The use of effective dose for medical procedures is inappropriate

Borrás, Cari; Huda, Walter; Orton, Colin G.

doi:10.1118/1.3377778

Cited by 22 publications

(12 citation statements)

References 9 publications

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“…31 Recently, the limitations of effective dose have been discussed in the literature, and there have been intensive debates over whether the concept is applicable to medical exposure and whether it should be replaced. 21,[38][39][40][41] Our calculation of effective dose using patient-specific organ dose values, while not being exactly as defined by ICRP, served two purposes: ͑a͒ it provided patient dose estimates using a concept that the medical imaging community is currently familiar with and thus can put in context with other dose studies and ͑b͒ it approximates the effective dose to a patient population ͑including both genders͒ who has similar anatomy and body habitus as the patient whose organ dose values were used in the effective dose calculation.…”

Section: Discussionmentioning

confidence: 99%

Patient‐specific radiation dose and cancer risk estimation in CT: Part II. Application to patients

et al. 2010

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Purpose: Current methods for estimating and reporting radiation dose from CT examinations are largely patient-generic; the body size and hence dose variation from patient to patient is not reflected. Furthermore, the current protocol designs rely on dose as a surrogate for the risk of cancer incidence, neglecting the strong dependence of risk on age and gender. The purpose of this study was to develop a method for estimating patient-specific radiation dose and cancer risk from CT examinations. Methods: The study included two patients ͑a 5-week-old female patient and a 12-year-old male patient͒, who underwent 64-slice CT examinations ͑LightSpeed VCT, GE Healthcare͒ of the chest, abdomen, and pelvis at our institution in 2006. For each patient, a nonuniform rational B-spine ͑NURBS͒ based full-body computer model was created based on the patient's clinical CT data. Large organs and structures inside the image volume were individually segmented and modeled. Other organs were created by transforming an existing adult male or female full-body computer model ͑developed from visible human data͒ to match the framework defined by the segmented organs, referencing the organ volume and anthropometry data in ICRP Publication 89. A Monte Carlo program previously developed and validated for dose simulation on the LightSpeed VCT scanner was used to estimate patient-specific organ dose, from which effective dose and risks of cancer incidence were derived. Patient-specific organ dose and effective dose were compared with patient-generic CT dose quantities in current clinical use: the volume-weighted CT dose index ͑CTDI vol ͒ and the effective dose derived from the dose-length product ͑DLP͒. Results: The effective dose for the CT examination of the newborn patient ͑5.7 mSv͒ was higher but comparable to that for the CT examination of the teenager patient ͑4.9 mSv͒ due to the size-based clinical CT protocols at our institution, which employ lower scan techniques for smaller patients. However, the overall risk of cancer incidence attributable to the CT examination was much higher for the newborn ͑2.4 in 1000͒ than for the teenager ͑0.7 in 1000͒. For the two pediatric-aged patients in our study, CTDI vol underestimated dose to large organs in the scan coverage by 30%-48%. The effective dose derived from DLP using published conversion coefficients differed from that calculated using patient-specific organ dose values by Ϫ57% to 13%, when the tissue weighting factors of ICRP 60 were used, and by Ϫ63% to 28%, when the tissue weighting factors of ICRP 103 were used. Conclusions: It is possible to estimate patient-specific radiation dose and cancer risk from CT examinations by combining a validated Monte Carlo program with patient-specific anatomical models that are derived from the patients' clinical CT data and supplemented by transformed models of reference adults. With the construction of a large library of patient-specific computer models encompassing patients of all ages and weight percentiles, dose and risk can be estimated for any ...

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Section: Discussionmentioning

confidence: 99%

Patient‐specific radiation dose and cancer risk estimation in CT: Part II. Application to patients

et al. 2010

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“…23 At high doses of radiation (above $100 mSv), the LNT model is widely accepted. However, at low doses (including most exposures from diagnostic and interventional radiology procedures), there is tremendous uncertainty.…”

Section: >15mentioning

confidence: 99%

Radiation-Related Injuries and Their Management: An Update

Wunderle

Gill

2015

Semin intervent Radiol

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Ionizing radiation (in the form of X-rays) is used for the majority of procedures in interventional radiology. This review article aimed at promoting safer use of this tool through a better understanding of radiation dose and radiation effects, and by providing guidance for setting up a quality assurance program. To this end, the authors describe different radiation descriptive quantities and their individual strengths and challenges, as well as the biologic effects of ionizing radiation, including patient-related effects such as tissue reactions (previously known as deterministic effects) and stochastic effects. In this article, the clinical presentation, immediate management, and clinical follow-up of these injuries are also discussed. Tissue reactions are important primarily from the patients' perspective, whereas stochastic effects are most relevant for pediatric patients and from an occupational viewpoint. The factors affecting the likelihood of skin reaction (the most common tissue reaction) are described, and how this condition should be managed is discussed. Setting up a robust quality assurance program around radiation dose is imperative for effective monitoring and reduction of radiation exposure to patients and operators. Recommendations for the pre-, peri-, and postprocedure periods are given, including recommendations for follow-up of high-dose cases. Special conditions such as pregnancy and radiation recall are also discussed.

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“…A common quantity for comparing doses is effective dose. This construct was proposed by the International Commission on Radiation Protection [27], and, despite its significant limitations [28], effective dose is often used as a convenient measure to describe radiation doses from imaging procedures. In brief, effective dose represents the potential risk of cancer from nonuniform radiation exposures based on individual organ doses and organ sensitivities [13].…”

Section: General Considerations Regarding Ct Dose Reductionmentioning

confidence: 99%

Pediatric CT: Strategies to Lower Radiation Dose

Zacharias

Alessio

Otto

et al. 2013

American Journal of Roentgenology

116

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OBJECTIVE The introduction of MDCT has increased the utilization of CT in pediatric radiology along with concerns for radiation sequelae. This article reviews general principles of lowering radiation dose, the basic physics that impact radiation dose, and specific CT integrated dose-reduction tools focused on the pediatric population. CONCLUSION The goal of this article is to provide a comprehensive review of the recent literature regarding CT dose reduction methods, their limitations, and an outlook on future developments with a focus on the pediatric population. The discussion will initially focus on general considerations that lead to radiation dose reduction, followed by specific technical features that influence the radiation dose.

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The use of effective dose for medical procedures is inappropriate

Cited by 22 publications

References 9 publications

Patient‐specific radiation dose and cancer risk estimation in CT: Part II. Application to patients

Patient‐specific radiation dose and cancer risk estimation in CT: Part II. Application to patients

Radiation-Related Injuries and Their Management: An Update

Pediatric CT: Strategies to Lower Radiation Dose

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