MDCT DIJAGNOSTIKA KOD TOTALNE ARTROPLASTIKE KOLENA
Sažetak
Prevalenca osteoartritisa kao degenerativne bolesti kolena stalno raste. Više od 50% starijih od 65 godina ima radiografske karakteristike osteoartritisa (1). Procenjuje se da će se broj procedura totalne atroplastike kolena (TKA) povećati 673%, a revizije TKA porasti 601% u perodu od 2005. do 2030 (29). Tri zglobne površine kolena se zamenjuju postavljanjem tri odgovarajuće komponente proteze. Postoji definitivna veza između preciznosti pozicije implanata i dugoročnosti proteze (4).
„Perth CT protokol“ pored metoda konvencionalne, „long-leg“ radiografije i CT skenograma daje najbolja raspoloživa sredstva za adekvatnu procenu poravnanja. Podrazumeva CT pregled ekstermiteta od krova acetebuluma do svoda talusa, u supinaciji, neutralnoj poziciji noge i maksimalnoj ekstenziji kolena. Postproceduralno, reformacijom u koronalnoj, sagitalnoj i aksijalnoj ravni, određuje se sedam karakteristika poravnanja, mehanička i anatomska osovina noge (5). Efektivna doza zračenja pri „long-leg“ radiografiji je oko 0,7 mSv, a kod Perth CT protokola oko 2,7 mSv (9).
Preporuke Međunarodne komisija za zaštitu od zračenja predstavljaju dva osnovna princima u zaštiti od zračenja prilikom medicinskog izlaganja: opravdanost pregleda i optimizaciju protokola. Kvalitet slike i doza zračenja prilikom CT pregleda direktno zavise od parametara akvizicije i rekonstrukcije slike. Optimizacija podrazumeva izbor parametara protokola pregleda takav da pacijentna doza bude što je moguće manja, a da dijagnostički kvalitete slike ostane zadovoljavajući - ALARA (As Low As Reasonably Achievable) princip (23).
Reference
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