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Medical imaging is both valuable and essential in the care of patients. Much of this imaging depends on ionizing radiation with attendant responsibilities for judicious use when performing an examination. This responsibility applies in settings of both individual as well as multiple (recurrent) imaging with associated repeated radiation exposures. In addressing the roles and responsibilities of the medical communities in the paradigm of recurrent imaging, both the International Atomic Energy Agency (IAEA) and the American Association of Physicists in Medicine (AAPM) have issued position statements, each affirmed by other organizations. The apparent difference in focus and approach has resulted in a lack of clarity and continued debate. Aiming towards a coherent approach in dealing with radiation exposure in recurrent imaging, the IAEA convened a panel of experts, the purpose of which was to identify common ground and reconcile divergent perspectives. The effort has led to clarifying recommendations for radiation exposure aspects of recurrent imaging, including the relevance of patient agency and the provider-patient covenant in clinical decision-making. CLINICAL RELEVANCE STATEMENT: An increasing awareness, generating some lack of clarity and divergence in perspectives, with patients receiving relatively high radiation doses (e.g., ≥ 100 mSv) from recurrent imaging warrants a multi-stakeholder accord for the benefit of patients, providers, and the imaging community. KEY POINTS: ⢠Recurrent medical imaging can result in an accumulation of exposures which exceeds 100 milli Sieverts. ⢠Professional organizations have different perspectives on roles and responsibilities for recurrent imaging. ⢠An expert panel reconciles differing perspectives for addressing radiation exposure from recurrent medical imaging.
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The benefits of biomedical research involving humans are well recognised, along with the need for conformity to international standards of science and ethics. When human research involves radiation imaging procedures or radiotherapy, an extra level of expert review should be provided from the point of view of radiological protection. The relevant publication of the International Commission for Radiological Protection (ICRP) is now three decades old and is currently undergoing an update. This paper aims to provoke discussions on how the risks of radiation dose and the benefits of research should be assessed, using a case study of diagnostic radiology involving volunteers for whom there is no direct benefit. Further, the paper provides the current understanding of key concepts being considered for review and revision-such as the dose constraint and the novel research methods on the horizon, including radiation biology and epidemiology. The analysis revisits the perspectives described in the ICRP Publication 62, and considers the recent progress in both radiological protection ethics and medical research ethics.
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Proteção Radiológica , Radiologia , Humanos , Proteção Radiológica/métodos , Ética em Pesquisa , Agências InternacionaisRESUMO
In March 2021 the International Atomic Energy Agency (IAEA) organised an online Technical Meeting on Developing Effective Methods for Radiation Protection Education and Training of Health Professionals with attendance of 230 participants representing 66 Member States and 24 international organizations, professional bodies and safety alliances. By means of a pre-meeting survey, presentations by experts, topical panel discussions and post-meeting feedback to the meeting summary, the meeting identified strengths, common weaknesses and possible solutions and actions for improving radiation protection education and training of health professionals. Available guidelines and resources for radiation protection training were also reviewed. The meeting discussion resulted in a strong consensus for the need of: (a) international guidance on education and training in radiation protection and safety for health professionals, (b) an international description of minimum standards of initial and ongoing competence and qualification in radiation protection for relevant professional groups, considering the available recommendations at international and regional levels. The proposed actions include provisions for train-the-trainer credentialing and facility training accreditation, balance betwee the online and face-to-face training, improved on-the job training, as well as improved inclusion in training programmes of aspects related to application of new technologies, ethical aspects, development of communication skills, and use of software tools for improving justification and optimisation. The need for making the ongoing training practical, applicable, and useful to the trainee was highlighted. The international consultation initiated by the IAEA was appreciated as a good approach to understand and promote coordination and collaboration at all levels, for best results in education and training in radiation protection of health professionals. Implementing such a holistic approach to education and training in radiation protection would contribute towards qualification and competence of health professionals needed to ensure application of high standards for quality and safety in medical uses of ionizing radiation.
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Energia Nuclear , Proteção Radiológica , Humanos , Agências InternacionaisRESUMO
Generally, intentional exposure of pregnant women is avoided as far as possible in both medical and occupational situations. This paper aims to summarise available information on sources of radiation exposure of the embryo/foetus primarily in medical settings. Accidental and unintended exposure is also considered. Knowledge on the effects of radiation exposure on the developing embryo/foetus remains incomplete-drawn largely from animal studies and two human cohorts but a summary is provided in relation to the key health endpoints of concern, severe foetal malformations/death, future cancer risk, and future impact on cognitive function. Both the specific education and training and also the literature regarding medical management of pregnant females is in general sparse, and consequently the justification and optimisation approaches may need to be considered on a case by case basis. In collating and reviewing this information, several suggestions for future basic science research, education and training, and radiation protection practice are identified.
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Exposição à Radiação , Proteção Radiológica , Animais , Feminino , Feto , Humanos , Gravidez , Gestantes , Exposição à Radiação/efeitos adversos , RiscoRESUMO
BACKGROUND: Screening tests are generally not recommended in patients with advanced cancer and limited life expectancy. Nonetheless, screening mammography still occurs and may lead to follow-up testing. OBJECTIVE: We assessed the frequency of downstream breast imaging following screening mammography in patients with advanced colorectal or lung cancer. DESIGN: Population-based study. PARTICIPANTS: The study included continuously enrolled female fee-for-service Medicare beneficiaries ≥65 years of age with advanced colorectal (stage IV) or lung (stage IIIB-IV) cancer reported to a Surveillance, Epidemiology, and End Results (SEER) registry between 2000 and 2011. MAIN MEASURES: We assessed the utilization of diagnostic mammography, breast ultrasound, and breast MRI following screening mammography. Logistic regression models were used to explore independent predictors of utilization of downstream tests while controlling for cancer type and patient sociodemographic and regional characteristics. KEY RESULTS: Among 34,127 women with advanced cancer (23% colorectal; 77% lung cancer; mean age at diagnosis 75 years), 9% (n = 3159) underwent a total of 5750 screening mammograms. Of these, 11% (n = 639) resulted in at least one subsequent diagnostic breast imaging examination within 9 months. Diagnostic mammography was most common (9%; n = 532), followed by ultrasound (6%; n = 334) and MRI (0.2%; n = 14). Diagnostic mammography rates were higher in whites than African Americans (OR, 1.6; p <0.05). Higher ultrasound utilization was associated with more favorable economic status (OR, 1.8; p <0.05). CONCLUSIONS: Among women with advanced colorectal and lung cancer, 9% continued screening mammography, and 11% of these screening studies led to at least one additional downstream test, resulting in costs with little likelihood of meaningful benefit.
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Neoplasias da Mama/diagnóstico por imagem , Detecção Precoce de Câncer/tendências , Medicare/tendências , Vigilância da População , Ultrassonografia Mamária/tendências , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/economia , Neoplasias da Mama/epidemiologia , Progressão da Doença , Detecção Precoce de Câncer/economia , Feminino , Health Insurance Portability and Accountability Act/economia , Health Insurance Portability and Accountability Act/tendências , Humanos , Medicare/economia , Programa de SEER/economia , Programa de SEER/tendências , Ultrassonografia Mamária/economia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: Imaging registries afford opportunities to study large, heterogeneous populations. The purpose of this study was to examine the American College of Radiology CT Dose Index Registry (DIR) for dose-related demographics and metrics of common pediatric body CT examinations. MATERIALS AND METHODS: Single-phase CT examinations of the abdomen and pelvis and chest submitted to the DIR over a 5-year period (July 2011-June 2016) were evaluated (head CT frequency was also collected). CT examinations were stratified into five age groups, and examination frequency was determined across age and sex. Standard dose indexes (volume CT dose index, dose-length product, and size-specific dose estimate) were categorized by body part and age. Contributions to the DIR were also categorized by region and practice type. RESULTS: Over the study period 411,655 single-phase pediatric examinations of the abdomen and pelvis, chest, and head, constituting 5.7% of the total (adult and pediatric) examinations, were submitted to the DIR. Head CT was the most common examination across all age groups. The majority of all scan types were performed for patients in the second decade of life. Dose increased for all scan types as age increased; the dose for abdominopelvic CT was the highest in each age group. Even though the DIR was queried for single-phase examinations only, as many as 32.4% of studies contained multiple irradiation events. When these additional scans were included, the volume CT dose index for each scan type increased. Among the studies in the DIR, 99.8% came from institutions within the United States. Community practices and those that specialize in pediatrics were nearly equally represented. CONCLUSION: The DIR provides valuable information about practice patterns and dose trends for pediatric CT and may assist in establishing diagnostic reference levels in the pediatric population.
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Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Doses de Radiação , Tomografia Computadorizada por Raios X/métodos , Imagem Corporal Total , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Radiografia Abdominal , Radiografia Torácica , Sistema de Registros , Estados UnidosRESUMO
BACKGROUND: Many patients at our pediatric hospital have had a contrast-enhanced CT of the abdomen and pelvis performed by an outside imaging facility before admission. We have noticed that many of these exams are multiphase, which may contribute to unnecessary radiation dose. OBJECTIVE: To determine the frequency of multiphase acquisitions and radiation dose indices in contrast-enhanced CTs of the abdomen and pelvis performed by outside imaging facilities in patients who were subsequently transferred to our pediatric hospital for care, and compare these metrics to contrast-enhanced CTs of the abdomen and pelvis performed internally. MATERIALS AND METHODS: A retrospective analysis was performed of contrast-enhanced CTs of the abdomen and pelvis from outside imaging facilities uploaded to our picture archiving and communication system (PACS) between January 1, 2012, and December 31, 2015. CT images and dose pages were reviewed to determine the number of phases and dose indices (CT dose index-volume [CTDIvol], dose-length product, size-specific dose estimate). Exams for abdominal or pelvic mass, trauma or urinary leak indications were excluded. Data were compared to internally acquired contrast-enhanced CTs of the abdomen and pelvis by querying the American College of Radiology (ACR) Dose Index Registry. This review was institutional review board and HIPAA compliant. RESULTS: There were 754 contrast-enhanced CTs of the abdomen and pelvis from 104 outside imaging facilities. Fifty-three percent (399/754) had 2 phases, and 2% (14/754) had 3 or more phases. Of the 939 contrast-enhanced CTs of the abdomen and pelvis performed internally, 12% (115) were multiphase exams. Of 88% (664) contrast-enhanced CTs of the abdomen and pelvis from outside imaging facilities with dose data, CTDIvol was 2.7 times higher than our institution contrast-enhanced CTs of the abdomen and pelvis (939) for all age categories as defined by the ACR Dose Index Registry (mean: 9.4 vs. 3.5 mGy, P<0.0001). The majority (74%) of multiphase exams were performed by 9 of 104 outside imaging facilities. CONCLUSION: Multiphase acquisitions in routine contrast-enhanced CT of the abdomen and pelvis exams at outside imaging facilities are more frequent than those at a dedicated pediatric institution and contribute to unnecessary radiation dose. A contrast-enhanced CT of the abdomen and pelvis exam from an outside imaging facility with two passes may have as much as four times to six times the dose as the same exam performed with a single pass at a pediatric imaging center. We advocate for imaging facilities with high multiphase rates to eliminate multiple phases from routine contrast-enhanced CT of the abdomen and pelvis exams in children.
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Padrões de Prática Médica/estatística & dados numéricos , Doses de Radiação , Radiografia Abdominal/métodos , Tomografia Computadorizada por Raios X/métodos , Procedimentos Desnecessários , Adolescente , Criança , Pré-Escolar , Meios de Contraste , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Melhoria de Qualidade , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: The purpose of this study was to evaluate the impact of trainee involvement and other factors on addendum rates in radiology reports. MATERIALS AND METHODS: This retrospective study was performed in a tertiary care pediatric hospital. From the institutional radiology data repository, we extracted all radiology reports from January 1 to June 30, 2016, as well as trainee (resident or fellow) involvement, imaging modality, patient setting (emergency, inpatient, or outpatient), order status (routine vs immediate), time of interpretation (regular work hours vs off-hours), radiologist's years of experience, and sex. We grouped imaging modalities as advanced (CT, MRI, and PET) or nonadvanced (any modality that was not CT, MRI, or PET) and radiologist experience level as ≤ 20 years or > 20 years. Our outcome measure was the rate of addenda in radiology reports. Statistical analysis was performed using multivariate logistic regression. RESULTS: From 129,033 reports finalized during the study period, 418 (0.3%) had addenda. Reports generated without trainees were 12 times more likely than reports with trainee involvement to have addenda (odds ratio [OR] = 12.2, p < 0.001). Advanced imaging studies were more likely than nonadvanced studies to be associated with addendum use (OR = 4.7, p < 0.001). Reports generated for patients in emergency or outpatient settings had a slightly higher likelihood of addendum use than those in an inpatient setting (OR = 1.5, p = 0.04; and OR = 1.3, p = 0.04, respectively). Routine orders had a slightly higher likelihood of addendum use compared with immediate orders (OR = 1.3, p = 0.01). We found no difference in addendum use by radiologist's sex, radiologist's years of experience, emergency versus outpatient setting, or time of interpretation. CONCLUSION: Trainees may add value to patient care by decreasing addendum rates in radiology reports.
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Comunicação , Erros de Diagnóstico/prevenção & controle , Prontuários Médicos , Radiologia/educação , Competência Clínica , Humanos , Estudos RetrospectivosRESUMO
AIM: To investigate determinants of receiving cancer-directed therapies and their potential survival impact in nonresected hepatocellular carcinoma (HCC) Materials & methods: Nonsurgically resected HCC patients between 2000 and 2010 were stratified by American Joint Committee on Cancer staging and the type of therapy. Predictors of receiving therapy were identified and implication on survival was evaluated. RESULTS: Out of 9239 patients included, those receiving any therapy demonstrated prolonged overall survival with following median overall survival (months): ablation (30.8), Yttrium-90 (15.6), transcatheter arterial chemoembolization (15.5), Sorafenib (5.6), versus no cancer-directed therapy (3.7; p-values <0.001). Overall, 36% of patients received cancer-directed therapy including 47% with stage I/II. Favorable sociodemographic factors predicted receipt of percutaneous locoregional therapies (p-values <0.05). DISCUSSION & CONCLUSION: There appears to be significant disparity in care of nonresected HCC patients with significant underutilization of cancer-directed therapies.
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Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/terapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/patologia , Terapia Combinada , Comorbidade , Feminino , Humanos , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/patologia , Masculino , Medicare , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Vigilância da População , Programa de SEER , Fatores Socioeconômicos , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
AIM: To investigate outcomes in unresectable hepatocellular carcinoma (HCC) patients stratified by sociodemographic and clinical factors in a population study. MATERIALS & METHODS: Surveillance, Epidemiology and End Results (SEER) database was used to identify patients diagnosed in 2000-2011. Overall survival (OS) was stratified using patient sociodemographic characteristics and American Joint Commission on Cancer (AJCC) staging. Log-rank test and Cox proportional hazard models were used to identify prognostic factors of OS. RESULTS: In patients with AJCC stage I and II unresectable HCC, prolonged OS was correlated with being married, younger age, ethnicity, geographic location, living in large urban areas, being insured and higher income and education levels. CONCLUSION: In AJCC stage I and II unresectable HCC patients with favorable sociodemographic factors, prolonged OS maybe in part related to better access to cancer-directed therapy.
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Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Carcinoma Hepatocelular/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/epidemiologia , Masculino , Estadiamento de Neoplasias , Avaliação de Resultados da Assistência ao Paciente , Vigilância da População , Fatores de Risco , Programa de SEER , Estados Unidos/epidemiologiaRESUMO
Integrating digital facial photographs of pediatric patients as identifiers (ID) with medical imaging (integrated photographic IDs) may increase the detection of mislabeled studies. The purpose of this study was to determine how different stakeholders would receive this novel technology. Parents or guardians of patients in a children's hospital outpatient radiology department, radiology faculty and residents, and radiology technologists and nurses were asked to complete a survey. The perception about the anticipated use of integrated photographic ID in different clinical scenarios was investigated, and its predictors were determined using logistic regression analysis. Four hundred ninety-eight parents responded (response rate 83 %); 96 and 97 % supported the use of integrated photographic ID, if it improves the radiologist's imaging interpretation or decreases the rate of mislabeled errors, respectively. Thirty-eight percent were worried that photographic IDs would impact patients' privacy. Ninety-four percent believed that they should be asked for their consent prior to obtaining their child's photograph. Seventy-eight radiologists responded (response rate 39 %); 63 and 59 % believed that the use of integrated photographic ID would result in improvement in accurate interpretation of images and identification of mislabeled patient errors, respectively. Forty-nine percent of radiologists had concern that integrated photographic ID would increase interpretation time. Fifty technologists and nurses responded (response rate 59 %); 71 and 73 % supported the technology if it resulted in more acute interpretation of images and identification of mislabeled patients, respectively. A majority of stakeholders support integrated photographic ID in order to improve safety. A majority of parents believe that consent should be obtained.
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Atitude , Diagnóstico por Imagem , Fotografação , Criança , Confidencialidade , Docentes de Medicina , Pesquisas sobre Atenção à Saúde , Humanos , Internato e Residência , Erros Médicos/prevenção & controle , Consentimento dos Pais , Pais , Radiografia , Radiologia , Serviço Hospitalar de RadiologiaRESUMO
PURPOSE: The study sought to assess the gastrointestinal (GI) distribution of oral contrast (OC) among emergency department (ED) patients and determine if contrast reaches the terminal ileum or site of pathology to assist in diagnosis. METHODS: Retrospectively, adults undergoing abdominal-pelvic computed tomography (APCT) in the ED at 2 hospitals were identified over a 3-month period. APCTs were reviewed for location of OC. Presence, site, type of bowel pathology, and prior gastrointestinal surgery were documented. When applicable, the site of bowel pathology was evaluated for the presence or absence of OC. RESULTS: There were 1349 exams with mean age 50.5 years (range 18-97 years), 41% male, with 530 (39%) receiving OC. In 271 of 530 (51%), OC reached the terminal ileum (TI). Bowel pathology was present in 31% of cases (165 of 530). When bowel pathology was present, 47% (77 of 165) had OC present at the pathology site. The GI tract was divided into 4 anatomic segments: OC most frequently reached pathology in stomach and duodenum (84%), but was present less frequently at sites of pathology from jejunum to TI (35%), proximal colon (57%), and distal colon (28%). In only 84 of 530 OC cases (16%) did contrast extend from the stomach to distal colon. OC administration contributed to longer mean APCT order to final report of 0.5 hours and longer mean ED length of stay of 0.8 hours compared with all patients who received APCT. CONCLUSIONS: Optimal OC distribution is not achieved in more than half of ED patients, raising questions about the continued use of OC in the ED.
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Meios de Contraste/análise , Trato Gastrointestinal/diagnóstico por imagem , Enteropatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Abdome/diagnóstico por imagem , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colo/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Serviço Hospitalar de Emergência , Feminino , Trato Gastrointestinal/cirurgia , Humanos , Íleo/diagnóstico por imagem , Jejuno/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVE: The purpose of this study was to estimate the prevalence of reported near-miss wrong-patient events in radiology at two large academic hospitals and its relation to imaging modality, clinical setting, and time of occurrence. MATERIALS AND METHODS: An institutional imaging report database was searched for reports between January 1, 2009, and May 30, 2013, that contained the phrases "incorrect patient" or "wrong patient." These imaging reports were categorized into either mislabeled or misidentified patient or wrong dictation or report events. The mislabeling-misidentification events involved patients whose images were incorrectly placed in another patient's folder. In wrong dictation or report events, a patient's images were placed in the correct imaging folder, but another patient's images were used in error for dictation of the report. The time to detect each of these events was also evaluated. RESULTS: Overall, 67 eligible reports were identified among 1,717,713 examinations performed during the study period. The estimated event rate was 4 per 100,000 examinations (mislabeling-misidentification, 52%; wrong dictation, 48%). The monthly mean of mislabeling-misidentification events was 0.7 (SD, 0.9) and of wrong dictation events was 0.6 (SD, 0.7). The median time for mislabeling-misidentification reports to be identified was 22 hours and for wrong dictation reports was 0 hours. Portable chest radiography was the modality involved in 69% (24/35) of reported mislabeling-misidentification and 44% (14/32) of wrong dictation events (p = 0.08); 43% (15/35) of mislabeling-misidentification and 28% (9/32) of wrong dictation events occurred during off hours; 63% (22/35) of mislabeling-misidentification and 56% (18/32) of wrong dictation events occurred in the inpatient setting. CONCLUSION: Despite use of the dual-identifier technique mandated by The Joint Commission, the number of near-miss mislabeled patient events for imaging tests and the delay in awareness of these events were substantial, especially for radiography.
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Erros de Diagnóstico/estatística & dados numéricos , Sistemas de Identificação de Pacientes , Sistemas de Informação em Radiologia , Erros de Diagnóstico/prevenção & controle , Humanos , Estados UnidosRESUMO
OBJECTIVE: The purpose of this study was to assess the effectiveness and safety of air versus liquid enema reduction in the treatment of intussusception in children. MATERIALS AND METHODS: Literature searches of the PubMed, Embase, and Cochrane Library databases were conducted from January 1, 1966, through May 31, 2013. Articles on the use of air or liquid enema in children with a confirmed diagnosis of intussusception and reporting either a success rate for enema reduction of intussusception or a perforation rate were selected. Enema reduction success rate, perforation rate, and recurrence rate were the main outcomes and were calculated by random effects modeling. RESULTS: One hundred two articles (101 reporting success rate, 71 reporting perforation rate) were included that presented results for 32,451 children (age range, 1 day-22 years; boys, 66%; girls, 34%). In 44 studies (16,187 children), the combined estimate for success rate of air enema was 82.7% (95% CI, 79.9-85.6%; inconsistency index [I(2)] = 97%), and in 52 studies (13,081 children) of liquid enema, it was 69.6% (95% CI, 65.0-74.1%; I(2) = 98%). In 38 studies (15,752 children), the combined estimate of perforation rate for air enema was 0.39% (95% CI, 0.23- 0.55%; I(2) = 40%), and in 30 studies (9429 children) of liquid enema, it was 0.43% (95% CI, 0.24- 0.62%; I(2) = 9%). Among 10,494 children (26 studies) undergoing air enema reduction, the rate of first intussusception recurrence was 6% (95% CI, 4.5-7.5%; I(2) = 89%), similar to the 7.3% (95% CI, 5.8-8.8%; I(2) = 71%) found for 4004 children (24 studies) undergoing liquid enema reduction. CONCLUSION: Air enema was superior to liquid enema for intussusception reduction. The success rate was higher without a difference in perforation rate. Limitations included heterogeneity and publication bias.
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Ar , Enema , Intussuscepção/terapia , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-NascidoRESUMO
OBJECTIVE. The purpose of this article is to examine the variation in radiation dose, CT dose index volume (CTDIvol), and dose-length product (DLP) for pediatric head CT examinations as a function of hospital characteristics across the United States. MATERIALS AND METHODS. A survey inquiring about hospital information, CT scanners, pediatric head examination protocol, CTDIvol, and DLP was mailed to a representative sample of U.S. hospitals. Follow-up mailings were sent to nonrespondents. Descriptive characteristics of respondents and nonrespondents were compared using design-based Pearson chi-square tests. Dose estimates were compared across hospital characteristics using Bonferroni-adjusted Wald test. Hospital-level factors associated with dose estimates were evaluated using multiple linear regressions and modified Poisson regression models. RESULTS. Surveys were sent out to 751 hospitals; 292 responded to the survey, of which 253 were eligible (35.5% response rate, calculated as number of hospitals who completed surveys [n = 253] divided by sum of number who were eligible and initially consented [n = 712] plus estimated number who were eligible among those who refused [n = 1]). Most respondents reported using MDCT scanners (99.2%) and having a dedicated pediatric head CT protocol (93%). Estimated mean reported CTDIvol values were 27.3 mGy (95% CI, 24.4-30.1 mGy), and DLP values were 390.9 mGy × cm (95% CI, 346.6-435.1 mGy × cm). These values did not vary significantly by region, trauma level, teaching status, CT accreditation, number of CT scanners, or report of a dedicated pediatric CT protocol. However, estimated CTDIvol reported by children's hospitals was 19% lower than that reported by general hospitals (p < 0.01). CONCLUSION. Most hospitals (82%) report doses that meet American College of Radiology accreditation levels. However, [corrected] the mean CTDI(vol) at children's hospitals was approximately 7 mGy (21%, adjusted for covariates), lower than that at nonchildren's hospitals.
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Cabeça/diagnóstico por imagem , Padrões de Prática Médica , Doses de Radiação , Tomografia Computadorizada por Raios X/normas , Criança , Pesquisas sobre Atenção à Saúde , Hospitais , Humanos , Estados UnidosRESUMO
Our objective is to design, implement, and phantom-test a device to automatically obtain point-of-care patient photographs along with portable radiographs. Such photographs could help with detection of wrong-patient errors. Our device consists of a camera controller (CC) and a camera that can be mounted on a portable conventional radiography (CR) machine. Radiation from the CR machine triggers an identification module (IM) embedded in the CR cassette. The IM then sends the cassette identifier--Plate_ID--to the CC along with a trigger to activate the camera. This trigger ensures simultaneous acquisition of radiograph and photograph, and the Plate_ID along with a time stamp ensures binding of the two images. We conducted phantom tests to determine if clinical portable radiography exposure settings (90 to 120 kVp and exposure time ranging from 0.63 to 8.0 ms) are sufficient to trigger the IM. Phantom experiments demonstrate acceptable sensor performance for clinical portable radiography exposures. Simultaneous acquisition of photographs is achieved by integrating a low-cost identification module containing a scintillator-detector into the radiographic cassette. Incident X-rays activate the scintillator-detector triggering photograph acquisition by a camera controller.
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Face/diagnóstico por imagem , Erros Médicos/prevenção & controle , Sistemas de Identificação de Pacientes , Fotografação , Sistemas Automatizados de Assistência Junto ao Leito , Sistemas de Informação em Radiologia , Humanos , Imagens de Fantasmas , RadiografiaRESUMO
OBJECTIVE: The purpose of this study was to determine MDCT dose variability due to technologist variability in performing CT studies. MATERIALS AND METHODS: Fifty consecutive adult patients who underwent two portal venous phase CT examinations of the abdomen and pelvis on the same 64-MDCT scanner between January and December 2011 were retrospectively identified. Tube voltage (kVp), tube current (mA), use of automated tube current modulation (ATCM), dose-length product (DLP), volume CT dose index (CTDIvol), table height, whether the localizer image was obtained using the posteroanterior or the anteroposterior technique, arm position, and number of overscanned slices were recorded. RESULTS: For a given patient, the total examination DLP difference comparing the two MDCT studies ranged from 0.1% to 238.0%. For the same patient, total examination DLP was always higher when the localizer image was obtained with the posteroanterior compared with the anteroposterior technique. When table position was closer to the x-ray source, patients appeared magnified in the posteroanterior localizer image (8-29%; average, 14%) and higher tube currents were selected with ATCM. Localizer technique, table height, arm position, number of overscanned slices, and technologist were all significant predictors of dose. CONCLUSION: Patient off-centering closer to the x-ray source resulted in patient magnification in the posteroanterior localizer image, leading to higher tube currents with ATCM and increased DLP. Differences in technologist, arm position, and overscanning also resulted in dose variability.
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Competência Clínica , Tomografia Computadorizada Multidetectores , Doses de Radiação , Radiografia Abdominal , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do PacienteRESUMO
This investigation evaluates the impact of the no oral contrast abdominopelvic CT examination (NOCAPE) on radiology turn around time (TAT), emergency department (ED) length of stay (LOS), and patient safety metrics. During a 12-month period at two urban teaching hospitals, 6,409 ED abdominopelvic (AP) CTs were performed to evaluate acute abdominal pain. NOCAPE represented 70.9 % of all ED AP CT examinations with intravenous contrast. Data collection included patient demographics, use of intravenous (IV) and/or oral contrast, order to complete and order to final interpretation TAT, ED LOS, admission, recall and bounce back rates, and comparison and characterization of impressions. The NOCAPE pathway reduced median order to complete TAT by 32 min (22.9 %) compared to IV and oral contrast AP CT examinations (traditional pathway) (P < 0.001). Median order to final TAT was 2.9 h in NOCAPE patients and 3.5 h in the traditional pathway, a 36-min (17.1 %) reduction (P < 0.001). Overall, the NOCAPE pathway reduced ED LOS by a median of 43 min (8.8 %) compared to the traditional pathway (8.2 vs 7.5 h) (P = 0.003). Recall and bounce back rates were 3.2 %, and only one patient had change in impression after oral contrast CT was repeated. The NOCAPE pathway is associated with decreased radiology TAT and ED LOS metrics. The authors suggest that NOCAPE implementation in the ED setting is safe and positively impacts both radiology and emergency medicine workflow.
Assuntos
Meios de Contraste/administração & dosagem , Serviço Hospitalar de Emergência/estatística & dados numéricos , Segurança do Paciente , Pelve/diagnóstico por imagem , Radiografia Abdominal/métodos , Tomografia Computadorizada por Raios X/métodos , Dor Abdominal/diagnóstico por imagem , Administração Oral , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Fluxo de TrabalhoRESUMO
Objective.International Commission on Radiological Protection (ICRP) Task Group 113 is developing reference values of organ and effective dose coefficients (DCs) for radiography, fluoroscopy, and computed tomography imaging exams. In support of these efforts, our focus is on pediatric diagnostic fluoroscopy. Contrast agents used during clinical examinations are an important consideration of the work undertaken by the Task Group. This work demonstrates the importance of including organ contrast volume concentrations for the calculation of reference organ DCs in the voiding cystourethrogram (VCUG).Approach.The ICRP newborn and 15 year female reference phantoms were utilized within the Particle and Heavy Ion Transport code system for the calculation of organ DCs. A pediatric radiologist with over 30 years of clinical experience defined the imaging fields for a VCUG examination consistent with clinical practice. Of these, four imaging fields were selected for investigation. The transport simulations modeled an iodinated contrast solution similar to Bracco Group's 18% weight per volume, cystografin diatrizoate meglumine and typical bladder content was supplemented to make up the remainder volume. Iodinated contrast volumes of 0%, 25%, 50%, 75%, and 100% concentration by volume were modeled and associated DCs for in-field organs were computed.Main results.Organ DCs were calculated for the urinary bladder wall, colon wall, ovaries, and uterus for both female phantoms under irradiation geometries representative of a VCUG examination. Some organ DCs increased with iodine volume in the bladder and other organ DCs decreased as the iodine contrast volume completely filled the bladder (100%).Significance.The study results demonstrate for the newborn phantom percent differences in organ DCs varied between 0%-10% for the organs of interest, while they varied between 0%-22% in the 15 year phantom suggesting the importance of including contrast media in Monte Carlo radiation transport simulations of the VCUG examination.