Use of BMI Guidelines and Individual Dose Tracking to Minimize Radiation Exposure from Low-dose Helical Chest CT Scanning in a Lung Cancer Screening Program

Rationale and Objectives: The increasing use of computed tomography (CT) has been accompanied by rising concerns over potential radiation-related health risks, especially cancer, and a need to minimize such risks. Materials and Methods: We conducted 2186 low-dose helical chest CT scans among 1235 nuclear weapons workers at elevated risk of lung cancer, setting the CT scanner tube current at 30 mAs for all participants with BMI <35 kg/m ² and permitting technologists to raise mAs levels for participants with BMI ≥35 kg/m ². Dose-length product (DLP) was recorded from the CT scanner, permitting calculation of effective dose. Phantom-based estimates of effective dose were also made. A chest radiologist recorded acceptability of image quality. Results: The study population was significantly overweight: 79% exceeded a body mass index (BMI) >25 kg/m ² and 37.1% exceeded a BMI ≥30 kg/m ². Nearly 90% of CT scans were performed using a tube current setting of 30 mAs and had a mean DLP-based effective dose of 1.3 mSv. The phantom-based estimate of effective dose was lower at 1.1 mSv. Among participants with a BMI ≥35 kg/m ², 92% were scanned at 40 or 50 mAs, which was associated with a DLP-based effective dose of 1.6 and 2.0 mSv, respectively. Image quality was satisfactory in 99.8% of scans. Conclusion: Application of simple BMI-based guidelines and DLP tracking of low-dose helical chest CT scans in a lung cancer screening program minimizes radiation dose, even in a largely overweight population.