CT Practice Monitoring

  • Aiping Ding
  • Francesco Ria
  • Ehsan SameiEmail author


Computed tomography (CT) is a leading advanced imaging modality today. Its use, however, has raised concerns regarding utilization costs, appropriate applications, and the associated potential radiation risks. Programmatic radiation dose reporting software has emerged to monitor radiation exposure towards proper CT imaging. Proper imaging implies both radiation risk and clinical value: current CT practice is highly valuable in caring for illness and injury across all ages. Ensuring the benefit of CT examination requires a combined image quality and dose monitoring program. A poor-quality exam is a disservice to the care of the patient, while an exam with more radiation dose than necessary can undermine its safety. Therefore, proper CT imaging requires a combined image quality and dose monitoring program. Such a program is a required element of value-based practice in CT imaging, providing opportunities for improved individual decision-making as well as for assessing and addressing the aggregate aspects of CT imaging practice to ensure rigorous patient safety and consistent imaging quality. This in turn paves the way towards consistent and high-quality imaging care across the healthcare enterprise.


Patient dose monitoring Image quality monitoring Value-based care CT protocol Computed Tomography 


  1. 1.
    Brenner DJ. Should we be concerned about the rapid increase in CT usage? Rev Environ Health. 2010;25(1):63–8.CrossRefGoogle Scholar
  2. 2.
    Sodickson A, Beayens PF, Andriole KP, Prevedello LM, Nawfel RD, Hanson R, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology. 2009;251(1):175–84.CrossRefGoogle Scholar
  3. 3.
    Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Pyo Kim K, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499–505.CrossRefGoogle Scholar
  4. 4.
    Boone JM, Hendee WR, McNitt-Gray MF, Seltzer SE. Radiation exposure from CT scans: how to close our knowledge gaps, monitor and safeguard exposure--proceedings and recommendations of the radiation dose summit, sponsored by NIBIB, February 24–25, 2011. Radiology. 2012;265(2):544–54.CrossRefGoogle Scholar
  5. 5.
    Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology. 2004;231(2):440–5.CrossRefGoogle Scholar
  6. 6.
    Meeson S, Patel R, Golding S. Clinical expansion of CT and radiation dose. In: Tack D, Kalra MK, Gevenois PA, editors. Radiation dose from multidetector CT. 2nd ed. Berlin: Springer-Verlag; 2012. p. 21–32.CrossRefGoogle Scholar
  7. 7.
    Bogdanich W, McGinty JC. Medicare claims show overuse for CT scanning. The New York Times [internet]. 17th June 2011. Available from
  8. 8.
    United Nations Scientific Committee on the Effects of Atomic Radiation. Sources and effects of ionizing radiation. UNSCEAR 2008 report to the general assembly with scientific annexes. New York: United Nations; 2010.Google Scholar
  9. 9.
    Brenner DJ. Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol. 2002;32(4):228–31.CrossRefGoogle Scholar
  10. 10.
    US Food and Drug Administration. White paper: initiative to reduce unnecessary radiation exposure from medical imaging. 2010.
  11. 11.
    Morin RL, Coombs LP, Chatfield MB. ACR dose index registry. J Am Coll Radiol. 2011;8(4):288–91.CrossRefGoogle Scholar
  12. 12.
    The Joint Commission. Radiation risks of diagnostic imaging. The joint commission: sentinel event alert. 2011;47:1–4..
  13. 13.
    Boone S, Cody D, Mc Collough C, McNitt-Gray M, Toth T. Size specific dose estimates (SSDE) in pediatric and adult body CT examinations. AAPM report no. 204. College Park: American Association of Physicists in Medicine; 2011.Google Scholar
  14. 14.
    NCRP 2009 Ionizing radiation exposure of the population of the United States NCRP Report no. 160. National Council on Radiation Protection and Measurements, 2009.Google Scholar
  15. 15.
    Li X, Samei E, Segars WP, Sturgeon GM, Colsher JG, Frush DP. Patient-specific radiation dose and cancer risk for pediatric chest CT. Radiology. 2011;259(3):862–74.CrossRefGoogle Scholar
  16. 16.
    Samei E, Tian X, Segars WP, Frush DP. Radiation risk index for pediatric CT: a patient-derived metric. Pediatr Radiol. 2017;47(13):1737–174.CrossRefGoogle Scholar
  17. 17.
    Dougeni E, Faulkner K, Panayiotakis G. A review of patient dose and optimization methods in adult and paediatric CT scanning. Eur J Radiol. 2012;81:e665–83.CrossRefGoogle Scholar
  18. 18.
    Abadi E, Sanders J, Samei E. Patient-specific quantification of image quality: an automated technique for measuring the distribution of organ Hounsfield units in clinical chest CT images. Med Phys. 2017;44(9):4736–46.CrossRefGoogle Scholar
  19. 19.
    Christianson O, Winslow J, Frush DP, Samei E. Automated technique to measure noise in clinical CT examinations. AJR. 2015;205:W93–9.CrossRefGoogle Scholar
  20. 20.
    Sanders J, Hurwitz L, Samei E. Patient-specific quantification of image quality: an automated method for measuring spatial resolution in clinical CT images. Med Phys. 2016;43(10):5330–8.CrossRefGoogle Scholar
  21. 21.
    Ria F, Davis JT, Solomon JB, Wilson JM, Smith TB, Frush DP, et al. Expanding the Concept of Diagnostic Reference Levels to Noise and Dose Reference Levels in CT. AJR Am J Roentgenol. 2019;213:1–6.CrossRefGoogle Scholar
  22. 22.
    ICRP. Diagnostic reference levels in medical imaging, ICRP Publication 135. Ann ICRP. 2017;46(1).Google Scholar
  23. 23.
    Frush DP, Samei E. CT radiation dose monitoring: current state and new prospects CME. Medscape [internet]. 19th March 2015. Available from
  24. 24.
  25. 25.
    Radiation Control: Health Facilities and Clinics, SB1237, 19 February 2010.
  26. 26.
    Texas Department of State Health Services. Computed Tomography (CT): Radiation Control Program. Updated 29 Dec 2011.
  27. 27.
    International Atomic Energy Agency, Radiation Protection of Patients (RPOP) – Diagnostic Reference Levels (DRLs). IAEA; 2017.
  28. 28.
    Ria F, Wilson JM, Zhang Y, Samei E. Image noise and dose performance across a clinical population: patient size adaptation as a metric of CT performance. Med Phys. 2017;44(6):2141–7.CrossRefGoogle Scholar
  29. 29.
    Samei E, Järvinen H, Kortesniemi M, Simantirakis G, Goh C, Wallace A, et al. Medical imaging dose optimization from ground up: expert opinion of an international summit. J Radiol Prot. 2018;38:967–89.CrossRefGoogle Scholar
  30. 30.
    Ria F, Bergantin A, Vai A, Bonfanti P, Martinotti AS, Redaelli I, et al. Awareness of medical radiation exposure among patients: a patient survey as a first step for effective communication of ionizing radiation risks. Phys Med. 2017;43:57–62.CrossRefGoogle Scholar
  31. 31.
    Zhang Y, Samei E, Nair S, Coombs LP, Jackson EF, Sullivan DC. Quantitative performance for ACR CT accreditation images across different vendors, protocols, and institutions: initial report of an ACR-RSNA collaboration. 102th RSNA conference, Nov 27th–Dec 2nd 2016, Chicago.Google Scholar
  32. 32.
    Christianson O, Chen JS, Yang Z, et al. An improved index of image quality for task-based performance of CT iterative reconstruction across three commercial implementations. Radiology. 2015;275(3):725–34.CrossRefGoogle Scholar
  33. 33.
    Christianson O, Li X, Frush DP, Samei E. Automated size-specific CT dose monitoring program: assessing variability in CT dose. Med Phys. 2012;39(11):7131–9.CrossRefGoogle Scholar
  34. 34.
    National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. 2006.Google Scholar
  35. 35.
    Ria F, Fu W, Hoye J, Segars WP, Kapadia A, Samei E. Characterization of radiation risk across a clinical CT patient population: comparison across 12 risks metrics. 104th RSNA conference. Nov 25th–30th 2018, Chicago, IL.Google Scholar
  36. 36.
    Mabotuwana T, Lee MC, Cohen-Solal EV, Chang P. Mapping institution-specific study descriptions to RadLex playbook entries. J Digit Imaging. 2014;27:321–30.CrossRefGoogle Scholar
  37. 37.
    Kanal KM, Butler PF, Sengupta D, Bhargavan-Chatfield M, Coombs LP, Morin RLUS. Diagnostic reference levels and achievable doses for 10 adult CT examinations. Radiology. 2017;284:120–34.CrossRefGoogle Scholar
  38. 38.
    Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 2010;256:32–61.CrossRefGoogle Scholar
  39. 39.
    American Association of Physicists in Medicine. Use of water equivalent diameter for calculating patient size and size-specific dose estimates (SSDE) in CT, Report no. 220. Report of the AAPM task group 220. College Park: AAPM; 2014.Google Scholar
  40. 40.
    McCollough CH, Leng S, Yu L, Cody DD, Boon JM, McNitt-Gray MF. CT dose index and patient dose: they are not the same thing. Radiology. 2011;259(2):311–6.CrossRefGoogle Scholar
  41. 41.
    Tian X, Li X, Segars WP, Frush DP, Paulson EK, Samei E. Dose coefficients in pediatric and adult abdominopelvic CT based on 100 patient models. Phys Med Biol. 2013;58(24):8755–68.CrossRefGoogle Scholar
  42. 42.
    Tian X, Li X, Segars WP, Frush DP, Samei E. Prospective estimation of organ dose in CT under tube current modulation. Med Phys. 2015;42(4):1575–85.CrossRefGoogle Scholar
  43. 43.
    Tian X, Samei E. Accurate assessment and prediction of noise in clinical CT images. Med Phys. 2015;43(1):475–82.CrossRefGoogle Scholar
  44. 44.
    Li X, Samei E, Segars WP, Sturgeon GM, Colsher JG, Toncheva G, et al. Patient-specific radiation dose and cancer risk estimation in CT: part I. development and validation of a Monte Carlo program. Med Phys. 2011;38(1):397–407.CrossRefGoogle Scholar
  45. 45.
    Li X, Samei E, Segars WP, Sturgeon GM, Colsher JG, Toncheva G, et al. Patient-specific radiation dose and cancer risk estimation in CT: part II. Application to patients. Med Phys. 2011;38(1):408–19.CrossRefGoogle Scholar
  46. 46.
    Fu W, Sturgeon GM, Agasthya G, Segars WP, Kapadia AJ, Samei E. Breast dose reduction with organ-based, wide-angle tube current modulated CT. J Med Imaging. 2017;4(3):031208.CrossRefGoogle Scholar
  47. 47.
    Fu W, Sharma S, Smith TB, Hou R, Abadi E, Vignesh S, et al. Multi-organ segmentation in clinical-computed tomography for patient-specific image quality and dose metrology. Proceedings Volume 10948, Medical Imaging 2019: Physical of Medical Imaging. 2019:1094829.Google Scholar
  48. 48.
    Ding A, Wilson J, Solomon J, Zhang Y, Mann S, Nelson J, Wells J, Samei E. METIS: next-generation performance informatics platform for value-based clinical imaging practice, 104th RSNA conference, 25th–30th Nov 2018, Chicago.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Clinical Imaging Physics GroupDuke UniversityDurhamUSA
  2. 2.Department of RadiologyDuke UniversityDurhamUSA

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