Establishing Diagnostic Reference Levels for CT Through a Provincial Medical Informatics Metadata Repository in Ontario

2020 ◽  
pp. 084653712092302
Author(s):  
Kate MacGregor ◽  
Lianne Concepcion ◽  
Tim Dowdell ◽  
Bruce Gray
Keyword(s):  
Computed Tomography ◽  
Radiation Dose ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Mean Values ◽  
Dose Metrics ◽  
Metadata Repository ◽  
Central Database ◽  
The Difference ◽  
Health Canada

Purpose: To determine whether computed tomography radiation dose data could be captured electronically across hospitals to derive regional diagnostic reference levels for quality improvement. Methods: Data on consecutive computed tomography examinations from 8 hospitals were collected automatically in a central database (Repository) from April 2017 to September 2017. The most frequently performed examinations were used to determine the standard protocols for each hospital. Diagnostic reference levels across hospitals were derived using statistical distribution for 2 radiation dose metrics. These values were compared between hospitals, within and between hospitals by scanner and against national Health Canada achievable doses and diagnostic reference levels. Results: Three master protocol groups, Head, Abdomen–Pelvis, and Chest–Abdomen–Pelvis, accounted for 43% of all valid studies (N = 40 277). For the Repository, 11 of 12 mean values and 75th percentile diagnostic reference levels were below the Health Canada mean and 75th percentile values, and one was the same as the Health Canada value. Mean radiation dose by protocol varied by as much as 97% between hospitals. There was no consistent pattern in the difference between mean doses between large and small hospitals. Conclusion: This electronic data acquisition process could be used to continually update achievable doses for frequently used computed tomography examinations in Ontario and eliminate the need for nationwide manual surveys. Results compared across institutions will allow hospitals to maintain achievable doses and lower patient exposure.

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

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

scholarly journals The 2020 national diagnostic reference levels for nuclear medicine in Japan

2020 ◽  
Vol 34 (11) ◽  
pp. 799-806
Author(s):  
Koichiro Abe ◽  
Makoto Hosono ◽  
Takayuki Igarashi ◽  
Takashi Iimori ◽  
Masanobu Ishiguro ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Nuclear Medicine ◽  
Radiation Dose ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Positron Emission ◽  
Pet Ct

Abstract The diagnostic reference levels (DRLs) are one of several effective tools for optimizing nuclear medicine examinations and reducing patient exposure. With the advances in imaging technology and alterations of examination protocols, the DRLs must be reviewed periodically. The first DRLs in Japan were established in 2015, and since 5 years have passed, it is time to review and revise the DRLs. We conducted a survey to investigate the administered activities of radiopharmaceuticals and the radiation doses of computed tomography (CT) in hybrid CT accompanied by single photon emission computed tomography (SPECT)/CT and positron emission tomography (PET)/CT. We distributed a Web-based survey to 915 nuclear medicine facilities throughout Japan and survey responses were provided by 256 nuclear medicine facilities (response rate 28%). We asked for the facility's median actual administered activity and median radiation dose of hybrid CT when SPECT/CT or PET/CT was performed for patients with standard habitus in the standard protocol of the facility for each nuclear medicine examination. We determined the new DRLs based on the 75th percentile referring to the 2015 DRLs, drug package inserts, and updated guidelines. The 2020 DRLs are almost the same as the 2015 DRLs, but for the relatively long-lived radionuclides, the DRLs are set low due to the changes in the Japanese delivery system. There are no items set higher than the previous values. Although the DRLs determined this time are roughly equivalent to the DRLs used in the US, overall they tend to be higher than the European DRLs. The DRLs of the radiation dose of CT in hybrid CT vary widely depending on each imaging site and the purpose of the examination.

scholarly journals Size-specific dose estimates of adult, chest computed tomography examinations: Comparison of Chinese and updated 2017 American College of Radiology diagnostic reference levels based on the water-equivalent diameter

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257294
Author(s):  
Xiaoyan Hu ◽  
Jie Gou ◽  
Wei Lin ◽  
Chunhua Zou ◽  
Wenbo Li
Keyword(s):  
Computed Tomography ◽  
Radiation Dose ◽  
Exposure Dose ◽  
Chest Ct ◽  
Equivalent Diameter ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Dose Length Product ◽  
Volume Computed Tomography ◽  
The One

Rationale and objectives This study aimed to compare the volume computed tomography dose index (CTDIvol), dose length product (DLP), and size-specific dose estimate (SSDE), with the China and updated 2017 American College of Radiology (ACR) diagnostic reference levels (DRLs) in chest CT examinations of adults based on the water-equivalent diameter (Dw). Materials and methods All chest CT examinations conducted without contrast administration from January 2020 to July 2020 were retrospectively included in this study. The Dw and SSDE of all examinations were calculated automatically by “teamplay”. The CTDIvol and DLP were displayed on the DICOM-structured dose report in the console based on a 32cm phantom.The differences in patient CTDIvol, DLP, and SSDE values between groups were examined by the one-way ANOVA. The differences in patient CTDIvol, DLP, and SSDE values between the updated 2017 ACR and the China DRLs were examined with one sample t-tests. Results In total 14666 chest examinations were conducted in our study. Patients were divided into four groups based on Dw:270 (1.84%) in 15–20 cm group, 10287 (70.14%) in the 21–25 cm group, 4097 (27.94%) in the 26–30 cm group, and 12 (0.08%) patients had sizes larger than 30 cm. CTDIvol, DLP, and SSDE increased as a function of Dw (p<0.05). CTDIvol was smaller than SSDE among groups (p<0.05). The mean CTDIvol and DLP values were lower than the 25th, 50th, and 75th percentile of the China DRLs (p <0.05). The CTDIvol, DLP, and SSDE were lower than the 50th and 75th percentiles of the updated 2017 ACR DRLs (p <0.05) among groups. Conclusions SSDE takes into account the influence of the scanning parameters, patient size, and X-ray attenuation on the radiation dose, which can give a more realistic estimate of radiation exposure dose for patients undergoing CT examinations. Establishing hospital’s own DRL according to CTDIvol and SSDE is very important even though the radiation dose is lower than the national DRLs.

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

Hand ◽  
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.

Establishing local diagnostic reference levels for adult computed tomography in Morocco

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.

Establishing national diagnostic reference levels (DRLs) for computed tomography in Egypt

2017 ◽  
Vol 39 ◽  
pp. 16-24 ◽  
Author(s):  
Dina Husseiny Salama ◽  
Jenia Vassileva ◽  
Gamal Mahdaly ◽  
Mona Shawki ◽  
Ahmad Salama ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Reference Levels ◽  
Reference Levels
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