Estimation of Doses in Routine Angiographic Exams in Health Services in Rio de
Janeiro
In recent years, computed tomography (CT) has become increasingly important in
diagnostic radiology worldwide. The introduction of dual-energy CT and photon-counting
computed tomography (PCCT) in clinical use has further expanded diagnostic possibilities with
improved image quality without increasing patient dose (1). Iterative algorithms and deep
learning reconstructions also enhance image quality by reducing noise (2, 7). Efforts to optimize
CT procedures are still necessary, as per findings by UNSCEAR 2020. Despite accounting for
only 10% of all examinations, CT scans contribute the highest percentage (62.6%) to the overall
collective dose. The estimated annual number of CT scans is about 400 million, with an 80%
increase in frequency and a 70% increase in collective dose (3).Currently, Brazil has not
established diagnostic reference levels. The limited number of studies conducted in the country
does not accurately reflect the situation.
According World Health Organization (WHO), the two main causes of death are
associated with the following diseases: cardiovascular (ischemic disease) cardiac, stroke),
respiratory (obstructive pulmonary disease). is one of the main causes of death in the world.
Between 2000 and 2019, registration 77.5% increase in the number of deaths from Heart
ischemic disease. Stroke and chronic obstructive pulmonary disease are 2nd and 3rd causes of
death, responsible for approximately 11% and 6% of total deaths, respectively [4]. In Brazil,
similar behavior was observed. Ischemic heart disease was the main cause of death between
2000 and 2017 for both sexes, Although there has been a reduction in mortality rates of 31.8%
for people between 60-64 years old and 24.9% for the elderly (80+ years old) (5).
The aim is this work is to evaluate routine angiographic procedures that have potential
for high dose on patients but are crucial for diagnostic of severe conditions such as CT brain
perfusion, coronary computed tomography angiography CCTA, CT pulmonary angiography
(CTPA), and brain angiography, using the anthropomorphic phantom Alderson-rando and TLD-
100 LiF dosimeters. Estimate the doses absorbed in different organs, the effective dose and
corresponding CTDIvol and DLP values applying different protocols used in chest and head
angiographic procedures.
a) Materials
TLD dosimeters (LiF:Mg,Ti TLD100) will be individually calibrated for the appropriate
beam energy according to the methodology described by Yoshizumi (16). Alderson-Rando adult
male anthropomorphic simulator (CIRS ATOM ®), available at IRD. The simulator features 25
mm thick sections and allows you to position the TLDs in 21internal organs
b) Methodology
The study was carried out in one hospital in Rio de Janeiro. The simulator anthropomorphic was
scanned with routine protocols to obtain absorbed doses in organs and effective doses and one
protocol elaborated using cientific literature and international recommendations. CT beam
dosimetry was carried out for control of CT scanner dose.
Results
Most of procedures are in according with the reference levels of administered dose.
Although some procedures could have optimized protocols, for dose reduction without
compromising diagnostic practice.
References
[1]. M Tortora , L Gemini, I D'Iglio, L Ugga,G Spadarella, R Cuocolo. Spectral Photon-
Counting Computed Tomography: A Review on Technical Principles and Clinical
Applications. Journal of Imaging. 2022; 8(4):112.
[2]. Y Nakamura,T Higaki, F Tatsugami, Y Honda, K Narita, M Akagi, K Awai. Possibility of
Deep Learning in Medical Imaging Focusing Improvement of Computed Tomography Image
Quality. J Comput Assist Tomogr. 2020 Mar/Apr;44(2):161-167.
[3]. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR).
UNSCEAR 2020/2021 report. ISBN: 978-92-1-139206-7,
e-ISBN: 978-92-1-001003-0
(4) WHO, 2020. The top 10 causes of death.
[Link]
(5) de Azeredo Passos, V.M., Champs, A.P.S., Teixeira, R. et al. The burden of disease among
Brazilian older adults and the challenge for health policies: results of the Global Burden of
Disease Study 2017. Popul Health Metrics 18, 14 (2020).