Variability in the available diagnostic procedures as well as in the amount of activities administered within the same procedure was appreciable not only in Brazil, but worldwide. Global efforts are needed to establish a concise DRL that can be applied in adult and pediatric nuclear medicine procedures as the application of DRL in clinical routine has been proven to be an important tool for controlling and reducing radiation doses received by patients in medical exposure.
It has been estimated that the number of diagnostic procedures in Nuclear Medicine has shown an annual growth rate of 5%, and consequently increasing the ionizing radiation exposition of patients, family and environment. The aim of diagnostic reference levels (DRL) is the standardization of techniques and decrease expositions to as low as possible and just compatible with the diagnostic exam under study. However, Brazilian Nuclear Medicine does not have those references, causing a decontrol of expositions and increasing the associated risks. The main objective of this study was the DRL development to Nuclear Medicine on the basis of diagnostic procedures, administered activities, adopted techniques, and the available equipments in the country. Forms were sent to all the Brazilian Nuclear Medicine Services-NMS (~430) aiming to obtain those information, as well as the rules applied to adjust the administered activities according to patient's age and body mass. All data were analyzed, and the percentile 75 (P75) of the maximum activity applied in each diagnostic exam was considered as the DRL. A total of 107 NMS have answered the form, representing 14 Brazilian states and Federal District. From the 64 diagnostic procedures studied, bone, kidney and parathyroid scintigraphy were found to be used in more than 85% of all the NMS analyzed. There was a large disparity among the activities administered, when applying the same procedure, reaching, in some cases, more than 20 times between the lowest and highest. Diagnostic exams based on 67 Ga, 201 Tl, and 131 I radioisotopes proved to be de major exams administering radiation doses to patients. The activities adjustment to pediatric patients has used different rules, including Webster rule, rule of three and empirical adjustments according to the patient's body weight. On introducing the DRL activity values into clinical routine, the minimum reduction in radiation doses received by patients was about 15%, the maximum was 95%, and the average was 50% compared with the previously reported administered activities. There were found 189 image equipments working, with mainly 4 different brands (Elscint, GE, Philips e Siemens). The variability in the administered activities to the same diagnostic procedure, respecting the existing differences in technology, may reflect the lack of radiation exposition control and the non-existence of a national reference guide to Nuclear Medicine, as well as exemplify the variability in the image protocols practiced in the country. The establishment of DRL to a Nuclear Medicine could considerably contribute toward the control and reduction of radiation exposure, thereby offering to the public high-technology exams with controlled risks.
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