Çocuk Hastalarda Acil Beyin BT Çekimlerinde Tarama Uzunluğunun Etkin Doza Etkisi

Year 2024, Volume: 46 Issue: 5, 681 - 688, 12.09.2024

Emre Emekli , Elif Zoroğlu Altınkaya

https://doi.org/10.20515/otd.1483947

Abstract

Günümüzde insan kaynaklı radyasyon kaynakların en önemlisi tıpta kullanılan tekniklerin ürettiği radyasyondur. Bu çalışmada acil serviste travma nedeniyle beyin BT çekimi gerçekleştirilen 0-6 yaş aralığındaki çocuk hastaların tetkilerinde çekim tekrarı gerekliliğinin araştırılması; tarama uzunluklarının uygunluğu, görüntü alanında el varlığının etkin doza etkisinin değerlendirilmesi amaçlanmıştır. Çalışmada 59 hasta değerlendirilmiştir. Vertex-C2 aralığından daha fazla tarama gerçekleştirilen hastalar tarama uzunluğu fazla olarak kaydedildi. İkinci olarak hastaların BT’de durması için görüntü aralığında başka bir insanın uzvunun (el vb.) girip girmediği kaydedildi. Bu parametrelere göre dört grup oluşturuldu; grup 1 (tarama uzunluğu uygun, el yok), grup 2 (tarama uzunluğu uygun, el var), grup 3 (tarama uzunluğu fazla, el yok), grup 4 (tarama uzunluğu fazla, el var). Tanısal kalitede olmayan görüntülerin oranı %13,56 olarak belirlenmiş, %54,34'ünde ise tarama uzunluğu optimalden fazla bulunmuştur. Gruplar arasında ED1 ve ED2 arasında istastistiksel olarak anlamlı fark vardı (p=0,033, p<0,001, sırasıyla). Ortalama doz değerleri literatürle karşılaştırıldığında yüksek bulunmuştur. Hastaların gruplara ayrılması ve ED değerlerinin analizi, fazla tarama uzunluğunun ED'yi artırdığını, görüntüye el girmesinin ise anlamlı fark göstermediğini ortaya koymuştur. Sonuç olarak, çalışma, çocuklarda doz optimizasyonun hastanemizde optimal sağlanamadığını göstermektedir. Bu bulgular, radyasyona duyarlı bu hasta grubunda radyasyon dozunun kontrol altında tutulmasının önemini vurgulamaktadır.

Keywords

Beyin BT, Çocuk, Radyasyon, Tetkik tekrarı, Doz optimizasyonu

The Effect of Scan Length on Effective Dose in Emergency Brain CT Scans in Pediatric Patients

Abstract

The most significant source of human-made radiation is the radiation generated by techniques used in medicine nowadays. This study aimed to investigate the necessity of repetition of brain CT scans due to trauma in pediatric patients aged 0-6 in the emergency department, evaluate the adequacy of scan lengths, and assess the effect of the presence of a hand in the field of view on effective dose. Fifty-nine patients were evaluated in the study. Patients who underwent scanning beyond the vertex-C2 interval were recorded to have excessive scan length. Secondly, the presence of another person's limb (such as a hand) in the field of view to keep the patients for CT was recorded. Four groups were formed according to these parameters: group 1 (appropriate scan length, no hand), group 2 (appropriate scan length, hand present), group 3 (excessive scan length, no hand), group 4 (excessive scan length, hand present). The rate of images with non-diagnostic quality was determined to be 13.56%, and 54.34% had scan lengths longer than optimal. There was a statistically significant difference between groups in terms of ED1 and ED2 (p=0.033, p<0.001, respectively). Mean dose values were found to be higher compared to the literature. The analysis of ED values showed that excessive scan length increased the ED, whereas presence of a hand in the field of view did not show a significant difference. In conclusion, the study demonstrates that dose optimization in children is not optimally achieved in our hospital. These findings emphasize the importance of controlling radiation dose in this sensitive patient group.

Keywords

Brain CT, Child, Radiation dose, Imaging repetition, Dose optimization

Ethical Statement

The study was approved by Eskişehir Osmangazi University Noninterventional Clinical Research Ethical Committee (Decision no: 33, Date: 27. 02.2024).

Supporting Institution

No conflict of interest was declared by the authors.

Thanks

No acknowledgement.

References

• 1. Mack SA. Eliminating the stigma: A systematic review of the health effects of low-dose radiation within the diagnostic imaging department and its implications for the future of medical radiation. J Med Imaging Radiat Sci 2020;51(4):662-70.
• 2. Goodman TR, Amurao M. Medical imaging radiation safety for the female patient: rationale and implementation. Radiographics. 2012;32(6):1829-37.
• 3. Hricak H, Brenner DJ, Adelstein SJ, Frush DP, Hall EJ, Howell RW, McCollough CH, Mettler FA, Pearce MS, Suleiman OH, Thrall JH, Wagner LK. Managing radiation use in medical imaging: a multifaceted challenge. Radiology. 2011;258(3):889-905.
• 4. Wildberger JE, Mahnken AH, Schmitz-Rode T, Flohr T, Stargardt A, Haage P, Schaller S, Günther RW. Individually adapted examination protocols for reduction of radiation exposure in chest CT. Invest Radiol 2001;36(10):604-11.
• 5. Jihong C, Penggang B, Xiuchun Z, Kaiqiang C, Wenjuan C, Yitao D, Jiewei Q, Kerun Q, Jing Z, Tianming W. Automated Intensity Modulated Radiation Therapy Treatment Planning for Cervical Cancer Based on Convolution Neural Network. Technol Cancer Res Treat 2020;19:1533033820957002.
• 6. Vosiak P, Schelin H, Bunick A, Yagui A, Legnani A. Evaluation of radiation dose in pediatric radiological exams. Eur J Public Health 2021;31:ckab120.084.
• 7. https://howradiologyworks.com/dlp-calculator/
• 8. Menoch MJ, Hirsh DA, Khan NS, Simon HK, Sturm JJ. Trends in computed tomography utilization in the pediatric emergency department. Pediatrics. 2012;129(3):e690-7.
• 9. Miglioretti DL, Johnson E, Williams A, Greenlee RT, Weinmann S, Solberg LI, Feigelson HS, Roblin D, Flynn MJ, Vanneman N, Smith-Bindman R. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013;167(8):700-7
• 10. Ohana O, Soffer S, Zimlichman E, Klang E. Overuse of CT and MRI in paediatric emergency departments. Br J Radiol 2018;91(1085):20170434.
• 11. Nagayama Y, Oda S, Nakaura T, Tsuji A, Urata J, Furusawa M, Utsunomiya D, Funama Y, Kidoh M, Yamashita Y. Radiation Dose Reduction at Pediatric CT: Use of Low Tube Voltage and Iterative Reconstruction. Radiographics 2018;38(5):1421-40.
• 12. Chen JX, Kachniarz B, Gilani S, Shin JJ. Risk of malignancy associated with head and neck CT in children: a systematic review. Otolaryngol Head Neck Surg 2014;151(4):554-66.
• 13. Bawazeer O, Saleem R, Alhazmi M, Asiri N, Mohammed T, Alsaab A, Ajlouni A. . Assessment of pediatric radiation doses in brain CT procedures. Radioprotection 2022;57:305-10.
• 14. Karappara J, Koteshwar P, Panakkal N. C, Sukumar S. Optimization of Pediatric CT Brain Protocol to Achieve Reduced Patient Dose. Biomed Pharmacol J 2020;13(1).
• 15. Obara H, Takahashi M, Kudou K, Mariya Y, Takai Y, Kashiwakura I. Estimation of effective doses in pediatric X-ray computed tomography examination. Exp Ther Med 2017;14(5):4515-20.
• 16. Kharbanda AB, Krause E, Lu Y, Blumberg K. Analysis of radiation dose to pediatric patients during computed tomography examinations. Acad Emerg Med 2015;22(6):670-5.
• 17. Bledsoe J, Liepert AE, Allen TL, Dong L, Hemingway J, Majercik S, Gardner S, Stevens MH. The salutary effect of an integrated system on the rate of repeat CT scanning in transferred trauma patients: Improved costs and efficiencies. Am J Surg 2017;214(2):198-200.
• 18. Hinzpeter R, Sprengel K, Wanner GA, Mildenberger P, Alkadhi H. Repeated CT scans in trauma transfers: An analysis of indications, radiation dose exposure, and costs. Eur J Radiol 2017;88:135-140.
• 19. Rose S, Viggiano B, Bour R, Bartels C, Szczykutowicz T. A Multiinstitutional Study on Wasted CT Scans for Over 60,000 Patients. AJR Am J Roentgenol 2020;215(5):1123-9.
• 20. Siegelman JR, Gress DA. Radiology stewardship and quality improvement: the process and costs of implementing a CT radiation dose optimization committee in a medium-sized community hospital system. J Am Coll Radiol 2013;10(6):416-22.
• 21. Kataria B, Sandborg M, Althén JN. Implications of Patient Centring on Organ Dose in Computed Tomography. Radiat Prot Dosimetry 2016;169(1-4):130-5.
• 22. Corwin MT, Chang M, Fananapazir G, Seibert A, Lamba R. Accuracy and radiation dose reduction of a limited abdominopelvic CT in the diagnosis of acute appendicitis. Abdom Imaging. 2015;40(5):1177-82.