{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T08:28:21Z","timestamp":1765268901328,"version":"3.41.2"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,12,28]],"date-time":"2022-12-28T00:00:00Z","timestamp":1672185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The assessment of risk related to medical exposures as a justification tool to assist decision\u2010making of the medical team is not available in clinical routine. The determination of diagnostic reference levels (DRLs) for nuclear medicine (NM) procedures has been proposed as an optimization tool, but this tool has still been aimed at a standard adult individual. It is known that the activity administered, and the consequent absorbed doses in critical organs, represents the risk of a procedure being cancer induction the greatest concern, especially for young patients. Thus, the adjustment of administered activity and procedure risk to promote risk\u2013benefit assessment is a promising tool for routine clinical use. This work aims to present a tool for determining DRLs in the administered activity related to the patient's characteristics\u2014age group, sex, and body mass index (BMI), in order to assist the medical decision regarding the risk\u2013benefit ratio. Thus, it is possible to assess the risk of carcinogenesis in groups of patients, considering absorbed doses in organs, cancer incidence, and mortality rates in our country. NIREA is an IT tool developed in PHP language for web environment as a friendly software. It allows the establishment of DRL and risk of cancer induced by radiation assessment through the estimation of absorbed doses in specific organs and based on the risk methodology of BEIR VII. The absorbed and effective doses were estimated based on the dose conversion factors of the radiopharmaceuticals published by the International Commission on Radiological Protection adjusted for the patient groups. Based on data from 2256 patients who underwent diagnostic procedures at National Cancer Institute between 2017 and 2019, the program was used, resulting in important information for conducting the clinical routine extracted as DRL, absorbed doses, and risk assessments, considering patient\u2010specific data such as age, sex, and BMI. The methodology developed in this work allows NM services to keep their data available and updated regarding local DRLs, in addition to allowing the nuclear physician to know the risk of each procedure performed, extracted by individual characteristics of the patient. The affirmative is significant because the data could be used by the regulatory body of practices with ionizing radiation in Brazil to establish a reference level in Activity that has not yet existed in the country.<\/jats:p>","DOI":"10.1002\/acm2.13658","type":"journal-article","created":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T06:39:38Z","timestamp":1672295978000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Attributable patient risk in nuclear medicine procedures and establishment of diagnostic reference levels"],"prefix":"10.1002","volume":"24","author":[{"given":"Julio Cesar","family":"de Souza Ribeiro","sequence":"first","affiliation":[{"name":"Instituto de Radioprote\u00e7\u00e3o e Dosimetria (DIFME\/IRD\/CNEN)  Rio de Janeiro Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jana\u00edna Dutra Silvestre","family":"de Mendes","sequence":"additional","affiliation":[{"name":"Instituto de Radioprote\u00e7\u00e3o e Dosimetria (DIFME\/IRD\/CNEN)  Rio de Janeiro Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lidia V.","family":"de S\u00e1","sequence":"additional","affiliation":[{"name":"Instituto Nacional de C\u00e2ncer (INCA)  Rio de Janeiro Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,12,28]]},"reference":[{"volume-title":"Explanatory Note: Diagnostic Reference Levels in Medical Imaging: Review and Additional Advice","year":"2001","author":"ICRP","key":"e_1_2_7_2_1"},{"volume-title":"Radiation Protection 154: European Guidance on Estimating Population Doses from Medical X\u2010Ray Procedures","year":"2008","author":"European Commission","key":"e_1_2_7_3_1"},{"volume-title":"Diretrizes B\u00e1sicas de Prote\u00e7\u00e3o Radiol\u00f3gica, CNEN\u2010NN\u20103.01","year":"2014","author":"Comiss\u00e3o Nacional de Energia Nuclear (CNEN)","key":"e_1_2_7_4_1"},{"volume-title":"Requisitos de Seguran\u00e7a e Prote\u00e7\u00e3o Radiol\u00f3gica para Servi\u00e7os de Medicina Nuclear, CNEN\u2010NN\u20103.05","year":"2013","author":"Comiss\u00e3o Nacional de Energia Nuclear (CNEN)","key":"e_1_2_7_5_1"},{"key":"e_1_2_7_6_1","first-page":"327","volume-title":"Sources and Effects of Ionizing Radiation, UNSCEAR, Annex. A \u2013 Medical Exposures","author":"UNSCEAR","year":"2008"},{"issue":"1","key":"e_1_2_7_7_1","first-page":"1","article-title":"1990 recommendations of the international commission on radiological protection","volume":"21","author":"ICRP","year":"1991","journal-title":"Ann ICRP"},{"key":"e_1_2_7_8_1","unstructured":"BEIR VII. Phase II Health Risks from Exposure to Low Levels of Ionizing Radiation.2006. ISBN 978\u20100\u2010309\u201009156\u20105 | DOI 10.17226\/11340."},{"issue":"2","key":"e_1_2_7_9_1","first-page":"1","article-title":"The ICRP computational framework for internal dose assessment for reference adults: specific absorbed fractions","volume":"45","author":"ICRP","year":"2016","journal-title":"Ann ICRP"},{"issue":"2","key":"e_1_2_7_10_1","first-page":"1","article-title":"Radiation dose to patients from radiopharmaceuticals (addendum 2 to ICRP publication 53)","volume":"28","author":"ICRP","year":"1998","journal-title":"Ann ICRP"},{"key":"e_1_2_7_11_1","first-page":"2","article-title":"The 2007 recommendations of the international commission on radiological protection","volume":"37","author":"ICRP","year":"2007","journal-title":"Ann ICRP"},{"volume-title":"Incid\u00eancia de C\u00e2ncer no Brasil","year":"2016","author":"INSTITUTO NACIONAL DE C\u00c2NCER\u2010INCA; DA SILVA JAG","key":"e_1_2_7_12_1"},{"issue":"1","key":"e_1_2_7_13_1","first-page":"1","article-title":"ICRP Publication 118: ICRP statement on tissue reactions\/early and late effects of radiation in normal tissues and organs \u2013 threshold doses for tissue reactions in a radiation protection context","volume":"41","author":"ICRP","year":"2012","journal-title":"Ann ICRP"},{"issue":"2","key":"e_1_2_7_14_1","first-page":"1","article-title":"The 2007 recommendations of the international commission on radiological protection. ICRP Publication 103","volume":"37","author":"ICRP","year":"2007","journal-title":"Ann ICRP"},{"issue":"1","key":"e_1_2_7_15_1","first-page":"1","article-title":"Radiation dose to patients from radiopharmaceuticals \u2013 addendum 3 to ICRP publication 53. 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