Risks, Benefits, and Risk Reduction Strategies in Thoracic CT Imaging

Xinhui Duan; Cynthia McCollough

doi:10.1055/s-0033-1363454

Seminars in Respiratory and Critical Care Medicine, Inhaltsverzeichnis

Semin Respir Crit Care Med 2014; 35(01): 083-090
DOI: 10.1055/s-0033-1363454

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risks, Benefits, and Risk Reduction Strategies in Thoracic CT Imaging

Xinhui Duan

¹Department of Radiology, Mayo Clinic, Rochester, Minnesota

,

Cynthia McCollough

¹Department of Radiology, Mayo Clinic, Rochester, Minnesota

› Institutsangaben

Abstract

Chest computed tomography (CT) is a useful tool for diagnosing various thoracic conditions and has become the diagnostic imaging modality of choice for many diseases. Recent discussions about the radiation dose from CT have attracted the attention of medical professionals and the general public. This article discusses radiation dose with an emphasis on chest CT and on current techniques for patient dose reduction. Four techniques are discussed in detail, including tube current modulation, automatic exposure control, automatic tube voltage selection, and iterative image reconstruction. Adopting these techniques in routine clinical practice can dramatically reduce radiation dose levels.

Keywords

thoracic CT - radiation dose - dose reduction

Volltext

Referenzen

References
1 Thoracic Imaging Criteria. Available at: http://www.acr.org/Quality-Safety/Appropriateness-Criteria/Diagnostic/Thoracic-Imaging . Accessed March, 2013
2 National Council on Radiation Protection and Measurements. National Council on Radiation Protection and Measurements. Scientific Committee 6–2 on Radiation Exposure of the U.S. Population. Ionizing Radiation Exposure of the Population of the United States: Recommendations of the National Council on Radiation Protection and Measurements. Bethesda, MD: National Council on Radiation Protection and Measurements; 2009
3 McCollough CH, Leng S, Yu L, Cody DD, Boone JM, McNitt-Gray MF. CT dose index and patient dose: they are not the same thing. Radiology 2011; 259 (2) 311-316
4 American Association of Physicists in Medicine. Size-Specific Dose Estimates (SSDE) in Pediatric and Adult Body CT Examinations (Report 204). College Park, MD: American Association of Physicists in Medicine; 2011
5 McCollough CH, Schueler BA. Calculation of effective dose. Med Phys 2000; 27 (5) 828-837
6 International Commission on Radiological Protection.. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007; 37 (2-4) 1-332
7 International Commission on Radiation Units and Measurements. Fundamental Quantities and Units for Ionizing Radiation (Report 60). J ICRU 1998; 30: 1-24
8 International Commission on Radiological Protection. Recommendations of the International Commission on Radiological Protection (ICRP #26). Oxford: The International Commission on Radiological Protection; 1977. . Report No.: ICRP Publication 26
9 National Research Council (U.S.). Committee to Assess Health Risks from Exposure to Low Level of Ionizing Radiation. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington, D.C.: National Academies Press; 2006
10 Tubiana M, Feinendegen LE, Yang CC, Kaminski JM. The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology 2009; 251 (1) 13-22
11 McCollough CH, Guimarães L, Fletcher JG. In defense of body CT. AJR Am J Roentgenol 2009; 193 (1) 28-39
12 Hendee WR, O'Connor MK. Radiation risks of medical imaging: separating fact from fantasy. Radiology 2012; 264 (2) 312-321
13 Health Physics Society. Radiation risk in perspective. Position Statement of the Health Physics Society: PS010–1 (Adopted 1996) 2010 (Revised)
14 American Association of Physicists in Medicine. AAPM Position Statement on Radiation Risks from Medical Imaging Procedures (Policy No. PP 25-A). 2011
15 Durand DJ. A rational approach to the clinical use of cumulative effective dose estimates. AJR Am J Roentgenol 2011; 197 (1) 160-162
16 Kalender WA, Wolf H, Suess C. Dose reduction in CT by anatomically adapted tube current modulation. II. Phantom measurements. Med Phys 1999; 26 (11) 2248-2253
17 Gies M, Kalender WA, Wolf H, Suess C. Dose reduction in CT by anatomically adapted tube current modulation. I. Simulation studies. Med Phys 1999; 26 (11) 2235-2247
18 Wang J, Duan X, Christner JA, Leng S, Yu L, McCollough CH. Radiation dose reduction to the breast in thoracic CT: comparison of bismuth shielding, organ-based tube current modulation, and use of a globally decreased tube current. Med Phys 2011; 38 (11) 6084-6092
19 AAPM Position Statement on the Use of Bismuth Shielding for the Purpose of Dose Reduction in CT scanning. 2012. Available at: http://www.aapm.org/publicgeneral/BismuthShielding.pdf . Accessed April 1, 2013
20 McCollough CH, Bruesewitz MR, Kofler Jr JM. CT dose reduction and dose management tools: overview of available options. Radiographics 2006; 26 (2) 503-512
21 Wilting JE, Zwartkruis A, van Leeuwen MS, Timmer J, Kamphuis AG, Feldberg M. A rational approach to dose reduction in CT: individualized scan protocols. Eur Radiol 2001; 11 (12) 2627-2632
22 Yu L, Li H, Fletcher JG, McCollough CH. Automatic selection of tube potential for radiation dose reduction in CT: a general strategy. Med Phys 2010; 37 (1) 234-243
23 Yu L, Bruesewitz MR, Thomas KB, Fletcher JG, Kofler JM, McCollough CH. Optimal tube potential for radiation dose reduction in pediatric CT: principles, clinical implementations, and pitfalls. Radiographics 2011; 31 (3) 835-848
24 CARE kV: Automated Dose-Optimized Selection of X-ray Tube Voltage, White Paper. Available at: http://www.medical.siemens.com/siemens/en_US/gg_ct_FBAs/files/Case_Studies/CarekV_White_Paper.pdf . Accessed March, 2013
25 Gnannt R, Winklehner A, Eberli D, Knuth A, Frauenfelder T, Alkadhi H. Automated tube potential selection for standard chest and abdominal CT in follow-up patients with testicular cancer: comparison with fixed tube potential. Eur Radiol 2012; 22 (9) 1937-1945
26 Hough DM, Fletcher JG, Grant KL , et al. Lowering kilovoltage to reduce radiation dose in contrast-enhanced abdominal CT: initial assessment of a prototype automated kilovoltage selection tool. AJR Am J Roentgenol 2012; 199 (5) 1070-1077
27 Pontana F, Pagniez J, Duhamel A , et al. Reduced-dose low-voltage chest CT angiography with Sinogram-affirmed iterative reconstruction versus standard-dose filtered back projection. Radiology 2013; 267 (2) 609-618
28 Boedeker KL, Cooper VN, McNitt-Gray MF. Application of the noise power spectrum in modern diagnostic MDCT: part I. Measurement of noise power spectra and noise equivalent quanta. Phys Med Biol 2007; 52 (14) 4027-4046
29 Boedeker KL, McNitt-Gray MF. Application of the noise power spectrum in modern diagnostic MDCT: part II. Noise power spectra and signal to noise. Phys Med Biol 2007; 52 (14) 4047-4061
30 Leipsic J, Nguyen G, Brown J, Sin D, Mayo JR. A prospective evaluation of dose reduction and image quality in chest CT using adaptive statistical iterative reconstruction. AJR Am J Roentgenol 2010; 195 (5) 1095-1099
31 Prakash P, Kalra MK, Digumarthy SR , et al. Radiation dose reduction with chest computed tomography using adaptive statistical iterative reconstruction technique: initial experience. J Comput Assist Tomogr 2010; 34 (1) 40-45
32 Pontana F, Duhamel A, Pagniez J , et al. Chest computed tomography using iterative reconstruction vs filtered back projection (Part 2): image quality of low-dose CT examinations in 80 patients. Eur Radiol 2011; 21 (3) 636-643
33 Singh S, Kalra MK, Gilman MD , et al. Adaptive statistical iterative reconstruction technique for radiation dose reduction in chest CT: a pilot study. Radiology 2011; 259 (2) 565-573
34 American Association of Physicists in Medicine. AAPM Recommendations Regarding Notification and Alert Values for CT Scanners: Guidelines for Use of the NEMA XR 25 CT Dose-Check Standard. 2011. Available at: http://www.aapm.org/pubs/CTProtocols/documents/NotificationLevelsStatement.pdf . Accessed March, 2013
35 CT Scan Protocols. Available at: http://www.aapm.org/pubs/CTProtocols/ . Accessed March, 2013
36 Image wisely: radiation safety in adult medical imaging. Available at: http://www.imagewisely.org/ . Accessed March, 2013
37 Image gently: the alliance for radiation safety in pediatric imaging. Available at: http://www.pedrad.org/associations/5364/ig/ . Accessed March, 2013
38 Computed Tomography Accrediation. Available at: http://www.acr.org/Quality-Safety/Accreditation/CT . Accessed March, 2013
39 Dose Index Registry. Available at: https://nrdr.acr.org/Portal/DIR/Main/page.aspx . Accessed March, 2013
40 Aberle DR, Berg CD, Black WC , et al; National Lung Screening Trial Research Team. The National Lung Screening Trial: overview and study design. Radiology 2011; 258 (1) 243-253
41 Mettler Jr FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 2008; 248 (1) 254-263