1
|
Popkowski A, Rhodes SC, Hatton JF. Proposed Diagnostic Reference Levels in the Missouri/Southern Illinois Region Associated with Cone-beam Computed Tomography Use in Endodontics. J Endod 2024; 50:966-975. [PMID: 38382736 DOI: 10.1016/j.joen.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Diagnostic reference levels (DRLs) are intended to improve patient safety and ensure that patient ionizing radiation doses are as low as reasonably achievable. The purpose of this dosimetry study was to establish regional DRL levels for cone-beam computed tomography (CBCT) imaging for specialty endodontics. Another aim was to compare phantom-measured ionizing radiation dose index 1 (DI1) index doses to the manufacturer-provided dose area product (DAP) radiation output values for each of the CBCT machines studied, to ascertain their degree of correlation. DAP refers to the dose area product, a measure of radiation dose monitoring which represents the dose within the beam times the area within the beam at that position. METHODS A thimble ionization chamber and polymethyl methacrylate phantom were used to obtain DI1 values using the SEDENTEXTCT method from 21 different CBCT units. DRLs were calculated based on the 75th percentile (third quartile) of the median output values. RESULTS The proposed DRL from the CBCT units surveyed has a DAP value of 838 mGy cm2 and a DI1 value of 3.924 mGy. DAP versus DI1 values of 500.6 mGy cm2 versus 2.006 mGy, and 838 mGy cm2 versus 3.906 mGy represented the third quartile of the median values for the 4-cm × 4-cm and 5-cm × 5-cm field of views (FOVs), respectively. CONCLUSIONS The DI1 and DAP values strongly correlated when 3 outlier CBCT machines (J Morita Veraview X800) using a novel 360° (full rotation) acquisition mode were excluded. The importance of selectable exposure parameters as directly related to ionizing radiation output is illustrated among the CBCT units surveyed. Although the actual FOV that is selected is ultimately dictated by the specific clinical requirements, a 4-cm × 4-cm FOV is recommended for specialist endodontics practice, whenever clinically practical, based on the decreased ionizing radiation output, as compared to that from a 5-cm × 5-cm FOV.
Collapse
Affiliation(s)
- Arthur Popkowski
- Department of Endodontics, Center for Advanced Dental Education, Saint Louis University, Saint Louis, Missouri
| | - S Craig Rhodes
- Department of Endodontics, Center for Advanced Dental Education, Saint Louis University, Saint Louis, Missouri.
| | - John F Hatton
- Department of Endodontics, Center for Advanced Dental Education, Saint Louis University, Saint Louis, Missouri
| |
Collapse
|
2
|
Negishi T, Koba Y, Shinsho K, Fujise D, Sai M, Nishide H. Data analysis of average glandular dose in mammography toward revision of the diagnostic reference level of Japan. Radiol Phys Technol 2024:10.1007/s12194-024-00823-9. [PMID: 38904916 DOI: 10.1007/s12194-024-00823-9] [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: 02/04/2024] [Revised: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024]
Abstract
Diagnostic reference level (DRL) for mammography for 2015 and 2020 has been published by J-RIME. More new dose studies are needed to revise the next DRL. In preparation for the next revision of the DRL for mammography, this study investigated data from the Japan Central Organization on Quality Assurance of Breast Cancer Screening on the mean average glandular dose (AGD) for institutional image accreditation in 2019-2023 and the relationship between the average at eligible institutions to date and the type of breast X-ray system. The 95th percentile values of the AGD distributions for the Computed Radiography (CR) and Flat Panel Detector (FPD) systems were 2.5 mGy and 2.0 mGy, respectively. Moreover, it is assumed that AGD is decreasing due to the spread of FPD systems, and it is expected that the further spread of FPD systems and systems with W/Rh target/filter will reduce AGD in future.
Collapse
Affiliation(s)
- Toru Negishi
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Yusuke Koba
- Institute of Radiological Sciences, National Institutes for Quantum Science and Technology, Chiba, Japan.
| | - Kiyomitsu Shinsho
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Daisuke Fujise
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Department of Information Technology and Management, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Masahiro Sai
- Japan Central Organization On Quality Assurance of Breast Cancer Screening, Nagoya, Japan
- Department of Radiology, Tohoku University Hospital, Sendai, Japan
| | - Hiroko Nishide
- Japan Central Organization On Quality Assurance of Breast Cancer Screening, Nagoya, Japan
- Department of Radiological Technology, School of Health Sciences, Gifu University of Medical Science, Seki, Japan
| |
Collapse
|
3
|
Pairodsantikul P, Wongsa P, Wongkri C, Burasothikul P, Jantarato A, Chotipanich C. Diagnostic Reference Levels in PET Imaging at Chulabhorn Hospital, Thailand. J Nucl Med Technol 2024:jnmt.124.267576. [PMID: 38901963 DOI: 10.2967/jnmt.124.267576] [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: 02/07/2024] [Accepted: 05/08/2024] [Indexed: 06/22/2024] Open
Abstract
Diagnostic reference levels (DRLs) are an important tool for controlling radiation exposure and ensuring safety in medical applications. In Thailand, DRL data have been gathered and established for nuclear medicine diagnostics since 2021. However, there is a lack of information on PET imaging examinations. At the National Cyclotron and PET Scan Centre, Chulabhorn Hospital, radiopharmaceuticals are produced for medical imaging and research, and a wide range of PET/CT and PET/MRI examinations are performed. Our objective was to investigate the administered activity of radiopharmaceuticals in patients undergoing PET imaging, especially the existing data on DRLs in medical diagnostic imaging. Methods: This was a retrospective study on nuclear medicine patients at the National Cyclotron and PET Scan Centre in 2023. Statistical analysis, including the mean and the 75th percentile values, was conducted to determine DRLs according to the International Commission on Radiological Protection guidelines. Results: The center performed 8,711 PET/CT and PET/MRI studies with 13 protocols in 2023. The most commonly administered activity was 18F-FDG in oncology and neurology examinations, with DRLs of 186.11 and 136.16 MBq, respectively. These values were notably almost twice lower than several reports in other countries. Conclusion: There is a lack of comprehensive data on most DRLs for PET imaging at this center because of the nonwidespread use of several radiopharmaceuticals. However, the lower DRLs for 18F-FDG can highlight the need for ongoing investigation toward the establishment of local DRLs, as well as assurance on the safety and efficiency of radiation used in nuclear medicine.
Collapse
Affiliation(s)
- Phornpailin Pairodsantikul
- School of Radiological Technology, Faculty of Health Science Technology, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand; and
| | - Paramest Wongsa
- School of Radiological Technology, Faculty of Health Science Technology, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand; and
| | - Chaluntorn Wongkri
- School of Radiological Technology, Faculty of Health Science Technology, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand; and
| | - Paphawarin Burasothikul
- School of Radiological Technology, Faculty of Health Science Technology, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand; and
| | - Attapon Jantarato
- National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand
| | | |
Collapse
|
4
|
Asadollahzadeh N, Razavi S, Zare MH. A survey on mean glandular dose in mammography examination and the factors affecting it in Shahid Sadoughi Hospital, Yazd, Iran. RADIATION PROTECTION DOSIMETRY 2024; 200:809-821. [PMID: 38811346 DOI: 10.1093/rpd/ncae121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/12/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND mammography is the gold standard in the early detection of breast cancer. Due to the increase in the rate of women suffering from this malignancy all over the world, this imaging modality has been widely used. Considering the side effects caused by ionizing radiation to measure the carcinogenic risk of mammography X-rays, mean glandular dose (MGD) is the best parameter to evaluate the dose received by patients undergoing mammography. The aims of this study were to measure MGD in mammography in mammographic craniocaudal (CC) and mediolateral oblique (MLO) projections and investigate the relationship of MGD with compressed breast thickness (CBT), body mass index, age of the patient, and device exposure conditions. MATERIALS AND METHODS this cross-sectional analytical study was conducted on women aged 30-70 referring to the mammography unit of Shahid Sadoughi Hospital in Yazd city from May to August 2022. The TLD-GR 200 (thermoluminescence dosimeter) was placed on the breast of the patients for CC and MLO projections, and then the MGD was obtained by multiplying the entrance surface dose and the normalized glandular dose. Analysis of data (such as demographic information of patients, CBT, kVp, and mAs) was done by SPSS 23 software. The normality of the data was checked using Shapiro-Wilk tests. It was found that except for age, other variables did not have a normal distribution; therefore, equivalent parametric and nonparametric tests were used. In this regard, Spearman's correlation was used to assess the correlation between variables. P-value < .05 was considered as level of significance. RESULTS The mean ± standard deviation (SD) age of patients was 47.3 ± 7.1 years. The median ± IQR (the interquartile range (IQR) is a measure of statistical dispersion, which is the spread of the data. It is defined as the difference between the 75th and 25th percentiles of the data.) (mean ± SD) value of MGD per woman was 1.2 ± 0.4 mGy (1.3 ± 0.3 mGy). The median ± IQR MGD in the MLO and CC projections was 1.6 ± 0.6 mGy and 0.9 ± 0.4 mGy, respectively. Significant relationships (P-value ≤ .001) were observed between MGD with CBT (R = 0.62) and age (R = -0.85). CONCLUSION The results showed that the mammography unit at Shahid Sadoughi Hospital in Yazd is functioning properly. The calculated median ± IQR MGD per woman referring to this unit (1.2 ± 0.4 mGy) was clearly below the dose limit recommended by American College of Radiology and International Commission on Radiological Protection (3 mGy). Moreover, among the factors affecting MGD, the highest correlation was seen between MGD and age (R = -0.85).
Collapse
Affiliation(s)
- Najmeh Asadollahzadeh
- Yazd Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, 8915173149, Iran
| | - SeidKazem Razavi
- Medical Physics Department, Yazd Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, 8915164481, Iran
| | - Mohammad Hossein Zare
- Medical Physics Department, Yazd Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, 8915164481, Iran
| |
Collapse
|
5
|
Vano E, Fernández-Soto JM, Sánchez-Casanueva RM, Ten Morón JI. Improving a regional project on diagnostic reference levels for interventional procedures (OPRIPALC) with the support of a dose management system for the protection of patients and staff. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021520. [PMID: 38834050 DOI: 10.1088/1361-6498/ad53d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/04/2024] [Indexed: 06/06/2024]
Abstract
Interventional radiology is a clinical practice with important benefits for patients, but which involves high radiation doses. The optimisation of radiation protection (RP) for paediatric interventional cardiology is a priority for both patients and staff. The use of diagnostic reference levels (DRLs) has been proposed by the International Commission on Radiological Protection to improve RP in imaging procedures. Dose management systems (DMSs) allow the automatic collection of dosimetric, geometric and technical data to assist the optimisation process, with a continuous audit of the procedures, generating alerts to implement corrective actions when necessary. Patient dose indicators may be analysed individually and for different radiation events (fluoroscopy and cine runs). Occupational doses per procedure may be analysed (if electronic dosimeters are available) and linked with patient doses for an integrated approach to RP. Regional optimisation programmes require data collection and processing from several countries to set and periodically update the DRLs. Patient data is anonymised, and each participating hospital has access to their data in a central computer server. Using DMSs may be one of the best ways to support these programs in the collection and analysis of data, raising alerts about high patient and occupational doses and suggesting optimisation actions.
Collapse
Affiliation(s)
- E Vano
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - J M Fernández-Soto
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - R M Sánchez-Casanueva
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - J I Ten Morón
- Unidad Técnica de Imagen Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| |
Collapse
|
6
|
Mardfar S, Ghaziyani MF, Mortezazadeh T, Zamani H, Rahimiyan M, Khezerloo D. Radiation doses and diagnostic reference levels for common CT scans in adults in Northwest region of Iran. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2024:10.1007/s00411-024-01074-3. [PMID: 38839606 DOI: 10.1007/s00411-024-01074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
This study aims to estimate organ dose and cancer risks, establish region-specific diagnostic reference levels (DRLs), and determine achievable doses (ADs) for common CT procedures in adults in the northwest of Iran. Effective and organ doses were estimated using VirtualDoseCT software in a sample of 480 adult patients who underwent head, sinus, chest, and abdomen-pelvis (AP) CT scans. The guidelines provided by the BEIR VII report were utilized to estimate cancer risks. Effective and organ doses for specific procedures were determined, with the highest mean organ dose being observed in the brain during head CT examinations, with a value of 54.02 mGy. It was observed that the lungs in chest examinations and the colon in AP examinations had the highest risk of cancer, with rates of 30.72 and 21.37 per 100,000 persons, respectively. Higher cancer risk values were generally exhibited by females compared to males. The DRLs for common CT examinations were established as follows: Head CT (CTDIvol 41 mGy, DLP 760 mGy cm), Sinus CT (CTDIvol 16 mGy, DLP 261 mGy cm), Chest CT (CTDIvol 8 mGy, DLP 287 mGy cm), and AP CT (CTDIvol 9 mGy, DLP 508 mGy cm). Significant variations in dose distribution among facilities were identified, indicating the need for optimization. The study highlights the importance of minimizing radiation exposure to critical organs and promoting patient safety in CT examinations. The establishment of region-specific DRLs and ADs can help optimize radiation doses and reduce cancer risks for patients.
Collapse
Affiliation(s)
- Sina Mardfar
- Department of Radiology, Faculty of Allied Medical Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Mona Fazel Ghaziyani
- Department of Radiology, Faculty of Allied Medical Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Tohid Mortezazadeh
- Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamed Zamani
- Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Melika Rahimiyan
- Department of Radiology, Faculty of Allied Medical Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Davood Khezerloo
- Department of Radiology, Faculty of Allied Medical Sciences, Tabriz University of Medical Science, Tabriz, Iran.
| |
Collapse
|
7
|
Suttho D. Establishment of National Diagnostic Reference Levels for Administered Activity in Diagnostic Nuclear Medicine in Thailand. J Nucl Med Technol 2024; 52:158-162. [PMID: 38627011 DOI: 10.2967/jnmt.123.266836] [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: 10/10/2023] [Revised: 02/13/2024] [Indexed: 06/07/2024] Open
Abstract
The diagnostic reference level (DRL) is a patient-exposure optimization tool used to evaluate radiation doses in medical imaging and provide guidance for protection from them. In Thailand, nuclear medicine DRLs have not been established yet. Therefore, this study surveyed dose levels in routine nuclear medicine procedures to provide national DRLs (NDRLs). Methods: NDRLs in Thailand were established by investigating the administered activity of radiopharmaceuticals in nuclear medicine examination studies. The NDRLs were determined on the basis of the 75th percentile (third quartile) of administered activity distribution as recommended by the International Commission on Radiological Protection. As part of a nationwide survey, datasets for the period between June 1, 2018, and August 31, 2019, were collected from 21 Thailand hospitals with nuclear medicine equipment. All hospitals were asked to report the nuclear medicine imaging devices in use, the standard protocol parameters for selected examinations, the injected activities, and the ages and weights of patients. All data were calculated to determine Thailand NDRLs, which were compared with international NDRLs. Results: The data reported by the 21 hospitals consisted of 4,641 examinations with SPECT or SPECT/CT for general nuclear medicine and 409 examinations with PET. The most widely performed examinations for SPECT were bone, thyroid, oncology, and cardiovascular imaging. The NDRLs for SPECT or SPECT/CT agreed well with published NDRLs for Europe, the United States, Japan, Korea, Kuwait, and Australia. In contrast, the NDRLs for 18F-FDG PET in oncology studies were higher than for Japan, Korea, Kuwait, and Australia but lower than for the United States, the United Kingdom, and the European Union. Conclusion: This study presents NDRL results for adults in Thailand as a way to optimize radiation protection in nuclear medicine imaging. Moreover, the reported injected activity levels were comparable to those of other countries.
Collapse
Affiliation(s)
- Dutsadee Suttho
- Department of Radiological Technology, Faculty of Allied Health Sciences, Thammasat University, Khlong Nueng, Thailand
| |
Collapse
|
8
|
Aly A, Tsapaki V, Ahmed AZ, Own A, Patro S, Al Naemi H, Kharita MH. Clinical diagnostic reference levels in neuroradiology based on clinical indication. RADIATION PROTECTION DOSIMETRY 2024; 200:755-762. [PMID: 38702851 PMCID: PMC11148473 DOI: 10.1093/rpd/ncae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/27/2024] [Accepted: 04/17/2024] [Indexed: 05/06/2024]
Abstract
This study focuses on patient radiation exposure in interventional neuroradiology (INR) procedures, a field that has advanced significantly since its inception in the 1980s. INR employs minimally invasive techniques to treat complex cerebrovascular diseases in the head, neck, and spine. The study establishes diagnostic reference levels (DRLs) for three clinical indications (CIs): stroke (S), brain aneurysms (ANs), and brain arteriovenous malformation (AVM). Data from 209 adult patients were analyzed, and DRLs were determined in terms of various dosimetric and technical quantities. For stroke, the established DRLs median values were found to be 78 Gy cm2, 378 mGy, 118 mGy, 12 min, 442 images, and 15 runs. Similarly, DRLs for brain AN are 85 Gy cm2, 611 mGy, 95.5 mGy, 19.5, 717 images, and 26 runs. For brain AVM, the DRL's are 180 Gy cm2, 1144 mGy, 537 mGy, 36 min, 1375 images, and 31 runs. Notably, this study is unique in reporting DRLs for specific CIs within INR procedures, providing valuable insights for optimizing patient safety and radiation exposure management.
Collapse
Affiliation(s)
- Antar Aly
- Medical Physics Section, Hamad Medical Corporation, Doha 3050, Qatar
- Radiology Department, Weill Cornell Medicine, Doha 24144, Qatar
| | - Virginia Tsapaki
- Medical Physics Department, Konstantopoulio Hospital, 142 33 Nea Ionia, Athens, Greece
| | | | - Ahmed Own
- Neurosurgery Department, Hamad Medical Corporation, Doha 3050, Qatar
| | - Satya Patro
- Neurosurgery Department, Hamad Medical Corporation, Doha 3050, Qatar
| | - Huda Al Naemi
- Radiology Department, Weill Cornell Medicine, Doha 24144, Qatar
| | | |
Collapse
|
9
|
Nishida T, Hayashi S, Takenaka M, Hosono M. Managing radiation safety and protection in gastroenterology in Japan: insights from the REX-GI study. J Gastroenterol 2024; 59:437-441. [PMID: 38703187 DOI: 10.1007/s00535-024-02106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
Fluoroscopy-guided gastrointestinal procedures, including gastrointestinal stenting, balloon-assisted endoscopy (BAE), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS), are essential for diagnosis and treatment in gastroenterology. Such procedures involve radiation exposure that necessitates strict safety measures to protect patients, doctors, and medical staff. The April 2020 update to Japan's Ionizing Radiation Injury Prevention Regulations for occupational exposure reduced the lens exposure dose limit to approximately one-seventh of its previous level. This change highlights the need for improved safety protocols. Without adaptation, the sustainability of fluoroscopy-based endoscopic techniques could be at risk due to the potential to exceed these new limits. This review examines the current state of medical radiation exposure in the field of gastroenterology in Japan and discusses the findings of the REX-GI study.
Collapse
Affiliation(s)
- Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan.
| | - Shiro Hayashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
- Hayashi Clinic, Suita, Osaka, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University, Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University, Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| |
Collapse
|
10
|
Vallot D, Cavillon A, Lusque A, Izard P, Salvignol G, Delpuech B, Fuzier R. Radiation dose reduction during venous access port implantation: the importance of upgrading equipment and radiation-protection training. Ir J Med Sci 2024; 193:1461-1466. [PMID: 38349509 DOI: 10.1007/s11845-024-03623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 01/29/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Implantable central venous port systems are widely used in oncology. We upgraded our fluoroscopy machines, and all anesthetists completed two training courses focusing on the risks of ionizing radiation for patients and health workers. AIMS This study aimed to evaluate the impact of upgrading the machines and the radiation-protection training on ionizing radiation exposure during venous port system implantation. METHODS We retrospectively analyzed consecutive venous port implantations between 2019 and 2022. The older fluoroscopy machines were replaced by two new machines. A first training session about health worker radioprotection was organized. The medical staff completed a second training course focused on protecting patients from ionizing radiation. We defined four distinct time intervals (TI): venous port implantations performed with the old equipment, the new fluoroscopy machines, after the first training course, and after the second training course. The air kerma-area product (KAP) was compared between these four TI and fluoroscopy times and the number of exposures only with the new machines. RESULTS We analyzed 2587 procedures. A 93% decrease in the median KAP between the first and last TI was noted (median KAP = 323.0 mGy.cm2 vs. 24.0 mGy.cm2, p < 0.0001). A decrease in the KAP was observed for each of the 11 anesthetists. We also noted a significant decrease in the time of fluoroscopy and the number of exposures. CONCLUSIONS Upgrading the fluoroscopy equipment and completing two dedicated training courses allowed for a drastic decrease patient exposure to ionizing radiation during venous access port implantation by non-radiologist practitioners.
Collapse
Affiliation(s)
- Delphine Vallot
- Department of Medical Physics, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Ana Cavillon
- Department of Biostatistics and Health Data Science, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Amélie Lusque
- Department of Biostatistics and Health Data Science, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Philippe Izard
- Department of Anesthesiology, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Geneviève Salvignol
- Department of Anesthesiology, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Bertrand Delpuech
- Department of Radioprotection, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Régis Fuzier
- Department of Anesthesiology, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France.
| |
Collapse
|
11
|
Uniyal SC, Singh V, Rawat A, Gururani K, Belwal CM. An audit of patient radiation doses during interventional cardiology procedures in Uttarakhand, India, and establishment of local diagnostic reference levels. Radiol Phys Technol 2024; 17:476-487. [PMID: 38652208 DOI: 10.1007/s12194-024-00805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
The objective of this study was to investigate patient radiation doses by a dose audit of three common interventional cardiology (IC) procedures: coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA) and CA-PTCA procedures performed in IC centres in the Uttarakhand state of India, for the establishment of local diagnostic reference levels (DRLs) and the estimation of average effective dose (Eav) for these procedures. For each procedure, the values of kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of cine images were recorded from 1233 CA, 458 PTCA and 736 CA-PTCA procedures performed over a 12-month period at 13 IC centres of the state. From the recorded dose data, 0.6%, 1.53% and 7.9% patients were identified to have exceeded the PKA trigger level of 500 Gy cm2 for possible skin injury for CA, PTCA and CA-PTCA procedures, respectively. The 3rd quartile of the distribution of the recorded PKA values for each type of procedure was calculated to estimate local DRL values. The estimated values of DRLs and Eav were 37, 153 and 224 Gy cm2, and 6.72, 23.97 and 34.79 mSv for CA, PTCA and CA-PTCA procedures, respectively. For about 77% of the surveyed centres, the recorded patient doses were in agreement with the international standards. The local DRLs proposed in this study may be used to achieve patient dose optimization during IC procedures and the obtained patient dose data may also be archived into national dose database for the establishment of national DRLs.
Collapse
Affiliation(s)
- Satish C Uniyal
- Department of Medical Physics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India.
| | - Vikram Singh
- Department of Medical Physics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Anurag Rawat
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Kunal Gururani
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Chandra Mohan Belwal
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| |
Collapse
|
12
|
Alhorani Q, Al-Ibraheem A, Rawashdeh M, Alkhybari E, Sabarudin A, A. Latiff R, Mohamad M. Investigating knowledge of DRLs, image quality and radiation dose in PET/CT and CT imaging among medical imaging professionals. Heliyon 2024; 10:e30030. [PMID: 38707442 PMCID: PMC11066384 DOI: 10.1016/j.heliyon.2024.e30030] [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: 08/25/2023] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Objective To investigate the knowledge of diagnostic reference levels (DRLs), image quality, radiation dose and protocol parameters among Jordanian medical imaging professionals (MIPs) involved in PET/CT and CT scan procedures. Materials and methods A questionnaire was designed and distributed to MIPs in Jordan. The survey comprised four sections: demographic data, MIP knowledge on dose/protocol parameters, image quality, and DRLs. Statistical analyses were performed utilizing Pearson's correlation, t-tests, ANOVA, and linear regression, with a significance level of 95 % and a p-value threshold of <0.05. Results The study involved 147 participants. Most respondents were male (76.2 %), and most were aged 26-35 years (44.2 %). Approximately 51 % held a bachelor's degree, and the most common range of experience was 3-5 years (28.6 %). Participants showed a moderate level of knowledge regarding dose and protocol parameters, with a mean score of 61.8 %. The mean scores for knowledge of image quality and DRLs were 45.2 % and 44.8 %, respectively. The age group of the MIPs and the total experience were found to have a significant impact on the knowledge of the dose and protocol parameters, as well as the DRLs. Additionally, experience was found to have a significant influence on knowledge of the dose and protocol parameters. The study revealed a positive and significant effect of MIPs' knowledge of dose/protocol parameters and image quality on their knowledge of DRLs. Conclusions This study indicates that professionals across five specialties who are engaged in PET/CT and CT imaging possess a moderate understanding of dosage and protocol parameters. However, there is a notable gap in knowledge regarding DRLs and image quality. To address this issue, it is recommended that MIPs actively engage in educational programs emphasizing exposure parameters and their impact on image quality. Additionally, access to comprehensive education and training programs will enable MIPs to grasp the complexities of DRLs and their implications, facilitating their implementation in clinical practice.
Collapse
Affiliation(s)
- Qays Alhorani
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mohammad Rawashdeh
- Radiologic Technology Program, Applied Medical Sciences College, Jordan University of Science and Technology, Irbid, Jordan
- Faculty of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Essam Alkhybari
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Saudi Arabia
| | - Akmal Sabarudin
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rukiah A. Latiff
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mazlyfarina Mohamad
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
13
|
Del Río-Solá ML, Rial R, Lopez-Espada C, Rodríguez-Morata A, Vañó E. National Diagnostic Reference Levels for Standard Descending Thoracic Endovascular Aortic Repair and Optimisation Strategies. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00390-3. [PMID: 38754725 DOI: 10.1016/j.ejvs.2024.05.012] [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: 08/30/2023] [Revised: 04/06/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE The International Commission on Radiological Protection has highlighted the large number of medical specialties that use fluoroscopy outside diagnostic imaging departments without radiation protection programmes for patients and staff. Vascular surgery is one of these specialties. Thoracic endovascular aortic repair (TEVAR) is a complicated procedure requiring radiation protection guidance and optimisation. The recent EU Basic Safety Standards Directive requires the use and periodic updating of diagnostic reference levels (DRLs) for interventional procedures. The aim of this study was to determine doses for patients undergoing TEVAR with mobile Xray systems and hybrid rooms (fixed Xray systems) to obtain national DRLs and to suggest optimisation actions. METHODS This was a retrospective cross sectional study. The Spanish Chapter of Endovascular Surgery conducted a national survey in 11 autonomous communities representing around 77.6% of the Spanish population (47.33 million inhabitants). A total of 266 TEVAR procedures from 17 Spanish centres were analysed, of which 53.0% were performed in hybrid operating rooms. National DRLs were obtained and defined as the third quartile of the median values from the different participating centres. RESULTS The proposed national DRLs are: for kerma area product (KAP), 113.81 Gy·cm2 for mobile Xray systems and 282.59 Gy·cm2 for hybrid rooms; and for cumulative air kerma (CAK) at the patient entry reference point, 228.38 mGy for mobile systems and 910.64 mGy for hybrid rooms. CONCLUSION Based on the requirement to know radiation doses for standard endovascular procedures, this study of TEVARs demonstrated that there is an increased factor of 2.48 in DRLs for KAP when the procedure is performed in a hybrid room compared with mobile C-arm systems, and an increased factor of 3.98 in DRLs for CAK when the procedure is performed with hybrid equipment. These results will help to optimise strategies to reduce radiation doses during TEVAR procedures.
Collapse
Affiliation(s)
- Maria L Del Río-Solá
- Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, University Clinical Hospital of Valladolid, University of Valladolid, Valladolid, Spain
| | - Rodrigo Rial
- Vascular and Endovascular Surgery Department, University Hospital HM Madrid-Torrelodones, Madrid, Spain
| | - Cristina Lopez-Espada
- Vascular Surgery Unit, University Hospital Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria - ibs.GRANADA, Granada, Spain; Department of Surgery, Faculty of Medicine, University of Granada, Granada, Spain.
| | | | - Eliseo Vañó
- Radiology Department, Complutense University, Madrid, Spain
| |
Collapse
|
14
|
Lyons A, Mohammed Ali A, England A, Moore N, Young R, Leamy B, Tam W, Bezzina P, Pongnapang N, McEntee MF. Expansion of Typical Values for Paediatric Patients in Ireland and Comparison with Published DRLs - Experiences of a Single Institution. J Med Imaging Radiat Sci 2024:101421. [PMID: 38735771 DOI: 10.1016/j.jmir.2024.04.014] [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: 10/10/2023] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION To reduce the risks involved with ionising radiation exposure, typical values (TVs) and diagnostic reference levels (DRLs) have been established to help keep radiation doses 'as low as reasonably practicable. TVs/DRLs provide standardised radiation dose metrics that can be used for comparative purposes. However, for paediatrics, such values should consider the size of the child instead of their age. This study aimed to establish and compare paediatric TVs for chest, abdomen and pelvis radiography. METHODS Study methods followed processes for establishing paediatric DRLs as outlined by the Health Information and Quality Authority (HIQA). Kerma-area product (KAP) values, excluding rejected images, were retrospectively acquired from the study institution's Picture Archiving and Communications System (PACS). Paediatric patients were categorised into the following weight-based groupings (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg) and stratified based on the examination that was performed (chest, abdomen, and pelvis), and where it was performed (the different X-ray rooms). Anonymised data were inputted into Microsoft Excel for analysis. Median and 3rd quartile KAP values were reported together with graphical illustrations. RESULTS Data from 407 X-ray examinations were analysed. For the previously identified weight categories (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg), TVs for the chest were 0.10, 0.19, 0.37 and 0.53 dGy.cm2, respectively. For the abdomen 0.39, 1.04, 3.51 and 4.05 dGy.cm2 and for the pelvis 0.43, 0.87, 3.50 and 7.58 dGy.cm2. Between X-ray rooms TVs varied against the institutional TVs by -60 to 119 % (chest), -50 to 103 % (abdomen) and -14 and 24 %% (pelvis). CONCLUSION TVs in this study follow established trends with patient weight and examination type and are comparable with published literature. Variations do exist between individual examination rooms and reasons are multifactorial. Given that age and size do not perfectly correlate further work should be undertaken around weight-based TVs/DRLs in the paediatric setting.
Collapse
Affiliation(s)
- Andrew Lyons
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Ali Mohammed Ali
- Department of Medical Physics, College of Applied Medical Sciences, University of Kerbala, Karbala, Iraq
| | - Andrew England
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland.
| | - Niamh Moore
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Rena Young
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Brid Leamy
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Winnie Tam
- Department of Radiography, City, University of London, London, UK
| | - Paul Bezzina
- Department of Radiography, University of Malta, Msida, Malta
| | - Napapong Pongnapang
- Department of Radiological Technology, Mahidol University, Bangkok, Thailand
| | - Mark F McEntee
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| |
Collapse
|
15
|
Garba I, Penelope EH, Davidson F, Ismail A. Prospective dose monitoring using a manual dose management system: experience in brain computed tomography from a tertiary hospital in Nigeria. RADIATION PROTECTION DOSIMETRY 2024; 200:648-658. [PMID: 38648160 DOI: 10.1093/rpd/ncae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/01/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
A manual radiation dose management system was developed to track the radiation dose and scan parameters of patients for brain computed tomography (CT). Radiation dose in volume computed tomography dose index (CTDIvol) and dose length product (DLP) were monitored to identify procedures that may require optimisation using notification values. The data were analysed and compared with national and international diagnostic reference levels (DRLs). A total of 596 brain CTs were monitored and grouped as <1: 36, 1-<5: 38, 5-<10: 25, 10-<15: 31 and adult: 466. The CTDIvol notification value identified the following number of examinations having high CTDIvol in <1 y: 1, 1-<5: 1, 5-<10: 0, 10-<15: 0 and adult (>15): 11. Furthermore, the DLP notification values identified the following examinations with high DLP in <1 y: 1, 1-<5:1, 5-<10:1, 10-<15: 1 and adults (>15): 18. The established local paediatric DLP DRLs were 2-3 times higher than the international paediatric DLP DRLs. This calls for a total protocol review and optimisation considering the local CT practices for paediatric imaging.
Collapse
Affiliation(s)
- Idris Garba
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Engel-Hills Penelope
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Florence Davidson
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Anas Ismail
- Department of Radiology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano, Kano 700001, Nigeria
| |
Collapse
|
16
|
Viry A, Vitzthum V, Monnin P, Bize J, Rotzinger D, Racine D. Optimization of CT pulmonary angiography for pulmonary embolism using task-based image quality assessment and diagnostic reference levels: A multicentric study. Phys Med 2024; 121:103365. [PMID: 38663347 DOI: 10.1016/j.ejmp.2024.103365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/12/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE To establish size-specific diagnostic reference levels (DRLs) for pulmonary embolism (PE) based on patient CT examinations performed on 74 CT devices. To assess task-based image quality (IQ) for each device and to investigate the variability of dose and IQ across different CTs. To propose a dose/IQ optimization. METHODS 1051 CT pulmonary angiography dose data were collected. DRLs were calculated as the 75th percentile of CT dose index (CTDI) for two patient categories based on the thoracic perimeters. IQ was assessed with two thoracic phantom sizes using local acquisition parameters and three other dose levels. The area under the ROC curve (AUC) of a 2 mm low perfused vessel was assessed with a non-prewhitening with eye-filter model observer. The optimal IQ-dose point was mathematically assessed from the relationship between IQ and dose. RESULTS The DRLs of CTDIvol were 6.4 mGy and 10 mGy for the two patient categories. 75th percentiles of phantom CTDIvol were 6.3 mGy and 10 mGy for the two phantom sizes with inter-quartile AUC values of 0.047 and 0.066, respectively. After the optimization, 75th percentiles of phantom CTDIvol decreased to 5.9 mGy and 7.55 mGy and the interquartile AUC values were reduced to 0.025 and 0.057 for the two phantom sizes. CONCLUSION DRLs for PE were proposed as a function of patient thoracic perimeters. This study highlights the variability in terms of dose and IQ. An optimization process can be started individually and lead to a harmonization of practice throughout multiple CT sites.
Collapse
Affiliation(s)
- Anaïs Viry
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Rue du Grand-Pré 1, 1007 Lausanne, Switzerland.
| | - Veronika Vitzthum
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Rue du Grand-Pré 1, 1007 Lausanne, Switzerland
| | - Pascal Monnin
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Rue du Grand-Pré 1, 1007 Lausanne, Switzerland
| | - Julie Bize
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Rue du Grand-Pré 1, 1007 Lausanne, Switzerland
| | - David Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Damien Racine
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Rue du Grand-Pré 1, 1007 Lausanne, Switzerland
| |
Collapse
|
17
|
Rao S, Sharan K, Chandraguthi SG, Dsouza RN, David LR, Ravichandran S, Mustapha MT, Shettigar D, Uzun B, Kadavigere R, Sukumar S, Ozsahin DU. Advanced Computational Methods for Radiation Dose Optimization in CT. Diagnostics (Basel) 2024; 14:921. [PMID: 38732335 PMCID: PMC11083136 DOI: 10.3390/diagnostics14090921] [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: 01/01/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND In planning radiotherapy treatments, computed tomography (CT) has become a crucial tool. CT scans involve exposure to ionizing radiation, which can increase the risk of cancer and other adverse health effects in patients. Ionizing radiation doses for medical exposure must be kept "As Low As Reasonably Achievable". Very few articles on guidelines for radiotherapy-computed tomography scans are available. This paper reviews the current literature on radiation dose optimization based on the effective dose and diagnostic reference level (DRL) for head, neck, and pelvic CT procedures used in radiation therapy planning. This paper explores the strategies used to optimize radiation doses, and high-quality images for diagnosis and treatment planning. METHODS A cross-sectional study was conducted on 300 patients with head, neck, and pelvic region cancer in our institution. The DRL, effective dose, volumetric CT dose index (CTDIvol), and dose-length product (DLP) for the present and optimized protocol were calculated. DRLs were proposed for the DLP using the 75th percentile of the distribution. The DLP is a measure of the radiation dose received by a patient during a CT scan and is calculated by multiplying the CT dose index (CTDI) by the scan length. To calculate a DRL from a DLP, a large dataset of DLP values obtained from a specific imaging procedure must be collected and can be used to determine the median or 75th-percentile DLP value for each imaging procedure. RESULTS Significant variations were found in the DLP, CTDIvol, and effective dose when we compared both the standard protocol and the optimized protocol. Also, the optimized protocol was compared with other diagnostic and radiotherapy CT scan studies conducted by other centers. As a result, we found that our institution's DRL was significantly low. The optimized dose protocol showed a reduction in the CTDIvol (70% and 63%), DLP (60% and 61%), and effective dose (67% and 62%) for both head, neck, and pelvic scans. CONCLUSIONS Optimized protocol DRLs were proposed for comparison purposes.
Collapse
Affiliation(s)
- Shreekripa Rao
- Department of Radiotherapy and Oncology, Manipal College of Health Professions, Manipal 576104, India (R.N.D.)
| | - Krishna Sharan
- Department of Radiotherapy and Oncology, Kasturba Medical College and Hospital, Manipal 576104, India; (K.S.); (S.G.C.)
| | | | - Rechal Nisha Dsouza
- Department of Radiotherapy and Oncology, Manipal College of Health Professions, Manipal 576104, India (R.N.D.)
| | - Leena R. David
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal 576104, India; (L.R.D.); (S.R.); (D.S.)
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Sneha Ravichandran
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal 576104, India; (L.R.D.); (S.R.); (D.S.)
| | - Mubarak Taiwo Mustapha
- Operational Research Centre in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey; (M.T.M.); (B.U.)
- Department of Biomedical Engineering, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey
| | - Dilip Shettigar
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal 576104, India; (L.R.D.); (S.R.); (D.S.)
| | - Berna Uzun
- Operational Research Centre in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey; (M.T.M.); (B.U.)
- Department of Mathematics, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey
| | - Rajagopal Kadavigere
- Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal 576104, India;
| | - Suresh Sukumar
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal 576104, India; (L.R.D.); (S.R.); (D.S.)
| | - Dilber Uzun Ozsahin
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Operational Research Centre in Healthcare, Near East University, TRNC Mersin 10, Nicosia 99138, Turkey; (M.T.M.); (B.U.)
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| |
Collapse
|
18
|
Issahaku S, Boadu M, Inkoom S, Hasford F, Sackey TA. Establishment and utilisation of national diagnostic reference level for adult computed tomography examinations in Ghana. RADIATION PROTECTION DOSIMETRY 2024; 200:564-571. [PMID: 38453140 DOI: 10.1093/rpd/ncae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 03/09/2024]
Abstract
The International Atomic Energy Agency, as part of the new regional project (RAF/9/059), recommend the establishment of diagnostic reference levels (DRLs) in Africa. In response to this recommendation, this project was designed to establish and utilise national DRLs of routine computed tomography (CT) examinations. These were done by estimating CT dose index and dose length product (DLP) from a minimum of 20 patient dose report of the most frequently used procedures using 75th percentile distribution of the median values. In all, 22 centres that formed 54% of all CT equipment in the country took part in this study. Additionally, a total of 2156 adult patients dose report were randomly selected, with a percentage distribution of 60, 12, 21 and 7% for head, chest, abdomen-pelvis and lumber spine, respectively. The established DRL for volume CT dose index were 60.0, 15.7, 20.5 and 23.8 mGy for head, chest, abdomen-pelvis and lumber spine, respectively. While the established DRL for DLP were 962.9, 1102.8, 1393.5 and 824.6 mGy-cm for head, chest, abdomen-pelvis, and lumber spine, respectively. These preliminary results were comparable with data from 16 other African countries, European Commission and the International Commission on Radiological Protection. Hence, this study would serve as a baseline for the establishment of a more generalised regional and national adult DRLs for Africa and other developing countries.
Collapse
Affiliation(s)
- Shiraz Issahaku
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Mary Boadu
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Stephen Inkoom
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Francis Hasford
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Theophilus A Sackey
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
- Korle-Bu Teaching Hospital, Department of Radiology, PMB, Accra, Ghana
| |
Collapse
|
19
|
Frush DP, Vassileva J, Brambilla M, Mahesh M, Rehani M, Samei E, Applegate K, Bourland J, Ciraj-Bjenlac O, Dahlstrom D, Gershan V, Gilligan P, Godthelp B, Hjemly H, Kainberger F, Mikhail-Lette M, Holmberg O, Paez D, Schrandt S, Valentin A, Van Deventer T, Wakeford R. Recurrent medical imaging exposures for the care of patients: one way forward. Eur Radiol 2024:10.1007/s00330-024-10659-x. [PMID: 38592419 DOI: 10.1007/s00330-024-10659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/17/2023] [Accepted: 01/23/2024] [Indexed: 04/10/2024]
Abstract
Medical imaging is both valuable and essential in the care of patients. Much of this imaging depends on ionizing radiation with attendant responsibilities for judicious use when performing an examination. This responsibility applies in settings of both individual as well as multiple (recurrent) imaging with associated repeated radiation exposures. In addressing the roles and responsibilities of the medical communities in the paradigm of recurrent imaging, both the International Atomic Energy Agency (IAEA) and the American Association of Physicists in Medicine (AAPM) have issued position statements, each affirmed by other organizations. The apparent difference in focus and approach has resulted in a lack of clarity and continued debate. Aiming towards a coherent approach in dealing with radiation exposure in recurrent imaging, the IAEA convened a panel of experts, the purpose of which was to identify common ground and reconcile divergent perspectives. The effort has led to clarifying recommendations for radiation exposure aspects of recurrent imaging, including the relevance of patient agency and the provider-patient covenant in clinical decision-making. CLINICAL RELEVANCE STATEMENT: An increasing awareness, generating some lack of clarity and divergence in perspectives, with patients receiving relatively high radiation doses (e.g., ≥ 100 mSv) from recurrent imaging warrants a multi-stakeholder accord for the benefit of patients, providers, and the imaging community. KEY POINTS: • Recurrent medical imaging can result in an accumulation of exposures which exceeds 100 milli Sieverts. • Professional organizations have different perspectives on roles and responsibilities for recurrent imaging. • An expert panel reconciles differing perspectives for addressing radiation exposure from recurrent medical imaging.
Collapse
Affiliation(s)
- Donald Paul Frush
- Department of Radiology, Duke University Medical Center, Durham, NC, 27705, USA.
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Marco Brambilla
- Department of Medical Physics, University Hospital of Novara, Novara, Italy
| | - Mahadevappa Mahesh
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Madan Rehani
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Ehsan Samei
- Department of Radiology, Duke University Medical Center, Durham, NC, 27705, USA
| | | | - John Bourland
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Vesna Gershan
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Paddy Gilligan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Barbara Godthelp
- Authority for Nuclear Safety and Radiation Protection, The Hague, The Netherlands
| | - Hakon Hjemly
- International Society of Radiographers and Radiological Technologists, London, UK
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Suz Schrandt
- ExPPect, Founder & CEO, and Patients for Patient Safety US, Champion (Affiliate, WHO PFPS Network), Arlington, VA, USA
| | - Andreas Valentin
- Department of Internal Medicine With Cardiology & Intensive Care Medicine Clinic Donaustadt Vienna Health Care Group, Vienna, Austria
| | | | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| |
Collapse
|
20
|
Benavides E, Krecioch JR, Connolly RT, Allareddy T, Buchanan A, Spelic D, O'Brien KK, Keels MA, Mascarenhas AK, Duong ML, Aerne-Bowe MJ, Ziegler KM, Lipman RD. Optimizing radiation safety in dentistry: Clinical recommendations and regulatory considerations. J Am Dent Assoc 2024; 155:280-293.e4. [PMID: 38300176 DOI: 10.1016/j.adaj.2023.12.002] [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: 07/26/2023] [Revised: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND The value of dental radiographs to oral health care decision making must be balanced with radiation safety to minimize patient exposure and occupational risk of oral health care providers. This review summarizes recommendations and regulatory guidance regarding dental radiography and cone-beam computed tomography. An expert panel presents recommendations on radiation safety, appropriate imaging practices, and reducing radiation exposure. TYPES OF STUDIES REVIEWED A systematic search run in Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews identified relevant topical systematic reviews, organizational guidelines, and regulatory reviews published in the peer-reviewed literature since 2010. A supplemental search of the gray literature (eg, technical reports, standards, and regulations) identified topical nonindexed publications. Inclusion criteria required relevance to primary oral health care (ie, general or pediatric dentistry). RESULTS A total of 95 articles, guidance documents, and regulations met the inclusion criteria. Resources were characterized as applicable to all modalities, operator and occupational protection, dose reduction and optimization, and quality assurance and control. PRACTICAL IMPLICATIONS Understanding factors affecting imaging safety and applying fundamental principles of radiation protection consistent with federal, state, and local requirements are essential for limiting patient ionizing radiation exposure, in conjunction with implementing optimal imaging procedures to support prudent use of dental radiographs and cone-beam computed tomographic imaging. The regulatory guidance and best practice recommendations summarized in this article should be followed by dentists and other oral health care providers.
Collapse
|
21
|
Rehani MM, Li X. Impact of equipment technology on reference levels in fluoroscopy-guided gastrointestinal procedures. Phys Med 2024; 120:103330. [PMID: 38522409 DOI: 10.1016/j.ejmp.2024.103330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/23/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVES To evaluate the effect of equipment technology on reference point air kerma (Ka,r), air kerma-area product (PKA), and fluoroscopic time for fluoroscopically-guided gastrointestinal endoscopic procedures and establish benchmark levels. METHODS This retrospective study included the consecutive patients who underwent fluoroscopically-guided gastrointestinal endoscopic procedures from May 2016 to August 2023 at a tertiary care hospital in the U.S. Fluoroscopic systems included (a) Omega CS-50 e-View, (b) GE Precision 500D, and (c) Siemens Cios Alpha. Radiation dose was analyzed for four procedure types of endoscopic retrograde biliary, pancreas, biliary and pancreas combined, and other guidance. Median and 75th percentile values were computed using software package R (version 4.0.5, R Foundation). RESULTS This large study analyzed 9,459 gastrointestinal endoscopic procedures. Among four procedure types, median Ka,r was 108.8-433.2 mGy (a), 70-272 mGy (b), and 22-55.1 mGy (c). Median PKA was 20.9-49.5 Gy∙cm2 (a), 13.4-39.7 Gy∙cm2 (b), and 8.91-20.9 Gy∙cm2 (c). Median fluoroscopic time was 2.8-8.1 min (a), 3.6-9.2 min (b), and 2.9-9.4 min (c). Their median value ratio (a:b:c) was 8.5:4.8:1 (Ka,r), 2.7:2.1:1 (PKA), and 1.0:1.1:1 (fluoroscopic time). Median value and 75th percentile are presented for Ka,r, PKA, and fluoroscopic time for each procedure type, which can function as benchmark for comparison for dose optimization studies. CONCLUSION This study shows manifold variation in doses (Ka,r and PKA) among three fluoroscopic equipment types and provides local reference levels (50th and 75th percentiles) for four gastrointestinal endoscopic procedure types. Besides procedure type, imaging technology should be considered for establishing diagnostic reference level. SUMMARY With manifold (2 to 12 times) variation in doses observed in this study among 3 machines, we recommend development of technology-based diagnostic reference levels for gastrointestinal endoscopic procedures.
Collapse
Affiliation(s)
- Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Xinhua Li
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| |
Collapse
|
22
|
Smith-Bindman R, Kang T, Chu PW, Wang Y, Stewart C, Das M, Duong PA, Cervantes L, Lamba R, Lee RK, MacLeod F, Kasraie N, Neill R, Pike P, Roehm J, Schindera S, Chung R, Delman BN, Jeukens CRLPN, Starkey LJ, Szczykutowicz TP. Large variation in radiation dose for routine abdomen CT: reasons for excess and easy tips for reduction. Eur Radiol 2024; 34:2394-2404. [PMID: 37735276 PMCID: PMC10957641 DOI: 10.1007/s00330-023-10076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/22/2023] [Accepted: 06/30/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To characterize the use and impact of radiation dose reduction techniques in actual practice for routine abdomen CT. METHODS We retrospectively analyzed consecutive routine abdomen CT scans in adults from a large dose registry, contributed by 95 hospitals and imaging facilities. Grouping exams into deciles by, first, patient size, and second, size-adjusted dose length product (DLP), we summarized dose and technical parameters and estimated which parameters contributed most to between-protocols dose variation. Lastly, we modeled the total population dose if all protocols with mean size-adjusted DLP above 433 or 645 mGy-cm were reduced to these thresholds. RESULTS A total of 748,846 CTs were performed using 1033 unique protocols. When sorted by patient size, patients with larger abdominal diameters had increased dose and effective mAs (milliampere seconds), even after adjusting for patient size. When sorted by size-adjusted dose, patients in the highest versus the lowest decile in size-adjusted DLP received 6.4 times the average dose (1680 vs 265 mGy-cm) even though diameter was no different (312 vs 309 mm). Effective mAs was 2.1-fold higher, unadjusted CTDIvol 2.9-fold, and phase 2.5-fold for patients in the highest versus lowest size-adjusted DLP decile. There was virtually no change in kV (kilovolt). Automatic exposure control was widely used to modulate mAs, whereas kV modulation was rare. Phase was the strongest driver of between-protocols variation. Broad adoption of optimized protocols could result in total population dose reductions of 18.6-40%. CONCLUSION There are large variations in radiation doses for routine abdomen CT unrelated to patient size. Modification of kV and single-phase scanning could result in substantial dose reduction. CLINICAL RELEVANCE Radiation dose-optimization techniques for routine abdomen CT are routinely under-utilized leading to higher doses than needed. Greater modification of technical parameters and number of phases could result in substantial reduction in radiation exposure to patients. KEY POINTS • Based on an analysis of 748,846 routine abdomen CT scans in adults, radiation doses varied tremendously across patients of the same size and optimization techniques were routinely under-utilized. • The difference in observed dose was due to variation in technical parameters and phase count. Automatic exposure control was commonly used to modify effective mAs, whereas kV was rarely adjusted for patient size. Routine abdomen CT should be performed using a single phase, yet multi-phase was common. • kV modulation by patient size and restriction to a single phase for routine abdomen indications could result in substantial reduction in radiation doses using well-established dose optimization approaches.
Collapse
Affiliation(s)
- Rebecca Smith-Bindman
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA.
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA.
| | - Taewoon Kang
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Philip W Chu
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Yifei Wang
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Carly Stewart
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Marco Das
- Department of Diagnostic and Interventional Radiology, Helios Hospital Duisburg, An Der Abtei 7-11, 47166, Duisburg, Germany
| | - Phuong-Anh Duong
- Department of Radiology, New York University Langone, 6 Ohio Drive, Lake Success, NY, 11042, USA
| | - Luisa Cervantes
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62Nd Avenue, Miami, FL, 33155, USA
| | - Ramit Lamba
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Ryan K Lee
- Department of Radiology, Ground Floor, Einstein Healthcare Network, 5501 Old York Road, Levy Bldg, Philadelphia, PA, 19141, USA
| | - Fiona MacLeod
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Nima Kasraie
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Rebecca Neill
- Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Pavlina Pike
- Huntsville Hospital, 101 Sivley Rd SW, Huntsville, AL, 35801, USA
| | | | - Sebastian Schindera
- Institute of Radiology, Kantonsspital Aarau AG, Tellstrasse 25, 5001, Aarau, Switzerland
| | - Robert Chung
- Department of Demography, University of California Berkeley, 310 Social Sciences Building, Berkeley, CA, 94720-2120, USA
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029-6574, USA
| | - Cécile R L P N Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25 6229 HX, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - L Jay Starkey
- Department of Radiology, St Luke's International Hospital, 9-1 Akashicho, Tokyo, 104-8560, Chuo City, Japan
| | - Timothy P Szczykutowicz
- Departments of Radiology, Medical Physics, and Biomedical Engineering, University of Wisconsin Madison, Madison, WI, USA
| |
Collapse
|
23
|
Krmek N, Környei L, Kralik I, Delić-Brkljačić D, Milošević M, Rode M, Kocsis F, Radeljić V. X-ray Doses in Relation to Body Mass, Indication, and Substrate During Pediatric Electrophysiological Procedures on the Heart. Pediatr Cardiol 2024; 45:804-813. [PMID: 38411709 DOI: 10.1007/s00246-024-03428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/21/2024] [Indexed: 02/28/2024]
Abstract
The main goal of this study is to determine typical values of dose area product (DAP) and difference in the effective dose (ED) for pediatric electrophysiological procedures on the heart in relation to patient body mass. This paper also shows DAP and ED in relation to the indication, the arrhythmia substrate determined during the procedure, and in relation to the reason for using radiation. Organ doses are described as well. The subjects were children who have had an electrophysiological study done with a 3D mapping system and X-rays in two healthcare institutions. Children with congenital heart defects were excluded. There were 347 children included. Significant difference was noted between mass groups, while heavier children had higher values of DAP and ED. Median DAP in different mass groups was between 4.00 (IQR 1.00-14.00) to 26.33 (IQR 8.77-140.84) cGycm2. ED median was between 23.18 (IQR 5.21-67.70) to 60.96 (IQR 20.64-394.04) µSv. The highest DAP and ED in relation to indication were noted for premature ventricular contractions and ventricular tachycardia-27.65 (IQR 12.91-75.0) cGycm2 and 100.73 (IQR 53.31-258.10) µSv, respectively. In arrhythmia substrate groups, results were similar, and the highest doses were in ventricular substrates with DAP 29.62 (IQR 13.81-76.0) cGycm2 and ED 103.15 (IQR 60.78-266.99) µSv. Pediatric electrophysiology can be done with very low doses of X-rays when using 3D mapping systems compared to X-rays-based electrophysiology, or when compared to pediatric interventional cardiology or adult electrophysiology.
Collapse
Affiliation(s)
- Nikola Krmek
- University of Zagreb, School of Medicine, Zagreb, Croatia.
| | - László Környei
- Gottsegen National Cardiovascular Center, Hungarian Paediatric Heart Center, Budapest, Hungary
| | | | | | | | - Mirta Rode
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Flóra Kocsis
- Gottsegen National Cardiovascular Center, Hungarian Paediatric Heart Center, Budapest, Hungary
| | | |
Collapse
|
24
|
Kito S, Suda Y, Tanabe S, Takizawa T, Nagahata T, Tohyama N, Okamoto H, Kodama T, Fujita Y, Miyashita H, Shinoda K, Kurooka M, Shimizu H, Ohno T, Sakamoto M. Radiological imaging protection: a study on imaging dose used while planning computed tomography for external radiotherapy in Japan. JOURNAL OF RADIATION RESEARCH 2024; 65:159-167. [PMID: 38151953 PMCID: PMC10959444 DOI: 10.1093/jrr/rrad098] [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: 08/08/2023] [Revised: 10/10/2023] [Indexed: 12/29/2023]
Abstract
Previous studies have primarily focused on quality of imaging in radiotherapy planning computed tomography (RTCT), with few investigations on imaging doses. To our knowledge, this is the first study aimed to investigate the imaging dose in RTCT to determine baseline data for establishing national diagnostic reference levels (DRLs) in Japanese institutions. A survey questionnaire was sent to domestic RT institutions between 10 October and 16 December 2021. The questionnaire items were volume computed tomography dose index (CTDIvol), dose-length product (DLP), and acquisition parameters, including use of auto exposure image control (AEC) or image-improving reconstruction option (IIRO) for brain stereotactic irradiation (brain STI), head and neck (HN) intensity-modulated radiotherapy (IMRT), lung stereotactic body radiotherapy (lung SBRT), breast-conserving radiotherapy (breast RT), and prostate IMRT protocols. Details on the use of motion-management techniques for lung SBRT were collected. Consequently, we collected 328 responses. The 75th percentiles of CTDIvol were 92, 33, 86, 23, and 32 mGy and those of DLP were 2805, 1301, 2416, 930, and 1158 mGy·cm for brain STI, HN IMRT, lung SBRT, breast RT, and prostate IMRT, respectively. CTDIvol and DLP values in institutions that used AEC or IIRO were lower than those without use for almost all sites. The 75th percentiles of DLP in each treatment technique for lung SBRT were 2541, 2034, 2336, and 2730 mGy·cm for free breathing, breath holding, gating technique, and real-time tumor tracking technique, respectively. Our data will help in establishing DRLs for RTCT protocols, thus reducing imaging doses in Japan.
Collapse
Affiliation(s)
- Satoshi Kito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan
- Department of Radiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Yuhi Suda
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan
- Department of Radiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Satoshi Tanabe
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Takeshi Takizawa
- Department of Radiation Oncology, Niigata Neurosurgical Hospital, 3057 Yamada, Nishi-ku, Niigata 950-1101, Japan
| | - Tomomasa Nagahata
- Radiological Division, Osaka Metropolitan University Hospital, 1-5-7 Asahi-chou, Osaka City, Osaka 545-8586, Japan
| | - Naoki Tohyama
- Division of Medical Physics, Tokyo Bay Makuhari Clinic for Advanced Imaging, Cancer Screening, and High-Precision Radiotherapy, 1-17 Toyosuna, Mihama-ku, Chiba 261-0024, Japan
| | - Hiroyuki Okamoto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takumi Kodama
- Department of Radiation Oncology, Saitama Cancer Center, 780, Ooazakomuro, Ina, Saitama 362-0806, Japan
| | - Yukio Fujita
- Department of Radiation Sciences, Komazawa University, 1-23-1 Komazawa, Setagaya, Tokyo 154-8525, Japan
| | - Hisayuki Miyashita
- Department of Radiation Oncology, St. Marianna University Hospital, 2-16-1, Sugao, Miyamae-ku, Kawasaki City, Kanagawa 216-8511, Japan
| | - Kazuya Shinoda
- Department of Radiation Therapy, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama City, Ibaraki 309-1793, Japan
| | - Masahiko Kurooka
- Department of Radiation Therapy, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Aichi 464-8684, Japan
| | - Takeshi Ohno
- Department of Health Sciences, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan
| | - Masataka Sakamoto
- Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan
| |
Collapse
|
25
|
Huo B, Chen X, Xu Z, He D, Wang J. Exposure frequency and radiation dose from CT examinations in Huaian. RADIATION PROTECTION DOSIMETRY 2024; 200:396-402. [PMID: 38195745 DOI: 10.1093/rpd/ncad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/12/2023] [Accepted: 11/22/2023] [Indexed: 01/11/2024]
Abstract
This study quantified the exposure frequency and established the local diagnostic reference levels (DRLs) for the most common computed tomography (CT) examinations. A combined method census and sampling survey was used to quantify both frequency and radiation dose of CT examinations. Data were acquired through Picture Archiving and Communication System (PACS) or Radiology Information System (RIS). The annual frequency of CT examinations was 239.8 per 1000 inhabitants. The P75 of volume CT dose index (CTDIvol) to adult patients from CT scanning for head, chest, abdomen and lumbar spine examinations were 63.0, 12.4, 20.0 and 24.0 mGy, respectively. The P75 of dose-length product were 858.6, 416.0, 620.7 and 559.2 mGy·cm, respectively. This dose audit of CT practice can act as a starting point for establishing Huaian local DRLs and could be a reference for dose optimisation in China. This study compared DRLs in different countries and analysed some reasons for the rapid growth of CT examination frequency in Huaian.
Collapse
Affiliation(s)
- Binbin Huo
- Occupational Health Division, Huaian Center for Disease Control and Prevention, Huaian, Jiangsu 223002, China
| | - Xiaomin Chen
- Occupational Health Division, Huaian Center for Disease Control and Prevention, Huaian, Jiangsu 223002, China
| | - Zhiyong Xu
- Occupational Health Division, Huaian Center for Disease Control and Prevention, Huaian, Jiangsu 223002, China
| | - Dongdong He
- Occupational Health Division, Huaian Center for Disease Control and Prevention, Huaian, Jiangsu 223002, China
| | - Jin Wang
- Radiation Protection Institute, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu 221005, China
| |
Collapse
|
26
|
Simantirakis G, Hourdakis CJ, Kalathaki M, Liotsou V, Nikolaou M, Pafilis C, Thrapsanioti Z, Tritakis P, Carinou E. Updating national diagnostic reference levels for computed tomography in Greece: Challenges on patient protection optimisation. Eur J Radiol 2024; 175:111429. [PMID: 38508091 DOI: 10.1016/j.ejrad.2024.111429] [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: 11/28/2023] [Revised: 01/18/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
The escalating use of Computed Tomography (CT) imaging necessitates establishment and periodic revision of Diagnostic Reference Levels (DRLs) to ensure patient protection optimization. This paper presents the outcomes of a national survey conducted from 2019 to 2022, focusing on revising DRLs for adult CT examinations. Dosimetric data from 127 scanners in 120 medical facilities, representing 25% of the country's CT scanners, were collected, emphasizing geographic distribution and technology representation. Τhe parameters used for DRLs were the CTDIvol and the DLP of a typical acquisition of the region of interest (scan DLP). In addition to the 7 CT examination for which the DRL values were revised, establishment of DRLs for neck, cervical spine, pelvic bones-hips, coronary artery calcium (Ca) score and cardiac computed tomography angiography (CCTA) examinations was performed. Revised DRLs exhibited a 15 % average decrease in CTDIvol and a 7 % average decrease in scan DLP from the initial DRLs. This reduction of dosimetric values is relatively low compared to other national studies. The findings revealed wide variations in dosimetric values and scan lengths among scanners, emphasizing the need for standardization and optimization. Incorporation of advanced technologies like Iterative Reconstruction (IR) showcased potential for further dose reduction, yet challenges in uniform implementation persist. The study underscores the importance of ongoing optimisation efforts, particularly in the context of increased CT utilization and evolving technology. The revised DRLs have been officially adopted in Greece, emphasizing the commitment to safe and effective CT practices.
Collapse
Affiliation(s)
- George Simantirakis
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece.
| | - Costas J Hourdakis
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Maria Kalathaki
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Vasiliki Liotsou
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Magda Nikolaou
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Christos Pafilis
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Zoi Thrapsanioti
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Panagiotis Tritakis
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Eleftheria Carinou
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| |
Collapse
|
27
|
Alhorani Q, Alkhybari E, Rawashdeh M, Sabarudin A, Latiff RA, Al-Ibraheem A, Mohamad M. National and local diagnostic reference levels for adult 18F-FDG and CT in Jordanian PET/CT: findings and implications in practice. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:011512. [PMID: 38387102 DOI: 10.1088/1361-6498/ad2c62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/22/2024] [Indexed: 02/24/2024]
Abstract
This study aims to report the findings of Jordanian national diagnostic reference level (NDRL) survey for fluorodeoxyglucose (18F-FDG) and local diagnostic reference level (LDRL) of computed tomography (CT) used for attenuation correction and anatomical localisation (AC-AL); and AC and diagnostic CT (AC-DX) within the context of whole-body WB and half-body HB adult oncology PET/CT scanning. Two-structured questionnaires were prepared to gather the necessary information: dosimetry data, patient demographics, equipment specification, and acquisition protocols for identified18F-FDG PET/CT procedures. The NDRL and achievable dose were reported based on the 75th and 50th percentiles for18F-FDG administered activity (AA), respectively. The LDRL was reported based on the 50th percentile for (CTDIvol) and (DLP). Data from 562 patients from four Jordanian PET/CT centres were collected. The survey revealed that Jordanian NDRL for AA (303 MBq) was within the acceptable range compared to the published-peer NDRL data (240-590 MBq). However, the18F-FDG AA varied across the participated PET/CT centres. The reported LDRL CTDIvoland DLP of CT used for (AC-AL) was 4.3 mGy and 459.3 mGy.cm for HB CT scan range, and 4.1 mGy and 659.9 mGy.cm for WB CT scans. The reported LDRL for CTDIvoland DLP for HB CT was higher when compared with the United Kingdom (3.2 mGy and 310 mGy.cm). Concurrently, in the context of WB CT, the reported values (i.e. CTDIvol and DLP) were also higher than both Kuwait (3.6 mGy and 659 mGy.cm) and Slovenia (3.6 mGy and 676 mGy.cm). The reported HB CT(AC-DX) was higher than Nordic, New Zealand and Swiss NDRLs and for WB (AC-DX) CT it was higher than Swiss NDRLs. This study reported the first Jordanian NDRL for18F-FDG and LDRL for HB and WB CT associated with18F-FDG PET/CT scans. This data is useful for Jordanian PET/CT centres to compare their LDRL to the suggested DRLs and utilise it in the process of optimising CT radiation doses.
Collapse
Affiliation(s)
- Qays Alhorani
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Essam Alkhybari
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohammad Rawashdeh
- Radiologic Technology Program, Applied Medical Sciences College, Jordan University of Science and Technology, Irbid, Jordan
- Faculty of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Akmal Sabarudin
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rukiah A Latiff
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mazlyfarina Mohamad
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
28
|
Kamdem EF, Fotue AJ, Kouam BBF, Abogo S, Samba ON. Estimation of diagnostic reference levels for pediatric head computed tomography in Yaoundé. RADIATION PROTECTION DOSIMETRY 2024; 200:259-263. [PMID: 38088439 DOI: 10.1093/rpd/ncad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 03/05/2024]
Abstract
The diagnostic reference levels (DRLs) are determined from dosimetry studies to compare and manage patient doses in medical imaging procedures. The aim of this work was to establish the first DRLs for pediatric patients during the most common computed tomography (CT) procedures in Yaoundé, Cameroon during routine head CT examinations to know how to improve our clinical practice tomorrow. The sample was classified per age group: ≤ 1-, 1-5-, 5-10- and 10-15-y-old. The retrospective study was used. The proposed DRLs were defined as 75th percentile of the median values of the distributions. In terms of Volume CT Dose Index (CTDIvol) and dose length product (DLP), the DRLs obtained for the ages groups were: 28.6 mGy and 545.8 mGy.cm, 32.6 mGy and 735 mGy.cm, 37.1 mGy and 761.6 mGy.cm and 44.2 mGy and 1081.2 mGy.cm, respectively. DRLs in Yaoundé for DLP were higher than those of comparison literatures. The Yaoundé CTDIvol was higher than the comparison literatures except for the IAEA (2015) values for the three older age groups. The DRLs reported in Yaoundé were compared to Morocco 2020, Switzerland 2018, IAEA 2015 and Iran 2020 values. The estimation of this first DRL for pediatric head CT scan in Yaoundé must be a starting point to spread this investigation towards other examinations and imaging modalities across the country. Therefore, optimization of the CT scan procedures and orderly updates of local DRLs are necessary to improve radioprotection.
Collapse
Affiliation(s)
- Eddy F Kamdem
- Condensed Matter, Electronics and Signal Processing Research Unit, Department of Physics, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Alain J Fotue
- Condensed Matter, Electronics and Signal Processing Research Unit, Department of Physics, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Brice B F Kouam
- Department of Radiology, Yaoundé General Hospital, Yaoundé, Cameroon
| | - Serge Abogo
- Department of Radiology, Bafoussam Regional Hospital, Bafoussam, Cameroon
| | - Odette N Samba
- Department of Radiography, National Social Insurance Fund Hospital, Yaoundé, Cameroon
| |
Collapse
|
29
|
Zarghani H, Pandesh S, Jabbari M. A review of 20 years publication in the field of radiation protection in diagnostic radiology in Iran. RADIATION PROTECTION DOSIMETRY 2024; 200:285-293. [PMID: 38123478 DOI: 10.1093/rpd/ncad300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
In recent years, knowing the risks of stochastic effects of radiation, patient dose in diagnostic radiology is taken in to consideration extensively. Many countries and international organization, including International Commission on Radiological Protection, use quantities such as dose area product, entrance surface dose, etc. in radiological investigations, which serve as a guide for patient dose reduction. The concept of diagnostic reference level (DRL) is used to optimizing the dose of patients undergoing diagnostic radiology examinations. The present study aimed to review the studies on the DRLs in Iran. This study was conducted to review the status of patient dose in diagnostic radiology in Iran. A comprehensive literature search was performed without time constraints in the popular databases such as Google Scholar, Medline, Embase, PubMed, Irandoc, Iran Medex, Magiran and Scientific Information Database under the key words 'Entrance Surface Dose', 'dose area product, 'diagnostic reference level' and 'DRL' in Iran. Data on the radiation dose to patients has demonstrated further reductions in patient doses in the Iran. Considering advanced techniques and dose reduction methodologies complicates comparability between studies. Joint efforts of experts in the field of radiological protection and medical imaging and training program are necessary for achieving an acceptable condition.
Collapse
Affiliation(s)
- Hassan Zarghani
- Department of Radiology Technology, School of Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Ghafari street, 971785307, Birjand, Iran
- Department of Medical Physics, School of Allied Medical Sciences, Sabzevar University of Medical Sciences, Sabzevar, Assad abadi street, 4401100, Iran
| | - Sajjad Pandesh
- Department of Radiology Technology, School of Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Ghafari street, 971785307, Birjand, Iran
| | - Masoud Jabbari
- Department of Radiology Technology, School of Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Ghafari street, 971785307, Birjand, Iran
| |
Collapse
|
30
|
Cadavid L, Karout L, Kalra MK, Morgado F, Londoño MA, Pérez L, Galeano M, Montaño M, Wesley L, Almanza J, Pacheco W, Gómez L, Moscatelli A, Muglia V, Kiipper F, Lucena R, Bernardo M, Ugas C. Setting up regional diagnostic reference levels for pediatric computed tomography in Latin America: preliminary results, challenges and the work ahead. Pediatr Radiol 2024; 54:457-467. [PMID: 37227466 DOI: 10.1007/s00247-023-05676-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/26/2023]
Abstract
We established a framework for collecting radiation doses for head, chest and abdomen-pelvis computed tomography (CT) in children scanned at multiple imaging sites across Latin America with an aim towards establishing diagnostic reference levels (DRLs) and achievable doses (ADs) in pediatric CT in Latin America. Our study included 12 Latin American sites (in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Honduras and Panama) contributing data on the four most common pediatric CT examinations (non-contrast head, non-contrast chest, post-contrast chest and post-contrast abdomen-pelvis). Sites contributed data on patients' age, sex and weight, scan factors (tube current and potential), volume CT dose index (CTDIvol) and dose length product (DLP). Data were verified, leading to the exclusion of two sites with missing or incorrect data entries. We estimated overall and site-specific 50th (AD) and 75th (diagnostic reference level [DRL]) percentile CTDIvol and DLP for each CT protocol. Non-normal data were compared using the Kruskal-Wallis test. Sites contributed data from 3,934 children (1,834 females) for different CT exams (head CT 1,568/3,934, 40%; non-contrast chest CT 945/3,934, 24%; post-contrast chest CT 581/3,934, 15%; abdomen-pelvis CT 840/3,934, 21%). There were significant statistical differences in 50th and 75th percentile CTDIvol and DLP values across the participating sites (P<0.001). The 50th and 75th percentile doses for most CT protocols were substantially higher than the corresponding doses reported from the United States of America. Our study demonstrates substantial disparities and variations in pediatric CT examinations performed in multiple sites in Latin America. We will use the collected data to improve scan protocols and perform a follow-up CT study to establish DRLs and ADs based on clinical indications.
Collapse
Affiliation(s)
- Lina Cadavid
- Department of Radiology, Hospital Pablo Tobón Uribe, Calle 78B#69-240, Medellín, Antioquia, 050034, Colombia.
| | - Lina Karout
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mannudeep K Kalra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Flavio Morgado
- Pontificie Universidade Católica de São Paulo, São Paulo, Brazil
| | - María Antonieta Londoño
- Universidad Nacional de Colombia/Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
| | - Lizbeth Pérez
- Department of Radiology, Clinica alemana de Santiago - Universidad del Desarrollo, Santiago de Chile, Chile
| | - Monica Galeano
- Department of Radiology, Hospital del Niño Prof Dr. Ramón Exeni, La Matanza provincia de Buenos Aires, Argentina
| | - Mario Montaño
- Department of Radiology, Hospital Santa Cruz C.P.S, Santa Cruz de la Sierra, Bolivia
| | - Lavinia Wesley
- Department of Radiology, Hospital del Niño Dr. José Renán Esquivel, Ciudad de Panamá, Panamá
| | - Judith Almanza
- Department of Radiology, Salud Digna., Ciudad de México, México
| | - Walter Pacheco
- Department of Radiology, Maria Hospital, Pediatric Specialties, Tegucigalpa, Honduras
| | - Lucia Gómez
- Department of Radiology, Hospital Metropolitano, Quito, Ecuador
| | | | - Valdair Muglia
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | - Monica Bernardo
- Pontifícia Universidade Católica de São Paulo, Hospital Miguel Soeiro, Sorocaba, Brazil
| | - Carlos Ugas
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| |
Collapse
|
31
|
Alzyoud K, Al-Murshedi S, England A. Diagnostic Reference Levels of Radiographic and CT Examinations in Jordan: A Systematic Review. HEALTH PHYSICS 2024; 126:156-162. [PMID: 38252949 DOI: 10.1097/hp.0000000000001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
ABSTRACT A comprehensive search was performed to examine the literature on diagnostic reference levels (DRL) for computed tomography (CT) and radiography examinations that are performed routinely in Jordan. EBSCO, Scopus, and Web of Science were used for the search. The acronym "DRL" and the additional phrase "dose reference levels" were used to search for articles in literature. Seven papers that reported DRL values for radiography and CT scans in Jordan were identified. One study reported DRLs for conventional radiography, two studies reported CT DRLs in pediatrics, and the remaining four studies provided DRL values for adult CT scans. The most popular techniques for determining the DRLs were the entrance surface dose, volume CT dose index (CTDIvol), and dose-length product (DLP) values. Variations in Jordanian DRL values were noted across both modalities. Lower radiation doses and less variation in DRL values may be achieved by educating and training radiographers to better understand dose reduction strategies. To limit dose variance and enable dosage comparison, CT DRLs must be standardized in accordance with the guidelines of the International Commission on Radiological Protection (ICRP).
Collapse
Affiliation(s)
- Kholoud Alzyoud
- Department of Medical Imaging, Faculty of Applied Health science, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
| | - Sadeq Al-Murshedi
- AL-Zahraa University for Women, College of Health and Medical Technology, Karbala, Iraq
| | | |
Collapse
|
32
|
Xu H, Sun QF, Yue BR, Cheng JS, Niu YT. Results and analysis of examination doses for paediatric CT procedures based on a nationwide survey in China. Eur Radiol 2024; 34:1659-1666. [PMID: 37672054 DOI: 10.1007/s00330-023-10005-7] [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: 05/18/2022] [Revised: 05/14/2023] [Accepted: 06/07/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE To report the results of a dose survey conducted across 31 provinces in mainland China from 2017 to 2018 and to analyse the dose level to determine the national diagnostic reference levels (DRLs) for paediatric CT procedures. METHODS At least ten patients for each age group (0- < 1, 1- < 5, 5- < 10, 10- < 15 years) and each procedure (head, chest and abdomen) for each CT scanner were selected from four to eight hospitals in each province. The dose information (CTDIvol and DLP) was collected from the HIS or RIS-PACS systems. The median values in each CT scanner were considered the representative dose values for the paediatric patients in CT scanning. The national DRLs were estimated based on the 75th percentile distribution of the median values. RESULTS A total of 24,395 patients and 319 CT scanners were investigated across 262 hospitals. For paediatric CT scanning in 4 different age groups, the median (P50) and the 75th percentile (P75) of CTDIvol and DLP for each scanning procedure were calculated and reported. National DRLs were then proposed for each procedure and age group. CONCLUSION The dose level of CT scanning for children in mainland China was reported for the first time. The DRLs for paediatric CT in the present study are similar to those in some Asian countries but higher than those in European countries. CLINICAL RELEVANCE STATEMENT The paediatric CT is an extensively used tool in diagnosing paediatric disease; however, children are more sensitive to radiation. Establishing the diagnostic reference level of paediatric CT examination is necessary to reduce the dose of CT in children and promote the optimisation of medical exposure. KEY POINTS • The DRLs for 3 paediatric CT procedures (head, chest and abdomen) and 4 age groups (0- < 1, 1- < 5, 5- < 10, 10- < 15 years) were proposed in mainland China first time. • The examination parameter and dose for children need to be further optimised in China, especially to lower the tube voltage in paediatric CT.
Collapse
Affiliation(s)
- Hui Xu
- Key Laboratory of Radiological Protection and Nuclear Emergency Chinese Center for Disease Control and Prevention, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, 100088, China
| | - Quan-Fu Sun
- Key Laboratory of Radiological Protection and Nuclear Emergency Chinese Center for Disease Control and Prevention, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, 100088, China.
| | - Bao-Rong Yue
- Key Laboratory of Radiological Protection and Nuclear Emergency Chinese Center for Disease Control and Prevention, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, 100088, China
| | - Jin-Sheng Cheng
- Key Laboratory of Radiological Protection and Nuclear Emergency Chinese Center for Disease Control and Prevention, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, 100088, China
| | - Yan-Tao Niu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| |
Collapse
|
33
|
Iball GR, Beeching CE, Gabe R, Tam HZ, Darby M, Crosbie PAJ, Callister MEJ. An evaluation of CT radiation doses within the Yorkshire Lung Screening Trial. Br J Radiol 2024; 97:469-476. [PMID: 38308037 DOI: 10.1093/bjr/tqad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/05/2023] [Accepted: 11/28/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To evaluate radiation doses for all low-dose CT scans performed during the first year of a lung screening trial. METHODS For all lung screening scans that were performed using a CT protocol that delivered image quality meeting the RSNA QIBA criteria, radiation dose metrics, participant height, weight, gender, and age were recorded. Values of volume CT dose index (CTDIvol) and dose length product (DLP) were evaluated as a function of weight in order to assess the performance of the scan protocol across the participant cohort. Calculated effective doses were used to establish the additional lifetime attributable cancer risks arising from trial scans. RESULTS Median values of CTDIvol, DLP, and effective dose (IQR) from the 3521 scans were 1.1 mGy (0.70), 42.4 mGycm (24.9), and 1.15 mSv (0.67), whilst for 60-80kg participants the values were 1.0 mGy (0.30), 35.8 mGycm (11.4), and 0.97 mSv (0.31). A statistically significant correlation between CTDIvol and weight was identified for males (r = 0.9123, P < .001) and females (r = 0.9052, P < .001), however, the effect of gender on CTDIvol was not statistically significant (P = .2328) despite notable differences existing at the extremes of the weight range. The additional lifetime attributable cancer risks from a single scan were in the range 0.001%-0.006%. CONCLUSIONS Low radiation doses can be achieved across a typical lung screening cohort using scan protocols that have been shown to deliver high levels of image quality. The observed dose levels may be considered as typical values for lung screening scans on similar types of scanners for an equivalent participant cohort. ADVANCES IN KNOWLEDGE Presentation of typical radiation dose levels for CT lung screening examinations in a large UK trial. Effective radiation doses can be of the order of 1 mSv for standard sized participants. Lifetime attributable cancer risks resulting from a single low-dose CT scan did not exceed 0.006%.
Collapse
Affiliation(s)
- Gareth R Iball
- Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, United Kingdom
- Department of Medical Physics & Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, LS1 3EX, United Kingdom
| | - Charlotte E Beeching
- Department of Medical Physics & Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, LS1 3EX, United Kingdom
| | - Rhian Gabe
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, United Kingdom
| | - Hui Zhen Tam
- Barts Clinical Trials Unit, Wolfson Institute of Population Health, Queen Mary University of London, EC1M 6BQ, United Kingdom
| | - Michael Darby
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
| | - Philip A J Crosbie
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, M13 9NT, United Kingdom
| | - Matthew E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
| |
Collapse
|
34
|
Albahiti SK, Khafaji M, Batawil N, Catipay N, Alsafi K. Enhancing Nuclear Medicine Practice in Saudi Arabia: Advocating for Comprehensive Guidelines and Local Diagnostic Reference Levels. Cureus 2024; 16:e54230. [PMID: 38496147 PMCID: PMC10944312 DOI: 10.7759/cureus.54230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Diagnostic reference levels (DRLs) were initially introduced by the International Commission on Radiation Protection (ICRP). It refers to the measured quantity of administered activity (MBq) in nuclear medicine imaging studies and is a type of investigation level. DRL is recommended to prevent excessive radiation exposure to patients while maintaining adequate image quality. It should not be implemented as a dose constraint or dose limit. The Saudi Food and Drug Authority (SFDA) is the primary government body responsible for reporting national diagnostic reference levels (NDRLs) for diagnostic medical imaging technologies in Saudi Arabia. Only NDRLs for computed tomography, general X-ray, and mammography have been published and enforced locally. This study aims to establish local DRLs for nuclear medicine imaging procedures at King Abdulaziz University Hospital, Saudi Arabia, preparing for compliance proof once required by local authorities. METHOD Data were collected from all machines, and six common protocols were studied, with data from 50 patients of standard body size for each identified protocol. The study was conducted retrospectively, and the 50th percentile was then calculated for each scan. RESULTS Both protocols for renal scans administered the lowest doses to patients (130 MBq and 148 MBq), respectively. The highest dose administered to patients was found to be in bone scans (1110 MBq). CONCLUSION The study establishes local DRLs for nuclear medicine imaging in our institution. Median activity dosages in renal, thyroid, and parathyroid imaging were comparable to locally and internationally published DRLs. However, they are higher in cardiac and bone imaging compared to local Saudi DRL and DRL in the European Union and the USA, likely due to the adopted protocols. These highlight the need for modifying the protocols to fulfill optimization efforts. These findings serve as a foundation for compliance with future regulatory requirements, ensuring patient safety and maintaining imaging quality in Saudi healthcare.
Collapse
Affiliation(s)
| | - Mawya Khafaji
- Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | - Norwin Catipay
- Radiology, King Abdulaziz University Hospital, Jeddah, SAU
| | | |
Collapse
|
35
|
D'Ercole L, Rosi A, Bernardi G, Compagnone G, Orlacchio A, Padovani R, Palma A, Grande S. National survey to update the diagnostic reference levels in interventional radiology procedures in Italy: working methodology. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:011505. [PMID: 38232403 DOI: 10.1088/1361-6498/ad1fe1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/17/2024] [Indexed: 01/19/2024]
Abstract
Interventional Radiology (IR) deals with the diagnosis and treatment of various diseases through medically guided imaging. It provides unquestionable benefits to patients, but requires, in many cases, the use of high doses of ionizing radiation with a high impact on radiation risks to patients and to overall dose to the population. The International Commission on Radiological Protection introduced Diagnostic reference levels (DRLs) as an effective tool to facilitate dose verification and optimize protection for patients undergoing radiological procedures. In addition, EURATOM Council Directive 2013/59 and its Italian transposition (Legislative Decree 101/2020) have reiterated that DRLs must be established for many common radiological diagnostic procedures to compare the radiation dose delivered for the same diagnostic examination. Within this framework, Istituto Superiore di Sanità-Italian National Institute of Health (ISS)-, in collaboration with relevant Italian Scientific Societies, has provided documents on DRLs in radiological practices such as diagnostic and IR and diagnostic nuclear medicine. These reference documents enable National Hospitals to comply national regulation. The implementation of DRLs in IR is a difficult task because of the wide distribution of doses to patients even within the same procedure. Some studies have revealed that the amount of radiation in IR procedures is influenced more by the complexity of the procedure than by the weight of the patient, so complexity should be included in the definition of DRLs. For this reason, ISS promoted a survey among a sample of Italian Centers update national DRL in IR procedures with related complexity factors than can be useful for other radiological centers and to standardize the DRLs values. In the present paper the procedural methodology developed by ISS and used for the survey will be illustrated.
Collapse
Affiliation(s)
- L D'Ercole
- S.C. Fisica Sanitaria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Rosi
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, Roma, Italy
| | - G Bernardi
- Struttura Sanitaria Polimedica di CODESS Friuli-Venezia Giulia, Pradamano (Udine), Italy
| | - G Compagnone
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Orlacchio
- Department of Surgical Science, 'Tor Vergata' University-Emergency Radiology-University Hospital 'Tor Vergata', Rome, Italy
| | - R Padovani
- International Center for Theoretical Physics, Trieste, Italy
| | - A Palma
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, Roma, Italy
| | - S Grande
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, Roma, Italy
| |
Collapse
|
36
|
Yagahara A, Ando D, Oda M. Demonstration of Japanese radiographic examination codes in establishing typical values for a wide variety of general radiography examinations. Sci Rep 2024; 14:2249. [PMID: 38278840 PMCID: PMC10817891 DOI: 10.1038/s41598-024-52294-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/16/2024] [Indexed: 01/28/2024] Open
Abstract
The purpose of this study was to demonstrate Japanese radiographic examination codes JJ1017 in establishing typical values for a wide variety of general radiography. About 200,000 sets of examination data were collected, including exposure conditions, JJ1017 code applied, examination room numbers and patient information. Typical values for adults, children, and infants were calculated from the collected data, and the following items were examined: comparing typical values of general radiography in Japan DRLs 2015 and typical values in a facility; comparison of typical values between X-ray equipment for examinations of DRLs 2015; comparison of typical values for different procedures at the same anatomical site; identification of examination items associated with high radiation doses. The total numbers of JJ1017 codes applicable to the examinations were 45,372 for adults, 542 for children, and 2339 for infants. To calculate the typical values and compare these with the DRLs, we used a combination of JJ1017 anatomical codes, posture codes, and direction of radiation codes. The combination of these codes allowed the calculation of a typical value and comparison with DRLs 2015. Comparison between devices reveals differences in radiation doses and provides an opportunity to review the characteristics of the devices and their operation to suggest dose reductions. By calculating typical values for examination items for which the DRLs were not available, we were able to identify examination items with high doses in a facility and suggest items that should be audited in the facility.
Collapse
Affiliation(s)
- Ayako Yagahara
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Japan.
| | - Daisuke Ando
- Department of Radiology, Southern TOHOKU Proton Therapy Center, Koriyama, Japan
| | - Makoto Oda
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Japan
| |
Collapse
|
37
|
Nassar J, Rizk C, Fares G, Tohme C, Braidy C, Farah J. Clinical image quality assessment and mean glandular dose for full field digital mammography. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:011503. [PMID: 38194904 DOI: 10.1088/1361-6498/ad1cd4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/09/2024] [Indexed: 01/11/2024]
Abstract
This study aims to assess the image quality (IQ) of 12 mammographic units and to identify units with potential optimisation needs. Data for 350 mammography examinations meeting inclusion criteria were collected retrospectively from April 2021 to April 2022. They were categorised based on the medical reports into 10 normal cases, 10 cases displaying calcifications and 10 cases presenting lesions. Two radiologists assessed the IQ of 1400 mammograms, evaluating system performance per Boitaet al's study and positioning performance following European guidelines. To measure agreement between the two radiologists, the Cohen's Kappa coefficient (κ) was computed, quantifying the excess of agreement beyond chance. The visual grading analysis score (VGAS) was computed to compare system and positioning performance assessments across different categories and facilities. Median average glandular dose (AGD) values for cranio caudal and medio lateral oblique views were calculated for each category and facility and compared to the national diagnostic reference levels. The health facilities were categorised by considering both IQ VGAS and AGD levels. Inter-rater agreement between radiologists ranged from poor (κ< 0.20) to moderate (0.41 <κ< 0.60), likely influenced by inherent biases and distinct IQ expectations. 50% of the facilities were classified as needing corrective actions for their system performance as they had IQ or high AGD that could increase recall rate and radiation risk and 50% of the health facilities exhibited insufficient positioning performance that could mask tumour masses and microcalcifications. The study's findings emphasise the importance of implementing quality assurance programs to ensure optimal IQ for accurate diagnoses while adhering to radiation exposure guidelines. Additionally, comprehensive training for technologists is essential to address positioning challenges. These initiatives collectively aim to enhance the overall quality of breast imaging services, contributing to improved patient care.
Collapse
Affiliation(s)
- Joyce Nassar
- Faculty of Sciences, Saint-Joseph University, PO Box 11-514, Riad El Solh, Beirut 1107 2050, Lebanon
| | - Chadia Rizk
- Faculty of Sciences, Saint-Joseph University, PO Box 11-514, Riad El Solh, Beirut 1107 2050, Lebanon
- Lebanese Atomic Energy Commission, National Council for Scientific Research, 11-8281 Beirut, Lebanon
| | - Georges Fares
- Faculty of Sciences, Saint-Joseph University, PO Box 11-514, Riad El Solh, Beirut 1107 2050, Lebanon
| | - Carla Tohme
- Radiology Department, Hôtel-Dieu de France Hospital, PO Box 166830, Beirut, Lebanon
| | - Chady Braidy
- Radiology Department, Hôtel-Dieu de France Hospital, PO Box 166830, Beirut, Lebanon
| | - Jad Farah
- Vision RT Ltd, Dove House, Arcadia Ave, Finchley, London N3 2JU, United Kingdom
| |
Collapse
|
38
|
Osawa M, Nagata A, Saijo T, Yamada T, Sugimoto N, Tokudome A, Suzuki K, Sakamoto H. [Questionnaire Survey on IVR Dose Management in Tokai Region]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:66-76. [PMID: 37967943 DOI: 10.6009/jjrt.2024-1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
PURPOSE National diagnostic reference levels in Japan 2020 (DRLs 2020) have been published. In the field of angiography, in addition to the fluoroscopic dose rate, incident air kerma at the patient entrance reference point displayed on the equipment (Ka,r: mGy) and air kerma-area product displayed on the equipment (PKA: Gycm2) were set. A questionnaire survey was conducted at each facility in the Tokai region to confirm the status of medical radiation dose control in the region. METHOD A questionnaire survey was conducted at each facility in the Tokai region. The items were fluoroscopic dose rate in each area (head and neck, cardiac, chest and abdomen, and limbs), DA and DSA dose rates, and dose area product meter (Ka,r, PKA) for the main procedures in each area. RESULT The median values in this study were lower than those in the DRLs 2020, indicating that appropriate dose control is being implemented in the Tokai region. The trends of fluoroscopic and radiographic dose rates were different in each area, and there was some variation among the facilities. CONCLUSION We believe that the incorporation of fluoroscopic and radiographic dose rates by area into the DRLs will facilitate more appropriate dose control at each facility in the future.
Collapse
Affiliation(s)
| | | | - Takaya Saijo
- Division of Radiology, Department of Medical Technology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital
| | | | - Naruto Sugimoto
- Radiological Technology, Department of Medical Technique, Nagoya University Hospital
| | | | - Kosuke Suzuki
- Central Department of Radiology, Gifu Prefectural Tajimi Hospital
| | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| |
Collapse
|
39
|
Osman ND, Abdulkadir MK, Shuaib IL, Nasirudin RA. Evaluation of a new predictive equation for automated calculation of size-specific dose estimate (SSDE) in CT imaging. Radiography (Lond) 2024; 30:237-244. [PMID: 38035439 DOI: 10.1016/j.radi.2023.11.012] [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: 06/30/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The adoption of size-specific dose estimate (SSDE) in clinical practice is still limited owing to the tedious and complex manual measurement of individual patient size for the clinical calculation of SSDE. Thus, the automation of SSDE is imperative. This study aims to evaluate a predictive equation for the automated calculation of SSDE. METHODS A user-friendly software was developed to accurately predict the individual size-specific dose estimation of paediatric patients undergoing computed tomography (CT) scans of the head, thorax, and abdomen. The software includes a calculation equation developed based on a novel SSDE prediction equation that used a population's pre-determined percentage difference between volume-weighted computed tomography dose index (CTDIvol) and SSDE with age. American Association of Physicists in Medicine (AAPM RPT 204) method (manual) and segmentation-based SSDE calculators (indoseCT and XXautocalc) were used to assess the proposed software predictions comparatively. RESULTS The results of this study show that the automated equation-based calculation of SSDE and the manual and segmentation-based calculation of SSDE are in good agreement for patients. The differences between the automated equation-based calculation of SSDE and the manual and segmentation-based calculation are less than 3%. CONCLUSION This study validated an accurate SSDE calculator that allows users to enter key input values and calculate SSDE. IMPLICATION FOR PRACTICE The automated equation-based SSDE software (PESSD) seems a promising tool for estimating individualised CT doses during CT scans.
Collapse
Affiliation(s)
- N D Osman
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, 13200, Penang, Malaysia
| | - M K Abdulkadir
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, 13200, Penang, Malaysia; Department of Radiography, Faculty of Basic Clinical Sciences, University of Ilorin, 240213 Ilorin, Nigeria.
| | - I L Shuaib
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, 13200, Penang, Malaysia
| | - R A Nasirudin
- Department of Radiography, Faculty of Basic Clinical Sciences, University of Ilorin, 240213 Ilorin, Nigeria
| |
Collapse
|
40
|
Tsitsiou Y, Velan B, Ross R, Lakshminarayan R, Rogers A, Hamady M. National UK Survey of Radiation Doses During Endovascular Aortic Interventions. Cardiovasc Intervent Radiol 2024; 47:92-100. [PMID: 37968425 PMCID: PMC10770209 DOI: 10.1007/s00270-023-03592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE Endovascular aortic repair (EAR) interventions, endovascular abdominal aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), are associated with significant radiation exposures. We aimed to investigate the radiation doses from real-world practice and propose diagnostic reference level (DRL) for the UK. MATERIALS AND METHODS Radiation data and essential demographics were retrospectively collected from 24 vascular and interventional radiology centres in the UK for all patients undergoing EAR-standard EVAR or complex, branched/fenestrated (BEVAR/FEVAR), and TEVAR-between 2018 and 2021. The data set was further categorised according to X-ray unit type, either fixed or mobile. The proposed national DRL is the 75th percentile of the collective medians for procedure KAP (kerma area product), cumulative air kerma (CAK), fluoroscopy KAP and CAK. RESULTS Data from 3712 endovascular aortic procedures were collected, including 2062 cases were standard EVAR, 906 cases of BEVAR/FEVAR and 509 cases of TEVAR. The majority of endovascular procedures (3477/3712) were performed on fixed X-ray units. The proposed DRL for KAP was 162 Gy cm2, 175 Gy cm2 and 266 Gy cm2 for standard EVAR, TEVAR and BEVAR/FEVAR, respectively. CONCLUSION The development of DRLs is pertinent to EAR procedures as the first step to optimise the radiation risks to patients and staff while maintaining the highest patient care and paving the way for steps to reduce radiation exposures.
Collapse
Affiliation(s)
- Yvonne Tsitsiou
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, Praed St, London, W2 1NY, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Bar Velan
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, Praed St, London, W2 1NY, UK
| | - Rebecca Ross
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, Praed St, London, W2 1NY, UK
| | | | - Andy Rogers
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mohamad Hamady
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, Praed St, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
41
|
Gizewski ER, Verius M, Rehani MM, Jaschke W. Cumulative Effective Dose During Fluoroscopically Guided Interventions (FGI): Analysis of More Than 5000 FGIs in a Single European Center. Cardiovasc Intervent Radiol 2024; 47:101-108. [PMID: 38110753 DOI: 10.1007/s00270-023-03604-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/23/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The number of fluoroscopically guided interventions (FGI) has increased significantly over time. However, little attention has been paid to possible stochastic radiation effects. The aim of this retrospective study was to investigate the number of patients who received cumulative effective doses over 100 mSv during FGI procedures. MATERIAL AND METHODS Five thousand five hundred and fifty four classified FGI procedures were included. Radiation dose data, retrieved from an in-house-dose-management system, was analysed. Effective doses and cumulative effective doses (CED) were calculated. Patients who received a CED > 100 mSv were identified. Radiology reports, patient age, imaging and clinical data of these patients were used to identify reasons for CED ≥ 100 mSv. RESULTS One Hundred and thirty two (41.1% female) of 3981 patients received a CED > 100 mSy, with a mean CED of 173.5 ± 84.5 mSv. Mean age at first intervention was 66.1 ± 11.7 years. 81 (61.4%) of 132 were older than 64 years, one patient was < 30 years. 110 patients received ≥ 100 mSv within one year (83.4%), through FGIs: EVAR, pelvic/mesenteric interventions (stent or embolization), hepatic interventions (chemoembolization, TIPSS), embolization of cerebral aneurysms or arterio-venous-malformations. CONCLUSIONS Substantial CED may occur in a small but not ignorable fraction of patients (~ 3%) undergoing FGIs. Approximately 2/3rd of patients may most likely not encounter radiation-related stochastic effects due to life-threatening diseases and age at first treatment > 65 years but 1/3rd may. Patients undergoing more than one FGI (77%) carry a higher risk of accumulating effective doses > 100 mSv. Remarkably, 23% received a mean CED 162.2 ± 72.3 mSv in a single procedure.
Collapse
Affiliation(s)
- Elke R Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
- Department of Radiology, Medical University Innsbruck, Anichstrasse. 35, 6020, Innsbruck, Austria
| | - Michael Verius
- Department of Radiology, Medical University Innsbruck, Anichstrasse. 35, 6020, Innsbruck, Austria.
| | - Madan M Rehani
- Global Outreach for Radiation Protection Program; Chair, Radiation Safety Committee, Massachusetts General Hospital, 175 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Werner Jaschke
- Department of Radiology, Medical University Innsbruck, Anichstrasse. 35, 6020, Innsbruck, Austria
| |
Collapse
|
42
|
Tsalafoutas IA, Arlany L, Titovich E, Pynda Y, Ruggeri R, Sánchez RM, Reiser I, Tsapaki V. Technical specifications of dose management systems: An international atomic energy agency survey. J Appl Clin Med Phys 2024; 25:e14219. [PMID: 38060709 PMCID: PMC10795438 DOI: 10.1002/acm2.14219] [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: 07/27/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 01/19/2024] Open
Abstract
PURPOSE Dose management systems (DMS) have been introduced in radiological services to facilitate patient radiation dose management and optimization in medical imaging. The purpose of this study was to gather as much information as possible on the technical characteristics of DMS currently available, regarding features that may be considered essential for simply ensuring regulatory compliance or desirable to fully utilize the potential role of DMS in optimization of many aspects of radiological examinations. METHODS A technical survey was carried out and all DMS developers currently available (both commercial and open source) were contacted and were asked to participate. An extensive questionnaire was prepared and uploaded in the IAEA International Research Integration System (IRIS) online platform which was used for data collection process. Most of the questions (93%) required a "Yes/No" answer, to facilitate an objective analysis of the survey results. Some free text questions and comments' slots were also included, to allow participants to give additional information and clarifications where necessary. Depending on the answer, they were considered either as "Yes" or "No." RESULTS Given the way that the questions were posed, every positive response indicated that a feature was offered. Thus, the percentage of positive responses was used as a measure of adherence. The percentages of positive answers per section (and sub-section) are presented in graphs and limitations of this type of analysis are discussed in detail. CONCLUSIONS The results of this survey clearly exhibit that large differences exist between the various DMS developers. Consequently, potential end users of a DMS should carefully determine which of the features available are essential for their needs, prioritize desirable features, but also consider their infrastructure, the level of support required and the budget available before selecting a DMS.
Collapse
Affiliation(s)
- Ioannis A. Tsalafoutas
- Hamad Medical Corporation, Occupational Health and SafetyMedical Physics SectionDohaQatar
| | | | - Egor Titovich
- Dosimetry and Medical Radiation Physics SectionInternational Atomic Energy AgencyViennaAustria
| | - Yaroslav Pynda
- Division of Human HealthInternational Atomic Energy AgencyViennaAustria
| | - Ricardo Ruggeri
- Fundación Médica de Río Negro y Neuquén‐Leben SaludRio NegroArgentina
| | | | - Ingrid Reiser
- Department of RadiologyThe University of ChicagoChicagoIllinoisUSA
| | - Virginia Tsapaki
- Dosimetry and Medical Radiation Physics SectionInternational Atomic Energy AgencyViennaAustria
| |
Collapse
|
43
|
Dalah EZ, Alsuwaidi JS, AlKtebi RS, AlMulla MAA, Gupta P. Establishing Protocol-based Dose Metrics for Common Abdomen and Pelvis Computed Tomography Protocols. Curr Med Imaging 2024; 20:e220523217204. [PMID: 37218187 DOI: 10.2174/1573405620666230522151357] [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: 09/28/2022] [Revised: 03/20/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND AIM The majority of the existing diagnostic reference levels (DRLs) that have been established for computed tomography (CT) are based on various anatomical locations, such as the head, chest, abdomen, etc. However, DRLs are initiated to improve radiation protection by conducting a comparison of similar examinations with similar objectives. The aim of this study was to explore the feasibility of establishing dose baselines based on common CT protocols for patients who underwent enhanced CT abdomen and pelvis exams. METHODS Dose length product total (tDLPs), volumetric CT dose index (CTDIvol), size-specific dose estimate (SSDE), effective dose (E), and scan acquisition parameters for a total of 216 adult patients, who underwent an enhanced CT abdomen and pelvis exams over a one-year period, were obtained and retrospectively analyzed. Spearman coefficient and one-way ANOVA tests were used to check significant differences between dose metrics and the different CT protocols. RESULTS The data exhibited 9 different CT protocols to acquire an enhanced CT abdomen and pelvis exam at our institute. Out of these, 4 were found more common, i.e., CT protocols were acquired for a minimum of 10 cases. Triphasic liver demonstrated the highest mean and median tDLPs across all 4 CT protocols. Triphasic liver protocol registered the highest E followed by gastric sleeve protocol with a mean of 28.7 and 24.7 mSv, respectively. Significant differences (p < 0.0001) were found between the tDLPs of anatomical location and the CT protocol. CONCLUSION Evidently, wide variability exists across CT dose indices and patient dose metrics relying on anatomical-based dose baseline, i.e., DRLs. Patient dose optimizations require establishing dose baselines based on CT protocols rather than the anatomical location.
Collapse
Affiliation(s)
- Entesar Zawam Dalah
- Department of Head Quarter Diagnostic Imaging, Dubai Health Authority, Dubai, United Arab Emirates
- College of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates
| | - Jamila Salam Alsuwaidi
- Department of Clinical Support Services and Nursing Sector, Dubai Health Authority, Dubai, United Arab Emirates
| | - Reem Salim AlKtebi
- Department of Radiology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Priyank Gupta
- Department of Radiology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| |
Collapse
|
44
|
Ngoye W, Ndukeki M, Muhogora W, Jusabani A, Ngaile J, Ngoya P, Sungura R, Ngatunga C, Hashmi N, Makungu H, Onoka E, Amirali M, Kileo A, Makoba A, Muhulo A, Ngulimi M, Balobegwa V, Edmund E, Masoud A, Matulanya M. Radiation exposure during CT procedures in Tanzania. RADIATION PROTECTION DOSIMETRY 2023; 200:97-105. [PMID: 37981295 DOI: 10.1093/rpd/ncad274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/03/2023] [Accepted: 10/02/2023] [Indexed: 11/21/2023]
Abstract
The aim of this study was to evaluate optimisation status during common computed tomography (CT) procedures by determining values of volume computed tomography dose index (CTDIvol) and dose-length product (DLP) per examination. Patient and exposure data were collected from the CT console during various CT procedures. The results show that variations in CTDIvol and DLP values were mainly because of differences in the techniques used. The 75th percentile values were set as the third quartile of the median CTDIvol or DLP values for all hospitals. These values of 40.9, 9.0, 9.4 and 16.2 mGy for CTDIvol were determined for head, high-resolution chest, abdomen-pelvis and lumbar spine, respectively. The corresponding DLP values for the same sequence of CT procedures were 900, 360, 487 and 721 mGy.cm, respectively. The updated results provide a basis for optimising the procedures of CT in this country.
Collapse
Affiliation(s)
- Wilson Ngoye
- Tanzania Atomic Energy Commission, P.O. Box 743, Block J, Njiro, 23114 Arusha, Tanzania
| | - Mussa Ndukeki
- Muhimbili National Hospital, Malik Road, P.O. Box 65000, West Upanga, 8920 Dar es Salaam, Tanzania
| | - Wilbroad Muhogora
- Tanzania Atomic Energy Commission, P.O. Box 743, Block J, Njiro, 23114 Arusha, Tanzania
| | - Ahmed Jusabani
- Aga Khan Medical Centre, P.O. Box 2289, Baraka Obama Road, 11103 Dar es Salaam, Tanzania
| | - Justine Ngaile
- Tanzania Atomic Energy Commission, P.O. Box 743, Block J, Njiro, 23114 Arusha, Tanzania
| | - Patrick Ngoya
- Bugando Medical Centre, P.O. Box 1370, Makongoro Road, 33109 Mwanza, Tanzania
| | - Richard Sungura
- Arusha Lutheran Medical Centre, P.O. Box 17047, Fr. Babu Road, Block No. 54 Levolosi, 23104 Arusha, Tanzania
| | - Cecilia Ngatunga
- Mbeya Zonal Referral Hospital, P.O. Box 419, Hospital Hill Road, 53107 Mbeya, Tanzania
| | - Nazrina Hashmi
- TMJ Hospital, Mwai Kibaki Road, P.O. Box 20439, Mikocheni, 14112 Dar es Salaam, Tanzania
| | - Hilda Makungu
- Muhimbili National Hospital, Malik Road, P.O. Box 65000, West Upanga, 8920 Dar es Salaam, Tanzania
| | - Erick Onoka
- Arusha Lutheran Medical Centre, P.O. Box 17047, Fr. Babu Road, Block No. 54 Levolosi, 23104 Arusha, Tanzania
| | - Mudassir Amirali
- Muhimbili National Hospital, Malik Road, P.O. Box 65000, West Upanga, 8920 Dar es Salaam, Tanzania
| | - Abdallah Kileo
- Tanzania Atomic Energy Commission, P.O. Box 743, Block J, Njiro, 23114 Arusha, Tanzania
| | - Atumaini Makoba
- Tanzania Atomic Energy Commission, P.O. Box 743, Block J, Njiro, 23114 Arusha, Tanzania
| | - Alex Muhulo
- Tanzania Atomic Energy Commission, P.O. Box 743, Block J, Njiro, 23114 Arusha, Tanzania
| | - Miguta Ngulimi
- Tanzania Atomic Energy Commission, P.O. Box 743, Block J, Njiro, 23114 Arusha, Tanzania
| | - Vitus Balobegwa
- Tanzania Atomic Energy Commission, P.O. Box 743, Block J, Njiro, 23114 Arusha, Tanzania
| | - Elisha Edmund
- Tanzania Atomic Energy Commission, P.O. Box 743, Block J, Njiro, 23114 Arusha, Tanzania
| | - Ali Masoud
- Tanzania Atomic Energy Commission, P.O. Box 743, Block J, Njiro, 23114 Arusha, Tanzania
| | - Machibya Matulanya
- Tanzania Atomic Energy Commission, P.O. Box 743, Block J, Njiro, 23114 Arusha, Tanzania
| |
Collapse
|
45
|
Inoue Y, Mori M, Itoh H, Mitsui K, Miyatake H, Yamane T, Hata H. Age-Dependent Changes in Effective Dose in Pediatric Brain CT: Comparisons of Estimation Methods. Tomography 2023; 10:14-24. [PMID: 38250948 PMCID: PMC10821001 DOI: 10.3390/tomography10010002] [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: 11/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
The effective dose (ED) in computed tomography (CT) may be calculated by multiplying the dose-length product (DLP) by a conversion factor. As children grow, automatic exposure control increases the DLP, while the conversion factor decreases; these two changes affect the ED in opposite ways. The aim of this study was to investigate the methods of ED estimation according to age in pediatric brain CT. We retrospectively analyzed 980 brain CT scans performed for various clinical indications in children. The conversion factor at each age, in integer years, was determined based on the values at 0, 1, 5, and 10 years provided by the International Commission on Radiological Protection (ICRP), using a curve (curve method) or lines (linear method). In the simple method, the ED was estimated using the ICRP conversion factor for the closest age. We also analyzed the ED estimated by a radiation dose management system. Although the median DLP at each age increased with age, the median ED estimated by the curve method was highest at 0 years, decreased with age, and then plateaued at 9 years. The linear method yielded mildly different results, especially at 2 and 3 years. The ED estimated by the simple method or the radiation dose management system showed inconsistent, up-and-down changes with age. In conclusion, the ED in pediatric brain CT decreases with age despite increased DLP. Determination of the conversion factor at each age using a curve is expected to contribute to estimating the ED in pediatric CT according to age.
Collapse
Affiliation(s)
- Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (M.M.); (K.M.); (T.Y.)
| | - Masahiro Mori
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (M.M.); (K.M.); (T.Y.)
| | - Hiroyasu Itoh
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0375, Japan; (H.I.); (H.M.); (H.H.)
| | - Kohei Mitsui
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (M.M.); (K.M.); (T.Y.)
| | - Hiroki Miyatake
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0375, Japan; (H.I.); (H.M.); (H.H.)
| | - Takuro Yamane
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (M.M.); (K.M.); (T.Y.)
| | - Hirofumi Hata
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0375, Japan; (H.I.); (H.M.); (H.H.)
| |
Collapse
|
46
|
Bramilla M, Berton L, Balzano RF, Cannillo B, Carriero A, Chauvie S, Gallo T, Cornacchia S, Cutaia C, D'Alessio A, Emanuele R, Fonio P, Matheoud R, Stasi M, Talenti A, Rampado O. Optimisation of protection in the medical exposure of recurrent adult patients due to computed tomography procedures: development of recurrent exposures reference levels. Eur Radiol 2023:10.1007/s00330-023-10520-7. [PMID: 38127075 DOI: 10.1007/s00330-023-10520-7] [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: 07/24/2023] [Revised: 11/06/2023] [Accepted: 11/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To assess the incidence (1 year) and the cumulative incidence (3 years) of the condition of patients accruing cumulative effective doses (CED) of ≥ 100 mSv and their variability among different hospitals. To establish and validate a reference level for the CED in patients with recurrent exposures (RERL) and provide a RERL value. METHODS Data of CT exposure was collected in 9 similar hospitals. The database included 294,222 patient*years who underwent 442,278 CT exams in 3 years. The incidence proportion of patients with CED ≥ 100 mSv in a given year (I100;1) and the 3-year cumulative incidence of patients with CED ≥ 100 mSv over 3 consecutive years (I100;3) were calculated and compared among different institutions. RESULTS I100;1 ranged from a minimum of 0.1% to a maximum of 5.1%. The percentage of recurrent patients was quite uniform among centres ranging from 23 to 38%. The I100;3 ranged from a minimum of 1.1 to 11.4%. There was a strong positive correlation between the third quartile values of yearly CED and yearly incidence (r = 0.90; R2 = 0.81; p < 0.0001). RERL value in our study was found at 34.0 mSv. CONCLUSION The management of patients with recurrent exposures is highly variable among hospitals leading to a 50-fold variation in I100;1 and to a tenfold variation in I100;3. RERL could be established and used by taking as a RERL quantity the CED and as a RERL value the 75th percentile of the third quartiles of the distribution of the yearly CED obtained by surveying different hospitals. CLINICAL RELEVANCE STATEMENT This is the first ever multicentre study that quantifies recurrent exposures in terms of incidence and cumulative incidence of patients with CED ≥ 100 mSv. RERL establishment and use could benefit the optimisation of radioprotection of patients with recurrent exposures. KEY POINTS This is the first multicentre study estimating yearly incidence and 3-year cumulative incidence of patients with cumulative effective doses ≥ 100 mSv. In this study, a 50-fold inter centre variation between the maximum (5.1%) and the minimum value (0.1%) of yearly incidence of patients with cumulative effective doses ≥ 100 mSv was reported. The range of the 3-year cumulative incidence extended from 1.1 to 11.4% (a tenfold variation) The third quartile of the yearly cumulative effective doses in a centre showed a strong positive correlation with the yearly incidence of patients with cumulative effective doses ≥ 100 mSv, with a potential of being used to set reference levels for recurrent exposures.
Collapse
Affiliation(s)
- Marco Bramilla
- Medical Physics Department, University Hospital "Maggiore Della Carità", Novara, Italy.
| | - Luca Berton
- Medical Physics Department, A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | | | - Barbara Cannillo
- Medical Physics Department, University Hospital "Maggiore Della Carità", Novara, Italy
| | - Alessandro Carriero
- Radiology Department, University Hospital "Maggiore Della Carità", Novara, Italy
| | - Stephane Chauvie
- Medical Physics Department, A.O. Santa Croce e Carle, Cuneo, Italy
| | - Teresa Gallo
- Radiology Department, A.O. Ordine Mauriziano, Turin, Italy
| | | | - Claudia Cutaia
- Medical Physics Department, A.O. Ordine Mauriziano, Turin, Italy
| | - Andrea D'Alessio
- Medical Physics Department, University Hospital "Maggiore Della Carità", Novara, Italy
| | - Roberto Emanuele
- Medical Physics Department, A.O. Santa Croce e Carle, Cuneo, Italy
| | - Paolo Fonio
- Radiology Department, A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Roberta Matheoud
- Medical Physics Department, University Hospital "Maggiore Della Carità", Novara, Italy
| | - Michele Stasi
- Medical Physics Department, A.O. Ordine Mauriziano, Turin, Italy
| | - Alberto Talenti
- Radiology Department, A.O. Santa Croce e Carle, Cuneo, Italy
| | - Osvaldo Rampado
- Medical Physics Department, A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy
| |
Collapse
|
47
|
Abdulwahid Noor K, Mohd Norsuddin N, Abdul Karim MK, Che Isa IN, Alshamsi W. Estimating Local Diagnostic Reference Levels for Mammography in Dubai. Diagnostics (Basel) 2023; 14:8. [PMID: 38201317 PMCID: PMC10804395 DOI: 10.3390/diagnostics14010008] [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: 09/26/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 01/12/2024] Open
Abstract
As the total volume of mammograms in Dubai is increasing consistently, it is crucial to focus on the process of dose optimization by determining dose reference levels for such sensitive radiographic examinations as mammography. This work aimed to determine local diagnostic reference levels (DRLs) for mammography procedures in Dubai at different ranges of breast thickness. A total of 2599 anonymized mammograms were randomly retrieved from a central dose survey database. Mammographic cases for screening women aged from 40 to 69 years were included, while cases of breast implants and breast thickness outside the range of 20-100 mm were excluded. Mean, median, and 75 percentiles were obtained for the mean glandular dose (MGD) distribution of each mammography projection for all compressed breast thickness (CBT) ranges. The local DRLs for mammography in Dubai were found to be between 0.80 mGy and 0.82 mGy for the craniocaudal (CC) projection and between 0.89 mGy and 0.971.8 mGy for the mediolateral oblique (MLO) projection. Local DRLs were proposed according to different breast thicknesses, starting from 20 to 100 mm. All groups of CBT showed a slight difference in MGD values, with higher values in MLO views rather than CC views. The local DRLs in this study were lower than some other Middle Eastern countries and lower than the standard reference levels reported by the International Atomic Energy Agency (IAEA) at 3 mGy/view.
Collapse
Affiliation(s)
- Kaltham Abdulwahid Noor
- Dubai Health Academic Corporate, Radiology Department, Rashid Hospital, Dubai 00971, United Arab Emirates;
- Center of Diagnostic, Therapeutic and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Norhashimah Mohd Norsuddin
- Center of Diagnostic, Therapeutic and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | | | - Iza Nurzawani Che Isa
- Center of Diagnostic, Therapeutic and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Wadha Alshamsi
- SEHA, Medical Physics Department, Al Ain Hospital, Abu Dhabi 80050, United Arab Emirates;
| |
Collapse
|
48
|
Kakuta K, Nemoto S, Ikeda M. Effect of shape of automatic dose rate control and wedge compensation filter on radiation dose in an angiography system with a flat-panel detector. Radiol Phys Technol 2023; 16:560-568. [PMID: 37733207 DOI: 10.1007/s12194-023-00742-1] [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: 04/25/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023]
Abstract
The purpose was to investigate air-kerma area product (PKA) and entrance surface air-kerma rate ([Formula: see text]a,e) on the effect of the shape of automatic dose rate control (ADRC) in the presence of a wedge compensation filter. We compared and evaluated the variability of the X-ray output using a combination of wedge compensation filters and the ADRC. Two ADRC shapes (round and square) and three poly-methyl-methacrylate thicknesses (15, 20, and 25 cm) were used. A wedge compensation filter was inserted 2 cm at a time, up to 6 cm. When the wedge compensation filter was inserted to 6 cm for 20 cm of poly-methyl-methacrylate, the X-ray output fluctuated significantly. The PKA was reduced by 39% when the wedge compensation filter was inserted to 6 cm and by 59% when it was inserted to 4 cm under round-type for 20 cm poly-methyl-methacrylate. The shape of the ADRC affects [Formula: see text]a,e and PKA.
Collapse
Affiliation(s)
- Kazuya Kakuta
- Department of Disaster Medicine, Fukushima Medical University Hospital, Fukushima, Japan.
- Department of Radiology, Fukushima Medical University Hospital, Fukushima, Japan.
| | - Shumpei Nemoto
- Department of Radiology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Masamitsu Ikeda
- Department of Radiology, Fukushima Medical University Hospital, Fukushima, Japan
| |
Collapse
|
49
|
Bärenfänger F, Schramm P, Rohde S. Radiation Exposure in Interventional Stroke Treatment : Analysis of the German Neurointerventional Database (DeGIR/DGNR) from 2019 to 2021. Clin Neuroradiol 2023; 33:1023-1033. [PMID: 37280392 PMCID: PMC10654203 DOI: 10.1007/s00062-023-01303-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/27/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE To evaluate patient-related radiation exposure in interventional stroke treatment by analyzing data from the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society of Neuroradiology (DGNR) quality registry from 2019-2021. METHODS The DeGIR/DGNR registry is the largest database of radiological interventions in Germany. Since the introduction of the registry in 2012, the participating hospitals have entered clinical and dose-related data on the procedures performed. To evaluate the current diagnostic reference level (DRL) for mechanical thrombectomy (MT) in stroke patients, we analyzed interventional data from 2019 to 2021 with respect to the reported dose area product (DAP) and factors that might contribute to the radiation dose, such as the localization of the occlusion, technical success using the modified treatment in cerebral ischemia (mTICI) score, number of passages, technical approach, additional intracranial/extracranial stenting, and case volume per center. RESULTS A total of 41,538 performed MTs from 180 participating hospitals were analyzed. The median DAP for MT was 7337.5 cGy∙cm2 and the corresponding interquartile range (IQR) Q25 = 4064 cGy∙cm2 to Q75 = 12,263 cGy∙cm2. In addition, we discovered that the dose was significantly influenced by occlusion location, number of passages, case volume per center, recanalization score, and additional stenting. CONCLUSION We conducted a retrospective study on radiation exposure during MT in Germany. Based on the results of more than 41,000 procedures, we observed that the DRL of 14,000 cGy·cm2 is currently appropriate but may be lowered over the next years. Furthermore, we identified several factors that contribute to high radiation exposure. This can aid in detecting the cause of an exceeded DRL and optimize the treatment workflow.
Collapse
Affiliation(s)
- Felix Bärenfänger
- Faculty for Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
- Department of Medical Physics and Radiation Protection, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Germany.
| | - Peter Schramm
- Department of Radiology and Neuroradiology, Campus Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Stefan Rohde
- Faculty for Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
- Department of Radiology and Neuroradiology, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Germany
| |
Collapse
|
50
|
Oliveira Bernardo M, Karout L, Morgado F, Ebrahimian S, Sarmet Santos A, Amorim C, Muniz Filho H, Moscatelli A, Francisco Muglia V, Schroeder H, Moulin Sales D, Gandolpho Henschel R, Giovanni Valese B, Kiipper F, Cesar Cavalcanti P, Lucena R, Jornada T, de Paula V, Zago M, Varella R, Anes M, Márcio Alves Pinheiro A, Claúdio de Moura Carvalho L, Santana de Melo Tapajos J, Antonio de Almeida F, Applegate K, Paulo G, Roberto Costa P. Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study. Eur J Radiol 2023; 169:111191. [PMID: 37976761 DOI: 10.1016/j.ejrad.2023.111191] [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: 08/09/2023] [Revised: 10/11/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Diagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based - DRL(DRLCI) and clinical indication - AD (ADCI) for adult CT in Brazil. METHODS The prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test. RESULTS In majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection. CONCLUSIONS There was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.
Collapse
Affiliation(s)
| | - Lina Karout
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Shadi Ebrahimian
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA.
| | | | - Clarissa Amorim
- Complexo Hospitalar de Niterói, Niterói, Rio de Janeiro, Brazil.
| | | | | | - Valdair Francisco Muglia
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Henrique Schroeder
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | | | | | | | | | | | - Ronaldo Lucena
- Unimed Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Tiago Jornada
- Hospital das Clínicas de Recife, Recife, Pernambuco, Brazil.
| | - Valnir de Paula
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Marcel Zago
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ricardo Varella
- Hospital Unimed de Vitória, Vitória, Espírito Santo, Brazil.
| | - Mauricio Anes
- Hospital das Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | | | | | | | - Kimberly Applegate
- University of Kentucky College of Medicine, Department of Radiology, Lexington, KY, USA.
| | - Graciano Paulo
- Escola Superior de Tecnologia da Saúde do Instituto Politécnico de Coimbra, Coimbra, Portugal.
| | | |
Collapse
|