Long-term experience and analysis of data on diagnostic reference levels: the good, the bad, and the ugly

Roch, P.; Célier, D.; Dessaud, Cécile; Étard, C.; Rehani, Madan M.

doi:10.1007/s00330-019-06422-2

Cited by 35 publications

(12 citation statements)

References 23 publications

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“…However, some limitations of this approach were pointed out for computed tomography (CT) as, for the same anatomical location, one could have several clinical indications with consequently different protocols corresponding to different exposure levels. For example, chest CT could correspond to the work-up for pulmonary embolism, lung cancer, or even coronary calcium scoring, each of which requires corresponding image quality parameters and scan length, and hence should have different DRLs [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Reference Levels based on clinical indications in computed tomography: a literature review

et al. 2020

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Background In August 2017, the European Commission awarded the “European Study on Clinical Diagnostic Reference levels for X-ray Medical Imaging” project to the European Society of Radiology, to provide up-to-date Diagnostic Reference Levels based on clinical indications. The aim of this work was to conduct an extensive literature review by analysing the most recent studies published and the data provided by the National Competent Authorities, to understand the current situation regarding Diagnostic Reference Levels based on clinical indications for computed tomography. Results The literature review has identified 23 papers with Diagnostic Reference Levels based on clinical indications for computed tomography from 15 countries; 12 of them from Europe. A total of 28 clinical indications for 6 anatomical areas (head, cervical spine/neck, chest, abdomen, abdomen-pelvis, chest-abdomen-pelvis) have been identified. Conclusions In all the six anatomical areas for which Diagnostic Reference Levels based on clinical indications were found, a huge variation of computed tomography dose descriptor values was identified, providing evidence for a need to develop strategies to standardise and optimise computed tomography protocols.

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Section: Introductionmentioning

confidence: 99%

Diagnostic Reference Levels based on clinical indications in computed tomography: a literature review

et al. 2020

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“…This individual-level variability has been supported by the finding that sites lacking a dedicated medical physicist and specialist imaging team are less likely to use existing "Dose Check" features [63]. The concept of diagnostic reference level has been used to achieve optimization of protection [64,65] despite some concerns about limitation of the concept [66,67]. Unfortunately, cases of variable and higher exposure have not been confined to abnormal patient attenuation or nonstandard cases.…”

Section: Lack Of Optimization By User Despite Better Technologymentioning

confidence: 99%

Higher patient doses through X-ray imaging procedures

Rehani

Nacouzi

2020

Physica Medica

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Medical imaging using X-rays has been one of the most popular imaging modalities ever since the discovery of Xrays 125 years ago. With unquestionable benefits, concerns about radiation risks have frequently been raised. Computed tomography (CT) and fluoroscopic guided interventional procedures have the potential to impart higher radiation exposure to patients than radiographic examinations. Despite technological advances, there have been instances of increased doses per procedure mainly because of better diagnostic information in images. However, cumulative dose from multiple procedures is creating new concerns as effective doses >100 mSv are not uncommon. There is a need for action at all levels. Manufacturers must produce equipment that can provide a quality diagnostic image at substantially lesser dose and better implementation of optimization strategies by users. There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering. It appears that a new monochromatic X-ray source will lead to replacement of X-ray tubes all over the world in coming years and will lead to a drastic reduction in radiation doses. This innovation will impact all X-ray imaging and will help dose reduction. For interventional procedures, the likely employment of robotic systems in practice may drastically reduce radiation exposures to operators-but patient exposure will still remain an issue. Training needs always need to be emphasized and practiced.

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“…While DRLs have proved to be of value for the purpose for which they were developed, that is, cutting down exposures higher than the 75th percentile of dose distribution, the limitations of DRLs in overall scheme of optimisation have increasingly been identified [11,12]. Some recent papers provide detailed analysis of long-term experience of France in DRLs and describe the good, the bad and the ugly aspects of DRLs [13][14][15]. The bad aspects of DRL include the following facts: First, the tendency to view DRLs as a "speed limit" and leading one to believe that being below the DRL means optimisation has been achieved.…”

Section: Introductionmentioning

confidence: 99%

“…Second, DRLs are defined for standard-sized adult patients only. Third, definition of DRLs requires many years of data collection and legal and administrative process during which technology normally would have changed [11][12][13]. The ugly aspects of DRLs include the following facts: First, DRLs are not applicable to individual patients.…”

Section: Introductionmentioning

confidence: 99%

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Development of image quality related reference doses called acceptable quality doses (AQD) in paediatric CT exams in Qatar

et al. 2020

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Objectives To describe first experience of integrating assessment of image quality in paediatric X-ray computed tomography (CT) with analysis of the radiation dose indices to develop reference doses called acceptable quality dose (AQD). Methods Image quality was scored by the radiologists at a tertiary care hospital in Qatar on a scale of 0 to 4 using the recently published scoring criteria. The patients undergoing head, chest and abdomen CT were divided in different weight groups as follows: < 5 kg, 5–< 15 kg, 15–< 30 kg, 30–< 50 kg, 50–< 80 kg and > 80 kg. The images that were clinically acceptable (score of 3) were included for assessment of median values of CTDIvol and DLP to obtain AQDs in different weight groups. Results After initial training in image quality scoring of CT images of 49 patients by three radiologists, the study on 715 patients indicated 665 studies (93%) were clinically acceptable as per scoring criteria. The median CTDIvol values for the above weight groups were 16, 20, 22, 22, 27 and 27 mGy and the median DLP values for these weight groups were 271, 377, 463, 486, 568 and 570 mGy cm, respectively, for head CT. Similar values are presented for chest and abdomen CTs. Conclusions The first ever experience of starting with image quality assessment and integrating it with analysis of dose indices to obtain AQD values shall provide a workable model for others and values for comparison within the facility and in other facilities leading to optimisation. Key Points • The first study to integrate image quality assessment with analysis of patient dose indices shows feasibility for routine practice in other centres. • The values of acceptable quality dose (AQD) were provided for head, chest and abdomen CT of children divided into weight groups rather than age. They shall act as reference values for future studies. • Verification of our findings on proportional increase in exposure parameters (CTDIvol and DLP) with weight by other investigators shall be helpful.

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Long-term experience and analysis of data on diagnostic reference levels: the good, the bad, and the ugly

Cited by 35 publications

References 23 publications

Diagnostic Reference Levels based on clinical indications in computed tomography: a literature review

Diagnostic Reference Levels based on clinical indications in computed tomography: a literature review

Higher patient doses through X-ray imaging procedures

Development of image quality related reference doses called acceptable quality doses (AQD) in paediatric CT exams in Qatar

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