Use of Multiphase CT Protocols in 18 Countries: Appropriateness and Radiation Doses.

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.

Comparison of patient effective doses from multiple CT examinations based on different calculation methods.

The aim of this study is to compare effective dose (E) estimations based on different methods for patients with recurrent computed tomography (CT) examinations. Seventeen methods were used to determine the E of each phase as well as the total E of the CT examination. These included three groups of estimations: based on the use of published E, calculated from typical or patient-specific values of volume computed tomography dose index (CTDIvol) and dose-length product (DLP) multiplied by conversion coefficients, and based on patient-specific calculations with use of software. The E from a single phase of the examination varied with a ratio from 1.3 to 6.8 for small size patients, from 1.2 to 6.5 for normal size patients, and from 1.7 up to 18.1 for large size patients, depending on the calculation method used. The cumulative effective dose (CED) ratio per patient for the different size groups varied as follows: from 1.4 to 2.5 (small), from 1.7 to 4.3 (normal), and from 2.2 up to 6.3 (large). The minimum CED across patients varied from 38 up to 200 mSv, while the variation of maximum CED was from 122 up to 538 mSv. Although E is recommended for population estimations, it is sometimes needed and used for individual patients in clinical practice. Its value is highly dependent on the method applied. Individual estimations of E can vary up to 18.1 times and CED estimations can differ up to 6 times. The related large uncertainties should always be taken into account.

PERFORMANCE COMPARISON OF SYSTEMS WITH FULL-FIELD DIGITAL MAMMOGRAPHY, DIGITAL BREAST TOMOSYNTHESIS AND CONTRAST-ENHANCED SPECTRAL MAMMOGRAPHY.

The purpose is to compare full-field digital mammography (FFDM), digital breast tomosynthesis (DBT) and contrast-enhanced spectral mammography (CESM) technologies on three mammography systems in terms of image quality and patient dose. Two Senographe Essential with DBT and CESM (denoted S1 and S2) and one Selenia Dimensions (S3) with FFDM and DBT were considered. Dosimetry methods recommended in the European protocol were used. Image quality was tested with CDMAM in FFDM and DBT and with ideal observer method in FFDM. Mean values of mean glandular dose (MGD) from whole patient samples on S1, S2 and S3 were as follows: FFDM 1.65, 1.84 and 2.23 mGy; DBT 2.03, 1.96 and 2.87 mGy; CESM 2.65 and 3.16 mGy, respectively. S3 exhibited better low-contrast detectability for the smallest sized discs of CDMAM and ideal observer in FFDM, and for the largest sized discs in DBT, at similar dose levels.

CT protocols and radiation doses for hematuria and urinary stones: Comparing practices in 20 countries.

PURPOSE: Patients with hematuria and renal colic often undergo CT scanning. The purpose of our study was to assess variations in CT protocols and radiation doses for evaluation of hematuria and urinary stones in 20 countries. METHOD: The International Atomic Energy Agency (IAEA) surveyed practices in 51 hospitals from 20 countries in the European region according to the IAEA Technical cooperation classification and obtained following information for three CT protocols (urography, urinary stones, and routine abdomen-pelvis CT) for 1276 patients: patient information (weight, clinical indication), scanner information (scan vendor, scanner name, number of detector rows), scan parameters (such as number of phases, scan start and end locations, mA, kV), and radiation dose descriptors (CTDIvol, DLP). Two radiologists assessed the appropriateness of clinical indications and number of scan phases using the ESR Referral Guidelines and ACR Appropriateness Criteria. Descriptive statistics and Student's t tests were performed. RESULTS: Most institutions use 3-6 phase CT urography protocols (80 %, median DLP 1793-3618 mGy.cm) which were associated with 2.4-4.9-fold higher dose compared to 2-phase protocol (20 %, 740 mGy.cm) (p < 0.0001). Likewise, 52 % patients underwent 3-5 phase routine abdomen- pelvis CT (1574-2945 mGy.cm) as opposed to 37 % scanned with a single-phase routine CT (676 mGy.cm). The median DLP for urinary stones CT (516 mGy.cm) were significantly lower than the median DLP for the other two CT protocols (p < 0.0001). CONCLUSIONS: Few institutions (4/13) use low dose CT for urinary stones. There are substantial variations in CT urography and routine abdomen-pelvis CT protocols result in massive radiation doses (up to 2945-3618 mGy.cm).

Quality Controls in Digital Mammography protocol of the EFOMP Mammo Working group.

This article aims to present the protocol on Quality Controls in Digital Mammography published online in 2015 by the European Federation of Organisations for Medical Physics (EFOMP) which was developed by a Task Force under the Mammo Working Group. The main objective of this protocol was to define a minimum set of easily implemented quality control tests on digital mammography systems that can be used to assure the performance of a system within a set and acceptable range. Detailed step-by-step instructions have been provided, limiting as much as possible any misinterpretations or variations by the person performing. It is intended that these tests be implemented as part of the daily routine of medical physicists and system users throughout Europe in a harmonised way so allowing results to be compared. In this paper the main characteristics of the protocol are illustrated, including examples, together with a brief summary of the contents of each chapter. Finally, instructions for the download of the full protocol and of the related software tools are provided.

Image quality and dose in mammography in 17 countries in Africa, Asia and Eastern Europe: results from IAEA projects.

PURPOSE: The objective is to study mammography practice from an optimisation point of view by assessing the impact of simple and immediately implementable corrective actions on image quality. MATERIALS AND METHODS: This prospective multinational study included 54 mammography units in 17 countries. More than 21,000 mammography images were evaluated using a three-level image quality scoring system. Following initial assessment, appropriate corrective actions were implemented and image quality was re-assessed in 24 units. RESULTS: The fraction of images that were considered acceptable without any remark in the first phase (before the implementation of corrective actions) was 70% and 75% for cranio-caudal and medio-lateral oblique projections, respectively. The main causes for poor image quality before corrective actions were related to film processing, damaged or scratched image receptors, or film-screen combinations that are not spectrally matched, inappropriate radiographic techniques and lack of training. Average glandular dose to a standard breast was 1.5 mGy (mean and range 0.59-3.2 mGy). After optimisation the frequency of poor quality images decreased, but the relative contributions of the various causes remained similar. Image quality improvements following appropriate corrective actions were up to 50 percentage points in some facilities. CONCLUSIONS: Poor image quality is a major source of unnecessary radiation dose to the breast. An increased awareness of good quality mammograms is of particular importance for countries that are moving towards introduction of population-based screening programmes. The study demonstrated how simple and low-cost measures can be a valuable tool in improving of image quality in mammography.