Prioritizing examination-centered over patient-centered dose reduction: a hazard of institutional "benchmarking".
Prioritizing examination-centered over patient-centered dose reduction: a hazard of institutional "benchmarking".
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DOI：
10.2214/ajr.13.11235
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发表时间：
2014-05
期刊：
影响因子：
--
通讯作者：
Pandharipande PV
中科院分区：
文献类型：
--
作者：
Eisenberg JD;Gilmore ME;Kalra MK;Kong CY;Pandharipande PV
To evaluate whether examination-specific radiation dose metrics reliably measure an institution's success in reducing cancer risks. We projected health benefits from dose-reduction programs in a hypothetical institution that sought to decrease exposures from abdominopelvic CT. Using modeling techniques to project radiation-induced cancer risks, and tertiary center data to inform the institution's abdominopelvic CT age distribution, we compared: a program in which effective doses were reduced equally (from 10 to 7-mSv) across all scans; to programs in which dose reduction was age-dependent. For each program, we projected lethal cancers averted, life expectancy gained, and average institutional dose achieved. Markov Chain Monte Carlo methods were used to estimate uncertainty in projections. The analysis’ age distribution drew from 20,979 CT scans; 39% were from patients ≥65-years-old. To illustrate trends yielded, if all patients in the hypothetical institution received 7-mSv (instead of 10-mSv) scans, we projected the maximum number of lethal cancers averted to be 7/100,000 patients, and maximum life expectancy gained to be 0.26 days per patient, when averaged over the institution's population. When restricting dose reduction (from 10 to 7-mSv) to patients <65-years-old, benefits were slightly lower (5/100,000 patients, 0.22 days gained); however, the average institutional dose was substantially higher (8.2-mSv). While dose reduction in ≥65-year-old patients accounted for only 16% of possible institutional life expectancy gains, this patient group contributed disproportionately (39%) to the institution's average dose. Institutional examination-specific dose metrics can be misleading, because the least benefited patients may contribute disproportionately towards “improved” averages.
