Radiologists and physicists expose successful initiatives in Brazil
Posted on: 2018-12-10
On December 5, the Paulista Society of Radiology (SPR) presented the last meeting of the year of its Radiological Protection Study Group, led by Dr. Hilton Muniz Leão Filho, president of Latin Safe. The meetings will be resumed on February 6 at 5:30 p.m. (Brasília time).
The event was attended by more than 20 professionals in the area of radiology and medical physics, both personally and online, since the meeting is transmitted in real time.
Several participants celebrated the fact that they had their work on correct dose approved for exposure at the European Congress of Radiology, through the EuroSafe initiative. We will be releasing details of these studies shortly.
Dr. Hilton, who attended the Annual Congress of RSNA, spoke about the activities at the event – there was a meeting of all the world’s initiatives with the International Society of Radiology (ISR); health-related entities, ultrasound groups, and atomic energy also attended. “We talked about the difficulties, about how much we are trying to increase the scope of Latin Safe. I showed some requests for exams in Brazil without justification, and the foreign professionals were impressed to know that they are approved, that our exams can be done without the need of the same in the requisition,” he said.
He also commented that there have been several lectures on ionizing radiation: “One group has shown the danger of diagnostic loss with the use of interactive reconstruction. I had already noticed that sometimes the imaging quality is not so good but had not qualitatively measured it. We need to alert ourselves to the theme,” he said. Also, he said that ultrasound was much discussed, especially in the pediatric setting – “when does the child need CT or US?”.
He presented the works developed by the Hospital de Clínicas de Porto Alegre – see the case of success here – and the Unimed of Sorocaba, as interesting initiatives to improve the principle of justification.
Reduction of unnecessary exams in pilot project in Sorocaba with National extension
Monica Oliveira Bernardo from Unimed told, during the meeting, that from 2011 to 2014 a master’s project was started at the Sorocaba Hospital. “We implanted Image Gently and their principles; in about 12 months, we changed the culture of the team of technicians – we did weekly activities with them and I periodically went to Emergency, spreading the principles of Image Gently. We took the concern of taking exams with the lowest dose, extension, indications, and this was extending to other exams. We have reduced the number of unnecessary exams in the Emergency, and then for all x-ray exams for children from zero to 12 years,” she said.
Then, through the support of the National Operator, at the end of 2015 so far, with the knowledge and participation of the CBR represented by Dr. Alair Augusto Sarmet Santos, people were prepared in other units to transmit the information. They were able to expand the initiative to 25 units in all Brazil – at that time, reduced skull CT scan by 50% and today they are standardized according to the European guidelines and also the PADI, accreditation program of the Brazilian College of Radiology. “However, there is still a lot of work to be done with the dose issue, including with radiologists,” she acknowledges. “At the Faculty of Medicine of PUC SP, we have made a teaching platform that is expanding for students from the first to the sixth year and the residents of the teaching hospital,” she added.
Monica also said that now in the Private Hospital in Sorocaba there is a new project since June 2018 with the support of the clinical board, working with the indication of the ten most frequent causes of request for adult and child examination, following the Campaign Choosing Wisely and, with they have already been able to reduce the indication of exams by 16%, using a filter with justifications and protocols.
HC: less dose without loss of diagnosis
Denise Nersissian, of the Hospital das Clínicas (HC) of São Paulo, also reported on a project of the international agency in which her group participates. “There are seven countries participating, with a survey of doses of CT, radiography and fluoroscopy; we are not in the most representative unit of the institution, because the Institute of Radiology (InRad) does not yet have as many children patients, but maybe we can take the project to the Children’s Institute. We made the first optimization proposal; on the CT, proposing and performing dose optimization and trained the technicians to use the new protocols,” she said.
On the issue of quality, she explains that although the dose reduction made the image a bit noisier, the team received no direct complaints of quality loss by radiologists in general. “The chest region had some dose-adjusted procedures for adult protocols in pediatric patients,” she emphasized.
They were able to reduce the dose in the Diagnostic Imaging Training Center by half in children from 5 to 10 years, and 63% in children from 0 to 5 years, and without loss of diagnosis.
PPE in pregnant women
Marcel Zago Botelho, director of diagnostic radiology at the Brazilian Association of Medical Physics (ABFM), said that he recently participated in an event about strategic planning guidelines, and that it was possible to strongly raise the flag that the radiologist is the supervisor of production in institutions, especially those of small and medium size. He awaits, however, the agency’s reply on these indications.
He also asked if there were any work done on personal protective equipment (PPE) in specifically pregnant patients. “The subject is very controversial, and we see use of protectors in dental radiology. The public questioning is immense – it is an excellent way of dissemination with basic actions,” he said.
Finally, he proposed the creation of Latin Safe Day, following examples from abroad, so that correct dose practices are better disseminated here not only among physicians and physicists, but also among patients.