RESUMO
AIM OF THE STUDY: Bleeding due to a vascular injury is a possible life-threatening complication of intertrochanteric femoral fracture internal fixation. Our goals were to find the current incidence of these events, and to describe the reasons, the presentation, and the treatment options. METHOD: We conducted a retrospective record review of 1,469 patients who were operated upon at our institution due to AO31A femoral fractures from 2011 through 2015 and were treated with closed reduction and internal fixation. RESULTS: Three patients were diagnosed with iatrogenic vascular bleeding, which constitute an incidence of 0.2%. The vascular injuries were detected as deep femoral artery bleeding adjacent to the distal locking screws. The patients were treated with ultrasound guided thrombin injection, endovascular coil embolization or with no endovascular intervention. DISCUSSION: Vascular injuries are caused mainly by perforating a vessel while drilling the distal locking screw holes. A high level of suspicion and immediate imaging work-up are mandatory. CONCLUSIONS: A vascular injury due to internal fixation of a proximal AO31A femoral fracture is a rare complication.
Assuntos
Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação de Fratura/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Lesões do Sistema Vascular/epidemiologia , Adulto , Idoso , Parafusos Ósseos/efeitos adversos , Feminino , Artéria Femoral/lesões , Fêmur/lesões , Fêmur/cirurgia , Fixação de Fratura/métodos , Fixação Interna de Fraturas/métodos , Técnicas Hemostáticas/estatística & dados numéricos , Humanos , Doença Iatrogênica/epidemiologia , Imageamento Tridimensional , Incidência , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/terapia , Adulto JovemRESUMO
OBJECTIVE: The purpose of this article is to discuss the first prospective study published to date that followed a large cohort of radiologic technologists; the authors examined the risks of cancer incidence and mortality in U.S. radiologic technologists (radiographers) assisting in fluoroscopically guided interventional procedures. CONCLUSION: There is an urgent need for implementing a radiation protection culture for medical procedures that use ionizing radiation.
Assuntos
Fluoroscopia/efeitos adversos , Neoplasias Induzidas por Radiação/epidemiologia , Doenças Profissionais/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Radiografia Intervencionista/efeitos adversos , Feminino , Humanos , MasculinoAssuntos
Dor nas Costas/epidemiologia , Cervicalgia/epidemiologia , Doenças Profissionais/epidemiologia , Saúde Ocupacional , Radiografia Intervencionista/efeitos adversos , Radiologistas , Absenteísmo , Dor nas Costas/diagnóstico , Dor nas Costas/prevenção & controle , Avaliação da Deficiência , Ergonomia , Humanos , Incidência , Descrição de Cargo , Cervicalgia/diagnóstico , Cervicalgia/prevenção & controle , Doenças Profissionais/diagnóstico , Doenças Profissionais/prevenção & controle , Postura , Prevalência , Roupa de Proteção/efeitos adversos , Lesões por Radiação/diagnóstico , Lesões por Radiação/epidemiologia , Lesões por Radiação/prevenção & controle , Proteção Radiológica/instrumentação , Medição de Risco , Fatores de Risco , Licença Médica , Fatores de TempoAssuntos
Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/transmissão , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Equipamento de Proteção Individual , Radiografia Intervencionista/normas , Radiologia Intervencionista/normas , Centers for Disease Control and Prevention, U.S. , Humanos , Internacionalidade , Estados UnidosRESUMO
PURPOSE: Evaluation and registration of patient and staff doses are mandatory under the current European legislation, and the occupational dose limits recommended by the ICRP have been adopted by most of the countries in the world. METHODS: Relevant documents and guidelines published by international organisations and interventional radiology societies are referred. Any potential reduction of patient and staff doses should be compatible with the clinical outcomes of the procedures. RESULTS: The review summarises the most common protective measures and the needed quality control for them, the criteria to select the appropriate protection devices, and how to avoid unnecessary occupational radiation exposures. Moreover, the current and future advancements in personnel radiation protection using medical simulation with virtual and augmented reality, robotics, and artificial intelligence (AI) are commented. A section on the personnel radiation protection in the era of COVID-19 is introduced, showing the expanding role of the interventional radiology during the pandemic. CONCLUSION: The review is completed with a summary of the main factors to be considered in the selection of the appropriate radiation protection tools and practical advices to improve the protection of the staff.
Assuntos
Exposição Ocupacional/prevenção & controle , Lesões por Radiação/prevenção & controle , Proteção Radiológica , COVID-19/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Pandemias , Doses de Radiação , Proteção Radiológica/métodos , Radiologia Intervencionista/métodos , SARS-CoV-2RESUMO
The benefits of fluoroscopically guided interventional procedures are significant and have established new standards in the clinical management of many diseases. Despite the benefits, it is known that they come with known risks, such as the exposure to ionizing radiation. To minimize such risks, it is crucial that the health professionals involved in the procedures have a common understanding of the concepts related to radiation protection, such as dose descriptors, diagnostic reference levels and typical dose values. An update about these concepts will be presented with the objective to raise awareness amongst health professionals and contribute to the increase in knowledge, skills and competences in radiation protection in fluoroscopically guided interventional procedures.
Assuntos
Segurança do Paciente , Doses de Radiação , Proteção Radiológica/métodos , Radiografia Intervencionista/métodos , Fluoroscopia , HumanosAssuntos
Traumatismos Ocupacionais/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Lesões por Radiação/prevenção & controle , Proteção Radiológica/normas , Radiografia Intervencionista/normas , Radiologia/normas , Europa (Continente) , Feminino , Humanos , Exposição Ocupacional/análise , Exposição Ocupacional/prevenção & controle , Exposição Ocupacional/normas , Traumatismos Ocupacionais/etiologia , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal/etiologia , Lesões por Radiação/etiologia , Radiografia Intervencionista/efeitos adversosRESUMO
Over recent years, an increasing number of fluoroscopically guided interventions (FGIs) have been performed by radiologists and non-radiologists. Also, the number of complex interventional procedures has increased. In the late nineties, first reports of skin injuries appeared in the literature. The medical community responded through increased awareness for radiation protection and public authorities by recommendations and legislation, for example, the European Basic Safety Standards (EU-BSS) which were published in 2014, or the international Basic Safety Standards (BSS). Implementation of the EU-BSS requires concerted action from interventionalists, radiographers, medical physics experts and competent national authorities. Interventionalists should play an important role in this project since implementation of the EU-BSS will affect their daily practice. This paper discusses some important issues of the EU-BSS such as unintended and accidental radiation exposures of patients, the meaning of significant dose events and how to deal with patients who were exposed to a substantial radiation dose with the risk of tissue injuries. In addition, this paper provides practical advice on how to implement alert and trigger levels in daily practice of FGIs in order to increase patient safety.
Assuntos
Segurança do Paciente , Doses de Radiação , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Proteção Radiológica/métodos , Radiologia Intervencionista/métodos , HumanosAssuntos
Patógenos Transmitidos pelo Sangue , Cardiologia/normas , Controle de Doenças Transmissíveis/normas , Infecção Hospitalar/prevenção & controle , Exposição Ocupacional/prevenção & controle , Guias de Prática Clínica como Assunto , Radiologia Intervencionista/normas , Europa (Continente) , Humanos , Medição de Risco/normasRESUMO
Medical staff should not be exposed to the primary X-ray beam during fluoroscopy-guided interventional procedures (FGIP). The main source of staff exposure is scatter radiation from the patient, which can be significant. Although many aspects of X-ray exposure to the patient as well as occupational exposure to interventional radiologists and other staff are strongly regulated and monitored in most countries, it is surprising how loosely the labeling and testing of the protective aprons is regulated. Interventional radiologists (IRs) have to be experts in interventional radiology as well as in basic facts regarding ways to provide a satisfactory level of protection from occupational exposure. IRs, however, are not familiar with the apron testing methods. The accompanying documents provided with aprons by manufacturers may not be informative enough. Vendors often report apron effectiveness at a single beam quality and attenuation. The vendor reports repeatedly disagree with independent reports, which clearly show that the attenuation of these garments at other important unreported energies may be lower than expected. Better trust no one and check your protective garment yourself, or, better yet, consult a medical physicist when making purchasing decisions related to protective garments. Each interventionist should choose garments that are appropriately protective for that individual's practice. Review of past personal dosimetry results and consultation with a medical physicist can help the IR make the best decision. This article will help the reader to understand why all protective garments are not created equally, and provides some practical tools that will allow safe and healthy practice in FGIP.
Assuntos
Chumbo , Exposição Ocupacional/prevenção & controle , Traumatismos Ocupacionais/prevenção & controle , Roupa de Proteção , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Proteção Radiológica/instrumentação , Radiologistas , Radiologia Intervencionista , Desenho de Equipamento , Humanos , Descrição de Cargo , Exposição Ocupacional/efeitos adversos , Saúde Ocupacional , Traumatismos Ocupacionais/etiologia , Fatores de Proteção , Doses de Radiação , Exposição à Radiação/efeitos adversos , Lesões por Radiação/etiologia , Fatores de Risco , Recursos HumanosRESUMO
BACKGROUND: Case of urinary bladder wall and surrounding tissue necrosis following bilateral superselective embolization of internal iliac artery branches due to unmanageable haematuria associated with aggressive bladder tumor. CASE: We achieved the bleeding control, but patient demonstrated severe postembolization syndrome at follow-up (low abdominal pain, arterial hypertension, hyperthermia). Severe bladder tissue and surrounding neoplastic tissue necrosis developed several days after procedure. Patient died from multiple organ dysfunction syndrome due to longstanding peritonitis. CONCLUSIONS: Tumor ischemia and bladder wall and surrounding tissue necrosis, are possible serious complications ofembolization using calibrated microspheres. These complications can be very dangerous, and even fatal.
Assuntos
Fluoroscopia/normas , Melhoria de Qualidade , Doses de Radiação , Lesões por Radiação/prevenção & controle , Monitoramento de Radiação/métodos , Proteção Radiológica/métodos , Radiografia Intervencionista/normas , Técnica Delphi , Humanos , Consentimento Livre e Esclarecido , Planejamento de Assistência ao Paciente , Fatores de Risco , Fatores de TempoRESUMO
For a long time, radiation-induced skin injuries were only encountered in patients undergoing radiation therapy. In diagnostic radiology, radiation exposures of patients causing skin injuries were extremely rare. The introduction of fast multislice CT scanners and fluoroscopically guided interventions (FGI) changed the situation. Both methods carry the risk of excessive high doses to the skin of patients resulting in skin injuries. In the early nineties, several reports of epilation and skin injuries following CT brain perfusion studies were published. During the same time, several papers reported skin injuries following FGI, especially after percutaneous coronary interventions and neuroembolisations. Thus, CT and FGI are of major concern regarding radiation safety since both methods can apply doses to patients exceeding 5 Gy (National Council on Radiation Protection and Measurements threshold for substantial radiation dose level). This paper reviews the problem of skin injuries observed after FGI. Also, some practical advices are given how to effectively avoid skin injuries. In addition, guidelines are discussed how to deal with patients who were exposed to a potentially dangerous radiation skin dose during medically justified interventional procedures.
Assuntos
Lesões por Radiação/prevenção & controle , Proteção Radiológica/métodos , Radiografia Intervencionista/efeitos adversos , Radiologia Intervencionista/métodos , Pele/efeitos da radiação , Tomografia Computadorizada por Raios X/efeitos adversos , Fluoroscopia/efeitos adversos , Humanos , Doses de Radiação , Radiologistas , Pele/lesõesAssuntos
Corpos Estranhos/prevenção & controle , Radiografia Intervencionista/normas , Radiologia Intervencionista/normas , Sociedades Médicas/normas , Instrumentos Cirúrgicos , Humanos , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/instrumentação , Tampões de Gaze CirúrgicosRESUMO
BACKGROUND: Intramural duodenal hematoma generates partial or complete obstruction that develops slowly and progressively with a consequent delay in diagnosis. Many diagnostic and therapeutic measures remain debatable and justify a review of current management policy. OBJECTIVES: To highlight the diagnostic and therapeutic steps in pediatric IDH. METHODS: The records of 12 children with post-traumatic IDH who were treated in the Hillel Yaffe Medical Center between 1986 and 2000 were retrospectively reviewed. Three of them had clotting disorders and were excluded. The interval between their admission and diagnosis as well as the therapeutic decisions were evaluated and analyzed. RESULTS: Nine children were treated for IDH. The interval between admission and diagnosis ranged from 24 hours to 6 days. Five children had associated traumatic pancreatitis. Initially, all the children were conservatively treated. In seven the hematoma resolved after 9-20 days. Two children were operated upon because the obstruction failed to resolve. All nine children recovered without permanent complications. CONCLUSIONS: Intramural duodenal hematoma has many clinical and therapeutic puzzling aspects. Bicycle handlebar, road accidents and sports trauma are the main etiologic factors in children, but child abuse should be kept in mind. Associated traumatic pancreatitis is common. Gastroduodenal endoscopy may be useful to clarify doubtful cases. Pediatric surgeons should increase awareness regarding IDH in order to reduce delay in diagnosis and the need for surgical decompression.
Assuntos
Traumatismos Abdominais/complicações , Obstrução Duodenal/etiologia , Hematoma/etiologia , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Adolescente , Ciclismo/lesões , Criança , Maus-Tratos Infantis , Pré-Escolar , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/cirurgia , Diagnóstico Precoce , Feminino , Hematoma/diagnóstico , Hematoma/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND CONTEXT: X-ray absorption is highest in the organs and tissues located closest to the radiation source. The photon flux that crosses the body decreases from the entry surface toward the image receptor. The internal organs absorb x-rays and shield each other during irradiation. Therefore, changing the x-ray projection angle relative to the patient for specific spine procedures changes the radiation dose that each organ receives. Every organ has different radiation sensitivity, so irradiation from different sides of the body changes the biological influence and radiation risk potential on the total body, that is the effective dose (ED). PURPOSE: The study aimed to determine the less radiation-sensitive sides of the body during lateral and anterior-posterior (AP) or posterior anterior (PA) directions. STUDY DESIGN: The study used exposure of patient phantoms and Monte Carlo simulation of the effective doses. PATIENT SAMPLE: Calculations for adults and 10-year-old children were included because the pediatric population has a greater lifetime radiation risk than adults. OUTCOME MEASURES: Pediatric and adult tissue and organ doses and ED from cervical, thoracic, and lumbar x-ray spine examinations were performed from different projections. METHODS: Standard mathematical phantoms for adults and 10-year-old children, using PCXMC 2.0 software based on Monte Carlo simulations, were used to calculate pediatric and adult tissue and organ doses and ED. The study was not funded. The authors have no conflicts of interest to declare. RESULTS: Spine x-ray exposure from various right (RT) LAT projection angles was associated with lower ED compared with the same left (LT) LAT projections (up to 28% and 27% less for children aged 10 and adults, respectively). The PA spine projections showed up to 64% lower ED for children aged 10 and 65% for adults than AP projections. The AP projection at the thoracic spine causes an excess breast dose of 543.3% and 597.0% for children aged 10 and adults, respectively. CONCLUSIONS: Radiation ED in spine procedures can be significantly reduced by performing x-ray exposures through the less radiation-sensitive sides of the body, which are PA in the frontal position and right lateral in the lateral position.
Assuntos
Doses de Radiação , Radiografia/métodos , Coluna Vertebral/diagnóstico por imagem , Adulto , Criança , Feminino , Humanos , Masculino , Método de Monte Carlo , Imagens de Fantasmas , Radiografia/efeitos adversos , Radiografia/normas , Software , Raios XRESUMO
Eight female adult ex-breeder New Zealand white rabbits underwent bilateral, unilateral, or superselective unilateral uterine artery embolization. The histopathologic changes after embolization in New Zealand white rabbits resemble those in humans, making rabbits an appropriate model for experimental uterine artery embolization.