Radioprotection 2024 , 59 ( 2 ), 111 – 116 © SFRP , 2024 https :// doi . org / 10.1051 / radiopro / 2024011
Available online at : www . radioprotection . org ARTICLE
Impact of implementing national diagnostic reference levels on radiation dose optimization in adult chest CT scans : a comparative analysis
R . Sindi 1 , B . Al-Shamrani 1 , A . Bana 1 , F . Al-Qurashi 1 , M . Al-Qarhi 1 , B . Al-Shehri 1 , R . Al-Otaibi 1 , S . Aldawood 2 and N . Shubayr 3 ,*
1 Medical Physics Department , King Fahd Armed Forces Hospital , 9862 Jeddah 21159 , Saudi Arabia . 2 Department of Physics and Astronomy , College of Science , P . O . Box 2455 , King Saud University , Riyadh 11451 , Saudi Arabia . 3 Diagnostic Radiograph Technology ( DRT ), College of Applied Medical Sciences , Jazan University , Jazan 45142 , Saudi Arabia .
Received : 7 December 2023 / Accepted : 15 March 2024
Abstract – The management and optimization of radiation dose in computed tomography ( CT ) examinations is of paramount importance , especially when the safety of patients is concerned . This study evaluated the effect of implementing national diagnostic reference levels ( NDRLs ) for radiation dose optimization in 1991 adult chest CT scans at a major Saudi hospital . Data was analyzed before and after NDRL implementation , with 21.5 % of scans using contrast and 78.5 % without . Before implementation , 11.1 % used contrast and 36.7 % did not ; after implementation , 10.4 % used contrast and 41.7 % did not . The majority ( 83.5 %) of scans passed NDRL criteria [ CTDIvol and DLP are set at 12 ( mGy ) and 430 ( mGy · cm )], with higher pass rates for contrast ( 91.8 %) versus non-contrast ( 81.5 %) scans . Effective dose ( ED ) was compared before and after NDRL implementation . For non-contrast scans , ED declined 2.43 % from 12.37 ± 5.25 mSv to 12.07 ± 4.99 mSv after implementation ( non-significant , p > 0.05 ). For contrast scans , ED declined more substantially , 6.77 % from 9.6 ± 4.61 mSv to 8.95 ± 4.44 mSv ( non-significant , p > 0.05 ). The findings highlight higher NDRL compliance in procedures with contrast and show areas for dose optimization improvement in procedures without contrast . Results suggest NDRLs provide guidance for optimizing radiation dose , but other factors like patient characteristics , protocol settings , and quality assurance programs should also be considered to ensure doses are as low as reasonably achievable ( ALARA ) without compromising diagnostic quality . Regular monitoring and review of CT protocols is recommended to avoid unintended consequences of dose reduction . Continued optimization is encouraged to reduce dose while ensuring quality .
Keywords : radiation dose / computed tomography / national diagnostic reference levels / dose length product / effective dose
1 Introduction
Radiation dose optimization in medical imaging has long been a focal point in radiological practices , given the inherent trade-off between diagnostic accuracy and patient safety ( Tsapaki , 2020 ). Computed tomography ( CT ) is a widely used diagnostic tool in radiology , providing high-resolution images of various anatomical structures and pathological conditions . However , CT exposes patients to relatively high doses of ionizing radiation compared to other radiological procedures . The rapid growth in CT utilization over the past few decades
* Corresponding author : nshubayr @ jazanu . edu . sa has raised concerns regarding the potential cancer risks associated with the cumulative radiation exposure in the population ( Shubayr et al ., 2023 ). Several studies have demonstrated a clear association between exposure to ionizing radiation from CT scans and increased lifetime attributable risk of cancer ( Alashban and Shubayr , 2023 ). Therefore , radiation protection in CT is essential to ensure that the benefits of the examination outweigh the potential harms , and that the radiation dose is kept as low as reasonably achievable ( ALARA ) without compromising the diagnostic quality .
One of the practical tools for radiation protection in CT is the use of diagnostic reference levels ( DRLs ), which provide guidance on radiation dose optimization in medical imaging procedures ( Rao et al ., 2023 ; Jasieniak et al ., 2023 ). DRLs are