Updated effective doses in radiology

Vilar-Palop, Jorge; Vilar, J.; Hernández-Aguado, Ildefonso; González‐Álvarez, Isabel; Lumbreras, Blanca

doi:10.1088/0952-4746/36/4/975

Cited by 50 publications

(48 citation statements)

References 34 publications

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“…We recorded the following variables from the medical records for each referral: demographic characteristics, setting (inpatient, outpatient, emergency room (ER)), type of department (clinical, surgical, general practice, and central departments including radiology and the ER), and the information on clinical suspicion which was then grouped into different categories, based on the 10th Revision of the International Statistical Classification of Diseases, Injuries and Causes of Death, that is, preoperative, neoplasm, diseases of the musculoskeletal system, digestive system diseases, respiratory system diseases and others. We also collected information about the imaging test, estimated the associated radiation effective dose using previous published evidence 22 and the costs according to the established prices in the National Health Care System. All the information about the imaging tests carried out in the last 12 months was also collected from the medical records.…”

Section: Methodsmentioning

confidence: 99%

Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

Vilar-Palop¹,

Hernández-Aguado

Pastor‐Valero

et al. 2018

BMJ Open

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ObjectivesTo determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated.DesignCross-sectional retrospective study.SettingTwo Spanish public tertiary hospitals.Participants2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded.Primary and secondary outcome measuresFive outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient’s clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category.ResultsApproximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95% CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95% CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays.ConclusionThere was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on sociodemographic and clinical characteristics such as sex, age, referral physician and medical imaging test.

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Section: Methodsmentioning

confidence: 99%

Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

Vilar-Palop¹,

Hernández-Aguado

Pastor‐Valero

et al. 2018

BMJ Open

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“…The optimal DLP was 30 mGy × cm with radiation exposure of 1.1 mSv for a scan range of 50 cm, which is close to the dose of plain radiography images. The dose of plain radiography in our center was approximately 0.7 mSv, although a value of 3.6 mSv for at least six needed plain radiography images has been reported . We prefer the use of 100 kVp with the Sn filter.…”

Section: Discussionmentioning

confidence: 85%

Low-Dose Computed Tomography With Two- and Three-Dimensional Postprocessing as an Alternative to Plain Radiography for Intrathecal Catheter Visualization: A Phantom Pilot Study

Delhaas

Lugt

2019

Neuromodulation: Technology at the Neural Interface

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Objectives In intrathecal drug delivery, visualization of the device has been performed with plain radiography. However, the visibility of the related structures can be problematic. In troubleshooting, after the contrast material injection via the catheter access port, a computed tomography (CT) scan has been used. In troubleshooting, we also used a non‐contrast CT scan with 2D and 3D reconstructions. With the current phantom study, we aimed to obtain high‐resolution imaging of a poor opaque catheter with the use of a low‐dose single‐energy 2D and 3D CT scan with limited radiation exposure as a substitute for plain radiography. Materials and Methods The catheter was placed into a fatty substance and mounted on an anthropomorphic abdomen phantom followed by CT with varying kVp settings and with added tin beam filtering. Dose levels corrected based on the spinal catheter tip on T8 would result in a calculated effective dose in the range of the mSv's calculated for the plain x‐ray examination. Results Ultimately, Sn100 kVp has the best trade‐off between visibility, artifacts, and noise for a fixed dose. Although 3D VRT imaging was challenging at this low dose level, we could make a full evaluation possible with complementary 2D projections. Conclusions We could correctly identify the catheter and related structures, which supports the investigation of this in vivo and side‐by‐side evaluation with plain radiography. If found superior, then this technique may be able to replace plain radiography, while providing better visualization and acceptable radiation exposure. Conflict of Interest Dr. Delhaas reports personal fees from Medtronic Inc., as a previous consultant, outside the submitted work; Prof. van der Lugt reports grants from GE Healthcare, Siemens, Stryker, Medtronic, and Penumbra outside the submitted work.

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“…Given that it was impossible to get individual machine parameters for all imaging tests, we estimated the associated radiation effective dose per test according to its region of anatomical coverage by age and using previously published evidence18 This review provides values of the typical effective doses associated with the 20 most frequent imaging tests for adults and children and for the most widely used set of weights (ICRP60) as well as for the most recent (ICRP103). We based our estimates on ICRP103, except in those cases where we did not have enough information.…”

Section: Methodsmentioning

confidence: 99%

Cumulative exposure to ionising radiation from diagnostic imaging tests: a 12-year follow-up population-based analysis in Spain

2019

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ObjectivesTo calculate each patient’s cumulative radiation exposure and the recurrent tests during a 12-year study period, according to sex and age, in routine practice.DesignRetrospective cohort study.SettingA general hospital with a catchment population of 224 751 people, in the Southeast of Spain.ParticipantsPopulation belonged to the catchment area of that hospital in 2007. We collected all consecutive diagnostic imaging tests undergone by this population until 31 December 2018. We excluded: imaging tests that did not involve radiation exposure.Main outcome measuresThe cumulative effective dose and the recurrent imaging tests by sex and age at entry of study.ResultsOf the 224 751 people, 154 520 (68.8%) underwent an imaging test. The population had 1 335 752 imaging tests during the period of study: 1 110 077 (83.0%) plain radiography; 156 848 (11.8%) CT; 63 157 (4.8%) fluoroscopy and 5670 (0.4%) interventional radiography. 25.4% of the patients who had a CT, underwent five or more CTs (5.4% in the 0–20 years age group). The median total cumulative effective dose was 2.10 mSv (maximum 3980.30) and 16.30 mSv (maximum 1419.30 mSv) if we considered only doses associated with CT. Women received more effective dose than men (median 2.38 vs median 1.90, p<0.001). A total of 7142 (4.6%) patients received more than 50 mSv, with differences in men and women (p<0.001) and 2.5% of the patients in the 0–20 years age group, if we considered only doses associated with CT.ConclusionsNearly 5% of patients received doses higher than 50 mSv during the 12-year period of study and 2.5% of the patients in the 0–20 years age group, if we considered only doses associated with CT. The rate of recurrent examinations was high, especially in older patients, but also relevant in the 0–20 years age group.

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Updated effective doses in radiology

Cited by 50 publications

References 34 publications

Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

Low-Dose Computed Tomography With Two- and Three-Dimensional Postprocessing as an Alternative to Plain Radiography for Intrathecal Catheter Visualization: A Phantom Pilot Study

Cumulative exposure to ionising radiation from diagnostic imaging tests: a 12-year follow-up population-based analysis in Spain

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