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

Gwenny Verfaillie; Caro Franck; An De Crop; Laurence Beels; Yves D'Asseler; Klaus Bacher

doi:10.1186/s40658-023-00553-8

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

EJNMMI Phys. 2023 May 25;10(1):32. doi: 10.1186/s40658-023-00553-8.

Authors

Gwenny Verfaillie¹, Caro Franck², An De Crop^{3

4}, Laurence Beels⁵, Yves D'Asseler^{6

7}, Klaus Bacher⁸

Affiliations

¹ Department of Human Structure and Repair, Ghent University, Ghent, Belgium. gwenny.verfaillie@ugent.be.
² mVISION, Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium.
³ Department of Nuclear Medicine, AZ Delta, Roeselare, Belgium.
⁴ Department of Radiology, AZ Delta, Roeselare, Belgium.
⁵ Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium.
⁶ Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
⁷ Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.
⁸ Department of Human Structure and Repair, Ghent University, Ghent, Belgium.

Abstract

Background: 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.

Methods: A systematic literature search was performed to identify original articles reporting CT dose index volume (CTDI_vol), 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.

Results: Twenty-seven articles were identified of which twelve reported national DRLs. For brain and tumour PET/CT imaging, CTDI_vol 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 CTDI_vol (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.

Conclusion: 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.

Keywords: CTDI; DLP; DRLs; Hybrid imaging; Nuclear medicine.

Publication types

Review

Grants and funding

7555523/H2020 Euratom