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Xu H, Sun QF, Yue BR, Cheng JS, Niu YT. Results and analysis of examination doses for paediatric CT procedures based on a nationwide survey in China. Eur Radiol 2024; 34:1659-1666. [PMID: 37672054 DOI: 10.1007/s00330-023-10005-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 05/14/2023] [Accepted: 06/07/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE To report the results of a dose survey conducted across 31 provinces in mainland China from 2017 to 2018 and to analyse the dose level to determine the national diagnostic reference levels (DRLs) for paediatric CT procedures. METHODS At least ten patients for each age group (0- < 1, 1- < 5, 5- < 10, 10- < 15 years) and each procedure (head, chest and abdomen) for each CT scanner were selected from four to eight hospitals in each province. The dose information (CTDIvol and DLP) was collected from the HIS or RIS-PACS systems. The median values in each CT scanner were considered the representative dose values for the paediatric patients in CT scanning. The national DRLs were estimated based on the 75th percentile distribution of the median values. RESULTS A total of 24,395 patients and 319 CT scanners were investigated across 262 hospitals. For paediatric CT scanning in 4 different age groups, the median (P50) and the 75th percentile (P75) of CTDIvol and DLP for each scanning procedure were calculated and reported. National DRLs were then proposed for each procedure and age group. CONCLUSION The dose level of CT scanning for children in mainland China was reported for the first time. The DRLs for paediatric CT in the present study are similar to those in some Asian countries but higher than those in European countries. CLINICAL RELEVANCE STATEMENT The paediatric CT is an extensively used tool in diagnosing paediatric disease; however, children are more sensitive to radiation. Establishing the diagnostic reference level of paediatric CT examination is necessary to reduce the dose of CT in children and promote the optimisation of medical exposure. KEY POINTS • The DRLs for 3 paediatric CT procedures (head, chest and abdomen) and 4 age groups (0- < 1, 1- < 5, 5- < 10, 10- < 15 years) were proposed in mainland China first time. • The examination parameter and dose for children need to be further optimised in China, especially to lower the tube voltage in paediatric CT.
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Affiliation(s)
- Hui Xu
- Key Laboratory of Radiological Protection and Nuclear Emergency Chinese Center for Disease Control and Prevention, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, 100088, China
| | - Quan-Fu Sun
- Key Laboratory of Radiological Protection and Nuclear Emergency Chinese Center for Disease Control and Prevention, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, 100088, China.
| | - Bao-Rong Yue
- Key Laboratory of Radiological Protection and Nuclear Emergency Chinese Center for Disease Control and Prevention, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, 100088, China
| | - Jin-Sheng Cheng
- Key Laboratory of Radiological Protection and Nuclear Emergency Chinese Center for Disease Control and Prevention, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing, 100088, China
| | - Yan-Tao Niu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
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Rawashdeh M, Saade C, Al Mousa DS, Abdelrahman M, Kumar P, Mcentee M. A new approach to dose reference levels in pediatric CT: Age and size-specific dose estimation. Radiat Phys Chem Oxf Engl 1993 2023; 205:110698. [DOI: 10.1016/j.radphyschem.2022.110698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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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.
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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
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Moghadam N, Lecomte R, Mercure S, Rehani MM, Nassiri MA. Simplified size adjusted dose reference levels for adult CT examinations: A regional study. Eur J Radiol 2021; 142:109861. [PMID: 34280596 DOI: 10.1016/j.ejrad.2021.109861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/30/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate retrospective classification of adult patients into small, average, and large based on effective diameter (EDia) from localizer image of computed tomography (CT) scans and to develop regional diagnostic reference levels (DRLs) and achievable doses (AD). METHOD The patients falling within the mean ± standard deviation (SD) of EDia were classified as average; those below this range as small and above as large. The CTDIvol,dose-length-product (DLP) and size-specific dose estimates (SSDE) of all adult patients undergoing CT examinations in 8 CT facilities for 11 months (Dec. 2019 - Oct. 2020) were evaluated. The 75th and 50th percentile values were compared with national and international values. RESULTS Of the total of 69,434 CT examinations, nearly 80% fell within average size. The 75th percentile values of CTDIvol and DLP for small patients for abdomen-pelvic exams were nearly half of average sized patients. Similarly, the 75th percentile values for large patients were nearly double. Similar findings were not found for chest exams. Analysis of image quality and dose factors such as noise, mean axial length, slice thickness, mean number of sequences, use of iterative reconstruction and tube current modulation (TCM) resulted in identification of opportunities for improvement and optimization of different CT facilities. CONCLUSIONS DRLs for adult patients were found to vary widely with patient size and thus establishing DRLs only for standard sized patient is not adequate. Simplified and intuitive methods for size classification was shown to provide meaningful information for optimization for patients outside the standard size adult.
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Affiliation(s)
- Narjes Moghadam
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Québec, Canada.
| | - Roger Lecomte
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada; Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
| | - Stéphane Mercure
- Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Québec, Canada
| | - Madan M Rehani
- Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Moulay Ali Nassiri
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Québec, Canada; Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
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Kharita MH, AlNaemi H, Kini V, Alkhazzam S, Rehani MM. Development of image quality related reference doses called acceptable quality doses (AQD) in paediatric CT exams in Qatar. Eur Radiol 2021; 31:3098-3105. [PMID: 33175202 PMCID: PMC8043894 DOI: 10.1007/s00330-020-07375-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/10/2020] [Accepted: 10/05/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To describe first experience of integrating assessment of image quality in paediatric X-ray computed tomography (CT) with analysis of the radiation dose indices to develop reference doses called acceptable quality dose (AQD). METHODS Image quality was scored by the radiologists at a tertiary care hospital in Qatar on a scale of 0 to 4 using the recently published scoring criteria. The patients undergoing head, chest and abdomen CT were divided in different weight groups as follows: < 5 kg, 5-< 15 kg, 15-< 30 kg, 30-< 50 kg, 50-< 80 kg and > 80 kg. The images that were clinically acceptable (score of 3) were included for assessment of median values of CTDIvol and DLP to obtain AQDs in different weight groups. RESULTS After initial training in image quality scoring of CT images of 49 patients by three radiologists, the study on 715 patients indicated 665 studies (93%) were clinically acceptable as per scoring criteria. The median CTDIvol values for the above weight groups were 16, 20, 22, 22, 27 and 27 mGy and the median DLP values for these weight groups were 271, 377, 463, 486, 568 and 570 mGy cm, respectively, for head CT. Similar values are presented for chest and abdomen CTs. CONCLUSIONS The first ever experience of starting with image quality assessment and integrating it with analysis of dose indices to obtain AQD values shall provide a workable model for others and values for comparison within the facility and in other facilities leading to optimisation. KEY POINTS • The first study to integrate image quality assessment with analysis of patient dose indices shows feasibility for routine practice in other centres. • The values of acceptable quality dose (AQD) were provided for head, chest and abdomen CT of children divided into weight groups rather than age. They shall act as reference values for future studies. • Verification of our findings on proportional increase in exposure parameters (CTDIvol and DLP) with weight by other investigators shall be helpful.
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Affiliation(s)
- Mohammad Hassan Kharita
- Hamad Medical Corporation, Occupational Health and Safety, Radiation Safety Section, Doha, Qatar.
| | - Huda AlNaemi
- Hamad Medical Corporation, Occupational Health and Safety, Radiation Safety Section, Doha, Qatar
| | - Vishwanatha Kini
- Hamad Medical Corporation, Occupational Health and Safety, Radiation Safety Section, Doha, Qatar
| | - Shady Alkhazzam
- Hamad Medical Corporation, Occupational Health and Safety, Radiation Safety Section, Doha, Qatar
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Kanda R, Akahane M, Koba Y, Chang W, Akahane K, Okuda Y, Hosono M. Developing diagnostic reference levels in Japan. Jpn J Radiol 2021; 39:307-314. [PMID: 33211263 PMCID: PMC8019674 DOI: 10.1007/s11604-020-01066-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Reiko Kanda
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan.
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan.
| | - Masaaki Akahane
- Department of Radiology, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Yusuke Koba
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Weishan Chang
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Keiichi Akahane
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Yasuo Okuda
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
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Delis H, Homolka P, Chapple C, Costa P, Attalla E, Lubis L, Sackey T, Fahey F, Lassmann M, Poli G. Developing and implementing a multi-modality imaging optimization study in paediatric radiology: Experience and recommendations from an IAEA coordinated research project. Phys Med 2021; 82:255-265. [DOI: 10.1016/j.ejmp.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022] Open
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Joseph Zira D, Haruna Yahaya T, Umar MS, Nkubli B F, Chukwuemeka NC, Sidi M, Emmanuel R, Ibrahim FZ, Laushugno SS, Ogenyi AP. Clinical indication-based diagnostic reference levels for paediatric head computed tomography examinations in Kano Metropolis, northwestern Nigeria. Radiography (Lond) 2020; 27:617-621. [PMID: 33339745 DOI: 10.1016/j.radi.2020.11.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Paediatric patients are recognised to be at higher risk of developing radiation-induced cancer than adults because of rapidly growing organs and tissues which are vulnerable to cellular damage. The aim of the study was to determine indication based Diagnostic Reference Levels (DRLCI) for paediatric head computed tomography (CT) examinations within Kano metropolis, Nigeria. METHODS CT dose index (CTDIvol), dose length product (DLP) and other scan parameters were recorded for 113 paediatric undergoing CT head examinations. Different clinical indications were recorded and categorised in addition to patient age. Third quartile values (75th percentile) of the median dose were considered as DRLCI. Analysis of Variance (ANOVA) was used to test for differences between DRLCI, for different age groups, and variations among institutions. The Statistical Package for Social Sciences version 23.0 was used for analysis. Statistical significance was set at p < 0.05. RESULTS DRLCI for Hydrocephalus for <5 years and 5-10 years was 28.10 mGy and 28.11 mGy with DLP of 1623.20 mGy cm and 1623.21 mGy cm, respectively. The 11-15 year group recorded 29.10 mGy and 1625.20 mGy cm. Indications of haemorrhage/trauma and post-seizure imaging all had same values for <5 years and 5-10 years (28.10 mGy and 1623.20 mGy cm) while the 11 to 15-year group recorded 39.60 mGy and 1626 mGy cm. Intracranial Space Occupying lesion had the same DRLCI value for < 5years and 5-10 years (29.0 mGy and 1600 mGy cm, respectively) the 11 to 15-year group recorded values of 46.20 mGy and 1663.4 mGy cm. There was no statistically significant difference between DRLCI for <5 years and 5 to 10-year age groups (p = 0.199), while different centres showed some statistically significant relationships (p = 0.02). CONCLUSION The study noted dose differences between age groups less than 10 years and above ten years, there were some statistically significant relationship with DRLCI. Dose optimisation techniques for paediatric examinations together with selection of the right protocol for paediatric head CT are necessary. IMPLICATIONS FOR PRACTICE The study has provided DRLCI for paediatric head CT examinations. These values can be used for future comparisons and as a potential dose optimisation tool. Such data can also guide radiographers when selecting appropriate parameters for indication-based CT examination to help achieve a low dose with acceptable image quality.
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Affiliation(s)
- D Joseph Zira
- Department of Radiography, Federal University Lafia, Nasarawa State, Nigeria.
| | | | - M S Umar
- Department of Radiography, Bayero University Kano, Nigeria
| | - F Nkubli B
- Department of Medical Radiography, University of Maiduguri, Borno State, Nigeria
| | - N C Chukwuemeka
- Department of Radiography, Nnamdi Azikiwe University, Anambra State, Nigeria
| | - M Sidi
- Department of Radiography, Bayero University Kano, Nigeria
| | - R Emmanuel
- Department of Radiography, Bayero University Kano, Nigeria
| | - F Z Ibrahim
- Department of Radiography, Federal University Lafia, Nasarawa State, Nigeria
| | - S S Laushugno
- Department of Radiography, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - A P Ogenyi
- Imperial Diagnostic Center, Bauchi State, Nigeria
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Anam C, Sutanto H, Adi K, Budi WS, Muhlisin Z, Haryanto F, Matsubara K, Fujibuchi T, Dougherty G. Development of a computational phantom for validation of automated noise measurement in CT images. Biomed Phys Eng Express 2020; 6. [PMID: 35135906 DOI: 10.1088/2057-1976/abb2f8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/26/2020] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to develop a computational phantom for validation of automatic noise calculations applied to all parts of the body, to investigate kernel size in determining noise, and to validate the accuracy of automatic noise calculation for several noise levels. The phantom consisted of objects with a very wide range of HU values, from -1000 to +950. The incremental value for each object was 10 HU. Each object had a size of 15 × 15 pixels separated by a distance of 5 pixels. There was no dominant homogeneous part in the phantom. The image of the phantom was then degraded to mimic the real image quality of CT by convolving it with a point spread function (PSF) and by addition of Gaussian noise. The magnitude of the Gaussian noises was varied (5, 10, 25, 50, 75 and 100 HUs), and they were considered as the ground truth noise (NG). We also used a computational phantom with added actual noise from a CT scanner. The phantom was used to validate the automated noise measurement based on the average of the ten smallest standard deviations (SD) from the standard deviation map (SDM). Kernel sizes from 3 × 3 up to 27 × 27 pixels were examined in this study. A computational phantom for automated noise calculations validation has been successfully developed. It was found that the measured noise (NM) was influenced by the kernel size. For kernels of 15 × 15 pixels or smaller, the NMvalue was much smaller than the NG. For kernel sizes from 17 × 17 to 21 × 21 pixels, the NMvalue was about 90% of NG. And for kernel sizes of 23 × 23 pixels and above, NMis greater than NG. It was also found that even with small kernel sizes the relationship between NMand NGis linear with R2more than 0.995. Thus accurate noise levels can be automatically obtained even with small kernel sizes without any concern regarding the inhomogeneity of the object.
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Affiliation(s)
- Choirul Anam
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof. Soedarto SH, Tembalang, Semarang 50275, Central Java, Indonesia
| | - Heri Sutanto
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof. Soedarto SH, Tembalang, Semarang 50275, Central Java, Indonesia
| | - Kusworo Adi
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof. Soedarto SH, Tembalang, Semarang 50275, Central Java, Indonesia
| | - Wahyu Setia Budi
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof. Soedarto SH, Tembalang, Semarang 50275, Central Java, Indonesia
| | - Zaenul Muhlisin
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof. Soedarto SH, Tembalang, Semarang 50275, Central Java, Indonesia
| | - Freddy Haryanto
- Department of Physics, Faculty of Mathematics and Natural Sciences, Bandung Institute of Technology, Bandung, West Java, Indonesia
| | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Toshioh Fujibuchi
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Geoff Dougherty
- Department of Applied Physics and Medical Imaging, California State University Channel Islands, Camarillo, CA 93012, United States of America
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Watanabe S, Ichikawa K, Kawashima H, Kono Y, Kosaka H, Yamada K, Ishii K. Image quality comparison of a nonlinear image-based noise reduction technique with a hybrid-type iterative reconstruction for pediatric computed tomography. Phys Med 2020; 76:100-108. [DOI: 10.1016/j.ejmp.2020.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 06/13/2020] [Accepted: 06/13/2020] [Indexed: 10/23/2022] Open
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Padole AM, Sagar P, Westra SJ, Lim R, Nimkin K, Kalra MK, Gee MS, Rehani MM. Development and validation of image quality scoring criteria (IQSC) for pediatric CT: a preliminary study. Insights Imaging 2019; 10:95. [PMID: 31549234 PMCID: PMC6757090 DOI: 10.1186/s13244-019-0769-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To develop and assess the value and limitations of an image quality scoring criteria (IQSC) for pediatric CT exams. METHODS IQSC was developed for subjective assessment of image quality using the scoring scale from 0 to 4, with 0 indicating desired anatomy or features not seen, 3 for adequate image quality, and 4 depicting higher than needed image quality. Pediatric CT examinations from 30 separate patients were selected, five each for routine chest, routine abdomen, kidney stone, appendicitis, craniosynostosis, and ventriculoperitoneal (VP) shunt. Five board-certified pediatric radiologists independently performed image quality evaluation using the proposed IQSC. The kappa statistics were used to assess the interobserver variability. RESULTS All five radiologists gave a score of 3 to two-third (67%) of all CT exams, followed by a score of 4 for 29% of CT exams, and 2 for 4% exams. The median image quality scores for all exams were 3 and the interobserver agreement among five readers (acceptable image quality [scores 3 or 4] vs sub-optimal image quality ([scores 1 and 2]) was moderate to very good (kappa 0.4-1). For all five radiologists, the lesion detection was adequate for all CT exams. CONCLUSIONS The image quality scoring criteria covering routine and some clinical indication-based imaging scenarios for pediatric CT examinations has potential to offer a simple and practical tool for assessing image quality with a reasonable degree of interobserver agreement. A more extensive and multi-centric study is recommended to establish wider usefulness of these criteria.
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Affiliation(s)
- Atul M Padole
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Pallavi Sagar
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Sjirk J Westra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Ruth Lim
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Katherine Nimkin
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Mannudeep K Kalra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 75 Cambridge Street, Suite 244, Boston, MA, 02114, USA.
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Al-Jabri AJ, Alzimami K, Alsafi K, Alaamer AS, Al-Rajhi MA, Suliman II. RETROSPECTIVE ANALYSIS OF PATIENT RADIATION DOSES IN DIGITAL CORONARY ANGIOGRAPHY AND INTERVENTIONS. Radiat Prot Dosimetry 2019; 183:496-501. [PMID: 30260437 DOI: 10.1093/rpd/ncy168] [Citation(s) in RCA: 5] [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: 03/13/2018] [Revised: 07/19/2018] [Accepted: 08/30/2018] [Indexed: 06/08/2023]
Abstract
This study sought to assess patient and operator eye lens doses in diagnostic coronary angiography (DCA) and percutaneous coronary interventions (PCI) in a University hospital in Oman. Kerma area product (PkA), cumulative air kerma (CAK) and fluoroscopic time (FT) were retrospectively recorded from the DICOM header for 264 patients. The median (interquartile range) of FT, PKA and CAK were: 5.3 min (2.6-10.5), 60.9 Gy cm2 (41.3-91.4) and 0.86 Gy (0.61-1.29), respectively, for DCA procedures, and they were 20.2 min (13.3-30.1), 174.0 Gy cm2 (113.7-253.3) and 2.6 Gy (1.8-3.9), respectively, for PCI procedures. The results revealed wide variability in patient doses among individual patients. Monitoring and recording patient dose data can be valuable for quality assurance and patient safety purposes. Feedback to the operator may help optimize radiation doses to patients and prompt further action, as needed.
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Affiliation(s)
- Amna J Al-Jabri
- Department of Radiology and Molecular Imaging, Medical Physics Section, College of Medicine & Health Sciences, Sultan Qaboos University, Al-Khod 123, Oman
| | - Khalid Alzimami
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - K Alsafi
- Department of Radiology, Medical Physics Unit, King Abdul Aziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulaziz S Alaamer
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
| | - M A Al-Rajhi
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
| | - I I Suliman
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
- Sudan Atomic Energy Commission, Institute of Nuclear and Radiological Safety, Khartoum, Sudan
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Lu H, Wang W, Li B, Sun S, Zhang H. A survey of pediatric CT doses in the Shanghai metropolitan area. J Radiol Prot 2019; 39:193-207. [PMID: 30560805 DOI: 10.1088/1361-6498/aaf923] [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: 06/09/2023]
Abstract
The purpose of this study was to evaluate computed tomography (CT) doses in child examinees at different ages throughout the Shanghai metropolitan area. The head and body CT dose indices (CTDIs) of 50 CT scanners were tested by phantom measurements using standard imaging protocols. The values of CTDIw, CTDIvol and dose length product (DLP) were calculated and saved in a table along with the parameters of routine head and chest scans for different age groups of children and adults. The effective doses were estimated from the K-factors by age and DLP. The CTDIvol, DLP and effective dose for multi-detector row CT (MDCT) in children during routine head scans were larger than those for single-detector row CT (SDCT) and dual-detector row CT (DDCT). The CTDIvol, DLP and effective dose for MDCT and DDCT in children during routine chest scans were lower than those for SDCT. Radiation risks are higher for children in CT examinations compared to adults.
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Affiliation(s)
- Heqing Lu
- Department of Medical Equipment, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, People's Republic of China
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Abstract
BACKGROUND As multisection spiral computed tomography (MSCT) have been extensively used, it is important to consider the amounts of doses the patients are exposed during a computed tomography (CT) examination. The aim of the current study was to summarize MSCT doses in Chinese patients to establish the diagnostic reference levels (DRLs). METHODS Radiation dose metrics were retrospectively collected from 164,073 CT examinations via the Radimetrics Enterprise Platform. Radiation dose metrics (volume CT dose index [CTDIvol], dose-length product [DLP], effective dose [ED], and organ dose) and size-specific dose estimate (SSDE) were calculated for adults and children based on anatomic area and scanner type. RESULTS The median CTDIvol and DLP values were highest in the head at 51.7 mGy (interquartile range [IQR], 33.2-51.7 mGy) and 906.5 mGy·cm (IQR, 582.4-1068.2 mGy·cm) and lowest in the chest at 7.9 mGy (IQR, 7.9-10.3 mGy) and 284.8 mGy·cm (IQR, 249.0-412.6 mGy·cm), respectively. The median SSDE values of chest and pelvis were 12.1 mGy (IQR, 10.8-14.1 mGy) and 36.3 mGy (IQR, 34.0-38.9 mGy), respectively. EDs for children were similar to adults except for an increased 1.5-, 0.77-, and 1.7-fold in the chest, neck, and pelvis, respectively (p < 0.001). Furthermore, radiation doses tended to increase with increasing slice number and decrease when exposure reduction techniques were used. CONCLUSION Our findings provide a basis for the evaluation of CT radiation doses and evidence for establishment of DRLs in China.
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Affiliation(s)
- Dan-Dan Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Pengfei Sun
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Zhifang Jia
- Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China
| | - Wanan Zhu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Guang Shi
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Boyu Kong
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Haifeng Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Huimao Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
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Rehani MM. Multinational Data Collection on Patient Radiation Doses: The Experience Is “More Than Meets the Eye”. J Am Coll Radiol 2018; 15:1660-1661. [DOI: 10.1016/j.jacr.2018.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 11/19/2022]
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16
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Lee RK, Sun JY, Lockerby S, Soltycki E, Matalon T. Reducing Variability of Radiation Dose in CT: The New Frontier in Patient Safety. J Am Coll Radiol 2018; 15:1633-1641. [DOI: 10.1016/j.jacr.2017.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/20/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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Yamazaki D, Miyazaki O, Takei Y, Matsubara K, Shinozaki M, Shimada Y, Suzuki S, Muramatsu Y. USEFULNESS OF SIZE-SPECIFIC DOSE ESTIMATES IN PEDIATRIC COMPUTED TOMOGRAPHY: REVALIDATION OF LARGE-SCALE PEDIATRIC CT DOSE SURVEY DATA IN JAPAN. Radiat Prot Dosimetry 2018; 179:254-262. [PMID: 29216387 DOI: 10.1093/rpd/ncx268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 11/14/2017] [Indexed: 06/07/2023]
Abstract
The objective of this research is to calculate the organ equivalent dose and effective dose from the scanning conditions at 165 centers in Japan using computed tomography (CT) Dose software and compare the results with the CT dose index volume (CTDIvol), dose length product (DLP) and size-specific dose estimates (SSDE) to validate the usefulness of SSDE. The CTDIvol and DLP were significantly lower in infants than in children (p < 0.05). No significant differences were found in the bone marrow equivalent dose and effective dose for the torso between infants and children (p > 0.05), and the bone marrow equivalent dose and effective dose for the head were higher in infants than children (p < 0.05). No significant difference was found in SSDE for the torso between infants and children (p > 0.05). Organ equivalent and effective doses for head CT scans are higher in infants than in children (I/P ratio ≥ 1). The I/P ratios of CTDIvol and DLP for chest and abdominal CT scans are also higher in Japan than in other countries. CTDIvol and DLP are not accurate when used as a dose index, and SSDE was considered suitable for dose assessment of the torso. However, for head CT in infants, a further reduction in radiation exposure is required.
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Affiliation(s)
- Daisuke Yamazaki
- Department of Radiology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | | | - Yasutaka Takei
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama701-0193, Japan
| | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan
| | - Masafumi Shinozaki
- Department of Radiology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Yoshiya Shimada
- Medical Exposure Research Project, National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba263-8555, Japan
| | - Shoichi Suzuki
- Faculty of Radiological Technology, School of Health Sciences, Fujita Health University, 1-98, Dengaku-gakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
| | - Yoshihisa Muramatsu
- Department of Radiology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
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Ideguchi R, Yoshida K, Ohtsuru A, Takamura N, Tsuchida T, Kimura H, Uetani M, Kudo T. The present state of radiation exposure from pediatric CT examinations in Japan-what do we have to do? J Radiat Res 2018; 59:ii130-ii136. [PMID: 29420748 PMCID: PMC5941147 DOI: 10.1093/jrr/rrx095] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/23/2017] [Indexed: 06/08/2023]
Abstract
The use of computed tomography (CT) has increased dramatically over the past several decades and has resulted in a concurrent increase in medical exposure to ionizing radiation. Several recent studies have examined the link between medical radiation and the risk of cancer, especially in children. The cancer risk associated medical exposure has not been definitively confirmed. However, we have to reduce unwarranted medical radiation exposure in pediatric patients. Justification and optimization are of great importance in order to minimize these risks, and the standardization of CT usage is essential. However, in Japan no clinical guidelines for the use of CT have been commonly agreed upon, especially in children. Furthermore, the CT-associated radiation exposure in Japan varies widely among the different facilities. Further studies based on a nationwide survey in Japan will be required in order to establish simple and useful clinical guidelines.
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Affiliation(s)
- Reiko Ideguchi
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Koji Yoshida
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Akira Ohtsuru
- Department of Radiation Health Management, Fukushima Medical University
| | - Noboru Takamura
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | | | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui
| | - Masataka Uetani
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University
| | - Takashi Kudo
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
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Fukuyama N, Kurata A, Kawaguchi N, Tashiro R, Higaki T, Yokoi T, Tanabe Y, Nishiyama H, Itoh T, Kido T, Miyagawa M, Mochizuki T. Two-Phase Contrast Injection Protocol for Pediatric Cardiac Computed Tomography in Children with Congenital Heart Disease. Pediatr Cardiol 2018; 39:518-525. [PMID: 29214485 DOI: 10.1007/s00246-017-1782-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/22/2017] [Indexed: 01/03/2023]
Abstract
To assess a two-phase contrast injection protocol for contrast enhancement during cardiac computed tomography (CT) in children with congenital heart disease. Forty-three children (20 boys, 23 girls) of median age 13 months (range 3 days-8.3 years) and weighing ≤ 20 kg who underwent cardiac CT using a two-phase contrast injection protocol at our institution were retrospectively identified. High-pitch spiral third-generation dual-source cardiac CT (tube voltage 70 kV) was performed with a fixed delay of 60 s after contrast injection in the order of 10 mgI/kg/s (30 s), 15 mgI/kg/s (20 s), and a saline chaser (10 s). Attenuation in the inferior vena cava (IVC), superior vena cava (SVC), right atrium (RA), right ventricle (RV), pulmonary artery (PA), left atrium (LA), left ventricle (LV), and descending aorta (AO) was compared using the Steel-Dwass and Fisher's exact tests. The median (interquartile range) attenuation in the IVC, SVC, RA, RV, PA, LA, LV, and AO was 285 (264-347) Hounsfield units (HU), 416 (370-445) HU, 368 (320-388) HU, 373 (322-417) HU, 397 (330-432) HU, 425 (373-469) HU, 435 (385-468) HU, and 437 (392-491) HU, respectively (p < 0.05, IVC vs. the other anatomic sites). There was no significant difference in diagnostic success rate for attenuation > 250 HU between the IVC (41 children, 95.3%) and the other sites (43 children, 100%). A two-phase contrast injection protocol is useful for effective contrast enhancement in pediatric cardiac CT.
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Affiliation(s)
- Naoki Fukuyama
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan.
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
| | - Ryo Tashiro
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takashi Higaki
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takahiro Yokoi
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
| | - Hikaru Nishiyama
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
| | - Toshihide Itoh
- Research and Collaboration, Siemens Healthcare, Tokyo, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
| | - Masao Miyagawa
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, 791-0295, Japan
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Journy NMY, Dreuil S, Boddaert N, Chateil JF, Defez D, Ducou-le-Pointe H, Garcier JM, Guersen J, Habib Geryes B, Jahnen A, Lee C, Payen-de-la-Garanderie J, Pracros JP, Sirinelli D, Thierry-Chef I, Bernier MO. Individual radiation exposure from computed tomography: a survey of paediatric practice in French university hospitals, 2010-2013. Eur Radiol 2018; 28:630-641. [PMID: 28836026 DOI: 10.1007/s00330-017-5001-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/12/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe computed tomography (CT) scanning parameters, volume CT dose index (CTDIvol) and dose-length product (DLP) in paediatric practice and compare them to current diagnostic reference levels (DRLs). METHODS The survey was conducted in radiology departments of six major university hospitals in France in 2010-2013. Data collection was automatised to extract and standardise information on scanning parameters from DICOM-header files. CTDIvol and DLP were estimated based on Monte Carlo transport simulation and computational reference phantoms. RESULTS CTDIvol and DLP were derived for 4,300 studies, four age groups and 18 protocols. CTDIvol was lower in younger patients for non-head scans, but did not vary with age for routine head scans. Ratios of 95th to 5th percentile CTDIvol values were 2-4 for most body parts, but 5-7 for abdominal examinations and 4-14 for mediastinum CT with contrast, depending on age. The 75th percentile CTDIvol values were below the national DRLs for chest (all ages) and head and abdominal scans (≥10 years). CONCLUSION The results suggest the need for a better optimisation of scanning parameters for routine head scans and infrequent protocols with patient age, enhanced standardisation of practices across departments and revision of current DRLs for children. KEY POINTS • CTDIvol varied little with age for routine head scans. • CTDIvol was lowest in youngest children for chest or abdominal scans. • Individual and inter-department variability warrant enhanced standardisation of practices. • Recent surveys support the need for revised diagnostic reference levels. • More attention should be given to specific protocols (sinuses, neck, spine, mediastinum).
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Affiliation(s)
- Neige M Y Journy
- Laboratoire d'épidémiologie des rayonnements ionisants, Unité Radioprotection de l'Homme, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France.
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA.
| | - Serge Dreuil
- Unité d'expertise en radioprotection médicale, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | - Nathalie Boddaert
- Service de radiologie pédiatrique, INSERM U1000, UMR 1163, Institut Imagine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75743, Paris Cedex 15, France
- PRES Sorbonne Paris, Cité Université René Descartes, 190 avenue de France, 75013, Paris, France
| | - Jean-François Chateil
- Service de radiologie et d'imagerie anténatale, de l'enfant et de la femme, Groupe Hospitalier Pellegrin, Centre Hospitalier Universitaire de Bordeaux, place Amélie Raba-Léon, 33000, Bordeaux, France
| | - Didier Defez
- Service de Physique Médicale, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Benite, France
| | - Hubert Ducou-le-Pointe
- Service de Radiologie, Hôpital d'Enfants Armand-Trousseau, 26 avenue du Dr A. Netter, 75012, Paris, France
| | - Jean-Marc Garcier
- Service de radiologie, Centre Hospitalier Universitaire Estaing, 1 place Lucie-Aubrac, 63003, Clermont-Ferrand Cedex 1, France
| | - Joël Guersen
- Pôle Imagerie et Radiologie Interventionnelle, Centre Hospitalier Universitaire Gabriel Montpied, 58 rue Montalembert, 63003, Clermont Ferrand cedex 1, France
| | - Bouchra Habib Geryes
- Direction des affaires médicales, de la qualité et la relation avec les usagers, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75743, Paris Cedex 15, France
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology (LIST), 5 avenue des Hauts-Fourneaux, L-4362, Esch/Alzette, Luxembourg, Luxembourg
| | - Choonsik Lee
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA
| | | | - Jean-Pierre Pracros
- Service d'imagerie pédiatrique, Hôpital Femme Mère Enfants, Groupe Hospitalier Est, 59 Boulevard Pinel, 69500, Bron, France
| | - Dominique Sirinelli
- Service de radiologie pediatrique, Hôpital Clocheville, Centre Hospitalier Régional Universitaire de Tours, 49 boulevard Béranger, 37000, Tours, France
| | - Isabelle Thierry-Chef
- Section of Environment and Cancer, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon cedex 08, France
| | - Marie-Odile Bernier
- Laboratoire d'épidémiologie des rayonnements ionisants, Unité Radioprotection de l'Homme, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
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Samei E, Li X, Frush DP. Size-based quality-informed framework for quantitative optimization of pediatric CT. J Med Imaging (Bellingham) 2017; 4:031209. [PMID: 28840168 DOI: 10.1117/1.jmi.4.3.031209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/06/2017] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to formulate a systematic, evidence-based method to relate quantitative diagnostic performance to radiation dose, enabling a multidimensional system to optimize computed tomography imaging across pediatric populations. Based on two prior foundational studies, radiation dose was assessed in terms of organ doses, effective dose ([Formula: see text]), and risk index for 30 patients within nine color-coded pediatric age-size groups as a function of imaging parameters. The cases, supplemented with added noise and simulated lesions, were assessed in terms of nodule detection accuracy in an observer receiving operating characteristic study. The resulting continuous accuracy-dose relationships were used to optimize individual scan parameters. Before optimization, the nine protocols had a similar [Formula: see text] of [Formula: see text] with accuracy decreasing from 0.89 for the youngest patients to 0.67 for the oldest. After optimization, a consistent target accuracy of 0.83 was established for all patient categories with [Formula: see text] ranging from 1 to 10 mSv. Alternatively, isogradient operating points targeted a consistent ratio of accuracy-per-unit-dose across the patient categories. The developed model can be used to optimize individual scan parameters and provide for consistent diagnostic performance across the broad range of body sizes in children.
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Affiliation(s)
- Ehsan Samei
- Duke University Medical Center, Departments of Radiology, Physics, Biomedical Engineering, and Electrical and Computer Engineering, Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Durham, North Carolina, United States
| | - Xiang Li
- Cleveland Clinic, Imaging Institute, Section of Medical Physics, Cleveland, Ohio, United States
| | - Donald P Frush
- Duke University Medical Center, Division of Pediatric Radiology, Department of Radiology, Medical Physics Graduate Program, Durham, North Carolina, United States
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22
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Hui PKT, Goo HW, Du J, Ip JJK, Kanzaki S, Kim YJ, Kritsaneepaiboon S, Lilyasari O, Siripornpitak S. Asian consortium on radiation dose of pediatric cardiac CT (ASCI-REDCARD). Pediatr Radiol 2017; 47:899-910. [PMID: 28435986 DOI: 10.1007/s00247-017-3847-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/17/2017] [Accepted: 03/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND With incremental utilization of pediatric cardiac CT in congenital heart disease, it is imperative to define its current radiation dose levels in clinical practice in order to help imagers optimize CT protocols, particularly in Asia and other developing countries where CT physicists are not readily available. OBJECTIVE To evaluate current radiation dose levels and influencing factors in cardiac CT in children with congenital heart disease in Asia by conducting a retrospective multi-center, multi-vendor study. MATERIALS AND METHODS We included 1,043 pediatric cardiac CT examinations performed in 8 centers between January 2014 and December 2014 to evaluate congenital heart disease. In five weight groups, we calculated radiation dose metrics including volume CT dose index, size-specific dose estimate, dose-length product and effective dose. Age at CT exam, gender, tube voltage, scan mode, CT indication and image reconstruction algorithm were analyzed to learn whether they influenced CT radiation dose. RESULTS Volume CT dose index, size-specific dose estimate, dose-length product and effective dose of pediatric cardiac CT showed variations in the range of 4.3-23.8 mGy, 4.9-17.6 mGy, 55.8-501.3 mGy∙cm and 1.5-3.2 mSv, respectively, within five weight groups. Gender, tube voltage, scan mode and cardiac function assessment significantly influenced CT radiation dose. CONCLUSION This multi-center, multi-vendor study demonstrated variations in radiation dose metrics of pediatric cardiac CT reflecting current practice in Asia. Gender, tube voltage, scan mode and cardiac function assessment should be considered as essential radiation dose-influencing factors in developing optimal pediatric cardiac CT protocols.
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Affiliation(s)
- Peter K T Hui
- Department of Radiology, Hong Kong Baptist Hospital, Hong Kong, SAR, China
| | - Hyun Woo Goo
- Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
| | - Jing Du
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Janice J K Ip
- Department of Radiology, Queen Mary Hospital, Hong Kong, SAR, China
| | - Suzu Kanzaki
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Young Jin Kim
- Department of Radiology, Yonsei University, Shinchon Severance Hospital, Seoul, South Korea
| | - Supika Kritsaneepaiboon
- Department of Radiology, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Thailand
| | - Oktavia Lilyasari
- Department of Cardiology, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Applegate KE, Frush DP. Image Gently: A Decade of International Collaborations to Promote Appropriate Imaging for Children. J Am Coll Radiol 2017; 14:956-957. [DOI: 10.1016/j.jacr.2017.04.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 11/29/2022]
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Abstract
The aim of this paper is to review the available published studies from African countries on patient doses and medical radiation protection and identify strengths, weaknesses, and challenges. Papers on radiation doses to patients published until 2016 pertaining to studies in African countries were reviewed. Radiography, interventional radiology, computed tomography (CT), and mammography modalities were covered. In radiography, the entrance surface air kerma values were below the established diagnostic reference levels (DRLs) provided by the International Atomic Energy Agency, European Commission, and National Council on Radiation Protection and Measurements. Patient and staff doses in interventional procedures were not on the higher side when compared with other published reports from developed countries. The dose length product values in CT in many situations were higher than established DRLs. In mammography, the variations of clinical image quality and dose to standard breast between African countries and other countries were insignificant. In conclusion, like in any continent, not all countries in Africa are active, but some have produced good results. The potential for optimization of radiation protection using simple and inexpensive techniques has been demonstrated. The lack of medical physicists is one of the important challenges.
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Affiliation(s)
| | - Madan M Rehani
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States.,Duke University, Department of Radiology, Durham, North Carolina, United States
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Martine RJ, Santangelo T, Colas L, Jean-Baptiste F, Duhamel A, Deschildre A, Remy J. Radiation dose levels in pediatric chest CT: experience in 499 children evaluated with dual-source single-energy CT. Pediatr Radiol 2017; 47:161-168. [PMID: 27830296 DOI: 10.1007/s00247-016-3731-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 09/24/2016] [Accepted: 10/07/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND The availability of dual-source technology has introduced the possibility of scanning children at lower kVp with a high-pitch mode, combining high-speed data acquisition and high temporal resolution. OBJECTIVE To establish the radiation dose levels of dual-source, single-energy chest CT examinations in children. MATERIALS AND METHODS We retrospectively recorded the dose-length product (DLP) of 499 consecutive examinations obtained in children <50 kg, divided into five weight groups: group 1 (<10 kg, n = 129); group 2 (10-20 kg, n = 176); group 3 (20-30 kg, n = 99), group 4 (30-40 kg, n = 58) and group 5 (40-49 kg, n = 37). All CT examinations were performed with high temporal resolution (75 ms), a high-pitch mode and a weight-adapted selection of the milliamperage. RESULTS CT examinations were obtained at 80 kVp with a milliamperage ranging between 40 mAs and 90 mAs, and a pitch of 2.0 (n = 162; 32.5%) or 3.0 (n = 337; 67.5%). The mean duration of data acquisition was 522.8 ± 192.0 ms (interquartile range 390 to 610; median 490). In the study population, the mean CT dose index volume (CTDIvol32) was 0.83 mGy (standard deviation [SD] 0.20 mGy; interquartile range 0.72 to 0.94; median 0.78); the mean DLP32 was 21.4 mGy.cm (SD 9.1 mGy.cm; interquartile range 15 to 25; median 19.0); and the mean size-specific dose estimate (SSDE) was 1.7 mGy (SD 0.4 mGy; interquartile range 1.5 to 1.9; median 1.7). The DLP32, CTDIvol32 and SSDE were found to be statistically significant in the five weight categories (P < 0.0001). CONCLUSION This study establishes the radiation dose levels for dual-source, single-kVp chest CT from a single center. In the five weight categories, the median values varied 15-37 mGy.cm for the DLP32, 0.78-1.25 mGy for the CTDIvol32 and 1.6-2.1 mGy for the SSDE.
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Affiliation(s)
- Remy-Jardin Martine
- Department of Thoracic Imaging, Hospital Calmette, CHU Lille (EA 2694) University of Lille, F-59000, Lille, France.
| | - Teresa Santangelo
- Department of Thoracic Imaging, Hospital Calmette, CHU Lille (EA 2694) University of Lille, F-59000, Lille, France.,Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lucie Colas
- Department of Thoracic Imaging, Hospital Calmette, CHU Lille (EA 2694) University of Lille, F-59000, Lille, France
| | - Faivre Jean-Baptiste
- Department of Thoracic Imaging, Hospital Calmette, CHU Lille (EA 2694) University of Lille, F-59000, Lille, France
| | - Alain Duhamel
- Department of Biostatistics; CHU Lille, University of Lille (EA 2694) , F-59000, Lille, France
| | - Antoine Deschildre
- Department of Pediatric Pulmonology,, CHU Lille - University of Lille, Lille, France
| | - Jacques Remy
- Department of Thoracic Imaging, Hospital Calmette, CHU Lille (EA 2694) University of Lille, F-59000, Lille, France
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Furuya K, Akiyama S, Nambu A, Suzuki Y, Hasebe Y. A Method for the Automatic Exposure Control in Pediatric Abdominal CT: Application to the Standard Deviation Value and Tube Current Methods by Using Patient's Age and Body Size. Nihon Hoshasen Gijutsu Gakkai Zasshi 2017; 73:33-41. [PMID: 28111396 DOI: 10.6009/jjrt.2017_jsrt_73.1.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We aimed to apply the pediatric abdominal CT protocol of Donnelly et al. in the United States to the pediatric abdominal CT-AEC. Examining CT images of 100 children, we found that the sectional area of the hepatic portal region (y) was strongly correlated with the body weight (x) as follows: y=7.14x + 84.39 (correlation coefficient=0.9574). We scanned an elliptical cone phantom that simulates the human body using a pediatric abdominal CT scanning method of Donnelly et al. in, and measured SD values. We further scanned the same phantom under the settings for adult CT-AEC scan and obtained the relationship between the sectional areas (y) and the SD values. Using these results, we obtained the following preset noise factors for CT-AEC at each body weight range: 6.90 at 4.5-8.9 kg, 8.40 at 9.0-17.9 kg, 8.68 at 18.0-26.9 kg, 9.89 at 27.0-35.9 kg, 12.22 at 36.0-45.0 kg, 13.52 at 45.1-70.0 kg, 15.29 at more than 70 kg. From the relation between age, weight and the distance of liver and tuber ischiadicum of 500 children, we obtained the CTDIvol values and DLP values under the scanning protocol of Donnelly et al. Almost all of DRL from these values turned out to be smaller than the DRL data of IAEA and various countries. Thus, by setting the maximum current values of CT-AEC to be the Donnelly et al.'s age-wise current values, and using our weight-wise noise factors, we think we can perform pediatric abdominal CT-AEC scans that are consistent with the same radiation safety and the image quality as those proposed by Donnelly et al.
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Affiliation(s)
- Ken Furuya
- Department of Radiology, Municipal Kofu Hospital
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Power SP, Moloney F, Twomey M, James K, O’Connor OJ, Maher MM. Computed tomography and patient risk: Facts, perceptions and uncertainties. World J Radiol 2016; 8:902-915. [PMID: 28070242 PMCID: PMC5183924 DOI: 10.4329/wjr.v8.i12.902] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/29/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Since its introduction in the 1970s, computed tomography (CT) has revolutionized diagnostic decision-making. One of the major concerns associated with the widespread use of CT is the associated increased radiation exposure incurred by patients. The link between ionizing radiation and the subsequent development of neoplasia has been largely based on extrapolating data from studies of survivors of the atomic bombs dropped in Japan in 1945 and on assessments of the increased relative risk of neoplasia in those occupationally exposed to radiation within the nuclear industry. However, the association between exposure to low-dose radiation from diagnostic imaging examinations and oncogenesis remains unclear. With improved technology, significant advances have already been achieved with regards to radiation dose reduction. There are several dose optimization strategies available that may be readily employed including omitting unnecessary images at the ends of acquired series, minimizing the number of phases acquired, and the use of automated exposure control as opposed to fixed tube current techniques. In addition, new image reconstruction techniques that reduce radiation dose have been developed in recent years with promising results. These techniques use iterative reconstruction algorithms to attain diagnostic quality images with reduced image noise at lower radiation doses.
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Nassiri MA, Rouleau M, Després P. CT dose reduction: approaches, strategies and results from a province-wide program in Quebec. J Radiol Prot 2016; 36:346-362. [PMID: 27270762 DOI: 10.1088/0952-4746/36/2/346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Many studies have shown a statistically significant increase of life-time risk of radiation-induced cancer from CT examinations. In this context, in Canada, the Quebec's provincial clinical center of expertise in radiation safety (CECR) has led a province-wide tour of 180 CT installations in order to: (i) evaluate the technical and functional performance of CT scanners, (ii) evaluate and improve radiation safety practices and (iii) initiate, with local teams, a CT dose optimization process. The CT tour consisted of a two day visit of CT installations by a CECR multidisciplinary team of medical physicists, engineers and medical imaging technologists (MITs) carried out in close collaboration with local teams composed of MITs, radiologists, physicists, engineers and managers. The CECR has evaluated 112 CT scanners since 2011. Optimization of CT protocols was performed in all centers visited. The average dose reduction obtained from optimization was [Formula: see text], [Formula: see text] and [Formula: see text] for adult head, thorax and abdomen-pelvis, respectively. The main recommendations often made by the CECR experts were: (1) the implementation of low-dose protocols for the follow-up of pulmonary nodules and for renal calculi, (2) the compliance to the prescribed scan range as defined by local guidelines, (3) the correct positioning of patients and (4) the use of bismuth shielding to reduce the dose to radiosensitive organs. The CECR approach to optimize CT doses to patients is based on the active participation of local stakeholders and takes into account the performance of CT scanners. The clinical requirements as expressed by radiologists remain at the core of the optimization process.
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Affiliation(s)
- Moulay Ali Nassiri
- Centre d'expertise clinique en radioprotection (CECR), Sherbrooke (Québec), Canada. Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier universitaire de Sherbrooke (Québec), Canada
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Muhogora W, Ngoye W, Byorushengo E, Lwakatare F, Kalambo C. Paediatric doses during some common X-ray procedures at selected referral hospitals in Tanzania. Radiat Prot Dosimetry 2016; 168:253-260. [PMID: 25790826 PMCID: PMC4884876 DOI: 10.1093/rpd/ncv021] [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: 10/14/2014] [Revised: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to determine the radiation doses to paediatric patients of different age groups at three large hospitals for optimisation purposes. The entrance surface air kerma (ESAK) values were determined from the measured X-ray output values using calibrated ionisation chamber, TW 233612 and clinical patient parameters. The air kerma-area product (KAP) values were measured using a calibrated Diamentor E2 system. The volume computed tomography dose index (CTDIvol) and dose length product (DLP) values were obtained from the computed tomography (CT) equipment verified by a calibrated CT chamber, Unifors Xi CT. Irrespective of age groups, the results show that the median ESAK values ranged from 62.6 to 248.1 µGy. The median KAP values ranged from 135.6 to 1612 µGy cm(2), while the median DLP values ranged from 119.1 to 600 mGy cm. Analysis of the results indicates that optimisation can be achieved through good practice awareness and patient dose and image quality evaluations.
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Affiliation(s)
- W Muhogora
- Tanzania Atomic Energy Commission, Block J, Njiro, Arusha, Tanzania
| | - W Ngoye
- Tanzania Atomic Energy Commission, Block J, Njiro, Arusha, Tanzania
| | - E Byorushengo
- Tanzania Atomic Energy Commission, Block J, Njiro, Arusha, Tanzania
| | - F Lwakatare
- Muhimbili National Hospital, Mariki Road, Dar es Salaam, Tanzania
| | - C Kalambo
- Kilimanjaro Christian Medical Centre, Off Sokoine Road, Moshi, Tanzania
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Takei Y, Miyazaki O, Matsubara K, Shimada Y, Muramatsu Y, Akahane K, Fujii K, Suzuki S, Koshida K. Nationwide survey of radiation exposure during pediatric computed tomography examinations and proposal of age-based diagnostic reference levels for Japan. Pediatr Radiol 2016; 46:280-5. [PMID: 26494635 DOI: 10.1007/s00247-015-3474-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/02/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diagnostic reference levels (DRLs) have not been established in Japan. OBJECTIVE To propose DRLs for CT of the head, chest and abdomen for three pediatric age groups. MATERIALS AND METHODS We sent a nationwide questionnaire by post to 339 facilities. Questions focused on pediatric CT technology, exposure parameters, CT protocols, and radiation doses for age groups <1 year, 1-5 years, and 6-10 years. RESULTS For the three age groups in the 196 facilities that responded, the 75th percentile values of volume CT dose index based on a 16-cm phantom (CTDIvol 16 [mGy]) for head, chest and abdominal CT were for infants 39.1, 11.1 and 12.0, respectively; for 1-to 5-year-olds 46.9, 14.3 and 16.7, respectively; and for 6-to 10-year-olds 67.7, 15.0 and 17.0, respectively. The corresponding dose–length products (DLP 16 [mGy・cm]) for head, chest and abdominal CT were for infants 526.1, 209.1 and 261.5, respectively; for 1-to 5-year-olds 665.5, 296.0 and 430.8, respectively; and for 6-to 10-year-olds 847.9, 413.0 and 532.2, respectively. CONCLUSION The majority of CTDIvol 16 and DLP 16 values for the head were higher than DRLs reported from other countries. For risk reduction, it is necessary to establish DRLs for pediatric CT in Japan.
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Suliman II, Khamis HM, Ombada TH, Alzimami K, Alkhorayef M, Sulieman A. Radiation exposure during paediatric CT in Sudan: CT dose, organ and effective doses. Radiat Prot Dosimetry 2015; 167:513-518. [PMID: 25377750 DOI: 10.1093/rpd/ncu321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/24/2014] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to assess the magnitude of radiation exposure during paediatric CT in Sudanese hospitals. Doses were determined from CT acquisition parameters using CT-Expo 2.1 dosimetry software. Doses were evaluated for three patient ages (0-1, 1-5 and 5-10 y) and two common procedures (head and abdomen). For children aged 0-1 y, volume CT air kerma index (Cvol), air Kerma-length product and effective dose (E) values were 19.1 mGy, 265 mGy.cm and 3.1 mSv, respectively, at head CT and those at abdominal CT were 8.8 mGy, 242 mGy.cm and 7.7 mSv, respectively. Those for children aged 1-5 y were 22.5 mGy, 305 mGy.cm and 1.1 mSv, respectively, at head CT and 12.6 mGy, 317 mGy.cm, and 5.1 mSv, respectively, at abdominal CT. Dose values and variations were comparable with those reported in the literature. Organ equivalent doses vary from 7.5 to 11.6 mSv for testes, from 9.0 to 10.0 mSv for ovaries and from 11.1 to 14.3 mSv for uterus in abdominal CT. The results are useful for dose optimisation and derivation of national diagnostic reference levels.
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Affiliation(s)
- I I Suliman
- Department of Radiology and Molecular Imaging, Medical Physics Section, College of Medicine and Health Sciences, Sultan Qaboos University, PO Box 35, 123 Al-Khod, Oman Sudan Atomic Energy Commission, Radiation Safety Institute, PO Box 3001, Khartoum, Sudan
| | - H M Khamis
- Sudan Atomic Energy Commission, Radiation Safety Institute, PO Box 3001, Khartoum, Sudan
| | - T H Ombada
- Faculty of Science and Technology, Department of Medical Physics, Al-Neelain University, PO Box 12702, Khartoum, Sudan
| | - K Alzimami
- Department of Radiological Sciences, Applied Medical Sciences College, King Saud University, PO Box 10219, Riyadh 11433, Saudi Arabia
| | - M Alkhorayef
- Department of Radiological Sciences, Applied Medical Sciences College, King Saud University, PO Box 10219, Riyadh 11433, Saudi Arabia
| | - A Sulieman
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Salman Bin Abdulaziz University, PO Box 422, Alkharj 11943, Saudi Arabia
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Paolicchi F, Miniati F, Bastiani L, Faggioni L, Ciaramella A, Creonti I, Sottocornola C, Dionisi C, Caramella D. Assessment of radiation protection awareness and knowledge about radiological examination doses among Italian radiographers. Insights Imaging 2015; 7:233-42. [PMID: 26596570 PMCID: PMC4805619 DOI: 10.1007/s13244-015-0445-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/12/2015] [Accepted: 10/21/2015] [Indexed: 01/17/2023] Open
Abstract
Objectives To evaluate radiation protection basic knowledge and dose assessment for radiological procedures among Italian radiographers Methods A validated questionnaire was distributed to 780 participants with balanced demographic characteristics and geographic distribution. Results Only 12.1 % of participants attended radiation protection courses on a regular basis. Despite 90 % of radiographers stating to have sufficient awareness of radiation protection issues, most of them underestimated the radiation dose of almost all radiological procedures. About 5 % and 4 % of the participants, respectively, claimed that pelvis magnetic resonance imaging and abdominal ultrasound exposed patients to radiation. On the contrary, 7.0 % of the radiographers stated that mammography does not use ionising radiation. About half of participants believed that radiation-induced cancer is not dependent on age or gender and were not able to differentiate between deterministic and stochastic effects. Young radiographers (with less than 3 years of experience) showed a higher level of knowledge compared with the more experienced radiographers. Conclusions There is a substantial need for radiographers to improve their awareness of radiation protection issues and their knowledge of radiological procedures. Specific actions such as regular training courses for both undergraduate and postgraduate students as well as for working radiographers must be considered in order to assure patient safety during radiological examinations. Main messages • Radiographers should improve their knowledge on radiation protection issues. • Only 12.1 % of participants attended radiation protection courses on a regular basis. • Specific actions must be considered in order to increase knowledge and awareness.
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Affiliation(s)
- F Paolicchi
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy.
| | - F Miniati
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
| | - L Bastiani
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124, Pisa, Italy
| | - L Faggioni
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
| | - A Ciaramella
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
| | - I Creonti
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
| | - C Sottocornola
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
| | - C Dionisi
- Department of Medical Physics, Piazzale Ospedale 1, 31100, Treviso, Italy
| | - D Caramella
- Diagnostic and Interventional Radiology, Via Roma 67, 56100, Pisa, Italy
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Vassileva J, Rehani M, Kostova-Lefterova D, Al-Naemi HM, Al Suwaidi JS, Arandjic D, Bashier EHO, Kodlulovich Renha S, El-Nachef L, Aguilar JG, Gershan V, Gershkevitsh E, Gruppetta E, Hustuc A, Jauhari A, Kharita MH, Khelassi-Toutaoui N, Khosravi HR, Khoury H, Kralik I, Mahere S, Mazuoliene J, Mora P, Muhogora W, Muthuvelu P, Nikodemova D, Novak L, Pallewatte A, Pekarovič D, Shaaban M, Shelly E, Stepanyan K, Thelsy N, Visrutaratna P, Zaman A. A study to establish international diagnostic reference levels for paediatric computed tomography. Radiat Prot Dosimetry 2015; 165:70-80. [PMID: 25836685 DOI: 10.1093/rpd/ncv116] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The article reports results from the largest international dose survey in paediatric computed tomography (CT) in 32 countries and proposes international diagnostic reference levels (DRLs) in terms of computed tomography dose index (CTDI vol) and dose length product (DLP). It also assesses whether mean or median values of individual facilities should be used. A total of 6115 individual patient data were recorded among four age groups: <1 y, >1-5 y, >5-10 y and >10-15 y. CTDIw, CTDI vol and DLP from the CT console were recorded in dedicated forms together with patient data and technical parameters. Statistical analysis was performed, and international DRLs were established at rounded 75th percentile values of distribution of median values from all CT facilities. The study presents evidence in favour of using median rather than mean of patient dose indices as the representative of typical local dose in a facility, and for establishing DRLs as third quartile of median values. International DRLs were established for paediatric CT examinations for routine head, chest and abdomen in the four age groups. DRLs for CTDI vol are similar to the reference values from other published reports, with some differences for chest and abdomen CT. Higher variations were observed between DLP values, based on a survey of whole multi-phase exams. It may be noted that other studies in literature were based on single phase only. DRLs reported in this article can be used in countries without sufficient medical physics support to identify non-optimised practice. Recommendations to improve the accuracy and importance of future surveys are provided.
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Affiliation(s)
- J Vassileva
- International Atomic Energy Agency, Vienna, Austria
| | - M Rehani
- Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | | | | | - J S Al Suwaidi
- Medical Education Department, Dubai Health Authority, Dubai, UAE
| | - D Arandjic
- Radiation Protection Department, Vinca Institute of Nuclear Sciences, Belgrade, Serbia
| | | | | | - L El-Nachef
- Lebanese Atomic Eneregy Commission, Beirut, Lebanon
| | - J G Aguilar
- National Institute for Nuclear Research, Carretera Mexico-Toluca, La Marquesa, Ocoyoacac, Mexico
| | - V Gershan
- Institute of Physics, Ss Cyril and Methodius University, Skopje, The former Yugoslav Republic of Macedonia
| | | | | | - A Hustuc
- National Centre of Public Health, Chisinau, Republic of Moldova
| | - A Jauhari
- Pusat Kajian Radiografi dan Imajing, Depok, Indonesia
| | | | - N Khelassi-Toutaoui
- Département de Physique Médicale, Centre de Recherche Nucléaire D'Alger, Algiers, Algiers
| | - H R Khosravi
- National Radiation Protection Department, Iranian Nuclear Regulatory Authority, Tehran, Iran
| | - H Khoury
- Universidade Federal de Pernambuco, Cidade Universitaria, Recife PE, Brazil
| | - I Kralik
- State Office for Radiological and Nuclear Safety, Zagreb, Croatia
| | - S Mahere
- Children Clinical University Hospital, Riga, Latvia
| | - J Mazuoliene
- Hospital of Lithuanian University of Health Science Kauno Klinikos, Kaunas, Lithuania
| | - P Mora
- Centro de Investigación en Ciencias Atómicas, Nucleares y Moleculares, Universidad de Costa Rica, San José, Costa Rica
| | - W Muhogora
- Tanzania Atomic Energy Commission, Arusha, Tanzania
| | - P Muthuvelu
- Ministry of Health Malaysia, Putrajaya Wilayah Persekutuan, Malaysia
| | - D Nikodemova
- Slovak Medical University, Limbova, Bratislava, Slovakia
| | - L Novak
- National Radiation Protection Institute, Prague, Czech Republic
| | - A Pallewatte
- Department of Radiology, The National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - D Pekarovič
- Clinical Radiology Institute, University Medical Center, Ljubljana, Slovenia
| | - M Shaaban
- Al-Sabah Hospital, Kuwait City, Kuwait
| | - E Shelly
- Ministry of Health, Medical Technology and Infrastructure Administration, Jerusalem, Israel
| | - K Stepanyan
- Research Center of Radiation Medicine and Burns, Yerevan, Armenia
| | - N Thelsy
- Radiologist Ministry of Health, Yangon, Myanmar
| | - P Visrutaratna
- Faculty of Medicine, Department of Radiology, Chiang Mai University, Chiang Mai, Thailand
| | - A Zaman
- Institute of Nuclear Medicine and Oncology, PAEC, Lahore, Pakistan
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Vassileva J, Rehani M. Patient grouping for dose surveys and establishment of diagnostic reference levels in paediatric computed tomography. Radiat Prot Dosimetry 2015; 165:81-85. [PMID: 25836695 DOI: 10.1093/rpd/ncv113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There has been confusion in literature on whether paediatric patients should be grouped according to age, weight or other parameters when dealing with dose surveys. The present work aims to suggest a pragmatic approach to achieve reasonable accuracy for performing patient dose surveys in countries with limited resources. The analysis is based on a subset of data collected within the IAEA survey of paediatric computed tomography (CT) doses, involving 82 CT facilities from 32 countries in Asia, Europe, Africa and Latin America. Data for 6115 patients were collected, in 34.5 % of which data for weight were available. The present study suggests that using four age groups, <1, >1-5, >5-10 and >10-15 y, is realistic and pragmatic for dose surveys in less resourced countries and for the establishment of DRLs. To ensure relevant accuracy of results, data for >30 patients in a particular age group should be collected if patient weight is not known. If a smaller sample is used, patient weight should be recorded and the median weight in the sample should be within 5-10 % from the median weight of the sample for which the DRLs were established. Comparison of results from different surveys should always be performed with caution, taking into consideration the way of grouping of paediatric patients. Dose results can be corrected for differences in patient weight/age group.
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Affiliation(s)
- J Vassileva
- International Atomic Energy Agency, Vienna, Austria
| | - M Rehani
- Harvard Medical School and Massachusetts General Hospital, Boston, USA
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35
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Stanescu G, Rosca-Fartat G, Stanescu D. Justification of CT scans using referral guidelines for imaging. Radiat Prot Dosimetry 2015; 165:43-46. [PMID: 25805882 DOI: 10.1093/rpd/ncv060] [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: 06/04/2023]
Abstract
This study analyses the efficiency of the justification of individual computed tomography (CT) procedures using the good practice guide. The conformity of the CT scans with guide's recommendations was retrospectively analysed in a paediatric emergency hospital in Romania. The involved patient doses were estimated. The results show that around one-third of the examinations were not prescribed in conformity with the guide's recommendations, but these results are affected by unclear guide provisions, discussed here. The implications of the provisions of the revised International Atomic Energy Agency's Basic Safety Standards and of the Council Directive 2013/59/EURATOM were analysed. The education and training courses for medical doctors disseminating the provisions of the good practice guide should be considered as the main support for the justification of the CT scans at the individual level.
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Affiliation(s)
- G Stanescu
- National Institute for Physics and Nuclear Engineering 'Horia Hulubei' (IFIN-HH), Nuclear Training Centre (CPSDN), 30 Reactorului Street, MagureleBucharest 077125, Romania
| | - G Rosca-Fartat
- Public Health Directorate, Ionizing Radiation Hygiene Laboratory, 72-74 Avrig St., Bucharest 2 21578, Romania
| | - D Stanescu
- M.S. CURIE Emergency Clinical Hospital for Children Bucharest, 20 C. Brancoveanu Bv, Bucharest 4, Romania
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Jackson D, Atkin K, Bettenay F, Clark J, Ditchfield MR, Grimm JE, Linke R, Long G, Onikul E, Pereira J, Phillips M, Wilson F, Paul E, Goergen SK. Paediatric CT dose: a multicentre audit of subspecialty practice in Australia and New Zealand. Eur Radiol 2015; 25:3109-22. [PMID: 26037714 DOI: 10.1007/s00330-015-3727-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 10/28/2014] [Revised: 03/17/2015] [Accepted: 03/20/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate paediatric CT dosimetry in Australia and New Zealand and calculate size-specific dose estimates (SSDEs) for chest and abdominal examinations. METHODS Eight hospitals provided data from 12 CT systems for 1462 CTs in children aged 0-15. Imaging data were recorded for eight examinations: head (trauma, shunt), temporal bone, paranasal sinuses, chest (mass) and chest HRCT (high-resolution CT), and abdomen/pelvis (mass/inflammation). Dose data for cranial examinations were categorised by age and SSDEs by lateral dimension. Diagnostic reference ranges (DRRs) were defined by the 25th and 75th percentiles. Centralised image quality assessment was not undertaken. RESULTS DRRs for 201 abdominopelvic SSDEs were: 2.8-4.7, 3.6-11.5, 8.5-15.0, 7.6-15, and 10.6-16.2 for the <15 cm, 15-19 cm, 20-24 cm, 25-29 cm and >30 cm groups, respectively. For 147 chest examinations using these body width categories, SSDE DRRs were 2.0-4.4, 3.3-7.9, 4.0-9.4, 4.5-12, and 6.5-12. Kilovoltage peak (kVp), but not AEC or IR, was associated with SSDE (parameter estimate [standard error]: 0.12 (0.03); p < 0.0001). CONCLUSIONS Australian and New Zealand paediatric CT DRRs and abdominal SSDEs are comparable to international data. SSDEs for chest examinations are proposed. Dose variations could be reduced by adjusting kVp. KEY POINTS • SSDEs can be calculated for all patients, CT systems, and practices • Kilovoltage peak (kVp) has the greatest association with dose in similar-sized patients • Paediatric DRRs for CT are now available for use internationally.
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Affiliation(s)
- D Jackson
- Diagnostic Imaging, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - K Atkin
- Diagnostic Imaging, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - F Bettenay
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - J Clark
- Diagnostic Imaging, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - M R Ditchfield
- Diagnostic Imaging, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia
- Monash Children's, Clayton, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| | - J E Grimm
- Royal Australian and New Zealand College of Radiologists, Sydney, New South Wales, Australia
| | - R Linke
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - G Long
- Royal Children's Hospital, Brisbane, Queensland, Australia
| | - E Onikul
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - J Pereira
- Sydney Children's Hospital, Randwick, New South Wales, Australia
- The University of New South Wales, Kensington, New South Wales, Australia
| | - M Phillips
- Mater Children's Hospital, Brisbane, Queensland, Australia
| | - F Wilson
- Starship Children's Health, Auckland, New Zealand
| | - E Paul
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - S K Goergen
- Diagnostic Imaging, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia.
- Department of Surgery, Southern Clinical School, Monash University, Clayton, Victoria, Australia.
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Al Mahrooqi KMS, Ng CKC, Sun Z. Pediatric Computed Tomography Dose Optimization Strategies: A Literature Review. J Med Imaging Radiat Sci 2015; 46:241-249. [PMID: 31052099 DOI: 10.1016/j.jmir.2015.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 02/20/2015] [Accepted: 03/23/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Computed tomography (CT) dose optimization is an important issue in radiography because CT is the largest contributor to medical radiation dose and its use is increasing. However, CT dose optimization for pediatric patients could be more challenging than their adult counterparts. The purpose of this literature review was to identify and discuss the current pediatric CT dose saving techniques. Optimized pediatric protocols were also proposed. METHODS A comprehensive literature search was conducted using the Medline, ProQuest Health and Medical Complete, PubMed, ScienceDirect, Scopus, Springer Link, and Web of Science databases and the keywords CT, pediatric, optimization, protocol, and radiation dose to identify articles focusing on pediatric CT dose optimization strategies published between 2004 and 2014. RESULTS AND SUMMARY Seventy-seven articles were identified in the literature search. Strategies for optimizing a range of scan parameters and technical considerations including tube voltage and current, iterative reconstruction, diagnostic reference levels, bowtie filters, scout view, pitch, scan collimation and time, overscanning, and overbeaming for pediatric patients with different ages and body sizes and compositions were discussed. An example of optimized pediatric protocols specific to age and body size for the 64-slice CT scanners was devised. It is expected that this example could provide medical radiation technologists, radiologists, and medical physicists with ideas to optimize their pediatric protocols.
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Affiliation(s)
| | - Curtise Kin Cheung Ng
- Department of Medical Radiation Sciences, Curtin University, Perth, Western Australia, Australia.
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, Western Australia, Australia
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Smith-Bindman R, Moghadassi M, Wilson N, Nelson TR, Boone JM, Cagnon CH, Gould R, Hall DJ, Krishnam M, Lamba R, McNitt-Gray M, Seibert A, Miglioretti DL. Radiation Doses in Consecutive CT Examinations from Five University of California Medical Centers. Radiology 2015; 277:134-41. [PMID: 25988262 DOI: 10.1148/radiol.2015142728] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To summarize data on computed tomographic (CT) radiation doses collected from consecutive CT examinations performed at 12 facilities that can contribute to the creation of reference levels. MATERIALS AND METHODS The study was approved by the institutional review boards of the collaborating institutions and was compliant with HIPAA. Radiation dose metrics were prospectively and electronically collected from 199 656 consecutive CT examinations in 83 181 adults and 3871 consecutive CT examinations in 2609 children at the five University of California medical centers during 2013. The median volume CT dose index (CTDIvol), dose-length product (DLP), and effective dose, along with the interquartile range (IQR), were calculated separately for adults and children and stratified according to anatomic region. Distributions for DLP and effective dose are reported for single-phase examinations, multiphase examinations, and all examinations. RESULTS For adults, the median CTDIvol was 50 mGy (IQR, 37-62 mGy) for the head, 12 mGy (IQR, 7-17 mGy) for the chest, and 12 mGy (IQR, 8-17 mGy) for the abdomen. The median DLPs for single-phase, multiphase, and all examinations, respectively, were as follows: head, 880 mGy · cm (IQR, 640-1120 mGy · cm), 1550 mGy · cm (IQR, 1150-2130 mGy · cm), and 960 mGy · cm (IQR, 690-1300 mGy · cm); chest, 420 mGy · cm (IQR, 260-610 mGy · cm), 880 mGy · cm (IQR, 570-1430 mGy · cm), and 550 mGy · cm (IQR 320-830 mGy · cm); and abdomen, 580 mGy · cm (IQR, 360-860 mGy · cm), 1220 mGy · cm (IQR, 850-1790 mGy · cm), and 960 mGy · cm (IQR, 600-1460 mGy · cm). Median effective doses for single-phase, multiphase, and all examinations, respectively, were as follows: head, 2 mSv (IQR, 1-3 mSv), 4 mSv (IQR, 3-8 mSv), and 2 mSv (IQR, 2-3 mSv); chest, 9 mSv (IQR, 5-13 mSv), 18 mSv (IQR, 12-29 mSv), and 11 mSv (IQR, 6-18 mSv); and abdomen, 10 mSv (IQR, 6-16 mSv), 22 mSv (IQR, 15-32 mSv), and 17 mSv (IQR, 11-26 mSv). In general, values for children were approximately 50% those for adults in the head and 25% those for adults in the chest and abdomen. CONCLUSION These summary dose data provide a starting point for institutional evaluation of CT radiation doses.
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Affiliation(s)
- Rebecca Smith-Bindman
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Michelle Moghadassi
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Nicole Wilson
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Thomas R Nelson
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - John M Boone
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Christopher H Cagnon
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Robert Gould
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - David J Hall
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Mayil Krishnam
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Ramit Lamba
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Michael McNitt-Gray
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Anthony Seibert
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
| | - Diana L Miglioretti
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 350 Parnassus Ave, Suite 307C, San Francisco, CA 94143-0336 (R.S.B., M.M., N.W., R.G.); Department of Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, Calif (R.S.B.); Department of Radiology, University of California-San Diego, San Diego, Calif (T.R.N., D.J.H.); Department of Radiology (J.M.B., R.L., A.S.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.), University of California-Davis, Davis, Calif; Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (C.H.C., M.M.G.); Department of Radiological Sciences, University of California-Irvine, Irvine, Calif (M.K.); and Group Health Research Institute, Group Health Cooperative, Seattle, Wash (D.L.M.)
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Rehani MM. Multi-national findings on radiation protection of children. Pediatr Radiol 2014; 44 Suppl 3:475-8. [PMID: 25304707 DOI: 10.1007/s00247-014-3125-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 06/06/2014] [Accepted: 07/11/2014] [Indexed: 10/24/2022]
Abstract
This article reviews issues of radiation protection in children in 52 low-resource countries. Extensive information was obtained through a survey by the International Atomic Energy Agency (IAEA); wide-ranging information was available from 40 countries and data from the other countries pertained to frequency of pediatric CT examinations. Of note is that multi-detector CT (MDCT) was available in 77% of responses to the survey, typically nodal centers in these countries. Nearly 75% of these scanners were reported to have dose displays. The pediatric CT usage was lower in European facilities as compared to Asian and African facilities, where usage was twice as high. The most frequently scanned body part was the head. Frequent use of 120 kVp was reported in children. The ratio of maximum to minimum CT dose index volume (CTDIvol) values varied between 15 for abdomen CT in the age group 5-10 years and 100 for chest CT in the age group <1 year. In 8% of the CT systems, CTDI values for pediatric patients were higher than those for adults in at least one age group and for one type of examination. Use of adult protocols for children was associated with CTDIw or CTDIvol values in children that were double those of adults for head and chest examination and 50% higher for abdomen examination. Patient dose records were kept in nearly half of the facilities, with the highest frequency in Europe (55% of participating facilities), and in 49% of Asian, 36% of Latin American and 14% of African facilities. The analysis of the first-choice examinations in seven clinical conditions showed that practice was in accordance with guidelines for only three of seven specified clinical conditions.
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Rehani MM. CT imaging in a large part of the world: what we know and what we can learn. Pediatr Radiol 2014; 44 Suppl 3:511-4. [PMID: 25304713 DOI: 10.1007/s00247-014-3045-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/15/2014] [Accepted: 05/12/2014] [Indexed: 10/24/2022]
Abstract
This paper describes how cooperation among international organizations, as modeled in Europe, can work to improve imaging safety and standards for children throughout the world. This is demonstrated in the mechanisms employed in a large-scale multi-national study on CT imaging safety practices described elsewhere in this issue of Pediatric Radiology. Here we learn approaches through which CT safety standards have been achieved and the international resources available to help in standardizing safety practices in medical imaging. There are unique strengths of the approach in Europe, which has mandatory requirements on member states to facilitate strengthening of radiation protection. Most countries have national regulatory mechanisms for radiation protection in medicine. International organizations play a significant role in supporting projects in lower-resource countries such that a large proportion of radiologic professionals in low-resource countries are trained through assistance by these organizations. Many of these international organizations make it possible for professionals worldwide to download free training material. Collaboration among international organizations and the Image Gently campaign toward consensus with regard to radiation protection can go further than individual opinions in promoting a higher standard of radiation protection around the world.
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Paolicchi F, Faggioni L, Bastiani L, Molinaro S, Puglioli M, Caramella D, Bartolozzi C. Optimizing the balance between radiation dose and image quality in pediatric head CT: findings before and after intensive radiologic staff training. AJR Am J Roentgenol 2014; 202:1309-15. [PMID: 24848830 DOI: 10.2214/AJR.13.11741] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the radiation dose and image quality of pediatric head CT examinations before and after radiologic staff training. MATERIALS AND METHODS Outpatients 1 month to 14 years old underwent 215 unenhanced head CT examinations before and after intensive training of staff radiologists and technologists in optimization of CT technique. Patients were divided into three age groups (0-4, 5-9, and 10-14 years), and CT dose index, dose-length product, tube voltage, and tube current-rotation time product values before and after training were retrieved from the hospital PACS. Gray matter conspicuity and contrast-to-noise ratio before and after training were calculated, and subjective image quality in terms of artifacts, gray-white matter differentiation, noise, visualization of posterior fossa structures, and need for repeat CT examination was visually evaluated by three neuroradiologists. RESULTS The median CT dose index and dose-length product values were significantly lower after than before training in all age groups (27 mGy and 338 mGy ∙ cm vs 107 mGy and 1444 mGy ∙ cm in the 0- to 4-year-old group, 41 mGy and 483 mGy ∙ cm vs 68 mGy and 976 mGy ∙ cm in the 5- to 9-year-old group, and 51 mGy and 679 mGy ∙ cm vs 107 mGy and 1480 mGy ∙ cm in the 10- to 14-year-old group; p < 0.001). The tube voltage and tube current-time values after training were significantly lower than the levels before training (p < 0.001). Subjective posttraining image quality was not inferior to pretraining levels for any item except noise (p < 0.05), which, however, was never diagnostically unacceptable. CONCLUSION Radiologic staff training can be effective in reducing radiation dose while preserving diagnostic image quality in pediatric head CT examinations.
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Martin CJ, Le Heron J, Borrás C, Sookpeng S, Ramirez G. Approaches to aspects of optimisation of protection in diagnostic radiology in six continents. J Radiol Prot 2013; 33:711-734. [PMID: 24025449 DOI: 10.1088/0952-4746/33/4/711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There has been an expansion in the use of x-ray imaging during the last 20 years. Effective arrangements for justification of exposures as well as for optimisation of protection are crucial. The amount of effort put into the latter, the way in which it is organised and the groups carrying this out vary across the globe. A simple survey of organisational arrangements relating to performance testing of x-ray equipment, management of patient dose and other aspects of implementing optimisation has been undertaken. A total of 137 completed survey forms were received from medical physicists in 48 countries. Results for individual countries from which more responses were received, or for groups of neighbouring ones, are compared to portray variations. Some performance testing of x-ray equipment was mandated in most countries (more than 90%), with the tests being performed primarily by hospital or private medical physicists, although other groups are involved. Testing of equipment prior to clinical use was generally high for most regions, but the frequency was lower in Latin America. There was considerable variation in the frequency and regularity of subsequent testing. The prevalence of patient dose surveys was high in Europe, but lower in other continents. Organisational arrangements for testing performance of x-ray equipment, patient dose surveys and implementing optimisation of protection in medical exposures across the globe can be divided into five main groups. Hospital medical physicists take the lead in western Europe and Australia with the involvement of radiographers. Private medical physicists test equipment in Brazil, the USA and New Zealand, and have some responsibility for optimisation in Brazil. University personnel have significant involvement, together with medical physicists in eastern Europe, but the extent of the coverage is uncertain. Government personnel and service engineers carry out equipment testing in many countries of Africa and Asia, while radiographers have a significant role in Thailand and other countries where the number of medical physicists is limited. In order for dose surveys to have an impact, action must be taken upon the findings, but there must be an effective link between surveyors and radiology facility staff to ensure that this is done.
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Affiliation(s)
- C J Martin
- Health Physics, Gartnavel Royal Hospital, Glasgow G12 0XH, UK
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