Establishment of Diagnostic Reference Levels and Evaluation of Radiation Dose in Double Phase Abdominopelvic Computed Tomography

Document Type : Original Paper

Author

Medical Physics and Radiology Department, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran

Abstract

Introduction: The purpose of this study was to establish of diagnostic reference level (DRL) and to compare radiation dose between single phase and unjustified double phase abdominopelvic CT imaging.
Material and Methods: A total of 163 patients, 85 patients with single phase and 78 patients with unjustified double phase abdominopelvic CT scans, were included in this retrospective study. Volumetric CT dose index (CTDIvol) and dose length product (DLP) were obtained from the CT console. The third quartile of CTDIvol and DLP were determined for diagnostic reference level (DRL). Effective dose (E) and organ dose were obtained using CT-Expo software (version 2.2). Single phase and double phase scans were compared in terms of CTDIvol, DLP, size-specific dose estimate (SSDE), E and organ doses.
Results: The institutional DRLs using CTDIvol and DLP for abdominopelvic CT were 9.8 mGy and 571 mGy.cm, respectively. The mean value of E was 5.4 ± 1.8 and 10.3 ± 3.4 for single phase and double phase imaging, respectively, resulting in 4.9 mSv excess dose per patient. Mean value of the DLP was 396.9 ± 142.7 and 759.0 ± 250.7 for single phase and double phase imaging, respectively. E was significantly higher in female compared to male (p < 0.05). Bladder has a highest lifetime attributed risk of cancer incidence among other organs. Also, the cancer risk incidence was higher for female than male.
Conclusion: The awareness of physicians about the correct indications of abdominopelvic CT should be increased by using associated reliable guidelines

Keywords

Main Subjects

References

  1. Sulieman A, Adam H, Tamam N, Alkhorayef M, Alhailiy A, Alghamdi S, et al. A survey of the pediatric radiation doses during multiphase abdominal computed tomography examinations. Radiation Physics and Chemistry. 2021;188:109662.
  2. Ferrero A, Takahashi N, Vrtiska TJ, Krambeck AE, Lieske JC, McCollough CH. Understanding, justifying, and optimizing radiation exposure for CT imaging in nephrourology. Nature Reviews Urology. 2019; 16(4):231-44.
  3. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. New England journal of medicine. 2007; 357(22):2277-84.
  4. Wall B, Kendall G, Edwards A, Bouffler S, Muirhead C, Meara J. What are the risks from medical X-rays and other low dose radiation? The British journal of radiology. 2006; 79(940):285-94.
  5. Pandharipande PV, Reisner AT, Binder WD, Zaheer A, Gunn ML, Linnau KF, et al. CT in the emergency department: a real-time study of changes in physician decision making. Radiology. 2016; 278(3):812-21.
  6. Rastogi S, Singh R, Borse R, Valkovic Zujic P, Segota D, Diklic A, et al. Use of multiphase CT protocols in 18 countries: appropriateness and radiation doses. Canadian Association of Radiologists Journal. 2021;72(3):381-7.
  7. Eurboonyanun K, Rungwiriyawanich P, Chamadol N, Promsorn J, Eurboonyanun C, Srimunta P. Accuracy of Nonenhanced CT vs Contrast-Enhanced CT for Diagnosis of Acute Appendicitis in Adults. Current problems in diagnostic radiology. 2021; 50(3):315-20.
  8. Naulet P, Wassel J, Gervaise A, Blum A. Evaluation of the value of abdominopelvic acquisition without contrast injection when performing a whole body CT scan in a patient who may have multiple trauma. Diagnostic and interventional imaging. 2013; 94(4):410-7.
  9. Guite KM, Hinshaw JL, Ranallo FN, Lindstrom MJ, Lee Jr FT. Ionizing radiation in abdominal CT: unindicated multiphase scans are an important source of medically unnecessary exposure. Journal of the American College of Radiology. 2011; 8(11):756-61.
  10. Keshtkar M, Saba V, Mosleh-Shirazi M. Application of different methods for reducing radiation dose to breast during MDCT. Journal of biomedical physics & engineering. 2018; 8(4):341.
  11. Saba V, Keshtkar M. Targeted radiation energy modulation using Saba shielding reduces breast dose without degrading image quality during thoracic CT examinations. Physica Medica. 2019; 65: 238-46.
  12. Singh R, Digumarthy SR, Muse VV, Kambadakone AR, Blake MA, Tabari A, et al. Image quality and lesion detection on deep learning reconstruction and iterative reconstruction of submillisievert chest and abdominal CT. American Journal of Roentgenology. 2020;214(3):566-73.
  13. Hwang SH, You JS, Song MK, Choi JY, Kim MJ, Chung YE. Comparison of diagnostic performance between single-and multiphasic contrast-enhanced abdominopelvic computed tomography in patients admitted to the emergency department with abdominal pain: potential radiation dose reduction. European radiology. 2015;25(4):1048-58.
  14. Abiar M, Mahdavi M, Haddadi G. Establishing local Diagnostic Reference Level for Adult Patients in Computed Tomography Examination in Kohgiluyeh and Boyer-Ahmad province. Iranian Journal of Medical Physics. 2021;18(4):247-54.
  15. Jafari S, Ghazikhanlu Sani K, Karimi M, Khosravi H, Goodarzi R, Pourkaveh M. Establishment of diagnostic reference levels for computed tomography scanning in hamadan. Journal of Biomedical Physics & Engineering. 2020; 10(6):792-800.
  16. Boone J, Strauss K, Cody D, McCollough C, McNitt-Gray M, Toth T, et al. AAPM report No. 204: size-specific dose estimates (SSDE) in pediatric and adult body CT examinations. American Association of Physicists in Medicine website. 2011.
  17. Zarei, F, Nasiri M, Etemadi Z, Haghighi RR, Chatterjee S, Khaneghah PA, et al. Evaluation of Size-Specific Dose Estimates for Optimizing Pediatric Chest CT Protocol. Iranian Journal of Medical Physics, 2022;19(5):315-21.
  18. Protection, R. ICRP publication 103. Ann ICRP. 2007; 37(2.4):2.
  19. Rostad BS, Applegate KE, Kim T, Mansour RM, Milla SS. Multiphase acquisitions in pediatric abdominal-pelvic CT are a common practice and contribute to unnecessary radiation dose. Pediatric Radiology. 2018;48(12):1714-23.
  20. Liang CR, Chen PX, Kapur J, Ong MK, Quek ST, Kapur SC. Establishment of institutional diagnostic reference level for computed tomography with automated dose‐tracking software. Journal of medical radiation sciences. 2017; 64(2):82-9.
  21. Abuzaid MM, Elshami W, El Serafi A, Hussien T, McConnell J, Tekin Ho. Toward national CT diagnostic reference levels in the United Arab Emirates: a multicenter review of CT dose index and dose length product. Radiation protection dosimetry. 2020;190(3):243-49.
  22. Kayun Z, Karim MK, Harun HH, Shaari AH, Mahmud R, Hamid HA, et al. Radiation doses and size-specific dose estimate from CT brain examinations according to head sizes in a tertiary hospital in Malaysia. Radiation Physics and Chemistry. 2021;189:109694.
  23. Dalah EZ, Obaideen A, Anam S, Khalid M, Nadishani T, Hashim S, et al. Cumulative lifetime attributed risks for patients subjected to contrast enhanced chest CT examinations. Radiation Physics and Chemistry. 2021; 189:109710.
  24. Al Naomi H, Aly A, Kharita MH, Al Hilli S, Al Obadli A, Singh R, et al. Multiphase abdomen-pelvis CT in women of childbearing potential (WOCBP): Justification and radiation dose. Medicine. 2020; 99(4):18485.
  25. Giannitto C, Campoleoni M, Maccagnoni S, Angileri AS, Grimaldi MC, Giannitto N, et al. Unindicated multiphase CT scans in non-traumatic abdominal emergencies for women of reproductive age: a significant source of unnecessary exposure. La radiologia medica. 2018; 123(3):185-90.
  26. Hoang JK, Reiman RE, Nguyen GB, Januzis N, Chin BB, Lowry C, Yoshizumi TT. Lifetime attributable risk of cancer from radiation exposure during parathyroid imaging: comparison of 4D CT and parathyroid scintigraphy. American Journal of Roentgenology. 2015 May;204(5):W579-85.

 

 

 

 

 

 

Iranian Journal of Medical Physics
Volume 20, Issue 2
March and April 2023
Pages 80-86

Files

History

  • Receive Date: 16 March 2022
  • Revise Date: 20 May 2022
  • Accept Date: 20 June 2022

Share

How to cite

Statistics