title: Dose reduction for abdominal and pelvic MDCT after change to graduated weight-based protocol for selecting quality reference tube current, peak kilovoltage, and slice collimation.
abstract: OBJECTIVE
  The purpose of this article is to determine the decrease in volume CT dose index (CTDI(vol)) and dose-length product (DLP) achieved by switching from fixed quality reference tube current protocols with automatic tube current modulation to protocols adjusting the quality reference tube current, slice collimation, and peak kilovoltage according to patient weight.
  
  
  METHODS
  All adult patients who underwent CT examinations of the abdomen or abdomen and pelvis during 2010 using weight-based protocols who also underwent a CT examination in 2008 or 2009 using fixed quality reference tube current protocols were identified from the radiology information system. Protocol pages were electronically retrieved, and the CT model, examination date, scan protocol, CTDI(vol), and DLP were extracted from the DICOM header or by optical character recognition. There were 15,779 scans with dose records for 2700 patients. Changes in CTDI(vol) and DLP were compared only between examinations of the same patient and same CT system model for examinations performed in 2008 or 2009 and those performed in 2010. The final analysis consisted of 1117 comparisons in 1057 patients, and 1209 comparisons in 988 patients for CTDI(vol) and DLP, respectively.
  
  
  RESULTS
  The change to a weight-based protocol resulted in a statistically significant reduction in CTDI(vol) and DLP on three MDCT system models (p < 0.001). The largest average CTDI(vol) decrease was 13.9%, and the largest average DLP decrease was 16.1% on a 64-MDCT system. Both the CTDI(vol) and DLP decreased the most for patients who weighed less than 250 lb (112.5 kg).
  
  
  CONCLUSIONS
  Adjusting the CT protocol by selecting parameters according to patient weight is a viable method for reducing CT radiation dose. The largest reductions occurred in the patients weighing less than 250 lb.
authors.affiliation: Imaging Institute, Cleveland Clinic, Desk Hb6, 9500 Euclid Ave, Cleveland, OH 44195, USA. hertsb@ccf.org
authors.forename: Brian R
authors.initials: BR
authors.lastname: Herts
authors.forename: Mark E
authors.initials: ME
authors.lastname: Baker
authors.forename: Nancy
authors.initials: N
authors.lastname: Obuchowski
authors.forename: Andrew
authors.initials: A
authors.lastname: Primak
authors.forename: Erika
authors.initials: E
authors.lastname: Schneider
authors.forename: Harpreet
authors.initials: H
authors.lastname: Rhana
authors.forename: Frank
authors.initials: F
authors.lastname: Dong
mesh_terms: D000328:Adult; D001835:Body Weight; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D061330:Multidetector Computed Tomography / Q000295:instrumentation / Q000379:methods*; D018579:Patient Selection; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011860:Radiography, Abdominal / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies