University Duesseldorf, Department of Diagnostic and Interventional Radiology, Moorenstraße 5, 40225 Duesseldorf, Germany.
University Duesseldorf, Department of Diagnostic and Interventional Radiology, Moorenstraße 5, 40225 Duesseldorf, Germany; Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Acad Radiol. 2019 Dec;26(12):1661-1667. doi: 10.1016/j.acra.2019.01.019. Epub 2019 Feb 22.
To generate institutional size-specific diagnostic reference levels (DRLs) for computed tomography angiography (CTA) examinations and assess the potential for dose optimization compared to size-independent DRLs.
CTA examinations of the aorta, the pulmonary arteries and of the pelvis/lower extremity performed between January 2016 and January 2017 were included in our retrospective study. Water equivalent diameter (Dw) was automatically calculated for each patient. The relationship between Dw and computed tomography dose index (CTDI) was analyzed and the 75th percentile was chosen as the upper limit for institutional DRLs. Size-specific institutional DRLs were compared to national size-independent DRLs from Germany and the UK.
A total of 1344 examinations were included in our study (n = 733 aortic CTA, n = 406 pulmonary CTA, n = 205 pelvic/lower extremity CTA). Mean Dw was 26 ± 9 cm and mean CTDI was 7.0 ± 4.6 mGy. For all CTA protocols, there was a linear progression of CTDI with increasing Dw with an R² = 0.95 in aortic CTA, R² = 0.94 in pulmonary CTA and R² = 0.93 in pelvic/lower extremity CTA. Median CTDI increased by 0.57 mGy per additional cm Dw in aortic CTA, by 1.1 mGy in pulmonary CTA and by 0.31 mGy in pelvic/lower extremity CTA. Institutional DRLs were lower than national DRLs for average size patients (aortic CTA: Dw 28.2 cm, CTDI 7.6 mGy; pulmonary CTA, Dw 27.9 cm, CTDI 11.8 mGy; pelvic/lower extremity CTA, Dw 20.0 cm, CTDI 6.4 mGy). More dose outliers in small patients were detected with size-specific DRLs compared to national size-independent DRLs (56.4% vs 16.2%).
We implemented institutional size-specific DRLs for CTA examinations which enabled a more precise analysis compared to national sizeindependent DRLs.
生成特定机构大小的计算机断层血管造影（CTA）检查诊断参考水平（DRL），并评估与大小无关的 DRL 相比，剂量优化的潜力。
回顾性研究纳入 2016 年 1 月至 2017 年 1 月期间进行的主动脉、肺动脉和骨盆/下肢 CTA 检查。自动计算每位患者的水当量直径（Dw）。分析 Dw 与计算机断层扫描剂量指数（CTDI）的关系，选择第 75 百分位数作为机构 DRL 的上限。将特定机构大小的 DRL 与德国和英国的国家大小无关的 DRL 进行比较。
共纳入 1344 例检查（n = 733 例主动脉 CTA，n = 406 例肺动脉 CTA，n = 205 例骨盆/下肢 CTA）。平均 Dw 为 26 ± 9 cm，平均 CTDI 为 7.0 ± 4.6 mGy。对于所有 CTA 方案，Dw 增加时 CTDI 呈线性增加，主动脉 CTA 的 R²=0.95，肺动脉 CTA 的 R²=0.94，骨盆/下肢 CTA 的 R²=0.93。主动脉 CTA 中 Dw 每增加 1 cm，CTDI 中位数增加 0.57 mGy，肺动脉 CTA 中增加 1.1 mGy，骨盆/下肢 CTA 中增加 0.31 mGy。与国家大小无关的 DRL 相比，平均大小患者的机构 DRL 较低（主动脉 CTA：Dw 28.2 cm，CTDI 7.6 mGy；肺动脉 CTA，Dw 27.9 cm，CTDI 11.8 mGy；骨盆/下肢 CTA，Dw 20.0 cm，CTDI 6.4 mGy）。与国家大小无关的 DRL 相比，使用特定机构大小的 DRL 检测到较小患者中的更多剂量异常值（56.4%对 16.2%）。
我们为 CTA 检查实施了特定机构大小的 DRL，与国家大小无关的 DRL 相比，这可以进行更精确的分析。
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