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          "pt" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o do AAEsq &#8211; diferencia&#231;&#227;o entre trombo e pseudotrombo&#46; Exemplo de pseudotrombo que pela densidade m&#233;dia elevada n&#227;o necessita de segunda aquisi&#231;&#227;o&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o e objetivos</span><p id="par0005" class="elsevierStylePara elsevierViewall">O isolamento percut&#226;neo das veias pulmonares est&#225; bem estabelecido para o tratamento da fibrilha&#231;&#227;o auricular&#44; &#233; uma &#225;rea de grande desenvolvimento cl&#237;nico e tecnol&#243;gico nos &#250;ltimos anos<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a>&#46; Antes da sua feitura&#44; &#233; necess&#225;ria a exclus&#227;o de trombo intracard&#237;aco&#44; nomeadamente no ap&#234;ndice auricular esquerdo &#40;AAEsq&#41;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2&#8211;4</span></a>&#46; A obten&#231;&#227;o pr&#233;via de mapa anat&#243;mico 3<span class="elsevierStyleHsp" style=""></span>D da aur&#237;cula esquerda &#40;AEsq&#41; e das veias pulmonares facilita o procedimento&#44; contribui para a sua seguran&#231;a&#44; reduz a radia&#231;&#227;o a que o doente &#233; submetido durante a abla&#231;&#227;o e poder&#225; aumentar a sua acuidade<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5&#8211;8</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A tomografia computorizada &#40;TC&#41; card&#237;aca &#233; um m&#233;todo imagiol&#243;gico com capacidade para fornecer toda essa informa&#231;&#227;o &#40;exclus&#227;o de trombo e informa&#231;&#227;o anat&#243;mica&#41; de forma n&#227;o invasiva<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a>&#44; pelo que tem ganhado preponder&#226;ncia nesses doentes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a>&#46; Este trabalho tem por objetivo avaliar a otimiza&#231;&#227;o dos protocolos de TC card&#237;aca pr&#233;via a abla&#231;&#227;o de fibrilha&#231;&#227;o auricular &#40;pr&#233;&#8208;abla&#231;&#227;o&#41;&#44; tem por base a dose de radia&#231;&#227;o e de contraste e a qualidade diagn&#243;stica&#44; tem em conta o aumento da experi&#234;ncia do centro e os avan&#231;os tecnol&#243;gicos dispon&#237;veis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Desenho do estudo e popula&#231;&#227;o</span><p id="par0015" class="elsevierStylePara elsevierViewall">De um registo prospetivo de centro &#250;nico de grande volume doentes submetidos a avalia&#231;&#227;o por TC card&#237;aca j&#225; descrito anteriormente<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a>&#44; selecionaram&#8208;se todos aqueles cuja indica&#231;&#227;o foi a avalia&#231;&#227;o pr&#233;via a abla&#231;&#227;o de fibrilha&#231;&#227;o auricular &#40;pr&#233;&#8208;abla&#231;&#227;o&#41;&#46; Desses foram constitu&#237;dos tr&#234;s grupos de doentes consecutivos&#44; independentes&#58; Grupo 1 &#8211; Os primeiros 150 doentes consecutivos inclu&#237;dos no registo&#59; Grupo 2 &#8211; Os &#250;ltimos 60 doentes efetuados com o mesmo aparelho de TC que tivemos dispon&#237;vel &#8211; TC dupla&#8208;ampola de 1&#46;&#170; gera&#231;&#227;o&#44; com 64 cortes &#40;SOMATOM Definition&#174;&#44; Siemens Healthcare&#41;&#59; Grupo 3 &#8211; Constitu&#237;do com os primeiros 60 doentes efetuados com o novo aparelho de TC dupla&#8208;ampola 3&#46;&#170; gera&#231;&#227;o &#8211; 192 detetores &#40;SOMATOM Force&#174;&#44; Siemens Healthcare&#41;&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figura 2</a>&#41;&#46; O Grupo 1 serviu de grupo controlo quando comparado com o Grupo 2&#44; para avalia&#231;&#227;o da experi&#234;ncia na otimiza&#231;&#227;o dos exames&#46; O Grupo 2 serviu de Grupo controlo quando comparado com o Grupo 3 para avalia&#231;&#227;o da evolu&#231;&#227;o tecnol&#243;gica na otimiza&#231;&#227;o dos exames&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Protocolo de aquisi&#231;&#227;o</span><p id="par0020" class="elsevierStylePara elsevierViewall">Todos os exames foram feitos dentro das 24<span class="elsevierStyleHsp" style=""></span>h pr&#233;vias &#224; feitura do procedimento ablativo&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Protocolo de aquisi&#231;&#227;o para o Grupo 1</span><p id="par0025" class="elsevierStylePara elsevierViewall">Exames feitos em TC dupla&#8208;ampola 1&#46;&#170; gera&#231;&#227;o &#8211; 64 detetores &#8211; SOMATOM Definition&#174;&#44; com resolu&#231;&#227;o temporal nativa de 83ms e velocidade de mesa &#40;<span class="elsevierStyleItalic">pitch</span>&#41; m&#225;ximo de 45&#44;7<span class="elsevierStyleHsp" style=""></span>mm&#47;s&#46; Aquisi&#231;&#227;o com protocolo retrospetivo&#44; com modula&#231;&#227;o da miliamperagem &#8211; com 20&#37; da miliamperagem fora dos intervalos de dose m&#225;xima&#44; escolhidos da seguinte forma&#58; se r&#237;tmico e frequ&#234;ncia card&#237;aca &#40;FC&#41; inferior a 70 batimentos por minuto &#40;bpm&#41; &#8211; dose m&#225;xima apenas aos 70&#37; do intervalo RR&#59; se arr&#237;tmico ou r&#237;tmico com FC 70&#8208;80bpm &#8211; dose m&#225;xima de 40 a 80&#37; do intervalo RR&#59; se r&#237;tmico e FC superior a 80bpm &#8211; dose m&#225;xima a 40&#8208;50&#37; do intervalo RR&#46; A kilovoltagem &#40;kV&#41; foi determinada da seguinte forma&#58; 100<span class="elsevierStyleHsp" style=""></span>kV se &#237;ndice de massa corporal &#40;BMI&#41; &#60;<span class="elsevierStyleHsp" style=""></span>30&#44; caso contr&#225;rio 120Kv&#46; As imagens foram reconstru&#237;das com protocolo de <span class="elsevierStyleItalic">filtered back projection</span> &#40;FBP&#41;&#44; com uma espessura de 1&#44;5<span class="elsevierStyleHsp" style=""></span>mm e um incremento de 0&#44;7<span class="elsevierStyleHsp" style=""></span>mm&#44; matriz 512 x 512&#46; O contraste usado tinha a concentra&#231;&#227;o de 320mgI&#47;ml e foi administrado num protocolo trif&#225;sico com um d&#233;bito de 6<span class="elsevierStyleHsp" style=""></span>ml&#47;seg&#44; da seguinte forma&#58; primeira fase com administra&#231;&#227;o de contraste puro com volume calculado segundo a f&#243;rmula&#58; volume de contraste administrado &#61; &#40;tempo de aquisi&#231;&#227;o &#43; tempo de espera&#41; x 6 &#40;valor do fluxo de administra&#231;&#227;o&#41;&#46; O tempo de espera foi fixado em sete segundos&#59; segunda fase com a administra&#231;&#227;o de 30<span class="elsevierStyleHsp" style=""></span>ml de contraste dilu&#237;do &#40;30&#37; contraste e 70&#37; soro&#41;&#59; terceira fase com administra&#231;&#227;o de 30<span class="elsevierStyleHsp" style=""></span>ml de soro&#46; Foi usada a t&#233;cnica de <span class="elsevierStyleItalic">bolus tracking</span> com regi&#227;o de interesse na aorta ascendente e in&#237;cio de aquisi&#231;&#227;o sete segundos ap&#243;s atingir a densidade de 150HU &#40;unidades de Hounsfield&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protocolo de aquisi&#231;&#227;o para o Grupo 2</span><p id="par0030" class="elsevierStylePara elsevierViewall">Exames feitos em TC dupla&#8208;ampola 1&#46;&#170; gera&#231;&#227;o &#8211; 64 detetores &#8211; SOMATOM Definition&#174;&#44; com resolu&#231;&#227;o temporal nativa de 83ms e velocidade de mesa &#40;<span class="elsevierStyleItalic">pitch</span>&#41; m&#225;ximo de 45&#44;7<span class="elsevierStyleHsp" style=""></span>mm&#47;s&#46; Aquisi&#231;&#227;o com protocolo prospetivo se doente r&#237;tmico ou arr&#237;tmico com pequena variabilidade RR&#59; noutros casos aquisi&#231;&#227;o retrospetiva &#40;modula&#231;&#227;o da miliamperagem com 20&#37; da miliamperagem fora dos intervalos de dose m&#225;xima&#44; com dose m&#225;xima de 40 a 80&#37; do intervalo RR&#41;&#46; A kV foi determinada da seguinte forma&#58; 80<span class="elsevierStyleHsp" style=""></span>kV se BMI &#60;<span class="elsevierStyleHsp" style=""></span>30&#44; caso contr&#225;rio 100<span class="elsevierStyleHsp" style=""></span>kV se peso inferior a 100<span class="elsevierStyleHsp" style=""></span>kg e 120<span class="elsevierStyleHsp" style=""></span>kV se peso superior a 100<span class="elsevierStyleHsp" style=""></span>kg&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As imagens foram reconstru&#237;das com protocolo de <span class="elsevierStyleItalic">filtered back projection</span> &#40;FBP&#41;&#44; com uma espessura de 1&#44;5<span class="elsevierStyleHsp" style=""></span>mm e um incremento de 0&#44;7<span class="elsevierStyleHsp" style=""></span>mm&#44; matriz 512 x 512&#46; O contraste usado tinha a concentra&#231;&#227;o de 370 mgI&#47;ml e foi administrado num protocolo trif&#225;sico com um d&#233;bito de 5<span class="elsevierStyleHsp" style=""></span>ml&#47;seg&#44; da seguinte forma&#58; primeira fase com administra&#231;&#227;o de contraste puro com volume calculado segundo a f&#243;rmula&#58; volume de contraste administrado &#61; &#40;tempo de aquisi&#231;&#227;o &#43; tempo de espera&#41; x 5 &#40;valor do fluxo de administra&#231;&#227;o&#41;&#46; O tempo de espera foi fixado em 10 segundos&#59; segunda fase com a administra&#231;&#227;o de 30<span class="elsevierStyleHsp" style=""></span>ml de contraste dilu&#237;do &#40;30&#37; contraste e 70&#37; soro&#41;&#59; terceira fase com administra&#231;&#227;o de 30<span class="elsevierStyleHsp" style=""></span>ml de soro&#46; Foi usada a t&#233;cnica de <span class="elsevierStyleItalic">bolus tracking</span> com regi&#227;o de interesse na aorta ascendente e in&#237;cio de aquisi&#231;&#227;o 10 segundos ap&#243;s atingir a densidade de 150HU &#40;unidades de Hounsfield&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protocolo de aquisi&#231;&#227;o para o Grupo 3</span><p id="par0040" class="elsevierStylePara elsevierViewall">Exames feitos em TC dupla&#8208;ampola 3&#46;&#170; gera&#231;&#227;o &#8211; 192 detetores &#8211; SOMATOM Force&#174;&#44; com resolu&#231;&#227;o temporal nativa de 66 ms e velocidade de mesa &#40;<span class="elsevierStyleItalic">pitch&#41;</span> m&#225;ximo em modo FLASH de 737<span class="elsevierStyleHsp" style=""></span>mm&#47;seg&#46; Aquisi&#231;&#227;o com protocolo FLASH &#40;aquisi&#231;&#227;o em batimento card&#237;aco &#250;nico com m&#233;todo de velocidade de mesa muito elevado 737<span class="elsevierStyleHsp" style=""></span>mm&#47;s&#41;&#44; exceto se doentes com FC m&#233;dia superior a 80 bpm&#44; nos quais se opta pela aquisi&#231;&#227;o em m&#233;todo prospetivo&#46; Aquisi&#231;&#227;o retrospetiva apenas em doentes com marcada variabilidade RR&#46; A determina&#231;&#227;o da kV e da miliamperagem &#40;mA&#41; &#233; efetuada de forma autom&#225;tica&#44; tem em conta a densidade do topograma e os par&#226;metros de refer&#234;ncia&#44; os quais opt&#225;mos por definir 80<span class="elsevierStyleHsp" style=""></span>kV com 200mAs&#47;rot&#44; com indica&#231;&#227;o de feitura de angio&#8208;TC&#46; Apenas se BMI<span class="elsevierStyleHsp" style=""></span>&#62;30&#44; os kV de refer&#234;ncia passam a 100<span class="elsevierStyleHsp" style=""></span>kV&#46; Os valores de refer&#234;ncia servem como um guia para o ru&#237;do admiss&#237;vel&#47;m&#225;ximo que se pretende ter na imagem&#44; faz o aparelho uma modifica&#231;&#227;o dos valores por forma a otimizar a dose de radia&#231;&#227;o&#44; mant&#233;m&#8208;se a qualidade da imagem&#46; As imagens foram reconstru&#237;das com protocolo iterativo &#8211; SAFFIRE &#8220;for&#231;a&#8221; 3&#44; com 1&#44;5<span class="elsevierStyleHsp" style=""></span>mm de espessura e 0&#44;7<span class="elsevierStyleHsp" style=""></span>mm de incremento&#44; com matriz 512 x 512&#46; O contraste usado tinha a concentra&#231;&#227;o de 370 mgI&#47;ml e foi administrado num protocolo trif&#225;sico com um d&#233;bito de 4<span class="elsevierStyleHsp" style=""></span>ml&#47;seg&#44; da seguinte forma&#58; primeira fase com administra&#231;&#227;o de contraste puro com volume calculado segundo a f&#243;rmula&#58; volume de contraste administrado &#61; &#40;tempo de aquisi&#231;&#227;o &#43; tempo de espera&#41; x 4 &#40;valor do fluxo de administra&#231;&#227;o&#41;&#46; O tempo de espera foi fixado em 15 segundos &#40;compensa a marcada diminui&#231;&#227;o do tempo de aquisi&#231;&#227;o que no protocolo FLASH &#233; inferior a 1 segundo&#41;&#59; segunda fase com a administra&#231;&#227;o de 30<span class="elsevierStyleHsp" style=""></span>ml de contraste dilu&#237;do &#40;30&#37; contraste e 70&#37; soro&#41;&#59; terceira fase com administra&#231;&#227;o de 30<span class="elsevierStyleHsp" style=""></span>ml de soro&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Foi usada a t&#233;cnica de <span class="elsevierStyleItalic">bolus tracking</span> com regi&#227;o de interesse na aorta ascendente e in&#237;cio de aquisi&#231;&#227;o 15 segundos ap&#243;s atingir a densidade de 150HU &#40;unidades de Hounsfield&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Avali&#225;mos a otimiza&#231;&#227;o do protocolo com base em diversos par&#226;metros&#58; A&#41; na dose de radia&#231;&#227;o em mSv&#44; calculada a partir dos DLP &#40;<span class="elsevierStyleItalic">dose lengh product</span>&#41; totais&#44; disponibilizados pelo aparelho&#44; multiplicados pelo fator de convers&#227;o 0&#44;014<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">12&#8211;14</span></a>&#59; B&#41; no volume de contraste usado em ml&#59; <span class="elsevierStyleSmallCaps">C</span>&#41; na avalia&#231;&#227;o subjetiva da qualidade diagn&#243;stica&#44; definida por exame com acuidade diagn&#243;stica para excluir trombo na aur&#237;cula esquerda e ap&#234;ndice auricular esquerdo&#44; avaliada por dois m&#233;dicos &#40;com n&#237;vel III de forma&#231;&#227;o em TC card&#237;aca&#41;&#44; de forma independente&#44; bem como pelo n&#250;mero de doentes em que foi considerada necess&#225;ria uma segunda aquisi&#231;&#227;o&#44; mais tardia &#40;sem nova administra&#231;&#227;o de contraste&#44; para avaliar adequadamente o ap&#234;ndice auricular esquerdo e permitir a exclus&#227;o de trombo&#41;&#59; D&#41; na avalia&#231;&#227;o objetiva da qualidade do exame&#44; efetuada para avalia&#231;&#227;o da capacidade de otimiza&#231;&#227;o do protocolo entre aparelhos diferentes &#40;aplicada ao Grupo 2 e 3&#41;&#44; caracterizada pelo r&#225;cio sinal&#47;ru&#237;do&#44; o r&#225;cio contraste&#47;ru&#237;do e a homogeneiza&#231;&#227;o de densidade entre a AEsq e o AAEsq</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Defini&#231;&#227;o dos par&#226;metros de avalia&#231;&#227;o quantitativa da qualidade de imagem</span><p id="par0055" class="elsevierStylePara elsevierViewall">O r&#225;cio sinal&#47;ru&#237;do &#233; obtido por desenho de uma regi&#227;o de interesse no centro da aur&#237;cula esquerda e dividindo a densidade m&#233;dia pelo desvio padr&#227;o&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figura 3</a>&#41;&#46; Em rela&#231;&#227;o ao r&#225;cio contraste&#47;ru&#237;do&#44; nesse tipo de exame e tendo em conta a import&#226;ncia de exclus&#227;o de trombo&#44; opt&#225;mos por definir esse par&#226;metro em rela&#231;&#227;o &#224; densidade do mioc&#225;rdio do ventr&#237;culo esquerdo&#44; e n&#227;o em rela&#231;&#227;o &#224; gordura epic&#225;rdica&#44; uma vez que o mioc&#225;rdio do ventr&#237;culo esquerdo &#233; a estrutura lim&#237;trofe com o AAEsq com menor diferen&#231;a de densidade em rela&#231;&#227;o ao l&#250;men do mesmo&#46; Para o c&#225;lculo desse par&#226;metro foram desenhadas regi&#245;es de interesse no AAEsq &#40;local de menor densidade visual&#41; e intramioc&#225;rdico&#44; no segmento do mioc&#225;rdio em maior proximidade do AAE&#46; O r&#225;cio foi obtido da seguinte forma &#40;densidade m&#233;dia do AAEsq &#8211; densidade m&#233;dia do mioc&#225;rdio&#41;&#47;desvio padr&#227;o do AAEsq&#46; A homogeneiza&#231;&#227;o de densidade entre a AEsq e o AAEsq &#233; obtida pela divis&#227;o da densidade m&#233;dia da AEsq obtida na regi&#227;o de interesse desenhada no local visual de maior densidade com a densidade m&#233;dia obtida da regi&#227;o de interesse desenhada no local de menor densidade visual no AAEsq&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figura 3</a>&#41;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Dentro de cada grupo foram ainda registadas caracter&#237;sticas demogr&#225;ficas &#40;g&#233;nero&#44; idade&#44; peso&#44; altura&#41;&#44; bem como o ritmo card&#237;aco e a frequ&#234;ncia card&#237;aca &#40;m&#225;xima&#44; m&#237;nima e m&#233;dia&#41; durante a aquisi&#231;&#227;o&#44; vari&#225;veis do protocolo usado &#40;retrospetivo&#44; prospectivo&#44; <span class="elsevierStyleItalic">flash</span>&#59; kV da aquisi&#231;&#227;o&#59; DLP do exame&#41;&#44; o volume auricular&#44; a presen&#231;a de trombo intracard&#237;aco e a presen&#231;a de complica&#231;&#245;es tromboemb&#243;licas ap&#243;s o procedimento de abla&#231;&#227;o at&#233; &#224; alta cl&#237;nica&#46; Todos os exames foram efetuados com sincroniza&#231;&#227;o com ECG&#44; procurou&#8208;se otimizar os par&#226;metros do protocolo ao doente&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Os exames foram avaliados logo ap&#243;s a sua feitura para decis&#227;o de necessidade de aquisi&#231;&#227;o complementar &#40;2&#46;&#170; aquisi&#231;&#227;o&#41; quando a opacifica&#231;&#227;o do AAESq era determinada insuficiente para exclus&#227;o segura de trombo ou quando&#44; por qualquer outra causa&#44; o exame era considerado n&#227;o diagn&#243;stico&#46; Essa segunda aquisi&#231;&#227;o era efetuada nos primeiros tr&#234;s minutos ap&#243;s a aquisi&#231;&#227;o inicial&#44; sem usar mais contraste e limitada ao AAEsq &#40;<a class="elsevierStyleCrossRefs" href="#fig0020">Figuras 4&#8208;5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lise estat&#237;stica</span><p id="par0070" class="elsevierStylePara elsevierViewall">As vari&#225;veis cont&#237;nuas apresentam&#8208;se como mediana &#40;intervalo interquartil&#41; e as categ&#243;ricas como n&#250;mero &#40;n&#41; e frequ&#234;ncia &#40;&#37;&#41;&#46; Para compara&#231;&#227;o entre vari&#225;veis cont&#237;nuas usaram&#8208;se os testes n&#227;o param&#233;tricos de Mann&#8208;Whitney ou Kruskal&#8208;Wallis&#46; O teste exato de Fisher foi usado para testar diferen&#231;as nas frequ&#234;ncias de vari&#225;veis categ&#243;ricas&#46; Foi usado o <span class="elsevierStyleItalic">software</span> Statistical Pack for Social Sciences &#40;IBM SPSS&#41; vers&#227;o 20 para Mac OSX&#46; Aceitou&#8208;se existir diferen&#231;a significativa quando p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 &#40;duas caudas&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">Os resultados da avalia&#231;&#227;o dos tr&#234;s grupos e da compara&#231;&#227;o entre grupos s&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Dose de radia&#231;&#227;o</span><p id="par0080" class="elsevierStylePara elsevierViewall">Os exames do Grupo 1 tiveram radia&#231;&#227;o mediana de 5&#44;6<span class="elsevierStyleHsp" style=""></span>mSv &#40;402DLP <span class="elsevierStyleItalic">dose lengh product</span> x 0&#44;014&#41;&#44; os do Grupo 2 &#8211; 1&#44;3<span class="elsevierStyleHsp" style=""></span>mSv &#40;95DLP x 0&#44;014&#41; e 0&#44;6<span class="elsevierStyleHsp" style=""></span>mSv para os doentes do Grupo 3 &#40;41DLP x 0&#44;014&#41;&#46; Salientamos a diferen&#231;a significativa no tipo de protocolo usado e na kV dos exames&#44; aspeto que contribui decisivamente para a diferen&#231;a significativa na mediana da dose de radia&#231;&#227;o dos exames&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Dose de contraste</span><p id="par0085" class="elsevierStylePara elsevierViewall">A evolu&#231;&#227;o do protocolo permitiu ainda uma redu&#231;&#227;o significativa entre os grupos da dose de contraste&#44; dos 100<span class="elsevierStyleHsp" style=""></span>ml de volume no Grupo 1 para os 65<span class="elsevierStyleHsp" style=""></span>ml usados no grupo 3&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Avalia&#231;&#227;o qualitativa da imagem</span><p id="par0090" class="elsevierStylePara elsevierViewall">Todos os exames foram considerados diagn&#243;sticos&#46; Apesar de n&#227;o ter atingido signific&#226;ncia&#44; existe uma tend&#234;ncia para a menor necessidade de 2&#46;&#170; aquisi&#231;&#227;o com o evoluir do protocolo&#44; com percentagem de 2&#46;&#170; aquisi&#231;&#245;es de 11&#37; no Grupo 1 &#40;desses 17 casos apenas num caso a &#225;rea de menor densidade traduzia imagem &#8220;correcta&#8221; dado corresponder a verdadeiro trombo&#44; confirmado por ecocardiografia transesof&#225;gica&#41; &#40;<a class="elsevierStyleCrossRefs" href="#fig0020">Figuras 4&#8208;6</a>&#41; e de apenas 5&#37; no grupo 3 &#40;p &#61; 0&#44;057&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Avalia&#231;&#227;o quantitativa da qualidade da imagem</span><p id="par0095" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o quantitativa da qualidade de imagem &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41; entre o Grupo</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">2 e o Grupo 3&#44; verificamos que apesar da redu&#231;&#227;o da dose de radia&#231;&#227;o e do volume de contraste&#44; os exames apresentaram melhor qualidade com r&#225;cios sinal&#47;ru&#237;do e contraste&#47;ru&#237;do significativamente maiores e com maior homogeneiza&#231;&#227;o de densidade entre a AEsq e o AAEsq&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> verificamos que a necessidade de 2&#46;&#170; aquisi&#231;&#227;o n&#227;o se correlacionou com o volume auricular &#40;apesar parecer existir uma tend&#234;ncia para ser necess&#225;ria em aur&#237;culas maiores&#44; p &#61; 0&#44;087&#41;&#44; mas apenas com a aquisi&#231;&#227;o em fibrilha&#231;&#227;o auricular e com a frequ&#234;ncia card&#237;aca m&#233;dia durante a aquisi&#231;&#227;o&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discuss&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">A TC card&#237;aca num contexto pr&#233;vio a abla&#231;&#227;o de fibrilha&#231;&#227;o auricular permite dispensar outros m&#233;todos de imagem&#44; &#233; capaz de fornecer um excelente mapa anat&#243;mico e excluir a presen&#231;a de trombos intracard&#237;acos<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">9&#44;15</span></a>&#46; No entanto&#44; para que a presen&#231;a de falsos positivos n&#227;o diminua a acuidade da t&#233;cnica e consequentemente o seu valor como &#8220;exame &#250;nico&#8221; pr&#233;vio &#224; t&#233;cnica ablativa&#44; &#233; necess&#225;rio diferenciar trombos verdadeiros de imagens referidas como pseudotrombos&#44; que n&#227;o s&#227;o infrequentes e resultam de insuficiente homogeneiza&#231;&#227;o contraste&#8208;sangue entre a AEsq e o AAEsq<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a>&#46; Existem diferentes formas de diferenciar essas entidades&#44; opt&#225;mos por avaliar sempre as imagens da primeira aquisi&#231;&#227;o logo ap&#243;s a sua reconstru&#231;&#227;o e caso a homogeneiza&#231;&#227;o de densidade AEsq&#47;AAEsq n&#227;o permitisse a exclus&#227;o de trombo&#44; repetimos a aquisi&#231;&#227;o limitada ao AAEsq sem mais contraste&#44; dentro de um per&#237;odo temporal de tr&#234;s minutos ap&#243;s a primeira aquisi&#231;&#227;o&#46; Para diminuir a necessidade de 2&#46;&#170; aquisi&#231;&#245;es&#44; que s&#227;o infrequentes &#40;11&#37; no Grupo 1 e 5&#37; no Grupo 3&#41;&#44; atras&#225;mos o in&#237;cio da aquisi&#231;&#227;o inicial aumentando o valor de densidade para in&#237;cio de aquisi&#231;&#227;o &#40;<span class="elsevierStyleItalic">trigger</span>&#41; no <span class="elsevierStyleItalic">bolus tracking</span>&#44; assim como o tempo de espera entre esse <span class="elsevierStyleItalic">trigger</span> e o in&#237;cio da aquisi&#231;&#227;o propriamente dita&#46; Apesar de essas modifica&#231;&#245;es de protocolo n&#227;o terem resultado numa diminui&#231;&#227;o significativa do n&#250;mero de 2&#46;&#170; aquisi&#231;&#245;es necess&#225;rias&#44; parece existir uma tend&#234;ncia nesse sentido &#40;de 11&#37; no Grupo 1 para 5&#37; no Grupo 3&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;057&#41;&#46; Verificamos que a necessidade de 2&#46;&#170; aquisi&#231;&#227;o se correlacionou com a aquisi&#231;&#227;o em fibrilha&#231;&#227;o auricular e com a frequ&#234;ncia card&#237;aca m&#233;dia durante a aquisi&#231;&#227;o&#44; mas n&#227;o com o volume auricular &#40;apesar parecer existir uma tend&#234;ncia para ser necess&#225;ria em aur&#237;culas maiores&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;087&#41;&#46; Esses aspetos est&#227;o de acordo com os fatores preditores de defeitos de preenchimento por contraste do AAEsq em TC card&#237;aca&#44; identificados por outros autores&#46; Na s&#233;rie de Singh et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> a dilata&#231;&#227;o da aur&#237;cula esquerda estava relacionada com defeitos de preenchimento da AAEsq na angio&#8208;TC&#46; No trabalho de Madan et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> verificou&#8208;se que os defeitos de preenchimento do AAEsq na TC se relacionaram com FA permanente&#44; ap&#243;s an&#225;lise multivariada a presen&#231;a de FA durante a aquisi&#231;&#227;o e a idade foram preditores independentes desses defeitos&#46; O <span class="elsevierStyleItalic">timing</span> da aquisi&#231;&#227;o do nosso protocolo procura&#44; para al&#233;m de diminuir a necessidade de segundas passagens&#44; otimizar a qualidade de imagem e manter bons r&#225;cios de sinal&#47;ru&#237;do e contraste&#47;ru&#237;do&#44; sem aumentar a dose de contraste ou a dose de radia&#231;&#227;o final&#46; Esse aspeto foi conseguido com doses de contraste e radia&#231;&#227;o significativamente menores &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; J&#225; anteriormente o nosso grupo publicou que a aquisi&#231;&#227;o em fibrila&#231;&#227;o auricular era um preditor de maior dose de radia&#231;&#227;o&#44; pelo que se torna ainda mais relevante a ado&#231;&#227;o de protocolos que visam reduzir a sua dose&#44; sobretudo em doentes que com frequ&#234;ncia necessitam de v&#225;rios exames seriados com radia&#231;&#227;o ionizante ao longo da sua vida<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">19&#44;20</span></a>&#46; Salientamos ainda que a compara&#231;&#227;o quantitativa da qualidade de imagem entre os dois aparelhos de TC foi traduzida por uma melhoria da qualidade de imagem apesar da redu&#231;&#227;o da radia&#231;&#227;o e contraste&#46; Acresce tamb&#233;m que todos os exames foram considerados com acuidade diagn&#243;stica para exclus&#227;o de trombo&#44; de forma independente&#44; por um radiologista e um cardiologista com larga experi&#234;ncia em TC card&#237;aca&#44; apesar dos 17&#37; de casos &#40;74 exames&#41; feitos em FA&#46; Nos exames feitos em FA a reconstru&#231;&#227;o em tempo absoluto &#40;em milissegundos&#41; imediatamente ap&#243;s a onda T permite &#8220;retirar&#8221; da imagem os artefactos condicionados pela arritmia&#44; quando a reconstru&#231;&#227;o &#233; feita em tempo relativo &#40;percentagem do intervalo RR&#41;&#44; obt&#234;m&#8208;se desse modo imagens com acuidade diagn&#243;stica&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Como referido anteriormente&#44; existem outras formas de procurar otimizar esses protocolos&#44; nomeadamente&#58; A&#41; Com protocolo de dupla aquisi&#231;&#227;o&#44; incluindo sempre aquisi&#231;&#227;o tardia&#44; como efectuado por Lazoura et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a>&#44; que estudaram 122 doentes&#44; com 16&#37; de defeitos de reple&#231;&#227;o do AAEsq na primeira aquisi&#231;&#227;o&#44; dos quais todos foram diagn&#243;stico na segunda aquisi&#231;&#227;o &#40;como na nossa s&#233;rie&#41;&#44; identificaram&#8208;se cerca de 3&#37; de trombos&#46; Neste artigo&#44; verifica&#8208;se ainda que a necessidade de segunda passagem avaliada atrav&#233;s da percentagem de defeitos de reple&#231;&#227;o do AAEsq era de apenas 16&#37; &#40;5&#37; no Grupo 3 do nosso estudo&#41;&#44; pelo que a decis&#227;o de segunda aquisi&#231;&#227;o apenas se necess&#225;rio&#44; como efetuado no nosso estudo&#44; parece&#8208;nos a mais acertada&#46; Comparativamente com o nosso estudo&#44; a dose de contraste e radia&#231;&#227;o foi superior&#46; B&#41; Com protocolo de dupla injec&#231;&#227;o de contraste e apenas adquirindo uma vez&#44; ap&#243;s a segunda administra&#231;&#227;o&#44; como efetuado por Teunissen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a>&#44; que estudaram 605 doentes&#44; com doses m&#233;dias de contraste de 100<span class="elsevierStyleHsp" style=""></span>ml e de radia&#231;&#227;o de 3&#44;1<span class="elsevierStyleHsp" style=""></span>mSv&#46; A percentagem de necessidade de segunda aquisi&#231;&#227;o foi de 4&#44;3&#37;&#46; Comparativamente com o nosso estudo&#44; esse protocolo obteve resultados semelhantes na necessidade de 2&#46;&#170;s aquisi&#231;&#245;es&#44; mas &#224; custa de maiores doses de contraste e radia&#231;&#227;o&#46; C&#41; Protocolo sem sincroniza&#231;&#227;o eletrocardiogr&#225;fica&#44; como o feito por Iwayama et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a>&#44; que estudaram 60 doentes&#44; mas n&#227;o avaliaram a presen&#231;a de trombo&#46; Obtiveram dose de radia&#231;&#227;o m&#233;dia de 1&#44;1<span class="elsevierStyleHsp" style=""></span>mSv&#46; No entanto&#44; a n&#227;o exclus&#227;o de trombo nesse protocolo n&#227;o permite a dispensa de ecocardiograma transesof&#225;gico &#40;ETE&#41;&#44; o que acresce custo e fonte de morbilidade aos doentes&#46; Mesmo fazendo o exame sem sincroniza&#231;&#227;o eletrocardiogr&#225;fica&#44; a dose de radia&#231;&#227;o foi superior &#224; usada no nosso estudo&#46; Noutro estudo&#44; igualmente com exames feitos sem sincroniza&#231;&#227;o eletrocardiogr&#225;fica&#44; Annoni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> estudaram 200 doentes&#44; 100 dos quais no grupo de menor dose de radia&#231;&#227;o&#46; N&#227;o avaliaram a presen&#231;a de trombo e obtiveram uma dose de radia&#231;&#227;o m&#233;dia de 0&#44;4<span class="elsevierStyleHsp" style=""></span>mSv&#46; Tal como no estudo de Iwayama&#44; a n&#227;o exclus&#227;o de trombo n&#227;o dispensa a ETE&#46; Salientamos que a dose de radia&#231;&#227;o do estudo de Annoni et al&#46; &#233; a mais reduzida&#44; com valores m&#233;dios de 0&#44;4<span class="elsevierStyleHsp" style=""></span>mSv &#40;valores semelhantes aos usados no Grupo 3 do nosso estudo &#8211; 0&#44;6<span class="elsevierStyleHsp" style=""></span>mSv&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">A preval&#234;ncia de trombos identificada antes de abla&#231;&#227;o de fibrila&#231;&#227;o auricular &#233; muito vari&#225;vel&#46; Numa metan&#225;lise que comparou diferentes estudos que usaram angio&#8208;TC e ETE&#44; a preval&#234;ncia variou entre 20&#44;6&#37; &#40;13 trombos em 63 doentes&#41; e 1&#44;3&#37; &#40;tr&#234;s trombos em 223 doentes&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a>&#46; Numa s&#233;rie mais recente&#44; Teunissen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> identificaram apenas dois trombos em 605 doentes&#44; o que correspondeu a uma preval&#234;ncia de apenas 0&#44;3&#37;&#46; Tal como no estudo de Teunissen et al&#46;&#44; a nossa preval&#234;ncia de trombos foi baixa &#40;cerca de 1&#37;&#41;&#44; o que poder&#225; dever&#8208;se &#224; popula&#231;&#227;o de doentes de menor risco&#44; com seguimento m&#233;dico regular e maior taxa de hipocoagula&#231;&#227;o&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Consideramos que&#44; face aos resultados apresentados&#44; esse protocolo de TC num contexto pr&#233;vio a abla&#231;&#227;o de FA&#44; como exame &#250;nico&#44; representa um protocolo com menor dose de radia&#231;&#227;o&#44; sem sacrif&#237;cio da qualidade conforme confirmado pela avalia&#231;&#227;o quantitativa da qualidade da imagem&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Limita&#231;&#245;es</span><p id="par0130" class="elsevierStylePara elsevierViewall">Como poss&#237;veis limita&#231;&#245;es deste estudo&#44; salientamos&#58; A&#41; N&#227;o foi feito ecocardiograma transesof&#225;gico sistem&#225;tico em todos os doentes&#44; mas apenas para confirma&#231;&#227;o dos trombos identificados na TC card&#237;aca&#46; No entanto&#44; apesar de poder ser considerada uma limita&#231;&#227;o&#44; a acuidade para excluir trombo da TC card&#237;aca &#233; muito elevada e quando acompanhada de aquisi&#231;&#227;o tardia o n&#250;mero de falsos positivos &#233; igualmente muito baixo<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a>&#59; B&#41; Entre o Grupo 1 e o Grupo 2 houve uma mudan&#231;a na concentra&#231;&#227;o de iodo do contraste usado &#40;320 para 370mgI&#47;ml&#41;&#44; mas que foi compensada pelo menor fluxo de administra&#231;&#227;o do mesmo no grupo 2&#59; C&#41; a nossa s&#233;rie apresenta um n&#250;mero reduzido de trombos&#44; mas esse aspeto &#233; uma caracter&#237;stica frequente na popula&#231;&#227;o que faz exame de TC pr&#233;&#8208;abla&#231;&#227;o de FA&#44; &#233; ainda poss&#237;vel fator contributivo o facto de se tratar de doentes eletivos&#44; com seguimento m&#233;dico regular e maior taxa de hipocoagula&#231;&#227;o&#59; D&#41; apenas foi avaliada quantitativamente a qualidade da imagem do Grupo 2 e 3&#44; dado ter coincidido com a introdu&#231;&#227;o de uma tecnologia nova&#46; Houve avalia&#231;&#227;o subjetiva da qualidade de imagem em todos os grupos&#59; E&#41; N&#227;o test&#225;mos um protocolo sem sincroniza&#231;&#227;o eletrocardiogr&#225;fica&#44; que poderia estar associado a menor dose de radia&#231;&#227;o<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a>&#46; No entanto&#44; em aquisi&#231;&#227;o em modo FLASH&#44; a redu&#231;&#227;o de dose n&#227;o deveria ser significativa&#46; Al&#233;m disso a acuidade para exclus&#227;o de trombo n&#227;o foi ainda estabelecida&#44; o que limitaria a sua ado&#231;&#227;o como exame &#250;nico pr&#233;vio &#224; abla&#231;&#227;o&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conclus&#245;es</span><p id="par0135" class="elsevierStylePara elsevierViewall">A otimiza&#231;&#227;o de protocolos e a evolu&#231;&#227;o tecnol&#243;gica permitiram redu&#231;&#245;es significativas nas doses de contraste e de radia&#231;&#227;o &#40;para valores submilisiviert&#41; na TC card&#237;aca pr&#233;&#8208;abla&#231;&#227;o de fibrilha&#231;&#227;o auricular&#44; sem diminui&#231;&#227;o da qualidade de imagem&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflitos de interesse</span><p id="par0140" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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    "fechaRecibido" => "2017-09-28"
    "fechaAceptado" => "2018-03-11"
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          "palabras" => array:4 [
            0 => "Tomografia computorizada card&#237;aca"
            1 => "Fibrilha&#231;&#227;o auricular"
            2 => "Dose de radia&#231;&#227;o"
            3 => "Aur&#237;cula esquerda"
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          "identificador" => "xpalclavsec1174799"
          "palabras" => array:4 [
            0 => "Cardiac computed tomography"
            1 => "Atrial fibrilation"
            2 => "Radiation dose"
            3 => "Left atrium"
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        "titulo" => "Resumo"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A capacidade de a TC card&#237;aca fornecer um mapa anat&#243;mico preciso e excluir a presen&#231;a de trombo intracard&#237;aco &#233; conhecida&#46; O objetivo deste estudo foi avaliar o impacto da otimiza&#231;&#227;o de protocolos e evolu&#231;&#227;o tecnol&#243;gica nas doses de radia&#231;&#227;o e contraste e na qualidade de imagem dos exames de TC card&#237;aca pr&#233;via a abla&#231;&#227;o de fibrilha&#231;&#227;o auricular &#40;FA&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Registo prospetivo de doentes consecutivos de centro &#250;nico&#44; foram inclu&#237;dos os que fizeram TC card&#237;aca num contexto de avalia&#231;&#227;o pr&#233;via a abla&#231;&#227;o de FA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>270&#41;&#44; distribu&#237;dos em tr&#234;s grupos&#58; Grupo 1&#44; constitu&#237;do pelos primeiros 150 doentes&#59; Grupo 2&#44; os &#250;ltimos 60 doentes feitos no mesmo aparelho&#59; Grupo 3&#44; os primeiros 60 doentes do novo aparelho&#46; Avali&#225;mos a otimiza&#231;&#227;o do protocolo com base na dose de radia&#231;&#227;o&#44; no volume de contraste&#44; na necessidade de aquisi&#231;&#227;o complementar e na avalia&#231;&#227;o objectiva&#160;da qualidade de imagem &#40;r&#225;cios sinal&#47;ru&#237;do&#44; contraste&#47;ru&#237;do e homogeneiza&#231;&#227;o de densidade AE&#47;AAE&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Houve uma redu&#231;&#227;o significativa da radia&#231;&#227;o entre cada um dos grupos e da dose de contraste entre o primeiro e o &#250;ltimo grupo &#40;G1&#58; 5&#44;6<span class="elsevierStyleHsp" style=""></span>mSv e 100<span class="elsevierStyleHsp" style=""></span>ml&#59; G2&#58; 1&#44;3<span class="elsevierStyleHsp" style=""></span>mSv e 90<span class="elsevierStyleHsp" style=""></span>ml&#59; G3&#58; 0&#44;6<span class="elsevierStyleHsp" style=""></span>mSv e 65<span class="elsevierStyleHsp" style=""></span>ml&#41;&#46; Apesar das menores doses de radia&#231;&#227;o e contraste&#44; o Grupo 3 apresentou resultados significativamente melhores de qualidade de imagem &#40;r&#225;cios sinal&#47;ru&#237;do 13&#44;5&#59; contraste&#47;ru&#237;do 14&#44;8&#59; homogeneiza&#231;&#227;o de densidade 0&#44;92&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#227;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A otimiza&#231;&#227;o de protocolos e a evolu&#231;&#227;o tecnol&#243;gica permitiram redu&#231;&#245;es significativas nas doses de radia&#231;&#227;o e de contraste usadas na TC card&#237;aca pr&#233;&#8208;abla&#231;&#227;o de FA&#44; sem prejudicar a qualidade de imagem&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introdu&#231;&#227;o"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclus&#227;o"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Cardiac computed tomography &#40;CT&#41; can provide a precise tridimentional anatomic map and exclude intra&#8208;cardiac thrombus&#46; We aimed to access the impact of CT protocol optimization and technological evolution on the contrast and radiation dose as well as on image quality previous to atrial fibrillation &#40;AF&#41; ablation&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">From a prospective registry of consecutive patients who underwent cardiac CT in a single center&#44; we selected 270 patients in whom the CT was done for evaluation prior to AF ablation and they were distributed in 3 groups&#58; Group1&#58; the first 150 patients included&#59; Group2&#58; the last 60 patients performed with the same CT scanner&#59; Group3&#58; the first 60 exams performed with the new CT scanner&#46; Quality of the protocol was access based on radiation dose&#44; contrast volume used&#44; the use of a second &#40;delayed&#41; acquisition&#44; and on quantitative image quality analisis &#40;signal to noise and contrast to noise ratios&#59; density homogeneity racio between LA and LAA&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We found a significant radiation dose as well as contrast dose reduction between the first and last subgroups &#40;G1&#58; 5&#44;6<span class="elsevierStyleHsp" style=""></span>mSv and 100<span class="elsevierStyleHsp" style=""></span>ml&#59; G2&#58; 1&#44;3<span class="elsevierStyleHsp" style=""></span>mSv and 90<span class="elsevierStyleHsp" style=""></span>ml&#59; G3&#58; 0&#44;6<span class="elsevierStyleHsp" style=""></span>mSv and 65<span class="elsevierStyleHsp" style=""></span>ml&#41;&#46; Even though group 3 had less radiation and contrast used it still had better quantitative image quality &#40;signal&#47;noise of 13&#44;5&#59; contrast&#47;noise 14&#44;8&#59; density homogeneity racio of 0&#44;92&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Protocol optimization and technology both contributed to significant lower radiation dose and contrast volume used on cardiac CTs prior to AF ablation&#44; without compromising image quality&#46;</p></span>"
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            "titulo" => "Methods"
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            "identificador" => "abst0035"
            "titulo" => "Results"
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            "identificador" => "abst0040"
            "titulo" => "Conclusion"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o por angioTC card&#237;aca da AEsq e do AAEsq&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o da permeabilidade do AAesq&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o da morfologia da AEsq e do padr&#227;o de drenagem das veias pulmonares&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Maior detalhe da drenagem da veia pulmonar inferior direita&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Detalhe morfol&#243;gico do AAESq&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o volum&#233;trica da AEsq&#46;</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Presen&#231;a de veia pulmonar supranumer&#225;ria com drenagem direta na AEsq&#46;</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Presen&#231;a de pequeno ap&#234;ndice acess&#243;rio&#46;</p>"
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          "pt" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Popula&#231;&#227;o do estudo&#46;</p>"
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          "pt" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">C&#225;lculo dos &#237;ndices de sinal&#47;ru&#237;do e contraste&#47;ru&#237;do&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">A&#41; Regi&#227;o de interesse &#40;ROI&#41; na AEsq&#59; B&#41; ROI no AAEsq&#59; C&#41; ROI na parede do VEsq&#46;</p> <p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">C&#225;lculo sinal&#47;ru&#237;do &#61; Densidade m&#233;dia AEsq&#47;Desvio padr&#227;o AEsq&#46;</p> <p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">C&#225;lculo contraste&#47;ru&#237;do &#61; &#40;densidade m&#233;dia AAEsq&#8208;densidade m&#233;dia da parede Vesq&#41;&#47;Desvio padr&#227;o AAEsq&#46;</p> <p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o da homogeniza&#231;&#227;o de contraste AEsq&#47;AAEsq &#61; Densidade m&#233;dia AEsq&#47;Densidade m&#233;dia da &#225;rea de menor densidade no AAEsq&#46;</p>"
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          "pt" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o do AAEsq &#8211; necessidade de 2&#46;&#170; aquisi&#231;&#227;o &#40;mais tardia&#41; para diferencia&#231;&#227;o entre trombo e pseudotrombo&#46; Exemplo de trombo &#8211; com a correspond&#234;ncia no ETE &#40;avalia&#231;&#227;o dimensional muito aproximada&#41;&#46;</p>"
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        "etiqueta" => "Figura 5"
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            "imagen" => "gr5.jpeg"
            "Alto" => 2249
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            "Tamanyo" => 350591
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          "pt" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o do AAEsq &#8211; necessidade de 2&#46;&#170; aquisi&#231;&#227;o para diferencia&#231;&#227;o entre trombo e pseudotrombo&#46; Exemplo de pseudotrombo &#8211; identificado pelo ganho de contraste na 2&#46;&#170; aquisi&#231;&#227;o &#40;mais tardia&#41;&#44; a sua densidade m&#233;dia e a homogeniza&#231;&#227;o de densidade com a restante aur&#237;cula&#46;</p>"
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        "etiqueta" => "Figura 6"
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          "pt" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o do AAEsq &#8211; diferencia&#231;&#227;o entre trombo e pseudotrombo&#46; Exemplo de pseudotrombo que pela densidade m&#233;dia elevada n&#227;o necessita de segunda aquisi&#231;&#227;o&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo 1 &#40;G1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">150&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Idade&#44; anos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63 &#40;53&#8208;69&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">65 &#40;56&#8208;70&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;1 &#40;24&#44;0&#8208;28&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;3 &#40;24&#44;5&#8208;28&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;987&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; ritmo sinusal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>112&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;590&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frequ&#234;ncia card&#237;aca&#44; bpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;59&#8208;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;58&#8208;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;58&#8208;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;746&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Protocolo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b&#44;c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; Protocolo retro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>150&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; Protocolo prospetivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; Protocolo FLASH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Volume de contraste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;90&#8208;108&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;80&#8208;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;60&#8208;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b&#44;c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radia&#231;&#227;o 1&#46;&#170; aquisi&#231;&#227;o&#44; mGy&#44;cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">402 &#40;286&#8208;670&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95 &#40;72&#8208;146&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;28&#8208;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b&#44;c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radia&#231;&#227;o 1&#46;&#170; aquisi&#231;&#227;o &#40;mediana&#41;&#44; dose efetiva mSv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b&#44;c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; 2<span class="elsevierStyleHsp" style=""></span>&#170; aquisi&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;165&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">kV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b&#44;c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; de aquisi&#231;&#227;o 70kv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;3&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; de aquisi&#231;&#227;o 80kv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; de aquisi&#231;&#227;o 90kv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; de aquisi&#231;&#227;o 100kv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>125&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; de aquisi&#231;&#227;o 120kv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presen&#231;a de trombo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;556&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acuidade diagn&#243;stica qualitativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vol AEsq a 70&#37; do ciclo card&#237;aco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83 &#40;65&#8208;105&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;69&#8208;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;66&#8208;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;767&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sinal&#47;ru&#237;do Aesq&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#44;0 &#40;8&#44;3&#8208;12&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;5 &#40;11&#44;0&#8208;16&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contraste&#47;ru&#237;do &#40;densidade AAEsq&#8208;VEsq&#47;DP AAEsq&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;8 &#40;7&#44;1&#8208;11&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;8 &#40;12&#44;6&#8208;17&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">R&#225;cio densidade m&#233;dia AEsq&#47;AAEsq&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;04 &#40;0&#44;93&#8208;1&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92 &#40;0&#44;86&#8208;0&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o quantitativa da qualidade de imagem</p>"
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          "leyenda" => "<p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">AE &#8211; aur&#237;cula esquerda&#59; FLASH&#58; protocolo de aquisi&#231;&#227;o num s&#243; batimento card&#237;aco com velocidade de mesa muito r&#225;pida&#59; IMC&#58; &#205;ndice de massa corporal&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>244&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Idade&#44; anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60 &#40;53&#8208;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61 &#40;51&#8208;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;836&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>178&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMC&#44; Kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27&#44;9 &#40;24&#44;1&#8208;30&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">26&#44;5 &#40;24&#44;4&#8208;29&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;455&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#37; ritmo sinusal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>183&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FC m&#233;dia&#44; bpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;65&#8208;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;58&#8208;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Protocolo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;381&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#37; Protocolo Retrospetivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">52&#44;5&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>128&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#37; protocolo prospetivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26&#44;2&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#37; protocolo FLASH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;3&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Volume de contraste&#44; mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95 &#40;80&#8208;103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;65&#8208;102&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;397&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Volume AE a 70&#37; do ciclo card&#237;aco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">93 &#40;70&#8208;118&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82 &#40;67&#8208;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;087&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Marques et al&#46; Protocolo atual &#8208; G3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lazoura et al&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Teunissen et al&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Iwayama et al&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Annoni et al&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#46;&#176; do grupo refer&#234;ncia &#40;n&#46;&#176; total do estudo&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60 &#40;270&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">122&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">605&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;200&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sincroniza&#231;&#227;o eletrocardiogr&#225;fica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dupla administra&#231;&#227;o de contraste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feito para exclus&#227;o de trombo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; de exames em que n&#227;o foi poss&#237;vel excluir trombo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37; de 2&#46;&#170; aquisi&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">necessidade de 2&#46;&#170; aquisi&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ETE pr&#233;vio &#224; abla&#231;&#227;o de FA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#227;o necess&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#227;o necess&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#227;o necess&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">necess&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">necess&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dose de radia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6mSv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5mSv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1mSv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;1mSv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4mSv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dose de contraste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;7ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
                0 => "xTab2171095.png"
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0165" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o com outras publica&#231;&#245;es</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "1"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Relationship between rotors and complex fractionated electrograms in atrial fibrillation using a novel computational analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Adrag&#227;o"
                            1 => "P&#46; Carmo"
                            2 => "D&#46; Cavaco"
                          ]
                        ]
                      ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2017.02.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol&#46;"
                        "fecha" => "2017"
                        "volumen" => "36"
                        "paginaInicial" => "233"
                        "paginaFinal" => "238"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28343787"
                            "web" => "Medline"
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              "identificador" => "bib0135"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2017 HRS&#47;EHRA&#47;ECAS&#47;APHRS&#47;SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation&#58; executive summary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Calkins"
                            1 => "G&#46; Hindricks"
                            2 => "R&#46; Cappato"
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1007/s10840-017-0277-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Interv Card Electrophysiol&#46;"
                        "fecha" => "2017"
                        "volumen" => "50"
                        "paginaInicial" => "1"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28914401"
                            "web" => "Medline"
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            2 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiofrequency Catheter Ablation For Atrial Fibrillation&#58; Approaches And Outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Kalla"
                            1 => "P&#46; Sanders"
                            2 => "J&#46;M&#46; Kalman"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hlc.2017.05.125"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Lung Circ&#46;"
                        "fecha" => "2017"
                        "volumen" => "26"
                        "paginaInicial" => "941"
                        "paginaFinal" => "949"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28697936"
                            "web" => "Medline"
                          ]
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              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
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                          "colaboracion" => "2016 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With EACTS"
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                          "autores" => array:3 [
                            0 => "P&#46; Kirchhof"
                            1 => "S&#46; Benussi"
                            2 => "D&#46; Kotecha"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Revista Espanola de Cardiologia &#40;English ed&#41;&#46;"
                        "fecha" => "2017"
                        "volumen" => "70"
                        "paginaInicial" => "50"
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