scholarly journals Cumulative effective dose from recurrent CT examinations in Europe: proposal for clinical guidance based on an ESR EuroSafe Imaging survey

2021 ◽  
Author(s):  
Guy Frija ◽  
◽  
John Damilakis ◽  
Graciano Paulo ◽  
Reinhard Loose ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Effective Dose ◽  
Team Approach ◽  
Imaging Procedures ◽  
Oncological Disease ◽  
Cumulative Effective Dose ◽  
Number Of Patients ◽  
Dose Management ◽  
Referring Physicians ◽  
Risk Of Cancer

Abstract In recent years, the issue of cumulative effective dose received from recurrent computed tomography examinations has become a subject of increasing concern internationally. Evidence, predominantly from the USA, has shown that a significant number of patients receive a cumulative effective dose of 100 mSv or greater. To obtain a European perspective, EuroSafe Imaging carried out a survey to collect European data on cumulative radiation exposure of patients from recurrent computed tomography examinations. The survey found that a relatively low percentage of patients (0.5%) received a cumulative effective dose equal to or higher than 100 mSv from computed tomography, most of them having an oncological disease. However, there is considerable variation between institutions as these values ranged from 0 to 2.72%, highlighting that local practice or, depending on the institution and its medical focus, local patient conditions are likely to be a significant factor in the levels of cumulative effective dose received, rather than this simply being a global phenomenon. This paper also provides some practical actions to support the management of cumulative effective dose and to refine or improve practice where recurrent examinations are required. These actions are focused around increasing awareness of referring physicians through encouraging local dialogue, actions focused on optimisation where a team approach is critical, better use of modern equipment and the use of Dose Management and Clinical Decision Support Systems together with focused clinical audits. The proper use of cumulative effective dose should be part of training programmes for referrers and practitioners, including what information to give to patients. Patient summary Radiation is used to the benefit of patients in diagnostic procedures such as CT examinations, and in therapeutic procedures like the external radiation treatment for cancer. However, radiation is also known to increase the risk of cancer. To oversee this risk, the cumulative effective dose (CED) received by a patient from imaging procedures over his or her life is important. In this paper, the authors, on behalf of EuroSafe Imaging, report on a survey carried out in Europe that aims to estimate the proportion of patients that undergo CT examinations and are exposed to a CED of more than 100 mSv. At the same time, the survey enquires about and underlines radiologists’ measures and radiology departments’ strategies to limit such exposure. Over the period of 2015–2018, respondents reported that 0.5% (0–2.72%) of patients were exposed to a CED of ≥ 100 mSv from imaging procedures. The background radiation dose in Europe depends on the location, but it is around 2.5 mSv per year. It is obvious that patients with cancer, chronic diseases and trauma run the highest risk of having a high CED. However, even if the number of patients exposed to ≥ 100 mSv is relatively low, it is important to lower this number even further. Measures could consist in using procedures that do not necessitate radiation, using very low dose procedures, being very critical in requiring imaging procedures and increasing awareness about the issue. Key Points • A relatively low percentage of patients (0.5%) received a cumulative effective dose from CT computed tomography equal to or greater than 100 mSv, in Europe, most of them having an oncological disease. • There is a wide range in the number of patients who receive cumulative effective dose equal to or greater than 100 mSv (0–2.72%) and optimisation should be improved. • Increasing the awareness of referring physicians through encouraging local dialogue, concrete actions focused on optimisation and development of dose management systems is suggested.

scholarly journals Radiation Exposure in Patients with Isolated Limb Trauma: Acceptable or Are We Imaging Too Much?

2020 ◽  
Vol 9 (11) ◽  
pp. 3609
Author(s):  
James A. Wheeler ◽  
Natasha Weaver ◽  
Zsolt J. Balogh ◽  
Herwig Drobetz ◽  
Andrew Kovendy ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Effective Dose ◽  
Radiation Risk ◽  
Plain Film ◽  
Study Cohort ◽  
X Ray ◽  
Cumulative Effective Dose ◽  
Orthopaedic Patients ◽  
Extremity Trauma ◽  
The Mean

The aim of our study was to investigate the cumulative effective dose of radiation resulting from medical imaging in orthopaedic patients with isolated extremity trauma. Deidentified radiology records of consecutive patients without age restriction with isolated extremity trauma requiring operative treatment at a regional hospital were reviewed retrospectively over a 1-year period, and the effective dose per patient for each study type of plain film X-ray, computed tomography, and operative fluoroscopy was used to calculate cumulative effective dose. Values were summarised as mean, ± standard deviation, maximum, and proportion with overdose (>20 mSv). The study cohort included 428 patients (193 male and 235 female) with an average age of 44 years (±28). There were 447 procedures performed, i.e., all involved operative fluoroscopy, 116 involved computed tomography, and 397 involved X-ray. The mean cumulative effective dose per patient was 1.96 mSv (±4.98, 45.12). The mean cumulative effective dose for operative fluoroscopy was 0.32 mSv (±0.73, 5.91), for X-ray was 1.12 mSv (±3.6, 39.23) and for computed tomography was 2.22 mSv (±4.13, 20.14). The mean cumulative effective dose of 1.96 mSv falls below the recommended maximum annual exposure of 20 mSv. This study can serve as a guide for informing clinicians and patients of the acceptable radiation risk in the context of isolated extremity trauma.

scholarly journals Challenges for managing the cumulative effective dose for patients

2020 ◽  
Vol 93 (1116) ◽  
pp. 20200814 ◽  
Author(s):  
Eliseo Vano
Keyword(s):  
Effective Dose ◽  
Radiation Effects ◽  
Risk Estimation ◽  
Patient Dose ◽  
International Commission ◽  
Future Research ◽  
Published Data ◽  
Radiological Protection ◽  
Cumulative Effective Dose ◽  
Number Of Patients

Notwithstanding that 100 mSv is not a threshold for radiation effects, cumulative effective dose (CED) for patients of ≥100 mSv derived from recurrent imaging procedures with ionising radiation has been recently the topic of several publications. The International Commission on Radiological Protection has alerted on the problems to use effective dose for risk estimation in individual patients but has accepted to use this quantity for comparison the relative radiation risks between different imaging modalities. A new International Commission on Radiological Protection document on the use of effective dose (including medicine), is in preparation. Recently published data on the number of patients with CED ≥100 mSv ranged from 0.6 to 3.4% in CT and around 4% in interventional radiology. The challenges to manage the existing situation are summarised. The main aspects identified are: 1) New technology with dose reduction techniques. 2) Refinements in the application of the justification and optimisation for these groups of patients. 3) Patient dose management systems with alerts on the cumulative high doses. 4) Education on the proper use of cumulative effective dose for referrers and practitioners including information for patients. 5) Future research programmes in radiation biology and epidemiology may profit the patient dose data from the groups with high cumulative dose values.

scholarly journals Cancer Risk Assessment of Patients Undergoing Computed Tomography Examination at the Korle-Bu Teaching Hospital

2018 ◽  
pp. 861-868
Author(s):  
T. A. Sackey ◽  
C. Schandorf ◽  
J. J. Fletcher ◽  
Y. B. Mensah ◽  
I. Shirazu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cancer Risk ◽  
Effective Dose ◽  
Teaching Hospital ◽  
Cancer Incidence ◽  
Attributable Risk ◽  
Cancer Risk Assessment ◽  
Dose Length Product ◽  
Effective Doses ◽  
Risk Of Cancer

The aim of this study is to estimate the effective dose and assess the lifetime attributable risk of cancer incidence of patients undergoing computed tomography scan at the Korle-Bu Teaching Hospital in the Greater Accra Region of Ghana. Data on Volume CT Dose Index ( ) and Dose Length Product ( ) displayed on the scanner control console was recorded after confirmation of the results by performing independent checks on a phantom. The effective doses were estimated using the  displayed and the anatomic region specific conversion factors ( ). The average effective dose for the head, abdomen, chest, neck, and pelvis were 3.63± 2.39mSv, 15.37±8.49 mSv, 12.72 ± 13.97 mSv, 4.04 ± 1.47 mSv and 15.8 ± 3.59 mSv respectively. Effective doses for the head and neck were within the typical range of (1-10mSv) for CT examinations whilst abdomen, chest and pelvis were above 10mSv. The average life attributable risk of cancer incidence for each region of examination were determined from the effective dose, sex and age using  the model proposed in BEIR VII Report . The average cancer risk incidence for head, neck, chest, abdomen and pelvis examinations were low in the range 1 in 10,000 to 1 in 1,000. There were wide variations in the effective dose values obtained for the same region under examination. This trend calls for the optimization of CT examination protocols to be established to ensure that patient doses are as low as reasonably achievable, economic and social factors being taken into account especially for chest examinations.

Cumulative Effective Dose Associated With Computed Tomography Examinations in Adolescent Trauma Patients

2014 ◽  
Vol 30 (7) ◽  
pp. 479-482 ◽  
Author(s):  
Seung Joon Choi ◽  
Eun Young Kim ◽  
Hyung Sik Kim ◽  
Hye-Young Choi ◽  
Jinseong Cho ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Effective Dose ◽  
Trauma Patients ◽  
Adolescent Trauma ◽  
Cumulative Effective Dose

Exposure of children with neuroblastoma to ionizing radiation during computed tomography and nuclear medicine imaging – a single centre experience

2019 ◽  
Vol 54 (3) ◽  
pp. 181-185
Author(s):  
J. Iwanowski ◽  
H. Piwowarska-Bilska ◽  
P. Wawrykow ◽  
A. Walecka ◽  
J. Peregud-Pogorzelski ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Nuclear Medicine ◽  
Ionizing Radiation ◽  
Effective Dose ◽  
Retrospective Analysis ◽  
Nuclear Medicine Imaging ◽  
Single Centre ◽  
Cumulative Effective Dose ◽  
Single Centre Experience ◽  
Diagnostic Ct

Purpose: To calculate cumulative doses of ionizing radiation absorbed by children with neuroblastoma during diagnostic CT and NM scans. Method: Retrospective analysis of 267 CT and NM scans performed in 21 children treated in 2009–2015. Results: The cumulative effective dose absorbed per child ranged from 58 to 536 mSv and was highest in infants under 3 years. Conclusion: Children with suspected neuroblastoma may be exposed to significant doses of radiation during the whole period of diagnosis and monitoring the progress of treatment.

scholarly journals Differences in radiation dose for computed tomography of the brain among pediatric patients at the emergency departments: an observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xi Min Tan ◽  
Mohammad Taufik Bin Mohamed Shah ◽  
Shu-Ling Chong ◽  
Yong-Kwang Gene Ong ◽  
Peck Har Ang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Effective Dose ◽  
Emergency Departments ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Radiological Protection ◽  
Radiation Doses ◽  
Reference Levels ◽  
Ct Brain ◽  
Risk Of Cancer

Abstract Background Computed tomography (CT) is associated with a risk of cancer development. Strategies to reduce radiation doses vary between centers. We compared radiation doses of CT brain studies between pediatric and general emergency departments (EDs), and determine the proportion studies performed within the reference levels recommended by the International Commission on Radiological Protection (ICRP). Methods A retrospective review was carried out in a healthcare network consisting of one pediatric ED and three general hospital EDs. Pediatric patients less than 16 years old with CT brain studies performed between 1 January 2015 and 31 December 2018 were included. Information on demographic, diagnosis, volume-averaged computed-tomography dose index and dose length product (DLP) were collected. Effective dose was then calculated from DLP using conversion factors, termed k-coefficients which were derived using a 16 cm head CT dose phantom. Results Four hundred and seventy-nine CT brain studies were performed – 379 (79.1%) at the pediatric ED. Seizure (149, 31.1%), head injury (147, 30.7%) and altered mental status (44, 9.2%) were the top three ED diagnoses. The median effective dose estimates were higher in general than pediatric EDs, particularly for those aged > 3 to ≤6 years old [1.57 mSv (IQR 1.42–1.79) versus 1.93 mSv (IQR 1.51–2.28), p = 0.047], > 6 to ≤10 years old [1.43 mSv (IQR 1.27–1.67) versus 1.94 mSv (IQR 1.61–2.59), p = 0.002) and > 10 years old (1.68 mSv (IQR 1.32–1.72) versus 2.03 mSv (IQR 1.58–2.88), p < 0.001). Overall, 233 (48.6%) and 13 (2.7%) studies were within the reference levels recommended by ICRP 60 and 103 respectively. Conclusions Radiation doses for CT brain studies were significantly higher at general EDs and less than half of the studies were within the reference levels recommended by ICRP. The development of diagnostic reference levels (DRLs) as a benchmark and clinical justification for performing CT studies can help reduce the radiation risks in the pediatric population.

scholarly journals A deep-learning method using computed tomography scout images for estimating patient body weight

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shota Ichikawa ◽  
Misaki Hamada ◽  
Hiroyuki Sugimori
Keyword(s):  
Computed Tomography ◽  
Body Weight ◽  
Deep Learning ◽  
Contrast Medium ◽  
Model Performance ◽  
Ct Scanning ◽  
Drug Dosing ◽  
Body Weights ◽  
Dose Management ◽  
Medium Dose

AbstractBody weight is an indispensable parameter for determination of contrast medium dose, appropriate drug dosing, or management of radiation dose. However, we cannot always determine the accurate patient body weight at the time of computed tomography (CT) scanning, especially in emergency care. Time-efficient methods to estimate body weight with high accuracy before diagnostic CT scans currently do not exist. In this study, on the basis of 1831 chest and 519 abdominal CT scout images with the corresponding body weights, we developed and evaluated deep-learning models capable of automatically predicting body weight from CT scout images. In the model performance assessment, there were strong correlations between the actual and predicted body weights in both chest (ρ = 0.947, p < 0.001) and abdominal datasets (ρ = 0.869, p < 0.001). The mean absolute errors were 2.75 kg and 4.77 kg for the chest and abdominal datasets, respectively. Our proposed method with deep learning is useful for estimating body weights from CT scout images with clinically acceptable accuracy and potentially could be useful for determining the contrast medium dose and CT dose management in adult patients with unknown body weight.

scholarly journals The Role of Transthoracic Ultrasound in the Study of Interstitial Lung Diseases: High-Resolution Computed Tomography Versus Ultrasound Patterns: Our Preliminary Experience

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 439
Author(s):  
Donato Lacedonia ◽  
Giulia Scioscia ◽  
Angelamaria Giardinelli ◽  
Carla Maria Irene Quarato ◽  
Ennio Vincenzo Sassani ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Lung Diseases ◽  
Interstitial Lung Diseases ◽  
High Resolution Computed Tomography ◽  
Pleural Line ◽  
Complementary Role ◽  
Number Of Patients ◽  
Significant Difference ◽  
Transthoracic Ultrasound

Transthoracic ultrasound (TUS) is a readily available imaging tool that can provide a quick real-time evaluation. The aim of this preliminary study was to establish a complementary role for this imaging method in the approach of interstitial lung diseases (ILDs). TUS examination was performed in 43 consecutive patients with pulmonary fibrosis and TUS findings were compared with the corresponding high-resolution computed tomography (HRCT) scans. All patients showed a thickened hyperechoic pleural line, despite no difference between dominant HRCT patterns (ground glass, honeycombing, mixed pattern) being recorded (p > 0.05). However, pleural lines’ thickening showed a significant difference between different HRCT degree of fibrosis (p < 0.001) and a negative correlation with functional parameters. The presence of >3 B-lines and subpleural nodules was also assessed in a large number of patients, although they did not demonstrate any particular association with a specific HRCT finding or fibrotic degree. Results allow us to suggest a complementary role for TUS in facilitating an early diagnosis of ILD or helping to detect a possible disease progression or eventual complications during routine clinical practice (with pleural line measurements and subpleural nodules), although HRCT remains the gold standard in the definition of ILD pattern, disease extent and follow-up.

scholarly journals CanAssist Breast Impacting Clinical Treatment Decisions in Early-Stage HR+ Breast Cancer Patients: Indian Scenario

2019 ◽  
Author(s):  
Satish Sankaran ◽  
Jyoti Bajpai Dikshit ◽  
Chandra Prakash SV ◽  
SE Mallikarjuna ◽  
SP Somashekhar ◽  
...  
Keyword(s):  
High Risk ◽  
Early Stage ◽  
Risk Groups ◽  
Treatment Decisions ◽  
Low Risk ◽  
Not Given ◽  
Breast Cancer Patients ◽  
Number Of Patients ◽  
Risk Of Cancer ◽  
The Impact

AbstractCanAssist Breast (CAB) has thus far been validated on a retrospective cohort of 1123 patients who are mostly Indians. Distant metastasis–free survival (DMFS) of more than 95% was observed with significant separation (P < 0.0001) between low-risk and high-risk groups. In this study, we demonstrate the usefulness of CAB in guiding physicians to assess risk of cancer recurrence and to make informed treatment decisions for patients. Of more than 500 patients who have undergone CAB test, detailed analysis of 455 patients who were treated based on CAB-based risk predictions by more than 140 doctors across India is presented here. Majority of patients tested had node negative, T2, and grade 2 disease. Age and luminal subtypes did not affect the performance of CAB. On comparison with Adjuvant! Online (AOL), CAB categorized twice the number of patients into low risk indicating potential of overtreatment by AOL-based risk categorization. We assessed the impact of CAB testing on treatment decisions for 254 patients and observed that 92% low-risk patients were not given chemotherapy. Overall, we observed that 88% patients were either given or not given chemotherapy based on whether they were stratified as high risk or low risk for distant recurrence respectively. Based on these results, we conclude that CAB has been accepted by physicians to make treatment planning and provides a cost-effective alternative to other similar multigene prognostic tests currently available.

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