اکبر علی اصغرزاده

Exposure to ionizing radiation from repeated CT scan examinations increases the risk of solid cancers and leukemia. This study aims to evaluate the cancer risk associated with chest CT radiation doses in COVID-19 patients at Shahid Beheshti Hospital in Kashan, Iran.

Between January 20 and March 29, 2022, high-resolution chest CT images were obtained from 2,471 COVID-19 patients, with a mean age of 54 years. Using the average doses calculated by IndoseCT software, we estimated the Lifetime Attributable Risk (LAR) of major cancers for each patient, following the methodology outlined in the BEIR VII report.

The mean effective dose was 3.47 millisieverts for women and 3.92 millisieverts for men. For men with COVID-19, lung cancer was identified as a major risk, with a mean LAR of 9.5 per 100,000 individuals. In women with COVID-19, lung, breast, and thyroid cancers were the major risk, with mean LARs of 19.7, 18.4, and 6.4 per 100,000 individuals, respectively. The overall mean LAR for solid cancers and leukemia across the entire population was estimated to be 19.4 and 1.7 per 100,000 individuals, respectively.

Despite a significant increase in chest CT examinations due to COVID-19 at Shahid Beheshti Hospital in Kashan, the overall cancer risk remains very low (LAR<20) according to the qualitative assessment by the World Health Organization.

Adjacent radiation fields are applied in some radiotherapeutic cases. When using these radiation fields, considerable dose errors across the junction of radiation fields are possible. Therefore, it is necessary to evaluate the accuracy of the dose calculated by the treatment planning system (TPS) when using the adjacent radiation fields. The present study aimed to quantify the dose calculation accuracy of ISOgray TPS for the photon-photon adjacent fields. To assess the accuracy of dose calculations, the dose profiles were first measured by a Semiflex TM31010 at 1, 1.5, 5, and 10 cm depths for different field sizes (6 × 6, 10 × 10, and 20 × 20 cm2). In the second step, corresponding data were extracted from the ISOgray TPS. Finally, the dosimetric performance of TPS was evaluated using a gamma index analysis. The overall dose calculation accuracy of ISOgray TPS was within the acceptable range for the build-up region (with acceptance criteria of dose difference (DD) = 15% and distance to agreement (DTA) =3 mm) and the depths after the build-up region (with acceptance criteria of DD = 5% and DTA = 3 mm). Moreover, the overall accuracy of dose calculations was not affected by the field size. A more detailed analysis of the findings revealed that the accuracy of dose calculations in the match line regions of the adjacent radiation fields for 1cm beam profiles was within the acceptable range; however, it declined for other depths. The findings showed that the overall dose calculation accuracy of ISOgray TPS was acceptable for evaluated adjacent radiation fields. However, the accuracy of dose calculations in the match line regions of the adjacent radiation fields for the depth after build-up was not within the acceptable range.

There is a bulk of studies supporting the positive effect of strategy instruction on reading comprehension. This study examined the effect of two reading strategies (i.e., false correction and inference strategy) on English reading comprehension of Iranian paramedical students, using a pretest, posttest, control group design. It also surveyed their attitudes toward the effect and usefulness of these strategies. The participants were sixty paramedical students, selected through availability sampling from the Medical University of Kashan. They were randomly assigned to two experimental groups and one control group (CG). The first experimental group was instructed to use inference strategy (henceforth IS), whereas the second was instructed to use a strategy based on elaborative interrogation theory (i.e., false correction strategy, henceforth FCS). The experimental data were collected through a researcher-made pretest and posttest, and survey data through a researcher-made questionnaire. The results of statistical analyses indicated that IS group significantly outperformed FCS and CG on the posttest. The results of questionnaire data also showed that IS led to more positive attitudes. Moreover, IS was perceived as more useful in meeting participants’ academic needs. The findings of the study imply a needs-based approach to ESP pedagogy.

This research aimed to measure the received photon and thermal neutron doses to contralateral breast (CB) surface in breast cancer radiation therapy for different field sizes in presence of dynamic and physical wedges. The photon and thermal neutron doses were measured by thermo uminescent dosimeter (TLDs) chips for 11 × 13, 11 × 17 and 11 × 21 cm2 field sizes in presence of physical and dynamic wedges. The findings of current study demonstrated that the received doses (both of the photon and thermal neutron) to CB surface in presence of physical wedge for 11 × 13, 11 × 17 and 11 × 21 cm2 field sizes were 12.06, 15.75 and 33.40% of the prescribed dose, respectively, as well as for dynamic wedge were 9.18, 12.92 and 29.26% of the prescribed dose, respectively. The received photon and thermal neutron doses to CB surface increased with increment of field sizes. In addition, the received photon and thermal neutron doses to CB surface in presence of dynamic wedge were less than physical wedge. Similar to recommendations of previous conducted studies, in breast radiation therapy with wedge technique, the using a dynamic wedge is preferable than a physical wedge, especially for medial tangential field.

Natural gamma background radiation can cause ionization in vital molecules such as DNA and can have destructive effects on human health. Measurement of these radiations is very important because they increase incidence of cancers and genetic damages. The aim of this study was to measure the dose rate, annual effective dose and incidence of cancer risk in Kashan city, north of Isfahan Province. In this cross-sectional study, measurements were performed using the dosimeter of the Radiation Alert Monitor 5 Model during daylight in outdoor and indoor in five geographical regions of Kashan city (north, south, east, west and center) and in four different seasons of the year. In each geographic region, measurements were carried out at three consecutive days in the middle of each season in ten random points. Then, the annual effective dose and excess lifetime cancer risk were calculated. The mean dose rates were 155±34 nSv/h and 186±34 nSv/h in outdoor and indoor, respectively. There was no significant difference between the mean dose rate in different seasons and different geographical regions. Furthermore, the annual effective dose was found to be 1.10 mSv while the estimated excess lifetime cancer risk was 4.16×10-3. The annual effective dose arising from natural gamma background radiation (1.10 mSv) in Kashan city is much higher than the worlds' average (0.48 mSv) and the values obtained in most cities in Iran

Regarding to the importance of controlling health care expenditure, necessity for proper distribution of health care resources and appropriate utilization of hospital resources through inappropriate services reduction for patients, this study aimed to assess suitability of brain CT scans, based on American College of Radiologists (ACR) appropriateness criteria in Shahid Beheshti Hospital affiliated to Kashan University of Medical Sciences (KAUMS).
This cross sectional and retrospective study was conducted in internal and surgery triage unites of an academic hospital in KAUMS to determine the appropriateness of brain CT scans. A General physician reviewed 361 medical records of patients through the check list based on ACR appropriateness criteria. Collected data was classified in three areas including appropriate, possibly appropriate and inappropriate. Data was analyzed using SPSS through descriptive statistics such as Index of dispersion and chi-square test.
Study findings revealed that among delivered CT scans, 310 (85.9%) appropriate, 38(10.5%) possibly appropriate and 13(3.6%) were inappropriate. The maximum and the minimum inappropriate brain CT scans rate 4 (4.17 %) were related to patients with Ataxia and zero (0 %) were related to patients with Headache, respectively.
Based on ACR appropriateness criteria, Brain CT scans were not utilized appropriately. In order to depict utilization review of radiology procedure in Iran, Developing a national guideline is necessary. To detect the effective factors regarding formulating targeted intervention, more comprehensive studies in various hospitals, different specialty and radiology modality seems necessary.

Background and Knowledge on the risks of radiation during diagnostic imaging is necessary to protect patients against the hazards of ionizing radiation. The aim of this study was to investigate the level of knowledge of interns, radiology residents, radiology students, and staff about radiation doses received by patients in radiological examinations.
During a cross-sectional study, 163 individuals (interns, radiology residents, students, and staff in Kashan University of Medical Sciences) were asked to identify the average dose of radiation received by patients. A researcher-made questionnaire was administered. Average of correct answers in the groups was analyzed using the SPSS 16 software. The scores above 75%, 75-50%, 50-25%, and below 25% were considered as very good, good, moderate, and poor levels of knowledge, respectively.
The mean scores for the level of knowledge about the dose received by patients were 57.9±2.45% and 52.4±2.65% in the staff and radiology students, while it was 35.35±-1.65% and 41.35±6% in interns and residents, respectively.
In this study most of the radiology staff and students had good levels of knowledge about the radiation dose received by patients during diagnostic radiological methods. Therefore, revising curricula with more emphasis on radiation protection is recommended for medical interns and residents.

Knowing patient exact dose during radiological activities is considered as one of the main principles to decrease radiation-induced dangers which are not really necessary and affect a great deal of people. In this respect, in recent years many extensive studies have been done on types of photodiodes and production of X-ray detectors using semiconductor elements. Since these elements are not very expensive and are too small in size and we can gain information of received dose immediately and without wasting time, they are mostly used. We aim to design a dosimeter using semiconductor elements for X-ray diagnostic radiation dosimetry. We used a typical silicon diode. Also, a stable circuit was applied to detect diagnostic X-ray radiations. To determine logical correlation between the electronic behavior of PIN sensor and specific parameters of X-ray (KV, mA.S), the designed circuit and calibrated ionization dosimeter were simultaneously irradiated by the diagnostic X-ray radiation with different energies and intensities. Finally, signal behavior was converted to digital amounts by the designed circuit. The amounts were then compared with received dose as recorded by ionization dosimetry. Results of the designed dosimetry behavior and ionization dosimetry simultaneously showed that the designed dosimetry responses are rather linear in different radiations whereas responses of the dosimetry under study is linear in low voltages while in high voltages no specific linear relation was found. It seems that used photodiode due to its availability, and low cost can be used as a dosimeter to measure diagnostic x-ray radiations in low energies.

Preparing Welcoming Ceremony and Orientation programs for freshmen acknowledge to work as an effective approach to decrease social, academic and emotional stressors. This study conducted to evaluate the role of Welcoming Ceremony to resolve freshmen's transitional-phase challenges. A special working group, including faculties and students, was formed to conduct Welcoming Ceremony and Orientation programs at Kashan School of Allied Health Professions. To evaluate the role of Welcoming ceremony a cross– sectional study was carried out through a distribution of a questionnaire among 92 newly admitted students (freshmen) in 1391. Majority of freshmen about 91 (97.8%) agreed that Welcoming Ceremony served as linkage between college student and university; 90 (97.8%) believed that Welcoming Ceremony assisted them to adjust with the university; 84 (90.3%) agreed that Welcoming Ceremony enhanced sense of belonging to university. In attention to the result of this study and in regarding to the importance of Welcoming Ceremony on all stages of university transitional phases, developing a specialized administrative unit in order to enhance awareness and capability of freshmen, advisors, senior students, and university staffs regarding to transitional challenges at Vice Chancellor for Students and Cultural is advisable.

The use of computed tomography (CT) as a diagnostic tool has been considerably increased. Therefore, the controlled and protection-based use of the CT scan is necessary to reduce the detrimental effects of radiation. This study was carried out to determine patient dose level in routine CT protocols and measure CTDIW and DLP in routine CT protocols among adult patients in Kashan Shahid Beheshti Hospital. The CT scanner used, was a single-slice Toshiba model Asteion CXGS-10A. Scan parameters for each protocol were registered for 10 standard-sized patients. Then, the data were applied to the CT system and mean values of CTDIW and DLP were calculated. Finally, the values were compared with the reference dose level. The mean values of CTDIw and DLP for Head, PNS, Chest, Abdomen, and Pelvis protocols were 34.11, 19.67, 15.47, 13.95, 10.08 mGy and 362.67, 153.97, 307.33, 346.07, 189.37 mGy.cm, respectively. The mean values of CTDIW and DLP obtained in all protocols were less and in some of the protocols even less than half compared with the European guidelines and UK reference values. This may be probably due to the mAs and lesser length of scan area. But the mean values of CTDIw in the Chest and Abdomen protocols were greater than IAEA reported values due to reduced use of mAs in this study. To obtain the maximum reduction in patient dose, the lower mAs level with higher KVp, lesser number of slices, length of scan area, and shorter scan time are recommended.

The objective of present study was to conduct a self-assessment of services'' quality، receiving student feedback، and initiate corrective actions to step towards EFQM model. The RADAR Logic was used to conduct self-assessment. To deploy RADAR Logic a descriptive – cross sectional study conducted on total students (270) at bachelor degree in Kashan University of Medical Sciences in first semester in 91-92. A questionnaire according to current performance and student expectations were evaluated and scored from good to poor. Variance and frequency were employed to describe qualitative variables. Consolatory and supportive services، management services and educational quality indicate major existing gap between current performance and students expectations. Using EFQM self-assessment method would work as quality improvement tools in Higher Education Institutions (HEIs). Due to the unfamiliarity of quality management philosophy in HEIs، corrective actions should focus on infrastructure functions including resources، processes، policies، and people to pave the way. To achieve and continue quality improvement، establishing a quality management committee at Medical Universities seems to be essential.

Diabetes, especially the gestational diabetes with its special fetal and maternal disorders, is the most common complication of pregnancy. Both gestational and type II diabetes mellitus are along with a disturbances to insulin secretion as well as insulin resistance. Considering the significant role of zinc in insulin function, the deficiency and importance of this element in gestational diabetes is a matter of consideration. This clinical trial was carried out on 60 pregnants suffering from gestational diabetes, and needing insulin injection from 32nd week to full-term. The patients were divided into two groups the case group (n=30), received daily zinc sulfate (25mg or 5cc) plus insulin and control group (n=30) received daily placebo (5 cc as syrup) plus insulin until the time of delivery. The required insulin dose was regulated through monitoring fasting blood sugar and blood sugar, 2 h postprandial, every two weeks in both groups. These groups were compared in terms of required insulin dose and maternal/fetal complications. Data were analyzed using t-test, OR, CI, Fisher Exact test, Kolmogorov-Smirnov and Chi-Square tests. The required dose of insulin had a significant decrease in the case group compared to the control one (p<0.001). However, the mean change in insulin dose in the case and control group compared to the beginning of study was 8.766 (SD:9.63) and 17.533 (SD: 10.54), respectively. The incidence of macrosomia in the case and control groups was significant (P<0.01). The odds ratio of control group compared to the case group was 7. The preeclampsia prevalence in both groups was not significant. Zinc supplementation in gestational diabetes may lead to the reduction of required insulin dose, incidence of macrosomia and the related complications (e.g., caesarian and delivery dystocia).

Compound depressed skull fracture (CDF) is a complication of trauma to head. In spite of many decades of studies on the management of CDF there is yet disagreements regarding primary repair or discarding the bone fragments and late repair. This study has conducted to evaluate infection rate in primary repair of CDF. This study included 60 patients with blunt trauma to head and CDF admitted to Naghavi hospital of Kashan University of Medical Sciences (KAUMS), from 1997 to 2005. Age, sex, the interval between admission and operation, severity of trauma, duration of hospital stay, and infections were recorded and analyzed with descriptive statistics. Male to female ratio was 7.6:1, and mean age 19±12.4 years. It was most common in the age range of 11-20 (19 patients, 31.7%). Motorcycle was the most common cause of the problem (45 patients, 75%). Tirty nine patients (65%) had dural laceration. The most common site of fracture was frontal bone (37 and 61.7%). Twenty eight cases (46.6%) had mild, 13 (21.7%) moderate, and 19 (31.7%) severe head injury. Fifty four patients (90%) underwent operation in less than 24 hours of their arrival to hospital and had primary bone replacement. In 6 months follow up there was no infection in either the wound or bone. In the absence of heavy contamination, and by carrying debridment as soon as possible there will be excellent outcome with primary replacement of bone fragments in CDF patients, excluding the need for another operation and the apprehension about infection.

This case-control study was carried out on 296 infertile patients. Patients with assisted hatching were 131 (case group) and non-treated patients were 165 (control group). Patients’ age, number of oocytes aspirated, number of oocytes fertilized, and numbers of embryos transferred were matched. The pregnancy was determined by positive β -HCG, 14 days after transfer and implantation was defined as presence of gestational sac in uterus on sonography. Statistical analysis was done with the student t-test and χ 2 test. A P-value of less than 0.05 was considered statistically significant. No significant difference was noted in the mean age of patients, the number of oocytes aspirated, the number of oocytes fertilized, and the number of embryos transferred between the case and control groups. In addition, no significant difference was observed in the rates of pregnancy between the hatched and control groups (22.9% versus 20.6%, respectively). Assisted hatching has no significant impact on pregnancy rates in the patients population studied. Further data are needed to determine if assisted hatching has beneficial effect on pregnancy rate.

One of the main goals of establishment of radiology technology discipline is training students who can imagine high-quality radiographic perspective. For this reason students must study theoretical basis of imaging techniques at first, and then follow this principle in lab and finally apply them on patients. At present, in our country the second stage of this process (taking an image in lab) doesn’t take place because of some restrictions such as radiographic phantoms. This matter causes some problems. The Aim of this study was construction of teaching radiographic phantoms to train students to get radiographic image in lab. After lab training, they enter into radiology departments (real environment). Methods and material: Natural bone from anatomy department was provided and then adjusted with respect to its anatomical position in body and various radiographic positions. Simultaneously from each region a mold was prepared and bones set in correct anatomical and radiographic position into that and then it was filled with melted paraffin. After cooling the phantoms, they were taken took out and colored. Investigation and comparison of results showed that instructed phantoms have very similarity with patient radiographs with regard to physical parameters such as density and contrast. This result showed that construction of radiographic teaching phantoms is possible in our country and according to their quality we can use them in training of students.

“Reject analysis” is considered as the critical evaluation of radiographs. Repeated films represent additional no billable costs as well as additional radiation exposure that affects patients and personnel and also is time consuming. This research was carried out to determine the rate of reject films in hospitals affiliated to Kashan University of medical sciences in 2003. This research was a descriptive study in which total radiographies were assessed and repeated films that were not accepted by radiographer and radiologist were determined. The common reasons of repeated films were incorrect exposure factors, incorrect patients position, x-ray equipment faults, processing equipment faults, little cooperation of patients, and miscellaneous reasons. Incidence rate was determined for total cases, body area, hospitals and finally for population. During the study 6438 radiographies were done. Repeated radiographies were 317 cases that constituted %4.9 of total radiographies. Shabihkhani Hospital and Naghavi Hospital had the highest (%6.9) and lowest (%3.8) rate, respectively. Among the most common reasons of repeated radiographies, incorrect exposure factors (%2) and incorrect patient position (%1) were reported. Skull and pelvis had the most repetition (%7). The repeated rate of radiographies in this study was similar to previous studies. The repeated rates in some hospitals and in some organs are not acceptable so we recommend continuous education programs to reduce the repeated radiographies.