Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry

Denise Bos; Sophronia Yu; Jason Luong; Philip Chu; Yifei Wang; Andrew J Einstein; Jay Starkey; Bradley N Delman; Phuong-Anh T Duong; Marco Das; Sebastian Schindera; Allen R Goode; Fiona MacLeod; Axel Wetter; Rebecca Neill; Ryan K Lee; Jodi Roehm; James A Seibert; Luisa F Cervantes; Nima Kasraie; Pavlina Pike; Anokh Pahwa; Cécile R L P N Jeukens; Rebecca Smith-Bindman

doi:10.1007/s00330-021-08266-1

Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry

Eur Radiol. 2022 Mar;32(3):1971-1982. doi: 10.1007/s00330-021-08266-1. Epub 2021 Oct 13.

Authors

Denise Bos¹, Sophronia Yu², Jason Luong², Philip Chu², Yifei Wang², Andrew J Einstein³, Jay Starkey⁴, Bradley N Delman⁵, Phuong-Anh T Duong⁶, Marco Das⁷, Sebastian Schindera⁸, Allen R Goode⁹, Fiona MacLeod¹⁰, Axel Wetter¹¹, Rebecca Neill¹², Ryan K Lee¹³, Jodi Roehm¹⁴, James A Seibert¹⁵, Luisa F Cervantes¹⁶, Nima Kasraie¹⁷, Pavlina Pike¹⁸, Anokh Pahwa¹⁹, Cécile R L P N Jeukens²⁰, Rebecca Smith-Bindman^{2

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Affiliations

¹ Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. denise.bos@uk-essen.de.
² Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
³ Department of Medicine, Seymour, Paul, and Gloria Division of Cardiology, and Department of Radiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 10-203B, New York, NY, 10032, USA.
⁴ Radiology St Luke's International Hospital, 9-1 Akashicho, Chuo City, Tokyo, 104-8560, Japan.
⁵ Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029-6574, USA.
⁶ Department of Radiology and Imaging Sciences, University of Utah, 50 N Medical Dr, Salt Lake City, UT, 84132, USA.
⁷ Department of diagnostic and interventional Radiology, Helios Hospital Duisburg, An der Abtei 7-11, 47166, Duisburg, Germany.
⁸ Institute of Radiology, Kantonsspital Aarau AG, Tellstrasse 25, 5001, Aarau, Switzerland.
⁹ Department of Radiology and Medical Imaging, UVA Health, 1215 Lee St, Charlottesville, VA, 22908, USA.
¹⁰ Radiology, John Radcliffe Hospital, Headley Way, Headington, OX3 9DU, Oxford, UK.
¹¹ Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
¹² Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Road NE, AT 631-A, Atlanta, GA, 30322, USA.
¹³ Department of Radiology, Einstein Healthcare Network, 5501 Old York Road, Philadelphia, PA, 19141, USA.
¹⁴ RAYUS Radiology, 5775 Wayzata Blvd., St. Louis Park, MN, 55416, USA.
¹⁵ Department of Radiology, UC Davis Health, 4860 Y Street, Sacramento, CA, 95817, USA.
¹⁶ Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA.
¹⁷ Radiology, UT Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX, 75235, USA.
¹⁸ Huntsville Hospital, 101 Sivley Rd SW, Huntsville, AL, 35801, USA.
¹⁹ Department of Radiological Sciences, Olive View - UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA, 91342, USA.
²⁰ Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands.
²¹ Philip R Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St, San Francisco, CA, 94118, USA.

Abstract

Ob jectives: The European Society of Radiology identified 10 common indications for computed tomography (CT) as part of the European Study on Clinical Diagnostic Reference Levels (DRLs, EUCLID), to help standardize radiation doses. The objective of this study is to generate DRLs and median doses for these indications using data from the UCSF CT International Dose Registry.

Methods: Standardized data on 3.7 million CTs in adults were collected between 2016 and 2019 from 161 institutions across seven countries (United States of America (US), Switzerland, Netherlands, Germany, UK, Israel, Japan). DRLs (75th percentile) and median doses for volumetric CT-dose index (CTDI_vol) and dose-length product (DLP) were assessed for each EUCLID category (chronic sinusitis, stroke, cervical spine trauma, coronary calcium scoring, lung cancer, pulmonary embolism, coronary CT angiography, hepatocellular carcinoma (HCC), colic/abdominal pain, appendicitis), and US radiation doses were compared with European.

Results: The number of CT scans within EUCLID categories ranged from 8,933 (HCC) to over 1.2 million (stroke). There was greater variation in dose between categories than within categories (p < .001), and doses were significantly different between categories within anatomic areas. DRLs and median doses were assessed for all categories. DRLs were higher in the US for 9 of the 10 indications (except chronic sinusitis) than in Europe but with a significantly higher sample size in the US.

Conclusions: DRLs for CTDI_vol and DLP for EUCLID clinical indications from diverse organizations were established and can contribute to dose optimization. These values were usually significantly higher in the US than in Europe.

Key points: • Registry data were used to create benchmarks for 10 common indications for CT identified by the European Society of Radiology. • Observed US radiation doses were higher than European for 9 of 10 indications (except chronic sinusitis). • The presented diagnostic reference levels and median doses highlight potentially unnecessary variation in radiation dose.

Keywords: Adult; Diagnostic reference levels; Registries; Tomography, X-ray computed; United States.

MeSH terms

Adult
Carcinoma, Hepatocellular*
Diagnostic Reference Levels
Humans
Liver Neoplasms*
Radiation Dosage
Reference Values
Registries
Tomography, X-Ray Computed

Abstract

MeSH terms

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