Size-specific dose estimates of adult, chest computed tomography examinations: Comparison of Chinese and updated 2017 American College of Radiology diagnostic reference levels based on the water-equivalent diameter

Abstract

Rationale and objectives This study aimed to compare the volume computed tomography dose index (CTDIvol), dose length product (DLP), and size-specific dose estimate (SSDE), with the China and updated 2017 American College of Radiology (ACR) diagnostic reference levels (DRLs) in chest CT examinations of adults based on the water-equivalent diameter (Dw). Materials and methods All chest CT examinations conducted without contrast administration from January 2020 to July 2020 were retrospectively included in this study. The Dw and SSDE of all examinations were calculated automatically by “teamplay”. The CTDIvol and DLP were displayed on the DICOM-structured dose report in the console based on a 32cm phantom.The differences in patient CTDIvol, DLP, and SSDE values between groups were examined by the one-way ANOVA. The differences in patient CTDIvol, DLP, and SSDE values between the updated 2017 ACR and the China DRLs were examined with one sample t-tests. Results In total 14666 chest examinations were conducted in our study. Patients were divided into four groups based on Dw:270 (1.84%) in 15–20 cm group, 10287 (70.14%) in the 21–25 cm group, 4097 (27.94%) in the 26–30 cm group, and 12 (0.08%) patients had sizes larger than 30 cm. CTDIvol, DLP, and SSDE increased as a function of Dw (p<0.05). CTDIvol was smaller than SSDE among groups (p<0.05). The mean CTDIvol and DLP values were lower than the 25th, 50th, and 75th percentile of the China DRLs (p <0.05). The CTDIvol, DLP, and SSDE were lower than the 50th and 75th percentiles of the updated 2017 ACR DRLs (p <0.05) among groups. Conclusions SSDE takes into account the influence of the scanning parameters, patient size, and X-ray attenuation on the radiation dose, which can give a more realistic estimate of radiation exposure dose for patients undergoing CT examinations. Establishing hospital’s own DRL according to CTDIvol and SSDE is very important even though the radiation dose is lower than the national DRLs.

Development of size-specific dose estimates for common computed tomography examinations: a study in Ghana

“…Elsewhere in the literature, contrasting values of the mean and median SSDE values have also been reported. In particular, Hu et al [18] obtained a lower mean value of 4.6 mGy, while Christner et al [19] and Rajaraman et al [13] recorded higher mean SSDE values of 21.8 mGy and 10.6 mGy respectively, compared to 8.1 mGy in this study.…”

Is it necessary to define new diagnostic reference levels during pandemics like the Covid19-?

“…Even though patient size affects the DLP, which is used to estimate effective dose. However, Hu et al (2021) declare that Size-specific dose estimatation of adult in chest CT scans is important. In this study, patient size was not considered directly in effective dose calculation, which can be another limitation of the study.…”

An in-house step-wedge phantom for the calibration of pixel values in CT localizer radiographs for water-equivalent diameter measurement

“…2 Unfortunately, CT results in a higher dose to the patient compared with other medical imaging modalities. 3,4 Several approaches have been introduced to optimize the patient dose, including tube current (mA) optimization. 5 The tube current has a linear correlation with CT output dose 6 because the number of X-ray photons produced is proportional to the tube current.…”