Niveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de Bogotá

ilustraciones, diagramas, fotografías, gráficas

Autores:: Londoño Arévalo, María Antonieta

Tipo de recurso:

Fecha de publicación:: 2022

Institución:: Universidad Nacional de Colombia

Repositorio:: Universidad Nacional de Colombia

Idioma:: spa

id	UNACIONAL2_b886101bc8038a75413d41a156a4b155
oai_identifier_str	oai:repositorio.unal.edu.co:unal/82905
network_acronym_str	UNACIONAL2
network_name_str	Universidad Nacional de Colombia
repository_id_str
dc.title.spa.fl_str_mv	Niveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de Bogotá
dc.title.translated.eng.fl_str_mv	Reference levels of diagnosis in computed tomography in a high complexity pediatric hospital of the city of Bogotá
title	Niveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de Bogotá
spellingShingle	Niveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de Bogotá 610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría Tomografía Computarizada por Rayos X Niveles de Referencia para Diagnóstico Tomography, X-Ray Computed Diagnostic Reference Levels Tomografía computarizada Diagnóstico Pediatría Computed tomography Diagnosis Pediatrics
title_short	Niveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de Bogotá
title_full	Niveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de Bogotá
title_fullStr	Niveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de Bogotá
title_full_unstemmed	Niveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de Bogotá
title_sort	Niveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de Bogotá
dc.creator.fl_str_mv	Londoño Arévalo, María Antonieta
dc.contributor.advisor.none.fl_str_mv	Moreno Gómez, Luz Ángela
dc.contributor.author.none.fl_str_mv	Londoño Arévalo, María Antonieta
dc.contributor.colaborator.none.fl_str_mv	Henao Gómez, Liliana López Cadena, Andrés Fernando
dc.contributor.researchgroup.spa.fl_str_mv	Grupo de Investigación en Radiología E Imágenes Diagnósticas (Grid)
dc.contributor.orcid.spa.fl_str_mv	Londoño Arévalo, Maria [0000-0002-1441-3354]
dc.contributor.cvlac.spa.fl_str_mv	Londoño Arévalo, María [https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001569205]
dc.subject.ddc.spa.fl_str_mv	610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría
topic	610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría Tomografía Computarizada por Rayos X Niveles de Referencia para Diagnóstico Tomography, X-Ray Computed Diagnostic Reference Levels Tomografía computarizada Diagnóstico Pediatría Computed tomography Diagnosis Pediatrics
dc.subject.decs.spa.fl_str_mv	Tomografía Computarizada por Rayos X Niveles de Referencia para Diagnóstico
dc.subject.decs.eng.fl_str_mv	Tomography, X-Ray Computed Diagnostic Reference Levels
dc.subject.proposal.spa.fl_str_mv	Tomografía computarizada Diagnóstico Pediatría
dc.subject.proposal.eng.fl_str_mv	Computed tomography Diagnosis Pediatrics
description	ilustraciones, diagramas, fotografías, gráficas
publishDate	2022
dc.date.issued.none.fl_str_mv	2022
dc.date.accessioned.none.fl_str_mv	2023-01-12T20:36:05Z
dc.date.available.none.fl_str_mv	2023-01-12T20:36:05Z
dc.type.spa.fl_str_mv	Trabajo de grado - Especialidad Médica
dc.type.driver.spa.fl_str_mv	info:eu-repo/semantics/masterThesis
dc.type.version.spa.fl_str_mv	info:eu-repo/semantics/acceptedVersion
dc.type.content.spa.fl_str_mv	Text
dc.type.redcol.spa.fl_str_mv	http://purl.org/redcol/resource_type/TM
status_str	acceptedVersion
dc.identifier.uri.none.fl_str_mv	https://repositorio.unal.edu.co/handle/unal/82905
dc.identifier.instname.spa.fl_str_mv	Universidad Nacional de Colombia
dc.identifier.reponame.spa.fl_str_mv	Repositorio Institucional Universidad Nacional de Colombia
dc.identifier.repourl.spa.fl_str_mv	https://repositorio.unal.edu.co/
url	https://repositorio.unal.edu.co/handle/unal/82905 https://repositorio.unal.edu.co/
identifier_str_mv	Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia
dc.language.iso.spa.fl_str_mv	spa
language	spa
dc.relation.references.spa.fl_str_mv	Abalo, K. D., Rage, E., Leuraud, K., Richardson, D. B., le Pointe, H. D., Laurier, D., & Bernier, M. O. (2021). Early life ionizing radiation exposure and cancer risks: systematic review and meta-analysis. Pediatric Radiology, 51(1), 45–56. https://doi.org/10.1007/s00247-020-04803-0 ACR-AAPM-SPR General Diagnostic Radiology Practice Parameters. Practice parameter for diagnostic reference levels and achievable doses in medical x-ray imaging. Disponible en: ACR–AAPM–SPR Practice Parameter for Diagnostic Reference Levels and Achievable Doses in Medical X-Ray Imaging Alzen, G., & Benz-Bohm, G. (2011). Kinderradiologie - besonderheiten des strahlenschutzes. In Deutsches Arzteblatt (Vol. 108, Issue 24, pp. 407–414). https://doi.org/10.3238/arztebl.2011.0407 American Association of Physycists in Medicine (AAPM). Size-specifric dose estimates (SSDE) in pediatric and adult body CT examinations: the report of AAPM Task Group 204. htps://www.aapm.org/pubs/reports/RPT_204. Pdf. Published 2011. Accessed October 9, 2021 American Association of Physicists in Medicine. (AAPM). (s.f). CT Scan Protocols - The Alliance for Quality Computed Tomography. Disponible en: https://www.aapm.org/pubs/CTProtocols Amis, E. S., & Butler, P. F. (2010). ACR white paper on radiation dose in medicine: Three years later. In Journal of the American College of Radiology (Vol. 7, Issue 11, pp. 865–870). Elsevier. https://doi.org/10.1016/j.jacr.2010.04.006 Amurao, M., King, S. H., Becker, M. D., Sheetz, M. A., Franz, S. C., Rubinstein, A. E., Gress, D. A., & Creech, W. (n.d.). ACR-AAPM Radiation Safety Officer Resources ACR-AAPM Radiation Safety Officer Resources ACR-AAPM Radiation Safety Officer Resources iii. Brady, A. P., Beets-Tan, R. G., Brkljačić, B., Catalano, C., Rockall, A., & Fuchsjäger, M. (2022). The role of radiologist in the changing world of healthcare: a White Paper of the European Society of Radiology (ESR). Insights into Imaging, 13(1). https://doi.org/10.1186/s13244-022-01241-4 Bos, D., Zensen, S., Opitz, M. K., Haubold, J., Nassenstein, K., Kinner, S., Schweiger, B., Forsting, M., Wetter, A., & Guberina, N. (2022). Diagnostic reference levels for chest computed tomography in children as a function of patient size. Pediatric Radiology, 52(8), 1446–1455. https://doi.org/10.1007/s00247-022-05340- 8 Cadavid Álvarez, L. M., Poveda Bolaño, J. F., Palacio Montoya, M. F., González Londoño, J. F., & Saldarriaga Arango, M. F. (2020). Niveles de referencia de dosis de radiación para la toma de imágenes en pediatría. Rev. Colomb. Radiol., 31(2), 5328–5334. Célier, D., Roch, P., Etard, C., Ducou Le Pointe, H., & Brisse, H. J. (2020). Multicentre survey on patient dose in paediatric imaging and proposal for updated diagnostic reference levels for France. Part 1: computed tomography. European Radiology, 30(2), 1156–1165. https://doi.org/10.1007/s00330-019-06405-3 De Crop, A., Smeets, P., Hoof, T.V., et al., 2015. Correlation of clinical and physical technical image quality in chest CT: a human cadaver study applied on iterative reconstruction. BMC Med. Imag. 15, 32 De Jesus FM, Magalhães LAG, Kodlulovich S. Paediatric CT exposure practice in the county of Rio de Janeiro: the need to establish diagnostic reference levels. Radiat Prot Dosimetry. noviembre de 2016;171(3):389-97 European Commission. Radiation Protection No 185 - European Guidelines on Diagnostic Reference Levels for Paediatric Imaging [Internet]. 2018 [citado 26 de enero de 2021]. Disponible en: http://www.eurosafeimaging.org/wp/wp content/uploads/2018/09/rp_185.pdf Food and drug administration (FDA). White paper: Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging. 2018. Disponible en: Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging \| FDA Frush DP, Soden B, Frush KS, Lowry C. Improved pediatric multidetector body CT using a size-based color-coded format. AJR Am J Roentgenol. 2002 Mar;178(3):721- 6. Doi: 10.2214/ajr.178.3.1780721. PMID: 11856705. Granata, C., Sorantin, E., Seuri, R., & Owens, C. M. (2019). European Society of Paediatric Radiology Computed Tomography and Dose Task Force: European guidelines on diagnostic reference levels for paediatric imaging. Pediatric Radiology, 49(5), 702–705. https://doi.org/10.1007/s00247-019-04346-z https://doi.org/10.1007/s00247-019-04346-z Greenwood, T. J., Lopez-Costa, R. I., Rhoades, P. D., Ramírez-Giraldo, J. C., Starr, M., Street, M., Duncan, J., & McKinstry, R. C. (2015). CT dose optimization in pediatric radiology: A multiyear effort to preserve the benefits of imaging while reducing the risks. Radiographics, 35(5), 1539–1554. https://doi.org/10.1148/rg.2015140267 Goske, M. J., Charkot, E., Herrmann, T., John, S. D., Mills, T. T., Morrison, G., & Smith, S. N. (2011). Image Gently: Challenges for radiologic technologists when performing digital radiography in children. Pediatric Radiology, 41(5), 611–619. https://doi.org/10.1007/s00247-010-1957-3 Hall EJ. Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol Roentgenol Nucl Med Ultrasound CT MRI. 1 de octubre de 2002;32(10):700-700-6. https://doi.org/10.1007/s00247-002-0774-8 . Harding K, Thomson WH. Radiological protection and safety in medicine - ICRP 73. Eur J Nucl Med. octubre de 1997;24(10):1207 Huda, W. (2004). Assessment of the problem: Pediatric doses in screen-film and digital radiography. Pediatric Radiology, 34(SUPPL. 3), 173–182. https://doi.org/10.1007/s00247-004-1267-8 IAEA Safety standards and related publications. (n.d.). http://www-ns.iaea.org/standards/ IEC, 2012. Medical Electrical Equipment – Part 2-44: Particular Requirements for the Basic Safety and Essential Performance of X-ray Equipment for Computed Tomography. IEC 60601-2-44, ed 3.1. IEC, Geneva. International Commission on Radiation Units and Measurements (ICRU), 1995. Medical imaging – the assessment of image quality. Report 54. International Commission on Radiation Units and Measurements, Bethesda, MD International Commission on Radiation Units and Measurements. ICRU Report No. 87: Radiation dose and image-quality assessment in computed tomography. J ICRU. 2012 Apr;12(1):1-149. doi: 10.1093/jicru/ndt007. PMID: 24158924. International Commission on Radiological Protection (ICRP), 1977. Recommendations of the ICRP. ICRP Publication 26. Ann. ICRP 1(3): 1 - 53. International Commission on Radiological Protection (ICRP), 1990. Recommendations of International Commission on Radiological Protection. ICRP Publication 60. Ann ICRP 21:1–120 Ann 1991;21(1-3):1-201. PMID: 2053748 International Commission on Radiological Protection (ICRP), 1996. Harding K, Thomson WH. Radiological protection and safety in medicine - ICRP Publication 73. Eur J Nucl Med. 1997 Oct;24(10):1207-9. PMID: 9323259. International Commission on Radiological Protection (ICRP), 2007a. ICRP Publication 103. The 2007 Recommendations of the International Commission on Radiological Protection. Ann ICRP. 2007;37(2-4):1-332. Doi: 10.1016/j.icrp.2007.10.003. PMID: 18082557. ICRP, Khong PL, Ringertz H, Donoghue V, Frush D, Rehani M, Appelgate K, Sanchez R. ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP. 2013 Apr;42(2):1-63. Doi: 10.1016/j.icrp.2012.10.001. Erratum in: Ann ICRP. 2020 Oct 5;146645320966413. Erratum in: Ann ICRP. 2021 Mar 25;1466453211000254. PMID: 23218172. ICRP, Vañó E, Miller DL, Martin CJ, Rehani MM, Kang K, Rosenstein M, Ortiz-López P, Mattsson S, Padovani R, Rogers A; Authors on behalf of ICRP. ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging. Ann ICRP. 2017 Oct;46(1):1- 144. Doi: 10.1177/0146645317717209. PMID: 29065694. IPSM/NRPB/CoR, 1992. National Protocol for Patient Dose Measurements in Diagnostic Radiology. National Radiological Protection Board, Chilton. Disponible en: Diagnostic radiology: national protocol for patient dose measurements - GOV.UK (www.gov.uk) International Radiation Protection Association (IRPA). IRPA Guiding Principles on radiation protection culture. 2014. Disponible en: IRPA - INTERNATIONAL RADIATION PROTECTION ASSOCIATION. IRPA Guiding Principles on RP Culture (2014).pdf Integrated Development Environment for R. RStudio, PBC, Boston, MA URL http://www.rstudio.com/). Järvinen H, Seuri R, Kortesniemi M, Lajunen A, Hallinen E, Savikurki-Heikkilä P, et al. Indication-based national diagnostic reference levels for paediatric CT: a new approach with proposed values. Radiat Prot Dosimetry. julio de 2015;165(1-4):86- 90. https://doi.org/10.1093/rpd/ncv044 Kanal, K. M., Butler, P. F., Chatfield, M. B., Wells, J., Samei, E., Simanowith, M., Golden, D., Gress, D. A., Burleson, J., Sensakovic, W. F., Strauss, K. J., & Frush, D. (2022). U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations. Radiology, 302(1), 164–174. https://doi.org/10.1148/radiol.2021211241 Kleinman, P.L., Strauss, K.J., Zurakowski, D., Buckley, K.S., Taylor, G.A., 2010. Patient size measured on CT images as a function of age at a tertiary care children’s hospital. AJR. Am. J. Roentgenol. 194, 1611–1619. Kalender W.A, Wolf H, Suess C, Gies M, Greess H, Bautz W.A. Dose reduction in CT by on-line tube current control principles and validation on phantoms and cadavers. Eur Radiol. 1999; 9: 323-328 Leung RS. Radiation protection of the child from diagnostic imaging. Curr Pediatr Rev.1 de enero de 2015;11(4):235-235-42 Linet, M. S., Kim, K. P., & Rajaraman, P. (2009). Children’s exposure to diagnostic medical radiation and cancer risk: Epidemiologic and dosimetric considerations. Pediatric Radiology, 39(SUPPL. 1). https://doi.org/10.1007/s00247-008-1026-3 Mahesh M. Update on radiation safety and dose reduction in pediatric neuroradiology. Pediatr Radiol. 1 de septiembre de 2015;45 Suppl 3:S370-S370 Mcnitt-Gray, M. F., & Morin, R. L. (2004). Selecting a New Computed Tomography Scanner: Things to Consider. www.acr.org/dyna/?docdepartments/stand_ Pearce MS, Salotti JA, Little MP, McHugh K, LeeC, Kim KP, Howe NL; Ronckers CM, Rajaraman P, Sir Craft AW, Parker L, Berrington de Gonzalez A. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancer. 2012 Aug 4;380(9840):499-505.doi: 10.1016/S0140-6736(12)60815-0.Epub 2012 Jun 7. PMID: 22681860; PMCID: PMC2418594. Ploussi, A., & Efstathopoulos, E. P. (2016). Importance of establishing radiation protection culture in Radiology Department. World Journal of Radiology, 8(2), 142. https://doi.org/10.4329/wjr.v8.i2.142 Rehani, M. M., Szczykutowicz, T. P., & Zaidi, H. (2020). CT is still not a low-dose imaging modality. In Medical Physics (Vol. 47, Issue 2, pp. 293–296). John Wiley and Sons Ltd. https://doi.org/10.1002/mp.14000 Rehani, M. M., & Brady, Z. (2021). Contemporary issues in radiation protection in medical imaging special feature: editorial Contemporary issues in radiation protection in medical imaging: introductory editorial 1. Samei, E., Christianson, O., 2014. Dose index analytics: more than a low number. J. Am. Coll. Radiol. 11, 832–834. Satharasinghe, D. M., Jeyasugiththan, J., Wanninayake, W. M. N. M. B., & Pallewatte, A. S. (2021). Paediatric diagnostic reference levels in computed tomography: A systematic review. In Journal of Radiological Protection (Vol. 41, Issue 1, pp. R1–R27). IOP Publishing Ltd. https://doi.org/10.1088/1361- 6498/abd840 Seidenbusch, M.C., Schneider, K., 2014. Conversion coefficients for determining organ doses in paediatric pelvis and hip joint radiography. Pediatr. Radiol. 44, 1110– 1123. Schauer DA, Linton OW. NCRP Report No. 160, Ionizing Radiation Exposure of the Population of the United States, medical exposure--are we doing less with more, and is there a role for health physicists? Health Phys. 2009 Jul;97(1):1-5. doi: 10.1097/01.HP.0000356672.44380.b7. PMID: 19509507 Siciliano, R. (2017). Radiological examinations in pediatric age. Annali Di Igiene Medicina Preventiva e Di Comunita, 29(2), 134–140. https://doi.org/10.7416/ai.2017.2140 Siegel, M. J., Mhlanga, J. C., Salter, A., & Ramirez-Giraldo, J. C. (2021). Comparison of radiation dose and image quality between contrast-enhanced single- and dual energy abdominopelvic computed tomography in children as a function of patient size. Pediatric Radiology, 51(11), 2000–2008. https://doi.org/10.1007/s00247-021- 05127-3 Slovis TL. CT and computed radiography: the pictures are great, but is the radiation dose greater than required? AJR Am J Roentgenol. 2002 Jul;179(1):39-41. DOI: 10.2214/ajr.179.1.1790039. PMID: 12076901. Slovis TL, Berdon WE. The ALARA concept in pediatric CT intelligent dose reduction. Pediatr Radiol 2002;32:217–317 Strauss, K. J., Racadio, J. M., Johnson, N., Patel, M., & Nachabe, R. A. (2015). Estimates of diagnostic reference levels for pediatric peripheral and abdominal fluoroscopically guided procedures. American Journal of Roentgenology, 204(6), W713–W719. https://doi.org/10.2214/AJR.14.13630 Strauss KJ, Somasundaram E, Sengupta D, Marin JR, Brady SL. Radiation Dose for Pediatric CT: Comparison of Pediatric versus Adult Imaging Facilities. Radiology 2019;291(1) Vassileva, J., Rehani, M., Kostova-Lefterova, D., et al., 2015. A study to establish international diagnostic reference levels for paediatric computed tomography. Radiat. Prot. Dosim. 165, 70–80. Vawda, Z., Pitcher, R., Akudugu, J., & Groenewald, W. (2015). Diagnostic reference levels for paediatric computed tomography. South African Journal of Radiology, 19(2). https://doi.org/10.4102/sajr.v19i2.846 Watson, D.J., Coakley, K.S., 2010. Paediatric CT reference doses based on weight and CT dosimetry phantom size: local experience using a 64-slice CT scanner. Pediatr. Radiol. 40, 693–703
dc.rights.spa.fl_str_mv	Derechos reservados al autor, 2022
dc.rights.coar.fl_str_mv	http://purl.org/coar/access_right/c_abf2
dc.rights.license.spa.fl_str_mv	Reconocimiento 4.0 Internacional
dc.rights.uri.spa.fl_str_mv	http://creativecommons.org/licenses/by/4.0/
dc.rights.accessrights.spa.fl_str_mv	info:eu-repo/semantics/openAccess
rights_invalid_str_mv	Reconocimiento 4.0 Internacional Derechos reservados al autor, 2022 http://creativecommons.org/licenses/by/4.0/ http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv	openAccess
dc.format.extent.spa.fl_str_mv	59 páginas
dc.format.mimetype.spa.fl_str_mv	application/pdf
dc.coverage.city.spa.fl_str_mv	Bogotá
dc.publisher.spa.fl_str_mv	Universidad Nacional de Colombia
dc.publisher.program.spa.fl_str_mv	Bogotá - Medicina - Especialidad en Radiología Pediátrica
dc.publisher.faculty.spa.fl_str_mv	Facultad de Medicina
dc.publisher.place.spa.fl_str_mv	Bogotá, Colombia
dc.publisher.branch.spa.fl_str_mv	Universidad Nacional de Colombia - Sede Bogotá
institution	Universidad Nacional de Colombia
bitstream.url.fl_str_mv	https://repositorio.unal.edu.co/bitstream/unal/82905/1/license.txt https://repositorio.unal.edu.co/bitstream/unal/82905/2/43984393.2022.pdf https://repositorio.unal.edu.co/bitstream/unal/82905/3/43984393.2022.pdf.jpg
bitstream.checksum.fl_str_mv	eb34b1cf90b7e1103fc9dfd26be24b4a 63454c13e11fb2638f35fff6a7006a5b 7636ce383d237a49ef80889c98e8c928
bitstream.checksumAlgorithm.fl_str_mv	MD5 MD5 MD5
repository.name.fl_str_mv	Repositorio Institucional Universidad Nacional de Colombia
repository.mail.fl_str_mv	repositorio_nal@unal.edu.co
_version_	1814089408891060224
spelling	Reconocimiento 4.0 InternacionalDerechos reservados al autor, 2022http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Moreno Gómez, Luz Ángelad80106f385b1f67170dfc36a43b379aaLondoño Arévalo, María Antonieta5e1207a318a423647c114307d0b47243600Henao Gómez, LilianaLópez Cadena, Andrés FernandoGrupo de Investigación en Radiología E Imágenes Diagnósticas (Grid)Londoño Arévalo, Maria [0000-0002-1441-3354]Londoño Arévalo, María [https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001569205]2023-01-12T20:36:05Z2023-01-12T20:36:05Z2022https://repositorio.unal.edu.co/handle/unal/82905Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, diagramas, fotografías, gráficasObjetivo: El objetivo de este estudio fue determinar los niveles de referencia diagnóstico locales (NRDL) y las dosis alcanzables (DA) para pacientes pediátricos durante los procedimientos de tomografía computarizada (TC) más comunes en un hospital pediátrico de tercer nivel en la ciudad de Bogotá, Colombia. Metodología: Estudio observacional descriptivo retrospectivo de corte transversal que incluyó estudios en un periodo de tiempo comprendido entre enero 2019 y abril 2022, de una fase, de cráneo, tórax simple, tórax contrastado y abdomen-pelvis contrastado. El Nivel de referencia de diagnóstico (NRD) se obtuvo en función del índice de dosis de TC de volumen (CTDI vol) y el producto de longitud de dosis (DLP) para cinco grupos de edad en población pediátrica (hasta 18 años). Resultados: Los datos de los pacientes (577) en cuanto a CTDI vol y DLP se registraron de cinco grupos etarios, de tal forma que los resultados pudieran ser comparados con las publicaciones existentes en la literatura. Los percentiles 75 de CTDI vol y DLP se consideraron como valores de NRDL y los percentiles 50 se describieron como DA para esos parámetros. En consecuencia, los NRDL adquiridos se compararon con otros valores publicados nacional e internacionalmente. Conclusiones: El NRD desempeña un papel fundamental en la optimización de las dosis de radiación administradas a los pacientes y en la mejora de su protección. Este estudio proporciona los NRD y AD locales para la tomografía computarizada pediátrica más común en el Hospital de referencia y se plantean propuestas de mejora que permitan optimizar la práctica clínica y seguridad de los pacientes. (Texto tomado de la fuente)Objective: To determine local diagnostic reference levels (LDRL) and achievable doses (AD) of common pediatric CT procedures in a third-level pediatric hospital in the city of Bogotá Colombia. Methodology: Retrospective cross-sectional descriptive observational study that included single phase studies (head CT, thorax with and without contrast and abdomen-pelvis) between January 2019 and April 2022. Standard dose indexes (volume CT dose index - CTDI vol- and dose length product -DLP- were categorized by body part and age in patients under 18 years of age. Results: Patient data (577 studies) on CTDI vol and DLP were recorded from five age groups so that the results could be compared with the existing publications in the literature. The 75th percentiles of CTDI vol and DLP were considered as LDRL values and the 50 th percentiles were described as DA. Accordingly, the acquired LDRL were compared with national and international published values Conclusions: DRL plays a critical role in optimizing radiation doses administered to patients and improving radioprotection. This study provides the local DRL and AD for the most common pediatric computed tomography studies in the reference hospital and proposes strategies to promote the improvement and optimizing clinical practice and patient safety.Especialidades MédicasEspecialista en Radiología PediátricaEstudio Observacional descriptivo retrospectivo de corte transversalImágenes pediátricas59 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en Radiología PediátricaFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatríaTomografía Computarizada por Rayos XNiveles de Referencia para DiagnósticoTomography, X-Ray ComputedDiagnostic Reference LevelsTomografía computarizadaDiagnósticoPediatríaComputed tomographyDiagnosisPediatricsNiveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de BogotáReference levels of diagnosis in computed tomography in a high complexity pediatric hospital of the city of BogotáTrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMBogotáAbalo, K. D., Rage, E., Leuraud, K., Richardson, D. B., le Pointe, H. D., Laurier, D., & Bernier, M. O. (2021). Early life ionizing radiation exposure and cancer risks: systematic review and meta-analysis. Pediatric Radiology, 51(1), 45–56. https://doi.org/10.1007/s00247-020-04803-0ACR-AAPM-SPR General Diagnostic Radiology Practice Parameters. Practice parameter for diagnostic reference levels and achievable doses in medical x-ray imaging. Disponible en: ACR–AAPM–SPR Practice Parameter for Diagnostic Reference Levels and Achievable Doses in Medical X-Ray ImagingAlzen, G., & Benz-Bohm, G. (2011). Kinderradiologie - besonderheiten des strahlenschutzes. In Deutsches Arzteblatt (Vol. 108, Issue 24, pp. 407–414). https://doi.org/10.3238/arztebl.2011.0407American Association of Physycists in Medicine (AAPM). Size-specifric dose estimates (SSDE) in pediatric and adult body CT examinations: the report of AAPM Task Group 204. htps://www.aapm.org/pubs/reports/RPT_204. Pdf. Published 2011. Accessed October 9, 2021American Association of Physicists in Medicine. (AAPM). (s.f). CT Scan Protocols - The Alliance for Quality Computed Tomography. Disponible en: https://www.aapm.org/pubs/CTProtocolsAmis, E. S., & Butler, P. F. (2010). ACR white paper on radiation dose in medicine: Three years later. In Journal of the American College of Radiology (Vol. 7, Issue 11, pp. 865–870). Elsevier. https://doi.org/10.1016/j.jacr.2010.04.006Amurao, M., King, S. H., Becker, M. D., Sheetz, M. A., Franz, S. C., Rubinstein, A. E., Gress, D. A., & Creech, W. (n.d.). ACR-AAPM Radiation Safety Officer Resources ACR-AAPM Radiation Safety Officer Resources ACR-AAPM Radiation Safety Officer Resources iii.Brady, A. P., Beets-Tan, R. G., Brkljačić, B., Catalano, C., Rockall, A., & Fuchsjäger, M. (2022). The role of radiologist in the changing world of healthcare: a White Paper of the European Society of Radiology (ESR). Insights into Imaging, 13(1). https://doi.org/10.1186/s13244-022-01241-4Bos, D., Zensen, S., Opitz, M. K., Haubold, J., Nassenstein, K., Kinner, S., Schweiger, B., Forsting, M., Wetter, A., & Guberina, N. (2022). Diagnostic reference levels for chest computed tomography in children as a function of patient size. Pediatric Radiology, 52(8), 1446–1455. https://doi.org/10.1007/s00247-022-05340- 8Cadavid Álvarez, L. M., Poveda Bolaño, J. F., Palacio Montoya, M. F., González Londoño, J. F., & Saldarriaga Arango, M. F. (2020). Niveles de referencia de dosis de radiación para la toma de imágenes en pediatría. Rev. Colomb. Radiol., 31(2), 5328–5334.Célier, D., Roch, P., Etard, C., Ducou Le Pointe, H., & Brisse, H. J. (2020). Multicentre survey on patient dose in paediatric imaging and proposal for updated diagnostic reference levels for France. Part 1: computed tomography. European Radiology, 30(2), 1156–1165. https://doi.org/10.1007/s00330-019-06405-3De Crop, A., Smeets, P., Hoof, T.V., et al., 2015. Correlation of clinical and physical technical image quality in chest CT: a human cadaver study applied on iterative reconstruction. BMC Med. Imag. 15, 32De Jesus FM, Magalhães LAG, Kodlulovich S. Paediatric CT exposure practice in the county of Rio de Janeiro: the need to establish diagnostic reference levels. Radiat Prot Dosimetry. noviembre de 2016;171(3):389-97European Commission. Radiation Protection No 185 - European Guidelines on Diagnostic Reference Levels for Paediatric Imaging [Internet]. 2018 [citado 26 de enero de 2021]. Disponible en: http://www.eurosafeimaging.org/wp/wp content/uploads/2018/09/rp_185.pdfFood and drug administration (FDA). White paper: Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging. 2018. Disponible en: Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging \| FDAFrush DP, Soden B, Frush KS, Lowry C. Improved pediatric multidetector body CT using a size-based color-coded format. AJR Am J Roentgenol. 2002 Mar;178(3):721- 6. Doi: 10.2214/ajr.178.3.1780721. PMID: 11856705.Granata, C., Sorantin, E., Seuri, R., & Owens, C. M. (2019). European Society of Paediatric Radiology Computed Tomography and Dose Task Force: European guidelines on diagnostic reference levels for paediatric imaging. Pediatric Radiology, 49(5), 702–705. https://doi.org/10.1007/s00247-019-04346-z https://doi.org/10.1007/s00247-019-04346-zGreenwood, T. J., Lopez-Costa, R. I., Rhoades, P. D., Ramírez-Giraldo, J. C., Starr, M., Street, M., Duncan, J., & McKinstry, R. C. (2015). CT dose optimization in pediatric radiology: A multiyear effort to preserve the benefits of imaging while reducing the risks. Radiographics, 35(5), 1539–1554. https://doi.org/10.1148/rg.2015140267Goske, M. J., Charkot, E., Herrmann, T., John, S. D., Mills, T. T., Morrison, G., & Smith, S. N. (2011). Image Gently: Challenges for radiologic technologists when performing digital radiography in children. Pediatric Radiology, 41(5), 611–619. https://doi.org/10.1007/s00247-010-1957-3Hall EJ. Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol Roentgenol Nucl Med Ultrasound CT MRI. 1 de octubre de 2002;32(10):700-700-6. https://doi.org/10.1007/s00247-002-0774-8. Harding K, Thomson WH. Radiological protection and safety in medicine - ICRP 73. Eur J Nucl Med. octubre de 1997;24(10):1207Huda, W. (2004). Assessment of the problem: Pediatric doses in screen-film and digital radiography. Pediatric Radiology, 34(SUPPL. 3), 173–182. https://doi.org/10.1007/s00247-004-1267-8IAEA Safety standards and related publications. (n.d.). http://www-ns.iaea.org/standards/IEC, 2012. Medical Electrical Equipment – Part 2-44: Particular Requirements for the Basic Safety and Essential Performance of X-ray Equipment for Computed Tomography. IEC 60601-2-44, ed 3.1. IEC, Geneva.International Commission on Radiation Units and Measurements (ICRU), 1995. Medical imaging – the assessment of image quality. Report 54. International Commission on Radiation Units and Measurements, Bethesda, MDInternational Commission on Radiation Units and Measurements. ICRU Report No. 87: Radiation dose and image-quality assessment in computed tomography. J ICRU. 2012 Apr;12(1):1-149. doi: 10.1093/jicru/ndt007. PMID: 24158924.International Commission on Radiological Protection (ICRP), 1977. Recommendations of the ICRP. ICRP Publication 26. Ann. ICRP 1(3): 1 - 53.International Commission on Radiological Protection (ICRP), 1990. Recommendations of International Commission on Radiological Protection. ICRP Publication 60. Ann ICRP 21:1–120 Ann 1991;21(1-3):1-201. PMID: 2053748International Commission on Radiological Protection (ICRP), 1996. Harding K, Thomson WH. Radiological protection and safety in medicine - ICRP Publication 73. Eur J Nucl Med. 1997 Oct;24(10):1207-9. PMID: 9323259.International Commission on Radiological Protection (ICRP), 2007a. ICRP Publication 103. The 2007 Recommendations of the International Commission on Radiological Protection. Ann ICRP. 2007;37(2-4):1-332. Doi: 10.1016/j.icrp.2007.10.003. PMID: 18082557.ICRP, Khong PL, Ringertz H, Donoghue V, Frush D, Rehani M, Appelgate K, Sanchez R. ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP. 2013 Apr;42(2):1-63. Doi: 10.1016/j.icrp.2012.10.001. Erratum in: Ann ICRP. 2020 Oct 5;146645320966413. Erratum in: Ann ICRP. 2021 Mar 25;1466453211000254. PMID: 23218172.ICRP, Vañó E, Miller DL, Martin CJ, Rehani MM, Kang K, Rosenstein M, Ortiz-López P, Mattsson S, Padovani R, Rogers A; Authors on behalf of ICRP. ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging. Ann ICRP. 2017 Oct;46(1):1- 144. Doi: 10.1177/0146645317717209. PMID: 29065694.IPSM/NRPB/CoR, 1992. National Protocol for Patient Dose Measurements in Diagnostic Radiology. National Radiological Protection Board, Chilton. Disponible en: Diagnostic radiology: national protocol for patient dose measurements - GOV.UK (www.gov.uk)International Radiation Protection Association (IRPA). IRPA Guiding Principles on radiation protection culture. 2014. Disponible en: IRPA - INTERNATIONAL RADIATION PROTECTION ASSOCIATION. IRPA Guiding Principles on RP Culture (2014).pdfIntegrated Development Environment for R. RStudio, PBC, Boston, MA URL http://www.rstudio.com/).Järvinen H, Seuri R, Kortesniemi M, Lajunen A, Hallinen E, Savikurki-Heikkilä P, et al. Indication-based national diagnostic reference levels for paediatric CT: a new approach with proposed values. Radiat Prot Dosimetry. julio de 2015;165(1-4):86- 90. https://doi.org/10.1093/rpd/ncv044Kanal, K. M., Butler, P. F., Chatfield, M. B., Wells, J., Samei, E., Simanowith, M., Golden, D., Gress, D. A., Burleson, J., Sensakovic, W. F., Strauss, K. J., & Frush, D. (2022). U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations. Radiology, 302(1), 164–174. https://doi.org/10.1148/radiol.2021211241Kleinman, P.L., Strauss, K.J., Zurakowski, D., Buckley, K.S., Taylor, G.A., 2010. Patient size measured on CT images as a function of age at a tertiary care children’s hospital. AJR. Am. J. Roentgenol. 194, 1611–1619.Kalender W.A, Wolf H, Suess C, Gies M, Greess H, Bautz W.A. Dose reduction in CT by on-line tube current control principles and validation on phantoms and cadavers. Eur Radiol. 1999; 9: 323-328Leung RS. Radiation protection of the child from diagnostic imaging. Curr Pediatr Rev.1 de enero de 2015;11(4):235-235-42Linet, M. S., Kim, K. P., & Rajaraman, P. (2009). Children’s exposure to diagnostic medical radiation and cancer risk: Epidemiologic and dosimetric considerations. Pediatric Radiology, 39(SUPPL. 1). https://doi.org/10.1007/s00247-008-1026-3Mahesh M. Update on radiation safety and dose reduction in pediatric neuroradiology. Pediatr Radiol. 1 de septiembre de 2015;45 Suppl 3:S370-S370Mcnitt-Gray, M. F., & Morin, R. L. (2004). Selecting a New Computed Tomography Scanner: Things to Consider. www.acr.org/dyna/?docdepartments/stand_Pearce MS, Salotti JA, Little MP, McHugh K, LeeC, Kim KP, Howe NL; Ronckers CM, Rajaraman P, Sir Craft AW, Parker L, Berrington de Gonzalez A. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancer. 2012 Aug 4;380(9840):499-505.doi: 10.1016/S0140-6736(12)60815-0.Epub 2012 Jun 7. PMID: 22681860; PMCID: PMC2418594.Ploussi, A., & Efstathopoulos, E. P. (2016). Importance of establishing radiation protection culture in Radiology Department. World Journal of Radiology, 8(2), 142. https://doi.org/10.4329/wjr.v8.i2.142Rehani, M. M., Szczykutowicz, T. P., & Zaidi, H. (2020). CT is still not a low-dose imaging modality. In Medical Physics (Vol. 47, Issue 2, pp. 293–296). John Wiley and Sons Ltd. https://doi.org/10.1002/mp.14000Rehani, M. M., & Brady, Z. (2021). Contemporary issues in radiation protection in medical imaging special feature: editorial Contemporary issues in radiation protection in medical imaging: introductory editorial 1.Samei, E., Christianson, O., 2014. Dose index analytics: more than a low number. J. Am. Coll. Radiol. 11, 832–834.Satharasinghe, D. M., Jeyasugiththan, J., Wanninayake, W. M. N. M. B., & Pallewatte, A. S. (2021). Paediatric diagnostic reference levels in computed tomography: A systematic review. In Journal of Radiological Protection (Vol. 41, Issue 1, pp. R1–R27). IOP Publishing Ltd. https://doi.org/10.1088/1361- 6498/abd840Seidenbusch, M.C., Schneider, K., 2014. Conversion coefficients for determining organ doses in paediatric pelvis and hip joint radiography. Pediatr. Radiol. 44, 1110– 1123.Schauer DA, Linton OW. NCRP Report No. 160, Ionizing Radiation Exposure of the Population of the United States, medical exposure--are we doing less with more, and is there a role for health physicists? Health Phys. 2009 Jul;97(1):1-5. doi: 10.1097/01.HP.0000356672.44380.b7. PMID: 19509507Siciliano, R. (2017). Radiological examinations in pediatric age. Annali Di Igiene Medicina Preventiva e Di Comunita, 29(2), 134–140. https://doi.org/10.7416/ai.2017.2140Siegel, M. J., Mhlanga, J. C., Salter, A., & Ramirez-Giraldo, J. C. (2021). Comparison of radiation dose and image quality between contrast-enhanced single- and dual energy abdominopelvic computed tomography in children as a function of patient size. Pediatric Radiology, 51(11), 2000–2008. https://doi.org/10.1007/s00247-021- 05127-3Slovis TL. CT and computed radiography: the pictures are great, but is the radiation dose greater than required? AJR Am J Roentgenol. 2002 Jul;179(1):39-41. DOI: 10.2214/ajr.179.1.1790039. PMID: 12076901.Slovis TL, Berdon WE. The ALARA concept in pediatric CT intelligent dose reduction. Pediatr Radiol 2002;32:217–317Strauss, K. J., Racadio, J. M., Johnson, N., Patel, M., & Nachabe, R. A. (2015). Estimates of diagnostic reference levels for pediatric peripheral and abdominal fluoroscopically guided procedures. American Journal of Roentgenology, 204(6), W713–W719. https://doi.org/10.2214/AJR.14.13630Strauss KJ, Somasundaram E, Sengupta D, Marin JR, Brady SL. Radiation Dose for Pediatric CT: Comparison of Pediatric versus Adult Imaging Facilities. Radiology 2019;291(1)Vassileva, J., Rehani, M., Kostova-Lefterova, D., et al., 2015. A study to establish international diagnostic reference levels for paediatric computed tomography. Radiat. Prot. Dosim. 165, 70–80.Vawda, Z., Pitcher, R., Akudugu, J., & Groenewald, W. (2015). Diagnostic reference levels for paediatric computed tomography. South African Journal of Radiology, 19(2). https://doi.org/10.4102/sajr.v19i2.846Watson, D.J., Coakley, K.S., 2010. Paediatric CT reference doses based on weight and CT dosimetry phantom size: local experience using a 64-slice CT scanner. Pediatr. Radiol. 40, 693–703Niveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de BogotáEstudiantesInvestigadoresPúblico generalLICENSElicense.txtlicense.txttext/plain; charset=utf-85879https://repositorio.unal.edu.co/bitstream/unal/82905/1/license.txteb34b1cf90b7e1103fc9dfd26be24b4aMD51ORIGINAL43984393.2022.pdf43984393.2022.pdfTrabajo de grado de Especialidad en Radiología pediátricaapplication/pdf3233329https://repositorio.unal.edu.co/bitstream/unal/82905/2/43984393.2022.pdf63454c13e11fb2638f35fff6a7006a5bMD52THUMBNAIL43984393.2022.pdf.jpg43984393.2022.pdf.jpgGenerated Thumbnailimage/jpeg5738https://repositorio.unal.edu.co/bitstream/unal/82905/3/43984393.2022.pdf.jpg7636ce383d237a49ef80889c98e8c928MD53unal/82905oai:repositorio.unal.edu.co:unal/829052024-08-13 23:38:37.693Repositorio Institucional Universidad Nacional de Colombiarepositorio_nal@unal.edu.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

Niveles de referencia de diagnóstico en tomografía computarizada en un hospital pediátrico de alta complejidad de la ciudad de Bogotá

Publicaciones similares