Establishment of national diagnostic reference levels for breast cancer CT protocols in radiation therapy

Connor, S. O’; Ardle, Orla Mc; Mullaney, L.

doi:10.1259/bjr.20160428

Cited by 8 publications

(11 citation statements)

References 15 publications

(38 reference statements)

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“…Only 2 centres indicated that they sometimes use IV contrast. For comparison with the study by Connor et al (2016), scanner mean values were also used to calculate equivalent reference values for breast CT planning scans (as given in Tables 3 and 6). The achievable (median) CTDI vol was 8.4 mGy (range 2.4 to 19.9 mGy), with a reference value (third quartile) of 12.5 mGy.…”

Section: Audit Of Uk Radiotherapy Treatment Planning Ct Scans and Promentioning

confidence: 99%

IPEM topical report: the first UK survey of dose indices from radiotherapy treatment planning computed tomography scans for adult patients

Wood¹,

Davis²,

Earley³

et al. 2018

Phys. Med. Biol.

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CT scans are an integral component of modern radiotherapy treatments, enabling the accurate localisation of the treatment target and organs-at-risk, and providing the tissue density information required for the calculation of dose in the treatment planning system. For these reasons, it is important to ensure exposures are optimised to give the required clinical image quality with doses that are as low as reasonably achievable. However, there is little guidance in the literature on dose levels in radiotherapy CT imaging either within the UK or internationally. This IPEM topical report presents the results of the first UK wide survey of dose indices in radiotherapy CT planning scans. Patient dose indices were collected for prostate, gynaecological, breast, lung 3D, lung 4D, brain and head and neck scans. Median values per scanner and examination type were calculated and national dose reference levels and 'achievable levels' of CT dose index (CTDI), dose-length-product (DLP) and scan length are proposed based on the third quartile and median values of these distributions, respectively. A total of 68 radiotherapy CT scanners were included in this audit. The proposed dose reference levels for CTDI and DLP are; prostate 16 mGy and 570 mGy · cm, gynaecological 16 mGy and 610 mGy · cm, breast 10 mGy and 390 mGy · cm, lung 3D 14 mGy and 550 mGy · cm, lung 4D 63 mGy and 1750 mGy · cm, brain 50 mGy and 1500 mGy · cm and head and neck 49 mGy and 2150 mGy · cm. Significant variations in dose indices were noted, with head and neck and lung 4D yielding a factor of eighteen difference between the lowest and highest dose scanners. There was also evidence of some clustering in the data by scanner manufacturer, which may be indicative of a lack of local optimisation of individual systems to the clinical task. It is anticipated that providing this data to the UK and wider radiotherapy community will aid the optimisation of treatment planning CT scan protocols.

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Section: Audit Of Uk Radiotherapy Treatment Planning Ct Scans and Promentioning

confidence: 99%

IPEM topical report: the first UK survey of dose indices from radiotherapy treatment planning computed tomography scans for adult patients

Wood¹,

Davis²,

Earley³

et al. 2018

Phys. Med. Biol.

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“…Even though the sit u a tion is not much better for the diag nos tic DRLs also, some as sess ments have been performed over the past few years [10]. The re sults were com pared to the sel dom pub lished data in or der to com pare the clin i cal prac tices [3][4][5][6]. Two of the published val ues are the na tional DRL val ues and therefore cor re spond to the 75 th per cen tile of the col lected data.…”

Section: Discussionmentioning

confidence: 99%

“…2). A com par i son of me dian CTDIvol of the UH Rijeka with pub lished data [3][4][5][6] is pre sented in fig. 1.…”

Section: Re Sultsmentioning

confidence: 99%

“…Some might ar gue that the CT doses are neg li gi ble com pared to the ther a peu tic doses. However, there is a grow ing aware ness of the dose de livered to the part of the body out side the tar get vol ume [3][4][5][6]. The CT is as so ci ated with rel a tively high ra di ation doses, caus ing con cerns re gard ing the risk of carcinogenesis [7,8].…”

Section: Introductionmentioning

confidence: 99%

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An assessment of dose indicators for computed tomography localization procedures in radiation therapy at the University Hospital Rijeka

et al. 2018

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Uni ver sity Hos pi tal Rijeka, Rijeka, Croatia Sci en tific pa per http://doi.org/10.2298/NTRP1803301DThe com puted to mog ra phy has be come a stan dard tool in ra di a tion ther apy treat ment planning. Ad di tion ally, there is a grow ing aware ness of the dose de liv ered to the part of the body out side the tar get vol ume. The ion iz ing ra di a tion car ries a sto chas tic risk of ma lig nancy, there fore, the doses should be kept as low as rea son ably achiev able in or der to pro vide an ad equate in for ma tion needed for the ra dio ther apy plan ning. The ob jec tive of this work was to set up the ini tial di ag nos tic ref er ence lev els and cor re late to the im age qual ity that would be used in the fu ture op ti mi za tion of lo cal iza tion scans. To quan tify the doses from com puted to mogra phy lo cal iza tion scans at the Uni ver sity Hos pi tal Rijeka, lo cal di ag nos tic ref er ence lev els were es tab lished for five most com mon pro ce dures of dif fer ent an a tom i cal re gions; head, head and neck, pel vis, breast and tho rax. The Com puted To mog ra phy Dose In dex vol u met ric and the Dose-Length Prod uct were used as dose in di ca tors and scan ning pa ram e ters were also re corded. The im age qual ity as sess ment was per formed for each set of im ages. The re sults were com pared to the sel dom pub lished data in or der to com pare the clin i cal prac tice. The image qual ity for al most all of the body re gions are scored as ac cept able in av er age but re quire im prove ment. It is shown that the op ti mi za tion of ra dio ther apy pro to cols is re quired. Therefore, these re sults will be used as a guide line for that pro cess. The es tab lish ment of the national di ag nos tic ref er ence lev els for com puted to mog ra phy lo cal iza tion pro ce dures in ra di ation ther apy is the next step and is cur rently an on go ing pro cess.Key words: com puted to mog ra phy, ra di a tion ther apy, op ti mi za tion A. Dikli}, et al.: An As sess ment of Dose In di ca tors for Com puted To mog ra phy . A. Dikli}, et al.: An As sess ment of Dose In di ca tors for Com puted To mog ra phy .

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“…Diagnostic DRLs exist in many countries and there is some literature investigating DRLs in RT thorax and breast imaging 11,12 but no attempts have been made to introduce dose audit in HN RT CT imaging. Different scanning volumes, protocols and image quality requirements between diagnostic and RT CT do not support the use of diagnostic imaging (DI) DRLs in RT practice.…”

Section: Introductionmentioning

confidence: 99%

Establishment of national diagnostic reference levels (DRLs) for radiotherapy localisation computer tomography of the head and neck

Clerkin

Brennan

Mullaney

2018

Reports of Practical Oncology & Radiotherapy

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Establishment of national diagnostic reference levels for breast cancer CT protocols in radiation therapy

Abstract: This article provides the first reported DRL for breast cancer CT localization procedure in RT and can be used as a benchmark for comparison for other RT centres.

Cited by 8 publications

References 15 publications

IPEM topical report: the first UK survey of dose indices from radiotherapy treatment planning computed tomography scans for adult patients

IPEM topical report: the first UK survey of dose indices from radiotherapy treatment planning computed tomography scans for adult patients

An assessment of dose indicators for computed tomography localization procedures in radiation therapy at the University Hospital Rijeka

Establishment of national diagnostic reference levels (DRLs) for radiotherapy localisation computer tomography of the head and neck

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