•The Deffρe method was proposed to overcome the challenges of using the water equivalent diameter (Dw) method used for SSDE.•The Deffρe method is based on correcting effective diameter (Deff) with ...electron densities of tissues of a scan area.•Results of the Deffρe method showed to be promise for the chest protocols, but was less accurate for other body protocols.•The Deff method was poorer for the chest protocols, but gave good assessments for other body protocols.•Correction of both dimensions, lateral (LAT) and anterior-posterior (AP), did not improve the accuracy of the Deffρe method.
An assessment of the effective diameter of a patient’s body using electron densities of tissues inside the scan area (Deffρe) was proposed to overcome challenges associated with the estimation of water-equivalent diameter (Dw), which is used for size-specific dose estimate (SSDE). The aims of this study were to (1) investigate the Deffρe method in two different forms using a wide range of patient sizes and scanning protocols, and (2) compare between four methods used to estimate the patient size for SSDE.
Under IRB approval, a total of 350 patients of varying sizes have been collected retrospectively from the Hospital. The Dw values were assessed over six different CT body protocols: (1) chest with contrast media, (2) chest High-Resolution Computed Tomography (HRCT) without contrast media, (3) abdomen-pelvis with contrast media, (4) abdomen-pelvis without contrast media, (5) chest-abdomen-pelvis with contrast media, and (6) pelvis without contrast media. A MATLAB-based code was developed in-house to assess the size of each patient using the conventional effective diameter method (Deff), Deffρe by correcting either both the lateral (LAT) and anterior-posterior (AP) dimensions (Deff,LAT+APρe) or LAT only (Deff,LATρe), and Dw at the mid-CT slice of the patient images.
The results of Deff,LAT+APρe and Deff,LATρe provided a better estimation for the chest protocols with the averages of absolute percentage difference (PD) values in the range of 3 – 7 % for all patient sizes as compared to the Dw method, whereas the averages of PD values for the Deff method were 9 – 15 %. However, Deff gave a better estimation for Dw values for the other body protocols, with differences of 2 – 4 %, which were lower than those obtained with the Deff,LAT+APρe and Deff,LATρe methods. For the chest protocols, statistically significant differences were found between Deff and the other methods, but there were no significant differences between all the methods for the other scanning protocols. The results show that the correction of both dimensions, LAT and AP, did not improve the accuracy of the Deffρe method, and, for most protocols, Deff,LAT+APρe gave larger range differences compared to those based on correction of the LAT dimension only.
If the Dw cannot be assessed, the Deff,LATρe method may only be considered for the chest protocols as an alternative approach. The Deff method may also be used for all regions taking into account the application of a correction factor for the chest protocols to avoid a significant under or overestimation of the patient dose.
Introduction: Computed Tomography Angiography (CTA) is useful for evaluating and diagnosing conditions related to blood vessels, such as aneurysms, stenosis (narrowing of vessels), vascular ...malformations, and blockages. It provides valuable information for planning and guiding interventions or surgeries. It is also important to measure patient doses during CTA operations to evaluate and optimise the technique and balance the benefits compared to radiation hazards. Aim: To calculate the CT Dose Index (CTDI), Dose Length Product (DLP), and effective dose for CT brain angiography and CT pulmonary angiography, and also to compare whether the measured values are within the International Commission on Radiological Protection (ICRP) recommended levels. Materials and Methods: A retrospective descriptive study was conducted in the Department of Radiodiagnosis at Yenepoya Medical College Hospital Mangaluru, Karnataka, India, from September 2022 to September 2023. A total of 52 data points were collected for CT brain and CT pulmonary angiography examinations, which were acquired before October 2022. Information on CTDI and DLP was collected, and the effective dose was calculated using the conversion factor. The values were then compared with the ICRP reference level. Descriptive statistics, mean, and standard deviation for continuous variables, and frequency and percentage for categorical variables were used. Results: There was a significantly lower value of CTDI, DLP, and effective dose for CT brain angiography and CT pulmonary angiography compared to the ICRP recommended reference levels. The mean CTDI and DLP for CT brain angiography were 111.56 mGy and 1153.31 mGy·cm, and the mean CTDI and DLP for CT pulmonary angiography were 24.56 mGy and 713.74 mGy·cm, respectively. The mean effective dose for CT brain and CT pulmonary angiography was 2.46 mSv and 9.94 mSv, respectively. Conclusion: The measured values were within the recommended values of ICRP regulations. It is recommended that CT brain angiography and CT pulmonary angiography examinations are safer for diagnostic purposes. Optimising scanning protocols, utilising low-dose techniques, and implementing dose monitoring and control are important clinical aspects. Compliance with the guidelines helps to enhance patient care and reduce the risk of radiation-related complications.
The purpose of this study was to evaluate image quality and radiation dose using a 100 kVp tube voltage scan protocol compared with standard 120 kVp for coronary computed tomography angiography ...(CTA).
Concerns have been raised about radiation exposure during coronary CTA. The use of a 100 kVp tube voltage scan protocol effectively lowers coronary CTA radiation dose compared with standard 120 kVp, but it is unknown whether image quality is maintained.
We enrolled 400 nonobese patients who underwent coronary CTA: 202 patients were randomly assigned to a 100 kVp protocol and 198 patients to a 120 kVp protocol. The primary end point was to demonstrate noninferiority in image quality with the 100 kVp protocol, which was assessed by a 4-point grading score (1 = nondiagnostic, 4 = excellent image quality). For the noninferiority analysis, a margin of -0.2 image quality score points for the difference between both scan protocols was pre-defined. Secondary end points included radiation dose and need for additional diagnostic tests during follow-up.
The mean image quality scores in patients scanned with 100 kVp and 120 kVp were 3.30 ± 0.67 and 3.28 ± 0.68, respectively (p = 0.742); image quality of the 100 kVp protocol was not inferior, as demonstrated by the 97.5% confidence interval of the difference, which did not cross the pre-defined noninferiority margin of -0.2. The 100 kVp protocol was associated with a 31% relative reduction in radiation exposure (dose-length product: 868 ± 317 mGy × cm with 120 kVp vs. 599 ± 255 mGy × cm with 100 kVp; p < 0.0001). At 30-day follow-up, the need for additional diagnostic studies did not differ (13.4% vs. 19.2% for 100 kVp vs. 120 kVp, respectively; p = 0.114).
A coronary CTA protocol using 100 kVp tube voltage maintained image quality, but reduced radiation exposure by 31% as compared with the standard 120 kVp protocol. Thus, 100 kVp scan protocols should be considered for nonobese patients to keep radiation exposure as low as reasonably achievable. (Prospective Randomized Trial on Radiation Dose Estimates of Cardiac CT Angiography in Patients Scanned With a 100 kVp Protocol PROTECTION II; NCT00611780).
Computed tomography dose index (CTDI) calculations based on measurements made with CT ionization chambers require characterization of two chamber properties: radiation sensitivity and effective ...length. The sensitivity of a CT ionization chamber is currently determined in some countries by calibration in an x-ray field that irradiates the entire chamber. Determination of the effective length is left to the user, and this value is frequently assumed to be equivalent to the nominal length-typically 100 mm-stated by the manufacturer. This assumption undermines the intention and usefulness of CTDI calculation. Thus, a slit-based calibration,
, of the CT ionization chambers was proposed by collimating the x-ray beam to a well-defined aperture width. The aim of this work is to compare the two methods.
Four different CT ionization chambers (Standard Imaging Exradin A101, Radcal 10x5-3CT, Victoreen 500-100, and Capintec PC-4P) are investigated in this work. Sensitivity profiles were measured for all four chambers and effective/rated chamber lengths were calculated. A novel Monte-Carlo based correction was proposed to account for the presence of the aperture. CTDI was calculated and compared for two calibration beams as well as for a commercial CT scanner using Exradin A101 and Radcal 10x5-3CT chambers.
The nominal chamber length was found to deviate up to 21% compared to the effective length. Correction for the aperture depended on the aperture opening size. CTDI calculation results illustrate the potential 17% error in CTDI calculation that can be caused by assuming the effective chamber length is equivalent to the manufacturer's stated nominal length. CTDI calculations with CT ionization chambers calibrated with an air-kerma length calibration method yield the smallest variation in the CTDI regardless of the chamber model.
To avoid an erroneous CTDI, information regarding the chamber's effective length must be included in the calibration or stated by the manufacturer. Alternatively, a slit-based calibration can be performed.
Abstract
Previous studies have primarily focused on quality of imaging in radiotherapy planning computed tomography (RTCT), with few investigations on imaging doses. To our knowledge, this is the ...first study aimed to investigate the imaging dose in RTCT to determine baseline data for establishing national diagnostic reference levels (DRLs) in Japanese institutions. A survey questionnaire was sent to domestic RT institutions between 10 October and 16 December 2021. The questionnaire items were volume computed tomography dose index (CTDIvol), dose–length product (DLP), and acquisition parameters, including use of auto exposure image control (AEC) or image-improving reconstruction option (IIRO) for brain stereotactic irradiation (brain STI), head and neck (HN) intensity-modulated radiotherapy (IMRT), lung stereotactic body radiotherapy (lung SBRT), breast-conserving radiotherapy (breast RT), and prostate IMRT protocols. Details on the use of motion-management techniques for lung SBRT were collected. Consequently, we collected 328 responses. The 75th percentiles of CTDIvol were 92, 33, 86, 23, and 32 mGy and those of DLP were 2805, 1301, 2416, 930, and 1158 mGy·cm for brain STI, HN IMRT, lung SBRT, breast RT, and prostate IMRT, respectively. CTDIvol and DLP values in institutions that used AEC or IIRO were lower than those without use for almost all sites. The 75th percentiles of DLP in each treatment technique for lung SBRT were 2541, 2034, 2336, and 2730 mGy·cm for free breathing, breath holding, gating technique, and real-time tumor tracking technique, respectively. Our data will help in establishing DRLs for RTCT protocols, thus reducing imaging doses in Japan.
This work aims to calculate size-specific dose estimates (SSDE) and establish the relationship between water equivalent diameter (Dw) values and SSDE in images of abdominal CT examinations undergone ...by 30 adult patients. These patients had a mean age of 51 years, a mean height of 164 cm, and a mean weight of 62.71 kg. The water equivalent diameters (Dw) measured 25.30 cm on average, with mean volumetric computed tomography dose index (CTDIvol) doses of 7.95 mGy and a mean SSDE of 11.31 mGy. Images were retrospectively collected using a Hitachi Supria 16-slice CT scanner, and Dw and SSDE values were calculated based on lateral and anteroposterior (LAT + AP) measurements of cross-sectional images from each CT examination. Dw was calculated from ED, and their close correspondence allowed for interchangeable use, following AAPM guidelines. The calculated doses (SSDE) were significantly higher than the doses displayed by the scanner (CTDI). Furthermore, a strong correlation (R2 = 0.63) was observed between SSDE and Dw. Consequently, assessing patient dose based on size becomes essential to optimize radiation exposure in CT imaging.
Background
Computed Tomography has become the major source of population exposure in diagnostic x-rays. This concerned issue will be resolved by stetting Local Diagnostic Reference Levels.
Objectives
...The main objective of this study is to assess dose indicators for the establishment of Local Diagnostic Reference Levels.
Materials and methods
A prospective cross-sectional study design was conducted on 8 public and private hospitals performing CT examinations. A total of 725 adult patients who underwent abdominopelvic, chest, and head CT examinations were evaluated from October 2021 to March 2022. Patients’ demography, exposure parameters, and dose descriptors were collected. The minimum, maximum, mean, median, and third quartile values were analyzed using SPSS software version 26. Finally, the third quartile values of collected data were compared with national and international values.
Results
The third quartile values obtained from median of volumetric computed tomography dose index (mGy) and dose length product (mGy.cm) which are considered as local DRLs for head, chest, and abdominopelvic CT examination, respectively, were 53 mGy, 14 mGy and 13 mGy; 1307 mGy.cm, 575 mGy.cm, and 932 mGy.cm.
Conclusion
The results of this study showed that practices of CT imaging in both public and private hospitals in Addis Ababa were comparable to other national and international values.
Purpose: The aim of this study was to determine the mean volume computed tomography dose index (CTDIvol) for the standard head and body phantoms and locally designed head and body phantoms ...respectively. Similarly, this study determined and compared the displayed mean CTDIvol and Dose Length Product (DLP) for the above phantoms from the CT monitor. In addition, the percentage deviations of both phantoms were compared with the recommended limits from the International Atomic Energy Agency (IAEA) and the American College of Radiologists (ACR). Materials and
Methods: Dose measurements were made using a standard polymethymethacrylate (PMMA) phantom for head and body as well as a locally designed phantom with four CT scanners using thermoluminescence dosimeters (TLDs). The locally designed phantoms were made using a PMMA sheet, which was bent to give the desired cylindrical shape and was made like the standard phantoms. The constructed phantom was filled with water and the TLD chips were inserted into the center and peripheries of the phantoms to obtain the absorbed doses.
Results: The CTDIvol for the standard head and body phantom for center A was 66.97 and 21.85mGy and for B was 23.39 and 6.29mGy respectively. Similarly, the CTDIvol for the constructed head and body phantom for center A was 63.91 and 19.84mGy and for B was 24.67 and 6.30mGy respectively. The uncertainty between the standard and constructed head phantoms for centers A and B was 4.6 and 5.5% respectively, while that of the standard and constructed body phantoms for centers A and B was 9.2 and 0.0% respectively. The maximum percent deviation from the console CTDIvol and DLP values with the four phantoms for centers A and B was within ±20%. The mean correction factors for the head and body were 0.998 and 1.05 respectively.
Conclusion: The uncertainties obtained in this study were within the IAEA and ACR recommended value of ±20%. The constructed phantom proved useful for CT dose measurements.
Context: Diagnostic reference level (DRL) is the first step in the optimization process to manage patient dose corresponding with the medical purpose. Aim: The objective of this study was to develop ...local DRL for computed tomography (CT) of the head and abdomen in adult patients in four CT centers in South-South Nigeria. Materials and Methods: A prospective, cross-sectional study of 546 adult patients that underwent CT examination of the head and abdomen from 2018 to 2020 using four different CT scanners. Volume CT dose index (CTDIvol) and dose length product (DLP) of contrast and non-contrast CT examinations of the head and abdomen were collated and the 50th percentile DRL was determined and compared to other published DRLs. Results: The 50th percentile CTDIvol/DLP for non-contrast head CT examination for centers A, B, C, and D was 75.3 mGy/1776.6 mGy.cm, 21.8 mGy/457 mGy.cm, 17.4 mGy/373.6 mGy.cm, and 29.6 mGy/628.5 mGy.cm, respectively. The 50th percentile CTDIvol/DLP for contrast head CT examination for centers A, B, C, and D was 150.6 mGy/3326.2 mGy.cm, 41.4 mGy/832.4 mGy.cm, 35.6 mGy/653.6 mGy.cm, and 77.9 mGy/1458.4 mGy.cm, respectively. The 50th percentile CTDIvol/DLP for non-contrast abdomen CT examination for centers A and B was 22.8 mGy/1488.5 mGy.cm and 7.9 mGy/302.3 mGy.cm, respectively. The 50th percentile CTDIvol/DLP for contrast abdomen CT examination for centers B and C was 19.6 mGy/825.7 mGy.cm and 31.5 mGy/1555.5 mGy.cm, respectively. There was correlation between contrast and non-contrast CTDI (P = 0.003) and DLP (P = 0.025) for the head. Conclusion: Wide variations CTDIvol and DLP values were observed among the centers for similar body part CT examinations.
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