An Approach to Establishing Diagnostic Reference Levels in Interventional Pediatric Cardiology from Different Regions of Brazil.

Diagnostic reference levels (DRLs) are a pivotal strategy to be implemented since pediatric interventional cardiology procedures are increasing. This work aimed to propose an initial set of Brazilian DRLs for pediatric interventional diagnostic and therapeutic (D&T) procedures. A retrospective study was carried out in four Brazilian states, distributed across the three regions of the country. Data were collected from pediatric patients undergoing cardiac interventional procedures (CIPs), including their age and anthropometric characteristics, and at least four parameters (number of images, exposure time, air kerma-area product-PKA, and cumulative air kerma). Data from 279 patients undergoing CIPs were gathered (147 diagnostic and 132 therapeutic procedures). There were no significant differences in exposure time and the number of images between the D&T procedures. A wide range of PKA was observed when the therapeutic procedures were compared to diagnostics for all age groups. There were significant differences between the D&T procedures, whether grouping data by patient weight or age. In terms of cumulative air kerma, it was noted that no value exceeded the level to trigger a monitoring process for patients. This study shows that it is possible to adopt them as the first proposal to establish national DRLs considering pediatric patient groups.

Quality assurance phantoms for cone beam computed tomography: a systematic literature review.

OBJECTIVES: To undertake a systematic review on quality assurance (QA) phantoms for CBCT imaging, including studies on the development and application of phantoms. METHODS: The MEDLINE (PubMed) bibliographic database was searched until May 2016 for studies evaluating the development and use of phantoms in CBCT image QA. The search strategy was restricted to English language publications using the following combined terms: (Cone Beam CT) OR (Cone Beam Computed Tomography) OR (Cone-Beam Computed Tomography) OR (CBCT) AND (quality OR phantom). It was assessed which of the six image quality parameters stated by the European Commission could be evaluated with each phantom and which of them actually were. RESULTS: The search strategy yielded 37 studies, which had developed and used (25 studies) or only used (12 studies) a phantom in CBCT image QA. According to the literature, in 7 phantoms, it is possible to evaluate 4 or more image quality parameters while in 11 phantoms, merely 1 parameter can be evaluated. Only two phantoms permit the evaluation of the six image quality parameters stated by the European Commission. The parameters, which can most often be evaluated using a phantom, are image density values, spatial resolution and geometric accuracy. The SEDENTEXCT phantom was used most frequently. In two studies, all quality parameters suggested by the European Commission were evaluated. CONCLUSIONS: QA phantoms rarely allow all image quality parameters stated by the European Commission to be evaluated. Furthermore, alternative phantoms, which allow all image quality parameters to be evaluated in a single exposure, even for a small field of view, should be developed.

Assessment of protocols in cone-beam CT with symmetric and asymmetric beams usingeffective dose and air kerma-area product.

This study aims to evaluate and compare protocols with similar purposes in a cone beam CT scanner using thermoluminescent dosimeter (TLD) and the air kerma-area product (PKA) as the kerma index. The measurements were performed on two protocols used to obtain an image of the maxilla-mandible using the equipment GENDEX GXCB 500: Protocol [GX1] extended diameter and asymmetric beam (14cm×8.5cm-maxilla/mandible) and protocol [GX2] symmetrical beam (8.5cm×8.5cm-maxillary/mandible). LiF dosimeters inserted into a female anthropomorphic phantom were used. For both protocols, the value of PKA was evaluated using a PTW Diamentor E2 meter and the multimeter Radcal Rapidose system. The results obtained for the effective dose/PKA were separated by protocol image. [GX1]: 44.5µSv/478mGycm(2); [GX2]: 54.8µSv/507mGycm(2). Although the ratio of the diameters (14cm/8.5cm)=1.65, the ratio of effective dose values (44.5µSv/54.8µSv)=0.81, that is, the effective dose of the protocol with extended diameter is 19% smaller. The PKA values reveal very similar results between the two protocols. For the cases where the scanner uses an asymmetric beam to obtain images with large diameters that cover the entire face, there are advantages from the point of view of reducing the exposure of patients when compared to the use of symmetrical beam and/or to FOV images with a smaller diameter.