Impact of active dose management on radiation exposure and image quality in computed tomography: An observational study in 1315 patients.

Purpose: To determine the clinical impact of CT dose management team on radiation exposure and image quality.

Methods: 2026 clinical routine CT examinations of 1315 patients were evaluated retrospectively. A CT dose management team was established as an integral part of the radiological department. It identified 5 CT protocols (A-E), where national reference values were exceeded the most. Those reference values included specifically the mean volumetric CT dose index (CTDI) and the mean dose-length product (DLP). Baseline data (period 1) and follow up data (period 2) were obtained after reduction of tube voltage and increase of pitch or noise index. Signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were calculated to compare image quality. Two-sided t-tests were performed.

Results: Mean CTDI and mean DLP of the chest protocol (A) decreased after reduction of tube voltage (P < 0.01). In the chest/abdomen/pelvis protocol (B), the increase of noise index resulted in a significant mean CTDI decrease (P < 0.02) without statistical significance of mean DLP (P < 0.12). In the abdomen/pelvis protocol (C), mean CTDI (P = 0.01) and mean DLP (P < 0.01) were significantly lower after noise index increase. In the staging of hepatocellular carcinoma (D), mean CTDI and mean DLP were significantly lower after increase of pitch and noise index (P < 0.01). The lung protocol (E) yielded no significant changes after modulation (P > 0.05). SNR (protocol A) was significantly higher in period 2 (P < 0.04). Protocol D showed significantly lower selected SNR and CNR (P < 0.02).

Conclusions: Establishing an operating dose management team as a standard for good clinical practice helps to considerably reduce CT radiation dose while preserving image quality.