Abstract
High-resolution computed tomography (HRCT) provides exceptional diagnostic precision but raises significant concerns about thyroid radiation exposure, given the gland’s high radiosensitivity and the increasing global burden of thyroid cancer. Approximately 560,000 new cases of thyroid cancer are diagnosed worldwide each year, with a female-to-male incidence ratio of roughly 3:1 and the highest age-standardized rates in high-income regions. Ionizing radiation is a well-established risk factor, particularly in children and adolescents, where even low doses (<0.2 Gy) can increase lifetime cancer risk. This review critically evaluates methods for quantifying thyroid dose during HRCT, including direct approaches such as thermoluminescent dosimeters (TLDs) and optically stimulated luminescent dosimeters (OSLDs), as well as indirect metrics like the computed tomography dose index (CTDI), dose– length product (DLP), and Monte Carlo simulations. Protective strategies are examined in detail, encompassing hardware-based measures (thyroid collars, bismuth shields), software and algorithmic solutions (automatic exposure control, iterative reconstruction), and imaging protocol optimization tailored to patient size, anatomy, and clinical need. Technological innovations, such as ultra-high-resolution CT and photon-counting detector CT, are discussed for their potential to reduce exposure without compromising diagnostic quality. The review also explores the influence of patient-specific factors, operator expertise, and cost–benefit considerations in implementing protective measures. Emphasis is placed on adhering to the “As Low as Reasonably Achievable” (ALARA) principle, ensuring that diagnostic accuracy is maintained while minimizing avoidable thyroid dose. Adoption of evidence-based protocols, accurate dosimetry, and continuous professional education is essential to enhance radiation safety in HRCT and reduce long-term thyroid health risks.