Submitted by Claudinei Pracidelli (cpracide@ipen.br) on 2016-06-22T11:21:31Z No. of bitstreams: 0 / Made available in DSpace on 2016-06-22T11:21:31Z (GMT). No. of bitstreams: 0 / O tratamento de câncer possui diversas modalidades. Uma delas é a utilização de fontes de radiação como principal protagonista do tratamento. A radioterapia e a medicina nuclear são exemplos desse tipo de tratamento. Por utilizarem a radiação ionizante como principal ferramenta para a terapia, há a necessidade de se efetuar diversas simulações do tratamento a fim de maximizar a dose nos tecidos tumorais sem ultrapassar os limites de dose nos tecidos sadios circunvizinhos. Os sistemas utilizados na simulação desses tipos de terapia recebem o nome de Sistemas de Planejamento Dosimétrico. A medicina nuclear e a radioterapia possuem seus próprios sistemas de planejamento dosimétricos devido a grande diversidade das informações necessárias às suas simulações. Os sistemas de planejamento em radioterapia são mais consolidados do que os de medicina nuclear e por tal motivo um sistema que aborde tanto os casos de radioterapia como de medicina nuclear contribuiria para significativos avanços na área de medicina nuclear. Dessa forma, o objetivo do trabalho foi modelar um Sistema de Planejamento Dosimétrico com o uso do código de Monte Carlo MCNP6 Monte Carlo N-Particle Transport Code que permitisse incorporar os casos de radioterapia e medicina nuclear e que fosse extensível a novos tipos de tratamentos. A modelagem desse sistema resultou na construção de um Framework, orientado a objetos, nomeado IBMC o qual auxilia no desenvolvimento de sistemas de planejamento que necessitam interpretar grandes quantidades de informações com o objetivo de escrever o arquivo base do MCNP6. O IBMC permitiu desenvolver de maneira rápida e prática sistemas de planejamento para radioterapia e medicina nuclear e os resultados foram validados com sistemas já consolidados. Ele também mostrou alto potencial para desenvolver sistemas de planejamento de novos tipos de tratamentos que utilizam a radiação ionizante. / Tese (Doutorado em Tecnologia Nuclear) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Submitted by Marco Antonio Oliveira da Silva (maosilva@ipen.br) on 2017-11-09T11:20:17Z No. of bitstreams: 0 / Made available in DSpace on 2017-11-09T11:20:17Z (GMT). No. of bitstreams: 0 / Em 1958 a Comissão Internacional de Proteção Radiológica (CIPR) propôs a primeira filosofia do sistema de limitação de dose, introduzindo os Limites Anuais Máximos Permissíveis (LAMP). O grande avanço da era nuclear nas últimas décadas impôs novos paradigmas e a necessidade de atualização da filosofia em questão. O presente trabalho tem por objetivo apresentar uma análise da evolução da filosofia do sistema de limitação de dose, desde a década de 50 até os dias atuais. A primeira mudança de paradigma se deu com a criação dos Limites Anuais Máximos Admissíveis (LAMA), ainda vigentes. Por meio de um cuidadoso estudo das publicações do Organismo Internacional de Energia Atômica (OIEA) e das recomendações da CIPR, foi possível evidenciar e detalhar o processo de evolução dos LAMA ao longo das últimas décadas. A pesquisa aborda momentos-chaves que impulsionaram mudanças na filosofia do sistema de limitações de dose como, por exemplo, a crise internacional do petróleo e suas implicações no desenvolvimento da área nuclear. A comparação entre as diversas publicações das duas entidades (OIEA e CIPR) permitiu um estudo aprofundado desde o surgimento dessas filosofias até suas últimas publicações. Os resultados deste estudo apontam importantes informações que constam em publicações da CIPR, hoje consideradas \"superseded\", que não são encontradas nas publicações atuais. O OIEA, que elabora suas recomendações baseado na filosofia da CIPR, também não aborda as referidas informações. Por meio da presente pesquisa, foi possível evidenciar e detalhar valiosas informações que se perderam durante o processo de atualização das publicações e edição de recomendações de ambas as entidades. Este trabalho se propõe a apresentar essas informações, que foram estudadas em profundidade, discutindo seu real valor, propondo à comunidade internacional novas reflexões sobre a importância e a possibilidade de reintroduzir as informações perdidas em futuras publicações. / Dissertação (Mestrado em Tecnologia Nuclear) / IPEN/D / Instituto de Pesquisas Energéticas e Nucleares - IPEN-CNEN/SP

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2016-09-05T12:29:29Z No. of bitstreams: 2 Dissertação - Leonardo Bastos Lage - 2016.pdf: 7742384 bytes, checksum: 8880ccdcfd1682cd3aef7d8b7c4458b8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-05T12:56:43Z (GMT) No. of bitstreams: 2 Dissertação - Leonardo Bastos Lage - 2016.pdf: 7742384 bytes, checksum: 8880ccdcfd1682cd3aef7d8b7c4458b8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-05T12:56:43Z (GMT). No. of bitstreams: 2 Dissertação - Leonardo Bastos Lage - 2016.pdf: 7742384 bytes, checksum: 8880ccdcfd1682cd3aef7d8b7c4458b8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-08-11 / Ionizing radiation has been cited as one of the risk factors for the increasing incidence of breast cancer, as demonstrated in studies after nuclear explosions. In the end of 1987 the world’s largest radiological accident in urban areas occurred in Goiânia, which brought concern about the possibility of increasing the rates of cancer incidence induced by radiation. This research aims to evaluate whether exposure to ionizing radiation to which women are subjected can be associated with the incidence of breast cancer in Goiânia. The defined study area is the central region of Goiânia, or the Sanitary Districts of Campinas-Centro and Sul, in which are the seven major accident sources of contamination with Cesium 137, and also, as shown by previous study, the majority of new cases of breast cancer (60,43 %). We used the geographical division of the city in census tracts and health districts. The data collection was divided in two stages: the first, for the survey of radiometric measurements, and the second, for identifying the addresses of women diagnosed with breast cancer. The radiometric survey occurred between 2010 and 2014, in which was used an environmental gamma radiation mobile measuring system. This system was composed by a high-sensitivity detector coupled to a Global Positioning System (GPS) and a microcomputer. The assembly was installed on a motor vehicle so that the height of the detector is found at one meter from the ground, and programmed to obtain a measurement of the doses absorbed in the air rate each second. The data collected were: doses absorbed in the air rate, geographical coordinates, altitude, date and time of acquisition. From Mobisys software, files were generated and from ArcGIS 10.0 platform, geospatial assessment survey through the elaboration of thematic maps and geospatial analysis statistics. The annual averages of effective doses and collective effective doses were estimated from the rate of doses absorbed in air collected by the system and the resident population in the census tracts. The second stage begun from the data collection at the Registry of Goiânia’s Population Based Cancer (RCBPGO), in which were identified addresses of women diagnosed with breast cancer between 2001 and 2010. Part of the data was geographically referenced and using census data were estimated and compared the annual averages of crude rates of incidence. The spatial correlation of groups (clusters) of new cases has been verified, through the Moran index, and from geographically referenced radiometric measurements obtained in the previous step, the correlation between the incidence of breast cancer and ionizing radiation levels was assessed by unconditional linear regression. The results were presented in two papers. In the first, radiometric surveys were conducted in 1.405 of the 1.636 (85,9%) census tracts sectors that make up the seven Sanitary Districts in the city of Goiânia. In total 197.811 geographically referenced measures of the absorbed dose rate in the air were made, with a average of 29,85 ± 7,47 and amplitude from 9,17 to 629,88 nGy/h. From these values were estimated the average of annual effective dose and collective effective dose for outdoor environments, with values of 0,036 ± 0,003 mSv/year and 28,51 ± 11,68 man.mSv/year, respectively. The levels of exposure to external gamma radiation, found in the city of Goiânia 28 years after the radiological accident with Cesium- 137, are compatible with the values estimated by UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation). And the value of the annual average of effective dose in Goiânia, is lower than in other places in Brazil, which have only "background" of natural radiation outdoors. The results obtained in this study indicate that the dosimetric situation in Goiânia does not present undue risk to people and the environment. In the second article, were identified 4.105 new cases of breast cancer, 2.233 in the study area and 1.286 (57,59%) of these geographically referenced. The annual average values of crude rates of incidence, considering the total numbers of cases and geographically referenced presented in the study area are, respectively, 102,91 and 71,86 new cases per 100.000 women. The crude rate of incidence in Goiânia was 66,59 cases per 100.000, while in the study area was 102,91 cases per 100.000 and, outside the area, 46,86 cases per 100.000. These values are within the range of average values presented by other Brazilian capitals, which is 130,99 cases per 100.000 in Porto Alegre-RS, and 20,04 cases in Macapá-AP, and the national average in the capital of 79,37 cases per 100.000 women. The cluster analysis showed a slight spatial correlation of crude rates of breast cancer incidence in three small sets of census tracts, far from the accident sources of contamination with Cesium-137. The scatter plot points and the R² value didn’t indicate any association between the crude rates of incidence and radiometric measurements. This study supports the hypothesis that ionizing radiation levels to which women living in Goiânia are exposed, are not associated with the emergence of new cases of breast cancer. / A radiação ionizante tem sido citada como um dos fatores de risco para o incremento da incidência de câncer de mama, como demonstrado, em estudos após explosões nucleares. No final de 1987, ocorreu em Goiânia o maior acidente radiológico em área urbana do mundo, que causou preocupação quanto à possibilidade de aumento das taxas de incidência de neoplasias induzidas por radiação. A presente pesquisa tem como objetivo avaliar se a exposição à radiação ionizante gama ambiental externa a qual as mulheres estão submetidas pode ser associada à incidência de câncer de mama em Goiânia. A região central de Goiânia, compreendida pelos Distritos Sanitários Campinas-Centro e Sul, que abriga os sete principais focos de contaminação do acidente com o Césio-137, e também, conforme estudo anterior, a maioria dos casos novos de câncer de mama (60,43%), foi definida como área de estudo. Utilizou-se a divisão geográfica da cidade em setores censitários e Distritos Sanitários. A coleta de dados foi dividida em duas etapas: a primeira, para levantamento das medidas radiométricas e a segunda, para identificação dos endereços das mulheres diagnosticadas com câncer de mama. O levantamento radiométrico ocorreu entre 2010 e 2014, tendo sido utilizado um sistema móvel de medição de radioatividade gama ambiental. Esse sistema era constituído por um detector de alta sensibilidade, acoplado a um Global Positioning System (GPS) e a um microcomputador. O conjunto foi instalado em um veículo automotor de forma que a altura do detector se encontrasse a um metro em relação ao solo e configurado para realizar medidas de taxa de dose absorvida no ar a cada segundo. Os dados coletados foram: taxa de dose absorvida no ar, coordenadas geográficas, altitude, data e hora da aquisição. A partir do software MobiSys, foram gerados arquivos e a partir da plataforma ArcGIS 10.0, foi realizada a avaliação geoespacial do levantamento por meio da elaboração de mapas temáticos e análises estatísticas geoespaciais. As médias anuais da dose efetiva e dose efetiva coletiva foram estimadas a partir da taxa de dose absorvida no ar coletada pelo sistema e a população residente no setor censitário. A segunda etapa se deu a partir do Registro de Câncer de Base Populacional de Goiânia (RCBPGO) através do qual foram identificados endereços de mulheres diagnosticadas com câncer de mama no período entre 2001 e 2010. Parte dos dados foi geograficamente referenciada e utilizando informações censitárias foram estimadas e comparadas médias anuais de taxas brutas de incidência. Foi verificada a correlação espacial de grupamentos (clusters) de casos novos, através do índice de Moran e a partir de medidas radiométricas geograficamente referenciadas, obtidas na etapa anterior, foi avaliada a correlação entre a incidência de câncer de mama e os níveis de radiação ionizante, através de regressão linear incondicional. Os resultados foram apresentados em dois artigos científicos. No primeiro, dos 1.636 setores censitários que compõem os sete Distritos Sanitários do município de Goiânia, foram realizados levantamentos radiométricos em 1.405 destes (85,9%). No total foram 197.811 medidas geograficamente referenciadas da taxa de dose absorvida no ar com média de 29,85 ± 7,47 e amplitude de 9,17 a 629,88 nGy/h. A partir desses valores foram estimadas as médias anuais da dose efetiva e dose efetiva coletiva para ambientes ao ar livre, com valores de 0,036 ± 0,003 mSv/ano e 28,51 ± 11,68 homem.mSv/ano, respectivamente. Os níveis de exposição à radiação gama terrestre externa, encontrados na cidade de Goiânia, 28 anos após o acidente radiológico com o Césio- 137, são compatíveis com os valores estimados pelo UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation). E o valor da média anual da dose efetiva em Goiânia, é menor do que em outras localidades no Brasil, que apresentam apenas “background” de radiação natural ao ar livre. Os resultados obtidos, neste estudo, indicam que a situação dosimétrica em Goiânia não apresenta risco indevido para a população e o meio ambiente. No segundo artigo, foram identificados 4.105 casos novos de câncer de mama, sendo 2.233, na área de estudo e destes, 1.286 (57,59%) geograficamente referenciados. Os valores de médias anuais de taxas brutas de incidência considerando os números totais de casos e os geograficamente referenciados, apresentaram na área de estudo, respectivamente 102,91 e 71,86 casos novos por 100 mil mulheres. A taxa bruta de incidência em Goiânia foi de 66,59 casos por 100 mil, enquanto na área de estudo foi de 102,91 casos por 100 mil e fora desta, 46.86 casos por 100 mil. Estes valores se encontram dentro do intervalo dos valores médios apresentados pelas demais capitais brasileiras que é de 130,99 casos por 100 mil em Porto Alegre-RS e 20,04 casos em Macapá-AP e a média brasileira nas capitais de 79,37 casos por 100 mil mulheres. A análise de clusters apresentou discreta correlação espacial de taxas brutas de incidência de câncer de mama, em três pequenos conjuntos de setores censitários, distantes dos focos de contaminação do acidente com o Césio-137. O gráfico de dispersão dos pontos e o valor de R2 não indicou qualquer associação entre as taxas brutas de incidência e medidas radiométricas. Este estudo reforça a hipótese de que os níveis de radiação ionizante aos quais as mulheres residentes em Goiânia estão expostas, não estão associados ao surgimento de casos novos de câncer de mama.

A dosimetria de pacientes associada à avaliação das condições de funcionamento dos equipamentos médicos e aos procedimentos empregados na realização dos exames, desempenha um papel fundamental no sistema de proteção radiológica das exposições médicas. Nesse sentido, foi realizado um levantamento em grande escala das doses recebidas pelos pacientes submetidos a exames radiológicos convencionais realizados em uma amostra representativa de estabelecimentos de saúde do estado de São Paulo. Nesse levantamento foi empregado um kit dosimétrico postal originalmente desenvolvido, que permitiu a determinação da dose de entrada na pele (DEP) através da técnica de dosimetria termoluminescente. Paralelamente foram realizadas visitas in-loco a uma sub-amostra de estabelecimentos, onde as condições de funcionamento dos equipamentos de raios X médicos e do sistema de imagem foram avaliadas empregando-se procedimentos e equipamentos já estabelecidos em protocolos de controle de qualidade. O estudo completou-se com a elaboração de um catálogo de espectros na faixa de energia do radiodiagnóstico, que, através de procedimento desenvolvido, permitiu inferir espectros equivalentes em equipamentos médicos. Na determinação dos espectros foi empregado um detector semicondutor de telureto de cádmio e zinco (CdZnTe), cujas curvas de eficiência e escape foram determinadas experimentalmente para realização do processo de correção dos espectros (stripping procedure). O processo de amostragem de estabelecimentos de saúde realizado neste estudo permitiu verificar a distribuição de equipamentos de diagnóstico por imagem e a freqüência de exames radiológicos no estado de São Paulo. A partir desses resultados foram escolhidos os exames de tórax, crânio (e seios da face) e coluna para avaliação de DEP, uma vez que os mesmos apresentam as maiores freqüências anuais de exames por 1.000 habitantes: 100, 46 e 29, respectivamente. Na técnica de amostragem dos estabelecimentos de saúde incluídos neste estudo foi empregado como critério de estratificação a quantidade anual de exames radiológicos associados ao município de localização do estabelecimento. Do total de 200 estabelecimentos sorteados, 50 participaram da primeira etapa e 38 da segunda. Um total de 83 salas de exames (ou equipamentos) e 868 pacientes foram incluídos, e um conjunto de 1415 valores de DEP foi determinado. O resultado da distribuição dos valores de DEP permitiu determinar os chamados níveis de referência, que, no caso de pacientes adultos, se mostraram bastante semelhantes aos encontrados em outros estudos internacionais. No caso de pacientes infantis, a situação é bem diferente, obtendo-se valores pelo menos 2 vezes superiores a outros recomendados internacionalmente para a radiografia infantil mais freqüente (tórax). Esse fato sugere que as práticas empregadas na realização dos exames devem ser revisadas e que recomendações específicas a esse grupo de pacientes, a partir de estudos dirigidos, sejam publicadas. Constatou-se também alguns casos de DEP elevada pelo uso desnecessário de radioscopia de localização. Os testes de desempenho dos equipamentos e a avaliação das imagens realizadas sugerem que há possibilidade de melhoria das condições de realização dos exames, sem perda de informação diagnóstica presente na imagem e com redução das doses. Alguns espectros de raios X determinados experimentalmente apresentaram divergência em relação a outros catálogos já estabelecidos, numa faixa específica de energia do espectro (entre 25 e 40 keV). Para a sua utilização em situações práticas há necessidade de algumas correções na curva de eficiência, o que não inviabiliza a metodologia e os procedimentos estabelecidos. De forma geral, os resultados encontrados neste estudo permitem traçar um panorama das exposições médicas em radiologia convencional no estado de São Paulo, contribuindo para o aperfeiçoamento de futuras pesquisas que sejam realizadas na área, ou mesmo, para a implementação de políticas públicas. / Patients dosimetry, associated with the assessment of the performance of the radiological equipment and of the series of procedures employed in the accomplishment of the examinations, plays fundamental role in the radiation protection system of medical exposures. Therefore, a large-scale survey of absorbed doses was carried out in health services localized in the state of São Paulo, including patients submitted to conventional radiological examinations. In this survey a postal dosimetric kit, originally developed, was employed. It allows the evaluation of the entrance surface dose (ESD) to patients with thermoluminescence dosimeters. Also a series visits to a sub-sample of services was carried out, giving rise to the in-loco evaluation of the performance of the medical x-ray equipment and of the image system, using procedures and equipments already established in protocols of quality control. The study is completed with the elaboration of a catalogue of x-ray spectra, which provides means to infer the spectra generated by medical x-ray equipments. Measurements of x-ray spectra were carried out with a cadmium zinc telluride detector (CdZnTe), and the stripping procedure was performed taking into account both the contributions of efficiency and x-ray escape fraction, experimentally determined in this work. The stratified sampling technique furnished important data on the distribution of equipments and the annual frequency of examinations performed in the state of São Paulo. From these results radiological examinations of the chest, skull and sinus, and spine were selected for the evaluation of ESD, as their annual frequencies are the highest observed: 100, 46 and 29 per thousand inhabitants, respectively. The number of x-ray examinations carried out annually in the cities of the state was employed as the stratification criterion to construct the sample. From a total of 200 health services sampled, 50 agreed to participate of the first stage, and 38 of the second. A total of 83 rooms (or x-ray equipments) and 868 patients was included, and a set of 1415 values of ESD was measured. Diagnostic reference levels were determined with the outcomes of the distribution of ESD. For adult patients, the reference levels achieved are very similar to others obtained in international surveys. However, as far as pediatric patients are concerned, the situation is very different: the values found in this survey are twice larger than the international recommendations to chest radiography of children. This points out that the practices need to be revised and that specific recommendations to this patient group, following specific surveys, should be provided. Also, a series of high ESD values due to unnecessary localizing radioscopy were detected among our data. The results of the equipment performance tests and of the evaluation of image quality suggest that it is possible to improve the conditions of the examinations and to reduce doses to patients, without impairment of the diagnostic information. Some of the experimentally determined x-ray spectra show a discrepancy, when compared to other catalogue spectra, in a particular energy range 25 to 40 keV. The practical application of them will require some corrections in the efficiency curve, but the established methodology and procedures remain legitimate. In an extensive approach, the results of this study supply a panorama of medical exposures in conventional radiology in the state of São Paulo, contributing with resources to future research in the field and also to governmental actions.

Durch die Einführung von Synchrozyklotronen und Laser-Teilchenbeschleunigern, entwickelt mit dem Ziel günstigere und kompaktere Protonentherapieanlagen bereitzustellen, werden stark gepulste Strahlenfelder möglicherweise Anwendung in der Teletherapie finden. Darüber hinaus bergen stark gepulste Strahlenfelder das Potential klinischer Vorteile durch eine bessere Schonung gesunden Gewebes oder die verbesserte Behandlung bewegter Tumore. Allerdings ergeben sich neue Herausforderungen im Bereich der Dosimetrie, der Grundlage für eine präzise therapeutische Anwendung ionisierender Strahlung. Diese Herausforderungen betreffen sowohl den Bereich der klinischen Dosimetrie für die unmittelbare Strahlenanwendung als auch die Strahlenschutzdosimetrie zum Schutz von Umwelt und Personal. Luftgefüllte Ionisationskammern, die primären Messinstrumente der klinischen Dosimetrie, sind von einem zunehmenden Signalverlust aufgrund von Volumenrekombination betroffen, da stark gepulste Strahlenfelder eine hohe Ionisationsdichte innerhalb eines sehr kurzen Zeitraums erzeugen. Beschreibungen für diese Effekte sind zwar gut etabliert für die moderat gepulsten Felder im gegenwärtigen klinischen Einsatz (Boags Theorie), allerdings sind die dafür nötigen Näherung höchst wahrscheinlich unzureichend für die stark gepulsten Strahlenfelder zukünftiger Beschleuniger. Ferner sind Dosisleistungsmessgeräte, welche im Strahlenschutz als fest installierte oder mobile Überwachungsdosimeter eingesetzt werden, nur für kontinuierliche Strahlenfelder geprüft und bauartzugelassen, was Zweifel an ihrer Eignung für die Messung gepulster Felder eröffnet. In dieser Arbeit wurden beide Bereiche der Dosimetrie, sowohl Strahlenschutz als auch klinische Dosimetrie, untersucht, um die medizinische Anwendung stark gepulster Strahlung zu ermöglichen. Für ein möglichst umfassendes Verständnis wurden dabei experimentelle Untersuchungen mit theoretischen Überlegungen und Entwicklungen verzahnt. Mit dem ELBE-Forschungsbeschleuniger wurde ein gepulster 20 MeV Elektronenstrahl und somit ein gepulstes Strahlungsfeld erzeugt, welches eine systematische Untersuchung in einem großen Bereich in Bezug auf Pulsdosis und Pulsdauer erlaubte. Ionisationskammern für den klinischen Einsatz wurden mit diesem Elektronenstrahl direkt bestrahlt und ein Faraday-Becher diente als unabhängige Referenzmessung. Dosisleistungsmessgeräte hingegen wurden im, durch den Elektronenstrahl im Faraday-Becher erzeugten, Bremsstrahlungsfeld bestrahlt. Dabei fungierte die Ionisationskammer vor dem Faraday-Becher als Strahlmonitor und diente zur Bestimmung der Referenzdosis des Bremsstrahlungsfeldes über eine Querkalibrierung mit Thermolumineszenzdosimetern. Es wurden drei Dosisleistungsmessgeräte basierend auf unterschiedlichen Messprinzipien untersucht, die damit einen großen Teil der im Strahlenschutz eingesetzten Messprinzipien abdecken: Die Ionisationskammer RamION, das Proportionalzählrohr LB1236-H10 und der Szintillationsdetektor AD-b. Für die klinische Dosimetrie wurden zwei verbreitete Ionisationskammergeometrien untersucht: die Advanced Markus Kammer als Flachkammer und die PinPoint Kammer als Kompaktkammer. Zusätzlich zu der üblichen Luftfüllung wurde außerdem eine Füllung mit reinem Stickstoff und zwei Flüssigionisationskammern mit Isooctan und Tetramethylsilan untersucht. Ferner wurde eine numerische Berechnung der Volumenrekombination in Ionisationskammern durch die Beschreibung der Prozesse von Ladungsfreisetzung, Ladungstransport und Reaktion entwickelt, um eine Beschreibung zu erhalten, die ohne die für Boags Theorie notwendigen Näherungen auskommt. Insbesondere berücksichtigt diese Berechnung den Einfluss der freigesetzten Ladungen auf das elektrische Feld, der in Boags Theorie vernachlässigt wird. Von den drei untersuchten Dosisleistungsmessgeräten zeigte nur das RamION Messungen innerhalb der gegebenen Toleranzen in den untersuchten Strahlungsfeldern. Die unerwartet schlechte Präzision des AD-b Szintillationsdetektors, der keinen prinzipiellen Beschränkungen in gepulsten Feldern unterliegen sollte, wurde auf die Signalverarbeitung im Messgerät zurückgeführt, welche das prinzipielle Problem einer unbekannten Signalverarbeitung in kommerziellen Geräten hervorhebt. Das LB 1236-H10 Proportionalzählrohr andererseits maß den Erwartungen entsprechend. Dies unterstützt zwar die in DIN IEC/TS 62743 dargelegten Erwartungen für zählende Dosimeter, zeigt allerdings zugleich die allgemeine Unzulänglichkeit solcher Instrumente für die Messung stark gepulster Felder und demonstriert die Notwendigkeit für weitere normative Bestrebungen, um einheitliche Bedingungen für die Untersuchung nicht-zählender Dosimeter (wie das RamION) zu schaffen. Durch die Aufnahme dieser Ergebnisse in die Literatur der Strahlenschutzkommission wurde hier der Grundstein für eine solche Entwicklung gelegt. Die Untersuchung der Ionisationskammern für klinische Dosimetrie zeigte z.T. starke Abweichungen zwischen Boags Theorie und experimentellen Beobachtungen. Boags Theorie beschreibt Volumenrekombination hinreichend genau lediglich für die zwei Flüssigionisationskammern. Im Falle sämtlicher gasgefüllter Kammern waren effektive Parameter notwendig, deren Wert kaum einen Zusammenhang mit der ursprünglichen Definition besaß. Doch auch dieser Ansatz versagt jedoch für die Advanced Markus-Kammer bei Sammelspannungen ≥ 300 V und Pulsdosen ab ca. 100 mGy. Das entwickelte numerische Berechnungsverfahren lieferte eine deutlich passendere Berechnung der Volumenrekombination und ermöglichte es, die Ursache für die Unterschiede zu Boags Theorie in dem Einfluss der freigesetzten Ladungen auf das elektrische Feld zu identifizieren. Eine aufgrund der erhöhten Pulsdosis erhöhte positive Raumladung verlangsamt die Sammlung der normalerweise schnellen freien Elektronen, welche von Volumenrekombination zunächst unbeeinträchtigt sind. Aufgrund der längeren Verweildauer im Kammervolumen, lagert sich jedoch ein höherer Anteil der Elektronen an und bildet negative Ionen. Der daraus resultierende höhere Anteil an Ladungen die Volumenrekombination ausgesetzt sind, zusätzlich zu der erhöhten Ladungsmenge, bedingt eine Erhöhung der Volumenrekombination mit der Pulsdosis, die sich nicht durch Boags Theorie beschreiben lässt. Insbesondere von Bedeutung ist dieser Effekt bei hohen elektrischen Feldstärken und kleinen Elektrodenabständen, die in einem hohen Anteil freier Elektronen resultieren. Des Weiteren erlaubt das numerische Verfahren die Berechnung für beliebige Pulsdauern, wohingegen Boags Theorie auf verschwindend geringe Pulsdauern beschränkt ist. Im Allgemeinen ergab das numerische Berechnungsverfahren Ergebnisse in guter Übereinstimmung mit den experimentellen Beobachtungen für die sehr verschiedenartigen Füllungen von Luft, Stickstoff und Flüssigkeiten. Auch die geometrisch komplexere Kompaktkammer konnte prinzipiell damit beschrieben werden, wobei sich jedoch für die untersuchte PinPoint-Kammer einige Diskrepanzen zu den experimentellen Beobachtungen ergaben. Eine vielversprechende Weiterentwicklung der Berechnung wäre die verbesserte Beschreibung der Sammelspannungsabhängigkeit der Volumenrekombination. In ihrer derzeitigen Form erfordert die Berechnung eine Charakterisierung jeder Kammer und Spannung, was durch eine Weiterentwicklung der Berechnung möglicherweise eliminiert werden könnte. Nichtsdestotrotz stellt die entwickelte numerische Berechnung eine deutliche Verbesserung gegenüber Boag's Theorie durch die korrekte Beschreibung der Pulsdosis- und Pulsdauerabhängigkeit der Volumenrekombination in stark gepulsten Felder dar, was prinzipiell eine absolute Dosimetrie dieser Felder ermöglichen sollte.:1 Introduction 2 Scientific Background 2.1 General Aspects of Dosimetry 2.1.1 The Radiation Dose 2.1.2 Limitations of Absorbed Dose 2.1.3 Radiation Therapy vs. Radiation Protection 2.2 Pulsed Radiation 2.2.1 Terminology 2.2.2 Sources 2.3 Ionization Chambers for Radiation Therapy Dosimetry 2.3.1 Principle of Operation 2.3.2 Calibration and Correction Factors 2.3.3 Saturation Correction and Volume Recombination 2.4 Numerical Solution of Advection-Diffusion-Reaction Equations 2.5 Dose Rate Meters for Radiation Protection Dosimetry 2.5.1 Counting Tubes 2.5.2 Scintillation Detectors 2.5.3 Current Regulatory Developments 3 Material and Methods 3.1 Common Experimental Setup 3.1.1 Radiation Source ELBE 3.1.2 Beam Monitoring Equipment 3.2 Dose Rate Meter Measurements 3.2.1 Measurement Series and Procedure 3.2.2 Reference Measurements 3.3 Ionization Chamber Measurements 3.3.1 Measurement Series and Procedure 3.3.2 Experimental Determination of Volume Recombination 3.4 Numerical Calculation of Volume Recombination 3.4.1 Plane-parallel Chamber Geometry 3.4.2 Adaption to Thimble Chamber Geometry 3.4.3 Input Parameters 4 Dose Rate Meter Investigation 4.1 Results 4.2 Discussion and Conclusion 5 Ionization Chamber Investigation 5.1 Field Homogeneity and Stability 5.2 Uncertainty Considerations 5.3 Advanced Markus Chamber in Air 5.3.1 Experimental and Calculation Results 5.3.2 Comparison to Literature 5.3.3 Validity of the Numerical Model 5.3.4 Discussion of the Recombination Rate 5.3.5 Relevance of the Free Electron Fraction 5.4 Advanced Markus Chamber in N 2 5.4.1 Experimental and Calculation Results 5.4.2 Discussion of the Electron-Ion Recombination 5.5 PinPoint Chamber 5.5.1 Results and Discussion 5.6 Liquid Ionization Chamber 5.6.1 Experimental and Calculation Results 5.6.2 Discussion 5.7 Conclusion and Outlook 6 Summary 7 Zusammenfassung Bibliography Appendix A Evaluation of the Faraday Cup Data B Description of the Implemented Numerical Solver Danksagung / Synchrocyclotrons and laser based particle accelerators, developed with the goal to enable more compact particle therapy facilities, may bring highly pulsed radiation field to external beam radiation therapy. In addition, such highly pulsed fields may be desirable due to their potential clinical benefits regarding better healthy tissue sparing or improved gating for moving tumors. However, they pose new challenges for dosimetry, the corner stone of any application of ionizing radiation. These challenges affect both clinical and radiation protection dosimetry. Air-filled ionization chambers, which dominate clinical dosimetry, face the problem of increased signal loss due to volume recombination when a highly pulsed field liberates a large amount of charge in a short time in the chamber. While well established descriptions exist for this volume recombination for the moderately pulsed fields in current use (Boag's formulas), the assumptions on which those descriptions are based will most likely not hold in the prospective, highly pulsed fields of future accelerators. Furthermore, ambient dose rate meters used in radiation protection dosimetry as survey meters or fixed installations are generally only tested for continuous fields, casting doubt on their suitability to measure pulsed fields. This thesis investigated both these aspects of dosimetry - clinical as well as radiation protection - to enable the medical application of highly pulsed radiation fields. For a comprehensive understanding, experimental investigations were coupled with theoretical considerations and developments. Pulsed fields, varying in both dose-per-pulse and pulse duration over a wide range, were generated with the ELBE research accelerator, providing a 20 MeV pulsed electron beam. Ionization chambers for clinical dosimetry were investigated using this electron beam directly, with an aluminium Faraday cup providing the reference measurement. Whereas the dose rate meters were irradiated in the photon field generated from stopping the electron beam in the Faraday cup. In those measurements, the reference was calculated from the ionization chamber, then serving a an electron beam monitor, cross-calibrated to the photon field with thermoluminescent dosimeters. Three dose rate meters based on different operating principles were investigated, covering a large portion of the operating principles used in radiation protection: the ionization chamber based RamION, the proportional counter LB 1236-H10 and the scintillation detector AD-b. Regarding clinical dosimetry, measurements of two prominent ionization chamber geometries, plane-parallel (Advanced Markus chamber) and thimble type (PinPoint chamber), were performed. In addition to common air-filled chambers, chambers filled with pure nitrogen and two non-polar liquids, tetramethylsilane and isooctane, were investigated. In conjunction with the experiments, a numerical solution of the charge liberation, transport, and recombination processes in the ionization chamber was developed to calculate the volume recombination independent of the assumptions necessary to derive Boag's formulas. Most importantly, the influence of the liberated charges in the ionization chamber on the electric field, which is neglected in Boag's formulas, is included in the developed calculation. Out of the three investigated dose rate meters only the RamION could be identified as an instrument truly capable of measuring a pulsed field. The AD-b performed below expectations (principally, a scintillator is not limited in detecting pulsed radiation), which was attributed to the signal processing, emphasizing the problem of a typical black-box signal processing in commercial instruments. The LB 1236-H10, on the other hand, performed as expected of a counting detector. While this supports the recent effort to formalize these expectations and standardize testing for counting dosimeters in DIN IEC/TS 62743, it also highlights the insufficiency of counting detectors for highly pulsed fields in general and shows the need for additional normative work to establish requirements for dose rate meters not based on a counting signal (such as the RamION), for which no framework currently exists. With these results recognized by the German radiation protection commission (SSK) the first steps towards such a framework are taken. The investigation of the ionization chambers used in radiation therapy showed severe discrepancies between Boag's formulas and the experimentally observed volume recombination. Boag's formulas describe volume recombination truly correctly only in the two liquid-filled chambers. All the gas-filled chambers required the use of effective parameters, resulting in values for those parameters with little to no relation to their original meaning. Even this approach, however, failed in the case of the Advanced Markus chamber for collection voltages ≥ 300 V and beyond a dose-per-pulse of about 100 mGy. The developed numerical model enabled a much better calculation of volume recombination and allowed the identification of the root of the differences to Boag's formulas as the influence of the liberated charges on the electric field. Increased positive space charge due to increased dose-per-pulse slows the collection and reduces the fraction of fast, free electrons, which are unaffected by volume recombination. The resultant increase in the fraction of charge undergoing volume recombination, in addition to the increase in the total amount of charge, results in an increase in volume recombination with dose-per-pulse that is impossible to describe with Boag's formulas. It is particularly relevant in the case of high electric fields and small electrode distances, where the free electron fraction is large. In addition, the numerical calculation allows for arbitrary pulse durations, while Boag's formulas apply only to very short pulses. In general, the numerical calculation worked well for plane-parallel chambers, including those filled with the very diverse media of liquids, nitrogen and air. Despite its increased complexity, the thimble geometry could be implemented as well, although, in the case of the PinPoint chamber, some discrepancies to the experimental data remained, probably due to the required geometrical approximations. A possible future development of the numerical calculation would be an improved description of the voltage dependence of the volume recombination. At the moment it requires characterizing a chamber at each desired collection voltage, which could be eliminated by an improved modeling of the volume recombination's dependence on collection voltage. Nevertheless, the developed numerical calculation presents a marked improvement over Boag's formulas to describe the dose-per-pulse dependence and pulse duration dependence of volume recombination in ionization chambers, in principle enabling the application of ionization chambers in the absolute dosimetry of highly pulsed fields.:1 Introduction 2 Scientific Background 2.1 General Aspects of Dosimetry 2.1.1 The Radiation Dose 2.1.2 Limitations of Absorbed Dose 2.1.3 Radiation Therapy vs. Radiation Protection 2.2 Pulsed Radiation 2.2.1 Terminology 2.2.2 Sources 2.3 Ionization Chambers for Radiation Therapy Dosimetry 2.3.1 Principle of Operation 2.3.2 Calibration and Correction Factors 2.3.3 Saturation Correction and Volume Recombination 2.4 Numerical Solution of Advection-Diffusion-Reaction Equations 2.5 Dose Rate Meters for Radiation Protection Dosimetry 2.5.1 Counting Tubes 2.5.2 Scintillation Detectors 2.5.3 Current Regulatory Developments 3 Material and Methods 3.1 Common Experimental Setup 3.1.1 Radiation Source ELBE 3.1.2 Beam Monitoring Equipment 3.2 Dose Rate Meter Measurements 3.2.1 Measurement Series and Procedure 3.2.2 Reference Measurements 3.3 Ionization Chamber Measurements 3.3.1 Measurement Series and Procedure 3.3.2 Experimental Determination of Volume Recombination 3.4 Numerical Calculation of Volume Recombination 3.4.1 Plane-parallel Chamber Geometry 3.4.2 Adaption to Thimble Chamber Geometry 3.4.3 Input Parameters 4 Dose Rate Meter Investigation 4.1 Results 4.2 Discussion and Conclusion 5 Ionization Chamber Investigation 5.1 Field Homogeneity and Stability 5.2 Uncertainty Considerations 5.3 Advanced Markus Chamber in Air 5.3.1 Experimental and Calculation Results 5.3.2 Comparison to Literature 5.3.3 Validity of the Numerical Model 5.3.4 Discussion of the Recombination Rate 5.3.5 Relevance of the Free Electron Fraction 5.4 Advanced Markus Chamber in N 2 5.4.1 Experimental and Calculation Results 5.4.2 Discussion of the Electron-Ion Recombination 5.5 PinPoint Chamber 5.5.1 Results and Discussion 5.6 Liquid Ionization Chamber 5.6.1 Experimental and Calculation Results 5.6.2 Discussion 5.7 Conclusion and Outlook 6 Summary 7 Zusammenfassung Bibliography Appendix A Evaluation of the Faraday Cup Data B Description of the Implemented Numerical Solver Danksagung

During interventional cardiology (IC), medical staff are exposed to scattered ionizing radiation from the patient, potentially leading to various radiation-induced health effects. Therefore, shielding devices are routinely used to reduce occupational exposure during IC procedures. This study explores how the positioning of shielding devices impacts radiation protection efficiency in clinical scenarios. The study aims to determine optimal setups and potential pitfalls that might significantly reduce the efficiency of the shielding devices. It also explores the relationship between DICOM-based production data, clinical observations, and phantom-based measurements to add knowledge to the research field of radiation protection in IC. Clinical DICOM-based production data from 4976 procedures were analyzed to identify C-arm projection angles used during different procedure types. This data and the results of an observational study were used to determine a scattered radiation measurement setup. A survey meter was used to measure air kerma at seven heights in the operator position while an anthropomorphic phantom was irradiated. The measurements were distributed over seven projections with 56 position combinations of the shielding devices. A total of 3171 measurements were performed. The measurements suggest significant variations in the operator dose depending on the projection and how the shielding devices are positioned. The most optimal combination of shielding devices was achieved when placing the table-mounted shield along the table, the ceiling-suspended shield caudal close to the phantom, and without the patient drape. Conversely, the least optimal combination was achieved when placing the table-mounted shield flared out, the ceiling-suspended shield cranial 10 cm above the phantom, and without the patient drape. The air kerma rate for these two shielding setups with the LAO25/CAUD30 projection was reduced from 0.19 μGy/s to 0.05 μGy/s at 110 cm from the floor. This height was shown to be the hardest to properly shield. Despite the implementation of the most optimal shielding combination, it is evident that certain heights present difficulties in effectively protecting the operator from scattered radiation.

Kärnkraftsindustrin är en bransch som präglas av avancerad teknik och omfattande säkerhetskrav. För att säkerställa en trygg arbetsmiljö krävs därför kontinuerlig fortbildning av medarbetarna. Syftet med denna studie var att undersöka en strålskyddsutbildning på ett svenskt kärnkraftverk och bidra med förslag på hur utbildningen kan förbättras för att minska kunskapsbortfallet över tid hos medarbetarna. För att utvärdera kunskapsbortfallet genomfördes en enkätundersökning med frågeformulär innehållandes kunskapsprov. Som grund för förbättringsförslagen intervjuades lärare som undervisar den utvalda kursen. Enkätsvaren analyserades statistiskt och intervjuerna behandlades med tematisk analys. En svag korrelation mellan kunskapsnivå och tid uppmättes men undersökningen visade även att medarbetarna hade goda teoretiska kunskaper om kursinnehållet även lång tid efter kurstillfället. Förbättringsförslag som presenteras inkluderar bland annat mer stöttning till lärarna för att säkerställa fysikalisk förståelse och bra exempel på erfarenhetsåterföring, samt utveckling av lokalerna för att stimulera samtal och mer autenticitet i det praktiska momentet. Det goda kunskapsresultatet styrker lärarnas bild av att radiologiska tillbud på kärnkraftverket förmodligen inte i första hand beror på kunskapsbrist utan snarare på andra faktorer så som attityd, stress och slarv. / The nuclear power industry is characterized by advanced technology and extensive safety requirements. Continuous training of employees must therefore ensure a safe working environment. The purpose of this study was to investigate a radiation protection training at a Swedish nuclear power plant and contribute suggestions on how the course can be improved to reduce knowledge loss over time among employees. Surveys containing a knowledge test were used to evaluate memory retention. As a basis for improvement suggestions, teachers who teach the selected course were interviewed. The surveys were statistically analyzed, and the interviews were subjected to thematic analysis. A weak correlation between knowledge level and time was measured, but the study also showed that employees had good theoretical knowledge of the course content even long after the course. Improvement suggestions presented include, among other things, more support to teachers to ensure physical understanding and good examples of experience feedback, as well as development of facilities to stimulate discussions and more authenticity in practical activities. The demonstrated proficiency level support the teachers' perception that radiological incidents at the nuclear power plant probably do not primarily result from lack of knowledge but rather from other factors such as attitude, stress, and negligence.

Bien que les technologies d’imagerie soient un acquis réel de la médecine moderne, leur introduction ne semble pas avoir été précédée d’une démarche réflexive suffisante qui aurait permis d’anticiper les multiples enjeux que rencontre la pratique radiologique actuelle. En effet, à force de se focaliser sur les acquis techniques et scientifiques, le cadre de radioprotection en place semble ne pas avoir suffisamment considéré l’apport essentiel que représente la connaissance des aspects sociaux, éthiques et humains que peuvent amener des domaines comme la bioéthique. Cette insuffisance fait en sorte que l’on se retrouve aujourd’hui face à des enjeux importants relatifs à la radioprotection du patient comme la surutilisation des examens radiologiques ou encore le manque d’information des acteurs du milieu face aux risques des rayonnements. Après un état des lieux des enjeux éthiques en radiologie diagnostique ayant un impact sur la radioprotection médicale des patients, un enjeu majeur de la pratique actuelle, qui est la justification inadéquate des prescriptions d’examens radiologiques, sera analysé selon une approche par principes. De cet exercice, visant à démontrer comment l’éthique peut concrètement contribuer à la radioprotection, découle l’impératif d’une vision nouvelle et globale permettant de proposer des pistes de solution aux controverses liées à l’utilisation actuelle de l’imagerie. Dans une perspective de santé des populations, il est important de contribuer à la diminution de la banalisation du recours au rayonnement ionisant dans la pratique médicale diagnostique en alliant bioéthique et radioprotection. Ce projet de recherche se veut être une étape limitée, mais nécessaire dans l’établissement de ce dialogue interdisciplinaire. / While imaging technologies represent a real achievement for modern medicine, their introduction seems not to have been preceded by a sufficiently reflective process that would have anticipated the multiple challenges arising in current radiological practice. In focusing on the technical and scientific achievements, the actual radiation protection framework fails to consider sufficiently the essential contribution brought by social, ethical and human dimensions of disciplines such as bioethics. This failure means that today we find ourselves faced with major issues related to patient radiation protection, such as overuse of radiological examinations or medical personnel’s lack of information about the risks of radiation. Following an overview of ethical issues in diagnostic radiology affecting medical radiation protection of patients, a major issue in current practice – i.e., the inadequate justification of radiological examination prescriptions – will be analyzed using a principle-based approach. From this exercise, which aims to demonstrate how ethics can contribute concretely to radiation protection, a need arises for a new and comprehensive vision leading to solutions for controversies related to the current use of medical imaging. In a population health perspective, it is important to contribute to the reduction of the trivialization of the use of ionizing radiation in diagnostic medical practice by combining both bioethics and radiation protection. This research project aims to be a modest but necessary first step in the establishment of such an interdisciplinary dialogue.

The department of Radiation Sciences at Umeå University has obtained an old linear accelerator, intended for educational purposes. The goal of this thesis was to find proper reinforced radiation protection in an intended bunker (a room with thick concrete walls), to ensure that the radiation outside the bunker falls within acceptable levels. The main method was with the use of Monte Carlo-simulations. To properly simulate the accelerator, knowledge of the energy distribution of emitted radiation was needed. For this, a novel method for spectra determination, using several depth dose measurements including off-axis, was developed. A method that shows promising results in finding the spectra when measurements outside the primary beam are included. The found energy spectrum was then used to simulate the accelerator in the intended bunker. The resulting dose distribution was visualized together with 3D CAD-images of the bunker, to easily see in which locations outside the bunker where the dose was high. An important finding was that some changes are required to ensure that the public does not receive too high doses of radiation on a public outdoor-area that is located above the bunker. Otherwise, the accelerator is only allowed to be run 1.8 hours per year. A workaround to this problem could be to just plant a thorn bush, covering the dangerous area of radius 3m. After such a measure has been taken, which is assumed in the following results, the focus moves to the radiation that leaks into the accelerator’s intended control room, which is located right outside the bunker’s entrance door. The results show that the accelerator is only allowed to be run for a maximum of 6.1 or 3.3 hours per year (depending on the placement of the accelerator in the room), without a specific extra reinforced radiation protection consisting mainly of lead bricks. With the specific extra protection added, the accelerator is allowed to be run 44 or 54 hours per year instead, showing a distinct improvement. However, the dose rate to the control room was still quite high, 13.7 μGy/h or 11.2 μGy/h, compared to the average dose received by someone living in Sweden, which is 0.27 μGy/h. Therefore, further measures are recommended. This is however a worst case scenario, since the leakage spectrum from the accelerator itself was simulated as having the same energy spectrum as the primarybeam at 0.1 % of the intensity, which is the maximum leakage dose according to the specifications for the accelerator. This is probably an overestimation of the intensity. Also, the energy spectra of the leakage is probably of lower energy than the primary beam in at least some directions. Implementing more knowledge of the leak spectra in future work, should therefore result in more allowed run hours for the accelerator.

Made available in DSpace on 2014-07-29T15:25:19Z (GMT). No. of bitstreams: 1 Tese Rosangela da S Correa.pdf: 1513256 bytes, checksum: a25a4559d449be027efcb11728fce7c2 (MD5) Previous issue date: 2012-04-10 / Among the available methods for the diagnosis and early detection of breast cancer, the most indicated for mass screening is the mammography. To guarantee its effectiveness, this exam needs to be performed using high quality standards and the lowest radiation dose possible. Therefore, the present research aimed to assess the infrastructure and performance of the equipments available at the mammography services in the state of Goiás, regarding coverage, quality, and radiological protection (dose) of patients, in order to provide early detection of breast cancer by an opportunistic screening. A prospective study was carried out, from 2007 to 2010, to observe the diagnostic imaging services which perform mammography, initially for the Brazilian Unified National Health System (SUS) and, in 2010, the services of the private system were included. Data collection was divided into two phases: the first, to collect information on infrastructure and the second, to apply tests in order to evaluate the performance characteristics of equipment and materials used. We calculated the conformity of the assessed items in terms of quality of image and equipment performance and estimated the average dose in glandular tissue and the risk of radioinduced carcinogenesis, as well as the risk of mortality by radioinduced tumors. The results were presented in four articles. In the first, we showed that mammography coverage in the state of Goiás in 2008 was 66% among women in the 50 69-year age group, considering biennial mammography. In the second article, we concluded that the implementation of the Mammography Quality Control Program was effective to achieve better quality mammography in SUS services. In the beginning of our research, only 2.9% of SUS services were within the desired range of quality and, after two interventions (2008 and 2009), 20% of them reached it. The results of the third article, in which we verified the infrastructure and quality of services performing mammography, both for SUS and private systems, showed no difference in quality of exams between them. However, the evaluation between types of technology used showed difference between radiation doses (p < 0.001) applied during mammography. In the fourth article, we estimated the benefit risk balance of screening mammography carried out in the state of Goiás in 2010. The excess absolute risk of radioinduced cancer and the lifetime risk presented significant difference for types of technology (p < 0.001) and types of health system (p < 0.019) according to the age group of screening. The ratio lives saved/lives lost was 75.5/1 for screening at the 40 70-year age group and 166.5/1 at the 50 70-year age group. The results showed that coverage of the 50 69-year age group in the state of Goiás is near the recommended standards for the beginning of organized screenings. However, when assessed per regional health unit, coverage was non-uniform, presenting high concentration of equipments and exames at the Central Regional. The initial evaluation of equipment performance indicated the need to implant actions for controlling mammography quality and risk. The actions of the Mammography Quality Control Program proved to be effective to enhance the quality of mammography, although the same does not remain true for the radiation dose used in mammography. These doses are lower in conventional mammography equipments than in those coupled to image digitization systems. Regarding radiological protection, screening women who are 50 70 years old, when performed biennially using conventional mammography equipments, presented more benefit. / Entre os métodos disponíveis para diagnóstico e detecção precoce de câncer de mama, o mais indicado para o rastreamento em massa é a mamografia. Para garantir sua efetividade, é preciso que esse exame seja realizado com padrão de qualidade ótimo e a menor dose possível. Nesse contexto, a presente pesquisa teve como proposta avaliar a infraestrutura e o desempenho dos equipamentos instalados nos serviços de mamografia no estado de Goiás, no que se refere à cobertura, qualidade da mamografia e proteção radiológica (dose de exposição) das pacientes, tendo em vista a proposta de detecção precoce do câncer de mama por meio de rastreamento oportunístico. Realizouse um estudo prospectivo, que compreendeu o período de 2007 a 2010, durante o qual foram observados os serviços de diagnóstico por imagem que realizavam mamografia, inicialmente para o Sistema Único de Saúde (SUS) e, em 2010, incluíram-se os serviços do sistema privado. Dividiu-se a coleta de dados em duas etapas: a primeira, para levantamento de informações sobre infraestrutura e a segunda, para aplicação de testes com o objetivo de avaliar os parâmetros de desempenho dos equipamentos e materiais utilizados. Foram calculados: o percentual de conformidade nos itens avaliados referentes a qualidade da imagem e desempenho dos equipamentos, e estimada a dose média no tecido glandular mamário e os riscos de carcinogênese radioinduzida, bem como, o risco de mortalidade por tumores radioinduzidos. Os resultados foram apresentados em quatro artigos científicos. No primeiro, mostrou-se que a cobertura da mamografia no estado de Goiás em 2008 foi de 66% entre as mulheres na faixa etária de 50 a 69 anos, considerando-se a realização de mamografia bienal. No segundo artigo, concluiu-se que a implantação do Programa de Controle de Qualidade em Mamografia foi efetiva para a melhoria da qualidade da mamografia nos serviços do SUS. No início da pesquisa, somente 2,9% dos serviços do SUS estavam na faixa desejável de qualidade e, após duas intervenções (2008 e 2009), 20% deles a atingiram. Os resultados do terceiro artigo, em que se verificou a infraestrutura e a qualidade dos serviços que realizavam mamografia, tanto para o sistema SUS, como para o sistema privado, mostraram não haver diferença na qualidade do exame entre eles. Porém, a avaliação entre os tipos de tecnologia empregados mostrou diferença entre as doses (p < 0,001) de radiação aplicadas durante a mamografia. No quarto artigo, estimou-se a relação benefício risco do rastreamento mamográfico realizado no estado de Goiás em 2010. O risco absoluto de excesso de câncer radioinduzido e o risco ao longo da vida apresentaram diferença significativa para os tipos de tecnologia (p < 0,001) e o tipo de atendimento dos serviços (p < 0,019) segundo a faixa etária de rastreamento. A razão de vidas salvas/vidas perdidas foi de 75,5/1 para o rastreamento na faixa de 40 a 70 anos e de 166,5/1 na faixa de 50 a 70 anos. Os resultados apontaram que a cobertura para a faixa de 50 a 69 anos no estado de Goiás está próxima do recomendado para o início de rastreamento organizado. Entretanto, quando avaliada por regional de saúde, a cobertura mostrou-se desigual e com grande concentração de equipamentos e exames na Regional Central. A avaliação inicial do desempenho dos equipamentos indicou a necessidade de implantação de ações para controle da qualidade da mamografia e do risco. As ações do Programa de Controle de Qualidade em Mamografia mostraram-se efetivas para a melhoria da qualidade da mamografia, embora o mesmo não tenha ocorrido com a dose de radiação empregada na mamografia. As doses nos mamógrafos convencionais são mais baixas do que nos mamógrafos acoplados aos digitalizadores de imagem. Em termos de proteção radiológica, o rastreamento na faixa etária de 50 a 70 anos, quando realizado bienalmente em mamógrafos com tecnologia convencional, apresentou maior benefício.