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Chiong J, Ramkumar PG, Weir NW, Weir-McCall JR, Nania A, Shaw LJ, Einstein AJ, Dweck MR, Mills NL, Newby DE, van Beek EJR, Roditi G, Williams MC. Evaluating Radiation Exposure in Patients with Stable Chest Pain in the SCOT-HEART Trial. Radiology 2023; 308:e221963. [PMID: 37526539 PMCID: PMC10478793 DOI: 10.1148/radiol.221963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 05/19/2023] [Accepted: 06/09/2023] [Indexed: 08/02/2023]
Abstract
Background In the Scottish Computed Tomography of the Heart (SCOT-HEART) trial in individuals with stable chest pain, a treatment strategy based on coronary CT angiography (CTA) led to improved outcomes. Purpose To assess 5-year cumulative radiation doses of participants undergoing investigation for suspected angina due to coronary artery disease with or without coronary CTA. Materials and Methods This secondary analysis of the SCOT-HEART trial included data from six of 12 recruiting sites and two of three imaging sites. Participants were recruited between November 18, 2010, and September 24, 2014, with follow-up through January 31, 2018. Study participants had been randomized (at a one-to-one ratio) to standard care with CT (n = 1466) or standard care alone (n = 1428). Imaging was performed on a 64-detector (n = 223) or 320-detector row scanner (n = 1466). Radiation dose from CT (dose-length product), SPECT (injected activity), and invasive coronary angiography (ICA; kerma-area product) was assessed for 5 years after enrollment. Effective dose was calculated using conversion factors appropriate for the imaging modality and body region imaged (using 0.026 mSv/mGy · cm for cardiac CT). Results Cumulative radiation dose was assessed in 2894 participants. Median effective dose was 3.0 mSv (IQR, 2.6-3.3 mSv) for coronary calcium scoring, 4.1 mSv (IQR, 2.6-6.1 mSv) for coronary CTA, 7.4 mSv (IQR, 6.2-8.5 mSv) for SPECT, and 4.1 mSv (IQR, 2.5-6.8 mSv) for ICA. After 5 years, total per-participant cumulative dose was higher in the CT group (median, 8.1 mSv; IQR, 5.5-12.4 mSv) compared with standard-care group (median, 0 mSv; IQR, 0-4.5 mSv; P < .001). In participants who underwent any imaging, cumulative radiation exposure was higher in the CT group (n = 1345; median, 8.6 mSv; IQR, 6.1-13.3 mSv) compared with standard-care group (n = 549; median, 6.4 mSv; IQR, 3.4-9.2 mSv; P < .001). Conclusion In the SCOT-HEART trial, the 5-year cumulative radiation dose from cardiac imaging was higher in the coronary CT angiography group compared with the standard-care group, largely because of the radiation exposure from CT. Clinical trial registration no. NCT01149590 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Dodd and Bosserdt in this issue.
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Affiliation(s)
- Justin Chiong
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Prasad Guntur Ramkumar
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Nicholas W. Weir
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Jonathan R. Weir-McCall
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Alberto Nania
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Leslee J. Shaw
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Andrew J. Einstein
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Marc R. Dweck
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Nicholas L. Mills
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - David E. Newby
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Edwin J. R. van Beek
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Giles Roditi
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
| | - Michelle C. Williams
- From the British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Chancellor's Building, 49 Little France
Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.);
Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical
Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of
Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility
QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N.,
E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal
Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal
Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik
Family Women's Health Research Institute, Icahn School of Medicine at
Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division
of Cardiology, Department of Medicine, and Department of Radiology, Columbia
University Irving Medical Center and New York-Presbyterian Hospital, New York,
NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK
(G.R.)
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Derikvand AM, Bagherzadeh S, MohammadSharifi A, Khoshgard K, AllahMoradi F. Estimation of cancer risks due to chest radiotherapy treatment planning computed tomography (CT) simulations. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2023; 62:269-277. [PMID: 37129707 DOI: 10.1007/s00411-023-01025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/28/2023] [Indexed: 05/03/2023]
Abstract
The objective of our study was to determine organ doses to estimate the lifetime attributable risk (LAR) of cancer incidence related to chest tomography simulations for Radiotherapy Treatment Planning (RTTP) using patient-specific information. Patient data were used to calculate organ doses and effective dose. The effective dose (E) was calculated by two methods. First, to calculate effective dose in a standard phantom, the collected dosimetric parameters were used with the ImPACT CT Patient Dosimetry Calculator and E was calculated by applying related correction factors. Second, using the scanner-derived Dose Length Product, LARs were computed using the US National Academy of Sciences (BEIR VII) model for age- and sex-specific risks at each exposure. DLP, CTDIvol, and scan length were 507 ± 143 mGy.cm, 11 ± 4 mGy, and 47 ± 7 cm, respectively. The effective dose was 10 ± 3 mSv using ImPACT patient dosimetry calculator software and 9 ± 2 mSv using the scanner-derived Dose Length Product. The LAR of cancer incidence for all cancers, all solid cancers and leukemia were 65 ± 29, 62 ± 27, 7 ± 2 cases per 100,000 individuals, respectively. Radiation exposure from the usage of CT for radiotherapy treatment planning (RTTP) causes non-negligible increases in lifetime attributable risk. The results of this study can be used as a guide by physicians to implement strategies based on the As Low As Reasonably Achievable (ALARA) principle that lead to a reduction dose without sacrificing diagnostic information.
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Affiliation(s)
- Afsaneh Mir Derikvand
- Department of Medical Physics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeed Bagherzadeh
- Department of Medical Physics, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Ali MohammadSharifi
- Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Karim Khoshgard
- Department of Medical Physics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fariba AllahMoradi
- Department of Medical Physics, Kermanshah University of Medical Sciences (KUMS), Building No. 1Shahid Beheshti Boulevard, Kermanshah, 6715847141, Iran.
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De Santis D, Polidori T, Tremamunno G, Rucci C, Piccinni G, Zerunian M, Pugliese L, Del Gaudio A, Guido G, Barbato L, Laghi A, Caruso D. Deep learning image reconstruction algorithm: impact on image quality in coronary computed tomography angiography. LA RADIOLOGIA MEDICA 2023; 128:434-444. [PMID: 36847992 PMCID: PMC10119038 DOI: 10.1007/s11547-023-01607-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To perform a comprehensive intraindividual objective and subjective image quality evaluation of coronary CT angiography (CCTA) reconstructed with deep learning image reconstruction (DLIR) and to assess correlation with routinely applied hybrid iterative reconstruction algorithm (ASiR-V). MATERIAL AND METHODS Fifty-one patients (29 males) undergoing clinically indicated CCTA from April to December 2021 were prospectively enrolled. Fourteen datasets were reconstructed for each patient: three DLIR strength levels (DLIR_L, DLIR_M, and DLIR_H), ASiR-V from 10% to 100% in 10%-increment, and filtered back-projection (FBP). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) determined objective image quality. Subjective image quality was assessed with a 4-point Likert scale. Concordance between reconstruction algorithms was assessed by Pearson correlation coefficient. RESULTS DLIR algorithm did not impact vascular attenuation (P ≥ 0.374). DLIR_H showed the lowest noise, comparable with ASiR-V 100% (P = 1) and significantly lower than other reconstructions (P ≤ 0.021). DLIR_H achieved the highest objective quality, with SNR and CNR comparable to ASiR-V 100% (P = 0.139 and 0.075, respectively). DLIR_M obtained comparable objective image quality with ASiR-V 80% and 90% (P ≥ 0.281), while achieved the highest subjective image quality (4, IQR: 4-4; P ≤ 0.001). DLIR and ASiR-V datasets returned a very strong correlation in the assessment of CAD (r = 0.874, P = 0.001). CONCLUSION DLIR_M significantly improves CCTA image quality and has very strong correlation with routinely applied ASiR-V 50% dataset in the diagnosis of CAD.
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Affiliation(s)
- Domenico De Santis
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Tiziano Polidori
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Giuseppe Tremamunno
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Carlotta Rucci
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Giulia Piccinni
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Marta Zerunian
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Luca Pugliese
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Antonella Del Gaudio
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Gisella Guido
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Luca Barbato
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Andrea Laghi
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
| | - Damiano Caruso
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
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Cao CF, Ma KL, Shan H, Liu TF, Zhao SQ, Wan Y, Jun-Zhang, Wang HQ. CT Scans and Cancer Risks: A Systematic Review and Dose-response Meta-analysis. BMC Cancer 2022; 22:1238. [PMID: 36451138 PMCID: PMC9710150 DOI: 10.1186/s12885-022-10310-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is still uncertainty on whether ionizing radiation from CT scans can increase the risks of cancer. This study aimed to identify the association of cumulative ionizing radiation from CT scans with pertaining cancer risks in adults. METHODS Five databases were searched from their inception to November 15, 2020. Observational studies reporting cancer risks from CT scans in adults were included. The main outcome included quantified cancer risks as cancer case numbers in exposed/unexposed adult participants with unified converted measures to odds ratio (OR) for relative risk, hazard ratio. Global background radiation (2.4 mSv per year) was used as control for lifetime attribution risk (LAR), with the same period from incubation after exposure until survival to 100 years. RESULTS 25 studies were included with a sum of 111,649,943 participants (mean age: 45.37 years, 83.4% women), comprising 2,049,943 actual participants from 6 studies with an average follow-up period as 30.1 years (range, 5 to 80 years); 109,600,000 participants from 19 studies using LAR. The cancer risks for adults following CT scans were inordinately increased (LAR adults, OR, 10.00 [95% CI, 5.87 to 17.05]; actual adults, OR, 1.17 [95%CI, 0.89 to 1.55]; combined, OR, 5.89 [95%CI, 3.46 to 10.35]). Moreover, cancer risks elevated with increase of radiation dose (OR, 33.31 [95% CI, 21.33 to 52.02]), and multiple CT scan sites (OR, 14.08 [95% CI, 6.60 to 30.05]). The risk of solid malignancy was higher than leukemia. Notably, there were no significant differences for age, gender, country, continent, study quality and studying time phrases. CONCLUSIONS Based on 111.6 million adult participants from 3 continents (Asia, Europe and America), this meta-analysis identifies an inordinately increase in cancer risks from CT scans for adults. Moreover, the cancer risks were positively correlated with radiation dose and CT sites. The meta-analysis highlights the awareness of potential cancer risks of CT scans as well as more reasonable methodology to quantify cancer risks in terms of life expectancy as 100 years for LAR. PROSPERO TRIAL REGISTRATION NUMBER CRD42019133487.
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Affiliation(s)
- Chun-Feng Cao
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160, Chongqing, People's Republic of China
| | - Kun-Long Ma
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160, Chongqing, People's Republic of China
| | - Hua Shan
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi'an, 712046, Shaanxi Province, People's Republic of China
| | - Tang-Fen Liu
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi'an, 712046, Shaanxi Province, People's Republic of China
| | - Si-Qiao Zhao
- Department of Orthopedics, No.1 Hospital of Xi'an City, Northwestern University, Xi'an, 710002, Shaanxi Province, People's Republic of China
| | - Yi Wan
- Department of Health Services, Fourth Military Medical University, Xi'an, 710032, No.169 West Changle Road, Shaanxi Province, People's Republic of China
| | - Jun-Zhang
- Baoji Central Hospital, 8 Jiangtan Road, Baoji, 721008, Shaanxi Province, People's Republic of China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi'an, 712046, Shaanxi Province, People's Republic of China.
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Bagherzadeh S, Jabbari N, Khalkhali HR. Radiation dose and cancer risks from radiation exposure during abdominopelvic computed tomography (CT) scans: comparison of diagnostic and radiotherapy treatment planning CT scans. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:579-589. [PMID: 34542682 DOI: 10.1007/s00411-021-00942-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
In the present study, radiation doses and cancer risks resulting from abdominopelvic radiotherapy planning computed tomography (RP-CT) and abdominopelvic diagnostic CT (DG-CT) examinations are compared. Two groups of patients who underwent abdominopelvic CT scans with RP-CT (n = 50) and DG-CT (n = 50) voluntarily participated in this study. The two groups of patients had approximately similar demographic features including mass, height, body mass index, sex, and age. Radiation dose parameters included CTDIvol, dose-length product, scan length, effective tube current, and pitch factor, all taken from the CT scanner console. The ImPACT software was used to calculate the patient-specific radiation doses. The risks of cancer incidence and mortality were estimated based on the BEIR VII report of the US National Research Council. In the RP-CT group, the mean ± standard deviation of cancer incidence risk for all cancers, leukemia, and all solid cancers was 621.58 ± 214.76, 101.59 ± 27.15, and 516.60 ± 189.01 cancers per 100,000 individuals, respectively, for male patients. For female patients, the corresponding risks were 742.71 ± 292.35, 74.26 ± 20.26, and 667.03 ± 275.67 cancers per 100,000 individuals, respectively. In contrast, for DG-CT cancer incidence risks were 470.22 ± 170.07, 78.23 ± 18.22, and 390.25 ± 152.82 cancers per 100,000 individuals for male patients, while they were 638.65 ± 232.93, 62.14 ± 13.74, and 575.73 ± 221.21 cancers per 100,000 individuals for female patients. Cancer incidence and mortality risks were greater for RP-CT than for DG-CT scans. It is concluded that the various protocols of abdominopelvic CT scans, especially the RP-CT scans, should be optimized with respect to the radiation doses associated with these scans.
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Affiliation(s)
- Saeed Bagherzadeh
- Department of Medical Physics, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Nasrollah Jabbari
- Solid Tumor Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran.
| | - Hamid Reza Khalkhali
- Patient Safety Research Center, Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran
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6
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Task-based assessment on various optimization protocols of computed tomography Pulmonary Angiography examination. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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7
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Mansour HH, Alajerami YS, Foster T. Estimation of Radiation Doses and Lifetime Attributable Risk of Radiation-induced Cancer from A Single Coronary Artery Bypass Graft Computed Tomography Angiography. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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8
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Radiation dose monitoring in computed tomography: Status, options and limitations. Phys Med 2020; 79:1-15. [DOI: 10.1016/j.ejmp.2020.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/21/2020] [Accepted: 08/19/2020] [Indexed: 02/02/2023] Open
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9
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Hosseini Nasab SMB, Deevband MR, Shabestani-Monfared A, Hoseini Amoli SA, Fatehi Feyzabad SH. ORGAN EQUIVALENT DOSE AND LIFETIME ATTRIBUTABLE RISK OF CANCER INCIDENCE AND MORTALITY ASSOCIATED WITH CARDIAC CT ANGIOGRAPHY. RADIATION PROTECTION DOSIMETRY 2020; 189:213-223. [PMID: 32195547 DOI: 10.1093/rpd/ncaa033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/08/2020] [Accepted: 02/24/2020] [Indexed: 06/10/2023]
Abstract
The aim of this study is the calculation of equivalent organ dose and estimation of lifetime attributable risk (LAR) of cancer incidence and mortality related to cardiac computed tomography angiography (CCTA) because the use of CT angiography as a noninvasive diagnostic method has increased. The organ dose has been calculated by ImPACT software based on the volumetric CT dose index (CTDIvol), and LAR of cancer risk incidence and mortality from CCTA has estimated according to the BEIR VII report. The median value of the effective dose was 13.78 ± 6.88 mSv for both genders. In all scanners, the highest median value for LAR of cancer incidence in males and females for lung cancer was 44.20 and 109.17 per 100 000, respectively. And in infants was 5.89 and 12 for lung cancer in males and breast cancer in females, respectively. Also, the median value of LAR of all cancer incidence from single CCTA in adult patients for males and females was 122 and 238 cases, respectively. Maximum LAR of cancer mortality in adults for lung cancer was 40.28 and 91.84 and in pediatrics was 5.69 and 8.50 in males and females, respectively. Despite many benefits of CTA in the heart disease evaluation, according to a high radiation dose in CCTA, to reduce the cancer risk: CCTA should be used cautiously, especially for pediatric and females.
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Affiliation(s)
| | - Mohammad Reza Deevband
- Department of Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Shabestani-Monfared
- Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Seyed Ali Hoseini Amoli
- Cardiovascular Imaging Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hasan Fatehi Feyzabad
- Cardiovascular Imaging Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Sabarudin A, Siong TW, Chin AW, Hoong NK, Karim MKA. A comparison study of radiation effective dose in ECG-Gated Coronary CT Angiography and calcium scoring examinations performed with a dual-source CT scanner. Sci Rep 2019; 9:4374. [PMID: 30867480 PMCID: PMC6416329 DOI: 10.1038/s41598-019-40758-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 02/21/2019] [Indexed: 11/08/2022] Open
Abstract
In this report we have evaluated radiation effective dose received by patients during ECG-gated CCTA examinations based on gender, heart rate, tube voltage protocol and body mass index (BMI). A total of 1,824 patients were retrospectively recruited (1,139 men and 685 women) and they were divided into Group 1 (CCTA with calcium scoring), Group 2 (CCTA without calcium scoring) and Group 3 (only calcium scoring), where the association between gender, heart rate, tube voltage protocol and body mass index (BMI) were analysed. Examinations were performed using a retrospective ECG-gated CCTA protocol and the effective doses were calculated from the dose length product with a conversion coefficient of 0.026 mSv.mGy-1cm-1. No significant differences were observed in the mean effective dose between gender in all groups. The mean estimated dose was significantly higher when the heart rate was lower in Group 1 (p < 0.001) and Group 2 (p = 0.002). There were also significant differences between the mean effective dose in tube voltage protocol and BMI among the three groups. The mean effective dose was positively correlated with BMI (p < 0.001), but inversely related to the heart rate. This study supported the theory that a high heart rate, low tube voltage and low BMI could significantly reduce radiation dose exposure.
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Affiliation(s)
- Akmal Sabarudin
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Tiong Wei Siong
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Ang Wee Chin
- Department of Physics, Faculty of Science, Universiti Teknologi Malaysia, 81300, Johor Bharu, Johor, Malaysia
| | - Ng Kwan Hoong
- Department of Biomedical Imaging, Universiti of Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Muhammad Khalis Abdul Karim
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
- Center for Diagnostic Nuclear Imaging, Faculty of Medicine Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
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11
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Affiliation(s)
| | - Christina Stewart
- Department of Medical Physics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicholas W Weir
- Department of Medical Physics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
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12
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Forte E, Monti S, Parente CA, Beyer L, De Rosa R, Infante T, Cavaliere C, Cademartiri F, Salvatore M, Stroszczynski C, Tedeschi C. Image Quality and Dose Reduction by Dual Source Computed Tomography Coronary Angiography: Protocol Comparison. Dose Response 2018; 16:1559325818805838. [PMID: 30349426 PMCID: PMC6194939 DOI: 10.1177/1559325818805838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 01/18/2023] Open
Abstract
Purpose: To compare image quality and radiation dose among different protocols in patients who underwent a 128-slice dual source computed tomography coronary angiography (DSCT-CTCA). Methods: Ninety patients were retrospectively grouped according to heart rate (HR): 26 patients (group A) with stable HR ≤60 bpm were acquired using high pitch spiral mode (FLASH); 48 patients (group B) with irregular HR ≤60 bpm or stable HR between 60 and 70 bpm using step and shoot mode; and 16 patients (group C) with irregular HR >60 bpm or stable HR ≥70 bpm by retrospective electrocardiogram pulsing acquisition. Signal to noise ratio (SNR) and contrast to noise ratio (CNR) were measured for the main vascular structures. Moreover, the dose-length product and the effective dose were assessed. Results: Both SNR and CNR were higher in group A compared to group C (18.27 ± 0.32 vs 11.22 ± 0.50 and 16.75 ± 0.32 vs 10.17 ± 0.50; P = .001). The effective dose was lower in groups A and B (2.09 ± 1.27 mSv and 4.60 ± 2.78 mSv, respectively) compared to group C (9.61 ± 5.95 mSv) P < .0001. Conclusion: The correct selection of a low-dose, HR-matched CTCA scan protocol with a DSCT scanner provides substantial reduction of radiation exposure and better SNR and CNR.
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Affiliation(s)
| | | | | | - Lukas Beyer
- Department of Radiology, Universitätsklinikum Regensburg, Regensburg, Germany
| | | | | | | | | | | | | | - Carlo Tedeschi
- Department of Radiology, Universitätsklinikum Regensburg, Regensburg, Germany.,P.S.I. Napoli Est, ASL Napoli 1 Centro, Naples, Italy
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13
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Villoing D, Kitahara CM, Passmore C, Simon SL, Yoder RC. Photon energy readings in OSL dosimeter filters: an application to retrospective dose estimation for nuclear medicine workers. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:1053-1063. [PMID: 29916399 PMCID: PMC6169304 DOI: 10.1088/1361-6498/aacd64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This work investigates the applicability of using data from personal monitoring dosimeters to assess photon energies to which medical workers were exposed. Such determinations would be important for retrospective assessments of organ doses to be used in occupational radiation epidemiology studies, particularly in the absence of work history or other information regarding the energy of the radiation source. Monthly personal dose equivalents and filter ratios under two different metallic filters contained in the Luxel+® dosimeter were collected from Landauer, Inc. from 19 nuclear medicine (NM) technologists employed by three medical institutions, the institution A only performing traditional NM imaging (primarily using 99m Tc) and institutions B and C also performing positron emission tomography (PET, using 18F). Calibration data of the Luxel+® dosimeter for various xray spectra were used to establish ranges of filter ratios from 1.1 to 1.6 for 99m Tc and below 1.1 for 18F. Median filter ratios were 1.33 (Interquartile range (IQR), 0.15) for institution A, 1.08 (IQR, 0.16) for institution B, and 1.08 (IQR, 0.14) for institution C. The distributions of these filter ratios were statistically-significantly different between the institution A only performing traditional NM imaging and institutions B and C also performing PET imaging. In this proof-of-concept study, filter ratios from personal monitoring dosimeters were used to assess differences in photon energies to which NM technologists were exposed. Dosimeters from technologists only performing traditional NM procedures mostly showed Al/Cu filter ratios above 1.2, those likely performing only PET in a particular month had filter ratios below 1.1, and those which showed filter ratios between 1.1 and 1.2 likely came from technologists rotating between traditional NM and PET imaging in the same month. These results suggest that it is possible to distinguish technologists who only worked with higher-energy procedures versus those who only worked with other types of NM procedures.
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Affiliation(s)
- Daphnée Villoing
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States of America
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14
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Diemberger I, Marazzi R, Casella M, Vassanelli F, Galimberti P, Luzi M, Borrelli A, Soldati E, Golzio PG, Fumagalli S, Francia P, Padeletti L, Botto G, Boriani G. The effects of gender on electrical therapies for the heart: procedural considerations, results and complications: A report from the XII Congress of the Italian Association on Arrhythmology and Cardiostimulation (AIAC). Europace 2018; 19:1911-1921. [PMID: 28520959 DOI: 10.1093/europace/eux034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/02/2017] [Indexed: 12/28/2022] Open
Abstract
Use of cardiac implantable devices and catheter ablation is steadily increasing in Western countries following the positive results of clinical trials. Despite the advances in scientific knowledge, tools development, and techniques improvement we still have some grey area in the field of electrical therapies for the heart. In particular, several reports highlighted differences both in medical behaviour and procedural outcomes between female and male candidates. Women are referred later for catheter ablation of supraventricular arrhythmias, especially atrial fibrillation, leading to suboptimal results. On the opposite females present greater response to cardiac resynchronization, while the benefit of implantable defibrillator in primary prevention seems to be less pronounced. Differences on aetiology, clinical profile, and development of myocardial scarring are the more plausible causes. This review will discuss all these aspects together with gender-related differences in terms of acute/late complications. We will also provide useful hints on plausible mechanisms and practical procedural aspects.
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Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesca Vassanelli
- Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - Paola Galimberti
- Electrophysiology and Pacing Unit, Humanitas Clinical and Research Center, Rozzano-Milano, Italy
| | - Mario Luzi
- Cardiology Clinic, Marche Polytechnic University, Ancona, Italy
| | | | - Ezio Soldati
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Italy
| | - Pier Giorgio Golzio
- Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Fumagalli
- Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy
| | - Pietro Francia
- Cardiac Electrophysiology Unit, Cardiology, St. Andrea Hospital, University "Sapienza", Rome, Italy
| | - Luigi Padeletti
- University of Florence, Florence, Italy IRCCS MultiMedica, Sesto San Giovanni, Italy
| | - Gianluca Botto
- EP Unit, Department of Medicine, Sant'Anna Hospital, Como, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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Khan K, Tewari S, Awasthi NP, Mishra SP, Agarwal GR, Rastogi M, Husain N. Flow cytometric detection of gamma-H2AX to evaluate DNA damage by low dose diagnostic irradiation. Med Hypotheses 2018; 115:22-28. [DOI: 10.1016/j.mehy.2018.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/14/2018] [Accepted: 03/25/2018] [Indexed: 01/25/2023]
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Bagherzadeh S, Jabbari N, Khalkhali HR. Estimation of lifetime attributable risks (LARs) of cancer associated with abdominopelvic radiotherapy treatment planning computed tomography (CT) simulations. Int J Radiat Biol 2018. [PMID: 29528791 DOI: 10.1080/09553002.2018.1450536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The present study attempts to calculate organ-absorbed and effective doses for cancer patients to estimate the possible cancer induction and cancer mortality risks resulting from 64-slice abdominopelvic computed tomography (CT) simulations for radiotherapy treatment planning (RTTP). MATERIAL AND METHODS A group of 70 patients, who underwent 64-slice abdominopelvic CT scan for RTTP, voluntarily participated in the present study. To calculate organ and effective doses in a standard phantom of 70 kg, the collected dosimetric parameters were used with the ImPACT CT Patient Dosimetry Calculator. Patient-specific organ dose and effective dose were calculated by applying related correction factors. For the estimation of lifetime attributable risks (LARs) of cancer incidence and cancer-related mortality, doses in radiosensitive organs were converted to risks based on the data published in Biological Effects of Ionizing Radiation VII (BEIR VII). RESULTS The mean ± standard deviation (SD) of the effective dose for males and females were 13.87 ± 2.37 mSv (range: 9.25-18.82 mSv) and 13.04 ± 3.42 mSv (range: 6.99-18.37 mSv), respectively. The mean ± SD of LAR of cancer incidence was 35.34 ± 13.82 cases in males and 34.49 ± 9.63 cases in females per 100,000 persons. The LAR of cancer mortality had the mean ± SD value of 15.38 ± 4.25 and 16.72 ± 3.87 cases per 100,000 persons in males and females respectively. CONCLUSION Increase in the LAR of cancer occurrence and mortality due to abdominopelvic treatment planning CT simulation is noticeable and should be considered.
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Affiliation(s)
- Saeed Bagherzadeh
- a Department of Medical Physics, School of Medicine , Urmia University of Medical Sciences , Urmia , Iran
| | - Nasrollah Jabbari
- b Solid Tumor Research Center , Urmia University of Medical Sciences , Urmia , Iran
| | - Hamid Reza Khalkhali
- c Patient Safety Research Center, Department of Biostatistics and Epidemiology , Urmia University of Medical Sciences , Urmia , Iran
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Gray JM, Rasanayagam S, Engel C, Rizzo J. State of the evidence 2017: an update on the connection between breast cancer and the environment. Environ Health 2017; 16:94. [PMID: 28865460 PMCID: PMC5581466 DOI: 10.1186/s12940-017-0287-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/17/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND In this review, we examine the continually expanding and increasingly compelling data linking radiation and various chemicals in our environment to the current high incidence of breast cancer. Singly and in combination, these toxicants may have contributed significantly to the increasing rates of breast cancer observed over the past several decades. Exposures early in development from gestation through adolescence and early adulthood are particularly of concern as they re-shape the program of genetic, epigenetic and physiological processes in the developing mammary system, leading to an increased risk for developing breast cancer. In the 8 years since we last published a comprehensive review of the relevant literature, hundreds of new papers have appeared supporting this link, and in this update, the evidence on this topic is more extensive and of better quality than that previously available. CONCLUSION Increasing evidence from epidemiological studies, as well as a better understanding of mechanisms linking toxicants with development of breast cancer, all reinforce the conclusion that exposures to these substances - many of which are found in common, everyday products and byproducts - may lead to increased risk of developing breast cancer. Moving forward, attention to methodological limitations, especially in relevant epidemiological and animal models, will need to be addressed to allow clearer and more direct connections to be evaluated.
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Affiliation(s)
- Janet M. Gray
- Department of Psychology and Program in Science, Technology, and Society, Vassar College, 124 Raymond Avenue, Poughkeepsie, NY 12604-0246 USA
| | - Sharima Rasanayagam
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Connie Engel
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Jeanne Rizzo
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
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Carpeggiani C, Picano E, Brambilla M, Michelassi C, Knuuti J, Kauffman P, Underwood SR, Neglia D. Variability of radiation doses of cardiac diagnostic imaging tests: the RADIO-EVINCI study (RADIationdOse subproject of the EVINCI study). BMC Cardiovasc Disord 2017; 17:63. [PMID: 28202051 PMCID: PMC5311725 DOI: 10.1186/s12872-017-0474-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 01/16/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients with coronary artery disease can accumulate significant radiation dose through repeated exposures to coronary computed tomographic angiography, myocardial perfusion imaging with single photon emission computed tomography or positron emission tomography, and to invasive coronary angiography. Aim of the study was to audit radiation doses of coronary computed tomographic angiography, single photon emission computed tomography, positron emission tomography and invasive coronary angiography in patients enrolled in the prospective, randomized, multi-centre European study-EVINCI (Evaluation of Integrated Cardiac Imaging for the Detection and Characterization of Ischemic Heart Disease). METHODS We reviewed 1070 tests (476 coronary computed tomographic angiographies, 85 positron emission tomographies, 310 single photon emission computed tomographies, 199 invasive coronary angiographies) performed in 476 patients (mean age 60 ± 9 years, 60% males) enrolled in 12 centers of the EVINCI. The effective doses were calculated in milli-Sievert (mSv) as median, interquartile range (IQR) and coefficient of variation of the mean. RESULTS Coronary computed tomographic angiography (476 exams in 12 centers) median effective dose was 9.6 mSv (IQR = 13.2 mSv); single photon emission computed tomography (310 exams in 9 centers) effective dose was 9.3 (IQR = 2.8); positron emission tomography (85 in 3 centers) effective dose 1.8 (IQR = 1.6) and invasive coronary angiography (199 in 9 centers) effective dose 7.4 (IQR = 7.3). Inter-institutional variability was highest for invasive coronary angiography (100%) and coronary computed tomographic angiography (54%) and lowest for single photon emission computed tomography (20%). Intra-institutional variability was highest for invasive coronary angiography (121%) and coronary computed tomographic angiography (115%) and lowest for single photon emission computed tomography (14%). CONCLUSION Coronary computed tomographic angiography and invasive coronary angiography doses vary substantially between and within centers. The variability in nuclear medicine procedures is substantially lower. The findings highlight the need to audit doses, to track cumulative exposures and to standardize doses for imaging techniques. TRIAL REGISTRATION The study protocol is available at https://www.clinicaltrials.gov/ (ClinicalTrials.gov Identifier: NCT00979199 ). Information provided on September 16, 2009.
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Affiliation(s)
- Clara Carpeggiani
- CNR Institute of Clinical Physiology, via Moruzzi, Pisa, 1-56124 Italy
| | - Eugenio Picano
- CNR Institute of Clinical Physiology, via Moruzzi, Pisa, 1-56124 Italy
| | - Marco Brambilla
- Medical Physics Department, University Hospital ‘Maggiore della Carità, Corso Mazzini, 18, Novara, 28100 Italy
| | | | - Juhani Knuuti
- University of Turku and Turku University Hospital, Kinakvarngatan 4-8, Åbo, 20520 Finland
| | - Philipp Kauffman
- University Hospital Zurich, Rämistrasse 100, Zurich, 8091 Switzerland
| | - S. Richard Underwood
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, Sydney Street, London, SW3 6NP UK
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio, via Moruzzi, 1, Pisa, Italy
| | - for the EVINCI Study Investigators
- CNR Institute of Clinical Physiology, via Moruzzi, Pisa, 1-56124 Italy
- Medical Physics Department, University Hospital ‘Maggiore della Carità, Corso Mazzini, 18, Novara, 28100 Italy
- University of Turku and Turku University Hospital, Kinakvarngatan 4-8, Åbo, 20520 Finland
- University Hospital Zurich, Rämistrasse 100, Zurich, 8091 Switzerland
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, Sydney Street, London, SW3 6NP UK
- Fondazione Toscana G. Monasterio, via Moruzzi, 1, Pisa, Italy
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Mehnati P, Amirnia A, Jabbari N. Estimating cancer induction risk from abdominopelvic scanning with 6- and 16-slice computed tomography. Int J Radiat Biol 2016; 93:416-425. [PMID: 27921444 DOI: 10.1080/09553002.2017.1268280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The biological effects of ionizing radiation (BEIR VII) report estimates that the risk of getting cancer from radiation is increased by about a third from current regulation risk levels. The propose of this study was to estimate cancer induction risk from abdominopelvic computed tomography (CT) scanning of adult patients using 6- and 16-slice CT scanners. MATERIALS AND METHODS A cross-sectional study on 200 patients with abdominopelvic CT scan in 6- and 16-slice scanners was conducted. The dose-length product (DLP) and volume CT Dose Index (CTDIvol) values from the scanners as well as the effective dose values from the ImPACT CT patient dosimetry calculator with the biological effects of ionizing radiation (BEIR VII) method were used to estimate the cancer induction risk. RESULTS The mean (and standard deviation) values of CTDIvol and DLP were 6.9 (±1.07) mGy and 306.44 (± 60.57) mGy.cm for 6-slice, and 5.19 (±0.91) mGy and 219.7 (±49.31) mGy.cm for 16-slice scanner, respectively. The range of effective dose in the 6-slice scanner was 2.61-8.15 mSv and, in the 16-slice scanner, it was 1.47-4.72 mSv. The mean and standard deviation values of total cancer induction risk in abdominopelvic examinations were 0.136 ± 0.059% for men and 0.135 ± 0.063% for women in the 6-slice CT scanner. The values were 0.126 ± 0.051% for men and 0.127 ± 0.056% for women in the 16-slice scanner. CONCLUSIONS The cancer induction risk of abdominopelvic scanning was noticeable. Therefore, radiation dose should be minimized by optimizing the protocols and applying appropriate methods.
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Affiliation(s)
- Parinaz Mehnati
- a Immunology Research Center, Department of Medical Physics, School of Medicine , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Ayoub Amirnia
- b Department of Medical Physics, School of Medicine , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Nasrollah Jabbari
- c Solid Tumor Research Center, Department of Medical Physics and Imaging , Urmia University of Medical Sciences , Urmia , Iran
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Evaluation for suspected acute appendicitis in the emergency department setting: a comparison of outcomes among three imaging pathways. Clin Imaging 2016; 40:788-92. [PMID: 27317225 DOI: 10.1016/j.clinimag.2016.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/17/2016] [Accepted: 02/21/2016] [Indexed: 11/23/2022]
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Huda W, Tipnis SV. Doses metrics and patient age in CT. RADIATION PROTECTION DOSIMETRY 2016; 168:374-380. [PMID: 25977348 DOI: 10.1093/rpd/ncv310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/27/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to investigate how effective dose and size-specific dose estimate (SSDE) change with patient age (size) for routine head and abdominal/pelvic CT examinations. Heads and abdomens of patients were modelled as a mass-equivalent cylinder of water corresponding to the patient 'effective diameter'. Head CT scans were performed at CTDIvol(S) of 40 mGy, and abdominal CT scans were performed at CTDIvol(L) of 10 mGy. Values of SSDE were obtained using conversion factors in AAPM Task Group Report 204. Age-specific scan lengths for head and abdominal CT scans obtained from the authors' clinical practice were used to estimate the dose-length product for each CT examination. Effective doses were calculated from previously published age- and sex-specific E/DLP conversion factors, based on ICRP 103 organ-weighting factors. For head CT examinations, the scan length increased from 15 cm in a newborn to 20 cm in adults, and for an abdominal/pelvic CT, the scan length increased from 20 cm in a newborn to 45 cm in adults. For head CT scans, SSDE ranged from 37.2 mGy in adults to 48.8 mGy in a newborn, an increase of 31 %. The corresponding head CT effective doses range from 1.4 mSv in adults to 5.2 mSv in a newborn, an increase of 270 %. For abdomen CT scans, SSDE ranged from 13.7 mGy in adults to 23.0 mGy in a newborn, an increase of 68 %. The corresponding abdominal CT effective doses ranged from 6.3 mSv in adults to 15.4 mSv in a newborn, an increase of 140 %. SSDE increases much less than effective dose in paediatric patients compared with adults because it does not account for scan length or scattered radiation. Size- and age-specific effective doses better quantify the total radiation received by patients in CT by explicitly accounting for all organ doses, as well as their relative radio sensitivity.
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Affiliation(s)
- Walter Huda
- Department of Radiology and Radiological Science, MUSC, 96 Jonathan Lucas St, MSC 323, Charleston, SC 29425-3230, USA
| | - Sameer V Tipnis
- Department of Radiology and Radiological Science, MUSC, 96 Jonathan Lucas St, MSC 323, Charleston, SC 29425-3230, USA
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Eid M, De Cecco CN, Schoepf UJ, Mangold S, Tesche C, Varga-Szemes A, Suranyi P, Stalcup S, Ball BD, Caruso D. The Role of MRI and CT in the Diagnosis of Atherosclerosis in an Aging Population. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0141-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fencl JL. Guideline Implementation: Radiation Safety. AORN J 2015; 102:630-6; quiz 637-9. [PMID: 26616323 DOI: 10.1016/j.aorn.2015.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/13/2015] [Indexed: 11/24/2022]
Abstract
Because radiologic technology is used in a variety of perioperative procedures and settings, it is essential for perioperative RNs to be knowledgeable of the risks related to radiation and the ways to adequately protect patients and health care providers from unintended radiation exposure. The updated AORN "Guideline for radiation safety" provides guidance on preventing injury from ionizing radiation exposure during therapeutic, diagnostic, and interventional procedures. This article focuses on key points of the guideline to help perioperative personnel practice radiation safety. The key points address the requirements for an organization's radiation safety program, measures used to keep radiation exposure as low as reasonably achievable, proper handling and testing of radiation protection devices, and considerations for protecting employees and patients who are pregnant and who will be exposed to radiation. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.
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Organ Doses and Radiation Risk of Computed Tomographic Coronary Angiography in a Clinical Patient Population: How Do Low-Dose Acquisition Modes Compare? J Comput Assist Tomogr 2015; 39:591-7. [PMID: 26182227 DOI: 10.1097/rct.0000000000000253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the organ doses and lifetime-attributable risk of cancer for electrocardiogram-triggered sequential and high-pitch helical scanning in a clinical patient population. METHODS Phantom thermoluminiscence dosimeter measurements were used as a model for the organ dose assessment of 314 individual patients who underwent coronary computed tomographic angiography. Patient-specific lifetime-attributable cancer risks were calculated. RESULTS Phantom measurements showed that heart rate had a significant influence on the delivered radiation exposure in sequential mode, and calcium scoring and contrast bolus tracking scans make a nonnegligible contribution to patients' dose. Therefore, they should be taken into account for patients' organ dose estimations. Median cancer induction risks are low, with 0.008% (0.0016%) and 0.022% (0.056%) for high-pitch and sequential scanning for men (women), respectively. CONCLUSIONS The use of high-pitch helical scanning leads to 65% and 72% lower lifetime-attributable risk values for men and women, respectively, compared with sequential scanning.
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Very low-dose (0.15 mGy) chest CT protocols using the COPDGene 2 test object and a third-generation dual-source CT scanner with corresponding third-generation iterative reconstruction software. Invest Radiol 2015; 50:40-5. [PMID: 25198834 DOI: 10.1097/rli.0000000000000093] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of ultralow radiation dose single-energy computed tomographic (CT) acquisitions with Sn prefiltration and third-generation iterative reconstruction on density-based quantitative measures of growing interest in phenotyping pulmonary disease. MATERIALS AND METHODS The effects of both decreasing dose and different body habitus on the accuracy of the mean CT attenuation measurements and the level of image noise (SD) were evaluated using the COPDGene 2 test object, containing 8 different materials of interest ranging from air to acrylic and including various density foams. A third-generation dual-source multidetector CT scanner (Siemens SOMATOM FORCE; Siemens Healthcare AG, Erlangen, Germany) running advanced modeled iterative reconstruction (ADMIRE) software (Siemens Healthcare AG) was used.We used normal and very large body habitus rings at dose levels varying from 1.5 to 0.15 mGy using a spectral-shaped (0.6-mm Sn) tube output of 100 kV(p). Three CT scans were obtained at each dose level using both rings. Regions of interest for each material in the test object scans were automatically extracted. The Hounsfield unit values of each material using weighted filtered back projection (WFBP) at 1.5 mGy was used as the reference value to evaluate shifts in CT attenuation at lower dose levels using either WFBP or ADMIRE. Statistical analysis included basic statistics, Welch t tests, multivariable covariant model using the F test to assess the significance of the explanatory (independent) variables on the response (dependent) variable, and CT mean attenuation, in the multivariable covariant model including reconstruction method. RESULTS Multivariable regression analysis of the mean CT attenuation values showed a significant difference with decreasing dose between ADMIRE and WFBP. The ADMIRE has reduced noise and more stable CT attenuation compared with WFBP. There was a strong effect on the mean CT attenuation values of the scanned materials for ring size (P < 0.0001) and dose level (P < 0.0001). The number of voxels in the region of interest for the particular material studied did not demonstrate a significant effect (P > 0.05). The SD was lower with ADMIRE compared with WFBP at all dose levels and ring sizes (P < 0.05). CONCLUSIONS The third-generation dual-source CT scanners using third-generation iterative reconstruction methods can acquire accurate quantitative CT images with acceptable image noise at very low-dose levels (0.15 mGy). This opens up new diagnostic and research opportunities in CT phenotyping of the lung for developing new treatments and increased understanding of pulmonary disease.
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Hagedorn JC, Emery SE, France JC, Daffner SD. Does CT Angiography Matter for Patients with Cervical Spine Injuries? J Bone Joint Surg Am 2014; 96:951-955. [PMID: 24897744 DOI: 10.2106/jbjs.m.00036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cervical injury can be associated with vertebral artery injury. This study was performed to determine the impact of computed tomography (CT) angiography of the head and neck on planning treatment of cervical spine fracture, if these tests were ordered appropriately, and to estimate cost and associated exposure to radiation and contrast medium. METHODS This retrospective review included all patients who underwent CT of the cervical spine and CT angiography of the head and neck from January 2010 to August 2011 at one institution. Patients were divided into those with and those without cervical spine fracture seen on CT of the cervical spine. We determined if the CT angiography of the head and neck was positive for vascular injury in the patients with a cervical fracture. Vascular injury treatment and alterations in surgical fracture treatment due to positive CT angiography of the head and neck were recorded. A scan was deemed appropriate if it had been ordered per established institutional protocol. RESULTS Of the 381 patients who underwent CT angiography of the head and neck, 126 had a cervical injury. Sixteen of the CT angiography studies were appropriately ordered for non-spinal indications, and twenty-three were inappropriately ordered. The CT angiography was positive for one patient for whom the imaging was off protocol and one for whom the indication was non-spinal. Nineteen patients had positive CT angiography of the head and neck; no patient underwent surgical intervention for a vascular lesion. Eleven patients underwent surgical intervention for a cervical fracture; the operative plan was changed because of vascular injury in one case. The CT angiography was positive for eleven of forty-eight patients who had sustained a C2 fracture; this group accounted for eleven of the nineteen positive CT angiography studies. Noncontiguous injuries occurred in nineteen patients; three had positive CT angiography of the head and neck. The approximate charge for the CT angiography was $3925, radiation exposure was approximately 4000 mGy/cm, and contrast-medium load was approximately 100 mL. CONCLUSIONS Positive CT angiography of the head and neck rarely altered surgical treatment of cervical spine injuries. This study supports the findings in the literature that C1-C3 spine injuries have an increased association with vertebral artery injury. CT angiography of the head and neck ordered off protocol had a low likelihood of being positive. Strict adherence to protocols for CT angiography of the head and neck can reduce costs and decrease unnecessary exposure to radiation and contrast medium. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- John C Hagedorn
- Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV 26506-9196. E-mail address for J.C. Hagedorn II:
| | - Sanford E Emery
- Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV 26506-9196. E-mail address for J.C. Hagedorn II:
| | - John C France
- Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV 26506-9196. E-mail address for J.C. Hagedorn II:
| | - Scott D Daffner
- Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV 26506-9196. E-mail address for J.C. Hagedorn II:
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Olcott EW, Shin LK, Sommer G, Chan I, Rosenberg J, Molvin FL, Boas FE, Fleischmann D. Model-based iterative reconstruction compared to adaptive statistical iterative reconstruction and filtered back-projection in CT of the kidneys and the adjacent retroperitoneum. Acad Radiol 2014; 21:774-84. [PMID: 24809318 DOI: 10.1016/j.acra.2014.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES To prospectively evaluate the perceived image quality of model-based iterative reconstruction (MBIR) compared to adaptive statistical iterative reconstruction (ASIR) and filtered back-projection (FBP) in computed tomography (CT) of the kidneys and retroperitoneum. MATERIALS AND METHODS With investigational review board and Health Insurance Portability and Accountability Act compliance, 17 adults underwent 31 contrast-enhanced CT acquisitions at constant tube potential and current (range 30-300 mA). Each was reconstructed with MBIR, ASIR (50%), and FBP. Four reviewers scored each reconstruction's perceived image quality overall and the perceived image quality of seven imaging features that were selected by the authors as being relevant to imaging in the region and pertinent to the evaluation of high-quality diagnostic CT. RESULTS MBIR perceived image quality scored superior to ASIR and FBP both overall (P < .001) and for observations of the retroperitoneal fascia (99.2%), corticomedullary differentiation (94.4%), renal hilar structures (96.8%), focal renal lesions (92.5%), and mitigation of streak artifact (100.0%; all, P < .001). MBIR achieved diagnostic overall perceived image quality with approximately half the radiation dose required by ASIR and FBP. The noise curve of MBIR was significantly lower and flatter (P < .001). CONCLUSIONS Compared to ASIR and FBP, MBIR provides superior perceived image quality, both overall and for several specific imaging features, across a broad range of tube current levels, and requires approximately half the radiation dose to achieve diagnostic overall perceived image quality. Accordingly, MBIR should enable CT scanning with improved perceived image quality and/or reduced radiation exposure.
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Dijkstra H, Groen JM, Bongaerts FAHH, van der Jagt EJ, de Bock TGH, Greuter MJW. The cumulative risk of multiple CT exposures using two different methods. HEALTH PHYSICS 2014; 106:475-483. [PMID: 24562068 DOI: 10.1097/hp.0000000000000083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to compare the summing method (A) with the complement method (B) for calculating the cumulative lifetime-attributable-risk (LAR(tot)) of tumor incidence and mortality of multiple CT exposures. Method A defines LAR(tot) as the summation of the risk of each separate exposure. Method B was defined as the complement of the probability of inducing no cancer in N separate exposures. The risk of each separate exposure was estimated using dose, gender, and age at exposure (BEIR VII phase 2). Both methods were compared in a simulation and applied to a database of 11,884 patients exposed to multiple CTs. The relative difference between the methods was defined as ΔP%. Simulation confirmed that Method A always overestimates LAR(tot). ΔP% was proportional to the dose per exposure and the number of exposures. The differences between Methods A and B were small. Average LAR(tot) of tumor incidence was 0.140% (Method A) and 0.139% (Method B) with maxima of 5.70% and 5.56%, respectively. Average LAR(tot) of mortality was 0.085% for both methods, with maxima of 2.20% and 2.18%, respectively. ΔP% was highest (2.43%) for a female patient (3-y old) exposed to eight recurrent scans and a cumulative dose of 144 mSv. Although Method B is more accurate, both methods can be used to estimate the cumulative risk of multiple CT exposures. These results have to be interpreted, however, in the perspective of the uncertainties in the cancer risk model, which have been estimated at a factor of 2 or 3.
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Affiliation(s)
- Hildebrand Dijkstra
- *University of Groningen, University Medical Center Groningen Department of Radiology, Groningen, The Netherlands
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Oh JS, Koea JB. Radiation risks associated with serial imaging in colorectal cancer patients: Should we worry? World J Gastroenterol 2014; 20:100-109. [PMID: 24415862 PMCID: PMC3885998 DOI: 10.3748/wjg.v20.i1.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/31/2013] [Accepted: 08/09/2013] [Indexed: 02/06/2023] Open
Abstract
To provide an overview of the radiation related cancer risk associated with multiple computed tomographic scans required for follow up in colorectal cancer patients. A literature search of the PubMed and Cochrane Library databases was carried out and limited to the last 10 years from December 2012. Inclusion criteria were studies where computed tomographic scans or radiation from other medical imaging modalities were used and the risks associated with ionizing radiation reported. Thirty-six studies were included for appraisal with no randomized controlled trials. Thirty-four of the thirty-six studies showed a positive association between medical imaging radiation and increased risk of cancer. The radiation dose absorbed and cancer risk was greater in children and young adults than in older patients. Most studies included in the review used a linear, no-threshold model to calculate cancer risks and this may not be applicable at low radiation doses. Many studies are retrospective and ensuring complete follow up on thousands of patients is difficult. There was a minor increased risk of cancer from ionizing radiation in medical imaging studies. The radiation risks of low dose exposure (< 50 milli-Sieverts) are uncertain. A clinically justified scan in the context of colorectal cancer is likely to provide more benefits than harm but current guidelines for patient follow up will need to be revised to accommodate a more aggressive approach to treating metastatic disease.
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Ma S, Kong B, Liu B, Liu X. Biological effects of low-dose radiation from computed tomography scanning. Int J Radiat Biol 2013; 89:326-33. [PMID: 23216318 DOI: 10.3109/09553002.2013.756595] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE With the widespread use of computed tomography (CT), the risks of low-dose radiation from CT have been increasingly highlighted. This study aims to illustrate the CT-induced biological effects and analyze the potential beneficial or harmful outcomes so as to provide radiologists with reasonable advice on CT usage. MATERIALS AND METHODS The related literature was analyzed according to the topics of stochastic effect, hereditary effect, deterministic effect, accumulative injuries, hormesis and adaptive response; population epidemiology data were also analyzed. RESULTS CT accounts for 9% of X-ray examinations and approximately 40-67% of medical-related radiation, the dose is within the range of low-dose radiation (LDR). Two opposite viewpoints exist nowadays regarding the biological effects of CT scanning: They are either harmful or harmless. Approximately 0.6% and 1.5% of the cumulative cancer risk could be attributed to diagnostic X-rays in the UK and Germany, respectively. The probability of CT scans induced-cancer is about 0.7% and CT angiography's risk is around 0.13%. It is estimated that approximately 29,000 cancers could be related to CT scans in the USA every year. Meanwhile, another investigation of 25,104 patients who underwent 45,632 CT scans in 4 years showed that the majority of CT-induced cancers were accidents rather than certainties of frequent CT scans. CONCLUSION Although the LDR effects of CT are still controversial, the current problems include the high frequency-use and abuse of CT scans, the increase of radiation dose and accumulative dose in high-accuracy CT, and the poor understanding of carcinogenic risks. The underlying biological basis needs further exploring and the ratio of risks and benefits should be considered.
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Affiliation(s)
- Shumei Ma
- Key Laboratory of Radiobiology (Ministry of Health), School of Public Health, Jilin University, Changchun, China
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Abstract
Widespread conservative management of low-risk chest pain has motivated the development of a rapid triage strategy based on CT coronary angiography (CTCA) in the Emergency Department (ED). Recently, three prominent trials using this technology in the ED setting have presented results in support of its routine use. However, these studies fail to show the incremental prognostic value of CTCA over clinical and biomarker-based risk-stratification strategies, demonstrate additional downstream costs and interventions, and result in multiple harms associated with radio-contrast and radiation exposure. Observing the widespread overdiagnosis of pulmonary embolism following availability of CT pulmonary angiogram as a practice pattern parallel, CTCA use for low-risk chest pain in the ED should be advanced only with caution.
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Affiliation(s)
- Ryan Patrick Radecki
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
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Asher E, Greenberg-Dotan S, Halevy J, Glick S, Reuveni H. Defensive medicine in Israel - a nationwide survey. PLoS One 2012; 7:e42613. [PMID: 22916140 PMCID: PMC3420907 DOI: 10.1371/journal.pone.0042613] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 07/10/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily as a safeguard against possible malpractice liability. We studied the extent, reasons, and characteristics of defensive medicine in the Israeli health care system. METHODS AND FINDINGS Cross-sectional study performed in the Israeli health care system between April and July 2008 in a sample (7%) of board certified physicians from eight medical disciplines (internal medicine, pediatrics, general surgery, family medicine, obstetrics and gynecology, orthopedic surgery, cardiology, and neurosurgery). A total of 889 physicians (7% of all Israeli board certified specialists) completed the survey. The majority [60%, (95%CI 0.57-0.63)] reported practicing defensive medicine; 40% (95%CI 0.37-0.43) consider every patient as a potential threat for a medical lawsuit; 25% (95%CI 0.22-0.28) have previously been sued at least once during their career. Independent predictors for practicing defensive medicine were surgical specialty [OR=1.6 (95%CI 1.2-2.2), p=0.0004], not performing a fellowship abroad [OR=1.5 (95%CI 1.1-2), p=0.027], and previous exposure to lawsuits [OR=2.4 (95%CI 1.7-3.4), p<0.0001]. Independent predictors for the risk of being sued during a physician's career were male gender [OR=1.6 (95%CI 1.1-2.2), p=0.012] and surgery specialty [OR=3.2 (95%CI 2.4-4.3), p<0.0001] (general surgery, obstetrics and gynecology, orthopedic surgery, and neurosurgery). CONCLUSIONS Defensive medicine is very prevalent in daily physician practice in all medical disciplines. It exposes patients to complications due to unnecessary tests and procedures, affects quality of care and costs, and undermines doctor-patient relationships. Further studies are needed to understand how to minimize defensive medicine resulting from an increased malpractice liability market.
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Affiliation(s)
- Elad Asher
- Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
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Huda W, He W. Estimating cancer risks to adults undergoing body CT examinations. RADIATION PROTECTION DOSIMETRY 2012; 150:168-179. [PMID: 21926419 DOI: 10.1093/rpd/ncr376] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of the study is to estimate cancer risks from the amount of radiation used to perform body computed tomography (CT) examination. The ImPACT CT Patient Dosimetry Calculator was used to compute values of organ doses for adult body CT examinations. The radiation used to perform each examination was quantified by the dose-length product (DLP). Patient organ doses were converted into corresponding age and sex dependent cancer risks using data from BEIR VII. Results are presented for cancer risks per unit DLP and unit effective dose for 11 sensitive organs, as well as estimates of the contribution from 'other organs'. For patients who differ from a standard sized adult, correction factors based on the patient weight and antero-posterior dimension are provided to adjust organ doses and the corresponding risks. At constant incident radiation intensity, for CT examinations that include the chest, risks for females are markedly higher than those for males, whereas for examinations that include the pelvis, risks in males were slightly higher than those in females. In abdominal CT scans, risks for males and female patients are very similar. For abdominal CT scans, increasing the patient age from 20 to 80 resulted in a reduction in patient risks of nearly a factor of 5. The average cancer risk for chest/abdomen/pelvis CT examinations was ∼26 % higher than the cancer risk caused by 'sensitive organs'. Doses and radiation risks in 80 kg adults were ∼10 % lower than those in 70 kg patients. Cancer risks in body CT can be estimated from the examination DLP by accounting for sex, age, as well as patient physical characteristics.
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Affiliation(s)
- Walter Huda
- Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC323, Charleston, SC 29425, USA
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He W, Marzolf SA, Tipnis S, Huda W. Scan region and organ doses in computed tomography. RADIATION PROTECTION DOSIMETRY 2012; 148:444-451. [PMID: 21561946 DOI: 10.1093/rpd/ncr200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of this study was to investigate how the choice of the scanned region affects organ doses in CT. ImPACT CT Patient Dosimetry Calculator (version 1.0) was used to compute absorbed doses to eight organs of interest in medical radiation dosimetry. For 13 dosimetry data sets, the authors calculated the maximum organ dose (D(max)) as well as the corresponding organ dose for a scan with selected length D(L). These data permitted the relative dose (D(r) = D(L)/D(max)) to be determined for varying scan lengths. Computations were performed for a nominal X-ray tube current of 100 mA, a rotation time of 1 s and a CT pitch of 1. The authors also determined values of D(max)/CTDI(vol), where CTDI(vol) is obtained in a 32-cm diameter CT dosimetry phantom using the same radiographic techniques. For each organ, D(r) was independent of the type of scanner, and increased monotonically to unity with increasing scan length. Relative doses for a scan restricted to the organ length ranged from 0.65 D(max) for the bladder to 0.86 D(max) for the lungs. There was good correlation (r = 0.64) between relative organ dose and the corresponding organ length. At 120 kV, the lowest value of D(max)/CTDI(vol) was 1.23 for the breast and the highest was 2.22 for the thyroid. Varying the X-ray tube voltage between 100 and 130 kV results in changes in D(max)/CTDI(vol) of no more than 4 %. CT scans limited to the direct irradiation of an average-sized organ results in an absorbed dose of ~0.75 D(max).
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Affiliation(s)
- Wenjun He
- Clemson-MUSC Bioengineering Program, Department of Bioengineering, Clemson University, 173 Ashley Avenue, PO Box 250508, Charleston, SC 29425, USA.
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Cardiac CT in women: clinical application and considerations. J Cardiovasc Comput Tomogr 2012; 6:71-7. [PMID: 22369778 DOI: 10.1016/j.jcct.2012.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 01/03/2012] [Accepted: 01/20/2012] [Indexed: 11/20/2022]
Abstract
Cardiac computed tomography (CT) has special considerations and applications in women for the evaluation of coronary heart disease (CHD). Unique aspects of cardiovascular disease (CVD) in women include atypical symptoms and a later presentation of CHD. Disparities exist in mortality trends of CVD between men and women along with a lack of patient awareness of CVD as a significant cause of mortality for women. Differences have also become evident among plaque characteristics between the 2 sexes, with a relative increased prevalence of noncalcified plaque in women. Traditional risk prediction models, such as the Framingham Risk Score (FRS), have limitations in this population. Coronary calcium scanning contributes significantly to the accuracy of CHD detection on top of traditional CV risk factors in asymptomatic women. Coronary CT angiography has proven accurate for the diagnosis of significant CHD as well as cost effective in the evaluation of symptomatic women. The safety issue of radiation exposure with cardiac CT warrants special consideration for women. Concern for radiation-related cancer risks and organ-specific dose delivered to the breast is being addressed by radiation-reducing techniques. Future technologic advances in CT may allow for simultaneous screening for CHD and other disease processes, such as osteoporosis, breast cancer, and visceral adiposity in one routine test.
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Dougeni E, Faulkner K, Panayiotakis G. A review of patient dose and optimisation methods in adult and paediatric CT scanning. Eur J Radiol 2011; 81:e665-83. [PMID: 21684099 DOI: 10.1016/j.ejrad.2011.05.025] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 05/18/2011] [Accepted: 05/19/2011] [Indexed: 12/14/2022]
Abstract
An increasing number of publications and international reports on computed tomography (CT) have addressed important issues on optimised imaging practice and patient dose. This is partially due to recent technological developments as well as to the striking rise in the number of CT scans being requested. CT imaging has extended its role to newer applications, such as cardiac CT, CT colonography, angiography and urology. The proportion of paediatric patients undergoing CT scans has also increased. The published scientific literature was reviewed to collect information regarding effective dose levels during the most common CT examinations in adults and paediatrics. Large dose variations were observed (up to 32-fold) with some individual sites exceeding the recommended dose reference levels, indicating a large potential to reduce dose. Current estimates on radiation-related cancer risks are alarming. CT doses account for about 70% of collective dose in the UK and are amongst the highest in diagnostic radiology, however the majority of physicians underestimate the risk, demonstrating a decreased level of awareness. Exposure parameters are not always adjusted appropriately to the clinical question or to patient size, especially for children. Dose reduction techniques, such as tube-current modulation, low-tube voltage protocols, prospective echocardiography-triggered coronary angiography and iterative reconstruction algorithms can substantially decrease doses. An overview of optimisation studies is provided. The justification principle is discussed along with tools that assist clinicians in the decision-making process. There is the potential to eliminate clinically non-indicated CT scans by replacing them with alternative examinations especially for children or patients receiving multiple CT scans.
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Affiliation(s)
- E Dougeni
- Imaging Physics and Radiation Safety Section, Regional Medical Physics Department, Freeman Hospital, Freeman Road, Newcastle Upon Tyne NE7 7DN, UK.
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