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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.
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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
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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.
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Affiliation(s)
- Dutsadee Suttho
- Department of Radiological Technology, Faculty of Allied Health Sciences, Thammasat University, Khlong Nueng, Thailand
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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; 55:101421. [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.
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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
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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.
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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
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Welarathna S, Velautham S, Sarasanandarajah S. Towards the establishment of national diagnostic reference levels for abdomen, KUB, and lumbar spine x-ray examinations in Sri Lanka: a multi-centric study. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021506. [PMID: 38537259 DOI: 10.1088/1361-6498/ad3837] [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: 01/19/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
Diagnostic reference levels (DRLs) and achievable doses (ADs) provide guidance to optimise radiation doses for patients undergoing medical imaging procedures. This multi-centre study aimed to compare institutional DRLs (IDRLs) across hospitals, propose ADs and multi-centric DRLs (MCDRLs) for four common x-ray examinations in Sri Lanka, and assess the potential for dose reduction. A prospective cross-sectional study of 894 adult patients referred for abdomen anteroposterior (AP), kidney-ureter-bladder (KUB) AP, lumbar spine AP, and lumbar spine lateral (LAT) x-ray examinations was conducted. Patient demographic information (age, sex, weight, BMI) and exposure parameters (tube voltage, tube current-exposure time product) were collected. Patient dose indicators were measured in terms of kerma-area product (PKA) using a PKAmeter. IDRLs, ADs, and MCDRLs were calculated following the International Commission on Radiological Protection guidelines, with ADs and MCDRLs defined as the 50th and 75th percentiles of the median PKAdistributions, respectively. IDRL ranges varied considerably across hospitals: 1.42-2.42 Gy cm2for abdomen AP, 1.51-2.86 Gy cm2for KUB AP, 0.83-1.65 Gy cm2for lumbar spine AP, and 1.76-4.10 Gy cm2for lumbar spine LAT. The proposed ADs were 1.82 Gy cm2(abdomen AP), 2.03 Gy cm2(KUB AP), 1.27 Gy cm2(lumbar spine AP), and 2.21 Gy cm2(lumbar spine LAT). MCDRLs were 2.24 Gy cm2(abdomen AP), 2.40 Gy cm2(KUB AP), 1.43 Gy cm2(lumbar spine AP), and 2.38 Gy cm2(lumbar spine LAT). Substantial intra- and inter-hospital variations in PKAwere observed for all four examinations. Although ADs and MCDRLs in Sri Lanka were comparable to those in the existing literature, the identified intra- and inter-hospital variations underscore the need for dose reduction without compromising diagnostic information. Hospitals with high IDRLs are recommended to review and optimise their practices. These MCDRLs serve as preliminary national DRLs, guiding dose optimisation efforts by medical professionals and policymakers.
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Affiliation(s)
- Sachith Welarathna
- Department of Physics, University of Peradeniya, Peradeniya 20400, Sri Lanka
- Postgraduate Institute of Science, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Sivakumar Velautham
- Department of Physics, University of Peradeniya, Peradeniya 20400, Sri Lanka
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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.
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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.
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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.
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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
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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.
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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
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O'Hora L, Neville N, Tuffy J, Craig A, O'Brien K, Sugrue K, McGarry M, Duggan B, Egan S. Establishing national diagnostic reference levels in radiography, mammography, and dual-energy x-ray absorptiometry services in Ireland and comparing these with European diagnostic reference levels. Eur Radiol 2023; 33:9469-9478. [PMID: 37505250 DOI: 10.1007/s00330-023-09992-4] [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: 03/10/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES The aim of this work was to establish national diagnostic reference levels (DRLs) in Ireland and compare these to existing European DRLs where available. This work surveyed all radiological facilities providing radiography, mammography, and dual-energy x-ray absorptiometry (DXA) services in Ireland. METHODS A list of common procedures and clinical tasks was established. A national database of service providers was used to identify the appropriate medical radiological facilities providing these services. These facilities were issued with an online survey. National DRLs were set as the 75th percentile of the distribution of median values obtained. A national median dose was also established. The broad categorisation of equipment type was also considered. Where differences between DRLs established using different detector types were deemed statistically significant, equipment-specific national DRLs were established. RESULTS National DRLs were established for 12 adult radiography projections. Equipment-specific (computed radiography and digital radiography) adult DRLs were established for four radiography projections. Paediatric DRLs were established for 11 radiography projections, including two based on clinical indications, for a range of paediatric weight categories. National DRLs were established for unilateral two-view mammography and breast tomosynthesis as well as for four DXA clinical indications and projections. All but one Irish DRL figure was found to be below or equal to European data. CONCLUSIONS This work provided a unique opportunity to establish national DRLs based on census data for a range of procedures and clinical tasks across radiography, mammography and DXA and compare these with European levels. CLINICAL RELEVANCE STATEMENT This work established national diagnostic reference levels (DRLs) based on census data for a range of procedures and clinical tasks across radiography, mammography and dual-energy x-ray absorptiometry. The establishment of national DRLs is an essential component in the optimisation of patient radiation dose. KEY POINTS • Diagnostic reference levels are easily measured quantities intended for use as an aid to optimise patient dose and to identify when levels of patient dose are unusually high. • Data from all medical radiological facilities in Ireland was obtained to establish national diagnostic reference level (DRL) values and national median dose values in radiography, x-ray breast imaging and dual-energy x-ray absorptiometry (DXA) scanning and these were compared to existing European DRLs where available. • National DRL values were established for the first time in breast tomosynthesis, DXA scanning, and paediatric radiography.
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Affiliation(s)
- Lee O'Hora
- The Health Information and Quality Authority (HIQA), Dublin, Ireland.
| | - Noelle Neville
- The Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - John Tuffy
- The Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Agnella Craig
- The Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Kirsten O'Brien
- The Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Kay Sugrue
- The Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Maeve McGarry
- The Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Brendan Duggan
- The Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Sean Egan
- The Health Information and Quality Authority (HIQA), Dublin, Ireland
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Tzanis E, Damilakis J. A neural network-enhanced methodology for the rapid establishment of local DRLs in interventional radiology: EVAR as a case example. Phys Med 2023; 114:103140. [PMID: 37741153 DOI: 10.1016/j.ejmp.2023.103140] [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: 05/17/2023] [Revised: 08/28/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023] Open
Abstract
PURPOSE To develop a neural network-enhanced workflow for the automatic and rapid establishment/update of local diagnostic reference levels (DRLs) in interventional radiology (IR) using endovascular aneurysm repair (EVAR) procedures as a case example. METHODS Radiation dose reports were collected retrospectively for 46 consecutive EVAR procedures. These reports served as demonstrative data for the development of the proposed methodology. An algorithm was developed to receive multiple dose reports, automatically extract the kerma area product (KAP), air kerma (Ka,r), number of exposure images, and fluoroscopy time (FT) from each report and calculate the first, second, third quartiles as well as the maximum and minimum values of the extracted parameters. To extract the values of interest from the dose reports, Tesseract, an open-source optical character recognition (OCR) engine was employed. Furthermore, the accuracy and time efficiency of the proposed methodology were assessed. Specifically, the values extracted from the algorithm were compared with the ground truth values and the algorithm's processing time was compared with the respective time needed to manually extract and process the values of interest. RESULTS The OCR-based algorithm managed to correctly recognize 182 from the 184 target values, resulting in an accuracy of 99%. Moreover, the proposed pipeline reduced the processing time for the establishment of DRLs by 98%. DRL value for EVAR procedures, set as the third quartile of KAP was found to be 551 Gy*cm2. CONCLUSION An accurate and time-efficient workflow was developed for the establishment of local DRLs in interventional radiology.
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Affiliation(s)
- Eleftherios Tzanis
- Department of Medical Physics, School of Medicine, University of Crete, P.O. Box 2208, 71003 Heraklion, Crete, Greece
| | - John Damilakis
- Department of Medical Physics, School of Medicine, University of Crete, P.O. Box 2208, 71003 Heraklion, Crete, Greece.
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Urban LABD, Chala LF, Paula IBD, Bauab SDP, Schaefer MB, Oliveira ALK, Shimizu C, Oliveira TMGD, Moraes PDC, Miranda BMM, Aduan FE, Rego SDJF, Canella EDO, Couto HL, Badan GM, Francisco JLE, Moraes TP, Jakubiak RR, Peixoto JE. Recommendations for the Screening of Breast Cancer of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Society of Mastology and Brazilian Federation of Gynecology and Obstetrics Association. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e480-e488. [PMID: 37683660 PMCID: PMC10491472 DOI: 10.1055/s-0043-1772498] [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: 09/10/2023] Open
Abstract
OBJECTIVE To present the update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology and the Brazilian Federation of Associations of Gynecology and Obstetrics for breast cancer screening in Brazil. METHODS Scientific evidence published in Medline, EMBASE, Cochrane Library, EBSCO, CINAHL and Lilacs databases between January 2012 and July 2022 was searched. Recommendations were based on this evidence by consensus of the expert committee of the three entities. RECOMMENDATIONS Annual mammography screening is recommended for women at usual risk aged 40-74 years. Above 75 years, it should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, with a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast cancer or chest irradiation before age 30, or even, carriers of a genetic mutation or with a strong family history, benefit from complementary screening, and should be considered individually. Tomosynthesis is a form of mammography and should be considered in screening whenever accessible and available.
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Affiliation(s)
| | - Luciano Fernandes Chala
- National Mammography Commission, Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | - Ivie Braga de Paula
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | - Selma di Pace Bauab
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | - Carlos Shimizu
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | | | - Flávia Engel Aduan
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | - Henrique Lima Couto
- National Mammography Commission, Representative of the Brazilian Society of Mastology, São Paulo, SP, Brazil
| | - Gustavo Machado Badan
- National Mammography Commission, Representative of the Brazilian Society of Mastology, São Paulo, SP, Brazil
| | - José Luis Esteves Francisco
- National Mammography Commission, Representative of the Brazilian Federation of Associations of Gynecology and Obstetrics, São Paulo, SP, Brazil
| | - Thaís Paiva Moraes
- National Mammography Commission, Representative of the Brazilian Federation of Associations of Gynecology and Obstetrics, São Paulo, SP, Brazil
| | | | - João Emílio Peixoto
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
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12
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Urban LABD, Chala LF, de Paula IB, Bauab SDP, Schaefer MB, Oliveira ALK, Shimizu C, de Oliveira TMG, Moraes PDC, Miranda BMM, Aduan FE, Rego SDJF, Canella EDO, Couto HL, Badan GM, Francisco JLE, Moraes TP, Jakubiak RR, Peixoto JE. Recommendations for breast cancer screening in Brazil, from the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations. Radiol Bras 2023; 56:207-214. [PMID: 37829583 PMCID: PMC10567087 DOI: 10.1590/0100-3984.2023.0064-en] [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: 06/15/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 10/14/2023] Open
Abstract
Objective To present an update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods Scientific evidence published between January 2012 and July 2022 was gathered from the following databases: Medline (PubMed); Excerpta Medica (Embase); Cochrane Library; Ebsco; Cumulative Index to Nursing and Allied Health Literature (Cinahl); and Latin-American and Caribbean Health Sciences Literature (Lilacs). Recommendations were based on that evidence and were arrived at by consensus of a joint committee of experts from the three entities.Recommendations: Annual mammographic screening is recommended for women between 40 and 74 years of age. For women at or above the age of 75, screening should be reserved for those with a life expectancy greater than seven years. Women at higher than average risk are considered by category: those with dense breasts; those with a personal history of atypical lobular hyperplasia, classical lobular carcinoma in situ, or atypical ductal hyperplasia; those previously treated for breast cancer; those having undergone thoracic radiotherapy before age 30; and those with a relevant genetic mutation or a strong family history. The benefits of complementary screening are also addressed according to the subcategories above. The use of tomosynthesis, which is an evolved form of mammography, should be considered in screening, whenever accessible and available.
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Affiliation(s)
- Linei Augusta Brolini Delle Urban
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Luciano Fernandes Chala
- Coordinator of the National Mammography Commission of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ivie Braga de Paula
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Selma di Pace Bauab
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Marcela Brisighelli Schaefer
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ana Lúcia Kefalás Oliveira
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Carlos Shimizu
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Tatiane Mendes Gonçalves de Oliveira
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Paula de Camargo Moraes
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Beatriz Medicis Maranhão Miranda
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Flávia Engel Aduan
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Salete de Jesus Fonseca Rego
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ellyete de Oliveira Canella
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Henrique Lima Couto
- Members of the National Mammography Commission, Representatives of the Sociedade Brasileira de Mastologia (SBM), Rio de Janeiro, RJ, Brazil
| | - Gustavo Machado Badan
- Members of the National Mammography Commission, Representatives of the Sociedade Brasileira de Mastologia (SBM), Rio de Janeiro, RJ, Brazil
| | - José Luis Esteves Francisco
- Members of the National Mammography Commission, Representatives of the Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO), Rio de Janeiro, RJ, Brazil
| | - Thaís Paiva Moraes
- Members of the National Mammography Commission, Representatives of the Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO), Rio de Janeiro, RJ, Brazil
| | - Rosangela Requi Jakubiak
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - João Emílio Peixoto
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
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