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Factors Affecting Radiation Dose in Computed Tomography Angiograms for Pulmonary Embolism: A Retrospective Cohort Study

  • Nagpal, Prashant1
  • Priya, Sarv1
  • Eskandari, Ali1
  • Mullan, Aidan2
  • Aggarwal, Tanya3
  • Narayanasamy, Sabarish1
  • Parashar, Kamesh4
  • Bhat, Ambarish P.5
  • Sieren, Jessica C.1, 6
  • 1 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City
  • 2 Department of Statistics, University of California, Berkeley, California
  • 3 Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City
  • 4 Department of Internal Medicine, Thomas Jefferson University, Philadelphia
  • 5 Department of Radiology, Interventional Radiology, University of Missouri, Columbia, Missouri
  • 6 Department of Biomedical Engineering, University of Iowa and Carver College of Medicine, Iowa City
Published Article
Journal of Clinical Imaging Science
Scientific Scholar
Publication Date
Nov 13, 2020
DOI: 10.25259/JCIS_168_2020
PMID: 33274118
PMCID: PMC7708960
PubMed Central
  • Original Research


Objectives: Computed tomography pulmonary angiogram (CTPA) is one of the most commonly ordered and frequently overused tests. The purpose of this study was to evaluate the mean radiation dose to patients getting CTPA and to identify factors that are associated with higher dose. Material and Methods: This institutionally approved retrospective study included all patients who had a CTPA to rule out acute pulmonary embolism between 2016 and 2018 in a tertiary care center. Patient data (age, sex, body mass index [BMI], and patient location), CT scanner type, image reconstruction methodology, and radiation dose parameters (dose-length product [DLP]) were recorded. Effective dose estimates were obtained by multiplying DLP by conversion coefficient (0.014 mSv•mGy−1•cm−1). Multivariate logistic regression analysis was performed to determine the factors affecting the radiation dose. Results: There were 2342 patients (1099 men and 1243 women) with a mean age of 58.1 years (range 0.2–104.4 years) and BMI of 31.3 kg/m2 (range 12–91.5 kg/m2). The mean effective radiation dose was 5.512 mSv (median – 4.27 mSv; range 0.1–43.0 mSv). Patient factors, including BMI >25 kg/m2, male sex, age >18 years, and intensive care unit (ICU) location, were associated with significantly higher dose ( P < 0.05). CT scanning using third generation dual-source scanner with model-based iterative reconstruction (IR) had significantly lower dose (mean: 4.90 mSv) versus single-source (64-slice) scanner with filtered back projection (mean: 9.29 mSv, P < 0.001). Conclusion: Patients with high BMI and ICU referrals are associated with high CT radiation dose. They are most likely to benefit by scanning on newer generation scanner using advance model-based IR techniques.

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