Radiation Effective Doses to Patients Undergoing Abdominal CT Examinations

Ware, D E; Huda, Walter; Mergo, Patricia J.; Litwiller, Anthony L.

doi:10.1148/radiology.210.3.r99mr05645

Cited by 134 publications

(55 citation statements)

References 13 publications

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“…Recently published data on the risk of carcinogenesis in adult patients due to CT quote significantly lower-risk percentages of 0.02-0.04% [56] (average effective dose of abdomino pelvic CT examination is around 15 mSv [57], and the average dose for CT enterography at our institution is also 15 mSv). The effective dose will be higher in paediatric patients [58] and, because younger patients are more likely to require more scans during their lifetime, serious consideration should be given to the use of small bowel MRI in younger patients over CT. The authors believe that CT enterography is an appropriate technique when used judiciously in the right patient groups.…”

Section: Radiation Exposurementioning

confidence: 99%

“…The authors believe that CT enterography is an appropriate technique when used judiciously in the right patient groups. Recent development of innovative techniques such as the adaptive statistical iterative reconstruction algorithm are promising and will probably provide diagnostic-quality CT images at significantly reduced radiation doses in the near future [58]. …”

Section: Radiation Exposurementioning

confidence: 99%

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CT enterography: review of technique and practical tips

Ilangovan¹,

Burling²,

George³

et al. 2012

BJR

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ABSTRACT. CT enterography is a new non-invasive imaging technique that offers superior small bowel visualisation compared with standard abdomino-pelvic CT, and provides complementary diagnostic information to capsule endoscopy and MRI enterography. CT enterography is well tolerated by patients and enables accurate, efficient assessment of pathology arising from the small bowel wall or surrounding organs. This article reviews the clinical role of CT enterography, and offers practical tips for optimising technique and accurate interpretation. Until recently, diagnosis of small bowel pathology had relied primarily on radiological techniques, in part due to the relative inaccessibility of the small bowel to conventional endoscopy. However, new endoscopic developments-notably the recent introduction of capsule endoscopy and double balloon enteroscopy-are challenging this position. Capsule endoscopy, for example, is now generally accepted as first-line investigation for occult gastrointestinal haemorrhage, and increasingly advocated for diagnosis of early Crohn's disease. However, the radiological community has not stood still. In parallel with the development of new endoscopic techniques, rapid progress has been made in crosssectional imaging technologies, harnessing the power of multidetector row CT (MDCT), MRI and ultrasound, facilitating rapid, accurate and minimally invasive investigation of the small bowel and adjacent tissues.CT enterography was first introduced by Raptopoulos et al [1] in 1997 as a modification to ''standard'' abdomino-pelvic CT examination to specifically examine the small bowel in detail, notably to assess the extent and severity of Crohn's disease [1,2]. They combined neutral (low-density) oral contrast with ''enteric phase'' CT to optimise contrast resolution between mucosa and lumen, thereby maximising conspicuity of abnormalities arising from the small bowel wall. Several authors have subsequently described similar techniques, which are broadly categorised into CT enterography (where patients drink oral contrast) and CT enteroclysis (luminal contrast is introduced via a nasojejunal tube placed fluoroscopically prior to CT examination). Although superior jejunal distension is attained using enteroclysis, the convenience, efficiency and superior patient experience achieved with CT enterography make it the preferred technique at the authors' institutions, and therefore the focus of this review. This paper will critically review the CT enterography technique and provide practical tips on interpretation to assist radiologists and help them avoid common interpretative pitfalls. We will also examine its role relative to other complementary non-ionising radiation radiological tests. TechniqueThe technique of CT enterography combines small bowel distension with a neutral or low-density oral contrast mixture and abdomino-pelvic CT examination during the enteric phase following administration of intravenous contrast. Patients drink approximately 1.5-2 l of oral contrast over 45-60 min. Patient comp...

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Section: Radiation Exposurementioning

confidence: 99%

Section: Radiation Exposurementioning

confidence: 99%

CT enterography: review of technique and practical tips

Ilangovan¹,

Burling²,

George³

et al. 2012

BJR

View full text Add to dashboard Cite

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“…Radiation exposure, therefore, remains a predominant issue in CT. In particular, the potential risk of exposing paediatric patients to ionising radiation has always been of concern to the medical community [3,4], especially because the radiosensitivity of children is higher than that of adults [5]; thus, for paediatric imaging, it is of the utmost importance to reduce radiation exposure to the minimum appropriate for diagnosis. In the United States we see an increased use of CT in paediatric populations and a concomitant increase in radiation dose and risk of cancer [2,6].…”

Section: Introductionmentioning

confidence: 99%

Dose reduction in CT examination of children by an attenuation-based on-line modulation of tube current (CARE Dose)

et al. 2002

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In a controlled patient study we investigated the potential of attenuation-based on-line modulation of the tube current to reduce milliampere values (mAs) in CT examinations of children without loss of image quality. mAs can be reduced for non-circular patient cross sections without an increase in noise if tube current is reduced at those angular positions where the patient diameter and, consequently, attenuation are small. We investigated a technical approach with an attenuation-based on-line control for the tube current realised as a workinprogress implementation. The CT projection data are analysed in real time to determine optimal mAs values for each projection angle. We evaluated mAs reduction for 100 spiral CT examinations with attenuation-based on-line modulation of the tube current in a group of children. Two radiologists evaluated image quality by visual interpretation in consensus. We compared the mAs values read from the CT scanner with preset mAs of a standard protocol. Four different scan regions were examined in spiral technique (neck, thorax, abdomen, thorax and abdomen). We found the mAs product to be reduced typically by 10-60% depending on patient geometry and anatomical regions. The mean reduction was 22.3% (neck 20%, thorax 23%, abdomen 23%, thorax and abdomen 22%). In general, no deterioration of image quality was observed. There was no correlation between the age and the mean mAs reduction in the different anatomical regions. By classifying the children respectively to their weight, there is a positive trend between increasing weight and mAs reduction. We conclude that mAs in spiral CT examinations of children can be reduced substantially by attenuation-based on-line modulation of the tube current without deterioration of image quality. Attenuation-based on-line modulation of tube current is efficient and practical for reducing dose exposure to children.

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“…It is important to realize that CT doses are much higher than conventional radiography doses (7,(35)(36)(37)(38), and that the effective dose for a chest CT is approximately 100 -1000 times larger than that for a corresponding chest x-ray examination. Table 1 shows the average effective doses used in 16 common x-ray procedures in 19 western countries, and illustrates that patient doses in CT are much higher than those in most common radiographic examinations (7).…”

Section: How Well Are Ct Doses (And Risks) Understood?mentioning

confidence: 99%

Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI

Semelka

Armao

Elias

et al. 2007

Magnetic Resonance Imaging

Self Cite

198

106

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“When one admits that nothing is certain one must, I think, also admit that some things are much more nearly certain than others.” Bertrand Russell (1872–1970) Computed tomography (CT) is one of the largest contributors to man‐made radiation doses in medical populations. CT currently accounts for over 60 million examinations in the United States, and its use continues to grow rapidly. The principal concern regarding radiation exposure is that the subject may develop malignancies. For this systematic review we searched journal publications in MEDLINE (1966–2006) using the terms “CT,” “ionizing radiation,” “cancer risks,” “MRI,” and “patient safety.” We also searched major reports issued from governmental U.S. and world health‐related agencies. Many studies have shown that organ doses associated with routine diagnostic CT scans are similar to the low‐dose range of radiation received by atomic‐bomb survivors. The FDA estimates that a CT examination with an effective dose of 10 mSv may be associated with an increased chance of developing fatal cancer for approximately one patient in 2000, whereas the BEIR VII lifetime risk model predicts that with the same low‐dose radiation, approximately one individual in 1000 will develop cancer. There are uncertainties in the current radiation risk estimates, especially at the lower dose levels encountered in CT. To address what should be done to ensure patient safety, in this review we discuss the “as low as reasonably achievable” (ALARA) principle, and the use of MRI as an alternative to CT. J. Magn. Reson. Imaging 2007;25:900–909. © 2007 Wiley‐Liss, Inc.

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Radiation Effective Doses to Patients Undergoing Abdominal CT Examinations

Abstract: Values of energy imparted to patients undergoing abdominal CT examinations were a factor of three higher in adults than in children, but the corresponding patient effective doses were 50% higher in children than in adults.

Cited by 134 publications

References 13 publications

CT enterography: review of technique and practical tips

CT enterography: review of technique and practical tips

Dose reduction in CT examination of children by an attenuation-based on-line modulation of tube current (CARE Dose)

Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI

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