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Erem G, Ameda F, Otike C, Olwit W, Mubuuke AG, Schandorf C, Kisolo A, Kawooya MG. Adult Computed Tomography examinations in Uganda: Towards determining the National Diagnostic Reference Levels. BMC Med Imaging 2022; 22:112. [PMID: 35690743 PMCID: PMC9188687 DOI: 10.1186/s12880-022-00838-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Diagnostic Reference Levels (DRLs), typically set at the 75th percentile of the dose distribution from surveys conducted across a broad user base using a specified dose-measurement protocol, are recommended for radiological examinations. There is a need to develop and implement DRLs as a standardisation and optimisation tool for the radiological protection of patients at Computed Tomography (CT) facilities. METHODS This was a retrospective cross-sectional study conducted in seven (7) different CT scan facilities in which participants were recruited by systematic random sampling. The study variables were dose length product (DLP) and volume-weighted CTDI (CTDIvol) for the radiation doses for head, chest, abdomen and lumbar spine CT examinations. The DRLs for CTDIvol and DLP were obtained by calculating the 3rd quartiles of the radiation doses per study site by anatomical region. The national diagnostic reference levels were determined by computation of DRLs using the 75th centile of the median values. RESULTS A total of 574 patients were examined with an average age of 47.1 years. For CTDIvol estimates; there was a strong positive significant relationship between the CTDIvol and examination mAs (rs = 0.9017, p-value < 0.001), and reference mAs (rs = 0.0.7708, p-value < 0.001). For DLP estimates; there was a moderate positive significant relationships between DLP and total mAs (rs = 0.6812, p-value < 0.001), reference mAs (rs = 0.5493, p-value < 0.001). The DRLs were as follows; for head CT scan - the average median CTDIvol was 56.02 mGy and the DLP was 1260.3 mGy.cm; for Chest CT, the CTDI volume was 7.82 mGy and the DLP was 377.0 mGy.cm; for the abdomen CT, the CTDI volume 12.54 mGy and DLP 1418.3 mGy.cm and for the lumbar spine 19.48 mGy and the DLP was 843 mGy.cm, respectively. CONCLUSION This study confirmed the need to optimize the CT scan parameters in order to lower the national DRLs. This can be achieved by extensive training of all the CT scan radiographers on optimizing the CT scan acquisition parameters. Continuous dose audits are also advised with new equipment or after every three years to ensure that values out of range are either justified or further investigated.
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Affiliation(s)
- Geoffrey Erem
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda. .,Clinical Epidemiology Unit, School of Medicine, Makerere University, Kampala, Uganda.
| | - Faith Ameda
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda
| | - Caroline Otike
- Clinical Epidemiology Unit, School of Medicine, Makerere University, Kampala, Uganda
| | - William Olwit
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda
| | - Aloysius G Mubuuke
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda
| | - Cyril Schandorf
- Department of Nuclear Safety and Security, School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
| | - Akisophel Kisolo
- Department of Nuclear Physics, Makerere University, Kampala, Uganda
| | - Michael G Kawooya
- Department of Radiology, School of Medicine, Makerere University, Kampala, Uganda.,Department of Radiology, Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda
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Awad MF, Karout L, Arnous G, Rawashdeh MA, Hneiny L, Saade C. A systematic review on the current status of adult diagnostic reference levels in head, chest and abdominopelvic Computed Tomography. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:R71-R98. [PMID: 32203948 DOI: 10.1088/1361-6498/ab826f] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Computed tomography (CT) is a routinely employed diagnostic tool for the detection and diagnosis of disease processes. Despite the primary focus of radiation dose reduction and improvements in CT scanners, radiation dose exposure remains an ever-increasing concern. Scanning protocol optimisation relative to body weight and scanner manufacturer still lags behind the diagnostic reference levels (DRLs) that are set on an international scale. The aim of this systematic review is to evaluate the current status of adult DRLs in head, chest and abdominopelvic CT over time on a global scale. A search was carried out in early 2019 using the Medline, PubMed, EMBASE, SCOPUS and manual databases. The reference lists of published articles were also assessed to identify further articles. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology was employed to evaluate articles for relevance. Articles were included if they assessed the DRL in head, chest and abdominopelvic scans. The search resulted in 6079 articles, of which 67 were included after a thorough screening process. The literature demonstrates a wide dose variation in reported head, chest and abdominopelvic dose length product (DLP) DRL, ranging from 700-1359, 330-707 and 550-1486 mGy·cm, respectively. Where reported, the volumed CT dose index (CTDIvol) DRL in the head, chest and abdominopelvic studies ranged from 30.4-85.5, 9-15 and 12.3-31 mGy·cm, respectively. The global means were shown to be slightly lower and significantly lower than the reported values of DLP and CTDIvol values for the American College of Radiology and European Commission, respectively. This review emphasises the need for an international standardisation for head and body DRL establishment methods, to provide a more comparable global measurement of dose variations across CT sites as well as regular monitoring of delivered radiation dose to patients.
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Affiliation(s)
- Mohamad Fawzi Awad
- Medical Imaging Sciences, Faculty of Health Sciences, American University of Beirut, PO Box: 11-0236 Riad El-Solh, Beirut 1107 2020, Lebanon
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Nakada Y, Okuda Y, Tsuge T, Suzuki J, Sakamoto H, Yamamoto T, Konishi Y, Tsujimoto T, Nishiki S, Satoh T, Aoyama N, Morimoto K, Aita M, Yamashita Y, Yoshitake T, Mukai M, Yokooka Y, Yokohama N, Akahane K. AUTOMATIC ACQUISITION OF CT RADIATION DOSE DATA: USING THE DIAGNOSTIC REFERENCE LEVEL FOR RADIATION DOSE OPTIMIZATION. RADIATION PROTECTION DOSIMETRY 2018; 181:156-167. [PMID: 29425381 DOI: 10.1093/rpd/ncy003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
The present work describes that we try to construct a system that collects dose information that performed CT examination from multiple facilities and unified management. The results of analysis are compared with other National diagnostic reference level (DRL), and the results are fed back to each facility and the cause of the abnormal value is investigated for dose optimization. Medical information collected 139 144 tests from 33 CT devices in 13 facilities. Although the DRL of this study is lower than that of Japan DRL, it was higher than the DRL of each country. When collecting all the examination, it is thought that the variation of the dose due to the error other than the intended imaging site is large. In future, we should continue to collect information in order to DRL renewal and we also think that it is desirable to collect information on physique and detailed scan region as well.
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Affiliation(s)
- Yoshihiro Nakada
- National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inaga-ku, Chiba-shi, Chiba
| | - Yasuo Okuda
- National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inaga-ku, Chiba-shi, Chiba
| | - Tatsuya Tsuge
- Anjyou Kousei Hospital, 28 Higashikurokute, Anjyou-sho, Anjyou-shi, Aichi
| | - Jyunichi Suzuki
- Okazaki City Hospital, 3-1 Goshoai, Kouryuji-sho, Okazaki-shi, Aichi
| | - Hiroshi Sakamoto
- Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi
| | - Tsuyoshi Yamamoto
- Oosaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Oosaka-shi, Oosaka
| | - Yasuhiko Konishi
- Rinku General Medical Center, 2-23 Rinkuouraikita, Izumisano-shi, Osaka
| | - Takeshi Tsujimoto
- Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto-shi, Kyoto
| | - Shigeo Nishiki
- Tenri Yorozu Sodanjo Hospital, 200 Mishima-cho, Tenri-shi, Nara
| | - Toshimitsu Satoh
- Yamagata University Hospital, 2-2-2 Iidanishi, Yamagata-shi, Yamagata
| | - Nobukazu Aoyama
- University of the Ryukyus Hospital, 207 Nishihara-cho Uehara, Chutogun, Okinawa
| | - Kyohei Morimoto
- Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Hiroshima-shi, Hiroshima
| | - Masamichi Aita
- Hiroshima University Hospital, 1-2-3 Kasumi, Hiroshima-shi, Hiroshima
| | - Yusuke Yamashita
- Kumamoto Chiiki Iryo Center, 5-16-10 Honjyo, Chuo-ku, Kumamoto-shi, Kumamoto
| | | | - Masami Mukai
- National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inaga-ku, Chiba-shi, Chiba
| | - Yuki Yokooka
- National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inaga-ku, Chiba-shi, Chiba
| | - Noriya Yokohama
- National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inaga-ku, Chiba-shi, Chiba
| | - Keiichi Akahane
- National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inaga-ku, Chiba-shi, Chiba
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Korir GK, Wambani JS, Korir IK, Tries MA, Boen PK. National diagnostic reference level initiative for computed tomography examinations in Kenya. RADIATION PROTECTION DOSIMETRY 2016; 168:242-52. [PMID: 25790825 PMCID: PMC4884875 DOI: 10.1093/rpd/ncv020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 02/07/2015] [Accepted: 02/18/2015] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to estimate the computed tomography (CT) examination frequency, patient radiation exposure, effective doses and national diagnostic reference levels (NDRLs) associated with CT examinations in clinical practice. A structured questionnaire-type form was developed for recording examination frequency, scanning protocols and patient radiation exposure during CT procedures in fully equipped medical facilities across the country. The national annual number of CT examinations per 1000 people was estimated to be 3 procedures. The volume-weighted CT dose index, dose length product, effective dose and NDRLs were determined for 20 types of adult and paediatric CT examinations. Additionally, the CT annual collective effective dose and effective dose per capita were approximated. The radiation exposure during CT examinations was broadly distributed between the facilities that took part in the study. This calls for a need to develop and implement diagnostic reference levels as a standardisation and optimisation tool for the radiological protection of patients at all the CT facilities nationwide.
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Affiliation(s)
- Geoffrey K Korir
- New York City Department of Health and Mental Hygiene, Office of Radiological Health, 42-09 28th Street, Long Island City, NY 11101, USA
| | - Jeska S Wambani
- Radiology Department, Kenyatta National Hospital, Hospital Road, P.O. Box 20723-00202, Nairobi, Kenya
| | - Ian K Korir
- National Nuclear Regulator, Eco Glades 2 Office Park, Block G, Eco Park, Centurion 0157, South Africa
| | - Mark A Tries
- Department of Physics and Applied Physics, University of Massachusetts Lowell, One University Avenue, Lowell, MA, USA
| | - Patrick K Boen
- Radiology Department, Kenyatta National Hospital, Hospital Road, P.O. Box 20723-00202, Nairobi, Kenya
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Ataç GK, Parmaksız A, İnal T, Bulur E, Bulgurlu F, Öncü T, Gündoğdu S. Patient doses from CT examinations in Turkey. Diagn Interv Radiol 2015; 21:428-34. [PMID: 26133189 PMCID: PMC4557329 DOI: 10.5152/dir.2015.14306] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 01/31/2015] [Accepted: 02/09/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to establish the first diagnostic reference levels (DRLs) for computed tomography (CT) examinations in adult and pediatric patients in Turkey and compare these with international DRLs. METHODS CT performance information and examination parameters (for head, chest, high-resolution CT of the chest [HRCT-chest], abdominal, and pelvic protocols) from 1607 hospitals were collected via a survey. Dose length products and effective doses for standard patient sizes were calculated from the reported volume CT dose index (CTDIvol). RESULTS The median number of protocols reported from the 167 responding hospitals (10% response rate) was 102 across five different age groups. Third quartile CTDIvol values for adult pelvic and all pediatric body protocols were higher than the European Commission standards but were comparable to studies conducted in other countries. CONCLUSION The radiation dose indicators for adult patients were similar to those reported in the literature, except for those associated with head protocols. CT protocol optimization is necessary for adult head and pediatric chest, HRCT-chest, abdominal, and pelvic protocols. The findings from this study are recommended for use as national DRLs in Turkey.
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Affiliation(s)
- Gökçe Kaan Ataç
- From the Department of Radiology (G.K.A. , S.G.) Ufuk University, Ankara, Turkey; the Department of Radiation Protection Unit (A.P., E.B., F.B., T.Ö.), Sarayköy Nuclear Research and Training Center, Ankara, Turkey; the Department of Electrical and Electronics Engineering (T.İ.), Ankara University, Ankara, Turkey
| | - Aydın Parmaksız
- From the Department of Radiology (G.K.A. , S.G.) Ufuk University, Ankara, Turkey; the Department of Radiation Protection Unit (A.P., E.B., F.B., T.Ö.), Sarayköy Nuclear Research and Training Center, Ankara, Turkey; the Department of Electrical and Electronics Engineering (T.İ.), Ankara University, Ankara, Turkey
| | - Tolga İnal
- From the Department of Radiology (G.K.A. , S.G.) Ufuk University, Ankara, Turkey; the Department of Radiation Protection Unit (A.P., E.B., F.B., T.Ö.), Sarayköy Nuclear Research and Training Center, Ankara, Turkey; the Department of Electrical and Electronics Engineering (T.İ.), Ankara University, Ankara, Turkey
| | - Emine Bulur
- From the Department of Radiology (G.K.A. , S.G.) Ufuk University, Ankara, Turkey; the Department of Radiation Protection Unit (A.P., E.B., F.B., T.Ö.), Sarayköy Nuclear Research and Training Center, Ankara, Turkey; the Department of Electrical and Electronics Engineering (T.İ.), Ankara University, Ankara, Turkey
| | - Figen Bulgurlu
- From the Department of Radiology (G.K.A. , S.G.) Ufuk University, Ankara, Turkey; the Department of Radiation Protection Unit (A.P., E.B., F.B., T.Ö.), Sarayköy Nuclear Research and Training Center, Ankara, Turkey; the Department of Electrical and Electronics Engineering (T.İ.), Ankara University, Ankara, Turkey
| | - Tolga Öncü
- From the Department of Radiology (G.K.A. , S.G.) Ufuk University, Ankara, Turkey; the Department of Radiation Protection Unit (A.P., E.B., F.B., T.Ö.), Sarayköy Nuclear Research and Training Center, Ankara, Turkey; the Department of Electrical and Electronics Engineering (T.İ.), Ankara University, Ankara, Turkey
| | - Sadi Gündoğdu
- From the Department of Radiology (G.K.A. , S.G.) Ufuk University, Ankara, Turkey; the Department of Radiation Protection Unit (A.P., E.B., F.B., T.Ö.), Sarayköy Nuclear Research and Training Center, Ankara, Turkey; the Department of Electrical and Electronics Engineering (T.İ.), Ankara University, Ankara, Turkey
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Lin CJ, Mok GSP, Tsai MF, Tsai WT, Yang BH, Tu CY, Wu TH. National Survey of Radiation Dose and Image Quality in Adult CT Head Scans in Taiwan. PLoS One 2015; 10:e0131243. [PMID: 26125549 PMCID: PMC4488422 DOI: 10.1371/journal.pone.0131243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 05/30/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction The purpose of the present study was to evaluate the influence of different variables on radiation dose and image quality based on a national database. Materials and Methods Taiwan’s Ministry of Health and Welfare requested all radiology departments to complete a questionnaire for each of their CT scanners. Information gathered included all scanning parameters for CT head scans. For the present analysis, CT machines were divided into three subgroups: single slice CT (Group A); multi-detector CT (MDCT) with 2-64 slices (Group B); and MDCT with more than 64 slices (Group C). Correlations between computed tomography dose index (CTDI) and signal-to-noise ratio (SNR) with cumulated tube rotation number (CTW(n)) and cumulated tube rotation time (CTW(s)), and sub group analyses of CTDI and SNR across the three groups were performed. Results CTDI values demonstrated a weak correlation (r = 0.33) with CTW(n) in Group A. SNR values demonstrated a weak negative correlation (r = -0.46) with CTW(n) in Group C. MDCT with higher slice numbers used more tube potential resulting in higher effective doses. There were both significantly lower CTDI and SNR values in helical mode than in axial mode in Group B, but not Group C. Conclusion CTW(n) and CTW(s) did not influence radiation output. Helical mode is more often used in MDCT and results in both lower CTDI and SNR compared to axial mode in MDCT with less than 64 slices.
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Affiliation(s)
- Chung-Jung Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Greta S. P. Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, China
| | - Mang-Fen Tsai
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
| | - Wei-Ta Tsai
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
- Department of Radiation Oncology, Tzu Chi General Hospital Dalin Branch, Chiayi, Taiwan
- Association of Medical Radiation Technologists, Taipei, Taiwan
| | - Bang-Hung Yang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Association of Medical Radiation Technologists, Taipei, Taiwan
| | - Chun-Yuan Tu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
- Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan
- Association of Medical Radiation Technologists, Taipei, Taiwan
- * E-mail: (THW); (CYT)
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
- * E-mail: (THW); (CYT)
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Korir GK, Wambani JS, Korir IK, Tries M, Kidali MM. Frequency and collective dose of medical procedures in Kenya. HEALTH PHYSICS 2013; 105:522-533. [PMID: 24162056 DOI: 10.1097/hp.0b013e31829c35f4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The first comprehensive national survey on frequency and radiation dose imparted to the population from radiological procedures was carried out in Kenya and reported here. This survey involved assessment of frequency, typical patient radiation exposure, and collective effective dose from general radiography, fluoroscopy, interventional procedures (IPs), mammography, and computed tomography. About 300 x-ray facilities across the country were invited to participate in the survey, and a 31% response was recorded. The individual and collective radiation burdens of more than 62 types of pediatric and adult radiological examinations were quantified using effective and collective dose. The average effective dose for each radiological examination was assessed from the x-ray efficiency performance tests and patient data from over 30 representative radiological facilities. The results found indicated that over 3 million x-ray procedures were performed in 2011, resulting in an annual collective effective dose of 2,157 person-Sv and an annual effective dose per capita of 0.05 mSv. The most frequent examinations were general radiography (94%), computed tomography (3.3%), and fluoroscopy (2.5%). Although the contribution of computed tomography was small in terms of frequency, this procedure accounted for 36% of the effective dose per capita. General radiography was the most frequent type of examination with a contribution of 55% of the effective dose per capita.
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Affiliation(s)
- Geoffrey K Korir
- *Department of Physics and Applied Physics, University of Massachusetts Lowell, One University Avenue, Lowell, MA 01854; †Radiology Department, Kenyatta National Hospital, Hospital Road, P.O. Box 20723-00202 Nairobi, Kenya; ‡National Nuclear Regulator, Eco Glades 2 Office Park, Block G, Eco Park, Centurion, 0157 South Africa
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