Analysis of paediatric ct head radiation doses as an initiation to establish local diagnostic reference levels

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

European Radiology ◽

10.1007/s00330-021-08266-1 ◽

2021 ◽

Author(s):

Denise Bos ◽

Sophronia Yu ◽

Jason Luong ◽

Philip Chu ◽

Yifei Wang ◽

...

Keyword(s):

European Society ◽

Chronic Sinusitis ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Coronary Ct ◽

Clinical Indications ◽

The Us ◽

European Society Of Radiology

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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TOWARD NATIONAL CT DIAGNOSTIC REFERENCE LEVELS IN THE UNITED ARAB EMIRATES: A MULTICENTER REVIEW OF CT DOSE INDEX AND DOSE LENGTH PRODUCT

Radiation Protection Dosimetry ◽

10.1093/rpd/ncaa100 ◽

2020 ◽

Vol 190 (3) ◽

pp. 243-249

Author(s):

Mohamed M Abuzaid ◽

Wiam Elshami ◽

A El Serafi ◽

T Hussien ◽

J R McConnell ◽

...

Keyword(s):

Computed Tomography ◽

United Arab Emirates ◽

Patient Characteristics ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Ct Dose ◽

Ct Head ◽

Computed Tomography Dose Index ◽

Dose Index

Abstract This multicenter study evaluated computed tomography dose index volume (CTDIvol) and dose length product (DLP) to contribute to establishing computed tomography (CT) national diagnostic reference levels (NDRLs) in the United Arab Emirates (UAE). Data from 240 patients, who underwent CT head, chest, abdomen–pelvis and urography examinations, were analyzed, including patient age, sex and weight, CTDIvol (mGy) and DLP (mGy cm). The proposed DRLs for each examination were calculated as the third quartile. DRLs are proposed using CTDIvol (mGy) and DLP (mGy cm) for CT head (67 and 1189, respectively), chest (8 and 302, respectively), abdomen–pelvis (28 and 1122, respectively) and urography (20 and 714, respectively). These values are comparable with the initial NDRLs and published international DRLs. Baseline values for International Radiology Center (IRC) CT DRLs were calculated on frequently performed CT examinations. Implementation of DRL values improves dose optimization based on procedures, scanner type and patient characteristics while maintaining acceptable image quality and diagnostic confidence.

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PROPOSED NATIONAL DIAGNOSTIC REFERENCE LEVELS FOR STANDARD RADIOGRAPHIC X-RAY PROCEDURES IN SUDAN

Radiation Protection Dosimetry ◽

10.1093/rpd/ncaa114 ◽

2020 ◽

Vol 190 (4) ◽

pp. 419-426

Author(s):

Nada A Ahmed ◽

E H Basheir ◽

A B Farah ◽

T S Mohammedzein ◽

I I Suliman

Keyword(s):

Lumbar Spine ◽

Dose Optimization ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

X Ray ◽

Air Kerma ◽

Tube Output ◽

The Mean ◽

Entrance Surface Air Kerma

Abstract This study aimed to calculate patient radiation doses for adults during the seven most commonly performed conventional X-ray procedures, and to propose national diagnostic reference levels (DRLs). A representative sample of patients from 29 hospitals was included. The entrance surface air kerma (ESAK) was calculated by measuring X-ray tube output and the corresponding technical and exposure factors for each patient. Third-quartile values of the mean ESAK distributions were proposed as DRL values. The DRLs in mGy were as follows: 0.6 for chest postero–anterior (PA), 3.5 for skull AP, 1.7 for skull lateral (LAT), 2.7 for abdominal, 2.6 for pelvic AP, 3.7 for lumbar spine AP and 8 for lumbar spine LAT. Compared with literature, the maximum percentages increase were in chest PA (329%) and skull AP (187%). Since the suggested DRL for chest PA was higher than literature values, dose optimization and a review of its value is recommended.

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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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