R . Sindi et al .: Radioprotection 2024 , 59 ( 2 ), 111 – 116 115 However , the slight increase in mAs for contrast-enhanced scans and in kVp for non-contrast scans warrants further investigation . The negligible increase , although counterintuitive , may be indicative of adjustments made to maintain image quality . It is crucial to balance the need for diagnostic image quality with the goal of minimizing radiation exposure . Studies have reported a reduction in radiation exposure without compromising image quality ( Kumamaru et al ., 2016 ; Aberle et al ., 2020 ; Sarma et al ., 2022 ). These findings highlight the importance of continuous monitoring and adjustment of CT scan parameters in line with NDRLs to ensure optimal patient safety .
The findings presented in Table 4 offer significant insights into the pass / fail distribution of contrast-related procedures against NDRLs . The pass / fail distribution based on NDRLs shows that most cases ( 83.5 %) passed the criteria . This is consistent with a range of studies that have found that most cases pass the NDRLs , suggesting that radiation doses in medical imaging are generally below the recommended NDRLs ( Wachabauer et al , 2020 ; Bijwaard et al ., 2017 ).
The higher pass rate in procedures with contrast ( 91.8 %) compared to those without ( 81.5 %) suggests that the use of contrast in diagnostic imaging might be associated with better adherence to NDRL standards . This could be due to more precise imaging achieved with contrast agents , leading to optimized radiation doses . Subsequently , the ED for noncontrast CT scans showed a small decline of 2.43 %, and for contrast scans , a more pronounced reduction of 6.77 % ( nonsignificant , p > 0.05 ). However , even small reductions in radiation exposure can be beneficial , especially when considering the cumulative effects of radiation from multiple CT scans over time . The use of NDRLs has been particularly effective in reversing the upward trend in radiation dose for chest CT scans ( Rawat et al , 2015 ; Yang , 2020 ).
Overall , prior to NDRLs , the ED distribution shows a wider range and a right-skewed tail of higher EDs , while post- NDRLs , the distribution shifts leftward with a lower peak dose and a tighter distribution , indicating lower average EDs with reduced variability and fewer high-dose instances . Moreover , the findings highlight higher NDRL compliance in procedures with contrast and indicates areas for dose optimization improvement in procedures without contrast . Ensuring adherence to NDRLs in these procedures is essential for patient safety , the overall effectiveness of diagnostic imaging and regulatory compliance . This might involve revisiting protocol standards , enhancing training , or incorporating advanced imaging technologies that optimize dose without compromising diagnostic quality ( Greenwood et al ., 2015 ; Guerra et al . 2019 ; Tsapaki , 2020 ).
A critical aspect to consider when evaluating the impact of NDRLs on radiological practices is the temporal proximity between the NDRL implementation and the subsequent evaluation period . The interval observed in this study is notably brief , suggesting that the window for instituting substantial modifications in clinical practices was limited . This constraint highlights a potential impediment to realizing more significant reductions in patient exposure to radiation . Furthermore , the endeavor to decrease patient exposure through changes in radiological practices extends beyond mere procedural adjustments ; it fundamentally necessitates awareness-raising actions and a commitment to continuous professional education ( Bertho and Habib , 2023 ). The importance of ongoing education for healthcare professionals in facilitating the adoption of safer , more effective radiological techniques that align with NDRL guidelines , emphasizing that such educational initiatives are vital for sustaining long-term improvements in patient safety and care quality .
4.1 Limitations of the study
This study has some limitations that should be considered when interpreting the results . This study only focused on chest CT examinations , which may not reflect the radiation dose variation and optimization for other CT examinations in different body regions . Future studies should include more body organs and larger and more representative samples ,
5 Conclusion
The adoption of the NDRLs has resulted in reduction in radiation doses during CT chest examinations . The ED declined by 2.29 % for non-contrast and 6.63 % for contrast CT scans A better adherence to NDRL standards with contrast use , as evidenced by a higher pass rate than non-contrast scans ( 91.8 % vs . 81.5 %). These findings suggest a regular monitoring and review for CT procedures to avoid unintended consequences . Therefore , this study recommends that CT users should follow the NDRLs as a guidance , but also consider other factors such as patient characteristics , protocol settings , and quality assurance program to ensure that the radiation dose is kept as low as reasonably achievable ( ALARA ) without compromising the diagnostic quality .
Acknowledgments
The authors would also like to extend their sincere appreciation to the Researcher supporting program at King Saud University , Riyadh , for funding this work under the project number ( RSP2024 R328 ).
Funding
This study was supported by the Researcher Supporting Program at King Saud University , Riyadh , under project number RSP2024 R328 .
Conflicts of Interest
The author declares that he has no conflicts of interest in relation to this article .
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request .
Author contribution statement
R . Sindi : Conceptualization , Methodology , Investigation , Writing – Original Draft , Project Administration . B . Al-Shamrani : Data curation , Investigation . A . Bana : Data curation , Investigation . F . Al-Qurashi : Data curation , Investigation . M . Al-Qarhi : Data curation , Investigation . B . Al-Shehri : Resources , Investigation . R . Al-Otaibi : Investigation , Formal Analysis . S . Aldawood : Validation , Visualization , Funding Acquisition . N . Shubayr : Conceptualization , Formal Analysis , Writing – Review & Editing , Writing – Original Draft , Supervision .