Abstract
Background
Recently, computed tomography (CT) has been used to diagnose fetal skeletal dysplasia. However, no surveys have been conducted to determine the radiation exposure dose and the diagnostic reference level (DRL).
Objective
To collect CT dose index volume (CTDIvol) and dose length product (DLP) data from domestic hospitals implementing fetal skeletal 3-D CT and to establish DRLs for Japan.
Materials and methods
Scan data of 125 cases of 20 protocols from 16 hospitals were analyzed. The minimum, first-quartile, median, third-quartile and maximum values of CTDIvol and DLP were determined. The time-dependent change in radiation dose setting in hospitals with three or more cases with scans was also examined.
Results
The minimum, first-quartile, median, third-quartile and maximum CTDIvol values were 2.1, 3.7, 7.7, 11.3 and 23.1 mGy, respectively, and these values for DLP were 69.0, 122.3, 276.8, 382.6 and 1025.6 mGy·cm, respectively. Six of the 12 institutions reduced the dose setting during the implementation period.
Conclusions
The DRLs of CTDIvol and DLP for fetal CT were 11.3 mGy and 382.6 mGy·cm, respectively. Institutions implementing fetal CT should use these established DRLs as the standard and make an effort to reduce radiation exposure by voluntarily decreasing the dose.
Similar content being viewed by others
References
Warman ML, Cormier-Daire V, Hall C et al (2011) Nosology and classification of genetic skeletal disorders: 2010 revision. Am J Med Genet A 155:943–948
Schumacher R, Seaver LH, Spranger J (2004) Introduction. In: Schumacher R, Seaver LH, Spranger J (eds) Fetal radiology, a diagnostic atlas, 1st edn. Springer, Berlin, pp 1–2
Ruano R, Molho M, Roume J et al (2004) Prenatal diagnosis of fetal skeletal dysplasias by combining two-dimensional and three-dimensional ultrasound and intrauterine three-dimensional helical computer tomography. Ultrasound Obstet Gynecol 24:134–140
Suzumura H, Kohno T, Nishimura G et al (2002) Prenatal diagnosis of hypochondrogenesis using fetal MRI: a case report. Pediatr Radiol 35:373–375
Garjian KV, Pretorius DH, Budorick NE et al (2000) Fetal skeletal dysplasia: three-dimensional US-initial experience. Radiology 21:717–723
Cassart M, Massez A, Cos T et al (2007) Contribution of three dimensional computed tomography in the assessment of fetal skeletal dysplasia. Ultrasound Obstet Gynecol 29:537–543
Cassart M (2010) Suspected fetal skeletal malformations or bone diseases: how to explore. Pediatr Radiol 40:1046–1051
Boulet S, Althuser M, Nugues F et al (2009) Prenatal diagnosis of achondroplasia: new specific signs. Prenat Diagn 29:697–702
Victoria T, Epelman M, Coleman BG et al (2013) Low-dose fetal CT in the prenatal evaluation of skeletal dysplasia and other severe skeletal abnormalities. AJR Am J Roentgenol 200:989–1000
Miyazaki O, Nishimura G, Sago H et al (2012) Prenatal diagnosis of fetal skeletal dysplasia with 3D CT. Pediatr Radiol 42:842–852
Macé G, Sonigo P, Cormier-Daire V et al (2013) Three-dimensional helical computed tomography in prenatal diagnosis of fetal skeletal dysplasia. Ultrasound Obstet Gynecol 42:161–168
Guillerman RP (2011) Newer CT applications and their alternatives: what is appropriate in children? Pediatr Radiol 41:s534–s548
The American College of Obstetrics and Gynecologists (2004) Guidelines for diagnostic imaging pregnancy. AOCG committee opinion No. 299. 104:647–651
Slovis TL, Hall ET, Huda W et al (2002) ALARA conference executive summary. Pediatr Radiol 32:221
Frush DP (2011) Justification and optimization of CT in children: how are we performing? Pediatr Radiol 41:s467–s471
Bach-Segura P (2006) Etude du squelette fœtal en scanner multibarrette: optimisation du protocole, traitement de l’image. J Radiol 87:1358
IAEA Radiation Protection of Patients (RPOP). Diagnostic reference levels (DRLs) in CT. https://rpop.iaea.org/RPOP/RPoP/Content/InformationFor/HealthProfessionals/1_Radiology/ComputedTomography/diagnostic-reference-levels.htm
Institute of Physics and Engineering in Medicine (IPEM) (2004) Guidance on the establishment and use of diagnostic reference levels for medical X-ray examinations. IPEM report 88.
European Commissions. Radiation protection 109. Guidance on diagnostic reference levels (DRLs) for medical exposure. http://ec.europa.eu/energy/nuclear/radiation_protection/doc/publication/109_en.pdf#search='European+Commission+%28EC%29.+Radiation+protection+109.+Guidance+on+diagnostic+reference+levels+%28DRLs%29+for+medical+exposures'
ACR–AAPM practice guideline for diagnostic reference levels and achievable dose in medical X-ray imaging. Revised 2013 (Resolution 47). http://www.acr.org/~/media/796DE35AA407447DB81CEB5612B4553D.pdf#search='ACR+PRACTICE+GUIDELINE+FOR+DIAGNOSTIC+REFERENCE+LEVELS+IN+MEDICAL+XRAY+IMAGING%2C+Revised+2008++Resolution+3'
Thomas KE (2011) CT utilization—trends and developments beyond the United States’ borders. Pediatr Radiol 41:s562–s566
Victoria T, Epelman M, Bebbington M et al (2012) Low-dose fetal CT for evaluation of severe congenital skeletal anomalies; preliminary experience. Pediatr Radiol 42:s142–s149
Shrimpton PC, Hillier MA, Lewis MA et al (2006) National survey of doses from CT in the UK: 2003. Br J Radiol 79:968–980
Kritsaneepaiboon S, Trinavarat P, Visrutarathna P (2012) Survey of pediatric MDCT radiation dose from university hospitals in Thailand: a preliminary for national dose survey. Acta Radiol 52:820–826
Watson DJ, Coakley KS (2010) Paediatric CT reference doses based on weight and CT dosimetry phantom size: local experience using a 64-slice CT scanner. Pediatr Radiol 40:693–703
Shoda S, Hamada H, Oki A et al (1997) Diagnosis of fetal anomalies by three-dimensional imaging using helical computed tomography. Prenat Diagn 17:670–674
Miyazaki O, Nishimura G, Sago H et al (2007) Prenatal diagnosis of chondrodysplasia punctata tibia-metacarpal type using multidetector CT and three-dimensional reconstruction. Pediatr Radiol 37:1151–1154
Tsutsumi S, Sawai H, Nishimura G et al (2008) Prenatal diagnosis of thanatophoric dysplasia by 3-D helical computed tomography and genetic analysis. Fetal Diagn Ther 24:420–424
Yamada T, Nishimura G, Nishida K et al (2011) Prenatal diagnosis of short-rib polydactyly syndrome type 3 (Verma-Naumoff type) by three-dimensional computed tomography. J Obstet Gynaecol Res 37:151–155
Bonnefoy O, Delbosc JM, Maugey-Laulom B et al (2006) Prenatal diagnosis of hypochondroplasia: three-dimensional multislice computed tomography findings and molecular analysis. Fetal Diagn Ther 21:18–21
Felmlee JP, Gray JE, Leetzow ML et al (1990) Estimated fetal radiation dose from multislice CT studies. AJR Am J Roentgenol 154:185–190
ICRP (2000) Annals of the ICRP publication 84, 30(1). Elsevier Science Ltd, London
Hurwitz LM, Yoshizumi T, Reiman RE et al (2005) Radiation dose to the fetus from body MDCT during early gestation. AJR Am J Roentgenol 186:871–876
Miyazaki O, Horiuchi T, Akahane M et al (2009) Radiation doses of three-dimensional MDCT for skeletal dysplasia: is the procedure warranted? Pediatr Radiol 39:S288–S327
Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukemia and brain tumors: a retrospective cohort study. Lancet 380:499–505
http://www.gehealthcare.com/dose/how-we-can-help/computed-tomography.html. Accessed 19 Jan 2013
Acknowledgments
This article was supported by a grant-in-aid for Scientific Research from the Ministry of Health, Labour and Welfare of Japan, H23-Nanchi-Ippan-123.
We very much appreciate the cooperation of the following subgroup members of the above research project: Dr. Yoshihisa Shimanuki, radiologist, and Mr. Kiyoaki Sasaki, chief radiological technologist, Miyagi Children’s Hospital; Mr. Hiroshi Nagamatsu and Ms. Ayano Shimada, radiological technologists, National Center for Child Health and Development; and Dr. Chihiro Tani, radiologist, and Mr. Masao Kiguchi, radiological technologist, Hiroshima University. Moreover, we very much appreciate the cooperation of all obstetricians, radiologists, and radiological technologists in all 16 hospitals.
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Miyazaki, O., Sawai, H., Murotsuki, J. et al. Nationwide radiation dose survey of computed tomography for fetal skeletal dysplasias. Pediatr Radiol 44, 971–979 (2014). https://doi.org/10.1007/s00247-014-2916-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-014-2916-1