Actualización en equipos de Rayos X portátiles en odontología: revisión de literatura / Update on Hand-Held X-Ray Devices in Dentistry: a Literature Review

Resumen En las últimas dos décadas ha aumentado el uso de equipos portátiles de rayos X intraorales, los cuales son estabilizados por el operador. Si bien todos los equipos radiográficos presentan un riesgo inherente por el uso de radiación ionizante, el uso indebido de los equipos portátiles puede aumentar la exposición del operador. Se recomienda el uso de los equipos portátiles en un trípode o activados desde un área protegida. Sin embargo, en casos altamente justificados para su uso sin estos aditamentos, se debe seguir recomendaciones para disminuir la exposición del operador. Debido a que la radioprotección es fundamental al trabajar con rayos X, se debe favorecer el uso de equipos radiográficos dentales fijos sobre los equipos portátiles, ya que estos proporcionan una menor dosis de radiación al operador.

Abstract In the last two decades, the use of portable intraoral X-ray devices, stabilized by the operator, has increased. While all radiographic devices present an inherent risk from ionizing radiation, improper use of portable devices can increase operator exposure. Use of portable devices on a tripod or powered from a protected area is recommended. However, in highly justified cases, for using without these accessories, recommendations should be followed to reduce operator exposure. Because radioprotection is essential when using X-rays, fixed dental radiographic devices should be favored over portable equipment since the first provides a lower radiation dose to the operator.

Descripción de elementos de radioprotección y dosimetría en unidades de cardiología intervencionista sudamericanas: un estudio piloto / Radioprotection and dosimetry in Interventional cardiology units in South America. a pilot study

ANTECEDENTES: Las unidades de Cardiología intervencional han evidenciado un número creciente de procedimientos, cada vez más variados y complejos, lo cual podría eventualmente generar daños a los profesionales ocupacionalmente expuestos a radiaciones ionizantes (POEs) de no contar con los adecuados elementos de radioprotección y un uso correcto de ellos. OBJETIVO: Caracterizar la disponibilidad y utilización de los elementos de radioprotección y dosimetría de unidades de cardiología intervencionista de centros Sudamericanos. MATERIAL Y MÉTODOS: Se realizó una encuesta autoaplicada a 139 POEs, de ambos sexos de 7 países, a través de una plataforma on-line, se les consultó sobre características demográficas, dosimétricas y de radioprotección. RESULTADOS: Los elementos de radioprotección más tradicionales; delantales y cuellos plomados se utilizaron un 99,5 % y 98,4 % respectivamente, aquellos elementos más recientes como gafas, gorros y paños plomados solo alcanzaron un 36,8 %, 6,8 % y 34,2%, de utilización respectivamente, en cuanto a la utilización de los dosímetros, solo un 7,9 % lo hace apegado a las normas de la Organización Internacional de Energía Atómica (OIEA). CONCLUSIÓN: Se constató en la muestra analizada una falta de elementos de radioprotección y un uso inadecuado de ellos, urge realizar intervenciones educativas y técnicas para mejorar estos datos.

BACKGROUND: Due to the increasing number of interventional cardiology procedures currently performed, health professionals (POE) are exposed to ionizing radiation unless adequate protective elements are used. AIM: to describe the use of radioprotection elements and dosimetry in interventional cardiology laboratories in South America. METHODS: A self-administered survey was performed on 139 POE of both sexes and 7 countries using an online platform. Demographic data, dosimetry and characteristics of radioprotection analyzed. RESULTS: Commonly used radioprotective elements (lead aprons and collars) were used in 99.5% and 98% respectively. Recently introduced protection elements like lead goggles, caps and drapery were used in 36.8, 6.8 and 34.2% , respectively. Dosimetry according to the International Atomic Energy Commission (OIAE) was performed in only 7.9% of the procedures. CONCLUSION: there is a severe lack of adequate radioprotection during interventional cardiology procedures. Urgent measures, including technical implementation and educational interventions are needed to improve radioprotection in interventional cardiology.

Determination of X-ray shielding thickness in two tertiary hospitals in Kano metropolis, Nigeria

Background: Radiation dose depends on the total workload (Wtot) which is affected by the number of patients, tube potential, and tube current. Despite the increment in patients visiting the X-ray units under study and X-ray tube revolutions, changes have not been made in the shielding material to suit the current situation. Aims: This study aims to evaluate the thickness of X-ray shielding barriers in two tertiary hospitals in Kano Metropolis using XRAYBAR software. Materials and Methods: This was a prospective, cross-sectional study and was undertaken from March 2017 to October 2017. A purposive sampling technique was employed to select two hospitals out of five. The two were named A and B, respectively. The minimum required thickness in each barrier was determined by XRAYBAR software. Results: The Wtot (workload) for room I, II and III was found to be 199.9, 146, and 149.1 mA-min per week. The shielding barrier thickness required to reduce the unshielded radiation dose to the design dose limit for wall 1, 2, 3, 4, and operating console of the Room I was found to be 17.5, 5.5, 0.2, 0.00, 3.3 cm, that of wall 1, 2, 3, and 4 of room II was found to be 9.1, 3.4, 0.02, 2.3 cm, while for the wall 1, 2, 3, 4, and operating console of room III was found to be 12.3, 4.8, 3.8, 3.2, and 26.5 cm, respectively. Conclusion: The calculated shielding barrier thickness from XRAYBARR code when compared to the design barrier thickness was found to be adequate

¿Es eficiente la protección anti-radiación otorgada por gorros de pabellón de tungsteno-bismuto en cardiología intervencionista? / Radiation protection provided by tungsten bismuth caps during interventional cardiology

Background: The effectiveness against radiation of tungsten bismuth caps, used in interventional cardiology is not well known. Aim: To determine the degree of radiation protection conferred by these caps in real work conditions. Material and Methods: We compared the gross electric charges received at brain lobe levels by three occupationally exposed professionals who participated in 22 consecutive procedures, inside and outside of the tungsten bismuth cap. Results: The median electric charges outside and inside the cap were 3.71 (range 1.46-5.62) and 2.2 (range 1.29-3.93) nC, which correspond to a 40% radiation attenuation. However, the protection was heterogeneous. Conclusions: Tungsten bismuth caps provide an adequate attenuation, but its degree is heterogeneous.

PREFACE: How Dangerous Are X-ray Studies That We Undertake Every Day?

No abstract available.

¿Es suficiente la protección otorgada por gafas plomadas en cardiología intervencionista? / Protection against ionizing radiation by leaded glass googles during interventional cardiology

Background: It is not known whether leaded glass goggles with 0.25 mm Pb equivalency, used in interventional cardiology procedures, attenuate radiation below the levels established by the latest recommendation of the International Commission on Radiological Protection (ICRP). Aim: To assess ifthe degree of attenuation of the secondary ionizing radiation achieved by the use of 0.25 mm Pb leaded glass goggles, in occupationally exposed workers in interventional cardiology procedures, meets the latest ICRP recommendations. Material and Methods: A prospective investigation was carried out to compare the eye exposure to secondary ionizing radiation received by occupationally exposed personnel in a 9 months period. A set of two thermo luminescent dosimeters was arranged in the front and back of leaded glass goggles in a cohort ofseven members of an interventional cardiology service, exposed to 1057 consecutive procedures. Results: The monthly dose equivalent measurement performed in front ofthe goggles ranged between 1.1 and 6.5 mSv, for paramedics and interventional cardiologists. The radiation measured in the back of the glass varied between 0.66 and 2.75 mSv, respectively. The degree of attenuation of the dose at eye level ranged from 40% to 57.7%, respectively. The projected annual exposure would reach 33 mSvfor the interventional cardiologist. Conclusions: With a similar load ofwork and wearing 0.25 mm Pb equivalent glass goggles, interventional cardiologists will exceed the crystalline equivalent dose limit recommended by the ICRP (20 mSv/year averaged over the past 5 years).

As normas de radioproteção e o uso dos equipamentos de proteção individual na concepção dos cirurgiões-dentistas / Radioprotection norms and the use of individual protection equipments from the view of surgeon-dentists

Mesmo reconhecendo a existência das normas, a maior parte dos profissionais de odontologia não demonstra perceber a necessidade justa e precisa de esclarecimento. A falta de percepção expõe a vários problemas como falta de informação sobre a necessidade de realização de exames médicos periódicos dos profissionais, falta de conhecimento na correta utilização do equipamento de raios X, desconhecimento da necessidade de calibração periódica do aparelho de raios X, ineficiência no cumprimento das normas de radioproteção, uso inadequado do equipamento de proteção individual (EPI) e ausência de um manual de normas das atividades profissionais. Com bases nesses resultados, pode-se chegar à conclusão de que os cirurgiões-dentistas não detêm o conhecimento necessário sobre as normas de radioproteção e da correta utilização do EPI. Assim, acredita-se que a implementação do programa de educação continuada a partir da realidade do profissional de odontologia forneça os meios para resolução de problemas crônicos detectados neste estudo no cumprimento das exigências das normas de radioproteção e afins, proporcionando manuseio seguro do equipamento de raios X no consultório odontológico.

ABSTRACT Although the odontology professional recognizes the existence of norms most of them had not demonstrated to perceive the fair and precise need of clarification. The perception lack displays to some problems as: lack of information on the necessity of accomplishment of periodic medical examinations of the professionals, lack of knowledge in the correct use of the equipment of rays-x, unfamiliarity of the necessity of periodic calibration of the device of rays-x, the inefficiency in the fulfilment of the radiation protection norms, the inadequate use of the equipment of individual protection (EPI) and absence of a manual of norms of the professional activities. Based in these results it can be concluded that the surgeon-dentists do not withhold the necessary knowledge on the norms of radiation protection and the correct use of the equipment of individual protection. Thus the implementation of a continued education program based on the reality of the dentist professional will be able to solve chronic problems identified in this study in the fulfilment of the requirements of the similar norms of radiation protection, and providing safe manuscript of the equipment of rays-x in the dentistry offices.

Sistema on-line para o cálculo de doses fetais de pacientes e trabalhadoras ocupacionalmente expostas em radiologia diagnóstica / On-line software for the estimation of fetal radiation dose to patients and staff members in diagnostic radiology

Neste trabalho descrevemos um sistema on-line, chamado “Dose Fetal Web”, que calcula a dose fetal e os riscos radiológicos devido a exposições clínicas ou ocupacionais de gestantes. O sistema utiliza a metodologia matemática onde são usados coeficientes de conversão de dose uterina para dose fetal, gerados por meio de simulações pelo método de Monte Carlo. Para exposição médica de uma paciente gestante, uma base de dados de informações de operação de equipamentos acompanhados por um programa de garantia de qualidade e parâmetros fetais e maternos coletados durante exames de ultrassonografia obstétrica são incorporados na estimativa da dose fetal. No caso de dose fetal de uma trabalhadora gestante sujeita à exposição ocupacional (IOE),informações de uma base de dados de monitoração pessoal como dose ocupacional e carga de trabalho são usadas nos cálculos. No primeiro caso, considerando-se uma paciente gestante de 26 semanas submetida a um procedimento abdominal AP (tensão aplicada ao tubo de 70 kVp e filtração total de 3 mmAl), a dose fetal calculada pelo sistema foi 4,61 mGy e os riscos radiológicos obtidos foram 5,0·10-4 e 0,14 para a probabilidade de indução de retardamento mental e declínio de pontos de QI, respectivamente. No segundo caso, considerando-se uma IOE gestante, e assumindo-se que ela utilize um avental de proteção de 0,5 mm de equivalência em chumbo durante cada procedimento de radiologia intervencionista, e que a leitura pessoal de um dosímetro TLD portado fora do avental foi de 2 mGy/mês, a dose fetal calculada pelo sistema foi 0,02 mSv/mês.

In this paper we describe an online software, named “Dose Fetal Web”, which calculates the dose of the fetus and the radiological risks from both medical and occupational exposures of pregnant women. The software uses a mathematical methodology where coefficients for converting uterus to fetal dose, NUD, have been calculated by using Monte Carlo simulation. In the fetal dose from diagnostic medical examination of the pregnant patient, database information regarding output and other equipment related parameters from the QA database, maternal and fetal parameters collected by ultrasound procedures were used for the fetal dose estimation. In the case of fetal dose of the pregnant staff member the database information regarding routine individual monitoring dosimetry, such as occupational dose and workload, were used for the estimation. In the first case, suppose a 26 weeks pregnant patient had to undergo a single AP Abdomen procedure (70 kVp peak tube voltage and total filtration 3 mmAl), the fetal dose calculated by the software was 4.61 mGy and the radiological risks would be 5.0·10-4 and 0.14 to the probability of mental retardation induction and decline in the IQ score, respectively. In the second case,considering that the staff member can be pregnant, and assuming that she wore a 0.5 mm lead equivalent apron during every interventional radiology procedure and a personal dosimetry reading of 2 mGyTLD/month measured with the TLDs outside the apron, the fetal dose calculated by the software was 0.02 mSv/month.

Radiation dose to medical staff in interventional radiology.

OBJECTIVE: The purposes of the present study were to determine the dose to medical staff in interventional radiology at different locations on the body measured by thermoluminescent dosimeter (TLD) and to relate the medical staff dose to patient dose measured by the dose-area product (DAP) meter. MATERIAL AND METHOD: The present study covered 42 patients in three interventional radiology procedures with three x-ray machines. Thermoluminescent dosimeters were stuck at eight positions on the radiologist's skin during the procedure. In addition, direct reading from the DAP meter placed in front of the collimator of the x-ray tube, was recorded to estimate the patient radiation dose. RESULTS: The surface dose to the primary radiologist showed maximum value at the left forearm of 407 microGy. The ratios between the maximum interventional radiologist surface dose and patient dose are 12.88 microGy per 10 Gycm2 for transarterial oily chemoembolization TOCE (Siemens Polystar), 22.58 microGy per 10 Gycm2 for transarterial oily chemoembolization TOCE (Siemens Neurostar), 148.29 microGy per 10 Gycm2 for percutaneous transhepatic biliary drainage PTBD (Siemens Polystar) and 100.46 microGy per 10 Gycm2for endoscopic retrograde cholangiopancreatography ERCP (GE Advantx). CONCLUSION: The interventional radiologist surface dose can be estimated from the mentioned ratio if the patient dose is measured. This will help the radiologists to avoid receiving an excess dose during their work.

Avaliaçäo do controle de qualidade e proteçäo radiológica na cidade do Rio de Janeiro / Evaluation of quality control and radiologic protection in Rio de Janeiro city

O objetivo deste trabalho foi avaliar as etapas da aquisiçäo das radiografias periapicais realizadas pelos cirurgiöes-dentistas da cidade do Rio de Janeiro, visando um controle de qualidade. Elaborou-se um questinonário para verificar aparelhos de raios X, filmes, materiais, técnicas e processamento empregados com 53 profissionais participando da pesquisa. Analisou-se os resultados por meio de tabelas de frequëncia absolutas e relativas. Apesar de algumas respostas satisfatórias, outras merecem atençäo, demonstrando a necessidade de uma maior divulgaçäo das normas atuais

Radiación ionizante secundaria generada en equipos de cineangiografía coronaria digital y analógica: influencia de los sistemas externos de protección radiológica / Secondary ionizing radiation generated by analog and digital coronary cineangiographic equipment: influence of external protection devices

Background: Exposure to ionizing radiation is a known hazard of radiological procedures. Aim: To compare the emission of secondary ionizing radiation from two coronary angiographic equipments, one with digital and the other with analog image generation. To evaluate the effectiveness of external radiological protection devices. Material and methods: Environmental and fluoroscopy generated radiation in the cephalic region of the patient was measured during diagnostic coronary angiographies. Ionizing radiation generated in anterior left oblique projection (ALO) and in anterior right oblique projection (ARO) were measured with and without leaded protections. In 19 patients (group 1), a digital equipment was used and in 21 (group 2), an analog equipment. Results: Header radiation for groups 1 and 2 was 1194 ñ 337 and 364 ñ 222 µGray/h respectively (p<0.001). During fluoroscopy and with leaded protection generated radiation for groups 1 and 2 was 612 ñ 947 and 70 ñ 61 µGray/h respectively (p<0.001). For ALO projection, generated radiation for groups 1 and 2 was 105 ñ 47 and 71 ñ 192 µGray/h respectively (p<0.001). During filming the radiation for ALO projection for groups 1 and 2 was 7252 ñ 9569 and 1671 ñ 2038 µGray/h respectively (p = 0.03). Out of the protection zone, registered radiation during fluoroscopy for groups 1 and 2 was 2800 ñ 1741 and 1318 ñ 954 µGray/h respectively (p < 0.001); during filming, the figures were 15500 ñ 5840 and 18961 ñ 10599 µGray/h respectively (NS). Conclusions: Digital radiological equipment has a lower level of ionizing radiation emission than the analog equipment

Discussäo das diretrizes de proteçäo radiológica em radiodiagnóstico médico e odontológico / Discussion of the radiation protection guidelines in medical and dental radiodiagnostics

Os autores se propöem a discutir os principais itens das Diretrizes de Proteçäo Radiológica em Radiodiagnóstico Médico e odontológico (versäo 2.1 "draft" - fevereiro/98) do Ministério da Saúde. Essas Diretrizes fazem parte da política nacional de proteçäo à saúde e abrangem a radiologia odontológica, pois a ciência é concisa em afirmar que näo existe dose de radiaçäo totalmente inócua aos seres vivos. A relaçäo risco/benefício deve ser soberana quando da utilizaçäo dos raios X para diagnóstico, a fim de minimizar os possíveis efeitos indevidos inerentes à utilizaçäo do principal exame complementar de diagnóstico em Odontologia

Protección a pacientes mediante la consideración de cinco parámetros del sistema de rayos-X / Patient's Protection by five standards for operating X-ray equipment

La Norma Oficial Mexicana NOM-158-SSA-1996, establece diez pruebas de control de calidad que se deben realizar a equipos de rayos-X y con la finalidad de verificar su estado de funcionamiento, de estas diez pruebas de control de calidad se realizaron cinco a un equipo de rayos-X, que se encuentra instalado en la radiología básica del Hospital Central Militar, con lo resultados obtenidos de las pruebas realizadas se comprobó que el equipo presenta variantes que pueden afectar en la formación de una imagen radiográfica. Se concluye que el correcto funcionamiento del equipo de rayos-X protege al paciente en virtud de usar sólo la radiación necesaria y de obtener mejores imágenes diagnósticas

Aplicación de normas de radioprotección en los servicios de radiología

Este trabajo tuvo por objeto verificar si los hospitales de la Ciudad Autónoma de Buenos Aires y del Gran Buenos Aires (GBA) cumplen con las normas básicas de seguridad radiológica en los servicios de radiología particularmente referidas al registro diario del dosímetro; al uso correcto del dosímetro, al uso correcto de los elementos de protección; al registro de placas radiológicas realizadas; al control de ingreso a las áreas restringidas de personas ajenas a los servicios; al uso de elementos de protección personal y finalmente si las instalaciones cuentan con los materiales aislantes adecuados y si se realiza el mantenimiento y supervisión de los equipos. Los resultados señalan que solo el Hospital Pirovano de la ciudad de Buenos Aires cumple con el 100 por ciento de las normas, seguido por los hospitales Roffo, Roca y San Isidro (GBA) con el 85 por ciento de cumplimiento. La investigación ha demostrado que existen graves irregularidades en la aplicación de las normas en la mayoría de los hospitale encuestados, especialmente en lo referente a la proteccion de las personas que ingresan en las areas restringidas ajenas a los servicios. Asimismo la investigacion remarca la importante diferencia entre los hospitales municipales de la Ciudad de Buenos Aires y provinciales del GBA respecto al uso de los elementos de proteccion por parte del personal (medicos y tecnicos radiologos) a favor de los primeros, infiriendose como factores a destacar en la falta de cumplimiento de las normas, la falta de concientizacion de los riesgos por el personal y la irresponsabilidad institucional, al no ejercer un adecuado control

O transporte de radioacidentados de Goiânia / Transport of radiation accidented patients of Goiania

Após breve introduçäo sobre os níveis de atendimento a radioacidentados, informa-se sobre os procedimentos de proteçäo dos meios de transporte utilizados para a remoçäo de pacientes contaminados no eixo GOIANIA-RIO-GOIANIA, bem como de proteçäo da equipe assistente. Os resultados práticos säo comentados

Apoio logístico / Logistic base

Os autores descrevem as várias etapas e os diversos itens que se fizeram necessários ao atendimento dos pacientes acidentados em Goiânia. Descrevem a necessidade de aquisiçäo imediata de equipamentos mais simples como luvas cirúrgicas, gorros e máscaras descartáveis, existentes no Hospital Naval Marcílio Dias em quantidades suficientes apenas para o consumo normal, bem como a dos mais sofisticados como um diluidor de hemácias CELM DA 500, um contador de hemácias/leucócitos Zenite, um separador automático de glóbulos e plaquetas, e outros. Citam a importância da implantaçäo de fluxos logísticos em relaçäo à destinaçäo dos escretas dos pacientes e do material médico-cirúrgico contaminados, com mediçöes radiométricas diárias no Instituto de Radioproteçäo e Dosimetria, permitindo regulagem adequada da posologia do Azul da Prússia