Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical College, NY 10065, USA.
AJR Am J Roentgenol. 2010 Jul;195(1):176-80. doi: 10.2214/AJR.09.3786.
The purpose of this study was to reduce the cumulative radiation exposure from CT of patients with aneurysmal subarachnoid hemorrhage.
Baseline data on 30 patients with aneurysmal subarachnoid hemorrhage were collected retrospectively for all CT examinations of the head performed throughout the hospital course. Radiation exposure estimates were obtained by recording dose-length products for each examination. As a departmental practice quality improvement project, an imaging protocol was implemented that included utilization guidelines to reduce radiation exposure in CTA and CT perfusion examinations performed to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage. Ten months after implementation of this protocol, data on 30 additional patients were analyzed. Means, medians, and SD estimates were compared for cumulative radiation exposure and absolute numbers of each examination.
Sixty patients were included in the study: 30 patients at baseline and 30 patients after implementation of the quality improvement plan. These patients underwent 435 CT examinations: 248 examinations at baseline and 187 examinations with the new protocol. With the new algorithm, the mean number of CT examinations per patient was 5.8 compared with 7.8 at baseline, representing a decrease of 25.6%. The number of CT perfusion examinations per patient decreased 32.1%. Overall, there was a 12.1% decrease in cumulative radiation exposure (p > 0.05).
With the structured imaging algorithm, the cumulative radiation exposure and number of CT examinations of the head decreased among patients with aneurysmal subarachnoid hemorrhage because utilization guidelines defined the appropriate imaging time points for detection of vasospasm. Application of these methods to other patient populations with high use of CT may reduce cumulative radiation exposure while the clinical benefits of imaging are maintained.
本研究旨在降低蛛网膜下腔出血患者 CT 的累积辐射暴露。
回顾性收集了 30 例蛛网膜下腔出血患者的基线数据，对患者整个住院期间进行的所有头部 CT 检查进行了分析。通过记录每次检查的剂量长度产品来获取辐射暴露估计值。作为部门实践质量改进项目，实施了成像方案，包括利用指南减少 CTA 和 CT 灌注检查的辐射暴露，以检测蛛网膜下腔出血患者的血管痉挛。在该方案实施 10 个月后，分析了另外 30 例患者的数据。比较了累积辐射暴露和每次检查的绝对数量的平均值、中位数和标准差估计值。
共有 60 例患者纳入研究：基线时 30 例，质量改进计划实施后 30 例。这些患者共进行了 435 次 CT 检查：基线时进行了 248 次检查，采用新方案进行了 187 次检查。采用新算法，每位患者的 CT 检查次数平均为 5.8 次，而基线时为 7.8 次，减少了 25.6%。每位患者的 CT 灌注检查次数减少了 32.1%。总的来说，累积辐射暴露降低了 12.1%（p>0.05）。
由于使用指南定义了检测血管痉挛的适当成像时间点，使用结构化成像算法使蛛网膜下腔出血患者的头部 CT 累积辐射暴露和检查次数减少。将这些方法应用于其他 CT 使用量高的患者群体中，可能在维持影像学临床获益的同时降低累积辐射暴露。
