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Avaliação dos valores de exposição de dose no acidente vascular cerebral
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Abstract(s)
Introdução: Sendo as doenças cerebrovasculares uma das principais causas de morte prematura e de incapacidade na Europa, com mais de 12,2 milhões de Acidentes Vasculares Cerebrais (AVC) registados anualmente, prevê-se que uma em cada quatro pessoas com mais de 25 anos sofrerá um AVC ao longo da vida. Assim, a via verde AVC melhora a eficiência do diagnóstico e tratamento, envolvendo o uso de radiação
ionizante desde o diagnóstico até o tratamento. Objetivo: Estabelecer Níveis de Referência de Diagnóstico (NRD) locais nas modalidades que utilizam radiação ionizante, incluindo radiografia, tomografia computorizada (TC) e fluoroscopia e avaliar a dose efetiva em AVC isquémico e hemorrágico desde o diagnóstico até à alta clínica. Métodos: Foi realizado um estudo retrospetivo com dados de exames de doentes com diagnóstico de AVC na Unidade Local de Saúde (ULS) de Coimbra, recolhidos ao longo de um ano (2022). Foram analisados o número de exames, os parâmetros de exposição e os descritores de dose como Kerma Area Product (KAP - Gy.cm2), AirKerma (k) tempo de fluoroscopia (minutos), número de imagens, Dose-Length Product (DLP) e Computed Tomography Dose Index volume (CTDIvol). Os NRD foram arredondados a partir do terceiro quartil. Foram também analisados os valores das escalas Alberta Stroke Programme Early CT Score (ASPECTS), Oxfordshire Community Stroke Project (OSCSP) e Thrombolysis in Cerebral Infarction (TICI). Resultados: Foram estabelecidos NRD locais para AVC isquémico e hemorrágico. Para AVC isquémico, os valores foram: radiografia torácica com KAP de 363 mGy.cm²; TC diagnóstico com DLP de 1887 mGy.cm e CTDIvol de 34 mGy; TC de controlo com DLP de 1119 mGy.cm e CTDIvol de 69 mGy; e fluoroscopia com KAP de 231 Gy.cm² e AirKerma de 1616 mGy. Resultando numa dose efetiva total de 28 mSv para AVC isquémico. Para AVC hemorrágico, a TC diagnóstico apresentou DLP de 1180 mGy.cm e CTDIvol de 68 mGy, enquanto a TC de controlo deteve um valor de DLP de 1156 mGy.cm e CTDIvol de 69 mGy, com uma dose efetiva de 5 mSv.Conclusão: Determinaram-se os valores de NRD Locais e a respetiva dose efetiva para o AVC isquémico e hemorrágico. Os valores obtidos foram na generalidade superiores às recomendações internacionais. A implementação destes NRD pretende melhorar a prática clínica, promovendo a segurança do doente e a comunicação informada sobre os riscos da radiação ionizante.
Introduction: Cerebrovascular diseases are among the leading causes of premature death and disability in Europe, with over 12,2 million strokes recorded annually. It is estimated that one in four people over 25 will experience a stroke in their lifetime. The stroke pathway improves the efficiency of diagnosis and treatment, involving the use of ionizing radiation from diagnosis to treatment. Objective: To establish local DRLs and evaluate the effective dose for ischemic and hemorrhagic stroke during hospitalization, across modalities using ionizing radiation, including radiography, computed tomography (CT), and fluoroscopy. Methods: A retrospective study was conducted with data collected over one year (2022) in patients diagnosed with ischemic and hemorrhagic stroke in the Local Health Unit of Coimbra. The number of exams, exposure parameters and dose descriptors such as Kerma Area Product (KAP), AirKerma (k), fluoroscopy time, number of images, Dose Length Product (DLP), and Computed Tomography Dose Index volume (CTDIvol) were analyzed. DRLs were rounded from the third quartile, and values from the Alberta Stroke Programme Early CT Score (ASPECTS), Oxfordshire Community Stroke Project (OSCSP), and Thrombolysis in Cerebral Infarction (TICI) scales were also assessed. Results: Local DRLs were established for ischemic and hemorrhagic stroke. For ischemic stroke, the values were: chest X-ray with KAP of 363 mGy·cm²; diagnostic CT with DLP of 1887 mGy.cm and CTDIvol of 34 mGy; control CT with DLP of 1119 mGy.cm and CTDIvol of 69 mGy; and fluoroscopy with KAP of 231 Gy.cm² and AirKerma of 1616 mGy. The number of images was 349 and the fluoroscopy time was 18 minutes, resulting in a total effective dose of 28 mSv. For hemorrhagic stroke, diagnostic CT showed DLP of 1180 mGy.cm and CTDIvol of 68 mGy, while control CT had DLP of 1156 mGy.cm and CTDIvol of 69 mGy, with an effective dose of 5 mSv. Conclusion: Local DRL values and the respective effective dose for ischemic and hemorrhagic stroke were determined. The values obtained were generally higher than international recommendations. The implementation of these DRLs aims to improve clinical practice, promoting patient safety and informed communication about the risks of ionizing radiation.
Introduction: Cerebrovascular diseases are among the leading causes of premature death and disability in Europe, with over 12,2 million strokes recorded annually. It is estimated that one in four people over 25 will experience a stroke in their lifetime. The stroke pathway improves the efficiency of diagnosis and treatment, involving the use of ionizing radiation from diagnosis to treatment. Objective: To establish local DRLs and evaluate the effective dose for ischemic and hemorrhagic stroke during hospitalization, across modalities using ionizing radiation, including radiography, computed tomography (CT), and fluoroscopy. Methods: A retrospective study was conducted with data collected over one year (2022) in patients diagnosed with ischemic and hemorrhagic stroke in the Local Health Unit of Coimbra. The number of exams, exposure parameters and dose descriptors such as Kerma Area Product (KAP), AirKerma (k), fluoroscopy time, number of images, Dose Length Product (DLP), and Computed Tomography Dose Index volume (CTDIvol) were analyzed. DRLs were rounded from the third quartile, and values from the Alberta Stroke Programme Early CT Score (ASPECTS), Oxfordshire Community Stroke Project (OSCSP), and Thrombolysis in Cerebral Infarction (TICI) scales were also assessed. Results: Local DRLs were established for ischemic and hemorrhagic stroke. For ischemic stroke, the values were: chest X-ray with KAP of 363 mGy·cm²; diagnostic CT with DLP of 1887 mGy.cm and CTDIvol of 34 mGy; control CT with DLP of 1119 mGy.cm and CTDIvol of 69 mGy; and fluoroscopy with KAP of 231 Gy.cm² and AirKerma of 1616 mGy. The number of images was 349 and the fluoroscopy time was 18 minutes, resulting in a total effective dose of 28 mSv. For hemorrhagic stroke, diagnostic CT showed DLP of 1180 mGy.cm and CTDIvol of 68 mGy, while control CT had DLP of 1156 mGy.cm and CTDIvol of 69 mGy, with an effective dose of 5 mSv. Conclusion: Local DRL values and the respective effective dose for ischemic and hemorrhagic stroke were determined. The values obtained were generally higher than international recommendations. The implementation of these DRLs aims to improve clinical practice, promoting patient safety and informed communication about the risks of ionizing radiation.
Description
Keywords
Nível de referência de diagnóstico Proteção radiológica Acidente vascular cerebral Tomografia computorizada Angiografia Diagnostic reference levels Radiation protection Stroke Computed tomography Angiography