Predictors of CT radiation dose and their effect on patient care: A comprehensive analysis using automated data

Rebecca Smith-Bindman, Yifei Wang, Thomas R. Yellen-Nelson, Michelle Moghadassi, Nicole Wilson, Robert Gould, J Anthony Seibert, John M Boone, Mayil S. Krishnam, Ramit Lamba, David J. Hall, Diana L Miglioretti

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine patient, vendor, and institutional factors that influence computed tomography (CT) radiation dose. Materials and Methods: The relevant institutional review boards approved this HIPAA-compliant study, with waiver of informed consent. Volume CT dose index (CTDIvol) and effective dose in 274 124 head, chest, and abdominal CT examinations performed in adult patients at 12 facilities in 2013 were collected prospectively. Patient, vendor, and institutional characteristics that could be used to predict (a) median dose by using linear regression after log transformation of doses and (b) high-dose examinations (top 25% of dose within anatomic strata) by using modified Poisson regression were assessed. Results: There was wide variation in dose within and across medical centers. For chest CTDIvol, overall median dose across all institutions was 11 mGy, and institutional median dose was 7-16 mGy. Models including patient, vendor, and institutional factors were good for prediction of median doses (R2 = 0.31-0.61). The specific institution where the examination was performed (reflecting the specific protocols used) accounted for a moderate to large proportion of dose variation. For chest CTDIvol, unadjusted median CTDIvol was 16.5 mGy at one institution and 6.7 mGy at another (adjusted relative median dose, 2.6 mGy [95% confidence interval: 2.5, 2.7]). Several variables were important predictors that a patient would undergo high-dose CT. These included patient size, the specific institution where CT was performed, and the use of multiphase scanning. For example, while 49% of patients (21 411 of 43 696) who underwent multiphase abdominal CT had a high-dose examination, 8% of patients (4977 of 62 212) who underwent single-phase CT had a high-dose examination (adjusted relative risk, 6.20 [95% CI: 6.17, 6.23]). If all patients had been examined with single-phase CT, 69% (18 208 of 26 388) of high-dose examinations would have been eliminated. Patient size, institutional-specific protocols, and multiphase scanning were the most important predictors of dose (change in R2 = 8%-32%), followed by manufacturer and iterative reconstruction (change in R2, 0.2%-15.0%). Conclusion: CT doses vary considerably within and across facilities. The primary factors that influenced dose variation were multiphase scanning and institutional protocol choices. It is unknown if the variation in these factors influenced diagnostic accuracy.

Original languageEnglish (US)
Pages (from-to)182-193
Number of pages12
JournalRadiology
Volume282
Issue number1
DOIs
StatePublished - Jan 1 2017

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Patient Care
Tomography
Radiation
Thorax
Health Insurance Portability and Accountability Act
Cone-Beam Computed Tomography
Research Ethics Committees
Informed Consent
Linear Models
Head
Confidence Intervals

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Predictors of CT radiation dose and their effect on patient care : A comprehensive analysis using automated data. / Smith-Bindman, Rebecca; Wang, Yifei; Yellen-Nelson, Thomas R.; Moghadassi, Michelle; Wilson, Nicole; Gould, Robert; Seibert, J Anthony; Boone, John M; Krishnam, Mayil S.; Lamba, Ramit; Hall, David J.; Miglioretti, Diana L.

In: Radiology, Vol. 282, No. 1, 01.01.2017, p. 182-193.

Research output: Contribution to journalArticle

Smith-Bindman, R, Wang, Y, Yellen-Nelson, TR, Moghadassi, M, Wilson, N, Gould, R, Seibert, JA, Boone, JM, Krishnam, MS, Lamba, R, Hall, DJ & Miglioretti, DL 2017, 'Predictors of CT radiation dose and their effect on patient care: A comprehensive analysis using automated data', Radiology, vol. 282, no. 1, pp. 182-193. https://doi.org/10.1148/radiol.2016151391
Smith-Bindman R, Wang Y, Yellen-Nelson TR, Moghadassi M, Wilson N, Gould R et al. Predictors of CT radiation dose and their effect on patient care: A comprehensive analysis using automated data. Radiology. 2017 Jan 1;282(1):182-193. https://doi.org/10.1148/radiol.2016151391
Smith-Bindman, Rebecca ; Wang, Yifei ; Yellen-Nelson, Thomas R. ; Moghadassi, Michelle ; Wilson, Nicole ; Gould, Robert ; Seibert, J Anthony ; Boone, John M ; Krishnam, Mayil S. ; Lamba, Ramit ; Hall, David J. ; Miglioretti, Diana L. / Predictors of CT radiation dose and their effect on patient care : A comprehensive analysis using automated data. In: Radiology. 2017 ; Vol. 282, No. 1. pp. 182-193.
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AU - Wilson, Nicole

AU - Gould, Robert

AU - Seibert, J Anthony

AU - Boone, John M

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N2 - Purpose: To determine patient, vendor, and institutional factors that influence computed tomography (CT) radiation dose. Materials and Methods: The relevant institutional review boards approved this HIPAA-compliant study, with waiver of informed consent. Volume CT dose index (CTDIvol) and effective dose in 274 124 head, chest, and abdominal CT examinations performed in adult patients at 12 facilities in 2013 were collected prospectively. Patient, vendor, and institutional characteristics that could be used to predict (a) median dose by using linear regression after log transformation of doses and (b) high-dose examinations (top 25% of dose within anatomic strata) by using modified Poisson regression were assessed. Results: There was wide variation in dose within and across medical centers. For chest CTDIvol, overall median dose across all institutions was 11 mGy, and institutional median dose was 7-16 mGy. Models including patient, vendor, and institutional factors were good for prediction of median doses (R2 = 0.31-0.61). The specific institution where the examination was performed (reflecting the specific protocols used) accounted for a moderate to large proportion of dose variation. For chest CTDIvol, unadjusted median CTDIvol was 16.5 mGy at one institution and 6.7 mGy at another (adjusted relative median dose, 2.6 mGy [95% confidence interval: 2.5, 2.7]). Several variables were important predictors that a patient would undergo high-dose CT. These included patient size, the specific institution where CT was performed, and the use of multiphase scanning. For example, while 49% of patients (21 411 of 43 696) who underwent multiphase abdominal CT had a high-dose examination, 8% of patients (4977 of 62 212) who underwent single-phase CT had a high-dose examination (adjusted relative risk, 6.20 [95% CI: 6.17, 6.23]). If all patients had been examined with single-phase CT, 69% (18 208 of 26 388) of high-dose examinations would have been eliminated. Patient size, institutional-specific protocols, and multiphase scanning were the most important predictors of dose (change in R2 = 8%-32%), followed by manufacturer and iterative reconstruction (change in R2, 0.2%-15.0%). Conclusion: CT doses vary considerably within and across facilities. The primary factors that influenced dose variation were multiphase scanning and institutional protocol choices. It is unknown if the variation in these factors influenced diagnostic accuracy.

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