1
|
Miftahuddin D, Prayitno AG, Hariyanto AP, Gani MRA, Endarko E. Evaluation of low-dose pediatric chest CT examination using in-house developed various age-size pediatric chest phantoms. Eur J Radiol 2024; 177:111599. [PMID: 38970995 DOI: 10.1016/j.ejrad.2024.111599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/03/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE This study aims to develop Various Age-size Pediatric Chest Phantoms (VAPC) to evaluate low-dose protocol that approximates clinical conditions achieved by low organ-specific doses and optimal image quality among the challenges of pediatric size variations. METHODS Three original pediatric data aged 1, 4, and 7 years were used as a reference for developing VAPC phantoms. Six protocols, namely standard dose (STD) and low dose (low mA and low kV) reconstructed using Filtered Back Projection (FBP) and iterative reconstruction (IR) algorithms, were investigated. This study directly measured the lungs, heart, and spinal cord dose using LD-V1 film. Linearity, Modulation Transfer Function (MTF), Contrast to Noise Ratio (CNR), and Noise Power Spectrum (NPS) were evaluated to assess the CT image quality of the VAPC phantom. RESULTS This study found that the mean organ-specific dose was higher than CTDIvol. A Comparison of mean lung doses showed VAPC phantom 1 (y.o.) received 74.8% and 137.2% more doses than 4 (y.o.) and 7 (y.o.), respectively. Low kV produces a lower organ dose than low mA. The linearity of CT numbers is not biased at low doses. Differences in age measures significantly influenced organ-specific dose, MTF, CNR, and NPS. CONCLUSION Smaller pediatrics are still exposed to higher doses at low-dose examinations, whereas larger pediatrics have lower contrast resolution and increased image noise. CT number linearity is unbiased. The combination of low kV with FBP produces higher spatial resolution, while low mA with IR effectively reduces noise to detect low-contrast objects better.
Collapse
Affiliation(s)
- Dafa Miftahuddin
- Department of Physics, Institut Teknologi Sepuluh Nopember, Kampus ITS - Sukolilo Surabaya 600111, East Java, Indonesia
| | - Audiena Gelung Prayitno
- Department of Physics, Institut Teknologi Sepuluh Nopember, Kampus ITS - Sukolilo Surabaya 600111, East Java, Indonesia
| | - Aditya Prayugo Hariyanto
- Department of Physics, Institut Teknologi Sepuluh Nopember, Kampus ITS - Sukolilo Surabaya 600111, East Java, Indonesia
| | - M Roslan A Gani
- Department of Radiology, Dharmais Hospital National Cancer Center, Jakarta 11420, Indonesia
| | - Endarko Endarko
- Department of Physics, Institut Teknologi Sepuluh Nopember, Kampus ITS - Sukolilo Surabaya 600111, East Java, Indonesia.
| |
Collapse
|
2
|
Lin CS, Peng BR, Ma HB, Chen KL, Lin TH, Pan LK, Lin YH. Inverse Problem Algorithm-Based Time-Resolved Imaging of Head and Neck Computed Tomography Angiography Contrast Kinetics with Clinical Testification. Diagnostics (Basel) 2023; 13:3354. [PMID: 37958250 PMCID: PMC10649766 DOI: 10.3390/diagnostics13213354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/18/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
This study mitigated the challenge of head and neck CT angiography by IPA-based time-resolved imaging of contrast kinetics. To this end, 627 cerebral hemorrhage patients with dizziness, brain aneurysm, stroke, or hemorrhagic stroke diagnosis were randomly categorized into three groups, namely, the original dataset (450), verification group (112), and in vivo testified group (65), in the Affiliated BenQ Hospital of Nanjing Medical University. In the first stage, seven risk factors were assigned: age, CTA tube voltage, body surface area, heart rate per minute, cardiac output blood per minute, the actual injected amount of contrast media, and CTA delayed trigger timing. The expectation value of the semi-empirical formula was the CTA number of the patient's left artery (LA). Accordingly, 29 items of the first-order nonlinear equation were calculated via the inverse problem analysis (IPA) technique run in the STATISTICA 7.0 program, yielding a loss function and variance of 3.1837 and 0.8892, respectively. A dimensionless AT was proposed to imply the coincidence, with a lower AT indicating a smaller deviation between theoretical and practical values. The derived formula was confirmed for the verification group of 112 patients, reaching high coincidence, with average ATavg and standard deviation values of 3.57% and 3.06%, respectively. In the second stage, the formula was refined to find the optimal amount of contrast media for the CTA number of LA approaching 400. Finally, the above procedure was applied to head and neck CTA images of the third group of 65 patients, reaching an average CTA number of LA of 407.8 ± 16.2 and finding no significant fluctuations.
Collapse
Affiliation(s)
- Chih-Sheng Lin
- Department of Radiology, BenQ Medical Center, Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 211166, China; (C.-S.L.); (H.-B.M.)
| | - Bing-Ru Peng
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan; (B.-R.P.); (T.-H.L.); (L.-K.P.)
| | - Hong-Bing Ma
- Department of Radiology, BenQ Medical Center, Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 211166, China; (C.-S.L.); (H.-B.M.)
| | - Ke-Lin Chen
- Department of Radiology, First Affiliated Hospital of Ningbo University, Ningbo 315012, China;
| | - Tsung-Han Lin
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan; (B.-R.P.); (T.-H.L.); (L.-K.P.)
- Department of Traditional Chinese Medicine, Taichung Armed Forces General Hospital, Taichung 411, Taiwan
| | - Lung-Kwang Pan
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan; (B.-R.P.); (T.-H.L.); (L.-K.P.)
| | - Ya-Hui Lin
- Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan; (B.-R.P.); (T.-H.L.); (L.-K.P.)
- Department of Clinical Pharmacy, Taichung Armed Forces General Hospital, Taichung 411, Taiwan
| |
Collapse
|
3
|
Mo X, Cui Y, Yuan J, Hang Z, Jiang X, Duan G, Liang L, Huang Z, Li S, Sun P, Chen W, Wei L, Guo Y, Deng D. Study on a new "One-stop-shop" scan protocol combining brain CT perfusion and head-and-neck CT angiography by using 256-detector CT for stroke patients. Eur J Radiol 2022; 154:110426. [PMID: 35797790 DOI: 10.1016/j.ejrad.2022.110426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/20/2022] [Accepted: 06/24/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE We sought to evaluate the performance of a new "one-stop-shop" scan protocol combining brain computed tomography perfusion (CTP) and head-and-neck CT angiography (CTA) imaging for acute stroke patients using a 256-detector CT scanner. METHOD From March to August 2020, 60 patients (30 men and 30 women) aged 22-88 years with suspected acute stroke were enrolled and randomly divided into 2 groups to undergo brain CTP and head-and-neck CTA with a 256-detector CT system. Group A used traditional scan protocol with a separate brain CTP and head-and-neck CT examination that included non-contrast-enhanced and contrast-enhanced acquisitions; group B used the new "one-stop-shop" scan protocol with head-and-neck CTA data inserted into brain CTP scans at the peak time (PT) of the arterial phase. The insertion point of the head-and-neck CTA data was determined by a test bolus. The examination time, contrast dose, radiation dose, and image quality were compared between the groups. RESULTS The total contrast dose was reduced by 40% in group B compared to group A (60 mL vs. 100 mL). The imaging time was 52.5 ± 2.6 s in group B and 74.9 ± 3.3 s in group A, showing a reduction of approximately 43% in group B. There was no significant difference in image quality both quantitatively and qualitatively between the groups (all P > 0.05). Group B had a slight reduction in dose length product (1139.0 ± 45.3 vs. 1211.6 ± 31.9 mGy·cm, P < 0.001). CONCLUSIONS The proposed "one-stop-shop" scan protocol combining brain CTP and head-and-neck CTA on a 256-detector CT system can reduce imaging time and contrast dose, without affecting image quality or perfusion results, compared to the traditional protocol of separating the examinations.
Collapse
Affiliation(s)
- Xiaping Mo
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Yu Cui
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Jie Yuan
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Zufei Hang
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Xueyuan Jiang
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Gaoxiong Duan
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China
| | - Lingyan Liang
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China
| | - Zengchao Huang
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Shasha Li
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Peiyi Sun
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Wei Chen
- Department of Neurology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Lanzhen Wei
- Department of Radiology, First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi, China
| | - Ying Guo
- GE Healthcare, Computed Tomography Research Center, Beijing 100176, China
| | - Demao Deng
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi, China.
| |
Collapse
|
4
|
Chen PA, Chen CW, Chou CC, Fu JH, Wang PC, Hsu SH, Lai PH. Impact of 80 kVp with iterative reconstruction algorithm and low-dose contrast medium on the image quality of craniocervical CT angiography. Clin Imaging 2020; 68:124-130. [PMID: 32592973 DOI: 10.1016/j.clinimag.2020.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/08/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the image quality of 80-kVp craniocervical CT angiography (CCCTA) protocol combined with adaptive statistical iterative reconstruction-V (ASIR-V) and low-dose contrast medium (CM). METHODS A total of 119 patients were randomly divided into three groups. For group A, 120-kVp protocol was followed with 60 ml CM and filtered back projection; for group B, 80-kVp protocol with 60 ml CM and ASIR-V; and for group C, 80-kVp protocol with 45 ml CM and ASIR-V. Both subjective and objective image quality and radiation doses were evaluated. RESULTS Arterial attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the head, neck, and shoulder regions were significantly higher in groups B and C compared with group A. Group C yielded significantly better subjective image quality than that observed in groups A and B (both p < .05). As compared with group A, effective radiation dose and the iodine load of group C were reduced by 51.4% and 25%, respectively. CONCLUSIONS The CCCTA protocol with 80 kVp, ASIR-V, and 45 ml of CM injected at 3 ml/s significantly reduced the radiation dose, iodine load, and iodine delivery rate while providing better subjective and objective image quality, including higher arterial enhancement and a higher SNR and CNR compared with the 120-kVp protocol.
Collapse
Affiliation(s)
- Po-An Chen
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 81362, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chih-Wei Chen
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 81362, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chiung-Chen Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 81362, Taiwan
| | - Jui-Hsun Fu
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 81362, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - Po-Chin Wang
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 81362, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - Shuo-Hsiu Hsu
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 81362, Taiwan
| | - Ping-Hong Lai
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 81362, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.
| |
Collapse
|
5
|
Chen PA, Chen CW, Chou CC, Fu JH, Wang PC, Hsu SH, Lai PH. Quantitative and qualitative evaluation of low-dose craniocervical computed tomography angiography with a lower tube voltage protocol. Acta Radiol 2019; 60:1380-1389. [PMID: 30732454 DOI: 10.1177/0284185119825488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Po-An Chen
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Chih-Wei Chen
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Chiung-Chen Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Jui-Hsun Fu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Po-Chin Wang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Shuo-Hsiu Hsu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Ping-Hong Lai
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung
| |
Collapse
|
6
|
Tube Current Reduction in CT Angiography: How Low Can We Go in Imaging of Patients With Suspected Acute Stroke? AJR Am J Roentgenol 2019; 213:410-416. [DOI: 10.2214/ajr.18.20954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
7
|
Chen CW, Chen PA, Chou CC, Fu JH, Wang PC, Hsu SH, Lai PH. Combination of Adaptive Statistical Iterative Reconstruction-V and Lower Tube Voltage During Craniocervical Computed Tomographic Angiography Yields Better Image Quality with a Reduced Radiation Dose. Acad Radiol 2019; 26:e233-e240. [PMID: 30195416 DOI: 10.1016/j.acra.2018.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate image quality and radiation exposure when using the adaptive statistical iterative reconstruction-V (ASIR-V) algorithm for reconstructing craniocervical computed tomographic angiography images acquired at 100 kVp. MATERIALS AND METHODS We randomly divided 121 patients into three groups: group A (conventional protocol), 120 kVp with filtered back projection; group B, 120 kVp with 50% ASIR-V; and group C, 100 kVp with 50% ASIR-V. All patients underwent scans in a 256-slice computed tomography (CT) scanner. Radiation dose (volume CT dose index), dose-length product, and effective dose, objective parameters such as arterial attenuation value, signal-to-noise ratio, contrast-to-noise ratio, and noise obtained at head, neck, and shoulder levels were compared among the groups. Subjective image quality was independently assessed by two radiologists, and interobserver reliability was assessed using kappa analysis. RESULTS The radiation dose in group C was the lowest (p < 0.01) with a 40% reduction in volume CT dose index, dose-length product, and effective dose values compared to group A, and group C showed higher arterial attenuation than either group A or B (p < 0.01). Additionally, signal-to-noise ratio and contrast-to-noise ratio were higher and noise was lower in groups B and C than group A. Group C had better subjective image quality than groups A and B (p < 0.05), and the interobserver reliability between the two radiologists was high (k = 0.783). CONCLUSION Compared to the conventional protocol, using 50% ASIR-V and the 100 kVp protocol during craniocervical computed tomographic angiography yields better objective and subjective image quality at lower radiation doses.
Collapse
|
8
|
Aschoff AJ, Catalano C, Kirchin MA, Krix M, Albrecht T. Low radiation dose in computed tomography: the role of iodine. Br J Radiol 2017; 90:20170079. [PMID: 28471242 PMCID: PMC5603952 DOI: 10.1259/bjr.20170079] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Recent approaches to reducing radiation exposure during CT examinations typically utilize automated dose modulation strategies on the basis of lower tube voltage combined with iterative reconstruction and other dose-saving techniques. Less clearly appreciated is the potentially substantial role that iodinated contrast media (CM) can play in low-radiation-dose CT examinations. Herein we discuss the role of iodinated CM in low-radiation-dose examinations and describe approaches for the optimization of CM administration protocols to further reduce radiation dose and/or CM dose while maintaining image quality for accurate diagnosis. Similar to the higher iodine attenuation obtained at low-tube-voltage settings, high-iodine-signal protocols may permit radiation dose reduction by permitting a lowering of mAs while maintaining the signal-to-noise ratio. This is particularly feasible in first pass examinations where high iodine signal can be achieved by injecting iodine more rapidly. The combination of low kV and IR can also be used to reduce the iodine dose. Here, in optimum contrast injection protocols, the volume of CM administered rather than the iodine concentration should be reduced, since with high-iodine-concentration CM further reductions of iodine dose are achievable for modern first pass examinations. Moreover, higher concentrations of CM more readily allow reductions of both flow rate and volume, thereby improving the tolerability of contrast administration.
Collapse
Affiliation(s)
- Andrik J Aschoff
- 1 Department for Diagnostic and Interventional Radiology and Neuroradiology, Klinikum Kempten, Kempten, Germany
| | - Carlo Catalano
- 2 Department of Radiological Sciences, University of Rome "La Sapienza", Rome, Italy
| | - Miles A Kirchin
- 3 Bracco Imaging SpA, Global Medical & Regulatory Affairs, Milan, Italy
| | - Martin Krix
- 4 Bracco Imaging Germany, Global Medical & Regulatory Affairs, Konstanz, Germany
| | - Thomas Albrecht
- 5 Institut für Radiologie und Interventionelle Therapie, Vivantes-Klinikum Neukölln, Berlin, Germany
| |
Collapse
|
9
|
Oei MTH, Meijer FJA, van der Woude WJ, Smit EJ, van Ginneken B, Manniesing R, Prokop M. Interleaving cerebral CT perfusion with neck CT angiography. Part II: clinical implementation and image quality. Eur Radiol 2016; 27:2411-2418. [PMID: 27651144 PMCID: PMC5408041 DOI: 10.1007/s00330-016-4592-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/23/2016] [Accepted: 08/29/2016] [Indexed: 12/28/2022]
Abstract
Objectives Feasibility evaluation of the One-Step Stroke Protocol, which is an interleaved cerebral computed tomography perfusion (CTP) and neck volumetric computed tomography angiography (vCTA) scanning technique using wide-detector computed tomography, and to assess the image quality of vCTA. Methods Twenty patients with suspicion of acute ischaemic stroke were prospectively scanned and evaluated with a head and neck CTA and with the One-Step Stroke Protocol. Arterial enhancement and contrast-to-noise ratio (CNR) in the carotid arteries was assessed. Three observers scored artefacts and image quality of the cervical arteries. The total z-coverage was evaluated. Results Mean enhancement in the carotid bifurcation was rated higher in the vCTA (595 ± 164 HU) than CTA (441 ± 117 HU). CNR was rated higher in vCTA. Image quality scores showed no significant difference in the region of the carotid bifurcation between vCTA and CTA. Lower neck image quality scores were slightly lower for vCTA due to artefacts, although not rated as diagnostically relevant. In ten patients, the origin of the left common carotid artery was missed by 1.6 ± 0.8 cm. Mean patient height was 1.8 ± 0.09 m. Carotid bifurcation and origin of vertebral arteries were covered in all patients. Conclusions The One-Step Stroke Protocol is feasible with good diagnostic image quality of vCTA, although full z-coverage is limited in tall patients. Key Points • Interleaving cerebral CTP with neck CTA (One-Step Stroke Protocol) is feasible • Diagnostic quality of One-Step Stroke Protocol neck CTA is similar to conventional CTA • One-Step Stroke Protocol neck CTA suffers from streak artefacts in the lower neck • A limitation of One-Step Stroke Protocol CTA is lack of coverage in tall patients • Precise planning of One-Step Stroke Protocol neck CTA is necessary in tall patients Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4592-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marcel T H Oei
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Frederick J A Meijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Willem-Jan van der Woude
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Ewoud J Smit
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Bram van Ginneken
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rashindra Manniesing
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
10
|
Shen Y, Hu X, Zou X, Zhu D, Li Z, Hu D. Did low tube voltage CT combined with low contrast media burden protocols accomplish the goal of "double low" for patients? An overview of applications in vessels and abdominal parenchymal organs over the past 5 years. Int J Clin Pract 2016; 70 Suppl 9B:B5-B15. [PMID: 27577514 DOI: 10.1111/ijcp.12861] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 06/15/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Imaging communities have already reached a consensus that the radiation dose of computed tomography (CT) should be reduced as much as reasonably achievable to lower population risks. Increasing attention is being paid to iodinated contrast media (CM) induced nephrotoxicity (CIN); a decrease in the intake of iodinated CM is required by increasingly more radiologists. Theoretically, the radiation dose varies with the tube current time and square of the tube voltage, with higher iodine contrast at low photon energies (Huda et al. [2000] Radiology, 21 7, 430-435).The use of low tube voltage is a promising strategy to reduce both the radiation dose and CM burden. The term 'double low' has been coined to describe scanning protocols that reduce radiation dose and iodine intake synchronously. These protocols are becoming increasingly popular in the clinical setting. PURPOSE The aim of this review was to describe all original studies using the 'double low' strategy in the last 5 years. METHODS We searched an online electronic database (PubMed) from January 2011 to December 2015 for original studies published on the relationship of low tube voltage with low radiation dose and low iodine contrast media burden in patients undergoing CT scans. Studies that failed to reduce radiation dose or iodine CM burden were excluded in this study. RESULTS Thirty-seven studies aimed at reducing radiation dose using low tube voltage combined with iodine CM reduced protocols were included in this study. Most studies evaluated conditions associated with arteries. Four were cerebral and neck computed tomography angiography (CTA) studies, 15 were pulmonary CTA (pCTA) and coronary CTA (cCTA) studies, one concerned myocardial perfusion, five studies focused on the thoracic and abdominal aorta, and one investigated renal arteries. Three studies consisted of CT venography (CTV) of the pelvis and lower extremities. Six publications examined the liver, and two focused on the kidney. CONCLUSION Overall, this review demonstrates that the low tube voltage CT protocol is a powerful tool to reduce the radiation dose in CTA, especially with pCTA and cCTA.
Collapse
Affiliation(s)
- Yaqi Shen
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xuemei Hu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xianlun Zou
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Di Zhu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhen Li
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Daoyu Hu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| |
Collapse
|
11
|
den Harder AM, Willemink MJ, de Jong PA, Schilham AMR, Rajiah P, Takx RAP, Leiner T. New horizons in cardiac CT. Clin Radiol 2016; 71:758-67. [PMID: 26932775 DOI: 10.1016/j.crad.2016.01.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/23/2015] [Accepted: 01/21/2016] [Indexed: 12/13/2022]
Abstract
Until recently, cardiovascular computed tomography angiography (CCTA) was associated with considerable radiation doses. The introduction of tube current modulation and automatic tube potential selection as well as high-pitch prospective ECG-triggering and iterative reconstruction offer the ability to decrease dose with approximately one order of magnitude, often to sub-millisievert dose levels. In parallel, advancements in computational technology have enabled the measurement of fractional flow reserve (FFR) from CCTA data (FFRCT). This technique shows potential to replace invasively measured FFR to select patients in need of coronary intervention. Furthermore, developments in scanner hardware have led to the introduction of dual-energy and photon-counting CT, which offer the possibility of material decomposition imaging. Dual-energy CT reduces beam hardening, which enables CCTA in patients with a high calcium burden and more robust myocardial CT perfusion imaging. Future-generation CT systems will be capable of counting individual X-ray photons. Photon-counting CT is promising and may result in a substantial further radiation dose reduction, vastly increased spatial resolution, and the introduction of a whole new class of contrast agents.
Collapse
Affiliation(s)
- A M den Harder
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands.
| | - M J Willemink
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands
| | - P A de Jong
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands
| | - A M R Schilham
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands
| | - P Rajiah
- Cardiothoracic Imaging Division, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA
| | - R A P Takx
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands
| | - T Leiner
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA Utrecht, The Netherlands
| |
Collapse
|
12
|
Kok M, Turek J, Mihl C, Reinartz SD, Gohmann RF, Nijssen EC, Kats S, van Ommen VG, Kietselaer BLJH, Wildberger JE, Das M. Low contrast media volume in pre-TAVI CT examinations. Eur Radiol 2015; 26:2426-35. [PMID: 26560728 PMCID: PMC4927596 DOI: 10.1007/s00330-015-4080-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/07/2015] [Accepted: 10/22/2015] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate image quality using reduced contrast media (CM) volume in pre-TAVI assessment. METHODS Forty-seven consecutive patients referred for pre-TAVI examination were evaluated. Patients were divided into two groups: group 1 BMI < 28 kg/m(2) (n = 29); and group 2 BMI > 28 kg/m(2) (n = 18). Patients received a combined scan protocol: retrospective ECG-gated helical CTA of the aortic root (80kVp) followed by a high-pitch spiral CTA (group 1: 70 kV; group 2: 80 kVp) from aortic arch to femoral arteries. All patients received one bolus of CM (300 mgI/ml): group 1: volume = 40 ml; flow rate = 3 ml/s, group 2: volume = 53 ml; flow rate = 4 ml/s. Attenuation values (HU) and contrast-to-noise ratio (CNR) were measured at the levels of the aortic root (helical) and peripheral arteries (high-pitch). Diagnostic image quality was considered sufficient at attenuation values > 250HU and CNR > 10. RESULTS Diagnostic image quality for TAVI measurements was obtained in 46 patients. Mean attenuation values and CNR (HU ± SD) at the aortic root (helical) were: group 1: 381 ± 65HU and 13 ± 8; group 2: 442 ± 68HU and 10 ± 5. At the peripheral arteries (high-pitch), mean values were: group 1: 430 ± 117HU and 11 ± 6; group 2: 389 ± 102HU and 13 ± 6. CONCLUSION CM volume can be substantially reduced using low kVp protocols, while maintaining sufficient image quality for the evaluation of aortic root and peripheral access sites. KEY POINTS • Image quality could be maintained using low kVp scan protocols. • Low kVp protocols reduce contrast media volume by 34-67 %. • Less contrast media volume lowers the risk of contrast-induced nephropathy.
Collapse
Affiliation(s)
- Madeleine Kok
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Jakub Turek
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Casper Mihl
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Sebastian D Reinartz
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Robin F Gohmann
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Estelle C Nijssen
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Suzanne Kats
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Vincent G van Ommen
- Department of Cardiology, Maastricht University Medical Center MUMC+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Bas L J H Kietselaer
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center MUMC+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Marco Das
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| |
Collapse
|
13
|
Evaluation of image quality and dose reduction of 80 kVp neck computed tomography in patients with suspected peritonsillar abscess. Clin Radiol 2015; 70:e67-73. [DOI: 10.1016/j.crad.2015.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/09/2015] [Accepted: 04/20/2015] [Indexed: 12/12/2022]
|
14
|
Objective and subjective image quality of primary and recurrent squamous cell carcinoma on head and neck low-tube-voltage 80-kVp computed tomography. Neuroradiology 2015; 57:645-51. [DOI: 10.1007/s00234-015-1512-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/13/2015] [Indexed: 11/24/2022]
|
15
|
|
16
|
Low-Dose Computed Tomography With Adaptive Statistical Iterative Reconstruction and Low Tube Voltage in Craniocervical Computed Tomographic Angiography. J Comput Assist Tomogr 2015; 39:774-80. [DOI: 10.1097/rct.0000000000000260] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Wichmann JL, Kraft J, Nöske EM, Bodelle B, Burck I, Scholtz JE, Frellesen C, Wagenblast J, Kerl JM, Bauer RW, Lehnert T, Vogl TJ, Schulz B. Low-tube-voltage 80-kVp neck CT: evaluation of diagnostic accuracy and interobserver agreement. AJNR Am J Neuroradiol 2014; 35:2376-81. [PMID: 25104285 DOI: 10.3174/ajnr.a4052] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Low-tube-voltage acquisition has been shown to facilitate substantial dose savings for neck CT with similar image contrast compared with standard 120-kVp acquisition. However, its potential for the detection of neck pathologies is uncertain. Our aim was to evaluate the effects of low-tube-voltage 80-kV(peak) acquisitions for neck CT on diagnostic accuracy and interobserver agreement. MATERIALS AND METHODS Three radiologists individually analyzed 80-kVp and linearly blended 120-kVp image series of 170 patients with a variety of pathologies who underwent dual-energy neck CT. Reviewers were unblinded to the clinical indication for CT but were otherwise blinded to any other data or images and were asked to state a final main diagnosis. Findings were compared with medical record charts, CT reports, and pathology results. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each observer. Interobserver agreement was evaluated by using intraclass correlation coefficients. RESULTS Diagnoses were grouped as squamous cell carcinoma-related (n = 107, presence/absence of primary/recurrent squamous cell carcinoma), lymphoma-related (n = 40, presence/absence of primary/recurrent lymphoma), and benign (n = 23, eg, abscess). Cumulative sensitivity, specificity, positive predictive value, and negative predictive value for 80-kVp and blended 120-kVp images were 94.8%, 93.0%, 95.9%, and 91.1%, respectively. Results were also consistently high for squamous cell carcinoma-related (94.8%/95.3%, 89.1%/89.1%, 94.3%/94.4%, 90.1%/91.0%) and lymphoma-related (95.0%, 100.0%, 100.0%, 95.2%) 80-kVp/120-kVp image series. Global interobserver agreement was almost perfect (intraclass correlation coefficient, 0.82, 0.80; 95% CI, 0.76-0.74, 0.86-0.85). Calculated dose-length product was reduced by 48% with 80-kVp acquisitions compared with the standard 120-kVp scans (135.5 versus 282.2 mGy × cm). CONCLUSIONS Low-tube-voltage 80-kVp CT of the neck provides sufficient image quality with high diagnostic accuracy in routine clinical practice and has the potential to substantially decrease radiation exposure.
Collapse
Affiliation(s)
- J L Wichmann
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| | - J Kraft
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| | - E-M Nöske
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| | - B Bodelle
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| | - I Burck
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| | - J-E Scholtz
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| | - C Frellesen
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| | - J Wagenblast
- Otolaryngology, Head and Neck Surgery (J.W.), University Hospital Frankfurt, Frankfurt, Germany
| | - J M Kerl
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| | - R W Bauer
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| | - T Lehnert
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| | - T J Vogl
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| | - B Schulz
- From the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
| |
Collapse
|