Analysis of national quality control testing training on radiodiagnostic and radiotherapy equipment from 2018 to 2022 / 中国辐射卫生

Objective To analyze the implementation of national training on quality control testing of radiodiagnostic and radiotherapy equipment from 2018 to 2022, and to summarize the effects of the training program. Methods We collected and analyzed the information on the national training program for quality control testing of radiodiagnostic and radiotherapy equipment organized by the National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention from 2018 to 2022. Results Five sessions of national training on quality control testing of radiodiagnostic and radiotherapy equipment were conducted from 2018 to 2022, with each session lasting four days. The proportion of teachers with senior professional titles was 87.5% (35/40). There were a total of 1045 attendances for radiological technician training, among which 75.1% (785/1045) had intermediate or lower technical titles and 87.1% (910/1045) had a bachelor’s degree or above. The qualified rate of training was 97.7% (905/926). In terms of the content, arrangement, and other key parts of training, the degrees of satisfaction of the trainees were all above 96.0%. Conclusion The national training program for quality control testing of radiodiagnostic and radiotherapy equipment worked well, with both the qualified rate and satisfaction degree above 95.0%. The program has helped professionals better understand and master the quality control testing of radiodiagnostic and radiotherapy equipment, and improved the high-quality development of continuing radiological education.

Contrast Agents during Pregnancy: Pros and Cons When Really Needed.

Many clinical conditions require radiological diagnostic exams based on the emission of different kinds of energy and the use of contrast agents, such as computerized tomography (CT), positron emission tomography (PET), magnetic resonance (MR), ultrasound (US), and X-ray imaging. Pregnant patients who should be submitted for diagnostic examinations with contrast agents represent a group of patients with whom it is necessary to consider both maternal and fetal effects. Radiological examinations use different types of contrast media, the most used and studied are represented by iodinate contrast agents, gadolinium, fluorodeoxyglucose, gastrographin, bariumsulfate, and nanobubbles used in contrast-enhanced ultrasound (CEUS). The present paper reports the available data about each contrast agent and its effect related to the mother and fetus. This review aims to clarify the clinical practices to follow in cases where a radiodiagnostic examination with a contrast medium is indicated to be performed on a pregnant patient.

Quality control and protection test and analysis of some radiodiagnostic equipment in Gansu Province, China / 中国辐射卫生

Objective To test and evaluate the protection and quality control status of some radiodiagnostic equipment in Gansu Province, China, and to strengthen the quality control and protection of radiodiagnostic equipment in hospitals. Methods A total of 72 medical institutions involving 203 sets of radiodiagnostic equipment and workplaces were selected to carry out the quality control and protection test according to relevant national standards. Results The qualified rate for the quality control test of the 203 sets of radiodiagnostic equipment was 92.1%, and that of the workplaces was 100%. Conclusion The results basically reflect the quality control and protection status of radiodiagnostic equipment in Gansu Province, indicating that regular inspection and timely debugging is very important.

Practical recommendations for the application of DE 59/2013.

The changes introduced with Council Directive 2013/59/Euratom will require European Member States adapt their regulations, procedures and equipment to the new high standards of radiation safety. These new requirements will have an impact, in particular, on the radiology community (including medical physics experts) and on industry. Relevant changes include new definitions, a new dose limit for the eye lens, non-medical imaging exposures, procedures in asymptomatic individuals, the use and regular review of diagnostic reference levels (including interventional procedures), dosimetric information in imaging systems and its transfer to the examination report, new requirements on responsibilities, the registry and analysis of accidental or unintended exposure and population dose evaluation (based on age and gender distribution). Furthermore, the Directive emphasises the need for justification of medical exposure (including asymptomatic individuals), introduces requirements concerning patient information and strengthens those for recording and reporting doses from radiological procedures, the use of diagnostic reference levels, the availability of dose-indicating devices and the improved role and support of the medical physics experts in imaging.

Effects of Patient Safety Culture on Patient Satisfaction With Radiological Services in Nigerian Radiodiagnostic Practice.

INTRODUCTION: Patient safety culture is believed to be the first step toward improvement in quality of health-care delivery which will impact patient satisfaction. OBJECTIVE: To assess the effect of patient safety culture on patient satisfaction in radiodiagnostic practice. METHOD: Two validated questionnaires via Hospital Survey on Patient Safety Culture by Agency of Health Research and Quality and patient satisfaction questionnaire by Hays were administered to radiodiagnostic staff and patients who came for diagnostic care, respectively. These questionnaires were based on 5-point Likert scale. Questionnaires on patient safety culture and patient satisfaction were administered to 80 radiology health workers and 376 patients of radiology, respectively. Simple random sampling was used to enlist the participants for patient satisfaction while a population study was carried out to enlist patient safety culture participants. Data were analyzed using SPSS version 17. RESULTS: Response rate for patient safety culture questionnaires was 94.6%, while that of patient satisfaction was 62.8%. Among the survey items of patient safety, teamwork has the highest positive response of 76.5%, while staffing has the least, 30%. Overall patient safety culture was 53.7%. The survey item with highest positive response in patient satisfaction survey was patient-provider relationship (80%), while service cost-effectiveness has the least of 59%. Overall patient satisfaction with radiological services was 72.6%. There is no correlation between patient safety culture and patient satisfaction. CONCLUSION: Even though there is an excellent level of patient satisfaction in this study, it is not related to the practice of patient safety culture in radiodiagnostic unit.

Thermoluminescent characteristics of LiF:Mg, Cu, P and CaSO4:Dy for low dose measurement.

Thermoluminescence (TL) characteristics for LiF:Mg, Cu, P, and CaSO4:Dy under the homogeneous field of X-ray beams of diagnostic irradiation and its verification using thermoluminescence dosimetry are presented. The irradiation were performed utilizing a conventional X-ray equipment installed at the Hospital Juárez Norte of México. Different thermoluminescence characteristics of two material were studied, such as batch homogeneity, glow curve, linearity, detection threshold, reproducibility, relative sensitivity and fading. Materials were calibrated in terms of absorbed dose to the standard calibration distance and they were positioned in a generic phantom. The dose analysis, verification and comparison with the measurements obtained by the TLD-100 were performed. Results indicate that the dosimetric peak appears at 202°C and 277.5°C for LiF:Mg, Cu, P and CaSO4:Dy, respectively. TL response as a function of X-ray dose showed a linearity behavior in the very low dose range for all materials. However, the TLD-100 is not accurate for measurements below 4mGy. CaSO4:Dy is 80% more sensitive than TLD-100 and it show the lowest detection threshold, whereas LiF:Mg, Cu, P is 60% more sensitive than TLD-100. All materials showed very good repeatability. Fading for a period of one month at room temperature showed low fading LiF:Mg, Cu, P, medium and high for TLD-100 and CaSO4:Dy. The results suggest that CaSO4:Dy and LiF:Mg, Cu, P are suitable for measurements at low doses used in radiodiagnostic.

S-Nitrosylation in Organs of Mice Exposed to Low or High Doses of γ-Rays: The Modulating Effect of Iodine Contrast Agent at a Low Radiation Dose.

The covalent addition of nitric oxide (NO•) onto cysteine thiols, or S-nitrosylation, modulates the activity of key signaling proteins. The dysregulation of normal S-nitrosylation contributes to degenerative conditions and to cancer. To gain insight into the biochemical changes induced by low-dose ionizing radiation, we determined global S-nitrosylation by the "biotin switch" assay coupled with mass spectrometry analyses in organs of C57BL/6J mice exposed to acute 0.1 Gy of 137Cs γ-rays. The dose of radiation was delivered to the whole body in the presence or absence of iopamidol, an iodinated contrast agent used during radiological examinations. To investigate whether similar or distinct nitrosylation patterns are induced following high-dose irradiation, mice were exposed in parallel to acute 4 Gy of 137Cs γ rays. Analysis of modulated S-nitrosothiols (SNO-proteins) in freshly-harvested organs of animals sacrificed 13 days after irradiation revealed radiation dose- and contrast agent-dependent changes. The major results were as follows: (i) iopamidol alone had significant effects on S-nitrosylation in brain, lung and liver; (ii) relative to the control, exposure to 0.1 Gy without iopamidol resulted in statistically-significant SNO changes in proteins that differ in molecular weight in liver, lung, brain and blood plasma; (iii) iopamidol enhanced the decrease in S-nitrosylation induced by 0.1 Gy in brain; (iv) whereas a decrease in S-nitrosylation occurred at 0.1 Gy for proteins of ~50 kDa in brain and for proteins of ~37 kDa in liver, an increase was detected at 4 Gy in both organs; (v) mass spectrometry analyses of nitrosylated proteins in brain revealed differential modulation of SNO proteins (e.g., sodium/potassium-transporting ATPase subunit beta-1; beta tubulins; ADP-ribosylation factor 5) by low- and high-dose irradiation; and (vi) ingenuity pathway analysis identified major signaling networks to be modulated, in particular the neuronal nitric oxide synthase signaling pathway was differentially modulated by low- and high-dose γ-irradiation.

Diagnóstico clínico e radiográfico de luxação traumática da articulação atlanto-occipital em dois cães / Clinical and radiographic diagnosis of traumatic dislocation of the atlanto-occipital joint in two dogs

A luxação da articulação atlanto-occipital é considerada uma afecção incomum no homem e nos animais. Radiografias laterais são recomendadas para o diagnóstico. No entanto, estão sujeitas a erros relacionados ao ângulo de radiação, ao alvo da imagem, à distância e à sobreposição óssea. Objetivou-se neste relato descrever os achados clínicos e radiográficos de dois cães com luxação traumática da articulação atlanto-occipital que apresentavam tetraparesia, dor cervical cranial, incapacidade de elevar a cabeça e déficits de nervos cranianos. No primeiro animal, observaram-se deslocamento craniodorsal do processo articular do atlas em relação a um dos côndilos do occipital, ausência de sobreposição dos forames vertebrais laterais e sobreposição do côndilo do occipital ao processo articular do atlas, no lado direito, caracterizando uma luxação unilateral. No segundo animal, observou-se deslocamento craniodorsal dos processos articulares do atlas em relação aos côndilos do occipital, com sobreposição dos forames vertebrais laterais e ausência de visibilização dos côndilos do occipital em virtude da projeção cranial dos processos articulares do atlas em direção ao crânio, caracterizando luxação bilateral. Conclui-se que o exame radiográfico simples, nas projeções laterolateral e ventrodorsal, apesar da dificuldade de ser interpretado, é eficiente para confirmar o diagnóstico da luxação atlanto-occipital traumática, tanto a simétrica quanto a assimétrica.

Atlanto-occipital luxation is considered rare in both humans and animals. Lateral radiographs are recommended for diagnosis, however, errors may occur related to the angle of radiation, image target, distance and overlapping of bone. Our objective is to report the clinical and radiographic findings in two dogs with traumatic atlanto-occipital luxation, which had tetraparesis, cranial neck pain, and inability to raise the head and cranial nerve deficits. The first animal had a cranio-dorsal dislocation of the articular process of the atlas in relation to one of the occipital condoles, with no overlapping of the transverse foramens or overlapping of the occipital condile in relation to the articular process of the atlas, on the right side, which characterizes a unilateral luxation. The second animal presented with a cranio-caudal dislocation of the articular processes of the atlas regarding the occipital condoles, with overlapping of the transverse foramens and inability to visualize the occipital condoles due to the cranial advancement of the articular processes of the atlas towards the skull, which characterizes a bilateral luxation. We conclude that a simple radiographic exam, in lateral and ventrodorsal projections, though difficult to interpret, is efficient in confirming a diagnosis of traumatic atlanto-occipital luxation, both symmetric and asymmetric.

Controle de riscos em radiodiagnóstico: uma abordagem de vigilância sanitária / Radio diagnostic risks control: an approach of sanitary surveillance

O radiodiagnóstico é uma das principais ferramentas de diagnose na medicina e seu papel, na saúde pública, depende da qualidade dos exames, cuja responsabilidade regulatória cabe principalmente ao Sistema Nacional de Vigilância Sanitária. Nessa perspectiva, foi desenvolvido um modelo matemático de avaliação de riscos potencial (MARP) em radiodiagnóstico e, através do seu uso em serviços de saúde da Bahia, analisada a situação encontrada e seus condicionantes. O MARP baseia-se no conceito de risco potencial e relaciona os indicadores de controle de riscos com os riscos potenciais e os responsáveis pelos controles. Usando esse modelo, avaliaram-se 94 procedimentos de 38 serviços de radiodiagnóstico. O estudo mostrou que 5,3 por cento dos serviços estavam com todos os procedimentos em nível de risco potencial aceitável. 23,7 por cento tinham pelo menos um procedimento com nível de risco potencial tolerável, e 71 por cento tinham pelo menos um procedimento com nível de risco potencial inaceitável. As análises mostraram que os principais condicionantes da situação encontrada dizem respeito à deficiência do sistema de vigilância sanitária na fiscalização dos serviços e da indústria, à ausência dos fundamentos de proteção radiológica nas diretrizes curriculares dos cursos de medicina e à fragilidade do controle das práticas pelos respectivos conselhos profissionais.

The X-ray diagnostic is one of the main diagnosis tools in medicine and its role, in public health, depends on the quality of the exams, the regulatory responsibility fits, mainly, in the National System of Sanitary Surveillance. With this perspective, it was developed a mathematical evaluation model of potential risks in radiodiagnostic and, through its use in the Brazilian health services of Bahia state, with the analysis of the situation found and its determinants. With that model, 94 procedures were evaluated in 38 Bahia state radiodiagnostic services. The study showed that 5.3 percent of the services had all of the procedures in level of acceptable potential risk. 23.7 percent showed, at least, one procedure with level of tolerable potential risk and 71 percent showed, at least, one procedure with a level of unacceptable potential risk. The analyses shows that the main determinants of the encountered situation are the deficient inspection by the sanitary surveillance system of the health services and of the industrial sector, the absence of basics of radiological protection in the curriculum of medicine courses and the fragility of practices control, by the respective professional council.