Radiation dose from multidetector row CT imaging for acute stroke

The objective of this study was to determine the radiation dose delivered during comprehensive computed tomography (CT) imaging for acute stroke. 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. Ninety-five examinations were included. Mean DLP was 6,790.0 mGy center dot 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. 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.