Expanding the Concept of Diagnostic Reference Levels to Noise and Dose Reference Levels in CT.
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2019-06-10
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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.
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Ria, Francesco, Joseph T Davis, Justin B Solomon, Joshua M Wilson, Taylor B Smith, Donald P Frush and Ehsan Samei (2019). Expanding the Concept of Diagnostic Reference Levels to Noise and Dose Reference Levels in CT. AJR. American journal of roentgenology. pp. 1–6. 10.2214/ajr.18.21030 Retrieved from https://hdl.handle.net/10161/18963.
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Francesco Ria
Dr. Francesco Ria is a medical physicist and he serves as an Assistant Professor in the Department of Radiology. Francesco has an extensive expertise in the assessment of procedure performances in radiology. In particular, his research activities focus on the simultaneous evaluation of radiation dose and image quality in vivo in computed tomography providing a comprehensive evaluation of radiological exams. Moreover, Francesco is developing and investigating novel mathematical models that, uniquely in the radiology field, can incorporate a comprehensive and quantitative risk-to-benefit assessment of the procedures; he is continuing to apply his expertise towards the definition of new patient specific risk metrics, and in the assessment of image quality in vivo also using state-of-the-art imaging technology, such as photon counting computed tomography scanners, and machine learning reconstruction algorithms.
Dr. Ria is a member of the American Association of Physicists in Medicine (AAPM) task group 392 (Investigation and Quality Control of Automatic Exposure Control System in CT), of the AAPM task group 430 (Comprehensive quantification and dissemination of patient-model-based organ and effective dose estimations and their associated uncertainties for CT examinations), of the AAPM Medicine Public Education working group (WGATE), and of the Italian Association of Medical Physics task group Dose Monitoring in Diagnostic Imaging.
Joshua Wilson
Donald Paul Frush
Current research interests are in the field of pediatric radiology. CT technology and application to children. Clinical interests include magnetic resonance imaging, sonography, computer tomography and sedation. Special interest in historical material in pediatric radiology.
Ehsan Samei
Dr. Ehsan Samei, PhD, DABR, FAAPM, FSPIE, FAIMBE, FIOMP, FACR is a Persian-American medical physicist. He is the Reed and Martha Rice Distinguished Professor of Radiology, and Professor of Medical Physics, Biomedical Engineering, Physics, and Electrical and Computer Engineering at Duke University. He serves as the Chief Imaging Physicist for Duke University Health System, the Director of the Carl E Ravin Advanced Imaging Laboratories and the Center for Virtual Imaging Trials (CVIT), and Co-Director of the Triangle Centers of Excellence in Regulatory Science and Innovation (Triangle CERSI). Certified by the American Board of Radiology, he is recognized as a Distinguished Investigator by the Academy of Radiology Research, awarded Fellow by five professional organizations, and has been the recipient of the Jimmy O. Fenn Lifetime Achievement Award of SEAAPM and the Marie Sklodowska-Curie Award by IOMP. He founded/co-founded the Duke Medical Physics Program, the Duke Imaging Physics Residency Program, the Duke Clinical Imaging Physics Group, the Center for Virtual Imaging Trials, and the Society of Directors of Academic Medical Physics Programs (SDAMPP). He has held senior leadership positions in the AAPM, SPIE, SDAMPP, and RSNA, including serving as president of the SEAAPM (2010-2011), SDAMPP (2011), and AAPM (2023). He is ranked 8th among over 56,000 medical physicists worldwide for his lifetime contribution to medical physics.
Dr. Samei has mentored over 160 trainees (graduate and postgraduate). He has over 1500 scientific publications, including 4 books, over 430 refereed journal papers, over 260 full-length conference articles, over 350 conference presentations, and over 340 invited talks. Citations to his work are reflected in an h-index of 82 and a Weighted Relative Citation Ratio of 759. His laboratory has been supported continuously for over two decades by 50 extramural grants totaling $47 million. Those include a Program Project grant from the NIH in 2021 to establish the National Center for Virtual Imaging Trials (CVIT), and a multi-institutional grant in 2023 from the FDA to establish the Triangle Center of Excellence in Regulatory Science and Innovation (Triangle CERSI), both joining highly selective biomedical research and regulatory science centers nationwide.
On the personal side, Ehsan Samei is a semi-professional musician, leads a chamber ensemble, and has an active interest in common traits and interactions between science, art, and faith. He has led workshops on leadership and leadership development. He has run five marathons (3:17 PR), including the 2013 Boston Marathon, is married to Dr. Maija Samei, a scholar of medieval Chinese literature, and is blessed with four gifted children.
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