Impact of physician practice on patient radiation dose during CT guided biopsy procedures

Abstract

PURPOSE: Patient radiation dose during Computed Tomography (CT) guided biopsy procedures is determined by both acquisition technical parameters and physician practice. The potential effect of the physician practice is of concern. This study is to investigate the effects of those intangibles on patient radiation dose. METHODS: Patient radiation dose from 252 patients who underwent CT guided biopsy from 2009 to 2010 were retrospectively studied. Ten physicians who used conventional intermittent shots, low mA dose saving feature, or both were included in the study. The patient dose reports were retrieved and the total dose length products (DLPs) were analyzed. Linear regression analysis performed between various variables and reported dose. Patient detriment index (PDI) was developed, which sets threshold (standard of practice) for comparing physician practice with their peers. Odds ratio was calculated to determine odds of a group of patients receiving dose above threshold when compared to another group. RESULTS: Median DLP among ten physicians was 1194 mGy-cm. There was a significant difference (p < 0.01) between reported DLPs doses when physicians used dose saving feature vs. when feature not used (539.8 ± 169.4 mGy-cm vs. 1269.7 ± 659.0 mGy-cm). In general, physicians who used dose saving feature had lower relative PDIs (< 1) compared to the PDIs (> 1) without the dose feature. Odds ratio estimate of 7.7 at 95% confidence level indicates that the odds of a group receiving a high dose depends on practitioner. CONCLUSION: Adjustments of practice habits, use of dose saving features or both may be needed to improve patient care for CT biopsy.

Patient Dose Estimation in Computed Tomography-Guided Biopsy Procedures

“…The DLP values obtained in this study were observed to surpass the 3rd quartile values proposed by Weir et al specifically for the purpose of tumor ablation in thoracic or abdominopelvic regions [18]. It is important to note, however, that Weir's study was conducted within the confines of a single medical center for each CT scan, and the DRLs they put forward primarily reflected localized practices, lacking the consideration of the substantial variabilities that have been previously highlighted.…”

Characterization of patient dose distributions and probabilistic risk analysis in cardiovascular catheterization laboratories

“…The magnitude of the time influence, and how that combines with BMI to give the inverse gamma error requires further study. We did not have enough data on the physicians involved in all cases to perform a useful analysis, but a previous study [22] showed that, while physician practice played a role in CT guided biopsies, experience was less a factor. In plotting the BMI distributions in figure 5, we chose to present the data for combined BMI for doses below and above 100 mGy.…”

Impact of an Augmented Reality Navigation System (SIRIO) on Bone Percutaneous Procedures: A Comparative Analysis with Standard CT-Guided Technique

“…Furthermore, the need for a smaller number of intra-procedural scans shortens the procedural times and improves comfort for the patient, who is required to maintain the same position for the entire duration of the procedure so that a mismatch between the CT acquisition volume and the real patient's position is not generated. On the contrary, standard CT-guided methods usually provide a higher number of CT scans to check the correct positioning and direction of the instrument, even after small advances or repositioning, weighing on the total radiation dose and on procedural times [34]. Moreover, SIRIO permits avoidance of damage to vulnerable structures near the lesions, such neuro-vascular bundles, allowing a prompt repositioning of the instrument.…”