Sarabjeet Singh MBBS, Presenter: Nothing to Disclose

Mannudeep Karanvir Singh Kalra MD, Abstract Co-Author: Research grant, General Electric Company

Michael Moore MBBCh, Abstract Co-Author: Nothing to Disclose

Randheer Shailam MD, Abstract Co-Author: Nothing to Disclose

Sjirk Jan Westra MD, Abstract Co-Author: Nothing to Disclose

Dose optimization in large institutions with multiple scanners at one or more locations and with multiple temporary or permanent radiologic technologists may require special efforts. The purpose of our study was to determine the radiation dose penalties for non-compliance with specific scanning protocols and assess effects of strategies to improve compliance with specified protocols.

In phase 1 of the study, size based dose optimization protocols were implemented on eight MDCT scanners in a large academic center for scanning children according to four categories of weight (n= 138,1-18years M: F 80:58). Technologists were informed with emails and personal communication about the protocols. Next, we recorded compliance of the technologists with the protocols by matching used scan parameters with those recommended with new protocols for all pediatric CT from the date of implementation of the protocols to October 1, 2007. In the phase 2 of the study, protocols were changed to further reduce radiation dose (n= 100, 1-18years, M:F 59: 41) and compliance was reassessed for all CT exams done between October 2007 and March 2008. Technologists were retrained with emails, personal communications, posters and handout of the new protocols. CTDI vol, DLP and scan parameters were recorded for all compliant and non-compliant CT. Transverse diameter and weight of each patient was also recorded. Data were analyzed using regression analysis.

In the first phase of dose reduction, there was 53% compliance for chest CT and 66% for abdominal CT, which increased to 79% and 80% respectively with the second phase of dose reduction. Non-compliant CT studies tended to be more frequent in subjects with higher weight (134 ± 57.8 lbs)as compared to the compliant studies (81.6 ± 37.4 lbs). With non-compliance, age-and-size matched subjects were exposed to 63 % higher dose for chest CT and 38 % for abdominal CT compared to weight based pediatric CT protocols (p<0.001).

Non-compliance with weight based pediatric CT protocols increases radiation dose substantially in large academic centers. Constant monitoring and didactic information to the technologists can help improve compliance and decrease radiation doses.

Weight based pediatric CT protocols help in dose reduction although non-compliance with the protocols can lead to substantially higher radiation doses.

Singh, S, Kalra, M, Moore, M, Shailam, R, Westra, S, The Penalty of Non-compliance: Improving Compliance with Standardized Pediatric Radiation Dose Protocols.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6012779.html