Abstract
Background
Many patients at our pediatric hospital have had a contrast-enhanced CT of the abdomen and pelvis performed by an outside imaging facility before admission. We have noticed that many of these exams are multiphase, which may contribute to unnecessary radiation dose.
Objective
To determine the frequency of multiphase acquisitions and radiation dose indices in contrast-enhanced CTs of the abdomen and pelvis performed by outside imaging facilities in patients who were subsequently transferred to our pediatric hospital for care, and compare these metrics to contrast-enhanced CTs of the abdomen and pelvis performed internally.
Materials and methods
A retrospective analysis was performed of contrast-enhanced CTs of the abdomen and pelvis from outside imaging facilities uploaded to our picture archiving and communication system (PACS) between January 1, 2012, and December 31, 2015. CT images and dose pages were reviewed to determine the number of phases and dose indices (CT dose index–volume [CTDIvol], dose-length product, size-specific dose estimate). Exams for abdominal or pelvic mass, trauma or urinary leak indications were excluded. Data were compared to internally acquired contrast-enhanced CTs of the abdomen and pelvis by querying the American College of Radiology (ACR) Dose Index Registry. This review was institutional review board and HIPAA compliant.
Results
There were 754 contrast-enhanced CTs of the abdomen and pelvis from 104 outside imaging facilities. Fifty-three percent (399/754) had 2 phases, and 2% (14/754) had 3 or more phases. Of the 939 contrast-enhanced CTs of the abdomen and pelvis performed internally, 12% (115) were multiphase exams. Of 88% (664) contrast-enhanced CTs of the abdomen and pelvis from outside imaging facilities with dose data, CTDIvol was 2.7 times higher than our institution contrast-enhanced CTs of the abdomen and pelvis (939) for all age categories as defined by the ACR Dose Index Registry (mean: 9.4 vs. 3.5 mGy, P<0.0001). The majority (74%) of multiphase exams were performed by 9 of 104 outside imaging facilities.
Conclusion
Multiphase acquisitions in routine contrast-enhanced CT of the abdomen and pelvis exams at outside imaging facilities are more frequent than those at a dedicated pediatric institution and contribute to unnecessary radiation dose. A contrast-enhanced CT of the abdomen and pelvis exam from an outside imaging facility with two passes may have as much as four times to six times the dose as the same exam performed with a single pass at a pediatric imaging center. We advocate for imaging facilities with high multiphase rates to eliminate multiple phases from routine contrast-enhanced CT of the abdomen and pelvis exams in children.
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References
Children’s Healthcare of Atlanta. https://med.emory.edu/clinical/childrens_healthcare.html. Accessed 9 Nov 2017
Agarwal S, Jokerst C, Siegel MJ et al (2015) Pediatric emergency CT scans at a children’s hospital and at community hospitals: radiation technical factors are an important source of radiation exposure. AJR Am J Roentgenol 205:409–413
Snow A, Milliren CE, Graham DA et al (2017) Quality of pediatric abdominal CT scans performed at a dedicated children’s hospital and its referring institutions: a multifactorial evaluation. Pediatr Radiol 47:391–397
Smith-Bindman R, Wang Y, Yellen-Nelson TR et al (2017) Predictors of CT radiation dose and their effect on patient care: a comprehensive analysis using automated data. Radiology 282:182–193
American College of Radiology ACR Appropriateness Criteria. https://acsearch.acr.org/docs/69467/Narrative/. Accessed 28 Jan 2018
Huda W, Mettler FA (2010) Volume CT dose index and dose-length product displayed during CT: what good are they? Radiology 258:236–242
Strauss KJ (2014) Dose indices: everybody wants a number. Pediatr Radiol 44:450–459
ACR Dose Index Registry. https://www.acr.org/Quality-Safety/National-Radiology-Data-Registry/Dose-Index-Registry. Accessed 11 Feb 2016
COCIR CT Manufacturers’ CTDIvol Reference Phantom Size FAQ. http://www.cocir.org/fileadmin/5_Initiatives/COCIR_CT_Manufacturers_Reference_phantom_size_FAQ_13102014.pdf. Accessed 11 Feb 2016
McNitt-Gray M (2011) Assessing radiation dose: how to do it right. AAPM Summit on CT Dose. https://www.aapm.org/meetings/2011CTS/documents/McNitt-GrayAssessingRadiationdoseFINAL.pdf. Accessed 7 June 2018
Radiation Dose Reporting. http://www.ucdmc.ucdavis.edu/radiology/RadiationDose.html. Accessed 11 Feb 2016
AAPM Computed Tomography Radiation Dose Education Slides. https://www.aapm.org/pubs/CTProtocols/documents/ToshibaEducationSlides.pdf. Accessed 11 Feb 2016
Seibert JA, Boone JM, Wootton-Gorges SL et al (2014) Dose is not always what it seems: where very misleading values can result from volume CT dose index and dose length product. J Am Coll Radiol 11:233–237
ACR Dose Index Registry Measures. https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/NRDR/DIR/DIR-Measures.pdf. Accessed 24 Nov 2016
Boone JM, Strauss KJ, Cody DD et al (2011) Size-Specific Dose Estimates (SSDE) in pediatric and adult body CT examinations. AAPM report No 204. http://www.aapm.org/pubs/reports/RPT_204.pdf. Accessed 11 Feb 2016
Strauss KJ, Goske MJ, Kaste SC et al (2010) Image gently: ten steps you can take to optimize image quality and lower CT dose for pediatric patients. AJR Am J Roentgenol 194:868–873
Guite KM, Hinshaw JL, Ranallo FN et al (2011) Ionizing radiation in abdominal CT: unindicated multiphase scans are an important source of medically unnecessary exposure. J Am Coll Radiol 8:756–761
Nievelstein RA, van Dam IM, van der Molen AJ (2010) Multidetector CT in children: current concepts and dose reduction strategies. Pediatr Radiol 40:1324–1344
Goske MJ, Applegate KE, Boylan J et al (2008) The “image gently” campaign: increasing CT radiation dose awareness through a national education and awareness program. Pediatr Radiol 38:265–269
Kanal KM, Butler PF, Sengupta D et al (2017) U.S. diagnostic reference levels and achievable doses for 10 adult CT examinations. Radiology 284:120–133
Goske MJ, Strauss KJ, Coombs LP et al (2013) Diagnostic reference ranges for pediatric abdominal CT. Radiology 268:208–218
Donnelly LF, Emery KH, Brody AS et al (2001) Minimizing radiation dose for pediatric body applications of single-detector helical CT. AJR Am J Roentgenol 176:303–306
Kim ME, Orth RC, Fallon SC et al (2015) Performance of CT examinations in children with suspected acute appendicitis in the community setting: a need for more education. AJR Am J Roentgenol 204:857–860
Goske MJ, Applegate KE, Bulas D et al (2012) Image Gently 5 years later: what goals remain to be accomplished in radiation protection for children? AJR Am J Roentgenol 199:477–479
Goske MJ, Applegate KE, Bulas D et al (2011) Image Gently: progress and challenges in CT education and advocacy. Pediatr Radiol 41:461–466
Parikh RA, Wien MA, Novak RD et al (2017) A comparison study of size-specific dose estimate calculation models. Pediatr Radiol 48:56–65
Karmazyn B, Ai H, Klahr P et al (2016) How accurate is size-specific dose estimate in pediatric body CT examinations? Pediatr Radiol 46:1234–1240
Little S, Grattan-Smith D, Johnson B (2012) CT radiation dose delivered by community hospitals and imaging centers. The Society of Pediatric Radiology 55th Annual Meeting
Acknowledgements
The authors would like to thank Christina A. Rostad, MD, for performing the statistical analysis and for preparing the figures.
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Rostad, B.S., Applegate, K.E., Kim, T. et al. Multiphase acquisitions in pediatric abdominal-pelvic CT are a common practice and contribute to unnecessary radiation dose. Pediatr Radiol 48, 1714–1723 (2018). https://doi.org/10.1007/s00247-018-4192-y
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DOI: https://doi.org/10.1007/s00247-018-4192-y