Establishment of national diagnostic dose reference levels (DRLs) for routine computed tomography examinations in Jordan (2025)

Radiation Dose Optimization Based on Saudi National Diagnostic Reference Levels and Effective Dose Calculation for Computed Tomography Imaging: A Unicentral Cohort Study

Applied Sciences

Few studies have reviewed the reduction of doses in Computed tomography (CT), while various diagnostic procedures use ionizing radiation to explore the optimal dose estimate using multiple exposure quantities, including milliampere-seconds, kilovoltage peak, and pitch factors while controlling the CT dose index volume (CTDIvol) and dose length product (DLP). Therefore, we considered optimizing CT protocols to reduce radiation and organ doses during head, chest, abdominal, and pelvic CT examinations. For establishing institutional diagnostic reference levels as a benchmark to correlate with national diagnostic reference levels (NDRLs) in KSA conforming to international guidelines for radiation exposure, 3000 adult-patients underwent imaging of organs. Dose parameters were obtained using Monte Carlo software and adjusted using the Siemens Teamplay™ software. CTDIvol, DLP, and effective dose were 40.67 ± 3.8, 757 ± 63.2, and 1.74 ± 0.19, for head; 14.9 ± 1.38, 547 ± 42.9, and 7.27 ± 0....

Development of acceptable quality radiation dose levels for common computed tomography examinations: A focused multicenter study in United Arab Emirates

Frontiers in Public Health

PurposeDiagnostic Reference Level (DRL) is a practical tool for radiation dose optimization, yet it does not indicate the patient size or image quality. The Acceptable Quality Dose (AQD) introduced to address the limitations of the DRLs and it is based on image quality, radiation dose, and patient weight. The aim of this study is to establish the AQD for adult patients' undergoing Computed Tomography (CT) examinations (Head, chest, abdomen).MethodsThis study is conducted in the four main hospitals at the Ministry of Health and Prevention. Patient information and exposure parameters were extracted. All the acceptable images are scored for their quality assessments. Data is classified as seven weight groups, <50, 50–59, 60–69, 70–79, 80–89, 90–99, and ≥100 kg. The mean ± SD, median, and 75th are calculated for the CTDIvol and DLP for each weight group per examination.ResultsOut of 392, 358 CT examinations are scored with acceptable quality. The median CTDIvol values for the wei...

Patient doses in CT Examinations in 18 countries: initial results from international atomic energy agency projects

Radiation Protection Dosimetry, 2009

The purpose of this prospective study at 73 facilities in 18 countries in Africa, Asia and Eastern Europe was to investigate if the CT doses to adult patients in developing countries are higher than international standards. The dose assessment was performed in terms of weighted computed tomography dose index (CTDIw) and dose length product (DLP) for chest, chest (high resolution), lumbar spine, abdomen and pelvis CT examinations using standard methods. Except in one case, the mean CTDIw values were below diagnostic reference level (DRL) while for DLP, 17 % of situations were above DRLs. The resulting CT images were of adequate quality for diagnosis. The CTDIw and DLP data presented herein are largely similar to those from two recent national surveys. The study has shown a stronger need to create awareness and training of radiology personnel as well as monitoring of radiation doses in many developing countries so as to conform to the ALARA principle.

Dose Assessment in Computed Tomography Examination and Establishment of Local Diagnostic Reference Levels in Mazandaran, Iran

DOAJ (DOAJ: Directory of Open Access Journals), 2015

Background: Medical X-rays are the largest man-made source of public exposure to ionizing radiation. While the benefits of Computed Tomography (CT) are well known in accurate diagnosis, those benefits are not risk-free. CT is a device with higher patient dose in comparison with other conventional radiation procedures. Objective: This study is aimed at evaluating radiation dose to patients from Computed Tomography (CT) examination in Mazandaran hospitals and defining diagnostic reference level (DRL). Methods: Patient-related data on CT protocol for four common CT examinations including brain, sinus, chest and abdomen & pelvic were collected. In each center, Computed Tomography Dose Index (CTDI) measurements were performed using pencil ionization chamber and CT dosimetry phantom according to AAPM report No. 96 for those techniques. Then, Weighted Computed Tomography Dose Index (CTDIW), Volume Computed Tomography Dose Index (CTDI vol) and Dose Length Product (DLP) were calculated. Results: The CTDIw for brain, sinus, chest and abdomen & pelvic ranged (15.6-73), (3.8-25. 8), (4.5-16.3) and (7-16.3), respectively. Values of DLP had a range of (197.4-981), (41.8-184), (131-342.3) and (283.6-486) for brain, sinus, chest and abdomen & pelvic, respectively. The 3rd quartile of CTDIW, derived from dose distribution for each examination is the proposed quantity for DRL. The DRLs of brain, sinus, chest and abdomen & pelvic are measured 59.5, 17, 7.8 and 11 mGy, respectively. Conclusion: Results of this study demonstrated large scales of dose for the same examination among different centers. For all examinations, our values were lower than international reference doses.

A single institution study of radiation dose received from CT imaging: A comparison to Malaysian NDRL

Journal of Physics: Conference Series

Advancement of CT technology has led to an increase in CT scanning as it improves the diagnosis. However, it is important to assess health risk of patients associated with ionising radiation received from CT. This study evaluated current dose distributions at Advanced Medical and Dental Institute (AMDI), Malaysia and was used to establish Local Diagnostic Reference Level (LDRL). Dose indicators such as CT Dose Index (CTDIvol and CTDIw) and Dose-Length Product (DLP) were gathered for all routine CT examinations performed at the Imaging Unit, AMDI from January 2015 to June 2016. The first and third quartile values for each dose indicator were determined. A total of 364 CT studies were performed during that period with the highest number of cases being Thorax-Abdomen-Pelvis (TAP) study (57% of total study). The CTDIw ranged between 2.0 mGy to 23.4 mGy per procedure. DLP values were ranged between 94 mGy.cm to 1687 mGy.cm. The local dose data was compared with the national DRL to monitor the current CT practice at AMDI and LDRL will be established from the calculated third quartile values of dose distribution. From the results, some of the local dose values exceeded the Malaysian and further evaluation is important to ensure the dose optimisation for patients.

Assessment of Radiation Dose in Computed Tomography Examination of Adult Patient in Abuja and Keffi, Hospitals in Nigerian

Journal of Nuclear Medicine & Radiation Therapy, 2021

Assessment of Radiation dose in computed tomography examination of Adult patient in Abuja and Keffi, Hospitals in Nigerian was carried out. The three study centers are National hospital Abuja, Garki hospital and federal Medical Centre Keffi, Nasarawa State. CT scan is considered to be the first investigative modality of choice for patient with severe head, chest and abdominal injuries. For us to achieve this, professionals must adhere to the principles of justification of practice and optimization of radiation protection. Dose report and scan parameters for head, chest and abdomen were assessed during seven months period at the three study centres. Ethical approval was obtained from the study centers. Data on CT Dose index (CTDI w) and dose length product (DLP) available and achieved on CT scanner control console was recorded for a minimum of 10 average sized patients for each facility to established a local Diagnostic reference level (LDRLs) and radiation dose optimization Data were collected, using a purposive sampling technique, from 131 adult patients weighing 70 ± 3 kg) from Philip brilliance, Toshiba Alexion and General Electric (GE) CT scanners for the study. The collected data were analyzed using SPPSS version (20) statistical software. Third quartile values of the estimated LDRLs for CTDI w and DLP were determined as (49.8 mGy and 9639 mGy) and (10.9 mGy and 432.8 mCy*cm) and (12.7 mGy and 560 mGy*cm) for head, chest and abdominal CT scan, respectively. This study has established local diagnostic reference levels (LDRLs). And the CTDI w obtained are almost relatively higher to the reported data from the European Commission (Head: 10 mGy, Chest: 10 mGy and Abdomen 12.7 mGy). The DLP are comparably lower than all the reported value from the European commission (Head: 1000mGy, Chest: 600 mGy and Abdomen: 800 mGy). Therefore, CT dose optimization is recommended.

Diagnostic Reference Levels for Computed Tomography Examinations in Iran: A Nationwide Radiation Dose Survey

Iranian Journal of Medical Physics, 2019

International Commission on Radiological Protection introduced three basic principles of radiation protection, namely justification, optimization, and dose limit. Medical exposure has no dose limits, and generally, diagnostic reference levels are used as a tool for optimization of patient protection. Material and Methods: Dosimetry was performed on 20 CT scanners located in 14 cities in 12 provinces of Iran. A calibrated pencil-shaped ionization chamber, standard head and body CT dosimetry phantoms and a radiation monitor were used to determine and calculate Computed Tomography Dose Index (CTDI) and Dose Length Product (DLP). The DLP-based estimates of effective dose were derived using effective dose conversion coefficients. The nCTDIw values for head phantoms fell within the range of 22. 05-168.38 and 43.77-426.69 µGy/mAs for 5 and 10mm slice thicknesses, respectively. These values for body phantom were 4.65-146.39 and 9.43-308.92 µGy/mAs for 5 and 10mm slice thicknesses, respectively. The third quartile of CTDIvol and DLP values for head CT examinations were 49.85 mGy and 1161.00 mGy-cm, respectively. The body CT examinations had the values of 8.89 mGy and 370.97 mGy-cm, respectively. The findings of this study revealed that the above-mentioned values can be considered as national diagnostic reference levels for head and body CT examinations in Iran. The results of the current study suggested that there is a need to re-assess DRLs for CT examinations at regular time intervals by the appropriate regulatory authority which can improve the continuous performance of CT scanners in Iran.

Assessment of Diagnostic Reference Dose Associated with Computed Tomography Examination

Journal of Nuclear Technology in Applied Science

The current study is aimed to estimate the diagnostic reference dose levels (DRLs), the volume computer tomogram dose index (CTDI vol), the CT air kerma-length product (P KL,CT) and the effective dose (E) for head, chest and chest-abdomen-pelvic CT examinations performed on adults in King Abdullah Medical City (KAMC), Saudi Arabia. Demographic parameters (such as age, gender, weight, height) for a sample of 535 computed tomography (CT) patients and physical scan parameters (such as patient tube voltage (kV), reference and effective mill ampere-second (mAs), scan length, number of slices, and pitch factor) were collected from a picture archiving and communication system (PACS). CTDI vol and P KL,CT were studied for different patients' weights (40-60 kg, 60-80 kg, 80-100 kg and 100-120 kg). Mean CTDI vol , P KL,CT and effective dose for a standard weight (70 kg ±10%) was evaluated according to the three CT protocols considered and the results were, as follows: for head examinations-61.8 mGy, 1212 mGy.cm and 2.55 mSv, respectively; for chest examinations-13.1 mGy, 657.5 mGy.cm and 9.21 mSv, respectively; for chest-abdomen-pelvic examinations-13.9 mGy, 782.5 mGy.cm and 11.73 mSv, respectively. The effective dose for the chest examinations was lower than the corresponding value communicated by the European study group under European Commission.

Comparison of Radiation Dose in CT Examinations At PIMS with European Commission Reference Doses

Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University

OBJECTIVE - The purpose of this study was to assess the radiation dose levels from common computed tomography (CT) examinations performed in Radiology Department of Pakistan Institute of Medical Sciences (PIMS), and evaluate these according to diagnostic reference levels (DRLs) proposed by European Commission (EC) guidelines, and thus contributing towards the establishment of local and national DRLs. To the best of our knowledge, this is the first study of its kind to explore radiation doses from CT examinations in Pakistan. STUDY DESIGN - This was a quantitative study conducted at PIMS, Islamabad, spanning a duration of eight weeks. Scan parameters and dose profile data of 1506 adults undergoing examinations of head, neck, chest and abdomen-pelvis regions, comprising of single- and multi-phase, contrast-enhanced and unenhanced studies. Dose indicators utilized by EC guidelines for DRLs include volume CT dose index (CTDIvol) and Dose Length Product (DLP) for single slice and complet...

Assessment of Patient Dose from CT Examinations in Khorasan, Iran

Iranian Journal of Medical Physics, 2012

Introduction Computed Tomography scans are a very important tool for diagnosis and assessment of response to treatment in the practice of medicine. Ionizing radiation in medical imaging is undoubtedly one of the most powerful diagnostic tools in medicine. Yet, as with all medical interventions, there are potential risks in addition to the clear potential benefits. Materials and Methods Two reference dose quantities have been defined in order to promote the use of good technique in CT. These are weighted CT dose index (CTDIw) in (mGy) for a single slice in serial scanning or per rotation in helical scanning, and dose�length product (DLP) per complete examination (mGy.cm), All measurements were performed using a pencil shaped ionization chamber introduced into polymethyl methacrylate cylindrical brain and body phantoms. This survey was performed on 7 CT scanners in Khorasan Province-Iran. Results DLP for brain, chest, abdomen and pelvic examinations had a range of 255 - 1026, 76-127...