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Garba I, Penelope EH, Davidson F, Ismail A. Prospective dose monitoring using a manual dose management system: experience in brain computed tomography from a tertiary hospital in Nigeria. RADIATION PROTECTION DOSIMETRY 2024; 200:648-658. [PMID: 38648160 DOI: 10.1093/rpd/ncae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/01/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
A manual radiation dose management system was developed to track the radiation dose and scan parameters of patients for brain computed tomography (CT). Radiation dose in volume computed tomography dose index (CTDIvol) and dose length product (DLP) were monitored to identify procedures that may require optimisation using notification values. The data were analysed and compared with national and international diagnostic reference levels (DRLs). A total of 596 brain CTs were monitored and grouped as <1: 36, 1-<5: 38, 5-<10: 25, 10-<15: 31 and adult: 466. The CTDIvol notification value identified the following number of examinations having high CTDIvol in <1 y: 1, 1-<5: 1, 5-<10: 0, 10-<15: 0 and adult (>15): 11. Furthermore, the DLP notification values identified the following examinations with high DLP in <1 y: 1, 1-<5:1, 5-<10:1, 10-<15: 1 and adults (>15): 18. The established local paediatric DLP DRLs were 2-3 times higher than the international paediatric DLP DRLs. This calls for a total protocol review and optimisation considering the local CT practices for paediatric imaging.
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Affiliation(s)
- Idris Garba
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Engel-Hills Penelope
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Florence Davidson
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Anas Ismail
- Department of Radiology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano, Kano 700001, Nigeria
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Garba I, Engel-Hills P, Davidson F, Ismail A. Radiation dose management system in computed tomography procedures: a systematic review. RADIATION PROTECTION DOSIMETRY 2023:7130979. [PMID: 37078550 DOI: 10.1093/rpd/ncad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 05/03/2023]
Abstract
A systematic literature review was carried out to explore articles that reported the use of radiation dose management systems (RDMSs) in computed tomography (CT). The preferred reporting items for systematic review and meta-analysis flow chart were used to screen articles in PubMed, EBSCOhost, Web of Science, SCOPUS and Cochrane Library. A total of 1041 articles were retrieved and screened. After evaluation against criteria, 38 articles were selected and synthesised narratively. The results revealed that several RDMSs have been used in CT. The review also indicated that the use of RDMSs has promoted the implementation of diagnostic reference levels for dose optimisation. A RDMS, such as DoseWatch, is associated with compatibility challenges and failure in data transmission, while manual RDMSs are cumbersome and prone to data entry errors. Thus, a robust automated RDMS that is compatible with the different CT systems would provide efficient CT dose management.
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Affiliation(s)
- Idris Garba
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Penelope Engel-Hills
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Florence Davidson
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town 8000, South Africa
| | - Anas Ismail
- Department of Radiology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano, Kano 700001, Nigeria
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Akyea-Larbi KO, Tetteh MA, Martinsen ACT, Hasford F, Inkoom S, Jensen K. BENCHMARKING OF A NEW AUTOMATIC CT RADIATION DOSE CALCULATOR. RADIATION PROTECTION DOSIMETRY 2020; 191:361-368. [PMID: 33151301 DOI: 10.1093/rpd/ncaa167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/03/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
Information on patient radiation dose is essential to meet the radiation protection regulations and the demands of dose optimization. Vendors have developed different tools for patient dose assessment for radiological purposes. In this study, estimated effective doses derived from a new image-based software tool (DoseWatch, GE Healthcare) was benchmarked against the corresponding doses from a dose calculator (CT-Expo, SASCRAD) and a conversion coefficient method. Dose data from 150 adult patients (66 male and 84 female), who underwent CT head, abdominopelvic or chest examinations, were retrospectively collected using DoseWatch. Effective dose estimated by DoseWatch was significantly lower than that of CT-Expo and DLP-E (k) (p ≤ 0.001). For the organ doses, DoseWatch resulted in lower dose than CT-Expo for all the organs with the exception of testis (p ≤ 001) and eye lenses (p ≤ 0.026).
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Affiliation(s)
- Kofi Okyere Akyea-Larbi
- Department of Medical Physics, School of Nuclear and Allied Sciences, University of Ghana, LG 25 Legon, Accra, Ghana
- Department of Physics, Norwegian University of Science and Technology (NTNU), NO-7491 Trondheim, Norway
| | - Mercy Afadzi Tetteh
- Department of Physics, Norwegian University of Science and Technology (NTNU), NO-7491 Trondheim, Norway
- Department of Diagnostic Physics, Oslo University Hospital, 0424 Oslo, Norway
| | - Anne Catrine T Martinsen
- Department of Diagnostic Physics, Oslo University Hospital, 0424 Oslo, Norway
- Faculty of Health sciences, Oslo Metropolitan University, N-0130 Oslo, Norway
| | - Francis Hasford
- Department of Medical Physics, School of Nuclear and Allied Sciences, University of Ghana, LG 25 Legon, Accra, Ghana
- Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, LG 80 Legon, Accra, Ghana
| | - Stephen Inkoom
- Department of Medical Physics, School of Nuclear and Allied Sciences, University of Ghana, LG 25 Legon, Accra, Ghana
- Radiation Protection Institute, Ghana Atomic Energy Commission, LG 80 Legon, Accra, Ghana
| | - Kristin Jensen
- Department of Diagnostic Physics, Oslo University Hospital, 0424 Oslo, Norway
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Dickinson N, Dunn M. A comparison of manually populated radiology information system digital radiographic data with electronic dose management systems. Br J Radiol 2020; 93:20200055. [PMID: 32462887 DOI: 10.1259/bjr.20200055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the accuracy and agreement of radiology information system (RIS) kerma-area product (KAP) data with respect to automatically populated dose management system (DMS) data for digital radiography (DR). METHODS All adult radiographic examinations over 12 months were exported from the RIS and DMS at three centres. Examinations were matched by unique identifier fields, and grouped by examination type. Each centre's RIS sample completeness was calculated, as was the percentage of the RIS examination KAP values within 5% of their DMS counterparts (used as an accuracy metric). For each centre, the percentage agreement between the RIS and DMS examination median KAP values was computed using a Bland-Altman analysis. At two centres, up to 42.5% of the RIS KAP units entries were blank or invalid; corrections were attempted to improve data quality in these cases. RESULTS Statistically significant intersite variation was seen in RIS data accuracy and the agreement between the uncorrected RIS and DMS median KAP data, with a Bland-Altman bias of up to 11.1% (with a -31.7% to 53.9% 95% confidence interval) at one centre. Attempts to correct invalid KAP units increased accuracy but produced worse agreement at one centre, a slight improvement at another and no significant change in the third. CONCLUSION The RIS data poorly represented the DMS data. ADVANCES IN KNOWLEDGE RIS KAP data are a poor surrogate for DMS data in DR. RIS data should only be used in patient dose surveys with an understanding of its limitations and potential inaccuracies.
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Affiliation(s)
- Nathan Dickinson
- Medical Physics and Clinical Engineering, Nottingham University Hospitals, Nottingham, NG5 1PB, United Kingdom
| | - Matthew Dunn
- Medical Physics and Clinical Engineering, Nottingham University Hospitals, Nottingham, NG5 1PB, United Kingdom
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Poehler GH, Alikhani B, Klimes F, Hauck EF, Ringe KI, Sonnow L, Wacker F, Raatschen HJ. Impact of active dose management on radiation exposure and image quality in computed tomography: An observational study in 1315 patients. Eur J Radiol 2020; 125:108900. [DOI: 10.1016/j.ejrad.2020.108900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/17/2022]
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Moore CS, Wood TJ, Saunderson JR, Beavis AW. The usefulness of large sample size patient dose audits for optimisation of CT automatic exposure control (AEC) settings. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:938-949. [PMID: 31382249 DOI: 10.1088/1361-6498/ab3894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The aim of this study was to demonstrate the usefulness of large sample size patient dose audits for optimisation of CT automatic exposure control (AEC) settings, even when the investigation is limited to only three scanners at a single institution. Pre-optimisation patient dose audits of common CT examinations (n > 200 for each protocol) on three CT scanners (two Philips Brilliance and one Toshiba Aquilion) using radiology information system (RIS) data were conducted showing sub-optimal CT AEC performance on the Toshiba scanner. Based on these results, an optimisation exercise was carried out on the non-optimally performing scanner by phantom measurement and investigation of system configuration. Post-optimisation patient dose audits were subsequently carried out to assess the success of the optimisation exercise demonstrating standardisation of doses; median dose-length-product values were reduced by up to 43% on the sub-optimal scanner without any adverse effect on clinical image quality. This study has demonstrated that large sample patient dose audits using RIS data can be instrumental in identifying and rectifying sub-optimal CT AEC performance, even when the investigation is limited to only three scanners at a single institution.
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Affiliation(s)
- Craig S Moore
- Medical Physics Service, Queen's Centre, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Castle Road, Hull, HU16 5JQ, United Kingdom
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Rampado O, Gianusso L, Nava C, Ropolo R. Analysis of a CT patient dose database with an unsupervised clustering approach. Phys Med 2019; 60:91-99. [DOI: 10.1016/j.ejmp.2019.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/19/2019] [Accepted: 03/17/2019] [Indexed: 11/25/2022] Open
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Optimization of CT protocols using cause-and-effect analysis of outliers. Phys Med 2018; 55:1-7. [PMID: 30471813 DOI: 10.1016/j.ejmp.2018.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to implement an outlier marking and analysis methodology to optimize CT examination protocols. CT Head examination data, including dose metrics along with technical parameters, were stored in an automatic dose registry system. Reference dose metrics distribution was obtained throughout a 1-year period. Outlier thresholds were calculated taking into account the specific shape of the distribution, by using a robust measure of the skewness; the medcouple parameter. Subsequently, outliers from a 4-month period were marked and Cause-and-Effect analysis was carried out by a multidisciplinary dose committee. Reference Dose metrics distributions were obtained from 3690 CT Head examinations. Both CTDIvol and DLP showed a certain degree of skewness, with a medcouple value of 0.05 and 0.11, respectively. All of the upper-outliers fell within 3 identifiable groups of causes, ordered by relative importance: i) inadequate protocol selection, ii) arms or objects in the field-of-view, and iii) abnormal scanning region diameter. Regarding the lower-outliers, 90% were attributable to the inclusion of additional series in the original head protocol and the remaining 10% to unknown causes. Also, a general Cause-and-Effect diagram for outliers was elaborated. While the Dose Reference Level method applies to the general performance of a CT protocol and allows comparison with other centers, the outlier method represents a step further in the optimization process. The proposed method focuses on detecting incorrect utilization of the CT, which mainly arises from inadequate knowledge of CT technology.
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Buytaert D, Eloot L, Mauti M, Drieghe B, Gheeraert P, Taeymans Y, Bacher K. Evaluation of patient and staff exposure with state of the art X-ray technology in cardiac catheterization: A randomized controlled trial. J Interv Cardiol 2018; 31:807-814. [PMID: 30168209 DOI: 10.1111/joic.12553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cardiac catheterization procedures result in high patient radiation exposure and corresponding staff doses are reported to be among the highest for medical staff. The purpose of current randomized controlled study was to quantify the potential radiation dose reduction for both patient and staff, enabled by recent X-ray technology. This technology is equipped with advanced image processing algorithms, real-time dose monitoring, and an acquisition chain optimized for cardiac catheterization applications. METHODS A total of 122 adult patients were randomly assigned to one of two cath labs, either the reference X-ray modality (Allura Xper FD10, Philips Healthcare, the Netherlands) or the new X-ray system (AlluraClarity FD20/10 Philips Healthcare, the Netherlands). Exposure parameters and staff dosimeter readings were recorded for each exposure. Technical measurements were performed to define the radiation scatter behavior. RESULTS With the newer equipment, patient radiation dose is reduced (as total dose-area product) by 67% based on geometric means with 95%CI of 53%, 77% for diagnostic and interventional procedures. The C-arm and leg dosimeter readings were both reduced with 65% (P < 0.001), while for the collar and chest dosimeter readings no statistically significant reduction was noticed. CONCLUSION The new x-ray and image processing technology, significantly reduces patient dose in coronary angiographies, and PCIs by 67%. In general, scatter dose was also reduced, yet for some dosimeters the reduction was limited and not statistically significant. This study clearly indicates that the scatter behavior is highly dependent on C-arm rotation, operator movement and height, dosimeter position, beam filtration, clinical procedure type and system geometry.
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Affiliation(s)
- Dimitri Buytaert
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Liesbeth Eloot
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | | | - Benny Drieghe
- Heart Centre, Ghent University Hospital, Ghent, Belgium
| | | | - Yves Taeymans
- Heart Centre, Ghent University Hospital, Ghent, Belgium
| | - Klaus Bacher
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
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Sarmento S, Mendes B, Gouvêa M. Automatic calculation of patient size metrics in computed tomography: What level of computational accuracy do we need? J Appl Clin Med Phys 2017; 19:218-227. [PMID: 29265700 PMCID: PMC5768030 DOI: 10.1002/acm2.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/04/2017] [Accepted: 11/14/2017] [Indexed: 12/04/2022] Open
Abstract
Objectives To compare the effectiveness of two different patient size metrics based on water equivalent diameter (Dw), the mid‐scan water equivalent diameter Dw_c, and the mean (average) water equivalent diameter in the imaged region, Dw_ave, for automatic detection of accidental changes in computed tomography (CT) acquisition protocols. Methods Patient biometric data (height and weight) were available from a previous survey for 80 adult chest examinations, and 119 adult single‐acquisition chest–abdomen–pelvis (CAP) examinations for two 16 slice scanners (GE LightSpeed and Toshiba Aquilion RXL) equipped with automatic tube current modulation (ATCM). Dw_c and Dw_ave were calculated from the archived CT images. Size‐specific dose estimates (SSDE) were obtained from volume CT dose index (CTDIvol), using the conversion factors for a patient diameter of Dw_c. Results CTDIvol and SSDE correlate better with Dw_ave than with Dw_c. R‐squared values of linear fits to CTDIvol of CAP examinations were 0.81–0.89 for Dw_c and 0.93–0.94 for Dw_ave (SSDE: 0.69–080 for Dw_c, 0.87–0.92 for Dw_ave). Percentage differences between Dw_c and Dw_ave were −4 ± 4% for chest and +5 ± 4% for CAP examinations (in % of Dw_ave). However, small Dw variations translated as larger variations in CTDIvol for these ATCM systems (e.g., a 24% increase in Dw doubled CTDIvol). The dependence of CTDIvol on Dw_ave was similar for chest and CAP examinations performed with similar ATCM parameters, while use of Dw_c resulted in a clear separation of the same data according to examination type. Maximum Dw variation in the imaged region was 5.6 ± 1.6 cm for chest and 6.5 ± 1.4 cm for CAP examinations. Conclusions Dw_ave is a better metric than Dw_c for binning similar‐sized patients in dose comparison studies, despite the additional computational effort required for its calculation Therefore, when implementing automatic determination of Dw for SSDE calculations, automatic calculation of Dw_ave should be considered.
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Affiliation(s)
- Sandra Sarmento
- Medical Physics, Radiobiology and Radiation Protection Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.,Medical Physics Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Bruno Mendes
- Medical Physics, Radiobiology and Radiation Protection Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.,Medical Physics Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Margarida Gouvêa
- Radiology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
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The evolution of radiation dose over time: Measurement of a patient cohort undergoing whole-body examinations on three computer tomography generations. Eur J Radiol 2017; 86:63-69. [DOI: 10.1016/j.ejrad.2016.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 11/23/2022]
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