2012, Número 2
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Anales de Radiología México 2012; 11 (2)
Radiación ionizante en tomografía computada: un tema de reflexión
Mendizábal MAL
Idioma: Español
Referencias bibliográficas: 46
Paginas: 90-97
Archivo PDF: 182.04 Kb.
RESUMEN
La tomografía computada ha revolucionado el diagnóstico por imagen. Debido a su rápida evolución tecnológica y mayor disponibilidad, su utilización crece de manera vertiginosa. Sin embargo, no es inocua, ya que los pacientes expuestos a dosis de radiación ionizante, especialmente los niños, corren un riesgo bajo pero significativo de desarrollar cáncer. Dado que se desconoce el riesgo a largo plazo, en el contexto de la protección radiológica del paciente se acepta que dichas dosis deben limitarse. Para ello se requiere un conocimiento general de los parámetros de medición, así como de los métodos de reducción y de control de la radiación. Este artículo pretende ser una guía de los conceptos importantes en la compresión de estos factores y proporcionar al lector bibliografía relacionada para un uso consciente de esta valiosa herramienta diagnóstica.
REFERENCIAS (EN ESTE ARTÍCULO)
Brenner D, Hall EJ. Computed Tomography-An increasing source of radiation exposure. NEJM 2007;357:2277-2284.
Sodickson A et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 2009;251(1):175-184.
AAPM report 96. Measurement, reporting, and management of radiation dose in CT: report of AAPM Task Group 23. Disponible en: www.aapm.org/pubs/reports/rpt_96.pdf
Lee, CI et al. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 2004;231(2):393-398.
Food and Drugs Administration [ Internet ]. What are the radiation risks from CT?, c 2002. Disponible en: http://www.fda.gov/RadiationEmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115329.htm.
Food and Drugs Administration [Internet]. Safety investigations of CT brain perfusion scans: Update 11/9/2010 Disponible en: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm185898.htm.
The National Academy Press [Internet]. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII – Phase 2, c 2006. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, N.R.C. Disponible en: http://www.nap.edu/catalog.php?record_id=11340.
Lobrich M et al. In vivo formation and repair of DNA double-strand breaks after computed tomography examinations. Proc Natl Acad Sci USA 2005;102(25):8984-8989.
Cardis E et al. The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: estimates of radiation-related cancer risks. Radiat Res 2007;167(4):396-416.
Little MP et al. Risks associated with low doses and low dose rates of ionizing radiation: why linearity may be (almost) the best we can do. Radiology 2009;251(1):6-12.
McNitt-Gray MF. AAPM/RSNA Physics Tutorial for Residents: Topics in CT. Radiation dose in CT. Radiographics 2002;22(6):1541-1553.
Wrixon AD. New ICRP recommendations. J Radiol Prot 2008;28(2):161-168.
Amis ES et al. American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol 2007;4(5):272-284.
Shrimpton PC. Assesment of patient dose in CT [Internet]. National Radiological Protection Board, 2004. Disponible en: http://www.biophysicssite.com/Documents/MSCT2004b/Appendix_C_Assessment_of_Patient_Dose_in_Paediatric_CT.pdf.
McCollough CH, Leng S, Yu L, Cody DD, Boone JM, McNitt-Gray MF. CT dose index and patient dose: they are not the same thing. Radiology 2011;259(2):311-316.
Payne JT. CT radiation dose and image quality. Radiol Clin North Am 2005;43(6):953-962.
Bongartz G, Golding SJ, Jurik AG, Leonardi M, van Meerten EvP, Rodríguez R, Schneider K, et al. European Guidelines for Multislice Computed Tomography [Internet]. Funded by the European Commission. c 2004 [citado el 15 nov 2011]. Disponible en: http://w3.tue.nl/fileadmin/sbd/Documenten/Leergang/BSM/European_Guidelines_Quality_Criteria_Computed_Tomography_Eur_16252.pdf.
McCollough CH, et al. Strategies for reducing radiation dose in CT. Radiol Clin North Am 2009;47(1):27-40.
McNitt-Gray MF. Radiation issues in computed tomography screening. Radiol Clin North Am 2004;42:711-723.
Singh S, et al. Dose reduction and compliance with pediatric CT protocols adapted to patient size, clinical indication, and number of prior studies. Radiology 2009;252(1):200-208.
Björkdahl P, Nyman U. Using 100- instead of 120-kVp computed tomography to diagnose pulmonary embolism almost halves the radiation dose with preserved diagnostic quality. Acta Radiol 2010;51(3):260-270.
Heyer CM, et al. Image quality and radiation exposure at pulmonary CT angiography with 100- or 120-kVp protocol: prospective randomized study. Radiology 2007;245(2):577-583.
Szucs-Farkas Z, et al. Patient exposure and image quality of low-dose pulmonary computed tomography angiography: comparison of 100- and 80-kVp protocols. Invest Radiol 2008;43(12):871-876.
Szucs-Farkas Z, et al. Detection of pulmonary emboli with CT angiography at reduced radiation exposure and contrast material volume: comparison of 80 kVp and 120 kVp protocols in a matched cohort. Invest Radiol 2009;44(12):793-799.
Szucs-Farkas Z, et al. Is body weight the most appropriate criterion to select patients eligible for low-dose pulmonary CT angiography? Analysis of objective and subjective image quality at 80 kVp in 100 patients. Eur Radiol 2009;19(8):1914-1922.
Raff GL. Radiation dose from coronary CT angiography: five years of progress. J Cardiovasc Comput Tomogr 2010;4(6):365-374.
Schilham A, et al. Overranging at multisection CT: an underestimated source of excess radiation exposure. Radiographics 2010;30(4):1057-1067.
Rogalla P, Kloeters C, Hein PA. CT technology overview: 64-slice and beyond. Radiol Clin North Am 2009;47(1):1-11.
Goetti R, Baumüeller S, Feuchtner G, Stolzmann P, Karlo C, Alkadhi H et al. High-pitch dual-source CT angiography of the thoracic and abdominal aorta: is simultaneous coronary artery assessment possible? Am J Roentgenol 2010;194(4):938-944.
Baumüeller S, Alkadhi H, Stolzmann P, Frauenfelder T, Goetti R, Schertler T. Computed tomography of the lung in the high-pitch mode: is breath holding still required? Invest Radiol 2011;46(4):240-245.
De Zordo T, Von Lutterotti K, Dejaco C, Soegner PF, Frank R, Algner F et al. Comparison of image quality and radiation dose of different pulmonary CTA protocols on a 128-slice CT: highpitch dual source CT, dual energy CT and conventional spiral CT. Eur Radiol 2011;22(2):279-286.
Hardie AD, Mayes N, Boulter DJ. Use of high-pitch dual-source computed tomography of the abdomen and pelvis to markedly reduce scan time: clinical feasibility study. J Comput Assist Tomogr 2011;35(3):353-355.
Kalra MK et al. Techniques and applications of automatic tube current modulation for CT. Radiology 2004;233(3):649-657.
Lee CH et al. Radiation dose modulation techniques in the multidetector CT era: from basics to practice. Radiographics 2008;28(5):1451-1459.
Tamm, EP, Rong J, Cody DD, Ernst RD, Fitzgerald NE, Kundra V. Quality Initiatives: CT Radiation Dose Reduction: How to Implement Change without Sacrificing Diagnostic Quality. Radiographics 2011;31(7):1823-1832.
Goske MJ. et al. The Image Gently campaign: working together to change practice. Am J Roentgenol 2008;190(2):273-274.
Image Gently The alliance for radiation safety in pediatric radiology [Internet]. Image Gently and SPR c 2011. Disponible en: http://spr.affiniscape.com/associations/5364/ig/.
Image Wisely Radiation safety in adult medical imaging [Internet]. American College of Radiology c 2010. Disponible en: http://www.imagewisely.org.
Brink, JA, Amis ES. Image Wisely: a campaign to increase awareness about adult radiation protection. Radiology 2010;257(3):601-602.
American College of Radiology [Internet]. Appropiateness criteria c 2011. Disponible en: http://www.acr.org/Secondary-MainMenuCategories/quality_safety/app_criteria.aspx.
Bagian JP et al. Radiation risks of diagnostic imaging. En: Sentinel Event Alert. 2011, The Joint Commission. p.1-4.
Lee CI, Flaster HV, Haims AH, Monico EP, Froman HP. Diagnostic CT scans: institutional informed consent guidelines and practices at academic medical centers. Am J Roentgenol 2006;187(2):282-287.
McCollough, C. Diagnostic reference levels [Internet]. American College of Radilogy c 2010. Disponible en:http://www.imagewisely.org/~/media/ImageWisely%20Files/Medical%20Physicist%20Articles/IW%20McCullough%20Diagnostic%20Reference%20Levels.pdf?CSRT=1667889089885741382.
AAPM. Dose check guidelines version 1.0. 04/27/2011. Disponible en: http://www.aapm.org/pubs/CTProtocols/documents/NotificationLevelsStatement_2011-04-27.pdf.
Coo TS, Zimmerman S, Maidment AD, Kim W, Boonn WW. Automated extraction of radiation dose information for CT examinations. J Am Coll Radiol 2010;7(11):871-877.
American College of Radiology. National Radiology Data Registry, Dose index registry c 2004-2011. Disponible en: https://nrdr.acr.org/Portal/DIR/Main/page.aspx.