ACR White Paper-Based Comprehensive Dose Reduction Initiative Is Associated With a Reversal of the Upward Trend in Radiation Dose for Chest CT

J Am Coll Radiol. 2015 Dec;12(12 Pt A):1251-6. doi: 10.1016/j.jacr.2015.07.022. Epub 2015 Oct 17.


Purpose: In 2010, the authors' department implemented a comprehensive dose reduction strategy based on the ACR white paper on radiation dose in medicine. The aim of this study was to evaluate the effectiveness of the dose reduction program.

Methods: In total, 1,234 adult chest CT scans from 2007 to 2012 were analyzed retrospectively, with institutional review board approval and a waiver of the requirement for informed consent. The primary outcome was effective dose in millisieverts during the three-year periods before (2007-2009) and after (2010-2012) dose reduction implementation. Dose trends were analyzed by fitted linear modeling. The use and effects on total exposure of dose reduction strategies (high pitch, adaptive statistical iterative reconstruction [ASIR], and low tube voltage) were analyzed.

Results: The overall mean dose for chest CT was 7.3 ± 5.1 mSv. The mean dose decreased by 30%, from 9.2 mSv (2007-2009) to 6.5 mSv (2010-2012) (P < .001). From 2007 to 2009, the mean dose increased by 1.2 mSv per year (P < .01). From 2010 to 2012, the mean dose decreased by 1.1 mSv per year (P < 0.01). High-pitch technique, ASIR, and low tube voltage increased significantly after dose reduction implementation. High pitch and ASIR were significantly associated with a reduced dose, whereas the effect of reduced voltage was not significant.

Conclusions: Reductions in radiation exposure from medical imaging rely on ongoing technical developments and consistent, vigilant use of dose reduction strategies. This comprehensive dose reduction strategy significantly reduced radiation exposure from chest CT. Annual increases in radiation dose reversed after the strategy was implemented and continued to decline over the study period.

Keywords: Dose reduction; chest CT; radiation dose.

Publication types

  • Comparative Study

MeSH terms

  • Age Factors
  • Aged
  • Cohort Studies
  • Dose-Response Relationship, Radiation
  • Female
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic / standards
  • Quality Improvement
  • Radiation Dosage*
  • Radiation Monitoring / methods*
  • Radiation Protection*
  • Radiography, Thoracic / adverse effects
  • Radiography, Thoracic / methods*
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Societies, Medical / standards
  • Tomography, X-Ray Computed / adverse effects
  • Tomography, X-Ray Computed / methods*