Radiation exposure of computed tomography imaging for the assessment of acute stroke

Abstract

Purpose To assess suspected acute stroke, the computed tomography (CT) protocol contains a non-contrast CT (NCCT), a CT angiography (CTA), and a CT perfusion (CTP). Due to assumably high radiation doses of the complete protocol, the aim of this study is to examine radiation exposure and to establish diagnostic reference levels (DRLs). Methods In this retrospective study, dose data of 921 patients with initial CT imaging for suspected acute stroke and dose monitoring with a DICOM header–based tracking and monitoring software were analyzed. Between June 2017 and January 2020, 1655 CT scans were included, which were performed on three different modern multi-slice CT scanners, including 921 NCCT, 465 CTA, and 269 CTP scans. Radiation exposure was reported for CT dose index (CTDIvol) and dose-length product (DLP). DRLs were set at the 75th percentile of dose distribution. Results DRLs were assessed for each step (CTDIvol/DLP): NCCT 33.9 mGy/527.8 mGy cm and CTA 13.7 mGy/478.3 mGy cm. Radiation exposure of CTP was invariable and depended on CT device and its protocol settings with CTDIvol 124.9–258.2 mGy and DLP 1852.6–3044.3 mGy cm. Conclusion Performing complementary CT techniques such as CTA and CTP for the assessment of acute stroke increases total radiation exposure. Hence, the revised DRLs for the complete protocol are required, where our local DRLs may help as benchmarks.

Safety of the effective radiation dose received during stroke hospitalization

“…Supplementary CT techniques (CT angiography and CT perfusion) for assessment of acute stroke increase total radiation exposure. 9 With the developments in technology over recent years, tests have become increasingly safer in terms of the amount of radiation required to obtain good-quality images. 17 A previous study confirmed that the radiation emitted by cranial CT devices in other clinical situations is safe regardless of the protocol adopted.…”

“…Supplementary CT techniques (CT angiography and CT perfusion) for assessment of acute stroke increase total radiation exposure. 9 With the developments in technology over recent years, tests have become increasingly safer in terms of the amount of radiation required to obtain good-quality images. 17 …”

“…Non-contrast head CT allows fast and safe evaluation to rule out hemorrhage or space-occupying lesions. 9 Studies were performed on a Toshiba Action 16 multislice scanner in the helical mode; 200-1200 images were acquired in each examination.…”

“…7 Previous studies have shown that the radiation dose administered during acute stroke care is safe. 8,9 Considering the life expectancy of the population, high recurrence of stroke, increasing occurrence of stroke in young individuals, and development of new imaging techniques and stroke treatments, the radiation doses received while in hospital for stroke must be checked to ensure radiological protection of patients. Therefore, this study aimed to evaluate the effective radiation dose (ERD) received while in hospital for stroke and analyze its safety according to current national guidelines.…”

Post-Contrast Acute Kidney Injury after Acute Stroke—Insights from a German Tertiary Care Center

“…Nevertheless, the debate regarding the implementation of routine CTP in CT stroke protocols is still ongoing, mainly due to additional iodinated contrast medium (CM) applications, radiation exposure, and time. To control and harmonize radiation exposure, different national and international guidelines were published to limit radiation exposure and state diagnostic reference levels [ 5 , 6 ]. Nevertheless, the additional use of iodinated contrast agents for CTP and the risk of contrast-associated acute kidney injury in these patients is an ongoing debate in daily clinical routine and needs further investigation [ 7 , 8 ].…”