Abstract
The past decade has seen a significant growth in diagnostic CT imaging as a direct result of the clinical value provided by CT imaging. At the same time, many new techniques and resources are now available to make CT imaging safe. This article presents the basics of CT dosimetry and their usage in clinical practices, methods to implement CT dose reduction, followed by a summary of legislation, and guidelines related to patient safety in diagnostic CT imaging. Also, CT radiation dose diagnostic reference levels from published regional and national surveys are reviewed and applied in a CT dose tracking and monitoring program.
Similar content being viewed by others
References
IMV—Medical Information Division (2014) CT Market Outlook Report [Internet] 2014. http://www.imvinfo.com/index.aspx?sec=ct&sub=dis&itemid=200081. Accessed Oct 8 2015
National Council on Radiation Protection and Measurements (2009) Ionizing radiation exposure of the population of the United States. Report No. 160 ed. Bethesda, MD: NCRP
National Council on Radiation Protection and Measurements (1987) Ionizing radiation exposure of the population of the United States. Report No. 93 ed. Bethesda, MD: NCRP
Kalender WA (2014) Dose in X-ray computed tomography. Phys Med Biol 59(3):R129–R150
American College of Radiology (2015) The ACR Appropriateness Criteria® [Internet]. http://www.acr.org/Quality-Safety/Appropriateness-Criteria/About-AC. Accessed 8 Oct 2015
The Alliance for Radiation in Pediatric Imaging (2015) Image Gently Campaign [Internet]. http://www.imagegently.org/. Accessed 8 Oct 2015
American College of Radiology (2015) Image Wisely Campaign [Internet]. http://www.imagewisely.org/. Accessed 8 Oct 2015
Jucius RA, Kambic GX (1977) Radiation dosimetry in computed tomography. Appl Opt Instrum Eng Med. 127:286–295
Shope TB, Gagne RM, Johnson GC (1981) A method for describing the doses delivered by transmission X-ray computed tomography. Med Phys 8(4):488–495
FDA (1984) Department of Health and Human Services, Food and Drug Administration. Code of Federal Regulations, 21 CFR Part 1020.33, Government Printing Office. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?FR=1020.33. Accessed 9 Mar 2016
Nickoloff EL, Dutta AK, Lu ZF (2003) Influence of phantom diameter, kVp and scan mode upon computed tomography dose index. Med Phys 30(3):395–402
Boone J, Strauss K, Cody D, McCollough C, McNitt-Gray M, Toth T (2011) Size-specific dose estimates (SSDE) in pediatric and adult body CT exams: Report of AAPM Task Group 204
McCollough C, Bakalyar DM, Bostani M, Brady S, Boedeker K, Boone JM, et al. (2014) Use of water equivalent diameter for calculating patient size and size-specific dose estimates (SSDE) in CT: the Report of AAPM Task Group 220
O’Connell T, Chang D, Aldrich JE, Mayo JR (2010) Creating an unified patient radiation dose tracking system. Chicago: Radiological Society of North America. https://www.rsna.org/uploadedFiles/RSNA/Content/Science_and_Education/Quality/3062-OConnell.pdf. Accessed 9 Mar 2016
Jones DG, Shrimpton PC (1991) Survey of CT practice in the UK. Part 3: normalised organ doses calculated using monte carlo techniques. Chilton
The 2007 Recommendations of the International Commission on Radiological Protection (2007) ICRP Publication 103, Ann. ICRP 37 (2–4), ICRP
Deak PD, Smal Y, Kalender WA (2010) Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 257(1):158–166
Blitman NM, Anwar M, Brady KB, Taragin BH, Freeman K (2015) Value of focused appendicitis ultrasound and alvarado score in predicting appendicitis in children: Can we reduce the use of CT? Am J Roentgenol 204(6):W707–W712
Spalluto LB, Woodfield CA, DeBenedectis CM, Lazarus E (2012) MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes. RadioGraphics 32(2):317–334
Patz EF Jr, Erasmus JJ, McAdams HP, et al. (1999) Lung cancer staging and management: comparison of contrast-enhanced and nonenhanced helical CT of the thorax. Radiology 212(1):56–60
Levin DC, Parker L, Halpern EJ, Rao VM (2014) Are combined CT scans of the thorax being overused? J Am Coll Radiol 11(8):788–790
Sadigh G, Applegate KE, Baumgarten DA (2014) Comparative accuracy of intravenous contrast-enhanced CT versus noncontrast CT plus intravenous contrast-enhanced CT in the detection and characterization of patients with hypervascular liver metastases: a critically appraised topic. Acad Radiol 21(1):113–125
Fletcher JG, Wiersema MJ, Farrell MA, et al. (2003) Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 229(1):81–90
Kalra MK, Maher MM, Toth TL, et al. (2004) Techniques and applications of automatic tube current modulation for CT. Radiology 233(3):649–657
Bae KT (2010) Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology 256(1):32–61
Patino M, Fuentes JM, Singh S, Hahn PF, Sahani DV (2015) Iterative reconstruction techniques in abdominopelvic CT: technical concepts and clinical implementation. Am J Roentgenol 205(1):W19–W31
Prepublication requirements: revised requirements for diagnostic imaging services, issued January 9, 2015, effective July 1, 2015. The Joint Commission 2015.
Cody DD, Pfeiffer D, McNitt-Gray MF, Ruckdeschel TG, Strauss KJ (2012) ACR computed tomography quality control manual. American College of Radiology
Shih G, Lu ZF, Zabih R, et al. (2011) Automated framework for digital radiation dose index reporting from CT dose reports. Am J Roentgenol 197(5):1170–1174
Medical Imaging and Technology Alliance. [Internet] (2015) Accessed 8 Oct 2015. http://www.medicalimaging.org/policy-and-positions/mita-smart-dose/
Protecting Access to Medicare Act of 2014 (2014) 113th Congress (2013–2014); 2014 Public Law No: 113–93. Accessed 8 Oct 2015. https://www.congress.gov/bill/113th-congress/house-bill/4302
Radiation protection (1997) Protection from potential exposures: application to selected radiation sources. A report of a task group of the International Commission on Radiation Protection. Ann ICRP 27(2):1–61
Shrimpton PC, Hillier MC, Meeson S, Golding SJ, Public Health E, Centre for Radiation C, et al. (2014) Doses from computer tomography (CT) examinations in the UK, 2011 review
National Council on Radiation Protection and Measurements (2012) Reference levels and achievable doses in medical and dental imaging: recommendations for the United States. Report No. 172. Bethesda: NCRP
Christianson O, Li X, Frush D, Samei E (2012) Automated size-specific CT dose monitoring program: assessing variability in CT dose. Med Phys 39(11):7131–7139
American College of Radiology (2015) Dose index registry [Internet]. http://www.acr.org/quality-safety/national-radiology-data-registry/dose-index-registry. Accessed 8 Oct 2015
Brink JA, Miller DL (2015) U.S. national diagnostic reference levels: closing the gap. Radiology 277(1):3–6
Escalon JG, Chatfield MB, Sengupta D, Loftus ML (2015) Dose length products for the 10 most commonly ordered CT examinations in adults: analysis of three years of the ACR dose index registry. J Am Coll Radiol 12(8):815–823
Radiological Society of North American (2015) RadLex Playbook [Internet]. https://www.rsna.org/RadLex_Playbook.aspx. Accessed 8 Oct 2015
Smith-Bindman R, Moghadassi M, Wilson N, et al. (2015) Radiation doses in consecutive CT examinations from five University of California Medical Centers. Radiology 277(1):134–141
MacGregor K, Li I, Dowdell T, Gray BG (2015) Identifying institutional diagnostic reference levels for CT with radiation dose index monitoring software. Radiology 276(2):507–517
McCollough CH, Bushberg JT, Fletcher JG, Eckel LJ (2015) Answers to Common Questions About the Use and Safety of CT Scans. Mayo Clin Proc 90(10):1380–1392
Health Physics Society (1996) Position statement of the Health Physics Society: radiation risk in perspective [Internet]. Accessed https://hps.org/documents/risk_ps010-2.pdf
National Council on Radiation Protection and Measurements (2012) Uncertainties in the estimation of radiation risks and probability of disease causation. Report No. 171. Bethesda, MD: NCRP
International Organization for Medical Physics (2013) Predictions of induced cancers and cancer deaths in a population of patients exposed to low doses (<100 mSv) of ionizing radiation during medical imaging procedures. [Internet], IOMP. http://www.iomp.org/sites/default/files/policy_statement_3.pdf. Accessed 8 Oct 2015
American Association of Physicists in Medicine (2011) Position statement on radiation risks from medical imaging procedures [Internet]. http://www.aapm.org/org/policies/details.asp?id=318&type=PP. Accessed 8 Oct 2015
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lu, Z.F., Thomas, S. Imaging wisely: patient safety in CT. Abdom Radiol 41, 452–460 (2016). https://doi.org/10.1007/s00261-016-0676-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-016-0676-0