Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry

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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Establishing local diagnostic reference levels for adult computed tomography in Morocco

Radioprotection ◽

10.1051/radiopro/2021035 ◽

2022 ◽

Author(s):

M. El Mansouri ◽

M. Talbi ◽

A. Choukri ◽

O. Nhila ◽

M. Aabid

Keyword(s):

Computed Tomography ◽

Adult Patients ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Head Ct ◽

Ct Examination ◽

Japanese Studies ◽

The Uk

In Morocco, the radiation doses received by adult patients are increasing due to the number of CT examinations performed and the larger number of computed tomography (CT) scanners installed. The aim of this study was to evaluate the radiation doses received by patients for the most common adult CT examinations in order to establish local diagnostic reference levels (DRLs). Data from 1016 adult patients were collected during 3 months from four Moroccan hospitals. Dose length product (DLP) and volumetric computed tomography dose index (CTDIvol) were evaluated by determining the 75th percentile as diagnostic reference levels for the most common examinations including head, chest and abdomen. The DRL for each examination was compared with other studies. The established DRLs in Morocco in terms of CTDIvol were 57.4, 12.3 and 10.9 for CT examinations of the head, chest, abdomen, respectively. For DLP, they were 1020, 632 and 714, respectively. These established DRLs for CTDIvol were almost similar to the UK DRLs at all examinations, higher than the Egyptian DRLs and lower than the Japanese DRLs at the head CT examination, lower than the DRLs from Egypt and Japan at the CT abdomen examination. In terms of DLP, the DRLs were higher than those of the British studies, lower than those of the Egyptian and Japanese studies at the head CT examination were higher at chest CT and lower at abdominal CT than those of all selected studies. The higher level of established DRLs in our study demonstrates the requirement of an optimization process while keeping a good image quality for a reliable diagnosis.

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Comparison of Radiation Dose in CT Examinations At PIMS with European Commission Reference Doses

Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University ◽

10.48036/apims.v17i3.511 ◽

2021 ◽

Vol 17 (3) ◽

pp. 216-221

Author(s):

Fawad Yasin ◽

Anum Rasheed ◽

Muhammad Nauman Malik ◽

Farheen Raza ◽

Ramish Riaz ◽

...

Keyword(s):

Computed Tomography ◽

Radiation Dose ◽

European Commission ◽

Large Scale ◽

Radiology Department ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Ct Dose

OBJECTIVE - The purpose of this study was to assess the radiation dose levels from common computed tomography (CT) examinations performed in Radiology Department of Pakistan Institute of Medical Sciences (PIMS), and evaluate these according to diagnostic reference levels (DRLs) proposed by European Commission (EC) guidelines, and thus contributing towards the establishment of local and national DRLs. To the best of our knowledge, this is the first study of its kind to explore radiation doses from CT examinations in Pakistan. STUDY DESIGN - This was a quantitative study conducted at PIMS, Islamabad, spanning a duration of eight weeks. Scan parameters and dose profile data of 1506 adults undergoing examinations of head, neck, chest and abdomen-pelvis regions, comprising of single- and multi-phase, contrast-enhanced and unenhanced studies. Dose indicators utilized by EC guidelines for DRLs include volume CT dose index (CTDIvol) and Dose Length Product (DLP) for single slice and complete examination radiation doses, respectively. METHOD - Values of CTDIvol, DLP and scan lengths were extracted from the CT operators console. Other control variables included gender, contrast enhancement and phasicity of study. IBM SPSS package was used to obtain descriptive statistics such as mean and quartiles. RESULTS - DRLs calculated as 75th percentile of CTDIvol, DLP for various anatomical regions are by and far comparable to European DRLs. CONCLUSION – This study describes institutional diagnostic reference levels for common CT exams in Islamabad and provides benchmark values for future reference. Our DRL values are mostly comparable to European and international DRLs. Similar, albeit large scale, surveys are recommended for establishment of local and national DRLs, eventually contributing towards development of regional DRLs. KEYWORDS: CTDIvol, DLP, Diagnostic Reference Levels, Computed Tomography, Radiation Monitoring, Scan length

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ADULT CT EXAMINATIONS IN ALGERIA: TOWARDS UPDATING NATIONAL DIAGNOSTIC REFERENCE LEVELS

Radiation Protection Dosimetry ◽

10.1093/rpd/ncaa116 ◽

2020 ◽

Vol 190 (4) ◽

pp. 364-371

Author(s):

Nadia Khelassi-Toutaoui ◽

Ahmed Merad ◽

Virginia Tsapaki ◽

Fouzia Meddad ◽

Zakia Sakhri-Brahimi ◽

...

Keyword(s):

Computed Tomography ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Institutional Evaluation ◽

Starting Point ◽

First Results ◽

Ct Radiation ◽

Computed Tomography Dose Index

Abstract A pilot study has concerned the most frequent computed tomography examinations (CT). This represents the first results based on actual survey for diagnostic reference levels (DRLs) establishment in Algeria. A total number of 2540 patients underwent this survey that has included the recording of CT parameters, computed tomography dose index (CTDIvol) and dose-length product of the head, thorax, abdomen, abdomen–pelvis (AP), lumbar spine (LS) and thorax–abdomen–pelvis (TAP) performed on standard patients. The proposed DRLs are 71 mGy/1282 mGy.cm for head, 16 mGy/555 mGy.cm for thorax, 18 mGy/671 mGy.cm for abdomen, 21 mGy/950 mGy.cm for AP, 36 mGy/957 mGy.cm for LS and 18 mGy/994 mGy.cm for TAP. The rounded 75th percentile seems to be higher in some examinations compared to the literature. Our findings confirm the need to optimise our practice. These results provide a starting point for institutional evaluation of CT radiation doses.

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Single- and Dual-Source CT Myelography: Comparison of Radiation Exposure and Establishment of Diagnostic Reference Levels

Diagnostics ◽

10.3390/diagnostics11101809 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1809

Author(s):

Sebastian Zensen ◽

Denise Bos ◽

Marcel Opitz ◽

Michael Forsting ◽

Nika Guberina ◽

...

Keyword(s):

Radiation Exposure ◽

Spontaneous Intracranial Hypotension ◽

Diagnostic Technique ◽

Anatomical Location ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Ct Myelography ◽

Dual Source

CT myelography (CTM) is a diagnostic technique for the evaluation of various spinal pathologies, and plays an important role in diagnosis of different diseases such as spontaneous intracranial hypotension and postoperative cerebrospinal fluid leaks. The aims of this study were to examine radiation exposure, establish diagnostic reference levels (DRLs) and compare radiation doses of single- and dual-source examinations and different CTM protocols. In this retrospective study, 183 CTMs comprising 155 single-source and 28 dual-source examinations, performed between May 2015 and December 2020, were analyzed. Dose data included 31 whole spine (A), 23 cervical (B), 10 thoracic (C), and 119 lumbar (D) CTMs. Radiation exposure was reported for volume-weighted CT dose index (CTDIvol) and dose-length product (DLP). Radiation doses for CTDIvol and DLP were distributed as follows (median, IQR): A: 7.44 mGy (6.01–11.17 mGy)/509.7 mGy·cm (382.4–682.9 mGy·cm), B: 9.31 mGy (7.20–14.64 mGy)/214.5 mGy·cm (153.7–308.2 mGy·cm), C: 6.80 mGy (6.14–8.26 mGy)/365.4 mGy·cm (222.8–432.4 mGy·cm), D: 11.02 mGy (7.97–14.89 mGy)/308.0 mGy·cm (224.7–413.7 mGy·cm). Local DRLs could be depicted as follows (CTDIvol/DLP): A: 11 mGy/683 mGy·cm, B: 15 mGy/308 mGy·cm, C: 8 mGy/432 mGy·cm, D: 15 mGy/414 mGy·cm. High image quality was achieved for all anatomical regions. Basically, radiation exposure of CTM differs according to anatomical location.

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Radiation Dose from Computed Tomography Scanning in Patients at Songklanagarind Hospital: Diagnostic Reference Levels

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2020732 ◽

2020 ◽

Vol 38 (2) ◽

pp. 135

Author(s):

Dechen Pema ◽

Supika Kritsaneepaiboon

Keyword(s):

Computed Tomography ◽

The United States ◽

Clinical Indication ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Abdominal Ct ◽

Dose Length Product ◽

Clinical Indications ◽

Computed Tomography Scanning ◽

Significant Difference

Objective: To determine diagnostic reference levels (DRLs) of computed tomography (CT) radiation doses in terms of CT dose index volume (CTDIvol) and dose length product (DLP) of CT scans of the head, chest and abdomen for patients at Songklanagarind Hospital, Thailand. Material and Methods: This was a retrospective analysis of 463 randomly selected head, chest and abdominal CT stuides from 416 patients enrolled from July 1st to 31st 2017. The CTDIvol, DLP and clinical indication for each CT study were conducted. The median and third quartile values were analysed and compared to the standard international DRLs. The DRL was defined as the third quartile value. Results: The DRLs for CTDIvol, and DLP of head, chest and whole abdominal CT were 57.5, 11.6 and 13.1 milliGray (mGy), and 1,102.6, 474.7 and 624.4 milliGray x centimetre (mGy.cm), respectively. The most common clinical indications were stroke (29.1%) for head CT and malignancy for both chest (73.6%) and abdominal CTs (49.6%). Conclusion: The DRLs of each CT region were mostly below standard international DRLs of Australia, Europe, Japan, the United Kingdom and the United States. The clinical indication for malignancy had significant difference in the DLP values than other clinical indications in head and chest CT.

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Diagnostic Reference Levels for Common Orthopedic Hand and Wrist Procedures Using Intraoperative mini C-arm Fluoroscopy

Hand ◽

10.1177/1558944721994257 ◽

2021 ◽

pp. 155894472199425

Author(s):

Kiran R. Madhvani ◽

Matthew J. R. Clark ◽

Alex A. J. Kocheta

Keyword(s):

Radiation Dose ◽

Fracture Fixation ◽

Wrist Fracture ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Audit Data ◽

Small Joint ◽

Open Fixation ◽

Phalangeal Fracture

Background: Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to contribute to national diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Small joint and digital fracture procedure diagnostic reference levels have not been reported in significant numbers previously with procedure-level stratification. Methods: Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on fluoroscopy machines. A total of 603 procedures were included. Results: The median radiation dose for wrist fracture open fixation was 2.73 cGycm2, Kirschner wiring (K-wiring) procedures was 2.36 cGycm2, small joint arthrodesis was 1.20 cGycm2, small joint injections was 0.58 cGycm2, and phalangeal fracture fixation was 1.05 cGycm2. Conclusions: Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses, and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. National and international recommendations are that institutional audit data should be collected regularly and should be stratified by procedure type. This study helps to define standards for this activity by adding to the data available for wrist fracture diagnostic reference levels and defining standards for digital and injection procedures.

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A MULTICENTRE SURVEY OF LOCAL DIAGNOSTIC REFERENCE LEVELS AND ACHIEVABLE DOSE FOR CORONARY ANGIOGRAPHY AND PERCUTANEOUS TRANSLUMINAL CORONARY INTERVENTION PROCEDURES IN KOREA

Radiation Protection Dosimetry ◽

10.1093/rpd/ncz178 ◽

2019 ◽

Vol 187 (3) ◽

pp. 378-382

Author(s):

Jung Su Kim ◽

Bong-Ki Lee ◽

Dong Ryeol Ryu ◽

Kwang Jin Chun ◽

Hyun-Hee Choi ◽

...

Keyword(s):

Coronary Angiography ◽

Interventional Cardiology ◽

Coronary Intervention ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

High Radiation ◽

Exposure Data ◽

Area Product ◽

Percutaneous Transluminal

Abstract Interventional cardiology procedures can involve relatively high radiation doses compared to general radiography. During coronary angiography (CAG) and percutaneous transluminal coronary intervention (PCI), the same area is exposed to radiation for a long period. In this study, radiation exposure data of 1071 examinations in Korean hospitals were collected, and the achievable dose (AD) and diagnostic reference levels (DRLs) in actual medical practice for two types of interventional cardiology procedures in Korea were established. In CAG, 75th percentile DRLs and AD of the total kerma-area product were 47.0 and 33.1 Gy·cm 2, respectively. In PCI, those values were 171.3 and 102.6 Gy·cm2, respectively. This is the first study to introduce the DRLs for cardiovascular interventional procedures in Korea. These results will help optimise the interventional cardiology procedures for Korean cardiac centres.

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Establishment of CTPA Local Diagnostic Reference Levels with Noise Magnitude as a Quality Indicator in a Tertiary Care Hospital

Diagnostics ◽

10.3390/diagnostics10090680 ◽

2020 ◽

Vol 10 (9) ◽

pp. 680

Author(s):

Hanif Haspi Harun ◽

Muhammad Khalis Abdul Karim ◽

Mohd Amiruddin Abd Rahman ◽

Hairil Rashmizal Abdul Razak ◽

Iza Nurzawani Che Isa ◽

...

Keyword(s):

Body Size ◽

Quality Indicator ◽

Tertiary Care ◽

Pulmonary Arteries ◽

The Body ◽

Care Hospital ◽

Diagnostic Reference Levels ◽

Ct Scanner ◽

Reference Levels ◽

Dose Length Product

This study aimed to establish the local diagnostic reference levels (LDRLs) of computed tomography pulmonary angiography (CTPA) examinations based on body size with regard to noise magnitude as a quality indicator. The records of 127 patients (55 males and 72 females) who had undergone CTPAs using a 128-slice CT scanner were retrieved. The dose information, scanning acquisition parameters, and patient demographics were recorded in standardized forms. The body size of patients was categorized into three groups based on their anteroposterior body length: P1 (14–19 cm), P2 (19–24 cm), and P3 (24–31 cm), and the radiation dose exposure was statistically compared. The image noise was determined quantitatively by measuring the standard deviation of the region of interest (ROI) at five different arteries—the ascending and descending aorta, pulmonary trunk, and the left and right main pulmonary arteries. We observed that the LDRL values were significantly different between body sizes (p < 0.05), and the median values of the CT dose index volume (CTDIvol) for P1, P2, and P3 were 6.13, 8.3, and 21.40 mGy, respectively. It was noted that the noise reference values were 23.78, 24.26, and 23.97 HU for P1, P2, and P3, respectively, which were not significantly different from each other (p > 0.05). The CTDIvol of 9 mGy and dose length product (DLP) of 329 mGy∙cm in this study were lower than those reported by other studies conducted elsewhere. This study successfully established the LDRLs of a local healthcare institution with the inclusion of the noise magnitude, which is comparable with other established references.

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Monitoring neurointerventional radiation doses using dose-tracking software: implications for the establishment of local diagnostic reference levels

European Radiology ◽

10.1007/s00330-018-5405-3 ◽

2018 ◽

Vol 28 (9) ◽

pp. 3669-3675 ◽

Cited By ~ 12

Author(s):

Holly Acton ◽

Karl James ◽

Richard G. Kavanagh ◽

Colm O’Tuathaigh ◽

Deirdre Moloney ◽

...

Keyword(s):

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels

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Patient doses in computed tomography: An assessment of local diagnostic reference levels in a large teaching hospital

Nuclear Technology and Radiation Protection ◽

10.2298/ntrp1203305h ◽

2012 ◽

Vol 27 (3) ◽

pp. 305-310 ◽

Cited By ~ 3

Author(s):

Darka Hadnadjev ◽

Danijela Arandjic ◽

Sanja Stojanovic ◽

Olivera Ciraj-Bjelac ◽

Predrag Bozovic ◽

...

Keyword(s):

Computed Tomography ◽

Dose Reduction ◽

Teaching Hospital ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Large Teaching Hospital ◽

Tube Current ◽

Patient Doses ◽

Computed Tomography Dose Index

This paper presents an estimation of local diagnostic reference levels in computed tomography in a large teaching hospital. Local diagnostic reference levels, expressed in terms of volume weighted computed tomography dose index and dose-length product, were estimated for three most frequent adult computer tomography examinations: head, abdomen and pelvis combined, and thorax. The established local diagnostic reference levels values were similar or slightly higher compared to the available guidelines, indicating the possibility for optimization of current practice. Analyzing the protocols used here and recently published studies on dose reduction in computed tomography, a dose-reduction technique, was proposed to decrease tube current values in all three examinations. However, the optimization should be restricted only to standard-sized patients.

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