Patient-Informed Organ Dose Estimation in Clinical CT: Implementation and Effective Dose Assessment in 1048 Clinical Patients.
Patient-Informed Organ Dose Estimation in Clinical CT: Implementation and Effective Dose Assessment in 1048 Clinical Patients.
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临床CT中患者知情的器官剂量估计：1048例临床患者的实施和有效剂量评估。
DOI：
10.2214/ajr.19.22482
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Samei E
中科院分区：
文献类型：
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作者：
Fu W;Ria F;Segars WP;Choudhury KR;Wilson JM;Kapadia AJ;Samei E
本研究的目的是在临床CT中全面实施患者知情器官剂量监测框架，并在1048例患者中比较根据患者知情器官剂量的有效剂量（艾德）和根据剂量长度乘积（DLP）的艾德。给定检查的器官剂量通过将拓扑图与来自拟人体模库的计算体模匹配并使用先前验证的基于卷积的技术通过检查体积CT剂量指数（CTDIvol）和管电流调制缩放固定管电流剂量系数来计算。在这项研究中，该库扩展到58名成人，56名儿童，5名孕妇和12名国际辐射防护委员会（ICRP）参考模型，该技术扩展到包括多个协议，偏差校正和不确定性估计。该方法在临床监测系统中实施，以估计器官剂量和基于器官剂量的艾德647例盆腔和401例胸部检查，这是比较基于DLP的艾德使用t检验。对于大多数器官，器官剂量估计的最大误差分别为18%和8%，在所有方案中取平均值，无偏倚校正和有偏倚校正。对于患者检查，基于DLP的艾德与基于器官剂量的艾德在胸部和骨盆扫描中的差异分别高达190.9%和234.7%（平均值分别为9.0%和24.3%）。差异具有统计学显著性（p < .001），并显示出对体型较大患者的高估和对体型较小患者的低估。全面实施了适用于成人、儿童和妊娠患者临床成像的患者知情器官剂量估计框架。与基于器官剂量的艾德相比，基于DLP的艾德可能高估了大体型患者的有效剂量，而低估了小体型患者的有效剂量。
The purpose of this study is to comprehensively implement a patient-informed organ dose monitoring framework for clinical CT and compare the effective dose (ED) according to the patient-informed organ dose with ED according to the dose-length product (DLP) in 1048 patients. Organ doses for a given examination are computed by matching the topogram to a computational phantom from a library of anthropomorphic phantoms and scaling the fixed tube current dose coefficients by the examination volume CT dose index (CTDIvol) and the tube-current modulation using a previously validated convolution-based technique. In this study, the library was expanded to 58 adult, 56 pediatric, five pregnant, and 12 International Commission on Radiological Protection (ICRP) reference models, and the technique was extended to include multiple protocols, a bias correction, and uncertainty estimates. The method was implemented in a clinical monitoring system to estimate organ dose and organ dose–based ED for 647 abdomen-pelvis and 401 chest examinations, which were compared with DLP-based ED using a t test. For the majority of the organs, the maximum errors in organ dose estimation were 18% and 8%, averaged across all protocols, without and with bias correction, respectively. For the patient examinations, DLP-based ED was significantly different from organ dose–based ED by as much as 190.9% and 234.7% for chest and abdomen-pelvis scans, respectively (mean, 9.0% and 24.3%). The differences were statistically significant (p < .001) and exhibited overestimation for larger-sized patients and underestimation for smaller-sized patients. A patient-informed organ dose estimation framework was comprehensively implemented applicable to clinical imaging of adult, pediatric, and pregnant patients. Compared with organ dose–based ED, DLP-based ED may overestimate effective dose for larger-sized patients and underestimate it for smaller-sized patients.