Taylor Brunton Smith1,2, John Heil3, Donald P Frush4, Ehsan Samei5,6,7. 1. Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University, 2424 Erwin Road, Suite 302, Durham, NC, 27705, USA. taylor.smith@duke.edu. 2. Medical Physics Graduate Program, Duke University, Durham, NC, USA. taylor.smith@duke.edu. 3. Imalogix, LLC, Bryn Mawr, PA, USA. 4. Department of Radiology, Lucile Salter Packard Children's Hospital, Stanford University, Stanford, CA, USA. 5. Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University, 2424 Erwin Road, Suite 302, Durham, NC, 27705, USA. 6. Medical Physics Graduate Program, Duke University, Durham, NC, USA. 7. Clinical Imaging Physics Group, Duke University Medical Center, Durham, NC, USA.
Abstract
BACKGROUND: Managing patient radiation dose in pediatric computed tomography (CT) examinations is essential. Some organizations, most notably Image Gently, have suggested techniques to lower dose to pediatric patients and mitigate risk while maintaining image quality. OBJECTIVE: We sought to validate whether institutions are observing Image Gently guidelines in practice. MATERIALS AND METHODS: Dose-relevant data from 663,417 abdomen-pelvis and chest CT scans were obtained from 53 facilities. Patients were assigned arbitrary age cohorts with a minimum size of n=12 patients in each age group, for statistical purposes. All pediatric (<19 years old) cohorts at a given facility were compared to the adult cohort by a Kruskal-Wallis test for each of the four scan parameters - (1) x-ray tube kilovoltage (kV), (2) tube-current-by-exposure-time product (tube mAs), (3) scan pitch and (4) tube rotation time - to assess whether the distribution of values in the pediatric cohorts differed from the adult cohort. The same was repeated with volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE) to assess whether pediatric cohorts received less dose than adult cohorts. A P-value of <0.05 was deemed significant. RESULTS: Across the 150 pediatric cohorts, 134 had scan parameters that were more child-sized than their adult counterparts. In 128 of these 134 pediatric cohorts, the CTDIvol was less than the adult counterpart. In 111 of these 128 pediatric cohorts, the SSDE was less than the adult counterpart. CONCLUSION: The study reaffirms that in practice, Image Gently's suggestions of lowering tube mAs and peak kilovoltage are commonly employed and effective at reducing pediatric CT dose.
BACKGROUND: Managing patient radiation dose in pediatric computed tomography (CT) examinations is essential. Some organizations, most notably Image Gently, have suggested techniques to lower dose to pediatric patients and mitigate risk while maintaining image quality. OBJECTIVE: We sought to validate whether institutions are observing Image Gently guidelines in practice. MATERIALS AND METHODS: Dose-relevant data from 663,417 abdomen-pelvis and chest CT scans were obtained from 53 facilities. Patients were assigned arbitrary age cohorts with a minimum size of n=12 patients in each age group, for statistical purposes. All pediatric (<19 years old) cohorts at a given facility were compared to the adult cohort by a Kruskal-Wallis test for each of the four scan parameters - (1) x-ray tube kilovoltage (kV), (2) tube-current-by-exposure-time product (tube mAs), (3) scan pitch and (4) tube rotation time - to assess whether the distribution of values in the pediatric cohorts differed from the adult cohort. The same was repeated with volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE) to assess whether pediatric cohorts received less dose than adult cohorts. A P-value of <0.05 was deemed significant. RESULTS: Across the 150 pediatric cohorts, 134 had scan parameters that were more child-sized than their adult counterparts. In 128 of these 134 pediatric cohorts, the CTDIvol was less than the adult counterpart. In 111 of these 128 pediatric cohorts, the SSDE was less than the adult counterpart. CONCLUSION: The study reaffirms that in practice, Image Gently's suggestions of lowering tube mAs and peak kilovoltage are commonly employed and effective at reducing pediatric CT dose.
Authors: G Sadigh; N Kadom; P Karthik; D Sengupta; K J Strauss; D Frush; K E Applegate Journal: AJNR Am J Neuroradiol Date: 2018-07-05 Impact factor: 3.825