Assessing Organ Doses from Paediatric CT Scans—A Novel Approach for an Epidemiology Study (the EPI-CT Study)

Thierry-Chef, Isabelle; Dabin, Jérémie; Friberg, Eva Godske; Hermen, Johannes; Istad, Tore S.; Jahnen, Andréas; Krille, Lucian; Lee, Choonsik; Maccia, C.; Nordenskjöld, Arvid; Olerud, Hilde Merete; Rani, Kaddour; Rehel, J.L.; Simon, Steven L.; Struelens, Lara; Kesminiene, Ausrele

doi:10.3390/ijerph10020717

Cited by 32 publications

(19 citation statements)

References 15 publications

(14 reference statements)

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“…These uncertainties regarding the absorbed radiation dose in the CT-exposed cohort may have led to overestimation of the cancer risks of CT. The upcoming European Epidemiologic Study to Quantify Risks for Pediatric Computed Tomography and to Optimize Doses (EPI-CT) study, which was designed to include approximately 1 million children exposed to CT, will offer opportunities to better address these limitations of the uncertainties induced by incomplete dosimetry (21). (20,21).…”

Section: Why We Must Reduce Radiation Dosementioning

confidence: 99%

Radiation Dose Reduction at Pediatric CT: Use of Low Tube Voltage and Iterative Reconstruction

et al. 2018

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Given the growing awareness of and concern for potential carcinogenic effects of exposure of children to ionizing radiation at CT, optimizing acquisition parameters is crucial to achieve diagnostically acceptable image quality at the lowest possible radiation dose. Among currently available dose reduction techniques, recent technical innovations have allowed the implementation of low tube voltage scans and iterative reconstruction (IR) techniques into daily clinical practice for pediatric CT. The benefits of lowering tube voltage include a considerable reduction in radiation dose and improved contrast on images, especially when an iodinated contrast medium is used. The increase in noise, which is attributed to decreased photon penetration, is a major drawback but is not as severe as that at adult CT because of the small body size of children. In addition, use of IR algorithms can suppress increased noise, yielding wider applicability for low tube voltage scans. However, a careful implementation strategy and methodologic approach are necessary to maximize the potential for dose reduction while preserving diagnostic image quality under each clinical condition. The potential pitfalls of and topics related to these techniques include (a) the effect of tube voltage on the surface radiation dose, (b) the effect of window settings, (c) accentuation of metallic artifacts, (d) deterioration of low contrast detectability at low-dose settings, (e) interscanner variation of x-ray spectra, and (f) a comparison with the use of a spectral shaping technique. Appropriate use of low tube voltage and IR techniques is helpful for radiation dose reduction in most applications of pediatric CT. Online DICOM image stacks are available for this article . RSNA, 2018.

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Section: Why We Must Reduce Radiation Dosementioning

confidence: 99%

Radiation Dose Reduction at Pediatric CT: Use of Low Tube Voltage and Iterative Reconstruction

et al. 2018

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“…Unless the reasons for the examination can be determined and dosimetry improved in future studies (Einstein, 2012;Thierry-Chef et al, 2013;Walsh et al, 2014), they too will be equally ambiguous.…”

Section: Discussionmentioning

confidence: 99%

Radiation epidemiology and recent paediatric computed tomography studies

Boice

2015

Ann ICRP

102

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Abstract-Recent record-linkage studies of cancer risk following computed tomography (CT)procedures among children and adolescents under 21 years of age must be interpreted with caution. The reasons why the examinations were performed were not known, and the dosimetric approaches did not include individual dose reconstructions or account for the possibility for missed examinations. The recent report (2013) on children by the United Nations Scientific Committee on the Effects of Atomic Radiation concluded that the associations may have resulted from confounding by indication (also called 'reverse causation'), and not radiation exposure. The reported cancer associations may very well have been related to the patients' underlying health conditions that prompted the examinations. Reverse causation has been observed in other epidemiological investigations, such as a Swedish study of thyroid cancer risk following I-131 scintillation imaging scans, and in studies of brain cancer risk following Thorotrast for cerebral angiography. Epidemiological patterns reported in the CT studies were also inconsistent with the world's literature. For example, in a UK study, teenagers had a higher risk of brain tumour than young children; in an Australian study, cancers not previously linked to radiation were significantly elevated; and in a Taiwanese study, the risk of benign tumours decreased with age at the time of CT examination. In all studies, solid tumours appeared much earlier than previously reported. Remarkably, in the Australian study, brain cancer excesses were seen regardless of whether or not the CT was to the head, i.e. a significant excess was reported for CT examinations of the abdomen and extremities, which involved no radiation exposure to the brain. In the UK study, the significance of the 'leukaemia' finding was only because myelodysplastic syndrome was added to the category, and there was no significance for leukaemia alone. Without knowledge of why CT examinations were performed, any future studies will be equally difficult to interpret. It is noteworthy that two recent studies of children in France and Germany found no significant excess cancer risk from CT scans once adjustment was made for conditions that prompted the scan, family This paper does not necessarily reflect the views of the International Commission on Radiological Protection. 236 history, or other predisposing factors known to be associated with increased cancer risk. Nonetheless, such studies have heightened awareness of these relatively high-dose diagnostic procedures, and the need to reduce unnecessary examinations and lower the dose per examination commensurate with the desired image quality.

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“…We found our method is highly efficient in large-scale dose calculations for CT patients and is more accurate than the ImPACT dosimetry tool although Monte Carlo transport calculations based on real patient CT images may provide more accurate individualized organ doses. We have successfully applied this method to a variety of CT-related studies including retrospective epidemiological study (1,5,18,19) and CT dose trend analysis studies (3,20). …”

Section: Discussionmentioning

confidence: 99%

Calculation of Organ Doses for a Large Number of Patients Undergoing CT Examinations

Bahadori

Miglioretti

Kruger

et al. 2015

American Journal of Roentgenology

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Purpose To develop and demonstrate an automated calculation method to provide organ dose assessment for a large cohort of pediatric and adult patients undergoing CT examinations. Methods We adopted two dose libraries that were previously published: the CTDIvol-normalized organ dose library and the mAs-normalized CTDIw library. We developed an algorithm to calculate organ doses using the two dose libraries and CT scan parameters available from DICOM data. To demonstrate the established method, we calculated organ doses for pediatric (n=2499) and adult (n=2043) CT scans randomly selected from four health care systems in the United States, and compared the adult organ doses with the values calculated from the ImPACT calculator. Results Median brain dose was 20 mGy (pediatric) and 24 mGy (adult), and brain dose was greater than 40 mGy for 11% (pediatric) and 18% (adult) of head scans. Both the NCI and the ImPACT methods provided similar organ doses (median discrepancy < 20%) for all organs except for the organs located close to scan boundaries. The visual comparisons of scan coverage and phantom anatomies revealed that the NCI method based realistic computational phantoms provides more realistic organ doses compared to the ImPACT method. Conclusion The automated organ dose calculation method developed in this study reduces the time needed to calculate doses on a large number of patients. We have successfully utilized this method for a variety of CT-related studies including retrospective epidemiological study and CT dose trend analysis studies.

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Assessing Organ Doses from Paediatric CT Scans—A Novel Approach for an Epidemiology Study (the EPI-CT Study)

Cited by 32 publications

References 15 publications

Radiation Dose Reduction at Pediatric CT: Use of Low Tube Voltage and Iterative Reconstruction

Radiation Dose Reduction at Pediatric CT: Use of Low Tube Voltage and Iterative Reconstruction

Radiation epidemiology and recent paediatric computed tomography studies

Calculation of Organ Doses for a Large Number of Patients Undergoing CT Examinations

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