructivo para padres y público en general.

Radiología diagnóstica en la era tecnológica: Comparación entre dos modelos / Diagnostic radiology in the technological era: Comparison between two models

La utilización de la tecnología como auxiliar en el diagnóstico y terapéutica médica tuvo su mayor desarrollo y esplendor durante las últimas décadas del siglo XX, debido a los beneficios directos que la radiología ofreció al proceso salud enfermedad, representando sin duda uno de los campos más dinámicos de la práctica médica. Sin embargo, en sociedades con alto desarrollo científico -económico (así como en algunas otras sociedades que intentan llegar a ese nivel) algunos de los valores humanos de la práctica médica como la compasión, la misericordia, calidez y algunas habilidades clínicas para el diagnóstico han sido desplazadas a menudo por el abuso de la tecnología, favoreciendo un empobrecimiento de la relación médico paciente, el encarecimiento de insumos, así como disminución en la satisfacción en los servicios de salud. Algunos medios de diagnóstico en la radiología actual como la tomografía axial computada (TAC), la resonancia magnética nuclear (RMN) o laboratorios de alta especialización, brindan eficiencia y velocidad en el diagnóstico y representan el ideal a seguir en muchos servicios de atención a la salud en diversos niveles de atención, en países en desarrollo. Sin embargo, esta visión de la práctica médica basada primordialmente en la ponderación de la tecnología también cuenta con numerosos claroscuros; por un lado, estos medios brindan el diagnóstico cercano a la verdad nosológica de la enfermedad con precisión asombrosa, pero de la misma manera si no son utilizados con mesura y reflexivamente dejan al descubierto aspectos delicados en el área afectiva del paciente y en la calidad en la relación con el prestador de servicios.

Diagnostic Radiology is a medical specialty that has played a dynamic role in the medical arena during the last three decades of the XX century. As a part of the evolution of this specialty, medicine and society at large have received diverse benefits in areas of diagnosis and for the decision making process in the clinical practice. Modern radiology has provided numerous advances and refined tools that give more convenience speed and precise diagnosis in the current medical practice. At the present time, these technologies are part of the standard of care in the US and other industrialized countries, representing the ultimate desire or goal to reach for other healthcare systems in developing countries as well. Unfortunately, many of the clinical skills in the health care personal have not evolved at the same pace of those modern technologies, conditioning a reduction in the performance of sensitive areas to the patient's interest, such as the caring, compassion and quality of health care. It is unquestionable the value and benefits that technologies such as CA T and MRI scans ha ve brought to the standard practice in the recent time. Nonetheless, it is desirable to maintain the highest possible level of clinical skills despite the extended use of modern technologies by the health personnel, without compromising the quality of care. Yet is pending the future role and rational use for those technologies in radiology, especially in times when delivering good, reliable health care have become a priority for many health institutions worldwide. This approach would be the ultimate goal to reach in times and circumstances where health for all is the highest precious value to obtain at global level.

Determinación de las condiciones de uso de los elementos de protección personal contra rayos X en Hospitales Públicos de la Región Metropolitana / Determination to the conditions of use of the Personal Protective Devices in Rays X in Public's Hospital of the Metropolitan Region, Chile

El presente trabajo se origina con la detección de delantales plomados que emiten radiaciones ionizantes, como consecuencia de este hallazgo se ha propuesto como objetivo verificar y dimensionar la presencia de elementos de protección personal contra los rayos X, que emiten radiaciones, así como también, las condiciones de uso y mantención de los mismos, las unidades a estudiar fueron hospitales de la Región Metropolitana, de los Servicios de Salud Sur y Norte. De esta manera, se plantea la importancia que tiene la homologación de alguna norma extranjera y la autorización de alguna institución competente que pueda entregar la certificación de este tipo de elementos con el fin de garantizar la adecuada protección de los trabajadores expuestos a radiaciones ionizantes, apoyándose en la legislación vigente.

Anatomía del error en radiología / Anatomy of error in radiology

La actividad médica, por su naturaleza, se desarrolla en un ambiente de incertidumbre, ya que sus resultados no son constantes en respuesta a actos médicos iguales, y por ello es una función de alto riesgo, siendo necesarias medidas y acciones para disminuirlo y aumentar la seguridad de la atención médica. Esto implica un conocimiento adecuado del error en el área médica en que nos desempeñamos, una cuantificación lo más ajustada posible de éste y la adopción de medidas preventivas y correctivas sobre personas, sistemas en los que estas trabajan e instituciones.

Comunicación en el departamento de radiología: radiológos y pacientes / Communication in the radiology department: radiologist and patients

El buen y efectivo ejercicio de la medicina requiere interacciones positivas y efectivas entre médicos y pacientes o parientes. El proceso de comunicación con ellos, que es una vía que corre en ambos sentidos, implica responsabilidades y deberes por ambas partes. Una relación médico paciente exitosa depende en una gran medida de las capacidades comunicacionales y de la sensibilidad del médico a las necesidades de los pacientes. Los radiólogos, con excepciones, no interactúan en forma directa con la mayoría de sus pacientes, pero en ocasiones se producen importantes contactos. A mayor abundamiento, es imperativo entregar destrezas comunicacionales efectivas a todo el personal que tiene contacto con los pacientes radiológicos, para su adecuada aplicación.

Elaboraçäo de um protocolo de controle de qualidade em radiodiagnóstico / Development

Introduçäo - Neste trabalho foi aplicado a um equipamento de raios X um protocolo de controle de qualidade baseado na Resoluçäo SS-625/94 e em Normas Internacionais. Materiais e métodos - Foram utilizados vários equipamentos de medida previamente calibrados, tais como: medidor de kVp, teste de ponto focal, "timer", dosímetro clínico, teste de colimador, teste de alinhamento, densitômetro, sensitômetro, etc. Foram determinados: quilovoltagens-pico, ponto focal, exatidäo e reprodutibilidade do tempo de exposiçäo, constância da taxa de exposiçäo, coincidência do campo luminoso com o campo de irradiaçäo, alinhamento vertical, camada semi-redutora, contato tela-filme, controle da processadora e padräo de dose dada ao paciente nos exames realizados no setor de diagnóstico por imagem da Instituiçäo. Resultados - Alguns resultados mostraram discrepâncias com as recomendaçöes nacionais e internacionais. Conclusöes - Sugerimos avaliaçäo periódica em todos os equipamentos da Instituiçäo e ajuste desses equipamentos, de acordo com as recomendaçöes, com o objetivo de produzirmos imagens de boa qualidade que permitam diagnóstico correto, com reduçäo da dose dada ao paciente e diminuiçäo dos custos, devido principalmente à repetiçäo de exames

Uso de agentes näo-iônicos e de pré-medicaçäo para reduzir a freqüência de reaçöes adversas aos meios de contraste radiográficos: o panorama brasileiro / The use of iodinated contrast media: the Brazilian panorama

Objetivo - Avaliar as decisöes tomadas por radiologistas em relaçäo à escolha do tipo de meio de contraste intravenoso (agente näo-iônico versus agente iônico convencional) e a freqüência do uso de esquemas profiláticos. Material e métodos - Um questionário, baseado em estudo publicado na literatura internacional, foi aplicado durante a 27ª Jornada Paulista de Radiologia, 1997. Foram coletados 432 questionários, sendo aproveitados para o estudo 187 (43 por cento). Resultados - A maioria dos radiologistas utiliza meio de contraste näo-iônico de forma seletiva. A profilaxia com corticosteróides e anti-histamínicos em pacientes com risco de reaçöes adversas é usada com freqüência similar, tanto nos casos de uso seletivo ou universal de meio de contraste näo-iônico. Há grande diversidade dos esquemas de pré-medicaçäo (tipo de droga usada e posologia), sendo que os anti-histamínicos, apesar de bastante usados em associaçäo com corticosteróides, säo raramente utilizados de forma isolada. Conclusäo - O meio de contraste näo-iônico é usado seletivamente pela maioria dos radiologistas que escolhem este tipo de contraste em pacientes que consideram com risco de reaçöes adversas. Os esquemas de pré-medicaçäo säo amplamente utilizados, havendo grande heterogeneidade quanto ao tipo de esquema utilizado para cada situaçäo clínica proposta