Patterns and trends of Computed Tomography usage among pediatric and young adult patients in a private hospital in Rio de Janeiro, 2005-2015
DOI:
https://doi.org/10.15392/bjrs.v6i1.333Palavras-chave:
Computed Tomography, Patterns, Trends, PediatricResumo
Computed tomography (CT) scanning is a relatively high-dose procedure which use has been rapidly increasing in many countries, although a decline has been observed recently in some developed countries. Relatively little is known about CT usage in Brazil. A recent report showed that number of CT procedures among outpatients of the Brazilian public healthcare system (SUS) tripled from 2001 to 2011 and about 13% of all CTs procedures were underwent among pediatric and young adult patients. In the present study, we aimed to evaluate CT use in the private healthcare system, where the larger availability of CT scanners may result in a different CT usage pattern. We evaluated data from 15,892 CT procedures underwent by children and young adults (<20 years) between 2005 and 2015 in a private general hospital in the city of Rio de Janeiro. These procedures represented about 8% of the overall number of CT scans in the hospital over the study period. The number of CT examinations increased 10% per year, from 902 in 2005 to 2,376 in 2015. Head/neck was the most frequently examined body anatomical region for all age groups, except for patients aged 15-19 years for whom abdomen/pelvis was the most common scanned region. One third of the patients underwent more than one CT examination in the hospital during the study period, with multiple CT exams increasing with patient age. The greater availability of other diagnostic imaging examinations in the private setting, such as magnetic resonance and ultrasound, could have contributed to the lower proportion of pediatric and young adult CT in the study hospital. The rapid increase of pediatric CT usage in the public and private healthcare setting reinforces the need for initiatives to avoid unwarranted CT exposure in Brazil.Downloads
Referências
METTLER, F.A. JR.; BHARGAVAN, M., FAULKNER, K. et al. Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiadion dose, and comparison with other radiation sorces: 1950-2007. Radiology 253 (2): 520-531, 2009.
METTLER F.A. JR.; BHARGAVAN, M., FAULKNER, K. et al. Radiology and Diagnostic Nuclear Medicine: A Catalog. Radiology 248:254-263, 2008.
LINET, M. S.; KIM, K.; RAJARAMAN, P. Children’s exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol (2009) 39 (Suppl 1):S4-S26. DOI 10.1007/s00247-008-1026-3
LEVIN, D.C.; RAO, V.M.; PARKER, L. The recent downturn in utilization of CT: the start of a new trend? J Am Coll Radiol, 9(11):795-8, 2012.
MIGLIORETTI, D. L. et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk JAMA Pediatr. 167 700–7, 2013.
BRADY, Z.; CAIN, T. M.; JOHNSTON, P. N. Paediatric CT imaging trends in Australia J. Med. Imaging Radiat. Oncol, 55 132–42, 2011.
CHODICK, G.; RONCKERS, C.; RON, E.; SHALEV, V. The utilization of pediatric computed tomography in a large Israeli Health Maintenance Organization Pediatr. Radiol. 36 485–90, 2006.
BRENNER. D.J.; ELLISTON, C.; HALL, E. et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176(2):289-296, 2001.
SMITH-BINDMAN, R.; MIGLIORETTI, D.L.; JOHNSON, E.; LEE, C.; FEIGELSON, H.S.; FLYNN, M. et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA; 307(22):2400-9, 2012.
NHS. National Health Services. Total number of imaging and radiodiagnostic examinations or tests, by imaging modality, England, 1995-96 to 2012-13 England, UK: NHS; 2013. Available at: <http://www.england.nhs.uk/statistics/statistical-work-areas/diagnostic-waiting-times-and-activity/imaging-and-radiodiagnostics-annual-data.>. Last accessed: 25 Jun. 2017.
BERNIER, M.O.; REHEL, H.J. et al. Radiation exposure from CT in early childhood: a French large-scale multicentre study. Br J Radiol 85(1009):53-60, 2012.
GALANSKI, M,; NAGEL, H. D.; STAMM, G. Results of a federation inquiry 2005/2006: pediatric CT x-ray practice in Germany. Rofo, 179 1110–1, 2007.
BERRINGTON DE GONZÁLEZ, A.; MAHESH, M.; KIM, K.P. et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 169 (22):2071-2077, 2009.
METTLER, F. A. JR.; WIEST, P. W.; LOCKEN, J. A.; KELSEY, C. A. 200 CT scanning: patterns of use and dose J. Radiol. Prot. 20 353–9, 2000.
PEARCE, M. S. et al 2012 CT scans in young people in Great Britain: temporal and descriptive patterns, 1993–2002 Radiol. Res. Pract. 594278, 2012.
THOMAS, K.E. CT utilization--trends and developments beyond the United States' borders. Pediatric Radiology. 2011;41 Suppl 2:562-6.
MUHOGORA, W.E.; AHMED, N.A.; BEGANOVIC, A.; BENIDER, A.; CIRAJ-BJELAC, O.;, GERSHAN, V. et al. Patient doses in CT examinations in 18 countries: initial results from International Atomic Energy Agency projects. Radiation Protection Dosimetry, 136(2):118-26, 2009.
PEARCE, M.S. Patterns in paediatric CT use: an international and epidemiological perspective. J Med Imaging Radiat Oncol, 55(2):107-9, 2011.
DOVALES, A.C., et al., Patterns and trends of computed tomography usage in outpatients of the Brazilian public healthcare system, 2001-2011. J Radiol Prot, 36(3): p. 547-560, 2016.
MALTA, D. C. S.; PEREIRA, S. R.; AZEREDO, C.; SZWARCWALD, C. L.; OLIVEIRA, M.; REIS, A. C, DOS. Cobertura de Planos de Saúde na população brasileira, segundo a Pesquisa Nacional de Saúde, 2013. Ciência & Saúde Coletiva, 22(1), 179-190, 2017.
ANS - Agência Nacional de Saúde Suplementar (Health insurance regulatory agency in Brazil). Available at: <http://www.ans.gov.br/anstabnet/cgi-bin/tabnet?dados/tabnet_tx.def>. Last accessed in: April 14, 2017.
MUGOHORA WE, AHMED NA, ALSUWAIDI JS, BEGANOVIC A, CIRAJ-BJELAC O, GERSHAN V, et al. Paediatric CT examinations in 19 developing countries: frequency and radiation dose. Radiation Protection Dosimetry. 2010;140(1):49-58.
VASSILEVA J, REHANI MM, AL-DHUHI H, ALl-NAEMI HM, AL-SUWAIDI JS, APPALEGATE K, et al. IAEA survey of pediatric CT practice in 40 countries in Asia, Europe, Latin America, and Africa: Part 1, frequency and appropriateness. AJR American Journal of Roentgenology. 2012;198(5):1021-31.
AROUA A, BOUCHUD FO, VALLEY JF, VADER JP, VERDUN FR. Number of X-ray examinations performed on paediatric and geriatric patients compared with adult patients. Radiation Protection Dosimetry. 2007;123(3):402-8.
SUS Database [Internet]. Ministério da Saúde, Brasil. Available at: < http://tabnet.datasus.gov.br/cgi/tabcgi.exe?ibge/cnv/popbr.def>. Last accessed in: April 14, 2017.
GALANSKI M, NAGEL HD, STAMM G (2006) Paediatric CT exposure practice in the Federal Republic of Germany—results of a nation-wide survey in 2005/2006. Hannover Medical School, Hannover, Germany.
CRCPD (2007) Nationwide evaluation of x-ray trends (NEXT): tabulation and graphical summary of 2000 survey of computed tomography. Conference of Radiation Control Program Directors, Frankfort, KY.
FRENN, K.A., HENDRCKSON, M., KHARBANDA, A. A. Reducing Pediatric CT Usage through Web-Based Education. Radiology Management, 36(3):12-6; quiz 17-8, May-Jun 2014.
GEOFFREY D. RUBIN, JONATHON LEIPSIC, U. JOSEPH SCHOEPF, DOMINIK FLEISCHMANN, SANDY NAPEL. CT Angiography after 20 Years: A Transformation in Cardiovascular Disease Characterization Continues to Advance. Radiology: Volume 271: Issue 3, June 2014. Doi: https://doi.org/10.1148/radiol.14132232
SIEGEL, M.J. Pediatric CT angiography. Eur Radiol. 2005 Nov;15 Suppl 4:D32-6.
COLLINS, A. C, MOLCHO, M., CARNEY, P., McEVOY, L., GEOGHEGAN, L., PHILLIPS, J. P., NICHOLSON, A.J.. Are boys and girls that different? An analysis of traumatic brain injury in children. Emerg Med J, 2013;30:675–678. doi:10.1136/emermed-2011-200496.
TOWNSEND, B.A., et al., Has pediatric CT at children's hospitals reached its peak? AJR Am J Roentgenol, 2010. 194(5): p. 1194-6. BRADY, Z., T.M. Cain, and P.N. Johnston, Paediatric CT imaging trends in Australia. J Med Imaging Radiat Oncol, 2011. 55(2): p. 132-42.
BRINK JA, AMIS ES, Jr. Image Wisely: a campaign to increase awareness about adult radiation protection. Radiology. 2010;257(3):601-2.
GOSKE MJ, APPALGATE KE, BULAS D, BUTLER PF, CALLAHAN MJ, COLEY BD, et al. Image Gently: progress and challenges in CT education and advocacy. Pediatric Radiology. 2011;41 Suppl 2:461-6.
PEARCE, M.S., SALOTTI, J.A., LITLLE, M.P., McHUGH, K., LEE, C., KIM, K.P., et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499-505.
EINSTEIN A.J., Effects of radiation exposure from cardiac imaging: how good are the data? J Am Coll Cardiol. 2012; 59: 553–65.
BOICE, J.D. Jr, PRESTON, D., DAVIS, F.G., MONSON, R.R., Frequent chest x-ray fluoroscopy and breast cancer incidence among tuberculosis patients in Massachusetts. Radiat Res. 1991; 125: 214–22.
Downloads
Publicado
Edição
Seção
Licença
Declaro que o presente artigo é original, não tendo sido submetido à publicação em qualquer outro periódico nacional ou internacional, quer seja em parte ou em sua totalidade. Declaro, ainda, que uma vez publicado na revista Brazilian Journal of Radiation Sciences, editada pela Sociedade Brasileira de Proteção Radiológica, o mesmo jamais será submetido por mim ou por qualquer um dos demais co-autores a qualquer outro periódico. Através deste instrumento, em meu nome e em nome dos demais co-autores, porventura existentes, cedo os direitos autorais do referido artigo à Sociedade Brasileira de Proteção Radiológica, que está autorizada a publicá-lo em meio impresso, digital, ou outro existente, sem retribuição financeira para os autores.
Licença
Os artigos do BJRS são licenciados sob uma Creative Commons Atribuição 4.0 Licença Internacional, que permite o uso, compartilhamento, adaptação, distribuição e reprodução em qualquer meio ou formato, desde que você dê o devido crédito ao (s) autor (es) original (is) e à fonte, forneça um link para a licença Creative Commons, e indique se mudanças foram feitas. As imagens ou outro material de terceiros neste artigo estão incluídos na licença Creative Commons do artigo, a menos que indicado de outra forma em uma linha de crédito para o material. Se o material não estiver incluído no licença Creative Commons do artigo e seu uso pretendido não é permitido por regulamentação legal ou excede o uso permitido, você precisará obter permissão diretamente do detentor dos direitos autorais. Para visualizar uma cópia desta licença, visite http://creativecommons.org/licenses/by/4.0/
