Abstract
PurposeTo assess suspected acute stroke, the computed tomography (CT) protocol contains a non-contrast CT (NCCT), a CT angiography (CTA), and a CT perfusion (CTP). Due to assumably high radiation doses of the complete protocol, the aim of this study is to examine radiation exposure and to establish diagnostic reference levels (DRLs).MethodsIn this retrospective study, dose data of 921 patients with initial CT imaging for suspected acute stroke and dose monitoring with a DICOM header–based tracking and monitoring software were analyzed. Between June 2017 and January 2020, 1655 CT scans were included, which were performed on three different modern multi-slice CT scanners, including 921 NCCT, 465 CTA, and 269 CTP scans. Radiation exposure was reported for CT dose index (CTDIvol) and dose-length product (DLP). DRLs were set at the 75th percentile of dose distribution.ResultsDRLs were assessed for each step (CTDIvol/DLP): NCCT 33.9 mGy/527.8 mGy cm and CTA 13.7 mGy/478.3 mGy cm. Radiation exposure of CTP was invariable and depended on CT device and its protocol settings with CTDIvol 124.9–258.2 mGy and DLP 1852.6–3044.3 mGy cm.ConclusionPerforming complementary CT techniques such as CTA and CTP for the assessment of acute stroke increases total radiation exposure. Hence, the revised DRLs for the complete protocol are required, where our local DRLs may help as benchmarks.
Highlights
Stroke is a frequent cause of disability and death in adults [1] and the etiology of stroke is either ischemic or hemorrhagic [2]
Non-contrast computed tomography (NCCT) of the head is widely recommended as initial imaging modality for suspected acute stroke because it is highly sensitive for Neuroradiology (2021) 63:511–518 depiction of intracranial hemorrhage [7, 8]
The mean radiation exposure in terms of CTDIvol and dose-length product (DLP) was distributed as follows median: for non-contrast CT (NCCT), 31.4 mGy (28.9–33.9; 31.5 ± 3.8) and 480.9 mGy cm (436.5–527.8; 486.6 ± 72.5), and
Summary
Stroke is a frequent cause of disability and death in adults [1] and the etiology of stroke is either ischemic or hemorrhagic [2]. Non-contrast computed tomography (NCCT) of the head is widely recommended as initial imaging modality for suspected acute stroke because it is highly sensitive for Neuroradiology (2021) 63:511–518 depiction of intracranial hemorrhage [7, 8]. Computed tomography angiography (CTA) enables assessment of brain supplying extra- and intracranial vessels and provides additional information about occlusion site and origin of infarction [2, 10, 11]. Computed tomography perfusion (CTP) depicts cerebral hemodynamics and enables evaluation of vessel occlusion found during CTA [12, 13]. Since its establishment in the late 1990s, CTP expanded the value of CT techniques in acute stroke imaging because it detects irreversibly ischemic tissue and enables differentiation between irreversibly infarcted and ischemic but potentially salvageable tissue [2, 6, 14, 15]
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