National dose reference levels in computed tomography–guided interventional procedures—a proposal

• Published in: European radiology Vol. 30; no. 10; pp. 5690 - 5701
• Main Authors: Greffier, Joël, Ferretti, Gilbert, Rousseau, Julia, Andreani, Olivier, Alonso, Emilie, Rauch, Aymeric, Gillet, Romain, Le Roy, Julien, Cabrol-Faivre, Laurie, Douane, Frederic, David, Arthur, Henry, Simon, Jacques, Thibaut, Stefanovic, Xavier, Decoux, Eric, Lafay, Frederic, Pilleul, Franck, Couzon, Franck, Boutet, Claire, Woerly, Bernard, Baur, Patrick, Sans, Nicolas, Faruch, Marie, Moussier-Lherm, Aurélie, Tselikas, Lambros, Jacquier, Alexis, Bigand, Emeline, Pessis, Eric, Teriitehau, Christophe, Magnier, Florian, Cassagnes, Lucie, Haberlay, Marc, Boutteau, David, De Kerviler, Eric, Majorel-Gouthain, Cynthia, Defez, Didier, Vuillod, Aurélie, Rouviere, Olivier, Hennequin, Laurent, Fohlen, Audrey, Alwan, Rabih, Malakhia, Alexandre, Aubry, Sébastien, Dohan, Anthony, Eresue-Bony, Marie, Gautier, Romain, Dal, Romaric, Dabli, Djamel, Hebert, Thomas, Kovacs, Robert, Hadid-Beurrier, Lama, Bousson, Valérie, Potel, Mélody, Barbotteau, Yves, Michel, Célian, Habib-Geryes, Bouchra, André, Marc, Arnaud, Thierry, Bestion, Nathalie, Ernst, Olivier, Monfraix, Sylvie, Brillet, Pierre Yves, Guiu, Boris, Boussel, Loic, Demonchy, Mathilde, Beregi, Jean Paul, Frandon, Julien
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2020; Springer Nature B.V; Springer Verlag
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biomedical materials; Biopsy; Bone surgery; Categories; Computed Tomography; Destruction; Diagnostic Radiology; Female; Fluoroscopy; Fluoroscopy - methods; France; Heterogeneity; Human health and pathology; Humans; Imaging; Infiltration; Internal Medicine; Interventional Radiology; Life Sciences; Male; Medicine; Medicine & Public Health; Metastases; Middle Aged; Neuroradiology; Optimization; Quartiles; Radiation Dosage; Radiography, Interventional - methods; Radiography, Interventional - standards; Radiology; Reference Values; Reproducibility of Results; Retrospective Studies; Spine; Surveys and Questionnaires; Thorax; Tomography, X-Ray Computed - methods; Tomography, X-Ray Computed - standards; Tumors; Ultrasound; Vertebroplasty; Wound drainage; Young Adult; France; Radiation exposure; Radiology, interventional; Physics; Multidetector computed tomography
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-020-06903-9

Objectives
To establish national reference levels (RLs) in interventional procedures under CT guidance as required by the 2013/59/Euratom European Directive.
Methods
Seventeen categories of interventional procedures in thoracic, abdominopelvic, and osteoarticular specialties (percutaneous infiltration, vertebroplasty, biopsy, drainage, tumor destruction) were analyzed. Total dose length product (DLP), number of helical acquisitions (NH), and total DLP for helical, sequential, or fluoroscopic acquisitions were recorded for 10 to 20 patients per procedure at each center. RLs were calculated as the 3rd quartiles of the distributions and target values for optimization process (TVOs) as the median. RLs and TVOs were compared with previously published studies.
Results
Results on 5001 procedures from 49 centers confirmed the great variability in patient dose for the same category of procedures. RLs were proposed for the DLPs and NHs in the seventeen categories. RLs in terms of DLP and NH were 375 mGy.cm and 2 NH for spinal or peri-spinal infiltration, 1630 mGy.cm and 3 NH for vertebroplasty, 845 mGy.cm and 4 NH for biopsy, 1950 mGy.cm and 8 NH for destruction of tumors, and 1090 mGy.cm and 5 NH for drainage. DLP and NH increased with the complexity of procedures.
Conclusions
This study was the first nationwide multicentric survey to propose RLs for interventional procedures under CT guidance. Heterogeneity of practice in centers were found with different levels of patient doses for the same procedure. The proposed RLs will allow imaging departments to benchmark their practice with others and optimize their protocols.
Key Points
• National reference levels are proposed for 17 categories of interventional procedures under CT guidance.
• Reference levels are useful for benchmarking practices and optimizing protocols.
• Reference levels are proposed for dose length product and the number of helical acquisitions.