1
|
Issahaku S, Boadu M, Inkoom S, Hasford F, Sackey TA. Establishment and utilisation of national diagnostic reference level for adult computed tomography examinations in Ghana. Radiat Prot Dosimetry 2024; 200:564-571. [PMID: 38453140 DOI: 10.1093/rpd/ncae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 03/09/2024]
Abstract
The International Atomic Energy Agency, as part of the new regional project (RAF/9/059), recommend the establishment of diagnostic reference levels (DRLs) in Africa. In response to this recommendation, this project was designed to establish and utilise national DRLs of routine computed tomography (CT) examinations. These were done by estimating CT dose index and dose length product (DLP) from a minimum of 20 patient dose report of the most frequently used procedures using 75th percentile distribution of the median values. In all, 22 centres that formed 54% of all CT equipment in the country took part in this study. Additionally, a total of 2156 adult patients dose report were randomly selected, with a percentage distribution of 60, 12, 21 and 7% for head, chest, abdomen-pelvis and lumber spine, respectively. The established DRL for volume CT dose index were 60.0, 15.7, 20.5 and 23.8 mGy for head, chest, abdomen-pelvis and lumber spine, respectively. While the established DRL for DLP were 962.9, 1102.8, 1393.5 and 824.6 mGy-cm for head, chest, abdomen-pelvis, and lumber spine, respectively. These preliminary results were comparable with data from 16 other African countries, European Commission and the International Commission on Radiological Protection. Hence, this study would serve as a baseline for the establishment of a more generalised regional and national adult DRLs for Africa and other developing countries.
Collapse
Affiliation(s)
- Shiraz Issahaku
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Mary Boadu
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Stephen Inkoom
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Francis Hasford
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Theophilus A Sackey
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
- Korle-Bu Teaching Hospital, Department of Radiology, PMB, Accra, Ghana
| |
Collapse
|
2
|
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. J Radiol Prot 2024; 44:021506. [PMID: 38537259 DOI: 10.1088/1361-6498/ad3837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| | | |
Collapse
|
3
|
Albeshan SM, Alhulail AA, Almuqbil MM. Glandular doses and diagnostic reference levels (DRLs) for Saudi breast cancer screening programme (2012-2021). Radiat Prot Dosimetry 2024; 200:467-472. [PMID: 38324508 DOI: 10.1093/rpd/ncae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/28/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024]
Abstract
The aim of this study was to report the diagnostic reference levels (DRLs) corresponding to different compressed breast thickness (CBT) ranges. To achieve this, mammographic examinations with 187,788 exposures were analysed. The mean average glandular (AGD) dose was calculated per view, examination, and center. Moreover, the DRL values corresponding to different CBT ranges were reported. The result of the mean AGD per view was found to be 1.36 mGy for craniocaudal (CC) and 1.54 mGy for Mediolateral oblique (MLO), while the mean AGD per examination for all women was 1.45 mGy. The DRL values corresponding to CBTs between 20 to 79 mm ranges were below 2 mGy. These results were from a population of mean age = 49 ± 8 years and mean CBT = 58 ± 8 mm, and was imaged with mean exposures of 29 ± 1 kVp and 74 ± 31 mAs, and a mean compression force of 135±37 N. In conclusion, good mammography practice has been shown, as DRL values are within the limits suggested by the international organizations.
Collapse
Affiliation(s)
- Salman M Albeshan
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 145111, Riyadh 4545, Saudi Arabia
| | - Ahmad A Alhulail
- Department of Radiology and Medical Imaging, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | - Maha M Almuqbil
- Ministry of Health, General Directorate for Health Programs and Chronic Diseases, Riyadh 12628, Saudi Arabia
| |
Collapse
|
4
|
Pimenta A, Azevedo L, Ramos I, Santos J. Establishment of Diagnostic Reference Levels in Portuguese Interventional Radiology departments. Eur J Radiol 2024; 173:111377. [PMID: 38382425 DOI: 10.1016/j.ejrad.2024.111377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE To establish Portuguese Diagnostic Reference Levels (DRLs), for six body fluoroscopy guided interventional procedures (FGIP). METHOD A retrospective study was conducted in five interventional departments most representative of Interventional Radiology (IR) practice. Dose values, in terms of air kerma area product (PKA in Gy.cm2), air kerma at the patient entrance reference point (Ka,r in mGy), and exposure parameters (fluoroscopy time (FT) and number of cine runs) were collected. Examinations were selected per procedure (at least 20), according to the antero-posterior and lateral diameter mean value (±5 cm), measured on previous Computed Tomography (CT) examinations. RESULTS Data of 489 body FGIP show a large variation on dose values per procedure and per department. National DRLs in terms of PKA were 20.2 Gy.cm2 for Percutaneous transhepatic biliary drainage (PTBD), 98.2 Gy.cm2 for Bronchial artery embolisation (BAE), 247.7 Gy.cm2 for Transarterial chemoembolisation (TACE), 331.6 Gy.cm2 for Inferior epigastric arteries embolisation (IEAE), 312.0 Gy.cm2 for Transjugular intrahepatic portosystemic shunt (TIPS) and 19.3 Gy.cm2 for Endovascular treatment of femoral popliteal arteries (ETFPA). CONCLUSIONS This is the first study reporting Interventional Radiology DRLs in Portugal and we propose preliminary national estimates for the six more common body FGIP. The results of this study will be presented and discussed with all Portuguese IR departments, to promote procedures optimisation.
Collapse
Affiliation(s)
- Andrea Pimenta
- University Hospital of St. John (CHUSJ), Radiology Department - Porto, Portugal.
| | - Luís Azevedo
- CINTESIS@RISE Department of Community, Information and Health Decision Sciences- MEDCIDS, Faculty of Medicine University of Porto, Porto, Portugal.
| | | | - Joana Santos
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Portugal.
| |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/23/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVES To evaluate the effect of equipment technology on reference point air kerma (Ka,r), air kerma-area product (PKA), and fluoroscopic time for fluoroscopically-guided gastrointestinal endoscopic procedures and establish benchmark levels. METHODS This retrospective study included the consecutive patients who underwent fluoroscopically-guided gastrointestinal endoscopic procedures from May 2016 to August 2023 at a tertiary care hospital in the U.S. Fluoroscopic systems included (a) Omega CS-50 e-View, (b) GE Precision 500D, and (c) Siemens Cios Alpha. Radiation dose was analyzed for four procedure types of endoscopic retrograde biliary, pancreas, biliary and pancreas combined, and other guidance. Median and 75th percentile values were computed using software package R (version 4.0.5, R Foundation). RESULTS This large study analyzed 9,459 gastrointestinal endoscopic procedures. Among four procedure types, median Ka,r was 108.8-433.2 mGy (a), 70-272 mGy (b), and 22-55.1 mGy (c). Median PKA was 20.9-49.5 Gy∙cm2 (a), 13.4-39.7 Gy∙cm2 (b), and 8.91-20.9 Gy∙cm2 (c). Median fluoroscopic time was 2.8-8.1 min (a), 3.6-9.2 min (b), and 2.9-9.4 min (c). Their median value ratio (a:b:c) was 8.5:4.8:1 (Ka,r), 2.7:2.1:1 (PKA), and 1.0:1.1:1 (fluoroscopic time). Median value and 75th percentile are presented for Ka,r, PKA, and fluoroscopic time for each procedure type, which can function as benchmark for comparison for dose optimization studies. CONCLUSION This study shows manifold variation in doses (Ka,r and PKA) among three fluoroscopic equipment types and provides local reference levels (50th and 75th percentiles) for four gastrointestinal endoscopic procedure types. Besides procedure type, imaging technology should be considered for establishing diagnostic reference level. SUMMARY With manifold (2 to 12 times) variation in doses observed in this study among 3 machines, we recommend development of technology-based diagnostic reference levels for gastrointestinal endoscopic procedures.
Collapse
Affiliation(s)
- Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Xinhua Li
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| |
Collapse
|
6
|
Alhorani Q, Alkhybari E, Rawashdeh M, Sabarudin A, Latiff RA, Al-Ibraheem A, Mohamad M. National and local diagnostic reference levels for adult 18F-FDG and CT in Jordanian PET/CT: findings and implications in practice. J Radiol Prot 2024; 44:011512. [PMID: 38387102 DOI: 10.1088/1361-6498/ad2c62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/22/2024] [Indexed: 02/24/2024]
Abstract
This study aims to report the findings of Jordanian national diagnostic reference level (NDRL) survey for fluorodeoxyglucose (18F-FDG) and local diagnostic reference level (LDRL) of computed tomography (CT) used for attenuation correction and anatomical localisation (AC-AL); and AC and diagnostic CT (AC-DX) within the context of whole-body WB and half-body HB adult oncology PET/CT scanning. Two-structured questionnaires were prepared to gather the necessary information: dosimetry data, patient demographics, equipment specification, and acquisition protocols for identified18F-FDG PET/CT procedures. The NDRL and achievable dose were reported based on the 75th and 50th percentiles for18F-FDG administered activity (AA), respectively. The LDRL was reported based on the 50th percentile for (CTDIvol) and (DLP). Data from 562 patients from four Jordanian PET/CT centres were collected. The survey revealed that Jordanian NDRL for AA (303 MBq) was within the acceptable range compared to the published-peer NDRL data (240-590 MBq). However, the18F-FDG AA varied across the participated PET/CT centres. The reported LDRL CTDIvoland DLP of CT used for (AC-AL) was 4.3 mGy and 459.3 mGy.cm for HB CT scan range, and 4.1 mGy and 659.9 mGy.cm for WB CT scans. The reported LDRL for CTDIvoland DLP for HB CT was higher when compared with the United Kingdom (3.2 mGy and 310 mGy.cm). Concurrently, in the context of WB CT, the reported values (i.e. CTDIvol and DLP) were also higher than both Kuwait (3.6 mGy and 659 mGy.cm) and Slovenia (3.6 mGy and 676 mGy.cm). The reported HB CT(AC-DX) was higher than Nordic, New Zealand and Swiss NDRLs and for WB (AC-DX) CT it was higher than Swiss NDRLs. This study reported the first Jordanian NDRL for18F-FDG and LDRL for HB and WB CT associated with18F-FDG PET/CT scans. This data is useful for Jordanian PET/CT centres to compare their LDRL to the suggested DRLs and utilise it in the process of optimising CT radiation doses.
Collapse
Affiliation(s)
- Qays Alhorani
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Essam Alkhybari
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohammad Rawashdeh
- Radiologic Technology Program, Applied Medical Sciences College, Jordan University of Science and Technology, Irbid, Jordan
- Faculty of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Akmal Sabarudin
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rukiah A Latiff
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mazlyfarina Mohamad
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
7
|
Kamdem EF, Fotue AJ, Kouam BBF, Abogo S, Samba ON. Estimation of diagnostic reference levels for pediatric head computed tomography in Yaoundé. Radiat Prot Dosimetry 2024; 200:259-263. [PMID: 38088439 DOI: 10.1093/rpd/ncad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 03/05/2024]
Abstract
The diagnostic reference levels (DRLs) are determined from dosimetry studies to compare and manage patient doses in medical imaging procedures. The aim of this work was to establish the first DRLs for pediatric patients during the most common computed tomography (CT) procedures in Yaoundé, Cameroon during routine head CT examinations to know how to improve our clinical practice tomorrow. The sample was classified per age group: ≤ 1-, 1-5-, 5-10- and 10-15-y-old. The retrospective study was used. The proposed DRLs were defined as 75th percentile of the median values of the distributions. In terms of Volume CT Dose Index (CTDIvol) and dose length product (DLP), the DRLs obtained for the ages groups were: 28.6 mGy and 545.8 mGy.cm, 32.6 mGy and 735 mGy.cm, 37.1 mGy and 761.6 mGy.cm and 44.2 mGy and 1081.2 mGy.cm, respectively. DRLs in Yaoundé for DLP were higher than those of comparison literatures. The Yaoundé CTDIvol was higher than the comparison literatures except for the IAEA (2015) values for the three older age groups. The DRLs reported in Yaoundé were compared to Morocco 2020, Switzerland 2018, IAEA 2015 and Iran 2020 values. The estimation of this first DRL for pediatric head CT scan in Yaoundé must be a starting point to spread this investigation towards other examinations and imaging modalities across the country. Therefore, optimization of the CT scan procedures and orderly updates of local DRLs are necessary to improve radioprotection.
Collapse
Affiliation(s)
- Eddy F Kamdem
- Condensed Matter, Electronics and Signal Processing Research Unit, Department of Physics, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Alain J Fotue
- Condensed Matter, Electronics and Signal Processing Research Unit, Department of Physics, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Brice B F Kouam
- Department of Radiology, Yaoundé General Hospital, Yaoundé, Cameroon
| | - Serge Abogo
- Department of Radiology, Bafoussam Regional Hospital, Bafoussam, Cameroon
| | - Odette N Samba
- Department of Radiography, National Social Insurance Fund Hospital, Yaoundé, Cameroon
| |
Collapse
|
8
|
Cadavid L, Karout L, Kalra MK, Morgado F, Londoño MA, Pérez L, Galeano M, Montaño M, Wesley L, Almanza J, Pacheco W, Gómez L, Moscatelli A, Muglia V, Kiipper F, Lucena R, Bernardo M, Ugas C. Setting up regional diagnostic reference levels for pediatric computed tomography in Latin America: preliminary results, challenges and the work ahead. Pediatr Radiol 2024; 54:457-467. [PMID: 37227466 DOI: 10.1007/s00247-023-05676-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/26/2023]
Abstract
We established a framework for collecting radiation doses for head, chest and abdomen-pelvis computed tomography (CT) in children scanned at multiple imaging sites across Latin America with an aim towards establishing diagnostic reference levels (DRLs) and achievable doses (ADs) in pediatric CT in Latin America. Our study included 12 Latin American sites (in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Honduras and Panama) contributing data on the four most common pediatric CT examinations (non-contrast head, non-contrast chest, post-contrast chest and post-contrast abdomen-pelvis). Sites contributed data on patients' age, sex and weight, scan factors (tube current and potential), volume CT dose index (CTDIvol) and dose length product (DLP). Data were verified, leading to the exclusion of two sites with missing or incorrect data entries. We estimated overall and site-specific 50th (AD) and 75th (diagnostic reference level [DRL]) percentile CTDIvol and DLP for each CT protocol. Non-normal data were compared using the Kruskal-Wallis test. Sites contributed data from 3,934 children (1,834 females) for different CT exams (head CT 1,568/3,934, 40%; non-contrast chest CT 945/3,934, 24%; post-contrast chest CT 581/3,934, 15%; abdomen-pelvis CT 840/3,934, 21%). There were significant statistical differences in 50th and 75th percentile CTDIvol and DLP values across the participating sites (P<0.001). The 50th and 75th percentile doses for most CT protocols were substantially higher than the corresponding doses reported from the United States of America. Our study demonstrates substantial disparities and variations in pediatric CT examinations performed in multiple sites in Latin America. We will use the collected data to improve scan protocols and perform a follow-up CT study to establish DRLs and ADs based on clinical indications.
Collapse
Affiliation(s)
- Lina Cadavid
- Department of Radiology, Hospital Pablo Tobón Uribe, Calle 78B#69-240, Medellín, Antioquia, 050034, Colombia.
| | - Lina Karout
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mannudeep K Kalra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Flavio Morgado
- Pontificie Universidade Católica de São Paulo, São Paulo, Brazil
| | - María Antonieta Londoño
- Universidad Nacional de Colombia/Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
| | - Lizbeth Pérez
- Department of Radiology, Clinica alemana de Santiago - Universidad del Desarrollo, Santiago de Chile, Chile
| | - Monica Galeano
- Department of Radiology, Hospital del Niño Prof Dr. Ramón Exeni, La Matanza provincia de Buenos Aires, Argentina
| | - Mario Montaño
- Department of Radiology, Hospital Santa Cruz C.P.S, Santa Cruz de la Sierra, Bolivia
| | - Lavinia Wesley
- Department of Radiology, Hospital del Niño Dr. José Renán Esquivel, Ciudad de Panamá, Panamá
| | - Judith Almanza
- Department of Radiology, Salud Digna., Ciudad de México, México
| | - Walter Pacheco
- Department of Radiology, Maria Hospital, Pediatric Specialties, Tegucigalpa, Honduras
| | - Lucia Gómez
- Department of Radiology, Hospital Metropolitano, Quito, Ecuador
| | | | - Valdair Muglia
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | - Monica Bernardo
- Pontifícia Universidade Católica de São Paulo, Hospital Miguel Soeiro, Sorocaba, Brazil
| | - Carlos Ugas
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| |
Collapse
|
9
|
Alzyoud K, Al-Murshedi S, England A. Diagnostic Reference Levels of Radiographic and CT Examinations in Jordan: A Systematic Review. Health Phys 2024; 126:156-162. [PMID: 38252949 DOI: 10.1097/hp.0000000000001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
ABSTRACT A comprehensive search was performed to examine the literature on diagnostic reference levels (DRL) for computed tomography (CT) and radiography examinations that are performed routinely in Jordan. EBSCO, Scopus, and Web of Science were used for the search. The acronym "DRL" and the additional phrase "dose reference levels" were used to search for articles in literature. Seven papers that reported DRL values for radiography and CT scans in Jordan were identified. One study reported DRLs for conventional radiography, two studies reported CT DRLs in pediatrics, and the remaining four studies provided DRL values for adult CT scans. The most popular techniques for determining the DRLs were the entrance surface dose, volume CT dose index (CTDIvol), and dose-length product (DLP) values. Variations in Jordanian DRL values were noted across both modalities. Lower radiation doses and less variation in DRL values may be achieved by educating and training radiographers to better understand dose reduction strategies. To limit dose variance and enable dosage comparison, CT DRLs must be standardized in accordance with the guidelines of the International Commission on Radiological Protection (ICRP).
Collapse
Affiliation(s)
- Kholoud Alzyoud
- Department of Medical Imaging, Faculty of Applied Health science, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
| | - Sadeq Al-Murshedi
- AL-Zahraa University for Women, College of Health and Medical Technology, Karbala, Iraq
| | | |
Collapse
|
10
|
Ramnarain J, Cartwright L, Diffey J. Trends in patient dose and compression force for digital (DR) mammography systems over an eleven-year period. Phys Eng Sci Med 2024; 47:215-222. [PMID: 38019445 DOI: 10.1007/s13246-023-01357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
This study evaluated trends in patient dose and compression force for screening digital (DR) mammography systems. The results of five audits (carried out in 2011, 2014, 2018, 2020 and 2022) were compared. For every audit, anonymised screening examinations from each system consisting of the standard craniocaudal (CC) and mediolateral oblique (MLO) views of both breasts were analysed. Exposure parameters were extracted from the Digital Imaging and Communications in Medicine (DICOM) header and the mean glandular dose (MGD) for each image was calculated. Trends in the distribution of MGD, compressed breast thickness, compression force and compression force per radiographer were investigated. The mean MGD per image (and mean compressed breast thickness) was 1.20 mGy (58 mm), 1.53 mGy (59 mm), 1.83 mGy (61 mm), 1.94 mGy (60 mm) and 2.11 mGy (61 mm) for 2011, 2014, 2018, 2020 and 2022 respectively. The mean (and standard deviation) compression force was 114 (32) N, 112 (29) N, 108 (27) N, 104 (24) N and 100 (23) N for 2011, 2014, 2018, 2020 and 2022 respectively. The mean MGD per image has increased over time but remains below internationally established Diagnostic Reference Levels (DRLs). This increase is primarily due to a change in the distribution of the different manufacturers and digital detector technologies, rather than an increase in the dose of the individual systems over time. The mean compression force has decreased over time in response to client feedback surveys. The standard deviation has also reduced, indicating more consistent application of force.
Collapse
Affiliation(s)
- Jaymanju Ramnarain
- Department of Medical Physics, Westmead Hospital, Westmead, NSW, Australia.
| | - Lucy Cartwright
- Department of Medical Physics, Westmead Hospital, Westmead, NSW, Australia
| | - Jennifer Diffey
- Department of Medical Physics, Hunter New England Imaging, John Hunter Hospital, New Lambton Heights, NSW, Australia
| |
Collapse
|
11
|
Ahmed AM, Musa A, Medani A, Mahmoud M, Osman H, Elsamani M, Kajoak S, Alghamdi SS, Tajaldeen A, Hanfi MY, Khandaker MU. Establishment of a local diagnostic reference level for computed tomography chest and abdomen in two different cities in Saudi Arabia. Appl Radiat Isot 2024; 204:111147. [PMID: 38113663 DOI: 10.1016/j.apradiso.2023.111147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/04/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND AIM Spiral computed tomography (CT) scans, which are considered a high-contrast resolution, quick and cross-sectional imaging technique, have grown in popularity as a result of technological advancements. However, these advancements have brought with them the potential for significantly increased radiation doses to the patient. Consequently, many organizations recommended optimization and establishing diagnostic reference levels. The aim of the current study was to assess CT radiation dose and propose a local diagnostic reference level (LDRL) for the adult trunk [chest and abdomen] using CT dose parameters such as CT dose index volume (CTDIvol) and dose length product (DLP) as well as to compare the practices for aforementioned examinations between two hospitals in Taif and Abha cities in Saudi Arabia. MATERIALS AND METHODS Data from 428 patients (216 for abdomen and 212 for chest) who were examined in two hospitals in Taif and Abha City in Saudi Arabia from December 2022 to March 2023, are used in this study. The data for hospitals in Taif and Abha are presented as 'T' and 'A' throughout this manuscript. The parameters of exposure and slice thickness were recorded in a specially designed data sheet together with the gender, age and patients morphometric. Microsoft Excel version 2010 was used to analyze results and plot the figures. The LDRL was achieved from the third quartile of CTDIvol and DLP for each hospital and examination. RESULTS The average DLP (mGy-cm) and CTDIvol (mGy) for the chest and abdomen were 243 mGy cm, 5.8 mGy and 549 mGy cm, 8.6 mGy respectively. The average effective dose (ED) for chest and abdomen were 5.10 and 21.10 mSv, respectively. The proposed LDRL for the chest and abdomen were 6.9 mGy (CTDIvol), 375 mGy-cm (DLP), 7.8 mGy (CTDIvol), and 747 (DLP) mGy-cm, respectively. CONCLUSION Hospital 'A' irradiated patients with a higher dose for the abdomen exam than Hospital 'T', but both hospitals agreed on the amount of radiation dose received by patients for chest imaging. The proposed LDRL for two examinations was less than the DRL obtained from the literature.
Collapse
Affiliation(s)
- Amna Mohamed Ahmed
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Alamin Musa
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Afaf Medani
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Mustafa Mahmoud
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Hamid Osman
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, 21944, Taif, Saudi Arabia.
| | - Mohammed Elsamani
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, 21944, Taif, Saudi Arabia
| | - Samih Kajoak
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, 21944, Taif, Saudi Arabia
| | - Salem Saeed Alghamdi
- Department of Applied Radiologic Technology, College of Applied Medical Sciences, University of Jeddah, Saudi Arabia
| | - Abdulrahman Tajaldeen
- Department of Applied Radiologic Technology, College of Applied Medical Sciences, University of Jeddah, Saudi Arabia
| | - Mohamed Y Hanfi
- Nuclear Materials Authority, P.O. Box 530 El-Maadi, Cairo, Egypt; Ural Federal University, St. Mira, 19, Yekaterinburg, 620002, Russia
| | - Mayeen Uddin Khandaker
- Applied Physics and Radiation Technologies Group, CCDCU, School of Engineering and Technology, Sunway University, Bandar Sunway, 47500, Malaysia; Daffodil International University, Daffodil Smart City, Birulia, Savar, Dhaka, 1216, Bangladesh
| |
Collapse
|
12
|
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. J Radiol Prot 2024; 44:011505. [PMID: 38232403 DOI: 10.1088/1361-6498/ad1fe1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/17/2024] [Indexed: 01/19/2024]
Abstract
Interventional Radiology (IR) deals with the diagnosis and treatment of various diseases through medically guided imaging. It provides unquestionable benefits to patients, but requires, in many cases, the use of high doses of ionizing radiation with a high impact on radiation risks to patients and to overall dose to the population. The International Commission on Radiological Protection introduced Diagnostic reference levels (DRLs) as an effective tool to facilitate dose verification and optimize protection for patients undergoing radiological procedures. In addition, EURATOM Council Directive 2013/59 and its Italian transposition (Legislative Decree 101/2020) have reiterated that DRLs must be established for many common radiological diagnostic procedures to compare the radiation dose delivered for the same diagnostic examination. Within this framework, Istituto Superiore di Sanità-Italian National Institute of Health (ISS)-, in collaboration with relevant Italian Scientific Societies, has provided documents on DRLs in radiological practices such as diagnostic and IR and diagnostic nuclear medicine. These reference documents enable National Hospitals to comply national regulation. The implementation of DRLs in IR is a difficult task because of the wide distribution of doses to patients even within the same procedure. Some studies have revealed that the amount of radiation in IR procedures is influenced more by the complexity of the procedure than by the weight of the patient, so complexity should be included in the definition of DRLs. For this reason, ISS promoted a survey among a sample of Italian Centers update national DRL in IR procedures with related complexity factors than can be useful for other radiological centers and to standardize the DRLs values. In the present paper the procedural methodology developed by ISS and used for the survey will be illustrated.
Collapse
Affiliation(s)
- L D'Ercole
- S.C. Fisica Sanitaria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Rosi
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, Roma, Italy
| | - G Bernardi
- Struttura Sanitaria Polimedica di CODESS Friuli-Venezia Giulia, Pradamano (Udine), Italy
| | - G Compagnone
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Orlacchio
- Department of Surgical Science, 'Tor Vergata' University-Emergency Radiology-University Hospital 'Tor Vergata', Rome, Italy
| | - R Padovani
- International Center for Theoretical Physics, Trieste, Italy
| | - A Palma
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, Roma, Italy
| | - S Grande
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, Roma, Italy
| |
Collapse
|
13
|
Nassar J, Rizk C, Fares G, Tohme C, Braidy C, Farah J. Clinical image quality assessment and mean glandular dose for full field digital mammography. J Radiol Prot 2024; 44:011503. [PMID: 38194904 DOI: 10.1088/1361-6498/ad1cd4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/09/2024] [Indexed: 01/11/2024]
Abstract
This study aims to assess the image quality (IQ) of 12 mammographic units and to identify units with potential optimisation needs. Data for 350 mammography examinations meeting inclusion criteria were collected retrospectively from April 2021 to April 2022. They were categorised based on the medical reports into 10 normal cases, 10 cases displaying calcifications and 10 cases presenting lesions. Two radiologists assessed the IQ of 1400 mammograms, evaluating system performance per Boitaet al's study and positioning performance following European guidelines. To measure agreement between the two radiologists, the Cohen's Kappa coefficient (κ) was computed, quantifying the excess of agreement beyond chance. The visual grading analysis score (VGAS) was computed to compare system and positioning performance assessments across different categories and facilities. Median average glandular dose (AGD) values for cranio caudal and medio lateral oblique views were calculated for each category and facility and compared to the national diagnostic reference levels. The health facilities were categorised by considering both IQ VGAS and AGD levels. Inter-rater agreement between radiologists ranged from poor (κ< 0.20) to moderate (0.41 <κ< 0.60), likely influenced by inherent biases and distinct IQ expectations. 50% of the facilities were classified as needing corrective actions for their system performance as they had IQ or high AGD that could increase recall rate and radiation risk and 50% of the health facilities exhibited insufficient positioning performance that could mask tumour masses and microcalcifications. The study's findings emphasise the importance of implementing quality assurance programs to ensure optimal IQ for accurate diagnoses while adhering to radiation exposure guidelines. Additionally, comprehensive training for technologists is essential to address positioning challenges. These initiatives collectively aim to enhance the overall quality of breast imaging services, contributing to improved patient care.
Collapse
Affiliation(s)
- Joyce Nassar
- Faculty of Sciences, Saint-Joseph University, PO Box 11-514, Riad El Solh, Beirut 1107 2050, Lebanon
| | - Chadia Rizk
- Faculty of Sciences, Saint-Joseph University, PO Box 11-514, Riad El Solh, Beirut 1107 2050, Lebanon
- Lebanese Atomic Energy Commission, National Council for Scientific Research, 11-8281 Beirut, Lebanon
| | - Georges Fares
- Faculty of Sciences, Saint-Joseph University, PO Box 11-514, Riad El Solh, Beirut 1107 2050, Lebanon
| | - Carla Tohme
- Radiology Department, Hôtel-Dieu de France Hospital, PO Box 166830, Beirut, Lebanon
| | - Chady Braidy
- Radiology Department, Hôtel-Dieu de France Hospital, PO Box 166830, Beirut, Lebanon
| | - Jad Farah
- Vision RT Ltd, Dove House, Arcadia Ave, Finchley, London N3 2JU, United Kingdom
| |
Collapse
|
14
|
Arriaga A, Gonçalves C, Teles P, Santos J, Simãozinho P, Sousa P. Establishment of local diagnostic reference levels for abdomen and chest radiographies in the region of Algarve, Portugal. Eur J Radiol 2024; 170:111248. [PMID: 38103493 DOI: 10.1016/j.ejrad.2023.111248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/16/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To assess doses variabilities in the same abdomen and chest RX exams for adults, to check the need for dose harmonization. To calculate Diagnostic Reference Levels (DRL), mandatory in the European Union, for the Algarve district in Portugal. Our results can be a valuable reference for the Portuguese official determination of DRLs, still in progress. METHOD We considered 4,936 abdomen and 41,320 chest radiographs of adults, covering 7 health centres and 35 radiographers in Algarve. Entrance skin dose (ESD) was calculated for each radiograph and the corresponding uncertainty estimated. Mean doses per centre and per technician, and their uncertainties, were calculated to access dose variabilities. DRLs, set at the 3rd quartile of the total ESD distribution, were determined for a standard patient and for intervals of body mass index (BMI) to study their correlation with patient anatomical variations. Standard quartile errors were estimated. RESULTS Our results suggest significant dispersion in applied ESDs among different centres and radiographers. Estimates of DRLs also show small fluctuations across years and an important dependence on BMI intervals. For a standard patient, they are 8.7 ± 0.1 (abdomen) and 0.44 ± 0.01 (chest), while the European DRLs are, respectively, 5.1 and 0.2 (all in mGy). CONCLUSIONS Results suggest that there is room for dose optimization and harmonization with European DRLs, urging a national dose survey and the establishment of official national DRLs. Official DRLs in intervals of BMI would be quite beneficial, to avoid unnecessary dose exposures.
Collapse
Affiliation(s)
- A Arriaga
- Departamento de Física da Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal.
| | - Cláudia Gonçalves
- Departamento de Física da Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal; Centro Oncológico Dra Natalia Chaves, Joaquim Chaves Saúde, Rua Manuel Anastácio Alves, 2 2795-533 Carnaxide, Portugal
| | - P Teles
- Departamento de Física e Astronomia da Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, s/n, 4169-007 Porto, Portugal; Centro de Investigação do IPO-PORTO, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Joana Santos
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal
| | - Paula Simãozinho
- Administração Regional de Saúde, Algarve, Largo de São Pedro,15, 8000-145 Faro, Portugal
| | - Patrick Sousa
- GyRad, Lda, University of Algarve, Gambelas campus, Pav. H5, 8005-139 Faro, Portugal
| |
Collapse
|
15
|
Oliveira Bernardo M, Karout L, Morgado F, Ebrahimian S, Sarmet Santos A, Amorim C, Muniz Filho H, Moscatelli A, Francisco Muglia V, Schroeder H, Moulin Sales D, Gandolpho Henschel R, Giovanni Valese B, Kiipper F, Cesar Cavalcanti P, Lucena R, Jornada T, de Paula V, Zago M, Varella R, Anes M, Márcio Alves Pinheiro A, Claúdio de Moura Carvalho L, Santana de Melo Tapajos J, Antonio de Almeida F, Applegate K, Paulo G, Roberto Costa P. Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study. Eur J Radiol 2023; 169:111191. [PMID: 37976761 DOI: 10.1016/j.ejrad.2023.111191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Diagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based - DRL(DRLCI) and clinical indication - AD (ADCI) for adult CT in Brazil. METHODS The prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test. RESULTS In majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection. CONCLUSIONS There was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.
Collapse
Affiliation(s)
| | - Lina Karout
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Shadi Ebrahimian
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA.
| | | | - Clarissa Amorim
- Complexo Hospitalar de Niterói, Niterói, Rio de Janeiro, Brazil.
| | | | | | - Valdair Francisco Muglia
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Henrique Schroeder
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | | | | | | | | | | | - Ronaldo Lucena
- Unimed Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Tiago Jornada
- Hospital das Clínicas de Recife, Recife, Pernambuco, Brazil.
| | - Valnir de Paula
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Marcel Zago
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ricardo Varella
- Hospital Unimed de Vitória, Vitória, Espírito Santo, Brazil.
| | - Mauricio Anes
- Hospital das Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | | | | | | | - Kimberly Applegate
- University of Kentucky College of Medicine, Department of Radiology, Lexington, KY, USA.
| | - Graciano Paulo
- Escola Superior de Tecnologia da Saúde do Instituto Politécnico de Coimbra, Coimbra, Portugal.
| | | |
Collapse
|
16
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
17
|
Ishii H, Chida K, Inaba Y, Abe K, Onodera S, Zuguchi M. Fundamental study on diagnostic reference level quantities for endoscopic retrograde cholangiopancreatography using a C-arm fluoroscopy system. J Radiol Prot 2023; 43:041510. [PMID: 37939385 DOI: 10.1088/1361-6498/ad0a9d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/08/2023] [Indexed: 11/10/2023]
Abstract
The diagnostic reference level (DRL) is an effective tool for optimising protection in medical exposures to patients. However regarding air kerma at the patient entrance reference point (Ka,r), one of the DRL quantities for endoscopic retrograde cholangiopancreatography (ERCP), manufacturers use a variety of the International Electrotechnical Commission and their own specific definitions of the reference point. The research question for this study was whetherKa,ris appropriate as a DRL quantity for ERCP. The purpose of this study was to evaluate the difference betweenKa,rand air kerma incident on the patient's skin surface (Ka,e) at the different height of the patient couch for a C-arm system. Fluoroscopy and radiography were performed using a C-arm system (Ultimax-i, Canon Medical Systems, Japan) and a over-couch tube system (CUREVISTA Open, Fujifilm Healthcare, Japan).Ka,ewas measured by an ion chamber placed on the entrance surface of the phantom. Kerma-area product (PKA) andKa,rwere measured by a built-inPKAmeter and displayed on the fluoroscopy system.Ka,edecreased whileKa,rincreased as the patient couch moved away from the focal spot. The uncertainty of theKa,e/Ka,rratio due to the different height of the patient couch was estimated to be 75%-94%.Ka,rmay not accurately representKa,e.PKAwas a robust DRL quantity that was independent of the patient couch height. We cautioned against optimising patient doses in ERCP with DRLs set in terms ofKa,rwithout considering the patient couch height of the C-arm system. Therefore, we recommend thatKa,ris an inappropriate DRL quantity in ERCP using the C-arm system.
Collapse
Affiliation(s)
- Hiroki Ishii
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
- Department of Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
- Division of Disaster Medical Science, International Research Institute of Disaster Science, Tohoku University, 468-1 Aoba, Aramaki, Aoba-ku, Sendai 980-8572, Japan
| | - Yohei Inaba
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
- Division of Disaster Medical Science, International Research Institute of Disaster Science, Tohoku University, 468-1 Aoba, Aramaki, Aoba-ku, Sendai 980-8572, Japan
| | - Keisuke Abe
- Department of Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Shu Onodera
- Department of Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Masayuki Zuguchi
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| |
Collapse
|
18
|
Ramanathan V, Senarathna HS, Gunaratna HU, Bandara PM, Horadigala CJ. Establishment of institutional diagnostic reference level for coronary angiography procedures in Sri Lanka. Radiat Prot Dosimetry 2023; 199:2311-2317. [PMID: 37624229 DOI: 10.1093/rpd/ncad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023]
Abstract
Amongst many interventional procedures performed in a cardiac catheterisation laboratory, the coronary angiography (CAG) is the most frequently performed cardiac interventional procedure. A diagnostic reference level (DRL) is an effective tool to optimise the radiation exposure to patients and staff whilst maintaining the adequate diagnostic image quality. The aim of the study was to establish institutional DRLs for the CAG procedures performed at a selected private hospital in Colombo, Sri Lanka. A total of 325 CAG procedures were selected for this study from two C-arm machines. The institutional DRLs of cumulative dose length product (DAP) and fluoroscopic time for the CAG procedure were calculated. The established institutional DRL for accumulated DAP and fluoroscopic time are 10 610 mGycm2 and 2.31 min, respectively. As this study conducted at only one institute we recommend to develop national DRLs for mostly performing interventional procedures in Sri Lanka by considering all influencing factors to optimise the patient dose.
Collapse
Affiliation(s)
- Vijitha Ramanathan
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Hasalanka S Senarathna
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Hasun U Gunaratna
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Praneeth M Bandara
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | | |
Collapse
|
19
|
Alhailiy A, Alkhybari E, Alghamdi S, Fisal N, Aldosari S, Albeshan S. Reporting Diagnostic Reference Levels for Paediatric Patients Undergoing Brain Computed Tomography. Tomography 2023; 9:2029-2038. [PMID: 37987345 PMCID: PMC10661294 DOI: 10.3390/tomography9060159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023] Open
Abstract
Brain computed tomography (CT) is a diagnostic imaging tool routinely used to assess all paediatric neurologic disorders and other head injuries. Despite the continuous development of paediatric CT imaging, radiation exposure remains a concern. Using diagnostic reference levels (DRLs) helps to manage the radiation dose delivered to patients, allowing one to identify an unusually high dose. In this paper, we propose DRLs for paediatric brain CT examinations in Saudi clinical practices and compare the findings with those of other reported DRL studies. Data including patient and scanning protocols were collected retrospectively from three medical cities for a total of 225 paediatric patients. DRLs were derived for four different age groupings. The resulting DRL values for the dose-length product (DLP) for the age groups of newborns (0-1 year), 1-y-old (1-5 years), 5-y-old (5-10 years) and 10-y-old (10-15 years) were 404 mGy cm, 560 mGy cm, 548 mGy cm, and 742 mGy cm, respectively. The DRLs for paediatric brain CT imaging are comparable to or slightly lower than other DRLs due to the current use of dose optimisation strategies. This study emphasises the need for an international standardisation for the use of weight group categories in DRL establishment for paediatric care in order to provide a more comparable measurement of dose quantities across different hospitals globally.
Collapse
Affiliation(s)
- Ali Alhailiy
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia;
| | - Essam Alkhybari
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia;
| | - Sultan Alghamdi
- Radiology and Nuclear Medicine Department, Security Force Hospital, P.O. Box 3643, Riyadh 11481, Saudi Arabia;
| | - Nada Fisal
- Radiology Department, King Fahad Medical City, P.O. Box 59042, Riyadh 11525, Saudi Arabia;
| | - Sultan Aldosari
- Medical Imaging Department, King Saud Medical City, Riyadh 12746, Saudi Arabia;
| | - Salman Albeshan
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 145111, Riyadh 4545, Saudi Arabia;
| |
Collapse
|
20
|
Alhorani Q, Alkhybari E, Rawashdeh M, Sabarudin A, Latiff RA, Al-Ibraheem A, Vinjamuri S, Mohamad M. Revising and exploring the variations in methodologies for establishing the diagnostic reference levels for paediatric PET/CT imaging. Nucl Med Commun 2023; 44:937-943. [PMID: 37615527 DOI: 10.1097/mnm.0000000000001748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
PET-computed tomography (PET/CT) is a hybrid imaging technique that combines anatomical and functional information; to investigate primary cancers, stage tumours, and track treatment response in paediatric oncology patients. However, there is debate in the literature about whether PET/CT could increase the risk of cancer in children, as the machine is utilizing two types of radiation, and paediatric patients have faster cell division and longer life expectancy. Therefore, it is essential to minimize radiation exposure by justifying and optimizing PET/CT examinations and ensure an acceptable image quality. Establishing diagnostic reference levels (DRLs) is a crucial quantitative indicator and effective tool to optimize paediatric imaging procedures. This review aimed to distinguish and acknowledge variations among published DRLs for paediatric patients in PET/CT procedures. A search of relevant articles was conducted using databases, that is, Embase, Scopus, Web of Science, and Medline, using the keywords: PET-computed tomography, computed tomography, PET, radiopharmaceutical, DRL, and their synonyms. Only English and full-text articles were included, with no limitations on the publication year. After the screening, four articles were selected, and the review reveals different DRL approaches for paediatric patients undergoing PET/CT, with primary variations observed in patient selection criteria, reporting of radiation dose values, and PET/CT equipment. The study suggests that future DRL methods for paediatric patients should prioritize data collection in accordance with international guidelines to better understand PET/CT dose discrepancies while also striving to optimize radiation doses without compromising the quality of PET/CT images.
Collapse
Affiliation(s)
- Qays Alhorani
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Essam Alkhybari
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Saudi Arabia
| | - Mohammad Rawashdeh
- Radiologic Technology Program, Applied Medical Sciences College, Jordan University of Science and Technology, Irbid
| | - Akmal Sabarudin
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rukiah A Latiff
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - Sobhan Vinjamuri
- Department of Nuclear Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mazlyfarina Mohamad
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
21
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
22
|
Efthymiou FO, Metaxas VI, Dimitroukas CP, Delis HB, Zikou KD, Ntzanis ES, Zampakis PE, Panayiotakis GS, Kalogeropoulou CP. A retrospective survey to establish institutional diagnostic reference levels for CT urography examinations based on clinical indications: preliminary results. Biomed Phys Eng Express 2023; 9:065005. [PMID: 37651989 DOI: 10.1088/2057-1976/acf582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/31/2023] [Indexed: 09/02/2023]
Abstract
Objective. To establish institutional diagnostic reference levels (IDRLs) based on clinical indications (CIs) for three- and four-phase computed tomography urography (CTU).Methods. Volumetric computed tomography dose index (CTDIvol), dose-length product (DLP), patients' demographics, selected CIs like lithiasis, cancer, and other diseases, and protocols' parameters were retrospectively recorded for 198 CTUs conducted on a Toshiba Aquilion Prime 80 scanner. Patients were categorised based on CIs and number of phases. These groups' 75th percentiles of CTDIvoland DLP were proposed as IDRLs. The mean, median and IDRLs were compared with previously published values.Results. For the three-phase protocol, the CTDIvol(mGy) and DLP (mGy.cm) were 22.7/992 for the whole group, 23.4/992 for lithiasis, 22.8/1037 for cancer, and 21.2/981 for other diseases. The corresponding CTDIvol(mGy) and DLP (mGy.cm) values for the four-phase protocol were 28.6/1172, 30.6/1203, 27.3/1077, and 28.7/1252, respectively. A significant difference was found in CTDIvoland DLP between the two protocols, among the phases of three-phase (except cancer) and four-phase protocols (except DLP for other diseases), and in DLP between the second and third phases (except for cancer group). The results are comparable or lower than most studies published in the last decade.Conclusions. The CT technologist must be aware of the critical dose dependence on the scan length and the applied exposure parameters for each phase, according to the patient's clinical background and the corresponding imaging anatomy, which must have been properly targeted by the competent radiologist. When clinically feasible, restricting the number of phases to three instead of four could remarkably reduce the patient's radiation dose. CI-based IDRLs will serve as a baseline for comparison with CTU practice in other hospitals and could contribute to national DRL establishment. The awareness and knowledge of dose levels during CTU will prompt optimisation strategies in CT facilities.
Collapse
Affiliation(s)
- Fotios O Efthymiou
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Christos P Dimitroukas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
| | - Harry B Delis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Kiriaki D Zikou
- Department of Radiology, University Hospital of Patras, 26504 Patras, Greece
| | | | - Petros E Zampakis
- Department of Radiology, University Hospital of Patras, 26504 Patras, Greece
- Department of Radiology, School of Medicine, University of Patras, 26504 Patras, Greece
| | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
| | - Christina P Kalogeropoulou
- Department of Radiology, University Hospital of Patras, 26504 Patras, Greece
- Department of Radiology, School of Medicine, University of Patras, 26504 Patras, Greece
| |
Collapse
|
23
|
Stein T, Schuermann T, Bamberg F, Mueller-Peltzer K. [Explaining radiation dose exposure : The role of the banana equivalent dose compared to the effective dose in patient communication]. Radiologie (Heidelb) 2023; 63:679-687. [PMID: 37639026 DOI: 10.1007/s00117-023-01196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Communicating the amount and effects of ionizing radiation to patients prior to an examination using x‑rays is associated with challenges: first, calculating the expected dose prior to the examination and, second, quantifying and illustrating cancer risks. Analogies, such as comparing radiation exposure to accident risks, have limitations and may evoke unease. This study explores and compares two new approaches to discuss radiation exposure from common clinical examinations with patients: effective dose and exposure based on radioactive potassium-40 intake from the ingestion of bananas, the banana equivalent dose (BED). MATERIALS AND METHODS The effective doses of the diagnostic reference levels (DRL) for computed tomography (CT) and X-ray examinations in adults were calculated using mean conversion factors for specific anatomic body regions. For the BED calculation of the diagnostic reference levels, the radiation dose from a conventional banana ingested over 50 years per becquerel was calculated. The outcomes were juxtaposed against an equivalent number of bananas and its respective radiation doses. RESULTS The calculated doses, namely effective dose and BED, of the German DRL can serve as a reliable metric to discuss radiation exposure from medical imaging with patients prior to an examination. CONCLUSION This is the first study to calculate the effective doses of the current DRL and to compare these with the pseudoscientific unit BED. While the BED serves as an interesting illustration to metaphorize radiation exposure, it is recommended to use the calculated effective dose of the DRL as the basis for educational consultations with patients.
Collapse
Affiliation(s)
- T Stein
- Abteilung für Diagnostik und Interventionelle Radiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland.
| | - T Schuermann
- Abteilung für Diagnostik und Interventionelle Radiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - F Bamberg
- Abteilung für Diagnostik und Interventionelle Radiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - K Mueller-Peltzer
- Abteilung für Diagnostik und Interventionelle Radiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| |
Collapse
|
24
|
Wang Q, Wang J, Cao X, Li Q, Xie S, Sang J, Zhang Y, Xue C, Fu Q. Preliminary study on diagnostic reference levels of whole-body PET-CT examinations in Jiangsu Province, China. Radiat Prot Dosimetry 2023; 199:1416-1422. [PMID: 37452483 DOI: 10.1093/rpd/ncad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/05/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023]
Abstract
To survey the whole-body positron emission tomography/computed tomography (PET-CT) examinations in Jiangsu Province and establish the diagnostic reference levels (DRL). A total of nine hospitals in southern, central and northern Jiangsu Provinces were selected. Activity duration product (ADP), activity per body weight (AW), dose-length product (DLP) and total effective dose (ET) were choosen to establish DRLs for whole-body PET-CT examinations. DRL and achievable dose (AD) were calculated according to International Commission on Radiological Protection report. The conversion coefficient method was used to calculate the ET induced by PET-CT whole-body imaging. DRLs of whole-body PET-CT examinations in Jiangsu Province were set to be 922 mGy·cm (DLP), 4453 MBq.min (ADP), 5.22 MBq.kg-1(AW), 19.8 mSv (ET). The ET for whole-body PET-CT examinations is higher than other countries. The effective dose from radionuclides (EF) in female patients is lower than that in male patients. Effective doses from CT(ECT), ET and ECT/ET in female patients are higher than that in male patients (P < 0.01). Provincial DRLs are established for four radiation metrics in whole-body PET-CT examinations. DRL of AW in whole-body PET-CT examinations is at the medium level, and DLP is higher than that reported in most literature, which has the potential to be further reduced.
Collapse
Affiliation(s)
- Qiang Wang
- Changzhou Center for Disease Control and Prevention, Changzhou 213022, China
| | - Jin Wang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Xingjiang Cao
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Qinghua Li
- Wuxi Center for Disease Control and Prevention, Wuxi 214023, China
| | - Shi Xie
- Zhenjiang Center for Disease Control and Prevention, Zhenjiang 212002, China
| | - Junyang Sang
- Nantong Center for Disease Control and Prevention, Nantong 226007, China
| | - Yifei Zhang
- Yancheng Center for Disease Control and Prevention, Yancheng 224001, China
| | - Cheng Xue
- Xuzhou Center for Disease Control and Prevention, Xuzhou 221002, China
| | - Qiang Fu
- Changzhou Center for Disease Control and Prevention, Changzhou 213022, China
| |
Collapse
|
25
|
Alrehily FA, Alqahtani KS, Aljohani MH, Alharbi NS, Alharbi RM, Abdulaal OM, Alshamrani AF, Alsaedi AS, Al-Murshedi SH, Alhazmi FH. Establishing local diagnostic reference levels for computed tomography examinations using size-specific dose estimates. Saudi Med J 2023; 44:761-766. [PMID: 37582572 PMCID: PMC10425620 DOI: 10.15537/smj.2023.44.8.20230230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVES To establish local DRL (LDRL) for computed tomography (CT) examinations based on size-specific dose estimates (SSDEs), which consider patient size. The concept of diagnostic reference level (DRL) was introduced to limit patient exposure to unnecessary radiation. However, traditional DRL values do not consider patient size. METHODS Following institutional committee approval, data were collected from CT examinations of adult patients at Madinah General Hospital, Al Madinah Al Munawwarah, Saudi Arabia from January to March 2023. The SSDE was calculated for each patient using the effective diameter (Deff). RESULTS The LDRLs of the brain, cervical spine, chest, thoracic spine and kidneys, ureters, and bladder (KUB) examinations were 118 mGy, 12 mGy, 8 mGy, 17 mGy, and 7 mGy, respectively. A strong correlation was observed between SSDEs and the volume computed tomography dose index (CTDIvol) for all examinations except chest scans (p<0.05). Size-specific dose estimates were higher than the CTDIvol, with a greater difference for patients with smaller Deff (p<0.05). CONCLUSION The established LDRL was within the international DRL. The use of SSDE has the potential to provide more accurate and relevant data for radiation safety practices; however, widespread adoption of SSDE in new CT scanners is necessary for promoting consistency and standardization methodologies.
Collapse
Affiliation(s)
- Faisal A. Alrehily
- From the Department of Diagnostic Radiology Technology (Alrehily, Alqahtani, Aljohani, Alharbi, Abdulaal, Alshamrani, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Radiology (Alharbi), King Salman bin Abdulaziz Medical City; from the Department of Nuclear Medicine (Alsaedi), King Fahad General Hospital (Alsaedi), Al Madinah Al Munawwarah, Kingdom of Saudi Arabia; from the Department of Radiological Techniques (Al-Murshedi,), AL-Zahraa University for Women, College of Health and Medical Technology, Karbala; and from Physics Department (Al-Murshedi), College of Education for Pure Sciences, University of Babylon, Iraq.
| | - Khalid S. Alqahtani
- From the Department of Diagnostic Radiology Technology (Alrehily, Alqahtani, Aljohani, Alharbi, Abdulaal, Alshamrani, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Radiology (Alharbi), King Salman bin Abdulaziz Medical City; from the Department of Nuclear Medicine (Alsaedi), King Fahad General Hospital (Alsaedi), Al Madinah Al Munawwarah, Kingdom of Saudi Arabia; from the Department of Radiological Techniques (Al-Murshedi,), AL-Zahraa University for Women, College of Health and Medical Technology, Karbala; and from Physics Department (Al-Murshedi), College of Education for Pure Sciences, University of Babylon, Iraq.
| | - Marwan H. Aljohani
- From the Department of Diagnostic Radiology Technology (Alrehily, Alqahtani, Aljohani, Alharbi, Abdulaal, Alshamrani, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Radiology (Alharbi), King Salman bin Abdulaziz Medical City; from the Department of Nuclear Medicine (Alsaedi), King Fahad General Hospital (Alsaedi), Al Madinah Al Munawwarah, Kingdom of Saudi Arabia; from the Department of Radiological Techniques (Al-Murshedi,), AL-Zahraa University for Women, College of Health and Medical Technology, Karbala; and from Physics Department (Al-Murshedi), College of Education for Pure Sciences, University of Babylon, Iraq.
| | - Nawaf S. Alharbi
- From the Department of Diagnostic Radiology Technology (Alrehily, Alqahtani, Aljohani, Alharbi, Abdulaal, Alshamrani, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Radiology (Alharbi), King Salman bin Abdulaziz Medical City; from the Department of Nuclear Medicine (Alsaedi), King Fahad General Hospital (Alsaedi), Al Madinah Al Munawwarah, Kingdom of Saudi Arabia; from the Department of Radiological Techniques (Al-Murshedi,), AL-Zahraa University for Women, College of Health and Medical Technology, Karbala; and from Physics Department (Al-Murshedi), College of Education for Pure Sciences, University of Babylon, Iraq.
| | - Reyan M. Alharbi
- From the Department of Diagnostic Radiology Technology (Alrehily, Alqahtani, Aljohani, Alharbi, Abdulaal, Alshamrani, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Radiology (Alharbi), King Salman bin Abdulaziz Medical City; from the Department of Nuclear Medicine (Alsaedi), King Fahad General Hospital (Alsaedi), Al Madinah Al Munawwarah, Kingdom of Saudi Arabia; from the Department of Radiological Techniques (Al-Murshedi,), AL-Zahraa University for Women, College of Health and Medical Technology, Karbala; and from Physics Department (Al-Murshedi), College of Education for Pure Sciences, University of Babylon, Iraq.
| | - Osamah M. Abdulaal
- From the Department of Diagnostic Radiology Technology (Alrehily, Alqahtani, Aljohani, Alharbi, Abdulaal, Alshamrani, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Radiology (Alharbi), King Salman bin Abdulaziz Medical City; from the Department of Nuclear Medicine (Alsaedi), King Fahad General Hospital (Alsaedi), Al Madinah Al Munawwarah, Kingdom of Saudi Arabia; from the Department of Radiological Techniques (Al-Murshedi,), AL-Zahraa University for Women, College of Health and Medical Technology, Karbala; and from Physics Department (Al-Murshedi), College of Education for Pure Sciences, University of Babylon, Iraq.
| | - Abdullah F. Alshamrani
- From the Department of Diagnostic Radiology Technology (Alrehily, Alqahtani, Aljohani, Alharbi, Abdulaal, Alshamrani, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Radiology (Alharbi), King Salman bin Abdulaziz Medical City; from the Department of Nuclear Medicine (Alsaedi), King Fahad General Hospital (Alsaedi), Al Madinah Al Munawwarah, Kingdom of Saudi Arabia; from the Department of Radiological Techniques (Al-Murshedi,), AL-Zahraa University for Women, College of Health and Medical Technology, Karbala; and from Physics Department (Al-Murshedi), College of Education for Pure Sciences, University of Babylon, Iraq.
| | - Abdulrahman S. Alsaedi
- From the Department of Diagnostic Radiology Technology (Alrehily, Alqahtani, Aljohani, Alharbi, Abdulaal, Alshamrani, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Radiology (Alharbi), King Salman bin Abdulaziz Medical City; from the Department of Nuclear Medicine (Alsaedi), King Fahad General Hospital (Alsaedi), Al Madinah Al Munawwarah, Kingdom of Saudi Arabia; from the Department of Radiological Techniques (Al-Murshedi,), AL-Zahraa University for Women, College of Health and Medical Technology, Karbala; and from Physics Department (Al-Murshedi), College of Education for Pure Sciences, University of Babylon, Iraq.
| | - Sadeq H. Al-Murshedi
- From the Department of Diagnostic Radiology Technology (Alrehily, Alqahtani, Aljohani, Alharbi, Abdulaal, Alshamrani, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Radiology (Alharbi), King Salman bin Abdulaziz Medical City; from the Department of Nuclear Medicine (Alsaedi), King Fahad General Hospital (Alsaedi), Al Madinah Al Munawwarah, Kingdom of Saudi Arabia; from the Department of Radiological Techniques (Al-Murshedi,), AL-Zahraa University for Women, College of Health and Medical Technology, Karbala; and from Physics Department (Al-Murshedi), College of Education for Pure Sciences, University of Babylon, Iraq.
| | - Fahad H. Alhazmi
- From the Department of Diagnostic Radiology Technology (Alrehily, Alqahtani, Aljohani, Alharbi, Abdulaal, Alshamrani, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Radiology (Alharbi), King Salman bin Abdulaziz Medical City; from the Department of Nuclear Medicine (Alsaedi), King Fahad General Hospital (Alsaedi), Al Madinah Al Munawwarah, Kingdom of Saudi Arabia; from the Department of Radiological Techniques (Al-Murshedi,), AL-Zahraa University for Women, College of Health and Medical Technology, Karbala; and from Physics Department (Al-Murshedi), College of Education for Pure Sciences, University of Babylon, Iraq.
| |
Collapse
|
26
|
Al-Qahtani SM, Alidasroos MA, Alkhybari EM, Althomali MA, Alomari AH, Bawazeer OA, Hawsawi HB, Aamry AI, Asiri JA, Aloufi AA, Aljehani AD, Al-Osaimi MB, Alosaimi AK, Alsulami AK, Sabi AY, Kamli TM, Sulieman AA, Ajlouni AW. The establishment of national diagnostic reference levels for adult SPECT-CT in Saudi Arabia. J Radiol Prot 2023; 43:031505. [PMID: 37406624 DOI: 10.1088/1361-6498/ace452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/05/2023] [Indexed: 07/07/2023]
Abstract
This study aims to introduce national diagnostic reference levels (NDRLs) for adult hybrid single photon emission computed tomography (SPECT-CT) in nuclear medicine (NM) departments in the Kingdom of Saudi Arabia. The administered activity (AA) of radiopharmaceuticals, volume-weighted computed tomography dose index (CTDIvol) and dose length product (DLP) for ten hybrid SPECT/CT examinations were collected and analysed for one year. The median of AA, CTDIvoland DLP for each dose quantity was derived and the suggested national DRLs were determined based on the 75thpercentile for all identified SPECT-CT examinations. A comparison of the defined adult NDRLs in Saudi Arabia with the published data of other countries was performed. Although there are no significant variations of the proposed NDRL of AA between countries, the proposed NDRLs of the integrated CT metrics exceed the published data in most procedures. NM departments are urged to consider optimisation for both image quality and radiation protection.
Collapse
Affiliation(s)
- Saeed Mueed Al-Qahtani
- Physics Department, College of Applied Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Essam M Alkhybari
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Marwan Ahmed Althomali
- Physics Department, College of Applied Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ali Hamed Alomari
- Physics Department, Al-Qunfudah University College, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Omemh Abdullah Bawazeer
- Physics Department, College of Applied Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hassan B Hawsawi
- Administration of Medical Physics, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Ali Ibrahim Aamry
- Nuclear Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia
| | | | | | | | | | | | | | - Ahmed Yahya Sabi
- Nuclear Medicine Department, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Talal Mosa Kamli
- Nuclear Medicine Department, King Fahd Central Hospital, Madinah, Saudi Arabia
| | - Abdelmoneim Adam Sulieman
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Abdul-Wali Ajlouni
- Physics Department, College of Applied Science, Umm Al-Qura University, Makkah, Saudi Arabia
| |
Collapse
|
27
|
Senthil Kumar M, Kumar CS, Parmar RU, Velmurugan J. NUCLEAR MEDICINE PROCEDURE VOLUME AND ESTIMATION OF COLLECTIVE EFFECTIVE DOSE IN TAMIL NADU TOWARDS THE ESTABLISHMENT OF DIAGNOSTIC REFERENCE LEVEL. Radiat Prot Dosimetry 2023; 199:373-381. [PMID: 36632802 DOI: 10.1093/rpd/ncac297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/18/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
With an objective to establish adult diagnostic reference levels in the practice of nuclear medicine (NM) in the state of Tamil Nadu (TN), data on the predominant NM procedures carried out in the state are analyzed. In this study, data on total NM diagnostic procedures during the years 2015-19 along with patient-specific diagnostic NM procedure data for the period April-June 2021 from all centers in Tamil Nadu are collected and analyzed using SPSS statistical software. Nine predominant types of NM scans are analyzed. Collective effective dose from NM scans and per capita dose for the TN population are estimated. The 75th percentile of the distribution and average administered activity (AAA) has been derived and local reference levels are reported. Based on the statistical analysis, it is observed that the whole-body positron emission tomography (PET), renal diethylenetriamine pentaacetate (DTPA) scan, bone methylene diphosphonate (MDP) scan, iodine-131 whole body scan, thyroid studies using Technetium per technetate, renal dimercaptosuccinic acid (DMSA), myocardial perfusion methoxyisobutyl isonitrile sestamibi (MIBI), mebrofenin, Galium-68 prostate-specific membrane antigen (PSMA) are the most common procedure covering >90% of the practices carried out. The collective effective dose is 410 man-Sv in the year 2019, leading to a mean effective dose of 0.006 mSv per capita of the TN state population. The 75th percentile of the distribution of AA is slightly higher than diagnostic reference level (DRL) as compared with Australian DRL (310 MBq). It is also observed that F-18 PET procedures are primarily responsible for most of the collective effective dose, local DRL is 316 MBq and it is important to establish national DRLs for NM diagnostic scans to optimize the NM examinations.
Collapse
Affiliation(s)
- M Senthil Kumar
- Southern Regional Regulatory Centre, Atomic Energy Regulatory Board, Dr. Rajendra Prasad Road, Pallavaram, Chennai, Tamil Nadu - 600043, India
| | - C Senthil Kumar
- Southern Regional Regulatory Centre, Atomic Energy Regulatory Board, Dr. Rajendra Prasad Road, Pallavaram, Chennai, Tamil Nadu - 600043, India
| | - R U Parmar
- Directorate of Regulatory Inspection, Atomic Energy Regulatory Board, Niyamak Bhavan, Anushakti Nagar, Mumbai - 400094, India
| | - J Velmurugan
- Department of Medical Physics, Anna University, Chennai, Tamil Nadu - 600 025, India
| |
Collapse
|
28
|
Dawd JE, Uzun Ozsahin D, Ozsahin I. DEVELOPING DIAGNOSTIC REFERENCE LEVELS FOR CT EXAMINATIONS IN ADDIS ABABA, ETHIOPIA. Radiat Prot Dosimetry 2023; 199:ncac263-245. [PMID: 36566497 DOI: 10.1093/rpd/ncac263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/12/2022] [Accepted: 11/13/2022] [Indexed: 06/17/2023]
Abstract
Diagnostic reference level (DRL) is an appropriate instrument toward promoting radiation doses optimisation in medical imaging. The goal of this research is developing DRL to optimise computed tomography (CT) doses in patient examination. Parameters were collected in CT facilities for common procedures such as head, chest, pelvic and cervical spine (c-spine) imaging. The dose descriptors considered were volume computed tomography dose index (CTDIv) and dose length product (DLP). The DRLs were proposed at 75th percentile CTDIv for head (without and with contrast materials), chest (without and with contrast materials), pelvic and c-spine only without contrast materials; their values were 52, 52, 17, 14, 14 and 38 mGy, respectively. Whereas, DLP values for the aforementioned protocols were 1237, 1459, 625, 565, 605 and 1106 mGy.cm, respectively. This study fruitfully developed the DRLs for head, chest, pelvic and c-spine and can be accepted for clinical purposes.
Collapse
Affiliation(s)
- Jemal E Dawd
- Technology Division Research Team, Ethiopian Technology Authority, Akaki Kality, Addis Ababa, Ethiopia
- Department of Biomedical Engineering, Near East University, Nicosia/TRNC, Mersin-10, Turkey
| | - Dilber Uzun Ozsahin
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Biomedical Engineering, Near East University, Nicosia/TRNC, Mersin-10, Turkey
- Operational Research Center in Healthcare, Near East University, Nicosia/TRNC, Mersin-10, Turkey
| | - Ilker Ozsahin
- Department of Biomedical Engineering, Near East University, Nicosia/TRNC, Mersin-10, Turkey
- Operational Research Center in Healthcare, Near East University, Nicosia/TRNC, Mersin-10, Turkey
- Department of Radiology, Weill Cornell Medicine, Brain Health Imaging Institute, New York, NY , USA
| |
Collapse
|
29
|
Vossou M, Spiliopoulos S, Palialexis K, Antonakos J, Efstathopoulos EP. DIAGNOSTIC REFERENCE LEVELS AND COMPLEXITY INDICES IN INTERVENTIONAL RADIOLOGY. Radiat Prot Dosimetry 2023; 199:ncac267-261. [PMID: 36566495 DOI: 10.1093/rpd/ncac267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
The establishment of typical diagnostic reference levels (DRLs) values according to the complexity indices (CIs) for hepatic chemoembolisation (HC), iliac stent placement (ISP) and femoropopliteal revascularisation (FR) is reported in this study. To estimate patients' stochastic effects, effective dose was calculated through dose area product (DAP) values of this study and E/DAP conversion factors derived from the literature. Data for DAP, Reference Air Kerma (Ka,r) and fluoroscopy time (FT) were collected for 218 patients and CIs were assigned to each procedure to extract DRLs. To estimate effective dose, conversion factors and DAP values were used for seven IR procedures. DRL values for DAP were 141, 130 and 28 Gy*cm2 for HC, ISP, and FR, respectively. The corresponding DRL values for Ka,r were 634.6, 300.1 and 112.0 mGy, and for FT were 15.3, 12.4 and 17.9 min, respectively. CIs in interventional radiology are a useful tool for the optimisation of DRLs since they contribute to patient's doses.
Collapse
Affiliation(s)
- Marialena Vossou
- University of Patras, School of Health Sciences, Patras 26644, Greece
| | - Stavros Spiliopoulos
- National and Kapodistrian University of Athens, 2nd Department of Radiology, 1st Rimini St, Chaidari Athens, Attica 12461, Greece
| | - Kostas Palialexis
- National and Kapodistrian University of Athens, 2nd Department of Radiology, 1st Rimini St, Chaidari Athens, Attica 12461, Greece
| | - John Antonakos
- National and Kapodistrian University of Athens, 2nd Department of Radiology, 1st Rimini St, Chaidari Athens, Attica 12461, Greece
| | - Efstathios P Efstathopoulos
- National and Kapodistrian University of Athens, 2nd Department of Radiology, 1st Rimini St, Chaidari Athens, Attica 12461, Greece
| |
Collapse
|
30
|
Madhvani KR, Clark MJR, Kocheta AAJ. Diagnostic Reference Levels for Common Orthopedic Hand and Wrist Procedures Using Intraoperative Mini C-arm Fluoroscopy. Hand (N Y) 2023; 18:153-157. [PMID: 33682471 PMCID: PMC9806543 DOI: 10.1177/1558944721994257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to contribute to national diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Small joint and digital fracture procedure diagnostic reference levels have not been reported in significant numbers previously with procedure-level stratification. METHODS Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on fluoroscopy machines. A total of 603 procedures were included. RESULTS The median radiation dose for wrist fracture open fixation was 2.73 cGycm2, Kirschner wiring (K-wiring) procedures was 2.36 cGycm2, small joint arthrodesis was 1.20 cGycm2, small joint injections was 0.58 cGycm2, and phalangeal fracture fixation was 1.05 cGycm2. CONCLUSIONS Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses, and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. National and international recommendations are that institutional audit data should be collected regularly and should be stratified by procedure type. This study helps to define standards for this activity by adding to the data available for wrist fracture diagnostic reference levels and defining standards for digital and injection procedures.
Collapse
|
31
|
Sanchez RM, Siiskonen T, Vano E. Current status of diagnostic reference levels in interventional cardiology. J Radiol Prot 2022; 42:041002. [PMID: 36379055 DOI: 10.1088/1361-6498/aca2b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
Interventional cardiology provides indisputable benefits for patients but uses a substantial amount of ionising radiation. The diagnostic reference level (DRL) is the tool recommended by the International Commission on Radiological Protection to optimise imaging procedures. In this work, a review of studies dealing with radiation dose or recommending DRL values for interventional cardiology since 2010 is presented, providing quantitative and qualitative results. There are many published papers on coronary angiography (CA) and percutaneous coronary intervention. The DRL values compiled for different continental regions are different: the DRL for CA is about 35 Gy cm2for Europe and 83 Gy cm2for North America. These differences emphasise the need to establish national DRLs considering different social and/or economic factors and the harmonisation of the survey methodology. Surveys with a large amount of data collected with the help of dose management systems provide more reliable information with less chance of statistical bias than those with a small amount of data. The complexity of procedures and improvements in technology are important factors that affect the radiation dose delivered to patients. There is a need for additional data on structural and electrophysiological procedures. The analysis of paediatric procedures is especially difficult because some studies present results split into age bands and others into weight bands. Diagnostic procedures are better described, but there is a great variety of therapeutic procedures with different DRL values (up to a factor of nine) and these require a dedicated review.
Collapse
Affiliation(s)
- Roberto M Sanchez
- Hospital Clinico Universitario San Carlos, Medical Physics, Madrid, Spain
| | - Teemu Siiskonen
- Radiation and Nuclear Safety Authority-STUK, Helsinki, Finland
| | - Eliseo Vano
- Radiology Department, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
32
|
Masubuchi Y, Chida K, Inaba Y, Kageyama M, Shimada S, Yamashita A. [Patient Radiation Dose for Percutaneous Coronary Intervention by Treatment Area: Dosimetry Using DRLs 2020]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:1306-1313. [PMID: 36198569 DOI: 10.6009/jjrt.2022-1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Skin injury in patients due to radiation exposure has been a complication in percutaneous coronary intervention (PCI) for a long time. To the best of our knowledge, there have been no reports comparing radiation dose by treatment area with diagnostic reference levels (DRLs) 2020, although the radiation dose varies by treatment area in PCI. METHODS In this study, the treatment areas were classified into four segments (i.e., AHA #1-3, AHA #4, AHA #5-10, and AHA #11-15), and each segment was compared with DRLs 2020. This retrospective study included 984 consecutive patients with single-vessel disease and non-chronic total occlusion. PCI was performed on a single device. RESULTS The median radiation dose was 1640.8 mGy, and the radiation dose for AHA #4 was 2732.0 mGy, which was significantly higher than the other treatment areas (p<0.001). In AHA #4, the radiation dose increased due to the heavy use of the left cranial view, and the patient background contributed to the increased lesion complexity. Therefore, it was challenging to evaluate AHA #4 and the other treatment areas with a uniform DRL value. CONCLUSION Establishing a subdivided index for each treatment area is crucial if DRLs are used as a reference during procedures and as a guide for dose optimization.
Collapse
Affiliation(s)
- Yusuke Masubuchi
- Department of Radiology, Nasu Red Cross Hospital
- Department of Radiological Examination and Technology, Tohoku University Graduate School of Medicine
| | - Koichi Chida
- Department of Radiological Examination and Technology, Tohoku University Graduate School of Medicine
- Disaster Medical Radiology, Division of Disaster Medical Science, International Research Institute of Disaster Science, Tohoku University
| | - Yohei Inaba
- Department of Radiological Examination and Technology, Tohoku University Graduate School of Medicine
- Disaster Medical Radiology, Division of Disaster Medical Science, International Research Institute of Disaster Science, Tohoku University
| | | | | | | |
Collapse
|
33
|
Jusoh II, Abdullah KA, Ali MH. DIAGNOSTIC REFERENCE LEVELS FOR COMMON CT EXAMINATIONS: RESULTS FROM A STATEWIDE DOSE SURVEY. Radiat Prot Dosimetry 2022; 198:1417-1423. [PMID: 36093894 DOI: 10.1093/rpd/ncac182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to investigate the current radiation doses for CT examinations throughout a state in Malaysia and, based on this data, to propose local diagnostic reference levels (DRLs) for the most common CT examinations. A study was conducted in three of the four hospitals that have provided CT services throughout the state. A survey booklet was designed to facilitate collection of pertinent CT scan data. The following information were extracted and recorded for each study: tube voltage, tube current, number of scans phases, CT dose index volume (CTDIvol) and dose length product (DLP). Proposed local DRLs of CT brain and thorax were up to 12% lower than the current national DRLs. However, an increase of DLP (median value) for CT abdomen was also found as compared to the 75th percentile of national DRLs. Therefore, considerable optimisation should be made to achieve a better dose reduction.
Collapse
Affiliation(s)
- Irwan Iskandar Jusoh
- School of Medical Imaging, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Nerus, Terengganu 21300, Malaysia
| | - Kamarul Amin Abdullah
- School of Medical Imaging, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Nerus, Terengganu 21300, Malaysia
| | - Mohd Hanafi Ali
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Level 7, University of Sydney, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW 2006, Australia
| |
Collapse
|
34
|
Alrehily F. DIAGNOSTIC REFERENCE LEVELS OF RADIOGRAPHIC AND CT EXAMINATIONS IN SAUDI ARABIA: A SYSTEMATIC REVIEW. Radiat Prot Dosimetry 2022; 198:1451-1461. [PMID: 36125219 DOI: 10.1093/rpd/ncac183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/16/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
A systematic search was conducted to explore the literature on the existing diagnostic reference level (DRL) of radiographic and computed tomography (CT) examinations in Saudi Arabia. The search was performed using Web of Science, Scopus and EBSCO. The search identified 19 studies that reported DRL values for radiographic and CT examinations in Saudi Arabia. Six of those studies reported DRL values for projection radiography, and the remaining studies reported DRL values for CT examinations (n = 13). The entrance surface dose, volume CT dose index (CTDIvol) and dose-length product (DLP) were the most common methods used for establishing the DRLs. Variations were observed in the Saudi DRL values, and this is consistent with the DRL values reported in the literature. Educating and training radiographers to better understand dose minimizing techniques may result in lower patient doses and lower variances in DRL values.
Collapse
Affiliation(s)
- Faisal Alrehily
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| |
Collapse
|
35
|
Nam S, Park H, Kwon S, Cho PK, Yoon Y, Yoon SW, Kim J. Updated National Diagnostic Reference Levels and Achievable Doses for CT Protocols: A National Survey of Korean Hospitals. Tomography 2022; 8:2450-2459. [PMID: 36287802 PMCID: PMC9612211 DOI: 10.3390/tomography8050203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: In 2021, the Korean government proposed a new CT diagnostic reference level. This study performed a nationwide survey and developed new DRLs and AD for 13 common CT examinations. We compared other countries’ DRLs for CT examinations. Methods: This study investigated the CTDIvol and DLP of the 12 types of CT protocols for adults and brain CT protocol for pediatrics. A total of 7829 CT examinations were performed using 225 scanners. We defined the DRLs values in the distribution of radiation exposure levels to determine the nationwide patient dose and distribution status of the dose. Results: This study showed that the new Korean national CT DRLs are slightly higher or similar to those of previous surveys and are similar or lower than those of other countries. In some protocols, although the DLP value increased, the CTDIvol decreased; therefore, it can be concluded that the patient’s dose in CT examinations was well managed. Conclusions: The new CT DRLs were slightly higher than or similar to that of the previous survey and were evaluated to be similar or lower than CT DRLs of other countries. These DRLs will be used for radiation optimization and effective dose calculation for an individual.
Collapse
Affiliation(s)
- Sora Nam
- Department of Bio-Convergence Engineering, Korea University Graduate School, Seoul 02841, Korea
| | - Hyemin Park
- Center for Radiological Environment & Health Science, Dongseo University, Busan 47011, Korea
| | - Soonmu Kwon
- Department of Radiological-Technology, Daegu Health College, Daegu 41453, Korea
| | - Pyong-kon Cho
- Department of Radiologic Science, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Yongsu Yoon
- Center for Radiological Environment & Health Science, Dongseo University, Busan 47011, Korea
- Department of Multidisciplinary Radiological Science, The Graduate School of Dongseo University, Busan 47011, Korea
| | - Sang-wook Yoon
- Department of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea
- Correspondence: (S.-w.Y.); (J.K.)
| | - Jungsu Kim
- Department of Radiological-Technology, Daegu Health College, Daegu 41453, Korea
- Correspondence: (S.-w.Y.); (J.K.)
| |
Collapse
|
36
|
Opitz M, Zensen S, Ludwig JM, Weber M, Alatzides G, Seifert R, Grüneisen J, Theysohn JM, Bos D, Schaarschmidt BM. Radiation dose aspects and establishment of diagnostic reference levels for 90Y radioembolisation during angiographic procedure. J Radiol Prot 2022; 42:031518. [PMID: 36067741 DOI: 10.1088/1361-6498/ac8f9e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
90Y radioembolisation (RE) is an angiographic procedure used in patients with both primary and secondary hepatic malignancies. Local tumour control can be achieved by short range tumour irradiation by the regional intra-arterial administration of glass or resin microspheres loaded with 90yttrium that accumulate in the tumorous tissue. The aim of this study was to investigate the radiation exposure of RE and to establish a local diagnostic reference level (DRL). In this retrospective study, dose data from 397 procedures in 306 patients (mean age 67.4 ± 10.6 years, 82 female) who underwent RE between 06/2017 and 01/2022 using one of two different angiography systems were analysed. DRL was set as the 75th percentile of the dose distribution. In the overall population, dose area product (DAP) (median (interquartile range, IQR)) was 26 Gy cm2(IQR 12-50) with a median fluoroscopy time (FT) of 4.5 min (IQR 2.9-8.0). FT and DAP increased significantly with the number of infusion positions (median, IQR): one position 23 Gy cm2(12-46), two positions 33 Gy cm2(14-60), three positions 50 Gy cm2(24-82) (p< 0.0001). Local DRL is 47 Gy cm2for RE and 111 Gy cm2for RE with additional embolisation. Radiation exposure and FT are significantly higher with increasing number of infusion positions as well as additional embolisation. Our established DRLs for RE may serve as a benchmark for dose optimisation.
Collapse
Affiliation(s)
- Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Johannes Maximilian Ludwig
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Georgios Alatzides
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Johannes Grüneisen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Jens Matthias Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Benedikt Michael Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| |
Collapse
|
37
|
Ubeda C, Vano E, Perez MD, Jímenez P, Ramirez R, Nader A, Miranda P, Azcurra P, Damsky J, Capdevila S, Oliveira M, Albuquerque J, Bocamino R, Schelin H, Yagui A, Aguirre D, Riquelme N, Cardenas L, Álvarez A, Mosquera W, Arias F, Gutierrez R, De la Mora R, Rivera T, Zapata J, Araujo P, Chiesa P. Setting up regional diagnostic reference levels for pediatric interventional cardiology in Latin America and the Caribbean countries: preliminary results and identified challenges. J Radiol Prot 2022; 42:031513. [PMID: 35940166 DOI: 10.1088/1361-6498/ac87b7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for pediatric interventional cardiology (IC) procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study was conducted in the framework of the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency. The first step of the program was focused on pediatric IC. Dose data from diagnostic and therapeutic procedures were collected between December 2020 and December 2021. Regional DRLs were set as the third quartile of patient dose data (kerma area product) collected in 18 hospitals from 10 countries in an initial sample of 968 procedures. DRLs were set for four age bands and five weight ranges. The values obtained for the four age bands (<1 yr, 1 to <5 yr, 5 to <10 yr and 10 to <16 yr) were 2.9, 6.1, 8.8 and 14.4 Gy cm2for diagnostic procedures, and 4.0, 5.0, 10.0 and 38.1 Gy cm2for therapeutic procedures, respectively. The values obtained for the five weight bands (<5 kg, 5 to <15 kg, 15 to <30 kg, 30 to <50 kg and 50 to <80 kg) were 3.0, 4.5, 8.1, 9.2 and 26.8 Gy cm2for diagnostic procedures and 3.7, 4,3, 7.3, 16.1 and 53.4 Gy cm2for therapeutic procedures, respectively. While initial data were collected manually as patient dose management systems (DMSs) were not available in most of the hospitals involved in the program, a centralized automatic DMS for the collection and management of patient dose indicators has now been introduced and is envisaged to increase the sample size. The possibility of alerting on high dose values and introducing corrective actions will help in optimization.
Collapse
Affiliation(s)
- C Ubeda
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica, Chile
| | - E Vano
- Radiology Department, Faculty of Medicine, Complutense University and IdIS, San Carlos Hospital, 28040 Madrid, Spain
| | - M D Perez
- World Health Organization (WHO), Geneva, Switzerland
| | - P Jímenez
- Pan American Health Organization (PAHO), Washington, DC, United States of America
| | - R Ramirez
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - A Nader
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - P Miranda
- Luis Calvo Mackenna's Hospital, AntonioVaras 360, Santiago, Chile
| | - P Azcurra
- Hemodynamic Service, Italian Hospital, Buenos Aires, Argentina
| | - J Damsky
- Hemodynamic Service, Pedro de Elizalde Children's Hospital, Buenos Aires, Argentina
| | - S Capdevila
- Hemodynamic Service, Santísima Trinidad Children's Hospital, Córdova, Argentina
| | - M Oliveira
- Department of Health Technology and Biology, Federal Institute of Bahia, Salvador, Brazil
| | - J Albuquerque
- University Hospital of the Federal University of Maranhão, San Luis, Brasil
| | - R Bocamino
- Clinical Hospital of the Federal University of Paraná, Curitiba, Brasil
| | - H Schelin
- Pequeno Príncipe Hospital, Curitiba, Brasil
| | - A Yagui
- Pequeno Príncipe Hospital, Curitiba, Brasil
| | - D Aguirre
- Hemodynamic Service, Roberto del Rio Children's, Santiago, Chile
| | - N Riquelme
- Hemodynamic Service, Roberto del Rio Children's, Santiago, Chile
| | - L Cardenas
- Hemodynamic Service, Santa Maria Clinic, Santiago, Chile
| | - A Álvarez
- Hemodynamic Service, Santa Maria Clinic, Santiago, Chile
| | - W Mosquera
- Valle del Lili Foundation University Hospital ICESI, Cali, Colombia
| | - F Arias
- National Children's Hospital, San José, Costa Rica
| | - R Gutierrez
- National Children's Hospital, San José, Costa Rica
| | - R De la Mora
- National Directorate of Environmental Health, Ministry of Public Health, Havana, Cuba
| | - T Rivera
- Center for Research in Applied Sciences and Advanced Technology Legaria, IPN, Ciudad de México, Mexico
| | - J Zapata
- National Institute of Child Health St. Borja, Lima, Peru
| | - P Araujo
- National Cardiovascular Institute, Lima, Peru
| | - P Chiesa
- Children's Cardiology Institute, Montevideo, Uruguay
| |
Collapse
|
38
|
Kamdem EF, Samba ON, Manemo CT, Kouam BBF, Abogo S, Tambe J, Amougou JCM, Guegang E, Zeh OF, Moifo B, Nguemgne C, Nana NFN, Fotue AJ. ESTABLISHMENT OF LOCAL DIAGNOSTIC REFERENCE LEVEL FOR ROUTINE PAEDIATRIC COMPUTED TOMOGRAPHY EXAMINATIONS IN BAFOUSSAM WEST CAMEROON. Radiat Prot Dosimetry 2022; 198:815-820. [PMID: 35718757 DOI: 10.1093/rpd/ncac143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
The main purpose of this study was to determine local diagnostic reference level (LDRL) for routine computed tomography (CT) examination in Bafoussam, western Cameroon. The exposure parameters and dose quantities were collected manually. This retrospective, evaluative and comparative study was conducted to determine LDRLs for routine head CT examination in Bafoussam, to optimize these procedures in the region. The 75th percentile values of the calculated volume CT dose index (CTDIvol) and dose length product (DLP) were proposed as LDRL. The sample was classified in four age groups: < 1, 1-5, 5-10 and 10-15 y. The LDRLs obtained for the four age groups were: 24 mGy and 381.32 mGy.cm, 42.5 mGy and 875.55 mGy.cm, 45.85 mGy and 939.62 mGy.cm, 57.12 mGy and 1222.3 mGy.cm, respectively. The 75th percentile CTDIvol and DLP dose values for this study are higher than international values. We propose a coordinating discussions and collaboration about patient's and specific equipment's change information's, between radiologists, medical imaging technicians and medical physicist, which can reduce absorbed doses and improved medical practice in hospitals.
Collapse
Affiliation(s)
- Eddy Fotso Kamdem
- Mesoscopic and Multilayers Structures Laboratory, Department of Physics, Faculty of Science, University of Dschang, P.O. Box 479, Dschang, Cameroon
| | | | - Cedric Tetchoka Manemo
- Mesoscopic and Multilayers Structures Laboratory, Department of Physics, Faculty of Science, University of Dschang, P.O. Box 479, Dschang, Cameroon
| | | | - Serge Abogo
- Department of Radiology, National Social Insurance Fund Hospital, Yaoundé, Cameroon
| | - Joshua Tambe
- Department of Radiology, Limbe Regional Hospital, Limbe, Cameroon
| | | | - Emilienne Guegang
- Department of Radiography, Yaoundé General Hospital, Yaoundé, Cameroon
| | - Odile Fernande Zeh
- Department of Radiology, Yaounde Gynaeco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon
| | - Boniface Moifo
- Department of Radiology, Yaounde Gynaeco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon
| | | | | | - Alain Jervé Fotue
- Mesoscopic and Multilayers Structures Laboratory, Department of Physics, Faculty of Science, University of Dschang, P.O. Box 479, Dschang, Cameroon
| |
Collapse
|
39
|
Šalát D, Nikodemová D, Klepanec A, Lehotská V, Šalátová A. DIAGNOSTIC REFERENCE LEVELS IN SCREENING MAMMOGRAPHY CENTERS IN SLOVAKIA. Radiat Prot Dosimetry 2022; 198:537-539. [PMID: 36005968 DOI: 10.1093/rpd/ncac095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Optimization in mammography remains the most important tool in practice. In the optimization process, we look for a balanced relationship between image quality and patient dose. For mammographic examinations, the diagnostic reference levels (DRLs) are expressed as the average glandular dose (AGD) based on the thickness of the compressed breast. The aim of this study was to analyse DRL compliance in diagnostic mammography at 16 mammography screening centres using an automated system for tracking patient doses during the period between January 2020 and December 2020 and to subsequently propose new DRLs for the screening mammography centres in Slovakia. The new DRLs were ~20% lower than the existing national DRLs in diagnostic mammography in Slovakia and significantly lower than the achievable AGD levels published in the fourth edition of the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis.
Collapse
Affiliation(s)
- Dušan Šalát
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Námestie Jozefa Herdu 577/2, 917 01 Trnava, Slovakia
| | - Denisa Nikodemová
- Slovak Medical University in Bratislava, Limbová 12, 833 03 Bratislava, Slovakia
| | - Andrej Klepanec
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Námestie Jozefa Herdu 577/2, 917 01 Trnava, Slovakia
- 2nd Radiology Department of Faculty of Medicine of Comenius University in Bratislava Slovakia and St. Elizabeth's Cancer Institute in Bratislava Slovakia, Špitálska 24, 813 72 Bratislava, Slovakia
| | - Viera Lehotská
- 2nd Radiology Department of Faculty of Medicine of Comenius University in Bratislava Slovakia and St. Elizabeth's Cancer Institute in Bratislava Slovakia, Špitálska 24, 813 72 Bratislava, Slovakia
| | - Anna Šalátová
- Institute of Radiation Protection in Trenčín, Staničná 1062/24, 911 05 Trenčín, Slovakia
| |
Collapse
|
40
|
Bouaoun A, Ben Omrane L, Douira Khomssi W. Towards the establishment of national diagnostic reference levels in Tunisia: a multicentre survey in paediatric CT. J Radiol Prot 2022; 42:031503. [PMID: 35671750 DOI: 10.1088/1361-6498/ac767a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
This work focuses on the determination of the radiation doses for a total sample of 916 children, categorised into four age groups (<1, 1-5, <5-10, <10-15 years) undergoing the most frequent paediatric CT scans performed in different scan facilities in Tunisia in order to establish the national diagnostic reference levels (DRLs). Dose evaluation concerned the dosimetric indicators: volume computed tomography dose index (CTDIvol)and dose-length product (DLP). The different paediatric CT protocols and practices were also evaluated. The results show a large variation in doses between different radiology departments. For head scans, the respective DRLs for children aged <1, 1-5, 5-10 and 10-15 years were 26, 38, 51 and 51 mGy, respectively, for CTDIvoland 384, 664, 873 and 978 mGy cm, respectively, for DLP. For the chest, the equivalent respective DRLs were 8, 10, 12 and 15 mGy for CTDIvoland 118, 330, 442 and 526 mGy cm for DLP. For the abdomen, the respective DRLs were 9, 13, 19 and 18 mGy for CTDIvoland 353, 485, 592 and 1073 mGy cm for DLP. This study shows that the optimisation of paediatric CT procedures should be a priority, especially within regional hospitals. The implementation of corrective actions will take place after the initial DRLs. These actions, including recommendations and guidelines to good practice, should be a joint effort of all stakeholders, including health authorities, the radiation protection regulator, professional societies and universities.
Collapse
Affiliation(s)
- Abir Bouaoun
- University of Tunis El Manar, Higher Institute of Medical Technologies of Tunis (ISTMT), LR13ES07 Laboratory of Biophysics and Medical Technologies, Tunis, Tunisia
| | - Latifa Ben Omrane
- University of Tunis El Manar, Higher Institute of Medical Technologies of Tunis (ISTMT), LR13ES07 Laboratory of Biophysics and Medical Technologies, Tunis, Tunisia
- National Centre of Radiation protection (CNRP), Tunis, Tunisia
| | | |
Collapse
|
41
|
Vieira LA, Silva FAR, Silva T, Nogueira MS. DIAGNOSTIC REFERENCE LEVELS BASED ON PATIENT BODY MASS INDEX FOR SELECT INTERVENTIONAL PROCEDURES IN MINAS GERAIS/BRAZIL. Radiat Prot Dosimetry 2022; 198:379-385. [PMID: 35512350 DOI: 10.1093/rpd/ncac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 02/15/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
This work establishes local diagnostic reference levels (DRLs) in interventional radiology based on adult patient body mass index (BMI). The monitoring was carried out from 23 institutions and patient data from 3015 procedures were collected, being 907 Catheterism (CAT), 921 Percutaneous transluminal coronary angioplasty (PTCA) and 1187 CAT/PTCA and 6 BMI ranges were taken, going from under 18 up to 40 kg·m-2. It is presented that 18 initial DRL values to be used in the county of Minas Gerais. The overall 75th kerma-area product (KAP), commonly considered DRL, in Gy·cm2, is 94.6(SD 119)-CAT, 88.6(SD 121)-PTCA and 33.0(SD 47.6)-CAT/PTCA. In considering KAP-BMI individual values, one obtain the min-max ranges, in Gy·cm2, 3.2-BMI A to 101-BMI B for CAT, 65-BMI A to 102-BMI F for PTCA and 10.4-BMI A to 59.2-BMI E for CAT/PTCA. The KAP-BMI approach has shown to be feasible as a DRL optimization process.
Collapse
Affiliation(s)
- L A Vieira
- Minas Gerais State Secretary of Health, Cidade Administrativa Presidente Tancredo Neves, Belo Horizonte, Brazil
- Centro de Desenvolvimento da Tecnologia Nuclear, CDTN - Avenida Presidente Antônio Carlos, Belo Horizonte, Brazil
| | - F A R Silva
- Minas Gerais State Secretary of Health, Cidade Administrativa Presidente Tancredo Neves, Belo Horizonte, Brazil
| | - T Silva
- Centro de Desenvolvimento da Tecnologia Nuclear, CDTN - Avenida Presidente Antônio Carlos, Belo Horizonte, Brazil
| | - M S Nogueira
- Centro de Desenvolvimento da Tecnologia Nuclear, CDTN - Avenida Presidente Antônio Carlos, Belo Horizonte, Brazil
| |
Collapse
|
42
|
Uushona V, Boadu M, Nyabanda R, Diagne M, Inkoom S, Issahaku S, Hasford F, Haiduwa P, Koteng A, Omondi B, Diop AY, Gilley DB. ESTABLISHMENT OF REGIONAL DIAGNOSTIC REFERENCE LEVELS IN ADULT COMPUTED TOMOGRAPHY FOR FOUR AFRICAN COUNTRIES: A PRELIMINARY SURVEY. Radiat Prot Dosimetry 2022; 198:414-422. [PMID: 35596952 DOI: 10.1093/rpd/ncac074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/09/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
This preliminary study aims towards the establishment of regional diagnostic reference levels (DRLs) for routine adult computed tomography (CT) examinations. The study was performed on 54 CT facilities from four African countries (Ghana, Kenya, Namibia and Senegal) and the results compared with international DRLs. Data were collected from facilities using a structured questionnaire provided by the International Atomic Energy Agency. Dose descriptors (volume computed tomography dose index [CTDIvol] and dose length product [DLP]) evaluations were performed on CT head and body phantoms for head, chest and abdomen CT examination protocols using standard methods. The estimated dose indices were compared with console-displayed dose values. Experienced radiologists accepted the diagnostic image quality of the images as per departmental imaging requirements. Median CTDIvol and DLP data from each facility were compiled to estimate the typical dose in each country. National DRLs were established based on the 75th percentile of median values, whereas the regional DRLs were based on the median of the national DRLs. Comparison of measured CTDIvol with console values of all facilities in all four countries was within 20% as recommended. The established CTDIvol DRLs for head CT, chest CT and abdomen CT were 60.9 mGy, 15.2 mGy and 15.7 mGy, respectively. Similarly, that of DLP, DRLs were 1259 mGy.cm, 544 mGy.cm and 737 mGy.cm, respectively for head CT, chest CT and abdomen CT. The established DRLs from this study were comparable to DRLs from other countries with some variations. This study would serve as baseline for establishment of a more generalized regional adult CT DRLs for Africa.
Collapse
Affiliation(s)
- Vera Uushona
- National Radiation Protection Authority of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - Mary Boadu
- Ghana Atomic Energy Commission, Accra, Ghana
| | - Rose Nyabanda
- Department of Radiology, Kenyatta National Hospital, Nairobi Kenya
| | - Magatte Diagne
- University Teaching Hospital-Senegal, Institut Curie, Hôpital Universitaire le Dantec, BP, Dakar, Senegal
| | | | | | | | - Paulus Haiduwa
- Nuclear Medicine Department, Windhoek Central Hospital, Windhoek, Namibia
| | | | - Bob Omondi
- Department of Radiology, Kenyatta National Hospital, Nairobi Kenya
| | - Adji Yaram Diop
- University Teaching Hospital-Senegal, Institut Curie, Hôpital Universitaire le Dantec, BP, Dakar, Senegal
| | - Debbie Bray Gilley
- Radiation Protection of Patients Unit, Radiation Safety and Monitoring Section, Division of Radiation, Transport and Waste Safety, Department of Nuclear Safety and Security, International Atomic Energy Agency (IAEA), Vienna International Centre, Vienna, Austria
| |
Collapse
|
43
|
Abdou SE, Salama DH, Ahmad KA, Sallam AM, El-Sayed ESM, Talaat MS, El-Farrash RA, Vassileva J. 2021 NATIONAL DIAGNOSTIC REFERENCE LEVELS FOR PAEDIATRIC COMPUTED TOMOGRAPHY IN EGYPT. Radiat Prot Dosimetry 2022; 198:423-433. [PMID: 35639601 DOI: 10.1093/rpd/ncac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To establish national diagnostic reference levels (NDRLs) for most common paediatric computed tomography (CT) examinations in Egypt. METHODS This was a prospective study that included all dedicated paediatric imaging centers in Egypt. Data from 1680 individual paediatric patients undergoing CT scanning of the head, chest and abdomen-pelvis were collected. Computed tomography dose indices were recorded, data were analysed and compared with the internationally published paediatric DRLs in14 countries. RESULTS The Egyptian NDRLs of the CTDIvol (mGy) for head, chest and abdomen-pelvis scans among four paediatric age groups were found to be (23, 27, 28, 32, 4, 5, 6, 8, 5, 6, 7, 9) mGy, respectively; and the corresponding NDRLs of the DLP (mGycm) for head, chest and abdomen-pelvis scans were found to be (345, 428, 499, 637, 67, 85, 145, 215, 97, 135, 240, 320) mGycm, respectively. There were variations in the radiation doses between CT centers and identical scanners indicating the need for dose optimization. The NDRLs of the CTDIvol (mGy) and the DLP (mGycm) values were similar to or lower than international DRLs. CONCLUSION This study summarizes the results of the first Egyptian Computed Tomography survey that provides national diagnostic reference levels for paediatric patients in Egypt. Despite the reasonable NDRLs values, the study depicted certain pros and cons concerning CT practice, and identified some problems that hinder the process of optimization as well as justification in children.
Collapse
Affiliation(s)
- Sayed E Abdou
- Ain Shams University Hospitals, Department of Radiology, Cairo 11591, Egypt
| | - Dina H Salama
- Misr University for Science and Technology and Egyptian Atomic Energy Authority, Radiology and Medical Imaging Technology Departments, Cairo 11787, Egypt
| | - Khaled A Ahmad
- Ain Shams University, Paediatric Imaging Department, Cairo 11591, Egypt
| | - Abdelsattar M Sallam
- Ain Shams University, Faculty of Science, Department of Physics, Cairo 11566, Egypt
| | | | - M S Talaat
- Ain Shams University, Faculty of Science, Department of Physics, Cairo 11566, Egypt
| | - Rania A El-Farrash
- Ain Shams University, Faculty of Medicine, Department of Pediatrics, Cairo 11591, Egypt
| | - J Vassileva
- International Atomic Energy Agency, Radiation Protection Specialists, Radiation Protection Unit of the International Atomic Energy Agency, 1400 Vienna, Austria
| |
Collapse
|
44
|
Srimahachota S, Krisanachinda A, Roongsangmanoon W, Sansanayudh N, Limpijankit T, Chandavimol M, Athisakul S, Siriyotha S, Rehani MM. Establishment of national diagnostic reference levels for percutaneous coronary interventions (PCIs) in Thailand. Phys Med 2022; 96:46-53. [PMID: 35219961 DOI: 10.1016/j.ejmp.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To establish national diagnostic reference levels (DRLs) for percutaneous coronary intervention (PCI) in Thailand for lesions of different complexity. METHODS Radiation dose quantity as kerma-area-product (KAP) and cumulative air-kerma at reference point (CAK) from 76 catheterization labs in 38 hospitals in PCI registry of Thailand was transferred online to central data management. Sixteen months data (May 2018 to August 2019) was analyzed. We also investigated role of different factors that influence radiation dose the most. RESULTS Analysis of 22,737 PCIs resulted in national DRLs for PCI of 91.3 Gy.cm2 (KAP) and 1360 mGy (CAK). The NDRLs for KAP for type C, B2, B1 and A lesions were 106.8, 82.6, 67.9, and 45.3 Gy.cm2 respectively and for CAK, 1705, 1247, 962, and 790 mGy respectively. Thus, as compared to lesion A, lesion C had more than double the dose and B2 had nearly 1.6 times and B1 had 1.2 times CAK. Our DRL values are lower than other Asian countries like Japan and Korea and are in the middle range of Western countries. University hospital had significantly higher dose than private or public hospital possibly because of higher load of complex procedures in university hospitals and trainees performing the procedures. Transradial approach showed lower doses than transfemoral approach. CONCLUSIONS This large multi-centric study established DRLs for PCIs which can act as reference for future studies. A hallmark of our study is establishment of reference levels for coronary lesions classified as per ACC/AHA and thus for different complexities.
Collapse
Affiliation(s)
- Suphot Srimahachota
- Cardiac Center and Division of Cardiovascular Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand.
| | - Anchali Krisanachinda
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Worawut Roongsangmanoon
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, Thailand
| | - Nakarin Sansanayudh
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Phramongkutklao Hostpital, Bangkok, Thailand
| | - Thosaphol Limpijankit
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mann Chandavimol
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siriporn Athisakul
- Cardiac Center and Division of Cardiovascular Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - Sukanya Siriyotha
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Madan M Rehani
- Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
45
|
Gerasia R, Cannataci C, Gallo GS, Tafaro C, Maruzzelli L, Cortis K, Miraglia R. LOCAL DIAGNOSTIC REFERENCE LEVELS FOR PEDIATRIC RETROGRADE WEDGE PORTOGRAPHY INTERVENTIONAL PROCEDURES USING A DOSE MONITORING SOFTWARE AT A TRANSPLANTATION INSTITUTE. Radiat Prot Dosimetry 2022; 198:100-108. [PMID: 35106583 DOI: 10.1093/rpd/ncab194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
The aim of this work was to establish local diagnostic reference levels (DRLs) for retrograde wedge portography (RWP) performed on pediatric patients assessing the usefulness of radiation dose monitoring software in the establishing process. Between September 2016 and April 2020, 66 consecutive RWP were performed at a transplantation institute and were included in our study. Patients were divided in three groups according to age: n = 25 infants, n = 20 middle childhood and n = 21 early adolescence. The third quartile of both Air Kerma at the reference point (Ka,r) and air kerma-area product (PKA) were evaluated to establish local DRLs (lDRLs). In addition, to control high Ka,r levels during procedures, the software notified to operators if Ka,r exceeded the dose 'alert' threshold set at 2 Gy. lDRLs were established for all three groups using PKA and Ka,r: infant group: 5.6 Gy.cm 2 and 0.034 Gy; middle childhood: 6.4 Gy.cm2 and 0.018 Gy and early adolescence: 12.8 Gy.cm2 and 0.059 Gy. The dose threshold 'alert' was never encountered (alert quota: 0%). The dose monitoring system supports the feasibility of accurate and easier lDRLs' establishment.
Collapse
Affiliation(s)
- R Gerasia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, Palermo 90127, Italy
- Italian Association of Interventional Radiographers (AITRI), Via S. Gregorio, 53, Milan 20124, Italy
- Italian Federation of Scientific Radiographers Societies (FASTeR), Via S. Gregorio, 53, Milan 20124, Italy
| | - C Cannataci
- Medical Imaging Department, Mater Dei Hospital, Triq Dun Karm, L-Imsida MSD9032, Malta
| | - G S Gallo
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, Palermo 90127, Italy
- Italian Association of Interventional Radiographers (AITRI), Via S. Gregorio, 53, Milan 20124, Italy
| | - C Tafaro
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, Palermo 90127, Italy
- Italian Association of Interventional Radiographers (AITRI), Via S. Gregorio, 53, Milan 20124, Italy
| | - L Maruzzelli
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, Palermo 90127, Italy
| | - K Cortis
- Medical Imaging Department, Mater Dei Hospital, Triq Dun Karm, L-Imsida MSD9032, Malta
| | - R Miraglia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, Palermo 90127, Italy
| |
Collapse
|
46
|
Amalaraj T, Satharasinghe D, Pallewatte A, Jeyasugiththan J. Establishment of national diagnostic reference levels for computed tomography procedures in Sri Lanka: first nationwide dose survey. J Radiol Prot 2022; 42:021504. [PMID: 34875641 DOI: 10.1088/1361-6498/ac40e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/06/2021] [Indexed: 06/13/2023]
Abstract
The main purpose of this study was to establish for the first time national diagnostic reference levels (NDRLs) for common computed tomography (CT) procedures in Sri Lanka. Patient morphometric data, exposure parameters and dose data such as volume CT dose index (CTDIvol) and dose-length product (DLP) were collected from 5666 patients who underwent 22 types of procedure. The extreme dose values were filtered before analysis to ensure that the data come from standard size patients. The median of the dose distribution was calculated for each institution, and the third quartile value of the median distribution was considered as the NDRL. Based on the inclusion and exclusion criteria, data from 4592 patients and 17 procedure types were considered for establishment of a NDRL, covering 41% of the country's CT machines. The proposed NDRLs based on CTDIvoland DLP were: non-contrast-enhanced (NC) head, 82.2 mGy/1556 mGy cm; contrast-enhanced (CE) head, 82.2 mGy/1546 mGy cm; chest NC, 7.4 mGy/350 mGy cm; chest CE, 8.3 mGy/464 mGy cm; abdomen NC, 10.5 mGy/721 mGy cm; abdomen arterial (A) phase, 13.4 mGy/398 mGy cm; abdomen venous (V) phase, 10.8 mGy/460 mGy cm; abdomen delay (D) phase, 12.6 mGy/487 mGy cm; sinus NC, 30.2 mGy/452 mGy cm; lumbar spine NC, 24.1 mGy/1123 mGy cm; neck NC, 27.5 mGy/670 mGy cm; high-resolution CT of chest, 10.3 mGy/341 mGy cm; kidneys ureters and bladder NC, 19.4 mGy/929 mGy cm; chest to pelvis (CAP) NC, 10.8 mGy/801 mGy cm; CAP A, 10.4 mGy/384 mGy cm; CAP V, 10.5 mGy/534 mGy cm; CAP D, 16.8 mGy/652 mGy cm. Although the proposed NDRLs are comparable with those of other countries, the observed broad dose distributions between the CT machines within Sri Lanka indicate that dose optimisation strategies for the country should be implemented for most of the CT facilities.
Collapse
Affiliation(s)
- T Amalaraj
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka
| | | | - Aruna Pallewatte
- Department of Radiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | |
Collapse
|
47
|
Liu Q, Suleiman ME, McEntee MF, Soh BP. Diagnostic reference levels in digital mammography: a systematic review. J Radiol Prot 2022; 42:011503. [PMID: 34891143 DOI: 10.1088/1361-6498/ac4214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/10/2021] [Indexed: 06/13/2023]
Abstract
Diagnostic reference levels (DRLs) in digital mammography (DM) serve as a useful benchmark for dose monitoring and optimisation, allowing comparison amongst countries, institutions and mammography units. A systematic review of DRLs in DM, published in 2014, reported a lack of consistent and internationally accepted protocol in DRLs establishment, thereby resulting in wide variations in methodologies which complicates comparability between studies. In 2017, the International Commission of Radiation Protection (ICRP) published additional guidelines and recommendations to provide clarity in the protocol used in DRLs establishment. With the continuing evolvement of technology, optimisation of examinations and updates in guidelines and recommendations, DRLs should be revised at regular intervals. This systematic review aims to provide an update and identify a more consistent protocol in the methodologies used to establish DRLs. Searches were conducted through Web of Science, PubMed-MEDLINE, ScienceDirect, CINAHL and Google Scholar, which resulted in 766 articles, of which 19 articles were included after screening. Relevant data from the included studies were summarised and analysed. While the additional guidelines and recommendations have provided clarifications in the methodologies used in DRLs establishment, such as data source (i.e. the preference to use data derived from patient instead of phantoms to establish DRLs), protocol (i.e. stratification of DRLs by compressed breast thickness and detector technology, and the use of median value for DRLs quantity instead of mean) and percentiles used to establish DRLs (i.e. set at the 75th percentile with a minimum sample size of 50 patients), other differences such as the lack of a standard dose calculation method used to estimate mean glandular dose continues to complicate comparisons between studies and different DM systems. This systematic review update incorporated the updated guidelines and recommendations from ICRP which will serve as a useful resource for future research efforts related to DRLs, dose monitoring and optimisation.
Collapse
Affiliation(s)
- Qiumei Liu
- Health and Social Sciences, Singapore Institute of Technology, Dover Road, Singapore
| | - Moayyad E Suleiman
- Faculty of Medicine and Health, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Mark F McEntee
- The Discipline of Medical Imaging and Radiation Therapy, School of Medicine, UGF 12, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - BaoLin P Soh
- Health and Social Sciences, Singapore Institute of Technology, Dover Road, Singapore
| |
Collapse
|
48
|
Kadavigere R, Sukumar S. Estimation of radiation dose and establishment of local diagnostic reference levels for computed tomography of head in pediatric population. J Xray Sci Technol 2022; 30:983-991. [PMID: 35786667 DOI: 10.3233/xst-221172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pediatric population is more sensitive to the effects of radiation than adults. Establishing diagnostic reference level (DRL) is an efficient dose optimization technique implemented by many countries for reducing radiation dose during Computed Tomography (CT) examinations. OBJECTIVES To estimate radiation dose and establish a new local diagnostic reference level for CT head examination in the pediatric population. MATERIALS AND METHODS We prospectively recruited 143 pediatric patients referred for CT head examination with age ranging from 0-5 years old. All patients had undergone CT head examination using the standard pediatric head protocol. Volumetric CT dose index (CTDIvol) and dose length product (DLP) were recorded. The effective dose was first calculated. Then, 75th percentile of dose indices was calculated to establish DRLs. RESULTS DRLs in terms of CTDIvol and DLP are 23.84 mGy, 555.99 mGy.cm for patients <1 years old and 28.65 mGy, 794.99 mGy.cm for patients from 1-5 years old, respectively. Mean effective doses for <1 years old patients and 1-5 years old patients are 2.91 mSv and 2.78 mSv respectively. CONCLUSION The study concludes that DRL in terms of CTDIvol is lower but DRL in terms of DLP and the effective dose is higher compared to a few other studies which necessitate the need for dose optimization.
Collapse
Affiliation(s)
- Rajagopal Kadavigere
- Department of Radio diagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Suresh Sukumar
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
49
|
Park H, Yoon Y, Kim E, Jeong H, Kim J. Monitoring clinical exposure index and deviation index for dose optimization based on national diagnostic reference level: Focusing on general radiography of extremities. J Xray Sci Technol 2022; 30:419-432. [PMID: 35124635 DOI: 10.3233/xst-211084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The International Electrotechnical Commission established the concept of the exposure index (EI), target exposure index (EIT) and deviation index (DI). Some studies have conducted to utilize the EI as a patient dose monitoring tool in the digital radiography (DR) system. OBJECTIVE To establish the appropriate clinical EIT, this study aims to introduce the diagnostic reference level (DRL) for general radiography and confirm the usefulness of clinical EI and DI. METHODS The relationship between entrance surface dose (ESD) and clinical EI is obtained by exposure under the national radiography conditions of Korea for 7 extremity examinations. The EI value when the ESD is the DRL is set as the clinical EIT, and the change of DI is then checked. RESULTS The clinical EI has proportional relationship with ESD and is affected by the beam quality. When the clinical EIT is not adjusted according to the revision of DRLs, there is a difference of up to 2.03 in the DI value and may cause an evaluation error of up to 1.6 times for patient dose. CONCLUSIONS If the clinical EIT is periodically managed according to the environment of medical institution, the appropriate patient dose and image exposure can be managed based on the clinical EI, EIT, and DI.
Collapse
Affiliation(s)
- Hyemin Park
- Department of Health and Safety Convergence Sciences, Korea University, Seoul, Korea
| | - Yongsu Yoon
- Department of Radiological Science, Dongseo University, Busan, Korea
| | - Eunhye Kim
- Department of Health and Safety Convergence Sciences, Korea University, Seoul, Korea
| | - Hoiwoun Jeong
- Department of Radiologic Science, Baekseok Culture University, Cheonan, Korea
| | - Jungsu Kim
- Department of Radiologic Technology, Daegu Health College, Daegu, Korea
| |
Collapse
|
50
|
Bos D, Zensen S, Opitz MK, Haubold J, Nassenstein K, Kinner S, Schweiger B, Forsting M, Wetter A, Guberina N. Diagnostic reference levels for chest computed tomography in children as a function of patient size. Pediatr Radiol 2022; 52:1446-1455. [PMID: 35378606 PMCID: PMC9271112 DOI: 10.1007/s00247-022-05340-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Radiation exposures from computed tomography (CT) in children are inadequately studied. Diagnostic reference levels (DRLs) can help optimise radiation doses. OBJECTIVE To determine local DRLs for paediatric chest CT performed mainly on modern dual-source, multi-slice CT scanners as a function of patient size. MATERIALS AND METHODS Five hundred thirty-eight chest CT scans in 345 children under 15 years (y) of age (median age: 8 y, interquartile range [IQR]: 4-13 y) performed on four different CT scanners (38% on third-generation and 43% on second-generation dual-source CT) between November 2013 and December 2020 were retrospectively analysed. Examinations were grouped by water-equivalent diameter as a measure of patient size. DRLs for volume CT dose index (CTDIvol) and dose-length product (DLP) were determined for six different patient sizes and compared to national and European DRLs. RESULTS The DRLs for CTDIvol and DLP are determined for each patient size group as a function of water-equivalent diameter as follows: (I) < 13 cm (n = 22; median: age 7 months): 0.4 mGy, 7 mGy·cm; (II) 13 cm to less than 17 cm (n = 151; median: age 3 y): 1.2 mGy, 25 mGy·cm; (III) 17 cm to less than 21 cm (n = 211; median: age 8 y): 1.7 mGy, 44 mGy·cm; (IV) 21 cm to less than 25 cm (n = 97; median: age 14 y): 3.0 mGy, 88 mGy·cm; (V) 25 cm to less than 29 cm (n = 42; median: age 14 y): 4.5 mGy, 135 mGy·cm; (VI) ≥ 29 cm (n = 15; median: age 14 y): 8.0 mGy, 241 mGy·cm. Compared with corresponding age and weight groups, our size-based DRLs for DLP are 54% to 71% lower than national and 23% to 85% lower than European DRLs. CONCLUSION We developed DRLs for paediatric chest CT as a function of patient size with substantially lower values than national and European DRLs. Precise knowledge of size-based DRLs may assist other institutions in further dose optimisation in children.
Collapse
Affiliation(s)
- Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Marcel K Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Kai Nassenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Sonja Kinner
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Bernd Schweiger
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
- Department of Diagnostic and Interventional Radiology, Neuroradiology, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Germany
| | - Nika Guberina
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| |
Collapse
|