Trends in radiation protection of positron emission tomography/computed tomography imaging

Over the past decade, the number of positron emission tomography/computed tomography (PET/CT) imaging procedures has increased substantially. This imaging technique provides accurate functional and anatomical information, particularly for oncological applications. Separately, both PET and CT are considered as high-dose imaging modalities. With the increased use of PET/CT, one could expect an increase in radiation doses to staff and patients. As such, major efforts have been made to reduce radiation dose in PET/CT facilities. Variations in working techniques have made it difficult to compare published results. This study aimed to review the literature on proposed methods to reduce patient and staff dose in clinical PET/CT imaging. A brief overview of some published information on staff and patient doses will be analysed and presented. Recent trends regarding radiation protection in PET/CT imaging will be discussed, and practical recommendations for reducing radiation doses to staff and patients will be discussed and summarised. Generally, the CT dose component is often higher in magnitude than the dose from PET alone; as such, focusing on CT dose reduction will decrease the overall patient dose in PET/CT imaging studies. The following factors should be considered in order to reduce the patient's dose from CT alone: proper justification for ordering contrast-enhanced CT; use of automatic exposure control features; use of adaptive statistical iterative reconstruction algorithms; and optimisation of scan parameters, especially scan length. The PET dose component can be reduced by administration of lower activity to the patient, optimisation of the workflow, and appropriate use of protective devices and engineered systems. At the international level, there is wide variation in work practices among institutions. The current observed trends are such that the annual dose limits for radiation workers in PET/CT imaging are unlikely to be exceeded.