Potential risk assessment: a model for quality evaluation in fluoroscopy-guided interventional procedures.

This study presented a model applied for potential risk assessment in an interventional radiology setting. The model of potential risk assessment (MARP) consisted of the creation of a scale of indicators ranging from 0 to 5. The radiation levels were categorized according to gender, kind of procedure, value of kerma air product (Pka), and accumulated radiation dose (mGy). The MARP model was applied in 121 institutions over 8 y. A total of 201 656 patient radiation doses (Dose-area product and accumulated kerma) data were launched into the system over time, with an average of 22 406 doses per year. In the context of the workers (cardiologists, radiographers, and nurses) monitored during the MARP application, 8007 cases (with an average of 890 per year) of occupational radiation doses were recorded. This study showed a strategy for quality evaluation in fluoroscopy using a model with a compulsory information system for monitoring safety.

Dosis efectivas asociadas a estudios híbridos SPECT-CT en pacientes adultos / Effective dose associated to hybrid SPECT-CT imaging in adult patients / Doses eficazes associadas a estudos de SPECT-CT híbridos em pacientes adultos

Introducción: la técnica de imagen híbrida de SPECT-CT combina la imagen de la tomografía por emisión de fotón único (SPECT) con el estudio de tomografía computada (TC), obteniendo información funcional y anatómica en un mismo estudio. La dosis efectiva total de radiación ionizante recibida en los estudios SPECT-CT puede ser estimada a partir de la dosis efectiva atribuible a la actividad administrada del radiofármaco y la dosis efectiva del componente de tomografía computada (TC). Objetivos: estimar la dosis efectiva total en los protocolos SPECT-CT utilizados en población adulta y determinar el aporte adicional del estudio TC sobre la dosis efectiva total. Método: se evaluaron 258 estudios SPECT-CT para estimar la dosis efectiva total aportada por la administración de los radiofármacos y los estudios de TC de baja dosis. Para estimar el aporte de ambos componentes se utilizaron factores de conversión específicos de cada radiofármaco y región explorada mediante TC. Resultados: la dosis efectiva total (media ± DS) en los estudios SPECT-CT fueron: 12,4 ± 1,44 mSv en el estudio de perfusión miocárdica, 1,14 ± 0,25 mSv en ganglio centinela de mama, 8,6 ± 0,6 mSv paratiroides, 1,48 ± 1,02 mSv tiroides y los estudios óseos de las regiones de cuello 4,5 ± 0,3, tórax 6,07 ± 0,3 mSv, abdomen y pelvis 6,1 ± 0,3 mSv. La dosis de radiación aportada por el estudio TC se encuentra entre 0,46 mSv para la región del tórax en el estudio de ganglio centinela de mama y 2,3 mSv para el SPECT-CT óseo en la región de abdomen y pelvis. Conclusión: se logró estimar la dosis efectiva en los protocolos SPECT-CT de uso clínico más frecuente en población adulta y el aporte de los estudios TC a la dosis efectiva total siendo relativamente baja comparado con la dosis aportada por los radiofármacos administrados con la excepción del estudio de ganglio centinela donde la contribución del componente TC es aproximadamente la mitad de la dosis efectiva total.

Introduction: SPECT-CT Hybrid image technique combines the SPECT (single-photon emission computed tomography) image with the CT (computerized tomography) image to obtain both functional and anatomical images in the same study. The total effective ionizing radiation dose received in SPECT-CT studies may be estimated based on the effective dose from the radiopharmaceutical administered and the effective dose from the CT (computerized tomography) component. Objectives: the study aims to estimate the total effective dose in SPECT-CT protocols applied for the adult population, and to determine the additional contribution from the CT component to the total effective dose. Method: 258 SPECT-CT studies were evaluated to estimate the total effective dose from the administration of radiopharmaceuticals and low dose CT studies. Specific conversion factors for each radiopharmaceutical and area of the body explored with the CT were used to estimate radiation doses from both components. Results: total effective dose (average ± SD) in the SPECT-CT studies was: 12.4 ± 1.44 mSv in the myocardial perfusion study, 1.14 ± 0.25 mSv in the breast sentinel lymph node study, 8.6 ± 0.6 mSv in the parathyroid study, 1.48 ± 1.02 mSv in the thyroid study. As to bone studies, doses found were: 4.5 ± 0.3, in neck studies, 6.07 ± 0.3 mSv in thoracic studies and 6.1 ± 0.3 mSv in abdominal and pelvic studies. The radiation dose from the CT study ranges from 0.46 mSv for the thoracic region on the breast sentinel lymph node study to 2.3 mSv for the bone SPECT-CT study of the abdominal and pelvic region. Conclusions: we managed to estimate the effective dose in the the most frequently used SPECT-CT protocols for the adult population and the contribution of CT studies to the total effective dose. It was found to be relatively low when compared to the dose contributed by the radiopharmaceuticals administered, with the exception of the sentinel lymph node study for which the contribution from the CT study is approximately half the total effective dose.

Introdução: a técnica de imagem híbrida SPECT-CT combina a imagem de tomografia por emissão de fóton único (SPECT) com o estudo de tomografia computadorizada (TC), obtendo informações funcionais e anatômicas no mesmo estudo. A dose efetiva total de radiação ionizante recebida em estudos SPECT-CT pode ser estimada a partir da dose efetiva atribuível à atividade administrada do radiofármaco e da dose efetiva do componente de tomografia computadorizada (TC). Objetivos: estimar a dose efetiva total nos protocolos SPECT-CT utilizados na população adulta e determinar a contribuição adicional do estudo de TC na dose efetiva total. Método : 258 estudos SPECT-CT foram avaliados para estimar a dose efetiva total fornecida pela administração de radiofármacos e estudos de TC de baixa dose. Para estimar a contribuição de ambos os componentes, foram utilizados fatores de conversão específicos para cada radiofármaco e região explorada pela TC. ⁠ Resultados: a dose efetiva total (média ± DP) nos estudos SPECT-CT foi: 12,4 ± 1,44 mSv no estudo de perfusão miocárdica, 1,14 ± 0,25 mSv no linfonodo sentinela mamário, 8,6 ± 0,6 mSv paratireoide, 1,48 ± 1,02 mSv estudos de tireoide e ossos das regiões do pescoço 4,5 ± 0,3, tórax 6,07 ± 0,3 mSv, abdômen e pelve 6,1 ±0,3mSv. A dose de radiação fornecida pelo estudo de TC está entre 0,46 mSv para a região do tórax no estudo do linfonodo sentinela da mama e 2,3 mSv para o SPECT-CT ósseo na região do abdome e pelve. Conclusão: foi possível estimar a dose efetiva nos protocolos de SPECT-CT mais utilizados clinicamente na população adulta e a contribuição dos estudos de TC para a dose efetiva total, sendo relativamente baixa em relação à dose fornecida pelos radiofármacos administrados com a exceção do estudo do linfonodo sentinela onde a contribuição do componente TC é aproximadamente metade da dose efetiva total.

Occupational exposure in the work process of radiology technologists with 68Ga-labeled radiopharmaceuticals.

The study identified occupational exposure in the work of radiology technologists with 68Ga radiopharmaceuticals, in a Nuclear Medicine service in southern Brazil, by means of observation and document analysis. The occupational exposure related the factors, distance, time and shielding. Thus, it was observed high times during handling of the material, small distances between sources and radiosensitive structures, such as the eye lens and the thyroid gland. It is recommended to reassess and standardize the work, once that critical moments should not be restricted only to dosimetric reading.

Copaifera langsdorffii Desf. bark extract: optimisation of dyeing conditions to wool and colour fastness properties.

The ability to add value to waste materials from industrial operations has come to the attention of the wood processing industry, with reports, for example, of extracts from the bark tree conveying colour and UV protection to textile fibres. The objective of the present work was to expand our developments in this arena by using Copaifera langsdorffii Desf. bark extract as a natural dye for textile dyeing. A complete 2³-statistical experimental design and the central point was elaborated. The results showed that the optimal dyeing conditions were 98 °C, for 60 min, using undiluted bark extract. The dyed fabric was analysed by a spectrophotometer using the CIELAB system for evaluation of the colour strength. The results showed a K/S value of 5.78, and the dyed fabric had good colour fastness to rubbing and washing.

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.

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.

Niveles de referencia para diagnóstico: una herramienta efectiva para la protección radiológica de pacientes / Diagnostic reference levels: an effective tool to radiological protection of patient

Se sabe que las exposiciones médicas con radiaciones ionizantes son actualmente la principal fuente de exposición a la radiación artificial a nivel global. Para prevenir dosis innecesariamente altas durante estas exposiciones a los pacientes, la Comisión Internacional de Protección Radiológica (ICRP) recomienda la utilización de los 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 para diagnóstico y procedimientos de intervención. Dado que la legislación chilena no tiene incorporado aún su uso, el presente trabajo de revisión tiene como objetivo, elaborar un documento guía para los profesionales de la salud y áreas afines, que contenga de manera sucinta y con recomendaciones prácticas, los principales aspectos a tener en cuenta para establecer los DRLs en procedimientos de radiodiagnóstico, intervencionismo y medicina nuclear, basados esencialmente en la publicación N° 135 de la ICRP sobre DRLs.

It is known that medical exposition with ionizing radiation is currently the main exposition source to artificial radiation at global level. To prevent unnecessarily high doses during these patient expositions, the International Commission on Radiological Protection (ICRP) recommends the use of Diagnostic Reference Levels (DRLs), as an effective tool to support the optimization of radiological protection for patient medical exposure for diagnosis and interventional procedures. Since that the Chilean legislation does not have its use incorporated yet, the present revision work aims to elaborate a guiding document for health professionals and related fields, that succinctly and with practical recommendations, the main aspects to consider for establishing DRLs in procedures for radiodiagnostic, intervention, and nuclear medicine, mainly based in N° 135 ICRP publication about DRLs.

RADIATION DOSES TO ANAESTHETISTS DURING PROSTATIC ARTERY EMBOLIZATION INTERVENTIONAL PROCEDURES.

The objective of this study was to assess the radiation doses received by anaesthetists from prostatic artery embolization (PAE) procedures. Ten PAE procedures conducted in a reference hospital in the city of Recife, Brazil were investigated. Occupational dosimetry was performed using thermoluminescent dosemeters which were located next to the eyes, close to the thyroid (over the shielding), on the thorax (under the apron), on the wrist and on the feet of the physician's body. The results showed that the anaesthetist's feet received the highest doses followed by the eyes and the hands. In some complex PAE procedures the doses received by anaesthetists on the lens of the eyes and the effective dose were higher than those received by the main operator due to the anaesthetist's close position to the patient's table and the use of oblique projections. The personal dose equivalent Hp(3) per procedure for the anaesthetist's right eyebrow ranged from 20.2 µSv to 568.3 µSv. This result shows that anaesthetists assisting PAE procedures can exceeds the annual eye lens dose limit of 20 mSv recommended by the ICRP with only one procedure per week if radiation protection measures are not implemented during procedures.

EXPERIMENTAL AND COMPUTATIONAL EVALUATION OF EFFECTIVE CENTRE FROM A LONG COUNTER AT NEUTRON METROLOGY LABORATORY IN BRAZIL.

A long counter detector was manufactured by the Institute of Advanced Studies (IEAV) and was characterised in the neutron low scattering room at Brazilian National Ionising Radiation Metrology Laboratory (LNMRI/IRD) to deploy a secondary Standard for neutron fluence. The effective centre was measured experimentally with 252Cf+D2O, 252Cf, 241AmBe and 238PuBe neutron sources, having average energies from 0.55 to 4.16 MeV. The experimental arrangement and detector construction were carefully reproduced in Monte Carlo simulations, and the computational results were found to be in good agreement with those from experiment.

Optimisation of radiation dose and image quality in mobile neonatal chest radiography.

PURPOSE: To optimise the radiation dose and image quality for chest radiography in the neonatal intensive care unit (NICU) by increasing the mean beam energy. METHODS: Two techniques for the acquisition of NICU AP chest X-ray images were compared for image quality and radiation dose. 73 images were acquired using a standard technique (56 kV, 3.2 mAs and no additional filtration) and 90 images with a new technique (62 kV, 2 mAs and 2 mm Al filtration). The entrance surface air kerma (ESAK) was measured using a phantom and compared between the techniques and against established diagnostic reference levels (DRL). Images were evaluated using seven image quality criteria independently by three radiologists. Images quality and radiation dose were compared statistically between the standard and new techniques. RESULTS: The maximum ESAK for the new technique was 40.20 µGy, 43.7% of the ESAK of the standard technique. Statistical evaluation demonstrated no significant differences in image quality between the two acquisition techniques. CONCLUSIONS: Based on the techniques and acquisition factors investigated within this study, it is possible to lower the radiation dose without any significant effects on image quality by adding filtration (2 mm Al) and increasing the tube potential. Such steps are relatively simple to undertake and as such, other departments should consider testing and implementing this dose reduction strategy within clinical practice where appropriate.

Magnitudes y unidades para dosimetría del personal ocupacionalmente expuesto en radiodiagnóstico e intervencionismo / Quantities and units for dosimetry of occupationally exposed personnel in diagnostic and interventional radiology

Resumen:Existen diversos documentos y recomendaciones internacionales sobre nombres, conceptos, definiciones y campos de aplicación para diversas magnitudes y unidades utilizadas para monitorear los niveles de radiación ionizante a los que son expuestos los trabajadores durante los procedimientos de Radiodiagnóstico e Intervencionismo. Sin embargo, la legislación nacional, al igual que para la dosimetría de los pacientes, no se encuentra actualizada en este sentido y no contempla en sus documentos un glosario actualizado que permita encontrar en forma rápida y precisa este tipo de información. Por lo anterior, este trabajo de revisión corresponde a un segundo documento guía, complementario a nuestro trabajo publicado en 2015 titulado "Magnitudes y unidades para dosimetría a pacientes en radiodiagnóstico e intervencionismo", que describe de manera didáctica y en un lenguaje sencillo para los profesionales de la salud y áreas afines, las principales magnitudes y unidades que se deben conocer y utilizar en la dosimetría ocupacional de los trabajadores que participan en procedimientos de Radiodiagnóstico e Intervencionismo.

Abstract: There are many documents and international recommendations offer names, concepts, definitions and fields of application for various quantities and units used to monitor the exposure levels of ionising radiation to which workers are exposed during the diagnostic and interventional radiology procedures. However, as in the case of patient dosimetry, national legislation is not up-to-date in this area and nowhere does it establish an up-to-date glossary that would facilitate rapid and precise location of this kind of information. In light of the foregoing, this review paper presents a second guidance document, complementary to our published article in 2015 titled "Quantities and units used in patient dosimetry in radiodiagnostic and intervencional procedures", which describes the principal quantities and units that must be known and used in occupational dosimetry for workers participating in diagnostic and interventional radiology procedures, in a didactical manner and using simple language for professionals in health and similar areas.

IMPROVEMENTS IN THE THERMAL NEUTRON CALIBRATION UNIT, TNF2, AT LNMRI/IRD.

The standard thermal neutron flux unit, TNF2, in the Brazilian National Ionizing Radiation Metrology Laboratory was rebuilt. Fluence is still achieved by moderating of four 241Am-Be sources with 0.6 TBq each. The facility was again simulated and redesigned with graphite core and paraffin added graphite blocks surrounding it. Simulations using the MCNPX code on different geometric arrangements of moderator materials and neutron sources were performed. The resulting neutron fluence quality in terms of intensity, spectrum and cadmium ratio was evaluated. After this step, the system was assembled based on the results obtained from the simulations and measurements were performed with equipment existing in LNMRI/IRD and by simulated equipment. This work focuses on the characterization of a central chamber point and external points around the TNF2 in terms of neutron spectrum, fluence and ambient dose equivalent, H*(10). This system was validated with spectra measurements, fluence and H*(10) to ensure traceability.

241Am-Be(α,n) CHARACTERIZATION FOR A NEW LABORATORY FACILITY IN BRAZIL.

The Laboratório de Ciências Radiológicas is developing an irradiator for neutron survey meters calibration. Part of this work is related to the characterization of the neutron source that will be used in the irradiator. Therefore, a source of 241Am-Be(α,n) was characterized according to the following attributes: neutron energy distribution, anisotropy and emission rate. In order to make these values into high-level metrological references traceable by the Bureau International des Poids et Mesures, these measurements were taken at the Neutron Laboratory part of the Laboratório Nacional de Metrologia das Radiações Ionizantes. Results obtained for the source spectrum have strong adherence to the reference spectrum established by ISO 8529-1. The new laboratory for neutron calibration will allow calibration in an approximate ambient dose equivalent ranging 20-4500 µSv/h.

Building a resistance to ignition testing device for sunglasses and analysing data: a continuing study for sunglasses standards.

BACKGROUND: Sunglasses popularity skyrocketed since its advent. The ongoing trend led to the creation of standards to protect consumers from injuries and secondary hazards due to spectacles use. In Brazil, the corresponding standard is NBR ISO 12312-1:2015 and since there is no mandatory testing, evaluating sunglasses performance provides an insight into compliance with the standard. In a continuing revision of sunglasses standards requirements, resistance to ignition is one of the concerns, since sunglasses should be protected from burning into flames at a pre-determined temperature, which may protect user of getting their sunglasses into flames if some, cigarette sparks reaches the spectacles, as an example. This paper describes the building of a resistance to ignition system and the results of 410 samples that have been tested accordingly to ISO 12312-1. METHODS: The procedure is in accordance with the resistance to ignition test. It consists of heating a steel rod to 650 °C and pressing it against the sample surface for 5 s, with a force equivalent to the rod weight. For carrying out the assessments, we have build resistance to ignition testing system and assured the testing requirements of the standard. The apparatus has an electrical furnace with a temperature acquisition circuit and electronic control that maintains the temperature of the steel rod at 650 °C. A linear actuator was designed for the project to drive the steel rod vertically and pressing it against the sunglasses samples. The control system is composed by a Freescale development board FRDM-KL25Z with an ARM Cortex-M0 embedded. We have also provided a LabView PC interface for acquiring, displaying, and storing data as well as added a physical control panel to the equipment for performing the evaluations. We assessed 410 sunglasses frames at the built apparatus, where the 410 lenses came out to be in accordance with the guidelines provided by the ignition to resistance test. Out of the 410 tested frames, 50% were made of polyamide (nylon 12); 10% were made of polyamide (nylon 11, mamona oil); 5% were made of cellulose acetate; 15% were made of ABS and 20% were made of polycarbonate. Out of the 410 tested lenses, 80% were polycarbonate; 2% were polymethyl methacrylate (PMMA); 5% CR-39 (with polarizing filter inside); 12.8% polyamide; 0.2% glass. RESULTS: For all the 410 tested spectacles frames and lenses, none burst into flames or continued to melt at the end of the procedure, being in compliance with ISO 12312-1:2013. CONCLUSIONS: The evidences show that all the tested thermoplastic and thermosetting materials are exceptionally resistant to ignition and all samples assessed comply with the resistance to ignition test. The analysis of the sunglasses made herein assures that most of sunglasses currently available to population are made of safe material.

Opportunities for improvement on current nuclear cardiology practices and radiation exposure in Latin America: Findings from the 65-country IAEA Nuclear Cardiology Protocols cross-sectional Study (INCAPS).

BACKGROUND: Comparison of Latin American (LA) nuclear cardiology (NC) practice with that in the rest of the world (RoW) will identify areas for improvement and lead to educational activities to reduce radiation exposure from NC. METHODS AND RESULTS: INCAPS collected data on all SPECT and PET procedures performed during a single week in March-April 2013 in 36 laboratories in 10 LA countries (n = 1139), and 272 laboratories in 55 countries in RoW (n = 6772). Eight "best practices" were identified a priori and a radiation-related Quality Index (QI) was devised indicating the number used. Mean radiation effective dose (ED) in LA was higher than in RoW (11.8 vs 9.1 mSv, p < 0.001). Within a populous country like Brazil, a wide variation in laboratory mean ED was found, ranging from 8.4 to 17.8 mSv. Only 11% of LA laboratories achieved median ED <9 mSv, compared to 32% in RoW (p < 0.001). QIs ranged from 2 in a laboratory in Mexico to 7 in a laboratory in Cuba. Three major opportunities to reduce ED for LA patients were identified: (1) more laboratories could implement stress-only imaging, (2) camera-based methods of ED reduction, including prone imaging, could be more frequently used, and (3) injected activity of 99mTc could be adjusted reflecting patient weight/habitus. CONCLUSIONS: On average, radiation dose from NC is higher in LA compared to RoW, with median laboratory ED <9 mSv achieved only one third as frequently as in RoW. Opportunities to reduce radiation exposure in LA have been identified and guideline-based recommendations made to optimize protocols and adhere to the "as low as reasonably achievable" (ALARA) principle.

SECOND LATIN AMERICAN INTERCOMPARISON ON INTERNAL DOSE ASSESSMENT.

Internal dosimetry intercomparisons are essential for the verification of applied models and the consistency of results'. To that aim, the First Regional Intercomparison was organised in 2005, and that results led to the Second Regional Intercomparison Exercise in 2013, which was organised in the frame of the RLA 9/066 and coordinated by Autoridad Regulatoria Nuclear of Argentina. Four simulated cases covering intakes of (131)I, (137)Cs and Tritium were proposed. Ninteen centres from thirteen different countries participated in this exercise. This paper analyses the participants' results in this second exercise in order to test their skills and acquired knowledge, particularly in the application of the IDEAS Guidelines. It is important to highlight the increased number of countries that participated in this exercise compared with the first one and, furthermore, the improvement in the overall performance. The impact of the International Atomic Energy Agency (IAEA) Projects since 2003 has led to a significant enhancement of internal dosimetry capabilities that strengthen the radiation protection of workers.

Protección radiológica en cardiología intervencionista / Radiation protection in interventional cardiology

La cardiología intervencionista ha logrado un progreso que hace que cada año se haga una mayor cantidad de procedimientos de complejidad progresiva con una muy buena tasa de éxito. El problema es que ese progreso conlleva mayor dosis de radiación no solo para el paciente sino también para los trabajadores ocupacionalmente expuestos. Existen métodos simples para minimizar la dosis recibida. Estos incluyen: minimizar el tiempo de radioscopia y la cantidad de imágenes adquiridas, utilizar las tecnologías disponibles de reducción de dosis para pacientes, usar adecuada geometría del equipo, colimar, evitar las zonas de radiación reflejada, utilizar todo el blindaje disponible, realizar controles de calidad del equipo de imagen y utilizar los dosímetros personales y conocer la dosis recibida. La utilización eficaz de estos métodos requiere no solo educación y entrenamiento para todo el personal ocupacionalmente expuesto sino la disponibilidad y el uso de los elementos radioprotectores de la sala y del equipo. La revisión regular del equipo y la investigación de las dosis recibidas por el personal acompañadas por los cambios necesarios en la manera en que los procedimientos se realizan asegura una mejor práctica de protección radiológica en la sala de intervencionismo cardiovascular.

Interventional: cardiology progress makes each year a greater number of procedures and increasing complexity with a very good success rate. The problem is that this progress brings greater dose of radiation not only for the patient but to occupationally exposed workers as well. Simple methods for reducing or minimizing occupational radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability and use of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite.

[Radiation protection in interventional cardiology]. / Protección radiológica en cardiología intervencionista.

INTERVENTIONAL: cardiology progress makes each year a greater number of procedures and increasing complexity with a very good success rate. The problem is that this progress brings greater dose of radiation not only for the patient but to occupationally exposed workers as well. Simple methods for reducing or minimizing occupational radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability and use of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite.