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Purpose:  To develop size-specific institutional diagnostic reference levels (DRLs) for computed tomography (CT) protocols used in neck CT imaging (cervical spine CT, cervical CT angiography (CTA) and cervical staging CT) and to compare institutional to national DRLs.  Materials and methods:  Cervical CT examinations (spine, n = 609; CTA, n = 505 and staging CT, n = 184) performed between 01/2016 and 06/2017 were included in this retrospective study. For each region and examination, the volumetric CT dose index (CTDI vol ) and dose-length product (DLP) were determined and binned into size bins according to patient water-equivalent diameter (d w ). Linear regression analysis was performed to calculate size-specific institutional DRLs for CTDI vol  and DLP, applying the 75th percentile as the upper limit for institutional DRLs. The mean institutional CTDI vol  and DLP were compared to national DRLs (CTDI vol  20 mGy for cervical spine CT (DLP 300 mGycm) and cervical CTA (DLP 600 mGycm), and CTDI vol  15 mGy for cervical staging CT (DLP 330 mGycm)).  Results:  The mean CTDI vol  and DLP (±standard deviation) were 15.2 ± 4.1 mGy and 181.5 ± 88.3 mGycm for cervical spine CT; 8.1 ± 4.3 mGy and 280.2 ± 164.3 mGycm for cervical CTA; 8.6 ± 1.9 mGy and 162.8 ± 85.0 mGycm for cervical staging CT. For all CT protocols, there was a linear increase in CTDI vol  and DLP with increasing d w . For the CTDI vol , size-specific institutional DRLs increased with d w  from 14 to 29 mGy for cervical spine CT, from 5 to 17 mGy for cervical CTA and from 8 to 13 mGy for cervical staging CT. For the DLP, size-specific institutional DRLs increased with d w  from 130 to 510 mGycm for cervical spine CT, from 140 to 640 mGycm for cervical CTA and from 140 to 320 mGycm for cervical staging CT. Institutional DRLs were lower than national DRLs by 81% and 67% for cervical spine CT (d w  = 17.8 cm), 43% and 51% for cervical CTA (d w  = 19.5 cm) and 59% and 53% for cervical staging CT (d w  = 18.8 cm) for CTDI vol  and DLP, respectively.  Conclusion:  Size-specific institutional DRLs were generated for neck CT examinations. The mean institutional CTDI vol  and DLP values were well below national DRLs.

Development of size-specific institutional diagnostic reference levels for computed tomography protocols in neck imaging