title: Use of BMI guidelines and individual dose tracking to minimize radiation exposure from low-dose helical chest CT scanning in a lung cancer screening program.
abstract: OBJECTIVE
  The increasing use of computed tomography (CT) has been accompanied by rising concerns over potential radiation-related health risks, especially cancer, and a need to minimize such risks.
  
  
  METHODS
  We conducted 2186 low-dose helical chest CT scans among 1235 nuclear weapons workers at elevated risk of lung cancer, setting the CT scanner tube current at 30 mAs for all participants with BMI <35 kg/m(2) and permitting technologists to raise mAs levels for participants with BMI ≥35 kg/m(2). Dose-length product (DLP) was recorded from the CT scanner, permitting calculation of effective dose. Phantom-based estimates of effective dose were also made. A chest radiologist recorded acceptability of image quality.
  
  
  RESULTS
  The study population was significantly overweight: 79% exceeded a body mass index (BMI) >25 kg/m(2) and 37.1% exceeded a BMI ≥30 kg/m(2). Nearly 90% of CT scans were performed using a tube current setting of 30 mAs and had a mean DLP-based effective dose of 1.3 mSv. The phantom-based estimate of effective dose was lower at 1.1 mSv. Among participants with a BMI ≥35 kg/m(2), 92% were scanned at 40 or 50 mAs, which was associated with a DLP-based effective dose of 1.6 and 2.0 mSv, respectively. Image quality was satisfactory in 99.8% of scans.
  
  
  CONCLUSIONS
  Application of simple BMI-based guidelines and DLP tracking of low-dose helical chest CT scans in a lung cancer screening program minimizes radiation dose, even in a largely overweight population.
authors.affiliation: Center for the Biology of Natural Systems, Queens College, City University of New York, 65-30 Kissena Boulevard, Remsen Hall, Flushing, NY 11367, USA. amanowitz@qc.cuny.edu
authors.forename: Amy
authors.initials: A
authors.lastname: Manowitz
authors.forename: Marija
authors.initials: M
authors.lastname: Sedlar
authors.forename: Mark
authors.initials: M
authors.lastname: Griffon
authors.forename: Albert
authors.initials: A
authors.lastname: Miller
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Miller
authors.forename: Steven
authors.initials: S
authors.lastname: Markowitz
mesh_terms: D001822:Body Burden; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000000981:diagnostic imaging* / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D054043:Nuclear Weapons; D017410:Practice Guidelines as Topic; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D013902:Radiography, Thoracic / Q000592:standards / Q000706:statistics & numerical data; D011874:Radiometry / Q000592:standards* / Q000706:statistics & numerical data; D036542:Tomography, Spiral Computed / Q000592:standards / Q000706:statistics & numerical data*