Effect of staff training on radiation dose in pediatric CT

Hojreh, Azadeh; Weber, Michael; Homolka, Peter

doi:10.1016/j.ejrad.2015.04.027

Cited by 21 publications

(13 citation statements)

References 24 publications

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“…Possible ionizing radiation effects in the young and growing bodies of children [ 1 , 2 ] require that radiation exposure and scan protocols must be carefully adapted to size, age, and clinical needs [ 3 – 7 ]. To reduce radiation dose, modern CT scanners provide automatic dose adjustment systems, such as automated tube current modulation (ATCM) [ 8 – 11 ] and automated tube voltage selection (ATVS) [ 12 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Automated tube voltage selection in pediatric non-contrast chest CT

et al. 2018

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BackgroundModern CT scanners provide automatic dose adjustment systems, which are promising options for reducing radiation dose in pediatric CT scans. Their impact on patient dose, however, has not been investigated sufficiently thus far.ObjectiveTo evaluate automated tube voltage selection (ATVS) in combination with automated tube current modulation (ATCM) in non-contrast pediatric chest CT, with regard to the diagnostic image quality.Materials and methodsThere were 160 non-contrast pediatric chest CT scans (8.7±5.4 years) analyzed retrospectively without and with ATVS. Correlations of volume CT Dose Index (CTDIvol) and effective diameter, with and without ATVS, were compared using Fisher’s z-transformation. Image quality was assessed by mean signal-difference-to-noise ratios (SDNR) in the aorta and in the left main bronchus using the independent samples t-test. Two pediatric radiologists and a general radiologist rated overall subjective Image quality. Readers’ agreement was assessed using weighted kappa coefficients. A p value <0.05 was considered significant.ResultsCTDIvol correlation with the effective diameter was r = 0.62 without and r = 0.80 with ATVS (CI: -0.04 to -0.60; p = 0.025). Mean SDNR was 10.88 without and 10.03 with ATVS (p = 0.0089). Readers’ agreement improved with ATVS (weighted kappa between pediatric radiologists from 0.1 (0.03–0.16) to 0.27 (0.09–0.45) with ATVS; between general and each pediatric radiologist from 0.1 (0.06–0.14) to 0.12 (0.05–0.20), and from 0.22 (0.11–0.34) to 0.36 (0.24–0.49)).ConclusionATVS, combined with ATCM, results in a radiation dose reduction for pediatric non-contrast chest CT without a loss of diagnostic image quality and prevents errors in manual tube voltage setting, and thus protecting larger children against an unnecessarily high radiation exposure.

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Section: Introductionmentioning

confidence: 99%

Automated tube voltage selection in pediatric non-contrast chest CT

et al. 2018

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“…Differences between subjective image quality scores 3 or 4 indicate that some radiologists are more radiation dose conscious than others and this creates the need for training and culture development on acceptance of low dose CT images (score 3) which does not have the image appearance of higher dose images (score 4). It has been shown that training leads to acceptance of low dose CT images and radiation dose optimization [23]. This paper showed that post-training image quality assessed subjectively in terms of artifacts, gray-white matter differentiation, and visualization of posterior fossa structures, and the need for repeat CT examination was not inferior to pre-training levels for most items.…”

Section: Discussionmentioning

confidence: 80%

Development and validation of image quality scoring criteria (IQSC) for pediatric CT: a preliminary study

et al. 2019

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Objective To develop and assess the value and limitations of an image quality scoring criteria (IQSC) for pediatric CT exams. Methods IQSC was developed for subjective assessment of image quality using the scoring scale from 0 to 4, with 0 indicating desired anatomy or features not seen, 3 for adequate image quality, and 4 depicting higher than needed image quality. Pediatric CT examinations from 30 separate patients were selected, five each for routine chest, routine abdomen, kidney stone, appendicitis, craniosynostosis, and ventriculoperitoneal (VP) shunt. Five board-certified pediatric radiologists independently performed image quality evaluation using the proposed IQSC. The kappa statistics were used to assess the interobserver variability. Results All five radiologists gave a score of 3 to two-third (67%) of all CT exams, followed by a score of 4 for 29% of CT exams, and 2 for 4% exams. The median image quality scores for all exams were 3 and the interobserver agreement among five readers (acceptable image quality [scores 3 or 4] vs sub-optimal image quality ([scores 1 and 2]) was moderate to very good (kappa 0.4–1). For all five radiologists, the lesion detection was adequate for all CT exams. Conclusions The image quality scoring criteria covering routine and some clinical indication-based imaging scenarios for pediatric CT examinations has potential to offer a simple and practical tool for assessing image quality with a reasonable degree of interobserver agreement. A more extensive and multi-centric study is recommended to establish wider usefulness of these criteria.

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“…Although technology may be necessary for improvement in practice, it may not be sufficient to change practice, since behavior must be modified across multiple sites of care and professional groups [32, 33]. Therefore, changing practice patterns is complex and such advances are not easily generalizable to the unique context of the CH.…”

Section: Discussionmentioning

confidence: 99%

A Toolkit for Pediatric CT Dose Reduction in Community Hospitals

Armao

Hartman

Shea³

et al. 2016

Journal of the American College of Radiology

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“Eighty percent of success is just showing up.”Woody AllenPediatric CT radiation dose optimization is a challenging process for pediatric-focused facilities and community hospitals alike. Ongoing experience and trial-and-error approaches to dose reduction in the large academic hospital setting may position these centers to help community hospitals who strive for CT quality improvement. In this pilot project, we describe our hands-on approach to develop a partnership between an academic medical center and a community hospital to develop a toolkit for implementing CT dose reduction. Our aims were to 1) assess the acceptability of an interactive educational program and electronic toolkit booklet, 2) conduct a limited test of the efficacy of the toolkit in promoting knowledge and readiness to change, and 3) assess the acceptability and practicality of a collaborative approach to implementing dose-reduction protocols in community hospitals. In partnering with the community hospital, we found that they had size specific radiation doses 2 to 3 times higher than those at our center. Survey results following a site visit with interactive educational presentations revealed an increase in knowledge, stronger opinions about the health risks of radiation from CT scans, and willingness and perceived ability to reduce pediatric CT doses.

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Effect of staff training on radiation dose in pediatric CT

Cited by 21 publications

References 24 publications

Automated tube voltage selection in pediatric non-contrast chest CT

Automated tube voltage selection in pediatric non-contrast chest CT

Development and validation of image quality scoring criteria (IQSC) for pediatric CT: a preliminary study

A Toolkit for Pediatric CT Dose Reduction in Community Hospitals

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