The use of positron emission tomography/computed tomography (PET/CT) system has heightened the need for medical diagnosis. However, the patient dose is increasing in comparison to whole-body PET/CT dose. The aim of this study is to determine the patient effective dose in 35 oncology Thai patients with the age range of 28-60 y from PET scan using [fluorine-18]-fluoro-2-deoxy-D-glucose and from CT scan. Cumulated activity and residence time of various organs were calculated from time-activity curves by using S-value based on the body mass. Mean organ absorbed dose and the effective dose from CT scan were calculated using the Medical Internal Radiation Dosimetry method and Monte Carlo simulation, respectively. The average whole-body effective doses from PET and CT were 4.40 + or - 0.61 and 14.45 + or - 2.82 mSv, respectively, resulting in the total patient dose of 18.85 mSv. This can be used as the reference dose in Thai patients.

The Determination of Patient Dose from [18] F-FDG PET/CT Examinations

While diagnostic reference levels (DRLs) are well-established for the radiopharmaceutical part, published DRLs for the CT component of positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT) are limited. This systematic review and meta-analysis provides an overview of the different objectives of CT in hybrid imaging and summarizes reported CT dose values for the most common PET/CT and SPECT/CT examinations. Also, an overview of already proposed national DRLs is given.A systematic literature search was performed to identify original articles reporting CT dose index volume (CTDIvol), dose-length product (DLP) and/or national DRLs for the most frequently performed PET/CT and/or SPECT/CT examinations. Data were grouped according to the clinical objective: diagnostic (D-CT), anatomical localisation (AL-CT) or attenuation correction (AC-CT) CT. Random-effects meta-analyses were conducted.Twenty-seven articles were identified of which twelve reported national DRLs. For brain and tumour PET/CT imaging, CTDIvol and DLP values were higher for a D-CT (brain: 26.7 mGy, 483 mGy cm; tumour: 8.8 mGy, 697 mGy cm) than for an AC/AL-CT (brain: 11.3 mGy, 216 mGy cm; tumour: 4.3 mGy, 419 mGy cm). Similar conclusions were found for bone and parathyroid SPECT/CT studies: D-CT (bone: 6.5 mGy, 339 mGy cm; parathyroid: 15.1 mGy, 347 mGy cm) results in higher doses than AL-CT (bone: 3.8 mGy, 156 mGy cm; parathyroid: 4.9 mGy, 166 mGy cm). For cardiac (AC-CT), mIBG/octreotide, thyroid and post-thyroid ablation (AC/AL-CT) SPECT/CT pooled mean CTDIvol (DLP) values were 1.8 mGy (33 mGy cm), 4.6 mGy (208 mGy cm), 3.1 mGy (105 mGy cm) and 4.6 mGy (145 mGy cm), respectively. For all examinations, high variability in nuclear medicine practice was observed.The large variation in CT dose values and national DRLs highlights the need for optimisation in hybrid imaging and justifies the clinical implementation for nuclear medicine specific DRLs. 

/pdf/a-systematic-review-and-meta-analysis-on-the-radiation-dose-7102aqen.pdf

A systematic review and meta-analysis on the radiation dose of computed tomography in hybrid nuclear medicine imaging

Background: In August 2017, the European Commission awarded the “European Study on Clinical Diagnostic Reference Levels (DRL) for X-ray Medical Imaging” project to the European Society of Radiology to provide up-to-date Diagnostic Reference Levels based on clinical indications. This work aimed to conduct an extensive literature review by analyzing the most recent studies published and the data provided by the National Competent Authorities to understand the current situation regarding Diagnostic Reference Levels based on clinical indications for Radiation Therapy Computed Tomography. Objective: To review the literature on established DRLs and methodologies for establishing Diagnostic reference levels in radiation therapy planning computed tomography (RTCT). Methods: Eligibility criteria: A cohort study (observational design) reporting DRLs in adult patients undergoing computed tomography (CT) for radiation therapy for the region head and neck or pelvis were included. The comprehensive literature searches for the relevant studies published between 2000 and 2021 were performed using PubMed, Scopus, CINHAL, Web of Science, and ProQuest. Results: Three hundred fifty-six articles were identified through an extensive literature search. Sixty-eight duplicate reports were removed. The title and abstract of 288 studies were assessed and excluded if they did not meet the inclusion criteria. Sixteen of 288 articles were selected for full-text screening (studies conducted between 2000 and 2021). Five articles were included in the review after the full-text screening. Conclusions: A globally approved standard protocol that includes scanning techniques, dose measurement method, and DRL percentile needs to be established to make a valuable and accurate comparison with international DRLs.

/pdf/systematic-review-on-diagnostic-reference-levels-for-2zhdb76g.pdf

Systematic Review on Diagnostic Reference Levels for Computed Tomography Examinations in Radiation Therapy Planning

PURPOSE
This study aims to report the findings of Jordanian national diagnostic reference level (NDRL) survey for fluorodeoxyglucose (18F-FDG) and local diagnostic reference level (LDRL) of computed tomography (CT) used for attenuation correction and anatomical localization (AC-AL); and attenuation correction and diagnostic CT (AC-DX) within the context of whole-body WB and half-body HB adult oncology PET/CT scanning. Methods: Two-structured questionnaires were prepared to gather the necessary information: dosimetry data, patient demographics, equipment specification, and acquisition protocols for identified 18F-FDG PET/CT procedures. The NDRL and achievable dose were reported based on the 75th and 50th percentiles for 18F-FDG administered activity (AA), respectively. The LDRL was reported based on the 50th percentile for (CTDIvol) and (DLP). Results: Data from 562 patients from four Jordanian PET/CT centres were collected. The survey revealed that Jordanian NDRL for administered activity (AA) (303 MBq) was within the acceptable range compared to the published-peer NDRL data (240 to 590 MBq). However, the 18F-FDG AA varied across the participated PET/CT centres. The reported LDRL CTDIvol and DLP of CT used for (AC-AL) was 4.3 mGy and 459.3 mGy.cm for HB CT scan range, and 4.1 mGy and 659.9 mGy.cm for WB CT scans. The reported LDRL for CTDIvol and DLP for HB CT was higher when compared with the United Kingdom (3.2 mGy and 310 mGy.cm). Concurrently, in the context of WB CT, the reported values (i.e., CTDIvol and DLP) were also higher than both Kuwait (3.6 mGy and 659 mGy.cm) and Slovenia (3.6 mGy and 676 mGy.cm). The reported HB CT(AC-DX) was higher than Nordic, New Zealand and Swiss NDRLs and for WB (AC-DX) CT it was higher than Swiss NDRLs Conclusion: This study reported the first Jordanian NDRL for 18F-FDG and LDRL for HB and WB CT associated with 18F-FDG PET/CT scans. This data is useful for Jordanian PET/CT centres to compare their LDRL to the suggested DRLs and utilize it in the process of optimising CT radiation doses. .

National and local diagnostic reference levels for adult 18F-FDG and CT in Jordanian PET/CT: findings and implications in practice.

Abstract Background Positron emission tomography-computed tomography (PET/CT) is a widely utilized hybrid imaging technique that combines functional and anatomical information. To ensure the safe and effective use of this imaging modality, Diagnostic Reference Levels (DRLs) have been established as standardized benchmarks for assessing and managing radiation doses in clinical practice. Several studies have reported DRLs for different radiotracers and imaging modalities, including PET/CT. However, there is a need for country-specific DRL data that reflect national clinical practices. While existing literature provides insights into DRLs for PET/CT procedures in various settings, there is a lack of PET/CT DRLs specific to the Jordanian context. Given the variations in patient populations, equipment specifications, and clinical protocols, it is crucial to establish NDRLs and local DRLs (LDRLs) in Jordan. Therefore, the study aimed to derive the country-specific reference levels for fluoride-18 fluorodeoxyglucose (18F-FDG) PET/CT scans in Jordan. Results The survey revealed that Jordanian NDRL for administered activity (AA) (303 MBq) was within the acceptable range compared to the published-peer NDRL data (240 to 590 MBq). However, the 18 F-FDG AA varied across the participated PET/CT centres. The reported LDRL CTDI vol and DLP of CT used for attenuation correction and anatomical localization (AC-AL) was 4.3 mGy and 459.3 mGy.cm for half-body (HB) CT scan range, and 4.05 mGy and 659.9 mGy.cm for whole-body (WB) CT scans. The reported LDRL for CTDI vol and DLP for HB CT was higher when compared with the United Kingdom (3.2 mGy and 310 mGy.cm). Meanwhile, it remained higher than both Kuwait (3.6 mGy and 659 mGy.cm) and Slovenia (3.6 mGy and 676 mGy.cm) for WB CT. The reported HB attenuation correction diagnostic CT(AC-DX) CT was higher than previously identified peer-reviewed NDRL data and lower than Slovenia for WB AC-DX CT acquisition protocols. Conclusion This study reported the first Jordanian NDRL for 18 F-FDG and LDRL for HB and WB CT associated with 18 F-FDG PET/CT scans. The data provides a valuable reference point for Jordanian PET/CT centres to compare their LDRL with the suggested DRLs. By utilizing this data, centres need to optimize CT radiation doses and tailor them to ensure appropriate image quality. 

/pdf/national-and-local-diagnostic-reference-levels-for-18f-fdg-31cibbpi.pdf

National and Local Diagnostic Reference Levels for 18F-FDG and CT in Jordanian PET/CT Scanning: Findings and Implications in Practice

The aim was to determine typical values of diagnostic reference level (DRL) quantities for the computed tomography (CT) part of the most common positron emission tomography-computed tomography (PET-CT) procedures in Slovenia. The most common PET-CT procedures were identified, and data collated for 565 patients imaged in all three PET-CT units in Slovenia during a time span of 11 months. As the number of facilities is too low to establish national DRLs, we followed ICRP recommendations and determined typical values of DRL quantities as the median values of the pooled set of data. Mean, median, and standard deviation of CT dose index (CTDIvol) and total dose length product (DLP) for the CT part of the most common PET-CT procedures were determined for pooled data as well as for each PET-CT unit. The data were compared between all three units to identify possible outliers that would likely benefit from optimization. Three most common CT protocols covering approximately 2/3 of all PET-CT imaging performed in Slovenia were considered: from the base of the cranium to the middle of the femur, from the top of the head to the middle of the femur, and for the whole-body PET-CT. The established typical values in terms of total DLP were 295, 359, and 676 mGyċcm, respectively; and in terms of CTDIvol3.05, 3.22, and 3.60 mGy, respectively. Comparing the data between all three units showed significantly higher (p< 0.001) patient doses on one unit, indicating a need for optimization. The results present the first-time data on the national typical values of DRL quantities for the CT part of most common PET-CT procedures in Slovenia. While the determined typical values are within the DRL values established in some other countries, significant differences were found between the individual units included in the study.

Establishment of typical adult CT dose indicators for PET-CT scans in Slovenia.

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Establishment of typical adult CT dose indicators for PET-CT scans in Slovenia.