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Mirzai M, Meltzer C, Vikgren J, Norrlund RR, Gottfridsson B, Johnsson Å, Båth M, Svalkvist A. The Effect of Dose Reduction on Overall Image Quality in Clinical Chest Tomosynthesis. Acad Radiol 2021; 28:e289-e296. [PMID: 32709583 DOI: 10.1016/j.acra.2020.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/27/2020] [Accepted: 05/31/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the effect of reduction in effective dose on the reproduction of anatomical structures in chest tomosynthesis (CTS). MATERIALS AND METHODS Twenty-four CTS examinations acquired at exposure settings resulting in an effective dose of 0.12 mSv for an average sized patient were included in the study. The examinations underwent simulated dose reduction to dose levels corresponding to 32%, 50%, and 70% of the original dose using a previously described and validated method. The image quality was evaluated by five thoracic radiologists who rated the fulfillment of specified image quality criteria in a visual grading study. The ratings for each image quality criterion in the dose-reduced images were compared to the corresponding ratings for the full-dose examinations using visual grading characteristics (VGC) analysis. The area under the resulting VGC curve (AUCVGC) provides a measure of the difference between the ratings, where an AUCVGC of 0.5 indicates no difference. RESULTS The dose reductions resulted in inferior reproduction of structures compared to the original dose level (AUCVGC <0.5). Structures in the central region of the lung obtained the lowest AUCVGC for each dose level whereas the reproduction of structures in the parenchyma was least affected by the dose reduction. CONCLUSION Although previous studies have shown that dose reduction in CTS is possible without affecting the performance of certain clinical tasks, the reproduction of normal anatomical structures is significantly degraded even at small reductions. It is therefore important to consider the clinical purpose of the CTS examinations before deciding on a permanent dose reduction.
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Cohen SL, Wang JJ, Chan N, Austin McCandlish J, Feizullayeva C, Cronin PP, Barish M, O'Connell W, Sanelli P. CT pulmonary angiography in pregnancy: Specific conversion factors to estimate effective radiation dose from dose length product: A retrospective cross-sectional study across a multi-hospital integrated healthcare network. Eur J Radiol 2021; 143:109908. [PMID: 34481118 DOI: 10.1016/j.ejrad.2021.109908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/28/2021] [Accepted: 08/08/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Effective dose describes radiation-related cancer risk from CT scans and is estimated using a readily available conversion factor (k-factor), which varies by body part and study type. To purpose of this study is to determine the specific k-factor for CTPA in pregnant patients and its predictive factors. METHODS This retrospective cross-sectional study evaluates CTPA in pregnancy across a multihospital integrated healthcare network from January 2012 to April 2017. Patient and CTPA-related data were obtained from the electronic health record and a radiation dose index monitoring system. Each patient's effective dose was determined by patient-specific Monte-Carlo simulation with Cristy phantoms and divided by patient dose-length-product to determine the k-factor. K-factor for pregnant patients was compared to the k-factor for adults of standard physique with a one-sample t-test. Bivariate and multivariable analyses were performed for patient and CT predictors of k-factor. RESULTS A total of 534 patients were included. The mean k-factor for all patients was 0.0249 (mSv·mGy-1·cm-1), 78% greater than k-factor of 0.014 (p < 0.001) suggested for the general adult population. Multivariable analysis demonstrated lower k-factors with increasing pitch (p = 0.0002), patient size (p < 0.001), and scan length (p < 0.0001). The 120 kVp (p < 0.001) and 140 kVp (p = 0.0028) analyses showed a larger k-factor than 80 and 100 kVp studies combined. CONCLUSIONS Specific k-factor for CTPA in pregnant patients is greater than the previously used generic chest CT k-factor and should be used to estimate the effective dose for CTPA exams in pregnancy.
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Affiliation(s)
- Stuart L Cohen
- Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, NY, United States; Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.
| | - Jason J Wang
- Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, NY, United States; Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - Nicholas Chan
- Department of Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - John Austin McCandlish
- Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, NY, United States; Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States; Georgia Institute of Technology, Atlanta, GA, United States
| | - Chinara Feizullayeva
- Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, NY, United States; Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - Paul P Cronin
- Emory University Hospital Department Of Radiology and Imaging Science, Atlanta, GA, United States
| | - Matthew Barish
- North Shore University Hospital/Northwell Health, Department of Radiology, Manhasset, NY, United States
| | - William O'Connell
- North Shore University Hospital/Northwell Health, Department of Radiology, Manhasset, NY, United States
| | - Pina Sanelli
- Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, NY, United States; Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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Peng R, Mardakhaev E, Shmukler A, Levsky JM, Haramati LB. Meeting ACR Dose Guidelines for CT Lung Cancer Screening in an Overweight and Obese Population. Acad Radiol 2021; 28:381-386. [PMID: 32284173 DOI: 10.1016/j.acra.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/01/2022]
Abstract
RATIONALE AND OBJECTIVES Lung cancer screening adoption coincides with a growing obesity epidemic. Maintaining high-quality imaging at low radiation dose is challenging in obesity. We investigate the feasibility of meeting American College of Radiology (ACR) dose guidelines for lung cancer screening in a predominantly overweight and obese population. MATERIALS AND METHODS Radiation dose (Volumetric CT dose index [CTDIvol], dose-length product), and body mass index (BMI) were collected for baseline screening CTs December, 2012-December, 2017. Dose metrics were analyzed according to BMI classification (normal <25, overweight 25-29, obese ≥30 kg/m2), using k = 0.014 mSv/mGy*cm. Results were compared to ACR dose guidelines and mean national 2017 Lung Cancer Screening Registry dose metrics. Analysis used Kruskal-Wallis (SPSS, version 24.0.0, IBM corp, Armonk, NY). RESULTS Study population comprised 1478 patients (49.2% [727] women: mean BMI 28.1 ± 6.5 kg/m2, 26.9% [397] normal weight, 35.9% [530] overweight, 37.2% [551] obese). ACR dose requirements were met for both genders in all BMI classifications. Dose metrics were higher in men than in women; median effective dose and CTDIvol were 1.39 (0.8-1.58) mSv and 2.78 (1.41-2.80) mGy in men versus 1.16 (0.71-1.43) mSv and 2.70 (1.4-2.78) mGy in women. There were significant differences in dose metrics between men and women in the same BMI classification and between BMI classifications (p < 0.001). Mean dose metrics in our program were considerably lower than 2017 national average- mean CTDIvol and effective dose 2.45 ± 1.14 mGy and 1.26 ± 0.59 mSv versus 3.24 mGy and 1.35 mSv, respectively for our program and nationally. Mean dose metrics were also lower in our obese patients versus obese patients nationally. CONCLUSION ACR dose metrics for lung cancer screening were met and can be appropriately tailored in a predominantly overweight and obese population clinical program.
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Affiliation(s)
- Robert Peng
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, New York 10467.
| | - Edward Mardakhaev
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, New York 10467
| | - Anna Shmukler
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, New York 10467
| | - Jeffrey M Levsky
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, New York 10467
| | - Linda B Haramati
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, New York 10467
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