Evaluation of radiation dose reduction in head CT using the half-dose method
Purpose The present study introduced the half-dose method (HDM), which halves the radiation dose for conventional head computed tomography (CT), for postoperative hydrocephalus and follow-up for craniosynostosis at a children’s hospital. This study aimed to evaluate the contribution of selective hea...
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Veröffentlicht in: | Japanese journal of radiology 2023-08, Vol.41 (8), p.872-881 |
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creator | Nakai, Yoshitomo Miyazaki, Osamu Kitamura, Masayuki Imai, Rumi Okamoto, Reiko Tsutsumi, Yoshiyuki Miyasaka, Mikiko Ogiwara, Hideki Miura, Hiroshi Yamada, Kei Nosaka, Shunsuke |
description | Purpose
The present study introduced the half-dose method (HDM), which halves the radiation dose for conventional head computed tomography (CT), for postoperative hydrocephalus and follow-up for craniosynostosis at a children’s hospital. This study aimed to evaluate the contribution of selective head CT scanning optimization towards the overall reduction of radiation exposure.
Materials and methods
We retrospectively assessed 1227 and 1352 head CT examinations acquired before and after the introduction of the HDM, respectively, in children aged 0–15 years. The radiation exposure was evaluated using the CT dose index volume (CTDI-vol), dose-length product (DLP), rate of HDM introduction, and effect of reducing in-hospital radiation dose before and after the introduction of the HDM. For an objective evaluation of the image quality, head CT scans acquired with HDM and full-dose method (FDM) were randomly selected, and the image noise standard deviation (SD) was measured for each scan. In addition, some HDM images were randomly selected and independently reviewed by two radiologists.
Results
The HDM was introduced in 27.9% of all head CTs. The mean CTDI-vol of all head CTs was 21.5 ± 6.9 mGy after the introduction, a 14.9% reduction. The mean DLP was 418.4 ± 152.9 mGy.cm after the introduction, a 17.2% reduction. Compared to the FDM images, the noise SD of the HDM ones worsened by almost 0.9; however, none of the images were difficult or impossible to evaluate.
Conclusion
The HDM yielded diagnostically acceptable images. In addition, a change in protocol for only two diseases successfully reduced the patients’ overall radiation exposure by approximately 15%. Introducing and optimizing the HDM for frequently performed target diseases will be useful in reducing the exposure dose for the hospital’s patient population. |
doi_str_mv | 10.1007/s11604-023-01410-5 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10366020</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2791373119</sourcerecordid><originalsourceid>FETCH-LOGICAL-c620t-5ea7d2038ec898952dfd6a0bd1e912d09c842121758947be4162ffe72486588c3</originalsourceid><addsrcrecordid>eNp9kU1v1EAMhkcIRMvCH-ihisSFS8CemczHqapW5UNaiUuRuI1mM84mVTZTZpJK_fcNm7ItHDjZlh-_tvUydobwEQH0p4yoQJbARQkoEcrqBTtFo3SJYH6-POYaT9ibnG8AlBRSvmYnQlmFSppTtrm68_3kxy4ORWyK5EO3FCFmKhKFqT6U3VC05EOxvi6m3A27YmypaH3flAdwT2Mbw1v2qvF9pnePccV-fL66Xn8tN9-_fFtfbspacRjLirwOHISh2lhjKx6aoDxsA5JFHsDWRnLkqCtjpd6SRMWbhjSXRlXG1GLFLhbd22m7p1DTMCbfu9vU7X26d9F37u_O0LVuF-8cglAK5tUr9uFRIcVfE-XR7btcU9_7geKUHdcWhRaIdkbf_4PexCkN83-OGwtCmMrgTPGFqlPMOVFzvAbB_XbLLW652S13cMtV89D58z-OI3_smQGxAHluDTtKT7v_I_sAR9ye4g</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2890338581</pqid></control><display><type>article</type><title>Evaluation of radiation dose reduction in head CT using the half-dose method</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Nakai, Yoshitomo ; Miyazaki, Osamu ; Kitamura, Masayuki ; Imai, Rumi ; Okamoto, Reiko ; Tsutsumi, Yoshiyuki ; Miyasaka, Mikiko ; Ogiwara, Hideki ; Miura, Hiroshi ; Yamada, Kei ; Nosaka, Shunsuke</creator><creatorcontrib>Nakai, Yoshitomo ; Miyazaki, Osamu ; Kitamura, Masayuki ; Imai, Rumi ; Okamoto, Reiko ; Tsutsumi, Yoshiyuki ; Miyasaka, Mikiko ; Ogiwara, Hideki ; Miura, Hiroshi ; Yamada, Kei ; Nosaka, Shunsuke</creatorcontrib><description>Purpose
The present study introduced the half-dose method (HDM), which halves the radiation dose for conventional head computed tomography (CT), for postoperative hydrocephalus and follow-up for craniosynostosis at a children’s hospital. This study aimed to evaluate the contribution of selective head CT scanning optimization towards the overall reduction of radiation exposure.
Materials and methods
We retrospectively assessed 1227 and 1352 head CT examinations acquired before and after the introduction of the HDM, respectively, in children aged 0–15 years. The radiation exposure was evaluated using the CT dose index volume (CTDI-vol), dose-length product (DLP), rate of HDM introduction, and effect of reducing in-hospital radiation dose before and after the introduction of the HDM. For an objective evaluation of the image quality, head CT scans acquired with HDM and full-dose method (FDM) were randomly selected, and the image noise standard deviation (SD) was measured for each scan. In addition, some HDM images were randomly selected and independently reviewed by two radiologists.
Results
The HDM was introduced in 27.9% of all head CTs. The mean CTDI-vol of all head CTs was 21.5 ± 6.9 mGy after the introduction, a 14.9% reduction. The mean DLP was 418.4 ± 152.9 mGy.cm after the introduction, a 17.2% reduction. Compared to the FDM images, the noise SD of the HDM ones worsened by almost 0.9; however, none of the images were difficult or impossible to evaluate.
Conclusion
The HDM yielded diagnostically acceptable images. In addition, a change in protocol for only two diseases successfully reduced the patients’ overall radiation exposure by approximately 15%. Introducing and optimizing the HDM for frequently performed target diseases will be useful in reducing the exposure dose for the hospital’s patient population.</description><identifier>ISSN: 1867-1071</identifier><identifier>EISSN: 1867-108X</identifier><identifier>DOI: 10.1007/s11604-023-01410-5</identifier><identifier>PMID: 36961648</identifier><language>eng</language><publisher>Singapore: Springer Nature Singapore</publisher><subject>Child ; Computed tomography ; Cranial sutures ; Craniosynostosis ; Drug Tapering ; Evaluation ; Head ; Hospitals ; Humans ; Hydrocephalus ; Image acquisition ; Image quality ; Imaging ; Medical imaging ; Medicine ; Medicine & Public Health ; Noise standards ; Nuclear Medicine ; Optimization ; Original ; Original Article ; Radiation ; Radiation Dosage ; Radiation effects ; Radiology ; Radiotherapy ; Retrospective Studies ; Tomography, X-Ray Computed - methods</subject><ispartof>Japanese journal of radiology, 2023-08, Vol.41 (8), p.872-881</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c620t-5ea7d2038ec898952dfd6a0bd1e912d09c842121758947be4162ffe72486588c3</citedby><cites>FETCH-LOGICAL-c620t-5ea7d2038ec898952dfd6a0bd1e912d09c842121758947be4162ffe72486588c3</cites><orcidid>0000-0002-8259-2147</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11604-023-01410-5$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11604-023-01410-5$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36961648$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nakai, Yoshitomo</creatorcontrib><creatorcontrib>Miyazaki, Osamu</creatorcontrib><creatorcontrib>Kitamura, Masayuki</creatorcontrib><creatorcontrib>Imai, Rumi</creatorcontrib><creatorcontrib>Okamoto, Reiko</creatorcontrib><creatorcontrib>Tsutsumi, Yoshiyuki</creatorcontrib><creatorcontrib>Miyasaka, Mikiko</creatorcontrib><creatorcontrib>Ogiwara, Hideki</creatorcontrib><creatorcontrib>Miura, Hiroshi</creatorcontrib><creatorcontrib>Yamada, Kei</creatorcontrib><creatorcontrib>Nosaka, Shunsuke</creatorcontrib><title>Evaluation of radiation dose reduction in head CT using the half-dose method</title><title>Japanese journal of radiology</title><addtitle>Jpn J Radiol</addtitle><addtitle>Jpn J Radiol</addtitle><description>Purpose
The present study introduced the half-dose method (HDM), which halves the radiation dose for conventional head computed tomography (CT), for postoperative hydrocephalus and follow-up for craniosynostosis at a children’s hospital. This study aimed to evaluate the contribution of selective head CT scanning optimization towards the overall reduction of radiation exposure.
Materials and methods
We retrospectively assessed 1227 and 1352 head CT examinations acquired before and after the introduction of the HDM, respectively, in children aged 0–15 years. The radiation exposure was evaluated using the CT dose index volume (CTDI-vol), dose-length product (DLP), rate of HDM introduction, and effect of reducing in-hospital radiation dose before and after the introduction of the HDM. For an objective evaluation of the image quality, head CT scans acquired with HDM and full-dose method (FDM) were randomly selected, and the image noise standard deviation (SD) was measured for each scan. In addition, some HDM images were randomly selected and independently reviewed by two radiologists.
Results
The HDM was introduced in 27.9% of all head CTs. The mean CTDI-vol of all head CTs was 21.5 ± 6.9 mGy after the introduction, a 14.9% reduction. The mean DLP was 418.4 ± 152.9 mGy.cm after the introduction, a 17.2% reduction. Compared to the FDM images, the noise SD of the HDM ones worsened by almost 0.9; however, none of the images were difficult or impossible to evaluate.
Conclusion
The HDM yielded diagnostically acceptable images. In addition, a change in protocol for only two diseases successfully reduced the patients’ overall radiation exposure by approximately 15%. Introducing and optimizing the HDM for frequently performed target diseases will be useful in reducing the exposure dose for the hospital’s patient population.</description><subject>Child</subject><subject>Computed tomography</subject><subject>Cranial sutures</subject><subject>Craniosynostosis</subject><subject>Drug Tapering</subject><subject>Evaluation</subject><subject>Head</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hydrocephalus</subject><subject>Image acquisition</subject><subject>Image quality</subject><subject>Imaging</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Noise standards</subject><subject>Nuclear Medicine</subject><subject>Optimization</subject><subject>Original</subject><subject>Original Article</subject><subject>Radiation</subject><subject>Radiation Dosage</subject><subject>Radiation effects</subject><subject>Radiology</subject><subject>Radiotherapy</subject><subject>Retrospective Studies</subject><subject>Tomography, X-Ray Computed - methods</subject><issn>1867-1071</issn><issn>1867-108X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kU1v1EAMhkcIRMvCH-ihisSFS8CemczHqapW5UNaiUuRuI1mM84mVTZTZpJK_fcNm7ItHDjZlh-_tvUydobwEQH0p4yoQJbARQkoEcrqBTtFo3SJYH6-POYaT9ibnG8AlBRSvmYnQlmFSppTtrm68_3kxy4ORWyK5EO3FCFmKhKFqT6U3VC05EOxvi6m3A27YmypaH3flAdwT2Mbw1v2qvF9pnePccV-fL66Xn8tN9-_fFtfbspacRjLirwOHISh2lhjKx6aoDxsA5JFHsDWRnLkqCtjpd6SRMWbhjSXRlXG1GLFLhbd22m7p1DTMCbfu9vU7X26d9F37u_O0LVuF-8cglAK5tUr9uFRIcVfE-XR7btcU9_7geKUHdcWhRaIdkbf_4PexCkN83-OGwtCmMrgTPGFqlPMOVFzvAbB_XbLLW652S13cMtV89D58z-OI3_smQGxAHluDTtKT7v_I_sAR9ye4g</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Nakai, Yoshitomo</creator><creator>Miyazaki, Osamu</creator><creator>Kitamura, Masayuki</creator><creator>Imai, Rumi</creator><creator>Okamoto, Reiko</creator><creator>Tsutsumi, Yoshiyuki</creator><creator>Miyasaka, Mikiko</creator><creator>Ogiwara, Hideki</creator><creator>Miura, Hiroshi</creator><creator>Yamada, Kei</creator><creator>Nosaka, Shunsuke</creator><general>Springer Nature Singapore</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8259-2147</orcidid></search><sort><creationdate>20230801</creationdate><title>Evaluation of radiation dose reduction in head CT using the half-dose method</title><author>Nakai, Yoshitomo ; Miyazaki, Osamu ; Kitamura, Masayuki ; Imai, Rumi ; Okamoto, Reiko ; Tsutsumi, Yoshiyuki ; Miyasaka, Mikiko ; Ogiwara, Hideki ; Miura, Hiroshi ; Yamada, Kei ; Nosaka, Shunsuke</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c620t-5ea7d2038ec898952dfd6a0bd1e912d09c842121758947be4162ffe72486588c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Child</topic><topic>Computed tomography</topic><topic>Cranial sutures</topic><topic>Craniosynostosis</topic><topic>Drug Tapering</topic><topic>Evaluation</topic><topic>Head</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hydrocephalus</topic><topic>Image acquisition</topic><topic>Image quality</topic><topic>Imaging</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Noise standards</topic><topic>Nuclear Medicine</topic><topic>Optimization</topic><topic>Original</topic><topic>Original Article</topic><topic>Radiation</topic><topic>Radiation Dosage</topic><topic>Radiation effects</topic><topic>Radiology</topic><topic>Radiotherapy</topic><topic>Retrospective Studies</topic><topic>Tomography, X-Ray Computed - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nakai, Yoshitomo</creatorcontrib><creatorcontrib>Miyazaki, Osamu</creatorcontrib><creatorcontrib>Kitamura, Masayuki</creatorcontrib><creatorcontrib>Imai, Rumi</creatorcontrib><creatorcontrib>Okamoto, Reiko</creatorcontrib><creatorcontrib>Tsutsumi, Yoshiyuki</creatorcontrib><creatorcontrib>Miyasaka, Mikiko</creatorcontrib><creatorcontrib>Ogiwara, Hideki</creatorcontrib><creatorcontrib>Miura, Hiroshi</creatorcontrib><creatorcontrib>Yamada, Kei</creatorcontrib><creatorcontrib>Nosaka, Shunsuke</creatorcontrib><collection>Springer Nature OA/Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Japanese journal of radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nakai, Yoshitomo</au><au>Miyazaki, Osamu</au><au>Kitamura, Masayuki</au><au>Imai, Rumi</au><au>Okamoto, Reiko</au><au>Tsutsumi, Yoshiyuki</au><au>Miyasaka, Mikiko</au><au>Ogiwara, Hideki</au><au>Miura, Hiroshi</au><au>Yamada, Kei</au><au>Nosaka, Shunsuke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of radiation dose reduction in head CT using the half-dose method</atitle><jtitle>Japanese journal of radiology</jtitle><stitle>Jpn J Radiol</stitle><addtitle>Jpn J Radiol</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>41</volume><issue>8</issue><spage>872</spage><epage>881</epage><pages>872-881</pages><issn>1867-1071</issn><eissn>1867-108X</eissn><abstract>Purpose
The present study introduced the half-dose method (HDM), which halves the radiation dose for conventional head computed tomography (CT), for postoperative hydrocephalus and follow-up for craniosynostosis at a children’s hospital. This study aimed to evaluate the contribution of selective head CT scanning optimization towards the overall reduction of radiation exposure.
Materials and methods
We retrospectively assessed 1227 and 1352 head CT examinations acquired before and after the introduction of the HDM, respectively, in children aged 0–15 years. The radiation exposure was evaluated using the CT dose index volume (CTDI-vol), dose-length product (DLP), rate of HDM introduction, and effect of reducing in-hospital radiation dose before and after the introduction of the HDM. For an objective evaluation of the image quality, head CT scans acquired with HDM and full-dose method (FDM) were randomly selected, and the image noise standard deviation (SD) was measured for each scan. In addition, some HDM images were randomly selected and independently reviewed by two radiologists.
Results
The HDM was introduced in 27.9% of all head CTs. The mean CTDI-vol of all head CTs was 21.5 ± 6.9 mGy after the introduction, a 14.9% reduction. The mean DLP was 418.4 ± 152.9 mGy.cm after the introduction, a 17.2% reduction. Compared to the FDM images, the noise SD of the HDM ones worsened by almost 0.9; however, none of the images were difficult or impossible to evaluate.
Conclusion
The HDM yielded diagnostically acceptable images. In addition, a change in protocol for only two diseases successfully reduced the patients’ overall radiation exposure by approximately 15%. Introducing and optimizing the HDM for frequently performed target diseases will be useful in reducing the exposure dose for the hospital’s patient population.</abstract><cop>Singapore</cop><pub>Springer Nature Singapore</pub><pmid>36961648</pmid><doi>10.1007/s11604-023-01410-5</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-8259-2147</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Child Computed tomography Cranial sutures Craniosynostosis Drug Tapering Evaluation Head Hospitals Humans Hydrocephalus Image acquisition Image quality Imaging Medical imaging Medicine Medicine & Public Health Noise standards Nuclear Medicine Optimization Original Original Article Radiation Radiation Dosage Radiation effects Radiology Radiotherapy Retrospective Studies Tomography, X-Ray Computed - methods |
title | Evaluation of radiation dose reduction in head CT using the half-dose method |
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