RESUMO
We established a framework for collecting radiation doses for head, chest and abdomen-pelvis computed tomography (CT) in children scanned at multiple imaging sites across Latin America with an aim towards establishing diagnostic reference levels (DRLs) and achievable doses (ADs) in pediatric CT in Latin America. Our study included 12 Latin American sites (in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Honduras and Panama) contributing data on the four most common pediatric CT examinations (non-contrast head, non-contrast chest, post-contrast chest and post-contrast abdomen-pelvis). Sites contributed data on patients' age, sex and weight, scan factors (tube current and potential), volume CT dose index (CTDIvol) and dose length product (DLP). Data were verified, leading to the exclusion of two sites with missing or incorrect data entries. We estimated overall and site-specific 50th (AD) and 75th (diagnostic reference level [DRL]) percentile CTDIvol and DLP for each CT protocol. Non-normal data were compared using the Kruskal-Wallis test. Sites contributed data from 3,934 children (1,834 females) for different CT exams (head CT 1,568/3,934, 40%; non-contrast chest CT 945/3,934, 24%; post-contrast chest CT 581/3,934, 15%; abdomen-pelvis CT 840/3,934, 21%). There were significant statistical differences in 50th and 75th percentile CTDIvol and DLP values across the participating sites (P<0.001). The 50th and 75th percentile doses for most CT protocols were substantially higher than the corresponding doses reported from the United States of America. Our study demonstrates substantial disparities and variations in pediatric CT examinations performed in multiple sites in Latin America. We will use the collected data to improve scan protocols and perform a follow-up CT study to establish DRLs and ADs based on clinical indications.
Assuntos
Níveis de Referência de Diagnóstico , Tomografia Computadorizada por Raios X , Feminino , Humanos , Criança , América Latina , Doses de Radiação , Valores de Referência , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: Diagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based - DRL(DRLCI) and clinical indication - AD (ADCI) for adult CT in Brazil. METHODS: The prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test. RESULTS: In majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection. CONCLUSIONS: There was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.
Assuntos
Níveis de Referência de Diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doses de Radiação , Estudos Prospectivos , Brasil/epidemiologia , Valores de Referência , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 is the new coronavirus responsible for the coronavirus disease 2019 pandemic, characterized by acute respiratory distress syndrome and atypical pneumonia. In nonpregnant women, studies have shown that severe acute respiratory syndrome coronavirus 2 causes cardiac injury, which can result in myocardial inflammation and damage. Despite many studies investigating the extent of cardiac compromise in patients with severe coronavirus disease 2019, little is known regarding its impact on pregnant women. OBJECTIVE: This study aimed to illustrate the clinical, laboratory, radiologic findings and outcomes of pregnant patients with coronavirus disease 2019 who developed myocardial injury with ventricular dysfunction. STUDY DESIGN: We retrospectively reviewed the paper records of 15 pregnant women with coronavirus disease 2019, who developed myocardial injury on a single tertiary care hospital in the Dominican Republic. Patients' baseline characteristics, clinical picture, and laboratory and radiologic findings were presented, and maternal and fetal outcomes were analyzed. RESULTS: Of 154 pregnant patients diagnosed as having coronavirus disease 2019 at our hospital during the study period, 15 (9.7%), developed myocardial injury. These patients' mean age and gestational age were 29.87±5.83 and 32.31±3.68, respectively. Furthermore, 66.7% of patients presented with shortness of breath and 16.3% with palpitations. All patients were admitted to the intensive care unit, and 86.6% needed intubation. Patients developed myocardial injury, confirmed with highly elevated troponin (34.6 [14.4-55.5 ng/mL]), and pro-B-type natriuretic peptide concentrations (209 [184-246 pg/mL]). In addition, all patients developed left ventricular dysfunction demonstrated by an echocardiogram with a mean left ventricular ejection fraction of 37.67±6.4. Unfortunately, 2 patients who presented with palpitations died a few days after admission. CONCLUSION: Our study showed coronavirus disease 2019 induced myocardial injury and left ventricular dysfunction in pregnant women with a 13.3% mortality rate, which was attributed to malignant arrhythmias.