Seminars in Ultrasound, CT and MRI
Volume 31, Issue 1 , Pages 29-38 , February 2010

Radiation Safety in Abdominal Computed Tomography

  • Virginia Tsapaki, MSc, PhD

      Affiliations

    • Medical Physics Unit, Konstantopoulio Hospital, Athens, Greece
    • Corresponding Author InformationAddress reprint requests to Virginia Tsapaki, MSc, PhD, Medical Physics Unit, Konstantopoulio Hospital, 1 Ifaistou St, 14569, Anixi, Athens, Greece
  • ,
  • Madan Rehani, PhD

      Affiliations

    • Radiation Protection of Patients Unit, RSM, NSRW, International Atomic Energy Agency, Vienna, Austria
  • ,
  • Sanjay Saini, MD

      Affiliations

    • Department of Radiology, Massachusetts General Hospital, Boston, MA

References 

  1. Mori S, Endo M, Nishizawa K, et al. Comparison of patient doses in 256-slice CT and 16-slice CT scanners. Br J Radiol. 2006;79:56–61
  2. Silverman JD, Paul NS, Siewerdsen JH. Investigation of lung nodule detectability in low-dose 320-slice computed tomography. Med Phys. 2009;36:1700–1710
  3. Baert AL, Knauth M, Sartor K. Radiation Dose From Adult and Pediatric Multidetector Computed Tomography. Berlin, Heidelberg, New York: Springer; 2007;
  4. Teeuwisse WM, Geleijns J, Broerse JJ, et al. Patient and staff dose during CT-guided biopsy, drainage and coagulation. Br J Radiol. 2001;74:720–726
  5. Makayama Y, Yamashita Y, Takahahi M. CT of the aorta and its major branches. In:  Reiser M,  Takahashi M,  Modic M, et al. editor. Multislice CT. Berlin Heidelberg, NY: Springer; 2001;
  6. Gaztanaga J, Garcia MJ. New noninvasive imaging technologies in coronary artery disease. Curr Cardiol Rep. 2009;11:252–257
  7. Benjamin MS, Drucker EA, McLoud TC, et al. Small pulmonary nodules: detection at chest CT and outcome. Radiology. 2003;226:489–493
  8. Pauls S, Gabelmann A, Heinz W. Liver perfusion with dynamic multidetector-row computed tomography as an objective method to evaluate the efficacy of chemotherapy in patients with colorectal cancer. Clin Imaging. 2009;33:289–294
  9. Akbar SA, Mortele KJ, Baeyens K, et al. Multidetector CT urography: Techniques, clinical applications, and pitfalls. Semin Ultrasound CT MR. 2004;25:41–54
  10. Türkvatan A, Olçer T, Cumhur T. Multidetector CT urography of renal fusion anomalies. Diagn Interv Radiol. 2009;15:127–134
  11. Tsalafoutas IA, Tsapaki V, Triantopoulou CH, et al. CT guided interventional procedures: Patient effective and skin dose considerations. AJR Am J Roentgenol. 2007;188:1479–1484
  12. Flor N, Zuin M, Brovelli F, et al: Regenerative nodules in patients with chronic Budd–Chiari syndrome: A longitudinal study using multiphase contrast-enhanced multidetector CT. Eur J Radiol (in press)
  13. Griffey RT, Sodickson A. Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT. AJR Am J Roentgenol. 2009;192:887–892
  14. Shrimpton PC. Protection of the patient in X-ray computed tomography. Documents of the National Radiological Protection Board (NRPB), V 3, N 4. Chilton: NRPB; 1992;
  15. Gray JE. Safety risk of diagnostic radiology procedures. In:  Janower ML,  Linton OW editor. Radiation Risk: A Primer. Reston, VA: American College of Radiology; 1996;p. 15–17
  16. Jacob K, Vivian G, Steel JR. X-ray dose training: Are we exposed to enough?. Clin Radiol. 2004;60:730
  17. Soye JA, Paterson A. A survey of awareness of radiation dose among health professionals in Northern Ireland. Br J Radiol. 2008;81:725–729
  18. McCollough CH, Primak AN, Braun N, et al. Strategies for reducing radiation dose in CT. Radiol Clin North Am. 2009;47:27–40
  19. Mettler FA, Huda W, Yoshizumi TT, et al. Effective doses in radiology and diagnostic nuclear medicine: A catalog. Radiology. 2008;248:254–263
  20. Nawfel RD, Judy PF, Schleipman AR, et al. Patient radiation dose at CT urography and conventional urography. Radiology. 2004;232:126–132
  21. Jensch S, van Gelder RE, Venema HW, et al. Effective radiation doses in CT colonography: Results of an inventory among research institutions. Eur Radiol. 2006;16:981–987
  22. Thomas KE, Wang B. Age-specific effective doses for pediatric MSCT examinations at a large children's hospital using DLP conversion coefficients: A simple estimation method. Pediatr Radiol. 2008;38:645–656
  23. Iannaccone R, Laghi A, Catalano C, et al. Detection of colorectal lesions: Lower-dose multi-detector row helical CT colonography compared with conventional colonoscopy. Radiology. 2003;229:775–781
  24. International Commission on Radiological Protection (ICRP). Recommendations of the International Commission on Radiological Protection. ICRP 60 In: Didcot, Oxfordshire, UK: Pergamon; 1991;p. 60
  25. Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology. Br J Radiol. 2008;81:362–378
  26. Park BJ, Byun JH, Jin YH, et al. CT-guided radiofrequency ablation for hepatocellular carcinomas that were undetectable at US: Therapeutic effectiveness and safety. J Vasc Interv Radiol. 2009;20:490–499
  27. Rhim H, Kim YS, Choi D, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma: Analysis of 80 patients treated with two consecutive sessions. Eur Radiol. 2008;18:1442–1448
  28. Hendee W, Mettler M, Walsh M, et al. International Atomic Energy Agency (IAEA) Report of a consultation on justification of patient exposures in medical imaging. Radiat Prot Dosimetry. 2009;135:137–144
  29. Golding SJ, Shrimpton PC. Radiation dose in CT: Are we meeting the challenge?. Br J Radiol. 2002;75:1–4
  30. The American College of Radiology Appropriateness Criteria. College Park, MD: American College of Radiology; 2008;
  31. The Royal College of Radiologists: Making the Best Use of Clinical Radiology Services: Referral Guidelines. ed 6. London: Royal College of Radiologists
  32. European Guidelines on Quality Criteria for Computed Tomography: Report EUR 16262. 1999;Brussels, EC
  33. Multislice Comptued Tomography (MSCT): 2004 CT quality criteria. Results from a European Concerted Action on CT (FIGM-CT-2000-20078). http://www.msct.info/CT_Quality_Criteria.htmAccessed May 5, 2006
  34. International Commission on Radiological Protection (ICRP). Managing patient dose in multi-detector computed tomography (MDCT), in Annals of the ICRP. ICRP 102, vol 37/1 Amsterdam, the Netherlands: Elsevier; 2007;
  35. Karsli T, Kalra MK, Self JL, et al. What physicians think about the need for informed consent for communicating the risk of cancer from low-dose radiation?. Pediatr Radiol. 2009;39:917–925
  36. Lee CI, Flaster HV, Haims AH, et al. Diagnostic CT scans: Institutional informed consent guidelines and practices at academic medical centers. AJR Am J Roentgenol. 2006;187:282–287
  37. Lee CI, Haims AH, Monico EP, et al. Diagnostic CT scans: Assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology. 2004;231:393–398
  38. Sistrom CL, Dang PA, Weilburg JB, et al. Effect of computerized order entry with integrated decision support on the growth of outpatient procedure volumes: Seven-year time series analysis. Radiology. 2009;251:147–155
  39. Shrimpton PC, Hillier MC, Lewes MA, et al. National Radiological Protection Board (NRPB): Doses from computed tomography examinations in the UK–2003 Review. NRPB-W67 2003;
  40. Dion AM, Berger F, Hélie O, et al. Dose reduction at abdominal CT imaging: Reduced tension (kV) or reduced intensity (mAs)?. J Radiol. 2004;85:375–380
  41. Tsapaki V, Rehani M. Dose management in CT facility. Biomed Imaging Interv J. 2007;3:e43
  42. McCollough CH. Automatic exposure control in CT: Are we done yet?. Radiology. 2005;237:755–756
  43. Funama Y, Awai K, Nakayama Y, et al. Radiation dose reduction without degradation of low-contrast detectability at abdominal multisection CT with a low–tube voltage technique: Phantom study. Radiology. 2005;237:905–910
  44. Kalender WA, Deak P, Kellermeier M. Application- and patient size-dependent optimization of x-ray spectra for CT. Med Phys. 2009;36:993–1007
  45. Matsubara K. Misoperation of CT automatic tube current modulation systems with inappropriate patient centering: phantom studies. AJR Am J Roentgenol. 2009;192:862–865
  46. Matsuoka S, Hunsaker AR, Gill RR, et al. Vascular enhancement and image quality of MDCT pulmonary angiography in 400 cases: Comparison of standard and low kilovoltage settings. AJR Am J Roentgenol. 2009;192:1651–1656
  47. Report of American Association of Physicists in Medicine (AAPM) Task Group 23: CT Dosimetry: The Measurement, Reporting, and Management of Radiation Dose in CT: AAPM Report 96. College Park, MD: One Physics Ellipse; 2008;
  48. Beaconsfield T, Nicholson R, Thornton A, et al. Would thyroid and breast shielding be beneficial in CT of the head?. Eur Radiol. 1998;8:664–667
  49. Hidajat N, Schroder RJ, Vogl T, et al. The efficacy of lead shielding in patient dosage reduction in computed tomography. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1996;165:462–465
  50. Fricke BL, Donnelly LF, Frush DP, et al. In-plane bismuth breast shields for pediatric CT: Effects on radiation dose and image quality using experimental and clinical data. AJR Am J Roentgenol. 2003;180:407–411
  51. Grobe H, Sommer M, Koch A, et al. Dose reduction in computed tomography: The effect of eye and testicle shielding on radiation dose measured in patients with beryllium oxide-based optically stimulated luminescence dosimetry. Eur Radiol. 2009;19:1156–1160
  52. Dauer LT, Casciotta KA, Erdi YE, et al. Radiation dose reduction at a price: The effectiveness of a male gonadal shield during helical CT scans. BMC Med Imaging. 2007;167:5
  53. International Commission on Radiological Protection (ICRP). ICRP Publication 87: Managing patient dose in computed tomography, 87. Annals of the ICRP. 2001;30/4
  54. Brix G, Nagel HD, Stamm G, et al. Radiation exposure in multi-slice versus single-slice spiral CT: Results of a nationwide survey. Eur Radiol. 2003;13:1979–1991
  55. Wall BF. What needs to be done about reducing patient doses from CT? (The North American approach). Br J Radiol. 2003;76:763–765
  56. Tsapaki V, Aldrich JE, Sharma R, et al. Dose reduction in CT while maintaining diagnostic confidence: Diagnostic reference levels at routine head, chest, and abdominal CT—IAEA coordinated research project. Radiology. 2006;240:828–834
  57. Nationwide evaluation of X-ray trends (NEXT): Tabulation and graphical summary of 2000 survey of computed tomography. Conference of Radiation Control Program Directors, Inc. CRCPD publication E-07-2, 2007. Frankfort, Kentucky, 40601
  58. Sodickson A. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology. 2009;251:175–184
  59. Al-Omran M, Mamdani M, McLeod RS. Epidemiologic features of acute appendicitis in Ontario, Canada. Can J Surg. 2003;46:263–268
  60. Wan MJ. Acute appendicitis in young children: Cost-effectiveness of US versus CT in diagnosis-a markov decision analytic model. Radiology. 2009;250:378–386
  61. Akbar SA, Mortele KJ, Baeyens K, et al. Multidetector CT urography: Techniques, clinical applications and pitfalls. Semin Ultrasound CT MR. 2004;25:41–54
  62. Kalra MK, Singh S, Blake MA. CT of the urinary tract: Turning attention to radiation dose. Radiol Clin North Am. 2008;46:1–9
  63. American Cancer Society. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps: A joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130–160
  64. Brant-Zawadzki M. CT screening: Why I do it. AJR Am J Roentgenol. 2003;228:346–351
  65. Brenner DJ, Elliston CD. Estimated radiation risks potentially associated with full-body CT screening. Radiology. 2004;232:735–738
  66. Salottolo K, Bar-Or R, Fleishman M, et al. Current utilization and radiation dose from computed tomography in patients with trauma. Crit Care Med. 2009;37:1336–1340
  67. Kim PK, Gracias VH, Maidment AD, et al. Cumulative radiation dose caused by radiologic studies in critically ill trauma patients. J Trauma. 2004;57:510–514
  68. Kalra MK, Maher MM, Toth TL, et al. Strategies for CT radiation dose optimization. Radiology. 2004;230:619–628
  69. International Commission on Radiation Units and Measurements (ICRU). Patient Dosimetry for X Rays Used in Medical Imaging: Report 74. Bethesda, MD: ICRU; 2006;
  70. Electrotechnical Commission (IEC). Medical electrical equipment-part 2-44 (Particular Requirements for the Safety of Equipment for CT). Electrotechnical Commission Standard 60601-2-44 Ed1 Geneva, Switzerland: IEC; 1999;
  71. Bauhs JA, Thomas JV, Primak AN, et al. CT dosimetry: Comparison of measurement techniques and devices. Radiographics. 2008;28:245–253
  72. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Sources and Effects of Ionising Radiation: Report to the General Assembly, with Scientific Annexes. New York: United Nations; 2000;
  73. National Research Council, Committee on the biological effects of ionizing radiation. In: Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR. Vol 2:Washington, DC: National Academy Press; 2006;

 The views expressed in the article are views of authors and not the organizations they belong to.

PII: S0887-2171(09)00084-5

doi: 10.1053/j.sult.2009.09.004

Seminars in Ultrasound, CT and MRI
Volume 31, Issue 1 , Pages 29-38 , February 2010