Ege Güleç BALBAY, Sinem SAFÇI, Emine Banu ÇAKIROĞLU, Alp Alper ŞAFAK

Bilgisayarlı Toraks Tomografisini Gereğinden Fazla mı İstiyoruz?

AMAÇ: Bu çalışmada Göğüs hastalıkları polikliniğine başvurmuş hastalardan istenen Toraks Bilgisayarlı Tomografileri BT ’nin hangi nedenlerle istendiğini ve saptanan radyolojik anormallikleri araştırmak amaçlandı. YÖNTEMLER: Tıp Fakültesi Göğüs Hastalıkları polikliniğinde 3 ay boyunca bakılmış tüm hastalardan istenmiş Toraks BT’ler retrospektif olarak değerlendirildi. BULGULAR: 3245 hastanın 215’ìnden %6.62 Toraks BT istenmişti. Yaş ortalamaları 58±14.97 olan 215 hastanın 142’sı erkek %66 idi. International Classification of Diseases ICD kodlarına bakıldığında en sık 57 %26.5 hastada öksürük, 49 %22,8 hastada akciğerin tanısal görüntülenmesinde anormal bulgular ve 18 %8.4 hastada da hemoptizi tanılarıyla Toraks BT istenmişti. İstenen tomografilerin 185 %86 ’sında patoloji saptanmıştı. En sık görülen radyolojik anormallikler sırasıyla lenfadenopati 69 %32,1 , nodül 60 %27.9 , fibrotik değişiklik 49 %22.8 idi. Bronş kanseri tanısıyla istenen Toraks BT’lerin %100 ‘ünde klinik olarak önemli en az bir patoloji saptanmışken, göğüs ağrısı tanısıyla istenenlerin ise %55.6’sında klinik olarak önemli patoloji saptanmamıştı. SONUÇ: Üçüncü basamak bir göğüs hastalıkları polikliniğinden istenen Toraks BT’lerin çoğunda patolojik bulgu saptandığı görüldü. ICD kodlarının hastanın tanısından çok şikayetine göre girildiği saptandı.

Anahtar Kelimeler:

Göğüs hastalıkları, poliklinik, toraks tomografisi

Do We Want Thorax Computed Tomography much more than Required?

OBJECTIVE: The aim of this study was to investigate Thoracic Computed Tomography TCT of the patients attended to the outpatient clinic of chest diseases regarding to reasons in which CT was prompted and which radiological abnormalities was found.METHODS: TCT of the patients attended to the outpatient clinic of chest diseases department of Faculty of Medicine was evaluated.RESULTS: TCT was prompted 215 out of 3245 patients %6.62 . The mean age was 58±14.97 142 male, %66 . According to the International Classification of Diseases ICD the reasons for prompting TCT were cough in 57 %26.5 , abnormal radiological findings in chest PA film in 49 %22.8 , hemoptysis in 18 %8.4 of patients. There was at least one pathology in 185 of TCT %86 . The most common radiological abnormalities were lymphadenopathy in 69 %32.1 , nodüle in 60 %27.9 , fibrotic changes in 49 %22.8 of 215 TCT. There was at least one pathology in TCT prompted in all patients with the diagnosis of broncheal carcinoma whereas there was no any pathology in %55.6 of patients with chest pain.CONCLUSION: There was any kind of radiological finding in most of TCT prompted from a chest disease polyclinic of tertiary hospital. The respiratory complaints were coded instead of ICD codes as a patient diagnosis.

Keywords:

Pulmonary diseases, polyclinic, thorax tomography,

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1. Seynaeve PC, Broos JI. The history of tomography. J Belge Radiol. 1995; 78(5): 284-8.
2. Huppmann MV, Johnson WB, Javitt MC. Radiation risks from exposure to chest computed tomography. Semin Ultrasound CT MR. 2010; 31(1): 14-8.
3. Beigelman C. Computed tomography in 2000: technique, expected progress, limitations,indications. Rev Pneumol Clin. 2000; 56(2): 73-81.
4. Bennett LM. Breast cancer: Genetic predisposition and exposure to radiation Molecular Carcinogenesis 1999; 26: 143-9.
5. Arslanoğlu A, Bilgin S, Kubalı Z, Ceyhan MN, İlhan MN, Maral I. Doctors’ and intern doctors’ knowledge about patients’ ionizing radiation exposure doses during common radiological examinations. Diagn Interv Radiol 2007; 13: 53-5.
6. Cimmino CV. Overutilization of radiological examinations. Radiology 1977 ; 123(1): 241.
7. Hall FM. Overutilization of radiological examinations. Radiology 1976; 120(2): 443-8.
8. Armao D, Semelka RC, Elias JJ. Radiology's ethical responsibility for healthcare reform: tempering the overutilization of medical imaging and trimming down a heavyweight. J Magn Reson Imaging. 2012; 35(3): 512-7.
9. Lu MT, Tellis WM, Fidelman N, Qayyum A, Avrin DE. Reducing the rate of repeat imaging: import of outside images to PACS. AJR Am J Roentgenol. 2012; 198(3): 628-34.
10. Hendee WR, Becker GJ, Borgstede JP, Bosma J, Casarella WJ, Erickson BA, Maynard CD, Thrall JH, Wallner PE. Addressing overutilization in medical imaging. Radiology 2010; 257(1): 240-5.
11. Zondervan RL, Hahn PF, Sadow CA, Liu B, Lee SI. Frequent body CT scanning of young adults: indications, outcomes, and risk for radiationinduced cancer. J Am Coll Radiol 2011; 8(7): 501-7.
12. Giles J. Study warns of ‘avoidable’ risks of CT scans. Nature 2004; 431: 391.
13. Berrington de Gonzalez A, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, Land C. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009; 169(22): 2071-2.
14. Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology. Br J Radiol 2008; 81(965): 362-78.
15. Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimates of the cancer risks from pediatric CT radiation are not merely theoretical. Med Phys 2001; 28: 2387-8.
16. Sources and effects of ionizing radiation: United Nations Scientific Committee on the Effects of Atomic Radiation: UNSCEAR 2000 report to the General Assembly. NewYork: United Nations, 2000.
17. Berrington de Gonzalez A, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 2004; 363: 345-51.
18. Sağlık Bakanlığı Sağlık Araştırmaları Genel Müdürlüğü Sağlık İstatistikleri Yıllığı 2011, http://sbu.saglik.gov.tr/Ekutuphane/kitaplar/siy_20 11.pdf, erişim tarihi: 01.02.2014
19. Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K. Chest pain in family practice. Diagnosis and long-term outcome in a community setting. Can Fam Physician. 1996; 42: 1122-8.
20. The International Early Lung Cancer Action Program Investigators. Survival of Patients with Stage I Lung Cancer Detected on CT Screening N Engl J Med 2006; 355: 1763-71