Modelo de gerenciamento de risco em radiologia intervencionista para fins regulatórios

• Ano de defesa: 2013
• Autor(a) principal: Navarro, Valéria Coelho Costa
• Orientador(a): Maia, Ana Figueiredo
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Programa de Pós-Graduação: Pós-Graduação em Física
• Palavras-chave em Português: Radiologia médica - Administração de risco; Raios X; Física médica
• Palavras-chave em Inglês: Medical physics; Radiology, Medical; Risk management; X-rays
• Área do conhecimento CNPq: CNPQ::CIENCIAS EXATAS E DA TERRA::FISICA
• Link de acesso: https://ri.ufs.br/handle/riufs/5342

The number of invasive procedures using interventional radiology has increased significantly in recent years. This fact is due to several factors, such as the aging population, the increased of obese population, which has immediate effects on the number of cancer and vascular diseases, the increased of incidence rate of alcoholism and hepatitis, which provide increased of cirrhosis, among others. Some medical specialties use this modality very often, in particular, the angiology, the cardiology, the hepatology and the neurology. The Interventional Radiology, however, can involve high doses and long exposure times, being considered currently the radiology practice of largest medical and occupational exposures, with the possibility of, not only stochastic, but also deterministic events, such as necrosis, erythema, epilation and cancer. In this context, the international studies indicate the need to revise the reference levels, to develop methodologies for dosimetry of patients and staff, including continuously optimization of dose parameters, such as filtration, collimation and rectification, to develop quality control tools and training in radiation protection for those involved in Interventional Radiology. In Brazil, the literature indicated ten publications addressing this topic, and three deal with the technical aspects of equipment performance, four of occupational exposures, medical exposures of two and a review general aspects of interventional radiology. The publications have reported studies that were performed by evaluating a maximum of two equipment, with results indicating high medical and occupational exposures, low image quality and the need to implement quality assurance programs. It is noteworthy that no studies have examined thoroughly the procedure, in others words, exposures and equipment performances, and they were restricted to one service. On the other hand, besides the few papers published, there is no specific legislation on the country, because the Federal Regulation SVS/MS 453/98 only addresses the general issues of fluoroscopy. Thus, the lack of studies about the reality of Interventional Radiology procedures, as well as more complete information of the procedures, require the new studies, especially now that the National Agency of Sanitary Surveillance - ANVISA is updating the Federal Regulation SVS/MS 453/98. Then, aiming to help filling a gap of knowledge in Medical Physics in Brazil and at Brazilian legislation, the objective of this study was to evaluate interventional radiology services in two states, Bahia and Santa Catarina, to characterize the technologies and practices used and the risk to patients and workers, proposing technical requirements and testing protocols, adequate to the actual situation, without losing the perspective of international standards and recommendations, as well as to develop the of Effective Potential Risk Assessment Model (EPRAM), a tool for auditing and risk management, that is an adaptation of a methodology for auditing radiology services, and to validate it in 20 rooms of interventional radiology procedures of 16 services in two Brazilian states. The results showed that no services meet the minimum requirements of the law and, even if some basic and essential requirements for safety were not considered, only 5 (25%) of the rooms were at potential effective risk acceptable