Factors Affecting Radiation Dose in Computed Tomography Angiograms for Pulmonary Embolism: A Retrospective Cohort Study.
Factors Affecting Radiation Dose in Computed Tomography Angiograms for Pulmonary Embolism: A Retrospective Cohort Study.
复制标题
影响肺栓塞的计算机断层扫描血管造影术中辐射剂量的因素：回顾性队列研究。
DOI：
10.25259/jcis_168_2020
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发表时间：
2020
影响因子：
0.9
通讯作者：
Sieren JC
中科院分区：
文献类型：
--
作者：
Nagpal P;Priya S;Eskandari A;Mullan A;Aggarwal T;Narayanasamy S;Parashar K;Bhat AP;Sieren JC
计算机断层扫描肺血管造影 (CTPA) 是最常用且经常过度使用的检查之一。本研究的目的是评估接受 CTPA 的患者的平均辐射剂量，并确定与较高剂量相关的因素。这项经机构批准的回顾性研究纳入了 2016 年至 2018 年间在三级护理中心接受 CTPA 以排除急性肺栓塞的所有患者。记录患者数据（年龄、性别、体重指数 [BMI] 和患者位置）、CT 扫描仪类型、图像重建方法和辐射剂量参数（剂量长度乘积 [DLP]）。有效剂量估计值通过将 DLP 乘以转换系数 (0.014 mSv•mGy−1•cm−1) 获得。进行多变量逻辑回归分析以确定影响辐射剂量的因素。共有 2342 名患者（1099 名男性和 1243 名女性），平均年龄为 58.1 岁（范围为 0.2-104.4 岁），BMI 为 31.3 kg/m2（范围为 12-91.5 kg/m2）。平均有效辐射剂量为 5.512 mSv（中位数 – 4.27 mSv；范围 0.1–43.0 mSv）。患者因素，包括 BMI >25 kg/m2、男性、年龄 >18 岁和重症监护病房 (ICU) 位置，与显着较高的剂量相关 (P < 0.05)。使用第三代双源扫描仪进行基于模型的迭代重建 (IR) 的 CT 扫描，其剂量明显低于采用滤波反投影的单源（64 切片）扫描仪（平均值：9.29 mSv，P < 0.001）（平均值：4.90 mSv）。高 BMI 和转诊 ICU 的患者与高 CT 辐射剂量相关。他们最有可能通过使用先进的基于模型的红外技术在新一代扫描仪上进行扫描而受益。
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. 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. 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). 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.