Patient centring and scan length. how inaccurate practice impacts on radiation dose in CT colonography (CTC)

Objective: The aim of this study was to acknowledge errors in patients positioning in CT colonography (CTC) and their effect in radiation exposure. Materials and methods: CTC studies of a total of 199 patients coming from two different referral hospitals were retrospectively reviewed. Two parameters have been considered for the analysis: patient position in relation to gantry isocentre and scan length related to the area of interest. CTDI vol and DLP were extracted for each patient. In order to evaluate the estimated effective total dose and the dose to various organs, we used the CT-EXPO ® software version 2.2. This software provides estimates of effective dose and doses to the other various organs. Results: Average value of the patients’ position is found to be below the isocentre for 48 ± 25 mm and 29 ± 27 mm in the prone and supine position. It was observed that the increase in CTDI and DLP values for patients in Group 1, due to the inaccurate positioning, was estimated at about 30% and 20% for prone and supine position, respectively, while in Group 2, a decrease in CTDI and DLP values was estimated at about 16% and 18% for prone and supine position, respectively, due to an average position above isocentre. A dose increase ranging from 4 up to 13% was calculated with increasing the over-scanned region below anal orifice. Conclusion: Radiographers and radiologists need to be aware of dose variation and noise effects on vertical positioning and over-scanning. More accurate training need to be achieved even so when examination protocol varies from general practice.