Readjustment of abdominal computed tomography protocols in a university hospital: impact on radiation dose

Romano, Renata Marino; Salvadori, Priscila Silveira; Torres, Lucas Rios; Bretas, Elisa Almeida Sathler; Bekhor, Daniel; Caldana, Rogério Pedreschi; Medeiros, Regina Bitelli; D'Ippólito, Giuseppe

doi:10.1590/0100-3984.2014.0054

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…At our institution, reducing the radiation dose is a major goal, the health care professionals are continuously informed about the radiation risks, as well as the need for a more conscientious use of radiological procedures, and protocols are constantly being changed in order to achieve that goal. Recent changes in the adult abdominal CT protocols at our institution-modifications in technical aspects of the examinations and in the number of acquisition phases-have reduced the median level of radiation exposure by half ( 45 ) , benefiting not only the patients, who are exposed to a lower radiation dose, but also the institution, because the scans have become faster and consequently less expensive ( 46 ) .…”

Section: Discussionmentioning

confidence: 99%

Utility of the inspiratory phase in high-resolution computed tomography evaluations of pediatric patients with bronchiolitis obliterans after allogeneic bone marrow transplant: reducing patient radiation exposure

2017

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ObjectiveTo evaluate the utility of the inspiratory phase in high-resolution computed tomography (HRCT) of the chest for the diagnosis of post-bone marrow transplantation bronchiolitis obliterans.Materials and MethodsThis was a retrospective, observational, cross-sectional study. We selected patients of either gender who underwent bone marrow transplantation and chest HRCT between March 1, 2002 and December 12, 2014. Ages ranged from 3 months to 20.7 years. We included all examinations in which the HRCT was performed appropriately. The examinations were read by two radiologists, one with extensive experience in pediatric radiology and another in the third year of residency, who determined the presence or absence of the following imaging features: air trapping, bronchiectasis, alveolar opacities, nodules, and atelectasis.ResultsA total of 222 examinations were evaluated (mean, 5.4 ± 4.5 examinations per patient). The expiratory phase findings were comparable to those obtained in the inspiratory phase, except in one patient, in whom a small uncharacteristic nodule was identified only in the inspiratory phase. Air trapping was identified in a larger number of scans in the expiratory phase than in the inspiratory phase, as was atelectasis, although the difference was statistically significant only for air trapping.ConclusionIn children being evaluated for post-bone marrow transplantation bronchiolitis obliterans, the inspiratory phase can be excluded from the chest HRCT protocol, thus reducing by half the radiation exposure in this population.

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Section: Discussionmentioning

confidence: 99%

Utility of the inspiratory phase in high-resolution computed tomography evaluations of pediatric patients with bronchiolitis obliterans after allogeneic bone marrow transplant: reducing patient radiation exposure

2017

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“…Among the various strategies for reducing radiation doses in abdominal scans, limiting the number of phases in CT scans has proven to be one of the most effective (12,13). Recent studies have demonstrated that it is possible to eliminate one or more phases during a CT scan in a range of clinical settings without significant impact on diagnostic accuracy (12)(13)(14). To the best of our knowledge, this hypothesis has not yet been specifically tested for CT examinations in patients with APN.…”

Section: Introductionmentioning

confidence: 99%

“…The main disadvantage of CT consists in exposing the patient to high doses of ionizing radiation when considering a standard protocol (8), especially when there is a need for repeat CT examinations (9). Among the various strategies for reducing radiation doses in abdominal scans, limiting the number of phases in CT scans has proven to be one of the most effective (12,13). Recent studies have demonstrated that it is possible to eliminate one or more phases during a CT scan in a range of clinical settings without significant impact on diagnostic accuracy (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Are the unenhanced and excretory CT phases necessary for the evaluation of acute pyelonephritis?

et al. 2016

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Background The most widely accepted computed tomography (CT) protocol for diagnosis of acute pyelonephritis (APN) includes at least a pre- and post-contrast scan, which may expose patients to higher doses of ionizing radiation. Purpose To establish the accuracy, reproducibility, and degree of confidence in CT diagnosis of acute pyelonephritis (APN) and urolithiasis using only images obtained during the nephrographic phase. Material and Methods A retrospective study of 100 consecutive patients (88 women; age range, 19-70 years) with clinical and laboratory suspicion of APN and who underwent triphasic abdominal CT scans (non-contrast, nephrographic, and excretory phases) was performed. Two readers first evaluated independently only the nephrographic phase of scans, and, in a second session, the entire study. The diagnostic reference standard was settled by a third experienced radiologist who reviewed all triphasic scans and clinical data. Results The accuracy of only nephrographic phase for diagnosis of APN and urolithiasis was in the range of 90.3-91.78% and 96.27-99.25%, respectively. There was no significant difference in comparison with the triphasic reading (z: -0.4 - 0.2; P = 0.34-0.83). The average degree of confidence for APN also showed no significant variation for both readers ( P = 0.4 and 0.08). Almost perfect inter-observer agreements for the diagnosis of APN (k = 0.86, P < 0.001) and for urolithiasis (k = 0.84, P < 0.001) were observed when considering only the nephrographic phase. Conclusion CT assessment of APN and urolithiasis can be accurately performed using only the late nephrographic phase, with consequent dose reduction.

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“…The involvement of professionals from various areas, without specific training in the field of radiation protection, can lead to excessive exposure to ionizing radiation in the operating room ( 2 , 3 ) . Previous studies have indicated that nonradiologist physicians possess heterogeneous, inadequate knowledge of ionizing radiation, suggesting that there is room for improvement ( 4 ) .…”

Section: Introductionmentioning

confidence: 99%

Study of scattered radiation during fluoroscopy in hip surgery

et al. 2016

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ObjectiveTo measure the scattered radiation dose at different positions simulating hip surgery.Materials and MethodsWe simulated fluoroscopy-assisted hip surgery in order to study the distribution of scattered radiation in the operating room. To simulate the patient, we used a anthropomorphic whole-body phantom, and we used an X-ray-specific detector to quantify the radiation. Radiographs were obtained with a mobile C-arm X-ray system in continuous scan mode, with the tube at 0º (configuration 1) or 90º (configuration 2). The operating parameters employed (voltage, current, and exposure time) were determined by a statistical analysis based on the observation of orthopedic surgical procedures involving the hip.ResultsFor all measurements, higher exposures were observed in configuration 2. In the measurements obtained as a function of height, the maximum dose rates observed were 1.167 (± 0.023) µSv/s and 2.278 (± 0.023) µSv/s in configurations 1 and 2, respectively, corresponding to the chest level of health care professionals within the operating room. Proximal to the patient, the maximum values were recorded in the position occupied by the surgeon.ConclusionWe can conclude that, in the scenario under study, health care professionals workers are exposed to low levels of radiation, and that those levels can be reduced through the use of personal protective equipment.

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Readjustment of abdominal computed tomography protocols in a university hospital: impact on radiation dose

Cited by 4 publications

References 27 publications

Utility of the inspiratory phase in high-resolution computed tomography evaluations of pediatric patients with bronchiolitis obliterans after allogeneic bone marrow transplant: reducing patient radiation exposure

Utility of the inspiratory phase in high-resolution computed tomography evaluations of pediatric patients with bronchiolitis obliterans after allogeneic bone marrow transplant: reducing patient radiation exposure

Are the unenhanced and excretory CT phases necessary for the evaluation of acute pyelonephritis?

Study of scattered radiation during fluoroscopy in hip surgery

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