Implementação de um programa de proteção radiológica no setor de hemodinâmica de um hospital universitário
Arquivos
Data
2017-09-28
Autores
Barbosa, Patricia Lopes 
Orientadores
Carvalho, Antonio Carlos de Camargo
Tipo
Dissertação de mestrado
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Resumo
A Cardiologia Intervencionista (CI) é uma das especialidades que proporciona as maiores doses de radiação a pacientes e profissionais. Devido à complexidade dos procedimentos e riscos associados às altas doses, é essencial que o serviço de CI tenha um programa ativo de proteção radiológica, com treinamento continuado, controle de qualidade dos equipamentos e monitoramento das doses efetivas dos profissionais e dos pacientes expostos aos raios X. Objetivo: Este estudo teve como objetivo criar ferramentas que possibilitassem melhorias na aplicação das normas de proteção radiológica em um setor de hemodinâmica. Método: O estudo foi realizado no setor de CI - Hospital Universitário da Unifesp no período de 2012 a 2017. Foi registrada a frequência de uso dos dispositivos de radioproteção por médicos e equipe de enfermagem e foram sugeridas ações que contribuíram para a otimização da proteção radiológica: elaboração de um programa de treinamento; criação de um Comitê Setorial de Proteção Radiológica (CSPR) e implantação do sistema de notificação e monitoramento de procedimentos que geram altas doses de radiação. Resultados: Foram acompanhados 183 procedimentos nos meses de março, maio e agosto de 2013, entre cateterismos diagnósticos (71% do total), angioplastias ad hoc (18%) e angioplastias eletivas (11%), nos quais todos os dispositivos de proteção coletiva instalados foram utilizados pelos médicos. Aventais de chumbo e protetores de tireóide foram utilizados pelas duas equipes. Houve aumento no uso dos dosímetros por todos os profissionais: médicos usaram o dosímetro em 50% dos procedimentos e a enfermagem em 95%. Ocorreu aumento no uso dos óculos plumbíferos pelos médicos. O programa de treinamento teve a participação das duas equipes e diversas reuniões do CSPR foram realizadas. Por meio do sistema de notificação e acompanhamento de pacientes, foi possível registrar 54 procedimentos geradores de altas doses em 2014 (2,02% do total de 2.662), 73 casos em 2015 (2,59% do total de 2.808) e 101 procedimentos (3,7% de 2.721) em 2016. Nenhum paciente apresentou alteração cutânea decorrente de lesão por radiação. Conclusão: A frequência de uso de dispositivos e meios de proteção à radiação pela equipe de médicos e enfermagem no setor de hemodinâmica aumentou após a implantação do programa de treinamento e capacitação e da criação do CSPR.
Interventional Cardiology (IC) is one of the specialties that provides the highest doses of radiation to patients and professionals. Due to the complexity of the procedures and risks associated with high doses, it is essential that the IC service has an active radiation protection program, with continuous training, equipment quality control and monitoring of effective doses of professionals and patients exposed to X-rays. Objective: This study aimed to create tools that would enable improvements in the application of radiation protection standards in a hemodynamic sector. Method: The study was carried out in the IC sector - University Hospital of Unifesp from 2012 to 2017. The frequency of use of the radioprotection devices by physicians and nursing staff was recorded and actions that contributed to the optimization of the radiological protection were suggested. The suggested actions were: elaboration of a training program; creation of a Sectorial Committee for Radiological Protection (SCRP) and implementation of the system of notification and monitoring of procedures that generate high doses of radiation. Results: A total of 183 procedures were followed in the months of March, May and August of 2013, among diagnostic catheters (71% of the total), ad hoc angioplasties (18%) and elective angioplasties (11%), in which all collective protection devices were used by doctors. Lead aprons and thyroid protectors were used by both teams. There was an increase in the use of dosimeters by all professionals: physicians used the dosimeter in 50% of the procedures and nursing in 95%. There has been an increase in the wearing of lead glasses by doctors. The training program was attended by both teams and several SCRP meetings were held. Through the system of notification and follow-up of patients, it was possible to register 54 high-dose procedures in 2014 (2.02% of the total of 2.662), 73 cases in 2015 (2.59% of the total of 2.808) and 101 procedures (3.7% of 2,721) in 2016. No patient presented skin alteration due to radiation injury. Conclusion: The frequency of use of devices and means of radiation protection by the medical and nursing team in the hemodynamic sector increased after the implementation of the training and capacity building program and the creation of the SCRP.
Interventional Cardiology (IC) is one of the specialties that provides the highest doses of radiation to patients and professionals. Due to the complexity of the procedures and risks associated with high doses, it is essential that the IC service has an active radiation protection program, with continuous training, equipment quality control and monitoring of effective doses of professionals and patients exposed to X-rays. Objective: This study aimed to create tools that would enable improvements in the application of radiation protection standards in a hemodynamic sector. Method: The study was carried out in the IC sector - University Hospital of Unifesp from 2012 to 2017. The frequency of use of the radioprotection devices by physicians and nursing staff was recorded and actions that contributed to the optimization of the radiological protection were suggested. The suggested actions were: elaboration of a training program; creation of a Sectorial Committee for Radiological Protection (SCRP) and implementation of the system of notification and monitoring of procedures that generate high doses of radiation. Results: A total of 183 procedures were followed in the months of March, May and August of 2013, among diagnostic catheters (71% of the total), ad hoc angioplasties (18%) and elective angioplasties (11%), in which all collective protection devices were used by doctors. Lead aprons and thyroid protectors were used by both teams. There was an increase in the use of dosimeters by all professionals: physicians used the dosimeter in 50% of the procedures and nursing in 95%. There has been an increase in the wearing of lead glasses by doctors. The training program was attended by both teams and several SCRP meetings were held. Through the system of notification and follow-up of patients, it was possible to register 54 high-dose procedures in 2014 (2.02% of the total of 2.662), 73 cases in 2015 (2.59% of the total of 2.808) and 101 procedures (3.7% of 2,721) in 2016. No patient presented skin alteration due to radiation injury. Conclusion: The frequency of use of devices and means of radiation protection by the medical and nursing team in the hemodynamic sector increased after the implementation of the training and capacity building program and the creation of the SCRP.
Descrição
Citação
BARBOSA, Patricia Lopes. Implementação de um programa de proteção radiológica no setor de hemodinâmica de um hospital universitário. São Paulo, 2017. Dissertação (Mestrado em Medicina: cardiologia) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2017.