Evidence map›Paper›PMID 37735276›Full record

ArticleEuropean radiology2024

Large variation in radiation dose for routine abdomen CT: reasons for excess and easy tips for reduction.

Rebecca Smith-Bindman, Taewoon Kang, Philip W Chu, Yifei Wang, Carly Stewart, Marco Das, Phuong-Anh Duong, Luisa Cervantes, Ramit Lamba, Ryan K Lee and 11 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European radiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
–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

10 citing papers in PubMed.

  1. Article
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  4. 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

21 authors.

Rebecca Smith-BindmanDepartment of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA. Rebecca.Smith-Bindman@ucsf.edu.ORCID http://orcid.org/0000-0003-1972-639X
Taewoon KangDepartment of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA.
Philip W 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.
Carly StewartDepartment of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA.
Marco DasDepartment of Diagnostic and Interventional Radiology, Helios Hospital Duisburg, An Der Abtei 7-11, 47166, Duisburg, Germany.
Phuong-Anh DuongDepartment of Radiology, New York University Langone, 6 Ohio Drive, Lake Success, NY, 11042, USA.
Luisa CervantesDepartment of Radiology, Nicklaus Children's Hospital, 3100 SW 62Nd Avenue, Miami, FL, 33155, USA.
Ramit LambaDepartment of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA.
Ryan K LeeDepartment of Radiology, Ground Floor, Einstein Healthcare Network, 5501 Old York Road, Levy Bldg, Philadelphia, PA, 19141, USA.
Fiona MacLeodDepartment of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK.
Nima KasraieDepartment of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Rebecca NeillDepartment of Radiology and Imaging Sciences, Emory University, 1365 Clifton Road NE, Atlanta, GA, 30322, USA.
Pavlina PikeHuntsville Hospital, 101 Sivley Rd SW, Huntsville, AL, 35801, USA.
Jodi RoehmNavvis Healthcare, Missouri, USA.
Sebastian SchinderaInstitute of Radiology, Kantonsspital Aarau AG, Tellstrasse 25, 5001, Aarau, Switzerland.
Robert ChungDepartment of Demography, University of California Berkeley, 310 Social Sciences Building, Berkeley, CA, 94720-2120, USA.
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.
Cécile R L P N JeukensDepartment of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25 6229 HX, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
L Jay StarkeyDepartment of Radiology, St Luke's International Hospital, 9-1 Akashicho, Tokyo, 104-8560, Chuo City, Japan.
Timothy P SzczykutowiczDepartments of Radiology, Medical Physics, and Biomedical Engineering, University of Wisconsin Madison, Madison, WI, USA.

Funding

CT DOSE CollaboratoryR01CA181191 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI SMITH-BINDMAN, REBECCA · 2014 to 2019
$6.2M
NCI NIH HHS R01 CA181191Patient-Centered Outcomes Research Institute DI-2018C1-11375
6 · The paper itself

Abstract

objectiveTo characterize the use and impact of radiation dose reduction techniques in actual practice for routine abdomen CT.

methodsWe retrospectively analyzed consecutive routine abdomen CT scans in adults from a large dose registry, contributed by 95 hospitals and imaging facilities. Grouping exams into deciles by, first, patient size, and second, size-adjusted dose length product (DLP), we summarized dose and technical parameters and estimated which parameters contributed most to between-protocols dose variation. Lastly, we modeled the total population dose if all protocols with mean size-adjusted DLP above 433 or 645 mGy-cm were reduced to these thresholds.

resultsA total of 748,846 CTs were performed using 1033 unique protocols. When sorted by patient size, patients with larger abdominal diameters had increased dose and effective mAs (milliampere seconds), even after adjusting for patient size. When sorted by size-adjusted dose, patients in the highest versus the lowest decile in size-adjusted DLP received 6.4 times the average dose (1680 vs 265 mGy-cm) even though diameter was no different (312 vs 309 mm). Effective mAs was 2.1-fold higher, unadjusted CTDI

conclusionThere are large variations in radiation doses for routine abdomen CT unrelated to patient size. Modification of kV and single-phase scanning could result in substantial dose reduction. CLINICAL RELEVANCE: Radiation dose-optimization techniques for routine abdomen CT are routinely under-utilized leading to higher doses than needed. Greater modification of technical parameters and number of phases could result in substantial reduction in radiation exposure to patients. KEY POINTS: • Based on an analysis of 748,846 routine abdomen CT scans in adults, radiation doses varied tremendously across patients of the same size and optimization techniques were routinely under-utilized. • The difference in observed dose was due to variation in technical parameters and phase count. Automatic exposure control was commonly used to modify effective mAs, whereas kV was rarely adjusted for patient size. Routine abdomen CT should be performed using a single phase, yet multi-phase was common. • kV modulation by patient size and restriction to a single phase for routine abdomen indications could result in substantial reduction in radiation doses using well-established dose optimization approaches.

Indexed as

Radiation ExposureTomography, X-Ray ComputedAbdomenAdultHumansRadiation DosageRetrospective StudiesAbdomenRadiation dosageTomography, X-ray computed

Identifiers

PMID37735276
PMCPMC10957641

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