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CT diagnostic reference levels: are they appropriately computed?

  • Computed Tomography
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Abstract

Objectives

To estimate the variability of CT diagnostic reference levels (DRLs) according to the methods used for computing collected data.

Methods

Dose-length products (DLP) were collected by our national nuclear control agency from the 250 devices installed in 140 medical centers in the country. In 2015, the number of head, thorax, abdomen, and lumbar spine examinations collected in these centers ranged from approximately 20,000 to 42,000. The impact on DRLs of the number of devices considered, as well as the differences in descriptive statistics (mean vs. median DLP) or methods of pooling DLP data (all devices vs. all patients), was investigated. Variability in DRLs was investigated using a bootstrapping method as a function of the numbers of devices and examinations per device.

Results

As expected, DRLs derived from means were higher than those from medians, with substantial differences between device- and patient-related DRLs. Depending on the numbers of devices and DLP data per device, the variability ranged from 10 to 40% but was stabilized at a level of 10–20% if the number of devices was higher than 50 to 60, regardless of the number of DLP data per device.

Conclusion

Number of devices and of DLP data per device, descriptive statistics, and pooling data influence DRLs. As differences in methods of computing survey data can artificially influence DRLs, harmonization among national authorities should be recommended.

Key Points

• Due to CT dose variability, that of DRLs is at least of 10%.

• DRLs derived from medians are lower than from means and differ from those obtained by pooling all patient data.

• Fifty to 60 devices should be sufficient for estimating national DRLs, regardless of the number of data collected per device.

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Abbreviations

D-P75:

Device-related diagnostic reference level

DLP:

Dose-length product

DRL:

Diagnostic reference level

EU:

European Union

P-P75:

Patient-related diagnostic reference level

P75:

75th percentile of dose distribution

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Federal Agency for Nuclear Control (FANC), Rue Ravenstein 36, 1000, Brussels, Belgium

    Thibault Vanaudenhove

  2. Department of Chest Medicine, Hôpital Erasme, Route de Lennik 808, 1070, Brussels, Belgium

    Alain Van Muylem

  3. Department of Radiology, Clinique des Grangettes, 7 Chemin des Grangettes, 1224, Chêne-Bougeries, Switzerland

    Nigel Howarth

  4. Department of Radiology, Hôpital Erasme, Route de Lennik 808, 1070, Brussels, Belgium

    Pierre Alain Gevenois

  5. Department of Radiology, Epicura, Clinique Louis Caty, 136 Rue Louis Caty, 7331, Baudour, Belgium

    Denis Tack

Authors
  1. Thibault Vanaudenhove
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  2. Alain Van Muylem
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  3. Nigel Howarth
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  4. Pierre Alain Gevenois
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  5. Denis Tack
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Corresponding author

Correspondence to Denis Tack.

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Guarantor

The scientific guarantor of this publication is Denis Tack.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because according to the EU legislation (i.e., the Directive 95/46/EC regarding the protection of data of individuals), a purely observational retrospective study with complete anonymization of the data at the source, which removes any possibility of identifying the individual patients, is not subject to ethical review or to written informed consent.

Ethical approval

Institutional Review Board approval was not required because for the same reasons as the informed consent. (See above.)

Methodology

• retrospective

• observational

• anonymized dose registry data analysis at national level.

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Vanaudenhove, T., Van Muylem, A., Howarth, N. et al. CT diagnostic reference levels: are they appropriately computed?. Eur Radiol 29, 5264–5271 (2019). https://doi.org/10.1007/s00330-019-06141-8

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  • DOI: https://doi.org/10.1007/s00330-019-06141-8

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