ABSTRACT
While the patterns and trends of computed tomography (CT) are well documented in developed countries, relatively little is known about CT usage in developing countries, including Brazil. We evaluated CT usage among outpatients from the public healthcare system in Brazil (SUS), which is the unique healthcare provider to about 75% of the Brazilian population. We collected the annual number of CT procedures and type of CT examinations performed in SUS for the period 2001-2011. Age at examination was evaluated for 2008-2011. CT usage in Brazil has more than tripled during the study period, but the most striking annual increase (17.5%) was observed over the years 2008-2011. Head was the most frequently examined region for all age groups, but a decreasing trend of proportional contribution of head CT, with a simultaneous increase of abdomen/pelvis and chest CT over time was observed. CT examination for pediatric and young adult patients was about 13% of all CTs (9% if we considered age-standardized CT rates). CT usage has grown rapidly in Brazil and may still be increasing. Increased CT usage may certainly be associated with improved patient care. However, given the high frequency of pediatric and young adult CT procedures and the suggested associated cancer risk, efforts need to be undertaken to reduce unwarranted CT scans in Brazil.
Subject(s)
Outpatients , Radiation Dosage , Tomography, X-Ray Computed/statistics & numerical data , Adolescent , Adult , Aged , Brazil , Child , Child, Preschool , Female , Hospitals, Public , Humans , Infant , Male , Middle Aged , Risk FactorsABSTRACT
The skyshine radiation phenomenon consists of the scattering of primary photon beams in the atmosphere above the roof of a medical linear accelerator facility, generating an additional dose at ground level in the vicinity of the treatment room. Thus, with respect to radioprotection, this situation plays an important role when the roof is designed with little shielding and there are buildings next to the radiotherapy treatment room. In literature, there are few reported skyshine-measured doses and these contain poor agreement with empirical calculations. In this work, we carried out measurements of skyshine photon dose rates produced from eight different 6 and 10 MV medical accelerators. Each measurement was performed outside the room facility, with the beam positioned in the upward direction, at a horizontal distance from the target and for a 40 cm × 40 cm maximum photon field size at the accelerator isocenter. Measured dose-equivalent rates results were compared with calculations obtained by an empirical expression, and differences between them deviated in one or more order of magnitude.
Subject(s)
Occupational Exposure/analysis , Particle Accelerators , Photons , Radiation Dosage , Radiation Monitoring/methods , Radiation Protection/methods , Equipment Failure Analysis , Scattering, RadiationABSTRACT
The Brazilian Institute of Radiation Protection and Dosimetry (IRD/CNEN) carried out quality assurance regulatory audits in Brazilian radiotherapy facilities from 1995 to 2007. In this work, the set of data collected from 195 radiotherapy facilities that use high-energy photon beams are analyzed. They include results from audits in linear electron accelerators and/or Co-60 units. The inspectors of IRD/CNEN performed the dosimetry of high-energy radiotherapy photon beams according to the IAEA dosimetry protocols TRS 277 and TRS 398, and the values of measurements were compared to stated values. Other aspects of radiological protection were checked during on-site audits such as calibration certification of clinical dosimeters and portable monitors, existence and use of check source, use of barometer and thermometer, individual dose registry and training of staff. It was verified that no check source was available in 38% of the visited facilities; the training of personnel was not adequate in 9% of the facilities and the registry of accumulated individual doses was not being done in 6% of the facilities. Measurements of absorbed dose have indicated deviations in the range ± 3% for 67.6% of the cobalt-60 units and 79.6% of medical linear accelerators; 18.5% of Co-60 irradiators and 9.6% of linear accelerators presented deviations in the range 3% < δ ≤ 5%. Finally, 13.9% of Co-60 facilities and 10.8% of linear accelerator facilities presented dosimetry deviations above 5%. The effort in dosimetric quality control performed by IRD/CNEN audits has yielded positive changes that make radiation treatment facilities more reliable.
