title: Dose reduction in multislice CT by means of bismuth shields: results of in vivo measurements and computed evaluation.
abstract: OBJECTIVE
  We investigated the amount of patient dose reduction in the thyroid, lens of the eye and the breast when using bismuth protections in multislice computed tomography (CT) exams as well as their influence on the quality of diagnostic images.
  
  
  METHODS
  The radiation dose was measured by using thermoluminescence dosimeters. The study was conducted on the two CT scanners installed in our radiology department (64 and eight slices). The shield effects on the CT image were evaluated by measuring the signal-to-noise ratio in a phantom and in vivo, and by verifying the presence of artefacts on patients' images. The obtained organ-dose reduction factors were used to evaluate the effects of shielding on the effective dose.
  
  
  RESULTS
  The shielding attenuation ranged from 30% to 60% depending on the CT scan protocols and organs. The difference between shielded and unshielded signal-to-noise ratio was statistically significant but within the standard requirements for quality assurance. Results were in agreement with the radiologists' perception of image quality. The use of the shields allowed up to 38% reduction of effective dose.
  
  
  CONCLUSIONS
  Use of bismuth shields significantly decreases both organ and effective radiation dose, with a consequent reduction in health risk for the patient, quantified in 1.4 fewer cases of radiation-induced tumours every 5 years in our centre (12,100 exams/year), in agreement with the risk factors proposed by Publication 60 of the International Commission on Radiological Protection (ICRP). The relative inexpensiveness of these protections, their easy application and their substantial lack of influence on image quality suggest their massive introduction into routine clinical practice.
authors.affiliation: Ospedale Regionale U. Parini, SC Fisica Sanitaria, AUSL Valle d'Aosta, Aosta, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Catuzzo
authors.forename: S
authors.initials: S
authors.lastname: Aimonetto
authors.forename: G
authors.initials: G
authors.lastname: Fanelli
authors.forename: P
authors.initials: P
authors.lastname: Marchisio
authors.forename: T
authors.initials: T
authors.lastname: Meloni
authors.forename: L
authors.initials: L
authors.lastname: Mistretta
authors.forename: M
authors.initials: M
authors.lastname: Pasquino
authors.forename: E
authors.initials: E
authors.lastname: Richetta
authors.forename: S
authors.initials: S
authors.lastname: Tofani
mesh_terms: D001729:Bismuth; D001940:Breast / Q000528:radiation effects*; D004307:Dose-Response Relationship, Radiation; D004867:Equipment Design; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007908:Lens, Crystalline / Q000528:radiation effects*; D011835:Radiation Protection / Q000379:methods*; D018570:Risk Assessment; D013819:Thermoluminescent Dosimetry / Q000379:methods; D013961:Thyroid Gland / Q000528:radiation effects*; D014057:Tomography, X-Ray Computed
chemical_list: D001729:Bismuth