JUSTIFICATION OF RADIOLOGICAL PROCEDURES ALGORITHM ADJUSTMENT IN DIAGNOSIS OF LOWER BACK PAIN CAUSE AT UNIVERSITY CLINICAL CENTER TUZLA

Q4 Medicine

Acta Medica Saliniana Pub Date : 2019-08-06 DOI:10.5457/AMS.V49I1.489

Aida Denjagić

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Abstract

Introduction: Lower Back Pain (LBP) is one of the most frequent reasons for visiting physican. Authors of guidelines scrutinizing use of radiography and Computed tomography (CT) or Magnetic resonance imaging (MRI) in LBP diagnostic. Method of choice in the LBP diagnostic should be MRI except in cases where we should get diagnostic informations as soon as possible (traumas etc.) and in strict indications in bone structures where CT should be a method of choice. Increase of CT use and following icrease CT derived radiation dose in patients are very serious problems of last decades. Aim: To show the nessesary of procedure algorithm adjusment in LBP diagnostic. Reasons are: danger of overdiagnosis leading to chronifications, loosing time and money to get exact diagnose and leading to cumulate very high ionizing doses (10 mSv per person with average body weight from lumbar spine CT) that could couse a cancer if it is over 100 mSv (in some studies if it is over 50 mSv). Patients and methods: Sixty-nine patients, average age of 51.35 years, were included in the study. Lumbar spine CT was performed and repeated procedure at MRI in a very short time in Clinic for Radiology and Nuclear Medicine of University Clinical Centre Tuzla from January 1 2017 to February 9 2018. The sample of patients was formed consecutively. Referral diagnosis for CT procedures were: M51 in 36 patients (52.17%), N/A in 13 (18.84%), M05 in 4 (5.8%), G83.4 in 3 (4.35%) and other in 13 (18.84%). Results: 30 (83.33%) of patients were referred from CT to MRI procedure in time under 42 days (during acute phase). Relation of justified and unjustified undertaken CT procedures were: 71% unjustified, 10% justified and 19% N/A.Conclusion: Performed study showed unjustified undertaken CT procedures and high unnecessary radiation dose in 71% patients. There are justified reasons for procedure algorithm adjusment in LBP diagnostic. Key words: lower back pain, diagnostic procedure algorithm, CT, MRI

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图兹拉大学临床中心放射学程序算法调整诊断下背痛原因的合理性

引言：下背痛（LBP）是就诊医师最常见的原因之一。指导方针的作者仔细审查在LBP诊断中使用射线照相和计算机断层扫描（CT）或磁共振成像（MRI）。LBP诊断的选择方法应该是MRI，除非我们应该尽快获得诊断信息（创伤等），并且在骨结构的严格适应症中，CT应该是一种选择方法。在过去的几十年里，CT使用的增加和患者CT辐射剂量的增加是非常严重的问题。目的：证明程序算法调整在LBP诊断中的必要性。原因是：过度诊断的危险导致慢性化，浪费时间和金钱来进行准确诊断，并导致累积非常高的电离剂量（腰椎CT平均体重为10 mSv），如果超过100 mSv（在一些研究中，如果超过50 mSv）可能导致癌症。患者和方法：69名患者，平均年龄51.35岁，纳入研究。2017年1月1日至2018年2月9日，在图兹拉大学临床中心放射和核医学诊所进行了腰椎CT检查，并在很短的时间内重复了MRI检查。病人的样本是连续形成的。CT转诊诊断为：M51 36例（52.17%），N/A 13例（18.84%），M05 4例（5.8%），G83.4 3例（4.35%），其他13例（18.34%）。合理和不合理的CT手术的关系为：71%的患者不合理，10%的患者合理，19%的患者不合格。LBP诊断中的程序算法调整是有正当理由的。关键词：下背痛，诊断程序算法，CT，MRI

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Acta Medica Saliniana Medicine-Medicine (all)

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