RESUMEN
Dose to the thyroid from helical chest CT can vary significantly due to the random tube start point, pitch factor, thyroid position relative to the isocenter, and beam width. We used optically stimulated luminescence dosimeters (OSLDs) and an adult anthropomorphic phantom to investigate the uncertainty of thyroid dose estimate. Maximum gap or overlap in the helical beam was estimated using the above factors. Using the maximum gap/overlap over the thyroid, different possible scenarios were simulated and the degree of missed thyroid tissue by the primary beam was estimated. Results showed a variation of >30% in the average thyroid dose, and >50% if a single dosimeter was used to determine dose to the thyroid. Furthermore, measured doses were compared to those calculated by Monte Carlo simulation software, which automatically matches the anatomy of the localizer radiograph with the stylized computational phantom used for dose calculation. The difference was significant: the dose given by the Monte Carlo software was â¼50% lower than the average dose measured with the phantom in all three chest protocols. In addition, the software does not take the effect of the random tube start angle into account.
Asunto(s)
Glándula Tiroides , Tomografía Computarizada por Rayos X , Método de Montecarlo , Fantasmas de Imagen , Glándula Tiroides/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , IncertidumbreRESUMEN
Las características de nuestro entorno sugieren que enfermedades como la queratosis actínica (QA) aumentarán su prevalencia y, en consecuencia, la demanda asistencial en los próximos años. Deben tenerse en cuenta una extensa lista de características clínicas en el abordaje terapéutico de la QA, hasta hace poco compuesto únicamente por técnicas ablativas y exclusivamente dirigidas a las lesiones, sin considerar el campo de cancerización. El incremento del arsenal terapéutico de los últimos años hace necesaria la homogenización de criterios que faciliten la elección de la mejor opción para cada paciente. La formulación de recomendaciones de consenso entre expertos a partir de la revisión de las evidencias científicas en cuanto a diagnóstico y tratamiento disponibles, permite aportar conocimiento dirigido a la mayor calidad en la atención de los pacientes, facilita una mayor homogeneidad en la toma de decisiones y promueve la sensibilización necesaria de todos los agentes sanitarios involucrados
Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the treatment of actinic keratosis. Until recently, therapeutic approaches focused solely on ablative procedures and the treatment of individual lesions and did not take into account areas of field cancerization. Now that the therapeutic arsenal has grown, standardized criteria are needed to guide the optimal choice of treatment for each patient. The elaboration of evidence-based consensus recommendations for the diagnosis and treatment of actinic keratosis generates knowledge that will help clinicians to deliver the highest level of care possible, standardizing decision-making processes and enhancing awareness among all the health professionals involved in the care pathway
Asunto(s)
Humanos , Queratosis Actínica/diagnóstico , Queratosis Actínica/terapia , Pautas de la Práctica en MedicinaRESUMEN
Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the treatment of actinic keratosis. Until recently, therapeutic approaches focused solely on ablative procedures and the treatment of individual lesions and did not take into account areas of field cancerization. Now that the therapeutic arsenal has grown, standardized criteria are needed to guide the optimal choice of treatment for each patient. The elaboration of evidence-based consensus recommendations for the diagnosis and treatment of actinic keratosis generates knowledge that will help clinicians to deliver the highest level of care possible, standardizing decision-making processes and enhancing awareness among all the health professionals involved in the care pathway.