Occupational radiation exposure among medical personnel in university and general hospitals in Japan.

OBJECTIVE: This study aimed to compare the occupational radiation exposure of medical workers between general hospitals and university hospitals. METHODS: Radiation exposure data from three hospitals in Hiroshima city, including one university hospital and two general hospitals, were collected using personal dosimeters. Monthly radiation doses were analyzed, and the annual sum of radiation exposure dose was calculated for 538 subjects in general hospitals and 1224 subjects in the university hospital. To assess the impact of locality, additional data from Nagasaki University Hospital and Fukushima Medical University Hospital were included for comparative analysis. Professional affiliations, such as doctors, nurses, and radiological technologists, were considered in the evaluation. RESULTS: The study revealed slight but significant differences in radiation doses between general and university hospitals. In general hospitals, except for radiological technologists, a slightly higher radiation dose was observed compared to university hospitals. Despite the annual increase in the use of medical radiation, the majority of hospital workers in both settings adhered to safety guidelines, with occupational radiation exposure remaining below the limit of detection (LOD). Workers who involved in fluoroscopic procedure, whether at university or general hospitals, had higher radiation doses than those who did not. CONCLUSION: The study's primary conclusion is that workers in general hospitals experience a slight but significantly higher radiation dose and a lower percentage below the LOD compared to university hospitals. The observed difference is attributed to the greater workload at general hospitals than at university hospitals, and also may be due to the different nature of university hospital and general hospital. University hospitals, characterized by greater academic orientation, tend to benefit from comprehensive support systems, specialized expertise, and advanced technology, leading to more structured and regulated radiation control. These findings provide a basis for targeted interventions, improved safety protocols.

Increasing the public awareness of justification.

One of the requirements of the UK Ionising Radiation (Medical Exposure) Regulations 2017 is that all medical exposures must be justified before the exposure can proceed. One of the main elements of justification is a determination that the medical benefits from the exposure will exceed the associated radiation detriment. The field of medical exposure to ionising radiation is in the rare position of having this explicit legal requirement for net benefit. In this article it is argued that, although separate information on benefit and detriment is also required for implied or explicit informed consent prior to exposure, justification comes first, is simple to explain, and is easily related to the commonly understood basis of medical ethics. It seems reasonable, therefore, to make patients and the public more aware of the protection that UK law already provides for them. A proposal for a single-sentence general statement on justification is made.

Comparing benefit and detriment from medical diagnostic radiation exposure using disability-adjusted life years: towards quantitative justification.

Justification of medical radiation exposure is one of the main elements of radiation protection for patients. For a medical exposure to proceed, the benefit from the procedure must have been determined to be greater than the detriment. It is rare, however, that justification can be stated quantitatively as a ratio of benefit to detriment, or as a net benefit, and this is particularly true for medical diagnostic exposures associated with non-fatal diseases where survival statistics do not apply. The concept of the disability-adjusted life year (DALY) is well established as a measure of disease severity in public health, and there have been calls to revise the international system of radiation protection dosimetry to employ the DALY as a measure of radiation detriment. This paper looks at possible routes to quantify the benefit and detriment aspects of justification based on initial published results for the use of the DALY as a measure of radiation detriment, together with established values of DALY for a range of diseases. Although spreadsheet-style solutions for the calculation of a justification factor based on statistical life tables can be devised, these will be shown to have some limitations. A justification factor based on the rate of change of benefit divided by the rate of change of detriment following medical exposure is proposed. This factor is simple to calculate, is age independent, can apply to non-fatal diseases and is argued to have logical and ethical advantages for the explanation of the relative benefits and detriments of radiological procedures to patients.

Education and training in radiation protection in Europe: results from the EURAMED Rocc-n-Roll project survey.

PURPOSE: To analyse the existing radiation protection (RP) education and training (E&T) capabilities in the European Union and identify associated needs, problems and challenges. METHOD: An online survey was disseminated via the EURAMED Rocc-n-Roll consortium network and prominent medical societies in the field of radiological research. The survey sections analyse the RP E&T during undergraduate, residency/internship and continuous professional development; RP E&T problems and legal implementation. Differences were analysed by European geographic regions, profession, years of professional experience and main area of practice/research. RESULTS: The majority of the 550 respondents indicated that RP topics are part of undergraduate curricula in all courses for their profession and country (55%); however, hands-on practical training is not included according to 30% of the respondents. The lack of E&T, practical aspects in current E&T, and mandatory continuing E&T were considered the major problems. The legal requirement that obtained higher implementation score was the inclusion of the practical aspects of medical radiological procedures on education (86%), and lower score was obtained for the inclusion of RP E&T on medical and dental school curriculums (61%). CONCLUSIONS: A heterogeneity in RP E&T during undergraduate, residency/internship and continuous professional development is evident across Europe. Differences were noted per area of practice/research, profession, and European geographic region. A large variation in RP E&T problem rating was also obtained.

The NBN founder mutation-Evidence for a country specific difference in age at cancer manifestation.

BACKGROUND: Nijmegen breakage syndrome (NBS) is an autosomal-recessive chromosome instability disorder characterized by, among others, hypersensitivity to X-irradiation and an exceptionally high risk for lymphoid malignancy. The vast majority of NBS patients is homozygous for a common Slavic founder mutation, c.657del5, of the NBN gene, which is involved in the repair of DNA double-strand breaks (DSBs). The founder mutation also predisposes heterozygous carriers to cancer, apparently however, with a higher risk in the Czech Republic/Slovakia (CS) than in Poland. AIM: To examine whether the age of cancer manifestation and cancer death of NBN homozygotes is different between probands from CS and Poland. METHODS: The study is restricted to probands born until 1989, before replacement of the communist regime by a democratic system in CS and Poland, and a substantial transition of the health care systems. Moreover, all patients were recruited without knowledge of their genetic status since the NBN gene was not identified until 1998. RESULTS: Here, we show that cancer manifestation of NBN homozygotes is at a significantly earlier age in probands from CS than from Poland. This is explained by the difference in natural and medical radiation exposure, though within the permissible dosage. CONCLUSION: It is reasonable to assume that this finding also sheds light on the higher cancer risk of NBN heterozygotes in CS than in Poland. This has implications for genetic counseling and individualized medicine also of probands with other DNA repair defects.

Study on correlation between medical exposure and healthcare level in China / 中华放射医学与防护杂志

Objective:To study the healthcare level (HCL) in China and its influencing factors.Methods:By using the data reported in the China statistical yearbook published by the National Bureau of Statistics and in other public literature, HCL was calculated in terms of the number of population and physicians in the whole country and various provinces. Multiple regression was used to analyze the relationship between HCL and regional population, area, number of administrative divisions and gross domestic product (GDP). Pearson correlation analysis was applied to analyze the relationship between healthcare level and medical radiation frequency. Results:Since 2015, Chinese HCL value was lower than 1 000, but there were two provinces with HCL value greater than 1 000 in 2019. Population and GDP were the influencing factors for the HCL, with correlation coefficients of 0.416 and -0.583, respectively. There was a correlation between HCL and medical exposure frequency of Chinese population( r= -0.620, P=0.028). Conclusions:Chinese HCL value was 542 in 2020, but there has been great differences between various provinces. HCL as an indicator of medical exposure assessment needs further research in China.

Influencing factors of medical exposure frequency for community residents / 中国辐射卫生

@#<b>Objective</b> To obtain the medical exposure frequency data of residents through a questionnaire survey on mobile phone networks in the community, and to analyze the main influencing factors. <b>Methods</b> A snowball sampling method was used to expand the sampling from medical staff in a county hospital to the community. The questionnaire included personal information such as occupation category, type of medical insurance, and education level as well as basic radiation-related knowledge and medical exposure type and frequency of respondents received in 2021. A logistic regression model was used to analyze the influencing factors of medical exposure. <b>Results</b> A total of 223 respondents were investigated, and 12.56% of them received radiological diagnosis and radiotherapy in 2021. The proportion of males receiving medical exposure was significantly higher than that of females (19.64% <i>vs</i> 10.18%). The likelihood of the person receiving medical exposure increased considerably with age, with the proportion of residents receiving medical exposure at 20, 30, 40, and 50 years of age being 6.25%, 7.95%, 19.23%, and 33.33%, respectively. Of persons who received medical exposure, 57.14% underwent CT scans. Persons participating in the new rural cooperative medical system were likely less to receive radiological diagnosis and radiotherapy than urban workers and residents (<i>OR</i> = 0.55, <i>CI</i>:0.13-2.23, <i>P</i> > 0.05). <b>Conclusion</b> Questionnaire survey in the community can obtain more information about the medical exposure of residents, and age and type of medical insurance are important factors affecting the frequency of medical exposure.

Development and test of new software for automatic acquisition of radiodiagnostic medical procedure frequency / 中华放射医学与防护杂志

Objective:To develop and test a software which can get and count the medical exposure frequency automatically.Methods:This study was based on the investigation of the frequency of radiodiagnostic medical procedures in China over the past by reference to the experience gained from the Electronic Medical Record Sharing and Reporting System in Beijing. The core elements for collecting the number of medical procedures and radiodiagnostic categories were determined. The collection process was then designed and the collection program software was written in a way for deployment on the front-end computer system of a general hospital for trial.Results:The field table to collect the number of medical procedures and the corresponding data structure were generated, and the data collection and statistics of the above fields were realized based on the survey data of DR and CT diagnostic examination frequency in a hospital in 2021. It took 15 s on average, and the statistical result are consistent with the manual statistical result using RIS source table.Conclusions:The software can realize the automatic acquisition and reporting of the number of radiodiagnostic medical procedures in hospital on a regular basis, which is worth promoting.

Current status of application of resources on medical exposure in Dongying, China / 中国辐射卫生

@#<b>Objective</b> To investigate the current status of application of resources on medical exposure in Dongying, China, and to provide fundamental data for setting up the health information management system of occupational radiation diseases and implementing health supervision and management strategies. <b>Methods</b> According to the requirements of monitoring program on radiation health of Dongying in 2021, a general survey was carried out in all medical institutions (other than dental clinics) providing radiodiagnosis and radiotherapy services by the field investigation method using the unified questionnaires and survey content, and a descriptive analysis was conducted on the results. <b>Results</b> There were 92 institutions of radiodiagnosis and radiotherapy in Dongying, 1112 radiation workers who accounted for 5.9% of all workers on duty, including 679 (61.1%) males and 433 (38.9%) females, and 364 pieces of radiation equipment, including 339 for X-ray diagnosis, 8 for radiotherapy, 2 for nuclear medicine, and 15 for interventional radiology. The allocation of personal protective equipment for interventional radiology staff in tertiary hospitals was higher than that in secondary hospitals, in which there were 0.36 and 0.23 pieces of lead-rubber aprons, 0.43 and 0.30 pieces of lead-rubber hats, 0.50 and 0.35 pieces of lead-rubber collars, 0.05 and 0 pairs of lead-rubber gloves, and 0.31 and 0.17 pairs of lead protection glasses per capita, respectively. The allocation rates of lead-rubber collars and lead protection glasses in the nuclear medicine staff were higher than those in the interventional radiology staff, with 0.63 collars and 0.88 pairs per capita, respectively. The annual frequency of medical exposure was calculated to be 864.3 person-times per 1000 population for radiodiagnosis and 5.2 patients per 1000 population for radiotherapy. <b>Conclusion</b> The allocation and application of resources on medical exposure in Dongying is unbalanced, so it is demanded to set up a health information management system of occupational radiation diseases for continuously mastering the application of medical exposure and adopting differentiated regulatory measures such as rating classification in Dongying.

A survey of the frequency of medical exposure in Fangshan District of Beijing, 2019 / 中国辐射卫生

Objective To investigate the basic situation of radiodiagnosis and radiotherapy institutions and the frequency of medical exposure in Fangshan District, Beijing, China. Methods A general survey using the questionnaire was conducted online to obtain the basic situation of the radiodiagnosis and radiotherapy institutions, the number of people in each type of radiodiagnosis and radiotherapy project, and the number of the usually resident population in the whole district in 2019, thus obtaining the frequency of medical exposure in each type of radiodiagnosis and radiotherapy project. Results There were 60 radiodiagnosis and radiotherapy institutions, 565 radiology staff, and 199 sets of radiodiagnosis and radiotherapy equipment in the whole district in 2019. The frequency of medical exposure was 521.29 per 1000 people, among which conventional medical diagnostic X-ray workers accounted for 301.79 per 1000 people (57.89%) and computed tomography workers accounted for 207.56 per 1000 people (39.82%). The number of tertiary hospitals accounted for 6.67% of the radiodiagnosis and radiotherapy institutions, and the number of people exposed tomedical radiation in tertiary hospitals accounted for 52.25% of the total. The number of secondary hospitals accounted for 5.00% of the radiodiagnosis and radiotherapy institutions, and the number of people exposed to medical radiation in secondary hospitals accounted for 27.83% of the total. Conclusion The distribution of medical exposure in Fangshan District is uneven. The radiodiagnosis and radiotherapy technology used is relatively single. Relevant departments should strengthen macroscopic readjustment and control, and formulate reasonable policies, so as to rationally allocate and effectively utilize medical and health resources.

The joint roadmap for radiation protection research: outreach and future.

During the last decade there has been remarkable integration of radiation protection research in Europe, driven by six research platforms. The platforms are associations of research centres, university research groups and funding bodies in Member States that are dedicated to specialised areas of research in radiation protection, such as health risks (MELODI), radioecology (ALLIANCE), radiological emergencies (NERIS), dosimetry (EURADOS), medical use of radiation (EURAMED) and societal aspects (SHARE). Recently these platforms established an umbrella organisation MEENAS, to endorse further integration and joint activities in research, education and training, and infrastructures. A milestone in this process of integration and priority setting was achieved in 2020 when the first edition of the joint roadmap for radiation protection research was finalised. In this paper we describe the various roles for research and development in the radiation protection context, ranging from basic scientific knowledge underpinning the system of protection to research supporting the development and application of international standards and research and development activities needed to ensure safety in radiation practices and in potential exposure scenarios. We describe the process of how the joint roadmap has been developed and how it could be implemented. Finally, we address the need to anticipate potential future exposure scenarios and to systematically consider the impact of emerging technologies and global challenges in the context of radiation protection. The joint roadmap is a living document that needs to be regularly updated to cover both current and potential exposures of humans and the environment.

Radiation exposures in pregnancy, health effects and risks to the embryo/foetus-information to inform the medical management of the pregnant patient.

Generally, intentional exposure of pregnant women is avoided as far as possible in both medical and occupational situations. This paper aims to summarise available information on sources of radiation exposure of the embryo/foetus primarily in medical settings. Accidental and unintended exposure is also considered. Knowledge on the effects of radiation exposure on the developing embryo/foetus remains incomplete-drawn largely from animal studies and two human cohorts but a summary is provided in relation to the key health endpoints of concern, severe foetal malformations/death, future cancer risk, and future impact on cognitive function. Both the specific education and training and also the literature regarding medical management of pregnant females is in general sparse, and consequently the justification and optimisation approaches may need to be considered on a case by case basis. In collating and reviewing this information, several suggestions for future basic science research, education and training, and radiation protection practice are identified.

Current status of the application of radiodiagnosis and radiotherapy resources in Huai′an City in 2020 / 中华放射医学与防护杂志

Objective:To investigate the current status of the radiodiagnosis and radiotherapy resources and medical exposure frequencies in Huai′an City.Methods:According to the monitoring data in the " Radiological Health Information Management Platform of Jiangsu Province" in 2020, a descriptive analysis was conducted on the personnel, equipment, and exposure frequencies in the institutes engaged in radiation-based diagnosis and treatment in Huai′an.Results:A total of 181 hospitals were investigated in 2020, including 7 tertiary hospitals(3.9%), 24 secondary hospitals(13.3%), 126 primary hospitals(69.6%), and 24 ungraded hospitals(13.3%). There were 1 397 radiation workers, including 948 males and 449 females, and 459 pieces of radiation equipment, including 420 for radio diagnosis, 13 for radiotherapy, 4 for nuclear medicine, and 22 for interventional radiology. The hospitals of different grades greatly differed in the number of radiation workers and equipment. There were 80.1, 20.9, 2.2, and 2.0 radiation workers and 15.7, 5.5, 1.4, and 1.6 pieces of radiation equipment in the tertiary hospitals, secondary hospitals, primary hospitals, and ungraded hospitals, respectively on average. There were 2 903 246, 27 648, 8 087, and 17 874 receiving radiodiagnosis, radiotherapy, nuclear medicine, and interventional radiology, respectively in 2020. The medical exposure frequencies in the whole city were calculated to be 599.50 per 1 000 population, including 334.59 treated with conventional X-rays, 239.82 receiving CT scan, 14.18 for breast and dentistry, 3.62 receiving interventional radiology, 5.61 treated with radiotherapy, and 1.69 receiving nuclear medicine.Conclusions:The radiodiagnosis and radiotherapy resources are unbalanced in the hospitals of different grades in Huai′an City. Therefore, it is necessary to pay more attention to the reasonable allocation of medical resources. Meanwhile, radiation workers in secondary hospitals may be more prone to job burnout. Facing the normalization of the prevention and control of COVID-19 epidemic, the supervision and management of radiological health should be strengthened to ensure the legitimacy of radiological diagnosis and radiotherapy and theoptimization of protection. The frequencies of medical exposure are consistent with the local economic level. To analyze the differences in medical exposure frequencies and predict the developmental trends in different regions, it is necessary to establish a more accurate prediction model.

Frequency and collective dose of medical radiation exposure in Hubei Province in 2018-2019 / 公共卫生与预防医学

Objective To assess the medical radiation exposure frequency and find out the main factors related to the collective dose derived from X-ray diagnosis procedures. Methods A survey of 3 178 hospitals was conducted to collect the basic information such as types of medical radiation, allocation of radiological diagnosis and treatment devices, the frequency of radiologic examinations, etc. By using a stratified sampling method，36 hospital were selected and more specific details, including 26 types of diagnostic radiologic examinations, were collected to estimate the collective dose to the population in Hubei, combining with the previous literature. Results A total number of 6 843 radiological diagnosis and treatment devices were covered and 33 771 855 medical radiologic procedures were counted in this survey. The result showed a annual frequency of 569.79 examinations per 1 000 population for all types of procedures. A large variation was revealed among different areas and the highest area was with a 4-fold frequency of the lowest area. Although tertiary hospitals accounted for 4.40% of the total hospitals, 48.42% procedures were carried out in them. The collective effective dose from X-ray diagnosis in Hubei was 65 399.55man·Sv, and the average annual effective dose was 1.10mSv, while contribution from CT scans accounted for 86.90% of the dose. Conclusion The frequency of medical radiologic procedures presented a consistent increase in Hubei province, with a uneven development among hospitals from urban and rural areas, or from different regions, or from different levels. Among all types of X-ray examinations, CT scan frequency had the fastest growth rate and accounted for the major annual collective effective dose. In order to reduce the health risk from medical radiologic exposure, CT scan need to be applied more properly and the radiation dose per single CT scan need to be limited to a reasonable level.

Niveles de Referencia para Diagnóstico en Procedimientos Radiológicos Dentales: Una Guía Práctica / Diagnostic Reference Levels in Dental Radiological Procedures: A Practical Guide

RESUMEN: Las exposiciones médicas con radiación ionizante son actualmente la principal fuente de exposición a la radiación artificial a nivel global, entre ellas, los exámenes dentales corresponden a uno de los más frecuentes. Para prevenir dosis innecesariamente altas a los pacientes durante estas exposiciones, la Comisión Internacional de Protección Radiológica (ICRP) recomienda la utilización de Niveles de Referencia para Diagnóstico (DRLs), como una herramienta efectiva de ayuda a la optimización de la protección radiológica en la exposición médica de pacientes. Dado que la legislación de Chile aún no ha incorporado el uso de los DRLs, el presente trabajo de revisión tuvo como objetivo analizar la publicación N° 135 de la ICRP para generar un documento que sirva de guía para los odontólogos, explicando de manera didáctica y en un lenguaje sencillo, pero técnico, los principales aspectos a tener en cuenta para establecer los DRLs en procedimientos de radiología dental.

SUMMARY: Currently exposure to ionizing radiation is currently the main source of exposure to artificial radiation worldwide, with dental examinations being one of the most frequent events. In order to prevent exposure of unnecessarily high doses in patients, the International Commission on Radiological Protection (ICRP) recommends the use of Diagnostic Reference Levels (DRLs), as an effective tool to help maximize protection from radiation during medical exposure of patients. Given that the Chilean legislation has not yet incorporated the use of DRLs, the purpose of this study was to analyze publication N° 135 of the ICRP to generate a document, to serve as a guide for dentists, didactically outlining in simple but technical language, the main aspects to consider when establishing DRLs in dental radiology procedures.

[Analysis on the use of radiation protective equipment for the accompanying examinees].

Objective: To investigate the situation of wearing protective equipment in the process of X-ray radiation examination (including DR and CT) in a 3A general hospital, so as to provide technical basis and solutions for better reducing the radiation dose of accompanying patients. Methods: From November 1, 2018 to June 30, 2019, the accompanying examinee 6 who had to stay in the examination room during the radiology examination (X-ray and CT examination) of a 3A general hospital from June 1, 2018 to June 30, 2019 was selected 535 people were divided into three groups according to whether they were reminded and instructed to wear protective equipment: group A was not reminded (group A) , group B was reminded to wear protective equipment, and group C was reminded and instructed to wear protective equipment (Group C) . Results: The wearing rates of protective equipment of the three groups were 35.0% (744/2126) , 85.2% (1858/2181) and 91.0% (2028/228) , and the complete wearing rates were 15.0% (319/2126) , 54.8% (1195/2181) and 88.0% (1960/228) , respectively. 4% (1450/3060) , 28.6% (876/3060) , 24.0% (734/3060) , respectively. 523 patients refused to wear protective equipment. The main reasons were emotion (33.8%, 177/523) and time (32.5%, 170/523) . Conclusion: The intervention of radiation workers can effectively improve the correct wearing rate of protective equipment and reduce the radiation exposure of accompanying people.

[A Questionnaire Survey on the Levels of Perception and Implementation on Diagnostic Reference Levels in Japan (Japan DRLs 2015)].

In June 2015, Japanese diagnostic reference levels (Japan DRLs 2015) was released by Japan Network for Research and Information on Medical Exposures (J-RIME). After six months the release of Japan DRLs 2015, we have conducted a questionnaire and received 222 responses from hospital staff regarding their perception level, and implementation on Japan DRLs 2015 at their facilities. 131 people (59.0%) were familiar with Japan DRLs 2015, of which 56 people (29.2%) were not currently implementation of them. A total of 66 people (30.1%) understood how to implement Japan DRLs 2015. There were 35 people (18.2%) who heard of diagnostic reference levels (DRLs) for the first time through this survey. Those are the levels of perception and implementation on Japan DRLs 2015 became clear. It is necessary to compare the dose levels used at each facility with Japan DRLs 2015 to optimize patient protection during medical exposure. It is essential to continue to grow the medical community's understanding of DRLs with the expanded perception and implementation of this survey as an opinion poll across Japan.

Estimation of cancer risks during mammography procedure in Saudi Arabia.

The aims of the present work were to quantify radiation doses arises from patients' exposure in mammographic X-ray imaging procedures and to estimate the radiation induced cancer risk. Sixty patients were evaluated using a calibrated digital mammography unit at King Khaled Hospital and Prince Sultan Center, Alkharj, Saudi Arabia. The average patient age (years) was 44.4 ±â€¯10 (26-69). The average and range of exposure parameters were 29.1 ±â€¯1.9 (24.0-33.0) and 78.4 ±â€¯17.5 (28.0-173.0) for X-ray tube potential (kVp) and current multiplied by the exposure time (s) (mAs), respectively. The MGD (mGy) per single projection for craniocaudal (CC), Medio lateral oblique (MLO) and lateromedial (LM) was 1.02 ±â€¯0.2 (0.4-1.8), 1.1 ±â€¯0.3 (0.5-1.8), 1.1 ±â€¯0.3 (0.5-1.9) per procedure, in that order. The average cancer risk per projection is 177 per million procedures. The cancer risk is significant during multiple image acquisition. The study revealed that 80% of the procedures with normal findings. However, precise justification is required especially for young patients.

The effect of virtual reality technology on preoperative anxiety in children: a Solomon four-group randomized clinical trial.

BACKGROUND: Preoperative anxiety correlates positively with the amount of postoperative pain, analgesic use, and length of hospital stay. The purpose of this study was to investigate the effect of virtual reality technology on pre-operative anxiety in children. METHODS: The study utilized Solomon four-group design intervention and a randomized clinical trial. A total of 40 candidates undergoing abdominal surgery were randomly divided into two groups. The pre-operative anxiety scale was assessed by a checklist containing a standardized Yale Preoperative Anxiety Scale questionnaire. The interventional group had a 5-min exposure to the operating room using virtual reality technology, but the control group did not receive virtual reality exposure. The data were analyzed using SPSS-23 software. RESULTS: Non-parametric test for two independent groups showed no significant difference in baseline scores between interventional 1 and control 1 groups except for vocalization (p = 0.019), but there was a significant change in all subscales among intervention group 1 from baseline to post-test (p < 0.05) except for state of apparent arousal. CONCLUSIONS: The medical treatment using virtual reality technology, as well as distraction and drowning in the virtual reality, reduced pre-operative anxiety in children.

Effect of ionizing radiation on the male reproductive system.

INTRODUCTION AND OBJECTIVE: In the light of current data concerning the growing exposure to ionizing radiation (IR) originating from atrificial sources, especially from medical ones, and also related to occupational exposure, it is justifiable to systematize the state of knowledge concerning the effect of IR on the male reproductive system. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: There is no basis for the application of the hypothesis of hormesis in the area of male reproductive health. Regarding the impact of IR on spermatogenesis, spermatogonia are less susceptible to the occurrence of DNA damage after exposition to IR, but are characterized by slower DNA repair compared to somatic cells. Damage to the genes after exposure to IR is possible at each stage of spermatogenesis; however, haploidal spermatids show the highest radiosensitivity in this respect. The genetic risk of the cells differentiating during spermatogenesis is limited to one cycle of spermatogenesis, whereas the genetic instability may persist for the whole period of life, and DNA damage induced by IR may be transmitted to future generations. The minimum dose causing detectable DNA damage was 30 Gy. While exceeding this dose, the number of single-strand DNA breaks increases. Among males exposed to IR, a decrease was observed in sperm motility and in the percentage of morphologically normal spermatozoa as well as in an intensification of vacuolization. The genetic material in the sperm of these males showed higher fragmentation and methylation of genomic DNA. CONCLUSION: In the context of the epidemiological situation concerning the prevalence of infertility, while assessing the health effects of exposure to IR from artificial, including medical sources, the reproductive risk should be considered.