Original InvestigationPatient-based Performance Assessment for Pediatric Abdominal CT: An Automated Monitoring System Based on Lesion Detectability and Radiation Dose
Section snippets
INTRODUCTION
A necessary consequence of computed tomography (CT) is the exposure of patients to ionizing radiation with consequent potential radiation-related risks (1, 2, 3, 4, 5, 6, 7, 8). While there are numerous resources dedicated to improving CT in children which emphasize appropriate radiation exposure, there is an increasing requirement for establishment of CT monitoring programs (9). This includes requirements and guidance standards established in Europe with the Directive Euratom/2013/59 (10), the
Clinical Cases
The study population consisted of 507 clinically-performed, contrast-enhanced AP CT scans of patients ages 0–<18 years (Fig 1) that were protocoled based on age and weight through a color-coded system (29). All studies were performed at a large academic medical center between June 2014 and November 2017. The studies were from three scanner models: Siemens SOMATOM Definition Flash (n = 364, Erlangen, Germany), GE Discovery CT750 HD (n = 53, Waukesha, WI), and GE LightSpeed VCT (n = 90, Waukesha,
RESULTS
Radiation dose in CTDIvol for a given kV trended slightly positively across ages. On Scanner 1, median CTDIvol at 100 kV was 3.0 mGy (2.8–3.3 mGy interquartile range [IQR]) and at 120 kV was 5.5 mGy (4.9–6.6 mGy IQR). On Scanner 2, median CTDIvol at 120 kV was 2.2 mGy (1.9–2.5 mGy IQR). On Scanner 3, median CTDIvol at 120 kV was 2.3 mGy (2.0–2.6 mGy IQR). Overall, the CTDIvol for the oldest age group on all scanners was approximately 1.35-fold the youngest age group. All aggregate median values
DISCUSSION
Automation of CT quality assessment facilitates potential integration with existing dose information into a more comprehensive and efficient assessment of CT practice. We deployed a tool which affords an automated method for quality quantification of pediatric body CT examinations for a reference diagnostic task—the detection of a small, focal liver lesion by combining published methodologies. Our study was based on a proven assumption that the detectability index metric correlates with higher
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