Diagnostic reference level: an important tool for reducing radiation doses in adult and pediatric nuclear medicine procedures in Brazil

被引:18
作者
Willegaignon, Jose [1 ,2 ]
Braga, Luis F. E. F. [1 ]
Sapienza, Marcelo T. [1 ,2 ]
Coura-Filho, George B. [1 ]
Cardona, Marissa A. R. [3 ]
Alves, Carlos E. R. [3 ]
Gutterres, Ricardo F. [3 ]
Buchpiguel, Carlos A. [1 ,2 ]
机构
[1] Univ Sao Paulo, Sch Med, Clin Hosp, Canc Inst Sao Paulo State ICESP, BR-05403010 Sao Paulo, SP, Brazil
[2] Univ Sao Paulo, Sch Med, Dept Radiol, Nucl Med Serv, BR-05403010 Sao Paulo, SP, Brazil
[3] Natl Commiss Nucl Energy, Rio De Janeiro, Brazil
关键词
diagnostic reference level; nuclear medicine; radiation exposure; radioisotopes; radiological risk; standard procedures; AMERICAN CONSENSUS GUIDELINES; DOSAGE CARD; COMPUTED-TOMOGRAPHY; EXPOSURE;
D O I
10.1097/MNM.0000000000000462
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
ObjectivesThis study aimed to establish a concise method for determining a diagnostic reference level (DRL) for adult and pediatric nuclear medicine patients on the basis of diagnostic procedures and administered radioisotope as a means of controlling medical exposure.MethodsA screening was carried out in all Brazilian Nuclear Medicine Service (NMS) establishments to support this study by collecting the average activities administered during adult diagnostic procedures and the rules applied to adjust these according to the patient's age and body mass. Percentile 75 was used in all the activities administered as a means of establishing DRL for adult patients, with additional correction factors for pediatric patients. Radiation doses from nuclear medicine procedures on the basis of average administered activity were calculated for all diagnostic exams.Results and DiscussionA total of 107 NMSs in Brazil agreed to participate in the project. From the 64 nuclear medicine procedures studied, bone, kidney, and parathyroid scans were found to be used in more than 85% of all the NMSs analyzed. There was a large disparity among the activities administered, when applying the same procedures, this reaching, in some cases, more than 20 times between the lowest and the highest. Diagnostic exams based on Ga-67, Tl-201, and I-131 radioisotopes proved to be the major exams administering radiation doses to patients. On introducing the DRL concept into clinical routine, the minimum reduction in radiation doses received by patients was about 15%, the maximum was 95%, and the average was 50% compared with the previously reported administered activities.ConclusionVariability in the available diagnostic procedures as well as in the amount of activities administered within the same procedure was appreciable not only in Brazil, but worldwide. Global efforts are needed to establish a concise DRL that can be applied in adult and pediatric nuclear medicine procedures as the application of DRL in clinical routine has been proven to be an important tool for controlling and reducing radiation doses received by patients in medical exposure. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
引用
收藏
页码:525 / 533
页数:9
相关论文
共 29 条
[1]  
[Anonymous], 2007, ANN ICRP
[2]   DETERMINATION OF DIAGNOSTIC REFERENCE LEVELS IN GENERAL RADIOGRAPHY IN LATIN AMERICA [J].
Blanco, Susana ;
Mora, Patricia ;
Almonte, Narkiss ;
Benavente, Tony ;
Benson, Nadja ;
Blanco, Daniel ;
Cardenas, Juan ;
Defaz Gomez, Yolanda ;
Edding, Oscar ;
Escobar, Carolina ;
Fonseca, Maria ;
Gamarra, Mirtha ;
Garcia Aguilar, Juan ;
Khoury, Helen Jamil ;
Rosa Quintero, Ana ;
Roas Zuniga, Norma ;
Zaire, Edgar ;
Nader, Alejandro .
RADIATION PROTECTION DOSIMETRY, 2013, 156 (03) :303-309
[3]   Current concepts - Computed tomography - An increasing source of radiation exposure [J].
Brenner, David J. ;
Hall, Eric J. .
NEW ENGLAND JOURNAL OF MEDICINE, 2007, 357 (22) :2277-2284
[4]  
Directorate-General Environment Nuclear Safety and Civil Protection European Commission, 1999, RAD PROT 109 GUID DI
[5]  
Edmonds K. D., 2009, Radiographer, V56, P32
[6]  
European Association of Nuclear Medicine and Molecular Imaging - EANMMI, GUIDELINES
[7]  
European Commission, 2014, RAD PROTECTION
[8]   Minimizing and Communicating Radiation Risk in Pediatric Nuclear Medicine [J].
Fahey, Frederic H. ;
Treves, S. Ted ;
Adelstein, S. James .
JOURNAL OF NUCLEAR MEDICINE, 2011, 52 (08) :1240-1251
[9]   Pediatric Radiopharmaceutical Administered Doses: 2010 North American Consensus Guidelines [J].
Gelfand, Michael J. ;
Parisi, Marguerite T. ;
Treves, S. Ted .
JOURNAL OF NUCLEAR MEDICINE, 2011, 52 (02) :318-322
[10]  
Hayward C, 2010, SPACEMED NEWSLETTER, V3