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Alhailiy AB, Ekpo EU, Kench PL, Ryan EA, Brennan PC, McEntee M. The associated factors for radiation dose variation in cardiac CT angiography. Br J Radiol 2019; 92:20180793. [PMID: 30633548 DOI: 10.1259/bjr.20180793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE: This study aimed to examine the associated factors for dose variation and influence cardiac CT angiography (CCTA) dose benchmarks in current CT imaging centres. METHODS: A questionnaire was distributed to CT centres across Australia and Saudi Arabia. All participating centres collected data for adults who underwent a CCTA procedure. The questionnaire gathered information about the examination protocol, scanning parameters, patient parameters, and volume CT dose index (CTDI vol) and dose-length product (DLP). A stepwise regression analysis was performed to assess the contribution of tube voltage (kV), padding time technique, cross-sectional area (CSA) of chest and weight to DLP. RESULTS: A total of 17 CT centres provided data for 423 CCTA examinations. The median CTDIvol, DLP and effective dose were 18 mGy, 256 mGy.cm and 5.2 mSv respectively. There was a statistically significant difference in DLP between retrospective and prospective ECG-gating modes (p = 0.001). Median DLP from CCTA using padding technique was 61% higher than CCTA without padding (p = 0.001). The stepwise regression showed that kV was the most significant predictor of DLP followed by padding technique then CSA while patient weight did not statistically significantly predict DLP. Correlation analysis showed a strong positive correlation between weight and CSA (r = 0.78), and there was a moderate positive correlation between weight and DLP (r = 0.42), as well as CSA and DLP (r = 0.48). CONCLUSION: Findings show radiation dose variations for CCTA. The associated factors for dose variation found in this study are scanning mode, kV, padding time technique and CSA of the chest. This results support the need to include CSA measurements in future dose survey and for setting DRLs. ADVANCES IN KNOWLEDGE: The study provides baseline information that helps to understand the associated factors for dose variations and high doses within and between centres performing CCTA.
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Affiliation(s)
- Ali B Alhailiy
- 1 The University of Sydney, Faculty of Health Sciences, Discipline of Medical Radiation Science , Sydney, NSW , Australia.,2 Prince Sattam Bin Abdulaziz University , Al-Kharj , Kingdom of Saudi Arabia
| | - Ernest U Ekpo
- 1 The University of Sydney, Faculty of Health Sciences, Discipline of Medical Radiation Science , Sydney, NSW , Australia
| | - Peter L Kench
- 1 The University of Sydney, Faculty of Health Sciences, Discipline of Medical Radiation Science , Sydney, NSW , Australia
| | - Elaine A Ryan
- 1 The University of Sydney, Faculty of Health Sciences, Discipline of Medical Radiation Science , Sydney, NSW , Australia
| | - Patrick C Brennan
- 1 The University of Sydney, Faculty of Health Sciences, Discipline of Medical Radiation Science , Sydney, NSW , Australia
| | - Mark McEntee
- 1 The University of Sydney, Faculty of Health Sciences, Discipline of Medical Radiation Science , Sydney, NSW , Australia
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402
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Smith-Bindman R, Wang Y, Chu P, Chung R, Einstein AJ, Balcombe J, Cocker M, Das M, Delman BN, Flynn M, Gould R, Lee RK, Nelson T, Schindera S, Seibert A, Starkey J, Suntharalingam S, Wetter A, Wildberger JE, Miglioretti DL. International variation in radiation dose for computed tomography examinations: prospective cohort study. BMJ 2019; 364:k4931. [PMID: 30602590 PMCID: PMC6314083 DOI: 10.1136/bmj.k4931] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine patient, institution, and machine characteristics that contribute to variation in radiation doses used for computed tomography (CT). DESIGN Prospective cohort study. SETTING Data were assembled and analyzed from the University of California San Francisco CT International Dose Registry. PARTICIPANTS Standardized data from over 2.0 million CT examinations of adults who underwent CT between November 2015 and August 2017 from 151 institutions, across seven countries (Switzerland, Netherlands, Germany, United Kingdom, United States, Israel, and Japan). MAIN OUTCOME MEASURES Mean effective doses and proportions of high dose examinations for abdomen, chest, combined chest and abdomen, and head CT were determined by patient characteristics (sex, age, and size), type of institution (trauma center, care provision 24 hours per day and seven days per week, academic, private), institutional practice volume, machine factors (manufacturer, model), country, and how scanners were used, before and after adjustment for patient characteristics, using hierarchical linear and logistic regression. High dose examinations were defined as CT scans with doses above the 75th percentile defined during a baseline period. RESULTS The mean effective dose and proportion of high dose examinations varied substantially across institutions. The doses varied modestly (10-30%) by type of institution and machine characteristics after adjusting for patient characteristics. By contrast, even after adjusting for patient characteristics, wide variations in radiation doses across countries persisted, with a fourfold range in mean effective dose for abdomen CT examinations (7.0-25.7 mSv) and a 17-fold range in proportion of high dose examinations (4-69%). Similar variation across countries was observed for chest (mean effective dose 1.7-6.4 mSv, proportion of high dose examinations 1-26%) and combined chest and abdomen CT (10.0-37.9 mSv, 2-78%). Doses for head CT varied less (1.4-1.9 mSv, 8-27%). In multivariable models, the dose variation across countries was primarily attributable to institutional decisions regarding technical parameters (that is, how the scanners were used). CONCLUSIONS CT protocols and radiation doses vary greatly across countries and are primarily attributable to local choices regarding technical parameters, rather than patient, institution, or machine characteristics. These findings suggest that the optimization of doses to a consistent standard should be possible. STUDY REGISTRATION Clinicaltrials.gov NCT03000751.
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Affiliation(s)
- Rebecca Smith-Bindman
- Department of Radiology and Biomedical Imaging Epidemiology and Biostatistics, Obstetrics Gynecology and Reproductive Sciences, Philip R Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Yifei Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Philip Chu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Robert Chung
- Department of Demography, University of California Berkeley, Berkeley, CA, USA
| | - Andrew J Einstein
- Department of Medicine, Division of Cardiology and Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | | | - Mary Cocker
- Department of Medical Physics, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Marcos Das
- Department of Diagnostic and Interventional Radiology, Helios Kliniken Duisburg, Duisburg, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bradley N Delman
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Flynn
- Henry Ford Health System, Radiology and Public Health Sciences, Detroit, MI, USA
| | - Robert Gould
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Ryan K Lee
- Department of Radiology, Einstein Healthcare Network, New York, NY, USA
| | - Thomas Nelson
- University of California San Diego, San Diego, CA, USA
| | | | - Anthony Seibert
- Department of Radiology, University California Davis Medical Center, Sacramento, CA, USA
| | - Jay Starkey
- St Luke's International Hospital, Tokyo, Japan
| | | | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University, Essen, Germany
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
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403
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Calculating organ and effective doses in paediatric interventional cardiac radiology based on DICOM structured reports – Is detailed examination data critical to dose estimates? Phys Med 2019; 57:17-24. [DOI: 10.1016/j.ejmp.2018.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/09/2018] [Accepted: 12/12/2018] [Indexed: 11/19/2022] Open
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404
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Hayashi S, Takenaka M, Hosono M, Nishida T. Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography. World J Clin Cases 2018; 6:1087-1093. [PMID: 30613666 PMCID: PMC6306631 DOI: 10.12998/wjcc.v6.i16.1087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 02/05/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use in these complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.
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Affiliation(s)
- Shiro Hayashi
- Department of Gastroenterology and Internal Medicine, Hayashi Clinic, Osaka, Suita 564-0018, Japan
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Toyonaka 560-8565, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Sayama 589-8511, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Sayama 589-8511, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Toyonaka 560-8565, Japan
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405
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Suzuki C, Yamauchi Y, Yamamura D, Takei Y, Suzuki S. [Evaluation of Radiation Exposure on Mass Screening Examination for Gastric Cancer Using an Air Kerma-area Product Meter]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:1434-1442. [PMID: 30568094 DOI: 10.6009/jjrt.2018_jsrt_74.12.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The present study grasped the radiation exposure per examination by incident air kerma (air kerma-area product; KAP and incident air kerma; Ka, e) using an air kerma-area product meter of our division with mobile population based gastric cancer screening. Initially, we measured the air kerma rate at the patient entrance reference point using an air kerma-area product meter and calibrated dosimeter, for three devices which an air kerma-area product meter was equipped, inspected the indication error of them. The error was 4.3% at the maximum, and accuracy was confirmed. The 816 patients who underwent gastric cancer screening in our division, the median values of KAP and Ka, e of the standard gastrography method 1 were 645.7 mGy·cm2, 37.4 mGy, respectively. The radiation dose of males were significantly higher than females, and the radiation dose increased in proportion to the BMI. The median values of calculated KAP and Ka, e of the standard gastrography method 1 for standard body size were 633.8 mGy·cm2, 37.0 mGy, respectively. We suggest that the patient exposure in gastrography can be optimized using an air kerma-area product meter.
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Affiliation(s)
- Chiaki Suzuki
- Department of Radiological Technology, Seirei Healthcare Support Center Shizuoka, Seirei Health Care Division
| | - Yukiko Yamauchi
- Department of Radiological Technology, Seirei Preventive Examination Center, Seirei Health Care Division
| | - Daisuke Yamamura
- Department of Radiological Technology, Seirei Preventive Examination Center, Seirei Health Care Division
| | - Yasutaka Takei
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare
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406
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Alkhybari EM, McEntee MF, Brennan PC, Willowson KP, Hogg P, Kench PL. Determining and updating PET/CT and SPECT/CT diagnostic reference levels: A systematic review. RADIATION PROTECTION DOSIMETRY 2018; 182:532-545. [PMID: 30137488 DOI: 10.1093/rpd/ncy113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/28/2018] [Indexed: 06/08/2023]
Abstract
The aim of this systematic review is to investigate the national diagnostic reference level (NDRL) methods for positron emission tomography/computed tomography (PET/CT) and single photon emission tomography/computed tomography (SPECT/CT) procedures. A search strategy was based on the preferred, reporting items for systematic review and meta-analysis (PRISMA). Relevant articles retrieved from Medline, Scopus, Web of Science, Embase, Cinahl, and Google Scholar published up to October 2017. The search yielded 1057 articles. Fourteen articles were included in the review after a screening process. Relevant information from the selected articles were summarised and analysed. Discrepancies were found between the methodologies utilised to establish and report both PET/CT and SPECT/CT NDRLs, e.g. patient sampling and administered activity. Further research should focus on reporting more NDRLs for hybrid PET/CT and SPECT/CT examinations, and establish a robust NDRL standard for the CT portion associated with PET/CT and SPECT/CT examinations. This review provides updated NDRL reommndations to deliver more comparable international radation doses for administered activity and CT dose across PET/CT and SPECT/CT clinics.
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Affiliation(s)
- Essam M Alkhybari
- The Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, NSW 2006 Australia
- Department of Radiology and Medical Imaging, Faculty of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Mark F McEntee
- The Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, NSW 2006 Australia
| | - Patrick C Brennan
- The Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, NSW 2006 Australia
| | - Kathy P Willowson
- Institute of Medical Physics, Faculty of Science, The University of Sydney, NSW, Australia
| | - Peter Hogg
- School of Health Sciences, University of Salford Manchester, UK
| | - Peter L Kench
- The Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, NSW 2006 Australia
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407
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Alhailiy AB, Ekpo EU, Ryan EA, Kench PL, Brennan PC, McEntee MF. DIAGNOSTIC REFERENCE LEVELS FOR CARDIAC CT ANGIOGRAPHY IN AUSTRALIA. RADIATION PROTECTION DOSIMETRY 2018; 182:525-531. [PMID: 30032302 DOI: 10.1093/rpd/ncy112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/27/2018] [Indexed: 06/08/2023]
Abstract
This study aims to assess patient radiation dose from cardiac computed tomography angiography (CCTA) with the aim of proposing a national diagnostic reference levels (NDRLs) for CCTA procedures in Australia. A questionnaire was used to retrospectively gather baseline information related to CCTA scanning and patient parameters in CT centres across the country. The 75th percentile of both volumetric CT dose index (CTDIvol) and dose length-product (DLP) was used as DRL values for CCTA. A DRL for CT calcium scoring test was also determined. NDRLs were compared with international published data. Data sets of 338 patients from nine CT centres were used for analysis. The CCTA DRL for the CTDIvol and the DLP were 22 mGy and 268 mGy cm, respectively. The CT calcium scoring test DRL for DLP was 137 mGy cm. The DRL values for CCTA in Australia have been recommended for the first time. DRLs are lower than those in most published studies due to the implementation of dose-saving technologies such as prospective ECG-gated mode and iterative reconstruction algorithms. Considerable variations remain in patient doses between hospitals for the most frequently used CCTA protocols, indicating the potential for DRLs to prompt dose optimisation strategies in CT facilities.
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Affiliation(s)
- Ali B Alhailiy
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
- Department of Radiology and Medical Imaging, Faculty of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Ernest U Ekpo
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Elaine A Ryan
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Peter L Kench
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Patrick C Brennan
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Mark F McEntee
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
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408
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Optimization of CT protocols using cause-and-effect analysis of outliers. Phys Med 2018; 55:1-7. [PMID: 30471813 DOI: 10.1016/j.ejmp.2018.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to implement an outlier marking and analysis methodology to optimize CT examination protocols. CT Head examination data, including dose metrics along with technical parameters, were stored in an automatic dose registry system. Reference dose metrics distribution was obtained throughout a 1-year period. Outlier thresholds were calculated taking into account the specific shape of the distribution, by using a robust measure of the skewness; the medcouple parameter. Subsequently, outliers from a 4-month period were marked and Cause-and-Effect analysis was carried out by a multidisciplinary dose committee. Reference Dose metrics distributions were obtained from 3690 CT Head examinations. Both CTDIvol and DLP showed a certain degree of skewness, with a medcouple value of 0.05 and 0.11, respectively. All of the upper-outliers fell within 3 identifiable groups of causes, ordered by relative importance: i) inadequate protocol selection, ii) arms or objects in the field-of-view, and iii) abnormal scanning region diameter. Regarding the lower-outliers, 90% were attributable to the inclusion of additional series in the original head protocol and the remaining 10% to unknown causes. Also, a general Cause-and-Effect diagram for outliers was elaborated. While the Dose Reference Level method applies to the general performance of a CT protocol and allows comparison with other centers, the outlier method represents a step further in the optimization process. The proposed method focuses on detecting incorrect utilization of the CT, which mainly arises from inadequate knowledge of CT technology.
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409
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Clinical application of radiation dose reduction for head and neck CT. Eur J Radiol 2018; 107:209-215. [DOI: 10.1016/j.ejrad.2018.08.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/14/2018] [Accepted: 08/23/2018] [Indexed: 12/12/2022]
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410
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Siiskonen T, Ciraj-Bjelac O, Dabin J, Diklic A, Domienik-Andrzejewska J, Farah J, Fernandez J, Gallagher A, Hourdakis C, Jurkovic S, Järvinen H, Järvinen J, Knežević Ž, Koukorava C, Maccia C, Majer M, Malchair F, Riccardi L, Rizk C, Sanchez R, Sandborg M, Merce MS, Segota D, Sierpowska J, Simantirakis G, Sukupova L, Thrapsanioti Z, Vano E. Establishing the European diagnostic reference levels for interventional cardiology. Phys Med 2018; 54:42-48. [DOI: 10.1016/j.ejmp.2018.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 11/29/2022] Open
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411
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Riccardi L, De Monte F, Cretti F, Pini S, Zucca S, Quattrocchi MG, Origgi D, del Vecchio A, Giordano C, Marini P, Lisciandro F, Trevisiol E, Zefiro D, Cutaia C, D’Ercole L, Gabusi M, Scaggion A, Paiusco M. Use of radiation dose index monitoring software in a multicenter environment for CT dose optimization. Radiol Med 2018; 123:944-951. [DOI: 10.1007/s11547-018-0925-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/25/2018] [Indexed: 11/29/2022]
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412
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Patient dose reference levels in surgery: a multicenter study. Eur Radiol 2018; 29:674-681. [DOI: 10.1007/s00330-018-5600-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/11/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
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413
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Matsubara K, Matsunaga Y, Yanagawa N, Muramatsu Y, Ida Y, Suzuki S, Akahane K, Ishiguchi T. [Survey of Recognition, Utilization, and Evaluation for Diagnostic Reference Levels in the Field of X-ray Computed Tomography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:700-707. [PMID: 30033964 DOI: 10.6009/jjrt.2018_jsrt_74.7.700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A survey on recognition, utilization, and evaluation for diagnostic reference levels (DRLs) after establishing Japan DRLs 2015 in the field of X-ray computed tomography (CT) was conducted for members of Japanese Society of Radiological Technology using web-based questionnaire system. The survey consisted of provincial branches to which respondents belong, their occupation, years of professional experience, years of experience in X-ray CT section, recognition of DRLs, and utilization and evaluation of DRLs in the field of X-ray CT section. Each survey item had one to eight questions. A total of 369 members completed the questionnaire. Among them, 295 out of 369 (79.9%) members knew that DRLs were released in Japan. After establishing the DRLs, 226 of 330 (68.5%) and 123 of 319 (38.6%) members investigated the doses used for adult and pediatric CT at their facilities, respectively. Although 345 of 369 (93.5%) members answered that DRLs are necessary for the field of X-ray CT, only 142 of 369 (38.5%) members thought that the established DRLs are enough to use in the field of X-ray CT. The survey has clarified the current status of recognition, utilization, and evaluation for DRLs in the field of X-ray CT after establishing the DRLs in Japan.
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Affiliation(s)
- Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | | | | | | | - Yoshihiro Ida
- Department of Radiology, Fujita Health University Hospital
| | - Shoichi Suzuki
- Faculty of Radiological Technology, School of Health Science, Fujita Health University
| | - Keiichi Akahane
- Department of Radiation Measurement and Dose Assessment, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology
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414
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Farah J, Rouchaud A, Henry T, Regen C, Mihalea C, Moret J, Spelle L. Dose reference levels and clinical determinants in stroke neuroradiology interventions. Eur Radiol 2018; 29:645-653. [DOI: 10.1007/s00330-018-5593-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/22/2018] [Accepted: 06/05/2018] [Indexed: 12/17/2022]
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415
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Statistical analysis for obtaining optimum number of CT scanners in patient dose surveys for determining national diagnostic reference levels. Eur Radiol 2018; 29:168-175. [PMID: 29955947 DOI: 10.1007/s00330-018-5547-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/27/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To statistically determine an 'optimum number of CT scanners' for obtaining 'diagnostic reference levels' (DRLs) in CT examinations as close as possible to 'ideal DRLs' when all available CT scanners are considered. METHODS First, six 'ideal DRLs' (CTDIVol and DLP) were determined for head, chest and abdomen/pelvis examinations by using patient-dose survey data of 100 CT scanners of different models in Tehran. Then, a 'random sampling method' was applied to different percent fractions of patient dose data of 100 CT scanners. The percent differences (PD) of the DRLs obtained from 'ideal DRLs' and their coefficients of variation (CVs) were calculated. The 'optimum number of CT scanners' determined met those of 'ideal DRL' criteria; i.e. precision (CV ≤ 10%) and accuracy (PD ≤ 10%). RESULTS 'Optimum number of CT scanners' for determining DRLs as close as possible to 'ideal DRLs', fulfilling the stated criteria, is 43 instead of using 100. CONCLUSION 'Optimum number of CT scanners' for obtaining DRLs as close as possible to 'ideal DRLs' was determined. This optimum number can be effectively applied in patient-dose survey situations with limited resources in a time- and cost-effective manner. KEY POINTS • Ideal DRLs were determined by a CT patient-dose survey applied to available scanners. • 'Optimum number of CT scanners' statistically determined for DRLs is 43%. • Optimum number can be used for DRLs as if 'ideal DRLs' were determined by all scanners.
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416
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Tsapaki V, Balter S, Cousins C, Holmberg O, Miller DL, Miranda P, Rehani M, Vano E. The International Atomic Energy Agency action plan on radiation protection of patients and staff in interventional procedures: Achieving change in practice. Phys Med 2018; 52:56-64. [PMID: 30139610 DOI: 10.1016/j.ejmp.2018.06.634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/22/2018] [Accepted: 06/15/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. MATERIAL AND METHODS The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. "Radiation protection of patients and staff in interventional procedures" session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. RESULTS Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. CONCLUSIONS Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
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Affiliation(s)
- V Tsapaki
- Konstantopoulio General Hospital, Agias Olgas 3-5, 14233 Nea Ionia, Greece.
| | - S Balter
- Department of Radiology and Medicine, Columbia University, New York, USA.
| | - C Cousins
- FRCP, FRCR, Chair ICRP, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada.
| | - O Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Center, Vienna, Austria.
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA.
| | - P Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile.
| | - M Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - E Vano
- Radiology Department, Medical School, Complutense University, 28040 Madrid, Spain.
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417
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Task-based quantification of image quality using a model observer in abdominal CT: a multicentre study. Eur Radiol 2018; 28:5203-5210. [PMID: 29858638 PMCID: PMC6223860 DOI: 10.1007/s00330-018-5518-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 11/23/2022]
Abstract
Objective We investigated the variability in diagnostic information inherent in computed tomography (CT) images acquired at 68 different CT units, with the selected acquisition protocols aiming to answer the same clinical question. Methods An anthropomorphic abdominal phantom with two optional rings was scanned on 68 CT systems from 62 centres using the local clinical acquisition parameters of the portal venous phase for the detection of focal liver lesions. Low-contrast detectability (LCD) was assessed objectively with channelised Hotelling observer (CHO) using the receiver operating characteristic (ROC) paradigm. For each lesion size, the area under the ROC curve (AUC) was calculated and considered as a figure of merit. The volume computed tomography dose index (CTDIvol) was used to indicate radiation dose exposure. Results The median CTDIvol used was 5.8 mGy, 10.5 mGy and 16.3 mGy for the small, medium and large phantoms, respectively. The median AUC obtained from clinical CT protocols was 0.96, 0.90 and 0.83 for the small, medium and large phantoms, respectively. Conclusions Our study used a model observer to highlight the difference in image quality levels when dealing with the same clinical question. This difference was important and increased with growing phantom size, which generated large variations in patient exposure. In the end, a standardisation initiative may be launched to ensure comparable diagnostic information for well-defined clinical questions. The image quality requirements, related to the clinical question to be answered, should be the starting point of patient dose optimisation. Key Points • Model observers enable to assess image quality objectively based on clinical tasks. • Objective image quality assessment should always include several patient sizes. • Clinical diagnostic image quality should be the starting point for patient dose optimisation. • Dose optimisation by applying DRLs only is insufficient for ensuring clinical requirements.
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418
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Holroyd JR, Edyvean S. Doses from cervical spine computed tomography (CT) examinations in the UK. Br J Radiol 2018; 91:20170834. [PMID: 29470099 PMCID: PMC6190793 DOI: 10.1259/bjr.20170834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To review doses to patients undergoing cervical spine CT examinations in the UK. METHODS A data collection form was developed and distributed to medical physicists and radiographers via e-mail distribution lists. The form requested details of CT scanners, exposure protocols and patient dose index information. RESULTS Data were received for 73 scanners. It was seen that 97% of scanners used automatic exposure control, and 60% of scanners used an iterative reconstruction technique for cervical spine examinations. The majority of scans were taken at 120 kV. The average patient dose indicators in terms of CT dose index (CTDIvol) ranged from 3.5 to 39.7 mGy (mean value 16.7 mGy), and for the DLP, ranged from 87 to 1030 mGy cm (mean value 379 mGy cm) as quoted for the standard 32 cm phantom. CONCLUSION The rounded third quartile value of the mean dose distributions from this study were a CT dose index (CTDIvol) of 20 mGy and a dose-length product of 440 mGy cm as quoted for a 32 cm body phantom. These are significantly higher than those in the 2011 Public Health England CT dose survey when adjusted for phantom size. It is suggested that the existing national diagnostic reference levels for cervical spine CT should be amended, both with the new values and also to quote according to the 32 cm phantom. Advances in knowledge: Proposed new national diagnostic reference levels are presented for cervical spine CT examinations.
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Affiliation(s)
- John R Holroyd
- Centre for Radiation, Chemical and Environmental Hazards (CRCE), Public Health England, Chilton, Didcot, Oxfordshire, UK
| | - Sue Edyvean
- Centre for Radiation, Chemical and Environmental Hazards (CRCE), Public Health England, Chilton, Didcot, Oxfordshire, UK
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419
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Acton H, James K, Kavanagh RG, O'Tuathaigh C, Moloney D, Wyse G, Fanning N, Maher M, O'Connor OJ. Monitoring neurointerventional radiation doses using dose-tracking software: implications for the establishment of local diagnostic reference levels. Eur Radiol 2018; 28:3669-3675. [PMID: 29651772 DOI: 10.1007/s00330-018-5405-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/10/2018] [Accepted: 02/22/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is potential for high radiation exposure during neurointerventional procedures. Increasing regulatory requirements mandate dose monitoring of patients and staff, and justification of high levels of radiation exposure. This paper demonstrates the potential to use radiation dose-tracking software to establish local diagnostic reference levels. METHODS Consecutive neurointerventional procedures, performed in a single institution within a one-year period, were retrospectively studied. Dose area product (DAP) data were collected using dose-tracking software and clinical data obtained from a prospectively generated patient treatment database. RESULTS Two hundred and sixty-four procedures met the selection criteria. Median DAP was 100 Gy.cm2 for aneurysm coiling procedures, 259 Gy.cm2 for arteriovenous malformation (AVM) embolisation procedures, 87 Gy.cm2 for stroke thrombolysis/thrombectomy, and 74 Gy.cm2 for four-vessel angiography. One hundred and nine aneurysm coiling procedures were further studied. Six significant variables were assessed using stepwise regression analysis to determine effect on DAP. Aneurysm location (anterior vs posterior circulation) had the single biggest effect (p = 0.004). CONCLUSIONS This paper confirms variable radiation exposures during neurointerventional procedures. The 75th percentile (used to define diagnostic reference levels) of DAP measurements represents a reasonable guidance metric for monitoring purposes. Results indicate that aneurysm location has the greatest impact on dose during coiling procedures and that anterior and posterior circulation coiling procedures should have separate diagnostic reference levels. KEY POINTS • Dose-tracking software is useful for monitoring patient radiation dose during neurointerventional procedures • This paper provides a template for methodology applicable to any interventional suite • Local diagnostic reference levels were defined by using the 75th percentile of DAP as per International Commission on Radiological Protection recommendations • Aneurysm location is the biggest determinant of radiation dose during coiling procedures. • Anterior and posterior circulation coiling procedures should have separate diagnostic reference levels.
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Affiliation(s)
- Holly Acton
- School of Medicine, University College Cork, Cork, Ireland
| | - Karl James
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Richard G Kavanagh
- School of Medicine, University College Cork, Cork, Ireland. .,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
| | | | - Deirdre Moloney
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Gerald Wyse
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Noel Fanning
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael Maher
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Owen J O'Connor
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
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420
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Branch KR. Incremental Benefit of CT Perfusion to CT Coronary Angiography: Another Step to the One-Stop-Shop? JACC Cardiovasc Imaging 2018; 12:350-352. [PMID: 29454771 DOI: 10.1016/j.jcmg.2017.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Kelley R Branch
- Department of Cardiology, University of Washington, Seattle, Washington.
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421
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Kanda R. [10. The Activities of J-RIME and the Revision of the DRLs]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:593-598. [PMID: 29925754 DOI: 10.6009/jjrt.2018_jsrt_74.6.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Reiko Kanda
- The J-RIME Secretariat, National Institutes for Quantum and Radiological Science and Technology
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422
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Iimori T. [8. DRL for Nuclear Medicine]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:196-199. [PMID: 29459547 DOI: 10.6009/jjrt.2018_jsrt_74.2.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Takashi Iimori
- Department of Radiology, National University Corporation Chiba University Hospital
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