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Li X, Rehani MM, Marschall TA, Yang K, Liu B. Cumulative radiation exposure from multimodality recurrent imaging of CT, fluoroscopically guided intervention, and nuclear medicine. Eur Radiol 2024; 34:3719-3729. [PMID: 37957362 DOI: 10.1007/s00330-023-10299-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES To assess cumulative effective dose (CED) over a 4-year period in patients undergoing multimodality recurrent imaging at a major hospital in the USA. METHODS CED from CT, fluoroscopically guided intervention (FGI), and nuclear medicine was analyzed in consecutive exams in a tertiary care center in 2018-2021. Patients with CED ≥ 100 mSv were classified by age and body habitus (underweight, healthy weight, overweight, obese), as per body mass index percentiles < 5th, 5th to < 85th, 85th to < 95th, and ≥ 95th (age 2-19 years), and its ranges < 18.5, 18.5-24.9, 25-29.9, and ≥ 30 (≥ 20 years), respectively. RESULTS Among a total of 205,425 patients, 5.7% received CED ≥ 100 mSv (mean 184 mSv, maximum 1165 mSv) and their ages were mostly 50-64 years (34.1%), followed by 65-74 years (29.8%), ≥ 75 years (19.5%), 20-49 years (16.3%), and ≤ 19 years (0.29%). Body habitus in decreasing occurrence was obese (38.6%), overweight (31.9%), healthy weight (27.5%), and underweight (2.1%). Classification by dose indicated 172 patients (≥ 500 mSv) and 3 (≥ 1000 mSv). In comparison, 5.3% of 189,030 CT patients, 1.6% of 18,963 FGI patients, and 0.19% of 41,401 nuclear-medicine patients received CED ≥ 100 mSv from a single modality. CONCLUSIONS The study of total dose from CT, FGI, and nuclear medicine of patients with CED ≥ 100 mSv indicates major (89%) contribution of CT to CED with 70% of cohort being obese and overweight, and 64% of cohort aged 50-74 years. CLINICAL RELEVANCE STATEMENT Multimodality recurrent exams are common and there is a lack of information on patient cumulative radiation exposure. This study attempts to address this lacuna and has the potential to motivate actions to improve the justification process for enhancing patient safety. KEY POINTS • In total, 5.7% of patients undergoing multimodality recurrent imaging (CT, fluoroscopically guided intervention, nuclear medicine) incurred a dose of ≥ 100 mSv. • Mean dose was 184 mSv, with 15 to 18 times contribution from CT than that from fluoroscopically guided intervention or nuclear medicine. • In total, 70% of those who received ≥ 100mSv were either overweight or obese.
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Affiliation(s)
- Xinhua Li
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Theodore A Marschall
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kai Yang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Bob Liu
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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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.
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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
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Usanase N, Uzun B, Ozsahin DU, Ozsahin I. A look at radiation detectors and their applications in medical imaging. Jpn J Radiol 2024; 42:145-157. [PMID: 37733205 DOI: 10.1007/s11604-023-01486-z] [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: 03/01/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023]
Abstract
The effectiveness and precision of disease diagnosis and treatment have increased, thanks to developments in clinical imaging over the past few decades. Science is developing and progressing steadily in imaging modalities, and effective outcomes are starting to show up as a result of the shorter scanning periods needed as well as the higher-resolution images generated. The choice of one clinical device over another is influenced by technical disparities among the equipment, such as detection medium, shorter scan time, patient comfort, cost-effectiveness, accessibility, greater sensitivity and specificity, and spatial resolution. Lately, computational algorithms, artificial intelligence (AI), in particular, have been incorporated with diagnostic and treatment techniques, including imaging systems. AI is a discipline comprised of multiple computational and mathematical models. Its applications aided in manipulating sophisticated data in imaging processes and increased imaging tests' accuracy and precision during diagnosis. Computed tomography (CT), positron emission tomography (PET), and Single Photon Emission Computed Tomography (SPECT) along with their corresponding radiation detectors have been reviewed in this study. This review will provide an in-depth explanation of the above-mentioned imaging modalities as well as the radiation detectors that are their essential components. From the early development of these medical instruments till now, various modifications and improvements have been done and more is yet to be established for better performance which calls for a necessity to capture the available information and record the gaps to be filled for better future advances.
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Affiliation(s)
- Natacha Usanase
- Operational Research Centre in Healthcare, Near East University, Mersin 10, Nicosia, Turkey.
| | - Berna Uzun
- Operational Research Centre in Healthcare, Near East University, Mersin 10, Nicosia, Turkey
- Department of Statistics, Carlos III Madrid University, Getafe, Madrid, Spain
| | - Dilber Uzun Ozsahin
- Operational Research Centre in Healthcare, Near East University, Mersin 10, Nicosia, Turkey
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ilker Ozsahin
- Operational Research Centre in Healthcare, Near East University, Mersin 10, Nicosia, Turkey
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, 10065, USA
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Li X, Srinivasa S, Rehani MM. Do patients with larger body sizes undergo more CT exams? Ir J Med Sci 2023; 192:2437-2439. [PMID: 36749423 DOI: 10.1007/s11845-023-03304-x] [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: 11/26/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Overweight and obese patients are known to have more diseases than normal weight individuals, but it is currently unknown if there is higher utilization of computed tomography (CT) exams among those with larger body sizes. AIMS To examine whether patients with larger body sizes undergo more CT exams and by how much more. METHODS Using the recently described T-shirt size assessed from the lateral and transverse dimensions in CT localizer radiographs as a surrogate for body size, patients were classified into seven T-shirt sizes (XXS, XS, S, M, L, XL, XXL). This multi-center study analyzed over one million CT exams performed in 256 medical institutions in the USA to assess the frequency of CT use in patients of different body sizes. RESULTS It was found that patients with larger body sizes (L, XL, XXL sizes) underwent 2.5-3.5 times more CT scans in the chest region and 7.8-17.7 times in the abdominopelvic region as compared to those with smaller body sizes (XXS, XS, S sizes). Further, the patients with extra-large body sizes (XL and XXL) underwent 4.6-9.9 times scans in the chest region and 39.2-187.8 times scans in the abdominopelvic region as compared to those with extra-small body sizes (XXS and XS). CONCLUSIONS Our first-of-its-kind study demonstrating the manyfold use of CT in patients with large body sizes may be interesting for healthcare policy planning and developing guidelines for allocating resources for obese patients.
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Affiliation(s)
- Xinhua Li
- Massachusetts General Hospital, 55 Fruit Str., MA, Boston, 02114, USA
| | - Suman Srinivasa
- Massachusetts General Hospital, 55 Fruit Str., MA, Boston, 02114, USA
| | - Madan M Rehani
- Massachusetts General Hospital, 55 Fruit Str., MA, Boston, 02114, USA.
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Li X, Hirsch JA, Rehani MM, Yang K, Marschall TA, Liu B. Patient follow-up for possible radiation injury from fluoroscopically-guided interventions: Need to consider high cumulative exposure from multiple procedures. Phys Med 2023; 106:102521. [PMID: 36610179 DOI: 10.1016/j.ejmp.2022.102521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Patient skin dose from interventional fluoroscopy procedures may exceed the threshold of tissue injuries and established guidelines recommend patient follow-up for air kerma at reference point (Ka,r) ≥ 5 Gy for individual procedures. Patients may undergo multiple procedures and skin injuries may be possible by cumulative exposure, even when individually insufficient to cause injury. This study sought to quantify the frequency of patients whose individual procedure doses are below 5 Gy but whose cumulative Ka,r is ≥ 5 Gy. METHODS This retrospective study analyzed 37,917 consecutive procedures in interventional radiology and vascular surgery at a tertiary-care hospital between January 2016 and June 2021. Radiation dosage was retrieved from the fluoroscopy acquisition systems. For a patient receiving multiple procedures, but each with Ka,r < 5 Gy, cumulative Ka,r within 2, 7, 14, 30, 183, and 365 days was assessed. RESULTS Nearly 1/3rd (37.4 %) patients underwent multiple procedures. With individual procedures of Ka,r < 5 Gy exclusively, 1.9, 4.4, and 5.6 in 1000 patients received cumulative Ka,r of 5-14.1 Gy from the procedures within 30, 183, and 365 days, respectively. From the procedures within 14 days, 1.3 in 1000 patients received cumulative Ka,r of 5-11.4 Gy; and from those within 7 days, 0.87 in 1000 patients received 5-9.1 Gy. In comparison, 4.3 in 1000 patients received Ka,r of 5-12 Gy from a single procedure. CONCLUSIONS In the absence of guidelines on patient follow-up for multiple procedures, our study may provide good material for setting up such guidelines.
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Affiliation(s)
- Xinhua Li
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Joshua Adam Hirsch
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Kai Yang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Theodore A Marschall
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Bob Liu
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Abuqbeitah M, Demir M, Sönmezoğlu K, Sayman H, Kabasakal L, Sağer S, Asa S, Uslu-Beşli L, Rehani MM. Original research patients undergoing multiple 18F-FDG PET/CT scans: frequency, clinical indications, and cumulative dose. HEALTH AND TECHNOLOGY 2023. [DOI: 10.1007/s12553-022-00716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Evaluation of a High-Sensitivity Organ-Targeted PET Camera. SENSORS 2022; 22:s22134678. [PMID: 35808181 PMCID: PMC9269056 DOI: 10.3390/s22134678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/05/2023]
Abstract
The aim of this study is to evaluate the performance of the Radialis organ-targeted positron emission tomography (PET) Camera with standardized tests and through assessment of clinical-imaging results. Sensitivity, count-rate performance, and spatial resolution were evaluated according to the National Electrical Manufacturers Association (NEMA) NU-4 standards, with necessary modifications to accommodate the planar detector design. The detectability of small objects was shown with micro hotspot phantom images. The clinical performance of the camera was also demonstrated through breast cancer images acquired with varying injected doses of 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (18F-FDG) and qualitatively compared with sample digital full-field mammography, magnetic resonance imaging (MRI), and whole-body (WB) PET images. Micro hotspot phantom sources were visualized down to 1.35 mm-diameter rods. Spatial resolution was calculated to be 2.3 ± 0.1 mm for the in-plane resolution and 6.8 ± 0.1 mm for the cross-plane resolution using maximum likelihood expectation maximization (MLEM) reconstruction. The system peak noise equivalent count rate was 17.8 kcps at a 18F-FDG concentration of 10.5 kBq/mL. System scatter fraction was 24%. The overall efficiency at the peak noise equivalent count rate was 5400 cps/MBq. The maximum axial sensitivity achieved was 3.5%, with an average system sensitivity of 2.4%. Selected results from clinical trials demonstrate capability of imaging lesions at the chest wall and identifying false-negative X-ray findings and false-positive MRI findings, even at up to a 10-fold dose reduction in comparison with standard 18F-FDG doses (i.e., at 37 MBq or 1 mCi). The evaluation of the organ-targeted Radialis PET Camera indicates that it is a promising technology for high-image-quality, low-dose PET imaging. High-efficiency radiotracer detection also opens an opportunity to reduce administered doses of radiopharmaceuticals and, therefore, patient exposure to radiation.
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Vassileva J, Zewde NT, Reim M, Holmberg O, Rehani MM. Communication of radiation risk from imaging studies: an IAEA-coordinated international survey. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021524. [PMID: 35320786 DOI: 10.1088/1361-6498/ac6047] [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: 01/27/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
The purpose of this IAEA-coordinated international study was to understand aspects related to the communication of radiation risk from imaging studies, such as how often imaging department personnel and referring physicians are asked about radiation risks in diagnostic imaging, who asks about these risks, how often professionals are able to provide satisfactory answers using qualitative metrics and how often quantitative risk estimates are needed. A web-based questionnaire with ten questions was completed by 386 healthcare professionals from 63 countries from all four continents, including clinicians/referring physicians (42.5%), radiologists or nuclear medicine physicians (26.7%), medical physicists (23.1%), radiographers/radiological technologists (6.2%) and others (1.6%). The results indicate that radiation risk-related questions are largely asked by patients (73.1%) and parents of child patients (38.6%), and 78% of the professionals believe they are able to answer those questions using qualitative metrics such as very small/minimal, small, medium rather than number of cancers likely occurring. The vast majority, with over three times higher frequency, indicated the purpose of knowing previous radiological exams as 'both clinical information and radiation exposure history' rather than 'only clinical information'. Nearly two-thirds of the clinicians/referring physicians indicated that knowing the radiation exposure history of the patient will affect their decision-making for the next exam, as against only about one-fifth who said 'no, it will not affect their decision-making'. The same question, when addressed to radiologists, resulted in a slightly larger fraction of about three-quarters who said 'yes', as opposed to a smaller fraction of about 12% who said 'no, it will not affect their decision-making'. Mapping the present situation of communication of benefits and risks for patients is important and may be the basis of further analysis, regular monitoring and possibly a target for clinical audits. Further studies focused on specific professional groups might help in obtaining á deeper understanding of the need for practical communication tools.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | | | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Madan M Rehani
- Massachusetts General Hospital, Boston, MA, United States of America
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Li X, Steigerwalt D, Rehani MM. T-shirt size as a classification for body habitus in computed tomography (CT) and development of size-based dose reference levels for different indications. Eur J Radiol 2022; 151:110289. [PMID: 35397408 DOI: 10.1016/j.ejrad.2022.110289] [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: 12/25/2021] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the impact of patient size on dose indices and develop size-based reference levels (50th and 75th percentiles) for 20 body CT exams for routine and organ-specific clinical indications. METHODS Based on effective diameter estimated from adult body CT, each acquisition was classified into T-shirt size as XXS, XS, S, M, L, XL, and XXL. Radiation dose indices for each size and each exam type were correlated. RESULTS About 0.93 million CT exams from 256 CT facilities in the United States were analysed. Taking T-shirt size M as a reference, the CTDIvol for other sizes were: XXS (∼60%), XS (∼65%), S (∼75%), L (∼130%), XL (∼165%), XXL (∼210%), or grossly small patients received about 60% of the dose as compared to M sized patients and XXL required doubling the dose. Taking ratio of the dose indices of the largest to smallest size, it was evident that SSDE variation was much less (about 50%) than that in CTDIvol, but there was still nearly 40 to 220% variation in SSDE across the range of t-shirt sizes. The 50th and 75th percentile values are presented for CTDIvol, SSDE and DLP for each of the 20 CT exams and for each of the seven T-shirt sizes. CONCLUSIONS A novel approach expressing body habitus in terms of T-shirt size is not only simple and intuitive, but it also provides a tool to have a perception of differences in dose metrices among patients of different body build.
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Affiliation(s)
- Xinhua Li
- Massachusetts General Hospital, 55 Fruit Str, Boston, MA 02114, USA
| | | | - Madan M Rehani
- Massachusetts General Hospital, 55 Fruit Str, Boston, MA 02114, USA.
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