儿科胸部 CT 诊断参考范围：制定与应用。
Pediatric Chest CT Diagnostic Reference Ranges: Development and Application.
机构信息
From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026 (K.J.S., M.J.G., A.J.T.); American College of Radiology National Radiology Data Registries, American College of Radiology, Reston, Va (D.S., M.B.C.); Department of Radiology, Boston Children's Hospital, Boston, Mass (M.J.C.); Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (K.D.); Department of Radiology, Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); Division of Pediatric Radiology, Duke University Medical Center, Durham, NC (D.P.F., C.M.); Section of Pediatric Radiology, Massachusetts General Hospital, Boston, Mass (S.J.W.); Department of Radiology, Primary Children's Hospital, Salt Lake City, Utah (J.S.P.); and Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, Ohio (H.W.).
出版信息
Radiology. 2017 Jul;284(1):219-227. doi: 10.1148/radiol.2017161530. Epub 2017 Feb 17.
Purpose To determine diagnostic reference ranges on the basis of the size of a pediatric patient's chest and to develop a method to estimate computed tomographic (CT) scanner-specific mean size-specific dose estimates (SSDEs) as a function of patient size and the radiation output of each CT scanner at a site. Materials and Methods The institutional review boards of each center approved this retrospective, HIPAA-compliant, multicenter study; informed consent was waived. CT dose indexes (SSDE, volume CT dose index, and dose length product) of 518 pediatric patients (mean age, 9.6 years; male patients, 277 [53%]) who underwent CT between July 1, 2012, and June 30, 2013, according to the guidelines of the Quality Improvement Registry in CT Scans in Children were retrieved from a national dose data registry. Diagnostic reference ranges were developed after analysis of image quality of a subset of 111 CT examinations to validate image quality at the lower bound. Pediatric dose reduction factors were calculated on the basis of SSDEs for pediatric patients divided by SSDEs for adult patients. Results Diagnostic reference ranges (SSDEs) were 1.8-3.9, 2.2-4.5, 2.7-5.1, 3.6-6.6, and 5.5-8.4 mGy for effective diameter ranges of less than 15 cm, 15-19 cm, 20-24 cm, 25-29 cm, and greater than or equal to 30 cm, respectively. The fractions of adult doses (pediatric dose reduction factors) used within the consortium for patients with lateral dimensions of 8, 11, 14, 17, 20, 23, 26, 29, 32, 35, and 38 cm were 0.29, 0.33, 0.38, 0.44, 0.50, 0.58, 0.66, 0.76, 0.87, 1.0, and 1.15, respectively. Conclusion Diagnostic reference ranges developed in this study provided target ranges of pediatric dose indexes on the basis of patient size, while the pediatric dose reduction factors of this study allow calculation of unique reference dose indexes on the basis of patient size for each of a site's CT scanners. RSNA, 2017 Online supplemental material is available for this article.
目的 基于儿科患者胸部大小确定诊断参考范围，并开发一种方法，以根据患者大小和每个 CT 扫描仪在某个部位的辐射输出，估计特定于 CT 扫描仪的平均大小特异性剂量估计值（SSDE）。
材料与方法 每个中心的机构审查委员会均批准了这项回顾性、符合 HIPAA 规定、多中心研究；豁免了知情同意。从全国剂量数据登记处检索了 2012 年 7 月 1 日至 2013 年 6 月 30 日期间根据 CT 扫描质量改进登记处指南为 518 名儿科患者（平均年龄 9.6 岁；男性患者 277 名[53%]）进行的 CT 剂量指数（SSDE、容积 CT 剂量指数和剂量长度乘积），这些患者进行 CT 检查的目的是为了评估儿童 CT 扫描的质量。从一组 111 次 CT 检查的图像质量分析中得出诊断参考范围，以验证下限的图像质量。基于儿科患者的 SSDE 除以成人患者的 SSDE，计算儿科患者的剂量减少因子。
结果 诊断参考范围（SSDE）分别为 1.8-3.9、2.2-4.5、2.7-5.1、3.6-6.6 和 5.5-8.4 mGy，适用于有效直径小于 15 cm、15-19 cm、20-24 cm、25-29 cm 和大于或等于 30 cm 的范围。在 consortium 中，对于横向尺寸为 8、11、14、17、20、23、26、29、32、35 和 38 cm 的患者，使用的成人剂量分数（儿科剂量减少因子）分别为 0.29、0.33、0.38、0.44、0.50、0.58、0.66、0.76、0.87、1.0 和 1.15。
结论 本研究中制定的诊断参考范围基于患者大小提供了儿科剂量指数的目标范围，而本研究中的儿科剂量减少因子允许根据每个部位 CT 扫描仪的患者大小计算独特的参考剂量指数。
RSNA，2017 在线补充材料可从本文获得。
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