OBJECTIVE: To configure an auxiliary equipment to allow videofluoroscopic study of swallowing and related disorders without the patients' active collaboration in obtaining the required positions, with reproducibility of views, postures and maneuvers needed for the examination, in spite of limitations imposed by associated diseases. MATERIALS AND METHODS: A Philips BV-22 C-Arm was utilized, with adaptation implemented to allow simultaneous images recording on both digital and analog media. Primary and secondary chairs were specially designed, built and attached to the equipment. RESULTS: Adults and children could be appropriately seated and all necessary radiographic views could be obtained without active positioning or cooperation from the volunteers. Additionally, a calibration system was developed, allowing the input of dimensional parameters for quantification of recorded phenomena. CONCLUSION: The videofluoroscopy utilization spectrum could be extended to agitated patients, and those with behavior similar to patients affected by neuromotor disorders, with greater effectiveness and consequently with lower radiation exposure time.

Keywords: Videofluoroscopy, Swallowing, Dysphagia, Neuromotor disorder, Adapted chair

OBJECTIVE: The purpose of thys study was to investigate the effect of the addition of aluminum (1 mm) and copper (0.4 mm) filters on effective radiation doses and image quality in videofluoroscopy. MATERIALS AND METHODS: An ionization chamber coupled with an electrometer was added to x-ray tube to measure the kerma area product with 65 kV and 0.7 mA technique, without and with additional filtration. Low contrast, gray scale and spatial resolution were measured utilizing Leeds test objects. Fifteen volunteers underwent pharynx study, ten without and five with aluminum and cooper filters associated, and had the kerma area product/minute compared. RESULTS: The specified filters addition, either separated or associated, allowed an expressive decrease in kerma area product besides an actual improvement in the videofluoroscopic images quality determined by a better gray tones differentiation and increased brightness contrast ratio in the gray curve. CONCLUSION: Additional aluminum and copper filters interposition, especially when associated, results in improved image quality with expressive reduction in the required radiation doses.

Keywords: Videofluoroscopy, Kerma area product, X-ray, Radiological image, Radiation dose

OBJECTIVE: The present study evaluates the dose distribution received by physicians involved in hemodynamic procedures of coronary angiography and coronariography. The influence of some factors such as pulsed or continuous fluoroscopy mode and vein and/or artery access site was investigated. MATERIALS AND METHODS: Measurements have been performed with LiF:Mg,Ti thermoluminescent dosimeters placed on seven different sites of the practitioners' bodies: hands, left knee, neck, forehead and chest, under and over the lead apron. Radiation doses for each procedure were evaluated in physicians who had performed 60 coronariography and 30 angioplasty procedures. The thermoluminescent dosimeters were calibrated in the operational quantity personal dose equivalent, Hp(d), at depths of 0.07, 3 and 10 mm. RESULTS: The results of the present study demonstrate the significant role played by thyroid protectors and lead aprons for reducing radiation doses received by practitioners. Occupational doses in continuous mode fluoroscopy through brachial access were higher than with pulsed mode fluoroscopy through femoral access. CONCLUSION: The present study has demonstrated the necessity of implementing additional protective measures as well as a mechanism of training in radiation protection for physicians involved in interventional cardiological procedures.

Keywords: Interventional radiology, Fluoroscopy, Hemodynamic procedures, Radiation protection, Thermoluminescent dosimetry

OBJECTIVE: To evaluate the performance and quality of images of a x-ray equipment utilized in interventional radiology, by means of some tests of quality control. MATERIALS AND METHODS: Measurements have been performed on a Philips Integris H3000 x-ray equipment dedicated to interventional procedures in the hemodynamics laboratory of a hospital in Rio de Janeiro, RJ, Brazil. Leeds test objects have been used to evaluate the image quality. Dosimetric measurements have been developed with a Radcal 9015 dosimetric system. RESULTS: In high and normal modes, the air kerma rates have been different from the expected results. In some cases, values have not been affected by the use of different magnification modes. The images quality evaluation has showed different results from those recommended by technical standards. This could lead to the acquisition of poor quality images besides an increase in the radiation exposure levels for both patients and staff. CONCLUSION: The results have shown the importance of a periodical quality control testing, allowing the monitoring of the x-ray equipment performance and evaluation of radiation exposure levels for both patients and staff. The results suggest the need of a revision of the x-ray images acquisition system.

Keywords: Interventional radiology, Hemodynamics, Quality control

We analyzed the dose area product (DAP) of 12 patients submitted to videofluoroscopic swallowing studies. The aim of this study was to establish, in a preliminary manner, the values of radiation exposure for patients submitted to this type of examination. A Diamentor equipment was used to register the cumulative radiation doses emitted by the x-ray tubes. Two different rooms with identical radiological equipment were used to collect the data. The protocol used was rigorously the same and the same experienced professional performed the examinations. DAP's values for the three phases (oral, pharyngeal and esophagogastric) of the videofluoroscopic swallowing study were, for the room A (7 patients), 4,101 cGy.cm², DAP/min. = 577 cGy.cm²/min., and for the room B (5 patients), 804 cGy.cm², DAP/min = 119 cGy.cm²/min. These different results were obtained from patients of the same height and weight, using the same examination time (around 7 minutes) for all patients. We concluded that the data showing doses five times lower in room B are more reliable that those obtained for room A and that DAP and DAP/min. are good elements to inform patient doses imparted by videofluoroscopic swallowing examination. We believe that the high dose differences observed between the two groups are due to lack of calibration of the x-ray equipment, since unfortunately "quality assurance programs" are not routinely implemented.

Keywords: Dosimetry, Videofluoroscopy, Dose area product (DAP), Swallowing