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Kahraman G, Haberal KM, Ağıldere AM. Establishment of local diagnostic reference levels for computed tomography with cloud-based automated dose-tracking software in Türkiye. Diagn Interv Radiol 2024; 30:205-211. [PMID: 37650522 PMCID: PMC11095070 DOI: 10.4274/dir.2023.232265] [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: 05/25/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The purpose of this study is to establish local diagnostic reference levels (LDRLs) for computed tomography (CT) procedures using cloud-based automated dose-tracking software. METHODS The study includes the dose data obtained from a total of 104,272 examinations performed on adult patients (>18 years) using 8 CT scanners over 12 months. The protocols included in our study were as follows: head CT without contrast, cervical spine CT without contrast, neck CT with contrast, chest CT without contrast, abdomen-pelvis CT without contrast, lumbar spine CT without contrast, high-resolution computed tomography (HRCT) of the chest, and coronary CT angiography (CTA). Dose data were collected using cloud-based automatic dose-tracking software. The 75th percentiles of the distributions of the median volume CT dose index (CTDIvol) and dose length product (DLP) values were used to determine the LDRLs for each protocol. The LDRLs were compared with national DRLs (NDRLs) and DRLs set in other countries. Inter-CT scanner variability, which is a measure of how well clinical practices are standardized, was determined for each protocol. Median values for each protocol were compared with the LDRLs for dose optimization in each CT scanner. RESULTS The LDRLs (for DLP and CTDIvol, respectively) were 839 mGy.cm and 41.2 mGy for head CT without contrast, 530.6 mGy.cm and 19.8 mGy for cervical spine CT without contrast, 431.9 mGy.cm and 15.5 mGy for neck CT with contrast, 364.8 mGy.cm and 9.3 mGy for chest CT without contrast, 588.9 mGy. cm and 11.2 mGy for abdomen-pelvis CT without contrast, 713 mGy.cm and 24.3 mGy for lumbar spine CT without contrast, 326 mGy.cm and 9.5 mGy for HRCT, and 642.3 mGy.cm and 33.4 mGy for coronary CTA. The LDRLs were comparable to or lower than NDRLs and DRLs set in other countries for most protocols. The comparisons revealed the need for immediate initiation of an optimization process for CT protocols with higher dose distributions. Furthermore, protocols with high inter-CT scanner variability revealed the need for standardization. CONCLUSION There is a need to update the NDRLs for CT protocols in Turkey. Until new NDRLs are established, local institutions in Turkey can initiate the optimization process by comparing their dose distributions to the LDRLs established in our study. Automated dose-tracking software can play an important role in establishing DRLs by facilitating the collection and analysis of large datasets.
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Affiliation(s)
- Gökhan Kahraman
- Başkent University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
| | - Kemal Murat Haberal
- Başkent University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
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Rizzo S, Bellesi L, D'Ermo A, Bonomo L, D'Ecclesiis O, Magoga F, Presilla S, Spanò A, Minzolini V, Lo Piccolo F, Heinkel J, Rezzonico E, Del Grande M, Merli M, Del Grande F. Body CT examinations in oncologic patients: the impact of subspecialty radiology on radiation exposure in the clinical practice. A quality care study. LA RADIOLOGIA MEDICA 2024; 129:429-438. [PMID: 38341817 PMCID: PMC10943144 DOI: 10.1007/s11547-024-01790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/13/2024]
Abstract
PURPOSES The primary objective of this retrospective study was to assess whether the CT dose delivered to oncologic patients was different in a subspecialty radiology department, compared to a general radiology department. The secondary explorative objective was to assess whether the objective image quality of CT examinations was different in the two settings. MATERIALS AND METHODS Chest and abdomen CT scans performed for oncologic indications were selected from a general radiology department and a subspecialty radiology department. By using a radiation dose management platform, we extracted and compared CT dose index (CTDIvol) and dose length product (DLP) both for each phase and for the entire CT exams. For objective image quality evaluation, we calculated the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) at the level of the liver and of the aorta. A P-value < 0.05 was considered significant. RESULTS A total of 7098 CT examinations were included. CTDIvol was evaluated in 12,804 phases; DLP in 10,713 phases and in 6714 examinations. The CTDIvol and DLP overall were significantly lower in the subspecialty radiology department compared to the general radiology department CTDI median (IQR) 5.19 (3.91-7.00) and 5.51 (4.17-7.72), DLP median and IQR of 490.0 (342.4-710.6) and 503.4 (359.9-728.8), p < 0.001 and p = 0.01, respectively. The objective image quality showed no significant difference in the general and subspecialty radiology departments, with median and IQR of 4.03 (2.82-5.51) and 3.84 (3.09-4.94) for SNRLiv (p = 0.58); 4.81 (2.70-7.62) and 4.34 (3.05-6.25) for SNRAo (p = 0.30); 0.83 (0.20-1.89) and 1.00 (0.35-1.57) for CNRLiv (p = 0.99); 2.23 (0.09-3.83) and 1.01 (0.15-2.84) for CNRAo (p = 0.24) with SNRLiv (p = 0.58), SNRAo (p = 0.30), CNRLiv (p = 0.99) and CNRAo (p = 0.24). CONCLUSION In a subspecialty radiology department, CT protocols are optimized compared to a general radiology department leading to lower doses to oncologic patients without significant objective image quality degradation.
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Affiliation(s)
- Stefania Rizzo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland.
| | - Luca Bellesi
- Service of Medical Physics, Maging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Andrea D'Ermo
- Service of Process Organization and Information, EOC, Support Area, Via Lugano 4D, 6500, Bellinzona, Switzerland
| | - Luca Bonomo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Oriana D'Ecclesiis
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Magoga
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Stefano Presilla
- Service of Medical Physics, Maging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Arturo Spanò
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Veronica Minzolini
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Francesca Lo Piccolo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Jurgen Heinkel
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Ermidio Rezzonico
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Maria Del Grande
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Matteo Merli
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Filippo Del Grande
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland
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Hayashi S, Takenaka M, Kogure H, Yakushijin T, Maruyama H, Hori Y, Yoshio T, Ikezawa K, Takagi T, Asai S, Matsunaga K, Matsumoto K, Tsumura H, Yamaguchi S, Sumiyoshi T, Nagaike K, Tamaru Y, Hara K, Fujisawa T, Oda I, Ohnita K, Kato M, Nebiki H, Mikami T, Nishihara A, Egawa S, Minami R, Hosono M, Nishida T. A questionnaire survey on radiation protection among 282 medical staff from 26 endoscopy-fluoroscopy departments in Japan. DEN OPEN 2021; 1:e5. [PMID: 35310150 PMCID: PMC8828237 DOI: 10.1002/deo2.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/11/2021] [Accepted: 01/30/2021] [Indexed: 04/25/2023]
Abstract
BACKGROUND AND AIMS It is essential for endoscopists, technologists, and nurses to understand radiation protection. However, protective equipment usage is still low, and there is little awareness of radiation protection in practice. METHODS We conducted a questionnaire survey on radiation protection from January to February 2020. The participants were medical staff, including medical doctors, nurses, and radiological and endoscopy technician in endoscopy-fluoroscopy departments. The questionnaire included 14 multiple-choice questions divided among three parts: background, equipment, and knowledge. RESULTS We surveyed a total of 282 subjects from 26 institutions. There were 168 medical doctors (60%), 90 nurses (32%), and 24 technologists (9%). Although almost all staff members (99%) always wore a lead apron, only a few wore a thyroid collar (32%) and lead glasses (21%). The rate of wearing a radiation dosimeter was insufficient (69%), especially among doctors (52%). A few subjects knew the radiation exposure dose of each procedure (15%), and slightly over half had attended lectures on radiation protection (64%) and knew about the three principles of radiation protection (59%). Protection adherence did not differ by years of experience, knowledge of fluoroscopy, awareness of radiation exposure doses, or attendance at basic lectures on radiation protection. However, medical doctors who were aware of the radiation exposure dose of each procedure were significantly more likely to wear dosimeters than those who were not (p = 0.0008). CONCLUSION Medical staff in endoscopy departments in Japan do not have enough radiation protection equipment or education.
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Affiliation(s)
- Shiro Hayashi
- Department of Gastroenterology and Internal MedicineHayashi ClinicOsakaJapan
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Mamoru Takenaka
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Hirofumi Kogure
- Department of GastroenterologyThe University of TokyoTokyoJapan
| | - Takayuki Yakushijin
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
| | - Hirotsugu Maruyama
- Department of GastroenterologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Yasuki Hori
- Department of Gastroenterology and MetabolismNagoya City University HospitalAichiJapan
| | - Toshiyuki Yoshio
- Department of GastroenterologyCancer Institute HospitalTokyoJapan
| | - Kenji Ikezawa
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Tadayuki Takagi
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Satoshi Asai
- Department of GastroenterologyTane General HospitalOsakaJapan
| | - Kazuhiro Matsunaga
- Department of GastroenterologyIshikawa Prefectural Central HospitalIshikawaJapan
| | - Kengo Matsumoto
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Hidetaka Tsumura
- Department of Grastroenterological OncologyHyogo Cancer CenterHyogoJapan
| | - Shinjiro Yamaguchi
- Department of Gastroenterology and HepatologyKansai Rosai HospitalHyogoJapan
| | | | - Koji Nagaike
- Department of Gastroenterology and HepatologySuita Municipal HospitalOsakaJapan
| | - Yuzuru Tamaru
- Department of GastroenterologyKure Medical Center and Chugoku Cancer CenterHiroshimaJapan
| | - Kazuo Hara
- Department of GastroenterologyAichi Cancer CenterAichiJapan
| | | | - Ichiro Oda
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Ken Ohnita
- Department of Gastroenterology and HepatologyShunkaikai Inoue HospitalNagasakiJapan
| | - Motohiko Kato
- Department of GastroenterologyKeio University School of MedicineTokyoJapan
| | - Hiroko Nebiki
- Department of GastroenterologyOsaka City General HospitalOsakaJapan
| | - Tatsuya Mikami
- Division of EndoscopyHirosaki University HospitalAomoriJapan
| | | | - Satoshi Egawa
- Department of GastroenterologyOsaka Police HospitalOsakaJapan
| | - Ryuki Minami
- Department of GastroenterologyTenri HospitalNaraJapan
| | - Makoto Hosono
- Department of RadiologyKindai University Faculty of MedicineOsakaJapan
| | - Tsutomu Nishida
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
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Ebrahiminia A, Asadinezhad M, Mohammadi F, Khoshgard K. EYE LENS DOSE OPTIMIZATION THROUGH GANTRY TILTING IN BRAIN CT SCAN: THE POTENTIAL EFFECT OF THE RADIOLOGICAL TECHNOLOGISTS' TRAINING. RADIATION PROTECTION DOSIMETRY 2020; 189:527-533. [PMID: 32472135 DOI: 10.1093/rpd/ncaa073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
This study was designed to evaluate the effect of the radiological technologists' training on optimising the eye lens dose in brain computed tomography (CT) examinations. The lens dose of 50 adult patients was measured using thermoluminescent dosimeters before and after technologists' training. Dose values of lenses, dose length product (DLP), volumetric CT dose index (CTDIvol) as well as image quality in terms of quantitative (contrast to noise ratio and signal to noise ratio) and subjective (artefact) parameters were compared before and after training. Lens dose values were 31.57 ± 9.84 mGy and 5.36 ± 1.53 mGy before and after training, respectively, which was reduced by ~83% (p < 0.05). The values of DLP, CTDIvol and image quality parameters were not significantly different (p > 0.05) and all images were diagnostically acceptable. Excluding the orbits from the scanning range is an efficient approach to optimize the lens dose; the training of the technologists has also a pivotal role in dose reducing.
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Affiliation(s)
- Ali Ebrahiminia
- Department of Medical Physics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohsen Asadinezhad
- Department of Radiology Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshteh Mohammadi
- Department of Radiology Technology, School of Paramedical Sciences, Guilan University of Medical Sciences, Rasht, Iran
| | - Karim Khoshgard
- Department of Medical Physics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Ekpo EU, Adejoh T, Erim AE. DOSE BENCHMARKS FOR PAEDIATRIC HEAD COMPUTED TOMOGRAPHY EXAMINATION IN NIGERIA. RADIATION PROTECTION DOSIMETRY 2019; 185:464-471. [PMID: 30916763 DOI: 10.1093/rpd/ncz036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/04/2019] [Accepted: 02/23/2019] [Indexed: 06/09/2023]
Abstract
Diagnostic reference levels (DRLs) provide benchmarks for dose optimisation. We aimed to propose DRLs for paediatric head computed tomography (CT) in Nigeria and assess if facilities adapt protocols to age-specific standardisations. Volume CT dose index (CTDIvol) and dose-length-product (DLP) of at least 20 paediatric patients per age group were extracted from 11 facilities and used to propose DRLs. Kruskal-Wallis and Median tests were used to assess the contribution of age to paediatric dose variations. CTDIvol (mGy)/DLP (mGy.cm) ranged 16-31/100-1603 (newborn), 10-92/75-4072 (1-y-old), 10-81/169-2603 (5-y-olds) and 14-86/119-3945 (≥10-y-olds). The 75th percentile CTDIvol/DLP values were 27/1040, 37/988, 48/1493 and 54/1824 for newborn, 1-y, 5-y, ≥10-y-olds, respectively. Age accounted for 18.4 and 5.3% variations in median CTDIvol and DLP, respectively. Paediatric head CT doses in Nigeria are higher than reported internationally, suggesting a need for dose optimisation interventions.
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Affiliation(s)
- Ernest Usang Ekpo
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Cumberland Campus, 75 East Street, Lidcombe NSW 2141, Australia
| | - Thomas Adejoh
- Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, PMB 5025 Nnewi, Anambra State, Nigeria
| | - Akwa Egom Erim
- Department of Radiography and Radiological Sciences, Faculty of Allied Medical Sciences, University of Calabar, PMB 1115 Calabar, Nigeria
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Rawashdeh M, Abdelrahman M, Zaitoun M, Saade C, Alewaidat H, McEntee MF. Diagnostic reference levels for paediatric CT in Jordan. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:1060-1073. [PMID: 31469115 DOI: 10.1088/1361-6498/ab3ee2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study aimed to investigate the current status of Diagnostic Reference Levels (DRLs) in paediatric CT across Jordan. The dose data for four main CT examinations (brain, chest, abdominopelvic, and chest, abdomen and pelvis (CAP)) in hospitals and imaging centres (n = 4) were measured. The volume CT dose index (CTDIvol) and Dose Length Product (DLP) values were compared within the different hospitals and age groups (<1 year, 1-4 years, 5-10 years and 11-18 years). DRLs in Jordan were compared to international DRLs. The paediatric population consisted of 1818 children; 61.4% of them were male. There were significant variations between the DRLs for each CT scanner with an up to four-fold difference in dose between hospitals. There were apparent significant differences between Jordan and other countries with the DLPs in Jordan being relatively high. However, for CTDIvol, the values in Jordan were close to those of other countries. This study confirmed variations in the CTDIvol and DLP values of paediatric CT scans in Jordan. These variations were attributed to the different protocols and equipment used. There is a need to optimise paediatric CT examinations doses in Jordan.
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Affiliation(s)
- Mohammad Rawashdeh
- Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, 222110, Jordan
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Varghese B, Kandanga I, Puthussery P, Vijayan D, Babu SPH, Aneesh MK, Noufal M, Binu EV, Babu AC, James SM, Kumar S. Radiation dose metrics in multidetector computed tomography examinations: A multicentre retrospective study from seven tertiary care hospitals in Kerala, South India. Indian J Radiol Imaging 2018; 28:250-257. [PMID: 30050252 PMCID: PMC6038221 DOI: 10.4103/ijri.ijri_394_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Presently, computed tomography (CT) is the most important source of medical radiation exposure. CT radiation doses vary considerably across institutions depending on the protocol and make of equipment. India does not yet have national or region-specific CT diagnostic reference levels. AIM To evaluate radiation doses of consecutive multidetector CT (MDCT) examinations based on anatomic region, performed in 1 month, collected simultaneously from seven tertiary care hospitals in Kerala. SETTINGS AND DESIGN Descriptive study. MATERIALS AND METHODS We collected the CT radiation dose data of examinations from the seven collaborating tertiary care hospitals in Kerala, performed with MDCT scanners of five different makes. The data included anatomic region, number of phases, CT dose index (CTDIvol), dose-length product (DLP), and effective dose (ED) of each examinations and patient demographic data. STATISTICAL ANALYSIS We calculated the 25th, 50th, and 75th percentiles of the CTDIvol, DLP, and ED according to anatomic region. We made descriptive comparisons of these results with corresponding data from other countries. RESULTS Of 3553 patients, head was the most frequently performed examination (60%), followed by abdomen (19%). For single-phase head examinations, 75th percentile of CTDIvol was 68.1 mGy, DLP 1120 mGy-cm, and ED 2.1 mSv. The 75th percentiles of CTDIvol, DLP, and ED for single-phase abdomen examinations were 10.6, 509.3, and 7.7, and multiphase examinations were 14.6, 2666.9, and 40.8; single-phase chest examinations were 23.4, 916.7, and 13.38, and multiphase examinations were 19.9, 1737.6, and 25.36; single-phase neck were 24.9, 733.6, and 3.814, and multiphase neck were 24.9, 2076, and 10.79, respectively. CONCLUSION This summary CT radiation dose data of most frequently performed anatomical regions could provide a starting point for institutional analysis of CT radiation doses, which in turn leads to meaningful optimization of CT.
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Affiliation(s)
- Binoj Varghese
- Department of Radiodiagnosis, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Indu Kandanga
- Department of Radiodiagnosis, Amala Institute of Medical Sciences, Thrissur and University Hospital of North Durham, Durham, United Kingdom
| | - Paul Puthussery
- Department of Radiodiagnosis, Govt Medical College, Thrissur, Kerala, India
| | - Dhanesh Vijayan
- Department of Radiodiagnosis, Travancore Medical College Hospital, Kollam, Kerala, India
| | - S P Harish Babu
- Department of Radiodiagnosis, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - M K Aneesh
- Department of Radiodiagnosis, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | | | - E V Binu
- Department of Radiodiagnosis, Daya Hospital, Thrissur, Kerala, India
| | - Arun C Babu
- Department of Radiodiagnosis, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Sheen M James
- Department of Radiodiagnosis, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Siva Kumar
- Department of Radiodiagnosis, Amala Institute of Medical Sciences, Thrissur, Kerala, India
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Radiation dose exposure in patients affected by lymphoma undergoing repeat CT examinations: how to manage the radiation dose variability. LA RADIOLOGIA MEDICA 2017; 123:191-201. [DOI: 10.1007/s11547-017-0826-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]
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Faggioni L, Paolicchi F, Bastiani L, Guido D, Caramella D. Awareness of radiation protection and dose levels of imaging procedures among medical students, radiography students, and radiology residents at an academic hospital: Results of a comprehensive survey. Eur J Radiol 2017; 86:135-142. [DOI: 10.1016/j.ejrad.2016.10.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/14/2016] [Accepted: 10/29/2016] [Indexed: 10/20/2022]
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Fukushima Y, Taketomi-Takahashi A, Nakajima T, Tsushima Y. Prefecture-wide multi-centre radiation dose survey as a useful tool for CT dose optimisation: report of Gunma radiation dose study. RADIATION PROTECTION DOSIMETRY 2015; 167:519-524. [PMID: 25344887 DOI: 10.1093/rpd/ncu323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 09/26/2014] [Indexed: 06/04/2023]
Abstract
The aim of this study was to verify the usefulness for the dose optimisation of setting a diagnostic reference level (DRL) based on the results of a prefecture-wide multi-centre radiation dose survey and providing data feedback. All hospitals/clinics in the authors' prefecture with computed tomography (CT) scanners were requested to report data. The first survey was done in July 2011, and the results of dose-length products (DLPs) for each CT scanner were fed back to all hospitals/clinics, with DRL set from all the data. One year later, a second survey was done in the same manner. The medians of DLP in the upper abdomen, whole body and coronary CT in 2012 were significantly smaller than those of the 2011 survey. The interquartile ranges of DLP in the head, chest, pelvis and coronary CT were also smaller in 2012. Radiation dose survey with data feedback may be helpful for CT dose optimisation.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- Female
- Gamma Rays
- Head/diagnostic imaging
- Humans
- Infant
- Infant, Newborn
- Male
- Middle Aged
- Pelvis/diagnostic imaging
- Radiation Dosage
- Radiation Monitoring/methods
- Radiation Protection/standards
- Radiography, Abdominal/methods
- Radiography, Abdominal/standards
- Radiography, Thoracic/methods
- Radiography, Thoracic/standards
- Surveys and Questionnaires
- Tomography Scanners, X-Ray Computed/standards
- Tomography, X-Ray Computed/methods
- Tomography, X-Ray Computed/standards
- Young Adult
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Affiliation(s)
- Yasuhiro Fukushima
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Ayako Taketomi-Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Takahito Nakajima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
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Paolicchi F, Miniati F, Bastiani L, Faggioni L, Ciaramella A, Creonti I, Sottocornola C, Dionisi C, Caramella D. Assessment of radiation protection awareness and knowledge about radiological examination doses among Italian radiographers. Insights Imaging 2015; 7:233-42. [PMID: 26596570 PMCID: PMC4805619 DOI: 10.1007/s13244-015-0445-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/12/2015] [Accepted: 10/21/2015] [Indexed: 01/17/2023] Open
Abstract
Objectives To evaluate radiation protection basic knowledge and dose assessment for radiological procedures among Italian radiographers Methods A validated questionnaire was distributed to 780 participants with balanced demographic characteristics and geographic distribution. Results Only 12.1 % of participants attended radiation protection courses on a regular basis. Despite 90 % of radiographers stating to have sufficient awareness of radiation protection issues, most of them underestimated the radiation dose of almost all radiological procedures. About 5 % and 4 % of the participants, respectively, claimed that pelvis magnetic resonance imaging and abdominal ultrasound exposed patients to radiation. On the contrary, 7.0 % of the radiographers stated that mammography does not use ionising radiation. About half of participants believed that radiation-induced cancer is not dependent on age or gender and were not able to differentiate between deterministic and stochastic effects. Young radiographers (with less than 3 years of experience) showed a higher level of knowledge compared with the more experienced radiographers. Conclusions There is a substantial need for radiographers to improve their awareness of radiation protection issues and their knowledge of radiological procedures. Specific actions such as regular training courses for both undergraduate and postgraduate students as well as for working radiographers must be considered in order to assure patient safety during radiological examinations. Main messages • Radiographers should improve their knowledge on radiation protection issues. • Only 12.1 % of participants attended radiation protection courses on a regular basis. • Specific actions must be considered in order to increase knowledge and awareness.
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Affiliation(s)
- F Paolicchi
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy.
| | - F Miniati
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
| | - L Bastiani
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124, Pisa, Italy
| | - L Faggioni
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
| | - A Ciaramella
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
| | - I Creonti
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
| | - C Sottocornola
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
| | - C Dionisi
- Department of Medical Physics, Piazzale Ospedale 1, 31100, Treviso, Italy
| | - D Caramella
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
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12
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Romano RFT, Salvadori PS, Torres LR, Bretas EAS, Bekhor D, Caldana RP, Medeiros RB, D'Ippolito G. Readjustment of abdominal computed tomography protocols in a university hospital: impact on radiation dose. Radiol Bras 2015; 48:292-7. [PMID: 26543280 PMCID: PMC4633073 DOI: 10.1590/0100-3984.2014.0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective To assess the reduction of estimated radiation dose in abdominal computed
tomography following the implementation of new scan protocols on the basis of
clinical suspicion and of adjusted images acquisition parameters. Materials and Methods Retrospective and prospective review of reports on radiation dose from abdominal
CT scans performed three months before (group A – 551 studies) and three months
after (group B – 788 studies) implementation of new scan protocols proposed as a
function of clinical indications. Also, the images acquisition parameters were
adjusted to reduce the radiation dose at each scan phase. The groups were compared
for mean number of acquisition phases, mean CTDIvol per phase, mean DLP
per phase, and mean DLP per scan. Results A significant reduction was observed for group B as regards all the analyzed
aspects, as follows: 33.9%, 25.0%, 27.0% and 52.5%, respectively for number of
acquisition phases, CTDIvol per phase, DLP per phase and DLP per scan
(p < 0.001). Conclusion The rational use of abdominal computed tomography scan phases based on the
clinical suspicion in conjunction with the adjusted images acquisition parameters
allows for a 50% reduction in the radiation dose from abdominal computed
tomography scans.
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Affiliation(s)
- Ricardo Francisco Tavares Romano
- Collaborating Physicians, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Priscila Silveira Salvadori
- Collaborating Physicians, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Lucas Rios Torres
- Masters, Physicians Assistants, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Elisa Almeida Sathler Bretas
- MD, Fellow, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Daniel Bekhor
- Masters, Physicians Assistants, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Regina Bitelli Medeiros
- Affiliate Professor, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Giuseppe D'Ippolito
- Private Docent, Associate Professor, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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13
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Lauretti DL, Neri E, Faggioni L, Paolicchi F, Caramella D, Bartolozzi C. Automated contrast medium monitoring system for computed tomography--Intra-institutional audit. Comput Med Imaging Graph 2015; 46 Pt 2:209-18. [PMID: 26365621 DOI: 10.1016/j.compmedimag.2015.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/23/2015] [Accepted: 08/07/2015] [Indexed: 12/21/2022]
Abstract
The aim of this study was to analyze the usage and the data recorded by a RIS-PACS-connected contrast medium (CM) monitoring system (Certegra(®), Bayer Healthcare, Leverkusen, Germany) over 19 months of CT activity. The system used was connected to two dual syringe power injectors (each associated with a 16-row and a high definition 64-row multidetector CT scanner, respectively), allowing to manage contrast medium injection parameters and to send and retrieve CT study-related information via RIS/PACS for any scheduled contrast-enhanced CT examination. The system can handle up to 64 variables and can be accessed via touchscreen by CT operators as well as via a web interface by registered users with three different hierarchy levels. Data related to CM injection parameters (i.e. iodine concentration, volume and flow rate of CM, iodine delivery rate and iodine dose, CM injection pressure, and volume and flow rate of saline), patient weight and height, and type of CT study over a testing period spanning from 1 June 2013 to 10 January 2015 were retrieved from the system. Technical alerts occurred for each injection event (such as system disarm due to technical failure, disarm due to operator's stop, incomplete filling of patient data fields, or excessively high injection pressure), as well as interoperability issues related to data sending and receiving to/from the RIS/PACS were also recorded. During the testing period, the CM monitoring system generated a total of 8609 reports, of which 7629 relative to successful injection events (88.6%). 331 alerts were generated, of which 40 resulted in injection interruption and 291 in CM flow rate limitation due to excessively high injection pressure (>325 psi). Average CM volume and flow rate were 93.73 ± 17.58 mL and 3.53 ± 0.89 mL/s, and contrast injection pressure ranged between 5 and 167 psi. A statistically significant correlation was found between iodine concentration and peak IDR (rs=0.2744, p<0.0001), as well as between iodine concentration and iodine dose (rs=0.3862, p<0.0001) for all CT studies. Automated contrast management systems can provide a full report of contrast use with the possibility to systematically compare different contrast injection protocols, minimize errors, and optimize organ-specific contrast enhancement for any given patient and clinical application. This can be useful to improve and harmonize the quality and consistency of contrast CT procedures within the same radiological department and across the hospital, as well as to monitor potential adverse events and overall costs.
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Affiliation(s)
- Dario Luca Lauretti
- Department of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2, 56125 Pisa, Italy.
| | - Emanuele Neri
- Department of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2, 56125 Pisa, Italy
| | - Lorenzo Faggioni
- Department of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2, 56125 Pisa, Italy
| | - Fabio Paolicchi
- Department of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2, 56125 Pisa, Italy
| | - Davide Caramella
- Department of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2, 56125 Pisa, Italy
| | - Carlo Bartolozzi
- Department of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2, 56125 Pisa, Italy
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14
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Hojreh A, Weber M, Homolka P. Effect of staff training on radiation dose in pediatric CT. Eur J Radiol 2015; 84:1574-1578. [PMID: 26001436 DOI: 10.1016/j.ejrad.2015.04.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/22/2015] [Accepted: 04/23/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the efficacy of staff training on radiation doses applied in pediatric CT scans. METHODS Pediatric patient doses from five CT scanners before (1426 scans) and after staff training (2566 scans) were compared statistically. Examinations included cranial CT (CCT), thoracic, abdomen-pelvis, and trunk scans. Dose length products (DLPs) per series were extracted from CT dose reports archived in the PACS. RESULTS A pooled analysis of non-traumatic scans revealed a statistically significant reduction in the dose for cranial, thoracic, and abdomen/pelvis scans (p<0.01). This trend could be demonstrated also for trunk scans, however, significance could not be established due to low patient frequencies (p>0.05). The percentage of scans performed with DLPs exceeding the German DRLs was reduced from 41% to 7% (CCT), 19% to 5% (thorax-CT), from 9% to zero (abdominal-pelvis CT), and 26% to zero (trunk; DRL taken as summed DRLs for thorax plus abdomen-pelvis, reduced by 20% accounting for overlap). Comparison with Austrian DRLs - available only for CCT and thorax CT - showed a reduction from 21% to 3% (CCT), and 15 to 2% (thorax CT). CONCLUSIONS Staff training together with application of DRLs provide an efficient approach for optimizing radiation dose in pediatric CT practice.
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Affiliation(s)
- Azadeh Hojreh
- Medical University of Vienna, Department of Biological Imaging and Image-guided Therapy, Division of General and Paediatric Radiology, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
| | - Michael Weber
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of General and Paediatric Radiology, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
| | - Peter Homolka
- Medical University of Vienna, Centre for Medical Physics and Biomedical Engineering, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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15
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Ryckx N, Gnesin S, Meuli R, Elandoy C, Verdun FR. Medical physicists' implication in radiological diagnostic procedures: results after 1 y of experience. RADIATION PROTECTION DOSIMETRY 2015; 164:120-125. [PMID: 25480839 DOI: 10.1093/rpd/ncu356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Since January 2008-de facto 2012-medical physics experts (MPEs) are, by law, to be involved in the optimisation process of radiological diagnostic procedures in Switzerland. Computed tomography, fluoroscopy and nuclear medicine imaging units have been assessed for patient exposure and image quality. Large spreads in clinical practice have been observed. For example, the number of scans per abdominal CT examination went from 1 to 9. Fluoroscopy units showed, for the same device settings, dose rate variations up to a factor of 3 to 7. Quantitative image quality for positron emission tomography (PET)/CT examinations varied significantly depending on the local image reconstruction algorithms. Future work will be focused on promoting team cooperation between MPEs, radiologists and radiographers and on implementing task-oriented objective image quality indicators.
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Affiliation(s)
- Nick Ryckx
- Institute of Radiation Physics, Lausanne University Hospital, Rue du Grand-Pré 1, Lausanne CH-1007, Switzerland
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, Rue du Grand-Pré 1, Lausanne CH-1007, Switzerland
| | - Reto Meuli
- Institute of Radiation Physics, Lausanne University Hospital, Rue du Grand-Pré 1, Lausanne CH-1007, Switzerland
| | - Christel Elandoy
- Institute of Radiation Physics, Lausanne University Hospital, Rue du Grand-Pré 1, Lausanne CH-1007, Switzerland
| | - Francis R Verdun
- Institute of Radiation Physics, Lausanne University Hospital, Rue du Grand-Pré 1, Lausanne CH-1007, Switzerland
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16
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Optimizing the balance between radiation dose and image quality in pediatric head CT: findings before and after intensive radiologic staff training. AJR Am J Roentgenol 2014; 202:1309-15. [PMID: 24848830 DOI: 10.2214/ajr.13.11741] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the radiation dose and image quality of pediatric head CT examinations before and after radiologic staff training. MATERIALS AND METHODS Outpatients 1 month to 14 years old underwent 215 unenhanced head CT examinations before and after intensive training of staff radiologists and technologists in optimization of CT technique. Patients were divided into three age groups (0-4, 5-9, and 10-14 years), and CT dose index, dose-length product, tube voltage, and tube current-rotation time product values before and after training were retrieved from the hospital PACS. Gray matter conspicuity and contrast-to-noise ratio before and after training were calculated, and subjective image quality in terms of artifacts, gray-white matter differentiation, noise, visualization of posterior fossa structures, and need for repeat CT examination was visually evaluated by three neuroradiologists. RESULTS The median CT dose index and dose-length product values were significantly lower after than before training in all age groups (27 mGy and 338 mGy ∙ cm vs 107 mGy and 1444 mGy ∙ cm in the 0- to 4-year-old group, 41 mGy and 483 mGy ∙ cm vs 68 mGy and 976 mGy ∙ cm in the 5- to 9-year-old group, and 51 mGy and 679 mGy ∙ cm vs 107 mGy and 1480 mGy ∙ cm in the 10- to 14-year-old group; p < 0.001). The tube voltage and tube current-time values after training were significantly lower than the levels before training (p < 0.001). Subjective posttraining image quality was not inferior to pretraining levels for any item except noise (p < 0.05), which, however, was never diagnostically unacceptable. CONCLUSION Radiologic staff training can be effective in reducing radiation dose while preserving diagnostic image quality in pediatric head CT examinations.
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