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6.
An Bras Dermatol ; 94(5): 532-541, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777353

RESUMO

BACKGROUND: The knowledge of general practitioners about photoprotection is unknown. OBJECTIVES: To develop and validate an instrument to evaluate the knowledge of general practitioners and pediatricians about photoprotection, gauging the knowledge of these professionals. METHODS: The study followed the steps: (1) Literature identification and item elaboration related to the theme; (2) Content validation; (3) Apparent validation; (4) Construct validation: internal consistency analysis and discriminatory analysis; (5) Reliability analysis. In Step 4, the instrument was applied to 217 general practitioners and pediatricians who worked in the host city of the study; the scores were compared with dermatologists scores. RESULTS: The final instrument had 41 items and showed satisfactory internal consistency (Cronbach's alpha=0.780), satisfactory reproducibility and good test-retest reliability (good-to-excellent kappa statistic in more than 60% of items). The discriminatory analysis registered a mean score of 54.1 points for dermatologists and 31.1 points for generalists and pediatricians, from a total of 82 possible points, representing a statistically significant difference (p<0.001). Generalists and pediatricians demonstrated an understanding of the relationship between excessive sun exposure and skin cancer, but they revealed lack of technical information necessary for their professional practice. STUDY LIMITATIONS: The instrument evaluates only knowledge, without evaluating the conduct of the participants. CONCLUSION: The results show that the instrument has good internal consistency and good reproducibility. It could be useful in the identification of general practitioners and pediatricians knowledge gaps on the subject, for the subsequent development of training and educational strategies.


Assuntos
Clínicos Gerais/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pediatras/estatística & dados numéricos , Proteção Radiológica/métodos , Energia Solar , Inquéritos e Questionários/normas , Raios Ultravioleta/efeitos adversos , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição à Radiação/prevenção & controle , Reprodutibilidade dos Testes , Neoplasias Cutâneas/prevenção & controle , Estatísticas não Paramétricas , Protetores Solares/uso terapêutico
7.
Tex Heart Inst J ; 46(3): 167-171, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708696

RESUMO

Exposure to ionizing radiation during cardiac catheterization can have harmful consequences for patients and for the medical staff involved in the procedures. Minimizing radiation doses during the procedures is essential. We investigated whether fine-tuning the radiation protocol reduces radiation doses in the cardiac catheterization laboratory. In January 2016, we implemented a new protocol with reduced radiation doses in the Hospital de Jerez catheterization laboratory. We analyzed 170 consecutive coronary interventional procedures (85 of which were performed after the new protocol was implemented) and the personal dosimeters of the interventional cardiologists who performed the procedures. Overall, the low-radiation protocol reduced air kerma (dose of radiation) by 44.9% (95% CI, 18.4%-70.8%; P=0.001). The dose-area product decreased by 61% (95% CI, 30.2%-90.1%; P <0.001) during percutaneous coronary interventions. We also found that the annual deep (79%, P=0.026) and shallow (62.2%, P=0.035) radiation doses to which primary operators were exposed decreased significantly under the low-radiation protocol. These dose reductions were achieved without increasing the volume of contrast media, fluoroscopy time, or rates of procedural complications, and without reducing the productivity of the laboratory. Optimizing the radiation safety protocol effectively reduced radiation exposure in patients and operators during cardiac catheterization procedures.


Assuntos
Cateterismo Cardíaco/métodos , Angiografia Coronária/efeitos adversos , Fluoroscopia/efeitos adversos , Exposição Ocupacional/efeitos adversos , Exposição à Radiação/efeitos adversos , Lesões por Radiação/prevenção & controle , Medição de Risco/métodos , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Exposição à Radiação/prevenção & controle , Lesões por Radiação/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia
8.
An Bras Dermatol ; 94(5): 567-573, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777358

RESUMO

BACKGROUND: One of the main prevention methods against skin cancer is the use of sunscreen; however, incidence of this disease has not declined despite prevention campaigns. OBJECTIVE: Investigate the prevalence of non-use of sunscreen and its associated factors. METHOD: A population-based cross-sectional study with individuals aged 18 years or over living in the urban area. Conducted between April and July of 2016. Participants were interviewed about socioeconomic, demographic, and behavioral questions. Non-use of sunscreen was considered as the outcome. For multivariate analysis, Poisson regression with robust adjustment for variance was used. RESULTS: Among the 1300 participants, prevalence of non-use of sunscreen was 38.2% (95% CI: 34.6-41.8). The variables independently associated with the outcome were male sex, older age, brown or black skin color, lower income, fewer years of education, no physical activity in leisure time, no medical consultations in the last year, and self-perception of health as regular or poor. STUDY LIMITATIONS: The prevalence may be underestimated by reports of more use of sunscreen than actually used, which could increase the figure in the outcome. CONCLUSION: It was estimated that about four out of ten adults and elderly do not use sunscreen in this sample. Prevention strategies are needed to advance health policy and ensure that sun protection options are easily accessible.


Assuntos
Exposição à Radiação/prevenção & controle , Protetores Solares/uso terapêutico , Raios Ultravioleta/efeitos adversos , Adolescente , Adulto , Distribuição por Idade , Brasil , Estudos Transversais , Autoavaliação Diagnóstica , Feminino , Comportamentos de Risco à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Neoplasias Cutâneas/prevenção & controle , Inquéritos e Questionários , Adulto Jovem
11.
Phys Med ; 64: 69-73, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31515037

RESUMO

INTRODUCTION: Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is an well-established endoscopic procedure for the management of biliary diseases. The use of fluoroscopy during ERCP has often raised concerns regarding potential risks from radiation exposure, particularly in complex cases. We investigated whether a new digital single-operator cholangioscopy (D-SOC) system, used adjunctively to ERCP, actually reduces patient radiation exposure. MATERIALS AND METHODS: We retrospectively analyzed a prospective database (April 2016 to October 2018) including consecutive patients who underwent successful management of difficult-to-treat biliary stones or indeterminate biliary strictures by using either conventional ERCP (ERCP cohort) or ERCP in conjunction with D-SOC (ERCP/D-SOC cohort). The overall patient radiation exposure outcomes were compared in terms of Kerma Area Product (KAP), Fluoroscopy time (T) and the total number of films (F). RESULTS: Overall, 47 patients (mean 71.8 years, 59.6% males) were included (ERCP cohort = 29, ERCP/D-SOC cohort = 18), referred either for difficult bile duct stones (n = 36) or indeterminate biliary strictures (n = 11). The median KAP, T and F in the ERCP/D-SOC cohort were 12.3 Gycm2, 3.7 min and 4 films respectively, compared with 52.1 Gycm2, 8.4 min, and 5 films respectively in the ERCP cohort. Statistically significant differences (P = 0.0001) were found for KAP and T. CONCLUSIONS: Adjunct use of a digital cholangioscopy platform appears to significantly reduce radiation exposure in patients undergoing ERCP for the management of difficult bile stones or indeterminate biliary strictures.


Assuntos
Ductos Biliares/diagnóstico por imagem , Ductos Biliares/efeitos da radiação , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Cálculos Biliares/diagnóstico por imagem , Exposição à Radiação/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Estudos Retrospectivos
12.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31533974

RESUMO

BACKGROUND: Computed tomography (CT) is commonly used for children when there is concern for traumatic brain injury (TBI) and is a significant source of ionizing radiation. Our objective was to determine the feasibility and accuracy of fast MRI (motion-tolerant MRI sequences performed without sedation) in young children. METHODS: In this prospective cohort study, we attempted fast MRI in children <6 years old who had head CT performed and were seen in the emergency department of a single, level 1 pediatric trauma center. Fast MRI sequences included 3T axial and sagittal T2 single-shot turbo spin echo, axial T1 turbo field echo, axial fluid-attenuated inversion recovery, axial gradient echo, and axial diffusion-weighted single-shot turbo spin echo planar imaging. Feasibility was assessed by completion rate and imaging time. Fast MRI accuracy was measured against CT findings of TBI, including skull fracture, intracranial hemorrhage, or parenchymal injury. RESULTS: Among 299 participants, fast MRI was available and attempted in 225 (75%) and completed in 223 (99%). Median imaging time was 59 seconds (interquartile range 52-78) for CT and 365 seconds (interquartile range 340-392) for fast MRI. TBI was identified by CT in 111 (50%) participants, including 81 skull fractures, 27 subdural hematomas, 24 subarachnoid hemorrhages, and 35 other injuries. Fast MRI identified TBI in 103 of these (sensitivity 92.8%; 95% confidence interval 86.3-96.8), missing 6 participants with isolated skull fractures and 2 with subarachnoid hemorrhage. CONCLUSIONS: Fast MRI is feasible and accurate relative to CT in clinically stable children with concern for TBI.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Pré-Escolar , Estudos de Viabilidade , Feminino , Hematoma Subdural/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Hemorragias Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Estudos Prospectivos , Exposição à Radiação/prevenção & controle , Reprodutibilidade dos Testes , Fraturas Cranianas/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos
14.
Bull Cancer ; 106(10): 903-914, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31495441

RESUMO

Germ-cell tumors are the most common solid tumors in young men. The follow-up of these patients is very important in their management. In stage I testicular cancer, surveillance is the standard for low-risk disease. In addition to the early detection of relapse, follow-up should be directed towards prevention, detection and treatment of late toxicity, and secondary malignancies. Follow up consists in physical examination, laboratory analysis and radiological imaging. Recently, guidelines recommend risk-adapted surveillance strategy, with a reduction of CT scans numbers, due to the recognition of the risk of ionizing radiation exposure. However, efforts to maintain adequate compliance with follow up are required.


Assuntos
Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Embrionárias de Células Germinativas/prevenção & controle , Segunda Neoplasia Primária/diagnóstico , Neoplasias Testiculares/prevenção & controle , Adulto , Humanos , Masculino , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Induzidas por Radiação/diagnóstico , Neoplasias Induzidas por Radiação/prevenção & controle , Cooperação do Paciente , Exposição à Radiação/prevenção & controle , Prevenção Secundária , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Int Heart J ; 60(5): 1091-1097, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484865

RESUMO

Low-voltage computed tomographic angiography (CTA) is a highly effective technique to reduce contrast media volume. We sought to examine the suitability of low tube voltage CTA with a reduced contrast media volume protocol using third-generation 192-slice dual-source CT in patients undergoing transcatheter aortic valve implantation (TAVI). CTA was performed to aid TAVI planning for 40 consecutive patients with severe aortic stenosis. For the first 10 patients (120/100 kV group), we used a conventional tube voltage combined CTA protocol (an ECG-gated helical scan; 120 kV, non-gated helical scan; 100 kV). For the subsequent 30 patients (70-kV group), we adopted a low tube voltage CTA protocol. We evaluated vascular attenuation, image noise, contrast-to-noise ratio (CNR), and renal function. The mean contrast media (CM) volume was 77.7 ± 17.7 mL in the 120/100-kV group and 30.9 ± 6.3 mL in the 70-kV group (P < 0.001). In the images of the aortic valve complex, the mean attenuation was not significant difference for both groups. In the images of the aorto-femoral arteries, mean attenuation was > 250 Hounsfield Units and CNR was > 10 in all vascular segments for both groups. There was no significant difference in the change of renal function in the 70-kV group, but renal function in the 120/100-kV group decreased within 1-3 months after CTA. Low tube voltage CTA using third-generation dual-source CT is suitable to assess procedural planning for TAVI. This approach maintains image quality and reduces the required CM volume.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Doses de Radiação , Exposição à Radiação/prevenção & controle , Substituição da Valva Aórtica Transcateter/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Coortes , Meios de Contraste , Feminino , Seguimentos , Hospitais Universitários , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
16.
J Clin Neurosci ; 69: 265-268, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31473093

RESUMO

Percutaneous pedicle screws have been used in the treatment of thoracolumbar fractures for decades, and conventional fluoroscopy is commonly used to confirm the positions of the Jamshidi needles during the procedure. In this article, a modified method is reported for the placement of Jamshidi needles. The attending surgeons did not receive any radiation during the procedure and the fluoroscopy time for the patients was little. In our method, all six Jamshidi needles were placed on the pedicles and hammered 2 mm into each entry site. When the verification images were acquired, the medical personnel went behind a lead-lined wall. The positions of the needles were first reviewed and adjusted as needed based on the anterior-posterior (AP) image. Then, the C-arm was rotated and lateral images were obtained to further verify the needle placement. The rest of the screw placement procedure remained the same. The proposed technique was applied in 45 patients with thoracolumbar fractures. It took an average (range) of 5 (4-7) single-shot images to ensure all the needles were positioned at the ideal entry site and 12 (10-17) minutes to complete this step. No neurological symptoms were reported by the patients. Using the proposed technique, the radiation exposure for the surgeons is zero, and the patients are well-protected from excessive radiation exposure. This modified method of embedding all the Jamshidi needles at the entry sites before fluoroscopy is an improved technique compared with the conventional method.


Assuntos
Parafusos Pediculares , Exposição à Radiação/prevenção & controle , Radiografia Intervencionista/métodos , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Fluoroscopia/efeitos adversos , Fluoroscopia/métodos , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Radiografia Intervencionista/efeitos adversos , Cirurgia Assistida por Computador/métodos , Vértebras Torácicas
18.
Artigo em Inglês | MEDLINE | ID: mdl-31277315

RESUMO

Sun protective behaviors and physical activity have the potential to reduce cancer risk. Walking is the most common type of physical activity in the United States, but it is unclear whether sun protective behaviors differ by categories of walking, such as leisure versus transportation walking. We examined whether sun protective behaviors varied by category or duration of walking in the 2015 National Health Interview Survey (N = 26,632), age ≥ 18 years. We used logistic regression to estimate sunscreen use, sun avoidance, and sun protective clothing use by four categories of walking (no reported walking, transportation only, leisure only, or walking for both) and separately for walking duration for the general population and sun-sensitive individuals. Prevalence of sunscreen use varied across walking categories and the odds of use were higher with longer walking duration for transportation and leisure compared to those who reported no walking. Sun avoidance varied across walking categories and the odds of avoidance were lower with longer duration leisure but not transportation walking. Sun protective clothing varied across walking categories and the odds of use were higher for longer duration transportation, but not leisure walking. Data on the concurrence of walking and sun protection is needed to further understand the relationship between these health behaviors. By examining leisure and transportation walking, we found variations in sun protective behaviors that may provide important insight into strategies to increase sun protection while promoting physical activity.


Assuntos
Exposição à Radiação/prevenção & controle , Caminhada , Adolescente , Adulto , Idoso , Estudos Transversais , Exercício , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Roupa de Proteção , Luz Solar , Protetores Solares/administração & dosagem , Transportes , Estados Unidos , Adulto Jovem
19.
J Med Radiat Sci ; 66(3): 200-211, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31332961

RESUMO

Uterine artery embolisation (UAE) is an interventional angiography procedure for the treatment of symptomatic fibroids and/or adenomyosis in women. UAE is a less invasive and non-surgical alternative to hysterectomy or myomectomy. However, ionising radiation is used for both fluoroscopic and angiographic image guidance to visualise and access the uterine arteries for embolisation and treatment of these benign conditions. Identifying the contributors and implementing dose reduction techniques are particularly important as UAE patients are usually of child-bearing age. The purpose of this review was to examine the progression of literature on radiation exposure measurements and identifying the factors contributing to the total radiation exposure of female patients undergoing UAE. A Medline, ProQuest Central, ScienceDirect and Scopus database search from 2000 to 2018 was performed and forty articles were deemed acceptable for review following the inclusion and exclusion criteria set. UAE is a viable alternative to hysterectomy and myomectomy, as the reviewed literature demonstrated that the reported radiation exposure doses appear to be below the threshold for any deterministic radiation risks. The total radiation exposure of UAE patients is affected independently by multiple patient, operator expertise and technique, angiographic imaging and x-ray unit variables. Uterus preservation can be attained post-UAE with dose reduction and optimisation, however, a longitudinal study on UAE patients and their risk of radiation-induced deterministic and/or stochastic effects is recommended.


Assuntos
Exposição à Radiação/prevenção & controle , Embolização da Artéria Uterina/efeitos adversos , Angiografia/efeitos adversos , Feminino , Humanos , Doses de Radiação , Embolização da Artéria Uterina/métodos
20.
Diagn Interv Radiol ; 25(4): 257-264, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31213426

RESUMO

PURPOSE: We aimed to assess the utility of dual-energy computed tomography (DECT) imaging in diagnosing acute appendicitis (AA) with density measurements of the appendix vermiformis. METHODS: A total of 210 consecutive patients presenting with acute abdominal pain were scanned using DECT between January and October 2016. Twenty-six patients had pathologically confirmed AA, while 30 had normal appendices. Appendiceal densities were measured in the true axial section of the appendix vermiformis at 80 kVp, 140 kVp, virtual noncontrast, iodine overlay, mixed, and monoenergetic (40, 50, 60, 70, 80, 90, 100 keV) images. RESULTS: Comparison of the appendix at different kVp and keV energy levels, virtual noncontrast, iodine overlay, and mixed images yielded significant differences between patients with appendicitis and those with a normal appendix (P < 0.001 for all). Receiver operating characteristic (ROC) curve analysis revealed that the 80 kVp image set yielded the best diagnostic performance among all image sets (area under the ROC curve [AUC], 0.996; P < 0.001), while 70 keV images yielded the highest diagnostic performance among the virtual monoenergetic image sets (AUC, 0.958; P < 0.001). Inter-rater agreement was good at 80 kVp images (intraclass correlation coefficient [ICC], 0.78, P < 0.001). CONCLUSION: Evaluation of DECT image reconstructions suggested that low tube voltage with 80 kVp demonstrated accurate diagnostic performance for AA. This finding suggests that low kVp CT may be useful for diagnosing AA with reduced patient radiation exposure.


Assuntos
Apendicite/diagnóstico por imagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adulto , Idoso , Apendicite/patologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Exposição à Radiação/prevenção & controle , Interpretação de Imagem Radiográfica Assistida por Computador/métodos
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