Problems of personnel irradiation in modern medical technologies

BACKGROUND: The widespread use of radiation sources in medical practice (cardio-endovascular surgery, endoscopy, traumatology, urology, neurosurgery, dentistry, and radioisotope diagnostics departments) leads to irradiation of the lens of the eye and the skin of the hands. The introduction of new recommendations by the IAEA to reduce the limit of the annual equivalent dose to the lens (20 mSv) has led to an inaccurate dose assessment based on the effective dose. AIM: To analyze approaches and assess equivalent doses of irradiation of the lens of the eye and skin of the hands of medical personnel during various diagnostic studies under the influence of X-rays and radiopharmaceuticals studies and to compare the results obtained with previously published data. MATERIALS AND METHODS: Thermo-luminescent dosimetry was used. Dose assessment was performed by cardio-endovascular surgery, endoscopy, isotope diagnostics, dentistry, and urology personnel. RESULTS: The estimated annual equivalent doses to the lens of the eye for doctors of cardio-endovascular surgery departments, in most cases, ranging 3590 mSv, 619 mSv for the average medical staff (in some cases, the doctor [225 mSv] and the nurse [180 mSv]) and 4.59 mSv for the staff of the department of radioisotope diagnostics. The annual calculated equivalent doses to the skin of the hands for cardio-endovascular surgery personnel were 17100 and 24220 mSv for the staff working with radiopharmaceuticals. It is shown that the use of an estimate of the average dose per operation by cardio-endovascular surgery doctors, as a rule, inevitably leads to an excess of the equivalent dose to the lens of the eye after a certain number of operations. CONCLUSION: When a certain number of operations are exceeded (100200), equivalent doses to the eyes lens in cardio-endovascular surgery doctors above 20 mSv per year can be formed. At current radiation levels, a lesion of the eyes lens was found in a cardio-endovascular surgery doctor. The results indicate the need for further dosimetric measurements and epidemiological studies, based on which recommendations for radiation protection of the eyes lens and the skin of the hands of medical personnel working in low-intensity, scattered, gamma X-ray radiation can be developed

The use of pulsed sonar underwater shower-massage after extracorporeal shock wave lithotripsy in patients with urolithiasis in the postoperative period

The objective of this work was to study the dynamics of change in subjective sensations (pain and dysuric syndrome), indicators of urinalysis, ultrasound pictures of the kidneys and upper urinary tract when carrying out physiotherapeutic treatment (sonar underwater shower-massage) and without it. The task is solved in that patients suffering from urolithiasis after ESWL held daily session sonar underwater shower-massage with subsequent assessment of the dynamics of change in subjective sensations (pain and dysuric syndrome), indicators of 0AM, ultrasound pictures of the kidneys and the upper urinary tract for 5,7 and 9 day. Analysis of the obtained data allowed to reveal the improvement of the above parameters in patients after ESWL carried out with further physiotherapy treatment, in comparison with patients without carried out physiotherapeutic treatment.Целью данной работы явилась изучение динамики изменения субъективных ощущений (дизурический и болевой синдром), показателей ОАМ, УЗИ-картины почек и верхних мочевых путей при проведении физиотерапевтического лечения (гидроакустический подводный душ-массаж) и без него. Поставленная задача решается тем, что пациентам, страдающим мочекаменной болезнью после проведенной ДУВЛ выполняется ежедневный сеанс гидроакустического подводного душ-массажа с последующей оценкой динамики изменения субъективных ощущений (дизурический и болевой синдром), показателей ОАМ, УЗИ-картины почек и верхних мочевых путей на 5,7 и 9 сутки. Анализ полученных данных позволил выявить улучшение вышеуказанных показателей у пациентов после проведенного ДУВЛ с последующим физиотерапевтическим лечением, в сравнении с пациентами без проведенного физиотерапевтического лечения

СОВРЕМЕННЫЕ ОСОБЕННОСТИ ФОРМИРОВАНИЯ УРОВНЕЙ МЕДИЦИНСКОГО ОБЛУЧЕНИЯ НАСЕЛЕНИЯ РЕСПУБЛИКИ ТАТАРСТАН ПРИ ВЫПОЛНЕНИИ РЕНТГЕНОЛОГИЧЕСКИХ ПРОЦЕДУР

The purpose. The purpose of the investigation is an assessment of the peculiarities of forming and registration of the collective doses of patients and the population of the Tatarsatan Republic (RT) from medical exposure and the development of measures for optimization of this radiation factor.Materials and methods. The analysis is based on the forms of the Federal statistical observation № 3-DOZ «Data on the exposure doses to patients obtained during medical radiological examination» (form № 3-DOZ) and radiation-hygienic passports of RT for the period from 2006 to 2013.The results. Annually in RT there is an increase of the number of performed X-ray procedures, which reached the value of 6279696 (1.64 procedures per resident per year) in 2013. During the reporting period (from 2006 to 2013) the structure of the performed X-ray procedures has also changed. It is observed that the percentage of fluorography procedures in the overall structure decreased from 41.3% to 31.3% at the same time the level of absolute value of annually performed fluorography procedures is stable. There is an increase in the absolute number of radiographic procedures performed during the period from 2578754 to 4072810 X-rays per year, that is 1.58 times higher. Absolute and relative values related to X-ray fluoroscopy examinations decreased from 1.1% to 0.7%. In contrast, the absolute number of annually performed X-ray computed tomography examinations (CT) has increased over the period by 3.3 times and percentage of CT in overall structure of X-ray procedure is 2.7%. The number of special investigations has increased in 2.1 times, but the relative value remained at average level of 0.4% on general background of the increasing of X-ray activity in the region. This fact influenced the change in the radiation-hygienic indexes of medical radiation exposure of the population of RT. According to №3-DOZ forms and radiation-hygienic passports of the territories, the levels of the annual collective effective dose from medical exposure to the patients and population increases in the period from 2006 to 2012. The structure of the medical exposure has been significantly changed. If the dominant role in the formation of the annual collective effective dose in 2006 performed the fluorography procedures (609.17 person-Sv; 34.03% in the structure of the total collective dose from medical exposure), then the primary importance passed to СТ in 2013 (748.18 person-Sv; 50.04%). The article considers the peculiarities of the formation and recording of exposure doses to patients when performing various types of x-ray procedures.Conclusion. The widespread use of the digital technologies of producing and processing of the X-ray images, an adjust instrumental control and registration of patient exposure doses, routine control of operational parameters of the equipment used for the fluorographic, X-ray and fluoroscopic procedures allowed to objectify and reduce correspondent indicators of the collective effective exposure doses to patients and population. There exists the reserve for organizational, technical measures for the further reduction of patient exposure doses during the performance of the routine X-ray procedures, namely the standardization of the performed examinations, further transition to the digital X-ray technologies of the image obtaining. The use of calculation methods of the patient dose registration continues to provide the significant influence on the statistical reporting when the performing of CT and special examinations. Taking into account the fact that CT provides the greatest contribution to the annual collective effective dose in the region in recent years (more than 50%, the first place in the structure of medical exposure), and special examinations of a high clinical efficient, are also accompanied by a significant radiation exposure it is necessary to apply the measures fore the objectification of the exposure doses for these types of examinations in order to develop scientifically justified measures to reduce adverse effects on the exposed population categories.Цель. Установление особенностей формирования и учета коллективных доз облучения пациентов и населения Республики Татарстан (РТ) от медицинского облучения и разработка мероприятий по оптимизации данного радиационного фактора.Материалы и методы. Для анализа использованы формы федерального государственного статистического наблюдения № 3-ДОЗ «Сведения о дозах облучения пациентов при проведении медицинских рентгенорадиологических исследований» (формы № 3-ДОЗ) и радиационно-гигиенические паспорта территории РТ за период с 2006 по2013 г.Результаты. Ежегодно в РТ наблюдается увеличение количества выполняемых рентгенологических процедур, которое в2013 г. достигло значения 6 279 696 (1,64 процедуры на жителя в год). За рассматриваемый период времени (с 2006 по2013 г.) изменилась также и структура выполняемых рентгено-диагностических процедур. Отмечается относительное снижение доли флюорографических процедур в общей структуре с 41,3% до 31,3% при сохранении стабильного уровня абсолютных значений выполняемых ежегодно флюорограмм. Наблюдается увеличение абсолютного количества выполняемых рентгенографических процедур за рассматриваемый период с 2 578 754 до 4 072 810 рентгенографий в год, то есть в 1,58 раза. Абсолютные и относительные значения, относящиеся к рентгеноскопическим исследованиям, уменьшились с 1,1% до 0,7%. Напротив, абсолютное количество выполняемых ежегодно рентгеновских компьютерно-томографических исследований (РКТ) возросло за рассматриваемый период в 3,3 раза и в общей структуре РКТ уже составляет 2,7%. Количество специальных исследований возросло в 2,1 раза, но на общем фоне увеличения рентгенодиагностической работы в регионе относительное значение сохранилось на среднемноголетнем уровне и составило 0,4%. Это не могло не повлиять на изменение радиационно-гигиенических показателей медицинского облучения населения РТ. Согласно формам № 3-ДОЗ и радиационно-гигиеническим паспортам территорий, за период с 2006 по2012 г. отмечался рост уровней годовых коллективных эффективных доз медицинского облучения пациентов и населения. Значительно изменилась структура медицинского облучения. Если в2006 г. доминирующее значение в формировании годовой коллективной эффективной дозы представляли флюорографические процедуры (609,17 чел.-Зв; 34,03% в общей структуре коллективной дозы медицинского облучения), то в2013 г. первостепенное значение стала занимать РКТ (748,18 чел.-Зв; 50,04%). В статье рассматриваются особенности формирования и учета доз облучения пациентов при выполнении различных видов рентгенологических процедур.Заключение. Широкое использование цифровых технологий получения и обработки рентгенологических изображений, налаженный инструментальный контроль и учет доз облучения пациентов, рутинный контроль эксплуатационных параметров используемого оборудования для флюорографических, рентгенографических и рентгеноскопических процедур позволили объективизировать и снизить соответствующие показатели коллективных эффективных доз облучения пациентов и населения. Существует резерв организационных, технических мероприятий по дальнейшему снижению доз облучения пациентов при выполнении рутинных рентгенографических процедур, а именно: стандартизация выполняемых исследований, дальнейший переход на цифровые технологии получения изображения. Существенное влияние на статистическую отчетность продолжает оказывать использование расчетных методов учета доз облучения пациентов при выполнении РКТ и специальных исследований. Учитывая то, что РКТ в последние годы обеспечивает наибольший вклад в годовую коллективную эффективную дозу облучения региона (более 50%, первое место в структуре медицинского облучения), а специальные исследования, обладающие высокой клинической эффективностью, также сопровождаются значительной лучевой нагрузкой, необходимы меры по объективизации доз облучения при данных видах исследований в целях разработки научно обоснованных мероприятий по снижению неблагоприятного воздействия на облучаемые категории населения

Radical cystectomy for bladder cancer: early and late postoperative complications

Background. Treatment of patients with bladder cancer remains one of the most pressing problems of oncourology. It is important to understand that the risks caused by the radical cystectomy are determined not only and even not so much by the technical difficulties of removal of the bladder, as by the somatic status of the patient who needs cystectomy. It is important to understand that radical cystectomy and urine derivation are essentially two stages of a single surgery intervetion. However, in the publications describing postoperative cystectomy complications often ignore the fact that the maximum number of complications develops and is associated with the complexity of the urinary diversion method. In a relatively recent long-term study on the results of radical cystectomy, the authors reported a 3% postoperative mortality rate and a 28% level of early postoperative complications (within 3 months after surgery). The authors paid attention to the fact that late complications was more often caused by the urinary diversion methods, whereas early complications are more often associated with radical cystectomy. In general, it is determined that morbidity and mortality are lower the more experience the clinic staff and the surgeon have in terms of patient management. The combination of these factors causes a slower recovery and a longer postoperative day. Despite the decrease in mortality, the level of complications of this procedure remains high even in the best centers of the world.Objective. Assessment of the prerequisites for the development of complications after radical cystectomy using different methods of urine diversion.Materials and methods. Oncological treatment results of 458 patients with bladder tumors were subjected to a detailed analysis.Results. The number of patients with comorbidities was significantly pronounced and noted in practically every patient (381 patients - 83.1%). At the same time, it was found that in the whole group of patients the average value of the Charlson's comorbidity index corrected for age turned out to be 2.6 ± 1.6 (from 0 to 8). Early postoperative complications were detected in 197 patients (43.0%). Early complications NOT associated with urinary diversion prevailed - 36.2%, while the frequency of early complications associated with urinary diversion was statistically significantly less on average 3 times and amounted 12.9%. The incidence of late postoperative complications (associated and NOT associated with the derivation of urine) was generally lower compared to early complications by almost 5 times (9.1%). At the same time, unlike the early postoperative period, among the late postoperative complications, mainly complications associated with the urine diversion of were recorded in 6.5% of cases. It is important that in the studied group of patients were recorded predominantly mild and moderate degrees of complication (Clavien-Dindo I-II) and amounted 41.7%.Conclusion. Obviously, radical cystectomy with urinary diversion are complex surgery with expected high rates of postoperative complications. In this regard, these indicators along with functional and oncological results should be taken into account when discussing a treatment strategy. Early postoperative complications are mainly related to technique of radical cystectomy performing, whereas late complications are more often due to used method of urinary diversion, while high indicators of the planned long-term survival indicate that it is not necessary to perform radical cystectomy. Thus, our findings unequivocally confirm the opinion of international experts and most researchers that achieving optimal optimal results in performing radical cystectomy with urinary intestinal diversion, maximizing morbidity and postoperative lethality is possible only with the accumulation of sufficient experience in this operation types

Palliative cystectomy. Is there a place in bladder cancer surgery?

Introduction. DPatients diagnosed with T4b bladder cancer represent a relatively limited group of patients presenting to the urology clinic. Besides, this category of patients is rarely selected for cystectomy. patients with T4b should be referred for chemotherapy and/or radiation therapy and only later, ultimately, for cystectomy. However, there are currently no studies on the real impact of various organ invasions in terms of survival and complications associated with surgery in T4b patients. Also, in this subgroup of patients, cystectomy helps alleviate current or future symptoms of bladder cancer, and it is suggested that surgery after chemotherapy may improve survival compared to chemotherapy alone.Purpose of the study. To evaluate the effectiveness of consolidating the surgery for bladder cancer cT4b, given the experience of cystectomy in terms of clinical and oncological results.Materials and methods. The study included 29 patients with bladder cancer who underwent palliative cystectomy (pc) and 404 patients after radical cystectomy (RcE) with lymphadenectomy and various methods of urine diversion in the period 1995 - 2019. Palliative treatment was determined by the extreme stages of the oncological process (the presence of stage T4b).Results. Preoperatively, the PC was planned to be performed in only 10 patients, whereas after the RCE it was palliative in 29 cases. According to our study, differences in the main treatment outcomes were not in favour of patients with PC. During the observation period, the overwhelming majority of patients — 24 of 29 (82.8%) died, while in the group after RCE, only 34.0% of patients died (p <0.05). No differences in the level of postoperative mortality were found (p >0.05). It was comparable with the data of modern literature in both cases (3.4% and 3.0%). This reflects the equal degree of safety of performing cystectomy in patients with bladder cancer at stage T4b in comparison with patients undergoing RCE, to a certain extent. The duration of the survivors' follow-up in the PC group ranges from 3 to 51 months with a median of 25.7 ± 13.9 months versus 73.9 ± 3.9 months in the RCE group in surviving patients (p <0.05) However, the analysis revealed that after 2 years in the group of patients who underwent PC more than 15% of survivors remain, which may indicate the possibility of using this type of treatment in patients with the last stage of bladder cancer.Conclusion. Palliative cystectomy can be effective in a select group of patients with T4b bladder cancer with equal safety compared to RCE while maintaining the probability of life expectancy up to 48 months. It is important to develop and implement into practice new protocols of multimodal therapy for patients with pT4b bladder cancer to increase the life expectancy of patients and improve its quality

COATED TOOL CUTTING TEMPERATURE

The analysis of the cutting area circuit diagram has shown that coatings on the edges of the hole and on the flank surface of the tool change the thermoelectric power measured by the dynamic thermocouple to the value of not more than 0.3-0.7%. So, only the composition and properties of the coatings will have an effect on the cutting temperature. Model theoretical temperature calculations according to the dependence proposed by the authors have shown that the temperatures are minimal when using single coatings ZrO2, TiN, AlN (for couples Т15К6 — St45), and ZrN, AlN, ZrO2, Al2O3 (for couples Т15К6 – 12H18N10Т). Experiments on turning St45 by carbide plates made of T15K6 have proved the efficiency of TiN+AlN coatings when the cutting temperature, chip shrinkage, and contact length on the front face (lc) are less than for the base alloy T15K6

Microbiota/microbiome urine and bladder cancer

© 2020 ABC-press Publishing House. All rights reserved. The aim of the review was to systematize the evidence available in the world literature on the influence of the role of microbiota and urinary microbiome on the development of bladder cancer. Given the constant development of medical technologies, patient examination algorithms, an obligate range of diagnostic tools, and the appropriateness of using the latest laboratory techniques are being reviewed