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1.
Eur Radiol ; 23(3): 623-31, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22940731

RESUMO

OBJECTIVE: To survey procedures and protocols in paediatric computed tomography (CT) in 40 less resourced countries. METHODS: Under a project of the International Atomic Energy Agency, 146 CT facilities in 40 countries of Africa, Asia, Europe and Latin America responded to an electronic survey of CT technology, exposure parameters, CT protocols and doses. RESULTS: Modern MDCT systems are available in 77 % of the facilities surveyed with dedicated paediatric CT protocols available in 94 %. However, protocols for some age groups were unavailable in around 50 % of the facilities surveyed. Indication-based protocols were used in 57 % of facilities. Estimates of radiation dose using CTDI or DLP from standard CT protocols demonstrated wide variation up to a factor of 100. CTDI(vol) values for the head and chest were between two and five times those for an adult at some sites. Sedation and use of shielding were frequently reported; immobilisation was not. Records of exposure factors were kept at 49 % of sites. CONCLUSION: There is significant potential for improvement in CT practice and protocol use for children in less resourced countries. Dose estimates for young children varied widely. This survey provides critical baseline data for ongoing quality improvement efforts by the IAEA.


Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Proteção Radiológica/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , África/epidemiologia , Ásia/epidemiologia , Europa (Continente)/epidemiologia , Pesquisas sobre Atenção à Saúde , Humanos , América Latina/epidemiologia , Doses de Radiação
2.
AJR Am J Roentgenol ; 198(5): 1021-31, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22528891

RESUMO

OBJECTIVE: The purpose of this study was to assess the frequency of pediatric CT in 40 less-resourced countries and to determine the level of appropriateness in CT use. MATERIALS AND METHODS: Data on the increase in the number of CT examinations during 2007 and 2009 and appropriate use of CT examinations were collected, using standard forms, from 146 CT facilities at 126 hospitals. RESULTS: The lowest frequency of pediatric CT examinations in 2009 was in European facilities (4.3%), and frequencies in Asia (12.2%) and Africa (7.8%) were twice as high. Head CT is the most common CT examination in children, amounting to nearly 75% of all pediatric CT examinations. Although regulations in many countries assign radiologists with the main responsibility of deciding whether a radiologic examination should be performed, in fact, radiologists alone were responsible for only 6.3% of situations. Written referral guidelines for imaging were not available in almost one half of the CT facilities. Appropriateness criteria for CT examinations in children did not always follow guidelines set by agencies, in particular, for patients with accidental head trauma, infants with congenital torticollis, children with possible ventriculoperitoneal shunt malfunction, and young children (< 5 years old) with acute sinusitis. In about one third of situations, nonavailability of previous images and records on previously received patient doses have the potential to lead to unnecessary examinations and radiation doses. CONCLUSION: With increasing use of CT in children and a lack of use of appropriateness criteria, there is a strong need to implement guidelines to avoid unnecessary radiation doses to children.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , África , Ásia , Criança , Pré-Escolar , Europa (Continente) , Humanos , Lactente , Recém-Nascido , Agências Internacionais , América Latina , Doses de Radiação , Proteção Radiológica , Inquéritos e Questionários
3.
AJR Am J Roentgenol ; 193(2): 559-69, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19620457

RESUMO

OBJECTIVE: The purpose of our study was to investigate the level of radiation protection of patients and staff during interventional procedures in 20 countries of Africa, Asia, and Europe. SUBJECTS AND METHODS: In a multinational prospective study, information on radiation protection tools, peak skin dose (PSD), and kerma-area product (KAP) was provided by 55 hospitals in 20 mainly developing countries (nine mostly in Eastern Europe, five in Africa, and six in Asia). RESULTS: Nearly 40% of the interventional rooms had an annual workload of more than 2,000 patients. It is remarkable that the workload of pediatric interventional procedures can reach the levels of adult procedures even in developing countries. About 30% of participating countries have shown a 100% increase in workload in 3 years. Lead aprons are used in all participating rooms. Even though KAP was available in almost half of the facilities, none had experience in its use. One hundred of 505 patients monitored for PSD (20%) were above the 2-Gy threshold for deterministic effects. CONCLUSION: Interventional procedures are increasing in developing countries, not only for adults but also for pediatric patients. The situation with respect to staff protection is considered generally acceptable, but this is not the case for patient protection. Many patients exceeded the dose threshold for erythema. A substantial number (62%) of percutaneous transluminal coronary angioplasty procedures performed in developing countries in this study are above the currently known dose reference level and thus could be optimized. Therefore, this study has significance in introducing the concept of patient dose estimation and dose management.


Assuntos
Exposição Ambiental/estatística & dados numéricos , Doses de Radiação , Monitoramento de Radiação/estatística & dados numéricos , Proteção Radiológica/estatística & dados numéricos , Radiografia Intervencionista/estatística & dados numéricos , Adulto , África , Poluentes Radioativos do Ar/análise , Ásia , Calibragem , Criança , Europa (Continente) , Feminino , Humanos , Masculino , Exposição Ocupacional/análise , Exposição Ocupacional/estatística & dados numéricos , Projetos Piloto , Estudos Prospectivos , Monitoramento de Radiação/métodos , Proteção Radiológica/métodos , Espalhamento de Radiação , Carga de Trabalho/estatística & dados numéricos
4.
Eur J Radiol ; 81(10): e982-9, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22835877

RESUMO

Recognizing the lack of information on image quality and patient doses in most countries in Asia, the International Atomic Energy Agency (IAEA) initiated a project to assess the status of imaging technology, practice in conventional radiography, mammography, computed tomography (CT) and interventional procedures, and to implement optimisation actions. A total of 20 countries participated. Obsolete practices of use of fluoroscopy for positioning, photofluorography, chest fluoroscopy and conventional tomography were reported by 4 out of 7 countries that provided this information. Low-kV technique for chest radiography is in use in participating countries for 20-85% of cases, and manual processing is in 5-85% of facilities in 5 countries. Instances of the use of adult CT protocol for children in three participating countries were observed in 10-40% of hospitals surveyed. After implementation of a Quality Control programme, the image quality in conventional radiography improved by zero to 13 percentage points in certain countries and dose reduction was from 10% to 85%. In mammography, poor quality, ranging from 10 to 29% of images in different countries was observed. The project increased attention to dose quantities and dose levels in computed tomography, although doses in most cases were not higher than reference levels. In this study 16-19% of patients in interventional cardiology received doses that have potential for either stochastic risk or tissue reaction. This multi-national study is the first of its kind in the Asia, and it provided insight into the situation and opportunities for improvement.


Assuntos
Carga Corporal (Radioterapia) , Diagnóstico por Imagem/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Lesões por Radiação/epidemiologia , Lesões por Radiação/prevenção & controle , Monitoramento de Radiação/estatística & dados numéricos , Proteção Radiológica/estatística & dados numéricos , Adulto , Ásia/epidemiologia , Criança , Coleta de Dados , Humanos , Vigilância da População
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