Evidence map›Paper›PMID 34642811›Full record

ArticleEuropean radiology2022

Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry.

Denise Bos, Sophronia Yu, Jason Luong, Philip Chu, Yifei Wang, Andrew J Einstein, Jay Starkey, Bradley N Delman, Phuong-Anh T Duong, Marco Das and 14 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European radiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

32 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. The accuracy of navigated vs. robot-assisted pedicle screw placement in spine surgery: a retrospective single-centre comparative study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
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  12. Appendicitis.Nature reviews. Disease primers · 2025
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Denise BosInstitute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. denise.bos@uk-essen.de.ORCID http://orcid.org/0000-0002-9585-9787
Sophronia YuDepartment of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
Jason LuongDepartment of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
Philip ChuDepartment of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
Yifei WangDepartment of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
Andrew J EinsteinDepartment of Medicine, Seymour, Paul, and Gloria Division of Cardiology, and Department of Radiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 10-203B, New York, NY, 10032, USA.
Jay StarkeyRadiology St Luke's International Hospital, 9-1 Akashicho, Chuo City, Tokyo, 104-8560, Japan.
Bradley N DelmanDepartment of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029-6574, USA.
Phuong-Anh T DuongDepartment of Radiology and Imaging Sciences, University of Utah, 50 N Medical Dr, Salt Lake City, UT, 84132, USA.
Marco DasDepartment of diagnostic and interventional Radiology, Helios Hospital Duisburg, An der Abtei 7-11, 47166, Duisburg, Germany.
Sebastian SchinderaInstitute of Radiology, Kantonsspital Aarau AG, Tellstrasse 25, 5001, Aarau, Switzerland.
Allen R GoodeDepartment of Radiology and Medical Imaging, UVA Health, 1215 Lee St, Charlottesville, VA, 22908, USA.
Fiona MacLeodRadiology, John Radcliffe Hospital, Headley Way, Headington, OX3 9DU, Oxford, UK.
Axel WetterInstitute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
Rebecca NeillDepartment of Radiology and Imaging Sciences, Emory University, 1365 Clifton Road NE, AT 631-A, Atlanta, GA, 30322, USA.
Ryan K LeeDepartment of Radiology, Einstein Healthcare Network, 5501 Old York Road, Philadelphia, PA, 19141, USA.
Jodi RoehmRAYUS Radiology, 5775 Wayzata Blvd., St. Louis Park, MN, 55416, USA.
James A SeibertDepartment of Radiology, UC Davis Health, 4860 Y Street, Sacramento, CA, 95817, USA.
Luisa F CervantesDepartment of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA.
Nima KasraieRadiology, UT Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX, 75235, USA.
Pavlina PikeHuntsville Hospital, 101 Sivley Rd SW, Huntsville, AL, 35801, USA.
Anokh PahwaDepartment of Radiological Sciences, Olive View - UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA, 91342, USA.
Cécile R L P N JeukensDepartment of Radiology and Nuclear Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands.
Rebecca Smith-BindmanDepartment of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.

Funding

CT DOSE CollaboratoryR01CA181191 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI SMITH-BINDMAN, REBECCA · 2014 to 2019
$6.2M
Deutsche Forschungsgemeinschaft FU356/12-1NCI NIH HHS R01 CA181191NIH HHS R01- CA181191Patient-Centered Outcomes Research Institute CD-1304-7043, DI-2018C1-11375
6 · The paper itself

Abstract

ob jectivesThe European Society of Radiology identified 10 common indications for computed tomography (CT) as part of the European Study on Clinical Diagnostic Reference Levels (DRLs, EUCLID), to help standardize radiation doses. The objective of this study is to generate DRLs and median doses for these indications using data from the UCSF CT International Dose Registry.

methodsStandardized data on 3.7 million CTs in adults were collected between 2016 and 2019 from 161 institutions across seven countries (United States of America (US), Switzerland, Netherlands, Germany, UK, Israel, Japan). DRLs (75th percentile) and median doses for volumetric CT-dose index (CTDI

resultsThe number of CT scans within EUCLID categories ranged from 8,933 (HCC) to over 1.2 million (stroke). There was greater variation in dose between categories than within categories (p < .001), and doses were significantly different between categories within anatomic areas. DRLs and median doses were assessed for all categories. DRLs were higher in the US for 9 of the 10 indications (except chronic sinusitis) than in Europe but with a significantly higher sample size in the US.

conclusionsDRLs for CTDI KEY POINTS: • Registry data were used to create benchmarks for 10 common indications for CT identified by the European Society of Radiology. • Observed US radiation doses were higher than European for 9 of 10 indications (except chronic sinusitis). • The presented diagnostic reference levels and median doses highlight potentially unnecessary variation in radiation dose.

Indexed as

Carcinoma, HepatocellularLiver NeoplasmsAdultDiagnostic Reference LevelsHumansRadiation DosageReference ValuesRegistriesTomography, X-Ray ComputedAdultDiagnostic reference levelsRegistriesTomography, X-ray computedUnited States

Identifiers

PMID34642811
PMCPMC8831291

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.