Campanha e carteira de radioproteção: estratégias educativas que reduzem a exposição excessiva de crianças a exames radiológicos / Radioprotection campaign and card: educational strategies that reduce children's excessive exposure to radiological exams

RESUMO Objetivos: Analisar resultados de iniciativa para racionalizar o uso de exames radiológicos, garantindo sua qualidade técnica, e implantar uma campanha de radioproteção que inclua a capacitação da equipe profissional e a Carteira de Radioproteção para crianças de até 12 anos como instrumento para que os pais e médicos controlem a exposição das crianças à radiação. Métodos: Em um sistema de saúde suplementar com cobertura de 140 mil pessoas, foi implantada a campanha de radioproteção com base nos protocolos Image Gently •, garantindo a menor dose possível de exposição à radiação, com qualidade técnica, e implantando a Carteira de Radioproteção. Para aferir a eficácia dessas ações, comparou-se o número de exames radiológicos realizados no setor de urgência e emergência pediátrica no período de um ano anterior à campanha com o número de exames radiológicos realizados no período de um ano posterior à campanha. Resultados: As ações foram bem-aceitas por todos os grupos envolvidos. No ano seguinte à implantação das estratégias de radioproteção, observou-se redução de 22% no número de exames radiológicos realizados no setor pediátrico de urgência e emergência. Houve ainda diminuição de 29% da solicitação de dois ou mais exames para a mesma criança ou de exames com duas ou mais incidências. Conclusões: A campanha de radioproteção e a implantação da Carteira de Radioproteção para crianças até 12 anos revelaram-se estratégias factíveis e associaram-se à redução dos exames radiológicos solicitados e realizados no setor de urgência e emergência pediátrica.

ABSTRACT Objectives: To analyze the results of an initiative aimed at improving the reasonable use of radiological examinations, ensuring their technical quality, implementing a radioprotection campaign that includes training of the professional team, and introducing the radioprotection card for children under 12 years old as a tool for parents and doctors to control children's exposure to radiation. Methods: The study was held in a health care insurance system covering 140,000 people. A radioprotection campaign was implemented according to Image Gently • protocols, ensuring the lowest dose of radiation and the quality of examinations, and the radioprotection card was implemented. To assess the effectiveness of these actions, the number of radiological examinations performed at the pediatric emergency room in a period of one year preceding the campaign was compared with the number of radiological examinations performed one year after the campaign. Results: The campaign was well accepted by all professionals, families, and patients involved. In the year following the implementation of radioprotection strategies, there was a 22% reduction of radiological examinations performed at the pediatric emergency room. There was also a 29% reduction in the request of two or more radiological examinations for the same child or examinations with two or more incidences. Conclusions: The campaign and the radioprotection card for children under 12 years old proved to be feasible strategies and correlated with a reduction in radiological examinations requested and performed at the pediatric emergency room.

Riesgos de la radiación en imágenes pediátricas / Radiation risks in pediatric images

The advance of medical imaging technology has led to an increase in the medical radiation exposure, especially derived from computed tomography (CT). Recent studies confirm a small but significant increase of cancer cases induced by CT radiation. Children are markedly more sensitive to radiation than adults and in addition, their life expectancy is longer, so we must use all resources to optimize and reduce the exposure dose using the ALARA concept. CT is an important diagnostic tool in medical practice and its benefits far outweigh the costs of radiation if the indication is properly justified.

El avance tecnológico de las imágenes para evaluación de enfermedades ha llevado a un aumento considerable de la radiación de origen médica, principalmente la proveniente de la tomografía computada (TC). Estudios recientes confirman un pequeño pero significativo incremento de casos de cáncer inducidos por radiación generada por la TC. Siendo los niños reconocidamente más sensibles a la radiación que los adultos y sumado a su mayor expectativa de vida, es que debemos usar todos los recursos para optimizar y reducir la dosis de exposición aplicando el concepto de ALARA. La TC es una herramienta diagnóstica importantísima en la práctica médica, y sus beneficios superan ampliamente los costos de la radiación si su indicación está adecuadamente justificada.

Disminución de la dosis de radiación en el radiodiagnóstico / Reducing the dose of radiation in diagnostic radiology

El número de procedimientos radiológicos ha tenido un incremento acelerado durante la primera década del siglo XXI, obteniendo un impacto beneficioso sobre la salud. Sin embargo, este incremento conlleva a una mayor exposición a las radiaciones ionizantes. El uso de la radiación ionizante tiene un riesgo inherente, aun cuando el riesgo asociado a un examen radiológico es menor comparado con el riesgo natural, cualquier riesgo añadido, no importa cuán pequeño sea, es inaceptable si no se beneficia el paciente. El concepto de niveles de referencia diagnósticos se debe utilizar para reducir las variaciones en la práctica entre las instituciones y promover rangos óptimos, indicadores de dosis para los protocolos específicos de las diferentes modalidades. En general, los principios básicos de la protección radiológica (justificación, optimización y límite de dosis) deben ser respetados para ayudar a contrarrestar el incremento injustificado en el número de procedimientos que se realizan.

The number of radiological procedures performed has had a rapid increase during the first decade of the 21st century, achieving a beneficial impact on healthcare. However, this increase leads to a greater exposure to ionizing radiation. The use of ionizing radiation has an inherent risk. Although the risk associated with a radiological examination is minor compared to the natural risk, any added risk, no matter how small, is unacceptable if it does not benefit the patient. The concept of diagnostic reference levels should be used to reduce variations in practice among institutions and to promote optimal dose indicator ranges for specific protocols of the different methods. In general, the basic principles of radiation protection (justification, optimization and dose limits) must be followed to reduce the unjustified increase in the number of procedures being performed.

Fetal radiation doses and subsequent risks from X-ray examinations: should we be concerned?

Pregnant women are sometimes exposed to ionizing radiation in radiology examinations for various reasons. In such cases, the radiation dose to the conceptus and subsequent risks should be estimated. The purpose of this study was the calculation and presentation of fetal dose and subsequent risks resulted from different X-ray examinations An analytical simulation study was conducted and six common radiographies in different views and three types of special examinations were evaluated. The entrance skin exposure [ESE] was measured using a solid-state dosimeter. A Monte Carlo program was used in order to simulate different views of X-ray examinations and calculate the radiation doses received by the conceptus for every view of each examination. Then the risk of childhood cancer and small head size were calculated for different radiographies. The fetal doses and consequence risks of the small head size and childhood cancer for the radiographs of chest, skull, and sinuses were negligible but the risks of childhood cancer and small head size due to radiographies of abdomen, lumbar spine, and pelvis areas were ponderable. Results of this study can be used for the pregnant women radiographies management

Assessment of physicians' knowledge and awareness about the hazards of radiological examinations on the health of their patients

Previous studies have shown that physicians tend to underestimate the risks to patients of radiation exposure. This study in 2 Palestinian hospitals aimed to assess physicians' knowledge about the risks associated with the use of radiological examinations. A questionnaire answered by 163 physicians revealed many gaps in knowledge. Only one-third of physicians had received a radiation protection course during their undergraduate study or in the workplace. Few physicians were able to answer correctly many scientific, knowledge-based questions. For example, only 6.1% of the respondents were able to identify the ALARA principle and 98.2% did not know that there is no safe dose limit according to international recommendations. Physicians' practices in terms of frequency of use of routine X-rays and discussing the risks with patients were also poor. These results clearly indicate the need to increase Palestinian physicians' knowledge and awareness about the potential hazards associated with the use of radiological examinations

Cone beam computed tomography in endodontics

Cone beam computed tomography (CBCT) is a contemporary, radiological imaging system designed specifically for use on the maxillo-facial skeleton. The system overcomes many of the limitations of conventional radiography by producing undistorted, three-dimensional images of the area under examination. These properties make this form of imaging particularly suitable for use in endodontics. The clinician can obtain an enhanced appreciation of the anatomy being assessed, leading to an improvement in the detection of endodontic disease and resulting in more effective treatment planning. In addition, CBCT operates with a significantly lower effective radiation dose when compared with conventional computed tomography (CT). The purpose of this paper is to review the current literature relating to the limitations and potential applications of CBCT in endodontic practice.

Tomografia computadorizada de feixe cônico (CBCT, sigla em Inglês para cone beam computed tomography) é um moderno sistema radiológico de imagem idealizado especificamente para uso no esqueleto maxilofacial. Este sistema supera muitas das limitações da radiografia convencional, produzindo imagens não distorcidas e tridimensionais da área examinada. Tais propriedades tornam este método de imagem especialmente apropriado para a Endodontia. O profissional consegue obter uma visão melhor da região anatômica desejada, resultando em melhor detecção de doenças de origem endodôntica e um planejamento mais efetivo do tratamento. Além disso, o sistema utiliza doses de radiação significantemente menores em comparação à tomografia computadorizada convencional. O objetivo deste artigo é revisar a literatura atual relativa às limitações e possíveis aplicações da CBCT na prática endodôntica.

Percepción de la población respecto a los riesgos asociados a los estudios de imágenes / Public perception of radiation-related risks of imaging studies

Introduction: In recent years, diagnostic procedures using ionizing radiation have achieved a great boom, although patients are often unaware of the risks they involve. Objectives: To know how is ionizing radiation perceived by the population attending Clínica Dávila, Department of Radiology (DRCD).Methods: A voluntary and anonymous survey was conducted on patients and / or companions. Results: A total of 330 adults were surveyed. An 57 percent had completed higher education, whereas 7.9 percent had only finished elementary schooling; 78.8 percent had undergone three or more imaging tests. CT examination was considered to pose the highest levels of risk (42.4 percent), followed by Ultrasonography (30.6 percent). Discussion: The survey group was made up of young adults, mostly college graduates, and predominantly female. Surprinsingly enough, considering that obstetric sonography is commonly used during pregnancy, US was ranked second in terms of associated health risks. There is an evident interest in the subject, since 90 percent of responders would like to receive further information.

Introducción: Los procedimientos diagnósticos que usan radiación ionizante están en auge, aunque conllevan riesgos muchas veces desconocidos por los pacientes. Objetivos: Conocer la percepción de la población que acude al Departamento de Radiología de Clínica Dávila (DRCD) sobre la radiación. Material y métodos: Se aplicó una encuesta voluntaria y anónima a pacientes y/o acompañantes. Resultados: Se encuestó a 330 adultos. El 57 por ciento poseía estudios superiores y 7,9 por ciento sólo estudios básicos. El 78,8 por ciento se había efectuado 3 o más estudios radiológicos. La TC fue el examen considerado con mayor riesgo (42,4 por ciento), luego la US (30,6 por ciento). Discusión: El grupo encuestado fueron adultos jóvenes, con estudios superiores en su mayoría y con predominio femenino. Sorprendió que la US se considerara como el segundo examen de mayor riesgo, ya que las mujeres poseen mayor contacto con este estudio durante el embarazo. Hay interés en el tema, porque el 90 por ciento desea recibir información.

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

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

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

Análise das ações de gestão dos efluentes do processamento de exames radiográficos na região de Corumbá, MS / Analysis of the actions of management of effluents from the processing of radiographic examinations in the region of Corumbá, MS

Os problemas de gestão dos efluentes do processamento de exames radiográficos na região de Corumbá, MS, são um fato, assim como a necessidade de resolvê-los. Com o crescimento populacional e econômico da cidade também aumentaram as demandas dos serviços de saúde e conseqüentemente os resíduos gerados em suas atividades. Soma-se o fato do município não possuir uma política pública eficaz para minimizar os problemas ambientais decorrentes do descarte inadequado desses resíduos, haja vista que o município não dispõe de política de orientação para descarte apropriado, nem alguma forma para tratamento prévio ao descarte. A dissertação tem por finalidade contribuir para o debate sobre a necessidade de implantar políticas públicas eficazes para a gestão dos efluentes do processamento de exames radiográficos na região de Corumbá, contribuindo assim de forma significativa para a formação de diretrizes que possam minimizar os impactos gerados pelo descarte inadequado.

The problems from management of the effluents from the processing of radiographic exams in the region of Corumbá, MS, are a fact, as well the need to solve them. Population and economic growth of the city also increased the demand of health services and consequently the waste generated by these activities. Add the fact that the municipality does not have an effective public policy to minimize the environmental problems raised from inadequate disposal of such waste, considering that does not have policy to guide a proper disposal, nor any way to treatment previous to disposal. The dissertation aims to contribute to the debate about the need to implement effective public policies for the effluents management from the processing of radiographic exams in the region of Corumbá, thus contributing significantly to the formation of guidelines that could minimize the impacts of inappropriate disposal.

Tecnologias emissoras de radiação ionizante e a necessidade de educação permanente para uma práxis segura da enfermagem radiológica / Issuing technologies of ionizing radiation and the need of permanent education for a safe praxis in radiological nursing / Tecnologías emisoras de radiación ionizante y la necesidad de la educación permanente para una praxis segura de la enfermería radiológica

Refletir acerca das tecnologias radiológicas e da necessidade da educação permanente que aborde temas relacionados com a aplicação das radiações ionizantes na práxis da enfermagem radiológica é mister, haja vista o avanço tecnológico que revolucionou as práticas em saúde e conseqüentemente a assistência de enfermagem, pois essas tecnologias incidem fortemente sobre o trabalho e a qualificação do trabalhador. Esta reflexão discorre sobre as áreas de atuação da enfermagem radiológica nos Serviços de Radiologia e Diagnóstico por Imagem (SRDI), assim como a necessidade da educação permanente para a práxis segura nessa especialidade. Apresenta estudos de alguns autores acerca dessas necessidades, principalmente no que tange à proteção radiológica e à necessidade de qualificação desses trabalhadores.

Reflecting about radiological technologies and the need for permanent education to address issues related to the application of ionizing radiation on radiological nursing practice is of a great importance, due to the technological progress that revolutionized practices in health and, consequently, the nursing care. So, these technologies strongly focus on labor and worker's qualification. This reflection happens in the acting areas of radiological nursing in the Radiology Services and Image Diagnosis (SRDI), as well as the need for permanent education to the safe praxis on this specialty which is presented through some authors´ studies. Primarily, in relation to the radiological protection and need to qualify these workers.

Reflexionar acerca de las tecnologías radiológicas y la necesidad de una educación permanente que aborde temas relacionados con la aplicación de radiaciones ionizantes en la praxis de la enfermería radiológica es fundamental, en virtud del avance tecnológico que revolucionó las prácticas en la salud y, consecuentemente, la asistencia de la enfermería, pues esas tecnologías inciden fuertemente sobre el trabajo y la calificación del trabajador. Esta reflexión discurre sobre las áreas de actuación de la enfermería radiológica en los Servicios de Radiología y Diagnóstico por Imagen (SRDI), así como la necesidad de una educación permanente para la praxis segura en esta especialidad, de la misma forma que los estudios de algunos autores son presentados en relación a estas necesidades; principalmente en lo que se refiere a la protección radiológica y a la necesidad de calificación de esos trabajadores.

Radiología diagnóstica en la embarazada: consideraciones sobre exposición a radiación y riesgo del feto / Diagnostic radiology in the pregnant: radiation exposure and risk to the fetus

El uso de exámenes de imágenes para el diagnóstico de condiciones no obstétricas puede ser requerido durante cualquier etapa del embarazo. Existe un riesgo teórico de defectos en el desarrollo fetal, el que se ha considerado no relevante con el nivel de dosis aportada por la radiología diagnóstica habitual. La comprensión de los efectos de la radiación en las diferentes etapas del desarrollo fetal y las dosis aportadas por las diferentes técnicas de imágenes debieran colaborar en la elección del tipo de examen a realizar y del mejor momento para hacerlo.

Diagnostic imaging studies can be required during any phase of the pregnancy for the diagnosis of not obstetric conditions. A theoretical risk of defects in the fetal development exists, but it has been considered insignificant at the dose level used for regular radiology practice. Comprehension of radiation effects over fetal development at different pregnancy stages and the relation between imaging modality and dose can help to make a choice, selecting the best radiologic examination and the best moment to do it.

Exames de diagnóstico por imagem: efeitos biológicos no feto / Image diagnostic tests: fetal biological effects

Os exames de imagem têm grande importância no diagnóstico de possíveis patologias materno-fetais, no seu acompanhamento e na escolha da terapêutica mais adequada para cada caso. É relevante a ocorrência de efeitos deletérios sobre o feto provocados pela utilização destes métodos durante a gestação, devendo-se levar em consideração a relação risco-benefício na sua indicação e realização durante este período. Nesse contexto, a ultra-sonografia e a ressonância magnética têm trazido enormes benefícios diagnósticos com pouco ou nenhum dano embrio-fetal, enquanto os exames radiológicos devem ter sua indicação reservada aos casos onde sua contribuição diagnóstica supere a dos exames previamente citados em detrimento do risco que podem acarretar ao embrião ou feto. Este trabalho é uma atualização sobre os princípios físicos dos principais exames diagnósticos por imagem (ultra-sonografia, ressonância magnética e exames radiológicos) e seus efeitos biológicos sobre o binômio materno-fetal.

Consideraciones sobre el uso de rayos X en la práctica médica convencional para la necesaria aplicación de normas básicas de seguridad / Considerations about the use of X-rays in the conventional medical practice for necesary aplication of basic security rules

The application maintained and increasing of the explorations with X-rays, consequence of significant development of the engineering together with evolved computacionals methodologies has allowed to reach to the great anatomical majority of locus where it seats the disease. The consequence immediate has been the increase of the exhibition of the patients to ionizing radiations. Different organizations, worried about the health publish, including with it to important societies of Radiology and also to tie international organizations directly related to the governments like the WHO and the OPS. They have emphasized the necessity to generateregulatory conducts destined to introduce the basic rules of the good medical practice. In our country a situation of smaller development in this particular area still persists. Contingencies experienced by general doctors in his professional practice in small town are described. Some situations derived from the use of conventional radiological procedures like mammography and axial computed tomography are presented commenting aspects that do necessary to prevent the doses that receive the patients in order to avoid the expression of stochasticor deterministic effects with high doses of radiation applied with medical intentions. General aspects of radiological procedures related to practices in pediatric patient emphasizing the conditions of increased risk for iatrogenic effects of radiation, particularly in those premature or new borns.

Counseling patients exposed to ionizing radiation during pregnancy

Health physicists and knowledgeable clinicians have the responsibility to counsel women of reproductive age about the reproductive risks of ionizing radiation exposure before conception or during pregnancy. It is important to realize that lay individuals have many misconceptions about the reproductive risks of ionizing radiation. Many patients who have already had or will undergo some type of radiological test are apprehensive about the reproductive and developmental risks of diagnostic radiological procedures. Epidemiological studies and animal studies indicate that high exposures of ionizing radiation can cause miscarriage, congenital malformations, growth retardation, stillbirth, and cancer. With the exception of cancer, there are threshold exposures for those outcomes, with exposures below certain radiation doses not increasing the reproductive or developmental risks. The threshold exposure for birth defects at the most sensitive stage of development is 0.2 Gy, and the threshold for growth retardation and miscarriage is even higher. However, embryonic loss can occur from low exposures during the preimplantation and presomite stages of development ("the all or none period"). This is a stage when the embryo is more likely to die than survive malformed. The most sensitive period for the induction of mental retardation is from the 8th week to the 15th week of gestation. The threshold for deterministic effects increases after early organogenesis and also as the exposure is protracted, e.g., with radionuclides or multiple radiological procedures. Awareness that the threshold dose for developmental effects increases as the fetus develops complicates counseling because we do not have definitive data on threshold exposures at all stages of gestation. Ionizing radiation exposures prior to pregnancy represent a very low risk for the increased incidence of genetic disease in the offspring of the parents who have had radiation exposures to the ovary...

Los físicos que trabajan en el ámbito de la salud y los clínicos que tienen conocimientos de radiología tienen la responsabilidad de asesorar a las mujeres de edad fecunda acerca de los riesgos reproductivos de la exposición a radiaciones ionizantes antes de la concepción o durante el embarazo. Es importante entender que las personas legas albergan muchas nociones equivocadas acerca de los riesgos asociados con ese tipo de radiaciones. Muchas pacientes que ya se han sometido o serán sometidas a algún tipo de prueba radiológica les temen a los correspondientes riesgos reproductivos y a las posibles consecuencias de estas pruebas diagnósticas para el desarrollo fetal. Según estudios epidemiológicos y con animales, un alto grado de exposición a radiaciones ionizantes puede provocar un aborto, anomalías congénitas, retraso del crecimiento, muerte fetal y cáncer. A salvedad de esto último, hay umbrales de exposición establecidos en relación con cada uno de estos problemas, y una exposición por debajo de ciertas dosis de radiación no se asocia con ninguna elevación del riesgo de sufrir daños reproductivos o del desarrollo. El umbral de exposición asociado con anomalías congénitas durante la etapa del desarrollo de mayor vulnerabilidad es de 0,2 Gy, y el umbral en el caso del retraso del crecimiento y del aborto espontáneo es aun mayor. No obstante, la pérdida de un embrión puede ocurrir incluso a dosis bajas durante las fases del desarrollo que preceden a la implantación o en la fase presomática (el llamado período de "todo o nada"). Esta es la etapa en que un embrión corre un mayor riesgo de morir que de sobrevivir con malformaciones. El período de mayor vulnerabilidad para la inducción de retraso mental dura desde la octava hasta la decimoquinta semana de gestación. El umbral para la aparición de efectos deterministas aumenta después de la embriogénesis temprana y a medida que la exposición se prolonga, sea, por ejemplo, por el uso de radionúclidos...

Por que reducir las dosis de radiacion en pediatria

Many reports have been publicated in the past few years orientate to reduce the irradiation dose in children. It was compared with survivors of the atomic bomb in Japan. The ones who received low doses, in order to the 10 to 50 mSv, levels that left inside of diagnostic radiology spectrum, and in asociation in a small but significant increase in the tumors incidence. The major radiosensibility of children, obligate us to take, the necessary measure to rationalize the use of ionization radiation in pediatric, in special the CT, wich is the method that gives the higher doses. This measures can be abridge to: 1. - Select properly the cases that are going to be benefit whit the method trough the pediatrician. 2.- Reduce the exposition factors. 3.- Direct the exam only to the specific study area. 4.- Except special cases, perform only single phase studies. 5. Protection for superficial organs. 6. Deliver information for parents and general public.

Múltiples trabajos se han publicado en los últimos años orientados a disminuir las dosis de irradiación en niños. La experiencia en sobrevivientes japoneses de la bomba atómica, que recibieron bajas dosis, dentro del espectro de la radiología diagnóstica, demostró que ellas se asocian a un pequeño, pero significativo aumento en la incidencia de tumores. El mayor efecto de las radiaciones en niños nos obliga a tomar medidas necesarias para racionalizar su uso especialmente el de la TC, método que aporta las mayores dosis. Estas medidas se pueden resumir en: 1.- Selección adecuada por parte del clínico de los casos que se van a beneficiar con el método. 2.- Disminuir los factores de exposición. 3.- Dirigir el examen sólo al área que es necesario estudiar. 4.- Salvo excepciones, realizar estudios de TC monofásicos. 5.- Protección de órganos superficiales. 6.- Instructivo para padres y público en general.

Dosis al feto en radiodiagnóstico / Dose to the fetus in radiodiagnostic

Se discute los efectos de la irradiación al feto y sus consecuencias, según dosis recibida, considerando la eventual suspensión de embarazo por esta causa.

Determinación de las condiciones de uso de los elementos de protección personal contra rayos X en Hospitales Públicos de la Región Metropolitana / Determination to the conditions of use of the Personal Protective Devices in Rays X in Public's Hospital of the Metropolitan Region, Chile

El presente trabajo se origina con la detección de delantales plomados que emiten radiaciones ionizantes, como consecuencia de este hallazgo se ha propuesto como objetivo verificar y dimensionar la presencia de elementos de protección personal contra los rayos X, que emiten radiaciones, así como también, las condiciones de uso y mantención de los mismos, las unidades a estudiar fueron hospitales de la Región Metropolitana, de los Servicios de Salud Sur y Norte. De esta manera, se plantea la importancia que tiene la homologación de alguna norma extranjera y la autorización de alguna institución competente que pueda entregar la certificación de este tipo de elementos con el fin de garantizar la adecuada protección de los trabajadores expuestos a radiaciones ionizantes, apoyándose en la legislación vigente.

Reproductive health of male radiographers

To compare certain reproductive health problems reported in 2 groups of males, one of which was exposed to x-ray radiation [radiographers] and the other group that was not exposed to x-ray radiation. The reproductive health problems were miscarriage, congenital anomalies, still births and infertility. Two groups of men were selected [90 in each group]. The first group consisted of radiographers and the other groups consisted of men not exposed to x-ray radiation. The 2 groups were matched for age and source. Relative risk, attributable risk percentage and level of significance were calculated. Incidence rate of reproductive health problems was increasing with the increase in duration of exposure to x-ray radiation ranging between 17% [for those exposed for 1-5 years] to 91% [for those exposed for more than 15 years]. There were significant associations between exposure to radiation and miscarriage [relative risk = 1.67, attributable risk percentage = 40%], congenital anomalies [relative risk = 10, attributable risk percentage = 90%], still birth [relative risk = 7, attributable risk percentage = 86%], and infertility [relative risk = 4.5, attributable risk = 78%]. The incidence rates of reproductive health problems reported by male radiographers were significantly higher than that reported by the non exposed group and higher than the incidence rates reported in community-based studies in Jordan. The incidence rates of fetal death [miscarriage and stillbirth together] and infertility reported by our radiographers were higher than had been reported by the British radiographers. An immediate plan of action is needed to protect our radiographers. Further studies are needed in this field taking into account all extraneous variables that may affect the reproductive health of radiographers