Use of diagnostic vs low-dose computed tomography in positron emission tomography-CT examinations.
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| Title: | Use of diagnostic vs low-dose computed tomography in positron emission tomography-CT examinations. |
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| Authors: | Malekhedayat, Matthew1 (AUTHOR), Stewart, Carly1 (AUTHOR), Chu, Philip W.1 (AUTHOR), Wang, Yifei1 (AUTHOR), Kasraie, Nima2 (AUTHOR), Franc, Benjamin3 (AUTHOR), Smith-Bindman, Rebecca1,4,5 (AUTHOR) Rebecca.Smith-Bindman@ucsf.edu |
| Source: | European Radiology. Sep2025, Vol. 35 Issue 9, p5468-5477. 10p. |
| Subjects: | Computed tomography, Radiation doses, Positron emission tomography computed tomography, Diagnostic imaging, Ionizing radiation |
| Abstract: | Objectives: To examine CT radiation dose variation in PET-CT and understand how often providers use diagnostic vs lower doses for attenuation correction and anatomic localization (AC/AL). Methods: Retrospective, multi-centered study of PET-CT exams from 2010 to 2021. Exams were categorized as body or brain. Radiation dose was quantified using dose length product (DLP), adjusted for patient size (DLPS-ADJ), and for size and scan length (DLPSL-ADJ). DLPS-ADJ variation was assessed by body region and facility. To ascertain whether sites use AC/AL or diagnostic doses, we compared each facility's DLPS-ADJ in CTs from PET-CT vs diagnostic CT exams of analogous body regions (not associated with PET), controlling for scan length using DLPSL-ADJ. Lastly, we categorized exams as likely diagnostic if they used multiple phases and/or contrast to compare dose and frequency with likely non-diagnostic exams. Results: Sixty-four thousand two hundred ten exams included 93% body, 7% brain. Doses were higher and more variable in the body than brain exams (adult mean DLPS-ADJ = 1004 vs 341 mGy-cm, respectively). For body exams, DLPS-ADJ was higher in older children than adults, and there was wide inter-facility variation (median DLPS-ADJ range = 245–2391 mGy-cm). Most facilities used higher CT doses in body PET-CT than in diagnostic CT exams even controlling for scan length. Fifty-three percent of adult and 76% of child body exams were likely diagnostic based on the use of diagnostic techniques. Conclusion: While diagnostic CT is sometimes indicated for PET-CT, body exams generally do not use AC/AL protocols. Doses were higher than previously reported, higher than analogous diagnostic CT exams, and higher in older children than adults when size adjusted. Key Points: Question How does CT radiation dose vary in PET-CT and how often do providers use diagnostic vs lower doses for AC/AL? FindingsMost facilities did not use AC/AL protocols for body PET-CT, and CT effective doses were higher than previously reported. Clinical relevanceThe considerable inter-facility variation observed suggests ample opportunity to reduce ionizing radiation doses for CT in body PET-CT by adopting low-dose (AC/AL) protocols and other dose reduction techniques. [ABSTRACT FROM AUTHOR] |
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| Database: | Engineering Source |
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| Abstract: | Objectives: To examine CT radiation dose variation in PET-CT and understand how often providers use diagnostic vs lower doses for attenuation correction and anatomic localization (AC/AL). Methods: Retrospective, multi-centered study of PET-CT exams from 2010 to 2021. Exams were categorized as body or brain. Radiation dose was quantified using dose length product (DLP), adjusted for patient size (DLPS-ADJ), and for size and scan length (DLPSL-ADJ). DLPS-ADJ variation was assessed by body region and facility. To ascertain whether sites use AC/AL or diagnostic doses, we compared each facility's DLPS-ADJ in CTs from PET-CT vs diagnostic CT exams of analogous body regions (not associated with PET), controlling for scan length using DLPSL-ADJ. Lastly, we categorized exams as likely diagnostic if they used multiple phases and/or contrast to compare dose and frequency with likely non-diagnostic exams. Results: Sixty-four thousand two hundred ten exams included 93% body, 7% brain. Doses were higher and more variable in the body than brain exams (adult mean DLPS-ADJ = 1004 vs 341 mGy-cm, respectively). For body exams, DLPS-ADJ was higher in older children than adults, and there was wide inter-facility variation (median DLPS-ADJ range = 245–2391 mGy-cm). Most facilities used higher CT doses in body PET-CT than in diagnostic CT exams even controlling for scan length. Fifty-three percent of adult and 76% of child body exams were likely diagnostic based on the use of diagnostic techniques. Conclusion: While diagnostic CT is sometimes indicated for PET-CT, body exams generally do not use AC/AL protocols. Doses were higher than previously reported, higher than analogous diagnostic CT exams, and higher in older children than adults when size adjusted. Key Points: Question How does CT radiation dose vary in PET-CT and how often do providers use diagnostic vs lower doses for AC/AL? FindingsMost facilities did not use AC/AL protocols for body PET-CT, and CT effective doses were higher than previously reported. Clinical relevanceThe considerable inter-facility variation observed suggests ample opportunity to reduce ionizing radiation doses for CT in body PET-CT by adopting low-dose (AC/AL) protocols and other dose reduction techniques. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 09387994 |
| DOI: | 10.1007/s00330-025-11391-w |
