1,720,968 research outputs found
Esiselvitys säteilylaissa tarkoitettujen lähettämissuositusten kehittämistä varten : Työryhmän loppuraportti sosiaali- ja terveysministeriölle
Get PDFTässä esiselvityksessä tehtyjen lääkäreille ja hammaslääkäreille suunnattujen kyselytutkimusten perusteella Suomeen tarvitaan terveydenhuollon tietojärjestelmiin ja sähköisiin lähetejärjestelmiin integroitu lähettämissuositus, joka sisältää myös päätöksenteon tuen. Kansallisen lähettämissuosituksen valmistelemiseksi, käyttöönottamiseksi ja ylläpitämiseksi tarvitaan moniammatillista yhteistyötä, johon osallistuvat useat tahot päättäjistä loppukäyttäjiin.
Esiselvityksessä perehdyttiin käytettävissä oleviin eurooppalaisiin lähettämissuosituksiin. Lisäksi vertailtiin eri lähettämissuositusten ominaisuuksia ja arvioituja kustannuksia ja hyötyjä. Vertailussa oli mukana mahdollinen itse kehitettävä järjestelmä.
Esiselvityksen perusteella lähettämissuosituksen valmisteluun ja käyttöönottoon tarvittaisiin ensin pilotointihanke. Tämä kannattaisi tehdä vastaavasti kuin muiden terveydenhuollon järjestelmien kehitystyö, esimerkiksi THL:n koordinoimana hankkeena. Pilotissa luotaisiin tai suomennettaisiin ohjeisto, joka linkitettäisiin käytössä olevaan tutkimuskoodistoon (Radiologisten tutkimusten ja toimenpiteiden nimikkeistö, Kuntaliitto). Lisäksi kehitettäisiin järjestelmä tai testattaisiin olemassa olevaa, hankittavaa järjestelmää tekniseltä kannalta. Järjestelmän laajempana tavoitteena on tukea terveydenhuollon kliinistä toiminnanohjausta sekä vaikuttavuuden mittausta.
Lähettämissuosituksen tekeminen ja ylläpitäminen vaatii paljon resursseja. Suosituksen tekeminen alkaa kirjallisuuteen perehtymisellä. Asiantuntijatyöryhmän yksimielisen kannan jälkeen tehdään laaja konsultaatio. Jos lähettämissuositus toteutetaan siten, että hankitaan valmis ohjelmisto, sen kustannuksista pääosa koostuu käyttömaksuista. Jos taas lähettämissuositus kehitetään itse ulkomaisten suositusten pohjalta, lähettämissuosituksen hankintahinta on suurehko, mutta käyttökustannukset ovat kohtuulliset. Tämän esiselvityksen perusteella molemmat vaihtoehdot ovat elinkaarikustannuksiltaan yhdenvertaiset, mutta itse kehitettävän järjestelmän riskit ovat suuremmat, erityisesti tarvittavien asiantuntijaresurssien osalta
Patient safety in external beam radiotherapy - Guidelines on risk assessment and analysis of adverse error-events and near misses: Introducing the ACCIRAD project
No full textIn 2011 the European Commission launched a tender to develop guidelines for risk analysis of accidental and unintended exposures in external beam radiotherapy. This tender was awarded to a consortium of 6 institutions, including the ESTRO, in late 2011. The project, denominated "ACCIRAD", recently finished the data collection phase. Data were collected by surveys administered in 38 European countries. Results indicate non-uniform implementation of event registration and classification, as well as incomplete or zero implementation of risk assessment and events analysis. Based on the survey results and analysis thereof, project leaders are currently drafting proposed guidelines entitled "Guidelines for patient safety in external beam radiotherapy - Guidelines on risk assessment and analysis of adverse-error events and near misses". The present article describes the aims and current status of the project, including results of the surveys
Radiation protection issues in radionuclide therapy – workers (medical staff), third persons, waste management
No full textRadionuclide therapies for treatment of diseases is common practice worldwide, while new radionuclides create new challenges for radiation protection. Many guidelines are still applicable for implementing dose constraints, using appropriate calibrated instruments for dose rate and contaminations measurements and following good practices of waste management. Special caution and considerations are needed to prevent annual dose limits to be exceeded in some situations with new radionuclide therapies. In fractionated therapies, dose constraints should be set considering anticipated repetition of the treatment. In handling of alpha emitters all contamination pathways need to be considered and training of workers is essential both to prevent contamination and to detect and measure contaminations. Waste management is an issue if there are radionuclides of long half-lives considering also possible impurities. In case there is a need for cremation after a radionuclide therapy with alpha emitters, it may be necessary to wait even several months prior to cremation
Patient exposure levels and collective effective dose to the population from radiological examinations - changes from 2008 to 2018 in Finland
Get PDFMedical exposures from x-rays and nuclear medicine (NM) have been the largest man-made source of population exposure to ionizing radiation in developed countries for many years. A collective effective dose can be assessed by summarizing effective doses from all radiological examinations together. The collective effective dose is the product of the mean effective dose in a group and the number of individuals in that group. The most common method to assess effective doses per radiological examinations is to use application specific measurable quantities that are multiplied by predefined effective dose conversion factors. Frequencies of radiological examinations can be surveyed by questionnaires.
In Finland the total collective effective dose from x-ray and NM procedures has increased 59% in 2008–2018, mainly due to the increase of collective effective doses from computed tomography (CT) and interventional radiology. The collective effective dose from NM examinations has slightly increased and its relative proportion is only 5% of the total collective dose from radiological examinations.
About 70% of the collective effective dose from x-ray examinations was caused by CT in 2018, while the proportion of CT procedures was only 17%. CT procedures are the major and increasing source of collective effective dose from x-ray procedures. While the use of new tissue weighting factors (ICRP 103) increases the population dose from plain radiography, it has minimal effect on the population dose from CT examinations.
There was a large amount of variation in the exposure levels and exposure parameters used for radiotherapy simulations. Patient exposure levels were generally much higher than those used for diagnostics. Exposure parameters should be reviewed and optimized together with the exposure level also for radiotherapy CT simulations.
Effective doses per radiological examinations can be used to compare medical exposures from different methodologies or between different units or hospitals. Per caput doses can be compared between countries. In comparison with 36 European countries is was shown that frequencies of both x-ray and NM examinations in Finland were less than in average in Europe. This indicates that the level of justification in Finland is at least at the average European level. The comparison of per caput effective doses showed that the dose in Finland was on the lowest quarter among European countries. Despite of the increased collective effective dose from x-ray and NM examinations the overall per caput effective
dose in Finland in 2018 was still well below the average of European countries in 2008 and only a third of the per caput effective dose in USA in 2016. This indicates that both justification and optimization of examinations in Finland is at a good European level
Radiation safety of current European practices of therapeutic nuclear medicine : survey results from 20 HERCA countries
No full textThe purpose of this study was to acquire up-to-date information on nuclear medicine treatments in Europe and on the implementation of the requirements of the Basic Safety Standards Directive in HERCA Heads of the European Radiological Protection Competent Authorities (HERCAs) member states. An electronic survey was distributed to competent authorities of 32 HERCA member states. The questionnaire addressed 33 explicitly considered treatments using 13 different radionuclides, and for each treatment, a similar set of questions was included. Questions covered the use of treatments, hospitalisation of patients and radioactive waste management related to therapeutic nuclear medicine involving other radionuclides than the well-known 131I. The survey also covered justification of treatments, individual treatment planning, involvement of a medical physics expert (MPE) and radiation protection instructions given to the patient at the time of release. Responses were obtained from 20 HERCA countries. All of these countries used Na[131I]I for benign thyroid diseases and thyroid ablation of adults. 223RaCl2 (Xofigo®) for bone metastases, 177Lu-somatostatin analogues for neuroendocrine tumours and 177Lu-labelled PSMA for castration resistant prostate cancer (PC) and PC-metastases were used in 90%, 65% and 55% of countries, respectively. Only a few countries had specific criteria for hospitalisation and waste management for new therapeutic nuclear medicine. Regulatory requirements for justification of new therapeutic nuclear medicine were in place in almost all countries. Individual treatment planning was required for all therapies in 55% and for some therapies in 28% of the responding countries. Implementation of the requirement for MPEs to be closely involved in nuclear medicine practices varied to a great extend among countries. Almost all responding countries answered that some radiation protection instructions existed for patients released after treatment with radionuclides other than 131I treatment, however only few countries had developed specific guidelines in the field
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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