Análisis de riesgo en la terapia paciente específica del hipertiroidismo en Cuba / Risk analysis in patient-specific therapy for hyperthyroidism in Cuba

Introducción: En Cuba, se prevé realizar la terapia paciente específica del hipertiroidismo. Se han desarrollado una metodología y herramientas computacionales con este propósito. El análisis del riesgo permitirá acometer con calidad y seguridad dicha práctica. Objetivo: Analizar los riesgos radiológicos en la terapia paciente específica del hipertiroidismo en Cuba. Material y Métodos: Se revisó y adaptó el modelo genérico de Medicina Nuclear paciente específica. Con el código cubano SECURE MR-FMEA versión 3.0 se determinaron el riesgo inherente y el residual, se identificaron las etapas del proceso, los sucesos iniciadores, las medidas y causas más contribuyentes, así como las consecuencias para los grupos expuestos. Resultados: Se obtuvo un nivel alto de riesgo que se controló con las medidas adicionadas. Las etapas más significativas son: la adquisición de imágenes pre- y post- tratamiento y la preparación del radiofármaco. Las medidas preventivas más importantes son: mantener una carga de trabajo moderada para el personal, las capacitaciones del físico médico y de los especialistas que realizan las revisiones del proyecto en la etapa de diseño del servicio. Los pacientes tienen consecuencias muy altas en 10,7 por ciento de las secuencias accidentales. Sin embargo, los trabajadores y el público presentan consecuencias medias en 29 por ciento y 16 por ciento, respectivamente. El incumplimiento de prácticas, protocolos, procedimientos o normas es la causa básica de fallo predominante. Conclusiones: Se facilita la toma de decisiones para la implementación del tratamiento paciente específico del hipertiroidismo en Cuba, a partir del empleo de la metodología que se propone en esta investigación(AU)

Introduction: In Cuba, there are plans to conduct patient-specific therapy for hyperthyroidism. A methodology and computational tools have been developed for this purpose. Risk analysis will allow us to undertake this practice with quality and safety. Objective: To analyze the radiological risks in the patient -specific therapy for hyperthyroidism in Cuba. Material and Methods: The generic patient-specific Nuclear Medicine model was reviewed and adapted. Inherent and residual risk were determined with the Cuban code SECURE MR-FMEA version 3.0; the stages of the process, the initiating events, the most contributing measures and causes, and the consequences for the exposed groups were identified. Results: A high level of risk was obtained, which was controlled with additional measures. The most significant stages are the acquisition of pre- and post-treatment images, and the preparation of the radiopharmaceutical. The most important preventive measures are: maintaining a moderate workload of the staff, and the training of the medical physicist and the specialists who perform the project reviews at the stages in service design. Patients have very high consequences in 10,7 percent of accidental sequences. However, the workers and the public show average consequences at 29 percent and 16 percent, respectively. Non-compliance with practices, protocols, procedures or standards is the predominant underlying cause of failure(AU)Conclusions: Decision-making for the implementation of patient-specific therapy for hyperthyroidism in Cuba, based on the use of the methodology proposed in this research, is facilitated(AU)

Análisis de riesgo en la Medicina Nuclear Terapéutica en Cuba con enfoque integrador / Risk assessment in Therapeutic Nuclear Medicine in Cuba with an integrated approach

Introducción: El análisis de riesgo en la gestión de la calidad y seguridad permite la mejora continua de los servicios médicos en Cuba. En Medicina Nuclear Terapéutica es requisito regulador que permite la continuidad de estos servicios a la población. Objetivo: Analizar los riesgos radiológicos con enfoque integrador dirigido a causas básicas de fallo en la práctica citada. Material y métodos: Se revisó y adaptó el modelo genérico de riesgo para cada caso de estudio. Los métodos prospectivos de matriz de riesgo y análisis de modos y efectos de fallo y reactivo de aprendizaje de las lecciones de sucesos registrados fueron utilizados con el código cubano SECURE MR-FMEA versión 3.0. Se determinó el riesgo inherente, su tratamiento y el riesgo residual por práctica. Se identificaron las etapas del proceso, las medidas y las causas básicas más contribuyentes. Resultados: No se obtuvo riesgo superior al del nivel alto. La radiosinoviortesis y el tratamiento radiactivo de la policitemia vera tuvieron la mayor cantidad de modificaciones al modelo genérico. Las etapas más significativas son prescripción clínica, preparación del radiofármaco y administración. Las medidas preventivas de mayor importancia son mantener una carga de trabajo moderada para el personal, las capacitaciones de los médicos nucleares y del técnico que realiza la administración. Conclusiones: Existe una no uniformidad en el nivel de calidad y seguridad entre los servicios analizados. Para el cambio, la adopción de decisiones se ve beneficiada en su eficacia y eficiencia, al integrarse los métodos prospectivos y reactivos de análisis de riesgo(AU)

Introduction: Risk assessment in quality and safety management allows the continuous improvement of the medical services in Cuba. In Therapeutic Nuclear Medicine, it is a regulatory requirement which allows the continuity of these services to the population. Objective: To assess radiological risks with an integrated approach focused on underlying causes of failure in the mentioned practice. Material and Methods: The generic risk model was reviewed and adapted for each case study. The prospective methods of risk assessment matrix of failure modes and effects and incident learning lessons from the events registered were used applying the Cuban code SECURE MR-FMEA version 3.0. The inherent risk, treatment, and residual risk in the practice were determined. The stages of the process, measurements, and the main contributing causes were identified. Results: There was no risk higher than the high level. Radiosynoviorthesis and the radioactive treatment of the Polycythemia Vera had the greatest amount of modifications to the generic model. The most significant stages are clinical prescription, preparation of the radiopharmaceutical formulation and administration. The most important preventive measures are to maintain a moderate workload for the personnel, and the training of the nuclear physicians and the technician who performs the administration. Conclusions: There is a non-uniformity in the level of quality and safety among the NTM services in Cuba. For change, decision-making is benefited in terms of effectiveness and efficiency by integrating prospective and reactive risk assessment methods(AU)

Avaliação do conhecimento de acadêmicos de medicina sobre os riscos da exposição ocupacional à radiação ionizante / Evaluation of medical students' knowledge about the risks of occupational exposure to ionizing radiation

Introdução: A despeito do conhecimento já consolidado sobre os riscos associados à exposição às radiações ionizantes, estudos demonstram que estudantes e profissionais de saúde negligenciam ações de proteção à radiação ionizante. A pesquisa realizada teve como objetivo geral avaliar o conhecimento de acadêmicos de Medicina sobre a exposição ocupacional à radiação ionizante no início, meio e final do curso. Métodos: Estudo observacional de tipo transversal com aplicação de questionários para 345 acadêmicos do curso de Medicina da Universidade do Sul de Santa Catarina ­ Unisul, no ano de 2015. Resultados: A maioria dos alunos respondeu que o tema radiação ionizante foi oferecido em algumas disciplinas do curso, contudo esta resposta foi mais prevalente entre os alunos de fases iniciais e intermediárias. Alunos das fases finais julgaram, em sua maioria, seu conhecimento sobre os efeitos nocivos da radiação como "sofrível". Conclusões: A percepção dos alunos do curso avaliado foi a de que o conhecimento adquirido ao longo do curso de Medicina não contribuiu para adesão a precauções e cuidados universais em relação à proteção contra os efeitos das radiações ionizantes no futuro profissional. A inclusão de informações sobre o tema ao longo do curso pode alterar a situação observada nos egressos desta universidade (AU)

Introduction: Despite the already consolidated knowledge about the risks associated with exposure to ionizing radiation, studies show that students and health professionals neglect protective actions against ionizing radiation. The aim of this study was to evaluate the medical students' knowledge about occupational exposure to ionizing radiation at the beginning, middle and end of the course. Method: A cross-sectional observational study with questionnaires for 345 medical students from the University of Southern Santa Catarina ­ Unisul, in the year 2015. Results: Most students answered that the topic of ionizing radiation was offered in some disciplines of the course. However, such answer was more prevalent among students at the initial and intermediate stages. Most students at the final stages considered their knowledge about the harmful effects of radiation as "poor". Conclusions: The students' perception of the evaluated course was that the knowledge acquired during the course of medicine did not contribute to adherence to precautions and universal care for protection against the effects of ionizing radiation by the future practitioner. The inclusion of information on the subject throughout the course may change the situation observed in the graduates of this university (AU)

Radiaciones ionizantes en las prácticas médicas "Primum non nocere" / Ionizing radiations in medical practice: Primum non nocere

La primera causa de irradiación de los seres humanos es la exposición a radiaciones ionizantes provocadas por procedimientos médicos. Los avances en la tecnología aplicada a diagnóstico por imágenes, la radioterapia y el aumento de intervenciones guiadas por rayos X, particularmente en los países desarrollados, ha aumentado de manera considerable la posibilidad de irradiar a pacientes y a trabajadores sanitarios. La situación es capaz de generar daños específicos. A partir de lecciones aprendidas al tratar algunos accidentes esta presentación pretende informar de los riesgos, recordar las particularidades de la protección radiológica y concientizar a la comunidad médica respecto de la importancia del entrenamiento y la capacitación en la protección radiológica. El compromiso ético por excelencia: "Primum non nocere", primero no dañar, resume la cuestión.

Exposure to ionizing radiation caused by medical procedures is the first cause of irradiation of human beings. Advances in technology applied to imaging diagnostic, radiotherapy and the increase of interventions guided by x-ray, particularly in developed countries, has increased considerably the possibility of irradiating patients and health workers. The situation is capable of generating specific damages. This presentation aims to report risks, to remember characteristics of radiation protection and to educate the medical community about the importance of training and training in radiation protection, from lessons learned treating some accidents The ethical commitment to excellence: "Primum non nocere", first not to damage, sums up the issue

A primeira causa de irradiação dos seres humanos é a exposição a radiações ionizantes provocadas por procedimentos médicos. Os avanços na tecnologia aplicada a diagnóstico por imagens, a radioterapia e o acréscimo das intervenções guiadas por raios X, notadamente nos países desenvolvidos, tem incrementado consideravelmente a possibilidade de irradiar pacientes e trabalhadores da saúde. Isto pode gerar danos específicos.Esta apresentação pretende informar respeito dos riscos na base de lições apreendidas por tratar alguns acidentes, lembrar as particularidades da proteção radiológica e conscientizar a comunidade médica respeito da importância do treinamento e o aperfeiçoamento na proteção radiológica. O compromisso ético por excelência: "Primum non nocere", primeiro não provocar danos, norteia a questão

Os efeitos da radiação diagnóstica / The effects of diagnostic radiation / Los efectos de la radiación diagnóstica

Após haver a exposição à bomba atômica no Japão, calcula-se que, em aproximadamente 100 mSv, a radiação produz danos no organismo, entre os quais estão os cânceres radioinduzidos. A radiação de diagnóstico tem uma categoria de dose abaixo de 100 mSv. Os efeitos da radiação a essas doses são baseados em estimativas; contudo, deve-se levar em consideração que as doses são acumulativas. Neste artigo, comenta-se sobre os riscos da radiação de diagnóstico e chama-se a atenção à racionalização do uso das pesquisas radiológicas e à aplicação dos critérios ALARA (as low as reasonably achievable).

After the exposition to the atomic bomb in Japan, it is calculated that over 100 mSv are the quantity of damage produced by radiation in the organism, among which it can be found radio induced cancers. The diagnostic radiation has a doses average that is below 100 mSv. The radiation effects to these doses are based on estimations; however, one should know that the doses are accumulative. In this article, diagnostic radiation risks are commented and it calls the attention to rationalizing the use of radiological explorations and to applying ALARA criteria.

Tras la exposición a la bomba atómica en Japón, se ha calculado que, por encima de 100 mSv, la radiación produce daños en el organismo, entre los que se encuentran los cánceres radioinducidos. La radiación diagnóstica tiene un rango de dosis que está por debajo de 100 mSv. Los efectos de la radiación a esta dosis se basan en estimaciones; sin embargo, hay que tener en cuenta que las dosis son acumulativas. En este artículo, se comentan los riesgos de la radiación diagnóstica y se hace una llamada de atención a la racionalización del uso de las exploraciones radiológicas y a la aplicación de los criterios ALARA (as low as reasonably achievable).

Overuse, Overdose, Overdiagnosis… Overreaction?

When x-rays were first discovered, the harmful effects of radiation had to be manifest in the early users before they were known. Today, radiation protection and safety have been established and the effects of radiation, as well as its risks, are known. Even so, medical radiation, in particular the growth in the use of computed tomography (CT), has resulted in soaring radiation doses received by the population in general. Inappropriate use has resulted in overuse, overdose and, perhaps, overdiagnosis, especially when used in screening. In the quest to control and curb the use of procedures involving radiation, however, we must be careful not to provoke a pandemic of irrational fear of radiation. Overreaction to the overuse and overdose of radiation might deter patients from life-saving procedures.

College of Radiology, Academy of Medicine of Malaysia position on whole body screening CT scans in healthy asymptomatic individuals (2008)

To date, the College of Radiology (CoR) does not see any clear benefit in performing whole body screening computed tomography (CT) examinations in healthy asymptomatic individuals. There are radiation risk issues in CT and principles of screening should be adhered to. There may be a role for targeted cardiac screening CT that derives calcium score, especially for asymptomatic medium-risk individuals and CT colonography when used as part of a strategic programme for colorectal cancer screening in those 50 years and older. However, population based screening CT examinations may become appropriate when evidence emerges regarding a clear benefit for the patient outweighing the associated radiation risks.