Little Brent P, Duong Phuong-Anh, Knighton Jessie, Baugnon Kristen, Campbell-Brown Erica, Kitajima Hiroumi D, St Louis Steve, Tannir Habib, Applegate Kimberly E
Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia.
J Am Coll Radiol. 2015 Dec;12(12 Pt A):1257-65. doi: 10.1016/j.jacr.2015.07.020. Epub 2015 Oct 21.
The purpose of this article is to demonstrate the role of the ACR Dose Index Registry(®) (DIR) in a dose reduction program at a large academic health care system.
Using the ACR DIR, radiation doses were collected for four common CT examination types (head without contrast, chest with contrast, chest without contrast, and abdomen and pelvis with contrast). Baseline analysis of 7,255 CT examinations from seven scanners across the institution was performed for the period from December 1, 2011, to March 15, 2012. A comprehensive dose reduction initiative was guided by the identification of targets for dose improvement from the baseline analysis. Data for 14,938 examinations from the same seven scanners were analyzed for the postimplementation period of January 1, 2013, to July 1, 2013.
The program included protocol changes, iterative reconstruction, optimization of scan acquisition, technologist education, and continuous monitoring with feedback tools. Average decrease in median dose-length product (DLP) across scanners was 30% for chest CT without contrast, 29% for noncontrast head CT, 26% for abdominal and pelvic CT with contrast, and 10% for chest CT with contrast. Compared with average median DLP in the ACR DIR, the median institution-wide CT DLPs after implementation were lower by 33% for chest CT without contrast, 32% for chest CT with contrast, 26% for abdominal and pelvic CT with contrast, and 6% for head CT without contrast.
A comprehensive CT dose reduction program using the ACR DIR can lead to substantial dose reduction within a large health care system.
本文旨在阐述美国放射学会剂量指数登记系统（ACR DIR）在一家大型学术医疗系统的剂量降低计划中所发挥的作用。
利用ACR DIR，收集了四种常见CT检查类型（平扫头颅、增强胸部、平扫胸部以及增强腹部和盆腔）的辐射剂量。对该机构内七台扫描仪在2011年12月1日至2012年3月15日期间的7255例CT检查进行了基线分析。通过基线分析确定剂量改进目标，进而指导了一项全面的剂量降低计划。对同一七台扫描仪在2013年1月1日至2013年7月1日的实施后阶段的14938例检查数据进行了分析。
该计划包括方案变更、迭代重建、扫描采集优化、技术人员培训以及利用反馈工具进行持续监测。各扫描仪上，平扫胸部CT的剂量长度乘积（DLP）中位数平均下降30%，平扫头颅CT下降29%，增强腹部和盆腔CT下降26%，增强胸部CT下降10%。与ACR DIR中的平均DLP中位数相比，实施后全机构CT的DLP中位数，平扫胸部CT降低了33%，增强胸部CT降低了32%，增强腹部和盆腔CT降低了26%，平扫头颅CT降低了6%。
在大型医疗系统中，使用ACR DIR的全面CT剂量降低计划可实现大幅剂量降低。
