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. 2023 Dec:169:111191.
doi: 10.1016/j.ejrad.2023.111191. Epub 2023 Nov 10.

Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study

Mônica Oliveira Bernardo  1 , Lina Karout  2 , Flávio Morgado  3 , Shadi Ebrahimian  4 , Alair Sarmet Santos  5 , Clarissa Amorim  6 , Hilton Muniz Filho  7 , Antonio Moscatelli  8 , Valdair Francisco Muglia  9 , Henrique Schroeder  10 , Danilo Moulin Sales  11 , Renan Gandolpho Henschel  12 , Bruno Giovanni Valese  13 , Felipe Kiipper  14 , Publio Cesar Cavalcanti  15 , Ronaldo Lucena  16 , Tiago Jornada  17 , Valnir de Paula  18 , Marcel Zago  19 , Ricardo Varella  20 , Mauricio Anes  21 , Antonio Márcio Alves Pinheiro  22 , Luiz Claúdio de Moura Carvalho  23 , Juliana Santana de Melo Tapajos  24 , Fernando Antonio de Almeida  25 , Kimberly Applegate  26 , Graciano Paulo  27 , Paulo Roberto Costa  28
Affiliations

Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study

Mônica Oliveira Bernardo et al. Eur J Radiol. 2023 Dec.

Abstract

Purpose: Diagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based - DRL(DRLCI) and clinical indication - AD (ADCI) for adult CT in Brazil.

Methods: The prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test.

Results: In majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection.

Conclusions: There was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.

Keywords: Diagnostic reference levels; Dose optimization; Patient doses.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.