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Expanding the Concept of Diagnostic Reference Levels to Noise and Dose Reference Levels in CT.

dc.contributor.author Ria, Francesco
dc.contributor.author Davis, Joseph T
dc.contributor.author Solomon, Justin B
dc.contributor.author Wilson, Joshua M
dc.contributor.author Smith, Taylor B
dc.contributor.author Frush, Donald P
dc.contributor.author Samei, Ehsan
dc.date.accessioned 2019-06-20T20:16:15Z
dc.date.available 2019-06-20T20:16:15Z
dc.date.issued 2019-06-10
dc.identifier.issn 0361-803X
dc.identifier.issn 1546-3141
dc.identifier.uri https://hdl.handle.net/10161/18963
dc.description.abstract OBJECTIVE. Diagnostic reference levels were developed as guidance for radiation dose in medical imaging and, by inference, diagnostic quality. The objective of this work was to expand the concept of diagnostic reference levels to explicitly include noise of CT examinations to simultaneously target both dose and quality through corresponding reference values. MATERIALS AND METHODS. The study consisted of 2851 adult CT examinations performed with scanners from two manufacturers and two clinical protocols: abdominopelvic CT with IV contrast administration and chest CT without IV contrast administration. An institutional informatics system was used to automatically extract protocol type, patient diameter, volume CT dose index, and noise magnitude from images. The data were divided into five reference patient size ranges. Noise reference level, noise reference range, dose reference level, and dose reference range were defined for each size range. RESULTS. The data exhibited strong dependence between dose and patient size, weak dependence between noise and patient size, and different trends for different manufacturers with differing strategies for tube current modulation. The results suggest size-based reference intervals and levels for noise and dose (e.g., noise reference level and noise reference range of 11.5-12.9 HU and 11.0-14.0 HU for chest CT and 10.1-12.1 HU and 9.4-13.7 HU for abdominopelvic CT examinations) that can be targeted to improve clinical performance consistency. CONCLUSION. New reference levels and ranges, which simultaneously consider image noise and radiation dose information across wide patient populations, were defined and determined for two clinical protocols. The methods of new quantitative constraints may provide unique and useful information about the goal of managing the variability of image quality and dose in clinical CT examinations.
dc.language eng
dc.publisher American Roentgen Ray Society
dc.relation.ispartof AJR. American journal of roentgenology
dc.relation.isversionof 10.2214/ajr.18.21030
dc.subject CT performance
dc.subject diagnostic reference levels
dc.subject image noise
dc.subject patient population
dc.subject radiation dose
dc.title Expanding the Concept of Diagnostic Reference Levels to Noise and Dose Reference Levels in CT.
dc.type Journal article
duke.contributor.id Ria, Francesco|0691782
dc.date.updated 2019-06-20T20:16:15Z
pubs.begin-page 1
pubs.end-page 6
pubs.organisational-group School of Medicine
pubs.organisational-group Duke
pubs.organisational-group Radiology
pubs.organisational-group Clinical Science Departments
pubs.publication-status Published
duke.contributor.orcid Ria, Francesco|0000-0001-5902-7396


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