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Purpose: The aim of this study was to evaluate the influence of different cone-beam computed tomography (CBCT) acquisition protocols on reducing the effective radiation dose while maintaining image quality. Materials and Methods: The effective dose emitted by a CBCT device was calculated using thermoluminescent dosimeters placed in a Rando Alderson phantom. Image quality was assessed by 3 experienced evaluators. The relationship between image quality and confidence was evaluated using the Fisher exact test, and the agreement among raters was assessed using the kappa test. Multiple linear regression analysis was performed to investigate whether the technical parameters could predict the effective dose. P-values<0.05 were considered to indicate statistical significance. Results: The optimized protocol (3 mA, 99 kVp, and 450 projection images) demonstrated good image quality and a lower effective dose for radiation-sensitive organs. Image quality and confidence had consistent values for all structures (P<0.05). Multiple linear regression analysis resulted in a statistically significant model. The milliamperage (b=0.504; t=3.406; P=0.027), kilovoltage peak (b=0.589; t=3.979; P=0.016) and number of projection images (b=0.557; t=3.762; P=0.020) were predictors of the effective dose. Conclusion: Optimized CBCT acquisition protocols can significantly reduce the effective radiation dose while maintaining acceptable image quality by adjusting the milliamperage and projection images.

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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.

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INTRODUCTION: in general, spine surgeons seek to minimize soft tissue damage by using less invasive approaches, which causes them to use intraoperative images much more frequently than other surgical specialties; therefore, they are at increased risk of radiation exposure. OBJECTIVE: the aim of this work was to analyse the amount of radiation to which the spine surgeon is exposed in different scenarios. MATERIAL AND METHODS: a prospective study with a descriptive, longitudinal non-randomized data source. We carried out this study in the period from 2015 to 2019, the radiologic protection consisted in lead apron, thyroid shield and leaded glasses, there were 10 badge dosimeters. RESULTS: only 4 dosimeters were included in the study, the other six were excluded. During the study period one surgeon suffered thyroid cancer and other suffered of liposarcoma. In the protected group were two surgeons, in the group of aleatory exposition was one surgeon and in the unprotected group was one surgeon. In the study the dosimeter in the unprotected group received more amount of radiation in all the years, we did an inferential analysis per year related with the number of surgeries without significant correlation, we attribute this result because we didn't classified the type of surgery realized by each surgeon. CONCLUSION: we conclude that the spine surgeon must apply the primary methods of radiological protection and that the unprotected spine surgeon receives more amount of radiation in comparison of the protected ones.

INTRODUCCIÓN: en general, los cirujanos de columna buscan minimizar el daño a tejidos blandos empleando abordajes menos invasivos, lo que ocasiona que utilicen imágenes intraoperatorias de una manera mucho más habitual que el resto de las especialidades quirúrgicas; por lo tanto, están en mayor riesgo de exposición de radiación. OBJETIVO: el propósito del trabajo es analizar la cantidad de radiación a la cual está expuesto el cirujano de columna en diferentes escenarios. MATERIAL Y MÉTODOS: estudio prospectivo con una fuente de datos descriptiva, longitudinal, no aleatorizada. Se llevó a cabo el estudio en el período del año 2015 al 2019; la protección radiológica consistió en chaleco plomado, protector de tiroides y lentes plomados; se usaron 10 dosímetros. RESULTADOS: cuatro dosímetros fueron incluidos en el estudio, los otros seis fueron excluidos. Durante el estudio, un cirujano sufrió de cáncer de tiroides y otro de liposarcoma. En el grupo de protegidos se incluyeron dos cirujanos, en el grupo de protección aleatorizada se incluyó un cirujano y en el grupo sin protección se incluyó un cirujano. El dosímetro del grupo sin protección recibió mayor cantidad de radiación en todos los años, se realizó un análisis inferencial por año relacionado con el número de cirugías no encontrando correlación significativa, atribuimos este resultado a que no clasificamos el tipo de cirugía realizada por cada cirujano. CONCLUSIÓN: el cirujano de columna debe de aplicar los métodos primarios de protección radiológica, ya que los cirujanos de columna sin equipo de protección reciben mayor cantidad de radiación en comparación con los protegidos.

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Mycobacterium bovis BCG Moreau is the main Brazilian strain for vaccination against tuberculosis. It is considered an early strain, more like the original BCG, whereas BCG Pasteur, largely used as a reference, belongs to the late strain clade. BCG Moreau, contrary to Pasteur, is naturally deficient in homologous recombination (HR). In this work, using a UV exposure test, we aimed to detect differences in the survival of various BCG strains after DNA damage. Transcription of core and regulatory HR genes was further analyzed using RT-qPCR, aiming to identify the molecular agent responsible for this phenotype. We show that early strains share the Moreau low survival rate after UV exposure, whereas late strains mimic the Pasteur phenotype, indicating that this increase in HR efficiency is linked to the evolutionary clade history. Additionally, RT-qPCR shows that BCG Moreau has an overall lower level of these transcripts than Pasteur, indicating a correlation between this gene expression profile and HR efficiency. Further assays should be performed to fully identify the molecular mechanism that may explain this differential phenotype between early and late BCG strains.

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Resumen: Introducción: en general, los cirujanos de columna buscan minimizar el daño a tejidos blandos empleando abordajes menos invasivos, lo que ocasiona que utilicen imágenes intraoperatorias de una manera mucho más habitual que el resto de las especialidades quirúrgicas; por lo tanto, están en mayor riesgo de exposición de radiación. Objetivo: el propósito del trabajo es analizar la cantidad de radiación a la cual está expuesto el cirujano de columna en diferentes escenarios. Material y métodos: estudio prospectivo con una fuente de datos descriptiva, longitudinal, no aleatorizada. Se llevó a cabo el estudio en el período del año 2015 al 2019; la protección radiológica consistió en chaleco plomado, protector de tiroides y lentes plomados; se usaron 10 dosímetros. Resultados: cuatro dosímetros fueron incluidos en el estudio, los otros seis fueron excluidos. Durante el estudio, un cirujano sufrió de cáncer de tiroides y otro de liposarcoma. En el grupo de protegidos se incluyeron dos cirujanos, en el grupo de protección aleatorizada se incluyó un cirujano y en el grupo sin protección se incluyó un cirujano. El dosímetro del grupo sin protección recibió mayor cantidad de radiación en todos los años, se realizó un análisis inferencial por año relacionado con el número de cirugías no encontrando correlación significativa, atribuimos este resultado a que no clasificamos el tipo de cirugía realizada por cada cirujano. Conclusión: el cirujano de columna debe de aplicar los métodos primarios de protección radiológica, ya que los cirujanos de columna sin equipo de protección reciben mayor cantidad de radiación en comparación con los protegidos.

Abstract: Introduction: in general, spine surgeons seek to minimize soft tissue damage by using less invasive approaches, which causes them to use intraoperative images much more frequently than other surgical specialties; therefore, they are at increased risk of radiation exposure. Objective: the aim of this work was to analyse the amount of radiation to which the spine surgeon is exposed in different scenarios. Material and methods: a prospective study with a descriptive, longitudinal non-randomized data source. We carried out this study in the period from 2015 to 2019, the radiologic protection consisted in lead apron, thyroid shield and leaded glasses, there were 10 badge dosimeters. Results: only 4 dosimeters were included in the study, the other six were excluded. During the study period one surgeon suffered thyroid cancer and other suffered of liposarcoma. In the protected group were two surgeons, in the group of aleatory exposition was one surgeon and in the unprotected group was one surgeon. In the study the dosimeter in the unprotected group received more amount of radiation in all the years, we did an inferential analysis per year related with the number of surgeries without significant correlation, we attribute this result because we didn't classified the type of surgery realized by each surgeon. Conclusion: we conclude that the spine surgeon must apply the primary methods of radiological protection and that the unprotected spine surgeon receives more amount of radiation in comparison of the protected ones.

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Objective: To measure the potential radiation dose emitted by patients who have recently undergone diagnostic nuclear medicine procedures, in order to establish optimal radiation safety measures for such procedures. Materials and Methods: We evaluated the radiation doses emitted by 175 adult patients in whom technetium-99m, iodine-131, and fluorine-18 radionuclides were administered for bone, kidney, heart, brain, and whole-body scans, as measured with a radiation detector. Those values served as the basis for evaluating whole-body radiopharmaceutical clearance, as well as the risk for the exposure of others to radiation, depending on the time elapsed since administration of the radiopharmaceutical. Results: The mean time to clearance of the radiopharmaceuticals administered, expressed as the effective half-life, ranged from 1.18 ± 0.30 h to 11.41 ± 0.02 h, and the mean maximum cumulative radiation dose at 1.0 m from the patients was 149.74 ± 56.72 µSv. Even at a distance of 0.5 m, the cumulative dose was found to be only half and one tenth of the limits established for exposure of the general public and family members/caregivers (1.0 mSv and 5.0 mSv per episode, respectively). Conclusion: Cumulative radiation doses emitted by patients immediately after diagnostic nuclear medicine procedures are considerably lower than the limits established by the International Commission on Radiological Protection and the International Atomic Energy Agency, and precautionary measures to avoid radiation exposure are therefore not required after such procedures.

Objetivo: O objetivo deste trabalho foi levantar o potencial de dose de radiação emitida por pacientes em procedimentos diagnósticos, visando a estabelecer cuidados de radioproteção mais otimizados. Materiais e Métodos: Taxas de dose de radiação emitidas por 175 pacientes administrados com os radionuclídeos 99mTc, 131I e 18F para cintilografias óssea, renal, cardíaca, cerebral e corpo inteiro, foram mensuradas com um detector de radiação, servindo para avaliar o clareamento do radiofármaco no organismo e risco de exposição após administração dos radiofármacos. Resultados: O clareamento, representado pela meia-vida efetiva, variou de 1,18 ± 0,30 h até 11,41 ± 0,02 h e a dose de radiação máxima acumulada oferecida pelos pacientes a 1,0 m foi de 149,74 ± 56,72 µSv. Mesmo para distâncias de 0,5 m, as doses estimadas foram, respectivamente, duas e dez vezes inferiores ao nível de restrição para o público geral (1,0 mSv) e exposição médica (5,0 mSv/episódio). Conclusão: Doses de radiação oferecidas por pacientes em procedimentos diagnósticos são inferiores aos níveis de restrição recomendados pela International Commission on Radiological Protection e International Atomic Energy Agency, e assim, cuidados de radioproteção são geralmente desnecessários.

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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.

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Abstract Objective: To measure the potential radiation dose emitted by patients who have recently undergone diagnostic nuclear medicine procedures, in order to establish optimal radiation safety measures for such procedures. Materials and Methods: We evaluated the radiation doses emitted by 175 adult patients in whom technetium-99m, iodine-131, and fluorine-18 radionuclides were administered for bone, kidney, heart, brain, and whole-body scans, as measured with a radiation detector. Those values served as the basis for evaluating whole-body radiopharmaceutical clearance, as well as the risk for the exposure of others to radiation, depending on the time elapsed since administration of the radiopharmaceutical. Results: The mean time to clearance of the radiopharmaceuticals administered, expressed as the effective half-life, ranged from 1.18 ± 0.30 h to 11.41 ± 0.02 h, and the mean maximum cumulative radiation dose at 1.0 m from the patients was 149.74 ± 56.72 µSv. Even at a distance of 0.5 m, the cumulative dose was found to be only half and one tenth of the limits established for exposure of the general public and family members/caregivers (1.0 mSv and 5.0 mSv per episode, respectively). Conclusion: Cumulative radiation doses emitted by patients immediately after diagnostic nuclear medicine procedures are considerably lower than the limits established by the International Commission on Radiological Protection and the International Atomic Energy Agency, and precautionary measures to avoid radiation exposure are therefore not required after such procedures.

Resumo Objetivo: O objetivo deste trabalho foi levantar o potencial de dose de radiação emitida por pacientes em procedimentos diagnósticos, visando a estabelecer cuidados de radioproteção mais otimizados. Materiais e Métodos: Taxas de dose de radiação emitidas por 175 pacientes administrados com os radionuclídeos 99mTc, 131I e 18F para cintilografias óssea, renal, cardíaca, cerebral e corpo inteiro, foram mensuradas com um detector de radiação, servindo para avaliar o clareamento do radiofármaco no organismo e risco de exposição após administração dos radiofármacos. Resultados: O clareamento, representado pela meia-vida efetiva, variou de 1,18 ± 0,30 h até 11,41 ± 0,02 h e a dose de radiação máxima acumulada oferecida pelos pacientes a 1,0 m foi de 149,74 ± 56,72 µSv. Mesmo para distâncias de 0,5 m, as doses estimadas foram, respectivamente, duas e dez vezes inferiores ao nível de restrição para o público geral (1,0 mSv) e exposição médica (5,0 mSv/episódio). Conclusão: Doses de radiação oferecidas por pacientes em procedimentos diagnósticos são inferiores aos níveis de restrição recomendados pela International Commission on Radiological Protection e International Atomic Energy Agency, e assim, cuidados de radioproteção são geralmente desnecessários.

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Abstract The study aimed to assess the influence of excessive use of a photostimulable phosphor plate (PSP) on the density, image noise, and contrast of radiographs. For that, radiographs of an acrylic block were acquired with a PSP of the Express intraoral system to assess the density and image noise. Initially, five images were obtained and exported (first group). After 400 exposures to X-rays and scannings of PSP, other five images were obtained and exported (second group). The same procedure was done after 800 (third group), 1200 (fourth group), 1600 (fifth group), and 2000 acquisitions (sixth group), resulting in 30 images to be evaluated. The mean and standard deviation of the gray values were calculated for the images using the ImageJ software. For contrast analysis, radiographs of an aluminum step-wedge were acquired with a new PSP following the same acquisition intervals. The percentage of contrast variation was calculated. Another two unused PSP receptors were employed to evaluate the method's reproducibility. The comparison of the results among the acquisition groups was performed with one-way Analysis of Variance (α=0.05). Intraclass Correlation Coefficient (ICC) assessed the reproducibility of the receptors. Image noise did not differ among the groups (p>0.05). There was a slight increase in density after 400 acquisitions and a slight difference in contrast for all acquisition groups without a pattern of increase or decrease (p<0.05). ICC showed excellent reliability for the methods. Therefore, excessive PSP use slightly affected the radiograph's density and contrast.

Resumo Objetivou-se avaliar a influência do uso excessivo de uma placa de fósforo fotoestimulável (PSP) na densidade, ruído e contraste das radiografias. Foram adquiridas radiografias de um bloco de acrílico com uma PSP do sistema intraoral Express para avaliar a densidade e o ruído da imagem. Inicialmente, cinco imagens foram obtidas e exportadas (primeiro grupo). Após 400 exposições aos raios X e escaneamentos, outras cinco imagens foram obtidas e exportadas (segundo grupo). O mesmo procedimento foi feito após 800 (terceiro grupo), 1200 (quarto grupo), 1600 (quinto grupo) e 2000 aquisições (sexto grupo), resultando em 30 imagens a serem avaliadas. A média e o desvio padrão dos valores de cinza foram calculados para as imagens usando o software ImageJ. Para análise de contraste, foram adquiridas radiografias de uma escala de alumínio com uma nova PSP seguindo os mesmos intervalos de aquisição. A porcentagem de variação do contraste foi calculada. Outras duas PSP sem uso prévio foram utilizadas para avaliar a reprodutibilidade dos métodos. A comparação dos resultados entre os grupos de aquisição foi realizada pela Análise de Variância one-way (α=0,05). O Coeficiente de Correlação Intraclasse (ICC) avaliou a reprodutibilidade dos receptores. O ruído da imagem não diferiu entre os grupos (p>0,05). Houve um leve aumento na densidade após 400 aquisições e uma pequena diferença no contraste para todos os grupos de aquisição sem padrão de aumento ou diminuição (p<0,05). O ICC mostrou excelente confiabilidade para os métodos. Portanto, o uso excessivo da PSP afetou levemente a densidade e o contraste radiográfico.

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SUMMARY OBJECTIVE: This study aimed to determine the role of magnetic resonance imaging in minimizing radiation exposure, especially in the follow-up of pulmonary nodules. METHODS: Patients who applied to our hospital between April 2013 and August 2018 for various reasons and had lung-mediastinal dynamic magnetic resonance imaging and thoracic computed tomography were included in the study. A total of 194 patients were included in the study, involving 84 females and 110 males. Scanning of the nodules was done retrospectively. This study was conducted by two readers: a thoracic radiologist with 15 years of experience and a nonspecific radiologist with 4 years of experience. Evaluations were made using the double-blind method. RESULTS: Of the 194 patients, 84 (43.3%) were female and 110 (56.7%) were male. For the first reader, 135 (69.5%) nodules were detected in postcontrast T1 vibe images, 130 (67%) in T2 fast spin echo, 128 (66%) in precontrast T1 vibe, and 98 (50.5%) in T2 turbo inversion recovery magnitude sequence. For the second reader, 133 (68%) nodules were detected in postcontrast T1 vibe images, 120 (61.9%) in T2 fast spin echo, 122 (62.9%) in precontrast T1 vibe, and 99 (51%) in T2 turbo inversion recovery magnitude sequence. Capability levels were examined in detecting nodules between the first and second readers, and the ratios were reached at 0.92 in T2 fast spin echo, 0.81 in postcontrast T1 vibe images, 0.93 in precontrast T1 vibe, and 0.96 in T2 turbo inversion recovery magnitude sequence. CONCLUSION: In this study of detecting pulmonary nodules by magnetic resonance imaging, which we performed with two different readers, one of whom was an experienced thoracic radiologist, both readers found the highest detection rate in the postcontrast T1 vibe sequence.

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Objective The present study aims to understand the perceptions of orthopedists and traumatologists regarding the risk of exposure to ionizing radiation in fluoroscopy procedures. Methods An objective, structured, self-administered questionnaire with sociodemographic, professional, and occupational variables was developed, available through an invitation sent to orthopedist physicians whose contacts were made publicly available. Results A total of 141 questionnaires were answered and analyzed. Most respondents (99%) use fluoroscopy in their surgeries, and only 34.8% of the participants feel safe with the use of the equipment. It was observed that the knowledge about ionizing radiation is inadequate, because 22.6% of the participants are unaware of the type of radiation emitted in fluoroscopy and its biological effects. In addition, 52% of the participants did not know or do not understand the principles of radiological protection and their relationship with surgical practices. Conclusion We concluded that the radiological protection of most orthopedists in surgical procedures is inadequate, and initial and continued training programs of professionals are necessary, bringing health benefits to orthopedists and their patients.

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Abstract Objective The present study aims to understand the perceptions of orthopedists and traumatologists regarding the risk of exposure to ionizing radiation in fluoroscopy procedures. Methods An objective, structured, self-administered questionnaire with sociodemographic, professional, and occupational variables was developed, available through an invitation sent to orthopedist physicians whose contacts were made publicly available. Results A total of 141 questionnaires were answered and analyzed. Most respondents (99%) use fluoroscopy in their surgeries, and only 34.8% of the participants feel safe with the use of the equipment. It was observed that the knowledge about ionizing radiation is inadequate, because 22.6% of the participants are unaware of the type of radiation emitted in fluoroscopy and its biological effects. In addition, 52% of the participants did not know or do not understand the principles of radiological protection and their relationship with surgical practices. Conclusion We concluded that the radiological protection of most orthopedists in surgical procedures is inadequate, and initial and continued training programs of professionals are necessary, bringing health benefits to orthopedists and their patients.

Resumo Objetivo Este estudo visa compreender as percepções dos médicos ortopedistas e traumatologistas em relação ao risco da exposição à radiação ionizante nos procedimentos de fluoroscopia. Métodos Desenvolveu-se um questionário objetivo, estruturado, autoaplicável e com variáveis sociodemográficas, profissionais e ocupacionais, disponibilizado através de convite enviado a médicos ortopedistas cujos contatos estavam disponibilizados publicamente. Resultados Foram respondidos e analisados 141 questionários. A maioria dos respondentes (99%) utilizam a fluoroscopia em suas cirurgias, e apenas 34,8% dos participantes se sentem seguros com o uso do equipamento. Observou-se que o conhecimento sobre radiação ionizante é inadequado, pois 22,6% dos respondentes desconhecem o tipo de radiação emitida na fluoroscopia e seus efeitos biológicos. Além disso, 52% dos respondentes não conhecem ou não compreendem os princípios de proteção radiológica e suas relações com as práticas cirúrgicas. Conclusão Conclui-se que a proteção radiológica da maioria dos ortopedistas nos procedimentos cirúrgicos é inadequada e são necessários programas de formação inicial e continuada dos profissionais, trazendo benefícios para a saúde dos ortopedistas e de seus pacientes.

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Objectives.To optimize the absorbed organ dose in relation to the field of view for temporomandibular joint examinations in four cone beam computed tomography devices.Methods.An anthropomorphic adult head and neck phantom, and 192 LiF dosimeters (TLD-100) were used. The dosimeters were placed in the region corresponding to the lens, parotid glands, submandibular glands, and thyroid. Small, medium and large FOVs were selected on Orthopantomograph OP300 Maxio, PaX-i3D Smart, ORTHOPHOS XG, and i-CAT Next Generation device when it was possible.Results.A wide range of absorbed dose values was recorded for all organs due to the different exposure parameters of each device. The radiosensitive organ with the highest dose was the parotid glands. The devices with 5 × 5 cm FOV recorded a lower dose in this protocol, while for the device without a small FOV (≤5 × 5 cm), the lowest dose was observed with the large FOV (6 × 16 cm).Conclusions.We recommend a double exposure with an FOV of 5 × 5 cm in the OP300 Maxio, PaX-i3D Smart, and ORTHOPHOS XG device, while in the i-CAT Next Generation device, a single exposure FOV of 6 × 16 cm is indicated.

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ABSTRACT Objective To estimate the amount of radiation received and accumulated in the bodies of two surgeons, one being the responsible surgeon and the other the assistant, performing spine surgery procedures over a period of 25 years. Methods Seventy-two spinal surgeries were performed during a seven-month period and the radiation loads were measured in both surgeons. The measurement of radiation was captured in fluoroscopy in anteroposterior and lateral incidences. The surgeon and the assistant used two dosimeters, one in the cervical region protecting the thyroid and the other on the lead apron in the genital region. The radioactive loads were measured in millisieverts and the accumulated charges were recorded monthly in both regions of the body in the two surgeons for seven months and the means for the work periods (1, 5, 10, 15, 20 and 25 years) were estimated. Results It was observed that in the surgeon the average accumulated radiation loads were 131.9% and 176.92% higher than those of the assistant in the cervical and genital regions, respectively. Conclusion While the use of X-rays is indispensable in routine orthopedic surgery, we have to consider the development of techniques of protection, rigor and discipline in the use of safety materials for surgeons. Preventive exposure reduction measures such as using thyroid protection equipment and turning the head away from the patient during fluoroscopy, among others, should be mandatory to promote less radiation exposure. Level of evidence II; Comparative prospective study.

RESUMO Objetivo Estimar a quantidade de radiação recebida e acumulada no corpo de dois cirurgiões, durante período de 25 anos de trabalho, sendo um o cirurgião responsável e outro, assistente, nos procedimentos de cirurgia da coluna vertebral. Métodos Foram realizadas 72 cirurgias de coluna vertebral em um período de sete meses, e as cargas de radiação foram medidas nos dois cirurgiões. A medição da radiação foi captada em fluoroscópio nas incidências anteroposterior e de perfil. O cirurgião e o auxiliar utilizaram dois dosímetros, sendo um na região cervical protegendo a tireoide e outro sobre o avental de chumbo, na região genital. As cargas radioativas foram medidas em milisievert e as cargas acumuladas foram registradas mensalmente em ambas as regiões do corpo nos dois cirurgiões, durante sete meses, foram estimadas as médias no período (1, 5, 10, 15, 20 e 25 anos) de trabalho. Resultados Observou-se que no cirurgião as médias das cargas de radiação acumulada foram 131,9% e 176,92% superiores às do assistente nas regiões cervical e genital, respectivamente. Conclusão Enquanto o uso dos raios X for indispensável na rotina da cirurgia ortopédica, há de se considerar o desenvolvimento de técnicas de proteção, rigor e disciplina no uso materiais de segurança para os cirurgiões. Medidas preventivas de redução da exposição, como uso de equipamento para proteção da tireoide e girar a cabeça para se afastar do paciente durante a fluoroscopia, entre outras, devem ser obrigatórias para promover menor exposição à radiação. Nível de evidência II; Estudo prospectivo comparativo.

RESUMEN Objetivo Estimar la cantidad de radiación recibida y acumulada en el cuerpo de dos cirujanos, durante 25 años de trabajo, siendo uno el cirujano responsable y el otro, asistente, en los procedimientos de cirugía de columna vertebral. Métodos Se realizaron 72 cirugías de columna vertebral en un período de siete meses, y las cargas de radiación fueron medidas en los dos cirujanos. La medición de la radiación fue captada en fluoroscopio en las incidencias anteroposterior y de perfil. El cirujano y el auxiliar usaron dos dosímetros, siendo uno en la región cervical protegiendo la tiroides y otro sobre el delantal de plomo, en la región genital. Las cargas radiactivas se midieron en milisievert, y las cargas acumuladas se registraron mensualmente en ambas regiones del cuerpo, en los dos cirujanos, durante siete meses, y se estimaron los promedios durante el período (1, 5, 10, 15, 20 y 25 años) de trabajo. Resultados Se observó que en el cirujano los promedios de las cargas de radiación acumulada fueron de 131,9% y 176,92% superiores a las del asistente en las regiones cervical y genital, respectivamente. Conclusión Mientras el uso de rayos X sea indispensable en la rutina de la cirugía ortopédica, hay que considerar el desarrollo de técnicas de protección, rigor y disciplina en el uso de materiales de seguridad para los cirujanos. Las medidas preventivas de reducción de la exposición, como uso de equipamiento para protección de la tiroides y girar la cabeza para alejarse del paciente durante la fluoroscopia, entre otras, deben ser obligatorias para promover menor exposición a la radiación. Nivel de evidencia II; Estudio prospectivo comparativo.

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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)

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BACKGROUND: This study aims to assess orthopaedic surgeon knowledge in Brazil about ionizing radiation and its health implications on surgical teams and patients. METHODS: A 15-question survey on theoretical and practical concepts of ionizing radiation was administered during the 23rd Brazilian Orthopaedic Trauma Association annual meeting. The survey addressed issues within orthopedic surgery, such as radiation safety concepts, protection, exposure, as well as the participant gender. Participants were either orthopedic surgeons or orthopedic surgery residents working at institutions in Brazil. RESULTS: One thousand surveys were distributed at the moment of the meeting registration, and 258 were answered completely (25.8% response rate). Only 5.8% of participants used basic radiation protection equipment; 47.3% used a dosimeter; 2.7% reached the annual maximum permissible radiation dose; 10.5% knew the period of increased risk to fetal gestation; 5.8% knew the maximum permissible radiation dose during pregnancy; 58.5% knew that the hands, eyes, and thyroid are the most exposed areas and at greater risk of radiation-related lesions; 25.2% knew the safe distance from a radiation-emitting tube is 3 m or more; 44.2% knew the safest positioning of the radiation-emitting tube; 25.2% knew that smaller tubes emit greater radiation at the entrance dose to magnify the image; and 55.4% knew that the surgery team receives more scattered radiation in surgical procedures performed on obese patients. CONCLUSION: This study revealed inadequate theoretical and practical knowledge about radiation exposure among orthopaedic surgeons in Brazil. Only a minority of orthopaedic surgeons used basic radiation protection equipment. No significant differences in knowledge were found when comparing all orthopedic surgery specialties. Our findings indicate an urgent need for education to increase knowledge among orthopaedic surgeons about the hazards of ionizing radiation. Personal protection and implementation of the ALARA (as low as reasonably achievable) protocol in daily practice are important behaviors to prevent the harmful effects of ionizing radiation.

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Objetivo: Determinar los conocimientos y hábitos de exposición solar en comerciantes ambulantes alrededor de un mercado de Chiclayo. Métodos: Se aplicó un cuestionario a 291 comerciantes ambulantes ubicados alrededor del mercado Modelo de Chiclayo, que evaluaron los hábitos de exposición solar, medidas de foto protección, antecedentes de quemaduras solares y cáncer de piel, asi como conocimientos de radiación ultravioleta y fuentes de información. Resultados: Las edades fueron, 18-25 (42,3%), 36-54 (38,1%), 55 -78 (19,6%). En nivel de educación, el 13,1% tiene primaria completa, el 32,6% tiene secundaria completa y el 8,2% superior completa. Al momento del estudio el 71,9% llevaban más de 3 años trabajando como comerciantes ambulantes. Los fototipos de los participantes fueron fototipo I (0,3%), fototipo II (4,5%), fototipo III (24,7%), fototipo IV (48,8%), fototipo V (19,6%), fototipo VI (2,15). Un 90 ± 3,5% reconoce que causa cáncer de piel, un 53,6% reconoce que una característica del envejecimiento de la piel por radiación son las manchas y verrugas, un 56% respondió que la radiación solar causa cataratas, un 52,92% respondió que la gente de piel blanca es más sensible a los rayos del sol. Un 48,5% de ellos declararon exponerse más de 6 horas a los rayos solares, un 24,7% se expone de 3 ­ 6 horas al día, mientras que el 8,6% registraron el menor tiempo de exposición solar (0 ­ 2 horas). El 75,3% no utiliza bloqueador solar. Conclusión: Los conocimientos y hábitos de exposición solar en los comerciantes ambulantes son de regular a adecuado y los hábitos deficientes.

Objective: To determine the knowledge and habits of solar exposure in street vendors around a Chiclayo market. Methods: A questionnaire were applied to 291 street vendors located around the Chiclayo Model market, who evaluated the habits of sun exposure, photo protection measures, a history of sunburn and skin cancer, as well as knowledge of ultraviolet radiation and sources of information. Results: The ages were, 18-25 (42.3%), 36-54 (38.1%), 55 -78 (19.6%). At the educational level, 13.1% have a complete primary, 32.6% have a complete secondary and 8.2% have a complete superior. At the time of the study, 71.9% had been working as street vendors for more than 3 years. The phototypes of the participants were phototype I (0.3%), phototype II (4.5%), phototype III (24.7%), phototype IV (48.8%), phototype V (19.6%) , phototype VI (2.15). 90 ± 3.5% recognize that it causes skin cancer, 53.6% acknowledge that a characteristic of skin aging by radiation is spots and warts, 56% answered that solar radiation causes cataracts, 52.92% He replied that white-skinned people are more sensitive to the sun's rays. 48.5% of them declared that they were exposed to sunlight for more than 6 hours, 24.7% were exposed to 3-6 hours a day, while 8.6% had the shortest time of sun exposure (0 - 2 hours). 75.3% do not use sunscreen. Conclusion: The knowledge and habits of sun exposure in street traders are from fair to adequate and poor habits.

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SUMMARY OBJECTIVE Our aim is to determine whether radiation affects the endothelial function of hospital staff working in the radiation unit for diagnostic and therapeutic purposes. We have evaluated endothelial function with vascular imaging parameters such as flow-mediated dilatation (FMD) and aortic stiffness index (ASI). METHODS A total of 75 employees, 35 of whom are exposed to radiation due to their profession and 40 as the control group, were included in our single-centered study. Demographic data, FMD, aortic stiffness, and echocardiographic findings of the two groups were compared. RESULTS There were no significant differences in demographic data. Median FMD values tended to be lower in the radiation exposure group [7.89 (2.17-21.88) vs. 11.69 (5.13-27.27) p=0.09]. The FMD value was significantly lower in the catheter laboratory group than in the radiation-exposed (p=0.034) and control (p=0.012) groups. However, there was no statistically significant difference between the non-catheter lab radiation exposed group and the control group (p=0.804). In addition, there was no statistically significant difference in the ASI value between the groups (p=0.201). CONCLUSION We have found that FMD is decreased among hospital staff working in radiation-associated areas. This may be an early marker for radiation-induced endothelial dysfunction.

RESUMO OBJETIVO O nosso objetivo é determinar se a radiação afeta a função endotelial de funcionários do hospital que trabalham em unidades com exposição à radiação para fins diagnósticos e terapêuticos. Avaliamos a função endotelial com parâmetros de imagens vasculares, tais como dilatação fluxo-mediada (FMD) e o índice de rigidez aórtica (ASI). METODOLOGIA Um total de 75 funcionários, 35 expostos à radiação devido à sua ocupação e 40 como grupo de controle, foram incluídos em nosso estudo monocêntrico. Os dados demográficos, de FMD, rigidez aórtica e ecocardiográficos dos dois grupos foram comparados. RESULTADOS Não houve diferenças significativas nos dados demográficos. Os valores médios de FMD, em geral, foram mais baixos no grupo de exposição à radiação [7,89 (2,17-21,88) e 11,69 (5,13-27,27) p=0,09]. O valor de FMD foi significativamente menor no grupo laboratorial com cateter do que no exposto à radiação (p=0,034) e no de controle (p=0,012). No entanto, não houve diferença estatisticamente significativa entre o grupo laboratorial sem cateter e exposto à radiação e o grupo de controle (p=0,804). Além disso, não houve diferença estatisticamente significativa quanto ao valor de ASI entre os grupos (p=0,201). CONCLUSÃO Observamos que a FMD é menor entre funcionários que trabalham em setores hospitalares associados à radiação. Isso pode ser um marcador inicial de disfunção endotelial induzida por radiação.

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