scholarly journals DIAGNOSTIC IMAGING AND IONIZING RADIATION EXPOSURE IN A LEVEL 1 TRAUMA CENTRE POPULATION MET WITH TRAUMA TEAM ACTIVATION: A ONE-YEAR PATIENT RECORD AUDIT

2020 ◽  
Vol 189 (1) ◽  
pp. 35-47
Author(s):  
Anna Bågenholm ◽  
Pål Løvhaugen ◽  
Rune Sundset ◽  
Tor Ingebrigtsen
Keyword(s):  
Diagnostic Imaging ◽  
Radiation Exposure ◽  
Effective Dose ◽  
Trauma Team ◽  
Trauma Centre ◽  
Whole Body ◽  
Reference Level ◽  
Dose Length Product ◽  
Trauma Team Activation ◽  
X Ray

Abstract This audit describes ionizing and non-ionizing diagnostic imaging at a regional trauma centre. All 144 patients (males 79.2%, median age 31 years) met with trauma team activation from 1 January 2015 to 31 December 2015 were included. We used data from electronic health records to identify all diagnostic imaging and report radiation exposure as dose area product (DAP) for conventional radiography (X-ray) and dose length product (DLP) and effective dose for CT. During hospitalization, 134 (93.1%) underwent X-ray, 122 (84.7%) CT, 92 (63.9%) focused assessment with sonography for trauma (FAST), 14 (9.7%) ultrasound (FAST excluded) and 32 (22.2%) magnetic resonance imaging. One hundred and sixteen (80.5%) underwent CT examinations during trauma admissions, and 73 of 144 (50.7%) standardized whole body CT (SWBCT). DAP values were below national reference levels. Median DLP and effective dose were 2396 mGycm and 20.42 mSv for all CT examinations, and 2461 mGycm (national diagnostic reference level 2400) and 22.29 mSv for a SWBCT.

scholarly journals Radiation Exposure From CT Scanning in the Resuscitative Phase of Trauma Care: A Level One Trauma Centre Experience

CJEM ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 617-623 ◽  
Author(s):  
Lorri Beatty ◽  
Elizabeth Furey ◽  
Cupido Daniels ◽  
Avery Berman ◽  
John M. Tallon
Keyword(s):  
Radiation Exposure ◽  
Tissue Injury ◽  
Tertiary Care ◽  
Trauma Team ◽  
Trauma Centre ◽  
Whole Body ◽  
Trauma Patients ◽  
X Rays ◽  
Imaging Data ◽  
Trauma Team Activation

AbstractObjectivesThe initial management of a trauma patient often involves imaging in the form of x-rays, computed tomography (CT) and other radiographic studies, which expose the patient to ionizing radiation, an entity known to cause tissue injury and malignancy at high doses. The purpose of this study was to use a calculation-based method to determine the radiation exposure of trauma patients undergoing trauma team activation in a Canadian tertiary-care trauma centre.MethodsA retrospective chart review was conducted using the Nova Scotia Provincial Trauma Registry. All patients age 16 years old and over who underwent trauma team activation between March 1, 2008 and March 1, 2009 were included. Patients who died prior to imaging tests were excluded. Dose reports for each CT were used to calculate a whole-body radiation dose for each patient.ResultsThere were 230 trauma team activations during the study period, of which 206 had CT imaging. Data were available for 162 patients. The mean whole-body radiation exposure for all patients was 24.4±10.3 mSv, which may correlate to one additional cancer death for every 100 trauma patients scanned.ConclusionsTrauma patients are exposed to significant amounts of radiation during their initial trauma work-up, which may increase the risk of fatal cancer. Clinicians who care for these patients must be aware of the radiation exposure, and take measures to limit radiation exposure of trauma patients.

scholarly journals Whole Body Low Dose Computed Tomography Using Third-Generation Dual-Source Multidetector With Spectral Shaping: Protocol Optimization and Literature Review

Dose-Response ◽  
2020 ◽  
Vol 18 (4) ◽  
pp. 155932582097313
Author(s):  
Dario Baldi ◽  
Liberatore Tramontano ◽  
Vincenzo Alfano ◽  
Bruna Punzo ◽  
Carlo Cavaliere ◽  
...  
Keyword(s):  
Effective Dose ◽  
Low Dose ◽  
Whole Body ◽  
Dose Length Product ◽  
Osteolytic Lesions ◽  
Subjective Image Quality ◽  
Ct Dose ◽  
Dual Source ◽  
Ct Dose Index ◽  
Low Dose Computed Tomography

For decades, the main imaging tool for multiple myeloma (MM) patient’s management has been the conventional skeleton survey. In 2014 international myeloma working group defined the advantages of the whole-body low dose computed tomography (WBLDCT) as a gold standard, among imaging modalities, for bone disease assessment and subsequently implemented this technique in the MM diagnostic workflow. The aim of this study is to investigate, in a group of 30 patients with a new diagnosis of MM, the radiation dose (CT dose index, dose-length product, effective dose), the subjective image quality score and osseous/extra-osseous findings rate with a modified WBLDCT protocol. Spectral shaping and third-generation dual-source multidetector CT scanner was used for the assessment of osteolytic lesions due to MM, and the dose exposure was compared with the literature findings reported until 2020. Mean radiation dose parameters were reported as follows: CT dose index 0.3 ± 0.1 mGy, Dose-Length Product 52.0 ± 22.5 mGy*cm, effective dose 0.44 ± 0.19 mSv. Subjective image quality was good/excellent in all subjects. 11/30 patients showed osteolytic lesions, with a percentage of extra-osseous findings detected in 9/30 patients. Our data confirmed the advantages of WBLDCT in the diagnosis of patients with MM, reporting an effective dose for our protocol as the lowest among previous literature findings.

RESULTS OF CZECH NATIONAL STUDY OF RADIATION EXPOSURE FROM RADIOTHERAPY OF NON-MALIGNANT DISEASES, IN PARTICULAR OF HEEL SPURS

2019 ◽  
Vol 186 (2-3) ◽  
pp. 386-390
Author(s):  
V Dufek ◽  
H Zackova ◽  
L Kotik ◽  
I Horakova
Keyword(s):  
Czech Republic ◽  
Clinical Practice ◽  
Radiation Exposure ◽  
Effective Dose ◽  
National Study ◽  
Malignant Diseases ◽  
Organ Doses ◽  
The Czech Republic ◽  
X Ray ◽  
Effective Doses

Abstract About 26 000 patients are treated per year with radiotherapy for non-malignant diseases in the Czech Republic. Approximately 75% of them are treated on X-ray therapy units and most of these patients undergo radiotherapy of heel spurs. The evaluation of radiation exposure of these patients was based on measured organ doses and on data from clinical practice. Collective effective doses for particular diagnoses were calculated in order to compare doses resulting from different diagnoses treated on X-ray therapy units. The collective effective dose from radiotherapy of heel spurs in the Czech Republic in 2013 was evaluated to 77 manSv. It represents 25.6% of the total collective effective dose for all diagnoses of radiotherapy for non-malignant diseases treated on X-ray therapy units.

scholarly journals Value of whole-body low-dose computed tomography in patients with ventriculoperitoneal shunts: a retrospective study

2018 ◽  
Vol 129 (6) ◽  
pp. 1598-1603 ◽  
Author(s):  
Andrej Pala ◽  
Fadi Awad ◽  
Michael Braun ◽  
Michal Hlavac ◽  
Arthur Wunderlich ◽  
...  
Keyword(s):  
Image Quality ◽  
Radiation Dose ◽  
Radiation Exposure ◽  
Low Dose ◽  
Whole Body ◽  
Consecutive Series ◽  
Dose Length Product ◽  
Shunt System ◽  
Distal Catheter ◽  
Vp Shunt

OBJECTIVEThe gold standard for evaluation of ventriculoperitoneal (VP) shunt position, dislocation, or disconnection is conventional radiography. Yet, assessment with this modality can be challenging because of low image quality and can result in repetitive radiation exposure with high fluctuation in the radiation dose. Recently, CT-based radiation doses have been significantly reduced by using low-dose protocols. Thus, whole-body low-dose CT (LDCT) has become applicable for routine use in VP shunt evaluation. The authors here compared image quality and approximate radiation dose between radiography and LDCT in patients with implanted VP shunt systems.METHODSVentriculoperitoneal shunt systems have been investigated with LDCT scanning at the authors’ department since 2015. A consecutive series of 57 patients (70 investigations) treated between 2015 and 2016 was retrospectively assessed. A historical patient cohort that had been evaluated with radiography was compared with the LDCT patients in terms of radiation dose and image quality. Three independent observers evaluated projection of the valve pressure level and correct intraperitoneal position, as well as complete shunt projection, using a Likert-type scale of 1–5, where 1 indicated “not assessable” and 5 meant “assessable with high accuracy.” Descriptive statistics and the Mann-Whitney U-test were used for analysis.RESULTSTwenty-seven radiographs (38.6%) and 43 LDCT scans (61.4%) were analyzed. The median dose-length product (DLP) of the LDCT scans was 100 mGy·cm (range 59.9–183 mGy·cm). The median total dose-area product (DAP) of the radiographic images was 3177 mGy·cm2 (range 641–13,833 mGy·cm2). The estimated effective dose (EED) was significantly lower with the LDCT scan (p < 0.001). The median EED was 4.93 and 1.90 mSv for radiographs and LDCT, respectively. Significantly better identification of the abdominal position of the distal shunt catheter was achieved with LDCT (p < 0.001). Simultaneously, significantly improved visualization of the entire shunt system was realized with this technique (p < 0.001). On the contrary, identification of the valve settings was significantly worse with LDCT (p < 0.001).CONCLUSIONSWhole-body LDCT scanning allows good visualization of the distal catheter after VP shunt placement. Despite the fact that only a rough estimation of effective doses is possible in a direct comparison of LDCT and radiography, the data showed that shunt assessment via LDCT does not lead to greater radiation exposure. Thus, especially in difficult anatomical conditions, as in patients who have undergone multiple intraabdominal surgeries, have a high BMI, or are immobile, the use of LDCT shunt evaluation has high clinical value. Further data are needed to determine the value of LDCT for the evaluation of complications or radiation dose in pediatric patients.

scholarly journals Retrospective analysis of alcohol testing in trauma team activation patients at a Canadian tertiary trauma centre

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024190 ◽  
Author(s):  
Mete Erdogan ◽  
Nelofar Kureshi ◽  
Saleema A Karim ◽  
John M Tallon ◽  
Mark Asbridge ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Trauma Team ◽  
Trauma Centre ◽  
System Level ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Trauma Team Activation ◽  
Factors Associated ◽  
Patient Level ◽  
Alcohol Testing

ObjectivesAlthough alcohol screening is an essential requirement of level I trauma centre accreditation, actual rates of compliance with mandatory alcohol testing in trauma patients are seldom reported. Our objective was to determine the prevalence of blood alcohol concentration (BAC) testing in patients requiring trauma team activation (TTA) for whom blood alcohol testing was mandatory, and to elucidate patient-level, injury-level and system-level factors associated with BAC testing.DesignRetrospective cohort study.SettingTertiary trauma centre in Halifax, Canada.Participants2306 trauma patients who required activation of the trauma team.Primary outcome measureThe primary outcome was the rate of BAC testing among TTA patients. Trends in BAC testing over time and across patient and injury characteristics were described. Multivariable logistic regression examined patient-level, injury-level and system-level factors associated with testing.ResultsOverall, 61% of TTA patients received BAC testing despite existence of a mandatory testing protocol. Rates of BAC testing rose steadily over the study period from 33% in 2000 to 85% in 2010. Testing varied considerably across patient-level, injury-level and system-level characteristics. Key factors associated with testing were male gender, younger age, lower Injury Severity Score, scene Glasgow Coma Scale score <9, direct transport to hospital and presentation between midnight and 09:00 hours, or on the weekend.ConclusionsAt this tertiary trauma centre with a policy of empirical alcohol testing for TTA patients, BAC testing rates varied significantly over the 11-year study period and distinct factors were associated with alcohol testing in TTA patients.

Determination of Radiation Exposure for Patients with Dental X-Ray Studies

2020 ◽  
Vol 65 (1) ◽  
pp. 13-16
Author(s):  
S. Somov
Keyword(s):  
Radiation Exposure ◽  
Effective Dose ◽  
Computer Programs ◽  
Federal State ◽  
Patient Exposure ◽  
X Ray ◽  
Effective Doses ◽  
Statistical Form

Purpose: Improving the quality of radiation assessment of patients of the medical institution of the dental profile using the calculated values of effective doses. Material and methods: Using the RED-2018 and ORTO-2018 programs, the values of effective patient exposure doses for 29 medical organizations of the dental profile were calculated. The obtained values of the effective dose were compared with the values specified in the methodological recommendations MP 0100 / 1659-07-26 of February 16, 2007 “Filling of forms of federal state statistical observation 3-DOZ”. Results: The analysis showed that the doses obtained using the RED-2018 and ORTO-2018 computer programs, respectively, are 21 and 14 times lower than the doses indicated in the methodological recommendations MP 0100 / 1659-07-26. Conclusion: It is shown that the developed computer programs can be applied by a dentist practicing physician who performs an x-ray examination in order to automatically and reliably determine the patient’s dose when performing x-ray-mathematical studies in accordance with the guidelines of MU 2.6.1.2944-11 “Monitoring effective doses of patients during x-ray examinations” also used in the preparation of radiation hygienic passports of organizations and statistical form 3-DOZ. The indication of the actually calculated values of the effective dose of the patient, rather than repeatedly overestimated averages, will reduce the level of radiophobia in society.

scholarly journals ESTIMATION OF ENTRANCE SURFACE DOSE (ESD) AS A DOSE PROFILE FOR PATIENTS UNDERGOING RADIOGRAPHY EXAMINATION BASED ON TUBE OUTPUT MEASUREMENT

2020 ◽  
Vol 4 (2) ◽  
pp. 72
Author(s):  
Risalatul Latifah ◽  
Muhammad Rosyid ◽  
Firdy Yuana ◽  
Achmad Hidayat
Keyword(s):  
Medical Imaging ◽  
Radiation Exposure ◽  
Reference Level ◽  
Surface Dose ◽  
Diagnostic Reference Level ◽  
Output Measurement ◽  
X Ray ◽  
Dose Profile ◽  
Entrance Surface Dose ◽  
Tube Output

Background: Radiography examinations are the most widely used and indispensable tools in medical imaging. The dose received by the patient should be known to prevent the risk of radiation exposure. Patient dose in radiography examination can be best estimated in terms of entrance surface dose (ESD). ESD value can be obtained by using the recorded dose viewer installed on the device. However,  not all devices have this feature. Other methods can be conducted using thermoluminescence dosimeter (TLD) although it practically requires a high cost. Purpose: The study aims to estimate the ESD as a dose profile for patients undergoing radiography examination using tube output. Method: The patient data and exposure factors were retrospectively recorded for 263 patients. The ESD was estimated from the measurements of the X-ray tube output and recorded exposure factors.  Results: The ESD value varied from 0.002 to 0.41 mGy. In the thorax PA, thorax LAT, cervical LAT, cervical AP, skull AP, skull LAT, genu LAT and waters was found (0,23±0.05) mGy, (0,09±0,05) mGy, (0,07±0,04) mGy, (0,13±0,08) mGy, (0,03±0,01) mGy, (0,06±0,02) mGy, (0,04±0,00) mGy (0,04±0,02) mGy, respectively. These results were further used to determine the Local Diagnostic Reference Level (LDRL) value. Conclusion:  The results revealed that LDRL fell below the national DRL value and international reference

scholarly journals Cone Beam CT Imaging of the Paranasal Region with a Multipurpose X-ray System—Image Quality and Radiation Exposure

2020 ◽  
Vol 10 (17) ◽  
pp. 5876
Author(s):  
Sabine Ohlmeyer ◽  
Marc Saake ◽  
Thomas Buder ◽  
Matthias May ◽  
Michael Uder ◽  
...  
Keyword(s):  
Image Quality ◽  
Radiation Exposure ◽  
Effective Dose ◽  
Sinus Surgery ◽  
Volume Index ◽  
Cone Beam ◽  
Slice Thickness ◽  
Surgery Planning ◽  
X Ray ◽  
Dose Levels

Besides X-ray and fluoroscopy, a previously introduced X-ray scanner offers a 3D cone beam option (Multitom Rax, Siemens Healthcare). The aim of this study was to evaluate various scan parameters and post-processing steps to optimize image quality and radiation exposure for imaging of the parasinus region. Four human cadaver heads were examined with different tube voltages (90–121 kV), dose levels (DLs) (278–2180 nGy) and pre-filtration methods (none, Cu 0.2 mm, Cu 0.3 mm and Sn 0.4 mm). All images were reconstructed in 2 mm slice thickness with and without a metal artifact reduction algorithm in three different kernels. In total, 80 different scan protocols and 480 datasets were evaluated. Image quality was rated on a 5-point Likert scale. Radiation exposure (mean computed tomography volume index (CTDIvol) and effective dose) was calculated for each scan. The most dose-effective combination for the diagnosis of sinusitis was 121 kV/DL of 278/0.3 mm copper (CTDIvol 1.70 mGy, effective dose 77 µSv). Scan protocols with 121 kV/DL1090/0.3 mm copper were rated sufficient for preoperative sinus surgery planning (CTDIvol 4.66 mGy, effective dose 212 µSv). Therefore, sinusitis and preoperative sinus surgery planning can be performed in diagnostic image quality at low radiation dose levels with a multipurpose X-ray system.

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