Congress:
EuroSafe Imaging 2017
Keywords:
Radioprotection / Radiation dose, Action 5 - Performance indicators for radiation protection management, Action 2 - Clinical diagnostic reference levels (DRLs), Action 6 - Clinical audit tool for imaging, Action 9 - Development of criteria for safe imaging procedures, Action 3 - Optimisation, diagnostic reference levels, image quality, Action 2 - Clinical audit, CT, Radiation safety, Quality assurance
Authors:
E. Neri, D. Caramella, G. Paulo, J. Damilakis, A. Torresin
DOI:
10.1594/esi2017/ESI-0061
Conclusion and Recommendations
The dose monitoring tools allows a precise internal audit of the dose behaviour in the radiological department,
tracking the general dosimetric trend,
that mainly depend on the adopted imaging protocols.
Such imaging protocols are frequently designed by an anatomical orientation with few concern about the specific clinical context in which the exam is performed.
In parallel the attention of dose reference levels (DRL) is oriented to the anatomical segments,
and not the clinical context.
One example: lung CT for screening has the same scan length of a lung CT for nodule characterization,
as well for pulmonary embolism,
but the 3 exams are strongly different by indication and as consequence by imaging protocols that influence the dose levels.
Another example of difference between anatomy and indication can be easily given with CT colonography; this exam is aimed at screening the colon for colorectal lesions and is performed at the lowest dose possible that allow to visualize the colonic lumen,
meanwhile parenchymatous organs are not the target of the exam (see figure 1).
Therefore it is clear that the actual dose reference levels,
based on the anatomical focus,
does not properly reflect the standard of dose.
Moreover,
in a same clinical context,
there is a potential variability of patients anatomy,
physiology,
and target disease,
which influences the CT imaging protocols,
that are more and more personalized.
Dose monitoring systems could be therefore an helpful tool for bulding new dose reference levels based on the clinical indications and on the patient’s specific factors,
driving the actual DRL based on anatomy toward clinical indication reference levels.