Radiation Exposure in CT Scanning and Risk: Where Are We?

Thrall, James H.

doi:10.1148/radiol.12121137

Cited by 53 publications

(44 citation statements)

References 15 publications

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“…Advances in CT technology have led to a dramatic increase in the number of CT examinations, with a concomitant increase in radiation dose [2][3][4]. The average effective radiation dose from abdominal radiography is slightly over 1 mSv [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…It might thus not be acceptable simply to replace abdominal radiography with standard (full-dose) abdominal CT, despite the anticipated higher diagnostic yield. CT can be performed at a much lower radiation level than with standard settings at the expense of increased image noise and reduced image quality; even with the same relatively low radiation dose as abdominal radiography [2,8]. The tube current-time product (milliampere-seconds, mAs) has a direct influence on patient radiation dose as it is directly proportional to the effective dose if all other technical parameters are held constant [9].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review

et al. 2015

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“…18,19 Iterative reconstruction has been demonstrated to reduce radiation dose while maintaining image quality at low dose. The current study evaluated the effect of iterative reconstruction (AIDR-3D) on image quality compared to traditional FDP techniques (ORG with and without QDSþ) and demonstrated significant noise reduction benefit from the application of iterative reconstruction compared to traditional FBP, both in native reconstructed images and derived parametric perfusion maps.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of radiation dose reduction using AIDR-3D in dynamic pulmonary CT perfusion

et al. 2015

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AIDR-3D produced significantly lower noise images than FBP-based algorithms and maintained consistent noise levels in lung at 12.5 mAs, indicating this algorithm is suitable for reduced dose lung perfusion imaging. Iterative reconstruction allows significant radiation dose reduction of up to fourfold in smaller patients, and up to twofold in the medium/large size patients. The increase in perfusion values at 25% simulated tube currents is attributed to attenuation bias.

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“…1 Indeed, radiologists should always attempt to obtain a diagnostic benefit to risk ratio as high as reasonably achievable (AHARA) 1 and such a radiation consciousness should primarily involve patients under 30 years, as the lifetime risk of radiation-induced cancer is greater the younger the patient. 2 While several dose reduction strategies can be successfully applied in contrast-enhanced abdominal MDCT, such as the use of iterative reconstruction algorithms combined with either low tube voltage 3,4 and/or low tube current protocols, 5 these technologies are still not widely available in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic efficacy of single-pass abdominal multidetector-row CT: prospective evaluation of a low dose protocol

Camera¹,

Liccardo²,

Romano³

et al. 2017

The British Journal of Radiology

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Objective: To evaluate the diagnostic efficacy of single-pass contrast-enhanced multidetector CT (CE-MDCT) performed with a low-radiation high-contrast (LR-HC) dose protocol in selected patients with non-traumatic acute bowel disease. Methods: 65 (32 males, 33 females; aged 20–67 years) consecutive patients with non-traumatic acute bowel disease underwent single-pass CE-MDCT performed 70–100 s after i.v. bolus injection of a non-ionic iodinated contrast medium (CM) (370 mgI ml−1). In 46 (70%) patients with a clinical and/or ultrasonographic suspicion of inflammatory bowel disease, up to 1.2–1.4 l of a 7% polyethylene-glycol solution was orally administered 45–60 mins prior to the CT examination. Patients were then divided into two groups according to age: Group A (20–44 years; n = 34) and Group B (45–70 years; n = 31). Noise index (NI) and CM dose were selected as follows: Group A (NI = 15; 2.5 ml kg−1) and Group B (NI = 12.5; 2 ml kg−1). All patients of Group A underwent thyroid functional tests at 4–6 weeks. Final diagnoses were obtained by open (n = 12) or laparoscopic surgery (n = 4), endoscopy w/without biopsy (n = 24) and clinical (n = 19) and/or instrumental (ultrasonography) (n = 6) follow-up at 11 ± 4 months (range 6–18 mo.). Statistical analysis was performed by χ 2 and Student's t-test for categorical and continuous variables, respectively. Results: Sensitivity and specificity were 91.3 vs 95.4% (p = 0.905) and 90.9 vs 88.8% (p = 0.998) with an overall diagnostic accuracy of 91.1 vs 93.5% (p = 0.756), whereas the radiation (in millisievert) and CM dose (in millilitre) were 7.5 ± 2.8 mSv and 155 ± 30 ml for Group A and 14.1 ± 5.3 mSv and 130 ± 24 ml for Group B (p < 0.001), respectively. No patients of Group A showed laboratory signs of thyrotoxicosis at follow-up. Conclusion: The LR-HC has proved to be a safe and a dose-effective protocol in the evaluation of selected young patients with non-traumatic acute bowel disease. Advances in knowledge: (1) As reaching the highest diagnostic benefit to risk ratio (AHARA) appears to be the current principle of MDCT imaging, an increased amount of iodinated CM (0.7–0.9 gI ml−1) can be safely administered to young patients (<40 years) with normal thyroid and renal function to compensate for the lower image quality resulting from low-dose CT protocols performed with the standard filter back-projection algorithm. Such an approach will result in a significant reduction of the radiation dose, which could be otherwise achieved only using iterative reconstruction algorithms combined with either low tube voltage and/or low tube current protocols. (2) An optimal scan delay (T delay) for a venous phase caudocranial acquisition can be calculated by the following formula: T delay = CI + 25 − T SD, where CI is the duration of the contrast injection, 25 is the average of the sum of abdominal aortic and peak hepatic arrival times and T SD is the scan duration. With such an approach, the radiation exposure resulting from bolus tracking, albeit performed with low-dose scans, can be spared in patients with normal transit times.

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Radiation Exposure in CT Scanning and Risk: Where Are We?

Cited by 53 publications

References 15 publications

Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review

Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review

Feasibility of radiation dose reduction using AIDR-3D in dynamic pulmonary CT perfusion

Diagnostic efficacy of single-pass abdominal multidetector-row CT: prospective evaluation of a low dose protocol

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