Standardization and Optimization of CT Protocols to Achieve Low Dose

Abstract

The increase in radiation exposure due to CT scans has been of growing concern in recent years. CT scanners differ in their capabilities and various indications require unique protocols, but there remains room for standardization and optimization. In this paper we summarize approaches to reduce dose, as discussed in lectures comprising the first session of the 2013 UCSF Virtual Symposium on Radiation Safety in Computed Tomography. The experience of scanning at low dose in different body regions, for both diagnostic and interventional CT procedures, is addressed. An essential primary step is justifying the medical need for each scan. General guiding principles for reducing dose include tailoring a scan to a patient, minimizing scan length, use of tube current modulation and minimizing tube current, minimizing-tube potential, iterative reconstruction, and periodic review of CT studies. Organized efforts for standardization have been spearheaded by professional societies such as the American Association of Physicists in Medicine. Finally, all team members should demonstrate an awareness of the importance of minimizing dose.

CT and MR Protocol Standardization Across a Large Health System: Providing a Consistent Radiologist, Patient, and Referring Provider Experience

“…The radiologist can determine the appropriate clinical indications for each protocol and how many protocols are actually needed, while the technologist has insight into the technical and workflow issues that go into the actual scanning and reconstruction activities [4]. The 1-day CT RIE was divided into four segments (chest, abdomen, neuro, and MSK) with overlap of neuro and MSK to address spine imaging (a shared responsibility at the academic campus).…”

“…The principle motivation is to achieve diagnostic quality images with the lowest radiation dose possible (ALARA) [3][4][5]. Most work in protocol management has defined tools to take the protocol output from the scanners and collect it in a standardized format on an electronic tool for the purposes of comparison and auditing [6][7][8][9].…”

“…Most work in protocol management has defined tools to take the protocol output from the scanners and collect it in a standardized format on an electronic tool for the purposes of comparison and auditing [6][7][8][9]. However, little has been written about standardization of imaging protocols in order to provide a consistent radiologist, patient, and referring provider experience [4].…”

Ką Turėtume Žinoti Apie Medicininę Apšvitą?

“…Todėl akivaizdu, jog tiriant dėl plaučių arterijos embolijos, tiriamoji sritis neturėtų būti tokia, kaip vertinant plaučių vėžio išplitimą. Skenavimų (fazių) skaičius turėtų būti apribotas priklausomai nuo diagnostinio uždavinio, pvz., vertinant dėl metastazių kepenyse, bekontrastinis skenavimas nėra reikšmingas metastazių diagnostikai, kaip ir PATE atveju -tai tik padidina pacientų apšvitą ir radiologų peržiūrimų vaizdų skaičių [53,54]. Neretai pasitaiko ir tokių atvejų, kai naviko atsakui į gydymą įvertinti atliekami daugiafaziai KT tyrimai (52,54).…”

Data-Driven CT Protocol Review and Management—Experience From a Large Academic Hospital

“…[1]. Protocol review plays a crucial role in the quality assurance process for CT, and its importance has been increasingly recognized by the imaging community [2][3][4][5][6]. Recent updates from the ACR and the Joint Commission reflect this trend:…”