Weisenthal Karrin, Karthik Priyadarshini, Shaw Melissa, Sengupta Debapriya, Bhargavan-Chatfield Mythreyi, Burleson Judy, Mustafa Adel, Kalra Mannudeep, Moore Christopher
From the Departments of Emergency Medicine, (K.W., M.S., C.M.) and Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, 464 Congress Ave, Suite 273, New Haven, CT 06510; Department of Quality and Safety, American College of Radiology, Reston, Va (P.K., D.S., M.B.C., J.B.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.K.).
Radiology. 2018 Feb;286(2):581-589. doi: 10.1148/radiol.2017170285. Epub 2017 Aug 31.
Purpose To determine if the use of reduced-dose computed tomography (CT) for evaluation of kidney stones increased in 2015-2016 compared with that in 2011-2012, to determine variability in radiation exposure according to facility for this indication, and to establish a current average radiation dose for CT evaluation for kidney stones by querying a national dose registry. Materials and Methods This cross-sectional study was exempt from institutional review board approval. Data were obtained from the American College of Radiology dose registry for CT examinations submitted from July 2015 to June 2016. Study descriptors consistent with single-phase unenhanced CT for evaluation of kidney stones and associated RadLex® Playbook identifiers (RPIDs) were retrospectively identified. Facilities actively submitting data on kidney stone-specific CT examinations were included. Dose metrics including volumetric CT dose index, dose-length product, and size-specific dose estimate, when available, were reported, and a random effects model was run to account for clustering of CT examinations at facilities. A z-ratio was calculated to test for a significant difference between the proportion of reduced-radiation dose CT examinations (defined as those with a dose-length product of 200 mGy · cm or less) performed in 2015-2016 and the proportion performed in 2011-2012. Results Three hundred four study descriptors for kidney stone CT corresponding to data from 328 facilities that submitted 105 334 kidney stone CT examinations were identified. Reduced-dose CT examinations accounted for 8040 of 105 334 (7.6%) CT examinations, a 5.6% increase from the 1010 of 49 903 (2%) examinations in 2011-2012 (P < .001). Mean overall dose-length product was 689 mGy · cm (95% confidence interval: 667, 712), decreased from the mean of 746 mGy · cm observed in 2011-2012. Median facility dose-length product varied up to sevenfold, from less than 200 mGy · cm to greater than 1600 mGy · cm. Conclusion Use of reduced-radiation dose CT for evaluation of kidney stones has increased since 2011-2012, but remains low; variability of radiation dose according to facility continues to be wide. National mean CT radiation exposure for evaluation of renal colic during 2015-2016 decreased relative to 2011-2012 values, but remained well above what is reasonably achievable. RSNA, 2017.
目的 确定与2011 - 2012年相比，2015 - 2016年使用低剂量计算机断层扫描（CT）评估肾结石的情况是否增加，确定根据医疗机构不同，该检查的辐射暴露差异，并通过查询国家剂量登记处确定当前CT评估肾结石的平均辐射剂量。材料与方法 本横断面研究无需机构审查委员会批准。数据来自美国放射学会剂量登记处，收集2015年7月至2016年6月提交的CT检查数据。回顾性识别与用于评估肾结石的单相非增强CT一致的研究描述符及相关的RadLex® Playbook标识符（RPID）。纳入积极提交肾结石特异性CT检查数据的医疗机构。报告包括容积CT剂量指数、剂量长度乘积和特定尺寸剂量估计（如可用）在内的剂量指标，并运行随机效应模型以考虑医疗机构CT检查的聚集性。计算z比值以检验2015 - 2016年进行的低辐射剂量CT检查（定义为剂量长度乘积为200 mGy·cm或更低的检查）比例与2011 - 2012年进行的比例之间是否存在显著差异。结果 识别出328家医疗机构提交的105334例肾结石CT检查数据对应的304个研究描述符。低剂量CT检查占105334例CT检查中的8040例（7.6%），比2011 - 2012年49903例检查中的1010例（2%）增加了5.6%（P <.001）。总体平均剂量长度乘积为689 mGy·cm（95%置信区间：667, 71 _ ），低于2011 - 2012年观察到的平均746 mGy·cm。医疗机构剂量长度乘积中位数变化高达7倍，从小于200 mGy·cm到大于1600 mGy·cm。结论 自2011 - 2012年以来，使用低辐射剂量CT评估肾结石的情况有所增加，但仍然较低；各医疗机构之间的辐射剂量差异仍然很大。2015 - 2016年评估肾绞痛的全国平均CT辐射暴露相对于2011 - 2012年有所下降，但仍远高于合理可达到的水平。RSNA，2017年
