A Review of Diagnostic Reference Levels in Computed Tomography

2021 ◽  
Vol 17 ◽  
Author(s):  
Jemal Edris Dawd ◽  
Dilber Uzun Ozsahin ◽  
Ilker Ozsahin
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Radiation Dose ◽  
Good Practice ◽  
Ct Scanning ◽  
Diagnostic Information ◽  
The Body ◽  
Reference Level ◽  
Technical Parameters ◽  
Wide Range

: Computed tomography (CT) scanning generate 3-D images of the inside structures of the body by delivering comparatively radiation dose to the patient. This requires high concern of optimization via establishing diagnostic reference level (DRL). DRL values can be estimated based on reference patient percentiles (such as 90th, 75th and 50th) dose distribution. DRL has significant uses in professional judgments by generating harmonized evidence about the radiation dose received by the patient. The primary goal of this review is to assess the practical application of DRL in CT procedures internationally. The main objective of establishing DRLs is to optimize the patient dose and without compromising the image quality in order to obtain adequate diagnostic information. That means inescapability of DRL for a country in medical diagnosis is to reduce the limitation of dose dispersion, to harmonize and expand good practice, to narrow large dispersion of doses, and to create systematic supervision for unwanted radiological doses. The review presents that international records have a wide-range of mean dose distributions due to the variation of exam protocols and technical parameters in use. Hence, this review recommends that each CT health facilities are required exercising careful dose reduction strategies by accounting adequate image quality with sufficient diagnostic information via through follow up of concerned bodies.

scholarly journals Radiation dose reduction in chest dual-energy computed tomography: effect on image quality and diagnostic information

2018 ◽  
Vol 51 (6) ◽  
pp. 377-384 ◽  
Author(s):  
Rodrigo Canellas ◽  
Subba Digumarthy ◽  
Azadeh Tabari ◽  
Alexi Otrakji ◽  
Shaunagh McDermott ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Radiation Dose ◽  
Dual Energy ◽  
Diagnostic Information ◽  
Lesion Detection ◽  
Kappa Statistics ◽  
Dual Energy Computed Tomography ◽  
Reduced Dose ◽  
Image Series

Abstract Objective: To determine whether dual-energy computed tomography (DECT) of the chest can be performed at a reduced radiation dose, with an emphasis on images generated with post-processing techniques. Materials and Methods: In 21 patients undergoing DECT of the chest in a dual-source scanner, an additional image series was acquired at a reduced radiation dose. Four thoracic radiologists assessed both image series for image quality, normal thoracic structures, as well as pulmonary and mediastinal abnormalities, on virtual monochromatic images at 40 keV and 60 keV. Data were analyzed with Student's t-test, kappa statistics, analysis of variance, and the Wilcoxon signed-rank test. Results: The overall image quality of 60 keV virtual monochromatic images at a reduced radiation dose was considered optimal in all patients, and no abnormalities were missed. Contrast enhancement and lesion detection performance were comparable between reduced-dose images at 40 keV and standard-of-care images at 60 keV. The intraobserver and interobserver agreement were both good. The mean volumetric CT dose index (CTDIvol), size-specific dose estimate (SSDE), dose-length product (DLP), and effective dose (ED) for reduced-dose DECT were 3.0 ± 0.6 mGy, 4.0 ± 0.6 mGy, 107 ± 30 mGy.cm, and 1.5 ± 0.4 mSv, respectively. Conclusion: DECT of the chest can be performed at a reduced radiation dose (CTDIvol < 3 mGy) without loss of diagnostic information.

Using 100- instead of 120-kVp computed tomography to diagnose pulmonary embolism almost halves the radiation dose with preserved diagnostic quality

2010 ◽  
Vol 51 (3) ◽  
pp. 260-270 ◽  
Author(s):  
Peter Björkdahl ◽  
Ulf Nyman
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Image Quality ◽  
Radiation Dose ◽  
Effective Dose ◽  
Ct Number ◽  
Subjective Image Quality ◽  
Diagnostic Quality ◽  
X Ray ◽  
Tube Potential

Background: Concern has been raised regarding the mounting collective radiation doses from computed tomography (CT), increasing the risk of radiation-induced cancers in exposed populations. Purpose: To compare radiation dose and image quality in a chest phantom and in patients for the diagnosis of pulmonary embolism (PE) at 100 and 120 peak kilovoltage (kVp) using 16-multichannel detector computed tomography (MDCT). Material and Methods: A 20-ml syringe containing 12 mg I/ml was scanned in a chest phantom at 100/120 kVp and 25 milliampere seconds (mAs). Consecutive patients underwent 100 kVp ( n = 50) and 120 kVp ( n = 50) 16-MDCT using a “quality reference” effective mAs of 100, 300 mg I/kg, and a 12-s injection duration. Attenuation (CT number), image noise (1 standard deviation), and contrast-to-noise ratio (CNR; fresh clot = 70 HU) of the contrast medium syringe and pulmonary arteries were evaluated on 3-mm-thick slices. Subjective image quality was assessed. Computed tomography dose index (CTDIvol) and dose–length product (DLP) were presented by the CT software, and effective dose was estimated. Results: Mean values in the chest phantom and patients changed as follows when X-ray tube potential decreased from 120 to 100 kVp: attenuation +23% and +40%, noise +38% and +48%, CNR −6% and 0%, and CTDIvol −38% and −40%, respectively. Mean DLP and effective dose in the patients decreased by 42% and 45%, respectively. Subjective image quality was excellent or adequate in 49/48 patients at 100/120 kVp. No patient with a negative CT had any thromboembolism diagnosed during 3-month follow-up. Conclusion: By reducing X-ray tube potential from 120 to 100 kVp, while keeping all other scanning parameters unchanged, the radiation dose to the patient may be almost halved without deterioration of diagnostic quality, which may be of particular benefit in young individuals.

scholarly journals Low-Dose Computed Tomography for the Optimization of Radiation Dose Exposure in Patients with Crohn’s Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Richard G. Kavanagh ◽  
John O’Grady ◽  
Brian W. Carey ◽  
Patrick D. McLaughlin ◽  
Siobhan B. O’Neill ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Crohn’S Disease ◽  
Image Quality ◽  
Crohn's Disease ◽  
Radiation Dose ◽  
Ionizing Radiation ◽  
Low Dose ◽  
Radiation Doses ◽  
Radiation Dose Exposure ◽  
Ct Technology

Magnetic resonance imaging (MRI) is the mainstay method for the radiological imaging of the small bowel in patients with inflammatory bowel disease without the use of ionizing radiation. There are circumstances where imaging using ionizing radiation is required, particularly in the acute setting. This usually takes the form of computed tomography (CT). There has been a significant increase in the utilization of computed tomography (CT) for patients with Crohn’s disease as patients are frequently diagnosed at a relatively young age and require repeated imaging. Between seven and eleven percent of patients with IBD are exposed to high cumulative effective radiation doses (CEDs) (>35–75 mSv), mostly patients with Crohn’s disease (Newnham E 2007, Levi Z 2009, Hou JK 2014, Estay C 2015). This is primarily due to the more widespread and repeated use of CT, which accounts for 77% of radiation dose exposure amongst patients with Crohn’s disease (Desmond et al., 2008). Reports of the projected cancer risks from the increasing CT use (Berrington et al., 2007) have led to increased patient awareness regarding the potential health risks from ionizing radiation (Coakley et al., 2011). Our responsibilities as physicians caring for these patients include education regarding radiation risk and, when an investigation that utilizes ionizing radiation is required, to keep radiation doses as low as reasonably achievable: the “ALARA” principle. Recent advances in CT technology have facilitated substantial radiation dose reductions in many clinical settings, and several studies have demonstrated significantly decreased radiation doses in Crohn’s disease patients while maintaining diagnostic image quality. However, there is a balance to be struck between reducing radiation exposure and maintaining satisfactory image quality; if radiation dose is reduced excessively, the resulting CT images can be of poor quality and may be nondiagnostic. In this paper, we summarize the available evidence related to imaging of Crohn’s disease, radiation exposure, and risk, and we report recent advances in low-dose CT technology that have particular relevance.

Image quality and radiation dose in 256-slice cardiac computed tomography: Comparison of prospective versus retrospective image acquisition protocols

2011 ◽  
Vol 80 (1) ◽  
pp. 127-135 ◽  
Author(s):  
Waldemar Hosch ◽  
Tobias Heye ◽  
Felix Schulz ◽  
Stephanie Lehrke ◽  
Martin Schlieter ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Radiation Dose ◽  
Cardiac Computed Tomography ◽  
Image Acquisition

Automated tube voltage adaptation in head and neck computed tomography between 120 and 100 kV: effects on image quality and radiation dose

2014 ◽  
Vol 56 (9) ◽  
pp. 797-803 ◽  
Author(s):  
Matthias S. May ◽  
Manuel R. Kramer ◽  
Achim Eller ◽  
Wolfgang Wuest ◽  
Michael Scharf ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Radiation Dose ◽  
Head And Neck ◽  
Tube Voltage

scholarly journals Reducing cranial computed tomography effective radiation dose by 30% using adaptive iterative dose reduction

2016 ◽  
Vol 25 (4) ◽  
pp. 230-234
Author(s):  
Wai-Yung Yu ◽  
Thye Sin Ho ◽  
Henry Ko ◽  
Wai-Yee Chan ◽  
Serene Ong ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Radiation Dose ◽  
Dose Reduction ◽  
Diagnostic Image Quality ◽  
Radiation Doses ◽  
Effective Radiation Dose ◽  
Diagnostic Image ◽  
Ct Head ◽  
Effective Radiation

Introduction: The use of computed tomography (CT) imaging as a diagnostic modality is increasing rapidly and CT is the dominant contributor to diagnostic medical radiation exposure. The aim of this project was to reduce the effective radiation dose to patients undergoing cranial CT examination, while maintaining diagnostic image quality. Methods: Data from a total of 1003, 132 and 27 patients were examined for three protocols: CT head, CT angiography (CTA), and CT perfusion (CTP), respectively. Following installation of adaptive iterative dose reduction (AIDR) 3D software, tube current was lowered in consecutive cycles, in a stepwise manner and effective radiation doses measured at each step. Results: Baseline effective radiation doses for CT head, CTA and CTP were 1.80, 3.60 and 3.96 mSv, at currents of 300, 280 and 130–150 mA, respectively. Using AIDR 3D and final reduced currents of 160, 190 and 70–100 mA for CT head, CTA and CTP gave effective doses of 1.29, 3.18 and 2.76 mSv, respectively. Conclusion: We demonstrated that satisfactory reductions in the effective radiation dose for CT head (28.3%), CTA (11.6%) and CTP (30.1%) can be achieved without sacrificing diagnostic image quality. We have also shown that iterative reconstruction techniques such as AIDR 3D can be effectively used to help reduce effective radiation dose. The dose reductions were performed within a short period and can be easily achievable, even in busy departments.

scholarly journals Low Dose Computed Tomography in Diagnosis of Ureteric Calculus in Obese Patients

2020 ◽  
Vol 9 (1) ◽  
pp. 27-31
Author(s):  
Mahesh Gautam ◽  
Aziz Ullah ◽  
Manish Raj Pathak
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Radiation Dose ◽  
Iterative Reconstruction ◽  
Low Dose ◽  
Standard Dose ◽  
Reconstruction Technique ◽  
Obese Patients ◽  
Low Dose Computed Tomography ◽  
Effective Radiation

Background: Standard dose computed tomography is standard imaging modality in diagnosis of urolithiasis. The introduction of low dose techniques results in decrease radiation dose without significant change in image quality. However, the image quality of low dose computed tomography is affected by skin fold thickness and subcutaneous abdominal adipose tissue. The aim of this study to evaluate stone location, size, and density using low dose computed tomography compared with standard dose computed tomography in obese population. Material and Methods: This non-randomized non-inferiority trial includes 120 patient having BMI≥25kg/m2 with acute ureteric colic. The low dose and standard dose computed tomography were performed accordingly. Effective radiation doses were calculated from dose-length product obtained from scan report using conversion factor of 0.015. The images were reconstructed using iterative reconstruction algorithm. Effective dose, number and size of stone, Hounsfield Unit value of stone and image quality was assessed. Results: Stones were located in 69 (57.5%) in right and 51 (42.5%) in left ureter. There was no statistical difference in mean diameter, number and density of stones in low dose as compared with standard dose. The radiation dose was significantly lower with low dose. (3.68 mSv) The delineation of the ureter, outline of the stones and image quality in low dose was overall sufficient for diagnosis. No images of low dose scan were subjectively rated as non-diagnostics. Conclusion: Low dose computed tomography with iterative reconstruction technique is as effective as standard dose in diagnosis of ureteric stones in obese patients with lower effective radiation dose.

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