A Comprehensive Approach to CT Radiation Dose Reduction: One Institution’s Experience

Antypas, Elias J.; Sokhandon, Farnoosh; Farah, Michael; Emerson, Scott S.; Bis, Kostaki G.; Tien, Hai; Mezwa, D G

doi:10.2214/ajr.11.6460

Cited by 20 publications

(16 citation statements)

References 18 publications

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“…These measurements correspond well with several other studies in the literature that report reductions between 25 and 40%. 6,23,30,31 Another study performed by Inkoom et al 32 explored the effect of combining bismuth shielding with AEC. The authors examined the effect that bismuth shielding, AEC and a combination of the both had on the dose to four pediatric anthropomorphic phantoms.…”

Section: Thyroid Dose Reductionmentioning

confidence: 99%

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The Current Use and Effectiveness of Bismuth Shielding in Computed Tomography: A Systematic Review

Lawrence¹,

Seeram²

2017

Radiol Open J

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CitationThe increased use of computed tomography (CT) has raised concerns regarding the radiation dose received by radiosensitive organs. It is important that practical and reliable dose reduction strategies are implemented to reduce patient radiation exposure. Aims: The purpose of this article is to evaluate the current clinical use and effectiveness of bismuth shielding as a dose reduction technique and assess its impact on image quality, in an attempt to develop a recommendation for dose reduction in CT. Methods: A systematic review of current literature was conducted using the PubMed and Scopus databases. A total of 50 relevant articles were thoroughly assessed and evaluated.Results: This review found that whilst bismuth shielding proves to provide significant dose reductions to radiosensitive organs, numerous concerns exist including wasted radiation, reduced image quality and unpredictable results when combined with AEC. Alternative methods such as tube current modulation and iterative reconstruction algorithms can provide equivalent dose savings at superior image quality, without the limitations of bismuth shields. Conclusion: Until these alternative methods become available in all departments, bismuth shielding remains a viable dose reduction strategy.

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Section: Thyroid Dose Reductionmentioning

confidence: 99%

“…32 While some studies disprove of the use of bismuth in thyroid CT examinations because of the degradation of image quality caused by such artifacts, 30,31 others conclude no quantitative or qualitative impact on image quality. 6,21,31 A key issue associated with thyroid shields is the negative impact on CT attenuation values.…”

Section: Image Qualitymentioning

confidence: 99%

The Current Use and Effectiveness of Bismuth Shielding in Computed Tomography: A Systematic Review

Lawrence¹,

Seeram²

2017

Radiol Open J

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“…The superior softtissue contrast of MR imaging, compared with CT, in evaluating lesion infiltration in soft-tissue planes and adjacent organs is a major step forward in the staging of various cancers (7,8), particularly in the brain, head and neck, liver, pelvis, and bone marrow (8,9). Furthermore, the lack of radiation using MR imaging is a major advantage over CT, though this is less significant after the introduction of CT dose modulation software, which has reduced the radiation to 2-5 mSv without any compromise in resolution (10,11). Nevertheless the benefit from PET/MR over PET/CT remains significant from a radiation exposure point of view in pediatric applications and in the many repeated studies inserted in patient management pathways.…”

mentioning

confidence: 99%

Qualitative and Quantitative Comparison of PET/CT and PET/MR Imaging in Clinical Practice

et al. 2013

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The aim of this study was to prospectively compare whole-body PET/MR imaging and PET/CT, qualitatively and quantitatively, in oncologic patients and assess the confidence and degree of inter-and intraobserver agreement in anatomic lesion localization. Methods: Fifty patients referred for staging with known cancers underwent PET/CT with low-dose CT for attenuation correction immediately followed by PET/MR imaging with 2-point Dixon attenuation correction. PET/CT scans were obtained according to standard protocols (56 6 20 min after injection of an average 367 MBq of 18 F-FDG, 150 MBq of 68 Ga-DOTATATE, or 333.8 MBq of 18 F-fluoro-ethyl-choline; 2.5 min/bed position). PET/MR was performed with 5 min/bed position. Three dual-accredited nuclear medicine physicians/radiologists identified the lesions and assigned each to an exact anatomic location. The image quality, alignment, and confidence in anatomic localization of lesions were scored on a scale of 1-3 for PET/CT and PET/MR imaging. Quantitative analysis was performed by comparing the standardized uptake values. Intraclass correlation coefficients and the Wilcoxon signed-rank test were used to assess intra-and interobserver agreement in image quality, alignment, and confidence in lesion localization for the 2 modalities. Results: Two hundred twenty-seven tracer-avid lesions were identified in 50 patients. Of these, 225 were correctly identified on PET/CT and 227 on PET/MR imaging by all 3 observers. The confidence in anatomic localization improved by 5.1% when using PET/MR imaging, compared with PET/CT. The mean percentage interobserver agreement was 96% for PET/CT and 99% for PET/MR imaging, and intraobserver agreement in lesion localization across the 2 modalities was 93%. There was 10% (5/50 patients) improvement in local staging with PET/MR imaging, compared with PET/CT. Conclusion: In this first study, we show the effectiveness of whole-body PET/MR imaging in oncology. There is no statistically significant difference between PET/MR imaging and PET/CT in respect of confidence and degree of inter-and intraobserver agreement in anatomic lesion localization. The PET data on both modalities were similar; however, the observed superior soft-tissue resolution of MR imaging in head and neck, pelvis, and colorectal cancers and of CT in lung and mediastinal nodal disease points to future tailored use in these locations.

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“…There are few data available on the outcomes of institutional programs of CT protocol review and optimization [6][7][8][9]. This could be partly because optimizing CT protocols for a facility involves significant time and expense [14].…”

Section: Discussionmentioning

confidence: 99%

“…Although the clinical necessity and minimal necessary radiation dose required for any particular CT scan are complex issues, it is important for quality and patient safety that each CT scan be conducted within the protocol standards set by a clinical practice and that the radiation dose not be exceeded unless required by extenuating circumstances. To this end, institutions have begun enterprise-wide programs focused on the standardization of imaging protocols and tracking of radiation exposures to identify potential overexposures [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

CT Radiation Dose Optimization and Tracking Program at a Large Quaternary-Care Health Care System

Goenka¹,

Dong²,

Wildman³

et al. 2015

Journal of the American College of Radiology

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A Comprehensive Approach to CT Radiation Dose Reduction: One Institution’s Experience

Cited by 20 publications

References 18 publications

The Current Use and Effectiveness of Bismuth Shielding in Computed Tomography: A Systematic Review

The Current Use and Effectiveness of Bismuth Shielding in Computed Tomography: A Systematic Review

Qualitative and Quantitative Comparison of PET/CT and PET/MR Imaging in Clinical Practice

CT Radiation Dose Optimization and Tracking Program at a Large Quaternary-Care Health Care System

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