Optimization of computed tomography urography protocol, 1997 to 2008: Effects on radiation dose

Background: Since computed tomography (CT) urography began to replace excretory urography as the primary imaging technique in uroradiology, the collective radiation dose to the patients has increased. Purpose: To examine the changes in the CT urography protocol for investigating suspected urinary tract malignancy between the years 1997 and 2008, and how these changes have influenced the mean effective dose. Material and Methods: The study was based on 102 patients (mean age 66.1±14.8 years, range 31–89 years; 30 female, 72 male) divided into five groups (groups A–E) corresponding to the time points at which changes were made to the CT urography protocol. The mean effective doses were estimated using the ImPACT CT Patient Dosimetry Calculator. Results: The number of scan phases at CT urography was reduced from four to three in 1999, resulting in a reduction of the mean effective dose from 29.9/22.5 (female [F]/male [M]) mSv (group A) to 26.1/18.9 (F/M) mSv (group B). In 2001, mAs settings were adapted to patient size, and the mean effective dose was reduced to 16.8/12.0 (F/M) mSv (group C). In 2005, scans were performed with a multidetector-row CT equipped with automatic tube current modulation in the x- and y-axis (CARE Dose). The effective mAs was also lowered in the unenhanced and excretory phase, yet the mean effective dose increased to 18.2/13.1 (F/M) mSv (group D), since the effective mAs had to be increased in the corticomedullary phase to maintain image quality. In 2008, as tube current modulation in the x-, y-, and z-axis was introduced (CARE Dose4D), the mean effective dose was reduced to 11.7/8.8 (F/M) mSv (group E). Conclusion: This study shows that the individual mean effective dose to patients undergoing CT urography has decreased by 60%, from 29.9/22.5 (F/M) mSv in 1997 to 11.7/8.8 (F/M) mSv in 2008.