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Kanal KM, Butler PF, Chatfield MB, Wells J, Samei E, Simanowith M, Golden D, Gress DA, Burleson J, Sensakovic WF, Strauss KJ, Frush D. U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations. Radiology 2021; 302:164-174. [PMID: 34698569 DOI: 10.1148/radiol.2021211241] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Diagnostic reference levels (DRLs) and achievable doses (ADs) were developed for the 10 most commonly performed pediatric CT examinations in the United States using the American College of Radiology Dose Index Registry. Purpose To develop robust, current, national DRLs and ADs for the 10 most commonly performed pediatric CT examinations as a function of patient age and size. Materials and Methods Data on 10 pediatric (ie, patients aged 18 years and younger) CT examinations performed between 2016 and 2020 at 1625 facilities were analyzed. For head and neck examinations, dose indexes were analyzed based on patient age; for body examinations, dose indexes were analyzed for patient age and effective diameter. Data from 1 543 535 examinations provided medians for AD and 75th percentiles for DRLs for volume CT dose index (CTDIvol), dose-length product (DLP), and size-specific dose estimate (SSDE). Results Of all facilities analyzed, 66% of the facilities (1068 of 1625) were community hospitals, 16% (264 of 1625) were freestanding centers, 9.5% (154 of 1625) were academic facilities, and 3.5% (57 of 1625) were dedicated children's hospitals. Fifty-two percent of the patients (798 577 of 1 543 535) were boys, and 48% (744 958 of 1 543 535) were girls. The median age of patients was 14 years (boys, 13 years; girls, 15 years). The head was the most frequent anatomy examined with CT (876 655 of 1 543 535 examinations [57%]). For head without contrast material CT examinations, the age-based CTDIvol AD ranged from 19 to 46 mGy, and DRL ranged from 23 to 55 mGy, with both AD and DRL increasing with age. For body examinations, DRLs and ADs for size-based CTDIvol, SSDE, and DLP increased consistently with the patient's effective diameter. Conclusion Diagnostic reference levels and achievable doses as a function of patient age and effective diameter were developed for the 10 most commonly performed CT pediatric examinations using American College of Radiology Dose Index Registry data. These benchmarks can guide CT facilities in adjusting pediatric CT protocols and resultant doses for their patients. © RSNA, 2021 An earlier incorrect version appeared online. This article was corrected on October 29, 2021.
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Affiliation(s)
- Kalpana M Kanal
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Priscilla F Butler
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mythreyi B Chatfield
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jered Wells
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ehsan Samei
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael Simanowith
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dan Golden
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dustin A Gress
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Judy Burleson
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - William F Sensakovic
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Keith J Strauss
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Donald Frush
- From the Department of Radiology (K.M.K), University of Washington, 1959 NE Pacific St, Box 357987, Seattle, WA 98195-7987; Department of Quality and Safety (P.F.B., M.B.C., M.S., D. Golden, D. Gress, J.B.), American College of Radiology, Reston, Va; Department of Radiology (J.W., E.S., D.F.), Duke University Medical Center, Durham, NC; Department of Radiology (W.S.), Mayo Clinic, Phoenix, Ariz; and Department of Radiology (K.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Muhammad NA, Abdul Karim MK, Abu Hassan H, Ahmad Kamarudin M, Ding Wong JH, Ng KH. Diagnostic Reference Level of Radiation Dose and Image Quality among Paediatric CT Examinations in A Tertiary Hospital in Malaysia. Diagnostics (Basel) 2020; 10:E591. [PMID: 32823818 PMCID: PMC7460376 DOI: 10.3390/diagnostics10080591] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 01/27/2023] Open
Abstract
Pediatrics are more vulnerable to radiation and are prone to dose compared to adults, requiring more attention to computed tomography (CT) optimization. Hence, diagnostic reference levels (DRLs) have been implemented as part of optimization process in order to monitor CT dose and diagnostic quality. The noise index has recently been endorsed to be included as a part of CT optimization in the DRLs report. In this study, we have therefore set local DRLs for pediatric CT examination with a noise index as an indicator of image quality. One thousand one hundred and ninety-two (1192) paediatric patients undergoing CT brain, CT thorax and CT chest-abdomen-pelvis (CAP) examinations were analyzed retrospectively and categorized into four age groups; group 1 (0-1 year), group 2 (1-5 years), group 3 (5-10 years) and group 4 (10-15 years). For each group, data such as the volume-weighted CT dose index (CTDIvol), dose-length product (DLP) and the effective dose (E) were calculated and DRLs for each age group set at 50th percentile were determined. Both CT dose and image noise values between age groups have differed significantly with p-value < 0.05. The highest CTDIvol and DLP values in all age groups with the lowest noise index value reported in the 10-15 age group were found in CT brain examination. In conclusion, there was a significant variation in doses and noise intensity among children of different ages, and the need to change specific parameters to fit the clinical requirement.
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Affiliation(s)
- Nor Azura Muhammad
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.A.M.); (M.A.K.)
| | - Muhammad Khalis Abdul Karim
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.A.M.); (M.A.K.)
- Centre of Diagnostic Nuclear Imaging, Faculty of Medicine, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Hasyma Abu Hassan
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| | - Mazliana Ahmad Kamarudin
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.A.M.); (M.A.K.)
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, University Malaya Medical Centre, Petaling Jaya 59100, Kuala Lumpur, Malaysia; (J.H.D.W.); (K.H.N.)
| | - Kwan Hoong Ng
- Department of Biomedical Imaging, University Malaya Medical Centre, Petaling Jaya 59100, Kuala Lumpur, Malaysia; (J.H.D.W.); (K.H.N.)
- Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Yang K, Ganguli S, DeLorenzo MC, Zheng H, Li X, Liu B. Procedure-specific CT Dose and Utilization Factors for CT-guided Interventional Procedures. Radiology 2018; 289:150-157. [PMID: 30015583 DOI: 10.1148/radiol.2018172945] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose To present procedure-specific radiation dose metric distributions and define quantitative CT utilization factors for CT-guided interventional procedures. Materials and Methods This single-center, retrospective study collected dictation reports and radiation dose data from 9143 consecutive CT-guided interventional procedures in adult patients from 2012 to 2017. Procedures were sorted into four major interventional categories: ablation, aspiration, biopsy, and drainage, each of which was further divided into subcategories. After exclusion, a total of 8213 procedures (4391 in men and 3822 in women) were divided into 21 subcategories. The mean patient age at examination for men was 62 years ± 15 (standard deviation; age range, 19-114 years), and for women it was 61 years ± 15 (age range, 19-113 years). Distributions of dose metrics and CT usage-related parameters were analyzed by category with descriptive statistic outcomes. Quantitative CT utilization factors (which measure average CT usage) for each interventional subcategory were derived by using total scan length, acquisition count, and number of images. Results Interventional CT scans have distinctly different dose metric characteristics from diagnostic CT scans. Wide variations of dose metrics were observed among subcategories, even within the same major category. For the most frequently performed CT-guided interventional procedures within each major category, liver ablation, chest aspiration, liver biopsy, and single abdominal drainage, the median dose-length product was 2351, 657, 1175, and 1125 mGy ∙ cm, respectively. Procedure-specific CT utilization factors ranged between 0.6 and 3.6. Conclusion This study provides procedure-specific CT dose metric distributions and quantitative CT utilization factors on the basis of a large number of procedures and categorization of CT-guided interventional procedures. © RSNA, 2018.
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Affiliation(s)
- Kai Yang
- From the Division of Diagnostic Imaging Physics, Department of Radiology (K.Y., M.C.D., X.L., B.L.), and Center for Image Guided Cancer Therapy, Department of Interventional Radiology (S.G.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; and MGH Biostatistics Center, Boston, Mass (H.Z.)
| | - Suvranu Ganguli
- From the Division of Diagnostic Imaging Physics, Department of Radiology (K.Y., M.C.D., X.L., B.L.), and Center for Image Guided Cancer Therapy, Department of Interventional Radiology (S.G.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; and MGH Biostatistics Center, Boston, Mass (H.Z.)
| | - Matthew C DeLorenzo
- From the Division of Diagnostic Imaging Physics, Department of Radiology (K.Y., M.C.D., X.L., B.L.), and Center for Image Guided Cancer Therapy, Department of Interventional Radiology (S.G.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; and MGH Biostatistics Center, Boston, Mass (H.Z.)
| | - Hui Zheng
- From the Division of Diagnostic Imaging Physics, Department of Radiology (K.Y., M.C.D., X.L., B.L.), and Center for Image Guided Cancer Therapy, Department of Interventional Radiology (S.G.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; and MGH Biostatistics Center, Boston, Mass (H.Z.)
| | - Xinhua Li
- From the Division of Diagnostic Imaging Physics, Department of Radiology (K.Y., M.C.D., X.L., B.L.), and Center for Image Guided Cancer Therapy, Department of Interventional Radiology (S.G.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; and MGH Biostatistics Center, Boston, Mass (H.Z.)
| | - Bob Liu
- From the Division of Diagnostic Imaging Physics, Department of Radiology (K.Y., M.C.D., X.L., B.L.), and Center for Image Guided Cancer Therapy, Department of Interventional Radiology (S.G.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; and MGH Biostatistics Center, Boston, Mass (H.Z.)
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