The Current State of CT Dose Management Across Radiology: Well Intentioned but Not Universally Well Executed

Szczykutowicz, Timothy P.; Bour, Robert K.; Ranallo, Frank N.; Pozniak, Myron A.

doi:10.2214/ajr.17.19266

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…Technical challenges and knowledge gaps encounter the feasibility of effectively implementing dose monitoring and management tools in a clinical practice. Such observation was supported by [ 9 , 22 ].…”

Section: Discussionsupporting

confidence: 63%

Challenges Associated with Effective Implementation of CT Dose Check Standards and Radiation Monitoring Index in Computed Tomography: Healthcare Sector Experience

et al. 2022

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Computed tomography (CT) radiation dose management tools should be used whenever possible, particularly with the increasing demand for acquiring CT studies. Herein, we aim to assess the advantages and challenges faced with implementing two CT dose management tools. A second aim was to highlight CT examinations exceeding dose notification values (NVs) and define the common set of causes. A total of 13,037 CT examinations collected over a six-month period, were evaluated, using two independent CT dose management tools, a CT Dose Notification prospective-view tool (PVT) following CT Dose Check standards and a retrospective statistical-based view tool (RSVT). Dose NVs were set to twice the Local Diagnostic Reference Levels. There was a significant discrepancy between dose NV counts registered with prospective (4.15%) and retrospective (7.98%) tools using T-Test. A core difference is the dose configuration setup, with PVT and RSVT being dose per series and whole study, respectively. Both prospective and retrospective dose management tools were equally useful despite their technical difference. Configuring the CT prospective dose notification check tool using NVs that is based on DRLs has limitations, and one needs to establish dose NVs per series to overcome this technical hurdle. Technical challenges make the implementation of CT Dose Check standards puzzling.

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Section: Discussionsupporting

confidence: 63%

Challenges Associated with Effective Implementation of CT Dose Check Standards and Radiation Monitoring Index in Computed Tomography: Healthcare Sector Experience

et al. 2022

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“…Despite advancements such as dual-energy sources or digital flat panel detectors that allow potential dose reductions of up to 30-60% [62], studies increasingly show that these technologies are often being used to acquire images of higher quality than necessary for diagnosis. At the user-level, technologists at many institutions are relied on to select imaging parameters, which introduces a significant amount of variability in image quality and patient exposure [63]. This individual-level variability has been supported by the finding that sites lacking a dedicated medical physicist and specialist imaging team are less likely to use existing "Dose Check" features [63].…”

Section: Lack Of Optimization By User Despite Better Technologymentioning

confidence: 99%

“…At the user-level, technologists at many institutions are relied on to select imaging parameters, which introduces a significant amount of variability in image quality and patient exposure [63]. This individual-level variability has been supported by the finding that sites lacking a dedicated medical physicist and specialist imaging team are less likely to use existing "Dose Check" features [63]. The concept of diagnostic reference level has been used to achieve optimization of protection [64,65] despite some concerns about limitation of the concept [66,67].…”

Section: Lack Of Optimization By User Despite Better Technologymentioning

confidence: 99%

Higher patient doses through X-ray imaging procedures

Rehani

Nacouzi

2020

Physica Medica

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Medical imaging using X-rays has been one of the most popular imaging modalities ever since the discovery of Xrays 125 years ago. With unquestionable benefits, concerns about radiation risks have frequently been raised. Computed tomography (CT) and fluoroscopic guided interventional procedures have the potential to impart higher radiation exposure to patients than radiographic examinations. Despite technological advances, there have been instances of increased doses per procedure mainly because of better diagnostic information in images. However, cumulative dose from multiple procedures is creating new concerns as effective doses >100 mSv are not uncommon. There is a need for action at all levels. Manufacturers must produce equipment that can provide a quality diagnostic image at substantially lesser dose and better implementation of optimization strategies by users. There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering. It appears that a new monochromatic X-ray source will lead to replacement of X-ray tubes all over the world in coming years and will lead to a drastic reduction in radiation doses. This innovation will impact all X-ray imaging and will help dose reduction. For interventional procedures, the likely employment of robotic systems in practice may drastically reduce radiation exposures to operators-but patient exposure will still remain an issue. Training needs always need to be emphasized and practiced.

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A Clinically Optimal Protocol for the Imaging of Enteric Tubes: On the Basis of Radiologist Interpreted Diagnostic Utility and Radiation Dose Reduction

Klejch¹,

Marshall²,

Blunt³

et al. 2022

Academic Radiology

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The Current State of CT Dose Management Across Radiology: Well Intentioned but Not Universally Well Executed

Abstract: Although CT dose awareness campaigns, mandatory standards, and software enhancements are well intentioned, their implementation is often suboptimal.

Cited by 5 publications

References 25 publications

Challenges Associated with Effective Implementation of CT Dose Check Standards and Radiation Monitoring Index in Computed Tomography: Healthcare Sector Experience

Challenges Associated with Effective Implementation of CT Dose Check Standards and Radiation Monitoring Index in Computed Tomography: Healthcare Sector Experience

Higher patient doses through X-ray imaging procedures

A Clinically Optimal Protocol for the Imaging of Enteric Tubes: On the Basis of Radiologist Interpreted Diagnostic Utility and Radiation Dose Reduction

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