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Published in: European Radiology 10/2011

01-10-2011 | Computed Tomography

An education and training programme for radiological institutes: impact on the reduction of the CT radiation dose

Authors: Sebastian T. Schindera, Reto Treier, Gabriel von Allmen, Claude Nauer, Philipp R. Trueb, Peter Vock, Zsolt Szucs-Farkas

Published in: European Radiology | Issue 10/2011

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Abstract

Objectives

To establish an education and training programme for the reduction of CT radiation doses and to assess this programme’s efficacy.

Methods

Ten radiological institutes were counselled. The optimisation programme included a small group workshop and a lecture on radiation dose reduction strategies. The radiation dose used for five CT protocols (paranasal sinuses, brain, chest, pulmonary angiography and abdomen) was assessed using the dose-length product (DLP) before and after the optimisation programme. The mean DLP values were compared with national diagnostic reference levels (DRLs).

Results

The average reduction of the DLP after optimisation was 37% for the sinuses (180 vs. 113 mGycm, P < 0.001), 9% for the brain (982 vs. 896 mGycm, P < 0.05), 24% for the chest (425 vs. 322 mGycm, P < 0.05) and 42% for the pulmonary arteries (352 vs. 203 mGycm, P < 0.001). No significant change in DLP was found for abdominal CT. The post-optimisation DLP values of the sinuses, brain, chest, pulmonary arteries and abdomen were 68%, 10%, 20%, 55% and 15% below the DRL, respectively.

Conclusions

The education and training programme for radiological institutes is effective in achieving a substantial reduction in CT radiation dose.
Literature
1.
go back to reference Brenner DJ, Hall EJ (2007) Computed tomography–an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRef Brenner DJ, Hall EJ (2007) Computed tomography–an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRef
2.
go back to reference Berrington de Gonzalez A, Mahesh M, Kim KP et al (2009) Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 169:2071–2077PubMedCrossRef Berrington de Gonzalez A, Mahesh M, Kim KP et al (2009) Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 169:2071–2077PubMedCrossRef
3.
go back to reference Marin D, Nelson RC, Schindera ST et al (2010) Low-tube-voltage, high-tube-current multidetector abdominal CT: improved image quality and decreased radiation dose with adaptive statistical iterative reconstruction algorithm–initial clinical experience. Radiology 254:145–153PubMedCrossRef Marin D, Nelson RC, Schindera ST et al (2010) Low-tube-voltage, high-tube-current multidetector abdominal CT: improved image quality and decreased radiation dose with adaptive statistical iterative reconstruction algorithm–initial clinical experience. Radiology 254:145–153PubMedCrossRef
4.
go back to reference Kalra MK, Maher MM, Toth TL et al (2004) Techniques and applications of automatic tube current modulation for CT. Radiology 233:649–657PubMedCrossRef Kalra MK, Maher MM, Toth TL et al (2004) Techniques and applications of automatic tube current modulation for CT. Radiology 233:649–657PubMedCrossRef
5.
go back to reference McCollough CH, Bruesewitz MR, Kofler JM Jr (2006) CT dose reduction and dose management tools: overview of available options. Radiographics 26:503–512PubMedCrossRef McCollough CH, Bruesewitz MR, Kofler JM Jr (2006) CT dose reduction and dose management tools: overview of available options. Radiographics 26:503–512PubMedCrossRef
6.
go back to reference Hara AK, Paden RG, Silva AC, Kujak JL, Lawder HJ, Pavlicek W (2009) Iterative reconstruction technique for reducing body radiation dose at CT: feasibility study. AJR Am J Roentgenol 193:764–771PubMedCrossRef Hara AK, Paden RG, Silva AC, Kujak JL, Lawder HJ, Pavlicek W (2009) Iterative reconstruction technique for reducing body radiation dose at CT: feasibility study. AJR Am J Roentgenol 193:764–771PubMedCrossRef
7.
go back to reference Campbell J, Kalra MK, Rizzo S, Maher MM, Shepard JA (2005) Scanning beyond anatomic limits of the thorax in chest CT: findings, radiation dose, and automatic tube current modulation. AJR Am J Roentgenol 185:1525–1530PubMedCrossRef Campbell J, Kalra MK, Rizzo S, Maher MM, Shepard JA (2005) Scanning beyond anatomic limits of the thorax in chest CT: findings, radiation dose, and automatic tube current modulation. AJR Am J Roentgenol 185:1525–1530PubMedCrossRef
8.
go back to reference Schindera ST, Graca P, Patak MA et al (2009) Thoracoabdominal-aortoiliac multidetector-row CT angiography at 80 and 100 kVp: assessment of image quality and radiation dose. Invest Radiol 44:650–655PubMedCrossRef Schindera ST, Graca P, Patak MA et al (2009) Thoracoabdominal-aortoiliac multidetector-row CT angiography at 80 and 100 kVp: assessment of image quality and radiation dose. Invest Radiol 44:650–655PubMedCrossRef
9.
go back to reference Szucs-Farkas Z, Kurmann L, Strautz T, Patak MA, Vock P, Schindera ST (2008) Patient exposure and image quality of low-dose pulmonary computed tomography angiography: comparison of 100- and 80-kVp protocols. Invest Radiol 43:871–876PubMedCrossRef Szucs-Farkas Z, Kurmann L, Strautz T, Patak MA, Vock P, Schindera ST (2008) Patient exposure and image quality of low-dose pulmonary computed tomography angiography: comparison of 100- and 80-kVp protocols. Invest Radiol 43:871–876PubMedCrossRef
10.
go back to reference Nakayama Y, Awai K, Funama Y et al (2005) Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise. Radiology 237:945–951PubMedCrossRef Nakayama Y, Awai K, Funama Y et al (2005) Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise. Radiology 237:945–951PubMedCrossRef
11.
go back to reference Poletti PA, Platon A, Rutschmann OT, Schmidlin FR, Iselin CE, Becker CD (2007) Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. AJR Am J Roentgenol 188:927–933PubMedCrossRef Poletti PA, Platon A, Rutschmann OT, Schmidlin FR, Iselin CE, Becker CD (2007) Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. AJR Am J Roentgenol 188:927–933PubMedCrossRef
12.
go back to reference Li J, Udayasankar UK, Toth TL, Seamans J, Small WC, Kalra MK (2007) Automatic patient centering for MDCT: effect on radiation dose. AJR Am J Roentgenol 188:547–552PubMedCrossRef Li J, Udayasankar UK, Toth TL, Seamans J, Small WC, Kalra MK (2007) Automatic patient centering for MDCT: effect on radiation dose. AJR Am J Roentgenol 188:547–552PubMedCrossRef
13.
go back to reference Kalra MK, Maher MM, Toth TL et al (2004) Strategies for CT radiation dose optimization. Radiology 230:619–628PubMedCrossRef Kalra MK, Maher MM, Toth TL et al (2004) Strategies for CT radiation dose optimization. Radiology 230:619–628PubMedCrossRef
14.
go back to reference Alkadhi H, Leschka S (2011) Radiation dose of cardiac computed tomography—what has been achieved and what needs to be done. Eur Radiol 21:505–509PubMedCrossRef Alkadhi H, Leschka S (2011) Radiation dose of cardiac computed tomography—what has been achieved and what needs to be done. Eur Radiol 21:505–509PubMedCrossRef
15.
go back to reference Schell B, Bauer RW, Lehnert T et al (2011) Low-dose computed tomography of the paranasal sinus and facial skull using a high-pitch dual-source system–first clinical results. Eur Radiol 21:107–112PubMedCrossRef Schell B, Bauer RW, Lehnert T et al (2011) Low-dose computed tomography of the paranasal sinus and facial skull using a high-pitch dual-source system–first clinical results. Eur Radiol 21:107–112PubMedCrossRef
16.
go back to reference Kazerooni E, Sundaram B, Hohenberg P, Hanlon D Availability, Awareness, and Use of Dose Reduction Technologies among Radiologists: The CT Awareness of Radiation Exposure Study (CARES). scientific presentation at RSNA meeting 2008 Kazerooni E, Sundaram B, Hohenberg P, Hanlon D Availability, Awareness, and Use of Dose Reduction Technologies among Radiologists: The CT Awareness of Radiation Exposure Study (CARES). scientific presentation at RSNA meeting 2008
18.
go back to reference Treier R, Aroua A, Verdun FR, Samara E, Stuessi A, Trueb PR (2010) Patient doses in CT examinations in Switzerland: implementation of national diagnostic reference levels. Radiat Prot Dosimetry 142:244–254PubMedCrossRef Treier R, Aroua A, Verdun FR, Samara E, Stuessi A, Trueb PR (2010) Patient doses in CT examinations in Switzerland: implementation of national diagnostic reference levels. Radiat Prot Dosimetry 142:244–254PubMedCrossRef
19.
go back to reference Huda W, Ogden KM, Khorasani MR (2008) Converting dose-length product to effective dose at CT. Radiology 248:995–1003PubMedCrossRef Huda W, Ogden KM, Khorasani MR (2008) Converting dose-length product to effective dose at CT. Radiology 248:995–1003PubMedCrossRef
20.
go back to reference International Commission on Radiological Protection (2008) 2007 Recommendations of the International Commission on Radiological, Annals of the ICRP, ICRP Publication 103. Pergamon, Oxford International Commission on Radiological Protection (2008) 2007 Recommendations of the International Commission on Radiological, Annals of the ICRP, ICRP Publication 103. Pergamon, Oxford
21.
go back to reference Kalra MK, Maher MM, Blake MA et al (2004) Detection and characterization of lesions on low-radiation-dose abdominal CT images postprocessed with noise reduction filters. Radiology 232:791–797PubMedCrossRef Kalra MK, Maher MM, Blake MA et al (2004) Detection and characterization of lesions on low-radiation-dose abdominal CT images postprocessed with noise reduction filters. Radiology 232:791–797PubMedCrossRef
22.
go back to reference Funama Y, Awai K, Miyazaki O et al (2006) Improvement of low-contrast detectability in low-dose hepatic multidetector computed tomography using a novel adaptive filter: evaluation with a computer-simulated liver including tumors. Invest Radiol 41:1–7PubMedCrossRef Funama Y, Awai K, Miyazaki O et al (2006) Improvement of low-contrast detectability in low-dose hepatic multidetector computed tomography using a novel adaptive filter: evaluation with a computer-simulated liver including tumors. Invest Radiol 41:1–7PubMedCrossRef
23.
go back to reference Shin HO, Falck CV, Galanski M (2004) Low-contrast detectability in volume rendering: a phantom study on multidetector-row spiral CT data. Eur Radiol 14:341–349PubMedCrossRef Shin HO, Falck CV, Galanski M (2004) Low-contrast detectability in volume rendering: a phantom study on multidetector-row spiral CT data. Eur Radiol 14:341–349PubMedCrossRef
24.
go back to reference von Falck C, Galanski M, Shin HO (2010) Informatics in radiology: sliding-thin-slab averaging for improved depiction of low-contrast lesions with radiation dose savings at thin-section CT. Radiographics 30:317–326CrossRef von Falck C, Galanski M, Shin HO (2010) Informatics in radiology: sliding-thin-slab averaging for improved depiction of low-contrast lesions with radiation dose savings at thin-section CT. Radiographics 30:317–326CrossRef
25.
go back to reference Brink JA, Amis ES Jr (2010) Image Wisely: a campaign to increase awareness about adult radiation protection. Radiology 257:601–602PubMedCrossRef Brink JA, Amis ES Jr (2010) Image Wisely: a campaign to increase awareness about adult radiation protection. Radiology 257:601–602PubMedCrossRef
26.
go back to reference Goske MJ, Applegate KE, Boylan J et al (2008) The Image Gently campaign: working together to change practice. AJR Am J Roentgenol 190:273–274PubMedCrossRef Goske MJ, Applegate KE, Boylan J et al (2008) The Image Gently campaign: working together to change practice. AJR Am J Roentgenol 190:273–274PubMedCrossRef
27.
go back to reference Raff GL, Chinnaiyan KM, Share DA et al (2009) Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques. JAMA 301:2340–2348PubMedCrossRef Raff GL, Chinnaiyan KM, Share DA et al (2009) Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques. JAMA 301:2340–2348PubMedCrossRef
28.
go back to reference Wallace AB, Goergen SK, Schick D, Soblusky T, Jolley D (2010) Multidetector CT dose: clinical practice improvement strategies from a successful optimization program. J Am Coll Radiol 7:614–624PubMedCrossRef Wallace AB, Goergen SK, Schick D, Soblusky T, Jolley D (2010) Multidetector CT dose: clinical practice improvement strategies from a successful optimization program. J Am Coll Radiol 7:614–624PubMedCrossRef
29.
go back to reference Hricak H, Brenner DJ, Adelstein SJ et al (2010) Managing radiation use in medical imaging: a multifaceted challenge. Radiology 258:889–905PubMedCrossRef Hricak H, Brenner DJ, Adelstein SJ et al (2010) Managing radiation use in medical imaging: a multifaceted challenge. Radiology 258:889–905PubMedCrossRef
30.
go back to reference Ertl-Wagner BB, Hoffmann RT, Bruning R et al (2004) Multi-detector row CT angiography of the brain at various kilovoltage settings. Radiology 231:528–535PubMedCrossRef Ertl-Wagner BB, Hoffmann RT, Bruning R et al (2004) Multi-detector row CT angiography of the brain at various kilovoltage settings. Radiology 231:528–535PubMedCrossRef
31.
go back to reference Waaijer A, Prokop M, Velthuis BK, Bakker CJ, de Kort GA, van Leeuwen MS (2007) Circle of Willis at CT angiography: dose reduction and image quality–reducing tube voltage and increasing tube current settings. Radiology 242:832–839PubMedCrossRef Waaijer A, Prokop M, Velthuis BK, Bakker CJ, de Kort GA, van Leeuwen MS (2007) Circle of Willis at CT angiography: dose reduction and image quality–reducing tube voltage and increasing tube current settings. Radiology 242:832–839PubMedCrossRef
32.
go back to reference Schueller-Weidekamm C, Schaefer-Prokop CM, Weber M, Herold CJ, Prokop M (2006) CT angiography of pulmonary arteries to detect pulmonary embolism: improvement of vascular enhancement with low kilovoltage settings. Radiology 241:899–907PubMedCrossRef Schueller-Weidekamm C, Schaefer-Prokop CM, Weber M, Herold CJ, Prokop M (2006) CT angiography of pulmonary arteries to detect pulmonary embolism: improvement of vascular enhancement with low kilovoltage settings. Radiology 241:899–907PubMedCrossRef
33.
go back to reference Heyer CM, Mohr PS, Lemburg SP, Peters SA, Nicolas V (2007) Image quality and radiation exposure at pulmonary CT angiography with 100- or 120-kVp protocol: prospective randomized study. Radiology 245:577–583PubMedCrossRef Heyer CM, Mohr PS, Lemburg SP, Peters SA, Nicolas V (2007) Image quality and radiation exposure at pulmonary CT angiography with 100- or 120-kVp protocol: prospective randomized study. Radiology 245:577–583PubMedCrossRef
34.
go back to reference Szucs-Farkas Z, Schaller C, Bensler S, Patak MA, Vock P, Schindera ST (2009) Detection of pulmonary emboli with CT angiography at reduced radiation exposure and contrast material volume: comparison of 80 kVp and 120 kVp protocols in a matched cohort. Invest Radiol 44:793–799PubMedCrossRef Szucs-Farkas Z, Schaller C, Bensler S, Patak MA, Vock P, Schindera ST (2009) Detection of pulmonary emboli with CT angiography at reduced radiation exposure and contrast material volume: comparison of 80 kVp and 120 kVp protocols in a matched cohort. Invest Radiol 44:793–799PubMedCrossRef
35.
go back to reference Wintersperger B, Jakobs T, Herzog P et al (2005) Aorto-iliac multidetector-row CT angiography with low kV settings: improved vessel enhancement and simultaneous reduction of radiation dose. Eur Radiol 15:334–341PubMedCrossRef Wintersperger B, Jakobs T, Herzog P et al (2005) Aorto-iliac multidetector-row CT angiography with low kV settings: improved vessel enhancement and simultaneous reduction of radiation dose. Eur Radiol 15:334–341PubMedCrossRef
36.
go back to reference Kalva SP, Sahani DV, Hahn PF, Saini S (2006) Using the K-edge to improve contrast conspicuity and to lower radiation dose with a 16-MDCT: a phantom and human study. J Comput Assist Tomogr 30:391–397PubMedCrossRef Kalva SP, Sahani DV, Hahn PF, Saini S (2006) Using the K-edge to improve contrast conspicuity and to lower radiation dose with a 16-MDCT: a phantom and human study. J Comput Assist Tomogr 30:391–397PubMedCrossRef
37.
go back to reference Schindera ST, Nauer C, Treier R et al (2010) Strategies for reducing the CT radiation dose. Radiologe 50:1120–1127PubMedCrossRef Schindera ST, Nauer C, Treier R et al (2010) Strategies for reducing the CT radiation dose. Radiologe 50:1120–1127PubMedCrossRef
38.
go back to reference Loupatatzis C, Schindera S, Gralla J et al (2008) Whole-body computed tomography for multiple traumas using a triphasic injection protocol. Eur Radiol 18:1206–1214PubMedCrossRef Loupatatzis C, Schindera S, Gralla J et al (2008) Whole-body computed tomography for multiple traumas using a triphasic injection protocol. Eur Radiol 18:1206–1214PubMedCrossRef
39.
go back to reference Kekelidze M, Dwarkasing RS, Dijkshoorn ML, Sikorska K, Verhagen PC, Krestin GP (2010) Kidney and urinary tract imaging: triple-bolus multidetector CT urography as a one-stop shop–protocol design, opacification, and image quality analysis. Radiology 255:508–516PubMedCrossRef Kekelidze M, Dwarkasing RS, Dijkshoorn ML, Sikorska K, Verhagen PC, Krestin GP (2010) Kidney and urinary tract imaging: triple-bolus multidetector CT urography as a one-stop shop–protocol design, opacification, and image quality analysis. Radiology 255:508–516PubMedCrossRef
40.
go back to reference Schindera ST, Nelson RC, Toth TL et al (2008) Effect of patient size on radiation dose for abdominal MDCT with automatic tube current modulation: phantom study. AJR Am J Roentgenol 190:W100–105PubMedCrossRef Schindera ST, Nelson RC, Toth TL et al (2008) Effect of patient size on radiation dose for abdominal MDCT with automatic tube current modulation: phantom study. AJR Am J Roentgenol 190:W100–105PubMedCrossRef
41.
go back to reference Nauer CB, Kellner-Weldon F, Von Allmen G, Schaller D, Gralla J (2009) Effective doses from scan projection radiographs of the head: impact of different scanning practices and comparison with conventional radiography. AJNR Am J Neuroradiol 30:155–159PubMedCrossRef Nauer CB, Kellner-Weldon F, Von Allmen G, Schaller D, Gralla J (2009) Effective doses from scan projection radiographs of the head: impact of different scanning practices and comparison with conventional radiography. AJNR Am J Neuroradiol 30:155–159PubMedCrossRef
42.
go back to reference O’Daniel JC, Stevens DM, Cody DD (2005) Reducing radiation exposure from survey CT scans. AJR Am J Roentgenol 185:509–515PubMed O’Daniel JC, Stevens DM, Cody DD (2005) Reducing radiation exposure from survey CT scans. AJR Am J Roentgenol 185:509–515PubMed
43.
go back to reference Smith AB, Dillon WP, Gould R, Wintermark M (2007) Radiation dose-reduction strategies for neuroradiology CT protocols. AJNR Am J Neuroradiol 28:1628–1632PubMedCrossRef Smith AB, Dillon WP, Gould R, Wintermark M (2007) Radiation dose-reduction strategies for neuroradiology CT protocols. AJNR Am J Neuroradiol 28:1628–1632PubMedCrossRef
44.
go back to reference Kalra MK, Maher MM, Toth TL, Kamath RS, Halpern EF, Saini S (2004) Radiation from “extra” images acquired with abdominal and/or pelvic CT: effect of automatic tube current modulation. Radiology 232:409–414PubMedCrossRef Kalra MK, Maher MM, Toth TL, Kamath RS, Halpern EF, Saini S (2004) Radiation from “extra” images acquired with abdominal and/or pelvic CT: effect of automatic tube current modulation. Radiology 232:409–414PubMedCrossRef
45.
go back to reference Brink M, de Lange F, Oostveen LJ et al (2008) Arm raising at exposure-controlled multidetector trauma CT of thoracoabdominal region: higher image quality, lower radiation dose. Radiology 249:661–670PubMedCrossRef Brink M, de Lange F, Oostveen LJ et al (2008) Arm raising at exposure-controlled multidetector trauma CT of thoracoabdominal region: higher image quality, lower radiation dose. Radiology 249:661–670PubMedCrossRef
46.
go back to reference Li J, Udayasankar UK, Toth TL, Small WC, Kalra MK (2008) Application of automatic vertical positioning software to reduce radiation exposure in multidetector row computed tomography of the chest. Invest Radiol 43:447–452PubMedCrossRef Li J, Udayasankar UK, Toth TL, Small WC, Kalra MK (2008) Application of automatic vertical positioning software to reduce radiation exposure in multidetector row computed tomography of the chest. Invest Radiol 43:447–452PubMedCrossRef
47.
go back to reference Matsubara K, Koshida K, Ichikawa K et al (2009) Misoperation of CT automatic tube current modulation systems with inappropriate patient centering: phantom studies. AJR Am J Roentgenol 192:862–865PubMedCrossRef Matsubara K, Koshida K, Ichikawa K et al (2009) Misoperation of CT automatic tube current modulation systems with inappropriate patient centering: phantom studies. AJR Am J Roentgenol 192:862–865PubMedCrossRef
Metadata
Title
An education and training programme for radiological institutes: impact on the reduction of the CT radiation dose
Authors
Sebastian T. Schindera
Reto Treier
Gabriel von Allmen
Claude Nauer
Philipp R. Trueb
Peter Vock
Zsolt Szucs-Farkas
Publication date
01-10-2011
Publisher
Springer-Verlag
Published in
European Radiology / Issue 10/2011
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-011-2168-5

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