Radiografia de tórax de rotina em terapia intensiva: impacto na tomada de decisão

Abstract

Objective: This study determined the prevalence of clinical abnormalities in chest radiographs and its relationship with decision-making in intensive care. Methods: This prospective cohort study involved nonconsecutive patients who were admitted to the intensive care unit at the Hospital Universitário Professor Polydoro Ernani de São Thiago of the Universidade Federal de Santa Catarina. Imaging tests in the intensive care unit (ICU) were assessed daily between February and May 2011 and divided according to the reason for hospitalization, the type of test requested, anatomical segment under assessment and the purpose of the request. The imaging tests were interpreted by intensivists and subsequently divided according to the detected abnormalities and changes in medical care. The chi-squared test was used for statistical analysis. Results: The study sample included 106 patients. A total of 447 imaging tests were assessed, 425 of which were anteroposterior chest radiographs. An average of 4.01 radiographs per patient was obtained. Among the requested radiographs, 79.3% were normal, and 35.2% of abnormal radiographs did not prompt changes in medical care. Conclusion: Most of the radiographs performed in the intensive care unit exhibited no statistically significant clinical alterations, and the radiographs that revealed abnormalities did not necessarily lead to changes in medical care.

Patient and staff dosimetry during radiographic procedures in an intensive care unit

“…This is markedly lower than the limit established by the ICRP for workers (20 mSv yr −1 ) and also lower than the natural background of our area. This finding includes the reading from the dosimeter placed in the bed next to patients being x-rayed, confirming that the safety of other patients in the room is not affected by the performance of more or fewer portable x-ray examinations in situ [16,17,[21][22][23][24].…”

“…Some authors [1,5,8,9] concluded that the irradiation dose can be reduced by up to 50% without degrading the image quality of fields in the lung but not in the mediastinum, upper abdomen, or retrocardiac region. Most studies on the usefulness of radiographs taken in the ICU [4,5,8,[10][11][12][13][14][15][16][17] have described an elevated frequency of this examination [5,15], identifying an 'excess' of x-rays that do not contribute to the diagnosis of patients [4]. Methods proposed to reduce the radiation received by healthcare personnel, especially radiology technicians [8,[18][19][20][21], include: customisation of the x-ray system, workflow adaptations, and lead shielding devices, including tableside lead drapes, ceiling-mounted lead acrylic protection, backscatter shields, and lead gloves, among other measures.…”