诊断参考水平：巴西成人和儿童核医学检查中降低辐射剂量的重要工具。

Diagnostic reference level: an important tool for reducing radiation doses in adult and pediatric nuclear medicine procedures in Brazil.

作者信息

Willegaignon José, Braga Luis F E F, Sapienza Marcelo T, Coura-Filho George B, Cardona Marissa A R, Alves Carlos E R, Gutterres Ricardo F, Buchpiguel Carlos A

机构信息

aCancer Institute of São Paulo State (ICESP), Clinical Hospital bNuclear Medicine Service, Department of Radiology, School of Medicine, University of São Paulo, São Paulo cNational Commission on Nuclear Energy, Rio de Janeiro, Brazil.

出版信息

Nucl Med Commun. 2016 May;37(5):525-33. doi: 10.1097/MNM.0000000000000462.

DOI:10.1097/MNM.0000000000000462

PMID:26657219

Abstract

OBJECTIVES

This study aimed to establish a concise method for determining a diagnostic reference level (DRL) for adult and pediatric nuclear medicine patients on the basis of diagnostic procedures and administered radioisotope as a means of controlling medical exposure.

METHODS

A screening was carried out in all Brazilian Nuclear Medicine Service (NMS) establishments to support this study by collecting the average activities administered during adult diagnostic procedures and the rules applied to adjust these according to the patient's age and body mass. Percentile 75 was used in all the activities administered as a means of establishing DRL for adult patients, with additional correction factors for pediatric patients. Radiation doses from nuclear medicine procedures on the basis of average administered activity were calculated for all diagnostic exams.

RESULTS AND DISCUSSION

A total of 107 NMSs in Brazil agreed to participate in the project. From the 64 nuclear medicine procedures studied, bone, kidney, and parathyroid scans were found to be used in more than 85% of all the NMSs analyzed. There was a large disparity among the activities administered, when applying the same procedures, this reaching, in some cases, more than 20 times between the lowest and the highest. Diagnostic exams based on Ga, Tl, and I radioisotopes proved to be the major exams administering radiation doses to patients. On introducing the DRL concept into clinical routine, the minimum reduction in radiation doses received by patients was about 15%, the maximum was 95%, and the average was 50% compared with the previously reported administered activities.

CONCLUSION

Variability in the available diagnostic procedures as well as in the amount of activities administered within the same procedure was appreciable not only in Brazil, but worldwide. Global efforts are needed to establish a concise DRL that can be applied in adult and pediatric nuclear medicine procedures as the application of DRL in clinical routine has been proven to be an important tool for controlling and reducing radiation doses received by patients in medical exposure.

摘要

目的

本研究旨在建立一种简洁的方法，根据诊断程序和所施用的放射性同位素来确定成人和儿童核医学患者的诊断参考水平（DRL），以此作为控制医疗照射的一种手段。

方法

在巴西所有核医学服务机构开展了一项筛查，通过收集成人诊断程序中施用的平均活度以及根据患者年龄和体重调整这些活度的规则来支持本研究。在所有施用的活度中使用第75百分位数来确定成人患者的DRL，并为儿童患者设置额外的校正因子。针对所有诊断检查，根据平均施用活度计算核医学程序的辐射剂量。

结果与讨论

巴西共有107家核医学服务机构同意参与该项目。在所研究的64种核医学程序中，发现骨、肾和甲状旁腺扫描在所有分析的核医学服务机构中使用超过85%。在应用相同程序时，所施用活度之间存在很大差异，在某些情况下，最低值和最高值之间相差超过20倍。基于镓、铊和碘放射性同位素的诊断检查被证明是给患者施用辐射剂量的主要检查。将DRL概念引入临床常规后，与先前报告的施用活度相比患者接受的辐射剂量最低减少约15%，最高减少95%，平均减少50%。