Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry

• Authors: Denise Bos, University Hospital Essen, Hufelandstrasse; Sophronia Yu, University of California San Francisco; Jason Luong, University of California San Francisco; Philip Chu, University of California San Francisco; Yifei Wang, University of California San Francisco; Andrew J Einstein, Columbia University; Jay Starkey, St Luke’s International Hospital; Bradley N Delman, Icahn School of Medicine at Mt Sinai; Phuong-Anh T Duong, University of Utah; Marco Das, Helios Hospital Duisburg; Sebastian Schindera, Kantonsspital Aarau AG; Allen R Goode, UVA Health; Fiona MacLeod, John Radcliffe Hosp; Axel Wetter, University Hospital Essen; Rebecca Neill, Emory University; Ryan K Lee, Einstein Healthcare Network; Jodi Roehm, RAYUS Radiol; James A Seibert, UC Davis Health; Luisa F Cervantes, Nicklaus Childrens Hospital; Nima Kasraie, UT Southwestern Med Ctr; Pavlina Pike, Huntsville Hospital AL; Anokh Pahwa, Olive View - UCLA Medical Center; Cécile RLPN Jeukens, Maastricht University Medical Centre; Rebecca Smith-Bindman, University of California San Francisco
• Journal Title: EUROPEAN RADIOLOGY
• Volume: Volume 32, Number 3
• Publisher: SPRINGER | 2021-10-13, Pages 1971-1982
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1007/s00330-021-08266-1
• Subjects: Health Sciences, Radiology; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Radiology, Nuclear Medicine & Medical Imaging; Tomography; X-ray computed; Adult; Diagnostic reference levels; United States; Registries; COMPUTED-TOMOGRAPHY; NATIONAL-SURVEY; CARDIAC CT; RADIATION; RISK; ESTABLISHMENT; EXPOSURE; CANCER

Abstract

Objectives: The European Society of Radiology identified 10 common indications for computed tomography (CT) as part of the European Study on Clinical Diagnostic Reference Levels (DRLs, EUCLID), to help standardize radiation doses. The objective of this study is to generate DRLs and median doses for these indications using data from the UCSF CT International Dose Registry. Methods: Standardized data on 3.7 million CTs in adults were collected between 2016 and 2019 from 161 institutions across seven countries (United States of America (US), Switzerland, Netherlands, Germany, UK, Israel, Japan). DRLs (75th percentile) and median doses for volumetric CT-dose index (CTDIvol) and dose-length product (DLP) were assessed for each EUCLID category (chronic sinusitis, stroke, cervical spine trauma, coronary calcium scoring, lung cancer, pulmonary embolism, coronary CT angiography, hepatocellular carcinoma (HCC), colic/abdominal pain, appendicitis), and US radiation doses were compared with European. Results: The number of CT scans within EUCLID categories ranged from 8,933 (HCC) to over 1.2 million (stroke). There was greater variation in dose between categories than within categories (p <.001), and doses were significantly different between categories within anatomic areas. DRLs and median doses were assessed for all categories. DRLs were higher in the US for 9 of the 10 indications (except chronic sinusitis) than in Europe but with a significantly higher sample size in the US. Conclusions: DRLs for CTDIvol and DLP for EUCLID clinical indications from diverse organizations were established and can contribute to dose optimization. These values were usually significantly higher in the US than in Europe. Key Points: • Registry data were used to create benchmarks for 10 common indications for CT identified by the European Society of Radiology. • Observed US radiation doses were higher than European for 9 of 10 indications (except chronic sinusitis). • The presented diagnostic reference levels and median doses highlight potentially unnecessary variation in radiation dose.