Variability in image quality and radiation dose within and across 97 medical facilities

Purpose: To characterize variability in image quality and radiation dose across a large cohort of computed tomography (CT) examinations and identify the scan factors with the highest influence on the observed variabilities. Approach: This retrospective institutional-review-board-exempt investigation was performed on 87,629 chest and abdomen-pelvis CT scans acquired for 97 facilities from 2018 to 2019. Images were assessed in terms of noise, resolution, and dose metrics (global noise, frequency in which modulation transfer function is at 0.50, and volumetric CT dose index, respectively). The results were fit to linear mixed-effects models to quantify the variabilities as affected by scan parameters and settings and patient characteristics. A list of factors, ranked by $$ -value with $$ , was ascertained for each of the six mixed effects models. A type III $$ -value test was used to assess the influence of facility. Results: Across different facilities, image quality and dose were significantly different ( $$ ), with little correlation between their mean magnitudes and consistency (Pearson's correlation $$ ). Scanner model, slice thickness, recon field-of-view and kernel, mAs, kVp, patient size, and centering were the most influential factors. The two body regions exhibited similar rankings of these factors for noise (Spearman's correlation $$ ) and dose (Spearman's correlation $$ ) but not for resolution (Spearman's correlation $$ ). Conclusions: Clinical CT scans can vary in image quality and dose with broad implications for diagnostic utility and radiation burden. Average scan quality was not correlated with interpatient scan-quality consistency. For a given facility, this variability can be quite large, with magnitude differences across facilities. The knowledge of the most influential factors per body region may be used to better manage these variabilities within and across facilities.