Correction to: Patient dose reference levels in surgery: a multicenter study.

The original version of this article, published on 01 August 2018, unfortunately contained two mistakes.

Patient dose reference levels in surgery: a multicenter study.

OBJECTIVE: To assess diagnostic reference levels (DRLs) in surgery for the most frequent procedures as required by the European Directive 2013/59/Euratom. METHODS: A survey was conducted in six centers. Eight orthopedic, urology and gastrointestinal surgical procedures were analyzed. Kerma area product (KAP) and fluoroscopy time (FT) were recorded for 50 patients (except for elbow: 30 patients) per procedure and per center from September 2016 to September 2017. DRLs were calculated as the 3rd quartiles of the distributions. For shoulder surgery, DRLs were defined according to the complexity of the procedure. For hand/wrist and foot/ankle surgery, DRLs were defined according to the technology (conventional C-arm vs. mini-C-arm). RESULTS: Results of 1870 procedures were retrieved. DRLs were calculated for the two dosimetric indicators and the eight procedures. DRLs were 2130 mGy.cm2 and 1.4 min for proximal femoral intramedullary nail, 1185 mGy.cm2 and 0.9 min for laparoscopic cholecystectomy and 2195 mGy.cm2 and 1.0 min for double-J (pigtail) ureteral catheter insertion. For shoulder surgery, KAP and FT were significantly higher (p < 0.05) for intramedullary procedures compared to extramedullary procedures. For hand/wrist and foot/ankle surgery, the KAPs were significantly higher (p < 0.05) with conventional C-arm compared to mini-C-arm, but FTs were not significantly different (p: not significant). CONCLUSION: This study reports DRLs in surgery based on a multicentric survey. KEY POINTS: • Delivered dose in surgery depends on procedure, practice and patient. • Diagnostic reference levels (DRLs) are proposed for eight surgical procedures. • DRLs are useful to benchmark practices and optimize protocols.

Establishment of diagnostic reference levels in cardiac CT in France: a need for patient dose optimisation.

The objective of this study was to propose diagnostic reference levels (DRLs) for coronary computed tomography angiography (CCTA), in the context of a large variability in patient radiation dose, and the lack of European recommendations. Volume Computed Tomography Dose Index (CTDIvol) and dose-length product (DLP) were collected from 460 CCTAs performed over a 3-month period at eight French hospitals. CCTAs (∼50 per centre) were performed using the routine protocols of the centres, and 64- to 320-detector CT scanners. ECG gating was prospective (n = 199) or retrospective (n = 261). The large gap in dose between these two modes required to propose specific DRLs: 26 and 44 mGy for CTDIvol, and 370 and 970 mGy cm for DLP, respectively. This study confirms the large variability in patient doses during CCTA and underlines the need for the optimisation of cardiac acquisition protocols. Availability of national DRLs should be mandatory in this setting.

Use of an automatic recording system for CT doses: evaluation of the impact of iterative reconstruction on radiation exposure in clinical practice.

OBJECTIVE: Despite the obligatory recording of doses administered to patients during CT scans, this data is not easily accessible. The objective of this study was to implement and validate a computerised automated dose-recording system for CT scans, for a single radiology department. MATERIAL AND METHODS: Every patient undergoing a CT scan in our department over a one-year period was included in the study. The CT scanner was upgraded after eight months (installation of iterative reconstruction and choice of an additional voltage of 100 kV). The system recorded, from DICOM image headers, the patient data and technical acquisition parameters. The statistical analysis compared the dose length products (DLP) before and after the upgrade, and compared them with the diagnostic reference levels (DRL). RESULTS: Four thousand seven hundred and ninety-five CT scans were included (2141 before the upgrade and 2654 after). For all of the acquisition protocols tested, there was a reduction in DLP after the upgrade. The mean reduction was 30%, with a range of 17% to 44% depending on the protocol. After the upgrade, all of the mean DLPs were under the DRL thresholds (P<0.0001). CONCLUSION: The proposed tool enabled systematic recording of the doses of radiation used in CT scans. It confirmed the significant reduction in the dose resulting from the implementation of iterative reconstruction, and enabled an exhaustive and rapid control of the respect of DRLs.