El Congreso Europeo de Radiología (ECR 2019) abrió inscripciones para trabajos para la 5ª edición de exhibición de carteles dedicados a la protección radiológica, en su iniciativa EuroSafe.

Profesionales de América Latina se reunieron e inscribieron sus estudios, contribuyendo así al fortalecimiento de la bandera Latin Safe!

A continuación se presentan los trabajos aprobados, presentados en orden alfabético de título. El ECR 2019 se realizará del 27 de febrero al 3 de marzo en Austria.

COMPARISON OF DIAGNOSTIC REFERENCE LEVELS (DRLS) IN GENERAL RADIOLOGY BETWEEN A CHILEAN HOSPITAL AND NATIONAL (UK) DRLS

Type: EuroSafe Imaging

Authors: M. Maturana1, D. Fabri1, P. Soffia1, R. Castillo1; 1Departamento de Imágenes Clínica Alemana Santiago/CL.

CREATION OF RADIOPROTECTION COMMITTEE AND IMPLEMENTATION OF RADIATION DOSE REDUCTION CAMPAIGN IN A TEACHING HOSPITAL IN BRAZIL: PROPER DOSE EXAMS AND BETTER EFFECTIVENESS

Authors: M. Bernardo1, A. A. S. M. D. Santos2, F. Morgado3, D. M. Sales4, A. Mekhitarian4, F. A. Almeida4, C. I. S. Rodrigues4; 1Sorocaba, SAO PAULO/BR, 2Rio de Janeiro/BR, 3SAO PAULO/BR, 4São Paulo/BR

Type: Educational Exhibit

Topic: Physics in Medical Imaging

Keywords: Paediatric, Professional issues, Radioprotection / Radiation dose, CT, Conventional radiography, Digital radiography, Education, Radiation safety, Safety, Education and training, Patterns of Care, Quality assurance

Learning objectives: Radioprotection Commission is applicable and effectiveness in practice in Hospital’s Programs.

Background: This paper aims to report the creation of a Radiation Protection Commission according to Brazilian rules. The objectives are: 1. To create the radiological protection commission and its internal regiment; 2. Implement radiation dose reduction measures while maintaining technical quality of the image; 3. Awareness of the multidisciplinary team and patients about the effects of radiation. 4. Elaboration of Continuing Education.

Findings and procedure details

Method: Commission implementation followed the principles of Image Gently, Eurosafe Imaging and Choosing Wisely Campaigns, and Kotter’s 8-Step Change

Management Methodology

Results: Actions taken: 1) Established a sense of urgency–radioprotection; 2) Created an administrative coalition– commitment of the Clinical and Technical Directors (Stakeholders); 3) Developed a vision and strategy– hospital committee, internal regulations document, radiation dose reduction with quality maintained, patient and multidisciplinary team awareness on radiation’s effects and benefits; 4) Communicated the vision of change – dissemination of campaign support material (radiological exams data reports, guidelines booklet for parents and pediatricians) following Image Gently standards; 5) Invested employees empowerment – radiologists, nursing, administrative, physicians; 6) Demonstrated achieved short-term achievements – equipment’s calibration, pediatricians’ guidelines, conscientious patients and dose reduction of ionizing exams; 7) Establishment of change of mentality – involvement of the academic community and perseverance of the committee’s deliberations.

Conclusion

Change safety culture was fundamental for the implementation of the Commission. In this processs strategies like dose radiation reduction, audit using indicators, multidisciplinary team training, disseminate protocols and patients / caregiver’sinformation are essential.

CT DRL VALUE FOR ADULT PATIENTS IN A UNIVERSITY HOSPITAL FROM BRAZIL

Authors: C. M. de Oliveira, A. Turcati Accorsi, L. Vinicius de Moura, A. Bacelar, M. ANÉS;

Hospital de Clínicas de Porto Alegre Porto Alegre/BR

Diagnostic Reference level is an important tool on the optimization process. Computed Tomography DRL has been especially relevant since CT exams compromise about half the radiation dose on medical imaging exposures. Recently, ICRP gave guidance in the DRL process through their publication 135, clarifying the methodology suggested when determining DRL Values.

Currently Brazil doesn’t have National DRL Values for the DRL quantities proposed by the ICRP (CTDIvol and DLP) so the aim of our study is to determine Local DRL Values for CT using the ICRP proposed methodology for head, chest and abdomen exams. The sample was filtered to fit in adult standard patient weight range. The results will be presented at the ECR 2019 EuroSafe Imaging Poster Exhibition, from 27th February to 3rd March, at Vienna.

ESTABLISHING DOSE REFERENCE LEVELS FOR CT IN A CHILEAN HOSPITAL INCLUDING TECHNOLOGIST PERFORMANCE

Type: EuroSafe Imaging

Authors: D. Fabri1, P. Soffia1, J. Sanguesa1, R. Castillo1; 1Departamento de Imágenes Clinica Alemana Santiago/CL.

EVALUATION OF MEDICAL JUSTIFICATIONS (CLINICAL INFORMATION) PROVIDED FOR ORDERING EXAMINATIONS WITH IONIZING RADIATION AT HOSPITAL DE CLINICAS DE PORTO ALEGRE

Juliana Monteiro Goulart1, 2, Ronaldo Lucena1,2 , Alexandre Bacelar1,2 , Ana Lucia Pinto1,2

1 Serviço de Física Médica e Radioproteção-Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil. 2 LABRAD-Laboratório de Imagens Médicas e Radioproteção, Porto Alegre, Brasil.

The prescription of procedures with ionizing radiation requires a medical justification based on the risk-benefit relationship for the patient.

The objective of this study is to make the requesting physicians to make an effort to describe a medical justification with the maximum possible information related to the patient’s pathology, in order to avoid the excess of unnecessary and complementary radiological exposures.

All the clinical information described in requests for imaging tests with ionizing radiation from a public teaching hospital in Brazil since January 2016 were evaluated. The information considered sufficient to carry out the examinations were classified as adequate justifications. In June / 2016, training in radiological protection was started at the requesting services. As of September / 2016, clinical information with less than 15 characters was not accepted in the electronic exam request system.

In June / 2016, training in radiological protection was started for 247 physicians requesting examinations. In the period between May 2016 and September 2016 the percentage of inadequate clinical information was reduced from 20.6% to 2.4%. The remaining months of 2016, 2017 and 2018 remained below 3%.

The educational system, audits and control of the radiological justification implemented optimizes the radiological protection, causing the requesting doctor to describe adequate and sufficient clinical information in the request of examinations with the use of ionizing radiation, avoiding that the patient is exposed unnecessary ionizing radiation.

EXPERIMENTAL METHODOLOGY IN CT DOSE OPTIMIZATION USING A ANTHROPOMORPHIC PHANTOM AND OSL DOSIMETER – EXPERIENCE IN A SINGLE HOSPITAL CENTER IN BRAZIL

Hilton Leao, Renato Dimenstein, Dany Jasinowodolinski, Lana Taniguti, Tiago Santos

Objective: Present an experimental model of dose evaluation and image quality that allows CT scan protocols optimization, maintaining a satisfactory signal-to-noise ratio (SNR), as well as a feasible radiation dose according to ALARA

Methods:

1. Acquisitions of CT images were performed with a Thorax simulator (Phantom).
2. The CT acquisitions were performed with FBP (Filtered Back projection) and IR (iterative Reconstruction) algorithms.
3. For each acquisition were inserted inside the phantom an OSL-type radiation meter simulator calibrated for 65 keV energy;
4. Images of the simulations and dose values were used for the determination of the technique of optimized examination

Conclusions: The reconstruction of images with lower dose values with iterative algorithm does not affect the SNR relation, for the ACR simulator and anthropomorphic Phantom.

MOST FREQUENT CAUSES OF RADIATION DOSE ALERTS IN CT AND HOW TO MANAGE THEM

Type: EuroSafe Imaging

Authors: J. Sanguesa1, D. Fabri1, P. Soffia1; 1Departamento de Imagenes Clinica Alemana Santiago/CL.

PAEDIATRIC CT DOSE OPTIMIZATION IN A GENERAL HOSPITAL

1. Yanikian Nersissian¹, H. Leao², C. S. Melo¹, V. Heidorne Guerra¹,
2. Gonçalves Freitas³, M. V. Y. Sawamura², E. M. M. S. Gebrim², P. R. Costa¹

¹Instituto de Física – Universidade de São Paulo (IF/USP)

²Instituto de Radiologia – Hospital das Clínicas – Faculdade de Medicina (INRAD/HC/FM/USP)

³ Faculdade de Medicina (FM/USP)

According to the publication, HHS 24 – Dosimetry in Diagnostic Radiology for Pediatric Patients – dosimetry for pediatric patients undergoing diagnostic radiology procedures require special consideration in addition to the dosimetry methods used for adult patients. The importance of dosimetry for this group of patients is more delicate than for adults given their: longer life expectancy, greater risk of radiation due to relative radiosensitivity of various body tissues that vary according to sex and age, collection and analysis of data for these patients are complex, fundamentally due to the large and continuous range of patients with distinct sizes present in the pediatric population. This work was carried out as part of the International Atomic Energy Agency (IAEA) Coordinated Research Project (CRP E2.40.20), entitled “Evaluation and Optimizations of Paediatric Imaging”, which consists of a consortium of 10 countries for the study of dose optimization in diagnostic procedures for paediatrics patients. The Dosimetry and Medical Physics Group (Grupo de Dosimetria e Física Médica) of the Physics Institute (IF/USP), which has been working for more than 10 years in a Quality Assurance Program (QA) at the Institute of Radiology of the Clinical Hospital of the School of Medicine (INRAD/HC/FM/USP), participates in this program in the areas of diagnostic radiology and computed tomography.

This work was focused on protocol optimization Head and Thorax exams, primarily. The first strategy was comparing the configuration of these protocols with the suggested by American Association of Physicist in Medicine (AAPM) in the Alliance for Quality Computed Tomography for routine pediatric Chest CT and Head CT. Initially, one CT equipment (Philips – Brilliance 64) of the facility was prioritized. The responsible radiologist and the radiographer checked the proposal and suggested some changes. The first comment of the radiographers was that protocols were with high dose and they liked to try some lower mAs values then the suggested by AAPM.

The medical physicist and the responsible radiographer have adapted the protocols for some ages for Head CT (0 – 1 year, 1 – 2 years, 2 – 6 years, 6 – 16 years and 16 – 20 years) in axial mode e one protocol for a helical mode when 3D reconstructions were necessary. For Chest CT, was suggested just three divisions (0 – 1 year, 1 – 10 years and 10 – 15 years) all in helical mode. The radiographers were trained in the news protocols which were let together in the same CT console screen with the adult’s protocols and started to use them in the exams.

After some weeks, the medical physicist group checked some of the Head and Chest protocols and figured out the radiographers were using the helical 3D routine Head for all the pediatric patients. The Chest protocols were well used because there weren’t so many options to choose. At this time of the implementation of the new protocols, none radiologist asked to change some parameters, complaining about the noise or other loss of image quality.

Another intervention was done, separating the pediatric from adult protocols and the medical physicist has followed some pediatric exams for training the whole team of radiographers, asking for technical question or others suggestions. To simplify the choice of the adequate protocols by the radiographers, the monitor screen of the CT equipment console was adapted considering the specificities of the paediatric patients.

The first results have presented the dose reductions without perceptive loss in image quality of these two general exams. Just for Head and Neck exam was observed degradation in the detail structures by the responsible radiologist. The medical physicist contacted the radiographer to made the necessary changes in this protocol. A preliminary global view of the effects of the optimization process is shown in Figure 3 and 4 for head and thorax CT, respectively, showing the comparative results for CTDI_vol quantity for each age group. Considering the 3^rd quartil as a dose reference level, a reduction of 50 % in the CTDI_vol was reached for patients of 5 – 16 year and for the youngest group (0 – 5 years) the reduction was 66 % for head exams. For thorax, the most expressive dose saving was for the 1 – 5 years group of 47%.

RADIOPROTECTION TRAINING SYSTEM TO MULTI-PROFESSIONAL TEAM AND MEDICAL STUDENTS IN A TEACHING HOSPITAL

Authors: Ricardo Fugiki, Jonathan Watanabe, Monica Oliveira Bernardo, Alair Augusto Sarmet Santos, Flavio Morgado, Danilo Moulin Sales, Cibele Rodrigues.

Teaching Points: To produce an online radioprotection training system to multi-professional team and medical students in a teaching hospital and evaluate the impact of the campaign on health professionals, on the management of the institution of the examinations with ionizing radiation in the hospital in adults and children and to evaluate the knowledge of medical students about radiological protection programs. Table of Contents/Outline: Before the Training System production, a survey was carried out on international radioprotection campaigns such as the Image Wisely®, Image Gently® and EuroSafe® programs for the production of content that would compose the platform. After, the platform was created and reviewed by medical radiologists. Before the implementation of the system, questionnaires were applied to evaluate all professionals and students about their knowledge about radioprotection. A total of 188 questionnaires were applied: 9% for pediatricians, 6% radiologists, 14% members of the radiation protection commission, 27% nurses, and administration officials, 14% radiology technicians and 30% medical students. It was noticed from the results that the professionals who work directly with the radiology service, that is, radiologists and radiology technicians, showed a greater contact with the campaign, but other areas such as nurses and medical students did not know the radioprotection program very well. It is argued that there is a need for greater dissemination of the radioprotection campaigns and the training system can be a useful tool. In view of this, the platform was launched and is being used by the university for training the professionals and medical students.

RELATIONSHIP BETWEEN THE FACTORS INFLUENCING THE PROVISION OF CLINICAL INFORMATION (MEDICAL JUSTIFICATION) IN THE ORDERING FOR RADIOLOGICAL EXAMINATIONS

Ronaldo Albé Lucena; Ricardo Sastre, Tarcísio Saurin

Objectives: to identify, through a Dynamic Systems model, factors and relationships that influence the quality and flow of information and radiological justification between the attending physician and the radiology system of a large public hospital during the procedure for requesting exams of image.

Research method: exploratory descriptive field research, using a qualitative technique and the construction of a cause and effect diagram, developed with the medical professionals of the radiology service and the medical physics service of the hospital, who act directly with the performance of imaging tests. The construction was performed through the qualitative evaluation of the clinical information provided in the examination requests and a questionnaire identifying factors of influence in the process.

Results: the analysis of the cause and effect diagram shows that the ability of the attending physician to provide adequate clinical information in the request for imaging tests can impact the choice of the imaging protocols, the time of release of the report, the quality of the report, in the reduction of radiation dose with adequacy of the investigation and reduction of additional tests. Thus, improvements are proposed in the diagnostic imaging service that can be used by the hospital institution, producing results in a timely, reliable, with the aid of appropriate techniques, reducing wait times and rework and improving the interrelationships between multidisciplinary teams.