Reducing effective dose to a paediatric phantom by using different combinations of kVp, mAs and additional filtration whilst maintaining image quality

Purpose: To determine whether using different combinations of kVp and mAs with additional filtration can reduce the effective dose to a paediatric phantom whilst maintaining diagnostic image quality. Methods: 27 images of a paediatric AP pelvis phantom were acquired with different kVp, mAs and additional copper filtration. Images were displayed on quality controlled monitors with dimmed lighting. Ten diagnostic radiographers (5 students and 5 experienced radiographers) had eye tests to assess visual acuity before rating the images. Each image was rated for visual image quality against a reference image using 2 alternative forced choice software using a 5-point Likert scale. Physical measures (SNR and CNR) were also taken to assess image quality. Results: Of the 27 images rated, 13 of them were of acceptable image quality and had a dose lower than the image with standard acquisition parameters. Two were produced without filtration, 6 with 0.1mm and 5 with 0.2mm copper filtration. Statistical analysis found that the inter-rater and intra-rater reliability was high. Discussion: It is possible to obtain an image of acceptable image quality with a dose that is lower than published guidelines. There are some areas of the study that could be improved. These include using a wider range of kVp and mAs to give an exact set of parameters to use. Conclusion: Additional filtration has been identified as amajor tool for reducing effective dose whilst maintaining acceptable image quality in a 5 year old phantom.

Estudo da distribuição de dose em torno de fontes usadas em braquiterapia

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia Biomédica

Potencial de redução de dose em tomografia computorizada com técnicas de reconstrução iterativa

A TC é um valioso método diagnóstico radiológico. O exame TC pode expor o paciente a uma dose elevada de exposição à radiação, causando risco acrescido. Uma das possíveis soluções para a redução da dose é o uso de técnicas de reconstrução iterativa (IR) em vez das reconstruções tradicionais (FBP). Com base nas suas capacidades de redução de ruído na imagem, a IR pode ter o potencial de reduzir significativamente a dose em pacientes submetidos a TC sem prejudicar a qualidade de imagem. Manter a qualidade de imagem clínica com um nível de qualidade aceitável e expondo o paciente à menor dose possível.

Therapeutical evaluation of different dose regimens of praziquantel in schistosomiasis mansoni, based on the quantitative oogram technique

A clinical trial involving 80 patients of both sexes, from ages 15 to 55, with chronic intestinal or hepatointestinal schistosomiasis mansoni, was carried out to evaluate the therapeutical efficacy of different dose regimens of praziquantel. The patients were randomly allocated into four groups with an equal number of cases and were then treated with one of the following dosages: 60 mg/kg for 1 day; 60 mg/kg daily for 2 days; 60 mg/kg daily for 3 days; and 30 mg/kg daily for 6 days. The assessment of parasitological cure was based on the quantitative oogram technique through rectal mucosa biopsies which were undertaken prior to, as well as, 1,2,4 and 6 months post-treatment. Concurrently, stool examinations according to the qualitative Hoffman, Pons & Janer (HPJ) and the quantitative Kato-Katz (K-K) methods were also performed. The best tolerability was observed with 30 mg/kg daily for 6 days whereas the highest incidence of side-effects (mainly dizziness and nausea) was found with 60 mg/kg daily for 3 days. No serious adverse drug reaction has occurred. The achieved cure rates were: 25% with 60 mg/kg for 1 day; 60% with 60 mg/kg daily for 2 days; 89.5% with 60 mg/kg daily for 3 days; and 90% with 30 mg/kg daily for 6 days. At the same time there has been a downfall of 64%, 73%, 87% and 84% respectively, in the median number of viable S. mansoni ova per gram of tissue. Thus, a very clear direct correlation between dose and effect could be seen. The corresponding cure rates according to stool examinations by HPJ were 39%, 80%, 100% and 95%; by K-K 89%, 100%, 100% and 100%. This discrepancy in results amongst the three parasitological methods is certainly due to their unequal accuracy. In fact, when the number of viable eggs per gram of tissue fell below 5,000 the difference in the percentage of false negative findings between HPJ (28%) and K-K (80%) became significative. When this number dropped to less than 2,000 the percentage of false negative results obtained with HPJ (49%) turned significant in relation to the oogram as well. In conclusion, it has been proven that praziquantel is a highly efficacious agent against S. mansoni infections. If administered at a total dose of 180 mg/kg divided into either 3 or 6 days, it yields a 90% cure rate. Possibly, one could reach 100% by increasing the total dose to 240 mg/kg. Furthermore, it was confirmed that the quantitative oogram technique is the most reliable parasitological method when evaluating the efficacy of new drugs in schistosomiasis mansoni.

Preventable exposure in routine chest CT examinations: evaluation of effective dose beyond prescribed anatomical landmarks

Objective - Evaluate preventable exposure dose in routine chest CT examinations beyond prescribed anatomical landmarks and estimate extra dose delivered to the patient. Background/rationale - Recent technical advances have greatly increased the clinical applications of CT; developments in multidetector-row CT (MDCT) technology have occurred; the major disadvantage with the increased use of MDCT is associated radiation exposure.

Avaliação da dose de exposição em tomografia computorizada: estudo comparativo antes e após otimização dos protocolos em neurorradiologia pediátrica

O número de exposições à radiação com fins médicos têm vindo a aumentar drasticamente devido ao crescimento do número de exames de Tomografia Computorizada (TC) realizados anualmente em crianças, o que faz com que aumentem também os potenciais efeitos indesejados associados à radiação ionizante. Este assunto torna-se ainda mais crítico na população pediátrica pelo que é imprescindível a otimização dos protocolos de aquisição e adoção de boas práticas no que respeita à redução da dose de exposição. A aplicação dos protocolos em neurorradiologia pediátrica carece de estratégias eficazes, as quais visam uma eficaz redução de dose mantendo a qualidade de imagem. Comparativamente aos descritores de dose (CTIvol e DLP) e parâmetros técnicos (Kvp, mAs, tempo de exposição e espessura de corte), foi objetivo deste estudo avaliar a redução da dose nos exames de neurorradiologia pediátrica através da comparação entre 2012 e 2013, ou seja, antes e depois da intervenção de otimização efetuada aos protocolos de aquisição.

Comparação da dose calculada entre a tomoterapia helicoidal e a arcoterapia de intensidade modulada em glioblastomas multiformes

Objetivo do estudo - Comparar a dose calculada nos órgãos de risco (OR’s) e no volume alvo de planeamento (PTV), entre a tomoterapia helicoidal (TH) e a arcoterapia de intensidade modulada (RapidArc®), em glioblastomas multiformes (GBM).

Um equilíbrio entre qualidade de imagem e dose efetiva na radiografia às órbitas para procura de objetos estranhos ferromagnéticos intraoculares: um estudo piloto

Objectivo do estudo - Investigar se os fatores standard de aquisição de radiografias às órbitas estão otimizados para a deteção de corpos estranhos ferromagnéticos intraoculares em pacientes que irão ser submetidos a ressonâncias magnéticas.

Quando o mercado não permite atingir a eficiência económica: falhas de mercado - as externalidades

Lição a que se refere a alínea b) do nº 10 do art.º 3º da Lei 7/2010 de 13 de Maio, no âmbito da prestação das Provas Públicas de avaliação da sua competência pedagógica e técnico-científica.

10 kVp rule - An anthropomorphic pelvis phantom imaging study using a CR system: impact on image quality and effective dose using AEC and manual mode

Purpose: This study aims to investigate the influence of tube potential (kVp) variation in relation to perceptual image quality and effective dose for pelvis using automatic exposure control (AEC) and non-AEC in a computed radiography (CR) system. Methods and Materials: To determine the effects of using AEC and non-AEC by applying the 10 kVp rule in two experiments using an anthropomorphic pelvis phantom. Images were acquired using 10 kVp increments (60-120 kVp) for both experiments. The first experiment, based on seven AEC combinations, produced 49 images. The mean mAs from each kVp increment were used as a baseline for the second experiment producing 35 images. A total of 84 images were produced and a panel of 5 experienced observers participated for the image scoring using the 2 AFC visual grading software. PCXMC software was used to estimate the effective dose. Results: A decrease in perceptual image quality as the kVp increases was observed both in non-AEC and AEC experiments, however no significant statistical differences (p> 0.05) were found. Image quality scores from all observers at 10 kVp increments for all mAs values using non-AEC mode demonstrates a better score up to 90 kVp. Effective dose results show a statistical significant decrease (p=0.000) on the 75th quartile from 0.3 mSv at 60 kVp to 0.1 mSv at 120 kVp when applying the 10 kVp rule in non-AEC mode. Conclusion: No significant reduction in perceptual image quality is observed when increasing kVp whilst a marked and significant effective dose reduction is observed.

Radiation dose rates and exposure associated to Technologically Enhanced Naturally Occurring Radioactive Materials (TENORM) at locations of a Portuguese coal-fired power plant

Coal contains trace quantities of natural radionuclides such as Th-232, U-235, U-238, as well as their radioactive decay products and 40K. These radionuclides can be released as fly ash in atmospheric emissions from coal-fired power plants, dispersed into the environment and deposited on the surrounding top soils. Therefore, the natural radiation background level is enhanced and consequently increase the total dose for the nearby population. A radiation monitoring programme was used to assess the external dose contribution to the natural radiation background, potentially resulting from the dispersion of coal ash in past atmospheric emissions. Radiation measurements were carried out by gamma spectrometry in the vicinity of a Portuguese coal-fired power plant. The radiation monitoring was achieved both on and off site, being the boundary delimited by a 20 km circle centered in the stacks of the coal plant. The measured radionuclides concentrations for the uranium and thorium series ranged from 7.7 to 41.3 Bq/kg for Ra-226 and from 4.7 to 71.6 Bq/kg for Th-232, while K-40 concentrations ranged from 62.3 to 795.1 Bq/kg. The highest values were registered near the power plant and at distances between 6 and 20 km from the stacks, mainly in the prevailing wind direction. The absorbed dose rates were calculated for each sampling location: 13.97-84.00 ηGy/h, while measurements from previous studies carried out in 1993 registered values in the range of 16.6-77.6 ηGy/h. The highest values were registered at locations in the prevailing wind direction (NW-SE). This study has been primarily done to assess the radiation dose rates and exposure to the nearby population in the surroundings of a coal-fired power plant. The results suggest an enhancement or at least an influence in the background radiation due to the coal plant past activities.

Avaliação sócio-económica e ambiental da co-combustão de carvão, biomassa e resíduos não tóxicos

Dissertação apresentada à Universidade Nova de Lisboa,Faculdade de Ciências e Tecnologia, para a obtenção do grau de Mestre em Engenharia do Ambiente

Contributos para a avaliação económica de medicamentos em Portu

RESUMO: A importância da avaliação económica na área da saúde tem sido crescente ao longo das últimas três décadas. É um campo de análise multi-disciplinar pelo qual se têm vindo a interessar investigadores de todo o mundo e onde, naturalmente, a economia da saúde tem contributos significativos para dar. Contudo, é uma área ainda relativamente inexplorada em termos de investigação metodológica em Portugal. Espera-se com este trabalho colmatar algumas das lacunas existentes e lançar pontes para investigação futura. Neste estudo pretendem-se desenvolver contributos autónomos, numa óptica de resolução de problemas concretos, para a avaliação económica de medicamentos em Portugal. Em primeiro lugar abordou-se a importância da estimação dos custos nos estudos de avaliação económica em saúde. Em segundo lugar determinou-se o custo de um doente com esclerose múltipla, por nível de severidade em Portugal com recurso à metodologia de estudos custo da doença. Em terceiro lugar, aplicando a mesma metodologia, determinou-se o custo de um doente com psoríase, por nível de severidade, em Portugal. Em quarto lugar mediu-se o impacto da psoríase na qualidade de vida relacionada com a saúde dos indivíduos afectados através de dois instrumentos genéricos de medição da qualidade de vida relacionada com a saúde (SF-36 e EQ-5D) e de dois instrumentos específicos (DLQI e PDI). Em quinto lugar, foi feita a adaptação de um modelo sobre a prevenção do tromboembolismo venoso em cirurgia ortopédica ao contexto nacional com recurso a dados recolhidos numa amostra de hospitais portugueses. Foi ainda apresentada uma estimativa do impacto orçamental decorrente da inclusão, ou não, de um novo medicamento na prática nacional. ABSTRACT: The importance of economic evaluation in the health care sector has been growing in the last three decades. It is a multidisciplinary field of research that attracts attention from researchers working all over the world. It is should be noted that health economics can contribute significantly to the development of this area. However, in Portugal is difficult to find methodological contributes in this field of research. With this work one hope to be able to overcome some of the existing shortcomings. This study seeks to develop independent contributions for the economic evaluation of pharmaceuticals in Portugal, aiming to help to solve existing problems. Firstly, one approached the importance of the accurate estimation of costs in economic evaluations of pharmaceuticals. Secondly, the cost of patient with multiple sclerosis was estimated, by severity level, in Portugal, using a cost of illness methodology. In third place, employing the same methodology, the cost of patient with psoriasis by severity level was estimated for Portugal. In fourth place, the impact of psoriasis in the quality of life related to health was ascertained by two generic measures (SF-36 and EQ-5D) and two specific measures (DLQI and PDI). Lastly, a model on the prevention of venous thromboembolism in orthopedic surgery was adapted for Portugal through the inclusion of data collected in a sample of Portuguese hospita

Ultrafine Particles in Ambient Air of an Urban Area: Dose Implications for Elderly

Due to their detrimental effects on human health, the scientific interest in ultrafine particles (UFP) has been increasing, but available information is far from comprehensive. Compared to the remaining population, the elderly are potentially highly susceptible to the effects of outdoor air pollution. Thus, this study aimed to (1) determine the levels of outdoor pollutants in an urban area with emphasis on UFP concentrations and (2) estimate the respective dose rates of exposure for elderly populations. UFP were continuously measured over 3 weeks at 3 sites in north Portugal: 2 urban (U1 and U2) and 1 rural used as reference (R1). Meteorological parameters and outdoor pollutants including particulate matter (PM10), ozone (O3), nitric oxide (NO), and nitrogen dioxide (NO2) were also measured. The dose rates of inhalation exposure to UFP were estimated for three different elderly age categories: 64–70, 71–80, and >81 years. Over the sampling period levels of PM10, O3 and NO2 were in compliance with European legislation. Mean UFP were 1.7 × 104 and 1.2 × 104 particles/cm3 at U1 and U2, respectively, whereas at rural site levels were 20–70% lower (mean of 1 ×104 particles/cm3). Vehicular traffic and local emissions were the predominant identified sources of UFP at urban sites. In addition, results of correlation analysis showed that UFP were meteorologically dependent. Exposure dose rates were 1.2- to 1.4-fold higher at urban than reference sites with the highest levels noted for adults at 71–80 yr, attributed mainly to higher inhalation rates.