The assessment of the ionizing radiation dose received by patients during some diagnostic X-ray examinations carried out on the basis of the working procedures in the health care entities

Background: X-ray examination is a popular and universally used injury and disease diagnostic method. A distinctive X ray examination feature is that it can be done quickly which is extremely important in case of the need for rapid diagnosis of patients in life threatening condition. Another advantage of the X-ray examinations is also relatively low cost of carry. However, X-ray examination involve adverse health effects. During the examination the patient is subjected to ionizing radiation that might have impact on his health. Objective: The aim of this study has been to determine and assess the size of the entrance surface doses (ESD) received by patients during selected X-ray examinations performed on the basis of the medical working procedures available in healthcare entities in Masovian Voivodeship in Poland. Materials and Method: The examinations were conducted for 71 X-ray units located in the Masovian Voivodeship. Measurements of doses received by the patients were based on our own validated test methods. Results: It was found that the range applied to the high voltage in healthcare entities does not always coincide with the values specified in the standard procedures. It was found in the skull projection radiography AP and LAT that the recorded values were from range 60 to 82 kV (the average value of 74 kV) while in accordance with a standard procedure they should be in the range from 65 to 75 kV. Only in case of cervical spine radiography in the AP projection, the LAT exposure conditions were matching with the standard obligatory procedures in Poland. The consequence of selecting exposure conditions are significant differences in the size of the doses the patient receive during the same medical procedures. The greatest range of ESD doses was found during radiography of the thoracic spine in the projection AP and LAT. The projection LAT measured values were in the range of 523 to 10550 µGy (average value 2175 µGy). Conclusions: It is necessary to update immediately the standard procedures and to develop detailed guidelines for the preparation of working procedures in X-ray rooms.

Dosages of ionizing radiation during limb diagnostic X-ray examinations.

BACKGROUND: X-ray examination is associated with the patient's exposure to ionizing radiation. The dose values depend on the type of the medical procedure used, the X-ray unit technical condition and exposure conditions selected by X-ray technicians. The aim of this study has been to assess the entrance surface dose (ESD) values received by patients during the limb X-ray examination. The results should help doctors in making the decision about sending patients for X-ray examination. At the same time the X-ray unit condition and examination method performance are important for the radiological protection of the medical staff. MATERIAL AND METHODS: The study covered the total number of 118 X-ray units located in 56 public healthcare entities and private medical centers in the Masovian Voivodeship. The measurement of the radiation dose rate received by patients was based on our own research procedures. RESULTS: The research has found that there are even more than 10-fold differences in the dose values received by adult patients with several-fold differences in the case of children patients. The broadest dose value range for adult patients was related to femur radiography. The ESD values for this procedure ranged 70.9-765.2 µGy (with the average value of 319.7 µGy). The broadest dose value range for children was related to the knee radiography. The range for children aged 5 years old was 11.8-95.8 µGy (with the average value of 48.9 µGy). CONCLUSIONS: It is essential to immediately implement X-ray room working procedures for the purpose of performing diagnostic examinations based on the existing model procedures. Med Pr 2016;67(3):321-326.

Assessing the dose values received by patients during conventional radiography X-ray examinations and the technical condition of the equipment used for this purpose.

BACKGROUND: X-ray examination is associated with patient exposure to ionizing radiation. Dose values depend on the type of medical procedure used, the X-ray unit technical condition and exposure conditions selected. The aim of this study was to determine the dose value received by patients during certain conventional radiography X-ray examinations and to assess the technical condition of medical equipment used for this purpose. MATERIAL AND METHODS: The study covered the total number of 118 conventional diagnostic X-ray units located in the Masovian Voivodeship. The methodology used to assess the conventional diagnostic X-ray unit technical condition and the measurement of the radiation dose rate received by patients are based on test procedures developed by the Department of Radiation Protection and Radiobiology of the National Institute of Public Health - National Institute of Hygiene (Warszawa, Poland) accredited for compliance with PN-EN 17025 standard by the Polish Centre for Accreditation. RESULTS: It was found that 84.7% of X-ray units fully meet the criteria set out in the Polish legislation regarding the safe use of ionizing radiation in medicine, while 15.3% of the units do not meet some of them. The broadest dose value range was recorded for adult patients. Particularly, during lateral (LATl) lumbar spine radiography the recorded entrance surface dose (ESD) values ranged from 283.5 to 7827 µGy (mean: 2183.3 µGy). CONCLUSIONS: It is absolutely necessary to constantly monitor the technical condition of all X-ray units, because it affects population exposure to ionizing radiation. Furthermore, it is essential to raise radiographers' awareness of the effects that ionizing radiation exposure can have on the human body.

Variable course of progression of oral cavity and oropharyngeal carcinoma in young adults.

AIM OF THE STUDY: The main aim of this article is the epidemiological analysis of patients treated due to oral and oropharyngeal cancer, with a special interest in the group under the age of 40, evaluation of the differences in the clinical course of the disease as well as assessment of the treatment results, regarding the age of the affected individuals. MATERIAL AND METHODS: 523 individuals affected by oral and oropharyngeal cancer who were treated in the Otolaryngology and Laryngeal Oncology Department between 2000 and 2008. Precise analysis was performed on 360 out of 523 affected individuals, in whom full clinical status was determined; 13 patients were young adults. The retrospective analysis was created based on case histories, surgical protocols and emergency records. RESULTS: In young adults there is a markedly increased risk of organ involvement according to the Mann-Whitney U-test analysis (p = 0.044907). The probability of recurrence in the group of young adults is also much higher. Analysis of Kaplan-Meier test results indicated that the chance for the lack of recurrence within a 6-month period was 85.7%; however, the risk of recurrence increased, and after 12 months was equal to the arithmetic data (50%). CONCLUSIONS: Among young adults there is an increased risk of local recurrence following 12 months after surgical intervention. According to our observations, despite rapid progression and early recurrence in young adults (4/7) the prognosis for both groups is not statistically different.

[Routine follow-up in patients treated of head and neck cancer]. / Problematyka monitorowania chorych leczonych z powodu nowotworów glowy i szyi.

OBJECTIVE: To evaluate the usefulness of routine follow-up in group of patients with head and neck cancer and to present the recommended schedule taking into consideration the oncological safety and costefectivness. AIM: Retrospective cohort study with follow-up of 3 years for all patients. RESULTS: In Outpatient Department in 2010 there were examined 3012 patients treated of head and neck cancer. The biggest group comprised patients with larynx and oral cavity cancer. During routine ENT examination 70% of recurrences was detected. CONCLUSION: In patients with head and neck cancer routine follow up is indispensable. Introduced modern schedules make the monitoring work-up shorter and more sensible, although the benefit in improving patients survival is doubtful.

[Paranasal sinuses melanoma--a case report]. / Czerniak zlosliwy zatok przynosowych--opis przypadku.

The malignant melanoma has been presented in majority in the skin location. The mucosal form of melanoma is extremely rare, the localisation involving the structures of paranasal sinuses is the most frequent location according to head and neck region. The authors present the patients case with that location of illness.

[Management of thyroid cancer metastases in lymph nodes]. / Postepowanie w przerzutach do wezlów chlonnych w przebiegu raka tarczycy.

BACKGROUND: We would like to present the specificity, technique and efficiency of neck surgery in patients with lymph node recurrence in the course of thyroid cancer treatment. MATERIAL: In the ENT Department of Medical University in Poznan, Poland, 16 patients were operated for diagnosed neck relapse of thyroid cancer in the years 2000-2005. All of them were directed from endocrinology or general surgery units, where were previously treated by means of total/partial thyroidectomy: in 7 cases high grade folliculary cancer, in 6 medullary, in 2 oxyphilic and 1 anaplastic cancer. RESULTS: In 5 patients bilateral (one site radical, one site selective), in 11 unilateral neck dissection were performed. The thyroid gland cancer metastases were predominantly localized in the level IV (in 15 of 16 cases) and in anterior neck compartment, i.e. level VI (7 of 16 cases). In 6 patients the remnant of thyroid tissue were excised. Complication - recurrent nerve paresis occured in one case. The time of observation ranged from 5 to 57 months. The neck relapse was observed in one patient with undiffeentiated thyroid cancer in 8 month time after selective neck dissection. The rest of the group is free of disease.

[The role of immunohistochemical staining (protein p53, cyclin D1) in the prognosis of adenoid cystic carcinoma salivary gland tumors]. / Rola badan immunohistochemicznych (bialka p53, cykliny D1) w prognozowaniu raka gruczolowato-torbielowatego (carcinoma adenoides cysticum) slinianek.

INTRODUCTION: Adenoid cystic carcinoma of the salivary glands (carcinoma adenoides cysticum) is malignant epithelial tumor of rare occurrence. Tumor of this kind has among salivary glands tumors uncertain prognosis and unpredictable course. The aim of the study was to characterize the patient population and the immunohistochemical analyses (p53 protein, cyclin D1). MATERIAL AND METHODS: The examined group consisted of 30 patients with adenoid cystic carcinoma of the salivary glands. The expression of p53 protein and D1 cyclin in the tumor was evaluated and the correlation between these proteins and the organ and clinical grading was defined. RESULTS: The immunohistochemical studies showed in 70% the positive staining for p53 protein and 90% for cyclin D1. There was not statistically significant difference between the advanced grading of the organic and clinical adenoid cystic carcinoma.

[Tumors infiltrating carotid artery--diagnostic and principles of treatment]. / Guzy naciekajace tetnice szyjna--diagnostyka i sposoby postepowania.

The involvement of internal or common carotid artery by neoplasmatic process usually indicates advanced stage of a disease and is always a serious problem for surgical treatment. The high risk of surgical and neurological complications, frequent local reappearance, distant metastases and significant loss of quality of life should have influence on mode of scheduled treatment. Current options of diagnosis and treatment with special focus on surgical carotid artery reconstruction are presented based on the review of the articles related to this problem. Our 3-years experience with this group of patients is presented.

[Histological charakteristics of tongue and floor of the mouth neoplasms and their clinical prognostic value]. / Cechy histologiczne raków jezyka i dna jamy ustnej a prognozowanie kliniczne.

INTRODUCTION: The number of histological classifications has been introduced to asses the squamous cell carcinoma in head and neck. The Jakobsson histological system employs 8 different morphological characteristics. Four of them concerning tumor cell population and another four describe relation to the adjacent tissues. MATERIAL AND METHODS: The material comprised tissue specimens from 80 patients with squamous cell carcinoma of the tongue and floor of the mouth who underwent the primary surgery. All the data concerning Jakobsson classification, histological differentiation G, TNM classification, and recurrence and survival rates were recorded and analyzed. RESULTS: Any significant correlation has been found between Jakobsson classification and histological differentiation. Nevertheless statistically significant correlation between Jakobsson classification and T of the tumor, nodal metastases and local and nodal relapse has been recorded. CONCLUSIONS: The Jakobsson classification constitute the important supplement of the routine histological assessment and may significantly contribute to the choice of therapy.

[Malignant tumours of the pharynx in the years 1992-2001]. / Nowotwory zlosliwe gardla w latach 1992-2001.

All cases of malignant tumours of the pharynx (excluding tumours of the tongue) were analyzed based on the retrospective data from the 5 clinical centers in Poland from the years 1992-2001. A considerable--over 50% increase in morbidity was found out regarding particularly tumours of the oropharynx. In the analyzed material there is a predominance of males (3:1) and the peak of morbidity significantly falls. The subjects with advanced tumours of the pharynx made 26% of the studied group. The most common histopathological diagnosis was squamous cell carcinoma and the most common site--the oropharynx, in particularly the tonsil. The data the center in Katowice, where tumours of the hypopharynx have been predominant in the last few years, may point a similar tendency in the other centers in the future.

[Laryngocoele]. / Laryngocoele.

Three cases of laryngocoele operated in ENT Department University of Medical Sciences in Poznan by an external approach are presented. Role of larynx tomography in diagnosis procedure and surgical technique is emphasised. Origin, classification, diagnosis and treatment methods are discussed.

[Endoscopic reconstruction of the anterior skull base in cerebrospinal rhinorrhea]. / Endoskopowa rekonstrukcja dolu przedniego czaszki w plynotokach nosowych.

Cerebrospinal rhinorrhea is a discharge of cerebrospinal fluid caused by the break continuity in dura mater and by bone defect in the base of anterior skull base. The pathological connections appear mainly in the regions of the skull base with the weaker bone structure (the roof of the frontal, ethmoid, sphenoid sinus and cribriform plate). The aim of the study was presenting the possibility of the endoscopic-surgical closing the fistula within the ethmoid roof. The E.N.T Department in Poznan treated 5 patients with cerebrospinal rhinorrhea. In four cases, cerebrospinal rhinorrhea was caused by operative trauma. In one case the rhinorrhea could not be established. All patients with traumatic rhinorrhea underwent operation treatment based on covering of the loss in dura mater with a piece of mucous membrane together with perichondrium of nasal septum or lyophilised dura. The material used for the plastic operation was sealed by tissue adhesive. In 2 cases rhinorrhea recurred. Using the endoscopic technique, after the identification the leak of the cerebrospinal fluid within ethmoid roof, the fistula has been reconstructed with use of the adipose tissue and temporal muscle fascia. Both cases led to complete recovery. Easy access, precision and accuracy of performance the surgery, the approach without external incision of the patient, makes the endoscopic technique very valuable method in treating rhinorrhea caused by the loss in ethmoid roof and cribriform plate.

[Neuroendocrine tumors of the larynx]. / Guzy neuroendokrynne krtani.

The classification, diagnosis, treatment and prognosis of neuroendocrine tumors are presented. Rare case of typical carcinoid of the larynx is described. This was the second primary tumor after squamous lung cancer treatment. The diagnosis was based on routine histological investigation, and then confirmed by immunohistochemical tests with synaptophysin, chromogranin, S-100 protein and cytokeratin markers. The clinical presentation of the patient, age, gender, localization, macroscopic appearance and slow growth dynamic was in accordance with cases described in the literature.

[Patients under 45 years of age "young adults" with head and neck squamous cell carcinoma. Retrospective, multivariable analysis--preliminary report ]. / Retrospektywna, wieloczynnikowa analiza raków plaskonablonkowych glowy i szyi u chorych ponizej 45 roku zycia "young adult"--doniesienie wstepne.

There is a clear tendency to diagnose squamous cell carcinoma of the head and neck more frequently in patients below 45 years of age. These neoplasms in "young adults" seem to be more aggressive with rapid progression, frequent reappearance after treatment and worse prognosis than is observed in older patient population. This preliminary report presents results of retrospective, multivariable analysis of patients below 45 years of age with squamous cell carcinoma of the head and neck. The special focus of the study were: disease progression (T), regional node and distant metastases (N,M), tobacco and alcohol consumption, environmental factors, concomitant diseases, kind of surgical technique and tumour histology.

[Objective audiometry in diagnosis of tinnitus]. / Obiektywne metody badania sluchu w diagnostyce szumów usznych.

During last 3 years there have been 900 tinnitus patients treated at ENT Rehabilitation Center in Poznan. Everyone underwent a thorough laryngological and audiological examination. Diagnostic procedure comprised also neurological and endocrinological consultations with accessory blood tests. Wide group of audiological tests used for diagnosis was divided into objective (BERA, OAE, tympanometry, stapedius reflex) and subjective (pure tone audiometry, speech audiometry, suprathreshold audiometry) methods. Otological diagnostic in tinnitus patients is difficult due to its subjective character. That is why it is so important to have objective methods for its evaluation. In this paper authors present results of BERA tests and impedance conducted on group of 900 patients. Performed objective tests enabled to diagnose otosclerosis, chronic otitis media and pathology in cerebello-pontine angle in patients without any abnormalities on physical examination.

[Correlation between ultrastructural changes and the presence of metastases in adenoid cystic carcinoma of salivary glands]. / Badania ultrastrukturalne a wystepowanie przerzutów w wezlach chlonnych w raku gruczolowato-torbielowatym slinianek.

Adenoid-cystic carcinoma is a malignant epithelial neoplasm which has different histological types. Still, an open question is, whether adenoid-cystic carcinoma of the salivary glands with metastases to lympho nodes and specific micro- and macroscopic features, allows us to define their progression. A group of 46 patients with adenoid-cystic cancer of the salivary glands was studied and was subjected to histological and ultrastructural assessment. In analysed group in 12 patient metastases to lympho nodes were confirmed. In 10 cases it was solid type of tumour and in 2 canaliculars type. In tumours with metastases to lympho nodes solid types prevailed and there was no a typical cribriform type. In all cases they were found fields of mixted texture of the tumours structure.

[Reconstructive surgery in huge tumors of salivary glands]. / Zabiegi rekonstrukcyjne w wielkich guzach gruczolów slinowych.

OBJECTIVE: Evaluation the outcome after extensive surgery of salivary glands tumors with simultaneous reconstruction of soft tissue and skin defect. MATERIAL: In the period 2007-2011, surgery treatments performed in 295 of major salivary glands. 31 patients underwent surgery due to malignant parotid gland tumors: 19 women (61%) and 12 men (39%). In 8 (26%) presented skin infiltration. 10 (32%) patients had facial palsy between II-IV degree (House Brackmann scale). The radiographic findings in some patients showed infiltration of the deep lobe of parotid gland, external auditory canal, infiltration of mastoid process, skull base and the subtemporal fossa. METHODS: Of the 31 patients in 13 (42%) reconstruction techniques with muscle cutaneous trapezius flap were applied in 4 (31%) patients. In group of 7 (54%) patients using a muscle flap based on the sterno-cleido-gland, in 2 (15%) patients defects were covered using the free anterior lateral thigh flap. RESULTS: In all patients, healing proceeded normally. In the operated patients, one patient did not receive radical surgery due to the infiltration of the skull base. Length of hospitalization ranged between 7-21 days. In no case was lost flap, also there was no local complications at the donor. CONCLUSIONS: The choice of treatment for malignant parotid gland tumors which are usually radioresistant is surgical resection. In patients with extensive tumors with infiltration of neighbouring organs reconstruction with use of distant flaps are recommended. It provides a good oncological and aesthetic result.