1
|
Røhme LAG, Homme THF, Johansen ECK, Schulz A, Aaløkken TM, Johansson E, Johansen S, Mussmann B, Brunborg C, Eikvar LK, Martinsen ACT. Image quality and radiation doses in abdominal CT: A multicenter study. Eur J Radiol 2024; 178:111642. [PMID: 39079322 DOI: 10.1016/j.ejrad.2024.111642] [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] [Received: 03/23/2024] [Revised: 06/18/2024] [Accepted: 07/22/2024] [Indexed: 08/18/2024]
Abstract
PURPOSE To benchmark image quality and corresponding radiation doses for acute abdominal CT examination across different laboratories and CT manufacturers. METHOD An anthropomorphic phantom was scanned once with local abdominal CT protocols at 40 CT scanners, from four vendors, in thirty-three sites. Quantitative image quality was evaluated by CNR and SNR in the liver and kidney parenchyma. Qualitative image quality was assessed by visual grading analysis performed by three experienced radiologists using a five-point Likert scale to score thirteen image quality criteria. The CTDIvol was recorded for each scan. Pearson's correlation coefficient was calculated for the continuous variables, and the intraclass correlation coefficient was used to investigate interrater reliability between the radiologists. RESULTS CTDIvol ranged from 3.5 to 12 mGy (median 5.3 mGy, third quartile 6.7 mGy). SNR in liver parenchyma ranged from 4.4 to 14.4 (median 8.5), and CNR ranged from 2.7 to 11.2 (median 6.1). A weak correlation was found between CTDIvol and CNR (r = 0.270, p = 0.092). Variations in CNR across scanners at the same dose level CTDIvol were observed. No significant difference in CTDIvol or CNR was found based on scanner installation year. The oldest scanners had a 15 % higher median CTDIvol and a 12 % lower median CNR. The ICC showed acceptable agreement for all dose groups: low (ICC=0.889), medium (ICC=0.767), high (ICC=0.847), and in low (ICC=0.803) and medium (ICC=0.811) CNR groups. CONCLUSION There was large variation in radiation dose and image quality across the different CT scanners. Interestingly, the weak correlation between CTDIvol and CNR indicates that higher doses do not consistently improve CNR, indicating a need for systematic assessment and optimization of image quality and radiation doses for the abdominal CT examination.
Collapse
Affiliation(s)
- Linn Andrea Gjerberg Røhme
- Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University Oslo, Norway.
| | - Tora Hilde Fjeld Homme
- Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University Oslo, Norway.
| | | | - Anselm Schulz
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Trond Mogens Aaløkken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Radiology and Nuclear Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
| | - Ellen Johansson
- Department of Radiology, Drammen Hospital, Vestre Viken Hospital Trust, Norway.
| | - Safora Johansen
- Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University Oslo, Norway; Department of Cancer Treatment, Oslo University Hospital, Oslo, Norway; Health and Social Science Cluster, Singapore Institute of Technology, Singapore.
| | - Bo Mussmann
- Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University Oslo, Norway; Department of Radiology, Odense University Hospital, Odense, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark.
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
| | - Lars Kristian Eikvar
- Department of Medicine and Health Services, The South-Eastern Norway Health Authority, Hamar, Norway.
| | - Anne Catrine T Martinsen
- Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University Oslo, Norway; Centre for Research and Innovation, Sunnaas Rehabilitation Hospital, Bjornemyr, Norway.
| |
Collapse
|
2
|
Mese I, Altintas Mese C, Demirsoy U, Anik Y. Innovative advances in pediatric radiology: computed tomography reconstruction techniques, photon-counting detector computed tomography, and beyond. Pediatr Radiol 2024; 54:1-11. [PMID: 38041712 DOI: 10.1007/s00247-023-05823-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
In pediatric radiology, balancing diagnostic accuracy with reduced radiation exposure is paramount due to the heightened vulnerability of younger patients to radiation. Technological advancements in computed tomography (CT) reconstruction techniques, especially model-based iterative reconstruction and deep learning image reconstruction, have enabled significant reductions in radiation doses without compromising image quality. Deep learning image reconstruction, powered by deep learning algorithms, has demonstrated superiority over traditional techniques like filtered back projection, providing enhanced image quality, especially in pediatric head and cardiac CT scans. Photon-counting detector CT has emerged as another groundbreaking technology, allowing for high-resolution images while substantially reducing radiation doses, proving highly beneficial for pediatric patients requiring frequent imaging. Furthermore, cloud-based dose tracking software focuses on monitoring radiation exposure, ensuring adherence to safety standards. However, the deployment of these technologies presents challenges, including the need for large datasets, computational demands, and potential data privacy issues. This article provides a comprehensive exploration of these technological advancements, their clinical implications, and the ongoing efforts to enhance pediatric radiology's safety and effectiveness.
Collapse
Affiliation(s)
- Ismail Mese
- Department of Radiology, Health Sciences University, Erenkoy Mental Health and Neurology Training and Research Hospital, 19 Mayis, Sinan Ercan Cd. No:23, Kadikoy, Istanbul, 34736, Turkey.
| | - Ceren Altintas Mese
- Department of Pediatrics, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ugur Demirsoy
- Department of Pediatric Oncology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Yonca Anik
- Department of Pediatric Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| |
Collapse
|
3
|
Sule JA, Chan XW, Sampath HK, Luo HD, Ahmed MU, Kang GS. Routine preoperative screening computed tomography of the thorax for cardiac surgery. Singapore Med J 2023:389384. [PMID: 38037774 DOI: 10.4103/singaporemedj.smj-2021-416] [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: 12/02/2023]
Abstract
Introduction This study aimed to evaluate the role of screening computed tomography (CT) of the thorax in cardiac surgery by analysing the presence of CT aortic calcifications in association with changes in operative strategy and postoperative stroke, and the CT features of emphysema with development of pneumonia. Methods All patients who underwent cardiac surgery from January 2013 to October 2017 by a single surgeon were retrospectively studied. Patients who underwent screening CT thorax before cardiac surgery (CT group) were compared to those who did not (no CT group). Multivariate subgroup analyses were performed to determine significant association with postoperative outcomes. Results A total of 392 patients were included, of which 156 patients underwent preoperative screening CT thorax. Patients in the CT group were older (63.9 vs. 59.0 years, P = 0.001), had fewer recent myocardial infarctions preoperatively (41% vs. 56.4%, P = 0.003) and had better ejection fraction (>30%; P = 0.02). Operative strategy was changed in 4.3% of patients, and 4.9% of patients suffered stroke postoperatively. The presence of CT aortic calcifications was significantly associated with change in operative strategy (P = 0.016) but not with postoperative stroke (P = 0.33). Age was an independent risk factor for change in operative strategy among patients with CT thorax (P = 0.02). Multivariate age-adjusted analysis showed only palpable plaque to be significantly associated with change in operative strategy (P < 0.001). None of the patients with CT emphysema features developed pneumonia. Conclusion The results of this study do not support routine use of preoperative screening CT thorax. Contrasted CT may be advisable in older patients and for other operative planning purposes.
Collapse
Affiliation(s)
- Jai Ajitchandra Sule
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore
| | - Xue Wei Chan
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore
| | - Hari Kumar Sampath
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore
| | - Hai Dong Luo
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore
| | - Mofassel Uddin Ahmed
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore
| | - Giap Swee Kang
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore
| |
Collapse
|
4
|
Establishment of national diagnostic dose reference levels (DRLs) for routine computed tomography examinations in Jordan. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2023. [DOI: 10.2478/pjmpe-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Abstract
Background: Dose reference levels (DRLs) are used as indicators as well as guidance for dose optimization and to ensure justification of appropriate dose for a given clinical indication. The main aims of this study were to establish local DRLs for each CT imaging protocol as a reference point to evaluate the radiation dose indices and to compare our DRLs with those established in other countries and against the internationally reported guidelines.
Materials and methods: 2000 CT dose reports of different adult imaging protocols from January 2021 until April 2022 were collected retrospectively at different hospitals in Jordan. Data were collected from CT scans that were performed using different types and models of CT scanners and included four adult non-enhanced, helical CT imaging protocols; Head, Chest, Abdomen-Pelvis, and Chest-Abdomen-Pelvis.
Results: The average doses of CTDIvol, DLP, and effective dose were (65.11 mGy, 1232.71 mGy·cm, 2.83 mSv) for the head scan, (16.6 mGy, 586.6 mGy·cm, 8.21 mSv) for the chest scan, (17.91 mGy, 929.9 mGy·cm, 13.9 mSv) for the abdomen-pelvis scan, and (19.3 mGy, 1152 mGy·cm, 17.25 mSv) for the chest-abdomen-pelvis scan. In comparison with results from different international studies, DLP values measured in the present study were lower for the chest-abdomen-pelvis and abdomen-pelvis CT scans, and higher for the head CT and chest CT scans.
Conclusions: It is very important that each country establishes its own DRLs and compares them with those reported by other countries, especially the developed ones. It is also important that these levels are regularly updated.
Collapse
|
5
|
De Monte F, Sapignoli S, Laura Cortinovis A, Di Maggio A, Nardin M, Pizzirani E, Scagliori E, Volpe A, Paiusco M, Roggio A. Effectiveness of body size stratification for patient exposure optimization in Computed Tomography. Eur J Radiol 2023; 163:110804. [PMID: 37043885 DOI: 10.1016/j.ejrad.2023.110804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE To establish size-dependent DRL and to estimate the effectiveness of the size-dependent DRLs over size-independent DRLs for a CT exposure optimization process. METHODS The study included 16,933 adult CT body examinations of the most common CT protocols. Acquisitions were included following an image quality assessment. Patients were grouped into five different classes by means of the water equivalent diameter (Dw): 21 ≤ Dw < 25, 25 ≤ Dw < 29, 29 ≤ Dw < 33,33 ≤ Dw < 37 (in cm). CTDIvol, DLP, DLPtot. and SSDE median values were provided both for the sample as a whole (size-independent approach) and for each Dw class (size-dependent approach). The performance of the two approaches in classifying sub-optimal examinations was evaluated through the confusion matrix and Matthews Correlation Coefficient (MCC) metric. The 75th percentile of the CTDIvol distribution was arbitrarily chosen as a threshold level above which the acquisitions are considered sub-optimal. RESULTS CTDIvol, DLP, DLPtot and SSDE typical values (median values) are statistically different across Dw groups. The confusion matrix analysis suggests that size-independent DRL could not mark potential suboptimal protocols for small and large patients. The agreement between the size-dependent and size-independent methods is strong only for the most populous classes (MCC > 0.7). For small and large patients size-independent approach fails to identify as sub-optimal around 20 % of the acquisition (MCC≪0.2). CONCLUSIONS It was proven by means of the confusion matrix and MCC metric that stratifying DRLs by patient size, size-dependent DRL can be a powerful strategy in order to improve the dose optimization process shown that a size-independent DRL fails to identify sub-optimal examinations for small and large patients.
Collapse
|
6
|
Establishing diagnostic reference levels for CT examinations in the south region of Saudi Arabia. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
7
|
|
8
|
Kayun Z, Karim M, Muhammad N, Aljewaw O, Chew M, Harun H. Implication of applying iterative reconstruction on Low Contrast Detectability in CT brain examination. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Botwe BO, Schandorf C, Inkoom S, Faanu A, Rolstadaas L, Goa PE. National indication-based diagnostic reference level values in computed tomography: Preliminary results from Ghana. Phys Med 2021; 84:274-284. [PMID: 33775566 DOI: 10.1016/j.ejmp.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/09/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This study was conducted to develop national indication-based DRL values for common indications of adult computed tomography (CT) examinations for clinical application in Ghana. MATERIALS AND METHODS The methodological approach recommended by the International Commission on Radiological Protection (ICRP), Publication 135, for the development of DRLs, was employed. Studies on CT infrastructure, common indications and quality control tests were first undertaken. A sample of 20 CT dose descriptor/quantity data sets were collected from each centre for each indication. Overall, 3960 data sets were collected for all identified common indications from 71.4% of the total CT scanners in Ghana (25/35). The data were collected from image folders reported and accepted by radiologists. The objective image quality was assessed through a signal to noise ratio (SNR) analysis prior to using the data and extracting DRL values. RESULTS Clinical indications and their respective DRL values in terms of volume weighted CT dose index (CTDIvol) and dose length product (DLP) were cerebrovascular accident (CVA)/stroke (77 mGy; 1313 mGy.cm), head trauma/injury (76 mGy; 1596 mGy.cm), brain tumour/space occupying lesion (SOL) (77 mGy; 2696 mGy.cm), lung tumour/cancer (12 mGy; 828 mGy.cm) and chest lesion with chronic kidney disease (CKD) (13 mGy; 467 mGy.cm). Others were abdominopelvic lesion (17 mGy; 1299 mGy.cm), kidney stones (15 mGy; 731 mGy.cm), urothelial malignancy/CT-intravenous urogram (CT-IVU) (11 mGy; 1449 mGy.cm) and pulmonary embolism (PE) (14 mGy; 942 mGy.cm). CONCLUSION National Indication-based DRL values developed in this study are recommended to be used to manage CT radiation dose in Ghana.
Collapse
Affiliation(s)
- Benard Ohene Botwe
- Radiography Department, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu Campus, Accra, Ghana; Department of Nuclear Safety and Security, School of Nuclear and Allied Sciences, University of Ghana, Atomic Campus, Accra, Legon, Ghana.
| | - Cyril Schandorf
- Department of Nuclear Safety and Security, School of Nuclear and Allied Sciences, University of Ghana, Atomic Campus, Accra, Legon, Ghana
| | - Stephen Inkoom
- Medical Physics Department, School of Nuclear and Allied Sciences, University of Ghana, Atomic Campus, Accra, Ghana; Radiation Protection Institute (RPI), Ghana Atomic Energy Commission, Accra, Ghana
| | - Augustine Faanu
- Radiological and Non-ionizing Radiation Directorate, Nuclear Regulatory Authority, Accra, Ghana
| | - Linn Rolstadaas
- Clinic of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Pål Erik Goa
- Clinic of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway; Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
10
|
Sulieman A, Adam H, Elnour A, Tamam N, Alhaili A, Alkhorayef M, Alghamdi S, Khandaker MU, Bradley D. Patient radiation dose reduction using a commercial iterative reconstruction technique package. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.108996] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
11
|
Yurt A, Özsoykal İ, Kandemir R, Ada E. LOCAL STUDY OF DIAGNOSTIC REFERENCE LEVELS FOR COMPUTED TOMOGRAPHY EXAMINATIONS OF ADULT PATIENTS IN İZMIR, TURKEY. RADIATION PROTECTION DOSIMETRY 2020; 190:446-451. [PMID: 32947621 DOI: 10.1093/rpd/ncaa121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE This study aims to develop local diagnostic reference levels (DRLs) for the most common computed tomography (CT) examinations carried out around Izmir, Turkey. METHODS Five common CT examinations (head, neck, chest, abdomen-pelvis (AP), chest-abdomen-pelvis (CAP)) from four different radiology centres have been included in the study. CT dose index-volume (CTDIvol) and dose length product (DLP) values were recorded for 50 patients per exam in each centre. Third quartiles of CTDIvol and DLP values were determined as DRLs and compared with international findings. RESULTS 51.3% of the patients were male and 48.7% were female, with a mean age of 57 (between 18 and 93). DRLs for CTDIvol were recorded as 70, 16, 15, 23 and 16 for head, neck, chest, AP and CAP examinations, respectively, while the corresponding DLPs were 1385, 604, 567, 998 and 1180 mGy.cm. CONCLUSION Results are mostly comparable to the latest international data, except for the head examinations, which were observed to slightly exceed the DRLs established by other countries.
Collapse
Affiliation(s)
- Ayşegül Yurt
- Department of Medical Physics, The Health Sciences Institute, Dokuz Eylül University, Balçova, İzmir, Turkey
- The Vocational School of Health Services, Dokuz Eylül University, Balçova, İzmir, Turkey
| | - İsmail Özsoykal
- Department of Medical Physics, The Health Sciences Institute, Dokuz Eylül University, Balçova, İzmir, Turkey
| | - Recep Kandemir
- Department of Medical Physics, The Health Sciences Institute, Dokuz Eylül University, Balçova, İzmir, Turkey
| | - Emel Ada
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, Balçova, İzmir, Turkey
| |
Collapse
|
12
|
Computed tomography diagnostic reference levels for adult brain, chest and abdominal examinations: A systematic review. Radiography (Lond) 2020; 27:673-681. [PMID: 32948454 DOI: 10.1016/j.radi.2020.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/16/2020] [Accepted: 08/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Radiation dose variation within and among Computed Tomography (CT) centres is commonly reported. This work systematically reviewed published articles on adult Diagnostic Reference Levels (DRLs) for the brain, chest and abdomen to determine the causes and extent of variation. A systematic literature search and review was performed in selected databases containing leading journals in radiography, radiology and medical physics using carefully defined search terms related to CT and DRLs. The quality of the included articles was determined using the Effective Public Health Practise Project tool for quantitative studies. KEY FINDINGS The 54 articles reviewed include: 45 studies using human data, 8 studies using phantom data, and one study with both human and phantom data. The main comparator in between studies was the dose indices used in reporting DRLs. DRL variations of up to a factor of 2 for the same procedure were noted in phantom studies, and up to a factor of 3 in human studies. Sources of variation include the type of scanner, the age of the scanner, differences in protocols, variations in patients, as well as variations in study design. Different combinations of dose indices were reported: volume computed tomography dose index (CTDIvol) and dose length product (DLP) (59%); DLP only (11%); weighted computed tomography dose index (CTDIw) and DLP (9%); CTDIvol only (7%); CTDIvol, DLP and effective dose (ED) (6%); CTDIw only (4%); CTDIvol, DLP and size specific dose estimate (SSDE) (1%) and CTDIw, CTDIvol and DLP (1%). The use of different dose indices limited dose comparison between studies. CONCLUSION The study noted a 2-3 fold variation in DRLs between studies for the same procedure. The causes of variation are reported and include study design, scanner technology and the use of different dose indices. IMPLICATIONS FOR PRACTICE There is a need for standardisation of CT DRLs in line with the International Commission on Radiological Protection recommendations to reduce dose variation and facilitate dose comparison.
Collapse
|
13
|
Diagnostic reference level for computed tomography abdominal examinations: A multicentre study. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.108963] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
14
|
Steuwe A, Thomas C, Kraus B, Bethge OT, Aissa J, Klosterkemper Y, Antoch G, Boos J. Development of size-specific institutional diagnostic reference levels for computed tomography protocols in neck imaging. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:68-82. [PMID: 31604340 DOI: 10.1088/1361-6498/ab4d00] [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
PURPOSE To develop size-specific institutional diagnostic reference levels (DRLs) for computed tomography (CT) protocols used in neck CT imaging (cervical spine CT, cervical CT angiography (CTA) and cervical staging CT) and to compare institutional to national DRLs. MATERIALS AND METHODS Cervical CT examinations (spine, n = 609; CTA, n = 505 and staging CT, n = 184) performed between 01/2016 and 06/2017 were included in this retrospective study. For each region and examination, the volumetric CT dose index (CTDIvol) and dose-length product (DLP) were determined and binned into size bins according to patient water-equivalent diameter (dw). Linear regression analysis was performed to calculate size-specific institutional DRLs for CTDIvol and DLP, applying the 75th percentile as the upper limit for institutional DRLs. The mean institutional CTDIvol and DLP were compared to national DRLs (CTDIvol 20 mGy for cervical spine CT (DLP 300 mGycm) and cervical CTA (DLP 600 mGycm), and CTDIvol 15 mGy for cervical staging CT (DLP 330 mGycm)). RESULTS The mean CTDIvol and DLP (±standard deviation) were 15.2 ± 4.1 mGy and 181.5 ± 88.3 mGycm for cervical spine CT; 8.1 ± 4.3 mGy and 280.2 ± 164.3 mGycm for cervical CTA; 8.6 ± 1.9 mGy and 162.8 ± 85.0 mGycm for cervical staging CT. For all CT protocols, there was a linear increase in CTDIvol and DLP with increasing dw. For the CTDIvol, size-specific institutional DRLs increased with dw from 14 to 29 mGy for cervical spine CT, from 5 to 17 mGy for cervical CTA and from 8 to 13 mGy for cervical staging CT. For the DLP, size-specific institutional DRLs increased with dw from 130 to 510 mGycm for cervical spine CT, from 140 to 640 mGycm for cervical CTA and from 140 to 320 mGycm for cervical staging CT. Institutional DRLs were lower than national DRLs by 81% and 67% for cervical spine CT (dw = 17.8 cm), 43% and 51% for cervical CTA (dw = 19.5 cm) and 59% and 53% for cervical staging CT (dw = 18.8 cm) for CTDIvol and DLP, respectively. CONCLUSION Size-specific institutional DRLs were generated for neck CT examinations. The mean institutional CTDIvol and DLP values were well below national DRLs.
Collapse
Affiliation(s)
- Andrea Steuwe
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Düsseldorf, Germany
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Bajc M, Lindqvist A. Ventilation/Perfusion SPECT Imaging Diagnosing PE and Other Cardiopulmonary Diseases. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
16
|
Bajc M, Schümichen C, Grüning T, Lindqvist A, Le Roux PY, Alatri A, Bauer RW, Dilic M, Neilly B, Verberne HJ, Delgado Bolton RC, Jonson B. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging 2019; 46:2429-2451. [PMID: 31410539 PMCID: PMC6813289 DOI: 10.1007/s00259-019-04450-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 12/18/2022]
Abstract
These guidelines update the previous EANM 2009 guidelines on the diagnosis of pulmonary embolism (PE). Relevant new aspects are related to (a) quantification of PE and other ventilation/perfusion defects; (b) follow-up of patients with PE; (c) chronic PE; and (d) description of additional pulmonary physiological changes leading to diagnoses of left ventricular heart failure (HF), chronic obstructive pulmonary disease (COPD) and pneumonia. The diagnosis of PE should be reported when a mismatch of one segment or two subsegments is found. For ventilation, Technegas or krypton gas is preferred over diethylene triamine pentaacetic acid (DTPA) in patients with COPD. Tomographic imaging with V/PSPECT has higher sensitivity and specificity for PE compared with planar imaging. Absence of contraindications makes V/PSPECT an essential method for the diagnosis of PE. When V/PSPECT is combined with a low-dose CT, the specificity of the test can be further improved, especially in patients with other lung diseases. Pitfalls in V/PSPECT interpretation are discussed. In conclusion, V/PSPECT is strongly recommended as it accurately establishes the diagnosis of PE even in the presence of diseases like COPD, HF and pneumonia and has no contraindications.
Collapse
Affiliation(s)
- Marika Bajc
- Department of Clinical Sciences, Clinical Physiology and Nuclear Medicine, University of Lund, Lund, Sweden.
| | - Carl Schümichen
- University of Rostock, Formerly Clinic for Nuclear Medicine, Rostock, Germany
| | - Thomas Grüning
- Department of Nuclear Medicine, University Hospitals Plymouth, Plymouth, UK
| | - Ari Lindqvist
- Research Unit of Pulmonary Diseases, Clinical Research Institute, HUS Helsinki University Hospital, Helsinki, Finland
| | | | - Adriano Alatri
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Ralf W Bauer
- RNS Gemeinschaftspraxis, Wiesbaden, Germany
- Department of Diagnostic and Interventional Radiology, Goethe University Frankfurt (Main), Frankfurt, Germany
| | - Mirza Dilic
- Clinic of Heart and Blood Vessel Disease, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Brian Neilly
- Department of Nuclear Medicine, Royal Infirmary, Glasgow, UK
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Bjorn Jonson
- Department of Clinical Sciences, Clinical Physiology and Nuclear Medicine, University of Lund, Lund, Sweden
| |
Collapse
|
17
|
Calderoni F, Campanaro F, Colombo PE, Campoleoni M, De Mattia C, Rottoli F, Galetta G, Zucconi F, Pola A, Righini A, Triulzi F, Vanzulli A, Torresin A. Analysis of a multicentre cloud-based CT dosimetric database: preliminary results. Eur Radiol Exp 2019; 3:27. [PMID: 31309360 PMCID: PMC6629733 DOI: 10.1186/s41747-019-0105-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/03/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To manage and analyse dosimetric data provided by computed tomography (CT) scanners from four Italian hospitals. METHODS A radiation dose index monitoring (RDIM) software was used to collect anonymised exams stored in a cloud server. Since hospitals use different names for the same procedure, digital imaging and communications in medicine (DICOM) tags more appropriate to describe exams were selected and associated to study common names (SCNs) from a radiology playbook according to scan region and use of contrast media. Retrospective analysis was carried out to describe population and to evaluate dosimetric indexes and inaccuracies associated with SCNs. RESULTS More than 400 procedures were clustered into 95 SCNs, but 78% of exams on adults were described with only 10 SCNs. Median values of dose-length product (DLP) and volumetric CT dose index (CTDIvol) for three analysed SCNs were in agreement with those previously published. The percentage of inaccuracies does not heavily affect the dosimetric analysis on the whole cloud, since variations in median values reached at most 8%. CONCLUSIONS Implementation of a cloud-based RDIM software and related issues were described, showing the strength of the chosen playbook-based clustering and its usefulness for homogeneous data analysis. This approach may allow for optimisation actions, accurate assessment of the risk associated with radiation exposure, comparison of different facilities, and, last but not least, collection of information for the implementation of the 2013/59 Euratom Directive.
Collapse
Affiliation(s)
- Francesca Calderoni
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Federica Campanaro
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Paola Enrica Colombo
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Mauro Campoleoni
- Medical Physics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Cristina De Mattia
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Federica Rottoli
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Giannicola Galetta
- Medical Physics, ASST Fatebenefratelli Sacco, via G.B. Grassi 74, 20157, Milan, Italy
| | - Fabio Zucconi
- Medical Physics, ASST Fatebenefratelli Sacco, via G.B. Grassi 74, 20157, Milan, Italy
| | - Andrea Pola
- Department of Energy, Politecnico di Milano, via La Masa 34, 20156, Milan, Italy
| | - Andrea Righini
- Pediatric Radiology and Neuroradiology Unit, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Fabio Triulzi
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Angelo Vanzulli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Alberto Torresin
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| |
Collapse
|
18
|
Brat H, Zanca F, Montandon S, Racine D, Rizk B, Meicher E, Fournier D. Local clinical diagnostic reference levels for chest and abdomen CT examinations in adults as a function of body mass index and clinical indication: a prospective multicenter study. Eur Radiol 2019; 29:6794-6804. [PMID: 31144074 DOI: 10.1007/s00330-019-06257-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare institutional dose levels based on clinical indication and BMI class to anatomy-based national DRLs (NDRLs) in chest and abdomen CT examinations and to assess local clinical diagnostic reference levels (LCDRLs). METHODS From February 2017 to June 2018, after protocol optimization according to clinical indication and body mass index (BMI) class (< 25; ≥ 25), 5310 abdomen and 1058 chest CT series were collected from 5 CT scanners in a Swiss multicenter group. Clinical indication-based institutional dose levels were compared to the Swiss anatomy-based NDRLs. Statistical significance was assessed (p < 0.05). LCDRLs were calculated as the third quartile of the median dose values for each CT scanner. RESULTS For chest examinations, dose metrics based on clinical indication were always below P75 NDRL for CTDIvol (range 3.9-6.4 vs. 7.0 mGy) and DLP (164.0-211.2 vs. 250 mGycm) in all BMI classes except for DLP in BMI ≥ 25 (248.8-255.4 vs. 250.0 mGycm). For abdomen examinations, they were significantly lower or not different than P50 NDRLs for all BMI classes (3.8-9.0 vs. 10.0 mGy and 192.9-446.8 vs. 470mGycm). The estimated LCDRLs show a drop in CTDIvol (21% for chest and 32% for abdomen, on average) with respect to current DRLs. When considering BMI stratification, the largest LCDRL difference within the same clinical indication is for renal tumor (4.6 mGy for BMI < 25 vs. 10.0 mGy for BMI ≥ 25; - 117%). CONCLUSION The results suggest the necessity of estimating clinical indication-based DRLs, especially for abdomen examinations. Stratifying per BMI class allows further optimization of the CT doses. KEY POINTS • Our data show that clinical indication-based DRLs might be more appropriate than anatomy-based DRLs and might help in reducing large variations in dose levels for the same type of examinations. • Stratifying the data per patient-size subgroups (non-overweight, overweight) allows a better optimization of CT doses and therefore the possibility to set LCDRLs based on BMI class. • Institutions who are fostering continuous dose optimization and LDRLs should consider defining protocols based on clinical indication and BMI group, to achieve ALARA.
Collapse
Affiliation(s)
- Hugues Brat
- Institut de Radiologie de Sion, Groupe 3R, Sion, Switzerland.
| | - Federica Zanca
- GE Healthcare, Buc, France.,Palindromo Consulting, Leuven, Belgium
| | | | - Damien Racine
- Institute of Radiation Physics (IRA), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Benoit Rizk
- Institut de Radiologie de Sion, Groupe 3R, Sion, Switzerland
| | - Eric Meicher
- Institut de Radiologie de Sion, Groupe 3R, Sion, Switzerland
| | | |
Collapse
|
19
|
Liang CR, Chen PXH, Kapur J, Ong MKL, Quek ST, Kapur SC. Establishment of institutional diagnostic reference level for computed tomography with automated dose-tracking software. J Med Radiat Sci 2017; 64:82-89. [PMID: 28247587 PMCID: PMC5454333 DOI: 10.1002/jmrs.210] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction The aim of this study was to establish institutional diagnostic reference levels (DRLs) by summarising doses collected across the five computed tomography (CT) system in our institution. Methods CT dose data of 15940 patients were collected retrospectively from May 2015 to October 2015 in five institutional scanners. The mean, 75th percentile and 90th percentile of the dose spread were calculated according to anatomic region. The common CT examinations such as head, chest, combined abdomen/pelvis (A/P), and combined chest/abdomen/pelvis (C/A/P) were reviewed. Distribution of CT dose index (CTDIvol), dose‐length product (DLP) and effective dose (ED) were extracted from the data for single‐phasic and multiphasic examinations. Results The institutional DRL for our CT units were established as mean (50th percentile) of CTDIvol (mGy), DLP (mGy.cm) and ED (mSv) for single and multiphasic studies using the dose‐tracking software. In single phasic examination, Head: (49.0 mGy), (978.0 mGy.cm), (2.4 mSv) respectively; Chest: (6.0 mGy), (254.0 mGy.cm), (4.9 mSv) respectively; CT A/P (10.0 mGy), (514.0 mGy.cm), (8.9 mSv) respectively; CT C/A/P (10.0 mGy), (674.0 mGy.cm), (11.8 mSv) respectively. In multiphasic studies: Head (45.0 mGy), (1822.0 mGy.cm), (5.0 mSv) respectively; Chest (8.0 mGy), (577.0 mGy.cm), (10.0 mSv) respectively; CT A/P: (10.0 mGy), (1153.0 mGy.cm), (20.2 mSv) respectively; CT C/A/P: (11.0 mGy), (1090.0 mGy.cm), (19.2 mSv) respectively. Conclusions The reported metrics offer a variety of information that institutions can use for quality improvement activities. The variations in dose between scanners suggest a large potential for optimisation of radiation dose.
Collapse
Affiliation(s)
- Chong R Liang
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Priscilla X H Chen
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Jeevesh Kapur
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Michael K L Ong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Swee T Quek
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Subhash C Kapur
- Department of Diagnostic Imaging, National University Hospital, Singapore
| |
Collapse
|