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Implementation of an audit and dose reduction program for ct matyagin
1. Implementation of an Audit and
Dose Reduction Program for CT
Y. Matyagin and P.J. Collins
Department of Nuclear Medicine, PET and Bone
Densitometry
Royal Adelaide Hospital
2. CT exposure
Increasing concern worldwide regarding the
relatively high level of CT radiation exposure
National Council on Radiation Protection and
Measurements: US average dose from medical
procedures increased 6x between 1980 and
2007
60% due to CT
F.A Mettler Jr., et al. Radiology 2009 Nov;253(2):520-31.
3. CT exposure
CT now constitutes:
15% of total number of radiological
imaging procedures
50% of population’s medical radiation
exposure
25% of total radiation exposure
F.A. Mettler Jr., et al Health Phys. 95(5), 502-507 (2008).
4. Radiation induced health risk
A 2009 study estimates (using LNT
model) 29,000 cases of cancer could be
due to CT scans that were performed in
USA during 2007
There is potential for significant dose
reduction in many studies as part of an
image/dose optimization process
B.A. de Gonzales, et al. Arch Intern Med 2009 Dec 14;169(22):2071-7.
6. Weighted Computed Tomography
Dose Index (CTDIw)
http://www.impactscan.org/slides/impactcourse/principles%20of%20ct%20dosimetry/index.html
• Weighted CTDI represents the average dose in scan
plane of Perspex phantom
• CTDIW = 1/3 CTDICentre + 2/3 CTDIPeriphery
• Phantom diameter:
32 cm or 16 cm
• Units: mGy
7. Volume CTDI (CTDIvol)
CTDIvol: average dose over scanned volume
CTDIvol: accounts for non-contiguous exposure along z-axis
CTDIvol = CTDIw / pitch
Pitch 1.5
Pitch 1.0
Pitch 0.75
8. Dose-length product (DLP)
Total dose: CTDIvol integrated along the scan
length, ie.
DLP = CTDIvol • L (where L = scan length)
Units: mGy • cm
9. Different tissues of the body have
different radiosensitivity
Unit of Effective dose (E) is the Sievert
where wT = weighting factor for organ, or tissue T
HT = equivalent dose to organ/tissue
Effective dose
E w HT T
T
11. Aim
Compare CT doses (adults) at RAH with
an International benchmark
Modify protocol settings to optimize
dose/image quality
12. Dose reference levels
RANZCR have adopted EC1999 values
European Guidelines (EC 2004) were
used in this study
Address multi-slice scanners
Includes data from 8 countries
EC 2004. G. Bongartz, et al. European Guidelines for Multislice Computed
Tomography. FIGM-CT2000-20078-CT-TIP. March 2004
13. Methods
CT configured to display relevant dose
information (CTDIvol, DLP etc.) in PACS
Baseline audit performed
CT scanner exposure settings were
reduced in step-wise fashion so as not
to compromise image quality
14. Results
CT Doses (% of EC2004)
Siemens "Somatom Definition AS+" and Toshiba "Aquilion 16"
15. Brain perfusion
Major International concern regarding
brain perfusion CT
Cedars-Sinai Medical Center in USA:
excessive CT doses in 250 patients
Some studies 8 times expected level
FDA reported significant CT
overexposure at several other medical
centers in 2009
16. Brain perfusion overdose
Hair loss in patients who
received radiation overdoses
W. Bogdanich, New York Times, July 31, 2010
17. Discussion
CT Doses (% of EC2004)
Siemens "Somatom Definition AS+" and Toshiba "Aquilion 16"
18. CT Doses (% of EC2004)
Siemens "Somatom Definition AS+" and Toshiba "Aquilion 16"
Discussion
19. CT Doses (% of EC2004)
Siemens "Somatom Definition AS+" and Toshiba "Aquilion 16"
Discussion
20. CT Doses (% of EC2004)
Siemens "Somatom Definition AS+" and Toshiba "Aquilion 16"
Discussion
21. Dose parameters - PACS
Store in separate dose information page:
CTDIvol
DLP
Dose/image quality reference settings
Scan time
Patient’s size information
25. Automatic exposure control (AEC)
AEC switched on
Dose references level set
Effect of other CT parameters on
functioning of AEC evaluated
Min and max tube current
Tube voltage
Beam collimation and reconstructed slice
thickness
Image reconstruction filters and algorithms
26. Large/small patients
A separate protocol should be employed:
Higher tube voltages for large and
(possibly) lower tube voltages for small
patients
Rotation time and pitch adjusted to
ensure tube current is within acceptable
limits
Somewhat higher image noise is
acceptable for large patients
27. Future work
More detailed analysis of image quality
eg. using phantoms
Investigate other key parameters
Slice thickness
Inter-slice intervals
Streak artefacts