{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T18:27:03Z","timestamp":1793730423265,"version":"4.6.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["1R01CA181191-01A1"],"award-info":[{"award-number":["1R01CA181191-01A1"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["CD-1304-7043"],"award-info":[{"award-number":["CD-1304-7043"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["DI-2018C1-11375"],"award-info":[{"award-number":["DI-2018C1-11375"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Identify routine diagnostic abdomen CT protocols in adults that achieve lower radiation doses, crowd-sourced from a large CT dose registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We retrospectively captured acquisition parameters, patient diameter, and patient size-adjusted and unadjusted radiation dose (CTDIvol and DLP). A protocol was defined as a unique combination of facility, scanner make\/model, CT indication, and protocol name. We used k-means clustering to classify protocols into clusters based on similarity of average acquisition parameters (mAs, pitch, kV, collimation, scan length, phase count), each representing a distinct pattern of protocol design choices. For each cluster, we summarized the mean technical parameters and dose metrics of its constituent protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Analyses included 907,992 exams from 1767 protocols at 132 facilities, grouped in 9 clusters. The number of protocols and exams within each cluster ranged from 62 to 508 and 15,317 to 381,457, respectively. Mean size-adjusted DLP varied threefold across clusters, ranging from 486 to 1382 mGy-cm, with no difference in patient diameter. Lowest-dosed clusters 1 and 2 minimized radiation primarily through low kV (around 100). Cluster 8 had the highest acquisition techniques (mean mAs = 338 and kV = 125), and cluster 9 had the highest dose due to phase (mean = 3.3, versus 1.1\u20131.6 for the remaining clusters).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The clustering approach offers a new framework for identifying optimized protocols, while highlighting variation in practice and worst-in-class technique, e.g., using three phases for routine abdomen. These findings may guide clinicians in protocol design, by providing best-practice protocols from a large registry, as well as a method for analyzing data within their own health system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Can we identify best-practice imaging protocols from a large CT registry, to offer clinicians a blueprint for optimizing radiation dose in routine abdomen CT?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Protocols were grouped into clusters using average acquisition parameters. Across clusters, patient size-adjusted radiation dose varied 486\u20131382 mGy-cm. Lowest-dosed protocols had one phase and low kVp.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>We used crowd-sourcing and k-means clustering to identify routine abdomen CT protocols that achieve lowest radiation dose, offering a playbook for protocol design from real clinical practice. Non-indicated phases were the greatest driver of excessive radiation dose.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-12131-w","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T14:47:46Z","timestamp":1763995666000},"page":"3454-3464","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Crowd-sourcing optimized abdomen CT protocols from 908,000 examinations in a large radiation dose registry"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1972-639X","authenticated-orcid":false,"given":"Rebecca","family":"Smith-Bindman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taewoon","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip W.","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy P.","family":"Szczykutowicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"12131_CR1","doi-asserted-by":"publisher","first-page":"k4931","DOI":"10.1136\/bmj.k4931","volume":"364","author":"R Smith-Bindman","year":"2019","unstructured":"Smith-Bindman R, Wang Y, Chu P et al (2019) International variation in radiation dose for computed tomography examinations: prospective cohort study. 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Alara Imaging had no role in the study, and Dr. Smith-Bindman has not received funding from Alara Imaging. The other authors have no conflicts to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Dr. Taewoon Kang performed all statistical analyses for this study, with biostatistical consultation from Mr. Philip Chu and Dr. Yifei Wang.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"The UCSF International CT Dose Registry (from which this work derived) was approved by the UCSF Institutional Review Board with a waiver of informed consent for all subjects. The waiver was approved for three reasons: the attempt to contact subjects poses a greater risk than this study; the large number of records required makes it impracticable to contact all potential subjects; and the researchers do not know the identity of the study subjects and therefore cannot contact them.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"As these data come from a CT radiation dose registry, some of the CT exams included in this study may be represented in previous publications, including the following: (1) Smith-Bindman et al [\n                      \n                      ]; (2) Wang et al [\n                      \n                      ]; (3) Smith-Bindman et al [\n                      \n                      ]; (4) Smith-Bindman et al [\n                      \n                      ].","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}