Can experienced CT radiologists use technique parameters to predict excessive patient dose? An analysis of the ACR CT accreditation database

Robert K. Zeman, Vincent Herlihy, Theresa A. Branham, Mythreyi Bhargavan, Krista M. Bush, Cynthia H. McCollough

Research output: Contribution to journalArticle

Abstract

Purpose: The aim of this study was to determine, for 3 basic clinical examinations, whether blinded, experienced CT radiologists participating in the ACR's CT Accreditation Program could use scan parameters such as tube current-time product (mAs), tube voltage (kVp), and pitch to predict scanner output settings, expressed as weighted CT dose index (CTDIw) and volume CT dose index (CTDIvol), exceeding CTDIw diagnostic reference levels (DRLs) set by the ACR in 2002 and CTDIvol DRLs adopted by the ACR in 2008. Methods: CT sites with 829 scanners submitted examinations to the ACR between 2002 and 2004, yielding 518 eligible examinations for analysis (138 adult head CT scans, 333 adult abdominal CT scans, and 47 pediatric abdominal CT scans). The sites' measured CTDIw values for each type of examination were compared with the ACR's CTDIw DRLs in effect from 2002 to 2004 and compared with comments regarding excessively high mAs or kVp made by radiologist clinical reviewers to determine if excessively high-dose index measurements could be predicted. The same analysis was repeated using CTDIvol DRLs adopted by the ACR in 2008 and compared with excessively high mAs or kVp and excessively low-pitch comments. Results: Excessively high mAs or kVp comments yielded sensitivity of only 21.2% in predicting examinations above the CTDIw DRLs, with specificity of 87.6%. Using the 2008 CTDIvol DRLs, the corresponding sensitivity was 13.1% and specificity was 86.2%. Significance was not achieved for use of clinical parameters in predicting either the CTDIw or CTDIvol. Conclusion: Experienced CT radiologists cannot reliably use scan parameters to predict examinations that exceed CTDIw or CTDIvol DRLs.

Original languageEnglish (US)
Pages (from-to)275-280
Number of pages6
JournalJournal of the American College of Radiology
Volume8
Issue number4
DOIs
StatePublished - 2011
Externally publishedYes

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Accreditation
Databases
Cone-Beam Computed Tomography
Head
Pediatrics
Radiologists

Keywords

  • CT
  • CT accreditation
  • diagnostic reference levels
  • radiation dose

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Can experienced CT radiologists use technique parameters to predict excessive patient dose? An analysis of the ACR CT accreditation database. / Zeman, Robert K.; Herlihy, Vincent; Branham, Theresa A.; Bhargavan, Mythreyi; Bush, Krista M.; McCollough, Cynthia H.

In: Journal of the American College of Radiology, Vol. 8, No. 4, 2011, p. 275-280.

Research output: Contribution to journalArticle

Zeman, Robert K. ; Herlihy, Vincent ; Branham, Theresa A. ; Bhargavan, Mythreyi ; Bush, Krista M. ; McCollough, Cynthia H. / Can experienced CT radiologists use technique parameters to predict excessive patient dose? An analysis of the ACR CT accreditation database. In: Journal of the American College of Radiology. 2011 ; Vol. 8, No. 4. pp. 275-280.
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abstract = "Purpose: The aim of this study was to determine, for 3 basic clinical examinations, whether blinded, experienced CT radiologists participating in the ACR's CT Accreditation Program could use scan parameters such as tube current-time product (mAs), tube voltage (kVp), and pitch to predict scanner output settings, expressed as weighted CT dose index (CTDIw) and volume CT dose index (CTDIvol), exceeding CTDIw diagnostic reference levels (DRLs) set by the ACR in 2002 and CTDIvol DRLs adopted by the ACR in 2008. Methods: CT sites with 829 scanners submitted examinations to the ACR between 2002 and 2004, yielding 518 eligible examinations for analysis (138 adult head CT scans, 333 adult abdominal CT scans, and 47 pediatric abdominal CT scans). The sites' measured CTDIw values for each type of examination were compared with the ACR's CTDIw DRLs in effect from 2002 to 2004 and compared with comments regarding excessively high mAs or kVp made by radiologist clinical reviewers to determine if excessively high-dose index measurements could be predicted. The same analysis was repeated using CTDIvol DRLs adopted by the ACR in 2008 and compared with excessively high mAs or kVp and excessively low-pitch comments. Results: Excessively high mAs or kVp comments yielded sensitivity of only 21.2{\%} in predicting examinations above the CTDIw DRLs, with specificity of 87.6{\%}. Using the 2008 CTDIvol DRLs, the corresponding sensitivity was 13.1{\%} and specificity was 86.2{\%}. Significance was not achieved for use of clinical parameters in predicting either the CTDIw or CTDIvol. Conclusion: Experienced CT radiologists cannot reliably use scan parameters to predict examinations that exceed CTDIw or CTDIvol DRLs.",
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AU - Herlihy, Vincent

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AU - Bhargavan, Mythreyi

AU - Bush, Krista M.

AU - McCollough, Cynthia H.

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N2 - Purpose: The aim of this study was to determine, for 3 basic clinical examinations, whether blinded, experienced CT radiologists participating in the ACR's CT Accreditation Program could use scan parameters such as tube current-time product (mAs), tube voltage (kVp), and pitch to predict scanner output settings, expressed as weighted CT dose index (CTDIw) and volume CT dose index (CTDIvol), exceeding CTDIw diagnostic reference levels (DRLs) set by the ACR in 2002 and CTDIvol DRLs adopted by the ACR in 2008. Methods: CT sites with 829 scanners submitted examinations to the ACR between 2002 and 2004, yielding 518 eligible examinations for analysis (138 adult head CT scans, 333 adult abdominal CT scans, and 47 pediatric abdominal CT scans). The sites' measured CTDIw values for each type of examination were compared with the ACR's CTDIw DRLs in effect from 2002 to 2004 and compared with comments regarding excessively high mAs or kVp made by radiologist clinical reviewers to determine if excessively high-dose index measurements could be predicted. The same analysis was repeated using CTDIvol DRLs adopted by the ACR in 2008 and compared with excessively high mAs or kVp and excessively low-pitch comments. Results: Excessively high mAs or kVp comments yielded sensitivity of only 21.2% in predicting examinations above the CTDIw DRLs, with specificity of 87.6%. Using the 2008 CTDIvol DRLs, the corresponding sensitivity was 13.1% and specificity was 86.2%. Significance was not achieved for use of clinical parameters in predicting either the CTDIw or CTDIvol. Conclusion: Experienced CT radiologists cannot reliably use scan parameters to predict examinations that exceed CTDIw or CTDIvol DRLs.

AB - Purpose: The aim of this study was to determine, for 3 basic clinical examinations, whether blinded, experienced CT radiologists participating in the ACR's CT Accreditation Program could use scan parameters such as tube current-time product (mAs), tube voltage (kVp), and pitch to predict scanner output settings, expressed as weighted CT dose index (CTDIw) and volume CT dose index (CTDIvol), exceeding CTDIw diagnostic reference levels (DRLs) set by the ACR in 2002 and CTDIvol DRLs adopted by the ACR in 2008. Methods: CT sites with 829 scanners submitted examinations to the ACR between 2002 and 2004, yielding 518 eligible examinations for analysis (138 adult head CT scans, 333 adult abdominal CT scans, and 47 pediatric abdominal CT scans). The sites' measured CTDIw values for each type of examination were compared with the ACR's CTDIw DRLs in effect from 2002 to 2004 and compared with comments regarding excessively high mAs or kVp made by radiologist clinical reviewers to determine if excessively high-dose index measurements could be predicted. The same analysis was repeated using CTDIvol DRLs adopted by the ACR in 2008 and compared with excessively high mAs or kVp and excessively low-pitch comments. Results: Excessively high mAs or kVp comments yielded sensitivity of only 21.2% in predicting examinations above the CTDIw DRLs, with specificity of 87.6%. Using the 2008 CTDIvol DRLs, the corresponding sensitivity was 13.1% and specificity was 86.2%. Significance was not achieved for use of clinical parameters in predicting either the CTDIw or CTDIvol. Conclusion: Experienced CT radiologists cannot reliably use scan parameters to predict examinations that exceed CTDIw or CTDIvol DRLs.

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