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International variation in radiation dose for computed tomography examinations: prospective cohort study.

Abstract：

OBJECTIVE:To determine patient, institution, and machine characteristics that contribute to variation in radiation doses used for computed tomography (CT). DESIGN:Prospective cohort study. SETTING:Data were assembled and analyzed from the University of California San Francisco CT International Dose Registry. PARTICIPANTS:Standardized data from over 2.0 million CT examinations of adults who underwent CT between November 2015 and August 2017 from 151 institutions, across seven countries (Switzerland, Netherlands, Germany, United Kingdom, United States, Israel, and Japan). MAIN OUTCOME MEASURES:Mean effective doses and proportions of high dose examinations for abdomen, chest, combined chest and abdomen, and head CT were determined by patient characteristics (sex, age, and size), type of institution (trauma center, care provision 24 hours per day and seven days per week, academic, private), institutional practice volume, machine factors (manufacturer, model), country, and how scanners were used, before and after adjustment for patient characteristics, using hierarchical linear and logistic regression. High dose examinations were defined as CT scans with doses above the 75th percentile defined during a baseline period. RESULTS:The mean effective dose and proportion of high dose examinations varied substantially across institutions. The doses varied modestly (10-30%) by type of institution and machine characteristics after adjusting for patient characteristics. By contrast, even after adjusting for patient characteristics, wide variations in radiation doses across countries persisted, with a fourfold range in mean effective dose for abdomen CT examinations (7.0-25.7 mSv) and a 17-fold range in proportion of high dose examinations (4-69%). Similar variation across countries was observed for chest (mean effective dose 1.7-6.4 mSv, proportion of high dose examinations 1-26%) and combined chest and abdomen CT (10.0-37.9 mSv, 2-78%). Doses for head CT varied less (1.4-1.9 mSv, 8-27%). In multivariable models, the dose variation across countries was primarily attributable to institutional decisions regarding technical parameters (that is, how the scanners were used). CONCLUSIONS:CT protocols and radiation doses vary greatly across countries and are primarily attributable to local choices regarding technical parameters, rather than patient, institution, or machine characteristics. These findings suggest that the optimization of doses to a consistent standard should be possible. STUDY REGISTRATION:Clinicaltrials.gov NCT03000751.

journal_name

BMJ

journal_title

BMJ (Clinical research ed.)

authors

Smith-Bindman R,Wang Y,Chu P,Chung R,Einstein AJ,Balcombe J,Cocker M,Das M,Delman BN,Flynn M,Gould R,Lee RK,Yellen-Nelson T,Schindera S,Seibert A,Starkey J,Suntharalingam S,Wetter A,Wildberger JE,Miglioretti DL

doi

10.1136/bmj.k4931

subject

Has Abstract

pub_date

2019-01-02 00:00:00

pages

k4931

eissn

0959-8138

issn

1756-1833

journal_volume

364

pub_type

杂志文章,多中心研究

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International variation in radiation dose for computed tomography examinations: prospective cohort study.