| Abstract | Kompjutorizirana tomografija izuzetno je značajna za procjenu stanja organa i patoloških promjena u području retroperitoneuma. Za procjenu gornjeg mokraćnog sustava i mokraćnog mjehura služi CT urografija. To je veoma bitna slikovna metoda koja je zbog svoje izuzetne dijagnostičke preciznosti zauzela važnu ulogu u detekciji tumora, anatomskih odstupanja, malformacija i lezija, te u otkrivanju i praćenju patologije prisutne u mokraćnom sustavu. Dakle, CT urografija je metoda izbora koja se koristi kako bi se utvrdilo postoje li bolesti bubrega i ostalih organa mokraćnog sustava i zdjelice, te za procjenu proširenosti istih. Može se reći kako je CTU uvelike zamijenila intravensku urografiju. Ona se najčešće upotrebljava prilikom sljedećih indikacija: prisutnost krvi u urinu, sumnja na tumore gornjeg mokraćnog sustava, praćenje benignih i malignih stanja lokaliziranih u mokraćnom sustavu, praćenje stanja nakon otkrića i liječenja tumora, traume mokraćnog sustava, različite infekcije mokraćnog sustava i slična stanja. Pretraga se izvodi s ili bez kontrastnog sredstva. Za izvođenje CT urografije ne postoji protokol koji je univerzalno prihvaćen, ali tehnike „Triple phase“ te „Split-bolus“ svakako predstavljaju najčešće korištene protokole ove pretrage. Uporabom istih omogućava se optimalno rastezanje mokraćnog trakta te se na taj način dobiva maksimalna vidljivost mogućih deformacija unutar istog. Sam naziv „Triple phase“ govori nam da postoje tri ključne faze prilikom provedbe ovog protokola. One su sljedeće: nativna faza, nefrografska faza, te ekskrecijska faza. Snimanje započinje nativnom fazom, a zatim slijede dvije odvojene faze nakon primjene kontrastnog jodnog sredstva. Tehnika „Split- bolus“ sastoji se od dvije faze. Započinje također nativnom fazom, a zatim se spajaju zadnje dvije faze: nefrografska i ekskrecijska faza. „Split bolus“ tehnikom smanjuje se doza radijacije za 30-50% u odnosu na „Triple phase“ protokol.
Cilj ovog istraživanja bio je usporediti dozu zračenja između dva protokola urografije, odnosno dokazati da je doza zračenja veća kod „Triple phase“ protokola nego „Split-bolus“ protokola. Pacijenti su bili podvrgnuti pregledu CT urografije na Kliničkom zavodu za radiologiju na lokalitetu Sušak, u razdoblju od 01.01.2019. do 31.12.2020. U tom periodu je prikupljeno 100 podataka iz medicinske dokumentacije pacijenata. Također, osim doze zračenja ispitivala se tehnička uspješnost pregleda ovisno o korištenom protokolu, te utjecaj tjelesne mase na primljenu dozu zračenja. |
| Abstract (english) | Computed tomography is extremely important for assessing the condition of organs and pathological changes in the area of the retroperitoneum. CT urography is used to assess the upper urinary tract and bladder. It is a very important imaging method which, due to its exceptional diagnostic precision, has taken an important role in the detection of tumors, anatomical abnormalities, malformations and lesions, and in the detection and monitoring of pathology present in the urinary system. Thus, CT urography is the method of choice used to determine the existence of diseases of the kidneys and other organs of the urinary system and pelvis, and to assess their enlargement. It can be said that CTU has largely replaced intravenous urography. It is most commonly used during the following indications: presence of blood in urine, suspected upper urinary tract tumors, monitoring of benign and malignant conditions localized in the urinary tract, monitoring of conditions after tumor detection and treatment, urinary trauma, various urinary tract infections and similar conditions. The examination is performed with or without contrast agent. There is no universally accepted protocol for performing CT urography, but the "Triple phase" and "Split-bolus" techniques are certainly the most commonly used protocols in this test. The application of the same enables optimal stretching of the urinary tract, thus achieving maximum visibility of possible deformations within it. The name "Triple phase" tells us that there are three key phases in verifying this protocol. They are as follows: native phase, nephrographic phase, and excretory phase. Recording begins with the native phase, followed by two separate phases after application of a contrast iodine agent. The "Split-bolus" technique consists of two phases. It also begins with the native phase, and then the last two phases merge: the nephrographic and the excretory phase. The "Split-bolus" technique reduces the radiation dose by 30-50% in relation to the "Triple-phase" protocol.
The aim of this study was to compare the radiation dose between two protocols of urography, ie to prove that the radiation dose is higher in the "Triple phase" protocol than the "Split-bolus" protocol. Patients underwent CT urography examination at the Clinical Department of Radiology, in the period from January 1, 2019. to 31.12.2020. During this period, 100 data from patients' medical records were collected. Also, in addition to the radiation dose, the technical success of the examination was analysed depending on the protocol used, as well as the influence of body weight on the received radiation dose. |
