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Guisantes R, Santos J, Ferreira AJ. Characterisation of Portuguese radiotherapy departments: Organisation, occupational exposure values and diagnostic reference levels for breast and prostate computed tomography planning. Radiography (Lond) 2024; 30:932-937. [PMID: 38657386 DOI: 10.1016/j.radi.2024.04.007] [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: 11/15/2023] [Revised: 03/25/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Portugal currently hosts 24 active radiotherapy departments, 8 public and 16 privates, presenting potential radiation exposure risks to multidisciplinary teams. Patients in these treatments also face ionising radiation during treatment planning and verification. METHODS Authorisation and ethical approval were secured for a national online survey, disseminated to radiotherapy departments across Portugal. The survey encompassed three sections: equipment, staff, and radiographer role characterisation; occupational exposure values for one month; and exposure parameters, including computed tomography (CT) dose values [CT dose index (CTDIvol) and dose length product (DLP)] for breast and prostate cancer CT planning. Local Diagnostic Reference Levels (DRLs) derived were based on the 75th percentile of median dose values. RESULTS The study garnered a 50% response rate from public institutions, 12,5% from private and 25% from all active radiotherapy institutions in Portugal. All departments employ Three-Dimensional Conformal Radiation Therapy (3D-CRT) and incorporate Intensity Modulated Radiation Therapy (IMRT) and/or Volumetric Modulated Arc Therapy (VMAT) irradiation techniques. Additionally, half of the departments also perform Brachytherapy (BT). Radiographers demonstrated an occupational dose of zero mSv. CT planning dose values were 13 mGy and 512 mGy cm for breast CT and 16 mGy and 689 mGy cm for prostate CT, pertaining to CTDIvol and DLP, respectively. CONCLUSION Most aspects of national radiotherapy characterisation align with the established literature. Occupational exposure values exhibited consistency across radiotherapy modalities. An approach to national DRLs was formulated for breast and prostate CT planning, yielding values congruent with recent European studies. IMPLICATIONS FOR PRACTICE This study offers vital insights for analysing occupational contexts and risk prevention, serving as the initial characterisation of the national radiotherapy landscape. It also pioneers the calculation of DRLs for CT planning in radiotherapy to optimise procedures.
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Affiliation(s)
- R Guisantes
- Unidade Local de Saúde de Coimbra, Radiotherapy Department, Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - J Santos
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854, Coimbra, Portugal.
| | - A J Ferreira
- Faculty of Medicine, University of Coimbra, Portugal.
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Simantirakis G, Hourdakis CJ, Kalathaki M, Liotsou V, Nikolaou M, Pafilis C, Thrapsanioti Z, Tritakis P, Carinou E. Updating national diagnostic reference levels for computed tomography in Greece: Challenges on patient protection optimisation. Eur J Radiol 2024; 175:111429. [PMID: 38508091 DOI: 10.1016/j.ejrad.2024.111429] [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: 11/28/2023] [Revised: 01/18/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
The escalating use of Computed Tomography (CT) imaging necessitates establishment and periodic revision of Diagnostic Reference Levels (DRLs) to ensure patient protection optimization. This paper presents the outcomes of a national survey conducted from 2019 to 2022, focusing on revising DRLs for adult CT examinations. Dosimetric data from 127 scanners in 120 medical facilities, representing 25% of the country's CT scanners, were collected, emphasizing geographic distribution and technology representation. Τhe parameters used for DRLs were the CTDIvol and the DLP of a typical acquisition of the region of interest (scan DLP). In addition to the 7 CT examination for which the DRL values were revised, establishment of DRLs for neck, cervical spine, pelvic bones-hips, coronary artery calcium (Ca) score and cardiac computed tomography angiography (CCTA) examinations was performed. Revised DRLs exhibited a 15 % average decrease in CTDIvol and a 7 % average decrease in scan DLP from the initial DRLs. This reduction of dosimetric values is relatively low compared to other national studies. The findings revealed wide variations in dosimetric values and scan lengths among scanners, emphasizing the need for standardization and optimization. Incorporation of advanced technologies like Iterative Reconstruction (IR) showcased potential for further dose reduction, yet challenges in uniform implementation persist. The study underscores the importance of ongoing optimisation efforts, particularly in the context of increased CT utilization and evolving technology. The revised DRLs have been officially adopted in Greece, emphasizing the commitment to safe and effective CT practices.
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Affiliation(s)
- George Simantirakis
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece.
| | - Costas J Hourdakis
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Maria Kalathaki
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Vasiliki Liotsou
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Magda Nikolaou
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Christos Pafilis
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Zoi Thrapsanioti
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Panagiotis Tritakis
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
| | - Eleftheria Carinou
- Greek Atomic Energy Commission, P.O. Box 60092, 153 10, Agia Paraskevi, Athens, Greece
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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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Costa H, Espírito-Santo M, Bispo J, Guedes J, Paulo G, Mimoso J, Palmeiro H, Baptista Gonçalves R, Vinhas H. Ionizing radiation exposure in complex percutaneous coronary intervention: Defining local diagnostic reference levels in the catheterization laboratory. Rev Port Cardiol 2024:S0870-2551(24)00014-3. [PMID: 38336222 DOI: 10.1016/j.repc.2023.10.010] [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: 02/14/2023] [Revised: 09/22/2023] [Accepted: 10/07/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Concerns regarding the consequences of ionizing radiation (IR) have been increasing in the field of interventional cardiology (IC). There is little information on reported national and local radiation diagnostic reference levels (DRLs) in catheterization laboratories in Portugal. This study was designed to assess the IR dose exposure during complex percutaneous coronary intervention (PCI), and to set the respective DRLs and future achievable doses (ADs). METHODS This was a retrospective cohort study which took place between 2019 and 2020, including patients who underwent complex PCI. Complex PCI was defined as all procedures that encompass treatment of chronic total occlusions (CTO) or left main coronary artery. DRLs were defined as the 75th percentile of the distribution of the median values of air kerma area product (PKA) and cumulative air kerma (Ka,r). ADs were set at the 50th percentile of the study dose distribution. Multivariate analysis was performed using linear regression to identify predictors significantly associated with radiation dose (Ka,r). RESULTS A total of 242 patients were included in the analysis. Most patients underwent a CTO procedure (146, 60.3%). Patients were aged 67.9±11.2 years and mostly male (81.4%). DRLs were set in Ka,r (3012 mGy) and PKA (162 Gy cm2) for complex PCI. ADs were also set in Ka,r (1917 mGy) and PKA (101 Gy cm2). Independent predictors of Ka,r with a positive correlation were PKA (0.893, p<0.001), fluoroscopy time (0.520, p<0.001) and PCI time (0.521, p<0.001). CONCLUSIONS This study reports the results of IR in complex PCI. DRLs were set for IR dose exposure measured in Ka,r (3012 mGy) and PKA (162 Gy cm2). ADs, values to be achieved in future assessment, were set to Ka,r (1917 mGy) and PKA (101 Gy cm2).
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Affiliation(s)
- Hugo Costa
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
| | | | - João Bispo
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - João Guedes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Graciano Paulo
- Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Coimbra, Portugal
| | - Jorge Mimoso
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Hugo Palmeiro
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | | | - Hugo Vinhas
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
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Arriaga A, Gonçalves C, Teles P, Santos J, Simãozinho P, Sousa P. Establishment of local diagnostic reference levels for abdomen and chest radiographies in the region of Algarve, Portugal. Eur J Radiol 2024; 170:111248. [PMID: 38103493 DOI: 10.1016/j.ejrad.2023.111248] [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: 07/05/2023] [Revised: 10/16/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To assess doses variabilities in the same abdomen and chest RX exams for adults, to check the need for dose harmonization. To calculate Diagnostic Reference Levels (DRL), mandatory in the European Union, for the Algarve district in Portugal. Our results can be a valuable reference for the Portuguese official determination of DRLs, still in progress. METHOD We considered 4,936 abdomen and 41,320 chest radiographs of adults, covering 7 health centres and 35 radiographers in Algarve. Entrance skin dose (ESD) was calculated for each radiograph and the corresponding uncertainty estimated. Mean doses per centre and per technician, and their uncertainties, were calculated to access dose variabilities. DRLs, set at the 3rd quartile of the total ESD distribution, were determined for a standard patient and for intervals of body mass index (BMI) to study their correlation with patient anatomical variations. Standard quartile errors were estimated. RESULTS Our results suggest significant dispersion in applied ESDs among different centres and radiographers. Estimates of DRLs also show small fluctuations across years and an important dependence on BMI intervals. For a standard patient, they are 8.7 ± 0.1 (abdomen) and 0.44 ± 0.01 (chest), while the European DRLs are, respectively, 5.1 and 0.2 (all in mGy). CONCLUSIONS Results suggest that there is room for dose optimization and harmonization with European DRLs, urging a national dose survey and the establishment of official national DRLs. Official DRLs in intervals of BMI would be quite beneficial, to avoid unnecessary dose exposures.
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Affiliation(s)
- A Arriaga
- Departamento de Física da Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal.
| | - Cláudia Gonçalves
- Departamento de Física da Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal; Centro Oncológico Dra Natalia Chaves, Joaquim Chaves Saúde, Rua Manuel Anastácio Alves, 2 2795-533 Carnaxide, Portugal
| | - P Teles
- Departamento de Física e Astronomia da Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, s/n, 4169-007 Porto, Portugal; Centro de Investigação do IPO-PORTO, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Joana Santos
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal
| | - Paula Simãozinho
- Administração Regional de Saúde, Algarve, Largo de São Pedro,15, 8000-145 Faro, Portugal
| | - Patrick Sousa
- GyRad, Lda, University of Algarve, Gambelas campus, Pav. H5, 8005-139 Faro, Portugal
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Oliveira Bernardo M, Karout L, Morgado F, Ebrahimian S, Sarmet Santos A, Amorim C, Muniz Filho H, Moscatelli A, Francisco Muglia V, Schroeder H, Moulin Sales D, Gandolpho Henschel R, Giovanni Valese B, Kiipper F, Cesar Cavalcanti P, Lucena R, Jornada T, de Paula V, Zago M, Varella R, Anes M, Márcio Alves Pinheiro A, Claúdio de Moura Carvalho L, Santana de Melo Tapajos J, Antonio de Almeida F, Applegate K, Paulo G, Roberto Costa P. Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study. Eur J Radiol 2023; 169:111191. [PMID: 37976761 DOI: 10.1016/j.ejrad.2023.111191] [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: 08/09/2023] [Revised: 10/11/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Diagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based - DRL(DRLCI) and clinical indication - AD (ADCI) for adult CT in Brazil. METHODS The prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test. RESULTS In majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection. CONCLUSIONS There was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.
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Affiliation(s)
| | - Lina Karout
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Shadi Ebrahimian
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA.
| | | | - Clarissa Amorim
- Complexo Hospitalar de Niterói, Niterói, Rio de Janeiro, Brazil.
| | | | | | - Valdair Francisco Muglia
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Henrique Schroeder
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | | | | | | | | | | | - Ronaldo Lucena
- Unimed Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Tiago Jornada
- Hospital das Clínicas de Recife, Recife, Pernambuco, Brazil.
| | - Valnir de Paula
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Marcel Zago
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ricardo Varella
- Hospital Unimed de Vitória, Vitória, Espírito Santo, Brazil.
| | - Mauricio Anes
- Hospital das Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | | | | | | | - Kimberly Applegate
- University of Kentucky College of Medicine, Department of Radiology, Lexington, KY, USA.
| | - Graciano Paulo
- Escola Superior de Tecnologia da Saúde do Instituto Politécnico de Coimbra, Coimbra, Portugal.
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Tzanis E, Damilakis J. A neural network-enhanced methodology for the rapid establishment of local DRLs in interventional radiology: EVAR as a case example. Phys Med 2023; 114:103140. [PMID: 37741153 DOI: 10.1016/j.ejmp.2023.103140] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/28/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023] Open
Abstract
PURPOSE To develop a neural network-enhanced workflow for the automatic and rapid establishment/update of local diagnostic reference levels (DRLs) in interventional radiology (IR) using endovascular aneurysm repair (EVAR) procedures as a case example. METHODS Radiation dose reports were collected retrospectively for 46 consecutive EVAR procedures. These reports served as demonstrative data for the development of the proposed methodology. An algorithm was developed to receive multiple dose reports, automatically extract the kerma area product (KAP), air kerma (Ka,r), number of exposure images, and fluoroscopy time (FT) from each report and calculate the first, second, third quartiles as well as the maximum and minimum values of the extracted parameters. To extract the values of interest from the dose reports, Tesseract, an open-source optical character recognition (OCR) engine was employed. Furthermore, the accuracy and time efficiency of the proposed methodology were assessed. Specifically, the values extracted from the algorithm were compared with the ground truth values and the algorithm's processing time was compared with the respective time needed to manually extract and process the values of interest. RESULTS The OCR-based algorithm managed to correctly recognize 182 from the 184 target values, resulting in an accuracy of 99%. Moreover, the proposed pipeline reduced the processing time for the establishment of DRLs by 98%. DRL value for EVAR procedures, set as the third quartile of KAP was found to be 551 Gy*cm2. CONCLUSION An accurate and time-efficient workflow was developed for the establishment of local DRLs in interventional radiology.
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Affiliation(s)
- Eleftherios Tzanis
- Department of Medical Physics, School of Medicine, University of Crete, P.O. Box 2208, 71003 Heraklion, Crete, Greece
| | - John Damilakis
- Department of Medical Physics, School of Medicine, University of Crete, P.O. Box 2208, 71003 Heraklion, Crete, Greece.
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Aboul Hamad MS, Attalla EM, Amer HH, Fathy MM. Assessment of diagnostic reference levels for paediatric cardiac computed tomography in accordance with European guidelines. Radiat Environ Biophys 2023:10.1007/s00411-023-01031-6. [PMID: 37349577 DOI: 10.1007/s00411-023-01031-6] [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] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/20/2023] [Indexed: 06/24/2023]
Abstract
Recently, paediatric cardiac computed tomography (CCT) has caused concerns that diagnostic image quality and dose reduction may require further improvement. Consequently, this study aimed to establish institutional (local) diagnostic reference levels (LDRLs) for CCT for paediatric patients, and assess the impact of tube voltage on proposed DRLs in terms of the volume computed tomography index (CTDIvol) and dose length product (DLP). In addition, effective doses (EDs) of exposure were estimated. A population of 453 infants, whose mass and age were less than 12 kg and 2 years, respectively, were considered from January 2018 to August 2021. Based on previous studies, this number of patients was considered to be sufficient for establishing LDRLs. A group of 245 patients underwent CCT examinations at 70 kVp tube voltage with an average scan range of 23.4 cm. Another set of 208 patients underwent CCT examinations at 100 kVp tube voltage with an average scan range of 15.8 cm. The observed CTDIvol and DLP values were 2.8 mGy and 54.8 mGy.cm, respectively. The mean effective dose (ED) was 1.2 mSv. It is concluded that provisional establishment and use of DRLs for cardiac computed tomography in children are crucial, and further research is needed to develop regional and international DRLs.
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Affiliation(s)
- Mohamed S Aboul Hamad
- Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt.
- Radiology Department, ALNas Hospital, Cairo, Egypt.
| | - Ehab M Attalla
- National Cancer Institute, Cairo University, Giza, Egypt
| | - Hanan H Amer
- Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt
| | - Mohamed M Fathy
- Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt
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Guðjónsdóttir J, Michelsen SS, Björnsdóttir G, Guðmundsdóttir VK. CT doses based on clinical indications. New national DRL's in Iceland. Phys Med 2023; 109:102576. [PMID: 37043969 DOI: 10.1016/j.ejmp.2023.102576] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/09/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023] Open
Abstract
A diagnostic reference level (DRL) is an investigation level to use in the optimization of a medical exposure using ionizing radiation. The aim of this project was to gather dose data from computed tomography (CT) studies in Iceland with the purpose of updating existing national DRL and proposing DRLs based on clinical indications. Dose data (total dose length product (DLP) and CT dose index) were retrospectively collected from all CT scanners in Iceland for 50 patients for all common CT studies. After cleaning the data, the data set contained total DLP for 8129 patients. Considering dose-relevant parameters such as the number of phases and scan length, each CT study was assigned to one of 42 study types and (at least) one clinical indication. Data were received from seven or more scanners for 13 clinical indications and from all scanners providing coronary angiography. There was considerable variation in the median total DLP from different scanners, e.g., from 13 to 139 mGycm for Sinusitis, and, the range of individual total DLPs varied between scanners. This underscores the importance of monitoring patients' exposure. The study shows that there is room for optimization. New Icelandic NDRLs were proposed for the total DLP of CT examinations based on ten different indications, including: Brain ischemia (1060 mGycm), Interstitial lung disease (310 mGycm) and Appendicitis (690 mGycm). The proposed NDRLs were the first clinical indication based NDRLs in Iceland. The Icelandic Radiation Safety Authority has decided to update the NDRLs based on the results of this study.
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Affiliation(s)
- Jónína Guðjónsdóttir
- Icelandic Radiation Safety Authority. Rauðarárstígur 10, 105 Reykjavík, Iceland; University of Iceland, Faculty of Medicine. Vatnsmýrarvegur 16, 101 Reykjavík, Iceland.
| | - Sigurbjörg Sigurðard Michelsen
- University of Iceland, Faculty of Medicine. Vatnsmýrarvegur 16, 101 Reykjavík, Iceland; Icelandic Heart Association. Holtasmári 1, 201 Kópavogur, Iceland.
| | - Guðlaug Björnsdóttir
- University of Iceland, Faculty of Medicine. Vatnsmýrarvegur 16, 101 Reykjavík, Iceland; Icelandic Heart Association. Holtasmári 1, 201 Kópavogur, Iceland.
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Wollschläger D, Jahnen A, Hermen J, Giussani A, Stamm G, Borowski M, Huisinga C, Mentzel HJ, Braun J, Sigmund G, Wagner J, Adolph J, Gunschera J, Koerber F, Schiefer A, Müller B, Lenzen H, Doering T, Entz K, Kunze C, Starck P, Staatz G, Mildenberger P, Pokora R. Pediatric computed tomography doses in Germany from 2016 to 2018 based on large-scale data collection. Eur J Radiol 2023; 163:110832. [PMID: 37059005 DOI: 10.1016/j.ejrad.2023.110832] [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: 07/25/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE Accumulating evidence from epidemiological studies that pediatric computed tomography (CT) examinations can be associated with a small but non-zero excess risk for developing leukemia or brain tumor highlights the need to optimize doses of pediatric CT procedures. Mandatory dose reference levels (DRL) can support reduction of collective dose from CT imaging. Regular surveys of applied dose-related parameters are instrumental to decide when technological advances and optimized protocol design allow lower doses without sacrificing image quality. Our aim was to collect dosimetric data to support adapting current DRL to changing clinical practice. METHOD Dosimetric data and technical scan parameters from common pediatric CT examinations were retrospectively collected directly from Picture Archiving and Communication Systems (PACS), Dose Management Systems (DMS), and Radiological Information Systems (RIS). RESULTS We collected data from 17 institutions on 7746 CT series from the years 2016 to 2018 from examinations of the head, thorax, abdomen, cervical spine, temporal bone, paranasal sinuses and knee in patients below 18 years of age. Most of the age-stratified parameter distributions were lower than distributions from previously-analyzed data from before 2010. Most of the third quartiles were lower than German DRL at the time of the survey. CONCLUSIONS Directly interfacing PACS, DMS, and RIS installations allows large-scale data collection but relies on high data-quality at the documentation stage. Data should be validated by expert knowledge or guided questionnaires. Observed clinical practice in pediatric CT imaging suggests lowering some DRL in Germany is reasonable.
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Affiliation(s)
- Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology (LIST), Esch-sur-Alzette, Luxembourg
| | - Johannes Hermen
- Luxembourg Institute of Science and Technology (LIST), Esch-sur-Alzette, Luxembourg
| | | | - Georg Stamm
- Department of Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Markus Borowski
- Department of Radiology and Nuclear Medicine, Städtisches Klinikum Braunschweig, Braunschweig, Germany
| | - Carolin Huisinga
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Hans-Joachim Mentzel
- Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Jochen Braun
- Diagnosticum Neuburg MVZ, Neuburg an der Donau, Germany
| | | | - Joachim Wagner
- Institute for Radiology and Interventional Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Juergen Adolph
- Department of Radiology, Klinikum Worms gGmbH, Worms, Germany
| | - Jana Gunschera
- Department of Radiology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - Friederike Koerber
- Institute for Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Anna Schiefer
- Pediatric Radiology, Klinikum Nuremberg, Nuremberg, Germany
| | - Birgit Müller
- Institute of Medical Physics, Klinikum Nuremberg, Nuremberg, Germany
| | - Horst Lenzen
- Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | | | - Kathrin Entz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Kunze
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Peter Starck
- Institute for Diagnostic and Interventional Radiology, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Gundula Staatz
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology. University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter Mildenberger
- Department of Diagnostic and Interventional Radiology. University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roman Pokora
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Damilakis J, Frija G, Brkljacic B, Vano E, Loose R, Paulo G, Brat H, Tsapaki V. How to establish and use local diagnostic reference levels: an ESR EuroSafe Imaging expert statement. Insights Imaging 2023; 14:27. [PMID: 36746832 PMCID: PMC9902573 DOI: 10.1186/s13244-023-01369-x] [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: 10/28/2022] [Accepted: 12/29/2022] [Indexed: 02/08/2023] Open
Abstract
Abstract Although the Diagnostic Reference Levels (DRLs) have been shown to be an important tool for optimising patient radiation protection, there are still difficulties related to the methodology that should be used to establish and use local DRL values. This statement represents the current view of the EuroSafe Imaging ‘Clinical DRLs’ working group formed with the purpose to produce scientific and educational material on DRLs and promote the concept of local DRLs. Guidelines on how to establish and how to use local DRLs presented herein can be implemented using a multidisciplinary team approach. Local DRLs are easy to determine and implement and they reflect local equipment performance and local clinical needs. They can be updated more frequently than the national DRLs, especially if a dose management system is available. To establish local DRLs, a practical approach could be to collect a reasonable set, i.e., at least 20–30 procedures, of data for well-defined clinical indications and calculate the 3rd quartile values. The median values of the distribution can be set to define the ‘typical values’. The International Commission of Radiological Protection (ICRP) suggests setting ‘typical values’ for newer technologies that enable decreased amounts of radiation exposure for a similar level of image quality. Local DRLs should be similar or lower to the national DRLs. They could be higher only if the clinical benefits for some medical indications are fully explained and reported. Local DRLs may be used as a quality benchmark to track outliers and can be also used as alert values. Key points Guidelines on how to establish and use local DRLs are presented. Local DRLs are easy to determine and implement and can be updated frequently Additionally, local DRLs can be used to track outliers.
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Affiliation(s)
- John Damilakis
- School of Medicine, University of Crete, Iraklion, Crete, Greece.
| | - Guy Frija
- grid.5842.b0000 0001 2171 2558Université de Paris, 12 Rue de L’École de Médecine, 75006 Paris, France
| | - Boris Brkljacic
- grid.4808.40000 0001 0657 4636School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Eliseo Vano
- grid.4795.f0000 0001 2157 7667Complutense University, Madrid, Spain
| | - Reinhard Loose
- Institute of Medical Physics, Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419 Nuremberg, Germany
| | - Graciano Paulo
- grid.88832.390000 0001 2289 6301Medical Imaging and Radiotherapy Department, ESTESC-Coimbra Health School, Instituto Politécnico de Coimbra, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854 Coimbra, Portugal
| | - Hugues Brat
- Institut de Radiologie de Sion, Rue du Scex 2, 1950 Sion, Switzerland
| | - Virginia Tsapaki
- grid.414012.20000 0004 0622 6596Medical Physics, Konstantopoulio General Hospital, Nea Ionia, Greece
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Abstract
BACKGROUND Increased radiation doses from computed tomography (CT) examinations is well known with proven risks of inducing cancers for effective dose >100 mSv (according to some studies >50 mSvs). PURPOSE To establish the diagnostic reference level (DRL) for low-dose renal CT examinations in the evaluation of renal stones. MATERIAL AND METHODS Patient demographics, CT parameters, and dosimetric indices (CTDIvol and dose length product [DLP]) were collected from 12 tertiary hospitals that routinely perform renal CT in the detection and evaluation of renal stones over a period of 12 weeks. Data obtained from 1418 average-sized patients in each category were recorded. The median values of dosimetric indices for each site were calculated. The DRL values were defined as the 75th percentile of the distribution of the median values of CTDIvol and DLP. RESULTS There were no significant differences between patient demographics. Mean kVp and mAs for protocols were 121.67 ± 11.56 and 226.91 ± 78.44, respectively. The CTDIvol values were in the range of 2-36.2 mGy, while the DLP values were in the range of 43-1942 mGy.cm. The DRL for the CTDIvol was 16.15 mGy and for the DLP 851.77 mGy.cm. The local median values of CDTIvol and DLP are higher than DRL in two hospitals. CONCLUSION Comparison of local median values of CDTIvol and DLP with DRL suggests the needs of an optimization strategy in some hospitals.
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Affiliation(s)
- Mohammad Rawashdeh
- Department of Allied Medical Sciences, 108612Jordan University of Science and Technology, Irbid, Jordan
| | - Charbel Saade
- Medical Imaging Sciences, Faculty of Health Sciences, University College Cork, Cork, Ireland
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Arlany L, Toh HG, Nazir B, Ng JJ, Tay YH, Tay YS, Poon CJX, Lee LN, Fum WKS, Lee EYT, Mariah SI, Fortier MV, Tham WP, Chew LL, Chong KHE, Chong LR. Establishment of CT diagnostic reference levels (DRLs) for a Singapore healthcare cluster. Radiography (Lond) 2023; 29:184-189. [PMID: 36469993 DOI: 10.1016/j.radi.2022.11.002] [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: 08/26/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION The use of computed tomography (CT) in healthcare institutions has increased rapidly in recent years. The Singapore Health Services (SingHealth) cluster of healthcare institutions has taken the first step in establishing a local cluster-wide CT Diagnostic Reference Levels (DRL) in Singapore. CT dose data from each institution were collected through two primary dosimetry metrics: volume CT dose index (CTDIvol measured in mGy) and dose-length product (DLP measured in mGy.cm). METHODS Data from 19 CT scanners in seven institutions under one of Singapore healthcare cluster were retrospectively collected and analysed. The five common adult CT examinations analysed were CT Brain (non-contrast enhanced), CT Chest (IV contrast enhanced), CT Kidney-Ureter-Bladder (CT KUB, non-contrast enhanced), CT Pulmonary Angiogram (CT PA, IV contrast enhanced) and CT Abdomen-Pelvis (CT AP, IV contrast enhanced, single phase). Median CTDIvol and DLP values for the five CT examinations from each institution were derived, with the cluster DRLs determined as the 75th percentile of the distribution of the institution median dose values. RESULTS A total of 2413 dose data points were collected over a six-month period from June to November 2020. The cluster CT DRLs for the five CT examinations were determined to be 47 mGy and 820 mGy.cm for CT Brain, 5.4 mGy and 225 mGy.cm for CT Chest, 6.7 mGy and 248 mGy.cm for CT PA, 4.6 mGy and 190 mGy.cm for CT KUB and 6.9 mGy and 349 mGy.cm for CT AP. CONCLUSION The establishment of the cluster CT DRLs provided individual institutions with a better understanding if their CT doses are unusually high or low, while emphasising that these DRLs are not meant as hard dose limits or constraints to follow strictly.
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Affiliation(s)
- L Arlany
- Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886.
| | - H G Toh
- Singapore General Hospital, Outram Road Singapore, Singapore 169608
| | - B Nazir
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610
| | - J J Ng
- Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886
| | - Y H Tay
- Kandang Kerbau Hospital, 100 Bukit Timah Road, Singapore 229899
| | - Y S Tay
- Singapore General Hospital, Outram Road Singapore, Singapore 169608
| | - C J X Poon
- Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - L N Lee
- Singapore General Hospital, Outram Road Singapore, Singapore 169608
| | - W K S Fum
- Singapore General Hospital, Outram Road Singapore, Singapore 169608
| | - E Y T Lee
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609
| | - S I Mariah
- National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433
| | - M V Fortier
- Kandang Kerbau Hospital, 100 Bukit Timah Road, Singapore 229899
| | - W P Tham
- Singapore General Hospital, Outram Road Singapore, Singapore 169608
| | - L L Chew
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610
| | - K H E Chong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609
| | - L R Chong
- Changi General Hospital, 2 Simei Street 3, Singapore 529889
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Ahmad M, Liu X, Morani AC, Ganeshan D, Anderson MR, Samei E, Jensen CT. Oncology-specific radiation dose and image noise reference levels in adult abdominal-pelvic CT. Clin Imaging 2023; 93:52-59. [PMID: 36375364 PMCID: PMC9712239 DOI: 10.1016/j.clinimag.2022.10.016] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To provide our oncology-specific adult abdominal-pelvic CT reference levels for image noise and radiation dose from a high-volume, oncologic, tertiary referral center. METHODS The portal venous phase abdomen-pelvis acquisition was assessed for image noise and radiation dose in 13,320 contrast-enhanced CT examinations. Patient size (effective diameter) and radiation dose (CTDIvol) were recorded using a commercial software system, and image noise (Global Noise metric) was quantified using a custom processing system. The reference level and range for dose and noise were calculated for the full dataset, and for examinations grouped by CT scanner model. Dose and noise reference levels were also calculated for exams grouped by five different patient size categories. RESULTS The noise reference level was 11.25 HU with a reference range of 10.25-12.25 HU. The dose reference level at a median effective diameter of 30.7 cm was 26.7 mGy with a reference range of 19.6-37.0 mGy. Dose increased with patient size; however, image noise remained approximately constant within the noise reference range. The doses were 2.1-2.5 times than the doses in the ACR DIR registry for corresponding patient sizes. The image noise was 0.63-0.75 times the previously published reference level in abdominal-pelvic CT examinations. CONCLUSIONS Our oncology-specific abdominal-pelvic CT dose reference levels are higher than in the ACR dose index registry and our oncology-specific image noise reference levels are lower than previously proposed image noise reference levels. ADVANCES IN KNOWLEDGE This study reports reference image noise and radiation dose levels appropriate for the indication of abdomen-pelvis CT examination for cancer diagnosis and staging. The difference in these reference levels from non-oncology-specific CT examinations highlight a need for indication-specific, dose index and image quality reference registries.
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Affiliation(s)
- Moiz Ahmad
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
| | - Xinming Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
| | - Ajaykumar C Morani
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
| | - Dhakshinamoorthy Ganeshan
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
| | - Marcus R Anderson
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
| | - Ehsan Samei
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Clinical Imaging Physics Group, Medical Physics Graduate Program, Departments of Radiology, Physics, Biomedical Engineering, and Electrical and Computer Engineering, Duke University Medical Center, Durham, NC, United States of America.
| | - Corey T Jensen
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, Houston, TX 77030-4009, United States of America.
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15
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Ammon J, Loose R. [Radiation protection during fluoroscopic interventions]. Radiologie (Heidelb) 2022; 62:1079-1088. [PMID: 36416929 DOI: 10.1007/s00117-022-01087-3] [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] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Facts and figures about the frequencies of fluoroscopically guided interventions (FGI), typical patient exposures and occupational exposures are listed. Limits of radiation exposure do not exist for patients but only for occupationally exposed medical personnel. Measures for radiation protection of patients and personnel are explained. Nearly all technical radiation protection measures for patients also protect the personnel. To reduce the exposure of medical personnel, radiation protection equipment should be attached to the X‑ray modality and personal radiation protection equipment should be worn. The diagnostic reference values and the obligation to report incidents, including the reporting criteria, are explained. The radiation protection of patients and personnel for FGI in Germany is well regulated by diagnostic reference values, reporting criteria, prescribed or recommended protective measures, personal dosimetry and the obligation to involve medical physics experts.
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Affiliation(s)
- J Ammon
- Institut für Medizinische Physik, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - R Loose
- Institut für Medizinische Physik, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
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Gomes YE, Brown GC, Davies J, Parange N, Chau M. Establishing diagnostic reference levels for pediatric fluoroscopic examinations in a tertiary hospital. Pediatr Radiol 2022; 52:1296-305. [PMID: 35284948 DOI: 10.1007/s00247-022-05290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/13/2021] [Accepted: 01/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Diagnostic reference levels (DRLs) identify unusually high patient radiation exposures and are required for dose optimisation. DRLs for pediatric fluoroscopic examinations are not widely determined in Australia. OBJECTIVE Our objectives were to establish DRLs for pediatric fluoroscopic examinations in a South Australian tertiary hospital and compare these to previously published data and to explore relationships between patient dose area product (DAP), age and fluoroscopy times. MATERIALS AND METHODS Dose data from 365 pediatric patients undergoing 5 fluoroscopic examinations were retrospectively collected for a 3-year period commencing January 2018 to develop local DRLs. Relationships between DAP, age and fluoroscopy time were explored using scatterplots, Spearman's correlation, and regression analyses. RESULTS Local DRLs were significantly lower than data published previously, possibly reflecting technological and procedural advancements. Each 1-year increase in patient age was associated with a 0.77 μGy·m2 increase in DAP for barium meal and follow-through studies (95% confidence interval [CI]=0.055, 1.48) (P=0.04), and a 1.37 μGy·m2 increase in DAP for barium swallow studies (95% CI=0.61, 2.12) (P<0.001). A low correlation was demonstrated between DAP and fluoroscopy time for micturating cystourethrography studies (r=0.35, 95% CI=0.15, 0.51, P<0.001) and barium meal and follow-through studies (r=0.37, 95% CI= -0.011, 0.65, P=0.05). Age and fluoroscopy time were not significantly related. CONCLUSION This study provides updated Australian pediatric fluoroscopic DRLs, with the intention of promoting a national database for benchmarking pediatric doses. The local DRLs can be used for dose comparisons and optimisation between facilities.
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Wachabauer D, Beyer T, Ditto M, Gallowitsch HJ, Hinterreiter M, Ibi B, Malle P, Mirzaei S, Smetana F, Staudenherz A, Warwitz B, Zettinig G, Rausch I. Diagnostic Reference Levels for nuclear medicine imaging in Austria: A nationwide survey of used dose levels for adult patients. Z Med Phys 2022; 32:283-95. [PMID: 35067426 DOI: 10.1016/j.zemedi.2021.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess dose levels in routine nuclear medicine (NUC) procedures in Austria as a prior to a legislative update of the National Diagnostic Reference Levels (NDRL). METHOD As part of a nationwide survey of common NUC-examinations between June 2019 and November 2019, data sets were collected from 33 Austrian hospitals with NUC equipment. All hospitals were asked to report the NUC imaging devices in use (model, type, year of manufacture, detector material, collimators), the standard protocol parameters for selected examinations (standard activity, collimator, average acquisition time, reconstruction type, use of time-of-flight) and to report data from 10 representative examinations (e.g. injected activity, weight), incl. the most common NUC-examinations for planar imaging/SPECT and PET. Median/mean values for injected activity were calculated and compared to current Austrian and international NDRL. A Pearson correlation coefficient was computed comparing different variables. RESULTS In total, all 33 hospitals (100% response rate) reported data for this study for 60 SPECT devices, 21 PET/CT devices and 23 scintigraphy devices. Fixed activity values for scintigraphy/SPECT and PET were employed by about 90% and 56% of the hospitals, respectively. The most widely performed examinations for scintigraphy/SPECT are bone imaging, thyroid imaging, renal imaging (with MAG3/EC) and lung perfusion imaging (in 88% of the hospitals) and F-18 FDG-PET studies for oncology indications (in 100% of the hospitals). Significant correlations were found for patient weight and injected activity (scintigraphy/SPECT), use of iterative reconstruction and injected activity (PET) as well as size of field-of-view and injected activity (PET). CONCLUSIONS The reported injected activity levels were comparable to those in other countries. However, for procedures for which NDRL exist, deviations in injected activities of >20% compared to the NDRL were found. These deviations are assumed to result mainly from advances in technology but also from deviations between NDRL and prescribed activities as given in the information leaflets of the radiopharmaceuticals.
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Kadavigere R, Sukumar S. Estimation of radiation dose and establishment of local diagnostic reference levels for computed tomography of head in pediatric population. J Xray Sci Technol 2022; 30:983-991. [PMID: 35786667 DOI: 10.3233/xst-221172] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pediatric population is more sensitive to the effects of radiation than adults. Establishing diagnostic reference level (DRL) is an efficient dose optimization technique implemented by many countries for reducing radiation dose during Computed Tomography (CT) examinations. OBJECTIVES To estimate radiation dose and establish a new local diagnostic reference level for CT head examination in the pediatric population. MATERIALS AND METHODS We prospectively recruited 143 pediatric patients referred for CT head examination with age ranging from 0-5 years old. All patients had undergone CT head examination using the standard pediatric head protocol. Volumetric CT dose index (CTDIvol) and dose length product (DLP) were recorded. The effective dose was first calculated. Then, 75th percentile of dose indices was calculated to establish DRLs. RESULTS DRLs in terms of CTDIvol and DLP are 23.84 mGy, 555.99 mGy.cm for patients <1 years old and 28.65 mGy, 794.99 mGy.cm for patients from 1-5 years old, respectively. Mean effective doses for <1 years old patients and 1-5 years old patients are 2.91 mSv and 2.78 mSv respectively. CONCLUSION The study concludes that DRL in terms of CTDIvol is lower but DRL in terms of DLP and the effective dose is higher compared to a few other studies which necessitate the need for dose optimization.
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Affiliation(s)
- Rajagopal Kadavigere
- Department of Radio diagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Suresh Sukumar
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Forbes A, Geryes BH, Hornbeck A, Kien N, Quelquejay C, Adamsbaum C, Farah J, le Pointe HD. Harmonisation of imaging protocols, radiation doses and image quality in gastrointestinal fluoroscopy examinations - multicentre study. Pediatr Radiol 2022; 52:50-57. [PMID: 34657168 DOI: 10.1007/s00247-021-05194-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/24/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Paediatric gastrointestinal fluoroscopy examinations can impart varying amounts of radiation for the same patient size and exam type. OBJECTIVE To investigate the variability of imaging protocol, radiation dose and image quality in paediatric fluoroscopy examinations in order to provide recommendations for the harmonisation and optimisation of local practices. MATERIALS AND METHODS Five paediatric radiology departments performing fluoroscopically-guided contrast enema, micturating cystourethrography and upper gastrointestinal tract examinations participated in this study. Information on imaging protocols and radiation doses was retrospectively collected for more than 2,400 examinations. Image quality was analysed on clinical and phantom images. RESULTS Patient doses showed great variability among centers with up to a factor of 5 for similar fluoroscopy times. The five departments had imaging protocols with major differences in fluoroscopy dose regulation curves and additional filtration. Image quality analysis on phantoms and patients images showed no major improvement in contrast, spatial resolution or noise when increasing the radiation dose. Age-based diagnostic reference levels using both dose area product and fluoroscopy time were proposed per procedure type. CONCLUSION Disparities between centers and no correlation of radiation dose with image quality criteria create margins for optimisation. These results highlight the need for guidelines on fluoroscopy image quality and dose reference levels in paediatric gastrointestinal examinations to harmonise practices and optimise patient dose.
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Affiliation(s)
- Aurélie Forbes
- Radiology Department, Public Assistance - Paris Hospitals Antoine Béclère Hospital, 157 Rue de la Porte de Trivaux, 92140, Clamart, France.
| | - Bouchra Habib Geryes
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Necker-Enfants Malades University Hospital, Paris, France
| | - Amaury Hornbeck
- Radiology Department, Public Assistance - Paris Hospitals Armand-Trousseau Paediatric Hospital, Paris, France
- ALARA Expertise, Entzheim, France
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
| | - Nicolas Kien
- ALARA Expertise, Entzheim, France
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
| | - Caroline Quelquejay
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Necker-Enfants Malades University Hospital, Paris, France
| | - Catherine Adamsbaum
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Jad Farah
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Hubert Ducou le Pointe
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
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Ihn YK, Kim BS, Jeong HW, Suh SH, Won YD, Lee YJ, Kim DJ, Jeon P, Ryu CW, Suh SI, Choi DS, Choi SS, Kim SH, Byun JS, Rho J, Song Y, Jeong WS, Hong N, Baik SH, Park JJ, Lim SM, Kim JJ, Yoon W. Monitoring Radiation Doses during Diagnostic and Therapeutic Neurointerventional Procedures: Multicenter Study for Establishment of Reference Levels. Neurointervention 2021; 16:240-251. [PMID: 34695909 PMCID: PMC8561028 DOI: 10.5469/neuroint.2021.00437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/17/2021] [Accepted: 10/18/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To assess patient radiation doses during diagnostic and therapeutic neurointerventional procedures from multiple centers and propose dose reference level (RL). MATERIALS AND METHODS Consecutive neurointerventional procedures, performed in 22 hospitals from December 2020 to June 2021, were retrospectively studied. We collected data from a sample of 429 diagnostic and 731 therapeutic procedures. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time (FT), and total number of image frames (NI) were obtained. RL were calculated as the 3rd quartiles of the distribution. RESULTS Analysis of 1160 procedures from 22 hospitals confirmed the large variability in patient dose for similar procedures. RLs in terms of DAP, CAK, FT, and NI were 101.6 Gy·cm2, 711.3 mGy, 13.3 minutes, and 637 frames for cerebral angiography, 199.9 Gy·cm2, 3,458.7 mGy, 57.3 minutes, and 1,000 frames for aneurysm coiling, 225.1 Gy·cm2, 1,590 mGy, 44.7 minutes, and 800 frames for stroke thrombolysis, 412.3 Gy·cm2, 4,447.8 mGy, 99.3 minutes, and 1,621.3 frames for arteriovenous malformation (AVM) embolization, respectively. For all procedures, the results were comparable to most of those already published. Statistical analysis showed male and presence of procedural complications were significant factors in aneurysmal coiling. Male, number of passages, and procedural combined technique were significant factors in stroke thrombolysis. In AVM embolization, a significantly higher radiation dose was found in the definitive endovascular cure group. CONCLUSION Various RLs introduced in this study promote the optimization of patient doses in diagnostic and therapeutic interventional neuroradiology procedures. Proposed 3rd quartile DAP (Gy·cm2) values were 101.6 for diagnostic cerebral angiography, 199.9 for aneurysm coiling, 225.1 for stroke thrombolysis, and 412.3 for AVM embolization. Continual evolution of practices and technologies requires regular updates of RLs.
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Affiliation(s)
- Yon-Kwon Ihn
- Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hae Woong Jeong
- Department of Radiology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Yoo Dong Won
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Young-Jun Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Department of Radiology, Severance Hospital, Yonsei Unviersity College of Medicine, Seoul, Korea
| | - Pyong Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - See Sung Choi
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Sang Heum Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jun Soo Byun
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Jieun Rho
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yunsun Song
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Sang Jeong
- Department of Radiology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Noah Hong
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
| | - Soo Mee Lim
- Department of Radiology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Jung-Jae Kim
- Department of Neurosurgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Woong Yoon
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
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González-Ruíz A, Ou-Saada I, Isidro-Ortega FJ, Sánchez-Mendoza HI. Local dose reference levels during transarterial chemoembolization procedure. Appl Radiat Isot 2021; 178:109982. [PMID: 34655924 DOI: 10.1016/j.apradiso.2021.109982] [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: 04/08/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
Abstract
The aim of this study was to develop local diagnostic reference levels (LDRL) during Transarterial chemoembolization (TACE). This cross-sectional study reports radiation dose indicators of 108 patients in a Mexican hospital, obtained over a period of 35 months. Kerma-area product (PKA), air-kerma at the reference point (Ka, r), and descriptive statistical analysis were examined according to sociodemographic characteristics of the sample patients. The LDRL obtained were then compared to a similar international framework. The present study contributes to the establishment of a TACE LDRL and identifies significant correlations among radiology factors and dosimetric quantities obtained.
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Affiliation(s)
- Abraham González-Ruíz
- Universidad Autónoma del Estado de México, Paseo Tollocan S/N, Toluca, Estado de México, 50180, México
| | - Imane Ou-Saada
- Laboratory of High Energy Physics, Modelling and Simulations Faculty of Sciences Rabat, Mohammed V University, 4 Avenue Ibn Battouta B.P. 1014, Rabat, Morocco
| | - Frank Jhonatan Isidro-Ortega
- División de Estudios de Posgrado e Investigación, Instituto Tecnológico de Toluca, Metepec, 52149, Estado de México, México
| | - Helen's Irais Sánchez-Mendoza
- Instituto Nacional de Salud Pública, Fray Pedro de Gante 12, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México.
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Bos D, Yu S, Luong J, Chu P, Wang Y, Einstein AJ, Starkey J, Delman BN, Duong PT, Das M, Schindera S, Goode AR, MacLeod F, Wetter A, Neill R, Lee RK, Roehm J, Seibert JA, Cervantes LF, Kasraie N, Pike P, Pahwa A, Jeukens CRLPN, Smith-Bindman R. Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry. Eur Radiol 2021. [PMID: 34642811 DOI: 10.1007/s00330-021-08266-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 11/02/2022]
Abstract
OB JECTIVES The European Society of Radiology identified 10 common indications for computed tomography (CT) as part of the European Study on Clinical Diagnostic Reference Levels (DRLs, EUCLID), to help standardize radiation doses. The objective of this study is to generate DRLs and median doses for these indications using data from the UCSF CT International Dose Registry. METHODS Standardized data on 3.7 million CTs in adults were collected between 2016 and 2019 from 161 institutions across seven countries (United States of America (US), Switzerland, Netherlands, Germany, UK, Israel, Japan). DRLs (75th percentile) and median doses for volumetric CT-dose index (CTDIvol) and dose-length product (DLP) were assessed for each EUCLID category (chronic sinusitis, stroke, cervical spine trauma, coronary calcium scoring, lung cancer, pulmonary embolism, coronary CT angiography, hepatocellular carcinoma (HCC), colic/abdominal pain, appendicitis), and US radiation doses were compared with European. RESULTS The number of CT scans within EUCLID categories ranged from 8,933 (HCC) to over 1.2 million (stroke). There was greater variation in dose between categories than within categories (p < .001), and doses were significantly different between categories within anatomic areas. DRLs and median doses were assessed for all categories. DRLs were higher in the US for 9 of the 10 indications (except chronic sinusitis) than in Europe but with a significantly higher sample size in the US. CONCLUSIONS DRLs for CTDIvol and DLP for EUCLID clinical indications from diverse organizations were established and can contribute to dose optimization. These values were usually significantly higher in the US than in Europe. KEY POINTS • Registry data were used to create benchmarks for 10 common indications for CT identified by the European Society of Radiology. • Observed US radiation doses were higher than European for 9 of 10 indications (except chronic sinusitis). • The presented diagnostic reference levels and median doses highlight potentially unnecessary variation in radiation dose.
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Papanastasiou E, Protopsaltis A, Finitsis S, Hatzidakis A, Prassopoulos P, Siountas A. Institutional Diagnostic Reference Levels and Peak Skin Doses in selected diagnostic and therapeutic interventional radiology procedures. Phys Med 2021; 89:63-71. [PMID: 34352677 DOI: 10.1016/j.ejmp.2021.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/13/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Institutional (local) Diagnostic Reference Levels for Cerebral Angiography (CA), Percutaneous Transhepatic Cholangiography (PTC), Transarterial Chemoembolization (TACE) and Percutaneous Transhepatic Biliary Drainage (PTBD) are reported in this study. MATERIALS AND METHODS Data for air kerma-area product (PKA), air kerma at the patient entrance reference point (Ka,r), fluoroscopy time (FT) and number of images (NI) as well as estimates of Peak Skin Dose (PSD) were collected for 142 patients. Therapeutic procedure complexity was also evaluated, in an attempt to incorporate it into the DRL analysis. RESULTS Local PKA DRL values were 70, 34, 189 and 54 Gy.cm2 for CA, PTC, TACE and PTBD respectively. The corresponding DRL values for Ka,r were 494, 194, 1186 and 400 mGy, for FT they were 9.2, 14.2, 27.5 and 22.9 min, for the NI they were 844, 32, 602 and 13 and for PSD they were 254, 256, 1598 and 540 mGy respectively. PKA for medium complexity PTBD procedures was 2.5 times higher than for simple procedures. For TACE, the corresponding ratio was 1.6. PSD was estimated to be roughly 50% of recorded Ka,r for procedures in the head/neck region and 10% higher than recorded Ka,r for procedures in the body region. In only 5 cases the 2 Gy dose alarm threshold for skin deterministic effects was exceeded. CONCLUSION Procedure complexity can differentiate DRLs in Interventional Radiology procedures. PSD could be deduced with reasonable accuracy from values of Ka,r that are reported in every angiography system.
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Affiliation(s)
- Emmanouil Papanastasiou
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
| | - Athanasios Protopsaltis
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Stefanos Finitsis
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Adam Hatzidakis
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Panos Prassopoulos
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Anastasios Siountas
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Viry A, Aberle C, Lima T, Treier R, Schindera ST, Verdun FR, Racine D. Assessment of task-based image quality for abdominal CT protocols linked with national diagnostic reference levels. Eur Radiol 2021. [PMID: 34327581 DOI: 10.1007/s00330-021-08185-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/04/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022]
Abstract
Objectives To assess task-based image quality for two abdominal protocols on various CT scanners. To establish a relationship between diagnostic reference levels (DRLs) and task-based image quality. Methods A protocol for the detection of focal liver lesions was used to scan an anthropomorphic abdominal phantom containing 8- and 5-mm low-contrast (20 HU) spheres at five CTDIvol levels (4, 8, 12, 16, and 20 mGy) on 12 CTs. Another phantom with high-contrast calcium targets (200 HU) was scanned at 2, 4, 6, 10, and 15 mGy using a renal stones protocol on the same CTs. To assess the detectability, a channelized Hotelling observer was used for low-contrast targets and a non-prewhitening observer with an eye filter was used for high contrast targets. The area under the ROC curve and signal to noise ratio were used as figures of merit. Results For the detection of 8-mm spheres, the image quality reached a high level (mean AUC over all CTs higher than 0.95) at 11 mGy. For the detection of 5-mm spheres, the AUC never reached a high level of image quality. Variability between CTs was found, especially at low dose levels. For the search of renal stones, the AUC was nearly maximal even for the lowest dose level. Conclusions Comparable task-based image quality cannot be reached at the same dose level on all CT scanners. This variability implies the need for scanner-specific dose optimization. Key Points • There is an image quality variability for subtle low-contrast lesion detection in the clinically used dose range. • Diagnostic reference levels were linked with task-based image quality metrics. • There is a need for specific dose optimization for each CT scanner and clinical protocol.
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Vano E, Frija G, Loose R, Paulo G, Efstathopoulos E, Granata C, Andersson J. Dosimetric quantities and effective dose in medical imaging: a summary for medical doctors. Insights Imaging 2021; 12:99. [PMID: 34255191 PMCID: PMC8276901 DOI: 10.1186/s13244-021-01041-2] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
This review presents basic information on the dosimetric quantities used in medical imaging for reporting patient doses and establishing diagnostic reference levels. The proper use of the radiation protection quantity "effective dose" to compare doses delivered by different radiological procedures and different imaging modalities with its uncertainties and limitations, is summarised. The estimates of population doses required by the European Directive on Basic Safety Standards is commented on. Referrers and radiologists should be familiar with the dose quantities to inform patients about radiation risks and benefits. The application of effective dose on the cumulative doses from recurrent imaging procedures is also discussed. Patient summary: Basic information on the measurement units (dosimetric quantities) used in medical imaging for reporting radiation doses should be understandable to patients. The Working Group on "Dosimetry for imaging in clinical practice" recommended that a brief explanation on the used dosimetric quantities and units included in the examination imaging report, should be available for patients. The use of the quantity "effective dose" to compare doses to which patients are exposed to from different radiological procedures and its uncertainties and limitations, should also be explained in plain language. This is also relevant for the dialog on to the cumulative doses from recurrent imaging procedures. The paper summarises these concepts, including the need to estimate the population doses required by the European Directive on Basic Safety Standards. Referrers and radiologists should be familiar with the dose quantities to inform patients about radiation risks and benefits.
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Affiliation(s)
- Eliseo Vano
- Radiology Department, Complutense University, 28040, Madrid, Spain.
| | - Guy Frija
- Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
| | - Reinhard Loose
- Institute of Medical Physics, Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Graciano Paulo
- ESTESC-Coimbra Health School, Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854, Coimbra, Portugal
| | - Efstathios Efstathopoulos
- 2Nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Claudio Granata
- Department of Paediatric Radiology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Jonas Andersson
- Department of Radiation Sciences, Umea University, Umeå, Sweden
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Almén A, Guðjónsdóttir J, Heimland N, Højgaard B, Waltenburg H, Widmark A. Establishing paediatric diagnostic reference levels using reference curves - A feasibility study including conventional and CT examinations. Phys Med 2021; 87:65-72. [PMID: 34118729 DOI: 10.1016/j.ejmp.2021.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/14/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To derive Regional Diagnostic Reference Levels (RDRL) for paediatric conventional and CT examinations using weight-based DRL curves and compare the outcome with DRL derived using the weight groups. METHODS Data from 1722 examinations performed at 29 hospitals in four countries were included. DRL was derived for four conventional x-ray (chest, abdomen, pelvis, hips/joints) and two types of CT examinations (thorax, abdomen). DRL curves were derived using an exponential fit to the data using weight as an independent variable and the respective radiation dose indices (PKA, CTDIvol, DLP) as dependent variables. DRL was also derived for weight groups for comparison. The result was compared with national diagnostic reference level (NDRL) curves. RESULTS The derived curves show similarities with the NDRL curves available and corresponded sufficiently well with DRL for weight groups using the same data set, if sufficient number of data was available. CONCLUSIONS We conclude that weight-based DRL curves are a feasible approach and could be used together with DRL for weight groups. The main advantage of DRL curves is its application in the clinic. When the examination frequency is low, time to collect enough data to establish typical values for one or several weight groups may be unreasonably long. The curve provides the means to compare dose level faster and with fewer data points.
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Malan L, Pitcher RD, da Silva M, Breuninger S, Groenewald W. Diagnostic reference levels for fluoroscopically guided procedures in a South African tertiary hospital. Acta Radiol 2021; 62:807-814. [PMID: 32640888 DOI: 10.1177/0284185120938371] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The burgeoning usage and complexity of fluoroscopically guided procedures (FGPs) contribute to extended examination times and increased risk of adverse radiation effects. Diagnostic reference levels (DRLs) play a pivotal role in dose optimization. There are limited DRL data for FGPs in low- and middle-income countries (LMICs). PURPOSE To determine local DRLs (LDRLs) for common FGPs in the South African (SA) context and compare these with published international data. MATERIAL AND METHODS A three-year, retrospective study of the 15 most frequently performed FGPs at a SA institution. For each procedure, the 50th and 75th percentiles of kerma area product (KAP), reference point air kerma (Ka,r), and fluoroscopy time data were derived. Published international FGP DRL data were collated and compared with the 75th percentiles of local institutional dosage parameters. RESULTS The commonest FGPs were aorto-bifemoral diagnostic angiography (n = 590), aorto-bifemoral interventional angiography (n = 287), nephrostomy (n = 265), and bronchial arterial embolization (BAE) (n = 208). Selective abdominal vessel interventional angiography (KAP = 170 Gy . cm2; Ka,r = 877 mGy) recorded the highest LDRL dosages; BAE was the longest procedure (LDRL = 38 min). Nephrostomies achieved the lowest LDRLs across all parameters (KAP = 10 Gy . cm2; Ka,r = 63 mGy, fluoroscopy time = 4.3 min). All Tygerberg Hospital LDRLs with comprehensive comparable data were within or below published ranges. CONCLUSION This study advances international radiation protection initiatives, addresses the paucity of LMIC DRL data, demonstrates broad alignment of Tygerberg Hospital FGP practice with international norms and highlights areas for optimization of institutional practice.
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Affiliation(s)
- Leon Malan
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Richard D Pitcher
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Michelle da Silva
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Sharlene Breuninger
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Wilhelm Groenewald
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
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Hadid-Beurrier L, Dabli D, Royer B, Demonchy M, Le Roy J. Diagnostic reference levels during fluoroscopically guided interventions using mobile C-arms in operating rooms: A national multicentric survey. Phys Med 2021; 86:91-97. [PMID: 34062338 DOI: 10.1016/j.ejmp.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/01/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To establish diagnostic reference levels (DRLs) and achievable levels (ALs) for the most common fluoroscopically guided interventions (FGIs) performed in operating rooms using mobile C-arm equipment. METHODS A national survey was performed in 57 centers in France. Anonymous data from 6817 patients undergoing FGIs were prospectively collected over a period of 7 months. DRLs (third quartile of the distribution) and ALs (median of the distribution) were determined for each type of intervention in terms of kerma area product (KAP) and fluoroscopy time (FT). RESULTS DRLs and ALs were proposed for 31 procedure types related to seven surgical specialties: orthopedics (n = 9), urology (n = 3), vascular (n = 6), cardiology (n = 5), neurosurgery (n = 3), gastrointestinal (n = 3), and multi-specialty (n = 2). DRLs in terms of KAP ranged from 0.1 Gy·cm2 for hallux valgus to 78 Gy·cm2 for abdominal aortic aneurysm endovascular repair. A factor of 155 was obtained between the FTs for a herniated lumbar disk (0.2 min) and an abdominal aortic aneurysm endovascular repair (31 min). The highest variations were obtained within orthopedic procedures in terms of KAP (ratio 122) and within gastrointestinal procedures in terms of FT (ratio 9). Overall, the FGIs associated with the highest radiation exposure (KAP > 10 Gy·cm2) were found in the cardiology, vascular, and gastrointestinal specialties. CONCLUSIONS DRLs and ALs are suggested for a wide range of FGIs performed in operating rooms using a mobile C-arm. We aim at providing a practical optimization tool for medical physicists and surgeons.
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Affiliation(s)
- Lama Hadid-Beurrier
- Department of Medical Physics and Radiation Protection, APHP, Lariboisière Hospital, Paris University, Paris, France.
| | - Djamel Dabli
- Department of Medical Imaging, CHU Nîmes, Montpellier University, Medical Imaging Group Nîmes, EA 2415, France
| | - Brice Royer
- Department of Medical Physics, C2i santé, Maxéville, France
| | - Mathilde Demonchy
- Department of Medical Physics, Fréjus-Saint-Raphaël hospital, Fréjus, France
| | - Julien Le Roy
- Department of Medical Physics, Montpellier University Hospital, Montpellier, France
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Schegerer AA, Frija G, Paulo G, Jaschke W, Tsapaki V, Repussard J, Damilakis J. Radiation dose and diagnostic reference levels for four interventional radiology procedures: results of the prospective European multicenter survey EUCLID. Eur Radiol 2021; 31:9346-9360. [PMID: 33991223 DOI: 10.1007/s00330-021-08029-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 01/29/2021] [Revised: 04/02/2021] [Accepted: 04/29/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess information reflecting radiation dose and define diagnostic reference levels (DRL) on a European basis for four interventional radiology (IR) procedures considering clinical indication, anatomical region, and procedure. METHODS A prospective European study was performed to provide data on the IR procedures percutaneous recanalization of iliac arteries, percutaneous recanalization of femoropopliteal arteries, transarterial chemoembolization of hepatocellular carcinoma, and percutaneous transhepatic biliary drainage. Hospitals were asked to complete a questionnaire giving information on procedure, equipment, and protocol. Patient size and weight, experience of the operator graded in number of procedures performed, and complexity level of each procedure were reported. Sixteen hospitals from 13 countries could be surveyed. The percentiles of the kerma-area product, fluoroscopy time, cumulative air kerma at the interventional reference point, and number of images were determined. The impact of equipment, year of installation, and complexity level of the procedure on dose were analyzed. RESULTS DRLs based on clinical indication were defined. Dose values varied considerably within hospitals, between them, and within each subgroup of complexity level. The use of state-of-the-art equipment reduced dose significantly by 52%. Although dose also varied within each subgroup of complexity level, for transarterial chemoembolization of hepatocellular carcinoma and percutaneous transhepatic biliary drainage, dose significantly correlated with complexity. CONCLUSIONS This was the first study reporting exposure practice and defining DRLs based on clinical indication for four IR procedures on a European basis. These DRLs can serve as a baseline for comparison with local practice, the study as a guideline for future surveys. KEY POINTS • The use of state-of-the-art angiographic equipment reduces dose significantly. • A significant correlation between radiation dose and complexity level is found. • Dose values vary considerably, both within and between individual hospitals, and within each complexity level of interventional radiology procedure.
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Affiliation(s)
- Alexander A Schegerer
- Department of Radiation Protection and Image Processing Systems, Hirslanden AG, Hirslanden Corporate Office, Boulevard Lilienthal 2, 8152, Opfikon-Glattpark, Switzerland. .,Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Neuherberg, Germany.
| | - Guy Frija
- Paris Descartes University, Paris, France
| | - Graciano Paulo
- ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854, Coimbra, Portugal
| | - Werner Jaschke
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - John Damilakis
- School of Medicine, University of Crete, Iraklion, Crete, Greece
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Lacy T, Ding A, Minkemeyer V, Frush D, Samei E. Patient-based Performance Assessment for Pediatric Abdominal CT: An Automated Monitoring System Based on Lesion Detectability and Radiation Dose. Acad Radiol 2021; 28:217-224. [PMID: 32063494 DOI: 10.1016/j.acra.2020.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/18/2020] [Accepted: 01/18/2020] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVE To deploy an automated tool for evaluating pediatric body computed tomography (CT) performance utilizing metrics of radiation dose and image quality for the task of liver lesion detection. MATERIALS AND METHODS This IRB approved retrospective investigation used 507 IV-contrast-enhanced abdominopelvic CT scans of pediatric patients (<18 years) between June 2014 and November 2017 acquired on three scanner models from two manufacturers. The scans were evaluated in terms of radiation metrics (CTDIvol, DLP, and SSDE) as well as task-based performance based on the clinical task of detecting a 5 mm liver lesion with a 10 HU attenuation difference from background liver. An informatics algorithm extracted a previously-validated quantitative detectability index (d') from each case reflective of the likelihood of detecting a liver lesion. The results were analyzed in terms of the relationship between d' and radiation dose metrics. RESULTS There was minimal SSDE variability by age. Median SSDE at 100 kV on one scanner model was 5.2 mGy (5.0-5.4 mGy interquartile range). However, when assessing image quality by applying d', the age groups separated such that the younger patients had higher d' values than older patients. Similar trends were seen in all scanners. CONCLUSIONS An automated method to assess clinical image quality for pediatric CT provided a metric of image quality that varied as expected across ages (i.e., higher quality for younger patients). This tool affords the establishment of a quality reference level that, in addition to dose estimations currently available, would allow for enhanced assessment (e.g., facilitated audit) of CT imaging performance.
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Dzidzornu E, Angmorterh SK, Ofori-Manteaw BB, Aboagye S, Dzefi-Tettey K, Ofori EK. Mammography Diagnostic Reference Levels (DRLs) in Ghana. Radiography (Lond) 2020; 27:611-616. [PMID: 33342686 DOI: 10.1016/j.radi.2020.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/05/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Diagnostic Reference Levels (DRLs) are essential for optimisation in mammography. A local DRL for screen-film mammography has been established in Ghana but none exists for the digital mammography systems. Furthermore, technological advancement is phasing out the use of screen-film mammography and replacing it with digital mammography systems. This study aims to establish the local DRLs used in digital mammography across three institutions in Ghana to guide mammography practice. METHODS Average glandular dose (AGD), compressed breast thickness (CBT), age of patients, entrance surface exposure (ESE), kVp, and mAs were retrospectively extracted from three digital mammography systems. The 75th and 95th percentile values were obtained for the AGD of each mammography projection and at CBT of 60 ± 5 mm. The correlation between the AGD and CBT, kVp, mAs, and ESE were investigated. RESULTS The 75th percentile for the AGD at CBT of 60 ± 5 mm for Centres 1, 2, 3, and all centres were 2.3, 1.8, 2.1, and 2.0 mGy respectively. The DRLs obtained were comparably higher than international studies except those of the United Kingdom. The AGD showed a strong positive correlation with the CBT, kVp, mAs, and ESE. There was variability in the AGD applied across the three centres for the craniocaudal (CC) and mediolateral oblique (MLO) projections. The mean AGD, mAs, and ESE for all the three centres and per centre recorded were higher than previous studies, but the mean kVp and CBT were lower than previous studies. CONCLUSION The higher DRLs estimated in this preliminary study indicates that there is a need for dose optimisation in digital mammography practice in Ghana to improve radiation protection. IMPLICATIONS FOR PRACTICE The findings will guide the process of optimisation and limit the variations in the radiation dose during mammography practice.
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Affiliation(s)
- E Dzidzornu
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences (UHAS), Ho, Ghana. https://twitter.com/BettyManteaw
| | - S K Angmorterh
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences (UHAS), Ho, Ghana.
| | - B B Ofori-Manteaw
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences (UHAS), Ho, Ghana. https://twitter.com/brytebarca
| | - S Aboagye
- Department of Speech, Language & Hearing Sciences, School of Allied Health Sciences, University of Health and Allied Sciences (UHAS), Ho, Ghana
| | - K Dzefi-Tettey
- Radiology Department, Korle-Bu Teaching Hospital, Accra, Ghana
| | - E K Ofori
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences (UHAS), Ho, Ghana
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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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Fukunaga M, Matsubara K, Ichikawa S, Mitsui H, Yamamoto H, Miyati T. CT dose management of adult patients with unknown body weight using an effective diameter. Eur J Radiol 2020; 135:109483. [PMID: 33388531 DOI: 10.1016/j.ejrad.2020.109483] [Citation(s) in RCA: 4] [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: 08/03/2020] [Revised: 12/02/2020] [Accepted: 12/15/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the usefulness of effective diameter (Deff) for CT dose management of adult patients with unknown body weight. METHODS A total of 642 adult patients whose height and weight had been measured before CT examination (chest CT using Aquilion Prime SP, 428 patients; chest CT using Biograph mCT, 100 patients; and abdominal CT using Aquilion Prime SP, 114 patients) were retrospectively examined between April 2018 and September 2019. The Deff was automatically calculated from the lateral diameter on a CT localizer radiograph by a dose management software (Radimetrics). In order to determine the correlation between body weight and Deff, we compared volume CT dose index and dose length product between patients with body weight between 50 and 70 kg and those with Deff equivalent to body weight between 50 and 70 kg. Correlation analysis was performed by Pearson's product-moment correlation, and statistical analyses were performed by using t-test. RESULTS The correlation coefficient values between body weight and Deff were 0.920 for chest CT using Aquilion Prime SP, 0.929 for chest CT using Biograph mCT, and 0.805 for abdominal CT using Aquilion Prime SP. In both chest and abdominal CT scans, there were no significant differences in volume CT dose index and dose length product between patients with body weight between 50 and 70 kg and those with Deff equivalent to body weight between 50 and 70 kg. CONCLUSIONS The Deff may be useful as a somatometric parameter for CT dose management of adult patients with unknown body weight.
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Affiliation(s)
- Masaaki Fukunaga
- Department of Radiological Technology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan; Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan.
| | - Kosuke Matsubara
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Shota Ichikawa
- Department of Radiological Technology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hideki Mitsui
- Department of Radiological Technology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hiroyuki Yamamoto
- Department of Radiological Technology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
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AlNaemi H, Tsapaki V, Omar AJ, AlKuwari M, AlObadli A, Alkhazzam S, Aly A, Kharita MH. Towards establishment of diagnostic reference levels based on clinical indication in the state of Qatar. Eur J Radiol Open 2020; 7:100282. [PMID: 33145375 PMCID: PMC7596105 DOI: 10.1016/j.ejro.2020.100282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/20/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The objectives of this study were to: 1) evaluate patient radiation exposure in CT and 2) establish CT Diagnostic Reference Levels (DRL)s based on clinical indication (CI) in Qatar. MATERIALS AND METHODS Patient data for 13 CIs were collected using specially designed collection forms from the dose management software (DMS) of Hamad Medical Corporation (HMC), the main Qatar healthcare provider. The methodology described in the International Commission on Radiological Protection (ICRP) Report 135 was followed to establish national clinical DRLs in terms of Volumetric Computed Tomography Dose Index (CTDIvol) and total Dose Length Product (DLPt). Effective dose (Ef) was estimated by DMS using DLPt and appropriate conversion factors and was analyzed for comparison purposes. RESULTS Data were retrospectively collected for 896 adult patients undergoing CT examinations in 4 hospitals and 7 CT scanners. CT for Diffuse infiltrative lung disease imparted the lowest radiation in terms of CTDIvol (5 mGy), DLPt (181 mGy.cm) and Ef (3.6 mSv). Total body CT for severe trauma imparted the highest DLPt (3137 mGy.cm) and Ef (38.6 mSv) of all CIs with a CTDIvol of 15 mGy. Rounded Third quartile CTDIvol and DLPt values were defined as the Qatar CT clinical DRLs. Comparison was limited due to sparse international literature. When this was possible data were lower or comparable with other studies. CONCLUSIONS This is the first study reporting national clinical DRLs in Asia and second one internationally after UK. For accurate comparison between studies, systemized CI nomenclature must be followed by researchers.
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Key Words
- CIs, Clinical Indications
- CT, Computed Tomography
- CTDI, Computed tomography dose index
- Clinical indication
- Clinical protocols
- Computed tomography
- DLP, Dose length product
- DMS, Dose Management Software
- DRL, Diagnostic reference level
- Diagnostic reference levels
- Ef, Effective dose
- HMC, Hamad Medical Corporation
- ICRP, International Commission on Radiological Protection
- JCI, Joint Commission International
- PACS, picture archiving and communication system
- Radiation exposure
- TAVI, Transcatheter Aortic Valve Implantation
- cDRLs, clinical diagnostic reference levels
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Affiliation(s)
- Huda AlNaemi
- Hamad Medical Corporation, 3050, Doha, Qatar
- Weill Cornell Medicine, 24144, Doha, Qatar
| | | | | | | | - Amal AlObadli
- Hamad Medical Corporation, 3050, Doha, Qatar
- Weill Cornell Medicine, 24144, Doha, Qatar
| | | | - Antar Aly
- Hamad Medical Corporation, 3050, Doha, Qatar
- Weill Cornell Medicine, 24144, Doha, Qatar
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Abstract
The benefits of fluoroscopically guided interventional procedures are significant and have established new standards in the clinical management of many diseases. Despite the benefits, it is known that they come with known risks, such as the exposure to ionizing radiation. To minimize such risks, it is crucial that the health professionals involved in the procedures have a common understanding of the concepts related to radiation protection, such as dose descriptors, diagnostic reference levels and typical dose values. An update about these concepts will be presented with the objective to raise awareness amongst health professionals and contribute to the increase in knowledge, skills and competences in radiation protection in fluoroscopically guided interventional procedures.
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Affiliation(s)
- Graciano Paulo
- Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854, Coimbra, Portugal.
| | | | - Eliseo Vano
- Radiology Department, Complutense University, Madrid, Spain
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Farah J, Gonzalez-Mendez LA, Dufay F, Amir S, Royer B, Gabriel H, Noel A. Patient exposure and diagnostic reference levels in operating rooms: a multi-centric retrospective study in over 150 private and public French clinics. J Radiol Prot 2020; 40:1024-1038. [PMID: 32750683 DOI: 10.1088/1361-6498/abac4f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To investigate patient exposure in operating rooms and establish Diagnostic Reference Levels (DRLs), fifteen different procedures and nearly 4500 surgeries performed between January 2017 and December 2019 at over 150 different private (79% of data) and public (21% of data) French clinics were recorded. Collected information include the used C-arm equipment, exposure parameters (kVp, mAs, Fluoroscopy Time - FT and Air Kerma-Area Product - PKA) and patient Body Mass Index (BMI) whenever available. Multi-centric DRLs were derived as the 75th percentile of the median exposure data collected in more than 10 different hospitals. For the less frequent procedures, DRLs were determined as the 75th percentile of pooled exposure data with a minimum of 4 centres and 100 patients. Patient exposure proved to be significantly different among the centres. Highest DRLs were found for Abdominal Aortic Aneurysm Endoprosthesis (18 min, 81 Gy cm2), Iliac Angioplasty (6 min, 24 Gy cm2) and Flutter Ablation surgeries (17 min, 14 Gy cm2). In opposition, lowest DRLs were obtained for Hallux Valgus (0.4 min, 0.04 Gy cm2), Hand/Wrist Fracture (0.6 min, 0.16 Gy cm2), and Venous Access Device Implantation surgeries (0.3 min, 0.36 Gy cm2). Similar exposure levels are registered in private clinics and public hospitals. Multi-centric DRLs for fifteen surgical procedures including six new reference values were established to help optimise patients' radiation protection.
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Affiliation(s)
- Jad Farah
- Hopitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, 94270, FRANCE
| | | | | | | | | | | | - Alain Noel
- Centre de Recherche en Automatique de Nancy, Vandoeuvre les Nancy, Grand Est, FRANCE
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Abuzaid MM, Elshami W, Tekin HO, Ghonim H, Shawki M, Salama DH. Computed tomography radiation doses for common computed tomography examinations: a nationwide dose survey in United Arab Emirates. Insights Imaging 2020; 11:88. [PMID: 32748218 PMCID: PMC7399721 DOI: 10.1186/s13244-020-00891-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/02/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Computed tomography (CT) scanning is an essential part of diagnostic and treatment plans, providing swift and accurate diagnostic images. The aim of this study is to develop diagnostic reference levels (DRLs) for the adult common CT examination in the United Arab Emirates (UAE). METHODS This study presents results of the survey of CT dose indices. The data were collected from 91% of the scanners registered at the Ministry of Health and Prevention (MOHAP) for five common examinations: head, chest, and abdomen-pelvis with and without CM. RESULTS CT dose index, dose-length product, and patient weight were analyzed; the reference dose was calculated on the 75th percentile, and an achievable dose was proposed from the median value. The results were compared with the UAE initial National Dose Report as well as the international reports. The proposed dose for CTDIvol (mGy) and DLP (mGy cm) is as follows: head without CM 40 and 695, head with CM 48 and 820, chest 10 and 275, abdomen-pelvis without CM 14 and 810, and abdomen-pelvis with CM 20 and 1025. CONCLUSIONS The results show low dose variations between the MOHAP scanners. The data also revealed CTDIvol and DLP values comparable to those in the initial NDRL report and international standards. The establishment of diagnostic reference levels will require a continuous dose monitoring system.
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Affiliation(s)
- Mohamed M Abuzaid
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, P.O.Box 27272, Sharjah, UAE.
| | - Wiam Elshami
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, P.O.Box 27272, Sharjah, UAE
| | - Huseyin Ozan Tekin
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, P.O.Box 27272, Sharjah, UAE
| | - Hatem Ghonim
- College of Medicine, University of Sharjah, Sharjah, UAE
| | - Mona Shawki
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Dina H Salama
- National Center of Radiation Research and Technology, Atomic Energy Authority, Cairo, Egypt
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Farah J, Pariente D, Esaki A, Deleuze C, Adamsbaum C, Franchi-Abella S. Establishing local diagnostic reference levels for pediatric percutaneous transhepatic cholangiography interventions and optimizing the routine practice. Pediatr Radiol 2020; 50:827-832. [PMID: 32072247 DOI: 10.1007/s00247-020-04627-y] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 12/10/2019] [Accepted: 01/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Liver-transplanted, immunosuppressed pediatric patients undergoing repeated percutaneous transhepatic cholangiography (PTC) require optimized exposure to ionizing radiation. OBJECTIVE To establish local diagnostic reference levels (DRL) for pediatric PTC and investigate the routine use of X-ray equipment. MATERIALS AND METHODS The study retrospectively analyzed data collected between October 2016 and June 2018 from a single center performing PTC. We collected exposure parameters including kerma area product (PKA), air kerma at patient entrance reference point (Ka,r) and fluoroscopy time via a dose archiving and communication system. Local diagnostic reference levels were derived as the 50th percentile of the distributions while considering published recommended weight groups. We investigated exposure variability with procedure complexity and with technical parameters recovered from the radiation dose structured report. RESULTS The analysis included 162 PTC procedures performed in 64 children: 58% male, average age 6 years (range 39 days to 16 years) and weight 24 kg (range 3-60 kg). Local DRLs for weight groups 0-5 kg, 5-15 kg, 15-30 kg, 30-50 kg and 50-80 kg were, respectively, 6 cGy.cm2, 22 cGy.cm2, 68 cGy.cm2, 107 cGy.cm2 and 179 cGy.cm2 in PKA. Local DRLs per weight group were also established for intermediate and complex procedures. Radiation dose structured report analysis highlighted good local practice with efficient collimation, low fluoroscopy pulse rate, no magnification and limited use of radiographic acquisitions. Meanwhile, table and detector positioning and tube projection could still be optimized. PKA correlated significantly with the number of acquisitions and tube-to-table distance. CONCLUSION We established local DRLs for children undergoing PTC.
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Affiliation(s)
- Jad Farah
- Diagnostic Radiology Department, Bicetre University Hospital, 78 Rue Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Daniele Pariente
- Diagnostic Radiology Department, Bicetre University Hospital, 78 Rue Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Aya Esaki
- Diagnostic Radiology Department, Bicetre University Hospital, 78 Rue Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Centrale Supélec, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Corinne Deleuze
- Diagnostic Radiology Department, Bicetre University Hospital, 78 Rue Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Catherine Adamsbaum
- Diagnostic Radiology Department, Bicetre University Hospital, 78 Rue Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Stephanie Franchi-Abella
- Diagnostic Radiology Department, Bicetre University Hospital, 78 Rue Général Leclerc, 94270, Le Kremlin-Bicêtre, France
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Morcillo AB, Alejo L, Huerga C, Bayón J, Obesso A, Corredoira E, Novo JR, Hernández T, Ponce MD, Fernández L, Rodríguez R, Garzón G, Vañó E, Guibelalde E. Local diagnostic reference levels for paediatric non-cardiac interventional radiology procedures. Phys Med 2020; 72:1-6. [PMID: 32179406 DOI: 10.1016/j.ejmp.2020.03.001] [Citation(s) in RCA: 4] [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: 11/15/2019] [Revised: 01/08/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To establish local diagnostic reference levels (DRLs) for non-cardiac interventional procedures in paediatrics. METHODS The type of procedure, the patient's weight and age and dose-related data from 279 interventions was recorded in a database completed by interventional radiologists, radiographers and technicians of the Medical Physics department. These procedures were classified into 14 categories and 6 weight ranges. Local DRLs were proposed for those ranges in which a sample of at least 15 patients could be gathered and were calculated as the third quartile (Q3) of the air kerma-area product (PKA) values. The Q3 of the fluoroscopy time (FT) and number of digital subtraction angiography (DSA) images were also obtained. Finally, the correlation between PKA and weight was analysed. RESULTS Local DRLs are proposed for three types of procedures: hepatic/biliary interventions (5-15 kg, 1304 cGy·cm2; 15-30 kg, 2121 cGy·cm2), sclerotherapy procedures (15-30 kg, 704 cGy·cm2; 30-50 kg, 4049 cGy·cm2; 50-80 kg, 3734 cGy·cm2) and central venous catheter (CVC) procedures (5-15 kg, 84 cGy·cm2). Hepatic/biliary interventions showed a moderate correlation (r = 0.61), while sclerotherapy procedures presented a poor correlation (r = 0.34) between PKA and weight, possibly due to the PKA dependence on the complexity level. Regarding CVC procedures, a clearly higher correlation was found when the fluoroscopy PKA value was normalised to the FT (r = 0.85 vs r = 0.35). CONCLUSIONS The results support the feasibility of establishing DRLs for the most common procedures (sclerotherapy, hepatic/biliary and CVC interventions) despite the small number of paediatric interventions.
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Affiliation(s)
- Ana Belén Morcillo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain.
| | - Luis Alejo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Carlos Huerga
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - José Bayón
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Alba Obesso
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eva Corredoira
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Joan Ricardo Novo
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Teresa Hernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María Dolores Ponce
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Lucía Fernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Ricardo Rodríguez
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Gonzalo Garzón
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eliseo Vañó
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
| | - Eduardo Guibelalde
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
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Abstract
In this study, we sought to estimate the patient radiation doses in the digital radiography X-ray examinations conducted in a large hospital. The patient exposure factors and kerma-area product (PKA) were retrospectively recorded via the Digital Imaging and Communications in Medicine (DICOM) header for 547 patients. The entrance surface air kerma (ESAK) was estimated from the measurements of the X-ray tube output and recorded exposure factors, as well as from the console that displayed PKA as an alternative method. Effective doses were estimated from ESAK and PKA values using the appropriate conversion coefficient. In the chest PA, chest LAT, cervical spine AP, cervical spine LAT, abdomen AP, pelvis AP, lumbar spine AP, and lumbar spine LAT, the median ESAK (mGy) was found to be 0.13, 0.27, 0.35, 0.52, 0.70, 1.06, 2.33, and 4.18 mGy, respectively. Median PKA values were 0.10, 0.26, 0.14, 0.17, 0.77, 0.68, 0.81, and 1.11 Gy cm2, respectively. The estimated effective dose from ESAK and PKA values yielded comparable results. The comparison revealed that the ESAK and PKA values fell far below the reported in the literature. The results showed that the information of the DICOM deader is valuable for dosimetry and optimization.
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Affiliation(s)
- Ibrahim I Suliman
- Sudan Atomic Energy Commission, Radiation Safety Institute, P.O. Box 3001, Khartoum, Sudan.
- Formerly at Medical Physics Section, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al-Khoudh, 123, Muscat, Oman.
- Physics Department, College of Science, Committee on Radiation and Environmental Pollution Protection, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11642, Saudi Arabia.
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Bebbington NA, Haddock BT, Bertilsson H, Hippeläinen E, Husby EM, Tunninen VI, Söderberg M. A Nordic survey of CT doses in hybrid PET/CT and SPECT/CT examinations. EJNMMI Phys 2019; 6:24. [PMID: 31845047 PMCID: PMC6915162 DOI: 10.1186/s40658-019-0266-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/26/2019] [Accepted: 11/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background Computed tomography (CT) scans are routinely performed in positron emission tomography (PET) and single photon emission computed tomography (SPECT) examinations globally, yet few surveys have been conducted to gather national diagnostic reference level (NDRL) data for CT radiation doses in positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT). In this first Nordic-wide study of CT doses in hybrid imaging, Nordic NDRL CT doses are suggested for PET/CT and SPECT/CT examinations specific to the clinical purpose of CT, and the scope for optimisation is evaluated. Data on hybrid imaging CT exposures and clinical purpose of CT were gathered for 5 PET/CT and 8 SPECT/CT examinations via designed booklet. For each included dataset for a given facility and scanner type, the computed tomography dose index by volume (CTDIvol) and dose length product (DLP) was interpolated for a 75-kg person (referred to as CTDIvol,75kg and DLP75kg). Suggested NDRL (75th percentile) and achievable doses (50th percentile) were determined for CTDIvol,75kg and DLP75kg according to clinical purpose of CT. Differences in maximum and minimum doses (derived for a 75-kg patient) between facilities were also calculated for each examination and clinical purpose. Results Data were processed from 83 scanners from 43 facilities. Data were sufficient to suggest Nordic NDRL CT doses for the following: PET/CT oncology (localisation/characterisation, 15 systems); infection/inflammation (localisation/characterisation, 13 systems); brain (attenuation correction (AC) only, 11 systems); cardiac PET/CT and SPECT/CT (AC only, 30 systems); SPECT/CT lung (localisation/characterisation, 12 systems); bone (localisation/characterisation, 30 systems); and parathyroid (localisation/characterisation, 13 systems). Great variations in dose were seen for all aforementioned examinations. Greatest differences in DLP75kg for each examination, specific to clinical purpose, were as follows: SPECT/CT lung AC only (27.4); PET/CT and SPECT/CT cardiac AC only (19.6); infection/inflammation AC only (18.1); PET/CT brain localisation/characterisation (16.8); SPECT/CT bone localisation/characterisation (10.0); PET/CT oncology AC only (9.0); and SPECT/CT parathyroid localisation/characterisation (7.8). Conclusions Suggested Nordic NDRL CT doses are presented according to clinical purpose of CT for PET/CT oncology, infection/inflammation, brain, PET/CT and SPECT/CT cardiac, and SPECT/CT lung, bone, and parathyroid. The large variation in doses suggests great scope for optimisation in all 8 examinations.
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Affiliation(s)
| | - Bryan T Haddock
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Ndr. Ringvej 57, 2600, Glostrup, Denmark
| | | | - Eero Hippeläinen
- HUS Medical Imaging Center, Clinical Physiology and Nuclear Medicine, Nuclear Medicine Unit, Meilahti Hospital, University of Helsinki and Helsinki University Hospital, Tukholmankatu 8 F, PL 442, 00029 HUS, Helsinki, Finland
| | - Ellen M Husby
- Department of Diagnostic Physics, Gaustad Hospital, Oslo University Hospital, Building 20, P.O. Box 4959, N-0424, Nydalen, Oslo, Norway
| | - Virpi I Tunninen
- Department of Nuclear Medicine, Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland
| | - Marcus Söderberg
- Medical Radiation Physics, Department of Translational Medicine, Lund university, Inga Marie Nilssons gata 49, 20502, Malmö, Sweden.,Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Inga Marie Nilssons gata 49, 20502, Malmö, Sweden
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Granata C, Sorantin E, Seuri R, Owens CM. European Society of Paediatric Radiology Computed Tomography and Dose Task Force: European guidelines on diagnostic reference levels for paediatric imaging. Pediatr Radiol 2019; 49:702-705. [PMID: 30783688 DOI: 10.1007/s00247-019-04346-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/11/2019] [Indexed: 11/25/2022]
Abstract
The recent European Council Directive 2013/59/EURATOM requires the establishment of diagnostic reference levels (DRLs) to optimise radiation dose in diagnostic and interventional radiology procedures. At the time this directive was enacted, just a few European countries had already set paediatric DRLs and many of these were outdated. For this reason, the European Commission launched a project addressing European Guidelines on Diagnostic Reference Levels for Paediatric Imaging that was awarded to a consortium led by the European Society of Radiology with the collaboration of the European Society of Paediatric Radiology and other European stakeholders involved in the radiation protection of children. The main aims of this project were to establish European DRLs to be used by countries without their own national paediatric DRLs and to provide a consistent method to establish new DRLs in the future. These European guidelines have been very recently endorsed by the European Commission and published in issue N° 185 of the Radiation Protection series. The purpose of this article is to introduce these guidelines to the wide community of paediatric radiologists.
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Affiliation(s)
- Claudio Granata
- Service of Radiology, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy.
| | - Erich Sorantin
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Raija Seuri
- HUS Medical Imaging, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Catherine M Owens
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Ferderbar ML, Doyle TE, Samavi R, Koff D. An Environmental Scan of the National and Provincial Diagnostic Reference Levels in Canada for Common Adult Computed Tomography Scans. Can Assoc Radiol J 2019; 70:119-124. [PMID: 30772107 DOI: 10.1016/j.carj.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/06/2018] [Revised: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 12/27/2022] Open
Abstract
Several regulatory bodies have agreed that low-dose radiation used in medical imaging is a weak carcinogen that follows a linear, non-threshold model of cancer risk. While avoiding radiation is the best course of action to mitigate risk, computed tomography (CT) scans are often critical for diagnosis. In addition to the as low as reasonably achievable principle, a more concrete method of dose reduction for common CT imaging exams is the use of a diagnostic reference level (DRL). This paper examines Canada's national DRL values from the recent CT survey and compares it to published provincial DRLs as well as the DRLs in the United Kingdom and the United States of America for the 3 most common CT exams: head, chest, and abdomen/pelvis. Canada compares well on the international scale, but it should consider using more electronic dose monitoring solutions to create a culture of dose optimization.
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Affiliation(s)
| | - Thomas E Doyle
- McMaster eHealth Program, McMaster University, Hamilton, Ontario, Canada
| | - Reza Samavi
- Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
| | - David Koff
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
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Lin ZX, Zhou CS, Schoepf UJ, Eid M, Duguay TM, Greenberg WT, Luo S, Quan W, Zhou F, Lu GM, Zhang LJ. Coronary CT angiography radiation dose trends: A 10-year analysis to develop institutional diagnostic reference levels. Eur J Radiol 2019; 113:140-7. [PMID: 30927938 DOI: 10.1016/j.ejrad.2019.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/31/2018] [Accepted: 02/12/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To develop institutional diagnostic reference levels (IDRL) for coronary CT angiography (CCTA) according to patient size by analyzing radiation dose changes over the past 10 years. MATERIALS AND METHODS This IRB approved retrospective investigation analyzed radiation dose data from CCTA between 2007 and 2016 at our institution. Annual trends in radiation dose were described for each scanner type and scanning mode. Radiation levels were analyzed for normorhythmic patients, patients with prior coronary artery bypass grafting (CABG), arrhythmia, and according to patient size and tube voltage. Median, and quartile values for volume CT dose index (CTDIvol), dose-length product (DLP), and size-specific dose estimate (SSDE) were calculated. Wilcoxon rank-sum test and Kruskal Wallis test were performed to assess the significance of quantitative data. RESULTS 35,375 examinations from 33,317 patients (median age, 58 [50-66] years; male patients, 21,087 [58.7%]) were analyzed. CTDIvol, DLP, and SSDE significantly decreased by 9.0%, 30.8%, and 40.1% (all P < 0.05) for all examinations, respectively. All radiation dose metrics progressively decreased across scanning modes (especially retrospectively ECG-gated spiral and prospectively ECG-triggered high-pitch spiral acquisition mode), but did not significantly change across scanners in the last 6 years. CTDIvol and DLP increased with patient size when water-equivalent diameters were >19 cm for normorhythmic and CABG patients. In arrhythmic patients, CTDIvol increased progressively with water-equivalent diameters across all groups. CONCLUSION CCTA radiation dose has progressively decreased in the past decade except in patients with prior CABG and arrhythmia. Size-specific IDRLs may optimize radiation utilization in these patients going forward.
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Hayashi S, Takenaka M, Hosono M, Nishida T. Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography. World J Clin Cases 2018; 6:1087-1093. [PMID: 30613666 PMCID: PMC6306631 DOI: 10.12998/wjcc.v6.i16.1087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 02/05/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use in these complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.
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Affiliation(s)
- Shiro Hayashi
- Department of Gastroenterology and Internal Medicine, Hayashi Clinic, Osaka, Suita 564-0018, Japan
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Toyonaka 560-8565, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Sayama 589-8511, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Sayama 589-8511, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Toyonaka 560-8565, Japan
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Clerkin C, Brennan S, Mullaney LM. Establishment of national diagnostic reference levels (DRLs) for radiotherapy localisation computer tomography of the head and neck. Rep Pract Oncol Radiother 2018; 23:407-412. [PMID: 30190653 PMCID: PMC6107902 DOI: 10.1016/j.rpor.2018.07.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 05/11/2018] [Accepted: 07/21/2018] [Indexed: 11/28/2022] Open
Abstract
AIM The aim of this research is to establish if variation exists in the dose delivered for head and neck (HN) localisation computed tomography (CT) imaging in radiation therapy (RT); to propose a national diagnostic reference levels (DRLs) for this procedure and to make a comparison between the national DRL and a DRL of a European sample. BACKGROUND CT has become an indispensable tool in radiotherapy (RT) treatment planning. It is a requirement of legislation in many countries that doses of ionising radiation for medical exposures be kept 'As Low As Reasonably Achievable'. There are currently no dose guidelines for RT localisation CT of the HN. MATERIALS AND METHODS All RT departments in Ireland and a sample of European departments were surveyed. Dose data on CT dose length product (DLP); dose index volume (CTDIvol); current time product; tube voltage and scan length was acquired for ten average-sized HN patients from each department. DRLs were proposed for DLP and CTDIvol using the rounded 75th percentile of the distribution of the means. RESULTS 42% of Irish departments and one European department completed the survey. Significant variation was found in the mean DLP, CTDIvol and scan lengths across the Irish departments. The proposed Irish DRL is 882 mGy cm and 21 mGy and the European department DRL is 816 mGy cm and 21 mGy, for DLP and CTDIvol, respectively. CONCLUSIONS Variation exists in doses used for HN RT localisation CT. DRLs have been proposed for comparison purposes with the aim of dose optimisation.
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Affiliation(s)
- Celine Clerkin
- Applied Radiation Therapy Trinity Research Group, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland
| | - Sinead Brennan
- Department of Radiation Oncology, St Luke's Radiation Oncology Network at St Luke's Hospital, Dublin 6, Ireland
| | - Laura M. Mullaney
- Applied Radiation Therapy Trinity Research Group, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland
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Niiniviita H, Kiljunen T, Huuskonen M, Teperi S, Kulmala J. Dose monitoring in pediatric and young adult head and cervical spine CT studies at two emergency duty departments. Emerg Radiol 2017; 25:153-159. [PMID: 29247394 DOI: 10.1007/s10140-017-1571-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/21/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE As the number of pediatric computed tomography (CT) imaging is increasing, there is a need for real-time radiation dose monitoring and evaluation of the imaging protocols. The aim of this study was to present the imaging data, patient doses, and observations of pediatric and young adult trauma-and routine head CT and cervical spine CT collected by a dose monitoring software. METHODS Patient age, study date, imaging parameters, and patient dose as volume CT dose index (CTDIvol) and dose length product (DLP) were collected from two emergency departments' CT scanners for 2-year period. The patients were divided into four age groups (0-5, 6-10, 11-15, and 16-20 years) for statistical analysis and effective dose determination. The 75th percentile doses were evaluated to be used as local diagnostic reference levels (DRLs). RESULTS Six hundred fifteen trauma head, 318 routine head, and 592 trauma cervical spine CT studies were assessed. All mean CTDIvol values were statistically lower in hospital B (40.3 ± 12.3, 30.03 ± 11.1, and 6.9 ± 3.1 mGy, respectively) than in hospital A (53.0 ± 12.9, 43.2 ± 8.7, and 18.3 ± 7.3 mGy, respectively). Statistically significant differences were observed on scanning length between hospitals and between CTDIvol values when protocol was updated. The 75th percentiles of trauma cervical spine in hospital B can be used as local DRL. Non-optimized protocols were also revealed in hospital A. CONCLUSION Dose monitoring software offers a valuable tool for evaluating the imaging practices and finding non-optimized protocols.
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Affiliation(s)
- Hannele Niiniviita
- Department of Medical Physics, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland. .,Medical Imaging Center of Southwest Finland, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
| | - Timo Kiljunen
- Docrates Cancer Center, Saukonpaadenranta 2, 00180, Helsinki, Finland
| | - Minna Huuskonen
- Department of Radiology, Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland
| | - Simo Teperi
- Department of Biostatistics, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Jarmo Kulmala
- Department of Medical Physics, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
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Heggie JCP, Barnes P, Cartwright L, Diffey J, Tse J, Herley J, McLean ID, Thomson FJ, Grewal RK, Collins LT. Position paper: recommendations for a digital mammography quality assurance program V4.0. Australas Phys Eng Sci Med 2017; 40:491-543. [PMID: 28914430 DOI: 10.1007/s13246-017-0583-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 08/04/2017] [Indexed: 12/21/2022]
Abstract
In 2001 the ACPSEM published a position paper on quality assurance in screen film mammography which was subsequently adopted as a basis for the quality assurance programs of both the Royal Australian and New Zealand College of Radiologists (RANZCR) and of BreastScreen Australia. Since then the clinical implementation of digital mammography has been realised and it has become evident that existing screen-film protocols were not appropriate to assure the required image quality needed for reliable diagnosis or to address the new dose implications resulting from digital technology. In addition, the advantages and responsibilities inherent in teleradiology are most critical in mammography and also need to be addressed. The current document is the result of a review of current overseas practice and local experience in these areas. At this time the technology of digital imaging is undergoing significant development and there is still a lack of full international consensus about some of the detailed quality control (QC) tests that should be included in quality assurance (QA) programs. This document describes the current status in digital mammography QA and recommends test procedures that may be suitable in the Australasian environment. For completeness, this document also includes a review of the QA programs required for the various types of digital biopsy units used in mammography. In the future, international harmonisation of digital quality assurance in mammography and changes in the technology may require a review of this document. Version 2.0 represented the first of these updates and key changes related to image quality evaluation, ghost image evaluation and interpretation of signal to noise ratio measurements. In Version 3.0 some significant changes, made in light of further experience gained in testing digital mammography equipment were introduced. In Version 4.0, further changes have been made, most notably digital breast tomosynthesis (DBT) testing and QC have been addressed. Some additional testing for conventional projection imaging has been added in order that sites may have the capability to undertake dose surveys to confirm compliance with diagnostic reference levels (DRLs) that may be established at the National or State level. A key recommendation is that dosimetry calculations are now to be undertaken using the methodology of Dance et al. Some minor changes to existing facility QC tests have been made to ensure the suggested procedures align with those most recently adopted by the Royal Australian and New Zealand College of Radiologists and BreastScreen Australia. Future updates of this document may be provided as deemed necessary in electronic format on the ACPSEM's website ( https://www.acpsem.org.au/whatacpsemdoes/standards-position-papers and see also http://www.ranzcr.edu.au/quality-a-safety/radiology/practice-quality-activities/mqap ).
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Affiliation(s)
| | - P Barnes
- I-Med Radiology Network, Head office Melbourne, Melbourne, Australia
| | - L Cartwright
- Medical Physics Department, Westmead Hospital, Westmead, Australia
| | - J Diffey
- Hunter New England Imaging, John Hunter Hospital, New Lambton Heights, Australia
| | - J Tse
- Medical Physics and Radiation Engineering, Canberra Hospital, Canberra, Australia
| | - J Herley
- Radiation Protection Services Pty Ltd, Brisbane, Australia
| | - I D McLean
- Medical Physics and Radiation Engineering, Canberra Hospital, Canberra, Australia
| | - F J Thomson
- Radiological Physics Consultants Ltd, Warrington, New Zealand
| | - R K Grewal
- Medical Physics Department, Westmead Hospital, Westmead, Australia
| | - L T Collins
- Medical Physics Department, Westmead Hospital, Westmead, Australia
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Ihn YK, Kim BS, Byun JS, Suh SH, Won YD, Lee DH, Kim BM, Kim YS, Jeon P, Ryu CW, Suh SI, Choi DS, Choi SS, Choi JW, Chang HW, Lee JW, Kim SH, Lee YJ, Shin SH, Lim SM, Yoon W, Jeong HW, Han MH. Patient Radiation Exposure During Diagnostic and Therapeutic Procedures for Intracranial Aneurysms: A Multicenter Study. Neurointervention 2016; 11:78-85. [PMID: 27621943 PMCID: PMC5018552 DOI: 10.5469/neuroint.2016.11.2.78] [Citation(s) in RCA: 27] [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: 04/19/2016] [Accepted: 08/11/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms across multi-centers and propose a diagnostic reference level (DRL). MATERIALS AND METHODS We studied a sample of 490 diagnostic and 371 therapeutic procedures for intracranial aneurysms, which were performed at 23 hospitals in Korea in 2015. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time and total angiographic image frames were obtained and analyzed. RESULTS Total mean DAP, CAK, fluoroscopy time, and total angiographic image frames were 106.2 ± 66.4 Gy-cm(2), 697.1 ± 473.7 mGy, 9.7 ± 6.5 minutes, 241.5 ± 116.6 frames for diagnostic procedures, 218.8 ± 164.3 Gy-cm(2), 3365.7 ± 2205.8 mGy, 51.5 ± 31.1 minutes, 443.5 ± 270.7 frames for therapeutic procedures, respectively. For diagnostic procedure, the third quartiles for DRLs were 144.2 Gy-cm(2) for DAP, 921.1 mGy for CAK, 12.2 minutes for fluoroscopy times and 286.5 for number of image frames, respectively. For therapeutic procedures, the third quartiles for DRLs were 271.0 Gy-cm(2) for DAP, 4471.3 mGy for CAK, 64.7 minutes for fluoroscopy times and 567.3 for number of image frames, respectively. On average, rotational angiography was used 1.5 ± 0.7 times/session (range, 0-4; n=490) for diagnostic procedures and 1.6 ± 1.2 times/session (range, 0-4; n=368) for therapeutic procedures, respectively. CONCLUSION Radiation dose as measured by DAP, fluoroscopy time and image frames were lower in our patients compared to another study regarding cerebral angiography, and DAP was lower with fewer angiographic image frames for therapeutic procedures. Proposed DRLs can be used for quality assurance and patient safety in diagnostic and therapeutic procedures.
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Affiliation(s)
- Yon Kwon Ihn
- Department of Radiology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Soo Byun
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Yoo Dong Won
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital Stroke Center, Yonsei Unviersity College of Medicine, Seoul, Korea
| | - Young Soo Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Korea
| | - Pyong Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - See Sung Choi
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Gyeonggi-do, Korea
| | - Hyuk Won Chang
- Department of Radiology, Keimyung University College of Medicine, Dongsan Medical Center, Daegu, Korea
| | - Jae-Wook Lee
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Korea
| | - Sang Heum Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Gyeonggi-do, Korea
| | - Young Jun Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Shang Hun Shin
- Department of Radiology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
| | - Soo Mee Lim
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Woong Yoon
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hae Woong Jeong
- Department of Radiology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Ruiz-Cruces R, Vano E, Carrera-Magariño F, Moreno-Rodriguez F, Soler-Cantos MM, Canis-Lopez M, Hernández-Armas J, Diaz-Romero FJ, Rosales-Espizua F, Fernandez-Soto JM, Sanchez-Casanueva R, Martin-Palanca A, Perez-Martinez M, Gil-Agudo A, Zarca-Diaz MA, Parra-Osorio V, Muñoz Ruiz-Canela JJ, Moreno-Sanchez T, Lopez-Medina A, Moreno-Saiz C, Galan-Montenegro P, Gallego-Beuter JJ, Gonzalez-de-Garay M, Zapata-Jimenez JC, Pastor-Vega JM, Cañete S. Diagnostic reference levels and complexity indices in interventional radiology: a national programme. Eur Radiol 2016; 26:4268-76. [PMID: 27384609 DOI: 10.1007/s00330-016-4334-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/02/2016] [Accepted: 03/14/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses. METHODS Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values. RESULTS The KAP (3rd quartile) in Gy cm2 for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4. CONCLUSIONS The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology. KEY POINTS • National DRLs for interventional procedures have been proposed given level of complexity • For clinical audits, the level of complexity should be taken into account. • An evaluation of the complexity levels of the procedure should be made.
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