Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography

Smith‐Bindman, Rebecca; Chu, Philip; Wang, Yifei; Chung, Robert; Lopez-Solano, Naomi; Solberg, Leif I.; Cervantes, Luisa F.; Yellen-Nelson, Thomas; Boswell, William D.; Delman, Bradley N.; Duong, Phuong-Anh T.; Goode, Allen R.; Kasraie, Nima; Lee, Ryan K.; Neill, Rebecca; Pahwa, Anokh; Pike, Pavlina; Roehm, J. O.; Schindera, Sebastian T.; Starkey, Jay; Suntharalingam, Saravanabavaan; Jeukens, Cécile R. L. P. N.; Miglioretti, Diana L.

doi:10.1001/jamainternmed.2020.0064

Cited by 17 publications

(11 citation statements)

References 26 publications

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“…The University of California San Francisco (UCSF) International CT Dose Registry includes 6.65 million CT exams assembled from across 160 hospital and imaging facilities [ 6 , 7 ]. The registry was created with funding from the University of California Office of the President, the Centers for Disease Control and Prevention, the National Institutes of Health and the Patient Centered Outcomes Research Institute, and includes data from health care institutions that used Radimetrics Radiation Dose Management Solution (Bayer HealthCare, Whippany, NJ) and expressed interest in collaborating with UCSF on radiation-related research.…”

Section: Methodsmentioning

confidence: 99%

“…ratio) between phantom sizes (16 cm vs. 32 cm) to measure the magnitude of difference due to reference phantom selection when there were at least 5 CT examinations performed by age and body region using each phantom. The Radimetrics dose tracking platform was employed to extract all patient, scanner and exam variables (see [ 6 , 7 ] for details), and SAS (version 9.3; SAS Institute, Cary, NC) and R (version 3.6.3; R Foundation for Statistical Computing, Vienna, Austria) were used for all analyses.…”

Section: Methodsmentioning

confidence: 99%

“…The University of California San Francisco (UCSF) International CT Dose Registry includes 6.65 million CT exams assembled from across 160 hospital and imaging facilities [6,7]…”

Section: Registrymentioning

confidence: 99%

“…The rapid rise over the last few decades in computed tomography (CT) imaging and consequent population exposure to ionizing radiation, a known carcinogen, have raised concerns about the levels and variability of radiation doses across patients, institutions and countries, as well as the need for dose optimization [1][2][3][4][5][6][7][8]. Diverse organizations and campaigns, such as Choosing Wisely and Image Gently, promote improving the safety and effective imaging care of children worldwide to optimize and reduce patient radiation dose exposures [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Reference phantom selection in pediatric computed tomography using data from a large, multicenter registry

Chu

Wang

et al. 2021

Pediatr Radiol

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Background Radiation dose metrics vary by the calibration reference phantom used to report doses. By convention, 16-cm diameter cylindrical polymethyl-methacyrlate phantoms are used for head imaging and 32-cm diameter phantoms are used for body imaging in adults. Actual usage patterns in children remain under-documented. Objective This study uses the University of California San Francisco International CT Dose Registry to describe phantom selection in children by patient age, body region and scanner manufacturer, and the consequent impact on radiation doses. Materials and methods For 106,837 pediatric computed tomography (CT) exams collected between Jan. 1, 2015, and Nov. 2, 2020, in children up to 17 years of age from 118 hospitals and imaging facilities, we describe reference phantom use patterns by body region, age and manufacturer, and median and 75th-percentile dose–length product (DLP) and volume CT dose index (CTDIvol) doses when using 16-cm vs. 32-cm phantoms. Results There was relatively consistent phantom selection by body region. Overall, 98.0% of brain and skull examinations referenced 16-cm phantoms, and 95.7% of chest, 94.4% of abdomen and 100% of cervical-spine examinations referenced 32-cm phantoms. Only GE deviated from this practice, reporting chest and abdomen scans using 16-cm phantoms with some frequency in children up to 10 years of age. DLP and CTDIvol values from 16-cm phantom-referenced scans were 2–3 times higher than 32-cm phantom-referenced scans. Conclusion Reference phantom selection is highly consistent, with a small but significant number of abdomen and chest scans (~5%) using 16-cm phantoms in younger children, which produces DLP values approximately twice as high as exams referenced to 32-cm phantoms

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The University of California San Francisco (UCSF) International CT Dose Registry includes 6.65 million CT exams assembled from across 160 hospital and imaging facilities [6,7]…”

Section: Registrymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reference phantom selection in pediatric computed tomography using data from a large, multicenter registry

Chu

Wang

et al. 2021

Pediatr Radiol

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“…Recent literature cites numerous publications that are related to the optimization process and patient dose reductions [41,. For example, Smith-Bindman R et al applied customized optimization steps in 100 facilities for 864 080 adult patients and 1,156,657 CT scans, and reported that detailed feedback on CT radiation dose combined with actionable suggestions and quality improvement education significantly reduced doses, whereas the effects of audit feedback alone were modest [68]. The same authors in another study that included hospitals from around the world (over 2 million CT examinations of adult patients from 151 institutions in Switzerland, Netherlands, Germany, United Kingdom, United States, Israel, and Japan), concluded that the dose variation across countries was primarily attributable to institutional decisions regarding the technical parameters of CT protocols rather than patient, institution or machine characteristics [69].…”

Section: Step 5: Evaluation Of Optimization Process: Effect In Patient Dose and Image Qualitymentioning

confidence: 99%

Radiation dose optimization in diagnostic and interventional radiology: Current issues and future perspectives

Tsapaki

2020

Physica Medica

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The medical radiological imaging technological evolution and wide availability has resulted in the exponential increase in utilization. Evidence for a risk of cancer arising from radiation doses of lower than 100 mSv is still limited. There is a need for patient dose optimization. A literature review was conducted to identify the reasons why optimization is important and the steps to be followed for a successful optimization process in digital radiology, Computed Tomography, interventional radiology and mammography.Based on recent literature, 5 steps for a dose optimization process are proposed. These steps are: 1) establishment of a quality assurance programme; a mistake, misuse or malfunction of an X-ray machine can potentially affect the health or life of thousands of people, 2) establishment of a dose optimization team consisting of a radiologist, medical physicist and radiation technologist, 3) determination of baseline dose levels and image quality as well as comparisons with benchmarks to decide which exam protocols should be optimized, 4) modification of protocols by the medical physicist and 5) evaluation of the optimization process and its effect on patient dose and image quality.The optimization process should include joint efforts focused on 1) equipment performance 2) exam protocol customization and 3) staff behaviour. Manufacturers should provide detailed descriptions of exam protocols and training on the use of dose reduction features. The diagnostic radiology medical physicist should emerge and take a proactive lead in the everyday clinical routine in order to promote the value of optimization process.

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Radiologic Sustainability of Cardiac Imaging

Andreassi,

Picano

2023

Stress Echocardiography

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Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography

Cited by 17 publications

References 26 publications

Reference phantom selection in pediatric computed tomography using data from a large, multicenter registry

Reference phantom selection in pediatric computed tomography using data from a large, multicenter registry

Radiation dose optimization in diagnostic and interventional radiology: Current issues and future perspectives

Radiologic Sustainability of Cardiac Imaging

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