Abstract
ObjectivesThe European Society of Radiology identified 10 common indications for computed tomography (CT) as part of the European Study on Clinical Diagnostic Reference Levels (DRLs, EUCLID), to help standardize radiation doses. The objective of this study is to generate DRLs and median doses for these indications using data from the UCSF CT International Dose Registry.MethodsStandardized data on 3.7 million CTs in adults were collected between 2016 and 2019 from 161 institutions across seven countries (United States of America (US), Switzerland, Netherlands, Germany, UK, Israel, Japan). DRLs (75th percentile) and median doses for volumetric CT-dose index (CTDIvol) and dose-length product (DLP) were assessed for each EUCLID category (chronic sinusitis, stroke, cervical spine trauma, coronary calcium scoring, lung cancer, pulmonary embolism, coronary CT angiography, hepatocellular carcinoma (HCC), colic/abdominal pain, appendicitis), and US radiation doses were compared with European.ResultsThe number of CT scans within EUCLID categories ranged from 8,933 (HCC) to over 1.2 million (stroke). There was greater variation in dose between categories than within categories (p < .001), and doses were significantly different between categories within anatomic areas. DRLs and median doses were assessed for all categories. DRLs were higher in the US for 9 of the 10 indications (except chronic sinusitis) than in Europe but with a significantly higher sample size in the US.ConclusionsDRLs for CTDIvol and DLP for EUCLID clinical indications from diverse organizations were established and can contribute to dose optimization. These values were usually significantly higher in the US than in Europe.Key Points• Registry data were used to create benchmarks for 10 common indications for CT identified by the European Society of Radiology.• Observed US radiation doses were higher than European for 9 of 10 indications (except chronic sinusitis).• The presented diagnostic reference levels and median doses highlight potentially unnecessary variation in radiation dose.
Highlights
Radiation doses for computed tomography (CT) are highly variable across patients, institutions, and countries [1,2,3,4,5]
The median dose was defined as the 50th percentile in dose distribution and the diagnostic reference levels (DRLs) was defined as the 75th percentile in dose distribution
Because the observed large differences across the EUCLID categories greatly exceeded the dose differences within categories, our results support the use of the EUCLID clinical indication-specific CT protocols, rather than combining all indications within anatomic areas
Summary
Radiation doses for computed tomography (CT) are highly variable across patients, institutions, and countries [1,2,3,4,5]. European Radiology relatively high radiation doses associated with CT, greater standardization is needed across institutions and countries for CT dose [4, 15]. The establishment of diagnostic reference levels (DRLs) was first implemented by the International Commission on Radiological Protection (ICRP) in 1996 to aid in optimization of medical radiation exposures [16]. The US National Council on Radiation Protection and Measurements (NCRP) implemented an additional concept of achievable doses (ADs) in 1999 reflecting the median. These doses were identified as doses that should help improve further dose optimization and encourage faculties to achieve lower doses than the DRL [17, 18]
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