Our estimates of neonatal radiation exposure fall short of reality.

The purpose of this study is to evaluate radiation exposure in newborns undergoing imaging tests during the first 30 days of neonatal intensive care unit (NICU) hospitalization. A retrospective cohort study was conducted from November 2018 to April 2019 with newborns admitted to the NICU. Thermoluminescent dosimeters (TLD-100™) measured radiation emitted during imaging exams over 1 month, with a comparison between measured and estimated radiation. The cohort exhibited a median gestational age of 33.0 (31.0, 37.0) weeks, a median birth weight of 1840 (1272, 2748) g, and a median length of stay of 25.5 (11.7, 55.0) days. Eighty-four patients underwent 314 imaging tests, with an estimated radiation dose (ERD) per patient of 0.116 mSv and a measured radiation dose (MDR) of 0.158 mSv. ERD consistently underestimated MDR, with a mean difference of -0.043 mSv (-0.049 to -0.036) in the Bland-Altman analysis. The regression equation was as follows: difference MRD - ERD = -1.7 × (mean (MRD + ERD)) + 0.056. The mean estimated radiation dose per exam was 0.030 mSv, and the chest X-rays accounted for 63.26% of total exams. The median number of radiographic incidences per patient was 2 (1, 4), with 5 patients undergoing three or more exams in a single day. CONCLUSION: Radiation exposure in these newborns was underestimated, emphasizing the need for awareness regarding associated risks and strict criteria for requesting radiological exams. Lung ultrasound is a radiation-free and effective option in managing respiratory diseases in newborns, reducing the reliance on chest X-rays. WHAT IS KNOWN: • Radiation used in diagnostic exams is not risk-free. • Radiation risk is much higher in small Infants due to the exposure area and the prolonged expectance of life. WHAT IS NEW: • Radiation exposure is underestimated in the neonatal population. • The study found a mean radiation exposure in neonates about 5% of the mean annual dose in the general population.

Randomized Noninferiority Trial of Radiation Exposure During Coronary Angiography: the Transradial and Transfemoral Approach by EXPERienced Operators in Daily rouTine (EXPERT) Trial.

BACKGROUND: The transradial approach (TRA) to coronary angiography reduces vascular complications but is associated with greater radiation exposure than the transfemoral approach (TFA). It is unknown whether exposure remains higher when TRA is performed by experienced operators. METHODS: Patients were randomly, prospectively assigned to TRA or TFA. The primary end point was patient radiation dose; secondary end points were the physician radiation dose and 30-day major adverse cardiac event rate. Coronary angiography was performed by experienced operators using a standardized protocol. RESULTS: Clinical and procedural characteristics were similar between the TRA (n = 150) and TFA (n = 149) groups, and they had comparable mean (SD) radiation doses for patients (616.51 [252] vs 585.57 [225] mGy; P = .13) and physicians (0.49 [0.3] vs 0.46 [0.29] mSv; P = .32). The mean (SD) fluoroscopy time (3.52 [2.02] vs 3.13 [2.46] min; P = .14) and the mean (SD) dose area product (35,496.5 [15,670] vs 38,313.4 [17,764.9] mGy·cm2; P = .2) did not differ. None of the following factors predicted higher radiation doses: female sex (hazard ratio [HR], 0.69 [95% CI, 0.38-1.3]; P = .34), body mass index >25 (HR, 0.84 [95% CI, 0.43-1.6]; P = .76), age >65 years (HR, 1.67 [95% CI, 0.89-3.1]; P = .11), severe valve disease (HR, 1.37 [95% CI, 0.52-3.5]; P = .68), or previous coronary artery bypass graft (HR, 0.6; 95% CI, 0.2-1.8; P = .38). CONCLUSION: TRA for elective coronary angiography is noninferior to TFA when performed by experienced operators.

Pirarucu larviculture in green water provides heavier fish and modulates locomotor activity / Larvicultura de pirarucu em água verde produz peixes mais pesados e modula a atividade locomotora

The green water technique uses microalgae in the water of indoor larviculture, providing a darker environment to favor fish growth, welfare and health. We evaluated growth performance and locomotor activity after light exposure of pirarucu (Arapaima gigas) larvae reared in green or clear water. During one test, pirarucu larvae (3.6 ± 0.3 cm; 0.36 ± 0.1 g) were reared in 50-L circular tanks (n = 3 per treatment, 50 larvae per tank) in a static system containing green water [microalgae (w3algae; Bernaqua® 10 g m-3) added] or clear water (control). Fish weaning was achieved by co-feeding with Artemia nauplii and microdiets for seven days until full microdiet substitution. Larvae were biometrically evaluated on days 10, 17 and 24 to assess growth performance. In a second test, the locomotor activity of the larvae was analyzed before and after light exposure (1400 ± 60 lx) for 48 h according to an ethogram. After 24 days, the larvae reared in the green water were significantly heavier than those from the clear water, and displayed significantly fewer circular swimming movements. Body cortisol increased in both groups after light exposure. The microalgae provided an additional food source for larvae, with positive impact on growth until day 17 of larviculture. Green water can be a strategy to achieve better results in pirarucu larviculture, especially during and up to 10 days after the co-feeding period.(AU)

A técnica de água verde utiliza microalgas na água durante a larvicultura indoor, proporcionando um ambiente mais escuro que favorece o crescimento, bem-estar e saúde dos peixes. Avaliamos o crescimento e a atividade locomotora após exposição à luz de larvas de pirarucu (Arapaima gigas) criadas em água verde ou clara. Em um teste, larvas de pirarucu (3,6 ± 0,3 cm; 0,36 ± 0,1 g) foram criadas em tanques circulares de 50 L (n = 3 por tratamento; 50 larvas por tanque) em sistema estático contendo água verde [microalgas (w3algae; Bernaqua® 10 g m-3) adicionadas] ou água clara (controle). A transição alimentar dos peixes ocorreu por co-alimentação com náuplios de Artemia e microdieta por sete dias até a substituição completa pela microdieta. A biometria das larvas foi avaliada nos dias 10, 17 e 24, para avaliar o crescimento. Um segundo teste avaliou a atividade locomotora das larvas antes e após exposição à luz (1.400 ± 60,47 lx) por 48 horas usando um etograma. Após 24 dias, os peixes criados em água verde pesaram significativamente mais que os da água clara, e apresentaram significativamente menos movimentos circulares de natação. A exposição à luz aumentou o cortisol corporal nos dois grupos depois da exposição à luz. O nível corporal de cortisol aumentou em ambos grupos após exposição à luz. As microalgas forneceram uma fonte adicional de alimento para as larvas, com impacto positivo sobre seu crescimento até o 17º dia de larvicultura. Água verde pode ser uma estratégia para obter melhores resultados na larvicultura de pirarucu, principalmente durante e até 10 dias após o período de co-alimentação.(AU)

Dual fluoroscopy with live-image digital zooming significantly reduces patient and operating staff radiation during fenestrated-branched endovascular aortic aneurysm repair.

OBJECTIVE: Fenestrated-branched endovascular aneurysm repair (F/B-EVAR) is a complex procedure that generates high radiation doses. Magnification aids in vessel cannulation but increases radiation. The aim of the study was to compare radiation doses to patients and operating room staff from two fluoroscopy techniques, standard magnification vs dual fluoroscopy with live-image digital zooming during F/B-EVAR. METHODS: An observational, prospective, single-center study of F/B-EVAR procedures using Philips Allura XperFD20 equipment (Philips Healthcare, Amsterdam, The Netherlands) was performed during a 42-month period. Intravascular ultrasound, three-dimensional fusion, and extreme collimation were used in all procedures. Intraoperative live-image processing was performed with two imaging systems: standard magnification in 123 patients (81%) and dual fluoroscopy with live-image digital zooming in 28 patients (18%). In the latter, the live "processed" zoomed images are displayed on examination displays and live images are displayed on reference displays. The reference air kerma was collected for each case and represents patient dose. Operating staff personal dosimetry was collected using the DoseAware system (Philips Healthcare). Patient and staff radiation doses were compared using nonparametric tests. RESULTS: Mean age was 71.6 ± 11.4 years. The median body mass index was 27 kg/m2 (interquartile range [IQR], 24.4-30.6 kg/m2) and was the same for both groups. Procedures performed with dual fluoroscopy with digital zooming demonstrated significantly lower median patient (1382 mGy [IQR, 999-2045 mGy] vs 2458 mGy [IQR, 1706-3767 mGy]; P < .01) and primary operator radiation doses (101 µSv [IQR, 34-235 µSv] vs 266 µSv [IQR, 104-583 µSv]; P < .01) compared with standard magnification. Similar significantly reduced radiation doses were recorded for first assistant, scrub nurse, and anesthesia staff in procedures performed with dual fluoroscopy. According to device design, procedures performed with four-fenestration/branch devices generated higher operator radiation doses (262 µSv [IQR, 116.5-572 µSv] vs 171 µSv [IQR, 44-325 µSv]; P < .01) compared with procedures with three or fewer fenestration/branches. Among the most complex design (four-vessel), operator radiation dose was significantly lower with digital zooming compared with standard magnification (128.5 µSv [IQR, 70.5-296 µSv] vs 309 µSv [IQR, 150-611 µSv]; P = .01). CONCLUSIONS: Current radiation doses to patients and operating personnel are within acceptable limits; however, dual fluoroscopy with live-image digital zooming results in dramatically lower radiation doses compared with the standard image processing with dose-dependent magnification. Operator radiation doses were reduced in half during procedures performed with more complex device designs when digital zooming was used.

Padronizando a Exposição à Radiação durante o Cateterismo Cardíaco em Crianças com Cardiopatia Congênita: Dados de um Registro Multicêntrico Brasileiro / Standardizing Radiation Exposure during Cardiac Catheterization in Children with Congenital Heart Disease: Data from a Multicenter Brazilian Registry

Resumo Fundamento Nos últimos anos, o recente aumento no número de procedimentos intervencionistas tem resultado em crescente preocupação em relação à exposição radiológica por pacientes e equipe médica. A avaliação da exposição dos níveis de radiação em crianças é difícil devido à grande variabilidade no peso corporal. Portanto, os valores de referência de radiação não estão bem definidos para essa população. Objetivos Avaliar e validar a razão do produto dose-área (DAP) em relação ao peso corporal como uma medida de referência de radiação em cateterismos cardíacos em crianças. Métodos Estudo multicêntrico observacional com dados do Registro Brasileiro de Cateterismo Cardíaco em Cardiopatias Congênitas (CHAIN) de março de 2013 a junho de 2014. Os critérios de inclusão foram: pacientes <18 anos submetidos a procedimentos hemodinâmicos para cardiopatia congênita, com DAP devidamente registrado. Foram considerados diferenças estatísticas significativas os valores de p < 0,05. Resultados Este estudo avaliou 429 pacientes com idade e peso medianos de 50 (10, 103) meses e 15 (7, 28) kg, respectivamente. O DAP mediano foi de 742,2 (288,8, 1.791,5) μGy.m2. Houve uma boa correlação entre o DAP e o produto peso/tempo de fluoroscopia (rs=0,66). Não foi observada diferença estatisticamente significativa na relação DAP/peso entre procedimentos terapêuticos e diagnósticos. Houve ampla variação da relação DAP/peso entre os procedimentos terapêuticos (p<0.001). Conclusões A proporção DAP/peso é a medida mais simples e aplicável para avaliar a exposição radiológica em uma população pediátrica. Apesar da escassa literatura disponível, as doses obtidas no presente estudo foram semelhantes àquelas encontradas anteriormente. Estudos de validação e comparação são importantes na avaliação do impacto de estratégias para redução da exposição radiológica nessa população. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background In recent years the increasing number of interventional procedures has resulted in growing concerns regarding radiation exposure for patients and staff. The evaluation of radiation exposure in children is difficult due to the great variability in body weight. Therefore, reference levels of radiation are not well defined for this population. Objectives To study and validate the ratio of dose-area product (DAP) to patient weight as a reference measurement of radiation for hemodynamic congenital heart disease procedures in children. Methods This observational multicenter study uses data obtained from a Brazilian registry of cardiac catheterization for congenital heart disease from March 2013 to June 2014. Inclusion criteria were all patients aged <18 years old undergoing hemodynamic procedures for congenital heart disease, with recorded DAP doses. P-value < 0.05 was considered as statistically significant. Results This study evaluated 429 patients with median age and weight of 50 (10, 103) months and 15 (7, 28) kg, respectively. Median DAP was 742.2 (288.8, 1,791.5) μGy.m2. There was a good correlation between DAP and weight-fluoroscopic time product(rs=0.66). No statistically significant difference was observed in DAP/weight ratio between therapeutic and diagnostic procedures. There was a wide variation in the DAP/weight ratio among the therapeutic procedures (p<0.001). Conclusions The DAP/weight ratio is the simplest and most applicable measurement to evaluate radiation exposure in a pediatric population. Although there is limited literature available, the doses obtained in the present study were similar to those previously found. Ongoing research is important to evaluate the impact of strategies to reduce radiation exposure in this population (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Standardizing Radiation Exposure during Cardiac Catheterization in Children with Congenital Heart Disease: Data from a Multicenter Brazilian Registry. / Padronizando a Exposição à Radiação durante o Cateterismo Cardíaco em Crianças com Cardiopatia Congênita: Dados de um Registro Multicêntrico Brasileiro.

BACKGROUND: In recent years the increasing number of interventional procedures has resulted in growing concerns regarding radiation exposure for patients and staff. The evaluation of radiation exposure in children is difficult due to the great variability in body weight. Therefore, reference levels of radiation are not well defined for this population. OBJECTIVES: To study and validate the ratio of dose-area product (DAP) to patient weight as a reference measurement of radiation for hemodynamic congenital heart disease procedures in children. METHODS: This observational multicenter study uses data obtained from a Brazilian registry of cardiac catheterization for congenital heart disease from March 2013 to June 2014. Inclusion criteria were all patients aged <18 years old undergoing hemodynamic procedures for congenital heart disease, with recorded DAP doses. P-value < 0.05 was considered as statistically significant. RESULTS: This study evaluated 429 patients with median age and weight of 50 (10, 103) months and 15 (7, 28) kg, respectively. Median DAP was 742.2 (288.8, 1,791.5) µGy.m2. There was a good correlation between DAP and weight-fluoroscopic time product(rs=0.66). No statistically significant difference was observed in DAP/weight ratio between therapeutic and diagnostic procedures. There was a wide variation in the DAP/weight ratio among the therapeutic procedures (p<0.001). CONCLUSIONS: The DAP/weight ratio is the simplest and most applicable measurement to evaluate radiation exposure in a pediatric population. Although there is limited literature available, the doses obtained in the present study were similar to those previously found. Ongoing research is important to evaluate the impact of strategies to reduce radiation exposure in this population (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

FUNDAMENTO: Nos últimos anos, o recente aumento no número de procedimentos intervencionistas tem resultado em crescente preocupação em relação à exposição radiológica por pacientes e equipe médica. A avaliação da exposição dos níveis de radiação em crianças é difícil devido à grande variabilidade no peso corporal. Portanto, os valores de referência de radiação não estão bem definidos para essa população. OBJETIVOS: Avaliar e validar a razão do produto dose-área (DAP) em relação ao peso corporal como uma medida de referência de radiação em cateterismos cardíacos em crianças. MÉTODOS: Estudo multicêntrico observacional com dados do Registro Brasileiro de Cateterismo Cardíaco em Cardiopatias Congênitas (CHAIN) de março de 2013 a junho de 2014. Os critérios de inclusão foram: pacientes <18 anos submetidos a procedimentos hemodinâmicos para cardiopatia congênita, com DAP devidamente registrado. Foram considerados diferenças estatísticas significativas os valores de p < 0,05. RESULTADOS: Este estudo avaliou 429 pacientes com idade e peso medianos de 50 (10, 103) meses e 15 (7, 28) kg, respectivamente. O DAP mediano foi de 742,2 (288,8, 1.791,5) µGy.m2. Houve uma boa correlação entre o DAP e o produto peso/tempo de fluoroscopia (rs=0,66). Não foi observada diferença estatisticamente significativa na relação DAP/peso entre procedimentos terapêuticos e diagnósticos. Houve ampla variação da relação DAP/peso entre os procedimentos terapêuticos (p<0.001). CONCLUSÕES: A proporção DAP/peso é a medida mais simples e aplicável para avaliar a exposição radiológica em uma população pediátrica. Apesar da escassa literatura disponível, as doses obtidas no presente estudo foram semelhantes àquelas encontradas anteriormente. Estudos de validação e comparação são importantes na avaliação do impacto de estratégias para redução da exposição radiológica nessa população. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

Deviation from Mendelian transmission of autosomal SNPs can be used to estimate germline mutations in humans exposed to ionizing radiation.

We aimed to estimate the rate of germline mutations in the offspring of individuals accidentally exposed to Cesium-137 ionizing radiation. The study included two distinct groups: one of cases, consisting of males and females accidentally exposed to low doses of ionizing radiation of Cs137, and a control group of non-exposed participants. The cases included 37 people representing 11 families and 15 children conceived after the accident. Exposed families incurred radiation absorbed doses in the range of 0.2 to 0.5 Gray. The control group included 15 families and 15 children also conceived after 1987 in Goiânia with no history of radiation exposure. DNA samples from peripheral blood were analyzed with the Affymetrix GeneChip® CytoScanHD™ to estimate point mutations in autosomal SNPs. A set of scripts previously developed was used to detect de novo mutations by comparing parent and offspring genotypes at the level of each SNP marker. Overall numbers of observed Mendelian deviations were statistically significant between the exposed and control groups. Our retrospective transgenerational DNA analysis showed a 44.0% increase in the burden of SNP mutations in the offspring of cases when compared to controls, based on the average of MFMD for the two groups. Parent-of-origin and type of nucleotide substitution were also inferred. This proved useful in a retrospective estimation of the rate of de novo germline mutations in a human population accidentally exposed to low doses of radiation from Cesium-137. Our results suggested that observed burden of germline mutations identified in offspring was a potentially useful biomarker of effect to estimate parental exposure to low doses of IR and could become an important marker suitable for biomonitoring human population exposed to environmental mutagens.

Radiation Exposure Biomarkers in the Practice of Medical Radiology: Cooperative Research and the Role of the International Atomic Energy Agency (IAEA) Biodosimetry/Radiobiology Laboratory.

The strategy toward personalized medicine in radiation oncology, nuclear medicine, and diagnostic and interventional radiology demands a specific set of assays for individualized estimation of radiation load for safety concerns and prognosis of normal tissue reactions caused by ionizing radiation. Apparently, it seems reasonable to use validated radiation dosimetric biomarkers for these purposes. However, a number of gaps in knowledge and methodological limitations still have to be resolved until dosimetric biomarkers will start to play a valuable role in clinical practice beyond radiation protection and radiation medicine. An extensive international multicenter research is necessary to improve the methodology of clinical applications of biodosimetry. That became a rationale for launching the IAEA Coordinated Research Project E35010 MEDBIODOSE: "Applications of Biological Dosimetry Methods in Radiation Oncology, Nuclear Medicine, and Diagnostic and Interventional Radiology." At the 2 Coordination Meeting on MEDBIODOSE (18-22 February 2019, Recife, Brazil), participants reported progress in the usage of biological dosimetry for genotoxicity assessment and/or individualization of radiotherapy treatment plans. Another avenue of research was the prognosis of normal tissue toxicity and cancer risk prediction using biomarkers' yield measured in vivo or after ex vivo irradiation of patients' cells. Other important areas are mechanisms of cytogenetic radiation response, validation of new radiation biomarkers, development of innovative techniques, automated and high-throughput assays for biodosimetry, and the overall improvement of biodosimetry service. An important aspect of clinical application of biodosimetry is standardization of techniques and unification of approaches to data interpretation. The new IAEA Biodosimetry/Radiobiology Laboratory, which is being established, will provide support for this activity. The declared lab's mission includes, among other tasks, a harmonization of the biodosimetry applications with relevant international standards, guidelines on good laboratory practice, and the IAEA EPR-Biodosimetry manual.

Evaluation of Glucosamine Effect Against Heart and Brain Damage Induced by Y-radiation or Aluminium Chloride in Female Rats

Abstract Glucosamine is known as anti-inflammatory, antioxidant and as neuroprotective as well as using to treat many of diseases. This work aimed to investigate the remedial effect of glucosamine (20mg/kg b.wt) against the damage induced by a single dose of γ-radiation (8Gy) or aluminium chloride (AlCl3) (100mg/kg b.wt) in the heart and brain tissues of female rats. Serum aspartate aminotransferase (AST), cholesterol, triglycerides (TGs), LDH and creatine kinase (CPK) were measured. Moreover, gene expression of amyloid protein precursor (APP) and seladin-1 were estimated in the brain tissue. Also, acetylcholinesterase activity (AChE) and p-tau protein expression were estimated in brain homogenate. Metallothioneine (MT) was estimated in the heart and brain tissues. Heart and brain histopathological examination was performed. Irradiation significantly decreased serum AST, CPK and LDH, as well as MT levels in heart and brain tissues. Also, gene expression of seladin-1 decreased. On the other hand, irradiation significantly increased serum TGs level and brain AchE activity, tau protein, and β-amyloid percursor (APP). AlCl3 administration (21 days) induced disturbance in most of the estimated parameters, especially AST, TGs, and MT. Glucosamine treatment with irradiation or AlCl3 improved most of the measured parameters. In addition, histopathological examination confirmed the biochemical results. In conclusion: Glucosamine could be used to improve the heart and brain damages induced by γ-radiation exposure or AlCl3.

Trends in the Incidence of Breast Cancer Following the Radiological Accident in Goiânia: A 25-Year Analysis.

BACKGROUND: The largest radiological accident to occur in any urban area happened in Goiânia, Brazil, in 1987. One major concern regarding deleterious effects in the population was a possible increase in the breast cancer incidence. This study analyzed trends in the incidence of breast cancer over the 25-year period following the radiological accident. METHODS: This ecological, population-based study was conducted to determine the incidence of breast cancer in female residents of Goiânia, Goiás, Brazil, between 1988 and 2012. The data were collected from the Goiânia population-based cancer registry. Crude and age-standardized incidence rates were calculated. The Joinpoint software program was used to calculate annual percent changes (APC) in the incidence of breast cancer. RESULTS: Overall, 7,365 new cases of breast cancer were identified, with an annual crude incidence rate of 23.09/100,000 women in 1988 and of 71.65/100,000 women in 2012. The age-standardized incidence rate was 35.63/100,000 women in 1988 and 65.63/100,000 women in 2012. Analysis of the APC showed a significant annual increase of 4.8% in the incidence between 1988 and 2005 (p<0.0001) followed by stabilization in 2005-2012, with an APC of -3.5% (p=0.1). CONCLUSION: There was an increase in the incidence of breast cancer in the female residents of Goiânia, Goiás in the first 17 years of evaluation (1988-2004) followed by a period of stabilization until 2012. However, the trends in the incidence suggest a lack of association with the radiological accident.

Incidencia de la exposición a los rayos X en cirugías de columna / Incidence of X-rays exposure in spinal surgeries

Introducción: El control radioscópico intraoperatorio es una práctica cada vez más frecuente, que no está libre de eventos adversos para el personal de la salud. Objetivos: Conocer la tasa de uso de radioscopia en la cirugía vertebral, reconocer las medidas de control, evaluar la asimilación del cirujano a los elementos de protección y analizar los eventos adversos en estos profesionales. Materiales y Métodos: Se envió, por correo electrónico, a cirujanos espinales, una encuesta de 17 preguntas de opciones múltiples. Resultados: Se recibieron 55 encuestas. El 87% se dedicaba a la columna, en más del 60% de sus prácticas. El arco en C es el método más utilizado para el control final, en forma pulsátil. Solo el 31% controla el tiempo real. El delantal plomado de una pieza es el método más utilizado, pero se desconoce cuándo se debe reemplazar. La mitad utiliza más de un elemento. Siete casos de trastornos visuales, 5 patologías tiroideas, 3 dermatitis y 2 casos de infertilidad. Tres cirujanos fueron operados por nódulos tiroideos, cataratas o neoplasia. Conclusiones: El control radioscópico intraoperatorio es una práctica frecuente en la cirugía espinal. El delantal plomado de una pieza es el método más utilizado y, muchas veces, se lo combina, pero se desconoce cuándo se deben renovar los plomados. Uno de cada tres cirujanos presentaron las patologías evaluadas y 3, cirugías relacionadas. Así queda en evidencia la protección y el control escasos que existen en los cirujanos especialistas, acompañados de una falta de protocolización que deja a la deriva este control. Nivel de Evidencia: IV

Background: Intraoperative radiographic control (IRC) is an increasingly common practice, but it causes certain adverse events for healthcare providers. Objectives: To measure the use of fluoroscopy in spinal surgery, recognize control measures, evaluate assimilation of protection elements by surgeons, and analyze adverse events for spinal surgeons. Materials and Methods: A survey of 17 multiple-choice questions was e-mailed to spinal surgeons. Results: 55 surveys were answered. More than 60% of surgeons were spinal surgeons. The C-arm is the most widely used machine for final control by pulsating X-rays. Real-time controls are carried out in 31% of cases. One-piece leaded aprons are the most commonly used method, but it is unknown when they should be replaced. Half of the respondents uses more than one protection element. There were seven cases of vision changes, 5 of thyroid disorders, 3 of dermatitis, and 2 of infertility. Three surgeons required surgery for thyroid nodules, cataracts or neoplasm. Conclusions: IRC is a common practice in spinal surgery. One-piece leaded aprons are the most commonly used method and they are often combined with other elements, but it is not known when aprons must be replaced. One in 3 surgeons suffered from the studied conditions, and there were 3 related surgeries. Lack of adequate protection and control is a reality for specialist surgeons, together with a lack of protocols, making this an unregulated issue. Level of Evidence: IV

REDUCTION OF STAFF RADIATION DOSE IN PROSTATIC ARTERY EMBOLISATION.

Prostatic artery embolisation (PAE) is used to treat patients with benign prostatic hyperplasia and with lower urinary obstructive tract symptoms. It is an interventional procedure which uses fluoroscopy equipment and can result in exposure to high doses of radiation in patients and staff. We aimed to demonstrate the reduction of radiation doses received by staff during PAE by implementing an optimised protocol called Radiation Exposure Curtailment for Embolisation (RECiFE). This protocol was implemented in cooperation with the medical team and technical team using Siemens Combined Applications to Reduce Exposure (CARE) protocol. The results showed approximately 83% reduction in the radiation doses received by the main physician during PAE. Thus, by adjusting the acquisition parameters of the angiographic equipment and implementing the RECiFE protocol, it is possible to optimise the PAE procedure and reduce the staff radiation dose.

Prevalence of Lens Opacity in Interventional Cardiologists and Professional Working in the Hemodynamics in Brazil / Prevalência de Opacidades do Cristalino em Cardiologistas Intervencionistas e Profissionais Atuantes na Área de Hemodinâmica no Brasil

Abstract Background: Posterior subcapsular cataract is a tissue reaction commonly found among professionals exposed to ionizing radiation. Objective: To assess the prevalence of cataract in professionals working in hemodynamics in Brazil. Methods: Professionals exposed to ionizing radiation (group 1, G1) underwent slit lamp examination with a biomicroscope for lens examination and compared with non-exposed subjects (group 2, G2). Ophthalmologic findings were described and classified by opacity degree and localization using the Lens Opacities Classification System III. Both groups answered a questionnaire on work and health conditions to investigate the presence of risk factors for cataract. The level of significance was set at 5% (p < 0.05). Results: A total of 112 volunteers of G1, mean age of 44.95 (±10.23) years, and 88 volunteers of G2, mean age of 48.07 (±12.18) years were evaluated; 75.2% of G1 and 85.2% of G2 were physicians. Statistical analysis between G1 and G2 showed a prevalence of posterior subcapsular cataract of 13% and 2% in G1 and G2, respectively (0.0081). Considering physicians only, 38% of G1 and 15% of G2 had cataract, with the prevalence of posterior subcapsular cataract of 13% and 3%, respectively (p = 0.0176). Among non-physicians, no difference was found in the prevalence of cataract (by types). Conclusions: Cataract was more prevalent in professionals exposed to ionizing radiation, with posterior subcapsular cataract the most frequent finding.

Resumo Fundamento: A catarata subcapsular posterior é uma reação tecidual encontrada com frequência nos profissionais expostos à radiação ionizante. Objetivo: Avaliar a prevalência de catarata nos profissionais que atuam na área de hemodinâmica no Brasil. Métodos: Profissionais expostos à radiação ionizante (grupo 1, G1) foram submetidos ao exame biomicroscópico com lâmpada de fenda para avaliação do cristalino, e comparados aos não expostos (grupo 2, G2). Os achados foram descritos e classificados quanto ao grau de opacidade e localização por meio do Lens opacities classification system III. Ambos os grupos responderam questionário sobre condições de trabalho e de saúde para afastar fatores de risco para catarata, e foram comparados quanto aos achados. Foi utilizado um nível de significância de 5% (p < 0,05). Resultados: Foram avaliados 112 voluntários (G1) com média de idade 44,95 (±10,23) anos e 88 voluntários (G2) com média de 48,07 (±12,18) anos. Desses, 75,2% (G1) e 85,2% (G2) eram médicos. A análise estatística entre os grupos G1 e G2 mostrou uma prevalência da catarata no grupo G1 de 33% comparada ao G2 de 16% (p = 0,0058), sendo a catarata subcapsular posterior presente em 13% no G1 e 2% no G2 (p = 0,0081). Considerando apenas os médicos, 38% no G1 e 15% no G2 (p = 0,0011) apresentaram catarata, sendo a subcapsular posterior 13% e 3% (p = 0,0176), respectivamente. No grupo dos profissionais não médicos, não houve diferença estatisticamente significativa na prevalência dos achados oftalmológicos. Conclusões: A catarata esteve mais presente no grupo de profissionais expostos à radiação ionizante, sendo que a catarata subcapsular posterior foi o dano tecidual mais encontrado.

Intensive Imaging Surveillance of Survivors of Breast Cancer May Increase Risk of Radiation-induced Malignancy.

BACKGROUND: Current clinical guidelines recommend mammography as the only imaging method for surveillance in asymptomatic survivors of early breast cancer (EBC). However, non-recommended tests are commonly used. We estimated the imaging radiation-induced malignancies (IRIM) risks in survivors of EBC undergoing different imaging surveillance models. MATERIALS AND METHODS: We built 5 theoretical models of imaging surveillance, from annual mammography only (model 1) to increasingly imaging-intensive approaches, including computed tomography (CT) scan, positron emission tomography-CT, bone scan, and multigated acquisition scan (models 2 through 5). Using the National Cancer Institute's Radiation Risk Assessment Tool, we compared the excess lifetime attributable cancer risk (LAR) for hypothetical survivors of EBC starting surveillance at the ages of 30, 60, or 75 years and ending at 81 years. RESULTS: For all age groups analyzed, there is a statistically significant increase in LAR when comparing model 1 with more intensive models. As an example, in a patient beginning surveillance at the age of 60 years, there is a 28.5-fold increase in the IRIM risk when comparing mammography only versus a schedule with mammography plus CT scan of chest-abdomen and bone scan. We found no differences when comparing models 2 through 5. LAR is higher when surveillance starts at a younger age, although the age effect was only statistically significant in model 1. CONCLUSION: Non-recommended imaging during EBC surveillance can be associated with a significant increase in LAR. In addition to the lack of survival benefit, additional tests may have significant IRIM risks and should be avoided.

Prevalence of Lens Opacity in Interventional Cardiologists and Professional Working in the Hemodynamics in Brazil.

BACKGROUND: Posterior subcapsular cataract is a tissue reaction commonly found among professionals exposed to ionizing radiation. OBJECTIVE: To assess the prevalence of cataract in professionals working in hemodynamics in Brazil. METHODS: Professionals exposed to ionizing radiation (group 1, G1) underwent slit lamp examination with a biomicroscope for lens examination and compared with non-exposed subjects (group 2, G2). Ophthalmologic findings were described and classified by opacity degree and localization using the Lens Opacities Classification System III. Both groups answered a questionnaire on work and health conditions to investigate the presence of risk factors for cataract. The level of significance was set at 5% (p < 0.05). RESULTS: A total of 112 volunteers of G1, mean age of 44.95 (±10.23) years, and 88 volunteers of G2, mean age of 48.07 (±12.18) years were evaluated; 75.2% of G1 and 85.2% of G2 were physicians. Statistical analysis between G1 and G2 showed a prevalence of posterior subcapsular cataract of 13% and 2% in G1 and G2, respectively (0.0081). Considering physicians only, 38% of G1 and 15% of G2 had cataract, with the prevalence of posterior subcapsular cataract of 13% and 3%, respectively (p = 0.0176). Among non-physicians, no difference was found in the prevalence of cataract (by types). CONCLUSIONS: Cataract was more prevalent in professionals exposed to ionizing radiation, with posterior subcapsular cataract the most frequent finding.

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.