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Adult exposures from MDCT including multiphase studies: first Italian nationwide survey

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the radiation dose in routine multidetector computed tomography (MDCT) examinations in Italian population.

Methods

This was a retrospective multicentre study included 5,668 patients from 65 radiology departments who had undergone common CT protocols: head, chest, abdomen, chest–abdomen–pelvis (CAP), spine and cardiac. Data included patient characteristics, CT parameters, volumetric CT dose index (CTDIvol) and dose length product (DLP) for each CT acquisition phase. Descriptive statistics were calculated, and a multi-regression analysis was used to outline the main factors affecting exposure.

Results

The 75th percentiles of CTDIvol (mGy) and DLP (mGy cm) for whole head were 69 mGy and 1,312 mGy cm, respectively; for chest, 15 mGy and 569 mGy cm; spine, 42 mGy and 888 mGy cm; cardiac, 7 mGy and 131 mGy cm for calcium score, and 61 mGy and 1,208 mGy cm for angiographic CT studies. High variability was present in the DLP of abdomen and CAP protocols, where multiphase examinations dominated (71 % and 73 % respectively): for abdomen, 18 mGy, with 555 and 920 mGy cm in abdomen and abdomen–pelvis acquisitions respectively; for CAP, 17 mGy, with 508, 850 and 1,200 mGy cm in abdomen, abdomen–pelvis and CAP acquisitions respectively.

Conclusion

The results of this survey could help in the definition of updated diagnostic reference levels (DRL).

Key Points

• Radiation dose associated with multidetector CT (MDCT) is an important health issue.

• This national survey assessed dose exposures of 5,668 patients undergoing MDCT.

• Dose indices correlate with BMI, voltage, rotation time, pitch and tube current.

• These results may contribute to an update of national diagnostic reference levels.

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Abbreviations

AIFM:

Italian Society of Medical Physics

BMI:

body mass index

CAP:

chest–abdomen–pelvis

CI:

confidence interval

CTDIvol :

volumetric computed tomography dose index

DLP:

dose length product

DRL:

diagnostic reference levels

ECTCM:

electrocardiographically controlled tube current modulation

FOV:

field of view

GEE:

generalized estimating equations

MDCT:

multidetector computed tomography

MV:

mean value

RIS:

radiology information system

SD:

standard deviation

SIRM:

Italian Society of Radiology

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Acknowledgments

We are pleased to acknowledge the collaboration of numerous radiologist colleagues and medical physicists (listed in the Appendix) that has allowed the achievement of this large-scale data collection. We are also grateful to the Italian Society of Radiology (SIRM) who financed and supported the study, and to the Italian Society of Medical Physics (AIFM), for its active collaboration.

Author information

Authors and Affiliations

  1. Fisica Sanitaria Istituto Europeo di Oncologia, Milan, Italy

    Federica Palorini & Daniela Origgi

  2. UOC di Radiologia Istituto Giannina Gaslini, Genoa, Italy

    Claudio Granata

  3. Dipartimento di Scienze per la Promozione della Salute e Materno-infantile “G. D’Alessandro”, Università degli Studi di Palermo, Palermo, Italy

    Domenica Matranga

  4. Dipartimento di Scienze Radiologiche, Policlinico Università di Palermo, Via del Vespro 127, 90127, Palermo, Italy

    Sergio Salerno

Authors
  1. Federica Palorini
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  2. Daniela Origgi
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  3. Claudio Granata
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  4. Domenica Matranga
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  5. Sergio Salerno
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Corresponding author

Correspondence to Sergio Salerno.

Appendix

Appendix

Participating centres

AOUP Policlinico Palermo, Ospedale P. V. Fazzi Lecce, Ospedale P.O. Spirito Santo Pescara, Ospedali Riuniti Ancona, Ospedale Maggiore Trieste, Azienda Ospedaliero Universitaria Careggi Firenze, A.O OIRM Sant'Anna Torino, Ospedale Belcolle ASL Viterbo, IRCCS Policlinico San Donato Milanese, Fatebenefratelli Sangiovanni Calabita Roma, Istituto Oncologico Veneto IRCCS Padova, Istituto Europeo di Oncologia Milano, Hsr Giglio Cefalù, Ospedale AOU Maggiore della Carità Novara, Ospedale San Donato Usl 8 Arezzo, Ospedale Carlo Poma Mantova, Istituto per la ricerca e la cura del cancro di Candiolo, Fondazione IRCC Policlinico San Matteo Pavia, Ospedale Circolo Fondazione Macchi Varese, Ospedale Niguarda Milano, Istituto Tumori Genova, ASL Cuneo 1, AO SS. Antonio e Biagio e C. Arrigo Alessandria, PO Santa Maria delle Grazie Pozzuoli, Ospedale San Bassiano Ulss3 Bassano del Grappa, Ospedale Santa Maria delle Croci Ravenna, Istituti Ospitalieri Cremona, A.O Città della salute e della scienza Torino, Ospedale Regionale U. Parini Ausl Valle d'aosta, Asl2 Savonese Ospedale Santa Corona Pietra Ligure, San Raffaele Milano, Azienda Ospedaliero Universitaria di Modena Policlinico, Azienda Ospedaliera San Gerardo Monza, Azienda Ospedaliera Polo Universitario L. Sacco Milano, Azienda Sanitaria di Firenze Ospedale del Mugello, Policlinico Universitario Messina, Azienda Sanitaria Locale Torino Ospedale Martini, Ospedale Asl 1 Imperiese Stabilimento Ospedaliero Imperia, Sanremo e Bordighera, Azienda Ospedaliera di Careggi Firenze, ASL 2 Savonese Ospedale Santa Maria di Misericordia Albenga, Azienda Ospedaliera Universitaria Santa Maria della Misericordia Udine, Ospedale Schio Thiene, Fondazione IRCCS Cà Grande Ospedale Maggiore Policlinico Milano, Ospedale Santa Chiara Trento, Asl 3 Genovese Villa Scassi Genova, Istituti Fisioterapici Ospedalieri Regina Elena Roma, Centro Cardiologico Monzino Milano, Fondazione IRCCS Istituto nazionale Tumori Milano, Ulss 20 Verona Ospedale Fracastoro, Azienda Ospedaliera Santa Maria della Misericordia Perugia, Asl Sassari Ospedale Santissima Annunnziata, Spedali Civili di Brescia, Azienda Ospedaliera Provincia Lecco, AOU Ospedale OORR San Giovanni di Dio e Ruggi D'aragona Salerno, Azienda Ospedaliera di Catanzaro Pugliese-Ciaccio, ASL TO 1 Ospedale Evangelico Valdese, Ospedale di Bressanone

Electronic appendix

For each CT examination performed, the phase 2 datasheet included the main data of the patients enrolled in the survey (age, gender, pseudonymous ID number and, if available, the weight and height) and the clinical indication.

For the main technical parameters that can affect dose, the datasheet included: tube voltage, use of automatic (anatomy-based) tube current modulation, fixed tube current value (for acquisitions without automatic modulation), the available current range (for automatic modulated acquisitions), tube rotation time, reconstructed slice thickness, beam collimation, CT field of view (CT acquisition FOV), z-axis length, the use of axial or spiral CT technique, pitch (for spiral acquisitions), reconstruction filter, the use of contrast agent and, if available, the image quality index used and the average mAs. For cardiac acquisitions, the presence of electrocardiographically controlled tube current modulation (ECTCM), the administration of beta-blockers, and the use of prospective vs retrospective acquisition mode were also recorded.

Finally, the dosimetric parameters of each phase were retrieved from the dose reports in terms of mean CTDIvol and Dose Length Product (DLP). The total DLP, referring to the complete patient examination, was also collected for completeness.

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Palorini, F., Origgi, D., Granata, C. et al. Adult exposures from MDCT including multiphase studies: first Italian nationwide survey. Eur Radiol 24, 469–483 (2014). https://doi.org/10.1007/s00330-013-3031-7

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