Abstract
Background: In 2010, the International Atomic Energy Agency launched the “3A’s campaign” as an effective tool for primary cancer prevention. In 2011, the American Association of Physicists in Medicine recommended the size specific dose estimate (SSDE). Objectives: To audit doses of Coronary CT Angiography (Coronary CTA) in tertiary care referral center. Methods: We reviewed 998 consecutive Coronary CTA (from 2007 to 2012). Doses (CTDIvol mGy), DLP (mGy*cm), effective dose (DLP*0.014, mSv) were on-line archived. SSDE was estimated retrospectively. Appropriateness score was evaluated for exams performed from the 2010. Results: Overall median dose per Coronary CTA was 49.7 mGy for CTDIvol, 55.5 mGy for SSDE, 994.96 mGy*cm for DLP, 13.9 mSv for effective dose. Median DLP decreased over time (1452.94 in 2007, 1605.56 in 2008, 1113.49 in 2009, 759.99 in 2010, 448.61 in 2011 and 497.88 mGy*cm in 2012, p 1 (88%) CTDIvol underestimated SSDE (48.49 vs 57.19 mGy), whilst in patients with SDF < 1 (12%) CTDIvol overestimated SSDE (56.46 vs 50.3 mGy). Scans were appropriate in 58%, uncertain in 24%, and inappropriate in 18% of cases. Doses were similar in appropriate, uncertain or inappropriate examinations and in excellent-to-good (81%) vs. sufficient-to-poor (19%) image quality exams. Conclusions: Coronary CTA reference doses can be very misleading. SSDE can allow individual technique optimization. The dose is similar in appropriate and inappropriate examinations, and unrelated to image quality. The rate of inappropriate examinations is still too high even after dissemination of guidelines.
Highlights
The use of procedures with a high load of radiation has changed the practice of medicine, with unprecedented clinical and diagnostic benefits
Optimization is especially important for Cardiac CT, whose doses may vary widely from less than 1 mSv to more than 50 mSv depending on the technology used, type of scan, administration of contrast, patient habits and attention paid to optimization [5], [6]
Recently the Food and Drug Administration [9], American Heart Association [10], American College of Cardiology [11] and American College of Radiology [12] strongly recommended that each user facility, to a feasible extent, develop its own locally-based diagnostic reference levels, for use and audit until more broadly recognized levels are available
Summary
The use of procedures with a high load of radiation has changed the practice of medicine, with unprecedented clinical and diagnostic benefits. In 2010 ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR published the “appropriate use criteria for cardiac computed tomography” [13], in 2011 the American Association of Physicists in Medicine, Task Group 204, provided an user-friendly method to estimate patient size specific dose (SSDE) [14] and Society of Cardiovascular Computed Tomography published the guidelines on radiation dose and dose-optimization strategies in cardiovascular CT [15]. All these tools foster justification and optimization balance. The rate of inappropriate examinations is still too high even after dissemination of guidelines
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