![\"\"](\"https:\/\/www.crpa-acrp-bulletin.ca\/wp-content\/uploads\/2023\/05\/Business-seminar-speaker-doing-presentation-and-professional-training-578574238_4712x3625-Converted-1024x788.png\")
<\/p>\n<\/p>\n
<\/p>\n
Chaque ann\u00e9e, le Comit\u00e9 des \u00e9tudiants et des jeunes professionnels organise, en combinaison avec le congr\u00e8s annuel de l\u2019ACRP, le concours de communications \u00e9tudiantes Anthony J. MacKay. Le concours est ouvert \u00e0 toutes les \u00e9tudiantes et tous les \u00e9tudiants inscrit(e)s \u00e0 temps plein dans un programme reli\u00e9 aux sciences des rayonnements, dans un \u00e9tablissement d\u2019enseignement (coll\u00e8ge ou universit\u00e9) canadien et le sujet est intentionnellement gard\u00e9 tr\u00e8s g\u00e9n\u00e9ral afin de permettre la participation d\u2019\u00e9tudiant(e)s provenant de disciplines diverses.<\/p>\n
De toutes les participations re\u00e7ues, trois finalistes ont \u00e9t\u00e9 retenu(e)s et auront l\u2019occasion de pr\u00e9senter leurs travaux au congr\u00e8s lors d\u2019une s\u00e9ance pl\u00e9ni\u00e8re. Les pr\u00e9sentations seront jug\u00e9es sur place, et le nom de la gagnante ou du gagnant sera annonc\u00e9 pendant le banquet du congr\u00e8s. La laur\u00e9ate ou le laur\u00e9at recevra le troph\u00e9e Anthony J. MacKay, verra son article publi\u00e9 dans le Bulletin de l\u2019ACRP et recevra un prix de 250 $ en esp\u00e8ces.<\/p>\n
<\/p>\n
![\"\"](\"https:\/\/www.crpa-acrp-bulletin.ca\/wp-content\/uploads\/2023\/05\/Bryce_Nelson_Photo-150x150.png\")
<\/b><\/h4>\ncandidat au doctorat en oncologie, Universit\u00e9 de l\u2019Alberta<\/p>\n
<\/a><\/p>\n \u00e9tudiante \u00e0 la ma\u00eetrise en sciences des rayonnements, Universit\u00e9 McMaster<\/p>\n Facteurs contribuant \u00e0 la d\u00e9gradation des microsph\u00e8res Ho 166\/PLLA<\/strong><\/a><\/p>\n <\/a><\/p>\n Mackenzie termine sa ma\u00eetrise en sciences des rayonnements et physique m\u00e9dicale \u00e0 l\u2019Universit\u00e9 McMaster. Sa recherche porte sur la production de microsph\u00e8res d\u2019acide polylactique \u00e0 base d\u2019holmium, au r\u00e9acteur nucl\u00e9aire de McMaster. Elle est une d\u00e9fenseure de l\u2019accessibilit\u00e9 aux sciences et participe \u00e0 divers projets de communication sur le nucl\u00e9aire. Elle a \u00e9galement publi\u00e9 deux livres, A Guide to Radiation for the Everyday Scientist<\/em> et ABCs of Nuclear Science<\/em> afin d\u2019expliquer ces sujets en langage claire et simple. Mackenzie a coordonn\u00e9 des \u00e9v\u00e9nements sp\u00e9ciaux pour Let\u2019s Talk Science o\u00f9 elle a organis\u00e9 de nombreux symposiums de recherche, dont Let\u2019s Talk Nuclear. Elle est passionn\u00e9e par le domaine nucl\u00e9aire et est ravie \u00e0 l\u2019id\u00e9e de d\u00e9velopper sa carri\u00e8re dans cette industrie.<\/p>\n candidat en m\u00e9decine, Universit\u00e9 McMaster<\/p>\n Aptitude des radiologistes \u00e0 identifier le bruit et la qualit\u00e9 de l\u2019image dans les fant\u00f4mes p\u00e9diatriques dans un \u00e9tablissement<\/strong><\/a><\/p>\n <\/a><\/p>\n Nikhil Patil est un \u00e9tudiant en derni\u00e8re ann\u00e9e de m\u00e9decine \u00e0 l\u2019Universit\u00e9 McMaster qui s\u2019int\u00e9resse \u00e0 la radiologie et \u00e0 la radioprotection. Il a pr\u00e9alablement \u00e9tudi\u00e9 l\u2019informatique de la sant\u00e9 et la physiologie et il a toujours \u00e9t\u00e9 int\u00e9ress\u00e9 par le croisement des soins de sant\u00e9 et la technologie. Durant ses \u00e9tudes en m\u00e9decine, il a r\u00e9dig\u00e9 plus de quinze articles publi\u00e9s dans des revues \u00e0 comit\u00e9 de lecture et il esp\u00e8re continuer \u00e0 contribuer au domaine de la radiologie universitaire.<\/p>\n Entrants are required to submit an abstract of no more than 750 words on a topic that is related to some aspect of radiation; the topic is intentionally kept broad to encourage participation from a wide range of students. Following are the abstracts submitted by this year’s finalists.<\/p>\n <\/p>\n Bryce Nelson, PhD candidate in oncology, University of Alberta<\/b><\/p>\n Coauthors<\/p>\n La th\u00e9ranostique en m\u00e9decine nucl\u00e9aire consiste \u00e0 marquer un vecteur de ciblage biologique d\u2019abord par un radionucl\u00e9ide pour de l\u2019imagerie diagnostique, puis par un radionucl\u00e9ide \u00e9metteur de particules pour une th\u00e9rapie cibl\u00e9e par ce radionucl\u00e9ide. Un essai clinique r\u00e9cent utilisant le Pb 212-DOTAMTATE pour traiter des tumeurs neuroendocrines m\u00e9tastatiques a d\u00e9coul\u00e9 en un taux de r\u00e9ponse global de 80 % chez les patients, exc\u00e9dant significativement les traitements standards. Cependant, les examens diagnostics pour suivre la th\u00e9rapie avec le Pb 212 ont \u00e9t\u00e9 effectu\u00e9s avec les radiotraceurs conventionnels fluor 18 et gallium 68. Ceci n\u2019est pas optimal puisque \u00e7a pourrait mener \u00e0 l\u2019irradiation involontaire de tissus sains par des particules \u03b1. L\u2019objectif de cette \u00e9tude \u00e9tait d\u2019\u00e9laborer une fa\u00e7on de produire un haut rendement de Pb 203 par cyclotron en utilisant le mat\u00e9riau cible enrichi par l\u2019isotope Tl 205 et la r\u00e9action Tl 205(p,3n) Pb 203 comme alternative \u00e0 la production d\u2019une \u00e9nergie plus faible par le biais de la r\u00e9action Tl 203(p,n) Pb 203.<\/p>\n<\/div>\n Nuclear medicine theranostics involves labelling a biological targeting vector first with a radionuclide for diagnostic imaging, followed by a particle-emitting radionuclide for targeted radionuclide therapy. Lead-212 (Pb-212, t1\/2<\/sub> = 10.6 h) is a particularly attractive therapeutic radionuclide due to its payload of one \u03b1 and two \u03b2–<\/sup> particles in its decay chain and the rapid decay of its progeny to stable Pb-208.<\/p>\n A recent clinical trial (Delpassand et al., 2022<\/a>)\u00a0using [Pb-212]Pb-DOTAMTATE to treat metastatic neuroendocrine tumours resulted in an 80% overall patient response rate, significantly exceeding standard-of-care treatments. However, diagnostic scans to track Pb-212 therapy were performed with conventional fluorine-18 and gallium-68 radiotracers. This is suboptimal, as dissimilar chemistries between the diagnostic and therapeutic radionuclides could result in different radiopharmaceutical biodistribution, potentially leading to unintended \u03b1-irradiation of healthy tissues.<\/p>\n Pb-212 is ideally paired with the chemically identical lead-203 (Pb-203, t1\/2<\/sub> = 51.9 h) to provide diagnostic SPECT imaging using the 279 keV (81%) gamma-photons emitted during Pb-203 decay. However, worldwide supply of Pb-203 is extremely limited since cyclotron Pb-203 production requires irradiating highly toxic thallium (Tl) material.<\/p>\n Our objectives were to develop a high-yield Pb-203 cyclotron production route using isotopically enriched Tl-205 target material and the Tl-205(p,3n) Pb-203 reaction as an alternative to lower energy production via the Tl-203(p,n) Pb-203 reaction. A robust cyclotron target and efficient chemical purification process must be designed to maximize Pb-203 yield and purity for research and clinical applications, while maintaining stringent radiation and chemical safety given the significant hazards presented to the operators and cyclotron facility.<\/p>\n Our entire process was designed around preserving radiation and chemical safety. To reduce Tl contamination risk, we employed our patent-pending sealed cyclotron target design that is used to produce other radionuclides.<\/p>\n Tl-205 metal (99.9% isotopic enrichment) was pressed using a hardened stainless-steel die.\u00a0High purity aluminum (Al) target discs (99.999%) were machined with a central depression and annulus groove.<\/p>\n A Tl-205 pellet was placed into the central depression of the Al disc, and indium wire was laid in the annulus. An aluminum foil cover was then pressed on, cold welding the cover to the disc via the indium with an airtight bond.<\/p>\n Targets were irradiated at 23.3 MeV for up to 516 minutes on a TR-24 cyclotron at proton currents up to 60 \u03bcA to produce Pb-203 via the Tl-205(p,3n)Pb-203 nuclear reaction. Following a period of >12 h to allow decay of Pb-204m (t1\/2<\/sub>\u00a0=\u00a067 min, 899 keV [99%]), the target was removed and Tl-205 was dissolved in HNO3<\/sub>.<\/p>\n A NEPTIS Mosaic-LC synthesis unit performed automated separation using Eichrom Pb resin, and Pb-203 was eluted with HCl or NH4<\/sub>OAc. The waste solution was diverted to a vial for subsequent Tl-205 recovery in an electrolytic cell.<\/p>\n Pb-203 product radionuclidic and elemental purity were assessed by high-purity germanium (HPGe) gamma spectroscopy and inductively coupled plasma optical emission spectroscopy (ICP-OES), respectively. Radiolabelling and stability studies were performed with PSC, TCMC, and DOTA chelators, and Pb-203 incorporation was verified by radio-TLC analysis.<\/p>\n Cyclotron irradiations were performed at a 60 \u03bcA proton beam current and 23.3 MeV energy without any target degradation. Automated purification took <4 h, yielding >85% decay-corrected Pb-203 with a radionuclidic purity of >99.9%. Purified Pb-203 yields up to 12 GBq were attained, and Pb-203 was successfully chelated and exhibited >99% incorporation after 120 h in human serum.<\/p>\n Radiation safety implications:<\/b> In over 100 production runs, there were no cyclotron target station or processing equipment contamination incidents.<\/p>\n Targets were irradiated during the afternoon and removed the following morning to permit decay of short-lived impurities. By allowing >12 hours (>10 Pb-204m half-lives) prior to target removal, operator dose was minimized.<\/p>\n Utilizing high purity Al target components nearly eliminated long-lived activation products, minimizing operator extremity dose when performing target recycling. When combined with a target retrieval shielding cart, a custom-designed lead-shielded processing castle, and an efficient automated process, the operator radiation dose per full production run is <10 \u00b5Sv (measured by electronic personal dosimeter).<\/p>\n Our recently published high-yield Pb-203 production process significantly enhances Pb-203 production capabilities to meet the rapidly growing worldwide preclinical and clinical demand for Pb-203 radiopharmaceuticals alongside Pb-212 alpha particle therapy.<\/p>\n Since January 2022, we have successfully shipped over 60 batches of Pb-203 to customers and collaborators in 11 locations across 5 countries for research and diagnostic SPECT imaging clinical trials of metastatic melanoma and neuroendocrine tumours. Although we anticipate continually increasing demand, we are confident that our robust process design will maintain operator radiation dose at a small fraction of the permitted annual limit.<\/p>\n <\/p>\n Mackenzie Tigwell, MSc radiation sciences student, McMaster University<\/b><\/p>\n Coauthor<\/p>\n La th\u00e9ranostique en m\u00e9decine nucl\u00e9aire consiste \u00e0 marquer un vecteur de ciblage biologique d\u2019abord par un radionucl\u00e9ide pour de l\u2019imagerie diagnostique, puis par un radionucl\u00e9ide \u00e9metteur de particules pour une th\u00e9rapie cibl\u00e9e par ce radionucl\u00e9ide. Un essai clinique r\u00e9cent utilisant le Pb 212-DOTAMTATE pour traiter des tumeurs neuroendocrines m\u00e9tastatiques a d\u00e9coul\u00e9 en un taux de r\u00e9ponse global de 80 % chez les patients, exc\u00e9dant significativement les traitements standards. Cependant, les examens diagnostics pour suivre la th\u00e9rapie avec le Pb 212 ont \u00e9t\u00e9 effectu\u00e9s avec les radiotraceurs conventionnels fluor 18 et gallium 68. Ceci n\u2019est pas optimal puisque \u00e7a pourrait mener \u00e0 l\u2019irradiation involontaire de tissus sains par des particules \u03b1. L\u2019objectif de cette \u00e9tude \u00e9tait d\u2019\u00e9laborer une fa\u00e7on de produire un haut rendement de Pb 203 par cyclotron en utilisant le mat\u00e9riau cible enrichi par l\u2019isotope Tl 205 et la r\u00e9action Tl 205(p,3n) Pb 203 comme alternative \u00e0 la production d\u2019une \u00e9nergie plus faible par le biais de la r\u00e9action Tl 203(p,n) Pb 203.<\/p>\n<\/div>\n Selective internal radiation therapy (SIRT) has been gaining popularity as a treatment for hepatocellular carcinoma. A beta-emitting isotope is encapsulated in microspheres and injected into the liver via the hepatic artery. Initial treatment options used Y-90 encapsulated in aluminosilicate glass (Barros et al., 2014<\/a>). Y-90 undergoes pure beta-minus decay with a 64.1 hour half-life. This results in concentrated doses of radiation directly at tumor locations and minimal external dose risk to manufacturing staff, administering physicians, and shielding requirements to ship treatments. However, Y-90 microspheres do not allow for any imaging to track the location of microspheres. Due to this major limitation, other isotopes were considered for selective internal therapy treatments.<\/p>\n Holmium-166\/PLLA microspheres can be used for SIRT while remaining imageable via MRI or SPECT (Yamazaki et al., 2020<\/a>). Ho-166 decays 100% via beta-minus decay followed by gamma ray emissions of 80\u00a0keV (6.5%) and 1379\u00a0keV (0.9%). Due to Ho-166 half-life of only 26.8 hours, higher specific activity is needed at production. The gamma emissions and higher specific activity cause radiation dose risk to production staff. Additionally, PLLA microspheres are staticky and act like a powder, unlike previous glass versions. This presents additional radiation protection challenges.<\/p>\n There are several considerations during the production and suspension of Ho-166\/PLLA microspheres to ensure adequate quality for patient treatment. Neutron irradiation causes damage to microspheres leading to decomposition. This damage is theorized to be caused by temperature, gamma photons, fast neutrons, and\/or side reactions of thermal neutron capture (Vente et al., 2009<\/a>).<\/p>\n Microspheres were exposed to a range of gamma doses (0 kGy to 800 kGy) using a cobalt-60 source. The microsphere batches were then divided and maintained at temperatures ranging from 20\u00b0C to 100\u00b0C for at least 4 hours. This created samples with unique combinations of temperature and gamma radiation exposure.<\/p>\n To assess environmental factors in-core, a rig with detachable Pb shielding was engineered. Shielding of 0.25 cm to 1.25 cm were tested for temperature, flux, and sample quality. Microspheres were tested at specific activities ~25\u00a0MBq\/mg and ~40\u00a0MBq\/mg.<\/p>\n All samples were suspended in media and imaged at 24-hour intervals. Sample quality was assessed by light microscope imaging with a digital camera attachment. The total number of damaged microspheres was calculated as a percentage of the total.<\/p>\n Temperature showed significant impact on quality. Batches below 55\u00b0C had minimal damage (~1% to 4%). The 60\u00b0C and 65\u00b0C samples represented a significant damage threshold, where damage was at least 2x that of a control sample at suspension (6% to 20%). A damage threshold of 60\u00b0C to 65\u00b0C coincides with the glass transition temperature (Tg) of PLLA. The 70+ \u00b0C batches had extreme levels of damage in all samples, in the range of 80% to 100% damage.<\/p>\n Gamma dose in temperatures below Tg did not show any notable impact on quality except for 600\u00a0kGy samples. Samples at 600\u00a0kGy showed more damage than 800\u00a0kGy samples in almost all trials. The effects of gamma radiation seen in these trials may change for increased dose rates, more representative of environments in-core. Notably, batches exposed only to gamma radiation and temperature did not show degradation over time, normally seen in samples irradiated in-core.<\/p>\n Variable shielding in core had prominent impacts on temperature, neutron flux, and sample quality. The temperature in the rig showed a decreasing trend with the increase of Pb shielding. Temperatures exceeded 60\u00b0C in the 0.25\u00a0cm shield but dropped to 43\u00b0C by the 1.25\u00a0cm attachment. Thermal neutron flux decreased with greater Pb thickness for attachments of 0.25 cm to 1.0 cm. The 1.25\u00a0cm shield increased thermal neutron flux. Microsphere samples in attachments 0.25, 0.5, and 0.75 were all viable at ~25\u00a0MBq\/mg. Microsphere samples at ~40\u00a0MBq\/mg showed unacceptable damage in attachments 0.25 cm to 1.0 cm of PB.<\/p>\n Temperature showed the most drastic impact on quality. The 60\/65 \u00b0C samples represented a significant damage threshold. This temperature coincides with the glass transition temperature (Tg) of PLLA, which falls in the range of 60\u00b0C to 65\u00b0C. Ionizing radiation inducing chain scissions reduces Tg and may account for the increasing damage in samples above 200\u00a0kGy heated to 65\u00b0C. Gamma dose had minimal impact on low temperature samples. Samples irradiated to 600\u00a0kGy had more severe damage than other batches and suggests a damage threshold induced by polymer chain-scissions. Further testing is needed for dose-rate impact. Finally, increased Pb shielding of samples was shown to decrease temperature in the sample chamber and alter the thermal neutron flux. These insights inform the selection and equipment production of new reactor sites for Ho-166\/PLLA microsphere production.<\/p>\n <\/p>\n Nikhil S. Patil, MD candidate, Michael DeGroote School of Medicine, McMaster University<\/b><\/p>\n Coauthors<\/p>\n Les patients p\u00e9diatriques expos\u00e9s aux rayonnements en raison de l\u2019imagerie diagnostique ont un risque accru de d\u00e9velopper de futures tumeurs malignes. Les proc\u00e9dures et technologies d\u2019examens radiologiques varient d\u2019un \u00e9tablissement \u00e0 l\u2019autre, rendant difficile l\u2019\u00e9laboration de strat\u00e9gies universelles pour la r\u00e9duction des doses de rayonnement. Nous avons men\u00e9 une \u00e9tude dans un seul \u00e9tablissement portant sur l\u2019aptitude des radiologistes \u00e0 d\u00e9tecter les changements dans le bruit de l\u2019imagerie et la qualit\u00e9 du diagnostic \u00e0 diff\u00e9rentes doses de rayonnement lors d\u2019examens avec des fant\u00f4mes p\u00e9diatriques.<\/p>\n<\/div>\n Pediatric patients exposed to radiation due to diagnostic imaging have an increased risk of developing future malignancies. Radiology scanning procedures and technology vary from institution to institution, making it difficult to come up with universal strategies for radiation dose reduction. We conducted a single-institution study investigating the ability of radiologists to detect changes in imaging noise and diagnostic quality at different radiation doses in pediatric phantom scans.<\/p>\n One pediatric \u201cphantom\u201d patient of a simulated head, chest\/abdomen\/pelvis, and abdomen\/pelvis was scanned using computed tomography at four different noise index levels. Each image set was scanned four times to create four different series, with each series having a different noise index level. To modify the noise index between image sets, the mAs was modified between each series.<\/p>\n Radiologists at our institution were surveyed for determining relative noise, identifying scans closest to the current standard of practice, and determining scans of diagnostic quality.<\/p>\n Ten radiologists were surveyed. The included participants were academic staff radiologists at McMaster University with 5 to 28 years of experience practising radiology. Six of the included radiologists were pediatric subspecialists, whereas the remaining four were adult radiologists. Similarly, the time spent reporting pediatric specific scans was widely variable, ranging from every day to rarely ever.<\/p>\n Overall, the included participants were able to correctly rank 104\/160 series when asked to order the series from least noise to most noise.<\/p>\n There was variability in classification accuracy for relative noise between the abdomen\/pelvis, chest\/abdomen\/pelvis, and head scans. Similarly, there was variability in the classification accuracy between the pediatric and adult radiologists.<\/p>\n This quality improvement study found that, in general, there was considerable variability in radiologists\u2019 ability to accurately determine the relative noise index of a scan when comparing it to the same scan of a different noise index, as radiologists were only able to correctly rank series from least noise to most noise\u00a060% of the time (104\/160).<\/p>\n Furthermore, this study showed that many radiologists report series with a NI higher than the institution standard were of diagnostic quality. This indicates the potential for increasing the noise index in order to reduce radiation dose, without losing diagnostic quality of that image.<\/p>\n Our institution-specific findings are consistent with the literature in that the ability for radiologists to accurately discern scans with higher noise from those with lower noise displays interobserver and international variability.<\/p>\n Interestingly, classification accuracy\u00a0for relative noise appeared to vary between the abdomen\/pelvis, chest,\u00a0and head scans.<\/p>\n When asked what series was most similar to radiologists\u2019 current standard of practice, there appeared to be a tendency to pick the series with the least noise. Additionally, multiple radiologists found scans to be of equal noise index, when in reality none of the scans had the same level of noise. This strengthens the possibility for increasing the noise index for the purpose of reducing pediatric radiation dose without sacrificing diagnostic quality.<\/p>\n Further investigation is warranted with regards to reducing radiation doses without sacrificing diagnostic quality. Eventually, conducting a similar study with patients would provide the highest quality evidence. Furthermore, we highlight the importance of conducting institution-specific dose reduction studies to improve radiation exposure practices at the institution level, and beyond.<\/p>\n <\/p>\n Gagnants du concours de communications \u00e9tudiantes Anthony J. Mackay 2022<\/em><\/a>, 16 f\u00e9vrier 2023<\/p>\n Concours de communications \u00e9tudiantes Anthony J. Mackay 2019<\/em><\/a>, 7 juin 2019<\/p>\nBryce a obtenu son baccalaur\u00e9at en g\u00e9nie chimique de l\u2019Universit\u00e9 de l\u2019Alberta et est pr\u00e9sentement candidat au doctorat en oncologie au Medical Isotope and Cyclotron Facility<\/i> d\u2019Edmonton et au Cross Cancer Institute<\/i>. Ses recherches porte sur le d\u00e9veloppement de proc\u00e9d\u00e9s de production de radionucl\u00e9ides par cyclotron et de purification automatis\u00e9e, en plus de l\u2019application des radionucl\u00e9ides pour le diagnostic et le traitement cibl\u00e9 de cancers. Outre sa recherche, Bryce est un coureur et un joueur de tennis passionn\u00e9. Il est pr\u00e9sentement le pr\u00e9sident de l\u2019association des \u00e9tudiant(e)s des cycles sup\u00e9rieurs en oncologie de l\u2019Universit\u00e9 de l\u2019Alberta et le pr\u00e9sident de Tennis Edmonton.<\/span><\/div>\n![\"\"](\"https:\/\/www.crpa-acrp-bulletin.ca\/wp-content\/uploads\/2023\/05\/Mackenzie-photo-150x150.png\")
Mackenzie Tigwell<\/b><\/h3>\n![\"\"](\"https:\/\/www.crpa-acrp-bulletin.ca\/wp-content\/uploads\/2023\/05\/Nikhil-Photo-150x150.png\")
Nikhil S. Patil<\/b><\/h3>\n
\nAbstracts<\/h2>\n
Production de Pb 203 par cyclotron \u00e0 haut rendement \u00e0 l\u2019aide d\u2019une cible solide scell\u00e9e de Tl 205<\/h1>\n
\n
\nR\u00e9sum\u00e9<\/h2>\n
Introduction<\/h2>\n
Methods<\/h2>\n
Results<\/h2>\n
Conclusion<\/h2>\n
\nFacteurs contribuant \u00e0 la d\u00e9gradation des microsph\u00e8res Ho 166\/PLLA<\/h1>\n
\n
\nR\u00e9sum\u00e9<\/h2>\n
Background<\/h2>\n
Methods<\/h2>\n
Results<\/h2>\n
Conclusions<\/h2>\n
\nAptitude des radiologistes \u00e0 identifier le bruit et la qualit\u00e9 de l\u2019image dans les fant\u00f4mes p\u00e9diatriques dans un \u00e9tablissement<\/h1>\n
\n
\nR\u00e9sum\u00e9<\/h2>\n
Introduction<\/h2>\n
Methods<\/h2>\n
Results<\/h2>\n
\n
Discussion<\/h2>\n
\nVoir les articles connexes :<\/h3>\n