Radiation exposure of computed tomography imaging for the assessment of acute stroke
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DIAGNOSTIC NEURORADIOLOGY
Radiation exposure of computed tomography imaging for the assessment of acute stroke Sebastian Zensen 1 & Nika Guberina 2 & Marcel Opitz 1 & Martin Köhrmann 3 & Cornelius Deuschl 1 & Michael Forsting 1 & Axel Wetter 1 & Denise Bos 1 Received: 26 June 2020 / Accepted: 31 August 2020 # The Author(s) 2020
Abstract Purpose To assess suspected acute stroke, the computed tomography (CT) protocol contains a non-contrast CT (NCCT), a CT angiography (CTA), and a CT perfusion (CTP). Due to assumably high radiation doses of the complete protocol, the aim of this study is to examine radiation exposure and to establish diagnostic reference levels (DRLs). Methods In this retrospective study, dose data of 921 patients with initial CT imaging for suspected acute stroke and dose monitoring with a DICOM header–based tracking and monitoring software were analyzed. Between June 2017 and January 2020, 1655 CT scans were included, which were performed on three different modern multi-slice CT scanners, including 921 NCCT, 465 CTA, and 269 CTP scans. Radiation exposure was reported for CT dose index (CTDIvol) and dose-length product (DLP). DRLs were set at the 75th percentile of dose distribution. Results DRLs were assessed for each step (CTDIvol/DLP): NCCT 33.9 mGy/527.8 mGy cm and CTA 13.7 mGy/478.3 mGy cm. Radiation exposure of CTP was invariable and depended on CT device and its protocol settings with CTDIvol 124.9–258.2 mGy and DLP 1852.6–3044.3 mGy cm. Conclusion Performing complementary CT techniques such as CTA and CTP for the assessment of acute stroke increases total radiation exposure. Hence, the revised DRLs for the complete protocol are required, where our local DRLs may help as benchmarks. Keywords Computed tomography perfusion . Radiation exposure . Stroke
Abbreviations AD Achievable dose NCCT Non-contrast computed tomography CTA Computed tomography angiography CTDIvol Volume-weighted CT dose index CTDIw Weighted CT dose index CTP Computed tomography perfusion DLP Dose-length product
DRL IQR kV mAs RIS SD
Diagnostic reference level Interquartile range Kilovolt (tube voltage) Milliampere second (tube current-time product) Radiological information system Standard deviation
Introduction * Sebastian Zensen [email protected] 1
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
2
Department of Radiotherapy, University Hospital Essen, Hufelandstraße 55, Essen 45147, Germany
3
Department of Neurology, University Hospital Essen, Hufelandstraße 55, Essen 45147, Germany
Stroke is a frequent cause of disability and death in adults [1] and the etiology of stroke is either ischemic or hemorrhagic [2]. Ischemic stroke accounts for more than 85% of acute strokes and has a high global morbidity and mortality [3, 4]. Due to rapid irreversible damage of tissue, quick and accurate diagnosis is crucial to enable prompt therapy [5, 6]. Non-contrast computed tomography (NCCT) of the head is widely recommended
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