Análise de segurança do protocolo de tomografia computadorizada da Unidade de AVC da Faculdade de Medicina de Botucatu – SP
Data
2021-02-01
Autores
Canton, Gregório Platero
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Este trabalho teve como principal objetivo analisar a segurança do protocolo de tomografia da UAVC-HCFMB. O acidente vascular cerebral (AVC) é a segunda maior causa de morte nos dias atuais e a terceira causa de incapacidade em todo o mundo, apresentando elevados índices de reincidência. O paciente que sofre AVC necessita de um atendimento multidisciplinar e rápido em que são feitos exames de imagem. Entre esses exames, o mais comum/recorrente é a tomografia computadorizada (TC), que é realizada repetidamente como uma forma de controle. Os exames de imagem para diagnosticar casos de AVC fazem uso de raios-X, que são um tipo de radiação ionizante. Os raios-X são conhecidos por causarem danos à saúde quando seu uso é excessivo. Por esse motivo, faz-se necessária uma análise de proteção radiológica, no que tange ao uso de raios-X em exames de imagem para o diagnóstico de AVC. Método: No período de março a agosto de 2019, foram analisados dados clínicos de 109 pacientes internados na Unidade de AVC do Hospital das Clínicas de Botucatu (UAVC-HCFMB), interior de São Paulo. Todos esses pacientes foram diagnosticados com AVC do tipo isquêmico (AVCi). Destes pacientes foram coletados os dados clínicos após isso foi feito um acompanhamento de todos os exames de imagem,coletando os dados de CTDI foram retirados diretamento do tomografo. Após esses procedimentos, os dados foram corrigidos para o padrão SSDE, e as doses efetivas de radiação recebida pelos pacientes durante sua internação foram calculadas. Resultados: Dos 109 pacientes, em sua maioria homens idosos, 18,3% eram reincidentes em algum tipo de AVC ou AIT, sendo que sua grande maioria sofria de hipertensão arterial (77%). Notou-se que o protocolo de aquisição de imagem foi seguido mesmo nos casos mais graves de AVCi, não gerando, portanto, diferença estatística para pacientes. Quando comparados pelo NIHSS de entrada ou de alta, os resultados foram favoráveis ao protocolo. Quando comparados pelas escalas de Bamford e TOAST, pacientes que fizeram TCMD, isoladamente ou associada a TC ou angiotomografia computadorizada, receberam doses efetivas significativamente mais altas em comparação com aqueles que não passaram por esse exame (p < 0,001). Discussão: Com relação às doses efetivas identificadas, verificou se que todas estão dentro dos padrões de segurança previstos pelos órgãos reguladores no país. Com a análise das condutas do protocolo adotado, o protocolo mostrou-se totalmente eficaz, independentemente da gravidade do AVCi, quando comparado a exposição às etiologias também não houve diferença na dose efetiva desses pacientes; porém, necessita-se de mais estudos sobre o assunto para melhor compreendê-lo.Conclusão: Verificou-se que o protocolo de TC da UAVC-HCFMB é seguro em sua totalidade, tendo em vista a legislação vigente no país e normatizada pela Vigilância Sanitário e pela Comissão Nacional de Energia Nuclear. Verificou-se, também, que não há diferença estatisticamente relevante na dose efetiva recebida pelos pacientes.
Introduction: The stroke is the second major cause of death today and the third major cause of incapacity all over the world, with high levels of incidence. This patient needs a quick and multidisciplinary treatment from wich there are done exams, including imaging exams, computarised tomography (CT) on the majority of these cases, wich are repeated as control. However these exams use X-rays, a type of ionizing radiation wich are known the damage caused by it's excessive use. For this reason a protection radiologic analysis is necessary. Method: 109 patiens were analyzed from the period of March to August 2019, all diagnosticated by having an isquemic stroke that were hospitalized at the Stroke Unit of the Hospital of Clinical from Botucatu (USHCFMB), São Paulo's county. From these patients were collected clinical data, and followed for their image exams and the CTDI data collected. Afterwards this data was corrected for the standard SSDE therefore calculated the effective dosage of radiation suffered by this patient during his hospitalization. Results: From the 109 patients, the majority of them men, elderly, 18,3% had a previous stroke(s) or AIT, the majority had arterial hypertension. The protocol was followed even in the worse cases, thus not generating statitical difference to patients when compared by the hospital entry NIHSS or hospital release. The results where favorable to the protocol when compared with the Bamford and TOAST scales, only MSCT or associated with CT or angiography, received higher doses than those who did not perform this, with statistical significance p <0.001. Discussion: This paper had as principal objective analise the safety of the Tomography protocol UAVC-HCFMB, aswell if the efective doses found were between the security patterns envisaged by the regulation entities in the country, analyzing if the practicies of the adopted protocol was totally efective, regardless of the patience severity. When compareded to the etiologies there wasn't difference on the effective dosage on those patients. However ther is the need of further studies about the subject to better understanding. Conclusion: We have concluded that the Computerized Tomography of the Unidade de AVC do Hospital das Clínicas de Bocatu-SP, is safe in altogether regarding the vigent leslislation on thecountry and standarded by Sanitary Vigilence and CNEN, not having difference on the efective dosage received by the patients according to the treatments and severity of the stroke.
Introduction: The stroke is the second major cause of death today and the third major cause of incapacity all over the world, with high levels of incidence. This patient needs a quick and multidisciplinary treatment from wich there are done exams, including imaging exams, computarised tomography (CT) on the majority of these cases, wich are repeated as control. However these exams use X-rays, a type of ionizing radiation wich are known the damage caused by it's excessive use. For this reason a protection radiologic analysis is necessary. Method: 109 patiens were analyzed from the period of March to August 2019, all diagnosticated by having an isquemic stroke that were hospitalized at the Stroke Unit of the Hospital of Clinical from Botucatu (USHCFMB), São Paulo's county. From these patients were collected clinical data, and followed for their image exams and the CTDI data collected. Afterwards this data was corrected for the standard SSDE therefore calculated the effective dosage of radiation suffered by this patient during his hospitalization. Results: From the 109 patients, the majority of them men, elderly, 18,3% had a previous stroke(s) or AIT, the majority had arterial hypertension. The protocol was followed even in the worse cases, thus not generating statitical difference to patients when compared by the hospital entry NIHSS or hospital release. The results where favorable to the protocol when compared with the Bamford and TOAST scales, only MSCT or associated with CT or angiography, received higher doses than those who did not perform this, with statistical significance p <0.001. Discussion: This paper had as principal objective analise the safety of the Tomography protocol UAVC-HCFMB, aswell if the efective doses found were between the security patterns envisaged by the regulation entities in the country, analyzing if the practicies of the adopted protocol was totally efective, regardless of the patience severity. When compareded to the etiologies there wasn't difference on the effective dosage on those patients. However ther is the need of further studies about the subject to better understanding. Conclusion: We have concluded that the Computerized Tomography of the Unidade de AVC do Hospital das Clínicas de Bocatu-SP, is safe in altogether regarding the vigent leslislation on thecountry and standarded by Sanitary Vigilence and CNEN, not having difference on the efective dosage received by the patients according to the treatments and severity of the stroke.
Descrição
Palavras-chave
Acidente vascular cerebral, Dosimetria, Proteção radiológica, Raio-X, Tomografia computadorizada, Stroke, Dosimetry, Tomography