Mora Patricia, Blanco Susana, Khoury Helen, Leyton Fernando, Cárdenas Juan, Defaz María Yolanda, Garay Fernando, Telón Flaviano, Aguilar Juan Garcia, Roas Norma, Gamarra Mirtha, Blanco Daniel, Quintero Ana Rosa, Nader Alejandro
Centro de Investigación en Ciencias Atómicas, Nucleares y Moleculares, University of Costa Rica, San Pedro, San Jose, Costa Rica
Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.
Radiat Prot Dosimetry. 2015 Mar;163(4):473-9. doi: 10.1093/rpd/ncu205. Epub 2014 Jul 3.
Latin American countries (Argentina, Brazil, Chile, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Nicaragua, Paraguay, Uruguay and Venezuela) working under the International Atomic Energy Agency (IAEA) Technical Cooperation Programme: TSA3 Radiological Protection of Patients in Medical Exposures have joined efforts in the optimisation of radiation protection in mammography practice. Through surveys of patient doses, the region has a unique database of diagnostic reference levels for analogue and digital equipment that will direct future optimisation activities towards the early detection of breast cancer among asymptomatic women. During RLA9/057 (2007-09) 24 institutions participated with analogue equipment in a dose survey. Regional training on methodology and measurement equipment was addressed in May 2007. The mean glandular dose (DG) was estimated using the incident kerma in air and relevant conversion coefficients for both projections craneo caudal and mediolateral oblique (CC and MLO). For Phase 2, RLA9/067 (2010-11), it was decided to include also digital systems in order to see their impact in future dose optimisation activities. Any new country that joined the project received training in the activities through IAEA expert missions. Twenty-nine new institutions participated (9 analogue and 20 digital equipment). A total of 2262 patient doses were collected during this study and from them D(G) (mGy) for both projections were estimated for each institution and country. Regional results (75 percentile in mGy) show for CC and MLO views, respectively: RLA9/057 (analogue) 2.63 and 3.17; RLA/067: 2.57 and 3.15 (analogue) and 2.69 and 2.90 (digital). Regarding only digital equipment for CC and MLO, respectively, computed radiography systems showed 2.59 and 2.78 and direct digital radiography (DDR) systems 2.78 and 3.04. Based on the IAEA Basic Safety Standard (BSS) reference dose (3 mGy), it can be observed that there is enough room to start optimisation processes in Latin America (LA); several countries or even particular institutions have values much higher than the 3 mGy. The main issues to address are lack of well-established quality assurance programmes for mammography, not enough medical physicists with training in mammography, an increase in patient doses with the introduction of digital equipment and to create awareness on radiation risk and optimisation strategies.
在国际原子能机构（IAEA）技术合作项目“TSA3 医疗照射中患者的放射防护”下开展工作的拉丁美洲国家（阿根廷、巴西、智利、哥斯达黎加、古巴、厄瓜多尔、萨尔瓦多、危地马拉、墨西哥、尼加拉瓜、巴拉圭、乌拉圭和委内瑞拉）共同努力优化乳腺摄影实践中的辐射防护。通过对患者剂量的调查，该地区拥有一个关于模拟和数字设备诊断参考水平的独特数据库，这将指导未来针对无症状女性早期乳腺癌检测的优化活动。在 RLA9/057（2007 - 09 年）期间，24 家机构使用模拟设备参与了剂量调查。2007 年 5 月开展了关于方法和测量设备的区域培训。平均腺体剂量（DG）是利用空气比释动能以及头尾位和内外侧斜位（CC 和 MLO）两种投照的相关转换系数估算得出的。对于第二阶段，即 RLA9/067（2010 - 11 年），决定将数字系统也纳入其中，以便了解它们对未来剂量优化活动的影响。任何加入该项目的新国家都通过国际原子能机构专家任务接受了活动培训。29 家新机构参与其中（9 家使用模拟设备，20 家使用数字设备）。在这项研究中总共收集了 2262 例患者剂量，并据此为每个机构和国家估算了两种投照的 D(G)（毫戈瑞）。区域结果（以毫戈瑞为单位的第 75 百分位数）显示，对于 CC 和 MLO 投照，分别为：RLA9/057（模拟）2.63 和 3.17；RLA/067：2.57 和 3.15（模拟）以及 2.69 和 2.90（数字）。仅就 CC 和 MLO 的数字设备而言，计算机 X 线摄影系统分别显示为 2.59 和 2.78，直接数字化 X 线摄影（DDR）系统为 2.78 和 3.04。基于国际原子能机构基本安全标准（BSS）的参考剂量（3 毫戈瑞）可以看出，拉丁美洲有足够的空间启动优化进程；一些国家甚至特定机构的值远高于 3 毫戈瑞。需要解决的主要问题包括乳腺摄影缺乏完善的质量保证计划、接受乳腺摄影培训的医学物理师不足、引入数字设备后患者剂量增加以及提高对辐射风险和优化策略的认识。
