Survey of patient dose in computed tomography in Syria 2009

Establishment of national diagnostic dose reference levels (DRLs) for routine computed tomography examinations in Jordan

Background: Dose reference levels (DRLs) are used as indicators as well as guidance for dose optimization and to ensure justification of appropriate dose for a given clinical indication. The main aims of this study were to establish local DRLs for each CT imaging protocol as a reference point to evaluate the radiation dose indices and to compare our DRLs with those established in other countries and against the internationally reported guidelines.

Materials and methods: 2000 CT dose reports of different adult imaging protocols from January 2021 until April 2022 were collected retrospectively at different hospitals in Jordan. Data were collected from CT scans that were performed using different types and models of CT scanners and included four adult non-enhanced, helical CT imaging protocols; Head, Chest, Abdomen-Pelvis, and Chest-Abdomen-Pelvis.

Results: The average doses of CTDIvol, DLP, and effective dose were (65.11 mGy, 1232.71 mGy·cm, 2.83 mSv) for the head scan, (16.6 mGy, 586.6 mGy·cm, 8.21 mSv) for the chest scan, (17.91 mGy, 929.9 mGy·cm, 13.9 mSv) for the abdomen-pelvis scan, and (19.3 mGy, 1152 mGy·cm, 17.25 mSv) for the chest-abdomen-pelvis scan. In comparison with results from different international studies, DLP values measured in the present study were lower for the chest-abdomen-pelvis and abdomen-pelvis CT scans, and higher for the head CT and chest CT scans.

Conclusions: It is very important that each country establishes its own DRLs and compares them with those reported by other countries, especially the developed ones. It is also important that these levels are regularly updated.

Adult Computed Tomography examinations in Uganda: Towards determining the National Diagnostic Reference Levels

INTRODUCTION

Diagnostic Reference Levels (DRLs), typically set at the 75th percentile of the dose distribution from surveys conducted across a broad user base using a specified dose-measurement protocol, are recommended for radiological examinations. There is a need to develop and implement DRLs as a standardisation and optimisation tool for the radiological protection of patients at Computed Tomography (CT) facilities.

METHODS

This was a retrospective cross-sectional study conducted in seven (7) different CT scan facilities in which participants were recruited by systematic random sampling. The study variables were dose length product (DLP) and volume-weighted CTDI (CTDIvol) for the radiation doses for head, chest, abdomen and lumbar spine CT examinations. The DRLs for CTDIvol and DLP were obtained by calculating the 3rd quartiles of the radiation doses per study site by anatomical region. The national diagnostic reference levels were determined by computation of DRLs using the 75th centile of the median values.

RESULTS

A total of 574 patients were examined with an average age of 47.1 years. For CTDIvol estimates; there was a strong positive significant relationship between the CTDIvol and examination mAs (r_s = 0.9017, p-value < 0.001), and reference mAs (r_s = 0.0.7708, p-value < 0.001). For DLP estimates; there was a moderate positive significant relationships between DLP and total mAs (r_s = 0.6812, p-value < 0.001), reference mAs (r_s = 0.5493, p-value < 0.001). The DRLs were as follows; for head CT scan - the average median CTDIvol was 56.02 mGy and the DLP was 1260.3 mGy.cm; for Chest CT, the CTDI volume was 7.82 mGy and the DLP was 377.0 mGy.cm; for the abdomen CT, the CTDI volume 12.54 mGy and DLP 1418.3 mGy.cm and for the lumbar spine 19.48 mGy and the DLP was 843 mGy.cm, respectively.

CONCLUSION

This study confirmed the need to optimize the CT scan parameters in order to lower the national DRLs. This can be achieved by extensive training of all the CT scan radiographers on optimizing the CT scan acquisition parameters. Continuous dose audits are also advised with new equipment or after every three years to ensure that values out of range are either justified or further investigated.

Computed tomography diagnostic reference levels for adult brain, chest and abdominal examinations: A systematic review

OBJECTIVES

Radiation dose variation within and among Computed Tomography (CT) centres is commonly reported. This work systematically reviewed published articles on adult Diagnostic Reference Levels (DRLs) for the brain, chest and abdomen to determine the causes and extent of variation. A systematic literature search and review was performed in selected databases containing leading journals in radiography, radiology and medical physics using carefully defined search terms related to CT and DRLs. The quality of the included articles was determined using the Effective Public Health Practise Project tool for quantitative studies.

KEY FINDINGS

The 54 articles reviewed include: 45 studies using human data, 8 studies using phantom data, and one study with both human and phantom data. The main comparator in between studies was the dose indices used in reporting DRLs. DRL variations of up to a factor of 2 for the same procedure were noted in phantom studies, and up to a factor of 3 in human studies. Sources of variation include the type of scanner, the age of the scanner, differences in protocols, variations in patients, as well as variations in study design. Different combinations of dose indices were reported: volume computed tomography dose index (CTDIvol) and dose length product (DLP) (59%); DLP only (11%); weighted computed tomography dose index (CTDIw) and DLP (9%); CTDIvol only (7%); CTDIvol, DLP and effective dose (ED) (6%); CTDIw only (4%); CTDIvol, DLP and size specific dose estimate (SSDE) (1%) and CTDIw, CTDIvol and DLP (1%). The use of different dose indices limited dose comparison between studies.

CONCLUSION

The study noted a 2-3 fold variation in DRLs between studies for the same procedure. The causes of variation are reported and include study design, scanner technology and the use of different dose indices.

IMPLICATIONS FOR PRACTICE

There is a need for standardisation of CT DRLs in line with the International Commission on Radiological Protection recommendations to reduce dose variation and facilitate dose comparison.

A systematic review on the current status of adult diagnostic reference levels in head, chest and abdominopelvic Computed Tomography

Computed tomography (CT) is a routinely employed diagnostic tool for the detection and diagnosis of disease processes. Despite the primary focus of radiation dose reduction and improvements in CT scanners, radiation dose exposure remains an ever-increasing concern. Scanning protocol optimisation relative to body weight and scanner manufacturer still lags behind the diagnostic reference levels (DRLs) that are set on an international scale. The aim of this systematic review is to evaluate the current status of adult DRLs in head, chest and abdominopelvic CT over time on a global scale. A search was carried out in early 2019 using the Medline, PubMed, EMBASE, SCOPUS and manual databases. The reference lists of published articles were also assessed to identify further articles. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology was employed to evaluate articles for relevance. Articles were included if they assessed the DRL in head, chest and abdominopelvic scans. The search resulted in 6079 articles, of which 67 were included after a thorough screening process. The literature demonstrates a wide dose variation in reported head, chest and abdominopelvic dose length product (DLP) DRL, ranging from 700-1359, 330-707 and 550-1486 mGy·cm, respectively. Where reported, the volumed CT dose index (CTDI_vol) DRL in the head, chest and abdominopelvic studies ranged from 30.4-85.5, 9-15 and 12.3-31 mGy·cm, respectively. The global means were shown to be slightly lower and significantly lower than the reported values of DLP and CTDI_vol values for the American College of Radiology and European Commission, respectively. This review emphasises the need for an international standardisation for head and body DRL establishment methods, to provide a more comparable global measurement of dose variations across CT sites as well as regular monitoring of delivered radiation dose to patients.

Radiation dose from CT scanning: can it be reduced?

CT has been used to save many patients’ lives and the demand for CT is still increasing. At the same time, there has been increasing concern of the probability of cancer induction by CT radiation. It is necessary for everyone involved in CT scanning, particularly physicians who have to communicate with patients when planning a CT scan, to have a basic knowledge of the CT radiation dose and its potential adverse effects. We have undertaken a systematic review of the literatures to document the radiation dose from CT, the lifetime cancer risk from CT exposure, CT dose parameters, the internationnal CT diagnostic reference levels, and the use and limitation of the CT effective dose. In addition, we conducted a brief survey of the use of CT scan in some university hospitals in Thailand and estimated current CT doses at these hospitals. Our review and survey suggests that CT scanning provides a great benefit in medicine but it also becomes the major source of X-ray exposure. Radiation doses from a CT scan are much higher than most conventional radiographic procedures. This raises concerns about the carcinogenic potentials. We encourage every CT unit to adhere to the International Guidelines of CT dose parameter references. Our preliminary survey from some university hospitals in Thailand revealed that CT radiation doses are within acceptable standard ranges. However, the justification for utilization of CT scans should also be required and monitored. The importance of adequate communication between attending physician and consulting radiologist is stressed.

National diagnostic reference level initiative for computed tomography examinations in Kenya

The purpose of this study was to estimate the computed tomography (CT) examination frequency, patient radiation exposure, effective doses and national diagnostic reference levels (NDRLs) associated with CT examinations in clinical practice. A structured questionnaire-type form was developed for recording examination frequency, scanning protocols and patient radiation exposure during CT procedures in fully equipped medical facilities across the country. The national annual number of CT examinations per 1000 people was estimated to be 3 procedures. The volume-weighted CT dose index, dose length product, effective dose and NDRLs were determined for 20 types of adult and paediatric CT examinations. Additionally, the CT annual collective effective dose and effective dose per capita were approximated. The radiation exposure during CT examinations was broadly distributed between the facilities that took part in the study. This calls for a need to develop and implement diagnostic reference levels as a standardisation and optimisation tool for the radiological protection of patients at all the CT facilities nationwide.

Effective radiation doses of CT examinations in Japan: a nationwide questionnaire-based study

OBJECTIVE

The aims of this study were to estimate the effective radiation doses from CT examinations of both adults and children in Japan and to study the impact of various scan parameters on the effective doses.

METHODS

A questionnaire, which contained detailed questions on the CT scan parameters employed, was distributed to 3000 facilities throughout Japan. For each scanner protocol, the effective doses for head (non-helical and helical), chest and upper abdomen acquisitions were estimated using ImPACT CT Patient Dosimetry Calculator software v. 1.0.4 (St George's Hospital, London, UK).

RESULTS

The mean effective doses for chest and abdominal examinations using 80-110 kV were significantly lower than those using 120 kV. However, there was no statistically significant difference in the mean effective doses for head scans between facilities employing 80-110 kV and 120 kV. In chest and abdominal examinations, the mean effective doses using CT scanners from Western manufacturers [Siemens (Forchheim, Germany), Philips (Eindhoven, Netherlands) and GE Medical Systems (Milwaukee, WI)] were significantly lower than those of examinations using Japanese scanners [Hitachi (Kashiwa, Japan) and Toshiba (Otawara, Tochigi, Japan)], except for in paediatric chest examinations.

CONCLUSION

The mean effective doses for adult head, chest and abdominal CT examinations were 2.9, 7.7 and 10.0 mSv, respectively, whereas the corresponding mean effective doses for paediatric examinations were 2.6, 7.1 and 7.7 mSv, respectively.

ADVANCES IN KNOWLEDGE

Facilities using CT scanners by Western manufacturers commonly adopt low-tube-voltage techniques, and low-tube-voltage CT may be useful for reducing the radiation doses to the patients, particularly for the body region.

Patient doses from CT examinations in Turkey

PURPOSE

We aimed to establish the first diagnostic reference levels (DRLs) for computed tomography (CT) examinations in adult and pediatric patients in Turkey and compare these with international DRLs.

METHODS

CT performance information and examination parameters (for head, chest, high-resolution CT of the chest [HRCT-chest], abdominal, and pelvic protocols) from 1607 hospitals were collected via a survey. Dose length products and effective doses for standard patient sizes were calculated from the reported volume CT dose index (CTDIvol).

RESULTS

The median number of protocols reported from the 167 responding hospitals (10% response rate) was 102 across five different age groups. Third quartile CTDIvol values for adult pelvic and all pediatric body protocols were higher than the European Commission standards but were comparable to studies conducted in other countries.

CONCLUSION

The radiation dose indicators for adult patients were similar to those reported in the literature, except for those associated with head protocols. CT protocol optimization is necessary for adult head and pediatric chest, HRCT-chest, abdominal, and pelvic protocols. The findings from this study are recommended for use as national DRLs in Turkey.

Survey of volume CT dose index in Japan in 2014

OBJECTIVE

The aims of this study are to propose a new set of Japanese diagnostic reference levels (DRLs) for 2014 and to study the impact of tube voltage and the type of reconstruction algorithm on patient doses. The volume CT dose index (CTDI(vol)) for adult and paediatric patients is assessed and compared with the results of a 2011 national survey and data from other countries.

METHODS

Scanning procedures for the head (non-helical and helical), chest and upper abdomen were examined for adults and 5-year-old children. A questionnaire concerning the following items was sent to 3000 facilities: tube voltage, use of reconstruction algorithms and displayed CTDI(vol).

RESULTS

The mean CTDI(vol) values for paediatric examinations using voltages ranging from 80 to 100 kV were significantly lower than those for paediatric examinations using 120 kV. For adult examinations, the use of iterative reconstruction algorithms significantly reduced the mean CTDI(vol) values compared with the use of filtered back projection. Paediatric chest and abdominal scans showed slightly higher mean CTDI(vol) values in 2014 than in 2011. The proposed DRLs for adult head and abdominal scans were higher than those reported in other countries.

CONCLUSION

The results imply that further optimization of CT examination protocols is required for adult head and abdominal scans as well as paediatric chest and abdominal scans.

ADVANCES IN KNOWLEDGE

Low-tube-voltage CT may be useful for reducing radiation doses in paediatric patients. The mean CTDI(vol) values for paediatric scans showed little difference that could be attributed to the choice of reconstruction algorithm.

National Survey of Radiation Dose and Image Quality in Adult CT Head Scans in Taiwan

Introduction

The purpose of the present study was to evaluate the influence of different variables on radiation dose and image quality based on a national database.

Materials and Methods

Taiwan’s Ministry of Health and Welfare requested all radiology departments to complete a questionnaire for each of their CT scanners. Information gathered included all scanning parameters for CT head scans. For the present analysis, CT machines were divided into three subgroups: single slice CT (Group A); multi-detector CT (MDCT) with 2-64 slices (Group B); and MDCT with more than 64 slices (Group C). Correlations between computed tomography dose index (CTDI) and signal-to-noise ratio (SNR) with cumulated tube rotation number (CTW(n)) and cumulated tube rotation time (CTW(s)), and sub group analyses of CTDI and SNR across the three groups were performed.

Results

CTDI values demonstrated a weak correlation (r = 0.33) with CTW(n) in Group A. SNR values demonstrated a weak negative correlation (r = -0.46) with CTW(n) in Group C. MDCT with higher slice numbers used more tube potential resulting in higher effective doses. There were both significantly lower CTDI and SNR values in helical mode than in axial mode in Group B, but not Group C.

Conclusion

CTW(n) and CTW(s) did not influence radiation output. Helical mode is more often used in MDCT and results in both lower CTDI and SNR compared to axial mode in MDCT with less than 64 slices.

Regional survey of image quality and radiation dose in computed tomography examinations in Saudi Arabia

This study is the first regional investigation in Najran, Saudi Arabia aimed at investigating radiation dose and image quality of computed tomography (CT) examinations. The survey data was collected from five scanners in four hospitals. For all CT scanners, a correction factor was calculated to measure the weighted computed tomography dose index (CTDIw) using standard dosimetry phantoms. The CTDIw were reported in this study and compared with other countries. It was found that most CTDIw values were close to the European reference levels and in line with the results of similar surveys in the other parts of world. Concerning image quality, 80 % of the scanners were found to be in compliance with the relative international guidelines for all the examined parameters.

The development of a diagnostic reference level on patient dose for head computed tomographyangiography examinations in Korea

The primary goal of this study was to analyse the state of patient doses in the field for head computed tomography angiography (HCTA) examinations in the Republic of Korea. All survey data, including CT application and patient dose details, were obtained from the general hospitals registered in the Korean Hospital Association. The systematic analysis of patient dose data would allow target value to be established for the weighted CT dose index (CTDIw), volume-weighted CTDI (CTDIvol) and a dose-length product (DLP), which might be used to set diagnostic reference levels. The survey on patients' dose showed that the 75th percentiles in the distribution of CTDIw, CTDIvol and DLP were 34.09, 26.7 and 1816 mGy for the HCTA examinations, respectively.

A dose comparison survey in CT departments of dedicated paediatric hospitals in Australia and Saudi Arabia

AIM: To measure and compare computed tomography (CT) radiation doses delivered to patients in public paediatric hospitals in Australia and Saudi Arabia.

METHODS: Doses were measured for routine CT scans of the head, chest and abdomen/pelvis for children aged 3-6 years in all dedicated public paediatric hospitals in Australia and Saudi Arabia using a CT phantom measurement cylinder.

RESULTS: CT doses, using the departments’ protocols for 3-6 year old, varied considerably between hospitals. Measured head doses varied from 137.6 to 528.0 mGy_·cm, chest doses from 21.9 to 92.5 mGy_·cm, and abdomen/pelvis doses from 24.9 to 118.0 mGy_·cm. Mean head and abdomen/pelvis doses delivered in Saudi Arabian paediatric CT departments were significantly higher than those in their Australian equivalents.

CONCLUSION: CT dose varies substantially across Australian and Saudi Arabian paediatric hospitals. Therefore, diagnostic reference levels should be established for major anatomical regions to standardise dose.

Diagnostic reference level of computed tomography (CT) in Japan

Optimisation of computed tomography (CT) parameters is important in avoiding excess radiation exposure. The aim of this study is to establish the diagnostic reference levels (DRL) of CT in Japan by using dose-length product (DLP). Datasheets were sent to all hospitals/clinics which had CT scanner(s) in Gunma prefecture. Data were obtained for all patients who underwent CT during a single month (June 2010), and the distributions of DLP were evaluated for eight anatomical regions and five patient age groups. The DRL was defined as the 25th and 75th percentiles of DLP. Datasheets were collected from 80 of 192 hospitals/clinics (26 090 patients). DLP for head CT of paediatric patients tended to be higher in Japan compared with DRLs of paediatric head CTs reported from the EU or Syria. Although this study was performed with limited samples, DLP for adult patients were at comparable levels for all anatomical regions.