Shivam Rastogi1, Ramandeep Singh1, Riddhi Borse1, Petra Valkovic Zujic2, Doris Segota3, Ana Diklic3, Slaven Jurkovic3, Antar Ali4, Hassan Mohammed Kharita4, Huda M Al-Naemi4, Jokha Alkalbani5, Amaal Al-Rasbi6, Vesna Gershan7, Stipe Galic8, Mohammad Yusuf9, Simona Avramova-Cholakova10, Ili Majidah Binti Hj Zulkipli11, Nilar Shein12, Seife Teferi13, Madan M Rehani1, Jenia Vassileva14, Mannudeep K Kalra1. 1. MGH Webster Center for Quality and Safety, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. 2. Department of Radiology, University Hospital Rijeka, Rijeka, Croatia. 3. Department of Medical Physics, University Hospital Rijeka, Rijeka, Croatia. 4. Hamad Medical Corporation, Doha, Qatar. 5. Department of Radiology, Royal Hospital, Muscat, Oman. 6. Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman. 7. Faculty of Natural Sciences and Mathematics, University SS Cyril and Methodius, Skopje, North Macedonia. 8. Medical Physics and Radiation Protection Office, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina. 9. Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan. 10. Medical Physics Laboratory, University Hospital Acibadem City Clinic, Sofia, Bulgaria. 11. Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam. 12. Department of Radiology, Pun Hlaing Siloam Hospital, Yangon, Myanmar. 13. Department of Radiology, Tikur Anbessa Specialized Hospital, Addis Abada, Ethiopia. 14. International Atomic Energy Agency, Vienna, Austria.
Abstract
PURPOSE: To assess the frequency, appropriateness, and radiation doses associated with multiphase computed tomography (CT) protocols for routine chest and abdomen-pelvis examinations in 18 countries. MATERIALS AND METHODS: In collaboration with the International Atomic Energy Agency, multi-institutional data on clinical indications, number of scan phases, scan parameters, and radiation dose descriptors (CT dose-index volume; dose-length product [DLP]) were collected for routine chest (n = 1706 patients) and abdomen-pelvis (n = 426 patients) CT from 18 institutions in Asia, Africa, and Europe. Two radiologists scored the need for each phase based on clinical indications (1 = not indicated, 2 = probably indicated, 3 = indicated). We surveyed 11 institutions for their practice regarding single-phase and multiphase CT examinations. Data were analyzed with the Student t test. RESULTS: Most institutions use multiphase protocols for routine chest (10/18 institutions) and routine abdomen-pelvis (10/11 institutions that supplied data for abdomen-pelvis) CT examinations. Most institutions (10/11) do not modify scan parameters between different scan phases. Respective total DLP for 1-, 2-, and 3-phase routine chest CT was 272, 518, and 820 mGy·cm, respectively. Corresponding values for 1- to 5-phase routine abdomen-pelvis CT were 400, 726, 1218, 1214, and 1458 mGy cm, respectively. For multiphase CT protocols, there were no differences in scan parameters and radiation doses between different phases for either chest or abdomen-pelvis CT (P = 0.40-0.99). Multiphase CT examinations were unnecessary in 100% of routine chest CT and in 63% of routine abdomen-pelvis CT examinations. CONCLUSIONS: Multiphase scan protocols for the routine chest and abdomen-pelvis CT examinations are unnecessary, and their use increases radiation dose.
PURPOSE: To assess the frequency, appropriateness, and radiation doses associated with multiphase computed tomography (CT) protocols for routine chest and abdomen-pelvis examinations in 18 countries. MATERIALS AND METHODS: In collaboration with the International Atomic Energy Agency, multi-institutional data on clinical indications, number of scan phases, scan parameters, and radiation dose descriptors (CT dose-index volume; dose-length product [DLP]) were collected for routine chest (n = 1706 patients) and abdomen-pelvis (n = 426 patients) CT from 18 institutions in Asia, Africa, and Europe. Two radiologists scored the need for each phase based on clinical indications (1 = not indicated, 2 = probably indicated, 3 = indicated). We surveyed 11 institutions for their practice regarding single-phase and multiphase CT examinations. Data were analyzed with the Student t test. RESULTS: Most institutions use multiphase protocols for routine chest (10/18 institutions) and routine abdomen-pelvis (10/11 institutions that supplied data for abdomen-pelvis) CT examinations. Most institutions (10/11) do not modify scan parameters between different scan phases. Respective total DLP for 1-, 2-, and 3-phase routine chest CT was 272, 518, and 820 mGy·cm, respectively. Corresponding values for 1- to 5-phase routine abdomen-pelvis CT were 400, 726, 1218, 1214, and 1458 mGy cm, respectively. For multiphase CT protocols, there were no differences in scan parameters and radiation doses between different phases for either chest or abdomen-pelvis CT (P = 0.40-0.99). Multiphase CT examinations were unnecessary in 100% of routine chest CT and in 63% of routine abdomen-pelvis CT examinations. CONCLUSIONS: Multiphase scan protocols for the routine chest and abdomen-pelvis CT examinations are unnecessary, and their use increases radiation dose.