Joël Greffier1, Gilbert Ferretti2, Julia Rousseau2, Olivier Andreani3, Emilie Alonso3, Aymeric Rauch4, Romain Gillet4, Julien Le Roy5, Laurie Cabrol-Faivre5, Frederic Douane6, Arthur David6, Simon Henry7, Thibaut Jacques7, Xavier Stefanovic8, Eric Decoux8, Frederic Lafay9, Franck Pilleul10, Franck Couzon11, Claire Boutet11, Bernard Woerly12, Patrick Baur12, Nicolas Sans13, Marie Faruch13, Aurélie Moussier-Lherm14, Lambros Tselikas15, Alexis Jacquier16, Emeline Bigand16, Eric Pessis17, Christophe Teriitehau17, Florian Magnier18, Lucie Cassagnes18, Marc Haberlay19, David Boutteau19, Eric De Kerviler20, Cynthia Majorel-Gouthain21,22, Didier Defez21, Aurélie Vuillod21,23, Olivier Rouviere22, Laurent Hennequin24, Audrey Fohlen25, Rabih Alwan26, Alexandre Malakhia26, Sébastien Aubry26, Anthony Dohan27, Marie Eresue-Bony28, Romain Gautier28, Romaric Dal29, Djamel Dabli30, Thomas Hebert31, Robert Kovacs32, Lama Hadid-Beurrier33, Valérie Bousson33, Mélody Potel34, Yves Barbotteau35, Célian Michel36, Bouchra Habib-Geryes37, Marc André38, Thierry Arnaud39, Nathalie Bestion39,40, Olivier Ernst41, Sylvie Monfraix42, Pierre Yves Brillet43, Boris Guiu44, Loic Boussel23, Mathilde Demonchy45, Jean Paul Beregi46, Julien Frandon46. 1. Department of Medical Imaging, Medical Imaging Group Nimes, CHU Nimes, Univ Montpellier, EA 2415, Bd Prof Robert Debré, 30029, Nîmes Cedex 9, France. joel.greffier@chu-nimes.fr. 2. Pole imagerie, CHU Grenoble Alpes, Grenoble, France. 3. Service de radiologie, Institut Arnault Tzanck, St Laurent du Var, France. 4. Service d'Imagerie Guilloz, CHRU de Nancy, Nancy, France. 5. Medical Physics Department, Montpellier University Hospital, Montpellier, France. 6. Service de Radiologie interventionnelle, CHU Nantes Hôtel-Dieu, Nantes, France. 7. Service d'imagerie musculo-squelettique, CHU Lille, Lille, France. 8. Groupe d'imagerie CRP, clinique du Parc, Castelnau-le-Lez, France. 9. Unité de physique médicale, CLCC Lyon Bérard, Lyon, France. 10. Service d'imagerie, CLCC Lyon Bérard, Lyon, France. 11. Service de Radiologie centrale, Hôpital Nord, CHU de Saint-Etienne, Univ de Lyon, Saint-Etienne, France. 12. Centre d'imagerie médicale, Clinique de l'orangerie, Strasbourg, France. 13. Département de Radiologie du CHU de Toulouse, Hôpital Riquet, Toulouse, France. 14. Department of Medical Physics, Gustave Roussy, Paris-Saclay University, Villejuif, France. 15. Medical Imaging Department, Interventional Radiology Unit, Paris-Saclay University, Villejuif, France. 16. Service de Radiologie et d'Imagerie Médicale, CHU Timone 2, Marseille, France. 17. Service de Radiologie Interventionnelle du centre Cardiologique Nord, Saint Denis, France. 18. Pole de radiologie, CHU de Clermont + TGI - Institut Pascal, UMR 6602 UCA /CNRS /SIGMA Clermont, Clermont Ferrand, France. 19. Service de radiologie interventionnelle et thérapies mini-invasives, CH de Valenciennes, Valenciennes, France. 20. Service de Radiologie, Hôpital Saint-Louis, Paris, France. 21. Service de Physique Médicale et Radioprotection, Centre Hospitalier Lyon Sud, Pierre-Bénite, France. 22. Service d'Imagerie Radiologique B, Hôpital Edouard Herriot, Hospices Civiles de Lyon, Lyon, France. 23. Service de Radiologie, Hospices Civiles de Lyon, Groupement hospitalier Nord, Lyon, France. 24. Division of Radiology, CHR Metz-Thionville, Ars-Laquenexy, France. 25. Service d'imagerie médicale, CHU Caen, Caen, France. 26. Department of Radiology, CHU Besancon, Besançon, France. 27. Service de radiologie A, APHP-Hôpital Cochin, Université de Paris, Paris Descartes, Paris, France. 28. Unité de Radiophysique et de Radioprotection, CHU de Bordeaux, Bordeaux, France. 29. Imagerie radiodiagnostique, Institut Curie, Paris, France. 30. Département de radiologie, CHU d'Angers, Angers, France. 31. Service de radiologie, Hôpital de la Cavale blanche, Brest, France. 32. Service de radiologie, Hôpital Nord Franche Comté, Belfort, France. 33. Radiology Department, Lariboisière University Hospital, AP-HP, Paris, France. 34. Unité de Physique Médicale, Hôpitaux Civils de Colmar, Colmar, France. 35. Centre d'Imagerie de Clairval, Hôpital Privé Clairval, Marseille, France. 36. Service de radiologie, Institut Curie, Saint Cloud, France. 37. Service de radiologie adulte, Hôpital Universitaire Necker Enfants-Malades, AP-HP Centre, Université Paris, Paris, France. 38. Service de Radiologie, Hôpital de la Conception, APHM, Marseille, France. 39. Service d'imagerie Médicale, GIE MANOSCAN, Manosque, France. 40. Service d'imagerie médicale, CH Aix en Provence, Aix en Provence, France. 41. Service d'imagerie médicale, Hôpital Claude Huriez, Lille, France. 42. Unité de Radiophysique et Radioprotection, CHU Toulouse, Toulouse, France. 43. Service de Radiologie, Hôpital Avicenne, Assistance Publique des Hôpitaux de Paris -INSERM UMR 1272 Hypoxie & Poumon, Université Paris 13, Bobigny, France. 44. Department of Radiology, St-Eloi University Hospital, Montpellier, France. 45. Service de radiologie, Centre Hospitalier Intercommunal Fréjus-Saint-Raphaël, Fréjus, France. 46. Department of Medical Imaging, Medical Imaging Group Nimes, CHU Nimes, Univ Montpellier, EA 2415, Bd Prof Robert Debré, 30029, Nîmes Cedex 9, France.
Abstract
OBJECTIVES: To establish national reference levels (RLs) in interventional procedures under CT guidance as required by the 2013/59/Euratom European Directive. METHODS: Seventeen categories of interventional procedures in thoracic, abdominopelvic, and osteoarticular specialties (percutaneous infiltration, vertebroplasty, biopsy, drainage, tumor destruction) were analyzed. Total dose length product (DLP), number of helical acquisitions (NH), and total DLP for helical, sequential, or fluoroscopic acquisitions were recorded for 10 to 20 patients per procedure at each center. RLs were calculated as the 3rd quartiles of the distributions and target values for optimization process (TVOs) as the median. RLs and TVOs were compared with previously published studies. RESULTS: Results on 5001 procedures from 49 centers confirmed the great variability in patient dose for the same category of procedures. RLs were proposed for the DLPs and NHs in the seventeen categories. RLs in terms of DLP and NH were 375 mGy.cm and 2 NH for spinal or peri-spinal infiltration, 1630 mGy.cm and 3 NH for vertebroplasty, 845 mGy.cm and 4 NH for biopsy, 1950 mGy.cm and 8 NH for destruction of tumors, and 1090 mGy.cm and 5 NH for drainage. DLP and NH increased with the complexity of procedures. CONCLUSIONS: This study was the first nationwide multicentric survey to propose RLs for interventional procedures under CT guidance. Heterogeneity of practice in centers were found with different levels of patient doses for the same procedure. The proposed RLs will allow imaging departments to benchmark their practice with others and optimize their protocols. KEY POINTS: • National reference levels are proposed for 17 categories of interventional procedures under CT guidance. • Reference levels are useful for benchmarking practices and optimizing protocols. • Reference levels are proposed for dose length product and the number of helical acquisitions.
OBJECTIVES: To establish national reference levels (RLs) in interventional procedures under CT guidance as required by the 2013/59/Euratom European Directive. METHODS: Seventeen categories of interventional procedures in thoracic, abdominopelvic, and osteoarticular specialties (percutaneous infiltration, vertebroplasty, biopsy, drainage, tumor destruction) were analyzed. Total dose length product (DLP), number of helical acquisitions (NH), and total DLP for helical, sequential, or fluoroscopic acquisitions were recorded for 10 to 20 patients per procedure at each center. RLs were calculated as the 3rd quartiles of the distributions and target values for optimization process (TVOs) as the median. RLs and TVOs were compared with previously published studies. RESULTS: Results on 5001 procedures from 49 centers confirmed the great variability in patient dose for the same category of procedures. RLs were proposed for the DLPs and NHs in the seventeen categories. RLs in terms of DLP and NH were 375 mGy.cm and 2 NH for spinal or peri-spinal infiltration, 1630 mGy.cm and 3 NH for vertebroplasty, 845 mGy.cm and 4 NH for biopsy, 1950 mGy.cm and 8 NH for destruction of tumors, and 1090 mGy.cm and 5 NH for drainage. DLP and NH increased with the complexity of procedures. CONCLUSIONS: This study was the first nationwide multicentric survey to propose RLs for interventional procedures under CT guidance. Heterogeneity of practice in centers were found with different levels of patient doses for the same procedure. The proposed RLs will allow imaging departments to benchmark their practice with others and optimize their protocols. KEY POINTS: • National reference levels are proposed for 17 categories of interventional procedures under CT guidance. • Reference levels are useful for benchmarking practices and optimizing protocols. • Reference levels are proposed for dose length product and the number of helical acquisitions.