PMID- 32948454
OWN - NLM
STAT- MEDLINE
DCOM- 20210929
LR  - 20210929
IS  - 1532-2831 (Electronic)
IS  - 1078-8174 (Linking)
VI  - 27
IP  - 2
DP  - 2021 May
TI  - Computed tomography diagnostic reference levels for adult brain, chest and 
      abdominal examinations: A systematic review.
PG  - 673-681
LID - S1078-8174(20)30172-3 [pii]
LID - 10.1016/j.radi.2020.08.011 [doi]
AB  - OBJECTIVES: Radiation dose variation within and among Computed Tomography (CT) 
      centres is commonly reported. This work systematically reviewed published 
      articles on adult Diagnostic Reference Levels (DRLs) for the brain, chest and 
      abdomen to determine the causes and extent of variation. A systematic literature 
      search and review was performed in selected databases containing leading journals 
      in radiography, radiology and medical physics using carefully defined search 
      terms related to CT and DRLs. The quality of the included articles was determined 
      using the Effective Public Health Practise Project tool for quantitative studies. 
      KEY FINDINGS: The 54 articles reviewed include: 45 studies using human data, 8 
      studies using phantom data, and one study with both human and phantom data. The 
      main comparator in between studies was the dose indices used in reporting DRLs. 
      DRL variations of up to a factor of 2 for the same procedure were noted in 
      phantom studies, and up to a factor of 3 in human studies. Sources of variation 
      include the type of scanner, the age of the scanner, differences in protocols, 
      variations in patients, as well as variations in study design. Different 
      combinations of dose indices were reported: volume computed tomography dose index 
      (CTDIvol) and dose length product (DLP) (59%); DLP only (11%); weighted computed 
      tomography dose index (CTDIw) and DLP (9%); CTDIvol only (7%); CTDIvol, DLP and 
      effective dose (ED) (6%); CTDIw only (4%); CTDIvol, DLP and size specific dose 
      estimate (SSDE) (1%) and CTDIw, CTDIvol and DLP (1%). The use of different dose 
      indices limited dose comparison between studies. CONCLUSION: The study noted a 
      2-3 fold variation in DRLs between studies for the same procedure. The causes of 
      variation are reported and include study design, scanner technology and the use 
      of different dose indices. IMPLICATIONS FOR PRACTICE: There is a need for 
      standardisation of CT DRLs in line with the International Commission on 
      Radiological Protection recommendations to reduce dose variation and facilitate 
      dose comparison.
CI  - Copyright (c) 2020 The College of Radiographers. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Garba, I
AU  - Garba I
AD  - Department of Radiography, Faculty of Health Sciences, University of Malta, 
      Msida, Malta. Electronic address: idris.garba.15@um.edu.mt.
FAU - Zarb, F
AU  - Zarb F
AD  - Department of Radiography, Faculty of Health Sciences, University of Malta, 
      Msida, Malta.
FAU - McEntee, M F
AU  - McEntee MF
AD  - Department of Radiography, University College Cork, Ireland.
FAU - Fabri, S G
AU  - Fabri SG
AD  - Department of Systems & Control Engineering, Faculty of Engineering, University 
      of Malta, Malta.
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20200915
PL  - Netherlands
TA  - Radiography (Lond)
JT  - Radiography (London, England : 1995)
JID - 9604102
SB  - IM
MH  - Abdomen/diagnostic imaging
MH  - Adult
MH  - Brain
MH  - *Diagnostic Reference Levels
MH  - Humans
MH  - Radiation Dosage
MH  - Reference Values
MH  - *Tomography, X-Ray Computed
OTO - NOTNLM
OT  - CT examination
OT  - Dose indices
OT  - Radiation dose limit
OT  - Radiation dose variation
EDAT- 2020/09/20 06:00
MHDA- 2021/09/30 06:00
CRDT- 2020/09/19 05:28
PHST- 2020/04/20 00:00 [received]
PHST- 2020/08/16 00:00 [revised]
PHST- 2020/08/28 00:00 [accepted]
PHST- 2020/09/20 06:00 [pubmed]
PHST- 2021/09/30 06:00 [medline]
PHST- 2020/09/19 05:28 [entrez]
AID - S1078-8174(20)30172-3 [pii]
AID - 10.1016/j.radi.2020.08.011 [doi]
PST - ppublish
SO  - Radiography (Lond). 2021 May;27(2):673-681. doi: 10.1016/j.radi.2020.08.011. Epub 
      2020 Sep 15.