Pediatrik hastalarda COVID-19 pandemisinde toraks BT kullanımına bağlı radyasyon maruziyetinin belirlenmesi

Yıl 2020, Cilt: 8 Sayı: 3, 79 - 82, 25.12.2020

Mehmet Coskun

https://doi.org/10.21765/pprjournal.853934

Öz

Amaç
Bu çalışmanın temel hedefi, çocuk hastalarda, Coronavirus hastalığı 2019 (COVID-19) pandemisinde toraks bilgisayarlı tomografisi (BT) kullanımının neden olduğu radyasyon maruziyetinin belirlenmesidir.
Gereç ve Yöntem
Nisan-Ekim 2019 ve Nisan-Ekim 2020 tarih aralığında enfeksiyon ön tanısıyla toraks BT çekilen çocuklar çalışmaya dahil edildi. 2020’de kVp %10 civarında düşürülerek çekim başına radyasyon maruziyeti azaltıldı. Doz-uzunluk çarpımı (DLP) BT taramasındaki hasta protokol ekranından elde edildi. Efektif doz hesaplamada yaşa göre değişen çevrim faktörü kullanıldı. Toplam radyasyon maruziyeti, 2019 ve 2020 yılları için ayrı ayrı, efektif dozlar toplanarak hesaplandı. Yıla (2019 ve 2020) göre, yaş ve cinsiyet farklılığı, sırasıyla T testi ve Fisher Exact Testi kullanılarak karşılaştırıldı.
Bulgular
Çalışmaya 366 çocuk dahil edildi. 2019 ve 2020 yıllarında BT çekilen olgu sayısı sırasıyla 70 ve 296 idi. Üç hasta, 2020’de BT ile tekrar tarandı. Ağustos ve Eylül 2020’de aynı zaman diliminde 2019’a göre BT kullanımında belirgin artış vardı (114’e karşın 8). 2019 ve 2020 için toplam efektif dozlar sırasıyla 223.21 mSv ve 590.92 mSv idi. 2020’de artan BT kullanımı ile birlikte radyasyon dozu 2.65 kat arttı. 2020’de BT yapılan olguların yaşı belirgin daha yüksek iken (p < 0.001), cinsiyet açısından fark yoktu (p = 0.11).
Sonuç
COVID-19 pandemi sürecinde toraks BT kullanımı nedeniyle çocuklarda radyasyon maruziyeti 2.65 kat arttı. Radyasyon maruziyeti konusunda farkındalık artırılmalı ve çocuklarda toraks BT kullanımından kaçınılmalıdır.

Anahtar Kelimeler

Bilgisayarlı tomografi, COVID-19, pandemi, radyasyon maruziyeti

Determination of radiation exposure with related to the use of chest CT in during COVID-19 pandemic in pediatric patients

Öz

Aim
The main goal of this study was to determine the radiation exposure with use of chest computed tomography (CT) in pediatric patients in Coronavirus disease 2019 (COVID-19) pandemic.
Materials and Methods
Children who underwent thorax CT with a pre-diagnosis of infection between April-September in 2019 and April-September in 2020 were included. kVp decreased about 10% to reduce radiation exposure per scans in 2020. Dose-length product (DLP) was acquired from patient protocol screen in CT scans. Age-specific conversion coefficients were used to determine effective dose. Total radiation exposure was calculated by summing effective doses in 2019 and 2020, respectively. Age and gender differences were compared among years (2019 vs 2020) using Student’s T test and Fisher’s Exact test, respectively.
Results
Three-hundred-sixty-six children were included. Seventy and 296 patients were scanned with chest CT in 2019 and 2020, respectively. Three patients re-scanned with CT in 2020. There was a substantial increase of CT use in August and September in 2020 compared with the same period of 2019 (114 vs 8). The total effective doses in 2019 and 2020 were 223.21 mSv and 590.92 mSv, respectively. Radiation dose increased by 2.65 times with increased use in 2020. Age of the patients was significantly higher in 2020 (p < 0.001) while there was no gender difference by years (p = 0.11).
Conclusion
Radiation dose increased 2.65 times in children with use of chest CT during the COVID-19 pandemic. Awareness should be raised on radiation exposure and use of chest CT should be avoided in children.

Anahtar Kelimeler

Computed tomography, COVID-19, pandemic, radiation exposure

Kaynakça

• 1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.
• 2. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536-44.
• 3. Organisation WH. WHO Director-General's opening remarks at the media briefing on COVID-19. 2020.
• 4. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. Jama. 2020;323(13):1239-42.
• 5. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422-6.
• 6. Zimmermann P, Curtis N. Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children. Pediatr Infect Dis J. 2020;39(5):355-68.
• 7. Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review. JAMA Pediatr. 2020;174(9):882-9.
• 8. Mantovani A, Rinaldi E, Zusi C, Beatrice G, Saccomani MD, Dalbeni A. Coronavirus disease 2019 (COVID-19) in children and/or adolescents: a meta-analysis. Pediatr Res. 2020.
• 9. Palabiyik F, Kokurcan SO, Hatipoglu N, Cebeci SO, Inci E. Imaging of COVID-19 pneumonia in children. Br J Radiol. 2020;93(1113):20200647.
• 10. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020;296(2):E115-e7.
• 11. Thomas KE, Wang B. Age-specific effective doses for pediatric MSCT examinations at a large children's hospital using DLP conversion coefficients: a simple estimation method. Pediatr Radiol. 2008;38(6):645-56.
• 12. Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S, et al. The Role of Chest Imaging in Patient Management During the COVID-19 Pandemic: A Multinational Consensus Statement From the Fleischner Society. Chest. 2020;158(1):106-16.
• 13. Borakati A, Perera A, Johnson J, Sood T. Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study. BMJ Open. 2020;10(11):e042946.
• 14. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020;296(2):E32-e40.
• 15. Li B, Zhang S, Zhang R, Chen X, Wang Y, Zhu C. Epidemiological and Clinical Characteristics of COVID-19 in Children: A Systematic Review and Meta-Analysis. Front Pediatr. 2020;8:591132.
• 16. Duan YN, Zhu YQ, Tang LL, Qin J. CT features of novel coronavirus pneumonia (COVID-19) in children. Eur Radiol. 2020;30(8):4427-33.
• 17. Shelmerdine SC, Lovrenski J, Caro-Domínguez P, Toso S. Coronavirus disease 2019 (COVID-19) in children: a systematic review of imaging findings. Pediatr Radiol. 2020;50(9):1217-30.
• 18. Homayounieh F, Holmberg O, Al Umairi R, Aly S, Basevičius A, Costa PR, et al. Variations in CT Utilization, Protocols, and Radiation Doses in COVID-19 Pneumonia: Results from 28 Countries in the IAEA Study. Radiology. 2020:203453.
• 19. Tabatabaei SMH, Talari H, Gholamrezanezhad A, Farhood B, Rahimi H, Razzaghi R, et al. A low-dose chest CT protocol for the diagnosis of COVID-19 pneumonia: a prospective study. Emerg Radiol. 2020;27(6):607-15.
• 20. Dangis A, Gieraerts C, Bruecker YD, Janssen L, Valgaeren H, Obbels D, et al. Accuracy and reproducibility of low-dose submillisievert chest CT for the diagnosis of COVID-19. Radiol Cardiothorac Imaging. 2020;2(2):e200196.
• 21. Shiri I, Akhavanallaf A, Sanaat A, Salimi Y, Askari D, Mansouri Z, et al. Ultra-low-dose chest CT imaging of COVID-19 patients using a deep residual neural network. Eur Radiol. 2020:1-12.