Mean Size-specific Dose Estimates Research Articles

Determination of water-equivalent diameter (Dw) and size-specific dose estimates (SSDE) for adult patients in abdominal CT examinations

This work aims to calculate size-specific dose estimates (SSDE) and establish the relationship between water equivalent diameter (Dw) values and SSDE in images of abdominal CT examinations undergone by 30 adult patients. These patients had a mean age of 51 years, a mean height of 164 cm, and a mean weight of 62.71 kg. The water equivalent diameters (Dw) measured 25.30 cm on average, with mean volumetric computed tomography dose index (CTDIvol) doses of 7.95 mGy and a mean SSDE of 11.31 mGy. Images were retrospectively collected using a Hitachi Supria 16-slice CT scanner, and Dw and SSDE values were calculated based on lateral and anteroposterior (LAT + AP) measurements of cross-sectional images from each CT examination. Dw was calculated from ED, and their close correspondence allowed for interchangeable use, following AAPM guidelines. The calculated doses (SSDE) were significantly higher than the doses displayed by the scanner (CTDI). Furthermore, a strong correlation (R2 = 0.63) was observed between SSDE and Dw. Consequently, assessing patient dose based on size becomes essential to optimize radiation exposure in CT imaging.

Low dose CTPA using a low kV technique combined with high IR: A clinical study

IntroductionTo investigate optimising a computerised tomography pulmonary angiogram (CTPA) scan protocol in terms of radiation dose and image quality using a low kV technique combined with high iterative reconstruction (IR) parameters (>50%) and apply the optimised protocol in clinical practice on patients irrespective of their body weight. MethodsCTPA examinations were performed on 64 patients equally divided into control and experimental groups. Patients in the control group were scanned using the current protocol (100 kV with 50% IR) while patients in the experimental group were scanned using an optimised protocol (80 kV with 60%IR). The radiation dose indices volume computerised tomography dose index (CTDIvol), dose length product (DLP), size specific dose estimates (SSDE) and effective dose (ED) were recorded. Subjective image quality was evaluated by 3 radiologists through absolute visual grading analysis (VGA) using an image quality scoring tool. The resultant image quality scores were analysed using Visual Grading Characteristics (VGC). Objective image quality was recorded in terms of contrast-to-noise-ratio (CNR) and signal-to-noise-ratio (SNR). ResultsThe application of the optimised protocol resulted in a statistically significant (p < 0.05) reduction in mean CTDIvol (−49%), DLP (−48%), SSDE (−52%) and ED (−49%). Objective image quality was significantly (p < 0.05) improved both in CNR (32%) and SNR (13%). Subjective image quality scores were higher for the current protocol but variation between the two protocols was not significant (p = 0.650). ConclusionsWhen applying the low kV technique combined with high IR parameters, a significant dose reduction may be achieved while still maintaining diagnostic image quality. Implications for practiceThe low kV technique combined with high IR parameters is an effective optimisation technique which can be easily implemented for the CTPA protocol.

Split-bolus CT urography after microwave ablation of renal cell carcinoma improves image quality and reduces radiation exposure.

To compare image quality and radiation dose between single-bolus 2-phase and split-bolus 1-phase CT Urography (CTU) performed immediately after microwave ablation (MWA) of clinically localized T1 (cT1) RCC. Forty-two consecutive patients (30M, mean age 67.5 ± 9.0) with cT1 RCC were treated with MWA from 7/2013 to 12/2013 at two academic quaternary-care institutions. Renal parenchymal enhancement, collecting system opacification and distention and size-specific dose estimate (SSDE) were quantified and image quality subjectively assessed on single-bolus 2-phase versus split-bolus 1-phase CTU. Kruskal-Wallis and Pearson's Chi-squared tests were performed to assess differences in continuous and categorical variables, respectively. Two-sample T test with equal variances was used to determine differences in quantitative and qualitative image data. Median tumor diameter was larger [2.9cm (IQR 1.7-5.3) vs 3.6cm (IQR 1.7-5.7), p = 0.01] in the split-bolus cohort. Mean abdominal girth (p = 0.20) was similar. Number of antennas used and unenhanced CTs obtained before and during MWA were similar (p = 0.11-0.32). Renal pelvis opacification (2.5 vs 3.5, p < 0.001) and distention (4mm vs 8mm, p < 0.001) were improved and renal enhancement (Right: 127 HU vs 177 HU, p = 0.001; Left: 124 HU vs 185 HU, p < 0.001) was higher for the split-bolus CTU. Image quality was superior for split-bolus CTU (3.2 vs 4.0, p = 0.004). Mean SSDE for the split-bolus CTU was significantly lower [163.9mGy (SD ± 73.9) vs 36.3mGy (SD ± 7.7), p < 0.001]. Split-bolus CTU immediately after MWA of cT1 RCC offers higher image quality, improved opacification/distention of the collecting system and renal parenchymal enhancement at a lower radiation dose.

Potential increase in radiation-induced DNA double-strand breaks with higher doses of iodine contrast during coronary CT angiography.

PurposeTo investigate the contrast media iodine dose dependency of radiation‐induced DNA double‐strand breaks (DSBs) during a coronary computed tomography angiography (CCTA) scan.MethodsThis prospective patient study was approved by the ethical committee. Between November 2018 and July 2019, 50 patients (31 males and 19 females, mean age 64 years) were included in the study, 45 CCTA and five noncontrast‐enhanced (NCE) cardiac computed tomography (CT) patients. A single‐heartbeat scan protocol with a patient‐tailored contrast media injection protocol was used, administering a patient‐specific iodine dose. DNA double‐strand breaks were quantified using a γH2AX foci assay on peripheral blood lymphocytes. The net amount of γH2AX/cell was normalized to the individual patient CT dose by the size‐specific dose estimate (SSDE). Correlation between the administered and blood‐iodine dose and the SSDE normalized amount of DNA DSBs was investigated using a Pearson correlation test.ResultsCCTA patients were scanned with a mean CTDIvol of 10.6 ± 5.6 mGy, corresponding to a mean SSDE of 11.3 ± 5.3 mGy while the NCE cardiac CT patients were scanned with a mean CTDIvol of 6.00 ± 1.8 mGy, corresponding to a mean SSDE of 6.6 ± 2.7 mGy. The administered iodine dose ranged from 16.5 to 34.0 gI in the CCTA patients, resulting in a blood‐iodine dose range from 5.1 to 15.0 gI in the exposed blood volume. A significant linear relationship (r = 0.79, p‐value < 0.001) was observed between the blood iodine dose and SSDE normalized radiation‐induced DNA DSBs. A similar significant linear relationship (r = 0.62, p‐value < 0.001) was observed between the administered iodine dose and SSDE normalized radiation‐induced DNA DSBs.ConclusionsThis study shows that contrast media iodine dose increases the level of radiation‐induced DNA DSBs in peripheral blood lymphocytes in a linear dose‐dependent manner with CCTA. Importantly, the level of DNA DSBs can be reduced by lowering the administered iodine dose.

Comparisons of Water-Equivalent Diameter Measured on Images of Abdominal Routine Computed Tomography with and without A Contrast Agent

Normal 0 false false false EN-ID JA AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman",serif; mso-ansi-language:EN-ID;} The size-specific dose estimate (SSDE) is a metric for an estimation of patient dose in computed tomography (CT). The SSDE strongly depends on the water-equivalent diameter (D W ). In abdominal CT examinations, a contrast agent is sometimes used to more clearly visualize tissue lesions. The Hounsfield unit (HU) of CT images with and without the use of a contrast agent at specific areas is slightly different and it may affect the D W value. This study aimed to compare the D W values calculated from axial CT images in patients who had undergone routine abdominal scans both with and without the use of a contrast agent. Axial images of 144 patients with a weight range of 3.5 kg to 90 kg who had undergone routine abdominal scans both with and without the use of a contrast agent using a Siemens Sensation 64 CT scanner were retrospectively collected. The D W values were automatically calculated using the Matlab-based IndoseCT (version 15a) software. The results show the percentage difference between D W,contrast and D W,non - contrast is below 2 %. As a result, the mean SSDE contrast is 1.5 % smaller than SSDE non - contrast . Due to the effect of a contrast agent on the D W and SSDE value s is below 2 %, the axial images of CT abdomen without the use of a contrast agent can be used as the accurate estimation of D W and SSDE for images with the use of a contrast agent. Normal 0 false false false EN-ID JA AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif"; mso-ansi-language:EN-ID; mso-fareast-language:EN-US;}

Optimisation of CT protocols in PET-CT across different scanner models using different automatic exposure control methods and iterative reconstruction algorithms

BackgroundA significant proportion of the radiation dose from a PET-CT examination is dependent on the CT protocol, which should be optimised for clinical purposes. Matching protocols on different scanners within an imaging centre is important for the consistency of image quality and dose. This paper describes our experience translating low-dose CT protocols between scanner models utilising different automatic exposure control (AEC) methods and reconstruction algorithms.MethodsThe scanners investigated were a newly installed Siemens Biograph mCT PET with 64-slice SOMATOM Definition AS CT using sinogram affirmed iterative reconstruction (SAFIRE) and two GE Discovery 710 PET scanners with 128-slice Optima 660 CT using adaptive statistical reconstruction (ASiR). Following exploratory phantom work, 33 adult patients of various sizes were scanned using the Siemens scanner and matched to patients scanned using our established GE protocol to give 33 patient pairs. A comparison of volumetric CT dose index (CTDIvol) and image noise within these patient pairs informed optimisation, specifically for obese patients. Another matched patient study containing 27 patient pairs was used to confirm protocol matching. Size-specific dose estimates (SSDEs) were calculated for patients in the second cohort. With the acquisition protocol for the Siemens scanner determined, clinicians visually graded the images to identify optimal reconstruction parameters.ResultsIn the first matched patient study, the mean percentage difference in CTDIvol for Siemens compared to GE was − 10.7% (range − 41.7 to 50.1%), and the mean percentage difference in noise measured in the patients’ liver was 7.6% (range − 31.0 to 76.8%). In the second matched patient study, the mean percentage difference in CTDIvol for Siemens compared to GE was − 20.5% (range − 43.1 to 1.9%), and the mean percentage difference in noise was 19.8% (range − 27.0 to 146.8%). For these patients, the mean SSDEs for patients scanned on the Siemens and GE scanners were 3.27 (range 2.83 to 4.22) mGy and 4.09 (range 2.81 to 4.82) mGy, respectively. The analysis of the visual grading study indicated no preference for any of the SAFIRE strengths.ConclusionsGiven the different implementations of acquisition parameters and reconstruction algorithms between vendors, careful consideration is required to ensure optimisation and standardisation of protocols.

Iodine Parameters in Triple-Bolus Dual-Energy CT Correlate With Perfusion CT Biomarkers of Angiogenesis in Renal Cell Carcinoma.

OBJECTIVE. The purpose of this study is to determine the degree of the relationship between perfusion CT (PCT) parameters and iodine concentration metrics derived from triple-bolus dual-energy CT (DECT) and to compare the radiation dose delivered. SUBJECTS AND METHODS. This single-center prospective study was conducted from October 2015 to September 2017. Twenty-three consenting adults (15 men and eight women; mean [± SD] age, 56 ± 13 years [range, 25-78 years]) with renal cell carcinomas underwent consecutive PCT and triple-bolus DECT examinations. Triple-bolus DECT consisted of synchronous corticomedullary, nephrographic, and delayed phase scans acquired using a dual-source DECT scanner. Two readers independently analyzed blood flow, blood volume, and permeability, as measured by PCT, and iodine density and iodine ratio, as measured by triple-bolus DECT. Size-specific dose estimates were calculated for both groups. RESULTS. Interreader agreement was good for permeability (intraclass correlation coefficient [ICC] =.812) and blood flow (ICC = 0.849) and excellent for blood volume (ICC = 0.956), iodine density (ICC = 0.961), and iodine ratio (ICC = 0.956). Very strong positive correlations were found between blood volume and iodine density (p < 0.001) and between blood volume and iodine ratio (p < 0.001). Strong positive correlations were found between blood flow and iodine density (p < 0.001) and between blood flow and iodine ratio (p < 0.001). The correlations between permeability and iodine density (p = 0.01) and between permeability and iodine ratio (p = 0.02) were moderate. The mean size-specific dose estimate of triple-bolus DECT was approximately 15 times lower than that of PCT (p < 0.001). CONCLUSION. Quantitative iodine metrics derived from triple-bolus DECT showed significant correlation with CT parameters in renal cell carcinoma, with a significantly lower radiation dose.

Size specific dose estimate (SSDE) for estimating patient dose from CT used in myocardial perfusion SPECT/CT.

Objective(s):Size specific dose estimate (SSDE) is a new parameter that includes patient size factor in its calculation. Recent studies have produced mixed results on the utility of SSDE, especially when automatic exposure control (AEC) was used. The objective of the study was to find out if there is a relationship between patient size and each of the parameters, SSDE and CTDIvol, when AEC is used.Methods:CT data of consecutively selected 111 patients were included for analysis. CTDIvol values of the CT scans were extracted for each patient. Effective diameter of each patient was calculated as geometric mean of anteroposterior and lateral diameters measured on axial CT images. Corresponding conversion factors for effective diameters were obtained from American Association of Physicists in Medicine (AAPM) report 204. SSDE was obtained as the product of CTDIvol and conversion factor values. Linear regression model was used to evaluate the relationship between patient size and the parameters SSDE and CTDIvol.Results:Mean weight was 62 (11.5) and range was 34 - 103 kg. Median CTDIvol (mGy) on AEC mode was 7.27(IQ range 7.27, 7.65) and mean effective diameter was 26.2 cm (2.4). Mean SSDE (mGy) was 10.6 (0.84). Good positive correlation was obtained between CTDIvol and effective diameter (r=0.536; p<0.0005). Strong inverse correlation was noted between SSDE and effective diameter (r=-0.777; p<0.0005). Linear regression model for establishing relationship between CTDIvol and effective diameter showed slope of 0.314mGy/cm (R=0.561; R2=0.314; P<0.0005) whereas between effective diameter and SSDE slope was -0.23mGy/cm (R=0.676; R2=0.457; P< 0.0005). Conclusion:The study shows that CTDIvol and SSDE vary but divergently, with patient size. SSDE is a better estimate of patient radiation dose from CT of MPI SPECT/CT than CTDIvol in systems that use automated exposure control.

Radiation exposure of image-guided intrathecal administration of nusinersen to adult patients with spinal muscular atrophy.

To examine diagnostic reference levels (DRL) and achievable doses (AD) of image-guided and size-specific dose estimates (SSDE) and organ and effective doses of CT-guided intrathecal nusinersen administration to adult patients with spinal muscular atrophy (SMA). This study involved a total of 60 image-guided intrathecal nusinersen treatments between August 2017 and June 2018. Patient cohort comprised 14 adult patients with the following SMA types: type 2 (n = 9) and type 3 (n = 5) with a mean age of 33.6years (age range 25-57years). DRL, AD, SSDE, organ, and effective doses were assessed with a dose-monitoring program based on the Monte Carlo simulation techniques. DRL and AD for computed tomography are summarised as follows: in terms of CT-dose index (CTDIvol), DRL 56.4mGy and AD 36.7mGy; in terms of dose-length product (DLP), DRL 233.1mGycm and AD 120.1mGycm. DRL and AD for fluoroscopic guidance were distributed as follows: in terms of dose-area product (DAP), DRL 239.1μGym2 and AD 135.2mGycm2. Mean SSDE was 9.2mGy. Mean effective dose of the CT-guided injections was 2.5mSv (median 2.0mSv, IQR 1.3-3.2mSv). Highest organ doses in the primary beam of radiation were the small intestine 12.9mSv, large intestine 9.5mSv, and ovaries 3.6mSv. Radiation exposure of SMA patients measured as DRLs is generally not higher compared with patients without SMA despite severe anatomical hazards. Dose monitoring data may allow clinicians to stratify radiation risk, identify organs at risk, and adopt measures for specific radiation dose reduction.

Reduction of the radiation dose and the amount of contrast material in hepatic dynamic CT using low tube voltage and adaptive iterative dose reduction 3-dimensional.

The purpose of this study was to prospectively evaluate the image quality and the diagnostic ability of low tube voltage and reduced contrast material dose hepatic dynamic computed tomography (CT) reconstructed with adaptive iterative dose reduction 3-dimensional (AIDR 3D).Eighty-nine patients underwent hepatic dynamic CT using one of the 2 protocols: tube voltage of 120 kVp, contrast dose of 600 mgI/kg, and filtered back projection in Protocol A (n = 46), and tube voltage of 100 kVp, contrast dose of 500 mgI/kg, and AIDR 3D in Protocol B (n = 43). The volume CT dose index (CTDIvol) and size-specific dose estimates (SSDEs) were compared between the 2 groups. Objective image noise and tumor to liver contrast-to-noise ratio (CNR) were also compared. Three radiologists independently reviewed image quality. The jackknife alternative free-response receiver-operating characteristic (JAFROC) analysis was performed to compare diagnostic performance.The mean CTDIvol and SSDE of Protocol B (14.3 and 20.2, respectively) were significantly lower than those of Protocol A (22.1 and 31.4, P < .001). There were no significant differences in either objective image noise or CNR. In the qualitative analysis, 2 readers assigned significant lower scores to images of Protocol B for at least one of the 3 phases regarding overall image quality (P < .05). There was no significant difference in the JAFROC1 figure of merit between protocols.Low tube voltage CT with AIDR 3D yielded a reduction in radiation dose and in the amount of contrast material while maintaining diagnostic performance.

Size-specific dose estimates in chest, abdomen, and pelvis CT examinations of pediatric patients.

Size-specific dose estimates (SSDEs) are the latest focus of interest among medical physicists studying radiation dose to the patient in computed tomography (CT). This study aims to make conversions from CTDIvol to SSDE and investigate the relationship between mean SSDE (SSDE) and central SSDE (SSDEcenter) values for pediatric patients of different age groups undergoing chest, abdomen, and pelvis scans. In this retrospective study, we examined 105 consecutive pediatric CT exams of chest, abdomen, and pelvis (CAP) classified in 3 separate groups according to age: 0-5 years, 6-10 years, and 11-16 years. A MATLAB program was developed to determine SSDE values for each patient along 6 subregions: chest, abdomen, pelvis, chest and abdomen, abdomen and pelvis, and CAP. SSDE values derived over the slice at the center of each scan range (SSDEcenter) were also recorded. SSDE and corresponding SSDEcenter results were compared for each age group. Root mean square differences (RMSD) between SSDE and SSDEcenter values ranged between 0.13 mGy and 2.1 mGy through all groups and subregions, corresponding to 1.2% and 11%, respectively. In pediatric CT exams involving CAP region, CTDIvol and the water equivalent diameter at the middle of the scan range can be used to provide a reasonable estimate of mean SSDE with an RMSD of 11% at most.

Tailoring CT Dose to Patient Size: Implementation of the Updated 2017 ACR Size-specific Diagnostic Reference Levels

To use an automatic computed tomography (CT) dose monitoring system to analyze the institutional chest and abdominopelvic CT dose data as regards the updated 2017 American College of Radiology (ACR) diagnostic reference levels (DRLs) based on water-equivalent diameter (Dw) and size-specific dose estimates (SSDE) to detect patient-size subgroups in which CT dose can be optimized. All chest CT examinations performed between July 2016 and April 2017 with and without contrast material, CT of the pulmonary arteries, and abdominopelvic CT with and without contrast material were included in this retrospective study. Dw and SSDE were automatically calculated for all scans using a previously validated in-house developed Matlab software and stored into our CT dose monitoring system. CT dose data were analyzed as regards the updated ACR DRLs (size groups: 21-25 cm, 25-29 cm, 29-33 cm, 33-37 cm, 37-41 cm). SSDE and volumetric computed tomography dose index (CTDIvol) were used as CT dose parameter. Overall, 30,002 CT examinations were performed in the study period, 3860 of which were included in the analysis (mean age 62.1 ± 16.4 years, Dw 29.0 ± 3.3 cm; n = 577 chest CT without contrast material, n = 628 chest CT with contrast material, n = 346 CT of chest pulmonary, n = 563 abdominopelvic CT without contrast material, n = 1746 abdominopelvic CT with contrast material). Mean SSDE and CTDIvol relative to the updated DRLs were 43.3 ± 26.4 and 45.1 ± 27.9% for noncontrast chest CT, 52.3 ± 23.1 and 52.0 ± 23.1% for contrast-enhanced chest CT, 68.8 ± 29.5 and 70.0 ± 31.0% for CT of pulmonary arteries, 41.9 ± 29.2 and 43.3 ± 31.3% for noncontrast abdominopelvic CT, and 56.8 ± 22.2 and 58.8 ± 24.4% for contrast-enhanced abdominopelvic CT. Lowest dose compared to the DRLs was found for the Dw group of 21-25 cm in noncontrast abdominopelvic CT (SSDE 30.4 ± 21.8%, CTDIvol 30.8 ± 21.4%). Solely the group of patients with a Dw of 37-41 cm undergoing noncontrast abdominopelvic CT exceeded the ACR DRL (SSDE 100.3 ± 59.0%, CTDIvol 107.1 ± 63.5%). On average, mean SSDE and CTDIvol of our institutional chest and abdominopelvic CT protocols were lower than the updated 2017 ACR DRLs. Size-specific subgroup analysis revealed a wide variability of SSDE and CTDIvol across CT protocols and patient size groups with a transgression of DRLs in noncontrast abdominopelvic CT of large patients (Dw 37-41 cm).

Institutional computed tomography diagnostic reference levels based on water-equivalent diameter and size-specific dose estimates

Size-specific institutional diagnostic reference levels (DRLs) were generated for chest and abdominopelvic computed tomography (CT) based on size-specific dose estimates (SSDEs) and depending on patients’ water-equivalent diameter (Dw). 1690 CT examinations were included in the IRB-approved retrospective study. SSDEs based on the mean water-equivalent diameter of the entire scan volume were calculated automatically. SSDEs were analyzed for different patient sizes and institutional DRLs (iDRLS; 75% percentiles) based on Dw and SSDEs were generated. iDRLs were compared to the national DRLs. Mean volumetric computed tomography dose index (CTDIvol), Dw and SSDEs for all 1690 CT examinations were 7.2 ± 4.0 mGy (0.84–47.9 mGy), 29.0 ± 3.4 cm and 8.5 ± 3.8 mGy (1.2–37.7 mGy), respectively. Overall, the mean SSDEs of all CT examinations were higher than the CTDIvol in chest CT, abdominopelvic CT and upper abdominal CT, respectively (p < 0.001 for all). There was a strong linear correlation between Dw and SSDEs in chest (R2 = 0.66), abdominopelvic (R2 = 0.98) and upper abdominal CT (R2 = 0.96) allowing for the implementation of size-specific institutional DRLs based on SSDEs and patients’ Dw. We generated size-specific, Dw-dependent institutional DRLs based on SSDEs, which allow for easier and more comprehensive analyses of CT radiation exposure. Our results indicate that implementation of SSDEs into national DRLs may be beneficial.

SIMPLE METHOD OF SIZE-SPECIFIC DOSE ESTIMATES CALCULATION FROM PATIENT WEIGHT ON COMPUTED TOMOGRAPHY.

The purpose of this study is to develop a new and simple methodology for calculating mean size-specific dose estimates (SSDE) over the entire scan range (mSSDE) from weight and volume CT dose index (CTDIvol). We retrospectively analyzed data from a dose index registry. Scan areas were divided into two regions: chest and abdomen-pelvis. The original mSSDE was calculated by a commercially available software. The conversion formulas for mSSDE were estimated from weight and CTDIvol (SSDEweight) in each region. SSDEweight were compared with the original mSSDE using Bland-Altman analysis. Root mean square differences were 1.4 mGy for chest and 1.5 mGy for abdomen-pelvis. Our method using formulae can calculate SSDEweight using weight and CTDIvol without a dedicated software, and can be used to calculate DRL to optimize CT exposure doses.

Assessment of radiation dose from abdominal quantitative CT with short scan length.

To assess radiation dose for patients who received abdominal quantitative CT and to compare the midpoint dose [DL(0)] at the centre of a 1-cm scan length with the volume CT dose index (CTDIvol). Although the size-specific dose estimate (SSDE) proposed in The American Association of Physicists in Medicine Report No. 204 is not applicable for short-length scans, commercial dose-monitoring software, such as Radimetrics™ Enterprise Platform (Bayer HealthCare, Whippany, NJ), reports SSDE for all scans. SSDE was herein compared with DL(0). Data were analyzed from 398 abdominal quantitative CT examinations in 165 males and 233 females. The CTDIvol was 4.66 mGy, and the scan length was 1 cm for all examinations. Radimetrics was used to extract patient diameter and SSDE. DL(0) was assessed using a previously reported method that takes into account both patient size and scan length. The mean patient diameter was 28.5 ± 6.3 cm (range, 16.5-46.6 cm); the mean SSDE was 6.22 ± 1.36 mGy (range, 3.12-9.42 mGy); and the mean DL(0) was 2.97 ± 0.95 mGy (range, 1.18-5.77 mGy). As patient diameter increased, the DL(0) to CTDIvol ratio decreased, ranging from 1.24 to 0.25; the DL(0) to SSDE ratio also decreased, ranging from 0.61 to 0.38. The dose to the patients from abdominal quantitative CT may be largely different from CTDIvol and SSDE. This study demonstrates the necessity of taking into account not only patient size but also scan length for evaluating the dose from short-length scans. Advances in knowledge: In CT examinations with 1-cm scan length, dose evaluation needs to take into account both patient size and scan length. An omission of either factor can result in an erroneous result.

Pediatric Chest CT Diagnostic Reference Ranges: Development and Application.

Purpose To determine diagnostic reference ranges on the basis of the size of a pediatric patient's chest and to develop a method to estimate computed tomographic (CT) scanner-specific mean size-specific dose estimates (SSDEs) as a function of patient size and the radiation output of each CT scanner at a site. Materials and Methods The institutional review boards of each center approved this retrospective, HIPAA-compliant, multicenter study; informed consent was waived. CT dose indexes (SSDE, volume CT dose index, and dose length product) of 518 pediatric patients (mean age, 9.6 years; male patients, 277 [53%]) who underwent CT between July 1, 2012, and June 30, 2013, according to the guidelines of the Quality Improvement Registry in CT Scans in Children were retrieved from a national dose data registry. Diagnostic reference ranges were developed after analysis of image quality of a subset of 111 CT examinations to validate image quality at the lower bound. Pediatric dose reduction factors were calculated on the basis of SSDEs for pediatric patients divided by SSDEs for adult patients. Results Diagnostic reference ranges (SSDEs) were 1.8-3.9, 2.2-4.5, 2.7-5.1, 3.6-6.6, and 5.5-8.4 mGy for effective diameter ranges of less than 15 cm, 15-19 cm, 20-24 cm, 25-29 cm, and greater than or equal to 30 cm, respectively. The fractions of adult doses (pediatric dose reduction factors) used within the consortium for patients with lateral dimensions of 8, 11, 14, 17, 20, 23, 26, 29, 32, 35, and 38 cm were 0.29, 0.33, 0.38, 0.44, 0.50, 0.58, 0.66, 0.76, 0.87, 1.0, and 1.15, respectively. Conclusion Diagnostic reference ranges developed in this study provided target ranges of pediatric dose indexes on the basis of patient size, while the pediatric dose reduction factors of this study allow calculation of unique reference dose indexes on the basis of patient size for each of a site's CT scanners. © RSNA, 2017 Online supplemental material is available for this article.

Quality of pediatric abdominal CT scans performed at a dedicated children's hospital and its referring institutions: a multifactorial evaluation.

Pediatric patients requiring transfer to a dedicated children's hospital from an outside institution may undergo CT imaging as part of their evaluation. Whether this imaging is performed prior to or after transfer has been shown to impact the radiation dose imparted to the patient. Other quality variables could also be affected by the pediatric experience and expertise of the scanning institution. To identify differences in quality between abdominal CT scans and reports performed at a dedicated children's hospital, and those performed at referring institutions. Fifty consecutive pediatric abdominal CT scans performed at outside institutions were matched (for age, gender and indication) with 50 CT scans performed at a dedicated freestanding children's hospital. We analyzed the scans for technical parameters, report findings, correlation with final clinical diagnosis, and clinical utility. Technical evaluation included use of intravenous and oral contrast agents, anatomical coverage, number of scan phases and size-specific dose estimate (SSDE) for each scan. Outside institution scans were re-reported when the child was admitted to the children's hospital; they were also re-interpreted for this study by children's hospital radiologists who were provided with only the referral information given in the outside institution's report. Anonymized original outside institutional reports and children's hospital admission re-reports were analyzed by two emergency medicine physicians for ease of understanding, degree to which the clinical question was answered, and level of confidence in the report. Mean SSDE was lower (8.68) for children's hospital scans, as compared to outside institution scans (13.29, P = 0.03). Concordance with final clinical diagnosis was significantly lower for original outside institution reports (38/48, 79%) than for both the admission and study children's hospital reports (48/50, 96%; P = 0.005). Children's hospital admission reports were rated higher than outside institution reports for completeness, ease of understanding, answering of clinical question, and level of confidence of the report (P < 0.001). Pediatric abdominal CT scans performed and interpreted at a dedicated children's hospital are associated with higher technical quality, lower radiation dose and a more clinically useful report than those performed at referring institutions.

Dual-Source Single-Energy Multidetector CT Used to Obtain Multiple Radiation Exposure Levels within the Same Patient: Phantom Development and Clinical Validation.

Purpose To develop, in a phantom environment, a method to obtain multidetector computed tomographic (CT) data sets at multiple radiation exposure levels within the same patient and to validate its use for potential dose reduction by using different image reconstruction algorithms for the detection of liver metastases. Materials and Methods The American College of Radiology CT accreditation phantom was scanned by using a dual-source multidetector CT platform. By adjusting the radiation output of each tube, data sets at six radiation exposure levels (100%, 75%, 50%, 37.5%, 25%, and 12.5%) were reconstructed from two consecutive dual-source single-energy (DSSE) acquisitions, as well as a conventional single-source acquisition. A prospective, HIPAA-compliant, institutional review board-approved study was performed by using the same DSSE strategy in 19 patients who underwent multidetector CT of the liver for metastatic colorectal cancer. All images were reconstructed by using conventional weighted filtered back projection (FBP) and sinogram-affirmed iterative reconstruction with strength level of 3 (SAFIRE-3). Objective image quality metrics were compared in the phantom experiment by using multiple linear regression analysis. Generalized linear mixed-effects models were used to analyze image quality metrics and diagnostic performance for lesion detection by readers. Results The phantom experiment showed comparable image quality between DSSE and conventional single-source acquisition. In the patient study, the mean size-specific dose estimates for the six radiation exposure levels were 13.0, 9.8, 5.8, 4.4, 3.2, and 1.4 mGy. For each radiation exposure level, readers' perception of image quality and lesion conspicuity was consistently ranked superior with SAFIRE-3 when compared with FBP (P ≤ .05 for all comparisons). Reduction of up to 62.5% in radiation exposure by using SAFIRE-3 yielded similar reader rankings of image quality and lesion conspicuity when compared with routine-dose FBP. Conclusion A method was developed and validated to synthesize multidetector CT data sets at multiple radiation exposure levels within the same patient. This technique may provide a foundation for future clinical trials aimed at estimating potential radiation dose reduction by using iterative reconstructions. © RSNA, 2016 Online supplemental material is available for this article.

Radiation dose levels in pediatric chest CT: experience in 499 children evaluated with dual-source single-energy CT.

The availability of dual-source technology has introduced the possibility of scanning children at lower kVp with a high-pitch mode, combining high-speed data acquisition and high temporal resolution. To establish the radiation dose levels of dual-source, single-energy chest CT examinations in children. We retrospectively recorded the dose-length product (DLP) of 499 consecutive examinations obtained in children <50kg, divided into five weight groups: group 1 (<10kg, n = 129); group 2 (10-20kg, n = 176); group 3 (20-30kg, n = 99), group 4 (30-40kg, n = 58) and group 5 (40-49kg, n = 37). All CT examinations were performed with high temporal resolution (75ms), a high-pitch mode and a weight-adapted selection of the milliamperage. CT examinations were obtained at 80kVp with a milliamperage ranging between 40mAs and 90mAs, and a pitch of 2.0 (n = 162; 32.5%) or 3.0 (n = 337; 67.5%). The mean duration of data acquisition was 522.8 ± 192.0ms (interquartile range 390 to 610; median 490). In the study population, the mean CT dose index volume (CTDIvol32) was 0.83mGy (standard deviation [SD] 0.20mGy; interquartile range 0.72 to 0.94; median 0.78); the mean DLP32 was 21.4mGy.cm (SD 9.1mGy.cm; interquartile range 15 to 25; median 19.0); and the mean size-specific dose estimate (SSDE) was 1.7mGy (SD 0.4mGy; interquartile range 1.5 to 1.9; median 1.7). The DLP32, CTDIvol32 and SSDE were found to be statistically significant in the five weight categories (P < 0.0001). This study establishes the radiation dose levels for dual-source, single-kVp chest CT from a single center. In the five weight categories, the median values varied 15-37mGy.cm for the DLP32, 0.78-1.25mGy for the CTDIvol32 and 1.6-2.1mGy for the SSDE.

Size specific dose estimates in pediatric chest, abdomen and pelvis CT examinations

Introduction Volume computed tomography dose index (CTDIvol) does not contain any dose information regarding the patient size. Size specific dose estimates (SSDE) give more reliable results accounting for the patient size as well. This parameter uses CTDIvol and size dependent conversion factors (fDw) which are calculated by means of water equivalent diameter (Dw) of the patient cross section in every slice of image. Purpose To develop software to automatically calculate SSDE and to assess the impact of variations in Dw along the z axis on SSDE for CT examinations of the torso in pediatric patients. Materials and methods 55 consecutive CT exams of the combined chest, abdomen and pelvis (CAP) have been examined. SSDE has been calculated for 6 hypothetical scan ranges: chest alone, abdomen alone, pelvis alone, chest and abdomen, abdomen and pelvis, and CAP. Two methods were used in mean SSDE approach: (1) mean SSDE over each scan range; (2) SSDE value at the middle of the scan range. Results For scan ranges 1 to 6, the average of the difference in maximal and minimal Dw accross patients was 3.7, 3.8, 2.6, 4.1, 4.4 and 4.5 cm. The mean SSDE values calculated using methods (1) and (2) were highly compatible, with root mean square differences of 0.4, 0.5, 0.3, 1.0, 1.5 and 0.7 mGy or 3%, 4%, 2%, 7%, 10%, 5%. Conclusion Using the mean CTDIvol and the water equivalent diameter at the middle of the scan range provides a reasonable estimation of patient dose in pediatric exams.