DIAGNOSTIC REFERENCE LEVELS IN CARDIAC COMPUTED TOMOGRAPHY ANGIOGRAPHY: A SYSTEMATIC REVIEW

Area of Science:

• Medical Imaging
• Radiology
• Cardiovascular Disease

Background:

• Cardiac computed tomography angiography (CCTA) is vital for diagnosing cardiovascular disease.
• Patient radiation dose from CCTA remains a significant concern, necessitating dose optimization and monitoring.
• Diagnostic reference levels (DRLs) are crucial for assessing and standardizing radiation doses across facilities.

Purpose of the Study:

• To systematically review the literature on methodologies used for establishing DRLs in CCTA.
• To identify variations in CCTA DRLs and the methods employed in their establishment.

Main Methods:

• A systematic literature search was conducted across multiple databases (Web of Science, SCOPUS, Medline, CINAHL, EMBASE).
• Reference lists of identified articles were also screened.
• The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology guided article selection.
• Articles assessing DRLs in CCTA were included, resulting in six studies for analysis.

Main Results:

• Reported CCTA DRLs for Dose Length Product (DLP) varied widely, from 671 to 1510 mGy cm.
• Where available, CTDIvol DRLs ranged from 26 to 70 mGy.
• Significant differences were observed in the methodologies used for DRL establishment, including patient sampling and scanning protocols.

Conclusions:

• There is a substantial variation in reported CCTA DRLs globally.
• Discrepancies in DRL establishment methodologies hinder comparable dose assessment.
• International standardization of DRL establishment methods for CCTA is urgently needed to ensure consistent dose monitoring and patient safety.