Rehani Madan M, Mataac Maria T, Kaviani Parisa, Kalra Mannudeep K, Li Xinhua
Massachusetts General Hospital, 55 Fruit Str. Boston, MA, USA.
Br J Radiol. 2025 Jul 24. doi: 10.1093/bjr/tqaf178.
To analyse high-dose CT examinations (≥50 mSv) over a 10-year period to study temporal changes and identify causes.
CT dose provided by the dose management system (Radimetrics) was assessed for the years 2013-2022. CT protocols that led to ≥ 50 mSv exams were identified. Using body mass index (BMI), patients were classified into underweight, normal weight, overweight, and obese, and correlation with dose was studied. Stratified analysis was performed for diagnostic and interventional examinations according to procedure type, patient age, and protocol.
Over 10 years, 1,353,168 consecutive CTs were performed on 381,790 patients. From 2017 to 2022, exams with doses ≥50 mSv increased by 244% (0.25% to 0.86%), despite introduction of new scanners. In the 4991 CTs for which BMI was available, about 80% pertained to overweight or obese patients. These groups showed nearly 7 times the increase (250 exam increase per year from 2018-2022 versus 39) of underweight and normal weight patients. Common protocols for these high-dose exams included CT angiography of the aorta, coronary arteries, head and neck, and thorax-abdomen/abdomen (for aortic aneurysm/dissection and aortic valve replacement planning).
The rise in ≥ 50 mSv CTs aligns with newer scanners having powerful X-ray tubes but with insufficient safeguards notably for overweight and obese patients.
The awareness of exams with ≥50 mSv and their increased frequency in recent years with some newer scanners and in patients with high BMI and in multiphase imaging necessitates actions by manufacturers, policymakers, regulators, and users.
分析10年间的高剂量CT检查（≥50 mSv），以研究其随时间的变化并确定原因。
对2013年至2022年期间剂量管理系统（Radimetrics）提供的CT剂量进行评估。确定导致≥50 mSv检查的CT方案。根据体重指数（BMI），将患者分为体重过轻、正常体重、超重和肥胖，并研究其与剂量的相关性。根据检查类型、患者年龄和方案，对诊断性和介入性检查进行分层分析。
在10年期间，对381,790名患者进行了1,353,168次连续CT检查。从2017年到2022年，尽管引入了新的扫描仪，但剂量≥50 mSv的检查增加了244%（从0.25%增至0.86%）。在有BMI数据的4991次CT检查中，约80%涉及超重或肥胖患者。与体重过轻和正常体重患者相比，这些组的增加幅度几乎是其7倍（2018年至2022年每年增加250次检查，而体重过轻和正常体重患者为39次）。这些高剂量检查的常见方案包括主动脉、冠状动脉、头颈部和胸腹部/腹部的CT血管造影（用于主动脉瘤/夹层和主动脉瓣置换计划）。
≥50 mSv CT检查的增加与新型扫描仪配备强大的X射线管但保障措施不足有关，尤其是对超重和肥胖患者。
近年来，对于≥50 mSv的检查及其在一些新型扫描仪、高BMI患者和多期成像中的频率增加的认识，制造商、政策制定者、监管机构和用户必须采取行动。
