Percorrer por autor "Paulo, Graciano"
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- Application of a newly developed software program for image quality assessment in cone-beam computed tomographyPublication . de Oliveira, Marcus Vinicius Linhares; Santos, António Carvalho; Paulo, Graciano; Campos, Paulo Sergio Flores; Santos, JoanaThe purpose of this study was to apply a newly developed free software program, at low cost and with minimal time, to evaluate the quality of dental and maxillofacial cone-beam computed tomography (CBCT) images.
- Call for implementing a radiation protection culture in fluoroscopically guided interventional proceduresPublication . Bartal, Gabriel; Roguin, Ariel; Paulo, GracianoThe purpose of this article is to discuss the first prospective study published to date that followed a large cohort of radiologic technologists; the authors examined the risks of cancer incidence and mortality in U.S. radiologic technologists (radiographers) assisting in fluoroscopically guided interventional procedures.
- Current practices and perceptions on diagnostic reference levels: a EuroSafe Imaging Survey AnalysisPublication . Damilakis, John; Brkljacic, Boris; Frija, Guy; De Bondt, Timo; Paulo, Graciano; Tsapak, Virginia; Vano, Eliseo; European Society of RadiologyDespite progress in implementing diagnostic reference levels (DRLs) across Europe, clinical practices remain variable. This prompts the EuroSafe Imaging campaign to conduct a survey assessing current practices, perceptions, and challenges related to DRLs. A total of 146 responses were collected from radiology departments in 38 countries, predominantly in the EU/EEA region. While 52.4% reported established local DRLs, significant gaps were identified, with 34.5% lacking local DRLs and 13.1% unaware of their existence. DRLs were primarily established for computed tomography (CT) (88.7%) and conventional radiography (77.5%), with lower implementation in interventional radiology (36.6%). Key challenges included time constraints, data collection difficulties, and limited standardization across institutions. Education gaps were notable, with less than half of the respondents reporting DRL-related training for radiology residents. Respondents emphasized the need for dose management systems, personalized DRLs based on clinical indications, and enhanced education and policy support. Addressing barriers through targeted training, policy enhancements, and technological innovations can improve DRL implementation. Future efforts should focus on promoting standardized clinical protocols, increasing awareness, and fostering European and international collaboration to ensure the consistent use and optimization of DRLs in clinical practice. Critical relevance statement. The article critically examines the variability and challenges in implementing diagnostic reference levels (DRLs) across European radiology departments, providing actionable recommendations on policy, education, and technological advancements to optimize radiation protection and improve clinical radiology practices. Patient summary. Diagnostic reference levels (DRLs) help healthcare providers ensure that radiation doses from medical imaging, like CT scans and X-rays, are not higher than necessary. This study looked at how DRLs are used across Europe. It found that while many hospitals have established and follow DRLs, others do not, which may affect patient safety. Challenges like time constraints and lack of training prevent better use of DRLs. Improving education for medical staff and updating protocols can help protect patients by reducing unnecessary radiation exposure while still ensuring accurate diagnoses. Key Points. ● Variability persists in diagnostic reference level (DRL) practices across Europe. ● Over half of radiology departments have established local DRLs. ● Less than half of radiology residents receive structured DRL training. ● Improved DRL adoption can optimize radiation protection and patient safety. ● Collaboration, training, and standardized protocols are essential for better DRL practices.
- Diagnostic reference levels in plain radiography for paediatric imaging: a portuguese studyPublication . Paulo, Graciano; Vañó, Eliseo; Rodrigues, AdrianaObjective: To determine diagnostic reference levels (DRLs) for the most frequent paediatric plain radiography examinations in Portugal (chest, pelvis and abdomen) and to characterise a standard paediatric patient for each age group used in literature. Methods: Anthropometric data was collected from 9935 patients. Each age group (<1, 1-<5, 5-<10, 10-<16, ≥16) was categorised by the median values of weight, height and BMI, to define a standard patient. Exposure parameters, kerma-area product (KAP-mGy cm2) and entrance surface air kerma (ESAK-μGy) were collected. DRLs for KAP and ESAK were defined as the 75th percentile (P75) of dose values and presented by age and weight. Results: In each age group the P75 of KAP varied from 11 to 77 mGy cm2 for chest; 23-816 mGy cm2 for pelvis; 25-979 mGy cm2 for abdomen. The P75 of ESAK varied from 49 to 67 μGy for chest; 98-1129 μGy for pelvis and 70-1060 μGy for abdomen. Conclusion: The P75 of dose values determined in this study were lower than those published in literature. When available, weight is the preferred parameter to categorise paediatric patients. The large ranges of dose values found in this study, demonstrates a clear need for the optimisation and harmonisation of practice.
- Dose na medida das necessidadesPublication . Paulo, Graciano
- Education and training in radiation protection in Europe: an analysis from the EURAMED rocc-n-roll projectPublication . Rainford, Louise; Santos, Joana; Alves, Francisco; Figueiredo, João; Hoeschen, Christoph; Damilakis, John; Frija, Guy; Andersson, Jonas; McNulty, Jonathan; Foley, Shane; Bacher, Klaus; Nestle, Ursula; Hierath, Monika; Paulo, GracianoBackground: A Strengths, weaknesses, opportunities and threats analysis was performed to understand the status quo of education and training in radiation protection (RP) and to develop a coordinated European approach to RP training needs based on stakeholder consensus and existing activities in the field. Fourteen team members represented six European professional societies, one European voluntary organisation, two international healthcare organisations and five professions, namely: Medical Physicists; Nuclear Medicine Physicians; Radiologists; Radiation Oncologists and Radiographers. Four subgroups analysed the “Strengths”, “Weaknesses”, “Opportunities” and “Threats” related to E&T in RP developed under previous European Union (EU) programmes and on the Guidelines on Radiation Protection Education and Training of Medical Professionals in the EU. Results: Consensus agreement identified four themes for strengths and opportunities, namely: (1) existing structures and training recommendations; (2) RP training needs assessment and education & training (E&T) model(s) development; (3) E&T dissemination, harmonisation, and accreditation; (4) financial supports. Weaknesses and Threats analysis identified two themes: (1) awareness and prioritisation at a national/global level and (2) awareness and prioritisation by healthcare professional groups and researchers. Conclusions: A lack of effective implementation of RP principles in daily practice was identified. EuRnR strategic planning needs to consider processes at European, national and local levels. Success is dependent upon efficient governance structures and expert leadership. Financial support is required to allow the stakeholder professional agencies to have sufficient resources to achieve a pan European radiation protection training network which is sustainable and accredited across multiple national domains.
- Estimation of the collective dose in the Portuguese population due to medical procedures in 2010Publication . Teles, Pedro; De Sousa, Carmen; Paulo, Graciano; Santos, Joana; Pascoal, Ana; Cardoso, Gabriela; Lança, Isabel; Matela, Nuno; Janeiro, Luís; Sousa, Patrick; Carvoeiras, Pedro; Parafita, Rui; Santos, A. I.; Simaozinho, Paula; Vaz, P.In a wide range of medical fields, technological advancements have led to an increase in the average collective dose in national populations worldwide. Periodic estimations of the average collective population dose due to medical exposure is, therefore of utmost importance, and is now mandatory in countries within the European Union (article 12 of EURATOM directive 97/43). Presented in this work is a report on the estimation of the collective dose in the Portuguese population due to nuclear medicine diagnostic procedures and the Top 20 diagnostic radiology examinations, which represent the 20 exams that contribute the most to the total collective dose in diagnostic radiology and interventional procedures in Europe. This work involved the collaboration of a multidisciplinary taskforce comprising representatives of all major Portuguese stakeholders (universities, research institutions, public and private healthcare providers, administrative services of the National Healthcare System, scientific and professional associations and private service providers). This allowed us to gather a comprehensive amount of data necessary for a robust estimation of the collective effective dose to the Portuguese population. The methodology used for data collection and dose estimation was based on European Commission recommendations, as this work was performed in the framework of the European wide Dose Datamed II project. This is the first study estimating the collective dose for the population in Portugal, considering such a wide national coverage and range of procedures and consisting of important baseline reference data. The taskforce intends to continue developing periodic collective dose estimations in the future. The estimated annual average effective dose for the Portuguese population was of 0.080±0.017 mSv caput(-1) for nuclear medicine exams and of 0.96±0.68 mSv caput(-1) for the Top 20 diagnostic radiology exams.
- Exploring the translational challenge for medical applications of ionising radiation and corresponding radiation protection researchPublication . Bockhold, Sophie; Foley, Shane J.; Rainford, Louise A.; Corridori, Riccardo; Eberstein, Annika; Hoeschen, Christoph; Konijnenberg, Mark W.; Molyneux-Hodgson, Susan; Paulo, Graciano; Santos, Joana; McNulty, Jonathan P.Background: Medical applications of ionising radiation and associated radiation protection research often encounter long delays and inconsistent implementation when translated into clinical practice. A coordinated efort is needed to analyse the research needs for innovation transfer in radiation-based high-quality healthcare across Europe which can inform the development of an innovation transfer framework tailored for equitable implementation of radiation research at scale. Methods: Between March and September 2021 a Delphi methodology was employed to gain consensus on key translational challenges from a range of professional stakeholders. A total of three Delphi rounds were conducted using a series of electronic surveys comprised of open-ended and closed-type questions. The surveys were disseminated via the EURAMED Rocc-n-Roll consortium network and prominent medical societies in the feld. Approximately 350 professionals were invited to participate. Participants’ level of agreement with each generated statement was captured using a 6-point Likert scale. Consensus was defined as median≥4 with≥60% of responses in the upper tertile of the scale. Additionally, the stability of responses across rounds was assessed. Results: In the first Delphi round a multidisciplinary panel of 20 generated 127 unique statements. The second and third Delphi rounds recruited a broader sample of 130 individuals to rate the extent to which they agreed with each statement as a key translational challenge. A total of 60 consensus statements resulted from the iterative Delphi process of which 55 demonstrated good stability. Ten statements were identifed as high priority challenges with≥80% of statement ratings either ‘Agree’ or ‘Strongly Agree’. Conclusion: A lack of interoperability between systems, insuficient resources, unsatisfactory education and training, and the need for greater public awareness surrounding the benefts, risks, and applications of ionising radiation were identifed as principal translational challenges. These findings will help to inform a tailored innovation transfer framework for medical radiation research.
- Impact of a radiological protection campaign in emergency paediatric radiology: a multicentric observational study in BrazilPublication . Oliveira Bernardo, Mônica; Morgado, Flávio; dos Santos, Alair Augusto Sarmet Moreira Damas; Foley, Shane; Paulo, Graciano; de Almeida, Fernando AntônioPurpose: To evaluate the impact of a paediatric radiological protection campaign, implemented in the emergency units of a healthcare provider network in Brazil. This campaign aimed to promote awareness among emergency department physicians, regarding justifcation of paediatric X-ray referrals for paranasal sinus, chest and CT exams, as a strategy to reduce exposure to ionising radiation. Method: Frequency analysis of common paediatric imaging referrals from 19 emergency departments was performed for a 3-year period (2015–2018) to coincide with before, during and after the implementation of the radiation protection campaign. The campaign was multifaceted and involved dissemination of educational materials and imaging referral guidelines along with quarterly meetings with participating centres’ leaderships. Additionally, patient dose cards were distributed to patients/carers. The Chi-Square test was used to examine the association between the type of examination and the patient’s age group. Exact-Fisher test was performed to check for an association between participant engagement and the existence of the radiation protection committee. Results: Referrals reduced by 25% following the campaign with no reports of misdiagnosis. Many referrals in the youngest age groups. In 15 units, a radiological protection committee was created to raise awareness and to create a multi professional team to communicate the risks and benefits of radiological procedure in children. Conclusion: The campaign resulted in a substantial reduction in radiological referrals while promoting a radiation protection culture. Simple education initiatives can contribute to savings in both finances and radiation doses, particularly important in radiosensitive cohorts.