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Sebelego I, Acho S, van der Merwe B, Rae WID. Size based dependence of patient dose metrics, and image quality metrics for clinical indicator-based imaging protocols in abdominal CT procedures. Radiography (Lond) 2023; 29:961-974. [PMID: 37572570 DOI: 10.1016/j.radi.2023.07.011] [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: 04/21/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Diagnostic reference level (DRL) values for computed tomography (CT) based on clinical indication are warranted since imaging protocols are indication-dependent. This study proposes clinical DRL values using the CT dose metrics and five patient size-related parameters while considering image quality. METHODS The volumetric CT dose index (CTDIvol), dose-length product (DLP) and five size-related parameters of size-specific dose estimates (SSDE), namely the anterior-posterior (AP) dimension, lateral (LAT) dimension, sum dimension, effective diameter, and the body mass index (BMI), were used to calculate DRL values for CT chest-abdomen-pelvis (CAP) and abdomen-pelvis (AbP) protocols. DRL values of the clinical indications for cancer, urinary system stones and other pathologies were assessed based on the BMI classifications using the median and 75th percentile. An image subtraction algorithm was used to assess the image quality metrics (IQM) of the CT images. RESULTS The 75th percentile for SSDEAP dimension for CAP cancer was 19.7, 14.9 and 12.7 mGy at Hospitals A, C and E, respectively. The median DLP for other AbP pathologies was 556.3, 1452.0 and 1960.7 mGy.cm for normal weight, overweight and obese patients, respectively, at Hospital A. The image quality varied among BMI classifications for different clinically indicated examinations. Although the dose increased with BMI, the image quality index was consistent because automatic tube current modulation (ATCM) was used. CONCLUSION DRL values are influenced by patient size-related parameters and the clinical indication protocols, while the image quality index is independent of the BMI. IMPLICATIONS FOR PRACTICE Size-related clinical DRL values and image quality index can be used to monitor and optimise dose and image quality. Acquisition parameters and image quality indexes should be investigated and adjusted when unusually high DRL values are noted.
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Affiliation(s)
- I Sebelego
- Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, South Africa.
| | - S Acho
- Department of Medical Physics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - B van der Merwe
- Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, South Africa
| | - W I D Rae
- Department of Medical Physics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa; Medical Imaging Department, Prince of Wales Hospital, Randwick, Australia
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Sebelego IK, Acho S, van der Merwe B, Rae WID. FACTORS INFLUENCING SIZE-SPECIFIC DOSE ESTIMATES OF SELECTED COMPUTED TOMOGRAPHY PROTOCOLS AT TWO CLINICAL PRACTICES IN SOUTH AFRICA. RADIATION PROTECTION DOSIMETRY 2023; 199:588-602. [PMID: 36928986 DOI: 10.1093/rpd/ncad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 01/19/2023] [Accepted: 01/29/2023] [Indexed: 05/05/2023]
Abstract
The study aimed to determine the factors that impact the size-specific dose estimate (SSDE) for computed tomography (CT) examinations of the chest-abdomen-pelvis and abdomen-pelvis protocols in two clinical radiology practices and evaluate the image quality of these protocols. Imaging parameters, protocols, dose metrics from the CT units and size-related parameters to calculate the SSDE were documented. The image quality of the CT images was assessed using an image subtraction algorithm. The SSDE increased as the volumetric CT dose index (CTDIvol), and the patient's body mass index increased, respectively. Significant differences (p < 0.001) occurred between the two hospitals regarding image quality. However, these differences were not indicative of differences in the diagnostic performances for task-based imaging protocols. Different clinical protocols should be reviewed to optimise dose. The inclusion of the pre-monitoring sequence, age of the machine and the scan requisition parameters impacted the SSDEs. Image quality should be assessed to evaluate the consistency of image quality between protocols applied by different CT units when assessing SSDEs.
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Affiliation(s)
- Ida-Keshia Sebelego
- Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, 9301, South Africa
| | - Sussan Acho
- Department of Medical Physics, Faculty of Health Sciences, University of the Free State, Bloemfontein, 9300, South Africa
| | - Belinda van der Merwe
- Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, 9301, South Africa
| | - William I D Rae
- Department of Medical Physics, Faculty of Health Sciences, University of the Free State, Bloemfontein, 9300, South Africa
- Medical Imaging Department, Prince of Wales Hospital, Randwick, 2133, Australia
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3
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Valeri F, Bartolucci M, Cantoni E, Carpi R, Cisbani E, Cupparo I, Doria S, Gori C, Grigioni M, Lasagni L, Marconi A, Mazzoni LN, Miele V, Pradella S, Risaliti G, Sanguineti V, Sona D, Vannucchi L, Taddeucci A. UNet and MobileNet CNN-based model observers for CT protocol optimization: comparative performance evaluation by means of phantom CT images. J Med Imaging (Bellingham) 2023; 10:S11904. [PMID: 36895439 PMCID: PMC9989681 DOI: 10.1117/1.jmi.10.s1.s11904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/09/2023] [Indexed: 03/09/2023] Open
Abstract
Purpose The aim of this work is the development and characterization of a model observer (MO) based on convolutional neural networks (CNNs), trained to mimic human observers in image evaluation in terms of detection and localization of low-contrast objects in CT scans acquired on a reference phantom. The final goal is automatic image quality evaluation and CT protocol optimization to fulfill the ALARA principle. Approach Preliminary work was carried out to collect localization confidence ratings of human observers for signal presence/absence from a dataset of 30,000 CT images acquired on a PolyMethyl MethAcrylate phantom containing inserts filled with iodinated contrast media at different concentrations. The collected data were used to generate the labels for the training of the artificial neural networks. We developed and compared two CNN architectures based respectively on Unet and MobileNetV2, specifically adapted to achieve the double tasks of classification and localization. The CNN evaluation was performed by computing the area under localization-ROC curve (LAUC) and accuracy metrics on the test dataset. Results The mean of absolute percentage error between the LAUC of the human observer and MO was found to be below 5% for the most significative test data subsets. An elevated inter-rater agreement was achieved in terms of S-statistics and other common statistical indices. Conclusions Very good agreement was measured between the human observer and MO, as well as between the performance of the two algorithms. Therefore, this work is highly supportive of the feasibility of employing CNN-MO combined with a specifically designed phantom for CT protocol optimization programs.
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Affiliation(s)
- Federico Valeri
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Florence, Italy.,Università degli Studi di Firenze, Scuola di Scienze della Salute Umana, Florence, Italy
| | - Maurizio Bartolucci
- Ospedale S. Stefano, Azienda USL Toscana Centro, SOC Radiodiagnostica, Prato, Italy
| | - Elena Cantoni
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Florence, Italy
| | - Roberto Carpi
- Ospedale Santa Maria Nuova, Azienda USL Toscana Centro, SOC Radiologia, Florence, Italy
| | - Evaristo Cisbani
- Istituto Superiore di Sanità, Centro Nazionale Tecnologie Innvative in Sanità Pubblica, Rome, Italy
| | - Ilaria Cupparo
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Florence, Italy.,Università degli Studi di Firenze, Scuola di Scienze della Salute Umana, Florence, Italy
| | - Sandra Doria
- Istituto di Chimica dei Composti OrganoMetallici, Consiglio Nazionale delle Ricerche, Florence, Italy.,Università degli Studi di Firenze, European Laboratory for Nonlinear Spectroscopy, Florence, Italy
| | - Cesare Gori
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Florence, Italy
| | - Mauro Grigioni
- Istituto Superiore di Sanità, Centro Nazionale Tecnologie Innvative in Sanità Pubblica, Rome, Italy
| | - Lorenzo Lasagni
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Florence, Italy.,Università degli Studi di Firenze, Scuola di Scienze della Salute Umana, Florence, Italy
| | - Alessandro Marconi
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Florence, Italy
| | - Lorenzo Nicola Mazzoni
- Ospedale San Jacopo, Azienda USL Toscana Centro, UO Fisica Sanitaria Prato e Pistoia, Pistoia, Italy
| | - Vittorio Miele
- Azienda Ospedaliero-Universitaria Careggi, SOD Radiodiagnostica di Emergenza-Urgenza, Florence, Italy
| | - Silvia Pradella
- Azienda Ospedaliero-Universitaria Careggi, SOD Radiodiagnostica di Emergenza-Urgenza, Florence, Italy
| | - Guido Risaliti
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Florence, Italy
| | - Valentina Sanguineti
- Istituto Italiano di Tecnologia, Pattern Analysis & Computer Vision, Genoa, Italy
| | - Diego Sona
- Fondazione Bruno Kessler, Data Science for Health Unit, Trento, Italy
| | - Letizia Vannucchi
- Ospedale S. Jacopo, AUSL Toscana Centro, SOC Radiodiagnostica, Pistoia, Italy
| | - Adriana Taddeucci
- Azienda Ospedaliero-Universitaria Careggi, UO Fisica Sanitaria, Florence, Italy.,Istituto Nazionale di Fisica Nucleare - Sezione di Firenze, Sesto Fiorentino, Italy
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4
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Estimation of effective and organ dose from chest CT. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chatzaraki V, Kubik-Huch RA, Potempa A, Gashi A, Friedl A, Heesen M, Wiggli B, Nocito A, Niemann T. Preoperative chest computed tomography in emergency surgery during COVID-19 pandemic. J Perioper Pract 2021:17504589211024405. [PMID: 34351807 DOI: 10.1177/17504589211024405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic challenges the recommendations for patients' preoperative assessment for preventing severe acute respiratory syndrome coronavirus type 2 transmission and COVID-19-associated postoperative complications and morbidities. PURPOSE To evaluate the contribution of chest computed tomography for preoperatively assessing patients who are not suspected of being infected with COVID-19 at the time of referral. METHODS Candidates for emergency surgery screened via chest computed tomography from 8 to 27 April 2020 were retrospectively evaluated. Computed tomography images were analysed for the presence of COVID-19-associated intrapulmonary changes. When applicable, laboratory and recorded clinical symptoms were extracted. RESULTS Eighty-eight patients underwent preoperative chest computed tomography; 24% were rated as moderately suspicious and 11% as highly suspicious on computed tomography. Subsequent reverse transcription polymerase chain reaction (RT-PCR) was performed for seven patients, all of whom tested negative for COVID-19. Seven patients showed COVID-19-associated clinical symptoms, and most were classified as being mildly to moderately severe as per the clinical classification grading system. Only one case was severe. Four cases underwent RT-PCR with negative results. CONCLUSION In a cohort without clinical suspicion of COVID-19 infection upon referral, preoperative computed tomography during the COVID-19 pandemic can yield a high suspicion of infection, even if the patient lacks clinical symptoms and is RT-PCR-negative. No recommendations can be made based on our results but contribute to the debate.
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Affiliation(s)
| | | | - Anna Potempa
- Department of Radiology, Kantonsspital Baden, Baden, Switzerland
| | - Andi Gashi
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology ETH Zurich, Zurich, Switzerland
| | - Andrée Friedl
- Department of Infectious Diseases, Kantonsspital Baden, Baden, Switzerland
| | - Michael Heesen
- Department of Anaesthesiology, Kantonsspital Baden, Baden, Switzerland
| | - Benedikt Wiggli
- Department of Infectious Diseases, Kantonsspital Baden, Baden, Switzerland
| | - Antonio Nocito
- Department of Surgery, Kantonsspital Baden, Baden, Switzerland
| | - Tilo Niemann
- Department of Radiology, Kantonsspital Baden, Baden, Switzerland
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6
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Alrowaili ZA, Ashari M. Evaluation of Radiation Doses from Computed Tomography Conducted in Al Jouf Region (Saudi Arabia). JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A safe radiation dose from computed tomography (CT) is normally specified through the Computed Tomography Dose Index (CTDI) as an “effective dose.” Radiation exposure from CT is relatively high in comparison with other radiological tests. In this paper, we evaluate doses
used on adult patients during typical CT scans, in Al Jouf, the northern region of Saudi Arabia. Scanning processes were taken place in different parts of the body; including the pelvis, head, abdomen, and chest. The dose indices were calculated using the CT-expo v2.5 computer software. A
comparison of the results with similar investigations, regionally and globally, was made. Other comparisons between displayed and calculated dose indices were also performed. The main values of CT volume are the dose index (CTDIvol) and dose-length product (DLP). The effectiveness results
for head CTs were 45.0 mGy, 488 mGy.cm, and 5.2 mSv; while for pelvic CTs they were 16.4 mGy, 391 mGy.cm, and 4.0 mSv; whereas for abdominal CTs they were 22.2 mGy, 613 mGy.cm, and 6.5 mSv; finally they were 17.5 mGy, 380 mGy.cm, and 3.9 mSv for chest CTs. It is confirmed that the values obtained
are within the internationally accepted values, except for the values of the head examination, in which the effective dose value of 5.2 mSv was higher than the recommended value. This work gives an overview of the doses received by adult patients during regular CT examination. It is the first
regional CT dose survey and provides a baseline for improvement and quality control in the region of Al Jouf.
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Affiliation(s)
- Ziyad Awadh Alrowaili
- Physics Department, College of Science, Jouf University, P.O. Box: 2014, Sakaka, Saudi Arabia
| | - M. Ashari
- Physics Department, College of Science, Jouf University, P.O. Box: 2014, Sakaka, Saudi Arabia
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Abstract
Millions of patients benefit from medical imaging every single day. However, we have entered an unprecedented era in imaging practices wherein 1 out of 125 patients can be exposed to effective dose >50 mSv from a single CT exam and 3 out of 10,000 patients undergoing CT exams could potentially receive cumulative effective doses > 100 mSv in a single day. Recurrent imaging with CT, fluoroscopically guided interventions, and hybrid imaging modalities such as positron emission tomography/computed tomography (PET/CT) is more prevalent today than ever before. Presently, we do not know the cumulative doses that patients may be receiving across all imaging modalities combined. Furthermore, patients with diseases with longer life expectancies are being exposed to high doses of radiation enabling radiation effects to manifest over a longer time period. The emphasis in the past on improving justification of imaging and optimization of technique and practice has proved useful. While that must continue, the current situation requires imaging device manufacturers to urgently develop imaging technologies that are safer for patients as high doses have been observed in patients where imaging has been justified through clinical decision-support and optimized by keeping doses below the national benchmark doses. There is a need to have a critical look at the fundamental principles of radiation protection as cumulative doses are likely to increase in the coming years.
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Rehani MM. Old enemy, new threat: you can't solve today's problems with yesterday's solution. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:452-458. [PMID: 33535195 DOI: 10.1088/1361-6498/abe2ba] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
The radiation protection principles of justification, optimization, and dose limitation as enumerated by the International Commission on Radiological Protection have been guiding light for the profession for over three decades. The dose limitation does not apply to medical exposure but keeping patients' doses low is achieved through optimization, particularly by developing and using diagnostic reference levels (DRLs). There are new findings that demonstrate that despite using the best possible approaches to justification and optimization including as well use of DRLs, a very large number of patients are receiving doses in excess of 100 mSv of effective dose or organ doses exceeding 100 mGy. A non-ignorable fraction of patients is receiving such high doses in a single day. The magnitude of such patients creates the need for a relook into the principles with the intent to understand what can be done to attend to today's problems. A look at other areas such as approaches, and principles used in the pharmaceutical industry and in traffic management throws some light into what can be learnt from these examples. It appears that the system needs to be enriched to deal with the protection of the individual patient. The currently available approaches and even the principles are largely based on the protection of the population or group of patients. The third level of justification for individual needs further refinement to take into account series of imaging many patients are needing, and cumulative radiation doses involved, many of which happen in a short duration of 1 to 5 years. There is every likelihood of patient radiation doses continuing to increase further that underscores the need for timely attention. This paper provides several suggestions to deal with the situation.
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Affiliation(s)
- Madan M Rehani
- Radiology Department, Massachusetts General Hospital, 175 Cambridge Str., Suite 244, Boston, MA, United States of America
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Chang W, Koba Y. Evaluation of Organ Doses for Pediatric Computed Tomography Using a Newly Designed Radiophotoluminescence Glass Dosimeter and Comparison with a Monte Carlo Simulation-based Dose Calculator. HEALTH PHYSICS 2021; 120:288-295. [PMID: 33044423 DOI: 10.1097/hp.0000000000001315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
ABSTRACT Management of patient dose is an effective way to help optimize computed tomography (CT) scanning conditions and CT dose. Organ dose is one of the preferred quantities for radiation protection because of its correlation with radiation risk. To date, the WAZA-ARI dose calculator is the only freely available CT dose calculator also applicable for pediatric patients. However, no reports of its evaluation have appeared since the latest version of WAZA-ARI was released. In this study, to evaluate the latest version of WAZA-ARI, we measured the organ dose in a 5-y-old anthropomorphic phantom by a newly developed radiophotoluminescence glass dosimeter (RGD) dosimetry system and compared these results with the calculation results from WAZA-ARI. The newly designed RGDs have less angular dependence because of the additional filter. RGDs were individually calibrated with the ISOVOLT TITAN-320 x-ray generator. All the experimental measurements for this study were performed using a CT scanner. To consider the difference of CT output between the nominal and actual machine, the measured CTDIair was used to correct the calculation results obtained from WAZA-ARI. After the corrections using the measured CTDIair, the calculation results from WAZA-ARI were relatively lower than the measured results with a range of 8-20%, which corresponds to the dose difference caused by the difference in effective diameter. In conclusion, the calculation accuracy of WAZA-ARI is guaranteed when the normalization factor specific to each CT scanner (CTDIair) and the shape of the phantom are taken into consideration.
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Affiliation(s)
- Weishan Chang
- Center for Radiation Protection Knowledge, National Institute of Radiological Sciences, QST, 4-9-1, Anagawa, Inage-ku, Chiba 263-8555, Japan
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Rehani MM, Nacouzi D. Higher patient doses through X-ray imaging procedures. Phys Med 2020; 79:80-86. [PMID: 33189060 DOI: 10.1016/j.ejmp.2020.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 02/07/2023] Open
Abstract
Medical imaging using X-rays has been one of the most popular imaging modalities ever since the discovery of X-rays 125 years ago. With unquestionable benefits, concerns about radiation risks have frequently been raised. Computed tomography (CT) and fluoroscopic guided interventional procedures have the potential to impart higher radiation exposure to patients than radiographic examinations. Despite technological advances, there have been instances of increased doses per procedure mainly because of better diagnostic information in images. However, cumulative dose from multiple procedures is creating new concerns as effective doses >100 mSv are not uncommon. There is a need for action at all levels. Manufacturers must produce equipment that can provide a quality diagnostic image at substantially lesser dose and better implementation of optimization strategies by users. There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering. It appears that a new monochromatic X-ray source will lead to replacement of X-ray tubes all over the world in coming years and will lead to a drastic reduction in radiation doses. This innovation will impact all X-ray imaging and will help dose reduction. For interventional procedures, the likely employment of robotic systems in practice may drastically reduce radiation exposures to operators- but patient exposure will still remain an issue. Training needs always need to be emphasized and practiced.
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Affiliation(s)
| | - David Nacouzi
- Duke University Medical Center, Durham, NC 27708, USA
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Zamani H, Masjedi H, Omidi R, Hosein Zare M. ESTABLISHMENT OF LOCAL DIAGNOSTIC REFERENCE LEVELS FOR COMMON PROCEDURES OF COMPUTED TOMOGRAPHY IN YAZD PROVINCE. RADIATION PROTECTION DOSIMETRY 2020; 188:222-231. [PMID: 31822910 DOI: 10.1093/rpd/ncz279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/13/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study was to propose first established diagnostic reference levels (DRLs) in computed tomography (CT) for adults, based on volume-averaged CTDI and dose length product (DLP) metrics in Yazd Province. MATERIALS AND METHODS Six multislice CT scanners located at diverse areas of Yazd Province and seven common procedures were selected for the present study. For each procedure, at least twenty patients 18 years and older were sampled at each institution. For each patient, dose report data and scan parameters as well as patient's information were abstracted from picture archiving and communication system. RESULTS Proposed DRLs in terms of computed tomography dose index (mGy) and DLP (mGy.cm) were as follows: brain (42, 527), sinus (25, 220), neck (14, 264), abdomen-pelvis (11, 295), routine chest (8, 247), CT pulmonary angiogram (32, 261) and chest HRCT (11, 455), respectively, slightly lower compared to other investigations. CONCLUSION The proposed DRLs in this study should be considered as the local DRLs for the seven most common adult CT examinations in Yazd province so as to optimize the patient dose while maintaining acceptable image quality for the clinical task.
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Affiliation(s)
- Hamed Zamani
- Medical Physics Department, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Yazd Province, Iran
| | - Hamidreza Masjedi
- Medical Physics Department, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Yazd Province, Iran
| | - Reza Omidi
- Medical Physics Department, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Yazd Province, Iran
| | - Mohammad Hosein Zare
- Medical Physics Department, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Yazd Province, Iran
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12
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Smith-Bindman R, Chu P, Wang Y, Chung R, Lopez-Solano N, Einstein AJ, Solberg L, Cervantes LF, Yellen-Nelson T, Boswell W, Delman BN, Duong PA, Goode AR, Kasraie N, Lee RK, Neill R, Pahwa A, Pike P, Roehm J, Schindera S, Starkey J, Suntharalingam S, Jeukens CRLPN, Miglioretti DL. Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:666-675. [PMID: 32227142 PMCID: PMC7105953 DOI: 10.1001/jamainternmed.2020.0064] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/08/2020] [Indexed: 12/27/2022]
Abstract
Importance Computed tomography (CT) radiation doses vary across institutions and are often higher than needed. Objective To assess the effectiveness of 2 interventions to reduce radiation doses in patients undergoing CT. Design, Setting, and Participants This randomized clinical trial included 864 080 adults older than 18 years who underwent CT of the abdomen, chest, combined abdomen and chest, or head at 100 facilities in 6 countries from November 1, 2015, to September 21, 2017. Data analysis was performed from October 4, 2017, to December 14, 2018. Interventions Imaging facilities received audit feedback alone comparing radiation-dose metrics with those of other facilities followed by the multicomponent intervention, including audit feedback with targeted suggestions, a 7-week quality improvement collaborative, and best-practice sharing. Facilities were randomly allocated to the time crossing from usual care to the intervention. Main Outcomes and Measures Primary outcomes were the proportion of high-dose CT scans and mean effective dose at the facility level. Secondary outcomes were organ doses. Outcomes after interventions were compared with those before interventions using hierarchical generalized linear models adjusting for temporal trends and patient characteristics. Results Across 100 facilities, 864 080 adults underwent 1 156 657 CT scans. The multicomponent intervention significantly reduced proportions of high-dose CT scans, measured using effective dose. Absolute changes in proportions of high-dose scans were 1.1% to 7.9%, with percentage reductions in the proportion of high-dose scans of 4% to 30% (abdomen: odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P < .001; chest: OR, 0.92; 95% CI, 0.86-0.99; P = .03; combined abdomen and chest: OR, 0.49; 95% CI, 0.41-0.59; P < .001; and head: OR, 0.71; 95% CI, 0.66-0.76; P < .001). Reductions in the proportions of high-dose scans were greater when measured using organ doses. The absolute reduction in the proportion of high-dose scans was 6.0% to 17.2%, reflecting 23% to 58% reductions in the proportions of high-dose scans across anatomical areas. Mean effective doses were significantly reduced after multicomponent intervention for abdomen (6% reduction, P < .001), chest (4%, P < .001), and chest and abdomen (14%, P < .001) CT scans. Larger reductions in mean organ doses were 8% to 43% across anatomical areas. Audit feedback alone reduced the proportions of high-dose scans and mean dose, but reductions in observed dose were smaller. Radiologist's satisfaction with CT image quality was unchanged and high during all periods. Conclusions and Relevance For imaging facilities, detailed feedback on CT radiation dose combined with actionable suggestions and quality improvement education significantly reduced doses, particularly organ doses. Effects of audit feedback alone were modest. Trial Registration ClinicalTrials.gov Identifier: NCT03000751.
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Affiliation(s)
- Rebecca Smith-Bindman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Philip Chu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Yifei Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Robert Chung
- Department of Demography, University of California, Berkeley
| | - Naomi Lopez-Solano
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Andrew J. Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Department of Radiology, Columbia University Irving Medical Center, New York, New York
- New York–Presbyterian Hospital, New York, New York
| | - Leif Solberg
- HealthPartners Institute, Minneapolis, Minnesota
| | | | | | - William Boswell
- Department of Radiology, City of Hope National Medical Center, Duarte, California
| | - Bradley N. Delman
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Phuong-Anh Duong
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Allen R. Goode
- Department of Radiology and Medical Imaging, University of Virginia Health System, Virginia
| | - Nima Kasraie
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Ryan K. Lee
- Department of Radiology, Einstein Healthcare Network, New York, New York
| | - Rebecca Neill
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Anokh Pahwa
- Department of Radiology Sciences, Olive View UCLA Medical Center, Los Angeles, California
| | | | - Jodi Roehm
- Center for Diagnostic Imaging, St Louis Park, Minnesota
| | | | - Jay Starkey
- St Luke's International Hospital, Chuo, Tokyo, Japan
| | | | - Cécile R. L. P. N. Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
- Kaiser Permanente Washington Health Research Institute, Seattle
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Padole AM, Sagar P, Westra SJ, Lim R, Nimkin K, Kalra MK, Gee MS, Rehani MM. Development and validation of image quality scoring criteria (IQSC) for pediatric CT: a preliminary study. Insights Imaging 2019; 10:95. [PMID: 31549234 PMCID: PMC6757090 DOI: 10.1186/s13244-019-0769-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To develop and assess the value and limitations of an image quality scoring criteria (IQSC) for pediatric CT exams. METHODS IQSC was developed for subjective assessment of image quality using the scoring scale from 0 to 4, with 0 indicating desired anatomy or features not seen, 3 for adequate image quality, and 4 depicting higher than needed image quality. Pediatric CT examinations from 30 separate patients were selected, five each for routine chest, routine abdomen, kidney stone, appendicitis, craniosynostosis, and ventriculoperitoneal (VP) shunt. Five board-certified pediatric radiologists independently performed image quality evaluation using the proposed IQSC. The kappa statistics were used to assess the interobserver variability. RESULTS All five radiologists gave a score of 3 to two-third (67%) of all CT exams, followed by a score of 4 for 29% of CT exams, and 2 for 4% exams. The median image quality scores for all exams were 3 and the interobserver agreement among five readers (acceptable image quality [scores 3 or 4] vs sub-optimal image quality ([scores 1 and 2]) was moderate to very good (kappa 0.4-1). For all five radiologists, the lesion detection was adequate for all CT exams. CONCLUSIONS The image quality scoring criteria covering routine and some clinical indication-based imaging scenarios for pediatric CT examinations has potential to offer a simple and practical tool for assessing image quality with a reasonable degree of interobserver agreement. A more extensive and multi-centric study is recommended to establish wider usefulness of these criteria.
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Affiliation(s)
- Atul M Padole
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Pallavi Sagar
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Sjirk J Westra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Ruth Lim
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Katherine Nimkin
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Mannudeep K Kalra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA.
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Karim MKA, Rahim NA, Matsubara K, Hashim S, Mhareb MHA, Musa Y. The effectiveness of bismuth breast shielding with protocol optimization in CT Thorax examination. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:139-147. [PMID: 30584178 DOI: 10.3233/xst-180397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Numerous techniques had been proposed to reduce radiation exposure in computed tomography (CT) including the use of radiation shielding. OBJECTIVE This study aims to evaluate efficacy of using a bismuth breast shield and optimized scanning parameter to reduce breast absorbed doses from CT thorax examination. METHODS Five protocols comprising the standard CT thorax clinical protocol (CP1) and four modified protocols (CP2 to CP5) were applied in anthropomorphic phantom scans. The phantom was configured as a female by placing a breast component on the chest. The breast component was divided into four quadrants, where 2 thermoluminescence dosimeters (TLD-100) were inserted into each quadrant to measure the absorbed dose. The bismuth shield was placed over the breast component during CP4 and CP5 scans. RESULTS The pattern of absorbed doses in each breast and quadrant were approximately the same for all protocols, where the 4th quadrant > 3rd quadrant > 2nd quadrant > 1st quadrant. The mean absorbed dose value in CP3 was reduced to almost 34% of CP1's mean absorbed dose. It was reduced even lower to 15% of CP1's mean absorbed dose when the breast shield was used in CP5. CONCLUSION This study showed that CT radiation exposure on the breast could be reduced by using a bismuth shield and low tube potential protocol without compromising the image quality.
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Affiliation(s)
- M K A Karim
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - N A Rahim
- Department of Radiology, National Cancer Institute, Precint 7, 62250 Putrajaya, Malaysia
| | - K Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Kanazawa University, Japan
| | - S Hashim
- Department of Physics, Faculty of Science, Universiti Teknologi Malaysia Johor Baru, Malaysia
| | - M H A Mhareb
- Department of Physics, College of Science, Imam Abdurrahman Bin Faisal University, Saudi Arabia, City Dammam, Saudi Arabia
| | - Y Musa
- Department of Physics, Faculty of Science, Universiti Teknologi Malaysia Johor Baru, Malaysia
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Schegerer AA, Nagel HD, Stamm G, Adam G, Brix G. Current CT practice in Germany: Results and implications of a nationwide survey. Eur J Radiol 2017; 90:114-128. [DOI: 10.1016/j.ejrad.2017.02.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
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Kalra MK, Sodickson AD, Mayo-Smith WW. CT Radiation: Key Concepts for Gentle and Wise Use. Radiographics 2016; 35:1706-21. [PMID: 26466180 DOI: 10.1148/rg.2015150118] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Use of computed tomography (CT) in medicine comes with the responsibility of its appropriate (wise) and safe (gentle) application to obtain required diagnostic information with the lowest possible dose of radiation. CT provides useful information that may not be available with other imaging modalities in many clinical situations in children and adults. Inappropriate or excessive use of CT should be avoided, especially if required information can be obtained in an accurate and time-efficient manner with other modalities that require a lower radiation dose, or non-radiation-based imaging modalities such as ultrasonography and magnetic resonance imaging. In addition to appropriate use of CT, the radiology community also must monitor scanning practices and protocols. When appropriate, high-contrast regions and lesions should be scanned with reduced dose, but overly zealous dose reduction should be avoided for assessment of low-contrast lesions. Patients' cross-sectional body size should be taken into account to deliver lower radiation dose to smaller patients and children. Wise use of CT scanning with gentle application of radiation dose can help maximize the diagnostic value of CT, as well as address concerns about potential risks of radiation. In this article, key concepts in CT radiation dose are reviewed, including CT dose descriptors; radiation doses from CT procedures; and factors and technologies that affect radiation dose and image quality, including their use in creating dose-saving protocols. Also discussed are the contributions of radiation awareness campaigns such as the Image Gently and Image Wisely campaigns and the American College of Radiology Dose Index Registry initiatives.
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Affiliation(s)
- Mannudeep K Kalra
- From the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (M.K.K.); and Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 and Harvard Medical School, Boston, Mass (A.D.S., W.W.M.S.)
| | - Aaron D Sodickson
- From the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (M.K.K.); and Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 and Harvard Medical School, Boston, Mass (A.D.S., W.W.M.S.)
| | - William W Mayo-Smith
- From the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (M.K.K.); and Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 and Harvard Medical School, Boston, Mass (A.D.S., W.W.M.S.)
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Karim M, Hashim S, Bradley D, Bakar K, Haron M, Kayun Z. Radiation doses from computed tomography practice in Johor Bahru, Malaysia. Radiat Phys Chem Oxf Engl 1993 2016. [DOI: 10.1016/j.radphyschem.2015.12.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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I Am Confused About the Cancer Risks Associated With CT: How Can We Summarize What Is Currently Known? AJR Am J Roentgenol 2015; 205:W2-3. [PMID: 26102415 DOI: 10.2214/ajr.15.14363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
The International Commission on Radiological Protection (ICRP) has sustained interest in radiological protection in computed tomography (CT), and ICRP Publications 87 and 102 focused on the management of patient doses in CT and multi-detector CT (MDCT) respectively. ICRP forecasted and 'sounded the alarm' on increasing patient doses in CT, and recommended actions for manufacturers and users. One of the approaches was that safety is best achieved when it is built into the machine, rather than left as a matter of choice for users. In view of upcoming challenges posed by newer systems that use cone beam geometry for CT (CBCT), and their widened usage, often by untrained users, a new ICRP task group has been working on radiological protection issues in CBCT. Some of the issues identified by the task group are: lack of standardisation of dosimetry in CBCT; the false belief within the medical and dental community that CBCT is a 'light', low-dose CT whereas mobile CBCT units and newer applications, particularly C-arm CT in interventional procedures, involve higher doses; lack of training in radiological protection among clinical users; and lack of dose information and tracking in many applications. This paper provides a summary of approaches used in CT and MDCT, and preliminary information regarding work just published for radiological protection in CBCT.
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Affiliation(s)
- M M Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Smith-Bindman R, Moghadassi M, Wilson N, Nelson TR, Boone JM, Cagnon CH, Gould R, Hall DJ, Krishnam M, Lamba R, McNitt-Gray M, Seibert A, Miglioretti DL. Radiation Doses in Consecutive CT Examinations from Five University of California Medical Centers. Radiology 2015; 277:134-41. [PMID: 25988262 DOI: 10.1148/radiol.2015142728] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To summarize data on computed tomographic (CT) radiation doses collected from consecutive CT examinations performed at 12 facilities that can contribute to the creation of reference levels. MATERIALS AND METHODS The study was approved by the institutional review boards of the collaborating institutions and was compliant with HIPAA. Radiation dose metrics were prospectively and electronically collected from 199 656 consecutive CT examinations in 83 181 adults and 3871 consecutive CT examinations in 2609 children at the five University of California medical centers during 2013. The median volume CT dose index (CTDIvol), dose-length product (DLP), and effective dose, along with the interquartile range (IQR), were calculated separately for adults and children and stratified according to anatomic region. Distributions for DLP and effective dose are reported for single-phase examinations, multiphase examinations, and all examinations. RESULTS For adults, the median CTDIvol was 50 mGy (IQR, 37-62 mGy) for the head, 12 mGy (IQR, 7-17 mGy) for the chest, and 12 mGy (IQR, 8-17 mGy) for the abdomen. The median DLPs for single-phase, multiphase, and all examinations, respectively, were as follows: head, 880 mGy · cm (IQR, 640-1120 mGy · cm), 1550 mGy · cm (IQR, 1150-2130 mGy · cm), and 960 mGy · cm (IQR, 690-1300 mGy · cm); chest, 420 mGy · cm (IQR, 260-610 mGy · cm), 880 mGy · cm (IQR, 570-1430 mGy · cm), and 550 mGy · cm (IQR 320-830 mGy · cm); and abdomen, 580 mGy · cm (IQR, 360-860 mGy · cm), 1220 mGy · cm (IQR, 850-1790 mGy · cm), and 960 mGy · cm (IQR, 600-1460 mGy · cm). Median effective doses for single-phase, multiphase, and all examinations, respectively, were as follows: head, 2 mSv (IQR, 1-3 mSv), 4 mSv (IQR, 3-8 mSv), and 2 mSv (IQR, 2-3 mSv); chest, 9 mSv (IQR, 5-13 mSv), 18 mSv (IQR, 12-29 mSv), and 11 mSv (IQR, 6-18 mSv); and abdomen, 10 mSv (IQR, 6-16 mSv), 22 mSv (IQR, 15-32 mSv), and 17 mSv (IQR, 11-26 mSv). In general, values for children were approximately 50% those for adults in the head and 25% those for adults in the chest and abdomen. CONCLUSION These summary dose data provide a starting point for institutional evaluation of CT radiation doses.
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Affiliation(s)
- Rebecca Smith-Bindman
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Michelle Moghadassi
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Nicole Wilson
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Thomas R Nelson
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - John M Boone
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Christopher H Cagnon
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Robert Gould
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - David J Hall
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Mayil Krishnam
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Ramit Lamba
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Michael McNitt-Gray
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Anthony Seibert
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Diana L Miglioretti
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
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Abstract
Several radiation-related professional societies have concluded that carcinogenic risks associated with doses below 50-100 mSv are either too small to be detected, or are nonexistent. This is especially important in the context of doses from medical imaging. Radiation exposure to the public from medical imaging procedures is rising around the world, primarily due to increased utilization of computed tomography. Professional societies and advisory bodies consistently recommend against multiplying small doses by large populations to predict excess radiation-induced cancers, in large part because of the potential for sensational claims of health impacts which do not adequately take the associated uncertainties into account. Nonetheless, numerous articles have predicted thousands of future cancers as a result of CT scanning, and this has generated considerable concern among patients and parents. In addition, some authors claim that we now have direct epidemiological evidence of carcinogenic risks from medical imaging. This paper critically examines such claims, and concludes that the evidence cited does not provide direct evidence of low-dose carcinogenicity. These claims themselves have adverse public health impacts by frightening the public away from medically justified exams. It is time for the medical and scientific communities to be more assertive in responding to sensational claims of health risks.
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Affiliation(s)
- Brant A. Ulsh
- Principal Health Physicist, M.H. Chew & Associates, Livermore, CA
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