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

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1809
Author(s):  
Sebastian Zensen ◽  
Denise Bos ◽  
Marcel Opitz ◽  
Michael Forsting ◽  
Nika Guberina ◽  
...  

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.

2022 ◽  
Author(s):  
M. El Mansouri ◽  
M. Talbi ◽  
A. Choukri ◽  
O. Nhila ◽  
M. Aabid

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.


2021 ◽  
Vol 17 (3) ◽  
pp. 216-221
Author(s):  
Fawad Yasin ◽  
Anum Rasheed ◽  
Muhammad Nauman Malik ◽  
Farheen Raza ◽  
Ramish Riaz ◽  
...  

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


2020 ◽  
Vol 190 (4) ◽  
pp. 364-371
Author(s):  
Nadia Khelassi-Toutaoui ◽  
Ahmed Merad ◽  
Virginia Tsapaki ◽  
Fouzia Meddad ◽  
Zakia Sakhri-Brahimi ◽  
...  

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.


2021 ◽  
pp. 028418512110032
Author(s):  
Sebastian Zensen ◽  
Denise Bos ◽  
Marcel Opitz ◽  
Johannes Haubold ◽  
Michael Forsting ◽  
...  

Background In the assessment of diseases causing skeletal lesions such as multiple myeloma (MM), whole-body low-dose computed tomography (WBLDCT) is a sensitive diagnostic imaging modality, which has the potential to replace the conventional radiographic survey. Purpose To optimize radiation protection and examine radiation exposure, and effective and organ doses of WBLDCT using different modern dual-source CT (DSCT) devices, and to establish local diagnostic reference levels (DRL). Material and Methods In this retrospective study, 281 WBLDCT scans of 232 patients performed between January 2017 and April 2020 either on a second- (A) or third-generation (B) DSCT device could be included. Radiation exposure indices and organ and effective doses were calculated using a commercially available automated dose-tracking software based on Monte-Carlo simulation techniques. Results The radiation exposure indices and effective doses were distributed as follows (median, interquartile range): (A) second-generation DSCT: volume-weighted CT dose index (CTDIvol) 1.78 mGy (1.47–2.17 mGy); dose length product (DLP) 282.8 mGy·cm (224.6–319.4 mGy·cm), effective dose (ED) 1.87 mSv (1.61–2.17 mSv) and (B) third-generation DSCT: CTDIvol 0.56 mGy (0.47–0.67 mGy), DLP 92.0 mGy·cm (73.7–107.6 mGy·cm), ED 0.61 mSv (0.52–0.69 mSv). Radiation exposure indices and effective and organ doses were significantly lower with third-generation DSCT ( P < 0.001). Local DRLs could be set for CTDIvol at 0.75 mGy and DLP at 120 mGy·cm. Conclusion Third-generation DSCT requires significantly lower radiation dose for WBLDCT than second-generation DSCT and has an effective dose below reported doses for radiographic skeletal surveys. To ensure radiation protection, DRLs regarding WBLDCT are required, where our locally determined values may help as benchmarks.


Author(s):  
Denise Bos ◽  
Sophronia Yu ◽  
Jason Luong ◽  
Philip Chu ◽  
Yifei Wang ◽  
...  

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.


2015 ◽  
Vol 16 (2) ◽  
pp. 71
Author(s):  
Eri Hiswara ◽  
Dewi Kartikasari

ABSTRAKDOSIS PASIEN PADA PEMERIKSAAN RUTIN SINAR-X RADIOLOGI DIAGNOSTIK. Teknik diagnosis untuk melihat kondisi fisik seorang pasien dengan menggunakan pesawat sinar-X merupakan teknik yang paling banyak digunakan di dunia.  Berdasarkan Badan PBB untuk Efek Radiasi Atom (UNSCEAR), pajanan radiasi sinar-X pada pemeriksaan rutin radiologi diagnostik memberikan kontribusi terbesar bagi penerimaan dosis radiasi oleh penduduk dunia. Untuk kepentingan keselamatan pasien, Badan Tenaga Atom Internasional (IAEA) telah merekomendasikan penggunaan tingkat acuan diagnostik (DRL) agar dosis radiasi yang diterima pasien tersebut optimum sambil tetap mempertahankan kualitas citra film yang dihasilkan dari aplikasi ini. Dalam kaitan ini telah dilakukan studi tingkat dosis radiasi yang diterima oleh pasien dari aplikasi radiasi di bidang radiologi diagnostik. Hasil studi dibandingkan dengan tingkat acuan diagnostik yang berlaku di Indonesia. Studi dilakukan dengan melakukan pengukuran dosis permukaan masuk pada 130 orang pasien yang menjalani pemeriksaan thorax (AP/PA), thorax lat, abdomen, kepala AP/PA, kepala Lat, lumbo sacral AP, lumbo sacral Lat, ekstremitas, pelvis AP, cervical AP, cervical Lat, cervical oblique, clavicula dan thoracal lumbal di tiga rumah sakit di kota Makassar, Sukabumi, dan Pontianak. Hasil studi menunjukkan bahwa data dosis radiasi yang diterima pasien pada pemeriksaan thorax AP/PA, thorax lat, abdomen, kepala AP/PA, kepala lat, lumbosacral AP, lumbosacral lat dan pelvis AP menunjukkan nilai yang tidak melebihi nilai tingkat acuan diagnostik yang berlaku di Indonesia, dan dosis radiasi yang diterima pasien anak lebih rendah daripada dosis pasien dewasa. Perbandingan nilai dosis pasien yang diperoleh pada studi ini dan di Malaysia dengan hasil yang diperoleh dari beberapa negara maju juga memperlihatkan bahwa dosis pasien di negara berkembang relatif tidak berbeda dengan dosis pasien di negara-negara maju tersebut. ABSTRACTDOSES TO PATIENTS IN ROUTINE X-RAY EXAMINATIONS OF DIAGNOSTIC RADIOLOGY. Diagnostic technique to study physical condition of a patient using X-rays is the most common technique used in the world. According to the United Nations Scientific Committee on Effects of Atomic Radiation (UNSCEAR), radiation exposures in routine X-rays examination of diagnostic radiology contribute to the biggest portion of radiation doses received by world’s population. For the purposes of patient safety, diagnostic reference levels have been recommended by the International Atomic Energy Agency (IAEA) to be used in order to optimize the dose received by patient while maintaining quality of film image produced by these procedures. In this regard study on the determination of the level of radiation doses received by patient, has been carried out. Results of study are compared to the diagnostic reference levels for medical exposures applied in Indonesia. The study was performed by measuring entrance surface doses in 130 patients who underwent the X-ray examinations of thorax AP/PA, thorax lat, abdomen, skull AP/PA, skull Lat, lumbo sacral AP, lumbo sacral Lat, extremities, pelvis AP, cervical AP, cervical Lat, cervical oblique, clavicula and thoracal lumbal in three hospitals in the cities of Makassar, Sukabumi, dan Pontianak. The results show all data of patient doses from examinations of thorax AP/PA, thorax lat, abdomen, skull AP/PA, skull Lat, lumbo sacral AP, lumbo sacral Lat, extremities and pelvis APwere less than the levels applied in Indonesia and doses received by children were  less than those by adult patients. Comparison of data obtained in this study and in Malaysia as developing countries with those from advanced countries also showed that they were relatively no difference between the two groups.


Hand ◽  
2021 ◽  
pp. 155894472199425
Author(s):  
Kiran R. Madhvani ◽  
Matthew J. R. Clark ◽  
Alex A. J. Kocheta

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.


2019 ◽  
Vol 187 (3) ◽  
pp. 378-382
Author(s):  
Jung Su Kim ◽  
Bong-Ki Lee ◽  
Dong Ryeol Ryu ◽  
Kwang Jin Chun ◽  
Hyun-Hee Choi ◽  
...  

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.


2021 ◽  
Vol 94 (1117) ◽  
pp. 20190878
Author(s):  
Anna Kropelnicki ◽  
Rosemary Eaton ◽  
Alexandra Adamczyk ◽  
Jacqueline Waterman ◽  
Pegah Mohaghegh

Objective: Mini C-arm fluoroscopes are widely used by orthopaedic surgeons for intraoperative image guidance without the need for radiographers. This puts the responsibility for radiation exposure firmly with the operating surgeon. In order to maintain safe and best practice under U.K. Ionising Radiation (Medical Exposure) Regulations, one must limit radiation exposure and audit performance using national diagnostic reference levels (DRLs). In the case of the mini C-arm, there are no national DRLs. IR(ME)R, therefore, require the establishment of local DRLs by each hospital to act as an alternative guideline for safe radiation use. The aim of our audit was to establish local DRLs based on our experience operating with the use of the mini C-arm over the last 7 years. Methods: This retrospective audit evaluates the end dose–area product (DAP) recorded for common trauma and orthopaedic procedures using the mini C-arm in a busy district general hospital. We present the quartile data and have set the cut-off point as the third quartile for formulating the local DRLs, consistent with the methodology for the conventional fluoroscope. Results: For our data set (n = 1664), the third quartile DAP values were lowest for surgeries to the forearm (5.38 cGycm2), hand (7.62 cGycm2), and foot/ankle (8.56 cGycm2), and highest for wrist (10.64 cGycm2) and elbow (14.61 cGycm2) procedures. Advances in knowledge: To our knowledge, this is the largest data set used to establish local DRLs. Other centres may find our guidelines useful whilst they establish their own local DRLs.


Diagnostics ◽  
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 ◽  
...  

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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