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Crowd-sourcing optimized abdomen CT protocols from 908,000 examinations in a large radiation dose registry
Rebecca Smith-Bindman1,2,3, Taewoon Kang4, Carly Stewart4
1Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. rebecca.smith-bindman@ucsf.edu.
European Radiology
|November 24, 2025
Summary
Crowd-sourced CT protocols reveal significant radiation dose variation in routine abdomen scans. Optimized low-dose protocols utilize fewer phases and lower kilovoltage (kV) settings.
Area of Science:
- Radiology
- Medical Imaging
- Radiation Dose Optimization
Background:
- Routine diagnostic abdomen CT protocols vary widely in radiation dose.
- Identifying optimized protocols is crucial for minimizing patient exposure.
Purpose of the Study:
- To identify routine diagnostic abdomen CT protocols that achieve lower radiation doses.
- To leverage a large CT dose registry for crowd-sourced protocol optimization.
Main Methods:
- Retrospective analysis of acquisition parameters and radiation dose (CTDIvol, DLP) from a large CT dose registry.
- K-means clustering to group protocols based on acquisition parameter similarity.
- Summarized technical parameters and dose metrics for each cluster.
Main Results:
- Analysis included nearly one million exams across 1767 protocols from 132 facilities, grouped into 9 clusters.
- Patient size-adjusted dose varied threefold (486-1382 mGy-cm) across clusters.
- Lowest-dosed clusters used low kV (around 100) and single-phase imaging; highest dose clusters used multiple phases.
Conclusions:
- Clustering identifies optimized protocols and highlights practice variations, such as unnecessary multi-phase imaging.
- Findings provide a framework and best-practice examples for clinicians to optimize abdomen CT protocols.
- Non-indicated imaging phases were identified as a major contributor to excessive radiation dose.
