Akciğer kanseri hastalarında tanısal amaçlı yapılan tıbbi görüntülemelerden dolayı oluşan radyasyon maruziyetlerinin belirlenmesi
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Dosyalar
Tarih
2021
Yazarlar
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Yayıncı
Trakya Üniversitesi Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Uluslararası ve ulusal düzeyde yapılan araştırmalarda akciğer kanseri en sık görülen kanser türü ile birlikte ölüm oranlarına bakıldığında ciddi anlamda sağlık sorunu olarak ele alınmaktadır. Hastalığın tanı, evreleme ve tedavinin değerlendirmesi aşamalarında multidisipliner yaklaşımla beraber gelişen teknolojilerin kullanımı sağkalım sürelerinin uzatılması ve yaşam kalitesi için önemlidir. Hastalığın doğru tanı ve takibi için kullanılan görüntüleme sistemlerinin çoğu iyonlaştırıcı radyasyondan yararlanmaktadır. Görüntüleme sistemlerinde oluşan hasta radyasyon doz maruziyetleri düşük ölçüde ve hasta lehine istenen klinik ihtiyaca göre optimize edilerek uygulanmasına rağmen düşük doz radyasyonun kanser ve genetik hasar riski konusunda endişeler bulunmaktadır. Yapılan çalışmada akciğer kanseri tanısı ile evreleme için Nükleer Tıp Ana bilim dalı’nda PET protokollerini tamamlamış tanı, evreleme ve tedavi değerlendirme süreci beş yılı aşkın hastaların iyonlaştırıcı radyasyon içeren görüntüleme sistem prosedürlerinden kaynaklı doz maruziyetleri retrospektif olarak araştırıldı. Trakya Üniversitesi Hastanesinde takibi yapılan, çalışma kriterlerine uygun, görüntüleme prosedürlerine erişimi sağlanan 142 hasta çalışmaya dahil edildi. Hastaların radyasyon doz maruziyetlerinin beş yıllık değerlendirmesi yapılarak ilk yıl ve beş yıllık ortalama radyasyon doz maruziyetleri değerlendirildi. Radyoloji ve Nükleer Tıp Ana bilim dallarında gerçekleştirilen prosedürler incelenerek BT, BT dışı xışını içeren uygulamalar, PET/BT ve PET/BT dışı Nükleer Tıp prosedürlerinin uygulama yoğunlukları irdelendi. Hastalığın doğru tanı ve tedavinin doğru değerlendirmesinde ilk yıl gerçekleştirilen görüntüleme prosedürlerinin sıklığı diğer yıllara oranla yüksekti. Bu oran radyasyon doz maruziyetinin ilk yıl daha fazla gerçekleştiği anlamına gelmektedir. Doz maruziyetlerindeki bulgular incelendiğinde 142 hastanın % 41,5’i birinci yıl 50 mSv ’ten fazla doza maruz kaldığını göstermekte ve beş yıllık ortalama doz maruziyetine baktığımızda bu oran % 4,9’a düşmektedir. Beş yıllık tüm prosedürler incelendiğinde Nükleer Tıp uygulamalarından PET prosedürü %11,3 oranına, radyolojik uygulamalarda BT prosedürü %36,4 oranına sahiptir. Bazı hastalarda biriken doz miktarı ve ihtiyaca yönelik prosedürlerdeki doz miktarı endişe verici olsa da hasta maruziyetine yönelik prosedürleri klinik ihtiyaca göre dengelemek zordur. Tıbbi prosedürler stokastik kanser risklerine karşı sınırlandırılamazlar. Bu nedenle tıbbi radyasyona maruz kalma ile ilgili öneriler, bir prosedür için klinik ihtiyaca göre ve radyasyon dozunun makul derecede olması için kullanımı optimize etmeye odaklanmıştır. Hasta merkezli çalışmayı sağlamak, disiplinler arası ekiplerle çalışmak, kanıta dayalı uygulamaları kullanmak, kalitede iyileştirmeyi uygulamak ve bilişimi kullanmak gibi yetkinlikler, dikkatli bir şekilde takip edilirse, tıbbi görüntüleme de dahil olmak üzere tıbbi teknolojilerin aşırı kullanımını önemli ölçüde azaltacaktır.
In international and national studies, lung cancer is considered as a serious health problem when looking at mortality rates along with being the most common type of cancer. Using developing technologies together with the multidisciplinary approach in the diagnosis, staging and evaluation of treatment of the disease is important for prolonged survival periods and quality of life. Most imaging systems used for the accurate diagnosis and monitoring of the disease benefit from ionizing radiation. Although radioactive dose exposures for patients in imaging systems are applied in low quantities and optimized according to the clinical need requested in favor of the patient, there are concerns about the risk of cancer and genetic damage of low dose radiation. In this study, dose exposures resulting from imaging system procedures containing ionizing radiation of patients who completed PET protocols in the Nuclear Medicine Department for staging with the diagnosis of lung cancer and whose diagnosis, staging and treatment evaluation process exceeded five years were investigated retrospectively. 142 patients who were followed up at Trakya University Hospital, who met the study criteria and whose imaging procedures were accessible were included in the study. A five-year assessment of the radiation dose exposures of the patients was determined and the average radiation dose exposures of the first year and five years in total were evaluated. The procedures that were carried out in the departments of Radiology and Nuclear Medicine were examined and the application intensities of CT, non-CT X-ray applications, PET/CT, and non PET/CT Nuclear Medicine procedures were examined. The frequency of imaging procedures performed in the first year for correct diagnosis and treatment of the disease was higher than in other years. This rate means that radiation dose exposure occurs more in the first year. When all procedures are examined for five years, PET procedure from Nuclear Medicine applications has 11.3% and CT procedure in radiological applications has 36.4%. When all five-year procedures are examined, pet procedure in Nuclear Medicine applications has 11.3% and CT procedure in radiological applications has 36.4%. Although the amount of dose accumulated in some patients and the amount of dose in need-oriented procedures is worrisome, it is difficult to balance patient exposure procedures with the clinical need. Medical procedures cannot be limited to stochastic cancer risks. Therefore, recommendations regarding exposure to medical radiation are focused on optimizing use according to the clinical need for a procedure and for the radiation dose to be reasonable. With the practice of patient-centered work, with the interdisciplinary teams, using evidencebased practice, improving quality improvement, and utilizing informatics will significantly reduce the overuse of medical technologies, including medical imaging.
In international and national studies, lung cancer is considered as a serious health problem when looking at mortality rates along with being the most common type of cancer. Using developing technologies together with the multidisciplinary approach in the diagnosis, staging and evaluation of treatment of the disease is important for prolonged survival periods and quality of life. Most imaging systems used for the accurate diagnosis and monitoring of the disease benefit from ionizing radiation. Although radioactive dose exposures for patients in imaging systems are applied in low quantities and optimized according to the clinical need requested in favor of the patient, there are concerns about the risk of cancer and genetic damage of low dose radiation. In this study, dose exposures resulting from imaging system procedures containing ionizing radiation of patients who completed PET protocols in the Nuclear Medicine Department for staging with the diagnosis of lung cancer and whose diagnosis, staging and treatment evaluation process exceeded five years were investigated retrospectively. 142 patients who were followed up at Trakya University Hospital, who met the study criteria and whose imaging procedures were accessible were included in the study. A five-year assessment of the radiation dose exposures of the patients was determined and the average radiation dose exposures of the first year and five years in total were evaluated. The procedures that were carried out in the departments of Radiology and Nuclear Medicine were examined and the application intensities of CT, non-CT X-ray applications, PET/CT, and non PET/CT Nuclear Medicine procedures were examined. The frequency of imaging procedures performed in the first year for correct diagnosis and treatment of the disease was higher than in other years. This rate means that radiation dose exposure occurs more in the first year. When all procedures are examined for five years, PET procedure from Nuclear Medicine applications has 11.3% and CT procedure in radiological applications has 36.4%. When all five-year procedures are examined, pet procedure in Nuclear Medicine applications has 11.3% and CT procedure in radiological applications has 36.4%. Although the amount of dose accumulated in some patients and the amount of dose in need-oriented procedures is worrisome, it is difficult to balance patient exposure procedures with the clinical need. Medical procedures cannot be limited to stochastic cancer risks. Therefore, recommendations regarding exposure to medical radiation are focused on optimizing use according to the clinical need for a procedure and for the radiation dose to be reasonable. With the practice of patient-centered work, with the interdisciplinary teams, using evidencebased practice, improving quality improvement, and utilizing informatics will significantly reduce the overuse of medical technologies, including medical imaging.
Açıklama
Anahtar Kelimeler
Tanısal Görüntüleme, Radyasyon Doz Maruziyeti, Nükleer Tıp, Radyoloji, Akciğer Kanseri, Diagnostic Imaging, Radiation Dose Exposure, Nuclear Medicine, Radiology, Lung Cancer
