Implementation of Institutional Size-Specific Diagnostic Reference Levels for CT Angiography.

RATIONALE AND OBJECTIVES:To generate institutional size-specific diagnostic reference levels (DRLs) for computed tomography angiography (CTA) examinations and assess the potential for dose optimization compared to size-independent DRLs. MATERIALS AND METHODS:CTA examinations of the aorta, the pulmonary arteries and of the pelvis/lower extremity performed between January 2016 and January 2017 were included in our retrospective study. Water equivalent diameter (Dw) was automatically calculated for each patient. The relationship between Dw and computed tomography dose index (CTDIvol) was analyzed and the 75th percentile was chosen as the upper limit for institutional DRLs. Size-specific institutional DRLs were compared to national size-independent DRLs from Germany and the UK. RESULTS:A total of 1344 examinations were included in our study (n = 733 aortic CTA, n = 406 pulmonary CTA, n = 205 pelvic/lower extremity CTA). Mean Dw was 26 ± 9 cm and mean CTDIvol was 7.0 ± 4.6 mGy. For all CTA protocols, there was a linear progression of CTDIvol with increasing Dw with an R² = 0.95 in aortic CTA, R² = 0.94 in pulmonary CTA and R² = 0.93 in pelvic/lower extremity CTA. Median CTDIvol increased by 0.57 mGy per additional cm Dw in aortic CTA, by 1.1 mGy in pulmonary CTA and by 0.31 mGy in pelvic/lower extremity CTA. Institutional DRLs were lower than national DRLs for average size patients (aortic CTA: Dw 28.2 cm, CTDIvol 7.6 mGy; pulmonary CTA, Dw 27.9 cm, CTDIvol 11.8 mGy; pelvic/lower extremity CTA, Dw 20.0 cm, CTDIvol 6.4 mGy). More dose outliers in small patients were detected with size-specific DRLs compared to national size-independent DRLs (56.4% vs 16.2%). CONCLUSION:We implemented institutional size-specific DRLs for CTA examinations which enabled a more precise analysis compared to national sizeindependent DRLs.