See

discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/301546668

Calculating Local CT Diagnostic Reference

Levels (DRLs), for SPECT/CT Studies

Conference Paper · April 2016

CITATIONS READS

0 145

6 authors, including:

Andrew Cheetham Glafkos Havariyoun

King's College Hospital NHS Foundation Trust King's College Hospital NHS Foundation Trust
24 PUBLICATIONS 73 CITATIONS 18 PUBLICATIONS 0 CITATIONS

SEE PROFILE SEE PROFILE

Dani Ruiz Gill Vivian

National University of Colombia National Health Service
29 PUBLICATIONS 79 CITATIONS 102 PUBLICATIONS 514 CITATIONS

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Sentinel lymph node in breast cancer two t.chnique View project

The Effect of Image Acquisition Duration on DaTSCAN Studies View project

All content following this page was uploaded by Andrew Cheetham on 20 May 2016.

The user has requested enhancement of the downloaded file.

King’s College Hospital

Aim

• To establish local Diagnostic Reference

Calculating local CT
Levels (DRLs) for the CT component
Diagnostic Reference
of our most common SPECT/CT studies.
Levels (DRLs)
for SPECT/CT studies

A Cheetham, G Havariyoun, E Kalogianni,

D Ruiz, L Devlin, G Vivian

Introduction Method
• Choice of CT Parameters for: • Dec 2014 - Dec 2015
– Attenuation Correction
• 432 SPECT/CT scans
– Localisation
– Diagnostic – no contrast
– Diagnostic – with contrast • For different scan procedures:
– CTDIVol (mGy)
• Move to One-Stop Shop: – DLP (mGycm)
– Increase in CT dose from SPECT/CT – patient’s weight (kg)
– Decrease overall patient dose – anatomical area

Method Results – CT Dose

• Neuro-Endocrine Tumour (NET) studies.
• DRLs for CTDIVol and DLP
5
• IPEM Report 88
CTDIvol (mGy)

4
• Patients weighing 50-90kg 3
111In-Octreotide
(mean 70kg +/- 5kg)
2 123I-MIBG
• DRL = 75th percentile
1
177Lu-Dotatate
0
30 80 130 180
Patient's Weight (kg)

www.kch.nhs.uk 1
King’s College Hospital

Results – CT Dose Results – CT Dose

• Neuro-Endocrine Tumour (NET) studies. • Neuro-Endocrine Tumour (NET) studies.
300
300
250 Abdo Pelvis

DLP (mGy.cm)
250
DLP (mGy.cm)

111In-Octreotide 200
200
150 150 Chest Abdo Pelvis
123I-MIBG
100 100
50 177Lu-Dotatate 50
Head Chest Abdo Pelvis
0 0
30 80 130 180 30 80 130 180
Patient's Weight (kg) Patient's Weight (kg)

Results – CT Dose Results – CT Dose

• Neuro-Endocrine Tumour (NET) studies. • All Bone Scans.
Abdo - non diag
No. of
Mean 35 Chest - non diag
Weight Hips - non diag
Pts
(kg)
CTDIvol DLP 30 Knees - non diag
CTDIvol (mGy)

L Spine - non diag

C Spine - non diag
25 Pelvis - non diag
Shoulders - non diag
All NET Studies 69 72.3 2.18 171.0 20 T Spine - non diag
Thorax Abdo - non diag
15 Tibia - non diag
Abdo Pelvis - diagnostic
C Spine - diagnostic
Abdo Pelvis 41 71.6 2.01 84.0 10 Elbows - diagnostic
Feet - diagnostic
5 Femora - diagnostic
Skull Thorax - diagnostic
Chest Abdo Pelvis 21 71.2 2.43 190.0 Hips - diagnostic
0 Hips Knees - diagnostic
Jaw - diagnostic
Head Chest Abdo Pelvis 6* 81.0 * 2.43 279.0 30 60 90 120 150 Knees - diagnostic
Knees Feet - diagnostic
Patient's Weight (kg) L Spine - diagnostic

Results – CT Dose Results – CT Dose

• Bone Scans - Torso Non Diagnostic. • Bone Scans - Feet Diagnostic.
4.5 Abdo - non diag 14
4 12
Chest - non diag
CTDIvol (mGy)

3.5
CTDIvol (mGy)

10
3 Hips - non diag
2.5 8
L Spine - non diag Feet -
2 6
1.5 C Spine - non diag 4 diagnostic
1
Pelvis - non diag 2
0.5
0 Shoulders - non diag 0
30 60 90 120 30 60 90 120 150
T Spine - non diag
Patient's Weight (kg) Patient's Weight (kg)

www.kch.nhs.uk 2
King’s College Hospital

Results – CT Dose Results – CT Dose

• Bone Scans – L Spine Diagnostic. • Bone Scans.
Mean
35 No. of
Weight
Pts CTDIvol DLP
(kg)
30
CTDIvol (mGy)

25
All Bone Scans 173 72.5 11.75 461.0
20
L Spine - Torso Non Diagnostic 32 70.7 2.18 91.0
15
10 diagnostic Feet Diagnostic 29 74.9 11.75 476.0

5 Knees Diagnostic 19 72.6 9.75 415.0

0 Hips Diagnostic 13 72.7 11.72 496.0
30 60 90 120 150
Patient's Weight (kg) L Spine Diagnostic 25 69.5 16.00 574.0

Results – CT Dose Discussion

• Other Studies. • Comparison with provisional IPEM figures
Mean
No. of CTDIvol CTDIvol DLP DLP
Weight
Pts CTDIvol DLP IPEM KCH IPEM KCH
(kg)

Hepato-Biliary (HIDA) 15 66.4 2.22 93.0 NET Studies 5.40 2.18 240.0 171.0

131I - Thyroid Therapy 11 71.8 2.35 98.0 131I – Thyroid Therapy 5.90 2.35 210.0 98.0

Parathyroid 22 71.4 2.60 214.5 Parathyroid 5.60 2.60 170.0 214.5

Bone Scans 5.60 11.75 180.0 461.0

• Parathyroid – 2 x SPECT/CT (to be reviewed)

• Bone Scans – dependent on case mix

Conclusion

• Established CT DRLs for:

– NET studies
– 131I – Thyroid Therapy Thank you
– Hepato-Biliary
– Parathyroid References:
– Bone Scans
1. Guidance on the establishment and use of diagnostic reference levels
for medical x-ray examinations. IPEM Report 88. IPEM, 2004.

• Compared with provisional IPEM values 2. IPEM working party recommendations on hybrid CT DRLs.

• Will be used to optimise studies

www.kch.nhs.uk
View publication stats 3