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Stammen L, Mihl C, Vandewall J, Pennetta F, Hersbach A, Wildberger JE, Martens B. Influence of Contrast Media Temperature and Concentration on Patient Comfort and Safety in Computed Tomography: CATCHY II Trial. Invest Radiol 2024; 59:577-582. [PMID: 38240647 DOI: 10.1097/rli.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND Previous research on the necessity to reduce the viscosity of contrast media (CM) by either prewarming CM before injection during computed tomography (CT) or by using less concentrated CM has yielded conflicting results. In addition, there is limited evidence on patient comfort. OBJECTIVES The aim of the study was to examine if prewarming CM, with varying CM concentrations, is superior to CM at room temperature, with respect to patient comfort and safety in CT. MATERIALS AND METHODS All elective patients scheduled for contrast-enhanced CT scans at Maastricht University Medical Center+ between October 27, 2021 and October 31, 2022 were eligible for inclusion when a questionnaire evaluating patient comfort was completed. This 1-year period was divided into 4 intervals (4 groups): group 1 (370 mg I/mL, 37°C), group 2 (370 mg I/mL, room temperature), group 3 (300 mg I/mL, 37°C), and group 4 (300 mg I/mL, room temperature). All CT scans were performed using state of the art equipment (Siemens Healthineers; SOMATOM Force and SOMATOM Definition AS, Forchheim, Germany). Contrast media injections were performed using a dual-head power injector (Stellant; Bayer Healthcare, Berlin, Germany) and individualized to body weight and/or tube voltage, depending on the CM protocols. After the CT scan, patients completed a questionnaire covering the primary outcomes comfort, pain, and adverse events such as feelings of heat, nausea, vomiting, itchiness, urticaria, difficulty breathing, dizziness, goosebumps, or an odd taste. Technicians were asked to report any adverse events, including extravasation and allergic-like reactions. The secondary outcome involved attenuation (in Hounsfield unit, HU), which was evaluated by assessing the HU of the coronary arteries for vascular CT, and liver enhancement in portal venous CT. The Kruskal-Wallis test was used for continuous scale outcomes and χ 2 tests for examining adverse events. RESULTS Results showed no significant differences examining comfort score ( P = 0.054), pain sensation ( P = 0.469), extravasation ( P = 0.542), or allergic-like reaction ( P = 0.253). Significant differences among the 4 groups were found with respect to heat sensation and dizziness ( P = 0.005 and P = 0.047, respectively), showing small effect sizes. All other adverse effects showed no significant results. No significant differences were observed in coronary attenuation among the 4 groups in coronary CT angiography ( P = 0.113). When analyzing attenuation in portal venous CT scans, significant differences were found among the 4 groups ( P = 0.008). CONCLUSIONS Administrating prewarmed CM is nonsuperior compared with CM at room temperature in relation to patient comfort and safety, regardless of CM concentration. These findings suggest that prewarming CM before usage is unnecessary, which will improve the efficiency of daily clinical workflow and brings environmentally friendly benefits.
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Affiliation(s)
- Lion Stammen
- From the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (L.S., C.M., J.V., F.P., A.H., J.E.W., B.M.); and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands (L.S., C.M., J.E.W., B.M.)
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Gnasso C, Vecsey-Nagy M, Schoepf UJ, Stock J, Zsarnoczay E, Pinos D, Tremamunno G, Giovagnoli V, Seidensticker P, Emrich T, Varga-Szemes A. Evaluation of a Tube Voltage-Based Contrast Media Adaptation in Coronary Computed Tomography Angiography Using Personalized Triphasic Injection Protocols: A Matched Case-Control Study. Acad Radiol 2024:S1076-6332(24)00256-3. [PMID: 38734579 DOI: 10.1016/j.acra.2024.04.039] [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: 02/14/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024]
Abstract
RATIONALE AND OBJECTIVES Coronary CT angiography (CCTA) has recently been established as a first-line test in patients with suspected coronary artery disease (CAD). Due to the increased use of CCTA, strategies to reduce radiation and contrast medium (CM) exposure are of high importance. The aim of this study was to evaluate the performance of automated tube voltage selection (ATVS)-adapted CM injection protocol for CCTA compared to a clinically established triphasic injection protocol in terms of image quality, radiation exposure, and CM administration MATERIAL AND METHODS: Patients undergoing clinically indicated CCTA were prospectively enrolled from July 2021 to July 2023. Patients underwent CCTA using a modified triphasic CM injection protocol tailored to the tube voltage by the ATVS algorithm, in a range of 70 to 130 kV with a 10 kV interval. The injection protocol consisted of two phases of mixed CM and saline boluses with different proportions to assure a voltage-specific iodine delivery rate, followed by a third phase of saline flush. This cohort was compared to a control group identified retrospectively and scanned on the same CT system but with a standard triphasic CM protocol. Radiation and contrast dose, subjective and objective image quality (contrast-to-noise-ratio [CNR] and signal-to-noise-ratio [SNR]) were compared between the two groups. RESULTS The final population consisted of 120 prospective patients matched with 120 retrospective controls, with 20 patients in each kV group. The 120 kV group was excluded from the statistical analysis due to insufficient sample size. A significant CM reduction was achieved in the prospective group overall (46.0 [IQR 37.0-52.0] vs. 51.3 [IQR 40.1-73.0] mL, p < 0.001) and at all kV levels too (all pairwise p < 0.001). There were no significant differences in radiation dose (6.13 ± 4.88 vs. 5.97 ± 5.51 mSv, p = 0.81), subjective image quality (median score of 4 [3-5] vs. 4 [3-5], p = 0.40), CNR, and SNR in the aorta and the left anterior descending coronary artery (all p > 0.05). CONCLUSION ATVS-adapted CM injection protocol allows for diagnostic quality CCTA with reduced CM volume while maintaining similar radiation exposure, subjective and objective image quality.
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Affiliation(s)
- Chiara Gnasso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA; Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
| | - Milan Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA; Heart and Vascular Centre, Semmelweis University, Varosmajor utca 68, Budapest 1122, Hungary
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA.
| | - Jonathan Stock
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA; Paracelsus Medical University, Nuremberg, Prof.-Ernst-Nathan-Strasse 1, 90419 Nuremberg, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA; MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, H-1082 Budapest, Üllői út 78, Budapest, Hungary
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA
| | - Giuseppe Tremamunno
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA; Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Vincent Giovagnoli
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA
| | - Peter Seidensticker
- Global Medical Affairs Radiology, Bayer US LLC, Pittsburgh, Pennsylvania, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA; Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, Mainz 55131, Germany; German Centre for Cardiovascular Research, Mainz 55131, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA
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Loch FN, Beyer K, Kreis ME, Kamphues C, Rayya W, Schineis C, Jahn J, Tronser M, Elsholtz FHJ, Hamm B, Reiter R. Diagnostic performance of Node Reporting and Data System (Node-RADS) for regional lymph node staging of gastric cancer by CT. Eur Radiol 2024; 34:3183-3193. [PMID: 37921924 PMCID: PMC11126430 DOI: 10.1007/s00330-023-10352-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/25/2023] [Accepted: 08/20/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVES Diagnostic performance of imaging for regional lymph node assessment in gastric cancer is still limited, and there is a lack of consensus on radiological evaluation. At the same time, there is an increasing demand for structured reporting using Reporting and Data Systems (RADS) to standardize oncological imaging. We aimed at investigating the diagnostic performance of Node-RADS compared to the use of various individual criteria for assessing regional lymph nodes in gastric cancer using histopathology as reference. METHODS In this retrospective single-center study, consecutive 91 patients (median age, 66 years, range 33-91 years, 54 men) with CT scans and histologically proven gastric adenocarcinoma were assessed using Node-RADS assigning scores from 1 to 5 for the likelihood of regional lymph node metastases. Additionally, different Node-RADS criteria as well as subcategories of altered border contour (lobulated, spiculated, indistinct) were assessed individually. Sensitivity, specificity, and Youden's index were calculated for Node-RADS scores, and all criteria investigated. Interreader agreement was calculated using Cohen's kappa. RESULTS Among all criteria, best performance was found for Node-RADS scores ≥ 3 and ≥ 4 with a sensitivity/specificity/Youden's index of 56.8%/90.7%/0.48 and 48.6%/98.1%/0.47, respectively, both with substantial interreader agreement (κ = 0.73 and 0.67, p < 0.01). Among individual criteria, the best performance was found for short-axis diameter of 10 mm with sensitivity/specificity/Youden's index of 56.8%/87.0%/0.44 (κ = 0.65, p < 0.01). CONCLUSION This study shows that structured reporting of combined size and configuration criteria of regional lymph nodes in gastric cancer slightly improves overall diagnostic performance compared to individual criteria including short-axis diameter alone. The results show an increase in specificity and unchanged sensitivity. CLINICAL RELEVANCE STATEMENT The results of this study suggest that Node-RADS may be a suitable tool for structured reporting of regional lymph nodes in gastric cancer. KEY POINTS • Assessment of lymph nodes in gastric cancer is still limited, and there is a lack of consensus on radiological evaluation. • Node-RADS in gastric cancer improves overall diagnostic performance compared to individual criteria including short-axis diameter. • Node-RADS may be a suitable tool for structured reporting of regional lymph nodes in gastric cancer.
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Affiliation(s)
- Florian N Loch
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Katharina Beyer
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Martin E Kreis
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Carsten Kamphues
- Department of Surgery, Parkklinik Weißensee, Schönstraße 80, 13086, Berlin, Germany
| | - Wael Rayya
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Schineis
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Janosch Jahn
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Moritz Tronser
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Fabian H J Elsholtz
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Rolf Reiter
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
- BIH Charité Digital Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, 10117, Berlin, Germany.
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Hagen F, Estler A, Hofmann J, Walder L, Faby S, Almarie B, Nikolaou K, Wrazidlo R, Horger M. Reduced versus standard dose contrast volume for contrast-enhanced abdominal CT in overweight and obese patients using photon counting detector technology vs. second-generation dual-source energy integrating detector CT. Eur J Radiol 2023; 169:111153. [PMID: 38250749 DOI: 10.1016/j.ejrad.2023.111153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE To compare image quality of contrast-enhanced abdominal-CT using 1st-generation Dual Source Photon-Counting Detector CT (DS-PCD-CT) versus 2nd-generation Dual-Source Energy Integrating-Detector CT (DS-EID-CT) in patients with BMI ≥ 25, applying two different contrast agent volumes, vendor proposed protocols and different virtual monoenergetic images (VMI). METHOD 68 overweight (BMI ≥ 25 kgm2) patients (median age: 65 years; median BMI 33.3 kgm2) who underwent clinically indicated, portal-venous contrast-enhanced abdominal-CT on a commercially available 1st-generation DS-PCD-CT were prospectively included if they already have had a pre-exam on 2nd-generation DS-EID-CT using a standardized exam protocol. Obesity were defined by BMI-calculation (overweight: 25-29.9, obesity grade I: 30-34.9; obesity grade II: 35-39.9; obesity grade III: > 40) and by the absolute weight value. Body weight adapted contrast volume (targeted volume of 1.2 mL/kg for the 1st study and 0.8 mL/kg for the 2nd study) was applied in both groups. Dual Energy mode was used for both the DS-PCD-CT and the DS-EID-CT. Polychromatic images and VMI (40 keV and 70 keV) were reconstructed for both the DS-EID-CT and the DS-PCD-CT data (termed T3D). Two radiologists assessed subjective image quality using a 5-point Likert-scale. Each reader drew ROIs within parenchymatous organs and vascular structures to analyze image noise, contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). RESULTS Median time interval between scans was 12 months (Min: 6 months; Max: 36 months). BMI classification included overweight (n = 10, 14.7 %), obesity grade I (n = 38, 55.9 %), grade II (n = 13, 19.1 %) and grade III (n = 7, 10.3 %). The SNR achieved with DS-PCD-CT at QIR level 3was 12.61 vs. 11.47 (QIR 2) vs. 10.53 (DS-EID-CT), irrespective of parenchymatous organs. For vessels, the SNR were 16.73 vs. 14.20 (QIR 2) vs. 12.07 (DS-EID-CT). Moreover, the obtained median noise at QIR level 3 was as low as that of the DS-EID-CT (8.65 vs. 8.65). Both radiologists rated the image quality higher for DS-PCD-CT data sets (p < 0.05). The highest CNR was achieved at 40 keV for both scanners. T3D demonstrated significantly higher SNR and lower noise level compared to 40 keV and 70 keV. Median CTDIvol and DLP values for DS-PCD-CT and DS-EID-CT were 10.90 mGy (IQR: 9.31 - 12.50 mGy) vs. 16.55 mGy (IQR: 15.45 - 18.17 mGy) and 589.50 mGy * cm (IQR: 498.50 - 708.25 mGy * cm) vs. 848.75 mGy * cm (IQR: 753.43 - 969.58 mGy * cm) (p < 0.001). CONCLUSION Image quality can be maintained while significantly reducing the contrast volume and the radiation dose (27% and 34% lower DLP and 31% lower CDTIvol) for abdominal contrast-enhanced CT using a 1st-generation DS-PCD-CT. Moreover, polychromatic reconstruction T3D on a DS-PCD-CT enables sufficient diagnostic image quality for oncological imaging.
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Affiliation(s)
- Florian Hagen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Arne Estler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Johannes Hofmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Lukas Walder
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | | | - Bassel Almarie
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Robin Wrazidlo
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
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Yoon JH, Park JY, Lee SM, Lee ES, Kim JH, Lee JM. Renal protection CT protocol using low-dose and low-concentration iodine contrast medium in at-risk patients of HCC and with chronic kidney disease: a randomized controlled non-inferiority trial. Cancer Imaging 2023; 23:100. [PMID: 37858212 PMCID: PMC10588122 DOI: 10.1186/s40644-023-00616-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Although efforts have been made to reduce the dose of Contrast Medium (CM) to improve patient safety, there are ongoing concerns regarding its potential effects on image quality and diagnostic performance. Moreover, research is lacking to establish a lower limit for safe and effective CM dose reduction. To determine whether the image quality of contrast-enhanced liver computed tomography (CT) using a reduced amount of iodinated CM was similar to that of standard liver CT. METHODS We enrolled participants at risk for hepatocellular carcinoma with decreased estimated glomerular filtration rates (< 60 mL/min/1.73m2). Participants were randomly assigned to the standard group or the renal protection protocol (RPP) group. In the standard group, images were reconstructed using hybrid iterative reconstruction (iDose), while in the RPP group, low monoenergetic (50-keV) images and deep learning (DL)-based iodine-boosting reconstruction were used. Four radiologists independently assessed image quality and lesion conspicuity. RESULTS Fifty-two participants were assigned to the standard (n = 25) or RPP (n = 27) groups. The iodine load was significantly lower in the RPP group than in the standard group (301.5 ± 1.71 vs. 524 ± 7.37 mgI/kg, P < 0.001). The 50-keV and DL-based iodine-boosting images from the RPP group exhibited higher image contrast than those from the standard group during arterial (3.60 ± 0.65, 3.75 ± 0.60, and 3.09 ± 0.43, respectively) and portal venous phases (4.01 ± 0.49, 3.86 ± 0.42, and 3.21 ± 0.31, respectively) (P < 0.05 for all). Overall image quality was superior in the RPP group (P < 0.05 for all). No significant difference in lesion conspicuity was observed (P > 0.017). CONCLUSIONS The reduction in image contrast and overall image quality caused by decreased CM can be restored using either low monoenergetic imaging or DL-based iodine-boosting reconstruction. TRIAL REGISTRATION clinicaltrials.gov, NCT04024514, Registered July 18, 2019, prospectively registered, https://classic. CLINICALTRIALS gov/ct2/show/NCT04024514 .
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Affiliation(s)
- Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Jin Young Park
- Department of Radiology, Inje University Busan Paik Hospital, Bokji-ro 75, Busangjin-gu, Busan, 47392, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, CHA Gangnam Medical Center, CHA University, 566 Nonhyun-ro, Gangnam-gu, Seoul, 06135, Republic of Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, 06973, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea.
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Abstract
ABSTRACT Noninvasive vascular imaging with computed tomography (CT) has become the clinical mainstay for many indications and body regions. The recent introduction of photon-counting detector (PCD)-CT into clinical routine has further broadened the spectrum of vascular applications. Technical improvements of PCD-CT, such as the decreased noise levels, improved contrast-to-noise ratio, and full spectral multienergy data information from every acquisition, have the potential to further impact on clinical decision making and ultimately on outcome of vascular patients. Early experience with the new PCD-CT technology demonstrates these improvements in various aspects. This review summarizes the main advantages of PCD-CT for vascular imaging a discussion of the PureLumen and PureCalcium algorithms.
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Affiliation(s)
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Haubold J, Zensen S, Hosch R, Schaarschmidt BM, Bos D, Schmidt B, Flohr T, Li Y, Forsting M, Pietsch H, Nensa F, Jost G. Individualized scan protocols for CT angiography: an animal study for contrast media or radiation dose optimization. Eur Radiol Exp 2023; 7:24. [PMID: 37185930 PMCID: PMC10130261 DOI: 10.1186/s41747-023-00332-1] [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: 10/05/2022] [Accepted: 02/16/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND We investigated about optimization of contrast media (CM) dose or radiation dose in thoracoabdominal computed tomography angiography (CTA) by automated tube voltage selection (ATVS) system configuration and CM protocol adaption. METHODS In six minipigs, CTA-optimized protocols were evaluated regarding objective (contrast-to-noise ratio, CNR) and subjective (6 criteria assessed by Likert scale) image quality. Scan parameters were automatically adapted by the ATVS system operating at 90-kV semi-mode and configured for standard, CM saving, or radiation dose saving (image task, quality settings). Injection protocols (dose, flow rate) were adapted manually. This approach was tested for normal and simulated obese conditions. RESULTS Radiation exposure (volume-weighted CT dose index) for normal (obese) conditions was 2.4 ± 0.7 (5.0 ± 0.7) mGy (standard), 4.3 ± 1.1 (9.0 ± 1.3) mGy (CM reduced), and 1.7 ± 0.5 (3.5 ± 0.5) mGy (radiation reduced). The respective CM doses for normal (obese) settings were 210 (240) mgI/kg, 155 (177) mgI/kg, and 252 (288) mgI/kg. No significant differences in CNR (normal; obese) were observed between standard (17.8 ± 3.0; 19.2 ± 4.0), CM-reduced (18.2 ± 3.3; 20.5 ± 4.9), and radiation-saving CTAs (16.0 ± 3.4; 18.4 ± 4.1). Subjective analysis showed similar values for optimized and standard CTAs. Only the parameter diagnostic acceptability was significantly lower for radiation-saving CTA compared to the standard CTA. CONCLUSIONS The CM dose (-26%) or radiation dose (-30%) for thoracoabdominal CTA can be reduced while maintaining objective and subjective image quality, demonstrating the feasibility of the personalization of CTA scan protocols. KEY POINTS • Computed tomography angiography protocols could be adapted to individual patient requirements using an automated tube voltage selection system combined with adjusted contrast media injection. • Using an adapted automated tube voltage selection system, a contrast media dose reduction (-26%) or radiation dose reduction (-30%) could be possible.
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Affiliation(s)
- Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147, Essen, Germany.
| | - Sebastian Zensen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147, Essen, Germany
| | - René Hosch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147, Essen, Germany
- Institute of Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Benedikt Michael Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147, Essen, Germany
| | - Denise Bos
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147, Essen, Germany
| | | | | | - Yan Li
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147, Essen, Germany
| | | | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147, Essen, Germany
- Institute of Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Gregor Jost
- MR and CT Contrast Media Research, Bayer AG, Berlin, Germany
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A New Algorithm for Automatically Calculating Noise, Spatial Resolution, and Contrast Image Quality Metrics: Proof-of-Concept and Agreement With Subjective Scores in Phantom and Clinical Abdominal CT. Invest Radiol 2023:00004424-990000000-00084. [PMID: 36719964 DOI: 10.1097/rli.0000000000000954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aims of this study were to develop a proof-of-concept computer algorithm to automatically determine noise, spatial resolution, and contrast-related image quality (IQ) metrics in abdominal portal venous phase computed tomography (CT) imaging and to assess agreement between resulting objective IQ metrics and subjective radiologist IQ ratings. MATERIALS AND METHODS An algorithm was developed to calculate noise, spatial resolution, and contrast IQ parameters. The algorithm was subsequently used on 2 datasets of anthropomorphic phantom CT scans, acquired on 2 different scanners (n = 57 each), and on 1 dataset of patient abdominal CT scans (n = 510). These datasets include a range of high to low IQ: in the phantom dataset, this was achieved through varying scanner settings (tube voltage, tube current, reconstruction algorithm); in the patient dataset, lower IQ images were obtained by reconstructing 30 consecutive portal venous phase scans as if they had been acquired at lower mAs. Five noise, 1 spatial, and 13 contrast parameters were computed for the phantom datasets; for the patient dataset, 5 noise, 1 spatial, and 18 contrast parameters were computed. Subjective IQ rating was done using a 5-point Likert scale: 2 radiologists rated a single phantom dataset each, and another 2 radiologists rated the patient dataset in consensus. General agreement between IQ metrics and subjective IQ scores was assessed using Pearson correlation analysis. Likert scores were grouped into 2 categories, "insufficient" (scores 1-2) and "sufficient" (scores 3-5), and differences in computed IQ metrics between these categories were assessed using the Mann-Whitney U test. RESULTS The algorithm was able to automatically calculate all IQ metrics for 100% of the included scans. Significant correlations with subjective radiologist ratings were found for 4 of 5 noise (R2 range = 0.55-0.70), 1 of 1 spatial resolution (R2 = 0.21 and 0.26), and 10 of 13 contrast (R2 range = 0.11-0.73) parameters in the phantom datasets and for 4 of 5 noise (R2 range = 0.019-0.096), 1 of 1 spatial resolution (R2 = 0.11), and 16 of 18 contrast (R2 range = 0.008-0.116) parameters in the patient dataset. Computed metrics that significantly differed between "insufficient" and "sufficient" categories were 4 of 5 noise, 1 of 1 spatial resolution, 9 and 10 of 13 contrast parameters for phantom the datasets and 3 of 5 noise, 1 of 1 spatial resolution, and 10 of 18 contrast parameters for the patient dataset. CONCLUSION The developed algorithm was able to successfully calculate objective noise, spatial resolution, and contrast IQ metrics of both phantom and clinical abdominal CT scans. Furthermore, multiple calculated IQ metrics of all 3 categories were in agreement with subjective radiologist IQ ratings and significantly differed between "insufficient" and "sufficient" IQ scans. These results demonstrate the feasibility and potential of algorithm-determined objective IQ. Such an algorithm should be applicable to any scan and may help in optimization and quality control through automatic IQ assessment in daily clinical practice.
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