Fatores associados a anormalidades na cintilografia de perfusão miocárdica de pacientes diabéticos / Factors associated with abnormalities on myocardial perfusion scintigraphy in diabetic patients

O diabetes melito é o maior fator de risco para doença arterial coronariana. Além da longa duração de diabetes, outros fatores, como presença de doença arterial periférica e tabagismo são fortes preditores para anormalidades na cintilografia de perfusão do miocárdio. O objetivo deste estudo foi avaliar o impacto dos fatores de risco de pacientes diabéticos nos resultados da cintilografia de perfusão do miocárdio e comparar com os resultados de pacientes não diabéticos em uma clínica de medicina nuclear. Foi realizado um estudo transversal retrospectivo por meio da análise de prontuários de pacientes que realizaram cintilografia miocárdica no período de 2010 a 2019. Foram avaliados 34.736 prontuários. Analisando a fase de estresse da cintilografia de perfusão do miocárdio, os portadores de diabetes melito precisaram receber estímulo farmacológico duas vezes mais que os não diabéticos para sua realização. Também foram avaliados fatores que tivessem impacto negativo no resultado da cintilografia de perfusão do miocárdio, e foi visto que o diabetes melito (33,6%), a insulinoterapia (18,1%), a hipertensão arterial sistêmica (69,9%), a dislipidemia (53%), o sedentarismo (83,1%), o uso de estresse farmacológico (50,6%), a dor torácica típica (8,5%) e a angina limitante durante o teste (1,7%) estiveram associados significativamente (p<0,001) a anormalidades neste exame. (AU)

Diabetes mellitus (DM) is the greatest risk factor for coronary artery disease. In addition to a long duration of diabetes, the presence of peripheral arterial disease and smoking are strong predictors of abnormalities on myocardial perfusion scintigraphy (MPS). This study aimed to assess the impact of risk factors in diabetic patients on MPS results and compare them with those of non-diabetic patients in a nuclear medicine clinic. A retrospective cross-sectional study was performed through the analysis of the medical records of patients who underwent MPS in 2010­2019. A total of 34,736 medical records were evaluated. Analyzing the stress phase of MPS, DM patients required two-fold more pharmacological stimulation than non-diabetic patients for MPS. Factors that negatively impact the MPS results were also evaluated, and DM (33.6%), insulin therapy (18.1%), systemic arterial hypertension (69.9%), dyslipidemia (53%), sedentary lifestyle (83.1%), use of pharmacological stress (50.6%), typical chest pain (8.5%), and limiting angina during the test (1.7%) were significantly associated (p < 0.001) with test abnormalities. (AU)

Herramienta basada en código abierto para el cálculo de blindaje en las instalaciones de Medicina Nuclear / Open Source Based Tool for Shielding Calculation in Nuclear Medicine Installations

Uno de los requerimientos indispensables en el diseño de las instalaciones donde se trabaja con radiación ionizante es la determinación del espesor adecuado de las paredes, pisos, techo y puertas de los locales, que garanticen dosis por debajo de las restricciones establecidas por la autoridad regulatoria. El objetivo del presente trabajo es desarrollar una herramienta interactiva, libre y de código abierto para calcular los blindajes requeridos en una instalación de Medicina Nuclear. En el código, desarrollado en Phyton utilizando el entorno interactivo Jupiter Notebook, se incluyó el análisis tanto para Tomografía por Emisión de Fotón Único como para Tomografía por Emisión de Positrones. La herramienta fue implementada para el cálculo de los blindajes de un departamento de Medicina Nuclear del Centro Internacional de Restauración Neurológica (CIREN). Esta herramienta libre y de código abierto facilita los cálculos de blindaje aumentando la velocidad, lo que contribuye a lograr una optimización de la protección radiológica, pero también puede usarse como herramienta pedagógica(AU)

One of the indispensable requirements in the design of the facilities where ionizing radiation is used is the determination of the adequate thickness of the walls, floors, ceiling and doors of the premises, which guarantee doses below the restrictions established by the regulatory authority. The goal of this work is to develop an interactive, free and open source tool to calculate the shields required in a Nuclear Medicine installation. Analysis for both Single Photon Emission Tomography and Positron Emission Tomography was included in the code, developed in Phyton using the interactive Jupiter Notebook environment. The tool was implemented to calculate the shields of a Nuclear Medicine department of the International Center for Neurological Restoration (CIREN). This free and open source tool facilitates shielding calculations by increasing speed, which contributes to the optimization of radiation protection, but can also be used as a pedagogical tool(AU)

Avaliação da metodologia de estimação da atividade em rejeitos sólidos radioativos perfurocortantes gerados em um Serviço de Medicina Nuclear / [Evaluation of the methodology for estimating activity in sharp radioactive solid waste generated in a Nuclear Medicine Service]

A utilização das radiações ionizantes deve trazer um benefício líquido para a sociedade. A medicina nuclear é uma especialidade médica que emprega radiofármacos para o diagnóstico e tratamento de diversas doenças, o que invariavelmente ocasiona a produção de rejeitos radioativos. Rejeitos radioativos são materiais contendo radionuclídeos sem utilização presente ou futura, e a sua liberação no meio ambiente pode causar a exposição da população. A Comissão Nacional de Energia Nuclear (CNEN), através da norma CNEN-NN-8.01 regulamenta os procedimentos para a gerência dos rejeitos radioativos, determinando como os mesmos devem ser descritos e classificados, os procedimentos para a sua coleta e segregação, embalagem, identificação, armazenamento, e os limites para a sua transferência para os serviços de coleta urbana. Como determinado pela CNEN, todos os embalados contendo rejeitos radioativos devem ter a atividade estimada e registrada em sinalização afixada em seu exterior e no inventário de rejeitos radioativos. A determinação ou a estimação da atividade é importante para o cálculo do tempo de armazenagem até a liberação dos rejeitos nos serviços de coleta de lixo hospitalar e urbano. Portanto, são necessários procedimentos práticos para mensurar ou estimar a atividade. A metodologia aplicada pelo Serviço de Medicina Nuclear do Instituto Nacional de Câncer José Alencar Gomes da Silva (SMN/INCA) para estimar a atividade nos coletores de perfurocortantes (rejeitos radioativos) utiliza algumas aproximações físicas, considerando os embalados como fontes pontuais, homogêneas e isotrópicas sem autoabsorção ou espalhamento das radiações. Essas aproximações não são geralmente compatíveis com a realidade, onde os embalados têm volumes consideráveis, com materiais que produzem atenuação e espalhamento das radiações. O objetivo desse trabalho é avaliar a metodologia aplicada pelo SMN/INCA para estimar a atividade nos coletores de perfurocortantes e comparar tais estimativas com a atividade real dos rejeitos radioativos, determinando um possível fator de correção para as mesmas. Foram realizados experimentos de forma a avaliar os procedimentos rotineiramente empregados no SMN/INCA, assumindo que podem existir diferenças significativas com relação a atividade presente nos embalados e aquelas estimadas por tais procedimentos, baseados nas medições obtidas com o uso de monitores de radiação calibrados na grandeza dosimétrica equivalente de dose ambiente - H*(10). Os resultados obtidos monstram que a metodologia empregada para estimar tal atividade dos embalados, contendo rejeitos radioativos perfurocortantes, subestima a atividade real contida nos embalados em até 20%. Essas diferenças são devidas as variações de leituras obtidas com o monitor de radiação Geiger-Müller. Entretanto, tais variações se encontram na faixa de tolerância para tal classe de monitores calibrados em H*(10). Embora existam diferenças entre a atividade real e a estimada, a correção é possível através de um fator de ajuste fixo (k = 1, 2) , que pode ser utilizado de forma a garantir que a metodologia produza resultados compativeis com os requisitos normativos de proteção radiológica definidos pela CNEN.

The use of ionizing radiation must provide net benefits to society. Nuclear medicine is a medical specialty that uses radiopharmaceuticals to diagnosis and treatment for several illnesses, inevitably producing radioactive waste. Radioactive waste is any material containing radionuclides with no present or future use, and your release in the environment can cause radioactivity exposure to the population. The Brazilian National Nuclear Energy Commission (CNEN), through norm CNEN NN-8.01, regulates the procedures for the management of such radioactive waste, determining how to describe and classify, the methods for their collection, segregation, packaging, identification, storage, and the limits to transfer it to urban waste collection services. As ruled by CNEN, all packages containing radioactive waste must have the estimated activity recorded in external labels and on the inventory of radioactive waste. The activity determination or estimation is essential to the calculation of the storage time until the release of such waste in medical or urban waste collecting services. Therefore, practical procedures are necessary to carry out that measurement or estimation. The methodology applied by the Nuclear Medicine Department of the Brazilian National Cancer Institute José de Alencar Gomes da Silva (SMN/INCA) to estimate the activity in the sharp containers (radioactive waste) uses some physical approximations to perform the activity estimation, considering the packages as punctual, homogeneous and isotropic sources with no radiation autoabsorption or scattering. Those approximations have no link to the reality where the packages have considerable volumes with materials that produce radiation attenuation and scattering. This work aims to evaluate the methodology applied by the SMN/INCA to estimate the activity in the sharp containers (radioactive waste) and compare the provided estimates with the actual activity on that waste, providing a correction factor for those estimations. Experiments were carried out to evaluate the procedures employed in the routine of the Service. Assuming that there may be significant differences about the actual activities present in the packages and those estimated by such methodology, based on measurements obtained with the use of radiation monitors calibrated in the dosimetric quantity equivalent of ambient dose - H*(10). The results show that the methodology can underestimate the activity contained in the packages by up to 20%. Those differences are due to the variation on the Geiger-Müller monitor readings. However, the differences are in the tolerance range for those instruments when calibrated on H*(10). Although there are differences between the actual activity and that estimated, the correction is possible with one fixed adjustment factor (k = 1, 2) , allowing the methodology gives results compatible with the regulatory requirements of radiological protection determined by CNEN.

68Ga activity calibrations for nuclear medicine applications in Cuba.

The realization and dissemination of the 68Ga activity measurement unit in Cuba is presented. Firstly, the implementation of the Triple to Double Coincidence Ratio (TDCR) method is described for the calibration of the activity concentration of a 68Ga solution using a Hidex™ commercial liquid scintillation counter and a FORTRAN code developed for the calculation of the 68Ga counting efficiencies in the given measurement system. The relative expanded uncertainty (k = 2) associated with the 68Ga activity concentration obtained with the TDCR method is equal to 2%. With the aim to validate this measurement uncertainty estimate, the method is also applied to an Amersham standard solution of 22Na - a positron emitter with a similar decay mode to the 68Ga disintegration scheme from the point of view of type of emitted particles detected in the measurement system. The observed difference between the measured 22Na activity concentration by the TDCR method and the corresponding reference value traceable to NIST is equal to 0.16%. Outcomes of transferring the 68Ga activity standard, realized with the TDCR method, to the secondary standard radionuclide calibrator Capintec CRC™ 15R and to three radionuclide calibrators used for 68Ga PET applications in a hospital are also shown.

Rapid and accurate assessment of the activity measurements in Brazilian hospitals and clinics.

Traceability in Nuclear Medicine Service (NMS) measurements was checked by the Institute of Radioprotection and Dosimetry (IRD) through the Institute of Energy and Nuclear Research (IPEN). In 2016, IRD ran an intercomparison program and invited Brazilian NMS authorized to administer 131I to patients. Sources of 131I were distributed to 33 NMSs. Three other sources from the same solution were sent to IRD, after measurement at IPEN. These sources were calibrated in the IRD reference system. A correction factor of 1.013 was obtained. Ninety percent of the NMS comparisons results are within ±10% of the National Laboratory of Metrology of Ionizing Radiation (LNMRI) value, the Brazilian legal requirement.

Evaluación de la efectividad de los medios de radioprotección en el personal de Imagenología del Hospital Nacional de Policía ocupacionalmente expuesto a radiaciones ionizantes en el periodo de enero 2011 a junio del 2011 / Evaluation of the effectiveness of the means of radiation protection in the staff of Imaging Unity of the National Hospital of Police occupationally exposed to ionizing radiation in the period of January 2011 to June 2011

Objetivo: Evaluar la efectividad de los medios de Radioprotección en el personal de Imagenología del Hospital Nacional de Policía ocupacionalmente expuesto a radiaciones ionizantes en el periodo de Enero a junio del 2011. Material y Método: Método observacional. Tipo de estudio realizado: Prospectivo, Diseño de investigación Transversal, Diseño Cuantitativo desarrollado en el Hospital Nacional de la Policía ubicada en el distrito de Jesús María, departamento de Lima durante el periodo de enero a Junio del 2011. Utilizando un cuestionario de autoevaluación a 46 trabajadores ocupacional mente expuestos a radiaciones de las unidades de radiodiagnóstico y medicina nuclear en el periodo enero 2011- junio 2011. Resultados: Al procesar los cuestionarios con el software SPSS encontramos conocimientos que se presentan agrupados de acuerdo a las actividades profesionales que realizan. La responsabilidad del auxiliar de radiología es diferente al del Tecnólogo médico o al del Médico. Claramente se aprecia que los auxiliares de radiología, cumplen al 100 por ciento con los conocimientos que dan soporte a sus actividades profesionales de esta unidad de competencia. Conclusiones: La autoevaluación demostró que los trabajadores poseen un excelente conocimiento y aplicación de las normas de radioprotección, observándose en ellos la posesión de actitudes idóneas para el trabajo en el servicio de Imagenología del Hospital. De esta manera el trabajador mantiene una actitud preventiva de vigilancia periódica del estado de su salud ante los riesgos laborales.

Purposes: To evaluate the effectiveness of the means of radiation protection the staff at Imaging National Police Hospital occupationally exposed to ionizing radiations in the period from January to June 2011. Materials and methods: Observational method. Type of study accomplished: Prospective, Research Design: Transversal. Quantitative design developed at the National Police Hospital located in the district of Jesus Maria. Lima department during the period from January to June 2011. Using a self-assessment questionnaire to 46 workers occupationally exposed to radiation units radiology and nuclear medicine in the period January 2011-June 2011. Results: When processing the questionnaires using SPSS software are presented know grouped according to the professional activities they perform. The responsibility of the radiology Auxiliary is different from the Medical Technologist or Medical. Clearly it shows that radiology auxiliaries comply 100 percent with the knowledge that give support to your professional activities of this unit of competence. Conclusion: The self-assessment showed that workers have an excellent knowledge and application of radiation protection standards. Showing them the possession of appropriate attitudes for work in the service of the Hospital Imaging. Thus the worker has a preventive attitude of regular monitoring of his health status to the occupational hazards.

An assessment of immediate DNA damage to occupationally exposed workers to low dose ionizing radiation by using the comet assay.

BACKGROUND: Several cytogenetic studies have shown an increased frequency of chromosomal aberrations for workers exposed to low dose ionizing radiation, however the dose, type of radiation and management vary among the areas of work; it is possible that this variation may generate different quantity of DNA damage, detectable within the first hours after exposure of the personnel. In this study we assessed early DNA lesions caused by exposure to low doses of ionizing radiation in 41 workers from the departments of Radiology, Nuclear Medicine and Radiotherapy and a group of 20 healthy unexposed individuals, all from the same Institution. MATERIAL AND METHODS: Blood samples were obtained from exposed and unexposed subjects for analysis of DNA damage using the comet assay. The migration of the comet's tail was compared before and after the workday, as well as among the groups; the relationship between DNA migration and the exposure dose of the month was also obtained. RESULTS: A significant increase in damage to DNA was seen after workday for the occupationally exposed group (p < 0.01) as compared with the samples before workday as well as with those from the unexposed group. A positive correlation was found between the monthly dose of radiation and the migration length of DNA before and after the workday (p < 0.01). There were significant differences in the length of the comet tails among workers from different departments: workers from Radiology (28.6 microm) have less DNA damage than those from Nuclear Medicine and Radiotherapy (92.5 microm, 63.4 microm respectively) departments. CONCLUSIONS: All the workers occupationally exposed showed an increase in DNA fragmentation after the workday. The amount of radiation in all three services is different, in Nuclear Medicine and Radiotherapy the workers showed a greater monthly dose of exposure and greater DNA damage than the Radiology workers. The longer tails were observed in Nuclear Medicine where radionuclides are used; these radioactive substances are handled and administered to patients orally or intravenously by the workers, which implies a different type of exposure and radiation, this may explain the differences found in this study. Most of the DNA damage detected by the comet assay is repaired, however a part of it may result in stable chromosomal rearrangements that may represent a long-term health risk. It is important to sensitize exposed workers on their responsibility of working with radiation and the improvement of the hospital safety practices.

Variações de exposição ocupacional à radiação ionizante em profissionais da equipe técnica do serviço de medicina nuclear com o uso clínico de 18F-FDG / / Variations in occupational exposure to ionizing radiation in professional technical team of nuclear medicine service with the clinical use of 18F-FDG

Introdução: O 18F-FDG, um análogo da glicose, é o principal radiofármaco emissor de pósitrons utilizado para imagens metabólicas em Medicina Nuclear. Vários estudos demonstram que o uso de 18F-FDG para exames de PET/CT aumenta a dose de exposição à radiação dos trabalhadores diretamente envolvidos na manipulação, aplicação e no posicionamento de pacientes injetados com este radiofármaco. Objetivos: Avaliar a contribuição da introdução e uso clínico do 18F-FDG, sobre a dose de exposição mensal, recebida pela equipe técnica do Serviço de Medicina Nuclear do Departamento de Diagnóstico por Imagem do Hospital A.C. Camargo, no período compreendido entre 2000 à 2008 e suas particularidades. Metodologia: estudo retrospectivo, estabelecido entre os anos de 2000 e 2008, e, fundamentado na análise das variáveis registradas no livro de controle diário do laboratório de manipulação de radioisótopos do Setor de Medicina Nuclear do Departamento de Diagnóstico por Imagem do Hospital A.C. Camargo e na análise das variáveis presentes no registro da leitura mensal dos dosímetros tipo TLD, utilizado ao nível do tórax e punho, individualmente, pela equipe técnica do laboratório de radioisótopos deste Setor. Resultados: observa-se influência significativa do 18F-FDG na dose de exposição do tórax dos IOEs entre os anos de 2000 e 2005 e no punho entre os anos de 2006 e 2008; a soma dos isótopos mais utilizados na Medicina Nuclear convencional como o 99mTc, 131Iodo e 67Galio não apresentou influência significativa na dose de exposição tanto no tórax quanto no punho nos períodos analisados. A identificação da variável responsável pela oscilação das doses de exposição destes indivíduos forneceu importantes informações para otimização da rotina de trabalho, permitindo minimizar a exposição e aumentar a efetividade operacional através da aplicação efetiva dos preceitos de proteção radiológica. Conclusão: A introdução e uso clínico do 18F-FDG aumenta a dose de exposição dos IOEs em relação a utilização de outros isótopos convencionais de Medicina Nuclear. A experiência e as práticas individuais de trabalho influenciam na dose de exposição recebida pelos trabalhadores. A adoção de medidas específicas de Proteção Radiológica permite o controle e manutenção destas doses dentro dos limites estabelecidos pela CNEN.

Introduction: The 18F-FDG, a glucose analogue, is the main positron emitting radiopharmaceutical used for metabolic images in nuclear medicine. Several studies have shown that the use of 18F-FDG examinations for PET / CT increases the dose of radiation exposure of workers directly involved in handling, application and placement of patients injected with this radiopharmaceutical. Objectives: To evaluate the contribution of the introduction and clinical use of 18F-FDG on the exposure dose monthly, received by the technical staff of the Department of Nuclear Medicine, Department of Diagnostic Imaging at Hospital A.C. Camargo, in the period 2000 to 2008 and its particularities. Methodology: A retrospective study established between 2000 and 2008, and based on the analysis of the variables recorded in the book of daily control of the handling of radioisotope laboratory of the Division of Nuclear Medicine, Department of Diagnostic Imaging at Hospital A.C. Camargo and analysis of variables present in the reading record monthly dosimeters TLD type used at the chest and wrist, individually, by the technical staff of the Radioisotope Laboratory of this Sector. Results: there is significant influence of 18F-FDG dose exposure of the chest of occupationally exposed individuals between the years 2000 and 2005 and the wrist between the years 2006 and 2008, more than the sum of the isotopes used in nuclear medicine as the conventional 9 9mTc, 131 iodo, 67Galio and showed no significant influence on the exposure dose in both the chest and in the wrist during the periods analyzed. The identification of the variable responsible for the oscillation of the levels of exposure of these individuals provided important information for optimization of the work routine, enabling minimize exposure and increase operational effectiveness through the effective application of the precepts of radiological protection. Conclusion: The introduction and clinical use of 18F-FDG increases the exposure dose of occupationally exposed individuals in relation to use of other conventional nuclear medicine isotopes. The adoption of specific measures for Radiological Protection allows control and maintenance of these doses within the limits established by CNEN

A enfermagem em radioiodoterapia: enfoque nas necessidades de ajuda dos clientes / La enfermeria en radioyodoterapia: enfoque en las necesidades de ayuda de los clientes / Nursing care in radioiodine Therapy: focusing on clients’ need for assistance

O estudo visou subsidiar o planejamento da assistência de enfermagem a clientes com câncer de tireoide submetidos à radioiodoterapia. Objetivos: descrever as necessidades de ajuda expressas por clientes submetidos à radioiodoterapia e analisar os cuidados de enfermagem requeridos para atender às necessidades identificadas. Adotou-se como marco referencial a relação de ajuda na totalidade da prática de enfermagem. O método foi o estudo de caso representativo, longitudinal, descritivo, com 24 clientes em tratamento no Serviço de Medicina Nuclear do Instituto Nacional de Câncer – Rio de Janeiro, no período de julho a setembro de 2006. Os resultados revelaram que os clientes, no transcurso da radioiodoterapia, requerem da equipe de enfermagem cuidados relacionados às orientações para o autocuidado, apoio emocional e cuidados físicos nas contingências das necessidades referidas. O que indica a importância da presença da enfermeira junto aos clientes para planejar e implementar cuidados com foco em suas necessidades.

This study aims to inform planning of nursing care for clients with thyroid cancer undergoing radioiodine therapy by describing the needs for assistance as expressed by such clients and analyzing the nursing care required to meet the needs identified. The framework adopted was the ratio of assistance to total nursing care, and the method, the descriptive, longitudinal, representative case study of twenty-four clients undergoing treatment from July to September 2006 at the Nuclear Medicine Service of the Instituto Nacional de Câncer, Rio de Janeiro. The results revealed that, in the course of radioiodine therapy, the care clients require from the nursing team includes self-care guidance, emotional support and physical care in contingences raising these needs. This indicates the importance of the nurse’s being present with clients during the planning and implementation of care that focuses on their needs.

El estudio visó subsidiar el planeamiento de la asistencia de enfermería a clientes con cáncer de tiroides sometidos a radioyodoterapia. Objetivos: describir las necesidades de ayuda expresas por clientes sometidos a la radioyodoterapia y analizar los cuidados de enfermería requeridos para atender a las necesidades identificadas. Se adoptó como marco referencial la relación de ayuda en la totalidad de la práctica de enfermería. El método fue el estudio de caso representativo, longitudinal, descriptivo, con 24 clientes en tratamiento en el Servicio de Medicina Nuclear del Instituto Nacional de Cáncer – Rio de Janeiro-Brasil, en el periodo de julio a septiembre.de 2006. Los resultados revelaron que los clientes, en el transcurso de la radioyodoterapia, requieren del equipo de enfermería cuidados relacionados a las orientaciones para el autocuidado, apoyo emocional y cuidados físicos en las contingencias de las necesidades referidas. Lo que indica la importancia de la presencia de la enfermera junto a los clientes para planear e implementar cuidados con foco en sus necesidades.

Política de calidad en instalación de medicina / Quality policy at nuclear medicine services

En el presente texto comentamos un modelo de Política de Calidad tipo a instaurar en un Servicio de Medicina Nuclear. La necesidad de un control estricto en todos y cada uno de los procesos que tienen lugar en un Servicio de Medicina Nuclear, requieren de una planificación exacta de la Política de Calidad específica según las necesidades de cada Servicio. La Política de Calidad ha de ser una Política viva, con capacidad de modificaciones y debe ser conocida y aceptada por todos los trabajadores de un Servicio de medicina Nuclear. Aunque el modelo presentado es concreto, puede ser extrapolado a cualquier Servicio de Medicina Nuclear, con sus consiguientes cambios, específicos en cada caso.

In the present text we comment about a Quality Policy model to establish in a Nuclear Medicine Service. The need for a strict control in every process that take place in a Nuclear Medicine Service, requires of an exact planification in terms of Quality Policy, specific to the real needs of every Service. Quality Policy must be a live Policy, with capability of changes and must be known for every workers in a Nuclear Medicine Service. Although the model showed in this text is concret for a specific Service type, it must be extrapolated to any Nuclear Medicine Service with the necessary changes.

Preliminary analysis of the resources in brachytherapy in Europe and its variability of use.

PURPOSE: The main objective of the program <> is to establish a group with detailed information on brachytherapy throughout Europe. METHODS: The data was compiled by the general coordinator, the ESTRO, and the <> through a website. RESULTS: A total of 32 countries reported data from at least 50% of their centres (criteria of inclusion). Countries were grouped in three categories based on the time of incorporation to the European Union. The majority of treatments belonged to gynaecological tumours. A large spread was found regarding workload of specialists depending on centre and group. CONCLUSION: Collection of information by a website is a feasible methodology. An increase in brachytherapy treatment was observed in all 3 groups by a rate of more than 20% (year 2002 versus year 1997). These results advocate for the continuation of the PCBE study to demonstrate the development in the field, such as an increase or decrease of patient numbers per tumour category.

Preliminary dosimetric characterisation of thermoluminescent materials for beta radiation monitoring at nuclear medicine services.

Beta emitters are widely used in nuclear medicine for diagnostic and therapeutic purposes. The critical groups exposed to a radioactive patient include the staff, other patients and members of the public accompanying the patient. The aim of this work is to characterise thermoluminescent (TL) materials for the staff monitoring of nuclear medicine services that manipulate beta radiation solutions of (153)Sm. This study was performed using CaSO(4):Dy + Teflon pellets, produced at IPEN, with different dimensions. For the dosimetric characterisation, these TL dosemeters were exposed to gamma source ((60)Co) and to beta sealed sources ((90)Sr + (90)Y, (204)Tl and (147)Pm) and to a non-sealed source ((153)Sm). Results were obtained related to reproducibility, lower detection limits, calibration curves, angle and energy dependence of response. All tested materials show usefulness for monitoring of workers exposed to beta radiation.

Comparisons of activity measurements with radionuclide calibrators.

The correct administration to a patient of the prescribed activity of a radiopharmaceutical is an important factor to ensure the confidence in the diagnosis or the therapeutic efficiency, while at the same time keeping the unnecessary human exposure as low as possible. Comparisons of activity measurements for 131I, 201Tl and 99mTc with radionuclide calibrators were organized the first time in Cuba during 2002 with the aim of obtaining information about the quality of administration of radiopharmaceuticals. Ten Cuban nuclear medicine departments and the laboratories involved in the production of these kinds of compounds participated in the comparison runs. The results presented in this paper facilitated the identification of several problems and initiated corrective actions. In addition, they indicate the necessity of establishing Quality Systems in nuclear medicine in Cuba.

Investigation of maximum doses absorbed by people accompanying patients in nuclear medicine departments.

In nuclear medicine, radioisotopes are bound to several compounds (called radiopharmaceuticals) for use in diagnostic and therapeutic applications. These unscaled sources are administered in various forms to patients, who remain radioactive for hours or days, and represent a source of potential radiation exposure for others. Thus, in nuclear medicine departments, radiation protection of workers and members of the public must take this exposure into account. In this context, the aim of this work was the investigation of maximum dose levels to which people accompanying patients are exposed. For monitoring, thermoluminescence dosemeters were given to 380 people in three nuclear medicine departments in Brazil. Exposure results are given, and issues regarding length of stay of members of the public in those departments are discussed.

Evaluación de la protección radiológica en un módulo de medicina nuclear de un hospital cubano / Evaluation of radiological protection in a department of nuclear medicine of a Cuban hospital

Se aplicó una encuesta en el módulo de medicina nuclear de un hospital cubano, que abordaba la problemática de la protección radiológica en éste, como punto de partida para mejorarla. La encuesta se confeccionó con 10 temáticas referentes a los aspectos relacionados con la protección del paciente, el trabajador expuesto a las radiaciones ionizantes y el público. Se recogieron 203 respuestas entre el personal médico, trabajadores expuestos del departamento, responsable de protección radiológica y pacientes. El conjunto de respuestas no respondía a una ley de distribución por lo cual se escogió, para el procesamiento de la muestra seleccionada dentro de la población de respuestas, un método no paramétrico (método de Van Der Varden). Se obtuvo como resultado que no existía una diferencia significativa entre las respuestas afirmativas y negativas, de donde se deduce la necesidad de aplicación de un Programa de Mejoras a la Protección Radiológica en este módulo de medicina nuclear

Solución analítica al blindaje de locales de telererapia con CO-60 según una ecuación semiempírica de atenuación de fotones / Analytic solution to the shielding of areas of teletherapy with Co-60 according to a semi-empirical equation of attenuation of photons

Se presenta la parametrización de una ecuación semiempírica de tipo exponencial-polinomial para la descripción de la transmisión de las diferentes calidades de la radiación gamma del Co-60 en medios finitos de hormigón (p = 2350 kgm(3)) y plomo. Esta ecuación unida a la expresión obtenida para la relación de dispersión, facilitaron la implementación en computadora de una solución analítica para la estimación de blindajes en locales de teleterapia con Co-60. Se obtuvo una adecuada correlación entre los valores de transmisión calculados y los datos experimentales correspondientes. El error estándar en la estimación de los parámetros para todos los casos es inferior al 1,7 por ciento, excepto para el caso de la atenuación en hormigón de la radiación dispersada según 150º que para uno de los parámetros resultó un error del 6,3 por ciento. Se comparan los espesores de blindaje obtenidos con los valores ofrecidos por el Consejo de protección contra las Radiaciones de los EE.UU. para las condiciones observándose una buena correlación. El programa de cálculo desarrollado adquiere aplicación práctica en el diseño y la comprobación de los blindajes en instalaciones de cobaltoterapia

Detección de hemorragia gastrointestinal mediante gammagrafía: estudio de 21 pacientes en el servicio de Medicina Nuclear de Solca

La gammagrafía utilizando glóbulos rojos radiomarcados ha sido un método empleado con éxito en la identificación del sitio y la intensidad del sangramiento digestivo. En casos pediátricos con diagnostico presuntivo de mucosa gástrica ectópica (diverticulo de Meckel), como causa de sangramiento digestivo, el uso de la gammagrafía también ha rendido resultados importantes. En este trabajo se reporta el estudio de 21 pacientes (grupo 1: nueve años con diagnostico presuntivo de divertículo de Meckel; Grupo II: 12 adultos con sangramiento digestivo) mediante gammagrafía con glóbulos rojos radiomarcados o con 99 mTC-pertecnetato. En tres de los nueve niños estudiados el método gammagráfico identificó la mucosa gástrica ectópica. En los restantes seis casos el diagnostico final no pudo ser establecido por lo que la negatividad de la gammagrafía no pudo ser tomada como evidencia de falsos negativos. En nueve de los 12 casos adultos con sangramiento digestivo, la gammagrafía mediante glóbulos rojos marcados evidencio el sitio y la intensidad del sangramiento, cuatro de estos casos fueron sometidos a cirugía debido a su patología de base, y en todos ellos la gammagrafía fue decisiva para la orientación quirurgica. Se concluye que este método gammagráfico para la identificación del sitio e intensidad del sangramiento digestivo debería ser indicado tempranamente en casos adultos con pérdida digestiva de sangre, o en niños en los que se sospeche fundamentalmente divertículo de Meckel.