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Weyland CS, Seker F, Potreck A, Hametner C, Ringleb PA, Möhlenbruch MA, Bendszus M, Pfaff JAR. Radiation exposure per thrombectomy attempt in modern endovascular stroke treatment in the anterior circulation. Eur Radiol 2020; 30:5039-5047. [PMID: 32328765 PMCID: PMC7431433 DOI: 10.1007/s00330-020-06837-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To quantify radiation exposure (RE) of endovascular stroke treatment (EST) in the anterior circulation per thrombectomy attempt and determine causes for interventions associated with high RE. METHODS A retrospective single-center study of an institutional review board-approved stroke database of patients receiving EST for large vessel occlusions in the anterior circulation between January 2013 and April 2018 to evaluate reference levels (RL) per thrombectomy attempt. ESTs with RE above the RL were analyzed to determine causes for high RE. RESULTS Overall, n = 544 patients (occlusion location, M1 and M2 segments of the middle cerebral artery 53.5% and 27.2%, carotid artery 17.6%; successful recanalization rate 85.7%) were analyzed. In the overall population, DAP (in Gy cm2, median (IQR)) was 113.7 (68.9-181.7) with a median fluoroscopy time of 31 min (IQR, 17-53) and a median of 2 (IQR, 1-4) thrombectomy attempts. RE increased significantly with every thrombectomy attempt (DAP1, 68.7 (51.2-106.8); DAP2, 106.4 (84.8-115.6); p value1vs2, < 0.001; DAP3, 130.2 (89.1-183.6); p value2vs3, 0.044; DAP4, 169.9 (128.4-224.1); p value3vs4, 0.001; and DAP5, 227.6 (146.3-294.6); p value4vs5, 0.019). Procedures exceeding the 90th percentile of the attempt-dependent radiation exposure level were associated with procedural complications (n = 17/52, 29.8%) or a difficult vascular access (n = 8/52, 14%). CONCLUSIONS Radiation exposure in endovascular stroke treatment is depending on the number of thrombectomy attempts. Radiation exposure doubles when three attempts and triples when five attempts are necessary compared with single-maneuver interventions. Procedural complications and difficult vascular access were associated with a high radiation exposure in this collective. KEY POINTS • Radiation exposure of endovascular stroke treatment (EST) is dependent on the number of thrombectomy attempts. • Reference levels as means for quality control in hospitals performing endovascular stroke treatment should be defined by the number of thrombectomy attempts-we suggest 107 Gy cm2, 156 Gy cm2, 184 Gy cm2, 244 Gy cm2, and 295 Gy cm2 for 1 to 5 maneuvers, respectively, for EST of the anterior circulation • Cases with high rates of radiation exposure are associated with periprocedural complications and difficult anatomical access as a probable cause for a high radiation exposure.
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Affiliation(s)
- Charlotte S Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Fatih Seker
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Arne Potreck
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Hametner
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Peter A Ringleb
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Johannes A R Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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302
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Awad MF, Karout L, Arnous G, Rawashdeh MA, Hneiny L, Saade C. A systematic review on the current status of adult diagnostic reference levels in head, chest and abdominopelvic Computed Tomography. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:R71-R98. [PMID: 32203948 DOI: 10.1088/1361-6498/ab826f] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Computed tomography (CT) is a routinely employed diagnostic tool for the detection and diagnosis of disease processes. Despite the primary focus of radiation dose reduction and improvements in CT scanners, radiation dose exposure remains an ever-increasing concern. Scanning protocol optimisation relative to body weight and scanner manufacturer still lags behind the diagnostic reference levels (DRLs) that are set on an international scale. The aim of this systematic review is to evaluate the current status of adult DRLs in head, chest and abdominopelvic CT over time on a global scale. A search was carried out in early 2019 using the Medline, PubMed, EMBASE, SCOPUS and manual databases. The reference lists of published articles were also assessed to identify further articles. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology was employed to evaluate articles for relevance. Articles were included if they assessed the DRL in head, chest and abdominopelvic scans. The search resulted in 6079 articles, of which 67 were included after a thorough screening process. The literature demonstrates a wide dose variation in reported head, chest and abdominopelvic dose length product (DLP) DRL, ranging from 700-1359, 330-707 and 550-1486 mGy·cm, respectively. Where reported, the volumed CT dose index (CTDIvol) DRL in the head, chest and abdominopelvic studies ranged from 30.4-85.5, 9-15 and 12.3-31 mGy·cm, respectively. The global means were shown to be slightly lower and significantly lower than the reported values of DLP and CTDIvol values for the American College of Radiology and European Commission, respectively. This review emphasises the need for an international standardisation for head and body DRL establishment methods, to provide a more comparable global measurement of dose variations across CT sites as well as regular monitoring of delivered radiation dose to patients.
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Affiliation(s)
- Mohamad Fawzi Awad
- Medical Imaging Sciences, Faculty of Health Sciences, American University of Beirut, PO Box: 11-0236 Riad El-Solh, Beirut 1107 2020, Lebanon
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Deleu M, Dagassan D, Berg I, Bize J, Dula K, Lenoir V, Ott B, Ott JG, Verdun FR, Weber R, Ziglinas P, Zingariello C, Sans Merce M. Establishment of national diagnostic reference levels in dental cone beam computed tomography in Switzerland. Dentomaxillofac Radiol 2020; 49:20190468. [PMID: 32267774 PMCID: PMC7461735 DOI: 10.1259/dmfr.20190468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to establish diagnostic reference levels (DRLs) in the field of dental maxillofacial and ear-nose-throat (ENT) practices using cone beam CT (CBCT) in Switzerland. METHODS A questionnaire was sent to owners of CBCTs in Switzerland; to a total of 612 institutions. The answers were analyzed for each indication, provided that enough data were available. The DRLs were defined as the 75th percentile of air kerma product distribution (PKA). RESULTS 227 answers were collected (38% of all centers). Third quartile of PKA values were obtained for five dental indications: 662 mGy cm² for wisdom tooth, 683 mGy cm² for single tooth implant treatment, 542 mGy cm² for tooth position anomalies, 569 mGy cm² for pathological dentoalveolar modifications, and 639 mGy cm² for endodontics. The standard field of view (FOV) size of 5 cm in diameter x 5 cm in height was proposed. CONCLUSIONS Large ranges of FOV and PKA were found for a given indication, demonstrating the importance of establishing DRLs as well as FOV recommendations in view of optimizing the present practice. For now, only DRLs for dental and maxillofacial could be defined; because of a lack of ENT data, no DRL values for ENT practices could be derived from this survey.
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Affiliation(s)
| | - Dorothea Dagassan
- University Center of Dental Medicine Basel, Center for Dental Imaging, University of Basel, Basel, Switzerland
| | | | - Julie Bize
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Karl Dula
- University of Bern, Bern, Switzerland
| | - Vincent Lenoir
- Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - Barbara Ott
- Radiation Protection Division, Federal office of Public Health, Bern, Switzerland
| | | | - Francis R. Verdun
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Robert Weber
- Division of Medical Radiation Physics, Inselspital, Bern, Switzerland
| | | | - Cesare Zingariello
- Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - Marta Sans Merce
- Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
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304
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Abe K, Hosono M, Igarashi T, Iimori T, Ishiguro M, Ito T, Nagahata T, Tsushima H, Watanabe H. The 2020 national diagnostic reference levels for nuclear medicine in Japan. Ann Nucl Med 2020; 34:799-806. [PMID: 32852747 PMCID: PMC7584529 DOI: 10.1007/s12149-020-01512-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/16/2020] [Indexed: 10/27/2022]
Abstract
The diagnostic reference levels (DRLs) are one of several effective tools for optimizing nuclear medicine examinations and reducing patient exposure. With the advances in imaging technology and alterations of examination protocols, the DRLs must be reviewed periodically. The first DRLs in Japan were established in 2015, and since 5 years have passed, it is time to review and revise the DRLs. We conducted a survey to investigate the administered activities of radiopharmaceuticals and the radiation doses of computed tomography (CT) in hybrid CT accompanied by single photon emission computed tomography (SPECT)/CT and positron emission tomography (PET)/CT. We distributed a Web-based survey to 915 nuclear medicine facilities throughout Japan and survey responses were provided by 256 nuclear medicine facilities (response rate 28%). We asked for the facility's median actual administered activity and median radiation dose of hybrid CT when SPECT/CT or PET/CT was performed for patients with standard habitus in the standard protocol of the facility for each nuclear medicine examination. We determined the new DRLs based on the 75th percentile referring to the 2015 DRLs, drug package inserts, and updated guidelines. The 2020 DRLs are almost the same as the 2015 DRLs, but for the relatively long-lived radionuclides, the DRLs are set low due to the changes in the Japanese delivery system. There are no items set higher than the previous values. Although the DRLs determined this time are roughly equivalent to the DRLs used in the US, overall they tend to be higher than the European DRLs. The DRLs of the radiation dose of CT in hybrid CT vary widely depending on each imaging site and the purpose of the examination.
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Affiliation(s)
- Koichiro Abe
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Makoto Hosono
- Department of Radiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takayuki Igarashi
- Department of Radiological Technology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita-shi, Chiba, 286-8520, Japan
| | - Takashi Iimori
- Department of Radiological Technology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Masanobu Ishiguro
- Department of Radiological Technology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Teruo Ito
- Department of Radiological Sciences, International University of Health and Welfare, 4-3 Kozunomori, Narita-shi, Chiba, 286-8686, Japan
| | - Tomomasa Nagahata
- Department of Radiological Technology, Osaka City University Hospital, 1-5-7, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8586, Japan
| | - Hiroyuki Tsushima
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0394, Japan
| | - Hiroshi Watanabe
- Department of Radiological Sciences, Faculty of Health Sciences, Gunma Paz University, 1-7-1 Tonyamachi, Takasaki-shi, Gunma, 370-0006, Japan
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305
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Hirschfeld CB, Dondi M, Pascual TNB, Mercuri M, Vitola J, Karthikeyan G, Better N, Mahmarian JJ, Bouyoucef SE, Hee-Seung Bom H, Lele V, Magboo VPC, Alexánderson E, Allam AH, Al-Mallah MH, Flotats A, Jerome S, Kaufmann PA, Luxenburg O, Underwood SR, Rehani MM, Vassileva J, Paez D, Einstein AJ. Worldwide Diagnostic Reference Levels for Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging: Findings From INCAPS. JACC Cardiovasc Imaging 2020; 14:657-665. [PMID: 32828783 DOI: 10.1016/j.jcmg.2020.06.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). BACKGROUND Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT MPI have previously been derived from national or regional registries. To date there have been no multiregional reports of DRLs for SPECT MPI from a single standardized dataset. METHODS Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study), a cross-sectional, multinational registry of MPI protocols. A total of 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data. RESULTS The aggregated worldwide DRLs for rest-stress or stress-rest studies employing technetium Tc 99m-labeled radiopharmaceuticals were 11.2 mCi (first dose) and 32.0 mCi (second dose) for 1-day protocols, and 23.0 mCi (first dose) and 24.0 mCi (second dose) for multiday protocols. Corresponding AAAs were 10.1 mCi (first dose) and 28.0 mCi (second dose) for 1-day protocols, and 17.8 mCi (first dose) and 18.7 mCi (second dose) for multiday protocols. For stress-only technetium Tc 99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26% to 92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions. CONCLUSIONS This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory protocols to regional trends. Organizations should continue to focus on establishing standardized reporting methods to improve the validity and comparability of regional DRLs.
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Affiliation(s)
- Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Maurizio Dondi
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Thomas N B Pascual
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Mathew Mercuri
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joao Vitola
- Quanta Diagnóstico e Terapia, Curitiba, Brazil
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nathan Better
- Department of Nuclear Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Salah E Bouyoucef
- Department of Nuclear Medicine, Centre Hospitalo-Universitaire de Bab El Ouéd, Alger, Algeria
| | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Vikram Lele
- Department of Nuclear Medicine and PET-CT, Jaslok Hospital and Research Centre, Mumbai, India
| | - Vincent Peter C Magboo
- Department of Physical Sciences and Mathematics, University of the Philippines, Quezon City, Philippines; Department of Nuclear Medicine, University of Santo Tomas Hospital, Manila, Philippines
| | - Erick Alexánderson
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico; Department of Physiology, School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Adel H Allam
- Cardiology Department, Al Azhar University, Cairo, Egypt
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Scott Jerome
- Intersocietal Accreditation Commission, Ellicott City, Maryland, USA; Division of Cardiovascular Medicine, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Philipp A Kaufmann
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel; Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - S Richard Underwood
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
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306
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Paulo G, Damilakis J, Tsapaki V, Schegerer AA, Repussard J, Jaschke W, Frija G. Diagnostic Reference Levels based on clinical indications in computed tomography: a literature review. Insights Imaging 2020; 11:96. [PMID: 32804275 PMCID: PMC7431477 DOI: 10.1186/s13244-020-00899-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/21/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In August 2017, the European Commission awarded the "European Study on Clinical Diagnostic Reference levels for X-ray Medical Imaging" project to the European Society of Radiology, to provide up-to-date Diagnostic Reference Levels based on clinical indications. The aim of this work was to conduct an extensive literature review by analysing the most recent studies published and the data provided by the National Competent Authorities, to understand the current situation regarding Diagnostic Reference Levels based on clinical indications for computed tomography. RESULTS The literature review has identified 23 papers with Diagnostic Reference Levels based on clinical indications for computed tomography from 15 countries; 12 of them from Europe. A total of 28 clinical indications for 6 anatomical areas (head, cervical spine/neck, chest, abdomen, abdomen-pelvis, chest-abdomen-pelvis) have been identified. CONCLUSIONS In all the six anatomical areas for which Diagnostic Reference Levels based on clinical indications were found, a huge variation of computed tomography dose descriptor values was identified, providing evidence for a need to develop strategies to standardise and optimise computed tomography protocols.
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Affiliation(s)
- Graciano Paulo
- ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854, Coimbra, Portugal.
| | - John Damilakis
- School of Medicine, University of Crete, Iraklion, Crete, Greece
| | | | - Alexander A Schegerer
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Neuherberg, Germany.,Radiation Protection and Image Processing Systems, Hirslanden AG, Glattpark, Switzerland
| | | | - Werner Jaschke
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Guy Frija
- Paris Descartes University, Paris, France
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307
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Storm C, Harvey A, Djukelic M. Mammography diagnostic reference levels in Western Australia. Phys Eng Sci Med 2020; 43:1125-1129. [PMID: 32757165 DOI: 10.1007/s13246-020-00914-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 12/24/2022]
Abstract
Mammography dose data has been collected from Western Australian units to establish Diagnostic Reference Levels for the state. Reference levels have been determined for a variety of phantom thicknesses for both full field digital mammography units and digital breast tomosynthesis units. Levels for the American College of Radiology (ACR) Phantom have been established as 1.3 mGy and 1.5 mGy mean glandular dose for full field digital mammography and digital breast tomosynthesis respectively. 2 cm PMMA was 0.9 mGy and 1.0 mGy and 6 cm PMMA had values of 2.0 mGy and 2.3 mGy. This data can be utilised to help establish national reference levels in the future.
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Affiliation(s)
- Cameron Storm
- Medical Technology & Physics, Sir Charles Gairdner Hospital, Perth, WA, Australia.
| | - Alicia Harvey
- Medical Technology & Physics, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Mario Djukelic
- Medical Technology & Physics, Sir Charles Gairdner Hospital, Perth, WA, Australia
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308
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Farah J, Gonzalez-Mendez LA, Dufay F, Amir S, Royer B, Gabriel H, Noel A. Patient exposure and diagnostic reference levels in operating rooms: a multi-centric retrospective study in over 150 private and public French clinics. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:1024-1038. [PMID: 32750683 DOI: 10.1088/1361-6498/abac4f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To investigate patient exposure in operating rooms and establish Diagnostic Reference Levels (DRLs), fifteen different procedures and nearly 4500 surgeries performed between January 2017 and December 2019 at over 150 different private (79% of data) and public (21% of data) French clinics were recorded. Collected information include the used C-arm equipment, exposure parameters (kVp, mAs, Fluoroscopy Time - FT and Air Kerma-Area Product - PKA) and patient Body Mass Index (BMI) whenever available. Multi-centric DRLs were derived as the 75th percentile of the median exposure data collected in more than 10 different hospitals. For the less frequent procedures, DRLs were determined as the 75th percentile of pooled exposure data with a minimum of 4 centres and 100 patients. Patient exposure proved to be significantly different among the centres. Highest DRLs were found for Abdominal Aortic Aneurysm Endoprosthesis (18 min, 81 Gy cm2), Iliac Angioplasty (6 min, 24 Gy cm2) and Flutter Ablation surgeries (17 min, 14 Gy cm2). In opposition, lowest DRLs were obtained for Hallux Valgus (0.4 min, 0.04 Gy cm2), Hand/Wrist Fracture (0.6 min, 0.16 Gy cm2), and Venous Access Device Implantation surgeries (0.3 min, 0.36 Gy cm2). Similar exposure levels are registered in private clinics and public hospitals. Multi-centric DRLs for fifteen surgical procedures including six new reference values were established to help optimise patients' radiation protection.
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Affiliation(s)
- Jad Farah
- Hopitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, 94270, FRANCE
| | | | | | | | | | | | - Alain Noel
- Centre de Recherche en Automatique de Nancy, Vandoeuvre les Nancy, Grand Est, FRANCE
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309
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Abuzaid MM, Elshami W, Tekin HO, Ghonim H, Shawki M, Salama DH. Computed tomography radiation doses for common computed tomography examinations: a nationwide dose survey in United Arab Emirates. Insights Imaging 2020; 11:88. [PMID: 32748218 PMCID: PMC7399721 DOI: 10.1186/s13244-020-00891-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Computed tomography (CT) scanning is an essential part of diagnostic and treatment plans, providing swift and accurate diagnostic images. The aim of this study is to develop diagnostic reference levels (DRLs) for the adult common CT examination in the United Arab Emirates (UAE). METHODS This study presents results of the survey of CT dose indices. The data were collected from 91% of the scanners registered at the Ministry of Health and Prevention (MOHAP) for five common examinations: head, chest, and abdomen-pelvis with and without CM. RESULTS CT dose index, dose-length product, and patient weight were analyzed; the reference dose was calculated on the 75th percentile, and an achievable dose was proposed from the median value. The results were compared with the UAE initial National Dose Report as well as the international reports. The proposed dose for CTDIvol (mGy) and DLP (mGy cm) is as follows: head without CM 40 and 695, head with CM 48 and 820, chest 10 and 275, abdomen-pelvis without CM 14 and 810, and abdomen-pelvis with CM 20 and 1025. CONCLUSIONS The results show low dose variations between the MOHAP scanners. The data also revealed CTDIvol and DLP values comparable to those in the initial NDRL report and international standards. The establishment of diagnostic reference levels will require a continuous dose monitoring system.
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Affiliation(s)
- Mohamed M Abuzaid
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, P.O.Box 27272, Sharjah, UAE.
| | - Wiam Elshami
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, P.O.Box 27272, Sharjah, UAE
| | - Huseyin Ozan Tekin
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, P.O.Box 27272, Sharjah, UAE
| | - Hatem Ghonim
- College of Medicine, University of Sharjah, Sharjah, UAE
| | - Mona Shawki
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Dina H Salama
- National Center of Radiation Research and Technology, Atomic Energy Authority, Cairo, Egypt
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310
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Praskalo J, Beganović A, Milanović J, Stanković K. INTRAORAL DENTAL X-RAY RADIOGRAPHY IN BOSNIA AND HERZEGOVINA: STUDY FOR REVISING DIAGNOSTIC REFERENCE LEVEL VALUE. RADIATION PROTECTION DOSIMETRY 2020; 190:90-99. [PMID: 32744623 DOI: 10.1093/rpd/ncaa081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/04/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
This paper presents the study that would allow a revision of the currently valid diagnostic reference level in intraoral dental X-ray radiography in Bosnia and Herzegovina. The study was conducted for six procedures that are used to capture incisor, premolar and molar teeth, of both maxilla and mandible, in adults. Measurements were performed on 41 intraoral X-ray devices, 20 of which were systems with digital image receptor and 21 film-based X-ray systems. In this study, incident air kerma (Ki) and air kerma-area product (PKA) were used as patient dose descriptors. The third quartile (Q3) of the measured incident air-kerma values was used to compare with the current national diagnostic reference level (DRL) for intraoral dental procedures. The obtained results of Q3 for both types of devices, with film-based and digital image receptors, have shown that the third quartile values are lower (3.5 and 1.2 mGy, respectively) than the current national DRL (7.0 mGy). Hence, new data can be used to re-establish the diagnostic reference levels in intraoral dental X-ray examinations in Bosnia and Herzegovina.
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Affiliation(s)
- Jovica Praskalo
- School of Electrical Engineering, University of Belgrade, Bulevar kralja Aleksandra 73, Belgrade 11120, Serbia
- Public Health Institute of the Republic of Srpska, Brаćе Pištеljićа 2, Bаnjаlukа 78000, BiH
| | - Adnan Beganović
- Clinical Center of Sarajevo University, Bolnicka 25, Sarajevo 71000, Bosnia & Herzegovina
| | - Jovana Milanović
- Innovation Center of the Faculty of Technology and Metallurgy, University of Belgrade, Karnegijeva 4, Belgrade 11000, Serbia
| | - Koviljka Stanković
- School of Electrical Engineering, University of Belgrade, Bulevar kralja Aleksandra 73, Belgrade 11120, Serbia
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311
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Kaushik C, Sandhu IS, Srivastava AK. ESTIMATES OF PATIENT DOSES AND KERMA-AREA PRODUCT MONITORING IN DIGITAL RADIOGRAPHY. RADIATION PROTECTION DOSIMETRY 2020; 190:22-30. [PMID: 32491168 DOI: 10.1093/rpd/ncaa072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/24/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
The application of the kerma-area product (PKA) meter is increased rapidly in dosimetry. This study presents measurements of PKA in adherence to the International Atomic Energy Agency protocol for 300 adult patients in digital radiographic procedures. Effective doses (ED) were calculated from PKA measurements and conversion coefficients (E-103/PKA) obtained from the International Commission on radiological protection 103. In skull posteroanterior (PA), skull lateral (LAT), cervical spine anteroposterior (AP), cervical spine LAT, chest PA, abdomen AP, lumbar spine AP, pelvis AP and lumbar spine LAT, the third-quartile PKA values were found to be 0.2, 0.28, 0.33, 0.19, 0.26, 0.95, 0.93, 0.96 and 3.15 Gycm2, and estimated mean EDs were 0.005, 0.008, 0.056, 0.021, 0.037, 0.146, 0.165, 0.097 and 0.258 mSv, respectively. The third-quartile PKA values were suggested as local diagnostic reference levels (LDRLs). Results were compared with the diagnostic reference levels (DRLs) of the UK, the European Commission, previously published LDRLs in Greece and China by Metaxas et al. and Zhang and Chu, respectively. The PKA (third-quartile) value for cervical spine AP was 120% higher than UK 2010 DRLs, lumbar spine LAT was 123% higher than LDRLs given by Metaxas et al. and chest PA was 160% higher than UK 2010 DRLs and 225% higher than Metaxas et al. provided LDRLs. The PKA results were lower than the UK, and two studies in Greece by Metaxas et al. except for chest PA, cervical spine AP and lumbar spine LAT showed the need for further optimization. The LDRLs reported in this study may further contribute to establishing future national DRLs.
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Affiliation(s)
- Chanchal Kaushik
- Chitkara School of Health Sciences, Chitkara University, Punjab, India
| | - Inderjeet Singh Sandhu
- Chitkara University Institute of Engineering & Technology, Chitkara University, Punjab, India
| | - A K Srivastava
- Department of Radiology, University College of Medical Sciences, Delhi, India
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312
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Hoseini Motlagh Z, Shabestani Monfared A, Deevband MR, Abedi-Firouzjah R, Ghaemian N, Abdi R, Ebrahimnejad Gorji K. DETERMINATION OF DIAGNOSTIC REFERENCE LEVEL IN ROUTINE EXAMINATIONS OF DIGITAL RADIOGRAPHY IN MAZANDARAN PROVINCE. RADIATION PROTECTION DOSIMETRY 2020; 190:31-37. [PMID: 32491180 DOI: 10.1093/rpd/ncaa074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 04/21/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The main purpose of this study was to determine the diagnostic reference level (DRL) for routine digital radiography examinations in Mazandaran province. MATERIALS AND METHODS Thirteen digital radiographic examinations at 18 high-patient-load radiography centres were investigated. The indirect dosimetry method was performed based on the IAEA report. Average entrance skin dose (ESD) and the third quartile of ESD as the DRL were evaluated from the measurement made by a semiconductor dosemeter. RESULTS DRL for the examinations of digital radiography was obtained as: Skull (postero-anterior [PA]): 2.2, skull (lateral [LAT]): 2.4, cervical spine (antero-posterior [AP]): 1.6, cervical spine (LAT): 1.7, thoracic spine (AP): 3.6, thoracic spine (LAT): 9.9, lumbar spine (AP): 5.3, lumbar spine (LAT): 11.8, chest (PA): 1.4, chest (LAT): 2.1, abdomen (AP): 4.3, pelvis (AP): 3.2 and hip (AP): 2.1 mGy. CONCLUSION Although DRL was not higher compared with the international organisations' levels, it can be reduced by adequate training of radiographers.
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Affiliation(s)
| | - Ali Shabestani Monfared
- Department of Medical Physics Radiobiology and Radiation Protection, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Reza Deevband
- Department of Biomedical Engineering and Medical Physics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Razzagh Abedi-Firouzjah
- Department of Medical Physics Radiobiology and Radiation Protection, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Naser Ghaemian
- Department of Radiology and Radiotherapy, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Rohollah Abdi
- Department of Radiology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kourosh Ebrahimnejad Gorji
- Department of Medical Physics Radiobiology and Radiation Protection, School of Medicine, Babol University of Medical Sciences, Babol, Iran
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313
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Jaschke W, Bartal G, Martin CJ, Vano E. Unintended and Accidental Exposures, Significant Dose Events and Trigger Levels in Interventional Radiology. Cardiovasc Intervent Radiol 2020; 43:1114-1121. [PMID: 32435834 PMCID: PMC7369256 DOI: 10.1007/s00270-020-02517-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/02/2020] [Indexed: 12/11/2022]
Abstract
Over recent years, an increasing number of fluoroscopically guided interventions (FGIs) have been performed by radiologists and non-radiologists. Also, the number of complex interventional procedures has increased. In the late nineties, first reports of skin injuries appeared in the literature. The medical community responded through increased awareness for radiation protection and public authorities by recommendations and legislation, for example, the European Basic Safety Standards (EU-BSS) which were published in 2014, or the international Basic Safety Standards (BSS). Implementation of the EU-BSS requires concerted action from interventionalists, radiographers, medical physics experts and competent national authorities. Interventionalists should play an important role in this project since implementation of the EU-BSS will affect their daily practice. This paper discusses some important issues of the EU-BSS such as unintended and accidental radiation exposures of patients, the meaning of significant dose events and how to deal with patients who were exposed to a substantial radiation dose with the risk of tissue injuries. In addition, this paper provides practical advice on how to implement alert and trigger levels in daily practice of FGIs in order to increase patient safety.
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Affiliation(s)
- Werner Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | | | - Colin J Martin
- Department of Clinical Physics and Bio-Engineering, Gartnavel Royal Hospital, University of Glasgow, Glasgow, G12 0XH, UK
| | - Eliseo Vano
- Department of Radiology, Medical Physics, Faculty of Medicine, Complutense University, 28040, Madrid, Spain
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314
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De Monte F, Castaldi B, Branchini M, Bettinelli A, Milanesi O, Paiusco M, Roggio A. Typical values for pediatric interventional cardiology catheterizations: A standardized approach towards Diagnostic Reference Level establishment. Phys Med 2020; 76:134-141. [DOI: 10.1016/j.ejmp.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/21/2020] [Accepted: 07/01/2020] [Indexed: 12/31/2022] Open
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315
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Hayashi T, Watanabe Y, Imazeki M, Takeda K, Sakiyama K, Hasegawa R, Tajima O, Tsukamoto A, Sato H, Shiraki H, Abe O. [Multicenter Survey on Radiation Dose of Cardiac Intervention]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:715-724. [PMID: 32684564 DOI: 10.6009/jjrt.2020_jjrt_76.7.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We conducted a nationwide survey of multiple institutions and collected data of various interventional procedures in the field of cardiology. Included in the analysis were 126 institutions, 381 X-ray systems, and 805 protocols. The dose values were compared with the Japanese diagnostic reference levels (DRLs) 2015. Fluoroscopy time, air kerma at the patient entrance reference point (Ka, r), and air kerma-area product (PKA ) were analyzed for various interventional procedures in 5,734 cardiology patients. The fluoroscopic dose rate (FDR) for pulmonary vein isolation (PVI) was less than half that of the 75th percentile of the Japanese DRLs 2015. The 75th percentiles of fluoroscopy time, Ka, r, and PKA for the respective interventional procedures were as follows: 11.0 min, 735 mGy, and 64 Gy・cm2 for diagnostic coronary angiography (CA); 13.2 min, 839 mGy, and 75 Gy・cm2 for CA + left ventriculography; 34.4 min, 1,810 mGy, and 148 Gy・cm2 for percutaneous coronary intervention (PCI) excluding chronic total occlusion; 80.1 min, 4,338 mGy, and 312 Gy・cm2 for PCI for chronic total occlusion; 74.4 min, 833 mGy, and 90 Gy・cm2 for PVI; and 34.0 min, 795 mGy, and 94 Gy・cm2 for transcatheter aortic valve implantation, respectively. In assessing dose values in interventional radiology, the difficulty of the technique needs to be considered, and the DRL values for FDR, fluoroscopic time, Ka, r, and PKA for each interventional procedure are considered necessary when reassessing or updating DRLs.
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Affiliation(s)
| | - Yuichi Watanabe
- Faculty of Health Sciences, Department of Radiological Sciences, Komazawa University
| | | | | | - Kouji Sakiyama
- Department of Radiology, Showa University Northern Yokohama Hospital
| | | | - Osamu Tajima
- Department of Radiological Technology, Saitama Cardiovascular and Respiratory Center
| | | | - Hisaya Sato
- Department of Radiology, Graduate School of Health Sciences, Showa University
| | - Hisashi Shiraki
- Department of Radiology, University of Tokyo Hospital (Current address: Department of Radiology, Nerima Hikarigaoka Hospital)
| | - Osamu Abe
- Department of Radiology, University of Tokyo Hospital.,Department of Radiology, Graduate School of Medicine, The University of Tokyo
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316
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Zalokar N, Resnik A, Mekiš N. RADIATION DOSE DURING PELVIC RADIOGRAPHY IN RELATION TO BODY MASS INDEX. RADIATION PROTECTION DOSIMETRY 2020; 189:294-303. [PMID: 32342096 DOI: 10.1093/rpd/ncaa042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/02/2020] [Accepted: 02/25/2020] [Indexed: 06/11/2023]
Abstract
The purpose of this research was to investigate the impact of body mass index (BMI) on dose area product (DAP), effective dose (E), dose to the organs and image quality (IQ) on 200 patients referred to pelvic radiography. Patients were classified into three groups according to BMI: normal (<24.99), overweight (25.0-29.99) and obese (>30). The results showed 52% and 135% higher DAP for overweight and obese patients compared to normal-weight patients (p < 0.001). A 46 and 123% rise of E for overweight and obese patients compared to normal-weight patients (p < 0.001) was discovered. Overweight patients received 37% higher dose and obese patients 107% higher dose to the organs compared to normal-weight patients. There were no statistically significant differences between IQ, except between normal weight and overweight patients. A strong correlation (r = 0.733) was found between BMI and DAP and between BMI and E (r = 0.776).
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Affiliation(s)
- Nika Zalokar
- University of Ljubljana, Faculty of Health Sciences, Department of Medical Imaging and Radiotherapy, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
| | - Anja Resnik
- University of Ljubljana, Faculty of Health Sciences, Department of Medical Imaging and Radiotherapy, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
| | - Nejc Mekiš
- University of Ljubljana, Faculty of Health Sciences, Department of Medical Imaging and Radiotherapy, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
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317
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Efthymiou FO, Metaxas VI, Dimitroukas CP, Panayiotakis GS. LOW BMI PATIENT DOSE IN DIGITAL RADIOGRAPHY. RADIATION PROTECTION DOSIMETRY 2020; 189:1-12. [PMID: 32043128 DOI: 10.1093/rpd/ncaa007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/11/2020] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
In this study, the radiation dose received by 364 low body mass index (BMI) adult patients undergoing chest, abdomen, lumbar spine, kidneys and urinary bladder (KUB) and pelvis X-ray examinations in an X-ray room with a digital radiography system was evaluated. The patients' kerma area product (KAP) values were recorded, and the entrance surface air kerma (ESAK) was calculated based on the X-ray tube output, exposure parameters and technical data. The 75th percentiles of the distribution of ESAK and KAP values were also estimated. The dose values were compared with the corresponding values for normal patients obtained from a previous survey in our hospital, as well as with the national and UK diagnostic reference levels (DRLs). The correlation of dose values with patient size metrics (mass, height, BMI) was also investigated. A statistically significant difference was found in KAP and the ESAK values between low BMI and normal patients (Mann-Whitney test, p < 0.05), for all examinations studied. The percentage difference for chest PA, chest LAT, abdomen PA, lumbar spine AP, lumbar spine LAT, pelvis AP and KUB AP examinations was 40, 36, 48, 68, 57, 46 and 67% for median KAP and 26, 43, 52, 48, 19, 44 and 51% for median ESAK, respectively. The corresponding 75th percentiles for low BMI patients were 0.065, 0.349, 0.683, 1.54, 3.92, 1.11, 0.67 mGy and 0.042, 0.218, 0.450, 0.280, 0.598, 0.597, 0.267 Gycm2 in terms of ESAK and KAP values, respectively. They were 74-90% lower compared to the national diagnostic reference levels (DRLs), 35-84% and 58-82% compared to the UK DRLs, for ESAK and KAP values, respectively. Regarding the gender of the patients, no statistically significant difference was found in the dose values between female and male patients (Mann-Whitney test, p > 0.05), for all examinations studied. A statistically significant correlation was found between ESAK and KAP values with BMI for KUB AP, pelvis AP, lumbar spine AP, lumbar spine LAT and chest PA, while for chest LAT examinations, only the ESAK were significantly correlated with BMI. They also significantly correlated with the mass for KUB AP, lumbar spine LAT, abdomen PA and chest PA examinations, while no significant correlation was found between the dose values and patients' height. It can be concluded that the low BMI patients received a significantly reduced radiation dose compared to normal patients. Additional studies need to be conducted for these patient groups, which could contribute to the further development of a radiation protection culture in diagnostic radiography.
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Affiliation(s)
- Fotios O Efthymiou
- Department of Medical Physics, School of Medicine, University of Patras, Patras 265 04, Greece
| | - Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, Patras 265 04, Greece
| | | | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, Patras 265 04, Greece
- Department of Medical Physics, University Hospital of Patras, Patras 265 04, Greece
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318
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Worrall M, Vinnicombe S, Sutton D. Determining patient abdomen thickness from a single digital radiograph with a computational model: clinical results from a proof of concept study. Br J Radiol 2020; 93:20200010. [PMID: 32267728 PMCID: PMC7336075 DOI: 10.1259/bjr.20200010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE A computational model has been created to estimate the abdominal thickness of a patient following an X-ray examination; its intended application is assisting with patient dose audit of paediatric X-ray examinations. This work evaluates the accuracy of the computational model in a clinical setting for adult patients undergoing anteroposterior (AP) abdomen X-ray examinations. METHODS The model estimates patient thickness using the radiographic image, the exposure factors with which the image was acquired, a priori knowledge of the characteristics of the X-ray unit and detector and the results of extensive Monte Carlo simulation of patient examinations. For 20 patients undergoing AP abdominal X-ray examinations, the model was used to estimate the patient thickness; these estimates were compared against a direct measurement made at the time of the examination. RESULTS Estimates of patient thickness made using the model were on average within ±5.8% of the measured thickness. CONCLUSION The model can be used to accurately estimate the thickness of a patient undergoing an AP abdominal X-ray examination where the patient's size falls within the range of the size of patients used to create the computational model. ADVANCES IN KNOWLEDGE This work demonstrates that it is possible to accurately estimate the AP abdominal thickness of an adult patient using the digital X-ray image and a computational model.
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Affiliation(s)
- Mark Worrall
- Medical Physics, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee, Scotland
| | | | - David Sutton
- Medical Physics, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee, Scotland
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319
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Jose A, Kumar AS, Govindarajan KN, Manimaran P. Assessment of Regional Pediatric Diagnostic Reference Levels for Panoramic Radiography Using Dose Area Product. J Med Phys 2020; 45:182-186. [PMID: 33487931 PMCID: PMC7810145 DOI: 10.4103/jmp.jmp_106_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 05/07/2020] [Accepted: 05/20/2020] [Indexed: 11/07/2022] Open
Abstract
AIM The current work aims to calculate dose area product (DAP) and to determine regional diagnostic reference level (DRL) for pediatric panoramic radiography in Tamil Nadu. MATERIALS AND METHODS In this study, DAP was calculated after finding the product of air kerma on the detector side of scanner with the corresponding exposed area. The obtained DAP values were further analyzed, and DRL was calculated using Microsoft Excel. The study was carried out with routine pediatric exposure parameters. RESULTS The obtained mean, range, and third quartile values for pediatric panoramic radiography are found to be 65 mGycm2, 11-148 mGycm2, and 82 mGycm2, respectively. The proposed DRL is comparable with the other countries' DRL. CONCLUSION Based on the results of the present study, it was observed that there exists a wide difference in mean doses among the panoramic scanners. The variation in radiation doses between the clinics/hospitals and similar scanners suggests a large potential for optimization of panoramic procedures.
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Affiliation(s)
- Amal Jose
- Department of Medical Physics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - A. Saravana Kumar
- Department of Medical Physics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - K. N. Govindarajan
- Department of Medical Physics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - P. Manimaran
- Department of Medical Physics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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320
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Crowhurst JA, Whitby M, Aroney N, Dautov R, Walters D, Raffel O. Primary operator radiation dose in the cardiac catheter laboratory. Br J Radiol 2020; 93:20200018. [PMID: 32543896 DOI: 10.1259/bjr.20200018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Radiation from cardiac angiography procedures is harmful to patients and the staff performing them. This study sought to investigate operator radiation dose for a range of procedures and different operators in order to investigate trends and optimise dose. METHODS Real-time dosemeters (RTDs) were worn by operators for angiography procedures for 3 years. Dose-area product (DAP) and RTD were collected. RTD was normalised to DAP (RTD/DAP) to compare radiation dose and radiation protection measures. Comparisons were made across procedure categories and individual operators. RESULTS In 7626 procedures, median and 75th percentile levels were established for operator dose for 8 procedure categories. There was a significant difference in all operator dose measures and DAP across procedure categories (p<0.001). DAP, RTD, and RTD/DAP were significantly different across 22 individual operators (p<0.001). CONCLUSION DAP was significantly different across procedure categories and a higher RTD was seen with higher DAP. RTD/DAP can demonstrate radiation protection effectiveness and identified differences between procedures and individual operators with this measure. Procedures and individuals were identified where further optimisation of radiation protection measures may be beneficial. A reference level for operator dose can be created and audited against on a regular basis. ADVANCES IN KNOWLEDGE This study demonstrates that operator dose can be easily and routinely measured on a case by case basis to investigate dose trends for different procedures. Normalising the operator dose to DAP demonstrates radiation protection effectiveness for the individual operator which can then be optimised as part of an ongoing audit program.
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Affiliation(s)
- James A Crowhurst
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark Whitby
- University of Queensland, St Lucia, Brisbane, Australia.,I-MED Radiology, Newstead, Queensland, Australia
| | - Nicholas Aroney
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
| | - Rustem Dautov
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
| | - Darren Walters
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia.,St Vincents Northside Private Hospital, Chermside, Queensland, Australia
| | - Owen Raffel
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
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321
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Zamani H, Masjedi H, Omidi R, Hosein Zare M. ESTABLISHMENT OF LOCAL DIAGNOSTIC REFERENCE LEVELS FOR COMMON PROCEDURES OF COMPUTED TOMOGRAPHY IN YAZD PROVINCE. RADIATION PROTECTION DOSIMETRY 2020; 188:222-231. [PMID: 31822910 DOI: 10.1093/rpd/ncz279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/13/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study was to propose first established diagnostic reference levels (DRLs) in computed tomography (CT) for adults, based on volume-averaged CTDI and dose length product (DLP) metrics in Yazd Province. MATERIALS AND METHODS Six multislice CT scanners located at diverse areas of Yazd Province and seven common procedures were selected for the present study. For each procedure, at least twenty patients 18 years and older were sampled at each institution. For each patient, dose report data and scan parameters as well as patient's information were abstracted from picture archiving and communication system. RESULTS Proposed DRLs in terms of computed tomography dose index (mGy) and DLP (mGy.cm) were as follows: brain (42, 527), sinus (25, 220), neck (14, 264), abdomen-pelvis (11, 295), routine chest (8, 247), CT pulmonary angiogram (32, 261) and chest HRCT (11, 455), respectively, slightly lower compared to other investigations. CONCLUSION The proposed DRLs in this study should be considered as the local DRLs for the seven most common adult CT examinations in Yazd province so as to optimize the patient dose while maintaining acceptable image quality for the clinical task.
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Affiliation(s)
- Hamed Zamani
- Medical Physics Department, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Yazd Province, Iran
| | - Hamidreza Masjedi
- Medical Physics Department, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Yazd Province, Iran
| | - Reza Omidi
- Medical Physics Department, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Yazd Province, Iran
| | - Mohammad Hosein Zare
- Medical Physics Department, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Yazd Province, Iran
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322
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Razali MASM, Ahmad MZ, Shuaib IL, Osman ND. OPTIMIZATION OF RADIATION DOSE IN CT IMAGING: ESTABLISHING THE INSTITUTIONAL DIAGNOSTIC REFERENCE LEVELS AND PATIENT DOSE AUDITING. RADIATION PROTECTION DOSIMETRY 2020; 188:213-221. [PMID: 31885043 DOI: 10.1093/rpd/ncz278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/01/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to propose local diagnostic reference levels (LDRLs) for the most common computed tomography (CT) examinations (including contrast and non-contrast scan phase) performed at Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia (USM), Malaysia. A retrospective CT dose survey of 1488 subjects from January 2015 until December 2018 was performed at AMDI USM, Malaysia. The proposed DRLs were established at 50th and 75th percentile of dose distribution for all dose metrics (CT dose index [CTDI]; CTDIvol, CTDIw and dose-length product). The proposed LDRLs were compared with national DRLs and other established DRLs. The 10 most common CT examinations at AMDI were thorax-abdomen-pelvis (TAP) CT (46%), followed by pelvis CT (17%), abdomen-pelvis CT (10%), brain/head CT (9%) and other CT protocols. The local DRLs were established using the third quartile values of dose distribution and were categorized based on CT region protocols. Most of the proposed DRLs were exceeded the national DRLs (63%) and other international DRLs (67%). From the dose auditing, almost half of the recent dose data (for year 2018) exceeded the proposed local DRLs and the unusual dose were observed in TAP, brain/head and pelvis CT examinations. The unusual higher dose could be due to higher mAs settings, higher number of scan phase for contrast study and higher pitch factor. The local DRLs should be established for dose optimization and reduction of the occurrence of excessive radiation exposure to the patients. The establishment of the Ads and LDRLs should also consider all the factors that affect the variation in DRLs such as CT technology, scanning protocols and population characteristics. The local dose distribution should always be revised for improvement of the current local practice.
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Affiliation(s)
- Mohd Amir Syahmi Mat Razali
- Oncological and Radiological Sciences Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Sains@Bertam, 13200 Kepala Batas, Penang, Malaysia
| | - Muhamad Zabidi Ahmad
- Oncological and Radiological Sciences Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Sains@Bertam, 13200 Kepala Batas, Penang, Malaysia
| | - Ibrahim Lutfi Shuaib
- Oncological and Radiological Sciences Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Sains@Bertam, 13200 Kepala Batas, Penang, Malaysia
| | - Noor Diyana Osman
- Oncological and Radiological Sciences Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Sains@Bertam, 13200 Kepala Batas, Penang, Malaysia
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323
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Lechner J, Zimmermann B, Schmidt M, von Baehr V. Ultrasound Sonography to Detect Focal Osteoporotic Jawbone Marrow Defects Clinical Comparative Study with Corresponding Hounsfield Units and RANTES/CCL5 Expression. Clin Cosmet Investig Dent 2020; 12:205-216. [PMID: 32801922 PMCID: PMC7401665 DOI: 10.2147/ccide.s247345] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction The presently used impulse echo ultrasound examination is not suitable to provide relevant and reliable information about the jawbone, because ultrasound (US) almost completely reflects from the hard cortical jawbone. At the same time, "focal osteoporotic bone marrow defects" (BoneMarrowDefects = BMD) in jawbone are the subject of scientific presentations and discussions. Purpose Can a newly developed trans-alveolar ultrasonic sonography (TAU-n) device locate and ascertain BMD? Patients and Methods TAU-n consists of a two-part handpiece with an extraoral ultrasound transmitter and an intraoral ultrasound receiver. The TAU-n computer display shows the different jawbone densities with corresponding colour coding. The changes in jawbone density are also displayed numerically. The validation of TAU-n readings: A usual orthopantomogram (2D-OPG) on its own is not suitable for unequivocally determining jawbone density and has to be excluded from this validation. For validation, a 3D-digital volume tomogram@/cone beam computer tomogram (DVT@/CBCT) with the capacity to measure Hounsfield units (HU) and a TAU-n are used to determine the presence of preoperative BMD in 82 patient cases. Postoperatively, histology samples and multiplex analysis of RANTES@/CCL5 (R@/C) expression derived from surgically cleaned BMD areas are evaluated. Results In all 82 bone samples, DVT-HU, TAU-n values and R/C expressions show the presence of BMD with chronic inflammatory character. However, five histology samples showed no evidence of BMD. All four evaluation criteria (DVT-HU, TAU-n, R/C, histology) confirm the presence of BMD in each of the 82 samples. Conclusion The TAU-n method almost completely matches the diagnostic reliability of the other methods. The newly developed TAU-n scanner is a reliable and radiation-free option to detect BMD.
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Affiliation(s)
- Johann Lechner
- Department of Clinical Research, Clinic Integrative Dentistry, Munich, Germany
| | | | - Marlene Schmidt
- Department of Statistics, STEYR Motorenwerke, Steyr, Austria
| | - Volker von Baehr
- Department of Immunology and Allergology, Institute for Medical Diagnostics Berlin, Germany
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324
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Abuhaimed A, Martin CJ. A Monte Carlo investigation of dose length product of cone beam computed tomography scans. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:393-409. [PMID: 31986511 DOI: 10.1088/1361-6498/ab703c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The dose length product (DLP) provides a measurement related to energy imparted from a computed tomography (CT) scan. The DLP is based on the volume-averaged CT dose index (CTDI vol), which is designed for fan beams. The aims of this study were to investigate the use of DLP for scans with wide beams used in cone beam CT (DLP CBCT) in radiotherapy that would be analogous to the DLP of fan beam scans (DLP CT), and to compare the efficiencies of DLP CT and DLP CBCT in reporting the total energy imparted in patients. A validated Monte Carlo model of a kV imaging system integrated into a Varian TrueBeam linac was employed. The DLP CT was assessed by multiplying the CTDI vol for a 20 mm fan beam by scan length, and the DLP CBCT determined through multiplying the CTDI vol, estimated for wide beams using a correction factor based on free-in-air measurements, by the beam width. Two scan protocols for head and body were investigated for tube potentials between 80 and 140 kV and a range of scan lengths/widths. Efficiency values were estimated by normalising the DLP CT and DLP CBCT with respect to the corresponding dose profile integrals (DPIs), which were evaluated within 900 mm long phantoms. The results show that the DLP CBCT values were within 1% of those for DLP CT of similar length performed on the same system, and the efficiencies decrease with tube potential. However, whereas DLP values for fan beams are approximately proportional to scan length, those for wide beams decrease by ∼2% between beam widths of 20 and 320 mm. As a result, while the DLP CT efficiency is similar over all scan lengths, that for DLP CBCT increases slightly with beam width. The DLP CT and DLP CBCT underestimated the total energy imparted by comparable amounts with efficiencies within the range of 80-81% and 80-83% for the head scans, and 71-76% and 70-77% for the body scans, respectively. The results indicate that the DLP CBCT can be considered as an analogous dose index to the DLP CT. It could, therefore, be used for quantification of doses from imaging in radiotherapy and provide a valuable tool to aid optimisation.
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Affiliation(s)
- Abdullah Abuhaimed
- King Abdulaziz City for Science and Technology (KACST), Riyadh, Saudi Arabia
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325
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Dickinson N, Dunn M. A comparison of manually populated radiology information system digital radiographic data with electronic dose management systems. Br J Radiol 2020; 93:20200055. [PMID: 32462887 DOI: 10.1259/bjr.20200055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the accuracy and agreement of radiology information system (RIS) kerma-area product (KAP) data with respect to automatically populated dose management system (DMS) data for digital radiography (DR). METHODS All adult radiographic examinations over 12 months were exported from the RIS and DMS at three centres. Examinations were matched by unique identifier fields, and grouped by examination type. Each centre's RIS sample completeness was calculated, as was the percentage of the RIS examination KAP values within 5% of their DMS counterparts (used as an accuracy metric). For each centre, the percentage agreement between the RIS and DMS examination median KAP values was computed using a Bland-Altman analysis. At two centres, up to 42.5% of the RIS KAP units entries were blank or invalid; corrections were attempted to improve data quality in these cases. RESULTS Statistically significant intersite variation was seen in RIS data accuracy and the agreement between the uncorrected RIS and DMS median KAP data, with a Bland-Altman bias of up to 11.1% (with a -31.7% to 53.9% 95% confidence interval) at one centre. Attempts to correct invalid KAP units increased accuracy but produced worse agreement at one centre, a slight improvement at another and no significant change in the third. CONCLUSION The RIS data poorly represented the DMS data. ADVANCES IN KNOWLEDGE RIS KAP data are a poor surrogate for DMS data in DR. RIS data should only be used in patient dose surveys with an understanding of its limitations and potential inaccuracies.
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Affiliation(s)
- Nathan Dickinson
- Medical Physics and Clinical Engineering, Nottingham University Hospitals, Nottingham, NG5 1PB, United Kingdom
| | - Matthew Dunn
- Medical Physics and Clinical Engineering, Nottingham University Hospitals, Nottingham, NG5 1PB, United Kingdom
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326
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Zucca S, Solla I, Boi A, Loi S, Rossi A, Sanna F, Loi B. The role of a commercial radiation dose index monitoring system in establishing local dose reference levels for fluoroscopically guided invasive cardiac procedures. Phys Med 2020; 74:11-18. [PMID: 32388465 DOI: 10.1016/j.ejmp.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The primary goal was to evaluate local dose level for fluoroscopically guided invasive cardiac procedures in a high-volume activity catheterization laboratory, using automatic data registration with minimal impact on operator workload. The secondary goal was to highlight the relationship between dose indices and acquisition parameters, in order to establish an effective strategy for protocols optimization. METHODS From September 2016 to December 2018, a dosimetric survey was conducted in the 2 rooms of the catheterization laboratory of our institution. Data collection burden was minimized using a commercial Radiation Dose Index Monitoring System (RDIMs) that analyzes dicom files automatically sent by the x-ray equipment. Data were combined with clinical information extracted from the HIS records reported by the interventional cardiologist. Local dose levels were established for different invasive cardiac procedures. RESULTS A total of 3029 procedures performed for 2615 patients were analyzed. Median KAP were 21 Gycm2 for invasive coronary angiography (ICA) procedures, 61 Gycm2 for percutaneous coronary intervention (PCI) procedures, 59 Gycm2 for combined (ICA+PCI) procedures, 87 Gycm2 for structural heart intervention (TAVI) procedures. A significant dose reduction (51% for ICA procedures and 58% for PCI procedures) was observed when noise reduction acquisition techniques were applied. CONCLUSIONS RDIMs are effective tools in the establishment of local dose level in interventional cardiology, as they mitigate the burden to collect and register extensive dosimetric data and exposure parameters. Systematic review of data support the multi-disciplinary team in the definition of an effective strategy for protocol management and dose optimization.
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Affiliation(s)
- Sergio Zucca
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy.
| | - Ignazio Solla
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Alberto Boi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Stefano Loi
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Angelica Rossi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Francesco Sanna
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Bruno Loi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
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327
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Estimation of size-specific dose estimates (SSDE) for paediatric and adults patients based on a single slice. Phys Med 2020; 74:30-39. [PMID: 32403067 DOI: 10.1016/j.ejmp.2020.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/15/2020] [Accepted: 05/01/2020] [Indexed: 02/04/2023] Open
Abstract
Volume averaged CT dose index (CTDIvol) is an important dose index utilized for CT dosimetry. Measurements of CTDIvol are performed in reference cylindrical phantoms of specified diameters. A size-specific dose estimate (SSDE) has been recommended for assessment of doses delivered to individual patients. Evaluation of the SSDE requires the size of the scanned region of the patient to be estimated in terms of water-equivalent diameter (Dw) to allow calculation of a dose value appropriate for the patient. Estimation of Dw, however, may be challenging and time consuming as it requires assessment of Dw for each slice within the scanned region. A study has been carried out to investigate the suitability of using Dw,mid for a single slice at the middle of the scanned region to estimate a value of Dw,mean to apply to all slices. 351 phantoms (158 paediatric and 193 adult) developed from reconstructed CT images of patients were employed. Six scan regions were studied: chest, abdomen, pelvis, chest and abdomen, abdomen and pelvis, and the whole trunk. Results show that the use of Dw,mid can lead to over or underestimation of Dw,mean by up to 13% for paediatric and adult patients. SSDE values based on Dw,mid and Dw,mean were assessed for each phantom, and a linear regression analysis was performed. Use of the analysis could provide a simple and practical approach to assessing SSDE for a given scan based on Dw,mid with the root-mean-square errors estimated to be in the range of 1.2%-4.0% for paediatric and 1.2%-5.9% for adults.
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328
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Greffier J, Ferretti G, Rousseau J, Andreani O, Alonso E, Rauch A, Gillet R, Le Roy J, Cabrol-Faivre L, Douane F, David A, Henry S, Jacques T, Stefanovic X, Decoux E, Lafay F, Pilleul F, Couzon F, Boutet C, Woerly B, Baur P, Sans N, Faruch M, Moussier-Lherm A, Tselikas L, Jacquier A, Bigand E, Pessis E, Teriitehau C, Magnier F, Cassagnes L, Haberlay M, Boutteau D, De Kerviler E, Majorel-Gouthain C, Defez D, Vuillod A, Rouviere O, Hennequin L, Fohlen A, Alwan R, Malakhia A, Aubry S, Dohan A, Eresue-Bony M, Gautier R, Dal R, Dabli D, Hebert T, Kovacs R, Hadid-Beurrier L, Bousson V, Potel M, Barbotteau Y, Michel C, Habib-Geryes B, André M, Arnaud T, Bestion N, Ernst O, Monfraix S, Brillet PY, Guiu B, Boussel L, Demonchy M, Beregi JP, Frandon J. National dose reference levels in computed tomography–guided interventional procedures—a proposal. Eur Radiol 2020; 30:5690-5701. [DOI: 10.1007/s00330-020-06903-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/05/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
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329
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Gershan V, Homayounieh F, Singh R, Avramova-Cholakova S, Faj D, Georgiev E, Girjoaba O, Griciene B, Gruppetta E, Hadnadjev Šimonji D, Kharuzhyk S, Klepanec A, Kostova-Lefterova D, Kulikova A, Lasic I, Milatovic A, Paulo G, Vassileva J, Kalra MK. CT protocols and radiation doses for hematuria and urinary stones: Comparing practices in 20 countries. Eur J Radiol 2020; 126:108923. [DOI: 10.1016/j.ejrad.2020.108923] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022]
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330
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Radiation dose and risk of exposure-induced death associated with common computed tomography procedures in Yazd Province. Eur J Radiol 2020; 126:108932. [DOI: 10.1016/j.ejrad.2020.108932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 02/07/2020] [Accepted: 03/02/2020] [Indexed: 01/12/2023]
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331
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Zalokar N, Žager Marciuš V, Mekiš N. Establishment of national diagnostic reference levels for radiotherapy computed tomography simulation procedures in Slovenia. Eur J Radiol 2020; 127:108979. [PMID: 32302897 DOI: 10.1016/j.ejrad.2020.108979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To propose national diagnostic reference levels (DRLs) for radiotherapy (RT) computed tomography (CT) localization purposes, compare both CT units used in the largest RT department in the country and to compare gathered results with other published DRLs in order to discover any need of optimization. METHODS In total, 1631 patient data (time spend of 4 months) regarding sex, examination type, total dose-length product (DLP) and CTDIvol was collated on two CT units. Those simulation procedures account for more than 80 % of all simulation procedures performed nationwide. Then, total DLP and CTDIvol was calculated and mean, median and 3rd quartile for both units together were presented to determine national DRLs for simulation procedures. The same data was later compared between both units to discover any potential need for optimization. RESULTS 3rd quartile values of DLP for abdomen, breast, chest, head, head and neck, pelvis and spine were 1116.2, 606.6, 832.4, 1942.4, 969.2, 677.1 and 1042.4 mGy∙cm, respectively. 3rd quartile CTDIvol values for the same sequence of procedures were 18.7, 13.3, 19.2, 76.9, 22.6, 17.9 and 22.2 mGy, respectively. Among the two units, the mentioned dose values were on average significantly higher on one CT unit than on the other unit. CONCLUSIONS When comparing collected dose values with other studies, RT CT DRLs showed that radiation doses from our institution were similar or even lower. Some variations were found between both CT units in certain protocols, so exposure parameters should be reviewed and optimized.
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Affiliation(s)
- Nika Zalokar
- University of Ljubljana, Faculty of Health Sciences, Medical Imaging and Radiotherapy Department, Zdravstvena pot 5, 1000, Ljubljana, Slovenia
| | - Valerija Žager Marciuš
- University of Ljubljana, Faculty of Health Sciences, Medical Imaging and Radiotherapy Department, Zdravstvena pot 5, 1000, Ljubljana, Slovenia; Institute of Oncology Ljubljana, Teleradiotherapy Department, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Nejc Mekiš
- University of Ljubljana, Faculty of Health Sciences, Medical Imaging and Radiotherapy Department, Zdravstvena pot 5, 1000, Ljubljana, Slovenia.
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332
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Ou-Saada I, Boujemaa S, Campoleoni M, Brambilla R, Bentayeb F. Local Diagnostic Reference Levels in Interventional Radiology. J Med Imaging Radiat Sci 2020; 51:307-311. [PMID: 32278664 DOI: 10.1016/j.jmir.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Interventional cardiology procedures, during which live images are acquired, involve exposure to x-rays. The use of fluoroscopy can cause high radiation doses to patients and operators because of the prolonged duration of x-ray emission. For this reason, special attention and constant vigilance represent challenges for commissions and groups of experts in the field. The purpose of this study is to establish local diagnostic reference levels (DRLs) for these procedures, to improve radiological practice, and to optimize radiation doses. METHODS This work was carried out in two university hospitals and two private medical facilities in Rabat, the capital of Morocco, during the period 2017-2018. The study concerns 657 interventional cardiology procedures (457 coronary angiography [CA] and 200 percutaneous transluminal coronary angioplasty [PTCA]), performed by 11 cardiologists on different installations in 5 catheterization rooms. The data collected for each procedure were patient age, height and weight, dosimeter indicators in terms of dose area product (PKA), total air kerma at the reference point (Kar), fluoroscopy time (FT), and the number of frames, together with the primary beam parameters as kV and total mAs. The proposed DRLs were set from the 75th percentile of the PKA and FT. RESULTS The mean of PKA for CA and PTCA procedures were 29.2 Gy∗cm2 and 70.4 Gy∗cm2, respectively, the mean of fluoroscopy time were 4.0 min and 12.17 min for 334 and 685 frames, respectively. Results for the local DRLs were 37.3 and 87.1 Gy cm2 for PKA and 4.48 and 16.15 min for FT, corresponding to CA and PTCA procedures. CONCLUSION This work focuses on proposing local DRLs in Morocco for CA and PTCA procedures. The results show that the values found conform with those of international studies.
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Affiliation(s)
- Imane Ou-Saada
- Laboratory of High Energy Physics, Modelisation and Simulation, Faculty of Sciences, Rabat, Morocco
| | - Soumaya Boujemaa
- Laboratory of High Energy Physics, Modelisation and Simulation, Faculty of Sciences, Rabat, Morocco
| | - Mauro Campoleoni
- Unità Operativa di Fisica Medica "Fondazione Ca 'Granda - Ospedale Maggiore Policlinico", Milano, Italy
| | - Roberto Brambilla
- Unità Operativa di Fisica Medica "Fondazione Ca 'Granda - Ospedale Maggiore Policlinico", Milano, Italy
| | - Farida Bentayeb
- Laboratory of High Energy Physics, Modelisation and Simulation, Faculty of Sciences, Rabat, Morocco.
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333
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Vanaudenhove T, Van Muylem A, Howarth N, Gevenois PA, Tack D. Variabilities in X-ray diagnostic reference levels. Eur Radiol 2020; 30:4641-4647. [PMID: 32270316 DOI: 10.1007/s00330-020-06819-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To estimate the variability of X-ray diagnostic reference levels (DRLs) depending on the number of X-ray devices and data per device. METHODS Dose-area products (DAP) were collected by the national nuclear control agency from the 590 devices installed in 345 medical centers in the country. From 2015 to 2017, the number of chest (postero-anterior (PA) view alone, and both postero-anterior and lateral views (PA/LAT)), abdomen, pelvis, and lumbar spine examinations collected in these centers ranged from 23,000 to 77,000. The impact of the number of devices and DAP data per device on DRLs' variabilities (95th confidence intervals divided by medians) is estimated using a bootstrapping method as a function of the number of devices and DAP per device. RESULTS The DRLs' variabilities ranged from 30 to 200% depending on the number of devices and DAP data per device but stabilized at 30% when the number of devices was higher than 200 for chest PA and abdomen examinations, 300 for lumbar spine and pelvis examinations, and 400 for chest PA/LAT examinations, regardless of the number of DAP data per device. Extrapolations of our results suggest that thousands of devices are necessary to reduce DRLs' variabilities to 10%. CONCLUSION DAP-related DRL variabilities are high but only moderately influenced by the number of DAP data per device and of devices provided this number is higher than 200 to 400 devices according to the type of examination. Harmonization of methods of data collection between the authorities of the EU states should be recommended. KEY POINTS • DAP-related DRLs are not fixed values but ranges of values with at least 30% variability. • DAP-related DRLs strongly depend on the number of devices included when lower than 100. • If the number of devices included exceeds 200 to 400, the DRLs' variabilities do not depend on the number of DAP per device and should not exceed 30%.
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Affiliation(s)
- Thibault Vanaudenhove
- Federal Agency for Nuclear Control (FANC), Rue Ravenstein 36, 1000, Brussels, Belgium
| | - Alain Van Muylem
- Department of Chest Medicine, Hôpital Erasme, Route de Lennik 808, 1070, Brussels, Belgium
| | - Nigel Howarth
- Department of Radiology, Clinique des Grangettes, 7 Chemin des Grangettes, 1224, Chêne-Bougeries, Switzerland
| | - Pierre Alain Gevenois
- Department of Radiology, Hôpital Erasme, Route de Lennik 808, 1070, Brussels, Belgium
| | - Denis Tack
- Department of Radiology, Epicura, Clinique Louis Caty, 136 Rue Louis Caty, 7331, Baudour, Belgium.
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334
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Gennaro G, Bigolaro S, Hill ML, Stramare R, Caumo F. Accuracy of mammography dosimetry in the era of the European Directive 2013/59/Euratom transposition. Eur J Radiol 2020; 127:108986. [PMID: 32298958 DOI: 10.1016/j.ejrad.2020.108986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/30/2020] [Accepted: 03/28/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the impact of increasing levels of accuracy for mean glandular dose (MGD) evaluation in the era of the European Directive 2013/59/Euratom transposition. METHOD 4028 women who had a mammography examination by one of five mammography units using different detector technologies were included in this study. 16,006 images were processed by a software algorithm that determines breast glandularity quantitatively and uses this to estimate patient-specific MGD (psMGD). Entrance dose (ED) values and half value layers (HVLs) measured for each mammography system were collected to evaluate the effect of equipment calibration in psMGD calculation. The psMGD values adjusted for system calibration were compared with organ dose (OD) provided by manufacturers as image metadata. RESULTS Overall median relative difference between calibrated psMGD and organ dose was below 3%, with larger differences for individual systems. The psMGD adjustment for system calibration was particularly useful for one system for which ED had an evident miscalibration issue. The mean difference between psMGD with calibration and organ dose provided by manufacturers was 4.1 %, ranging from -16.3 % to +24.5 %. The proportion of images for which organ dose was more than 10 % 'inaccurate' compared to psMGD was between 11 % and 46 %, depending on the mammography system. CONCLUSION Patient-specific mean glandular dose, possibly adjusted for system calibration, allows more accurate individual breast dosimetry than what would be performed using organ dose provided by manufacturers. Conversely, definition of diagnostic reference levels could be achieved using either psMGD or organ dose.
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Affiliation(s)
| | | | - Melissa L Hill
- Volpara Health Technologies Ltd., Wellington, New Zealand
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Compagnone G, Padovani R, D'Ercole L, Orlacchio A, Bernardi G, D'Avanzo MA, Grande S, Palma A, Campanella F, Rosi A. Provision of Italian diagnostic reference levels for diagnostic and interventional radiology. Radiol Med 2020; 126:99-105. [PMID: 32239471 DOI: 10.1007/s11547-020-01165-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/02/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The diagnostic reference level (DRL) is a useful tool for the optimisation of medical exposures. Thus, a Working Party coordinated by the Italian National Institute of Health and the National Workers Compensation Authority has been formed to provide Italian DRLs, for both diagnostic and interventional procedures, to be used as appropriate for the implementation of the 2013/59 European Directive into the national regulation. MATERIALS AND METHODS The multidisciplinary Working Party was formed by professionals involved in diagnostic and interventional radiology medical exposures and started from a critical revision of both the literature and the results of previous Italian surveys. The procedures were divided into five sections for adult (projection radiography, mammography, diagnostic fluoroscopy, CT and interventional radiology) and two sections for paediatric patients (projection radiography and CT). The provided DRL values have been identified for "normal" adult patients and for age-classes of paediatric patients. RESULTS Some of the DRL values provided by the Working Party are reported in this study as an example, divided by adult/paediatric patients, radiological technique and examination: specifically, DRLs for new radiological practices and new dose quantities as DRLs metric were introduced. The median value (rather than the mean) for each procedure, derived from a sample of patients, has to be compared with the corresponding DRL value, and dosimetric data related to a minimum number of patients should be collected for each examination. CONCLUSIONS The approach to the definition and use of DRLs through guidelines of national Authorities in collaboration with scientific Associations should simplify the periodical updating and could be useful for keeping the optimisation of medical exposures faithful to the development of radiological practice.
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Affiliation(s)
- Gaetano Compagnone
- Department of Medical Physics, S.Orsola-Malpighi University Hospital, Via Massarenti, 9, 40138, Bologna, BO, Italy.
| | - Renato Padovani
- Abdus Salam International Centre for Theoretical Physics, Trieste, Italy
| | - Loredana D'Ercole
- Department of Medical Physics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Orlacchio
- Department of Radiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Maria Antonietta D'Avanzo
- Department of Medicine Epidemiology and Environmental Sanitation, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro (INAIL), Rome, Italy
| | - Sveva Grande
- National Centre for Innovative Technologies in Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Alessandra Palma
- National Centre for Innovative Technologies in Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Francesco Campanella
- Department of Medicine Epidemiology and Environmental Sanitation, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro (INAIL), Rome, Italy
| | - Antonella Rosi
- National Centre for Innovative Technologies in Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
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Gao Y, Mahmood U, Liu T, Quinn B, Gollub MJ, Xu XG, Dauer LT. Patient-Specific Organ and Effective Dose Estimates in Adult Oncologic CT. AJR Am J Roentgenol 2020; 214:738-746. [PMID: 31414882 PMCID: PMC7393764 DOI: 10.2214/ajr.19.21197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Patient-specific organ and effective dose provides essential information for CT protocol optimization. However, such information is not readily available in the scan records. The purpose of this study was to develop a method to obtain accurate examination- and patient-specific organ and effective dose estimates by use of available scan data and patient body size information for a large cohort of patients. MATERIALS AND METHODS. The data were randomly collected for 1200 patients who underwent CT in a 2-year period. Physical characteristics of the patients and CT technique were processed as inputs for the dose estimator. Organ and effective doses were estimated by use of the inputs and computational human phantoms matched to patients on the basis of sex and effective diameter. Size-based ratios were applied to correct for patient-phantom body size differences. RESULTS. Patients received a mean of 59.9 mGy to the lens of the eye per brain scan, 10.1 mGy to the thyroid per chest scan, 17.5 mGy to the liver per abdomen and pelvis scan, and 19.0 mGy to the liver per body scan. A factor of 2 difference in dose estimates was observed between patients of various habitus. CONCLUSION. Examination- and patient-specific organ and effective doses were estimated for 1200 adult oncology patients undergoing CT. The dose conversion factors calculated facilitate rapid organ and effective dose estimation in clinics. Compared with nonspecific dose estimation methods, patient dose estimations with data specific to the patient and examination can differ by a factor of 2.
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Affiliation(s)
- Yiming Gao
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Usman Mahmood
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Tianyu Liu
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Brian Quinn
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Marc J. Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - X. George Xu
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Lawrence T. Dauer
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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337
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Vano E, Frija G, Stiller W, Efstathopoulos E, Granata C, Loose R, Paulo G, Pekarovic D, Sjöberg J, Donoso-Bach L. Harmonisation of imaging dosimetry in clinical practice: practical approaches and guidance from the ESR EuroSafe Imaging initiative. Insights Imaging 2020; 11:54. [PMID: 32232684 PMCID: PMC7105556 DOI: 10.1186/s13244-020-00859-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/05/2020] [Indexed: 11/10/2022] Open
Abstract
The European Directive 2013/59/EURATOM requires member states of the European Union to ensure justification and optimisation of the radiological procedures and to include information on patient exposure as part of the report of the examinations. The EuroSafe Imaging campaign of the European Society of Radiology created a working group (WG) on "Dosimetry for imaging in clinical practice" with the aim to help with the dosimetry aspects required by European and national regulations. The primary focus topics were selected and a survey among the experts of the WG, allowed suggesting some initial consensus approaches.For information on patient exposure, it was agreed to include the dosimetric values reported by the imaging modalities (validated by a medical physics expert). It was also suggested to prepare educational material on dosimetric quantities for patients. Individual optimisation was considered a challenge, especially for interventional procedures. In these cases, patient and occupational doses should be part of the global optimisation process and trigger levels should be defined to avoid skin radiation injuries. Diagnostic Reference Levels (DRLs) always need to be considered for comparison with periodic patient dose audits. In the case of accidental or unintended exposures, a report should be produced for the Quality Assurance programme, together with an educational note to avoid the repetition of incidents. Dose registry and management systems should allow fulfilling the regulatory requirements of national and European regulations. In a second step, and after the initial experience with the Directive implementation, a wider survey will be considered.
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Affiliation(s)
- Eliseo Vano
- Radiology department (Medical Physics), Complutense University, Madrid, Spain.
| | - Guy Frija
- Paris Georges Pompidou European Hospital, Paris, France
| | - Wolfram Stiller
- Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Heidelberg, Germany
| | | | | | | | - Graciano Paulo
- Instituto Politécnico de Coimbra - Escola Superior de Tecnologia da Saúde de Coimbra (ESTeSC), Coimbra, Portugal
| | - Dean Pekarovic
- Institute of Radiology, University Medical Centre, Ljubljana, Slovenia
| | - Johan Sjöberg
- Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden
| | - Lluís Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
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338
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Ria F, Samei E. Is regulatory compliance enough to ensure excellence in medicine? Radiol Med 2020; 125:904-905. [PMID: 32193869 DOI: 10.1007/s11547-020-01171-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Francesco Ria
- Carl E. Ravin Advanced Imaging Labs and Clinical Imaging Physics Group, Duke University Health System, 2424 Erwin Road, Suite 302, Durham, NC, 27710, USA.
| | - Ehsan Samei
- Carl E. Ravin Advanced Imaging Labs, Clinical Imaging Physics Group, Medical Physics Graduate Program, Departments of Radiology, Physics, Biomedical Engineering, and Electrical and Computer Engineering, Duke University, 2424 Erwin Road, Suite 302, Durham, NC, 27710, USA
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339
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Forbrig R, Ozpeynirci Y, Grasser M, Dorn F, Liebig T, Trumm CG. Radiation dose and fluoroscopy time of modern endovascular treatment techniques in patients with saccular unruptured intracranial aneurysms. Eur Radiol 2020; 30:4504-4513. [PMID: 32193640 PMCID: PMC8093177 DOI: 10.1007/s00330-020-06777-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
Objectives Modern endovascular treatment of unruptured intracranial aneurysms (UIAs) demands for observance of diagnostic reference levels (DRLs). The national DRL (250 Gy cm2) is only defined for coiling. We provide dosimetric data for the following procedures: coiling, flow diverter (FD), Woven EndoBridge (WEB), combined techniques. Methods A retrospective single-centre study of saccular UIAs treated between 2015 and 2019. Regarding dosimetric analysis, the parameters dose area product (DAP) and fluoroscopy time were investigated for the following variables: endovascular technique, aneurysm location, DSA protocol, aneurysm size, and patient age. Results Eighty-seven patients (59 females, mean age 54 years) were included. Total mean and median DAP (Gy cm2) were 119 ± 73 (89–149) and 94 (73; 130) for coiling, 128 ± 53 (106–151) and 134 (80; 176) for FD, 128 ± 56 (102–153) and 118 (90; 176) for WEB, and 165 ± 102 (110–219) and 131 (98; 209) for combined techniques (p > .05). Regarding the aneurysm location, neither DAP nor fluoroscopy time was significantly different (p > .05). The lowest and highest fluoroscopy times were recorded for WEB and combined techniques, respectively (median 26 and 94 min; p < .001). A low-dose protocol yielded a 43% reduction of DAP (p < .001). Significantly positive correlations were found between DAP and both aneurysm size (r = .320, p = .003) and patient age (r = .214, p = .046). Conclusions This UIA study establishes novel local DRLs for modern endovascular techniques such as FD and WEB. A low-dose protocol yielded a significant reduction of radiation dose. Key Points • This paper establishes local diagnostic reference levels for modern endovascular treatment techniques of unruptured intracranial aneurysms, including flow diverter stenting and Woven EndoBridge device. • Dose area product was not significantly different between endovascular techniques and aneurysm locations, but associated with aneurysm size and patient age. • A low-dose protocol yielded a significant reduction of dose area product and is particularly useful when applying materials with a high radiopacity (e.g. platinum coils).
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Affiliation(s)
- Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Franziska Dorn
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christoph G Trumm
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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340
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Morcillo AB, Alejo L, Huerga C, Bayón J, Obesso A, Corredoira E, Novo JR, Hernández T, Ponce MD, Fernández L, Rodríguez R, Garzón G, Vañó E, Guibelalde E. Local diagnostic reference levels for paediatric non-cardiac interventional radiology procedures. Phys Med 2020; 72:1-6. [PMID: 32179406 DOI: 10.1016/j.ejmp.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/08/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To establish local diagnostic reference levels (DRLs) for non-cardiac interventional procedures in paediatrics. METHODS The type of procedure, the patient's weight and age and dose-related data from 279 interventions was recorded in a database completed by interventional radiologists, radiographers and technicians of the Medical Physics department. These procedures were classified into 14 categories and 6 weight ranges. Local DRLs were proposed for those ranges in which a sample of at least 15 patients could be gathered and were calculated as the third quartile (Q3) of the air kerma-area product (PKA) values. The Q3 of the fluoroscopy time (FT) and number of digital subtraction angiography (DSA) images were also obtained. Finally, the correlation between PKA and weight was analysed. RESULTS Local DRLs are proposed for three types of procedures: hepatic/biliary interventions (5-15 kg, 1304 cGy·cm2; 15-30 kg, 2121 cGy·cm2), sclerotherapy procedures (15-30 kg, 704 cGy·cm2; 30-50 kg, 4049 cGy·cm2; 50-80 kg, 3734 cGy·cm2) and central venous catheter (CVC) procedures (5-15 kg, 84 cGy·cm2). Hepatic/biliary interventions showed a moderate correlation (r = 0.61), while sclerotherapy procedures presented a poor correlation (r = 0.34) between PKA and weight, possibly due to the PKA dependence on the complexity level. Regarding CVC procedures, a clearly higher correlation was found when the fluoroscopy PKA value was normalised to the FT (r = 0.85 vs r = 0.35). CONCLUSIONS The results support the feasibility of establishing DRLs for the most common procedures (sclerotherapy, hepatic/biliary and CVC interventions) despite the small number of paediatric interventions.
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Affiliation(s)
- Ana Belén Morcillo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain.
| | - Luis Alejo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Carlos Huerga
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - José Bayón
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Alba Obesso
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eva Corredoira
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Joan Ricardo Novo
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Teresa Hernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María Dolores Ponce
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Lucía Fernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Ricardo Rodríguez
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Gonzalo Garzón
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eliseo Vañó
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
| | - Eduardo Guibelalde
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
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341
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Lee KL, Beveridge T, Sanagou M, Thomas P. Updated Australian diagnostic reference levels for adult CT. J Med Radiat Sci 2020; 67:5-15. [PMID: 32040878 PMCID: PMC7063242 DOI: 10.1002/jmrs.372] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/17/2019] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION In 2018, ARPANSA published updated national DRLs for adult CT, which were first published in 2012, and augmented the national DRL categories. This paper presents the updated national DRLs and describes the process by which they were produced. METHODS Examine patient survey data submitted to the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) National Diagnostic Reference Level Service (NDRLS). Determine the quartiles of the distributions of median survey dose metrics with categorisation by procedure type. Engage a liaison panel representing the radiology professions to review procedure categories and recommend revised national DRLs. The revised NDRL procedure categories are: head (non-contrast brain (trauma/headache)), cervical spine (Non-contrast (trauma)), soft-tissue neck (post-contrast (oncology)), chest (post-contrast (oncology)), abdomen-pelvis (post-contrast (oncology)), kidney-ureter-bladder (non-contrast (suspected renal colic)), chest-abdomen-pelvis (post-contrast (oncology)) and lumbar spine (non-contrast (degenerative pain)). RESULTS The existing six procedure categories were revised and refined. Updated Australian national diagnostic reference levels for adult CT were recommended and endorsed for eight procedure categories: head (52 mGy/880 mGycm), cervical spine (23 mGy/470 mGycm),soft-tissue neck (17 mGy/450 mGycm), chest (10 mGy/390 mGycm), abdomen-pelvis (13 mGy/600 mGycm), kidney-ureter-bladder (13 mGy/600 mGycm), chest-abdomen-pelvis (11 mGy/940 mGycm) and lumbar spine (26 mGy/670 mGycm). The updated national DRLs are between 12 and 26% lower than the previous DRLs for dose-length product and between 13 and 63% lower for volume computed tomography dose index. CONCLUSIONS Australian national DRLs for adult CT have been reviewed and revised. The revised national DRLs are lower, better reflecting current practice among imaging facilities in Australia. The revised Australian national DRLs are similar to those in other developed countries.
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Affiliation(s)
- Kam L. Lee
- Australian Radiation Protection and Nuclear Safety AgencyYallambieVictoriaAustralia
| | - Toby Beveridge
- Australian Radiation Protection and Nuclear Safety AgencyYallambieVictoriaAustralia
| | - Masoumeh Sanagou
- Australian Radiation Protection and Nuclear Safety AgencyYallambieVictoriaAustralia
| | - Peter Thomas
- Australian Radiation Protection and Nuclear Safety AgencyYallambieVictoriaAustralia
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Nishida T, Hayashi S, Takenaka M, Hosono M, Kogure H, Hasatani K, Yamaguchi S, Maruyama H, Doyama H, Ihara H, Yoshio T, Nagaike K, Yamada T, Yakushijin T, Takagi T, Tsumura H, Kurita A, Asai S, Ito Y, Kuwai T, Hori Y, Maetani I, Ikezawa K, Iwashita T, Matsumoto K, Inada M. Multicentre prospective observational study protocol for radiation exposure from gastrointestinal fluoroscopic procedures (REX-GI study). BMJ Open 2020; 10:e033604. [PMID: 32107268 PMCID: PMC7202697 DOI: 10.1136/bmjopen-2019-033604] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Recently, the use of various endoscopic procedures under X-ray fluoroscopic guidance, such as endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasonography (EUS), enteral endoscopy and stenting, has been rapidly increasing because of the minimally invasive nature of these procedures compared with that of surgical intervention. With the spread of CT and fluoroscopic interventions, including endoscopic procedures under X-ray guidance, high levels of radiation exposure (RE) from medical imaging have led to major concerns throughout society. However, information about RE related to these image-guided procedures in gastrointestinal endoscopy is scarce, and the RE reference levels have not been established. The aim of this study is to prospectively collect the actual RE dose and to help establish diagnostic reference levels (DRLs) in the field of gastroenterology in Japan. METHODS AND ANALYSIS This is a multicentre, prospective observational study that is being conducted to collect the actual RE from treatments and diagnostic procedures, including ERCP, interventional EUS, balloon-assisted enteroscopy, enteral metallic stent placement and enteral tube placement. We will measure the total fluoroscopy time (min), the total dose-area product (Gycm2) and air-kerma (mGy) of those procedures. Because we are collecting the actual RE data and identifying the influential factors through a prospective, nationwide design, this study will provide guidance regarding the DRLs of ERCP, interventional EUS, balloon-assisted enteroscopy, enteral metallic stent placement and enteral tube placement. ETHICS AND DISSEMINATION Approval was obtained from the Institutional Review Board of Toyonaka Municipal Hospital (25 April 2019). The need for informed consent will be waived via the opt-out method of each hospital website. TRIAL REGISTRATION NUMBER The UMIN Clinical Trials Registry, UMIN000036525.
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Affiliation(s)
- Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Shiro Hayashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
- Department of Gastroenterology and Internal Medicine, Hayashi Clinic, Suita, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Hirofumi Kogure
- Department of Gastroenterology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kenkei Hasatani
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan
| | - Shinjiro Yamaguchi
- Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | | | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Hideyuki Ihara
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koji Nagaike
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Suita, Osaka, Japan
| | - Takuya Yamada
- Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Takayuki Yakushijin
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidetaka Tsumura
- Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Akira Kurita
- Department of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Osaka, Japan
| | - Satoshi Asai
- Department of Gastroenterology, Tane General Hospital, Osaka, Japan
| | - Yukiko Ito
- Department of Gastroenterology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, Kure Medical Center, Kure, Hiroshima, Japan
| | - Yasuki Hori
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Iruru Maetani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kenji Ikezawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Kengo Matsumoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Masami Inada
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
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Sakamoto H, Igarashi T, Kato M, Kawauchi S, Kato H, Tsukamoto A, Moritake T, Akahane M. [Examination of Effectiveness Verification and Additional Items in Angiography and IVR of DRLs 2015]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:210-217. [PMID: 32074530 DOI: 10.6009/jjrt.2020_jsrt_76.2.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Japanese Diagnostic Reference Levels (DRLs) were released as "Japan DRLs 2015" from Japan Network for Research and Information on Medical Exposure (J-RIME) in June 2015. In "Japan DRLs 2015", DRLs in angiography and interventional procedures are set at a fluoroscopic dose rate of 20 mGy/min at the interventional reference point using a phantom. In order to achieve optimization with DRLs, then it need to be revised regularly. Therefore, we (research group to examine the effect of Japan DRLs 2015 and the necessity of additional items in angiography and vascular interventions) examined the effects of "Japan DRLs 2015" on angiography and interventional procedures. And we also investigated for DRLs revision in the future. As a result, it turned out that it is important to create DRLs in medical procedures that can be effectively used in clinical settings.
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Affiliation(s)
- Hajime Sakamoto
- Department of Radiology, Yamanashi University Hospital (Current address: Department of Radiological Technology, Faculty of Health Science, Juntendo University)
| | - Takayuki Igarashi
- Department of Medical Technology, Radiological Section, Asahi General Hospital (Current address: Department of Radiological Technology, International University of Health and Welfare Narita Hospital)
| | - Mamoru Kato
- Department of Radiology and Nuclear Medicine, Akita Cerebrospinal and Cardiovascular Center
| | | | | | | | - Takashi Moritake
- Department of Radiological Health Science, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health
| | - Masaaki Akahane
- Department of Radiology, School of Medicine, International University of Health and Welfare
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344
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Measuring the dose-width product and proposing the local diagnostic reference level in panoramic dental radiography: a multi-center study from Iran. Oral Radiol 2020; 37:80-85. [PMID: 32065334 DOI: 10.1007/s11282-020-00428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although radiation exposure associated with dental radiography is relatively low, patient exposure must be kept practically low. Therefore, it is necessary for each country to establish its own diagnostic reference levels (DRLs) suitable for its equipment and practice. In the present study, dose-width product (DWP) values for panoramic dental radiography were measured and a local DRL was established. METHODS Five panoramic devices from five radiology clinics of Kashan, Iran were selected to measure the DWP values of panoramic dental radiography. To investigate the DWP values, the parameters of each patient's exposure (e.g., tube voltage, tube current, and exposure time) at these five radiology clinics were extracted. Then, the dose value received by each patient was measured based on a CT pencil chamber. Finally, the overall median DWP values for the patients with small, medium, and large sizes were obtained, and these values were considered as the local DRLs for panoramic dental radiography. RESULTS A total of 99 adult patients were included in the present study. The findings demonstrated that the median and third-quartile DWP values for these five radiology clinics ranged from 42.3 to 94.3 and 49.7 to 142.8 mGy mm, respectively. The local DRL values, which were established as the overall median DWP values, were 43.4, 52.0, and 80.3 mGy mm for the adults with small, medium, and large sizes, respectively. CONCLUSION The local DRL proposed in this study for the adult with standard/medium size was lower than those proposed by other reports and seemed acceptable for panoramic radiography in Kashan, Iran.
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Jeukens CRLPN, Kütterer G, Kicken PJ, Frantzen MJ, van Engelshoven JMA, Wildberger JE, Kemerink GJ. Gonad shielding in pelvic radiography: modern optimised X-ray systems might allow its discontinuation. Insights Imaging 2020; 11:15. [PMID: 32030539 PMCID: PMC7005227 DOI: 10.1186/s13244-019-0828-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE As gonad shielding is currently under debate, this study evaluates the practice, from its introduction in about 1905 until today. METHODS The literature was searched for developments in shielding and insights into the effects of ionising radiation on gonads. Based on own pre-1927 dose reconstructions, reported doses after 1927, a 2015-report from the European Union and recent own measurements, the effects of technological evolution and optimisation on radiation dose and hereditary risk were assessed. RESULTS In the 1900s, gonad shielding was first applied to prevent male sterility, but was discontinued when instrumental developments led to reduced radiation doses. In the 1950s, concerns about hereditary risks intensified and gonad shielding was recommended again, becoming routine worldwide. Imaging-chain improvements over time were considerable: in 2018, the absorbed dose was 0.5% of its 1905 value for the testes and 2% for the ovaries, our optimised effective dose a factor five lower than the value corresponding to the current EU diagnostic reference level, and the reduction in detriment-adjusted risk by shielding less than 1 × 10-6 for women and 5 × 10-6 for men. CONCLUSIONS Assessment of pelvic doses revealed a large reduction in radiation risks facilitated by technological developments. Optimisation likewise contributed, but unfortunately, its potential was never adequately exploited. Today, using a modern and optimised X-ray system, gonad shielding can be safely discontinued for women. For men, there might be a marginal benefit, but potential negative side-effects may well dominate. Discontinuation of gonad shielding seems therefore justifiable.
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Affiliation(s)
- Cécile R L P N Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debijelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Gerhard Kütterer
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debijelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Pierre J Kicken
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debijelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Marij J Frantzen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debijelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Jos M A van Engelshoven
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debijelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debijelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Gerrit J Kemerink
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debijelaan 25, 6229 HX, Maastricht, The Netherlands
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346
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Suliman II. Estimates of Patient Radiation Doses in Digital Radiography Using DICOM Information at a Large Teaching Hospital in Oman. J Digit Imaging 2020; 33:64-70. [PMID: 30891650 PMCID: PMC7064681 DOI: 10.1007/s10278-019-00199-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In this study, we sought to estimate the patient radiation doses in the digital radiography X-ray examinations conducted in a large hospital. The patient exposure factors and kerma-area product (PKA) were retrospectively recorded via the Digital Imaging and Communications in Medicine (DICOM) header for 547 patients. The entrance surface air kerma (ESAK) was estimated from the measurements of the X-ray tube output and recorded exposure factors, as well as from the console that displayed PKA as an alternative method. Effective doses were estimated from ESAK and PKA values using the appropriate conversion coefficient. In the chest PA, chest LAT, cervical spine AP, cervical spine LAT, abdomen AP, pelvis AP, lumbar spine AP, and lumbar spine LAT, the median ESAK (mGy) was found to be 0.13, 0.27, 0.35, 0.52, 0.70, 1.06, 2.33, and 4.18 mGy, respectively. Median PKA values were 0.10, 0.26, 0.14, 0.17, 0.77, 0.68, 0.81, and 1.11 Gy cm2, respectively. The estimated effective dose from ESAK and PKA values yielded comparable results. The comparison revealed that the ESAK and PKA values fell far below the reported in the literature. The results showed that the information of the DICOM deader is valuable for dosimetry and optimization.
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Affiliation(s)
- Ibrahim I Suliman
- Sudan Atomic Energy Commission, Radiation Safety Institute, P.O. Box 3001, Khartoum, Sudan.
- Formerly at Medical Physics Section, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al-Khoudh, 123, Muscat, Oman.
- Physics Department, College of Science, Committee on Radiation and Environmental Pollution Protection, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11642, Saudi Arabia.
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Sánchez R, Vañó E, Fernández Soto JM, Ten JI, Escaned J, Delgado C, García B, Carrera Magariño F, Fernández JFD, Luna RJM, Moreno MAR, Catalán A, Ojeda FB, Rosales Espizua FJ, Moreno JRS, Pifarré X, Goicolea J, Ordiales JM, Nogales JM, Martinez G, García P, Benedicto A, Castillo MFR, Torres LP, Font J, Bethencourt A, Cesteros MJ, Pérez A, Pinar E, Tobarra B. Updating national diagnostic reference levels for interventional cardiology and methodological aspects. Phys Med 2020; 70:169-175. [DOI: 10.1016/j.ejmp.2020.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/05/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022] Open
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348
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Miller DL. Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures. Med Phys 2020; 47:975-982. [DOI: 10.1002/mp.13990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Donald L. Miller
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring MD 20993USA
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Jose A, Kumar AS, Govindarajan KN, Devanand B, Elango N. Assessment of Adult Diagnostic Reference Levels for Panoramic Radiography in Tamil Nadu Region. J Med Phys 2020; 44:292-297. [PMID: 31908390 PMCID: PMC6936199 DOI: 10.4103/jmp.jmp_77_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/13/2019] [Accepted: 10/26/2019] [Indexed: 12/02/2022] Open
Abstract
Aim: The aim of this study was to calculate dose area product (DAP) and to determine diagnostic reference level (DRL) for adult panoramic procedures in Tamil Nadu. Materials and Methods: In this study, air kerma on the front side of the secondary collimator was measured with a Black Piranha, RTI Electronics, Sweden and multiplied with the corresponding exposed area to calculate DAP. The obtained DAP values were further analyzed, and DRL was calculated using the Microsoft Excel software. The study was carried out with regular adult exposure parameters. Results: The mean, range, and 3rd quartile values for 67 panoramic scanners in Tamil Nadu, India, were calculated as 94 mGycm2, 41 mGycm2–165 mGycm2, and 114.3 mGycm2, respectively. The results are comparable with other international studies. Conclusion: The present study suggests that further optimization can be achieved in many centers by the recruitment of professionally qualified radiographers and conducting periodic training programs on the optimization of exposure parameters. Considering this as the first study for the dental DRL assessment, further studies are suggested to establish national dental DRL in India.
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Affiliation(s)
- Amal Jose
- Department of Medical Physics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - A Saravana Kumar
- Department of Medical Physics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - K N Govindarajan
- Department of Medical Physics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - B Devanand
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - N Elango
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Effective Dose Assessment for Patients Undergoing Contemporary Fluoroscopically Guided Interventional Procedures. AJR Am J Roentgenol 2020; 214:158-170. [DOI: 10.2214/ajr.19.21804] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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