Advertisement

National reference levels of CT procedures dedicated for treatment planning in radiation oncology

Published:March 14, 2022DOI:https://doi.org/10.1016/j.ejmp.2022.03.001

      Highlights

      • DRLs can help the imaging related to treatment planning in radiation oncology.
      • The intention is to propose RPRLs and compare these values with published data.
      • Results show variations in CT planning which call for optimization of procedures.

      Abstract

      Objective

      To present results of the first national survey on reference levels of CT imaging performed for the treatment planning purposes in radiation oncology in Croatia.

      Methods

      Data for CT protocols of five anatomical regions including head, head and neck, pelvis, breast, and thorax were collected at eight radiation oncology departments in Croatia. Data included volume CT dose index (CTDIvol), dose-length product (DLP), scan length and set of acquisition and reconstruction parameters. Data on a total of 600 patients were collected. Median values of scan length, DLP and CTDIvol were calculated for each acquisition protocol. Third quartiles of the median CTDIvol and DLP values were proposed as the national radiotherapy planning reference levels (RPRL).

      Results

      The largest CoV were assessed for RT Breast (63.8% for CTDIvol), RT Thorax (79.7% for DLP) and RT H&N (21.2% for scan length). RT Head had the lowest CoV for CTDIvol (1,9%) and DLP (17,2%), while RT Breast had the lowest coefficient of variation for scan length (12.8%). Proposed national RPRLs are: for RT Head CTDIvol16cm = 62 mGy and DLP16cm = 1738 mGy.cm; for RT H&N CTDIvol16cm = 35 mGy and DLP16cm = 1444 mGy.cm; for RT Breast CTDIvol32cm = 16 mGy and DLP32cm = 731 mGy.cm; for RT Thorax CTDIvol32cm = 17 mGy and DLP32cm = 865 mGy.cm; for RT Pelvis CTDIvol32cm = 20 mGy and DLP32cm = 1133 mGy.cm.

      Conclusions

      Results of this study show variations in CT imaging for treatment planning practice at the national level which call for optimization of procedures.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Physica Medica: European Journal of Medical Physics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Barton M.B.
        • Jacob S.
        • Shafiq J.
        • Wong K.
        • Thompson S.R.
        • Hanna T.P.
        • et al.
        Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012.
        Radiother Oncol. 2014; 112: 140-144https://doi.org/10.1016/j.radonc.2014.03.024
        • Wood T.J.
        • Davis A.T.
        • Earley J.
        • Edyvean S.
        • Findlay U.
        • Lindsay R.
        • et al.
        IPEM topical report: the first UK survey of dose indices from radiotherapy treatment planning computed tomography scans for adult patients.
        Phys Med Biol. 2018; 63: 185008https://doi.org/10.1088/1361-6560/aacc87
        • Sanderud A.
        • England A.
        • Hogg P.
        • Fosså K.
        • Svensson S.F.
        • Johansen S.
        Radiation dose differences between thoracic radiotherapy planning CT and thoracic diagnostic CT scans.
        Radiography. 2016; 22: 107-111
      1. National Research Council. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington, DC: The National Academies Press; 2006. https://doi.org/10.17226/11340.

        • Hall E.J.
        • Brenner D.J.
        Cancer risks from diagnostic radiology.
        Br J Radiol. 2008; 81: 362-378https://doi.org/10.1259/bjr/01948454
        • Giacometti V.
        • Hounsell A.R.
        • McGarry C.K.
        A review of dose calculation approaches with cone beam CT in photon and proton therapy.
        Phys Med. 2020; 76: 243-276https://doi.org/10.1016/j.ejmp.2020.06.017
      2. Law on Radiation Protection and Safety, Regulation on the Applications of Ionizing Radiation in medicine, Official gazette; May 9, 2018.

        • Šegota D.
        • Diklic A.
        • Jurkovic S.
        Establishment of local diagnostic reference levels for typical radiography examinations in the west region of Croatia.
        Nucl Technol Rad Protection. 2019; 34: 102-106https://doi.org/10.2298/NTRP180831015S
        • Dundara Debeljuh D.
        • Jurković S.
        • Pribanić I.
        • Poljak F.
        • Kralik I.
        • Krstonošić B.
        • et al.
        National survey to set diagnostic reference levels in nuclear medicine single photon emission imaging in Croatia.
        Phys Med. 2020; 78: 109-116https://doi.org/10.1016/j.ejmp.2020.09.005
        • Vañó E.
        • Miller D.L.
        • Martin C.J.
        • Rehani M.M.
        • Kang K.
        • Rosenstein M.
        • et al.
        Authors on behalf of ICRP. ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging.
        Ann ICRP. 2017; 46: 1-144https://doi.org/10.1177/0146645317717209
      3. European Commission. Radiation protection N° 162. Criteria for Acceptability of Medical Radiological Equipment used in Diagnostic Radiology, Nuclear Medicine and Radiotherapy; 2012.

      4. Law on Radiation Protection and Safety, Regulation on the conditions and radiation protection measures for performing activities with ionizing radiation sources, Official gazette; June 8, 2018.

        • Diklic A.
        • Segota D.
        • Belac-Lovasic I.
        • Jurkovic S.
        An assessment of dose indicators for computed tomography localization procedures in radiation therapy at the University Hospital Rijeka.
        Nucl Technol Radiat Prot. 2018; 33: 301-306https://doi.org/10.2298/NTRP1803301D
        • Boone J.M.
        • Strauss K.J.
        • Cody D.D.
        • McCollough C.H.
        • McNitt-Gray M.F.
        • Toth T.L.
        Size specific dose estimates (SSDE) in pediatric and adult body CT examinations (Task Group 204).
        American Association of Physicists in Medicine, College Park, MD2011
      5. Brink J.A., Boone J.M., Feinstein K.A., Michalski J.M., Pizzutiello Jr R.J., Spelic D.C., White S.C., Yee J., 2012. Report No. 172 - Reference Levels and Achievable Doses in Medical and Dental Imaging: Recommendations for the United States. [online] Available at: http://www.ncrppublications.org/Reports/172.

        • Iball G.R.
        • Bebbington N.A.
        • Burniston M.
        • Edyvean S.
        • Fraser L.
        • Julyan P.
        • et al.
        A national survey of computed tomography doses in hybrid PET-CT and SPECT-CT examinations in the UK.
        Nucl Med Commun. 2017; 38: 459-470https://doi.org/10.1097/MNM.0000000000000672
        • Connor S.O.
        • Mc Ardle O.
        • Mullaney L.
        Establishment of national diagnostic reference levels for breast cancer CT protocols in radiation therapy.
        Br J Radiol. 2016 Oct; 89: 20160428https://doi.org/10.1259/bjr.20160428
        • Clerkin C.
        • Brennan S.
        • Mullaney L.M.
        Establishment of national diagnostic reference levels (DRLs) for radiotherapy localisation computer tomography of the head and neck.
        Rep Practical Oncol Radiother. 2018; 23: 407-412
        • Zalokar N.
        • Žager Marciuš V.
        • Mekiš N.
        Establishment of national diagnostic reference levels for radiotherapy computed tomography simulation procedures in Slovenia.
        Eur J Radiol. 2020; 127108979https://doi.org/10.1016/j.ejrad.2020.108979
        • Toroi P.
        • Kaijaluoto S.
        • Bly R.
        Patient exposure levels in radiotherapy CT simulations in Finland.
        Radiat Prot Dosimetry. 2015 Dec; 167: 602-607https://doi.org/10.1093/rpd/ncu363
      6. International Atomic Energy Agency Safety Standards, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards, SERIES No. GSR Part 3, Vienna, 2014.

        • Garcia-Ramirez J.L.
        • Mutic S.
        • Dempsey J.F.
        • Low D.A.
        • Purdy J.A.
        Performance evaluation of an 85-cm-bore X-ray computed tomography scanner designed for radiation oncology and comparison with current diagnostic CT scanners.
        Int J Radiat Oncol Biol Phys. 2002; 52: 1123-1131https://doi.org/10.1016/s0360-3016(01)02779-1
        • Martin C.J.
        • Kron T.
        • Vassileva J.
        • Wood T.J.
        • Joyce C.
        • Ung N.M.
        • et al.
        An international survey of imaging practices in radiotherapy.
        Phys Med. 2021; 90: 53-65https://doi.org/10.1016/j.ejmp.2021.09.004
        • Tsalafoutas I.A.
        • Hassan Kharita M.
        • Al-Naemi H.
        • Kalra M.K.
        Radiation dose monitoring in computed tomography: Status, options and limitations.
        Phys Med. 2020; 79: 1-15https://doi.org/10.1016/j.ejmp.2020.08.020