Swiss survey on hybrid imaging CTs doses in Nuclear Medicine and proposed national dose reference levels

Lima, Thiago Viana Miranda; Gnesin, Silvano; Ryckx, Nick; Strobel, Klaus; Stritt, N.; Linder, Reto

doi:10.1016/j.zemedi.2018.01.005

Cited by 21 publications

(30 citation statements)

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“…1. It is therefore not surprising that it has been the most widely investigated MI examination in terms of CT radiation dosimetry, with several national CT dose surveys published in the literature, namely from France [10], Bulgaria [11], USA [12, 13], Korea [14], UK [2], Switzerland [15], and Australia and New Zealand [16]. Excessive variation in dose between facilities was also noted for PET/CT oncology examinations in France [10], Korea [14], the UK [2], and Australia and New Zealand [16], suggesting great scope for optimisation globally.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are to date no published NDRLs for CT in hybrid imaging for the vast majority of countries worldwide. CT radiation doses for PET/CT oncology whole body examinations are the most widely investigated of all MI examinations, with national surveys having been conducted in France [10], Bulgaria [11], United States of America (USA) [12, 13], Korea [14], UK [2], Switzerland [15], and Australia and New Zealand [16]. Meanwhile, CT dose data for SPECT/CT and other PET/CT examinations is more sparse, with national surveys for SPECT/CT having only been conducted in the UK [2], Switzerland [15], and Bulgaria [17].…”

Section: Introductionmentioning

confidence: 99%

“…CT radiation doses for PET/CT oncology whole body examinations are the most widely investigated of all MI examinations, with national surveys having been conducted in France [10], Bulgaria [11], United States of America (USA) [12, 13], Korea [14], UK [2], Switzerland [15], and Australia and New Zealand [16]. Meanwhile, CT dose data for SPECT/CT and other PET/CT examinations is more sparse, with national surveys for SPECT/CT having only been conducted in the UK [2], Switzerland [15], and Bulgaria [17]. These studies have shown large diversity amongst facilities in the clinical purpose of CT for the same examination [2], and in mean radiation doses given by different facilities for the same examination and clinical purpose, which demonstrates a great need for optimisation for CT in hybrid imaging [2, 10, 14].…”

Section: Introductionmentioning

confidence: 99%

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A Nordic survey of CT doses in hybrid PET/CT and SPECT/CT examinations

et al. 2019

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BackgroundComputed tomography (CT) scans are routinely performed in positron emission tomography (PET) and single photon emission computed tomography (SPECT) examinations globally, yet few surveys have been conducted to gather national diagnostic reference level (NDRL) data for CT radiation doses in positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT). In this first Nordic-wide study of CT doses in hybrid imaging, Nordic NDRL CT doses are suggested for PET/CT and SPECT/CT examinations specific to the clinical purpose of CT, and the scope for optimisation is evaluated. Data on hybrid imaging CT exposures and clinical purpose of CT were gathered for 5 PET/CT and 8 SPECT/CT examinations via designed booklet. For each included dataset for a given facility and scanner type, the computed tomography dose index by volume (CTDIvol) and dose length product (DLP) was interpolated for a 75-kg person (referred to as CTDIvol,75kg and DLP75kg). Suggested NDRL (75th percentile) and achievable doses (50th percentile) were determined for CTDIvol,75kg and DLP75kg according to clinical purpose of CT. Differences in maximum and minimum doses (derived for a 75-kg patient) between facilities were also calculated for each examination and clinical purpose.ResultsData were processed from 83 scanners from 43 facilities. Data were sufficient to suggest Nordic NDRL CT doses for the following: PET/CT oncology (localisation/characterisation, 15 systems); infection/inflammation (localisation/characterisation, 13 systems); brain (attenuation correction (AC) only, 11 systems); cardiac PET/CT and SPECT/CT (AC only, 30 systems); SPECT/CT lung (localisation/characterisation, 12 systems); bone (localisation/characterisation, 30 systems); and parathyroid (localisation/characterisation, 13 systems). Great variations in dose were seen for all aforementioned examinations. Greatest differences in DLP75kg for each examination, specific to clinical purpose, were as follows: SPECT/CT lung AC only (27.4); PET/CT and SPECT/CT cardiac AC only (19.6); infection/inflammation AC only (18.1); PET/CT brain localisation/characterisation (16.8); SPECT/CT bone localisation/characterisation (10.0); PET/CT oncology AC only (9.0); and SPECT/CT parathyroid localisation/characterisation (7.8).ConclusionsSuggested Nordic NDRL CT doses are presented according to clinical purpose of CT for PET/CT oncology, infection/inflammation, brain, PET/CT and SPECT/CT cardiac, and SPECT/CT lung, bone, and parathyroid. The large variation in doses suggests great scope for optimisation in all 8 examinations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Nordic survey of CT doses in hybrid PET/CT and SPECT/CT examinations

et al. 2019

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“…A similar work by the CT working groups in the UK, Swiss and France have recently been performed and the results have been published [37][38][39]. Some of the protocols exercised in Kuwait are common and thus DRL's can be directly compared.…”

Section: International Comparisonmentioning

confidence: 99%

Establishment of National DRL for CT in Hybrid Imaging Studies (The Second Phase of the National NM CT (PET) Dose Audit for Kuwait Population -2019)

Masoomi

Al-Shammeri

Al-Kandari

et al. 2020

Preprint

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DRLs for CT part used in PET/CT examinations are limited. The aim was to execute the second phase of the national DRL for CT part of PET/CT imaging operating in KW, in support of optimisation and dose reduction as imaging technology is advancing. In this multicentre collaborative PET centers (No:8) audit, data collection was restricted to the adult oncology patients due to a limited number of the other studies and also due to the National MOH Ethical Committee recommendation. The CTDIvol, DLP and SL were recorded and the Median, Mean, SD, 75th, 25th percentiles as well as WB effective dose (ED) were calculated. Dose and scan length statistics for HB and WB scans (65% and 35% of total: 309) and the WB+HB presented together with the proposed NDRLs and the Achievable doses. Third quartile DLP (mGy x cm) and CTDIvol (mGy) values for the HB were (537, 5) which were higher than the UK NDRL (400, 4.3) but were lower than the Swiss NDRL (620, 6) and the France NDRL (762, 7.7). Comparatively, the Proposed NDRLs for (WB) were (684, 4.1) which were lower than Swiss National Data (720, 5.0). It is worth noted that, the Swiss had about 5000 (HB) & 706 (WB), the UK had 370 (HB) and France had 1000 (HB) entries. Calculated ED varied from 4.1 to 10.2 mSv, (mean values=6.9 mSv) for HB and from 2.6 to 7 mSv (mean value=4.6 mSv) for WB scans which were lower than the first phase (2018). Although, there was 9.1% improvement in NDRL, but the outcome suggested there is a continuous need for monitoring NDRL. KEY WORDS: PET/CT, NDRL, CTDvol, DLP, Molecular Imaging

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“…General and individual justification of the examination Choice of the radiopharmaceuticals, promoting the ones with shorter physical and biological half-lives Adherence to national and/or institutional DLRs Patient hydration and bladder voiding Execution phase Detectors with higher energy resolution (CdZnTe in SPECT/CT) Special collimators, which allow a higher sensitivity (variable focus collimators) Iterative algorithms able to reconstruct the image with less counts without affecting spatial resolution diagnostic DRLs is not appropriate because of differences in the clinical purpose, scan range, and image quality requirements of hybrid imaging CT scan. Two surveys have been recently conducted in Switzerland and UK in order to evaluate CT doses for a wide range of PET/CT and SPECT/CT procedures aiming to propose national DRLs [16,25]. Hydration and bladder voiding are also important ways for dose reduction in hybrid imaging since they limit the radiation dose to the bladder, which is the critical organ subject to the higher exposure.…”

Section: Planning Phasementioning

confidence: 99%

Radiation dose in nuclear medicine: the hybrid imaging

et al. 2019

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Hybrid imaging procedures such as single-photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography/computed tomography (PET/CT) showed a rapid diffusion in recent years because of their high sensitivity, specificity, and accuracy, due to a more accurate localization and definition of scintigraphic findings. However, hybrid systems inevitably lead to an increase in patient radiation exposure because of the added CT component. Effective doses due to the radiopharmaceuticals can be estimated by multiplying the administered activities by the effective dose coefficients, while for the CT component the dose-length product can be multiplied by a conversion coefficient k. However, the effective dose value is subject to a high degree of uncertainty and must be interpreted as a broad, generic estimate of biologic risk. Although the effective dose can be used to estimate and compare the risk of radiation exposure across multiple imaging techniques, clinicians should be aware that it represents a generic evaluation of the risk derived from a given procedure to a generic model of the human body. It cannot be applied to a single individual and should not be used for epidemiologic studies or the estimation of population risks due to the inherent uncertainties and oversimplifications involved. Practical ways to reduce radiation dose to patients eligible for hybrid imaging involve adjustments to both the planning phase and throughout the execution of the study. These methods include individual justification of radiation exposure, radiopharmaceutical choice, adherence to diagnostic reference levels (DLR), patient hydration and bladder voiding, adoption of new technical devices (sensitive detectors or collimators) with new reconstruction algorithms, and implementation of appropriate CT protocols and exposure parameters.

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Swiss survey on hybrid imaging CTs doses in Nuclear Medicine and proposed national dose reference levels

Cited by 21 publications

References 3 publications

A Nordic survey of CT doses in hybrid PET/CT and SPECT/CT examinations

A Nordic survey of CT doses in hybrid PET/CT and SPECT/CT examinations

Establishment of National DRL for CT in Hybrid Imaging Studies (The Second Phase of the National NM CT (PET) Dose Audit for Kuwait Population -2019)

Radiation dose in nuclear medicine: the hybrid imaging

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