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Purpose Optimization of CT scan practices can help achieve and maintain optimal radiation protection. The aim was to assess centering, scan length, and positioning of patients undergoing chest CT for suspected or known COVID-19 pneumonia and to investigate their effect on associated radiation doses. Methods With respective approvals from institutional review boards, we compiled CT imaging and radiation dose data from four hospitals belonging to four countries (Brazil, Iran, Italy, and USA) on 400 adult patients who underwent chest CT for suspected or known COVID-19 pneumonia between April 2020 and August 2020. We recorded patient demographics and volume CT dose index (CTDIvol) and dose length product (DLP). From thin-section CT images of each patient, we estimated the scan length and recorded the first and last vertebral bodies at the scan start and end locations. Patient mis-centering and arm position were recorded. Data were analyzed with analysis of variance (ANOVA). Results The extent and frequency of patient mis-centering did not differ across the four CT facilities (>0.09). The frequency of patients scanned with arms by their side (11–40% relative to those with arms up) had greater mis-centering and higher CTDIvol and DLP at 2/4 facilities (p = 0.027–0.05). Despite lack of variations in effective diameters (p = 0.14), there were significantly variations in scan lengths, CTDIvol and DLP across the four facilities (p Conclusions Mis-centering, over-scanning, and arms by the side are frequent issues with use of chest CT in COVID-19 pneumonia and are associated with higher radiation doses.

Computed tomography (CT) provides useful information in patients with known or suspected COVID-19 infection. However, there are substantial variations and challenges in scanner technologies and scan practices that have negative effect on the image quality and can increase radiation dose associated with CT. Objective: In this article, we present major issues and challenges with use of CT at five Brazilian CT facilities for imaging patients with known or suspected COVID-19 infection and offer specific mitigating strategies. Methods: Observational, retrospective and prospective study of five CT facilities from different states and regions of Brazil, with approval of research and ethics committees. Results: The most important issues include frequent use of CT, lack of up-to-date and efficient scanner technologies, over-scanning and patient off-centring. Mitigating strategies can include updating scanner technology and improving scan practices.

O ecodopplercardiograma transtorácico é um exame de imagem de ampla aplicabilidade clínica que, apesar do requerimento de grande experiência do operador e de possibilidade de janelas acústicas ruins, permite a obtenção de muitas informações de maneira não invasiva, sem riscos de ionização para o paciente, com baixo custo. Quando realizado sob estresse físico ou farmacológico, torna-se uma opção com apropriada acurácia diagnóstica para investigação de isquemia miocárdica. Dentre os recursos disponíveis, o strain rate tem se mostrado útil na detecção de alterações incipientes da função sistólica segmentar, inclusive em pacientes portadores de hipertensão arterial sistêmica e doença arterial coronária. O presente trabalho demonstra o caso de uma paciente do gênero feminino assintomática que, após a submissão ao ecodopplercardiograma sob estresse farmacológico, apresentou hipertrofia do ventrículo esquerdo e strain rate alterado, mesmo sem alterações segmentares de motilidade miocárdica.

Introduction: The worldwide increases in availability and request of computed tomography in children have brought concern about the cumulative effect of radiation. Traumatic brain injury is a clinical situation in which tomography is frequently necessary. Objectives: 1. Evaluating if the reduction of the radiation dose of head computed tomography in children with head trauma would affect the diagnosis and medical conduct; 2. Promoting a radioprotection campaign in a private health care system. Method: We selected two groups of computed tomography from children with head trauma: 30 performed before the study period, with usual doses of radiation; and 30 tomographies performed during the project, in which we applied the protocol of The Radiation Safety The Alliance for Imaging in Pediatric with 50% radiation dose reduction. The two series of exams were presented to 19 pediatricians, 2 neurosurgeons and 7 radiologists who were unaware of the technical differences and they answered a questionnaire. Results: The professionals had no difficulty in making a diagnosis and establish a conduct with both series of exams. Four participants noted more grainy images in the exams with lower radiation dose. A radioprotection campaign distributed 17,000 radioprotection wallets for children up to 12 years. Professionals involved and parents joined the campaign strongly and rationally. Conclusions: It is possible to reduce the computed tomography radiation dose for children with head trauma without any prejudice to the diagnosis and treatment. The radioprotection campaign was effective and well accepted by professionals and family and will become a national campaign.

Pheochromocytomas — 90% of those being benign — are relatively rare tumors of the adrenal medulla, catecholamines producers. About 75% of patients manifest the sudden classic triad characterized by severe hypertension, palpitations and headache. The diagnosis is confirmed by urinary metanephrines dosage, and radiological tests such as ultrasonography, computed tomography and magnetic resonance imaging. The curative treatment consists in removing the tumor, and videolaparoscopy is the chosen surgical technique. This report describes the case of a woman, who sought the emergency unit complaining of left back, and after imaging tests, was evidenced a large adrenal mass. The patient presented as a symptom linked to the secreting tumor was only secondary hypertension. It was opted to perform an open surgery as a consequence of the tumor dimensions, and the person presents herself normotensive after left adrenectomy.

Empathy is a fundamental humanistic component of patient care which facilitates efficient and patient-centered clinical encounters. Despite being the principal recipient of physician empathy little work on how patients perceive/report receiving empathy from their physicians has been undertaken. In the context of doctor-patient interactions, knowledge about empathy has mostly originated from physicians' perspectives and has been developed from studies using self-assessment instruments. In general, self-assessment may not correlate well with the reality observed by others., Funding was provided by Fapesp-Fundação de Amparo a Pesquisa do Estado de São Paulo(2016/11908-1) to Dr Marco Antonio Carvalho-Filho, info:eu-repo/semantics/publishedVersion

O presente trabalho relata um caso de uma das formas mais graves de pancreatite aguda, a pancreatite necro- hemorrágica. Nessa condição, o paciente fica em uma linha tênue entre uma boa evolução e a queda do estado geral, com alta mortalidade. O paciente deu entrada no hospital com fortes dores em abdome superior. No exame tomográfico constatou-se pancreatite com sinais sugestivos de necrose, sendo tratado clinicamente por sete dias. Após manutenção radiológica do quadro, o paciente foi submetido a uma laparotomia exploradora com necrosectomia e colocação de dreno. Paciente evoluiu bem clinicamente, tendo alta hospitalar no 17º dia de internação.

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.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.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.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.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.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.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.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.

Feocromocitomas são tumores — 90% benignos — relativamente raros da medula da suprarrenal, produtores de catecolaminas. Cerca de 75% dos pacientes manifestam a tríade súbita clássica, caracterizada por hipertensão grave, palpitações e cefaleia. O diagnóstico é confirmado por meio da dosagem de metanefrinas urinárias, além de exames radiológicos, como ultrassonografia, tomografia computadorizada e ressonância nuclear magnética. O tratamento curativo consiste na retirada do tumor, sendo a videolaparoscopia a técnica cirúrgica utilizada. O presente relato descreve o caso de uma mulher que procurou a emergência com queixa de lombalgia à esquerda e, após exames de imagem, ficou evidenciada massa de grandes dimensões em suprarrenal. A paciente apresentava como sintomatologia ligada ao tumor secretor apenas a hipertensão arterial secundária. Optou-se pela cirurgia aberta devido às dimensões do tumor e, após adrenectomia esquerda, a paciente apresentou-se normotensa.

A dilatação segmentar de uma artéria é definida como aneurisma arterial sendo manifestação freqüente de distúrbios clínicos. Os sinais e sintomas apresentados, em especial as lesões gengivais e penianas e as alterações da visão, associados ao diagnóstico radiológico dos aneurismas das artérias pulmonares apontam para esta Doença de Behçet. Trata-se de doença sistêmica atingindo vários órgãos e portanto de interesse para diversos especialistas, tais como: dermatologista, oftalmologista, estomatologista, reumatologista, etc. Em virtude de impossibilidade de tratamento cirúrgico, o paciente foi encaminhado para o tratamento clínico.

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.

Objective: To evaluate the knowledge of health professionals about radiological protection and to implement educational actions to promote a safe working environment for professionals, patients and companions. Method: An exploratory cross-sectional study, applying a questionnaire to 59 participants from different sectors of a teaching hospital. Open-ended questions were analyzed through the discourse of the collective subject and closed-ended questions were analyzed through quantitative analysis. Results: In the opinion of the participants, their professional training did not offer radioprotection class or the training was insufficient for the practice. In addition, the work environment does not provide regulatory norms and training on radioprotection. Most participants do not have solid knowledge and do not present safe behavior in radioprotection. In the internal week for the prevention of work accidents, a lecture and a theatricalisation about the topic of radioprotection were conducted and a booklet was distributed. Conclusion: Radiation protection education is necessary in the curricula of the training courses for health professionals and in the work environment. RESUMEN Objetivo: Evaluar los conocimientos de los profesionales de la salud sobre la protección radiológica con el intuito de implementar acciones educativas para promover un ambiente de trabajo seguro para los profesionales, pacientes y acompañantes Método: Se trata de un estudio transversal exploratorio, desarrollado por medio de un cuestionario aplicado a 59 participantes de diferentes sectores de un hospital de enseñanza. Se analizaron las cuestiones abiertas mediante el discurso del sujeto colectivo, y las cerradas, mediante análisis cuantitativo. Resultados: Según la opinión de los participantes, el curso no sumó conocimiento sobre la radioprotección o fue insuficiente para la práctica. El ambiente de trabajo tampoco pone a disposición normas reguladoras y formación sobre el tema. La mayoría de los participantes no poseen conocimiento sólido y comportamiento seguro en radioprotección. Durante la semana interna de prevención de accidentes de trabajo, se realizaron conferencias y teatralización sobre el tema radioprotección y se distribuyeron cartillas. Conclusión: Es necesario la inclusión educativa sobre radioprotección en los planes de estudio de los cursos formadores de profesionales de la salud y en el ambiente de trabajo. RESUMO Objetivo: Avaliar o conhecimento que os profissionais de saúde têm sobre proteção radiológica e implementar ações educativas para promover um ambiente de trabalho seguro aos profissionais, pacientes e acompanhantes. Método: Estudo transversal exploratório, aplicando-se um questionário a 59 participantes de diferentes setores de um hospital de ensino. Questões abertas foram analisadas pelo discurso do sujeito coletivo. Questões fechadas tiveram análise quantitativa. Resultados: Na opinião dos participantes, o curso que fizeram não ofereceu formação sobre radioproteção ou foi insuficiente para a prática. O ambiente de trabalho também não disponibiliza normas regulatórias e formação sobre radioproteção. A maioria dos participantes não tem conhecimento sólido e comportamento seguro em radioproteção. Na semana interna de prevenção de acidentes de trabalho, foram feitas palestra e teatralização sobre o tema radioproteção e distribuída cartilha. Conclusões: São necessárias inserções educativas em radioproteção nas grades curriculares dos cursos formadores de profissionais de saúde e no ambiente de trabalho.

Learning objectives Background Findings and procedure details Conclusion Personal information and conflict of interest References, Learning objectives: The purpose of this study is to investigate the radiation dose in computed tomography (CT) based on clinical indication protocols in a Pilot Study in Brazil. Preliminary results are presented. The learning objective is that the investigation of...