article · World Journal of Nuclear Medicine
A retrospective study across three South African nuclear medicine centres between 2021 and 2024 evaluated radiation doses from 175 adult ventilation-perfusion SPECT/CT examinations. The work set out to establish preliminary multicentre local diagnostic reference levels for clinical dose optimisation. For two-day ventilation-perfusion protocols evaluated at a single centre, provisional benchmark values were established at 500 MBq for ventilation, 185 MBq for perfusion, and specific CT dose metrics of 3.9 mGy for volume CT dose index and 142 mGy.cm for dose-length product. For one-day perfusion-only examinations evaluated across all three sites, reference levels were derived at 285 MBq for perfusion, 4.6 mGy, and 172 mGy.cm respectively. Substantial variability between centres was observed in CT dose metrics, and administered activities for one-day perfusion scans exceeded international recommendations, highlighting areas requiring protocol review and standardisation.
Medical radiation exposure must be balanced against image quality to ensure patient safety. Establishing local diagnostic reference levels gives clinical departments tangible benchmarks to identify unnecessarily high radiation doses. This helps nuclear medicine facilities standardise their procedures, reduce excess patient exposure, and align their clinical imaging practices with international safety standards.
The findings provide applied clinical benchmarks directly usable by hospital radiology and nuclear medicine departments to audit and standardise imaging protocols. Medical physicists and clinic managers can immediately adopt these provisional levels for quality assurance. While this is applied operational research rather than a standalone commercial product, expanding the dataset could inform software tools for automated clinical dose monitoring and regulatory compliance reporting.
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Abstract The aim of this study was to establish facility-specific and provisional multicenter local diagnostic reference levels (LDRLs) for adult ventilation–perfusion (V/Q) single-photon emission computed tomography (SPECT)/computed tomography (CT) examinations in South African nuclear medicine facilities using a structured multicenter approach consistent with international DRL methodology. A retrospective study was conducted between 2021 and 2024 across three South African nuclear medicine facilities. Adult patients (≥18 years) undergoing either 2-day V/Q SPECT/CT or 1-day perfusion-only SPECT/CT were included. Facility median administered activities and CT dose metrics including volume computed tomography dose index (CTDIvol) and dose-length product (DLP) were calculated. Provisional multicenter LDRLs were derived as the 75th percentile of facility median values. Owing to the limited number of participating facilities (n = 3), the resulting values are presented as preliminary multicenter optimization benchmarks rather than nationally representative DRLs. A total of 175 adult studies were analyzed (median age 50 years; interquartile range: 33.0–67.5). One facility performed 2-day V/Q imaging using Technegas and 99mTc-MAA, whereas all three facilities performed 1-day perfusion-only protocols using 99mTc-MAA. For the 2-day V/Q protocol, provisional benchmark values derived from a single participating facility were 500 MBq for ventilation activity, 185 MBq for perfusion activity, 3.9 mGy for CTDIvol, and 142 mGy·cm for DLP. For 1-day perfusion-only studies, the provisional LDRLs were 285 MBq for perfusion activity, 4.6 mGy for CTDIvol, and 172 mGy·cm for DLP. Substantial interfacility variability was observed, particularly for CT dose metrics. This study established the first provisional multicenter LDRLs for adult V/Q SPECT/CT in South Africa. Considerable interfacility variability in CT dose metrics was observed, reflecting differences in scanner technology, exposure-control strategies, protocol implementation, and scan-length selection. The proposed protocol-specific optimization benchmarks, comprising provisional multicenter LDRLs for 1-day perfusion-only imaging and provisional benchmarks for the 2-day V/Q protocol, provide practical guidance for dose harmonization across participating facilities. Elevated administered activities observed for 1-day perfusion-only protocol exceeded internationally recommended activity ranges and therefore represent an important target for protocol optimization. Further multicenter expansion will be required to support the future development of nationally representative diagnostic reference levels for adult V/Q SPECT/CT practice in South Africa.
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DOI: 10.1055/s-0046-1827861
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