Radiation Dose Metrics in CT: Assessing Dose Using the National Quality Forum CT Patient Safety Measure

Keegan, Jillian; Miglioretti, Diana L.; Gould, Robert G.; Donnelly, Lane F.; Wilson, Nicole; Smith‐Bindman, Rebecca

doi:10.1016/j.jacr.2013.10.009

Cited by 10 publications

(16 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…dose benchmarks (20). We believe these data can contribute to the creation of meaningful reference levels in the United States.…”

Section: Fundingmentioning

confidence: 84%

“…The median DLPs for single-phase, multiphase, and all examinations, respectively, were as follows: head, 880 mGy · cm (IQR, 640-1120 mGy · cm), 1550 mGy · cm (IQR, 1150-2130 mGy · cm), and 960 mGy · cm (IQR, 690-1300 mGy · cm); chest, 420 mGy · cm (IQR, 260-610 mGy · cm), 880 mGy · cm (IQR, 570-1430 mGy · cm), and 550 mGy · cm (IQR 320-830 mGy · cm); and abdomen, 580 mGy · cm (IQR, 360-860 mGy · cm), 1220 mGy · cm (IQR, 850-1790 mGy · cm), and 960 mGy · cm (IQR, 600-1460 mGy · cm). Median effective doses for single-phase, multiphase, and all examinations, respectively, were as follows: head, 2 mSv (IQR, 1-3 mSv), 4 mSv (IQR, 3-8 mSv), and 2 mSv (IQR, 2-3 mSv); chest, 9 mSv (IQR, 5-13 mSv), 18 mSv (IQR, 12-29 mSv), and 11 mSv (IQR, 6-18 mSv); and abdomen, 10 mSv (IQR, 6-16 mSv), 22 mSv (IQR, 15-32 mSv), and 17 mSv (IQR,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). In general, values for children were approximately 50% those for adults in the head and 25% those for adults in the chest and abdomen.…”

Section: Resultsmentioning

confidence: 99%

“…The measures, organized according to anatomic region and number of phases, offer practical data that CT imaging facilities can use as a starting point for assessing their own doses when more detailed and protocol-specific targets are not available. Our approach parallels the CT radiation dose measure adopte d by the National Quality Forum in 2011 (20). Furthermore, because the United States lacks summary data on radiation doses for CT based on large numbers of patients, our data can contribute to the creation of radiation dose benchmarks by oversight and health care quality organizations.…”

Section: Discussionmentioning

confidence: 96%

See 2 more Smart Citations

Radiation Doses in Consecutive CT Examinations from Five University of California Medical Centers

Smith‐Bindman¹,

Moghadassi²,

Wilson³

et al. 2015

Radiology

Self Cite

112

View full text Add to dashboard Cite

Purpose:To summarize data on computed tomographic (CT) radiation doses collected from consecutive CT examinations performed at 12 facilities that can contribute to the creation of reference levels. Materials and Methods:The study was approved by the institutional review boards of the collaborating institutions and was compliant with HIPAA. Radiation dose metrics were prospectively and electronically collected from 199 656 consecutive CT examinations in 83 181 adults and 3871 consecutive CT examinations in 2609 children at the five University of California medical centers during 2013. The median volume CT dose index (CTDI vol ), dose-length product (DLP), and effective dose, along with the interquartile range (IQR), were calculated separately for adults and children and stratified according to anatomic region. Distributions for DLP and effective dose are reported for single-phase examinations, multiphase examinations, and all examinations. Results:For adults, the median CTDI vol was 50 mGy (IQR, 37-62 mGy) for the head, 12 mGy (IQR, 7-17 mGy) for the chest, and 12 mGy (IQR, 8-17 mGy) for the abdomen. The median DLPs for single-phase, multiphase, and all examinations, respectively, were as follows: head, 880 mGy · cm (IQR, 640-1120 mGy · cm), 1550 mGy · cm (IQR, 1150-2130 mGy · cm), and 960 mGy · cm (IQR, 690-1300 mGy · cm); chest, 420 mGy · cm (IQR, 260-610 mGy · cm), 880 mGy · cm (IQR, 570-1430 mGy · cm), and 550 mGy · cm (IQR 320-830 mGy · cm); and abdomen, 580 mGy · cm (IQR, 360-860 mGy · cm), 1220 mGy · cm (IQR, 850-1790 mGy · cm), and 960 mGy · cm (IQR, 600-1460 mGy · cm). Median effective doses for single-phase, multiphase, and all examinations, respectively, were as follows: head, 2 mSv (IQR, 1-3 mSv), 4 mSv (IQR, 3-8 mSv), and 2 mSv (IQR, 2-3 mSv); chest, 9 mSv (IQR, 5-13 mSv), 18 mSv (IQR, 12-29 mSv), and 11 mSv (IQR, 6-18 mSv); and abdomen, 10 mSv (IQR, 6-16 mSv), 22 mSv (IQR, 15-32 mSv), and 17 mSv (IQR,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). In general, values for children were approximately 50% those for adults in the head and 25% those for adults in the chest and abdomen. Conclusion:These summary dose data provide a starting point for institutional evaluation of CT radiation doses.q RSNA, 2015

show abstract

“…dose benchmarks (20). We believe these data can contribute to the creation of meaningful reference levels in the United States.…”

Section: Fundingmentioning

confidence: 84%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Radiation Doses in Consecutive CT Examinations from Five University of California Medical Centers

Smith‐Bindman¹,

Moghadassi²,

Wilson³

et al. 2015

Radiology

Self Cite

112

View full text Add to dashboard Cite

show abstract

“…Its benefits are accompanied by risks such as radiation exposure [7], incidental findings [8], and high costs [9]. Efforts can be made to optimize radiation exposure [10,11] and to utilize imaging more effectively [12]. Radiation exposure provides an attractive improvement opportunity since it is relatively easy to measure and the risk of harm from cancer induction steadily rises with increasing exposure [13].…”

mentioning

confidence: 99%

“…Replacement strategies exploit instances where relatively small amounts of diagnostic data from nonimaging sources might reliably address clinical uncertainty. Reduction strategies combat the natural tendency to collect just one more bit of data and instead truncate 3-20 mGy a The expected range in this example are based on the 25th-75th percentiles observed for adult abdomen/pelvis exams from 2010 to 2012 by Keegan et al [11]. b CT studies per illness can be determined by number of billed procedures.…”

mentioning

confidence: 99%

Information overload: when less is more in medical imaging

Duncan

2017

Diagnosis

View full text Add to dashboard Cite

Abstract:In medicine, data collection and analysis provide the information needed to reduce diagnostic uncertainty. An examination of how medical imaging data is collected and then transformed into diagnostic information provides testable ideas for better managing this dynamic process. In other fields, process data is systematically assessed for differences between observed and predicted values. For studies that expose patients to the potentially harmful effects of ionizing radiation, monitoring imaging studies/illness, images/imaging study and radiation exposure/image would be steps towards developing radiation dose budgets for the diagnosis and treatment of common conditions. Random variation within the expected range would signal a high quality process. Conversely, single outlying cases or nonrandom variation within the expected range would trigger an investigation for a possible underlying cause. Such investigations would provide insights into how to continually improve this important aspect of healthcare.

show abstract

Optimizing Radiation Doses for Computed Tomography Across Institutions

et al. 2017

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Radiation doses for computed tomography (CT) vary substantially across institutions. OBJECTIVE To assess the impact of institutional-level audit and collaborative efforts to share best practices on CT radiation doses across 5 University of California (UC) medical centers. DESIGN, SETTING, AND PARTICIPANTS In this before/after interventional study, we prospectively collected radiation dose metrics on all diagnostic CT examinations performed between October 1, 2013, and December 31, 2014, at 5 medical centers. Using data from January to March (baseline), we created audit reports detailing the distribution of radiation dose metrics for chest, abdomen, and head CT scans. In April, we shared reports with the medical centers and invited radiology professionals from the centers to a 1.5-day in-person meeting to review reports and share best practices. MAIN OUTCOMES AND MEASURES We calculated changes in mean effective dose 12 weeks before and after the audits and meeting, excluding a 12-week implementation period when medical centers could make changes. We compared proportions of examinations exceeding previously published benchmarks at baseline and following the audit and meeting, and calculated changes in proportion of examinations exceeding benchmarks. RESULTS Of 158 274 diagnostic CT scans performed in the study period, 29 594 CT scans were performed in the 3 months before and 32 839 CT scans were performed 12 to 24 weeks after the audit and meeting. Reductions in mean effective dose were considerable for chest and abdomen. Mean effective dose for chest CT decreased from 13.2 to 10.7 mSv (18.9% reduction; 95% CI, 18.0%-19.8%). Reductions at individual medical centers ranged from 3.8% to 23.5%. The mean effective dose for abdominal CT decreased from 20.0 to 15.0 mSv (25.0% reduction; 95% CI, 24.3%-25.8%). Reductions at individual medical centers ranged from 10.8% to 34.7%. The number of CT scans that had an effective dose measurement that exceeded benchmarks was reduced considerably by 48% and 54% for chest and abdomen, respectively. After the audit and meeting, head CT doses varied less, although some institutions increased and some decreased mean head CT doses and the proportion above benchmarks. CONCLUSIONS AND RELEVANCE Reviewing institutional doses and sharing dose-optimization best practices resulted in lower radiation doses for chest and abdominal CT and more consistent doses for head CT.

show abstract

Radiation Dose Metrics in CT: Assessing Dose Using the National Quality Forum CT Patient Safety Measure

Cited by 10 publications

References 15 publications

Radiation Doses in Consecutive CT Examinations from Five University of California Medical Centers

Radiation Doses in Consecutive CT Examinations from Five University of California Medical Centers

Information overload: when less is more in medical imaging

Optimizing Radiation Doses for Computed Tomography Across Institutions

Contact Info

Product

Resources

About