Download Hot Topic: Limiting Radiation Exposure in Radiographic Evaluation

Hot Topic: Limiting Radiation
Exposure in Radiographic Evaluation
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Advanced Topics
• Gonadal Shielding
• CT
– Dose reduction software
– Dual Energy CT
– CT dose adjusted
• Scoliosis
• Internal Q/A
• Pt knowledge/education
– Consent
Gonadal Shielding
Where are the
gonads?
Left:
Center:
Right:
Typical placement of a shield with limited pelvic coverage.
Theoretical shield coverage of the entire pelvis, extending cephalocaudal from the
symphysis pubis to the iliac crests and mediolaterally from ASIS to ASIS, would
protect all ovaries.
Proposed ovarian shielding technique: the lateral pelvis is shielded, protecting the
majority of ovaries but allowing midline pelvic and spinal structures to be seen
radiographically.
SPR 2015 Paper #: 037 Lead Gonad Shields: Good or Bad for Patient Radiation
Exposure? Summer Kaplan, Dennise Magill, Marc Felice, Sayed Ali, Xiaowei Zhu.
SPR 2015 Paper #: 038
Table top Fluoroscopy: To Shield or Not to Shield
Frank Goerner, PhD, Cristina Dodge, Robert Orth, MD, PhD
Dose Reduction Software
Emerging Techniques for Dose Optimization in Abdominal CT
Ravi K. Kaza, MD • Joel F. Platt, MD • Mitchell M. Goodsitt, PhD • Mahmoud M. Al-Hawary, MD •
Katherine E. Maturen, MD • Ashish P. Wasnik, MD • Amit Pandya, MD RadioGraphics 2014; 34:4–17
GE ASIR
Appearance of liver parenchyma and a
lesion using filtered back projection (FBP)
and iterative reconstruction technique (IRT)
at multiple radiation doses in a 12-year-old
boy.
CT scans acquired at 120 kV
and 200 mAs (a–d) and 50 mAs (e–h) using
ASIR 30–70% reconstruction technique.
•
JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 14, NUMBER 4, 2013
263 263 264 Ghetti et al.: Physical characterization of SAFIRE 264 Journal of
Applied Clinical Medical Physics, Vol. 14, No. 4, 2013
Dual Energy CT
Dual- and Multi-Energy CT:
Principles, Technical
Approaches, and
Clinical Applications. Cynthia H.
McCollough, PhD Shuai Leng,
PhD Lifeng Yu, PhD Joel G.
Fletcher, MD Radiology: Volume
276: Number 3—September
2015
Dual
Energy
CT
Dual- and Multi-Energy CT: Principles, Technical Approaches, and
Clinical Applications. Cynthia H. McCollough, PhD Shuai Leng, PhD Lifeng Yu, PhD Joel G. Fletcher, MD Radiology: Volume 276: Number 3—
September 2015
Dual
Energy
rd
CT
3 Generation Dual Energy CT
CTDIVOL x scan length=
The single dose that best
represents the distribution of
doses delivered to the
cross-sectional area of the
phantom , it was intended as
a tool,“to provide a
standardized method to
estimate and compare the
radiation output of different
CT scanners sic not a patient
dose index”
DLP
SSDE
Does not represent
a patient dose
index
but rather the
energy deposited in
a standard
phantom in
all three
dimensions.
Size-Specific Dose
Estimates (SSDE) which
is an estimate of the
radiation dose to the
patient’s tissues within the
scan volume of the CT.
The accuracy of the SSDE is
believed to be within 20%.
(Requires measurement of
greatest ap and lateral
Dimensions to obtain
conversion factors)
Scoliosis Imaging
Doody M, Lonstein JE, Stovall M, et al (2000) Breast cancer mortality after
diagnostic radiography: findings from the U.S. Scoliosis Cohort Study. Spine
25:2052–2063
• Decreases Scatter
Radiation
• Amplification
technique of
detector improves
SNR
Internal Q/A,
PQI,
QRS
TUV
Patient Knowledge
and education
Point – Counterpoint Radiation Consent
Radiology January 2012 ;262:1
Should be required
Richard C. Semelka, MD,
Diane M. Armao, MD,
Jorge Elias, Jr, MD, PhD and
Eugenio Picano, MD
We believe that the radiology
community should take the
initiative to adopt guidelines
and require that all imaging
facilities use some form of
active information process
describing the risks of medical
radiation .
Should not be required
James A. Brink , MD
Marilyn J. Goske , MD
John A. Patti , MD
The alternative approach of
informed decision making is
an even more aggressive,
collaborative educational
opportunity that radiologists
should embrace with their
patients and is a better
alternative. Informed
decision making trumps
informed consent
Kathy Boutis, MD, William Cogollo, MD, Jason Fischer, MD, Stephen B. Freedman, MD,
Guila Ben David, MRT(R), and Karen E. Thomas, MD
CONCLUSIONS: Approximately half of the participating parents were aware of
the potential increased lifetime malignancy risk associated with head CT
imaging. Willingness to proceed with CT testing was reduced after risk
disclosure but was a significant barrier for a small minority of parents. Most
parents wanted to be informed of potential malignancy risks before proceeding
with imaging. We strongly recommend that physicians be well informed of the
benefits and potential risks of CT imaging.
Web Data from Image Gently
2012
464, 166 Page views
55, 548 Site visits
37, 824 Unique views
2013
336, 808 Page views
46, 544 Site visits
32, 054 Unique views
2014
209, 689 Page views
74, 928 Site visits
56, 096 Unique views
2015
258, 576 Page views
86, 478 Site visits
61, 387 Unique views
Courtesy Shaniece Rigans
How old was Roentgen’s wife?
Radiation Reporting
• California and other states have mandated
– The original law mandated that facilities must
include CT radiation dose in patient records. The
new law states that facilities are not required to
report dose if the CT scan is used for therapeutic
treatment planning or nuclear medicine.
– Second, the original law indicated that all facilities
must verify dose annually to ensure displayed
dose remains within 20% of measured actual dose