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National dose reference levels in computed tomography–guided interventional procedures—a proposal

Authors
  • Greffier, Joël1
  • Ferretti, Gilbert2
  • Rousseau, Julia2
  • Andreani, Olivier3
  • Alonso, Emilie3
  • Rauch, Aymeric4
  • Gillet, Romain4
  • Le Roy, Julien5
  • Cabrol-Faivre, Laurie5
  • Douane, Frederic6
  • David, Arthur6
  • Henry, Simon7
  • Jacques, Thibaut7
  • Stefanovic, Xavier8
  • Decoux, Eric8
  • Lafay, Frederic9
  • Pilleul, Franck9
  • Couzon, Franck10
  • Boutet, Claire10
  • Woerly, Bernard11
  • And 47 more
  • 1 CHU Nimes, Univ Montpellier, EA 2415, Bd Prof Robert Debré, Nîmes Cedex 9, 30029, France , Nîmes Cedex 9 (France)
  • 2 CHU Grenoble Alpes, Grenoble, France , Grenoble (France)
  • 3 Institut Arnault Tzanck, St Laurent du Var, France , St Laurent du Var (France)
  • 4 CHRU de Nancy, Nancy, France , Nancy (France)
  • 5 Montpellier University Hospital, Montpellier, France , Montpellier (France)
  • 6 CHU Nantes Hôtel-Dieu, Nantes, France , Nantes (France)
  • 7 CHU Lille, Lille, France , Lille (France)
  • 8 Groupe d’imagerie CRP, clinique du Parc, Castelnau-le-Lez, France , Castelnau-le-Lez (France)
  • 9 CLCC Lyon Bérard, Lyon, France , Lyon (France)
  • 10 Hôpital Nord, CHU de Saint-Etienne, Univ de Lyon, Saint-Etienne, France , Saint-Etienne (France)
  • 11 Clinique de l’orangerie, Strasbourg, France , Strasbourg (France)
  • 12 Hôpital Riquet, Toulouse, France , Toulouse (France)
  • 13 Paris-Saclay University, Villejuif, France , Villejuif (France)
  • 14 CHU Timone 2, Marseille, France , Marseille (France)
  • 15 Service de Radiologie Interventionnelle du centre Cardiologique Nord, Saint Denis, France , Saint Denis (France)
  • 16 Pole de radiologie, CHU de Clermont + TGI - Institut Pascal, UMR 6602 UCA /CNRS /SIGMA Clermont, Clermont Ferrand, France , Clermont Ferrand (France)
  • 17 CH de Valenciennes, Valenciennes, France , Valenciennes (France)
  • 18 Hôpital Saint-Louis, Paris, France , Paris (France)
  • 19 Centre Hospitalier Lyon Sud, Pierre-Bénite, France , Pierre-Bénite (France)
  • 20 Hôpital Edouard Herriot, Hospices Civiles de Lyon, Lyon, France , Lyon (France)
  • 21 Service de Radiologie, Hospices Civiles de Lyon, Groupement hospitalier Nord, Lyon, France , Lyon (France)
  • 22 CHR Metz-Thionville, Ars-Laquenexy, France , Ars-Laquenexy (France)
  • 23 CHU Caen, Caen, France , Caen (France)
  • 24 CHU Besancon, Besançon, France , Besançon (France)
  • 25 Université de Paris, Paris Descartes, Paris, France , Paris (France)
  • 26 CHU de Bordeaux, Bordeaux, France , Bordeaux (France)
  • 27 Institut Curie, Paris, France , Paris (France)
  • 28 CHU d’Angers, Angers, France , Angers (France)
  • 29 Hôpital de la Cavale blanche, Brest, France , Brest (France)
  • 30 Hôpital Nord Franche Comté, Belfort, France , Belfort (France)
  • 31 Lariboisière University Hospital, AP-HP, Paris, France , Paris (France)
  • 32 Hôpitaux Civils de Colmar, Colmar, France , Colmar (France)
  • 33 Hôpital Privé Clairval, Marseille, France , Marseille (France)
  • 34 Institut Curie, Saint Cloud, France , Saint Cloud (France)
  • 35 Université Paris, Paris, France , Paris (France)
  • 36 Hôpital de la Conception, APHM, Marseille, France , Marseille (France)
  • 37 GIE MANOSCAN, Manosque, France , Manosque (France)
  • 38 CH Aix en Provence, Aix en Provence, France , Aix en Provence (France)
  • 39 Hôpital Claude Huriez, Lille, France , Lille (France)
  • 40 CHU Toulouse, Toulouse, France , Toulouse (France)
  • 41 Université Paris 13, Bobigny, France , Bobigny (France)
  • 42 St-Eloi University Hospital, Montpellier, France , Montpellier (France)
  • 43 Centre Hospitalier Intercommunal Fréjus-Saint-Raphaël, Fréjus, France , Fréjus (France)
Type
Published Article
Journal
European Radiology
Publisher
Springer-Verlag
Publication Date
May 02, 2020
Volume
30
Issue
10
Pages
5690–5701
Identifiers
DOI: 10.1007/s00330-020-06903-9
Source
Springer Nature
Keywords
License
Yellow

Abstract

ObjectivesTo establish national reference levels (RLs) in interventional procedures under CT guidance as required by the 2013/59/Euratom European Directive.MethodsSeventeen categories of interventional procedures in thoracic, abdominopelvic, and osteoarticular specialties (percutaneous infiltration, vertebroplasty, biopsy, drainage, tumor destruction) were analyzed. Total dose length product (DLP), number of helical acquisitions (NH), and total DLP for helical, sequential, or fluoroscopic acquisitions were recorded for 10 to 20 patients per procedure at each center. RLs were calculated as the 3rd quartiles of the distributions and target values for optimization process (TVOs) as the median. RLs and TVOs were compared with previously published studies.ResultsResults on 5001 procedures from 49 centers confirmed the great variability in patient dose for the same category of procedures. RLs were proposed for the DLPs and NHs in the seventeen categories. RLs in terms of DLP and NH were 375 mGy.cm and 2 NH for spinal or peri-spinal infiltration, 1630 mGy.cm and 3 NH for vertebroplasty, 845 mGy.cm and 4 NH for biopsy, 1950 mGy.cm and 8 NH for destruction of tumors, and 1090 mGy.cm and 5 NH for drainage. DLP and NH increased with the complexity of procedures.ConclusionsThis study was the first nationwide multicentric survey to propose RLs for interventional procedures under CT guidance. Heterogeneity of practice in centers were found with different levels of patient doses for the same procedure. The proposed RLs will allow imaging departments to benchmark their practice with others and optimize their protocols.Key Points• National reference levels are proposed for 17 categories of interventional procedures under CT guidance.• Reference levels are useful for benchmarking practices and optimizing protocols.• Reference levels are proposed for dose length product and the number of helical acquisitions.

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