CT diagnostic reference levels based on clinical indications: results of a large-scale European survey

Tsapaki, Virginia; Damilakis, John; Paulo, Graciano; Schegerer, Alexander; Repussard, Jacques; Jaschke, Werner; Frija, G.

doi:10.1007/s00330-020-07652-5

Cited by 55 publications

(28 citation statements)

References 23 publications

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“…Compared with recently published results from the large-scale, survey-based EUCLID study on standard-sized patients, most DRLs from the UCSF CT International Dose Registry, which includes all patient sizes, were higher than DRLs from the EUCLID study, except for stroke and lung cancer [21].…”

contrasting

confidence: 80%

“…Larger surveys are necessary to account for variations based on size and variations that may result from inclusion of a single or small number of scanners [25]. The recently published EUCLID study is also based on a large-scale survey that collected at least 20 CT examinations of standard-sized patients from each hospital for each EUCLID indication [21]. The differences in the DRLs of the UCSF CT International Dose Registry and this study may be mainly attributable to the inclusion of all patients and all CT scans in the registry rather than only selected patients.…”

Section: Discussionmentioning

confidence: 99%

“…This included searching for explicit terms and classifying exams using the most specific and highest dose category. In the EUCLID study, ten common clinical indications for undergoing CT were identified [21]. These EUCLID clinical indications or categories include (1) sinus to asses for sinusitis and polyps; (2) stroke, which we aligned with a routine brain examination, and imaging of the brain to assess for hemorrhage;…”

Section: Indication For Ct Examinationmentioning

confidence: 99%

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

Bos

Luong

et al. 2021

Eur Radiol

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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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contrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Indication For Ct Examinationmentioning

confidence: 99%

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

Bos

Luong

et al. 2021

Eur Radiol

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“…For example, the exposure can vary for a repeated assessment of ventricular size in a chronic condition of ventriculoperitoneal shunt presence versus level 1 trauma head CT although the RadLex® Playbook identifier mapping for both would be the same. Indication-based DRLs for CT, such as those that have been investigated in Europe (33,34), would be of value. Indication-based DRLs would result in dose being adjusted according to clinical indication for the same anatomic region, and the concept of "one dose fits all" would not apply.…”

Section: Discussionmentioning

confidence: 99%

U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations

et al. 2022

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Background: Diagnostic reference levels (DRLs) and achievable doses (ADs) were developed for the 10 most commonly performed pediatric CT examinations in the United States using the American College of Radiology Dose Index Registry.Purpose: To develop robust, current, national DRLs and ADs for the 10 most commonly performed pediatric CT examinations as a function of patient age and size.Materials and Methods: Data on 10 pediatric (ie, patients aged 18 years and younger) CT examinations performed between 2016 and 2020 at 1625 facilities were analyzed. For head and neck examinations, dose indexes were analyzed based on patient age; for body examinations, dose indexes were analyzed for patient age and effective diameter. Data from 1 543 535 examinations provided medians for AD and 75th percentiles for DRLs for volume CT dose index (CTDI vol ), dose-length product (DLP), and size-specific dose estimate (SSDE).Results: Of all facilities analyzed, 66% of the facilities (1068 of 1625) were community hospitals, 16% (264 of 1625) were freestanding centers, 9.5% (154 of 1625) were academic facilities, and 3.5% (57 of 1625) were dedicated children's hospitals. Fifty-two percent of the patients (798 577 of 1 543 535) were boys, and 48% (744 958 of 1 543 535) were girls. The median age of patients was 14 years (boys, 13 years; girls, 15 years). The head was the most frequent anatomy examined with CT (876 655 of 1 543 535 examinations [57%]). For head without contrast material CT examinations, the age-based CTDI vol AD ranged from 19 to 46 mGy, and DRL ranged from 23 to 55 mGy, with both AD and DRL increasing with age. For body examinations, DRLs and ADs for size-based CTDI vol , SSDE, and DLP increased consistently with the patient's effective diameter. Conclusion:Diagnostic reference levels and achievable doses as a function of patient age and effective diameter were developed for the 10 most commonly performed CT pediatric examinations using American College of Radiology Dose Index Registry data. These benchmarks can guide CT facilities in adjusting pediatric CT protocols and resultant doses for their patients.

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“…Decisions based on cumulative effective dose, and attendant real or potential small biological risks should also consider the far greater cumulative benefit. The influence of the regional practice on CED should also be considered as there are radiation exposure differences for the same clinical context [5,6] making a fixed CED reference value challenging. The CED paradigm suffers too from the significance of regional anatomic risks from the same 100-mSv "alert", such as from recurrent brain versus abdomen pelvis CT examinations.…”

mentioning

confidence: 99%

Looking critically at the paradigm of radiation exposure from multiple imaging examinations

Frush

Frija

2022

Eur Radiol

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CT diagnostic reference levels based on clinical indications: results of a large-scale European survey

Cited by 55 publications

References 23 publications

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

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

U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations

Looking critically at the paradigm of radiation exposure from multiple imaging examinations

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