Optimization of Radiation Protection in Pediatric Interventional Radiology in Latin America and the Caribbean: Development, Advancements, Challenges and Achievements of the OPRIPALC Program.

This article presents the development, advancements, challenges and achievements of the "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) program. This international initiative is led by the World Health Organization, the Pan American Health Organization and the International Atomic Energy Agency. The main objectives of OPRIPALC are to foster a culture of radiological protection in pediatric interventions, enhance these procedures' quality, and define optimization strategies such as the use of diagnostic reference levels (DRLs). Currently, 33 centers from 12 countries participate actively in the program. Significant progress has been made towards the proposed objectives, overcoming the challenges posed by the COVID-19 pandemic. Through many virtual meetings for coordination, planning, training and follow-up, a comprehensive set of DRLs for both diagnostic and therapeutic procedures, categorized by weight and age, have been established and are in use. A consensus document on good practices is in the final stage of development. The program's continuation into at least a second phase is essential to address pending issues, including the integration of automatic dose management systems, the levels of occupational radiation doses, their correlation with pediatric patient doses, and strategies to reduce them.

New Optimization Strategies on Radiation Protection in Fluoroscopy-Guided Interventional Procedures in Pediatrics.

The term fluoroscopically guided interventional procedure describes a clinical practice in medicine, where fluoroscopic systems are used to conduct diagnostic procedures or provide image guidance for therapeutic interventional procedures performed via percutaneous or other access routes [...].

Avances y desafíos de la protección radiológica en cardiología intervencionista pediátrica para Chile entre los años 2013-2021 / Updating radiological protection for interventional procedures in pediatric cardiology in Chile

RESUMEN: En el año 2013, se publicó un artículo acerca de lo realizado en Chile en temas de protección radiológica en cardiología intervencionista (CI) pediátrica. A continuación se muestra el trabajo de continuidad realizado en los últimos 8 años, destacando los principales resultados alcanzados y proponiendo mejoras en la seguridad y protección radiológica en esta práctica clínica. Desde el año 2013 se han seguido evaluando en términos de dosis de radiación y calidad de imagen, los sistemas de rayos X utilizados en Chile para procedimientos de CI pediátricos y, en particular, los equipos de los servicios de los Hospitales Luis Calvo Mackenna y Roberto del Rio. Se han medido las tasas de dosis de radiación dispersa a la posición habitual de los ojos y tobillos de los cardiólogos que operan los equipos de rayos X. También contamos con un conjunto de "Niveles de Referencia para Diagnóstico" clasificados por rangos de edad y peso, junto con la estimación de valores de dosis por órgano y dosis efectiva para los pacientes. Podemos afirmar que, actualmente, contamos con una metodología consolidada para caracterizar, en términos de dosis y calidad de imagen, los sistemas de rayos X. Sin embargo, sigue pendiente actualizar la normativa nacional que regula el uso seguro de las radiaciones ionizantes en medicina, como también aspectos de formación en protección radiológica para el personal médico implicado.

ABSRSCT: An article on the status of radiological protection during procedures of interventional cardiology in pediatric patients in Chile was published in 2013. The present article relates the continuing efforts to improve radiological protection highlighting their results and proposing additional measures to improve radiological protection during the procedure. Since 2013 we have continued the evaluation of radiation doses, image quality, and X Ray systems used in Chile. We have measured diffused radiation dose at operator´s eye and ankle levels to elaborate a "Reference guide" according to patient´s age and weight. However, we still lack a national regulatory norm for the X Ray systems to be used and for the appropriate training of those involved in procedures of interventional cardiology in pediatric patients.

Optimización de la protección en radiología y cardiología intervencionista pediatrica en América Latina y el Caribe (OPRIPALC) / Optimization of protection in pediatric interventional cardiology and radiology in Latin America and the Caribbean (OPRIPALC)

El objetivo del presente artículo ha sido describir el programa "Optimización de la Protección en Radiología Intervencionista Pediátrica en América Latina y el Caribe" (OPRIPALC) que nace el año 2018 como respuesta conjunta de la Organización Panamericana de la Salud y la Organización Mundial de la Salud, en cooperación con el Organismo Internacional de Energía Atómica, para colaborar con sus Estados miembros en asegurar que las exposiciones a la radiación de los pacientes pediátricos sean las mínimas necesarias durante los procedimientos intervencionistas. Actualmente, hay 18 centros de los siguientes 10 países que participan: Argentina, Brasil, Chile, Colombia, Costa Rica, Cuba, Ecuador, México, Perú y Uruguay. Para el desarrollo del programa se plantean una serie de objetivos, productos, actividades y resultados esperados. La puesta en marcha de la WEB de OPRIPALC ha significado un instrumento muy válido para seguir la información actualizada del programa. Un programa actualizado de formación en radioprotección para los profesionales implicados en el programa, se está realizando por medio de "webinars". Se deberá seguir actuando en la aplicación del programa de control de calidad básico para los equipos de rayos X participantes y validar los valores de los Niveles de Referencia para Diagnóstico (NRDs). Se propone formar un equipo de trabajo entre los Físicos Médicos y Tecnólogos Médicos participantes de OPRIPALC para implicarse en las pruebas de control básicas que todos los centros debieran realizar. Se han presentado algunos resultados iniciales de OPRIPALC en eventos científicos internacionales. Se está avanzando en proponer unos primeros valores sobre NRDs en procedimientos de intervencionismo cardiológico pediátrico por bandas de edad y peso. OPRIPALC es una de las pocas iniciativas de carácter regional para obtener valores de NRDs en procedimientos intervencionistas pediátricos. Se espera que tanto los valores de referencia como la metodología empleada en OPRIPALC, puedan ser utilizados en otras regiones del mundo.

The objective of this article has been to describe the program "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) that was born in 2018 as a joint response of the Pan American Health Organization and the World Organization of the Health, in cooperation with the International Atomic Energy Agency, to collaborate with its member states in ensuring that radiation exposures of pediatric patients are the minimum necessary during interventional procedures. Currently, there are 18 centers from the following 10 countries participating: Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Peru and Uruguay. For the development of the program, a series of objectives, products, activities and expected results are proposed. The launch of the OPRIPALC WEBSITE has been a very valid instrument for following up-to-date information on the program. An updated training program in radiation protection for the professionals involved in the program is being carried out through webinars. It should continue acting in the application of the basic quality control program for the participating X-ray equipment and validate the values of the Diagnostic Reference Levels (DRLs). It is proposed to form a work team among the OPRIPALC participating medical physicists to get involved in the basic control tests that all centers should carry out. Some initial results of OPRIPALC have been presented at international scientific events. Progress is being made in proposing first values on DRLs in pediatric cardiac intervention procedures by age and weight bands. OPRIPALC is one of the few regional initiatives to obtain DRLs values in pediatric interventional procedures. It is expected that both the reference values and the methodology used in OPRIPALC can be used in other regions of the world.

Aspectos Éticos de la Protección Radiológica en Procedimientos de Radiología Dental

RESUMEN: Se sabe de los beneficios que la radiología dental ha significado para mejorar la calidad de vida de las personas en todo el mundo, sin embargo, también conocemos los riesgos asociados a su uso. Para disminuir estos riegos, diferentes organizaciones a nivel internacional han desarrollado un SISTEMA DE PROTECCIÓN RADIOLÓGICA (SRP) basado en los principios de: Justificación, optimización y limitación de dosis, los cuales a su vez han evolucionado en base al desarrollo de la ciencia, los valores éticos, y la experiencia acumulada en la práctica cotidiana de los profesionales de la protección radiológica. Al revisar la normativa que regula el uso de las radiaciones ionizantes en Chile, analizamos que no se tienen en cuenta los aspectos o valores éticos al momento de hablar y aplicar el SPR en procedimientos de radiología dental. Por todo lo anterior, el objetivo del presente trabajo de revisión narrativa fue elaborar un nuevo documento de consulta para los odontólogos, que contenga de manera resumida y con definiciones precisas, los principales aspectos a tener en cuenta a la hora de comprender como funciona el SPR y los valores éticos que lo fundamentan, ayudando de esta manera a resolver objetivamente los juicios de valor que se pueden presentar durante la solicitud, ejecución e interpretación de los procedimientos de radiología dental.

ABSTRACT: The benefits of dental radiology that improve the quality of life of populations worldwide have been well established. However, the risks associated with its use are also known. With these risks in mind, various international organizations have developed a Radiological Protection System (RPS) based on the principles of: Justification, optimization and dose limitation, which in turn have evolved based on science, values ethics, and the experience accumulated during the daily practice by radiation protection professionals. While reviewing the standards that regulate the use of ionizing radiation in Chile, we observed that ethical aspects or values are not taken into account when applying the RPS in dental radiology procedures. In light of these findings, the objective of this narrative review was to develop a new consultation procedure for dentists, which contains the main aspects to consider when understanding how SPR works, in a summarized precise form, as well as the supporting ethical values. Thereby helping to resolve the value judgments that may arise during the performance and interpretation of dental radiology procedures.

Niveles de Referencia para Diagnóstico Locales en Procedimientos Radiográficos Dentales Periapicales. Primeros valores para Chile

RESUMEN: La información que aportan los procedimientos de radiología dental, tanto en la evaluación, como en el diagnóstico y tratamiento de patologías y/o alteraciones dento maxilofaciales, hace que correspondan al tipo más frecuente de estudio radiológico. Sin embargo, existe un escaso conocimiento en nuestro país respecto de los niveles de dosis que se imparten en dichos procedimientos, haciendo necesaria su determinación para maximizar el beneficio derivado de los mismos y minimizar el riesgo radiológico para los pacientes. El presente estudio determinó el nivel de referencia para diagnóstico (NRD) local en la radiografía periapical de Molar maxilar e Incisivo, para ello se realizaron simulaciones de los procedimientos radiográficos en un maniquí antropomorfo seccional y se determinó el valor de Kerma aire en la superficie de entrada con retrodispersión mediante dosimetría termoluminiscente. Los NRD locales determinados en la radiografía periapical de Molar maxilar fueron 5,6 mGy para adultos y 4,0 mGy para niños; mientras que en la radiografía periapical de Incisivo fue de 9,2 mGy para pacientes adultos y 1,8 mGy para niños. Los resultados obtenidos buscan orientar la ejecución de futuras investigaciones en el área y aportar información del nivel de radiación en estos procedimientos, con lo que se espera promover una cultura de radioprotección y motivar la optimización de las dosis registradas.

ABSTRACT: The information provided by dental radiology procedures, both in evaluation, as well as in the diagnosis and treatment of pathologies and / or dentomaxilofacial alterations, makes them the most frequent type of radiological study. However, there is a meager knowledge in our country regarding dose levels applied in such procedures, making their determination necessary to maximize the benefits and to minimize the radiological risk to patients. The present study determined the local diagnostic reference level (LDRL) for the periapical radiography of the Maxillary molar and Incisive. Simulations of radiographic procedures were performed and the value of air Kerma at the entrance surface with backscattering, was estimated using thermo luminescent dosimetry. The LDRL determined in the maxillary molar periapical radiography was 5.6 mGy for adults and 4.0 mGy for children; while on the incisive periapical radiography it was 9.2 mGy for adult patients and 1.8 mGy for children. The results obtained seek to guide the execution of future research in the area and provide information on the radiation doses delivered in these procedures, which is expected to promote a radiation protection culture and motivate the optimization of the registered doses.

RADIATION DOSE FOR PATIENTS WITH KAWASAKI DISEASE UNDERGOING FLUOROSCOPICALLY GUIDED CARDIAC CATHETERIZATION.

The goal of the present study was to estimate the radiation dose for a group of 45 Kawasaki disease (KD) patients undergoing fluoroscopically guided cardiac catheterization. The sample of procedures corresponds to a single hospital and was collected in 10 years. Anthropometric characteristics and the quantities of air kerma-area product (PKA) among others were recorded for each procedure. Monte Carlo PCXMC 2.0 software was used to estimate organ and effective doses. The PKA value of 7.2 Gy cm2 was proposed as the local Diagnostic Reference Level for KD. For organ absorbed doses, median values for thyroid, heart, lungs, esophagus, skin, active bone and breast were 1.2; 2.2; 4.6; 2.7; 1.1; 1.2 and 2.7 mGy, respectively. For effective dose, the mean value was 2.7 ± 2.5 mSv. This paper presents the first patient dose values for the KD using catheterization techniques, in Latin America and the Caribbean Region.

Kinetics of Torque Teno virus DNA in stools may predict occurrence of acute intestinal graft versus host disease early after allogeneic hematopoietic stem cell transplantation.

Torque Teno virus (TTV) DNA load in blood may act as a marker of immune competence after allogeneic hematopoietic stem cell transplant recipients (allo-HSCT). Conflicting data have been reported as to the value of this biomarker for anticipating acute Graft versus host disease (aGvHD) occurrence. Here, we hypothesized that quantitation of TTV DNA load in stool specimens early after allo-HSCT could be used to identify patients at high risk of acute intestinal graft versus host disease (aIGvHD). In this prospective two-center study, we recruited a total of 83 nonconsecutive adult patients undergoing allo-HSCT. The study period comprised the first 120 days after allo-HSCT. TTV DNA was quantitated in paired stool samples collected at a median of 2 days prior to cell infusion and at a median of 14 days after allo-HSCT by real-time PCR. Thirty-seven patients developed aGVHD, of whom 25 had aIGVHD (diagnosed at a median of 42 days after allo-HSCT). Median TTV DNA load values in posttransplant stools specimens were comparable (P = .34) in patients with or without subsequent aIGvHD; nevertheless, a falling trajectory (decrease in TTV DNA load >0.5 log10 copies/0.1 g) in paired pretransplant and posttransplant specimens was independently associated with the occurrence of aIGvHD (OR, 5.2; 95% CI, 1.3-21.3; P = .02). Notably, displaying a rising trajectory had a negative predictive value of 87.5% for aIGvHD. In summary, in this hypothesis-generating study, we suggest that the decrease in TTV DNA load from baseline in stool specimens may identify patients at risk of aIGVHD.

The ADAR Family in Amphioxus: RNA Editing and Conserved Orthologous Site Predictions.

RNA editing is a relatively unexplored process in which transcribed RNA is modified at specific nucleotides before translation, adding another level of regulation of gene expression. Cephalopods use it extensively to increase the regulatory complexity of their nervous systems, and mammals use it too, but less prominently. Nevertheless, little is known about the specifics of RNA editing in most of the other clades and the relevance of RNA editing from an evolutionary perspective remains unknown. Here we analyze a key element of the editing machinery, the ADAR (adenosine deaminase acting on RNA) gene family, in an animal with a key phylogenetic position at the root of chordates: the cephalochordate amphioxus. We show, that as in cephalopods, ADAR genes in amphioxus are predominantly expressed in the nervous system; we identify a number of RNA editing events in amphioxus; and we provide a newly developed method to identify RNA editing events in highly polymorphic genomes using orthology as a guide. Overall, our work lays the foundations for future comparative analysis of RNA-editing events across the metazoan tree.

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.

Planarian cell number depends on blitzschnell, a novel gene family that balances cell proliferation and cell death.

Control of cell number is crucial to define body size during animal development and to restrict tumoral transformation. The cell number is determined by the balance between cell proliferation and cell death. Although many genes are known to regulate those processes, the molecular mechanisms underlying the relationship between cell number and body size remain poorly understood. This relationship can be better understood by studying planarians, flatworms that continuously change their body size according to nutrient availability. We identified a novel gene family, blitzschnell (bls), that consists of de novo and taxonomically restricted genes that control cell proliferation:cell death ratio. Their silencing promotes faster regeneration and increases cell number during homeostasis. Importantly, this increase in cell number leads to an increase in body size only in a nutrient-rich environment; in starved planarians, silencing results in a decrease in cell size and cell accumulation that ultimately produces overgrowths. bls expression is downregulated after feeding and is related to activity of the insulin/Akt/mTOR network, suggesting that the bls family evolved in planarians as an additional mechanism for restricting cell number in nutrient-fluctuating environments.

Organ and effective doses detriment to paediatric patients undergoing multiple interventional cardiology procedures.

The aims of the present study were to present the frequency of multiple interventional cardiac procedures for a certain group of patients obtained at one of the largest paediatric hospitals in Chile. In addition it has been analysed cumulative kerma area product (KAP) and cumulative air kerma (CAK), and calculated organ doses for the patient groups undergoing 2, 3 and ≥ 4 procedures, using Monte Carlo software. Effective doses were also estimated for epidemiological purposes and to permit comparison with other imaging procedures. The sample used corresponds to the last 9 years and refers to a total of 1521 paediatric patients and 1824 interventional cardiac procedures. The results for frequency were: 13.7% of patients underwent 2 procedures, 4.1% underwent 3 procedures and 1.4% underwent 4 or more procedures. The median KAP and CAK values measured for the cumulative procedures in these three groups of patients were 3.7, 5.4 and 10.8 Gy·cm2 and 59.9, 83.2 and 147.6 mGy, respectively. In terms of the most irradiated organs during interventional cardiac procedures, the highest median values (for the group of ≥4 procedures) were: active bone marrow 5.0 mGy, lungs 23.5 mGy, oesophagus 15.2 mGy, thyroid 7.8 mGy and breast 11.0 mGy. Median dose value to the heart (for the group of ≥4 procedures) was 12.7 mGy. Median values in terms of calculated effective dose for the three patient groups (with 2, 3 and ≥4 procedures) were 3.4, 5.9 and 8.7 mSv, respectively.

The development of a free radiological anatomy software teaching tool / Desarrollo de un software libre de anatomia radiológica como una herramienta de enseñanza

SUMMARY: The purpose of this research was to develop a free radiological anatomy software for radiologic anatomy education to assist students and professionals in health science. The study was divided into two phases: image acquisition and software development. The first phase was to obtain plain radiographic images and computed tomographic (CT) scans of an anthropomorphic phantom of head and neck. In addition, plain radiographic images of an anthropomorphic phantom of the chest were obtained. The second phase was the development of the anatomy software as an ImageJ macro. The software was developed through the insertion of the radiologic anatomy landmarks into the images that were obtained and application of multiple choice questions. The software was then tested for usability by getting the professors to answer the multiple choice questions. The software presented radiologic anatomy from 1) Head projections: Waters view, Towne view, Caldwell view, Lateral view, Submentovertex, PA view; 2) Thoracic Spine projections: AP and Lateral View and 3) Chest: PA view, Lateral and Oblique. Tomographic imaging presented one hundred radiologic landmarks of head. In total, there were 354 questions. A final report containing the score of correct answers, as well as the user ID, Date and Time of the test were showed. The test were available in three languages (Spanish, English and Portuguese). A user-friendly and inexpensive software was developed and presented. Students and professionals from several countries are able to practice, repeatedly, the recognition of radiologic anatomical landmarks.

RESUMEN: El propósito de esta investigación fue desarrollar un software gratuito de anatomía radiológica para la educación de anatomía radiológica para ayudar a estudiantes y profesionales de ciencias de la salud. El estudio se dividió en dos fases: adquisición de imágenes y desarrollo de software. La primera fase consistió en obtener imágenes radiográficas simples y tomografías computarizadas (TC) de un fantasma antropomórfico de cabeza y cuello. Además, se obtuvieron imágenes radiográficas simples de un fantasma antropomórfico del tórax. La segunda fase fue el desarrollo del software de anatomía como una macro ImageJ. El software se desarrolló a través de la inserción de los puntos de referencia de la anatomía radiológica en las imágenes que se obtuvieron y la aplicación de preguntas de opción múltiple. Luego, se probó la usabilidad del software haciendo que los profesores respondieran las preguntas de opción múltiple. El software presentó la anatomía radiológica de 1) Proyecciones de la cabeza: vista de aguas, vista de Towne, vista de Caldwell, vista lateral, Submentovertex, vista de PA; 2) proyecciones de la columna torácica: vista AP y lateral y 3) Cofre: vista de PA, lateral y oblicua. Las imágenes tomográficas presentaron cien puntos de referencia radiológica de la cabeza. En total, hubo 354 preguntas. Se mostró un informe final con la puntuación de las respuestas correctas, así como la identificación del usuario, la fecha y la hora de la prueba. Las pruebas estaban disponibles en tres idiomas (español, inglés y portugués). Se desarrolló y presentó un software fácil de usar y de bajo costo. Estudiantes y profesionales de varios países pueden practicar, repetidamente, el reconocimiento de puntos de referencia anatómicos radiológicos.

Seguridad y Protección Radiológica en Procedimientos Imagenológicos Dentales / Safety and Radiological Protection in Dental Imaging Procedures

RESUMEN: Los procedimientos de imagenología dental son el tipo más frecuente de estudio radiológico y aportan información esencial para apoyar la evaluación, diagnóstico y tratamiento de patologías y/o alteraciones dentomaxilofaciales. La presente revisión narrativa, muestra los procedimientos de radiología dental, define conceptos asociados a la protección radiológica en éstos y entrega una guía con recomendaciones para mejorar la seguridad y protección radiológica del paciente y del operador, en esta clase de procedimientos imagenológicos. Comprender que bajo el actual sistema de protección radiológica, es el Odontólogo quién debe justificar la realización o no de un tipo de procedimiento radiológico, teniendo presente los costos económicos y sobre todo los costos en términos de dosis para el paciente.

ABSTRACT: Dental imaging procedures are the most frequent type of radiological study and provide essential information to support the evaluation, diagnosis and treatment of pathologies and / or dentomaxillofacial alterations. The present narrative review shows dental radiology procedures, defines concepts associated with radiological protection in these and provides a guide with recommendations to improve the safety and radiological protection of the patient and the operator in this kind of imaging procedures. Understanding that under the current system of radiological protection, it is the dentist who must confirm the realization or not, of a type of radiological procedure, keeping in mind the financial costs, and above all, consequences to the patient in terms of dose used in the procedure.

Sclerosing angiomatoid nodular transformation of the spleen. A case report.

A 57 year old woman presenting with heartburn and a one month history of epigastric abdominal pain and left hypochondrium pain. After conducting an ultrasound scan and a CT scan, a low attenuation lesion in the spleen was found, and the definitive diagnosis was sclerosing angiomatoid nodular transformation of the spleen (STANT) which was based on a splenectomy and a pathologic study. SANT is a benign rare vascular disease consisting of proliferation of angiomatoid/vascular nodules which predominantly affects women aged 27 to 68. It is usually detected as a coincidental finding in asymptomatic patients. The presumptive diagnosis is established by imaging tests, especially CT and MR; and the final diagnosis is as well established on the basis of pathology after a splenectomy.

LATIN AMERICAN IMAGE QUALITY SURVEY IN DIGITAL MAMMOGRAPHY STUDIES.

Under International Atomic Energy Agency regional programme TSA3 Radiological Protection of Patients in Medical Exposures, Latin American countries evaluated the image quality and glandular doses for digital mammography equipment with the purpose of seeing the performance and compliance with international recommendations. Totally, 24 institutions participated from Brazil, Chile, Costa Rica, El Salvador, Mexico, Paraguay and Venezuela. Signal difference noise ratio results showed for CR poor compliance with tolerances; better results were obtained for full-field digital mammography equipment. Mean glandular dose results showed that the majority of units have values below the acceptable dose levels. This joint Latin American project identified common problems: difficulty in working with digital images and lack of specific training by medical physicists from the region. Image quality is a main issue not being satisfied in accordance with international recommendations; optimisation processes in which the doses are increased should be very carefully done in order to improve early detection of any cancer signs.