Local clinical diagnostic reference levels for chest and abdomen CT examinations in adults as a function of body mass index and clinical indication: a prospective multicenter study.

Details

Serval ID
serval:BIB_36D1256973D8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Local clinical diagnostic reference levels for chest and abdomen CT examinations in adults as a function of body mass index and clinical indication: a prospective multicenter study.
Journal
European radiology
Author(s)
Brat H., Zanca F., Montandon S., Racine D., Rizk B., Meicher E., Fournier D.
ISSN
1432-1084 (Electronic)
ISSN-L
0938-7994
Publication state
Published
Issued date
12/2019
Peer-reviewed
Oui
Volume
29
Number
12
Pages
6794-6804
Language
english
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Abstract
To compare institutional dose levels based on clinical indication and BMI class to anatomy-based national DRLs (NDRLs) in chest and abdomen CT examinations and to assess local clinical diagnostic reference levels (LCDRLs).
From February 2017 to June 2018, after protocol optimization according to clinical indication and body mass index (BMI) class (< 25; ≥ 25), 5310 abdomen and 1058 chest CT series were collected from 5 CT scanners in a Swiss multicenter group. Clinical indication-based institutional dose levels were compared to the Swiss anatomy-based NDRLs. Statistical significance was assessed (p < 0.05). LCDRLs were calculated as the third quartile of the median dose values for each CT scanner.
For chest examinations, dose metrics based on clinical indication were always below P75 NDRL for CTDI <sub>vol</sub> (range 3.9-6.4 vs. 7.0 mGy) and DLP (164.0-211.2 vs. 250 mGycm) in all BMI classes except for DLP in BMI ≥ 25 (248.8-255.4 vs. 250.0 mGycm). For abdomen examinations, they were significantly lower or not different than P50 NDRLs for all BMI classes (3.8-9.0 vs. 10.0 mGy and 192.9-446.8 vs. 470mGycm). The estimated LCDRLs show a drop in CTDI <sub>vol</sub> (21% for chest and 32% for abdomen, on average) with respect to current DRLs. When considering BMI stratification, the largest LCDRL difference within the same clinical indication is for renal tumor (4.6 mGy for BMI < 25 vs. 10.0 mGy for BMI ≥ 25; - 117%).
The results suggest the necessity of estimating clinical indication-based DRLs, especially for abdomen examinations. Stratifying per BMI class allows further optimization of the CT doses.
• Our data show that clinical indication-based DRLs might be more appropriate than anatomy-based DRLs and might help in reducing large variations in dose levels for the same type of examinations. • Stratifying the data per patient-size subgroups (non-overweight, overweight) allows a better optimization of CT doses and therefore the possibility to set LCDRLs based on BMI class. • Institutions who are fostering continuous dose optimization and LDRLs should consider defining protocols based on clinical indication and BMI group, to achieve ALARA.
Keywords
Abdomen/diagnostic imaging, Adolescent, Adult, Aged, Aged, 80 and over, Body Mass Index, Female, Humans, Male, Middle Aged, Physical Examination, Prospective Studies, Radiation Dosage, Radiography, Abdominal/methods, Radiography, Thoracic/methods, Reference Values, Thorax/diagnostic imaging, Tomography, X-Ray Computed/methods, Young Adult, Clinical protocols, Health care, Multidetector computed tomography, Radiometry
Pubmed
Web of science
Create date
18/06/2019 16:41
Last modification date
18/02/2020 6:20
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