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Zensen S, Bos D, Opitz M, Haubold J, Forsting M, Guberina N, Wetter A. Radiation exposure and establishment of diagnostic reference levels of whole-body low-dose CT for the assessment of multiple myeloma with second- and third-generation dual-source CT. Acta Radiol 2022; 63:527-535. [PMID: 33745295 DOI: 10.1177/02841851211003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the assessment of diseases causing skeletal lesions such as multiple myeloma (MM), whole-body low-dose computed tomography (WBLDCT) is a sensitive diagnostic imaging modality, which has the potential to replace the conventional radiographic survey. PURPOSE To optimize radiation protection and examine radiation exposure, and effective and organ doses of WBLDCT using different modern dual-source CT (DSCT) devices, and to establish local diagnostic reference levels (DRL). MATERIAL AND METHODS In this retrospective study, 281 WBLDCT scans of 232 patients performed between January 2017 and April 2020 either on a second- (A) or third-generation (B) DSCT device could be included. Radiation exposure indices and organ and effective doses were calculated using a commercially available automated dose-tracking software based on Monte-Carlo simulation techniques. RESULTS The radiation exposure indices and effective doses were distributed as follows (median, interquartile range): (A) second-generation DSCT: volume-weighted CT dose index (CTDIvol) 1.78 mGy (1.47-2.17 mGy); dose length product (DLP) 282.8 mGy·cm (224.6-319.4 mGy·cm), effective dose (ED) 1.87 mSv (1.61-2.17 mSv) and (B) third-generation DSCT: CTDIvol 0.56 mGy (0.47-0.67 mGy), DLP 92.0 mGy·cm (73.7-107.6 mGy·cm), ED 0.61 mSv (0.52-0.69 mSv). Radiation exposure indices and effective and organ doses were significantly lower with third-generation DSCT (P < 0.001). Local DRLs could be set for CTDIvol at 0.75 mGy and DLP at 120 mGy·cm. CONCLUSION Third-generation DSCT requires significantly lower radiation dose for WBLDCT than second-generation DSCT and has an effective dose below reported doses for radiographic skeletal surveys. To ensure radiation protection, DRLs regarding WBLDCT are required, where our locally determined values may help as benchmarks.
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Affiliation(s)
- Sebastian Zensen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Denise Bos
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Radiation exposure of computed tomography imaging for the assessment of acute stroke. Neuroradiology 2020; 63:511-518. [PMID: 32901338 PMCID: PMC7966220 DOI: 10.1007/s00234-020-02548-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022]
Abstract
Purpose To assess suspected acute stroke, the computed tomography (CT) protocol contains a non-contrast CT (NCCT), a CT angiography (CTA), and a CT perfusion (CTP). Due to assumably high radiation doses of the complete protocol, the aim of this study is to examine radiation exposure and to establish diagnostic reference levels (DRLs). Methods In this retrospective study, dose data of 921 patients with initial CT imaging for suspected acute stroke and dose monitoring with a DICOM header–based tracking and monitoring software were analyzed. Between June 2017 and January 2020, 1655 CT scans were included, which were performed on three different modern multi-slice CT scanners, including 921 NCCT, 465 CTA, and 269 CTP scans. Radiation exposure was reported for CT dose index (CTDIvol) and dose-length product (DLP). DRLs were set at the 75th percentile of dose distribution. Results DRLs were assessed for each step (CTDIvol/DLP): NCCT 33.9 mGy/527.8 mGy cm and CTA 13.7 mGy/478.3 mGy cm. Radiation exposure of CTP was invariable and depended on CT device and its protocol settings with CTDIvol 124.9–258.2 mGy and DLP 1852.6–3044.3 mGy cm. Conclusion Performing complementary CT techniques such as CTA and CTP for the assessment of acute stroke increases total radiation exposure. Hence, the revised DRLs for the complete protocol are required, where our local DRLs may help as benchmarks.
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Grajo JR, Sahani DV. Dual-Energy CT of the Abdomen and Pelvis: Radiation Dose Considerations. J Am Coll Radiol 2018; 15:1128-1132. [DOI: 10.1016/j.jacr.2017.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/05/2017] [Accepted: 08/14/2017] [Indexed: 12/12/2022]
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White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 2. J Comput Assist Tomogr 2016; 40:846-850. [DOI: 10.1097/rct.0000000000000539] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Garba I, Engel-Hills P, Davidson F, Tabari AM. Computed tomography dose index for head CT in northern Nigeria. RADIATION PROTECTION DOSIMETRY 2015; 165:98-101. [PMID: 25889610 DOI: 10.1093/rpd/ncv188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Computed tomography dose index w and dose length product were recorded for the purpose of developing diagnostic reference levels (DRLs) for radiation dose optimisation. The study was conducted in three radiology departments with CT centres in Northern Nigeria. Data were collected from 54 consenting adult participants (weighing 70 kg ± 3) that had head CT scans. Analysis was done using SPSS version statistical software. A combined dose for the three centres was calculated and compared with the reported data from the international communities where there are established DRLs. Third quartile values of CTDIw and DLP were determined as 77 mGy and 985 mGy cm, respectively. Local DRLs that are significantly higher than most of the reported data in the literature have been established.
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Affiliation(s)
- I Garba
- Department of Medical Radiography, Bayero University Kano, Kano, Kano State, Nigeria
| | - P Engel-Hills
- Department of Nursing and Radiography, Cape Peninsula University of Technology Cape Town, Cape Town, South Africa
| | - F Davidson
- Department of Nursing and Radiography, Cape Peninsula University of Technology Cape Town, Cape Town, South Africa
| | - A M Tabari
- Department of Radiology, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
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Goren AD, Prins RD, Dauer LT, Quinn B, Al-Najjar A, Faber RD, Patchell G, Branets I, Colosi DC. Effect of leaded glasses and thyroid shielding on cone beam CT radiation dose in an adult female phantom. Dentomaxillofac Radiol 2013; 42:20120260. [PMID: 23412460 DOI: 10.1259/dmfr.20120260] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aims to demonstrate the effectiveness of leaded glasses in reducing the lens of eye dose and of lead thyroid collars in reducing the dose to the thyroid gland of an adult female from dental cone beam CT (CBCT). The effect of collimation on the radiation dose in head organs is also examined. METHODS Dose measurements were conducted by placing optically stimulated luminescent dosemeters in an anthropomorphic female phantom. Eye lens dose was measured by placing a dosemeter on the anterior surface of the phantom eye location. All exposures were performed on one commercially available dental CBCT machine, using selected collimation and exposure techniques. Each scan technique was performed without any lead shielding and then repeated with lead shielding in place. To calculate the percent reduction from lead shielding, the dose measured with lead shielding was divided by the dose measured without lead shielding. The percent reduction from collimation was calculated by comparing the dose measured with collimation to the dose measured without collimation. RESULTS The dose to the internal eye for one of the scans without leaded glasses or thyroid shield was 0.450 cGy and with glasses and thyroid shield was 0.116 cGy (a 74% reduction). The reduction to the lens of the eye was from 0.396 cGy to 0.153 cGy (a 61% reduction). Without glasses or thyroid shield, the thyroid dose was 0.158 cGy; and when both glasses and shield were used, the thyroid dose was reduced to 0.091 cGy (a 42% reduction). CONCLUSIONS Collimation alone reduced the dose to the brain by up to 91%, with a similar reduction in other organs. Based on these data, leaded glasses, thyroid collars and collimation minimize the dose to organs outside the field of view.
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Affiliation(s)
- A D Goren
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY 10010, USA.
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Ngaile JE, Msaki P, Kazema R. Patient-size-dependent radiation dose optimisation technique for abdominal CT examinations. RADIATION PROTECTION DOSIMETRY 2012; 148:189-201. [PMID: 21357583 DOI: 10.1093/rpd/ncr021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Since patient doses from computed tomography (CT) are relatively high, risk-benefit analysis requires dose to patients and image quality be optimised. The aim of this study was to develop a patient-dependent optimisation technique that uses patient diameter to select a combination of CT scanning parameters that minimise dose delivered to patients undergoing abdominal CT examinations. The study was performed using cylindrical phantoms of diameters ranging from 16 to 40 cm in order to establish the relationship between image degradation, CT scanning techniques, patient dose and patient size from two CT scanners. These relationships were established by scanning the phantoms using standard scanning technique followed by selected combinations of scanning parameters. The image noises through phantom images were determined using region of interest software available in both scanners. The energy depositions to the X-ray detector through phantoms were determined from measurements of CT dose index in air corrected for attenuation of the phantom materials. The results demonstrate that exposure settings (milliampere seconds) could be reduced by up to 82 % for smaller phantom relative to standard milliampere seconds, while detector signal could be reduced by up to 93 % for smaller phantom relative to energy depositions required when scanned using standard scanning protocols. It was further revealed that the use of the object-specific scanning parameters on studies performed with phantom of different diameters could reduce the incident radiation to small size object by up to 86 % to obtain the same image quality required for standard adult object. In view of the earlier mentioned fact, substantial dose saving from small-sized adults and children patients undergoing abdomen CT examinations could be achieved through optimal adjustment of CT scanning technique based on the patient transverse diameter.
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Affiliation(s)
- J E Ngaile
- Directorate of Radiation Control, Tanzania Atomic Energy Commission, PO Box 743 Arusha, Tanzania.
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Brady Z, Cain T, Johnston P. Differences in using the international commission on radiological protection’s publications 60 and 103 for determining effective dose in paediatric CT examinations. RADIAT MEAS 2011. [DOI: 10.1016/j.radmeas.2011.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pantos I, Thalassinou S, Argentos S, Kelekis NL, Panayiotakis G, Efstathopoulos EP. Adult patient radiation doses from non-cardiac CT examinations: a review of published results. Br J Radiol 2011; 84:293-303. [PMID: 21266399 PMCID: PMC3473464 DOI: 10.1259/bjr/69070614] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 07/29/2010] [Accepted: 08/16/2010] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES CT is a valuable tool in diagnostic radiology but it is also associated with higher patient radiation doses compared with planar radiography. The aim of this article is to review patient dose for the most common types of CT examinations reported during the past 19 years. METHODS Reported dosimetric quantities were compared with the European diagnostic reference levels (DRLs). Effective doses were assessed with respect to the publication year and scanner technology (i.e. single-slice vs multislice). RESULTS Considerable variation of reported values among studies was attributed to variations in both examination protocol and scanner design. Median weighted CT dose index (CTDI(w)) and dose length product (DLP) are below the proposed DRLs; however, for individual studies the DRLs are exceeded. Median reported effective doses for the most frequent CT examinations were: head, 1.9 mSv (0.3-8.2 mSv); chest, 7.5 mSv (0.3-26.0 mSv); abdomen, 7.9 mSv (1.4-31.2 mSv); and pelvis, 7.6 mSv (2.5-36.5 mSv). CONCLUSION The introduction of mechanisms for dose reduction resulted in significantly lower patient effective doses for CT examinations of the head, chest and abdomen reported by studies published after 1995. Owing to the limited number of studies reporting patient doses for multislice CT examinations the statistical power to detect differences with single-slice scanners is not yet adequate.
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Affiliation(s)
- I Pantos
- Second Department of Radiology, Medical School, University of Athens, Greece
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Radiation dose for routine clinical adult brain CT: Variability on different scanners at one institution. AJR Am J Roentgenol 2010; 195:433-8. [PMID: 20651201 DOI: 10.2214/ajr.09.3957] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine, using an anthropomorphic phantom, whether patients are subject to variable radiation doses based on scanner assignment for routine CT of the brain. MATERIALS AND METHODS Twenty metal oxide semiconductor field effect transistor dosimeters were placed in the brain of a male anthropomorphic phantom scanned three times with a routine clinical brain CT protocol on four scanners from one manufacturer in four configurations and on one 64-MDCT scanner from another manufacturer. Absorbed organ doses were measured for skin, cranium, brain, lens of the eye, mandible, and thyroid. Effective dose was calculated on the basis of the dose-length product recorded on each scanner. RESULTS Organ dose ranges were as follows: cranium, 2.57-3.47 cGy; brain, 2.34-3.78 cGy; lens, 2.51-5.03 cGy; mandible 0.17-0.48 cGy; and thyroid, 0.03-0.28 cGy. Statistically significant differences between scanners with respect to dose were recorded for brain and lens (p < 0.05). Absorbed doses were lowest on the single-detector scanner. In the comparison of MDCT scanners, the highest doses were found on the 4-MDCT scanner and the dual-source 64-MDCT scanner not capable of gantry tilt. Effective dose ranged from 1.22 to 1.86 mSv. CONCLUSION According to the phantom data, patients are subject to different organ doses in the lens and brain depending on scanner assignment. At our institution with existing protocols, absorbed doses at brain CT are lowest with the single-detector CT scanner, followed by MDCT scanners capable of gantry tilt. On scanners without gantry tilt, CT of the brain should be performed with careful head positioning and shielding of the orbits. These precautions are especially true for patients who need repeated scanning and for pediatric patients.
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Suzuki S, Furui S, Ishitake T, Abe T, Machida H, Takei R, Ibukuro K, Watanabe A, Kidouchi T, Nakano Y. Lens exposure during brain scans using multidetector row CT scanners: methods for estimation of lens dose. AJNR Am J Neuroradiol 2010; 31:822-6. [PMID: 20044501 PMCID: PMC7964184 DOI: 10.3174/ajnr.a1946] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 10/01/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Some recent studies on radiation lens injuries have indicated much lower dose thresholds than specified by the current radiation protection guidelines. The purpose of this research was to measure the lens dose during brain CT scans with multidetector row CT and to assess methods for estimating the lens dose. MATERIALS AND METHODS With 8 types of multidetector row CT scanners, both axial and helical scans were obtained for the head part of a human-shaped phantom by using normal clinical settings with the orbitomeatal line as the baseline. We measured the doses on both eyelids by using an RPLGD during whole-brain scans including the orbit with the starting point at the level of the inferior orbital rim. To assess the effect of the starting points on the lens doses, we measured the lens doses by using 2 other starting points for scanning (the orbitomeatal line and the superior orbital rim). RESULTS The CTDIvols and the lens doses during whole-brain CT including the orbit were 50.9-113.3 mGy and 42.6-103.5 mGy, respectively. The ratios of lens dose to CTDIvol were 80.6%-103.4%. The lens doses decreased as the starting points were set more superiorly. The lens doses during scans from the superior orbital rim were 11.8%-20.9% of the doses during the scans from the inferior orbital rim. CONCLUSIONS CTDIvol can be used to estimate the lens dose during whole-brain CT when the orbit is included in the scanning range.
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Affiliation(s)
- S Suzuki
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan.
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Baraff LJ, Byyny RL, Probst MA, Salamon N, Linetsky M, Mower WR. Prevalence of herniation and intracranial shift on cranial tomography in patients with subarachnoid hemorrhage and a normal neurologic examination. Acad Emerg Med 2010; 17:423-8. [PMID: 20370782 DOI: 10.1111/j.1553-2712.2010.00704.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Patients frequently present to the emergency department (ED) with headache. Those with sudden severe headache are often evaluated for spontaneous subarachnoid hemorrhage (SAH) with noncontrast cranial computed tomography (CT) followed by lumbar puncture (LP). The authors postulated that in patients without neurologic symptoms or signs, physicians could forgo noncontrast cranial CT and proceed directly to LP. The authors sought to define the safety of this option by having senior neuroradiologists rereview all cranial CTs in a group of such patients for evidence of brain herniation or midline shift. METHODS This was a retrospective study that included all patients with a normal neurologic examination and nontraumatic SAH diagnosed by CT presenting to a tertiary care medical center from August 1, 2001, to December 31, 2004. Two neuroradiologists, blinded to clinical information and outcomes, rereviewed the initial ED head CT for evidence of herniation or midline shift. RESULTS Of the 172 patients who presented to the ED with spontaneous SAH diagnoses by cranial CT, 78 had normal neurologic examinations. Of these, 73 had initial ED CTs available for review. Four of the 73 (5%; 95% confidence interval [CI] = 2% to 13%) had evidence of brain herniation or midline shift, including three (4%; 95% CI = 1% to 12%) with herniation. In only one of these patients was herniation or shift noted on the initial radiology report. CONCLUSIONS Awake and alert patients with a normal neurologic examination and SAH may have brain herniation and/or midline shift. Therefore, cranial CT should be obtained before LP in all patients with suspected SAH.
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Affiliation(s)
- Larry J Baraff
- University of California Los Angeles Emergency Medicine Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Probst MA, Baraff LJ, Hoffman JR, Wolfson AB, Ourian AJ, Mower WR. Can patients with brain herniation on cranial computed tomography have a normal neurologic exam? Acad Emerg Med 2009; 16:145-50. [PMID: 19076104 DOI: 10.1111/j.1553-2712.2008.00312.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Herniation of the brain outside of its normal intracranial spaces is assumed to be accompanied by clinically apparent neurologic dysfunction. The authors sought to determine if some patients with brain herniation or significant brain shift diagnosed by cranial computed tomography (CT) might have a normal neurologic examination. METHODS This is a secondary analysis of the National Emergency X-Radiography Utilization Study (NEXUS) II cranial CT database compiled from a multicenter, prospective, observational study of all patients for whom cranial CT scanning was ordered in the emergency department (ED). Clinical information including neurologic examination was prospectively collected on all patients prior to CT scanning. Using the final cranial CT radiology reports from participating centers, all CT scans were classified into three categories: frank herniation, significant shift without frank herniation, and minimal or no shift, based on predetermined explicit criteria. These reports were concatenated with clinical information to form the final study database. RESULTS A total of 161 patients had CT-diagnosed frank herniation; 3 (1.9%) had no neurologic deficit. Of 91 patients with significant brain shift but no herniation, 4 (4.4%) had no neurologic deficit. CONCLUSIONS A small number of patients may have normal neurologic status while harboring significant brain shift or brain herniation on cranial CT.
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Affiliation(s)
- Marc A Probst
- University of California, Los Angeles Emergency Medicine Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Hurwitz LM, Yoshizumi TT, Goodman PC, Frush DP, Nguyen G, Toncheva G, Lowry C. Effective Dose Determination Using an Anthropomorphic Phantom and Metal Oxide Semiconductor Field Effect Transistor Technology for Clinical Adult Body Multidetector Array Computed Tomography Protocols. J Comput Assist Tomogr 2007; 31:544-9. [PMID: 17882029 DOI: 10.1097/rct.0b013e31802d3dd2] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the organ doses and total body effective dose (ED) delivered to an anthropomorphic phantom by multidetector array computed tomography (MDCT) when using standard clinical adult body imaging protocols. MATERIALS AND METHODS Metal oxide semiconductor field effect transistor (MOSFET) technology was applied during the scanning of a female anthropomorphic phantom to determine 20 organ doses delivered during clinical body computed tomography (CT) imaging protocols. A 16-row MDCT scanner (LightSpeed, General Electric Healthcare, Milwaukee, Wis) was used. Effective dose was calculated as the sum of organ doses multiplied by a weighting factor determinant found in the International Commission on Radiological Protection Publication 60. Volume CT dose index and dose length product (DLP) values were recorded at the same time for the same scan. RESULTS Effective dose (mSv) for body MDCT imaging protocols were as follows: standard chest CT, 6.80 +/- 0.6; pulmonary embolus CT, 13.7 +/- 0.4; gated coronary CT angiography, 20.6 +/- 0.4; standard abdomen and pelvic CT, 13.3 + 1.0; renal stone CT, 4.51 + 0.45. Effective dose calculated by direct organ measurements in the phantom was 14% to 37% greater than those determined by the DLP method. CONCLUSIONS Effective dose calculated by the DLP method underestimates ED as compared with direct organ measurements for the same CT examination. Organ doses and total body ED are higher than previously reported for MDCT clinical body imaging protocols.
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Affiliation(s)
- Lynne M Hurwitz
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
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Tsapaki V, Aldrich JE, Sharma R, Staniszewska MA, Krisanachinda A, Rehani M, Hufton A, Triantopoulou C, Maniatis PN, Papailiou J, Prokop M. Dose reduction in CT while maintaining diagnostic confidence: diagnostic reference levels at routine head, chest, and abdominal CT--IAEA-coordinated research project. Radiology 2006; 240:828-34. [PMID: 16837668 DOI: 10.1148/radiol.2403050993] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To measure radiation doses for computed tomography (CT) of the head, chest, and abdomen and compare them with the diagnostic reference levels, as part of the International Atomic Energy Agency Research coordination project. MATERIALS AND METHODS The local ethics committees of all participating institutions approved the study protocol. Written informed consent was obtained from all patients. All scanners were helical single-section or multi-detector row CT systems. Six hundred thirty-three patients undergoing head (n = 97), chest (n = 243), or abdominal (n = 293) CT were included. Collected data included patient height, weight, sex, and age; tube voltage and tube current-time product settings; pitch; section thickness; number of sections; weighted or volumetric CT dose index; and dose-length product (DLP). The effective dose was also estimated and served as collective dose estimation data. RESULTS Mean volumetric CT dose index and DLP values were below the European diagnostic reference levels: 39 mGy and 544 mGy . cm, respectively, at head CT; 9.3 mGy and 348 mGy . cm, respectively, at chest CT; and 10.4 mGy and 549 mGy . cm, respectively, at abdominal CT. Estimated effective doses were 1.2, 5.9, and 8.2 mSv, respectively. CONCLUSION Comparison of CT results with diagnostic reference levels revealed the need for revisions, partly because the newer scanners have improved technology that facilitates lower patient doses.
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Affiliation(s)
- Virginia Tsapaki
- CT Department, Konstantopoulio Agia Olga Hospital, 1 Ifaistou St, 14569 Anixi, Athens, Greece.
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Williams L, Adams C. Computed tomography of the head: An experimental study to investigate the effectiveness of lead shielding during three scanning protocols. Radiography (Lond) 2006. [DOI: 10.1016/j.radi.2005.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Muhogora WE, Nyanda AM, Ngoye WM, Shao D. Radiation doses to patients during selected CT procedures at four hospitals in Tanzania. Eur J Radiol 2005; 57:461-7. [PMID: 16165335 DOI: 10.1016/j.ejrad.2005.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2005] [Revised: 07/27/2005] [Accepted: 08/10/2005] [Indexed: 12/21/2022]
Abstract
The dose characteristics of CT scanners from local scanning protocols were investigated on the basis of questionnaire information provided by four hospitals conducting CT procedures in Tanzania. The information included scanner model, scanner manufacturer, number of most frequent CT examinations and the employed scanning parameters to previously diagnosed patients. For each scan technique, patient doses were estimated in terms of computerized tomography dose index, dose length product and effective dose using the software developed by the ImPACT scan group in conjunction with the NRPB conversion coefficients data. The results show that the mean CTDI_w,100, DLP and effective dose ranged from 8.5 +/- 2.8 to 79.3 +/- 23.7mGy, 145 +/- 5 to 1400 +/- 812.5 mGy cm and 3 +/- 2.3 to 15.7 +/- 10.4 mSv, respectively. On average, the observed CT doses are however roughly higher than the reported literature data such as 30 to 60 mGy, 570 to 1050 mGy cm and 2.4 to 11.7 mSv recommended by European Commission for similar CT examinations. The higher dose levels, which are possibly associated with significant risks, justify extensive similar studies at the national level in order to unify different approaches towards optimisation of CT examinations. In pursue of this noble objective, the need to train the radiology personnel, establish and using protocols and continuously monitor the performance of CT equipment to control patient CT doses is of utmost importance.
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Affiliation(s)
- W E Muhogora
- Tanzania Atomic Energy Commission, P.O. Box 743, Arusha, United Republic of Tanzania.
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Gadda D, Vannucchi L, Niccolai F, Neri AT, Carmignani L, Pacini P. Multidetector computed tomography of the head in acute stroke: predictive value of different patterns of the dense artery sign revealed by maximum intensity projection reformations for location and extent of the infarcted area. Eur Radiol 2005; 15:2387-95. [PMID: 16059679 DOI: 10.1007/s00330-005-2850-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Revised: 06/12/2005] [Accepted: 06/21/2005] [Indexed: 11/25/2022]
Abstract
Maximum intensity projections reconstructions from 2.5 mm unenhanced multidetector computed tomography axial slices were obtained from 49 patients within the first 6 h of anterior-circulation cerebral strokes to identify different patterns of the dense artery sign and their prognostic implications for location and extent of the infarcted areas. The dense artery sign was found in 67.3% of cases. Increased density of the whole M1 segment with extension to M2 of the middle cerebral artery was associated with a wider extension of cerebral infarcts in comparison to M1 segment alone or distal M1 and M2. A dense sylvian branch of the middle cerebral artery pattern was associated with a more restricted extension of infarct territory. We found 62.5% of patients without a demonstrable dense artery to have a limited peripheral cortical or capsulonuclear lesion. In patients with a 7-10 points on the Alberta Stroke Early Programme Computed Tomography Score and a dense proximal MCA in the first hours of ictus the mean decrease in the score between baseline and follow-up was 5.09+/-1.92 points. In conclusion, maximum intensity projections from thin-slice images can be quickly obtained from standard computed tomography datasets using a multidetector scanner and are useful in identifying and correctly localizing the dense artery sign, with prognostic implications for the entity of cerebral damage.
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Affiliation(s)
- Davide Gadda
- U.O. Radiodiagnostica, Ospedale del Ceppo, Piazza San Lorenzo, 51100, Pistoia, Italy.
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Origgi D, Vigorito S, Villa G, Bellomi M, Tosi G. Survey of computed tomography techniques and absorbed dose in Italian hospitals: a comparison between two methods to estimate the dose–length product and the effective dose and to verify fulfilment of the diagnostic reference levels. Eur Radiol 2005; 16:227-37. [PMID: 15711836 DOI: 10.1007/s00330-005-2682-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Revised: 12/20/2004] [Accepted: 01/13/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study was the production of the first Italian survey of radiation dose in computed tomography (CT) prior to the widespread adoption of multislice CT, in order to have a reference point to facilitate later investigation of dose exposure changes brought by this new CT modality. The collected dose data were compared with diagnostic reference levels (DRLs). The agreement between experimental dose evaluation and Monte Carlo (MC) simulations was investigated. The survey was carried out in 29 Italian hospitals, covered 48 CT scanners and 232 examinations. The dose-length product (DLP) and effective dose (E) values were estimated based on MC simulations for seven clinical protocols using the CT-Dose program. Statistical analysis showed a significant difference (p<0.01) in the DLP between the two methods, with MC values being greater than the experimental ones. For E, the MC values were greater in routine head (8.2%), cervical spine (2.7%) and lumbar spine (2.9%) studies. The weighted CT dose index, the DLP and E were always below the DRLs set by the European Community. This dose survey gives a good but incomplete picture of the Italian CT dose situation and may be useful as a reference baseline for defining clinical multislice protocols in the near future.
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Affiliation(s)
- Daniela Origgi
- Department of Medical Physics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
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Huda W, Lieberman KA, Chang J, Roskopf ML. Patient size and x-ray technique factors in head computed tomography examinations. I. Radiation doses. Med Phys 2004; 31:588-94. [PMID: 15070258 DOI: 10.1118/1.1646232] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We investigated how patient age, size and composition, together with the choice of x-ray technique factors, affect radiation doses in head computed tomography (CT) examinations. Head size dimensions, cross-sectional areas, and mean Hounsfield unit (HU) values were obtained from head CT images of 127 patients. For radiation dosimetry purposes patients were modeled as uniform cylinders of water. Dose computations were performed for 18 x 7 mm sections, scanned at a constant 340 mAs, for x-ray tube voltages ranging from 80 to 140 kV. Values of mean section dose, energy imparted, and effective dose were computed for patients ranging from the newborn to adults. There was a rapid growth of head size over the first two years, followed by a more modest increase of head size until the age of 18 or so. Newborns have a mean HU value of about 50 that monotonically increases with age over the first two decades of life. Average adult A-P and lateral dimensions were 186+/-8 mm and 147+/-8 mm, respectively, with an average HU value of 209+/-40. An infant head was found to be equivalent to a water cylinder with a radius of approximately 60 mm, whereas an adult head had an equivalent radius 50% greater. Adult males head dimensions are about 5% larger than for females, and their average x-ray attenuation is approximately 20 HU greater. For adult examinations performed at 120 kV, typical values were 32 mGy for the mean section dose, 105 mJ for the total energy imparted, and 0.64 mSv for the effective dose. Increasing the x-ray tube voltage from 80 to 140 kV increases patient doses by about a factor of 5. For the same technique factors, mean section doses in infants are 35% higher than in adults. Energy imparted for adults is 50% higher than for infants, but infant effective doses are four times higher than for adults. CT doses need to take into account patient age, head size, and composition as well as the selected x-ray technique factors.
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Affiliation(s)
- Walter Huda
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York 13210, USA.
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Hidajat N, Wolf M, Nunnemann A, Liersch P, Gebauer B, Teichgräber U, Schröder RJ, Felix R. Survey of conventional and spiral ct doses. Radiology 2001; 218:395-401. [PMID: 11161152 DOI: 10.1148/radiology.218.2.r01ja12395] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the radiation dose for conventional computed tomography (CT) and spiral CT during different CT examinations at various hospitals and practices. MATERIALS AND METHODS CT dose index with an active length of 15 cm was measured in 16 different types of CT scanners by using ionization chamber dosimetry. Twenty-six holders (one who has legal responsibility under national law for a radiologic installation) operating a total of seven conventional and 20 spiral CT scanners were asked for their standard parameters for various CT examinations. Weighted CT dose index and dose-length product were determined for each examination. RESULTS For most examinations, the tube current time product was significantly higher for conventional CT than for spiral CT (.002 </= P </=.05). The ratio of section distance to section thickness for conventional CT was significantly lower than the pitch for spiral CT (.001 </= P </=.05). The weighted CT dose index and dose-length product for spiral CT were about half of those for conventional CT. The third quartiles for weighted CT dose index and dose-length product for spiral CT were much lower than those recommended as reference doses. CONCLUSION CT examinations with conventional CT scanners are often performed with unnecessarily high radiation dose. For the establishment of reference doses, the radiation dose with spiral CT scanners should be taken into account.
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Affiliation(s)
- N Hidajat
- Department of Radiology, Charité, Virchow-Clinic of the Humboldt-University, Augustenburger Platz 1, 13353 Berlin, Germany.
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Shah G, Buxton A. Survey of dose associated with chest radiography in the Hunter Valley region of Australia. Radiography (Lond) 1999. [DOI: 10.1016/s1078-8174(99)90005-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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