Limited information related to: - Type and frequency of procedures; - Exposure levels involved.

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2 Limited information related to: Outside Radiological Department - Type and frequency of procedures; - Exposure levels involved. Majority of the examinations performed outside the department. 2

3 Patients usually unable to cooperate due to their condition Room conditions aren't proper for standard examination protocols and positioning accuracy Great variations on examination techniques in use Variation in radiation doses received by patients Ionizing radiation effects Based on ALARA principle 3 (ACR, 2011) (International Atomic Energy Agency, 2006) (ACR, 2008) (Lanhede et al, 2002) (ICRP, 2007)

4 To compare data recorded at two different Radiological Departments; Optimization of bedside chest radiography protocols for adults. 4

5 Unfors EDD- 30 Educational Direct Dosimeter Mobile X- ray unit Measuring tape 5

6 Standard patients Bedside chest radiography examinations Hospitals A and B Patient: Weight (Kg) Height (cm) Examination: SRD - cm, RSD cm, Exposure parameters (kv, mas), ESD - µsv 6

7 N Minimum Maximum Mean Standard- Deviation Weight (Kg) 65,00 75,00 71,27 3,66 Height (cm) ,00 182,00 169,45 4,32 BMI 21,90 29,30 24,87 1,68 Weight (Kg) Height (cm) IMC Hospital A Hospital B Phase 1 Hospital B Phase 2 Mean 71,60 69,80 72,80 Standard- Deviation 3,86 3,41 3,17 Mean 170,00 168,65 169,80 Standard- Deviation 3,29 3,15 6,50 Mean 24,86 24,55 25,32 Standard- Deviation 1,71 1,53 1,83 p >0,05 7

8 Tube tension (kv) Tube current (mas) SRD (cm) RSD (cm) ESD (µsv) Hospital A Hospital B Phase 1 Mean 108,80 84,00 Standard deviation 4,79 4,14 Mean 1,74 2,09 Standard deviation 0,37 0,27 Mean 124,45 115,40 Standard deviation 13,96 8,83 Mean 141,56 223,28 Standard deviation 27,92 26,19 Mean 16,45 21,94 Standard deviation 1,16 4,72 p <0,05 8

9 Exposure parameters: 100 kv 1 mas 9

10 Hospital B ESD (µsv) p Mean 21,94 Phase 1 Standard devia,on 4,72 P75 27,28 Mean 17,00 <0,05 Phase 2 Standard devia,on 1,51 P75 17,61 10

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12 113,13 cm 115, 40 cm 124,45 cm 12

13 AP Chest Bedside Radiography: SRD between 100 e 180 cm Difference between mean SRD in use it s the most important factor related to high dose levels. 13 *ACR - American College of Radiology ARI - Aberdeen Royal Infirmary

14 (Simpson, et al, 1998) (Kotsubo et al, 2003) With tube tension increase, greater the affinity towards current decline as well as dose exposure. 14

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16 1. Padovani, Renato, et al. Radiological procedures performed outside the radiological departments ACR. Practice guideline for the performance of pediatric and adult portable (mobile unit) chest radiography ACR Practice Guideline. 3. UNSCEAR. Effects and Risks of Ionizing Radiation. s.l. : United Nations Scientific Committee on the Effects of Atomic Radiation, New International Comission on Radiological Protection Recommendations. Wrixon, A D. 2008, Journal of Radiological Protection., Vol. 28, pp Diagnostic reference levels as a quality assurance tool. Edmonds, K D. [ed.] Australian Institute of Radiography. 3, Australia : s.n., 2009, The Radiographer, Vol A study of chest radiography with mobile X- ray units. Simpson, P D, et al. 1998, The British Journal of Radiology, Vol. 71, pp Diagnostic Image quality of mobile neonatal chest x- rays and the radiation exposure incurred. Lowe, A, et al. 1999, The British Journal of Radiology. 8. The influence of different technique factors on image quality of chest radiographs as evaluated by modified CEC image quality criteria. LANHEDE, B, et al. 2002, The British Journal of Radiology. 9. Applying radiation safety standards in diagnostic radiology and interventional procedures using X- rays. International Atomic Energy Agency. VIENNA : s.n., 2006, Vol ICRP Publication. The 2007 Recommendations of the International Commission on Radiological Protection. s.l. : Elsevier, Council Directive 97/43 Euratom of 30 June 1997 on health protection of individuals against the dangers of ionising radiation to medical exposure, and repealing Directive 84/466 Euratom. 1997, Official Journal of the European Communities. 12. ACR. ACR Pratice Guideline For Diagnostic Reference Levels In Medical X- Ray Imaging. s.l. : American College of Radiology, Hart, D, Hillier, M C e Wall, B F. Doses to Patients from Medical X- ray Examinations in the UK. UK : NRPB, Almeida, Ana, et al. Níveis Referência de Diagnóstico no RX ao Tórax no Leito Estudo Dosimétrico de Radiografias de Tórax Com o Emprego de Técnicas de Alta Quilovoltagem. Kotsubo, Martha Tidori Kiota, Marchiori, Edson e Azevedo, Ana Cecília Pedrosa. s.l. : Radiologia Brasileira, 2003, pp