Radiation Dose from Multidetector CT

642 Pages·2012·26.898 MB·English

by  Thomas Flohr (auth.), Denis Tack, Mannudeep K. Kalra, Pierre Alain Gevenois (eds.)

Medical Radiology
Diagnostic Imaging
Series Editors
Maximilian F. Reiser
Hedvig Hricak
Michael Knauth
Editorial Board
Andy Adam, London
Fred Avni, Brussels
Richard L. Baron, Chicago
Carlo Bartolozzi, Pisa
George S. Bisset, Durham
A. Mark Davies, Birmingham
William P. Dillon, San Francisco
D. David Dershaw, New York
Sam Sanjiv Gambhir, Stanford
Nicolas Grenier, Bordeaux
Gertraud Heinz-Peer, Vienna
Robert Hermans, Leuven
Hans-Ulrich Kauczor, Heidelberg
Theresa McLoud, Boston
Konstantin Nikolaou, Munich
Caroline Reinhold, Montreal
Donald Resnick, San Diego
Rüdiger Schulz-Wendtland, Erlangen
Stephen Solomon, New York
Richard D. White, Columbus
For furthervolumes:
http://www.springer.com/series/4354
Denis Tack Mannudeep K. Kalra
•
Pierre Alain Gevenois
Editors
Radiation Dose from
Multidetector CT
Second Edition
Foreword by
Maximilian F. Reiser
123
Editors
Prof.Dr. DenisTack Prof.Dr.Pierre AlainGevenois
Department of Radiology Department ofRadiology
Réseau Hospitalierde Médecine Sociale Université librede BruxellesHôspital
RueLouisCaty 136 Erasme
7331Baudour Routede Lennik808
Belgium 1070Brussels
Belgium
Asst.Prof.Dr. MannudeepK.Kalra
Department of Radiology
Harvard Medical School
Massachusetts General Hospital
55Fruit Street
02114Boston MA
USA
Additionalmaterialtothisbookcanbedownloadedfromhttp://extras.springer.com/
ISSN 0942-5373
ISBN 978-3-642-24534-3 ISBN 978-3-642-24535-0 (eBook)
DOI 10.1007/978-3-642-24535-0
SpringerHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2012934251
(cid:2)Springer-VerlagBerlinHeidelberg2012
Thisworkissubjecttocopyright.Allrightsarereserved,whetherthewholeorpartofthematerialis
concerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation,broadcasting,
reproductiononmicrofilmorinanyotherway,andstorageindatabanks.Duplicationofthispublication
orpartsthereofispermittedonlyundertheprovisionsoftheGermanCopyrightLawofSeptember9,
1965,initscurrentversion,andpermissionforusemustalwaysbeobtainedfromSpringer.Violationsare
liabletoprosecutionundertheGermanCopyrightLaw.
The use of general descriptive names, registered names, trademarks, etc. in this publication does not
imply, even in the absence of a specific statement, that such names are exempt from the relevant
protectivelawsandregulationsandthereforefreeforgeneraluse.
Product liability: The publishers cannot guarantee the accuracy of any information about dosage and
application contained in this book. In every individual case the user must check such information by
consultingtherelevantliterature.
Printedonacid-freepaper
SpringerispartofSpringerScience+BusinessMedia(www.springer.com)
Foreword
Theintroductionofspiralandmulti-detector-rowcomputedtomographyhasa
profound impact on radiological practice. Within one and a half decades we
witnessed a breathtaking technological development allowing for high quality
imagingdatawithinaveryshortacquisitiontimeandprovidingexcellentimage
qualityanddiagnosticaccuracy.Notsurprisingly,therewasalsoaconsiderable
increaseinradiationexposuretothepatientsandthepopulation.Thisresulted
in concerns about potential health hazards as well as various initiatives and
actionsof governmental and non-governmental bodies. At thesame timegreat
effortsweremadeinordertoreducetheradiationexposuretopatientswithout
compromising image quality and diagnostic efficacy.
The high actuality of this topic isunderlined by the fact,that within a short
period of time a second edition of the book ‘‘Radiation dose in CT’’ became
necessary.ItisthegreatmeritoftheeditorsDenisTack,MannudeepK.Kalra
and Pierre Alain Gevenois and the authors contributing to this book, to
compose a second edition which covers many important issues such as CT
technology and use, general aspects of CT radiation, practical approaches to
dose reduction, radiation risk management in low dose MDCT screening
programmes, initiatives for dose reduction and the vendor perspective on CT
radiation dose. The editors as well as the authors are internationally distin-
guished scientists inthefield. Thisbook gives acomprehensive overview on all
aspects of radiation dose in CT. I would like to express my great appreciation
and thanks forthis magnificentwork which I amconfident will be of great use
not only for radiologists and CT practitioners but also for those interested in
radiation protection as well as for political decision makers.
Prof. Dr. Maximilian F. Reiser
Munich
v
Preface
RadiationdoseinCTisthesecondeditionofourtextbooktitledRadiationDose
from Adult and Pediatric Multidetector Computed Tomography. The second
edition of this textbook was necessitated by continued technologic advances in
multidetector-rowcomputedtomography(MDCT)sincethefirsteditionaswell
asbydevelopmentofnewandpromisingradiationdosereductiontechnologies.
Despite these developments, MDCT still poses challenges in radiological
protection to the extent that CT radiation dose has been labelled by some as
one of the topmost patient safety concerns. Applications and use of MDCT
continuetoproliferatewithemergenceofnewerclinicalindications;requestsof
clinicians for high diagnostic confidence as provided by MDCT are factors
contributing to a continuous increase in the collective radiation dose from
diagnostic CT imaging.
The first edition of the textbook dealt with radiation issues with MDCT in
two parts. The first part was preceded with detailed discussions on the clinical
use and expansion of CT in modern medical practice. In Part I, the book
provided a comprehensive approach to perceived and potential risks of low
radiation dose, influence of CT technical factors on the radiation dose, and
technologicdevelopmentsforoptimization andreductionoftheradiation dose
peracquisition.InPartII,acomprehensiveclinicalapproachofradiationdose
justification, optimization, and reduction was provided, covering the fields of
pediatric, head and neck, chest, abdomen, cardiovascular, bone and joint, and
interventionalMDCT.Finally,adetaileddiscussiononthebalancebetweenthe
risksandbenefitsofscreeningforcancerusinglow-doseMDCTwaspresented
in the field of lung cancer and colon cancer.
Thesecondeditionofthetextbookhasrecentandupdatedinformationabout
thetwopartspresentedinthefirstedition.Severalnewchaptersfromrenowned
internationalradiationexpertshavebeenaddedtoembellishthesecondedition,
which now boasts seven parts including an online only Interactive Atlas-based
teachingpartwhichhasfouradditionalchaptersforunderstandingtheeffectof
CTradiationdoseonimagequalityandlesiondetectionandappearance.Inthe
secondedition,PartIdealswithtechnologicadvancesinMDCTandupdateson
clinical expansion in useof MDCT.PartIIdeals withrisk issueswith CT, and
severaltechnicalaspectsofCTradiationdosemanagementwithnewchapterson
iterative reconstruction techniques, noise reduction filters, hardware develop-
mentsfordoseoptimization,tubepotentialadjustmentsfordosereduction,and
anunbiasedperspectiveontheuseofshieldingdevicesinCT.Anewchapteron
radiationdoserecordingand auditing has also been added tothis part.
vii
viii Preface
Practicalandclinicalapproaches todoseoptimization indifferentradiology
subspecialties are presented in Part III of the second edition, which has been
enhanced by addition of a chapter based on issues with CT scanning in preg-
nant patients. Part IV deals with radiation issues and dose reduction strategies
forlungandcoloncancerscreeningCTprotocols.PartVpresentsperspectives
of several regulatory bodies, organizations, and campaigns on CT radiation
dose including the IAEA, FDA, ICRP, Image Gently, and Image Wisely. This
part also includes two chapters on software for estimating CT dose and risks,
and on discussion of guidelines for appropriate use of CT. Part VI brings
entirely new content to the second chapter with four new chapters from major
CT vendors outlining their CT radiation dose reduction and optimization
technologies.
Several international experts, from Europe and North America, selected for
theirimportantcontributionstothescientificliterature,havecontributedtothis
bookwithacommonobjectiveofprovidingreaderswithacomprehensive,up-
to-date, practical, clinical, and well-documented approach on radiation dose
optimization and reduction, suitable for daily MDCT practice.
Among thethree editors, Denis Tack,isa general radiologist subspecialized
in MDCT, and Pierre Alain Gevenois is Chest radiologist and Professor of
medicalimagingattheFacultyofMedicineandtheSchoolofPublicHealthof
the University of Brussels, Belgium. Their researches deal with radiation dose
reduction with MDCT, and quantification of pulmonary emphysema and
pulmonary edema by computed tomography. The new editor, Mannudeep K.
KalraisaChestandCardiacradiologistattheMassachusettsGeneralHospital
and an Assistant Professor at Harvard Medical School in Boston with key
interest in CT radiation dose research and education.
Denis Tack
Mannudeep K. Kalra
Pierre Alain Gevenois
Contents
Part I CT Technology and Use
Multi-Detector Row CT–Recent Developments, Radiation Dose
and Dose Reduction Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Thomas Flohr
Clinical Expansion of CT and Radiation Dose . . . . . . . . . . . . . . . . . . . 21
Stuart Meeson, Rajesh Patel, and Stephen Golding
Part II General Aspects of CT Radiation
Risks from Ionising Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Kenneth H. Chadwick and Hendrik P. Leenhouts
The Cancer Risk from Low Level Radiation . . . . . . . . . . . . . . . . . . . . 61
Bernard L. Cohen
Image Quality in CT: Challenges and Perspectives. . . . . . . . . . . . . . . . 81
Thomas L. Toth
Radiation Dose Metrics and the Effect of CT Scan
Protocol Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Sue Edyvean, Maria Lewis, and Alan Britten
Scan Parameters and CT Radiation Dose. . . . . . . . . . . . . . . . . . . . . . . 119
Sarabjeet Singh and Mannudeep K. Kalra
Optimization of Tube Potential for Radiation Dose
Reduction in CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Lifeng Yu, Joel G. Fletcher, and Cynthia H. McCollough
Conventional and Newer Reconstruction Techniques in CT . . . . . . . . . 143
Homer Pien, Synho Do, Sarabjeet Singh, and Mannudeep K. Kalra
ix
x Contents
Image Noise Reduction Filters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Sarabjeet Singh and Mannudeep K. Kalra
Hardware Developments for Radiation Dose Reduction . . . . . . . . . . . . 175
Rich Mather
Application of Shielding in CT Radiation Dose Reduction. . . . . . . . . . . 183
Shima Aran, Sarabjeet Singh, and Mannudeep K. Kalra
Radiation Dose: Records and Audits . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Tessa S. Cook, William W. Boonn, and Woojin Kim
Collective Radiation Dose from MDCT: Critical Review
of Surveys Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Georg Stamm
ALARA Concept for MDCT Optimization: What is Reasonable,
What is Achievable? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Denis Tack
Automatic Exposure Control in Multidetector-row CT. . . . . . . . . . . . . 259
Mannudeep K. Kalra
Patient Centering in MDCT: Dose Effects . . . . . . . . . . . . . . . . . . . . . . 273
Mannudeep K. Kalra and Thomas L. Toth
Part III Practical Approaches to Dose Reduction
Dose Optimization and Reduction in CT of the Brain and Head
and Neck Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Tom Mulkens, Rodrigo Salgado, and Patrick Bellinck
Dose Reduction and Optimization in Computed Tomography
of the Chest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Pierre Alain Gevenois and Denis Tack
Dose Optimization and Reduction in MDCT of the Abdomen. . . . . . . . 317
Caroline Keyzer and Denis Tack
Radiation Dose Optimisation of Cardiac and Vascular MDCT
in Adults and Paediatric Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Jean François Paul, Caroline Keyzer, Michelle Williams, and Denis Tack
Dose Optimization and Reduction in Musculoskeletal CT
Including the Spine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
A. Gervaise, P. Teixeira, N. Villani, S. Lecocq, M. Louis, and A. Blum
Contents xi
Dose Reduction in CT Fluoroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
N. Buls, F. Vandenbroucke, and J. de Mey
Dose Optimization and Reduction in CT of Children . . . . . . . . . . . . . . 419
Peter Vock, Enno Stranzinger, and Rainer Wolf
CT Scanning in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
D. E. Litmanovich and A. A. Bankier
Part IV Radiation Risk Management in Low Dose
MDCT Screening Programs
Radiation Risk Associated with Lung Cancer Screening. . . . . . . . . . . . 455
Cornelia Schaefer-Prokop, Krijn van Muiswinkel, and Mathias Prokop
Dose Reduction in Screening Programs: Colon Cancer Screening. . . . . 469
Thierry N. Boellaard, Henk W. Venema, and Jaap Stoker
Part V Initiatives for Dose Reduction
CT Dose Perspectives and Initiatives of the IAEA . . . . . . . . . . . . . . . . 495
Madan M. Rehani and Olivera Ciraj-Bjelac
The Image Gently Campaign: Championing Radiation
Protection for Children Through Awareness, Educational
Resources and Advocacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509
Marilyn J. Goske, Michael J. Callahan, Donald P. Frush, Sue C. Kaste,
Gregory Morrison, and Keith J. Strauss
CT Radiation Dose and Safety: Perspectives at the U.S. Food
and Drug Administration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537
Stanley H. Stern, Sean Boyd, Kish Chakrabarti, Iacovos S. Kyprianou,
Thalia T. Mills, and David C. Spelic
ICRP’s Role in Patient Dose Management in CT . . . . . . . . . . . . . . . . . 557
Madan M. Rehani
Software for Calculating Dose and Risk. . . . . . . . . . . . . . . . . . . . . . . . 563
Georg Stamm
Image Wisely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569
James A. Brink and E. Stephen Amis
Guidelines for Appropriate CT Imaging. . . . . . . . . . . . . . . . . . . . . . . . 575
Kristie M. Guite, J. Louis Hinshaw, Frank N. Ranallo, and Fred T. Lee