Nova metodologia de estimativa de exposição ocupacional em radiologia intervencionista
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Data
2022-03-29
Autores
Oliveira, Abner Alves [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A Radiologia Intervencionista é uma área da medicina que utiliza radiação ionizante como guia de intervenções. Os valores de dose aos quais os intervencionistas são expostos são difíceis de padronizar. Nesta pesquisa é apresentado uma avaliação das exposições ocupacionais nos seguintes procedimentos vasculares: angiografia coronariana, angioplastia coronariana, angiografia cerebral, angiografia de extremidades e angioplastia de extremidades. Essa pesquisa foi abordada em 2 etapas. A primeira etapa caracterizou-se a exposição ocupacional, através de dosimetria de Luminescência Opticamente Estimulada (OSL) em diferentes partes do corpo: cristalino, tireoide, tórax, abdômen, pés e mãos. Foi realizado em três modalidades diferentes de procedimentos de radiologia intervencionista: coronariano, cerebral e periféricas. Na segunda etapa foi determinado a dose efetiva através da dosimetria, utilizando a conversão de 6 regiões com dose superficial em aventais plumbíferos para 26 regiões internas. Através de parâmetros de rotina, foi estimado a dose efetiva através do Produto Kerma Área (PKA) obtido através de equipamentos fluoroscópicos, onde a estimativa é realizada através de fator obtido para cada modalidade. As doses efetivas, calculada através da dosimetria e estimada por PKA, foram comparadas através do método de Bland Altman avaliando a concordância entre os dois métodos. A utilização de fatores experimentais para estimar a dose efetiva é proposta para auxiliar o programa de radioproteção. As maiores doses equivalentes encontradas foram abdômen e mãos para as modalidades coronarianas e periféricas, cristalino e mãos para modalidades cerebrais. A dose no tórax como representativo para o corpo todo pode subestimar outras doses como abdômen, extremidades e cristalinos. As modalidades coronarianas e cerebral apresentaram viés entre -1 e 0 µSv, onde a estimativa através do PKA infere valores de dose efetiva próximos ao calculado por dosímetros. As modalidades periféricas apresentaram um viés entre -11 e -7 µSv subestimando a dose efetiva, onde a proximidade do intervencionista implica em maiores níveis de exposições de radiação espalhada em contraste com menores valores de PKA, devido as regiões de extremidades.
Interventional Radiology is an area of medicine that uses ionizing radiation as a guide to interventions. The dose values the interventionists are exposed to are difficult to standardize. This presents an assessment of the occupational: coronary angiography, coronary angioplasty, cerebral angiography, borderline angiography and borderline angioplasty. This was addressed in 2 steps. The first stage was characterized by occupational exposure, through Optically Stimulated Luminescence (OSL) dosimetry in different parts of the body: thyroid, lens, abdomen, feet and hands. It was performed in three different modalities of interventional radiology procedures: coronary, cerebral and peripheral. In the second step, an effective dose was determined through dosimetry, using the conversion of 6 regions with surface dose in lead aprons to 26 internal regions. Through routine parameters, the effectiveness was estimated through the Product through Kerma Area (KPA) performed through fluoroscopic equipment, where a factor calculation is performed for each modality. As the effective doses, through the combination of the two methods and calculated by KPAi, were projected through alternative methods of agreement between the two methods. The use of experimental factors to estimate the effective dose is proposed to help the radioprotection program. The highest equivalent doses were total abdominal and hands for coronary and peripheral modalities, crystalline and for modern modalities. The dose cannot as representative for the whole body underestimate other doses such as abdomen, limits and lens. The coronary and cerebral modalities showed a bias between -1 and 0 µSv, where the estimate through KPA infers effective dose values close to those calculated by dosimeters. Peripheral modalities showed a bias between -11 and -7 µSv, underestimating the effective dose, where the proximity of the interventionist implies higher levels of scattered radiation exposure in contrast to lower KPA values, due to the extremity regions
Interventional Radiology is an area of medicine that uses ionizing radiation as a guide to interventions. The dose values the interventionists are exposed to are difficult to standardize. This presents an assessment of the occupational: coronary angiography, coronary angioplasty, cerebral angiography, borderline angiography and borderline angioplasty. This was addressed in 2 steps. The first stage was characterized by occupational exposure, through Optically Stimulated Luminescence (OSL) dosimetry in different parts of the body: thyroid, lens, abdomen, feet and hands. It was performed in three different modalities of interventional radiology procedures: coronary, cerebral and peripheral. In the second step, an effective dose was determined through dosimetry, using the conversion of 6 regions with surface dose in lead aprons to 26 internal regions. Through routine parameters, the effectiveness was estimated through the Product through Kerma Area (KPA) performed through fluoroscopic equipment, where a factor calculation is performed for each modality. As the effective doses, through the combination of the two methods and calculated by KPAi, were projected through alternative methods of agreement between the two methods. The use of experimental factors to estimate the effective dose is proposed to help the radioprotection program. The highest equivalent doses were total abdominal and hands for coronary and peripheral modalities, crystalline and for modern modalities. The dose cannot as representative for the whole body underestimate other doses such as abdomen, limits and lens. The coronary and cerebral modalities showed a bias between -1 and 0 µSv, where the estimate through KPA infers effective dose values close to those calculated by dosimeters. Peripheral modalities showed a bias between -11 and -7 µSv, underestimating the effective dose, where the proximity of the interventionist implies higher levels of scattered radiation exposure in contrast to lower KPA values, due to the extremity regions
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Palavras-chave
Radiologia Intervencionista, Dosimetria, Produto Kerma Área, Dosímetro Opticamente Estimulado