title: Automated size-specific CT dose monitoring program: assessing variability in CT dose.
abstract: OBJECTIVE
  The potential health risks associated with low levels of ionizing radiation have created a movement in the radiology community to optimize computed tomography (CT) imaging protocols to use the lowest radiation dose possible without compromising the diagnostic usefulness of the images. Despite efforts to use appropriate and consistent radiation doses, studies suggest that a great deal of variability in radiation dose exists both within and between institutions for CT imaging. In this context, the authors have developed an automated size-specific radiation dose monitoring program for CT and used this program to assess variability in size-adjusted effective dose from CT imaging.
  
  
  METHODS
  The authors radiation dose monitoring program operates on an independent health insurance portability and accountability act compliant dosimetry server. Digital imaging and communication in medicine routing software is used to isolate dose report screen captures and scout images for all incoming CT studies. Effective dose conversion factors (k-factors) are determined based on the protocol and optical character recognition is used to extract the CT dose index and dose-length product. The patient's thickness is obtained by applying an adaptive thresholding algorithm to the scout images and is used to calculate the size-adjusted effective dose (ED(adj)). The radiation dose monitoring program was used to collect data on 6351 CT studies from three scanner models (GE Lightspeed Pro 16, GE Lightspeed VCT, and GE Definition CT750 HD) and two institutions over a one-month period and to analyze the variability in ED(adj) between scanner models and across institutions.
  
  
  RESULTS
  No significant difference was found between computer measurements of patient thickness and observer measurements (p = 0.17), and the average difference between the two methods was less than 4%. Applying the size correction resulted in ED(adj) that differed by up to 44% from effective dose estimates that were not adjusted by patient size. Additionally, considerable differences were noted in ED(adj) distributions between scanners, with scanners employing iterative reconstruction exhibiting significantly lower ED(adj) (range: 9%-64%). Finally, a significant difference (up to 59%) in ED(adj) distributions was observed between institutions, indicating the potential for dose reduction.
  
  
  CONCLUSIONS
  The authors developed a robust automated size-specific radiation dose monitoring program for CT. Using this program, significant differences in ED(adj) were observed between scanner models and across institutions. This new dose monitoring program offers a unique tool for improving quality assurance and standardization both within and across institutions.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, NC, USA. olav.christianson@duke.edu
authors.forename: Olav
authors.initials: O
authors.lastname: Christianson
authors.forename: Xiang
authors.initials: X
authors.lastname: Li
authors.forename: Donald
authors.initials: D
authors.lastname: Frush
authors.forename: Ehsan
authors.initials: E
authors.lastname: Samei
mesh_terms: D000465:Algorithms; D001331:Automation; D049628:Body Size; D006801:Humans; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*