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Radiation Dose and Image Quality in CT Imaging

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 29912

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Dr. Matthias S. May

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Imaging Science Institute, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
Interests: computed tomography; intervention; artificial intelligence; dual energy; personalized medicine; imaging biomarkers; photon counting; radiation dose
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Dear Colleagues,

Computed tomography (CT) has revolutionized medicine. It is widely available and rapid, providing details that are three-dimensional and, in most situations, explicit. Its vast application accounts for the majority of medical radiation exposure in Western populations, concerning both patients and medical staff. Paracelsus, in the early modern period, already knew what was proven by scientific research centuries later: “only the dose makes that a thing is no poison”, equating to the currently accepted linear-no-threshold model for biological radiation dose–response. The minimum diagnostically required “as low as reasonably achievable” (ALARA) radiation dose is often demanded by medical physics experts. Manifold techniques that promise decisive advantages over other vendors are repeatedly presented by the industry. It appears mandatory to know potential risks, on one side, and the tools that are available for radiation dose optimization, on the other side. However, the actual art of CT is to adapt this knowledge to every individual situation. A low dose in a young patient could potentially result in a higher extent of stochastic radiation damage than a repetitive high radiation dose in an elder oncologic patient. With this Special Issue, we aim to present a collection of papers that covers all aspects of radiation dose and its close link to image quality. Original research articles about radiation dose assessment and monitoring, radiation biology, radiation dose reduction or efficiency, the radiation dose to medical staff, and protocol design will be considered along with manuscripts about image quality improvements, enhanced image content, personalization, patient preparation, and automation. We wish to increase attention regarding this technical foundation of CT and work out a basic procedure for daily clinical practice.

Dr. Matthias S. May
Guest Editor

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Keywords

radiation dose
image quality
personalization
efficiency
reconstruction
exposure parameters
dual energy
automation
personalization
visualization

Published Papers (11 papers)

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Research

15 pages, 3015 KiB

Open AccessArticle

Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios

by Elke A. Nekolla, Gunnar Brix and Jürgen Griebel

Diagnostics 2022, 12(2), 364; https://doi.org/10.3390/diagnostics12020364 - 1 Feb 2022

Cited by 10 | Viewed by 2432

Abstract

Lung cancer is a severe disease that affects predominantly smokers and represents a leading cause of cancer death in Europe. Recent meta-analyses of randomized controlled trials (RCTs) have yielded that low-dose computed tomography (LDCT) screening can significantly reduce lung cancer mortality in heavy smokers or ex-smokers by about 20% compared to a control group of persons who did not receive LDCT. This benefit must be weighed against adverse health effects associated with LDCT lung screening, in particular radiation risks. For this purpose, representative organ doses were determined for a volume CT dose index of 1 mGy that can be achieved on modern devices. Using these values, radiation risks were estimated for different screening scenarios by means of sex-, organ-, and age-dependent radio-epidemiologic models. In particular, the approach was adjusted to a Western European population. For an annual LDCT screening of (ex-)smokers aged between 50 and 75 years, the estimated radiation-related lifetime attributable risk to develop cancer is below 0.25% for women and about 0.1% for men. Assuming a mortality reduction of about 20% and taking only radiation risks into account, this screening scenario results in a benefit–risk ratio of about 10 for women and about 25 for men. These benefit–risk ratio estimates are based on the results of RCTs of the highest evidence level. To ensure that the benefit outweighs the radiation risk even in standard healthcare, strict conditions and requirements must be established for the entire screening process to achieve a quality level at least as high as that of the considered RCTs. Full article

(This article belongs to the Special Issue Radiation Dose and Image Quality in CT Imaging)

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14 pages, 3310 KiB

Open AccessArticle

Dual-Energy Lung Perfusion in Portal Venous Phase CT—A Comparison with the Pulmonary Arterial Phase

by Isabelle Praël, Wolfgang Wuest, Rafael Heiss, Marco Wiesmueller, Markus Kopp, Michael Uder and Matthias S. May

Diagnostics 2021, 11(11), 1989; https://doi.org/10.3390/diagnostics11111989 - 26 Oct 2021

Cited by 3 | Viewed by 1648

Abstract

Pulmonary arterial dual-energy (aDE) CT is an established technique for evaluating pulmonary perfusion blood volume (PBV). As DECT protocols are increasingly used for thoraco-abdominal CT, this study assessed image quality and clinical findings in portal–venous phase dual-energy (vDE) CT and compared it to aDE. In 95 patients, vDE-CT was performed using a dual-source scanner (70/Sn150 kV, 560/140 ref.mAs). Pulmonary triggered aDE-CT served as reference (n = 94). PBV was reconstructed using a dedicated algorithm. Mean relative attenuation was measured in the pulmonary trunk, aorta, and segmented lung parenchyma. A distribution ratio (DL) between vessels and parenchyma was calculated to assess the iodine uptake of the lung parenchyma. Subjective overall diagnostic image quality was assessed for PBV images on a five-point Likert scale. Image artifacts were classified into five groups based on scale rating and compared between vDE and aDE. Pathological findings were correlated with the anatomical image datasets. Mean relative attenuation of the lung parenchyma was comparable in both groups (vDE: 23 ± 6 HU and aDE: 22 ± 7 HU), but significantly lower in the vessels of vDE. Therefore, iodine uptake of the lung parenchyma was significantly higher in vDE (DL: 10% vs. 8%, p < 0.01). The subjective overall image quality of the PBV images was comparable (p = 0.5). Rotation and streak artifacts were found in most of the patients (>86%, both p > 0.6). Dual-source artifacts were found in only a few patients in both groups (vDE 5%, aDE 7%, p = 0.5). Recess and subpleural artifacts were increased in vDE (vDE 53/27%, aDE 24/7%, both p < 0.001). Pathological findings were found in 19% of the vDE patients and 59% of the aDE patients. Comparable objective and subjective image quality of lung perfusion can be obtained in vDE and aDE. Iodine uptake of the lung parenchyma is increased in vDE compared to aDE, suggesting an interstitial pooling effect. Knowledge of the different appearances of artifacts will aid in the interpretation of the images. Additional clinical information about the lung parenchyma can be provided by PBV evaluation in vDE. Full article

(This article belongs to the Special Issue Radiation Dose and Image Quality in CT Imaging)

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13 pages, 1404 KiB

Open AccessArticle

ALADA Dose Optimization in the Computed Tomography of the Temporal Bone: The Diagnostic Potential of Different Low-Dose CT Protocols

by Barbara Kofler, Laura Jenetten, Annette Runge, Gerald Degenhart, Natalie Fischer, Romed Hörmann, Michael Steurer and Gerlig Widmann

Diagnostics 2021, 11(10), 1894; https://doi.org/10.3390/diagnostics11101894 - 15 Oct 2021

Cited by 6 | Viewed by 4075

Abstract

Objective: Repeated computed tomography (CT) is essential for diagnosis, surgical planning and follow-up in patients with middle and inner ear pathology. Dose reduction to “as low as diagnostically acceptable” (ALADA) is preferable but challenging. We aimed to compare the diagnostic quality of images of subtle temporal bone structures produced with low doses (LD) and reference protocols (RP). Methods: Two formalin-fixed human cadaver heads were scanned using a 64-slice CT scanner and cone-beam CT (CBCT). The protocols were: RP (120 kV, 250 mA, CTDIvol 83.72 mGy), LD1 (100 kV, 80 mA, CTDIvol 26.79 mGy), LD2 (100 kV, 35 mA, CTDIvol 7.66 mGy), LD3 (80 kV, 40 mA, CTDIvol 4.82 mGy), and CBCT standard protocol. Temporal bone structures were assessed using a 5-point scale. Results: A median score of ≥2 was achieved with protocols such as the tendons of m. tensor tympani (RP/LD1/LD2/CBCT) and m. stapedius (CBCT), the incudostapedial joint (RP/LD1/CBCT), the incudomalleolar joint (RP/LD1/LD2/CBCT), the stapes feet (RP/LD1/CBCT), the stapes head (RP/LD1/LD2/CBCT), the tympanic membrane (RP/LD1/LD2/CBCT), the lamina spiralis ossea (none), the chorda tympani (RP/LD1/CBCT), and the modiolus (RP/LD1/LD2/CBCT). Adaptive statistical iterative reconstructions did not show advantages over the filtered back projection. Conclusions: LD protocols using a CTDIvol of 7.66 mGy may be sufficient for the identification of temporal bone structures. Full article

(This article belongs to the Special Issue Radiation Dose and Image Quality in CT Imaging)

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10 pages, 1727 KiB

Open AccessArticle

Evaluation of CT-Guided Ultra-Low-Dose Protocol for Injection Guidance in Preparation of MR-Arthrography of the Shoulder and Hip Joints in Comparison to Conventional and Low-Dose Protocols

by Anja Goeller, Tobias Pogarell, Matthias Stefan May, Michael Uder and Peter Dankerl

Diagnostics 2021, 11(10), 1835; https://doi.org/10.3390/diagnostics11101835 - 4 Oct 2021

Cited by 2 | Viewed by 2930

Abstract

To evaluate patients’ radiation exposure undergoing CT-guided joint injection in preparation of MR-arthrography. We developed a novel ultra-low-dose protocol utilizing tin-filtration, performed it in 60 patients and compared the radiation exposure (DLP) and success rate to conventional protocol (26 cases) and low-dose protocol (37 cases). We evaluated 123 patients’ radiation exposure undergoing CT-guided joint injection from 16 January–21 March. A total of 55 patients received CT-guided joint injections with various other examination protocols and were excluded from further investigation. In total, 56 patients received shoulder injection and 67 received hip injection with consecutive MR arthrography. The ultra-low-dose protocol was performed in 60 patients, the low-dose protocol in 37 patients and the conventional protocol in 26 patients. We compared the dose of the interventional scans for each protocol (DLP) and then evaluated success rate with MR-arthrography images as gold standard of intraarticular or extracapsular contrast injection. There were significant differences when comparing the DLP of the ultra-low-dose protocol (DLP 1.1 ± 0.39; p < 0.01) to the low dose protocol (DLP 5.3 ± 3.24; p < 0.01) as well as against the conventional protocol (DLP 22.9 ± 8.66; p < 0.01). The ultra-low-dose protocol exposed the patients to an average effective dose of 0.016 millisievert and resulted in a successful joint injection in all 60 patients. The low dose protocol as well as the conventional protocol were also successful in all patients. The presented ultra-low-dose CT-guided joint injection protocol for the preparation of MR-arthrography demonstrated to reduce patients’ radiation dose in a way that it was less than the equivalent of the natural radiation exposure in Germany over 3 days—and thereby, negligible to the patient. Full article

(This article belongs to the Special Issue Radiation Dose and Image Quality in CT Imaging)

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12 pages, 2101 KiB

Open AccessArticle

Single- and Dual-Source CT Myelography: Comparison of Radiation Exposure and Establishment of Diagnostic Reference Levels

by Sebastian Zensen, Denise Bos, Marcel Opitz, Michael Forsting, Nika Guberina, Cornelius Deuschl and Axel Wetter

Diagnostics 2021, 11(10), 1809; https://doi.org/10.3390/diagnostics11101809 - 30 Sep 2021

Cited by 2 | Viewed by 2000

Abstract

CT myelography (CTM) is a diagnostic technique for the evaluation of various spinal pathologies, and plays an important role in diagnosis of different diseases such as spontaneous intracranial hypotension and postoperative cerebrospinal fluid leaks. The aims of this study were to examine radiation exposure, establish diagnostic reference levels (DRLs) and compare radiation doses of single- and dual-source examinations and different CTM protocols. In this retrospective study, 183 CTMs comprising 155 single-source and 28 dual-source examinations, performed between May 2015 and December 2020, were analyzed. Dose data included 31 whole spine (A), 23 cervical (B), 10 thoracic (C), and 119 lumbar (D) CTMs. Radiation exposure was reported for volume-weighted CT dose index (CTDI_vol) and dose-length product (DLP). Radiation doses for CTDI_vol and DLP were distributed as follows (median, IQR): A: 7.44 mGy (6.01–11.17 mGy)/509.7 mGy·cm (382.4–682.9 mGy·cm), B: 9.31 mGy (7.20–14.64 mGy)/214.5 mGy·cm (153.7–308.2 mGy·cm), C: 6.80 mGy (6.14–8.26 mGy)/365.4 mGy·cm (222.8–432.4 mGy·cm), D: 11.02 mGy (7.97–14.89 mGy)/308.0 mGy·cm (224.7–413.7 mGy·cm). Local DRLs could be depicted as follows (CTDI_vol/DLP): A: 11 mGy/683 mGy·cm, B: 15 mGy/308 mGy·cm, C: 8 mGy/432 mGy·cm, D: 15 mGy/414 mGy·cm. High image quality was achieved for all anatomical regions. Basically, radiation exposure of CTM differs according to anatomical location. Full article

(This article belongs to the Special Issue Radiation Dose and Image Quality in CT Imaging)

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19 pages, 4187 KiB

Open AccessArticle

Quantitative Image Quality Metrics of the Low-Dose 2D/3D Slot Scanner Compared to Two Conventional Digital Radiography X-ray Imaging Systems

by Ahmed Jibril Abdi, Bo R. Mussmann, Alistair Mackenzie, Oke Gerke, Benedikte Klaerke and Poul Erik Andersen

Diagnostics 2021, 11(9), 1699; https://doi.org/10.3390/diagnostics11091699 - 17 Sep 2021

Cited by 4 | Viewed by 3517

Abstract

The aim of this study was to determine the quantitative image quality metrics of the low-dose 2D/3D EOS slot scanner X-ray imaging system (LDSS) compared with conventional digital radiography (DR) X-ray imaging systems. The effective detective quantum efficiency (eDQE) and effective noise quantum equivalent (eNEQ) were measured using chest and knee protocols. Methods: A Nationwide Evaluation of X-ray Trends (NEXT) of a chest adult phantom and a PolyMethylmethacrylate (PMMA) phantom were used for the chest and knee protocols, respectively. Quantitative image quality metrics, including effective normalised noise power spectrum (eNNPS), effective modulation transfer function (eMTF), eDQE and eNEQ of the LDSS and DR imaging systems were assessed and compared. Results: In the chest acquisition, the LDSS imaging system achieved significantly higher eNEQ and eDQE than the DR imaging systems at lower and higher spatial frequencies (0.001 ≤ p ≤ 0.044). For the knee acquisition, the LDSS imaging system also achieved significantly higher eNEQ and eDQE than the DR imaging systems at lower and higher spatial frequencies (0.001 ≤ p ≤ 0.002). However, there was no significant difference in eNEQ and eDQE between DR systems 1 and 2 at lower and higher spatial frequencies (0.10 < p < 1.00) for either chest or knee protocols. Conclusion: The LDSS imaging system performed well compared to the DR systems. Thus, we have demonstrated that the LDSS imaging system has the potential to be used for clinical diagnostic purposes. Full article

(This article belongs to the Special Issue Radiation Dose and Image Quality in CT Imaging)

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9 pages, 1747 KiB

Open AccessArticle

Strategy to Reduce the Collective Equivalent Dose for the Lens of the Physician’s Eye Using Short Radiation Protection Curtains to Prevent Cataracts

by Koichi Nakagami, Takashi Moritake, Keisuke Nagamoto, Koichi Morota, Satoru Matsuzaki, Tomoko Kuriyama and Naoki Kunugita

Diagnostics 2021, 11(8), 1415; https://doi.org/10.3390/diagnostics11081415 - 5 Aug 2021

Cited by 6 | Viewed by 2063

Abstract

A short curtain that improves on the low versatility of existing long curtains was developed as a dedicated radiation protective device for the over-table tube fluorographic imaging units. The effect of this short curtain in preventing cataracts was then examined. First, the physician lens dose reduction rate was obtained at the position of the lens. Next, the reduction rate in the collective equivalent dose for the lens of the physician’s eye was estimated. The results showed that lens dose reduction rates with the long curtain and the short curtain were 88.9% (literature-based value) and 17.6%, respectively, higher with the long curtain. In our hospital, the reduction rate in the collective equivalent dose for the lens of the physician’s eye was 9.8% and 17.6% with a procedures mixture, using the long curtain where technically possible and no curtain in all other procedures, and the short curtain in all procedures, respectively, higher with the short curtain. Moreover, a best available for curtains raised the reduction rate in the collective equivalent dose for the lens of the physician’s eye a maximum of 25.5%. By introducing the short curtain, it can be expected to have an effect in preventing cataracts in medical staff. Full article

(This article belongs to the Special Issue Radiation Dose and Image Quality in CT Imaging)

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15 pages, 2994 KiB

Open AccessArticle

Diagnostic Performance of a Contrast-Enhanced Ultra-Low-Dose High-Pitch CT Protocol with Reduced Scan Range for Detection of Pulmonary Embolisms

by Andreas S. Brendlin, Moritz T. Winkelmann, Felix Peisen, Christoph P. Artzner, Konstantin Nikolaou, Ahmed E. Othman and Saif Afat

Diagnostics 2021, 11(7), 1251; https://doi.org/10.3390/diagnostics11071251 - 13 Jul 2021

Cited by 4 | Viewed by 2442

Abstract

(1) Background: To evaluate the diagnostic performance of a simulated ultra-low-dose (ULD), high-pitch computed tomography pulmonary angiography (CTPA) protocol with low tube current (mAs) and reduced scan range for detection of pulmonary embolisms (PE). (2) Methods: We retrospectively included 130 consecutive patients (64 ± 16 years, 69 female) who underwent clinically indicated high-pitch CTPA examination for suspected acute PE on a 3rd generation dual-source CT scanner (SOMATOM FORCE, Siemens Healthineers, Forchheim, Germany). ULD datasets with a realistic simulation of 25% mAs, reduced scan range (aortic arch—basal pericardium), and Advanced Modeled Iterative Reconstruction (ADMIRE®, Siemens Healthineers, Forchheim, Germany) strength 5 were created. The effective radiation dose (ED) of both datasets (standard and ULD) was estimated using a dedicated dosimetry software solution. Subjective image quality and diagnostic confidence were evaluated independently by three reviewers using a 5-point Likert scale. Objective image quality was compared using noise measurements. For assessment of diagnostic accuracy, patients and pulmonary vessels were reviewed binarily for affection by PE, using standard CTPA protocol datasets as the reference standard. Percentual affection of pulmonary vessels by PE was computed for disease severity (modified Qanadli score). (3) Results: Mean ED in ULD protocol was 0.7 ± 0.3 mSv (16% of standard protocol: 4.3 ± 1.7 mSv, p < 0.001, r > 0.5). Comparing ULD to standard protocol, subjective image quality and diagnostic confidence were comparably good (p = 0.486, r > 0.5) and image noise was significantly lower in ULD (p < 0.001, r > 0.5). A total of 42 patients (32.2%) were affected by PE. ULD protocol had a segment-based false-negative rate of only 0.1%. Sensitivity for detection of any PE was 98.9% (95% CI, 97.2–99.7%), specificity was 100% (95% CI, 99.8–100%), and overall accuracy was 99.9% (95% CI, 98.6–100%). Diagnoses correlated strongly between ULD and standard protocol (Chi-square (1) = 42, p < 0.001) with a decrease in disease severity of only 0.48% (T = 1.667, p = 0.103). (4) Conclusions: Compared to a standard CTPA protocol, the proposed ULD protocol proved reliable in detecting and ruling out acute PE with good levels of image quality and diagnostic confidence, as well as significantly lower image noise, at 0.7 ± 0.3 mSv (84% dose reduction). Full article

(This article belongs to the Special Issue Radiation Dose and Image Quality in CT Imaging)

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12 pages, 2412 KiB

Open AccessArticle

Radiation Dose Reduction in CT Torsion Measurement of the Lower Limb: Introduction of a New Ultra-Low Dose Protocol

by Gabriel Keller, Simon Götz, Mareen Sarah Kraus, Leonard Grünwald, Fabian Springer and Saif Afat

Diagnostics 2021, 11(7), 1209; https://doi.org/10.3390/diagnostics11071209 - 3 Jul 2021

Cited by 6 | Viewed by 2717

Abstract

This study analyzed the radiation exposure of a new ultra-low dose (ULD) protocol compared to a high-quality (HQ) protocol for CT-torsion measurement of the lower limb. The analyzed patients (n = 60) were examined in the period March to October 2019. In total, 30 consecutive patients were examined with the HQ and 30 consecutive patients with the new ULD protocol comprising automatic tube voltage selection, automatic exposure control, and iterative image reconstruction algorithms. Radiation dose parameters as well as the contrast-to-noise ratio (CNR) and diagnostic confidence (DC; rated by two radiologists) were analyzed and potential predictor variables, such as body mass index and body volume, were assessed. The new ULD protocol resulted in significantly lower radiation dose parameters, with a reduction of the median total dose equivalent to 0.17 mSv in the ULD protocol compared to 4.37 mSv in the HQ protocol (p < 0.001). Both groups showed no significant differences in regard to other parameters (p = 0.344–0.923). CNR was 12.2% lower using the new ULD protocol (p = 0.033). DC was rated best by both readers in every HQ CT and in every ULD CT. The new ULD protocol for CT-torsion measurement of the lower limb resulted in a 96% decrease of radiation exposure down to the level of a single pelvic radiograph while maintaining good image quality. Full article

(This article belongs to the Special Issue Radiation Dose and Image Quality in CT Imaging)

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14 pages, 5690 KiB

Open AccessArticle

Cerebral CT Perfusion in Acute Stroke: The Effect of Lowering the Tube Load and Sampling Rate on the Reproducibility of Parametric Maps

by Georgios S. Ioannidis, Søren Christensen, Katerina Nikiforaki, Eleftherios Trivizakis, Kostas Perisinakis, Adam Hatzidakis, Apostolos Karantanas, Mauricio Reyes, Maarten Lansberg and Kostas Marias

Diagnostics 2021, 11(6), 1121; https://doi.org/10.3390/diagnostics11061121 - 19 Jun 2021

Cited by 8 | Viewed by 2444

Abstract

The aim of this study was to define lower dose parameters (tube load and temporal sampling) for CT perfusion that still preserve the diagnostic efficiency of the derived parametric maps. Ninety stroke CT examinations from four clinical sites with 1 s temporal sampling and a range of tube loads (mAs) (100–180) were studied. Realistic CT noise was retrospectively added to simulate a CT perfusion protocol, with a maximum reduction of 40% tube load (mAs) combined with increased sampling intervals (up to 3 s). Perfusion maps from the original and simulated protocols were compared by: (a) similarity using a voxel-wise Pearson’s correlation coefficient r with in-house software; (b) volumetric analysis of the infarcted and hypoperfused volumes using commercial software. Pearson’s r values varied for the different perfusion metrics from 0.1 to 0.85. The mean slope of increase and cerebral blood volume present the highest r values, remaining consistently above 0.7 for all protocol versions with 2 s sampling interval. Reduction of the sampling rate from 2 s to 1 s had only modest impacts on a TMAX volume of 0.4 mL (IQR −1–3) (p = 0.04) and core volume of −1.1 mL (IQR −4–0) (p < 0.001), indicating dose savings of 50%, with no practical loss of diagnostic accuracy. The lowest possible dose protocol was 2 s temporal sampling and a tube load of 100 mAs. Full article

(This article belongs to the Special Issue Radiation Dose and Image Quality in CT Imaging)

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9 pages, 1084 KiB

Open AccessArticle

Cutting Staff Radiation Exposure and Improving Freedom of Motion during CT Interventions: Comparison of a Novel Workflow Utilizing a Radiation Protection Cabin versus Two Conventional Workflows

by Peter Dankerl, Matthias Stefan May, Christian Canstein, Michael Uder and Marc Saake

Diagnostics 2021, 11(6), 1099; https://doi.org/10.3390/diagnostics11061099 - 16 Jun 2021

Cited by 1 | Viewed by 1960

Abstract

This study aimed to evaluate the radiation exposure to the radiologist and the procedure time of prospectively matched CT interventions implementing three different workflows—the radiologist—(I) leaving the CT room during scanning; (II) wearing a lead apron and staying in the CT room; (III) staying in the CT room in a prototype radiation protection cabin without lead apron while utilizing a wireless remote control and a tablet. We prospectively evaluated the radiologist’s radiation exposure utilizing an electronic personal dosimeter, the intervention time, and success in CT interventions matched to the three different workflows. We compared the interventional success, the patient’s dose of the interventional scans in each workflow (total mAs and total DLP), the radiologist’s personal dose (in µSV), and interventional time. To perform workflow III, a prototype of a radiation protection cabin, with 3 mm lead equivalent walls and a foot switch to operate the doors, was built in the CT examination room. Radiation exposure during the maximum tube output at 120 kV was measured by the local admission officials inside the cabin at the same level as in the technician’s control room (below 0.5 μSv/h and 1 mSv/y). Further, to utilize the full potential of this novel workflow, a sterile packed remote control (to move the CT table and to trigger the radiation) and a sterile packed tablet anchored on the CT table (to plan and navigate during the CT intervention) were operated by the radiologist. There were 18 interventions performed in workflow I, 16 in workflow II, and 27 in workflow III. There were no significant differences in the intervention time (workflow I: 23 min ± 12, workflow II: 20 min ± 8, and workflow III: 21 min ± 10, p = 0.71) and the patient’s dose (total DLP, p = 0.14). However, the personal dosimeter registered 0.17 ± 0.22 µSv for workflow II, while I and III both documented 0 µSv, displaying significant difference (p < 0.001). All workflows were performed completely and successfully in all cases. The new workflow has the potential to reduce interventional CT radiologists’ radiation dose to zero while relieving them from working in a lead apron all day. Full article

(This article belongs to the Special Issue Radiation Dose and Image Quality in CT Imaging)

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