Skip to main content
SpringerLink
Log in

Radiation dose from multidetector row CT imaging for acute stroke

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

The objective of this study was to determine the radiation dose delivered during comprehensive computed tomography (CT) imaging for acute stroke.

Methods

All CT examinations performed over 18 months using our acute stroke protocol were included. Protocol includes an unenhanced CT head, CT angiography from the arch to vertex, CT perfusion/permeability, and an enhanced CT head. All imaging was acquired with a 64-MDCT. Examinations where any element of the protocol was repeated or omitted due to mistimed injection or patient motion were excluded. Dose-length products (DLP) for all components of each examination were obtained from dose reports generated at the time of acquisition, separating neck, and head calculations. Effective doses for each examination were calculated using the DLP and normalized values of effective dose per DLP appropriate for the body regions imaged.

Results

Ninety-five examinations were included. Mean DLP was 6,790.0 mGy·cm. Effective doses ranged from 11.8 to 27.3 mSv, mean effective dose of 16.4 mSv. Mean effective dose for acquisition of the unenhanced head was 2.7 mSv. Largest contribution to effective dose was the CTA with a mean effective dose of 5.4 mSv. Mean effective dose for the CT perfusion was 4.9 mSv.

Conclusion

A comprehensive CT acute stroke protocol delivered a mean effective dose of 16.4 mSv, which is approximately six times the dose of an unenhanced CT head. These high-dose results must be balanced with the benefits of the detailed anatomic and physiologic data obtained. Centers should implement aggressive dose reduction strategies and freely use MR as a substitute.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. O’Rourke F, Dean N, Akhtar N, Shuaib A (2004) Current and future concepts in stroke prevention. CMAJ 170:1123–1133

    PubMed  Google Scholar 

  2. Statistics Canada (1997) Selected leading causes of death by sex. Statistics Canada, Ottawa

    Google Scholar 

  3. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587

    Article  Google Scholar 

  4. del Zoppo GJ, Higashida RT, Furlan AJ et al (1998) PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. Stroke 29:4–11

    PubMed  Google Scholar 

  5. Furlan A, Higashida R, Wechsler L et al (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA 282:2003–2011

    Article  PubMed  CAS  Google Scholar 

  6. Mullins ME, Schaefer PW, Sorensen AG et al (2002) CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology 224:353–360

    Article  PubMed  Google Scholar 

  7. Lovblad KO, Laubach HJ, Baird AE et al (1998) Clinical experience with diffusion-weighted MR in patients with acute stroke. Am J Neuroradiol 19:1061–1066

    PubMed  CAS  Google Scholar 

  8. Baird AE, Lovblad KO, Dashe JF et al (2000) Clinical correlations of diffusion and perfusion lesion volumes in acute ischemic stroke. Cerebrovasc Dis 10:441–448

    Article  PubMed  CAS  Google Scholar 

  9. Singer OC, Sitzer M, du Mesnil de Rochemont R, Neumann-Haefelinl T (2004) Practical limitations of acute stroke MRI due to patient-related problems. Neurology 62:1848–1849

    PubMed  Google Scholar 

  10. Wintermark M, Meuli R, Browaeys P et al (2007) Comparison of CT perfusion and angiography and MRI in selecting stroke patients for acute treatment. Neurology 68:694–697

    Article  PubMed  CAS  Google Scholar 

  11. Miles KA (2004) Brain Perfusion: computed tomography applications. Neuroradiology 46(Suppl 2):S194–S200

    Article  PubMed  Google Scholar 

  12. Aviv RI, d’Esterre C, Murphy B et al (2009) Relationship between CT perfusion derived blood-brain barrier permeability surface area product and hemorrhagic transformation of ischemic stroke. Radiology 250:867–877

    Article  PubMed  Google Scholar 

  13. Huda W, Ogden KM, Khorasani MR (2008) Converting dose-length product to effective dose at CT. Radiology 248:995–1003

    Article  PubMed  Google Scholar 

  14. Jessen KA, Shrimpton PC, Geleijns J et al (1999) Dosimetry for optimization of patient protection in computed tomography. Appl Radiat Isot 50:165–172

    Article  PubMed  CAS  Google Scholar 

  15. Katz SI, Saluja S, Brink JA, Forman HP (2006) Radiation dose associated with unenhanced CT for suspected renal colic: impact of repetitive studies. Am J Roentgenol 186:1120–1124

    Article  Google Scholar 

  16. Horiguchi J, Kiguchi M, Fujioka C et al (2008) Radiation dose, image quality, stenosis measurement, and CT densitometry using ECG-triggered coronary 64-MDCT angiography: a phantom study. Am J Roentgenol 190:315–320

    Article  Google Scholar 

  17. Cohnen M, Wittsack HJ, Assadi S et al (2006) Radiation exposure of patients in comprehensive computed tomography of the head in acute stroke. Am J Neuroradiol 27:1741–1745

    PubMed  CAS  Google Scholar 

  18. Imanishi Y, Fukui A, Niimi H et al (2005) Radiation-induced temporary hair loss as a radiation damage only occurring in patients who had combination of MDCT and DSA. Eur Radiol 15:41–46

    Article  PubMed  Google Scholar 

  19. Pierce DA, Preston DL (2000) Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 154:178–186

    Article  PubMed  CAS  Google Scholar 

  20. Cardis E, Vrijheid M, Blettner M et al (2007) The 15-country collaborative study of cancer risk among radiation workers in the nuclear industry: estimates of radiation-related cancer risks. Radiat Res 167:396–416

    Article  PubMed  CAS  Google Scholar 

  21. National Council on Radiation Protection and Measurements (1993) Limitation of exposure to ionizing radiation. NUCRP report 116. National Council on Radiation Protection and Measurements, Bethesda

    Google Scholar 

  22. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, National Research Council (2006) Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. National Academies, Washington, DC

    Google Scholar 

  23. Shrimpton PC, Hillier MC, Lewis MA et al (2006) National survey of doses from CT in the UK: 2003. Br J Radiol 79:968–980

    Article  PubMed  CAS  Google Scholar 

  24. Hall EJ, Giaccia AJ (2006) Radiation cataractogenisis. In Radiobiology for the radiologist, 6th edn. Lippincott Williams Williams, Philadelphia

    Google Scholar 

  25. Neriishi K, Nakashima E, Minamoto A et al (2007) Postoperative cataract cases among atomic bomb survivors: radiation dose response and threshold. Radiation Research 168:404–408

    Article  PubMed  CAS  Google Scholar 

  26. Wintermark M, Maeder P, Verdun FR et al (2000) Using 80 kVp versus 120 kVp in perfusion CT measurement of regional cerebral blood flow. Am J Neuroradiol 21:1881–1884

    PubMed  CAS  Google Scholar 

  27. Hirata M, Murase K, Sugawara Y et al (2005) A method for reducing radiation dose in cerebral CT perfusion study with variable scan schedule. Radiat Med 23:162–169

    PubMed  Google Scholar 

  28. Smith AB, Dillon WP, Lau BC et al (2008) Radiation dose reduction strategy for CT protocols: successful implementation in neuroradiology section. Radiology 247:499–506

    Article  PubMed  Google Scholar 

  29. Ederies A, Demchuk A, Chia T et al (2009) Postcontrast CT extravasation is associated with hematoma expansion in CTA spot negative patients. Stroke 40(5):1672–1676

    Article  PubMed  Google Scholar 

  30. Smith AB, Dillon WP, Gould R et al (2007) Radiation dose-reduction strategies for Neuroradiology CT protocols. Am J Neuroradiol 28:1628–1632

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Imaging, Division of Neuroradiology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada

    Anisa Mnyusiwalla, Richard I. Aviv & Sean P. Symons

  2. Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Sean P. Symons

  3. Sunnybrook Research Institute, 2075 Bayview Avenue, Room AG31D, Toronto, ON, Canada, M4N 3M5

    Sean P. Symons

Authors
  1. Anisa Mnyusiwalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard I. Aviv
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sean P. Symons
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sean P. Symons.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mnyusiwalla, A., Aviv, R.I. & Symons, S.P. Radiation dose from multidetector row CT imaging for acute stroke. Neuroradiology 51, 635–640 (2009). https://doi.org/10.1007/s00234-009-0543-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-009-0543-6

Keywords

Search

Navigation