InstructionsRER9132: Strengthening Member State Technical Capabilities in Medical Radiation Protection (2014 2015)Task 1.Development of diagnostic reference doses at clinically acceptable image qualityModality: Comuted tomography (CT)Instructions for project task implementationChoose CT rooms for data collectionCollect data for each CT scanner in a separate filePreferably collect data prospectivelyName the file in the following way: Country_City_CTscannerID.xlsIn the form CT1 provide data for the CT scannerUse form CT2 to collect data for patient examinations. Separate worksheets are provided for adult and paediatric examination. You may use one or both for a particular scanner.Collect in a separate worksheet data for each of the following examinations (related to the most common indication is given in the parenthesis):AdultHead (acute stroke)ChildrenHead (Brain +soft tissues)Chest (lung cancer)Chest/thoraxChest high resolution (interstitial lung disease)AbdomenAbdomen (liver metastases)Abdomen and pelvis (abscess)Chest-abdomen-pelvis (cancer)For each examination, collect data for at least 20 adult patients (age >15) and 50 pediatric patients of different size/age pooled together. No weight restriction applies.For each patient, indicate the Image quality score (three level scale), see instructions in the formAdditional instructions are included in the forms

Form CT1Contact detailsCountryCityHospitalName of the person completed the formPosition/professionThe forms completed on (Day/Month/Year)e-mailData for the CT scannerCT manufacturerCT modelYear of installationYear of manufacturingNumber of detector rowsAutomatic exposure control (tube current modulation) available?CTDI / DLP display available?If Yes, CTDI displayed in CTDIw or CTDIvol?If Yes, was CTDI display verified by measurements? Agreement (%)?CTDI for pediatric body displayed for which phantom (16 cm or 32 cm)?Annual workload (No of adult examinations/year)Annual workload (No of paediatric examinations/year)

Form CT2 adultsPatient NoData of examinationPatient dataScout image/images: AP; PA; Lat?Patient body AP diameter, cm *Lateral body width, cm*Clinical indicationNumber of examination seqencesSequence labelContrast material usedExposure parametersPitch, pBeam width (NxT), mmScanning range (cm)Scanning modeDose data displayedShielding used?Image quality scoreGender (m/f)AgeHeight (cm)Weight (kg)kVmAmAstrot (s)CTDI (mGy): list in separate rows for each phase/secuenceReference phantom (16 cm or 32 cm)DLP (mGy.cm) total for the examinationAverage000000000Standard deviation000000000Minimum000000000Maximum000000000Median000000000Third quartile000000000NB: Please copy rows from above to provide more data*For AP and lateral body width, select an image in the middle of the scan region. Measure diameters, as shown on the image. Lateral body width corresponds to patient width measured along major (transverse) axis in middle image of main scan sequence. AP body diameter corresponds to patient width measured along minor (anterior-posterior) axis in middle image of main scan sequence.Contrast material used: No - no contrast; O - oral; IV - intravenous; R - rectalProtective shield used: Pb - lead shield; Bi - Bismuth shield; No - shield not usedImage quality scoring to be done by a radiologist:1 - fully acceptable2 - acceptable with remarks3 - unacceptable

Lateral body widthAP body diameterA seqence is related to the aqusition of series of imaging data using a particular set of exposure parameters ( may be in relation to imaging for different phases in the distribution of contrast medium)If the examinations or phase of examination consists of more than one sequences with different scanning parameters, enter a separate row for each of them. This also could be within a single phaseFor SSCT = slice thickness h;For MSCT = product of slice collimation hcol and the number N of slices acquired simultaneouslyPb - lead shieldBi - Bismuth shieldNo - not usedtime for one slice in axial mode or time for one rotation in spiral modeDelete the wrong symbol. Provide CTDI for each seqence.If mA modulation is applied, enter the average mA/mAs for all slices in the sequenceIf mA modulation is applied, enter the average mA/mAs for all slices in the sequenceProvide DLP only for the whole examination, inluding all seqences.

Form CT2 childrenPatient NoData of examinationPatient dataScout image/images: AP; PA; Lat?Patient body AP diameter, cm *Lateral body width, cm*Clinical indicationNumber of examination seqencesSequence labelContrast material usedExposure parametersPitch, pBeam width (NxT), mmScanning range (cm)Scanning modeDose data displayedShielding used?Image quality scoreImmobilisation means usedSedation used?Somebody to support patient in the room?Gender (m/f)Age (in days for age 1 y)Height (cm)Weight (kg)kVmAmAstrot (s)CTDI (mGy): list in separate rows for each phase/secuenceReference phantom (16 cm or 32 cm)DLP (mGy.cm) total for the examinationAverage000000000Standard deviation000000000Minimum000000000Maximum000000000Median000000000Third quartile000000000NB: Please copy rows from above to provide more data*For AP and lateral body width, select an image in the middle of the scan region. Measure diameters, as shown on the image. Lateral body width corrresponds to patient width measured along major (transverse) axis in middle image of main scan sequence. AP body diameter coresponds to patient width measured along minor (antero-posterior) axis in middle image of main scan sequence.Contrast material used: No - no contrast; O - oral; IV - intravenous; R - rectalProtective shield used: Pb - lead shield; Bi - Bismuth shield; No - shield not usedImage quality scoring to be done by a radiologist:1 - fully acceptable2 - acceptable with remarks3 - unacceptable

Lateral body widthAP body diameterA seqence is related to the aqusition of series of imaging data using a particular set of exposure parameters ( may be in relation to imaging for different phases in the distribution of contrast medium).If the examinations or phase of examination consists of more than one sequences with different scanning parameters, enter a separate row for each of them. This also could be within a single phase.For SSCT = slice thickness h;For MSCT = product of slice collimation hcol and the number N of slices acquired simultaneouslyPb - lead shieldBi - Bismuth shieldNo - not usedIf mA modulation is applied, enter the average mA/mAs for all slices in the sequenceIf mA modulation is applied, enter the average mA/mAs for all slices in the sequencetime for one slice in axial mode or time for one rotation in spiral modeDelete the wrong symbol. Provide CTDI for each seqence.Provide DLP only for the whole examination, inluding all seqences.

Data for drop-down listsIndicationOther data for drop-down listsHead (acute stroke):Head: acute strokeManufacturersRowsYNPhantomGenderScoutContrastModeShieldingImageQualityImmobilisationSupportCTDIHead:query strokeGE