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Total risk index: a mathematical model for decision making based on clinical and radiation risk assessment in CT

dc.contributor.author Ria, Francesco
dc.contributor.author Smith, Taylor
dc.contributor.author Hoye, Jocelyn
dc.contributor.author Marin, Daniele
dc.contributor.author Samei, Ehsan
dc.date.accessioned 2019-12-09T17:31:07Z
dc.date.available 2019-12-09T17:31:07Z
dc.date.issued 2019-12-04
dc.identifier.uri https://hdl.handle.net/10161/19570
dc.description.abstract Purpose. Radiological risk is a combination of radiation and clinical risk (likelihood of not delivering a proper diagnosis), which together may be characterized as a total risk index (TRI). While many strategies have been developed to ascertain radiation risk, there has been a paucity of studies assessing the clinical risk. This knowledge gap makes impossible to determine the total radiological procedure risk and, thus, to perform a comprehensive optimization. The purpose of this study was to develop a mathematical model to ascertain TRI and to identify the minimum TRI (mTRI) in a clinical CT population. Materials and Methods. This IRB approved study included 21 adults abdomen exams performed on a dual-source single energy CT at two different dose levels (84 CT series). Virtual liver lesions were inserted into projection data to simulate localized stage liver cancer (LSLC). The detectability index (d') was calculated in each series and converted to percentage of correct observer answers (AUC) in a two-alternative forced-choice model. The AUC was converted into the loss of 5-year relative survival rate (SEER, NCI), considering an upper bound on patient's risk for a misdiagnosis of LSLC (false positive + false negative). Concerning radiation risk, organ doses were estimated using a Monte Carlo method and the Risk Index was calculated and converted in 5-year relative survival rate for cancer. Finally, the two risks were weighted equally into a combined TRI curve per each patient as a function of CTDIvol. The analytical minimum of each TRI curve provided the patient mTRI. Results. The mTRI for LSLC patients that underwent an abdominal CT exhibited a rapid rise at low radiation dose due to enhanced clinical risk of under-dosed examinations. Increasing dose offered less risk with mortality per 100 patients between 2.1 and 6.5 (mean 4.5) at CTDIvol=5mGy, between 1.1 and 5.9 (mean 3.5) at CTDIvol=10mGy and between 0.5 and 5.4 (mean 3.0) at CTDIvol=20 mGy. Conclusion. The clinical risk seems to play a more dominant factor in designing optimum CT protocols. The TRI may provide an objective and quantifiable metric of the interplay of radiation and clinical risks during the optimization of the CT technique for individual patients. Clinical Relevance statement. CT risk-based optimization can be made possible by first quantifying both radiation and clinical risk using comparable units, then calculating an overall risk, and finally minimizing the total risk.
dc.title Total risk index: a mathematical model for decision making based on clinical and radiation risk assessment in CT
dc.type Conference
duke.contributor.id Ria, Francesco|0691782
duke.contributor.id Samei, Ehsan|0261465
dc.date.updated 2019-12-09T17:31:06Z
pubs.organisational-group Staff
pubs.organisational-group Duke
pubs.organisational-group Radiology
pubs.organisational-group Clinical Science Departments
pubs.organisational-group School of Medicine
pubs.publication-status Published
duke.contributor.orcid Ria, Francesco|0000-0001-5902-7396
duke.contributor.orcid Samei, Ehsan|0000-0001-7451-3309


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