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Challenges experienced in establishing clinical indication based diagnostic reference levels: Pilot study
Entesar Zawam Dalah1, Jamila Salam Alsuwaidi1, Mohammed Samir Hamed2
1Department of Clinical Support Services and Nursing Sector, Dubai Health Authority, Dubai, United Arab Emirates.
This study establishes clinical indication-based Diagnostic Reference Levels (DRLs) for Computed Tomography (CT) scans of the head, abdomen, pelvis, and kidneys. These DRLs aid in optimizing radiation doses for various patient conditions.
Area of Science:
- Medical Imaging Physics
- Radiology
- Radiation Protection
Background:
- Computed Tomography (CT) examinations are crucial diagnostic tools.
- Radiation dose optimization in CT is essential for patient safety.
- Establishing standardized radiation dose metrics is vital for quality assurance.
Purpose of the Study:
- To establish clinical-indication based Diagnostic Reference Levels (DRLs) for CT Head, CT Abdomen & Pelvis + Contrast, and CT Kidney Ureter Bladder (KUB) examinations.
- To identify high-dose CT cases for targeted dose optimization strategies.
- To correlate radiation dose with specific clinical indications.
Main Methods:
- Retrospective analysis of 715 patient CT examinations (Head, Abdomen & Pelvis + Contrast, KUB).
- Utilized an electronic patient radiation dose monitoring system (DOSE-TQM) linked to PACS.
- Collected patient demographics, clinical indications, and scan acquisition parameters.
- Employed ANOVA and Tukey's tests to assess statistical differences in dose length products (tDLPs) across indications.
Main Results:
- Proposed DRLs (total DLP in mGy.cm) for specific indications: abdominal pain (CT Abdomen & Pelvis + Contrast: 441, CT KUB: 311), appendicitis (484), head trauma (544), stroke (544), and renal colic (308).
- These proposed DRLs are comparable to international benchmarks.
- Patient weight was identified as a significant factor influencing radiation dose.
Conclusions:
- Significant variations in DLP exist within and across similar CT studies and clinical indications.
- Clinical indication-based DRLs offer a more refined approach to CT dose optimization, accounting for patient morphology and clinical practice.
- This study provides a foundation for improved radiation dose management in routine CT imaging.
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