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Schüle S, Bunert F, Hackenbroch C, Beer M, Ostheim P, Stewart S, Port M, Scherthan H, Abend M. The Influence of Computed Tomography Contrast Agent on Radiation-Induced Gene Expression and Double-Strand Breaks. Radiat Res 2024; 201:396-405. [PMID: 38282002 DOI: 10.1667/rade-23-00118.1] [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: 06/24/2023] [Accepted: 10/14/2023] [Indexed: 01/30/2024]
Abstract
After nuclear scenarios, combined injuries of acute radiation syndrome (ARS) with, e.g., abdominal trauma, will occur and may require contrast-enhanced computed tomography (CT) scans for diagnostic purposes. Here, we investigated the effect of iodinated contrast agents on radiation-induced gene expression (GE) changes used for biodosimetry (AEN, BAX, CDKN1A, EDA2R, APOBEC3H) and for hematologic ARS severity prediction (FDXR, DDB2, WNT3, POU2AF1), and on the induction of double-strand breaks (DSBs) used for biodosimetry. Whole blood samples from 10 healthy donors (5 males, 5 females, mean age: 28 ± 2 years) were irradiated with X rays (0, 1 and 4 Gy) with and without the addition of iodinated contrast agent (0.016 ml contrast agent/ml blood) to the blood prior to the exposure. The amount of contrast agent was set to be equivalent to the blood concentration of an average patient (80 kg) during a contrast-enhanced CT scan. After irradiation, blood samples were incubated at 37°C for 20 min (DSB) and 8 h (GE, DSB). GE was measured employing quantitative real-time polymerase chain reaction. DSB foci were revealed by γH2AX + 53BP1 immunostaining and quantified automatically in >927 cells/sample. Radiation-induced differential gene expression (DGE) and DSB foci were calculated using the respective unexposed sample without supplementation of contrast agent as the reference. Neither the GE nor the number of DSB foci was significantly (P = 0.07-0.94) altered by the contrast agent application. However, for some GE and DSB comparisons with/without contrast agent, there were weakly significant differences (P = 0.03-0.04) without an inherent logic and thus are likely due to inter-individual variation. In nuclear events, the diagnostics of combined injuries can require the use of an iodinated contrast agent, which, according to our results, does not alter or influence radiation-induced GE changes and the quantity of DSB foci. Therefore, the gene expression and γH2AX focus assay can still be applied for biodosimetry and/or hematologic ARS severity prediction in such scenarios.
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Affiliation(s)
- Simone Schüle
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstraße 11, 80937 Munich, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, German Armed Force Hospital of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Felix Bunert
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstraße 11, 80937 Munich, Germany
| | - Carsten Hackenbroch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, German Armed Force Hospital of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
- Department of Radiology, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Meinrad Beer
- Department of Radiology, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Patrick Ostheim
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstraße 11, 80937 Munich, Germany
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg
| | - Samantha Stewart
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstraße 11, 80937 Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstraße 11, 80937 Munich, Germany
| | - Harry Scherthan
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstraße 11, 80937 Munich, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstraße 11, 80937 Munich, Germany
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Yap LPP, Sani FM, Chung E, Gowdh NFM, Ng WL, Wong JHD. Customised weight-based volume contrast media protocol for multiphase abdominal computed tomography. Singapore Med J 2024:00077293-990000000-00085. [PMID: 38305361 DOI: 10.4103/singaporemedj.smj-2021-461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 10/19/2022] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Multiphase computed tomography (CT) using fixed volume contrast media may lead to high radiation exposure and toxicity in patients with low body weight. We evaluated a customised weight-based protocol for multiphase CT in terms of radiation exposure, image quality and cost savings. METHODS A total of 224 patients were recruited. An optimised CT protocol was applied using 100 kV and 1 mL/kg of contrast media dosing. The image quality and radiation dose exposure of this CT protocol were compared to those of a standard 120 kV, 80 mL fixed volume protocol. The radiation dose information and CT Hounsfield units were recorded. The signal-to-noise ratio, contrast-to-noise ratio (CNR) and figure of merit (FOM) were used as comparison metrics. The images were assessed for contrast opacification and visual quality by two radiologists. The renal function, contrast media volume and cost were also evaluated. RESULTS The median effective dose was lowered by 16% in the optimised protocol, while the arterial phase images achieved significantly higher CNR and FOM. The radiologists' evaluation showed more than 97% absolute agreement with no significant differences in image quality. No significant differences were found in the pre- and post-CT estimated glomerular filtration rate. However, contrast media usage was significantly reduced by 1,680 mL, with an overall cost savings of USD 421 in the optimised protocol. CONCLUSION The optimised weight-based protocol is cost-efficient and lowers radiation dose while maintaining overall contrast enhancement and image quality.
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Affiliation(s)
- Lilian Poh Poh Yap
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Biomedical Imaging, Universiti Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Fadhli Mohamed Sani
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Biomedical Imaging, Universiti Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Eric Chung
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Biomedical Imaging, Universiti Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Nadia Fareeda Muhammad Gowdh
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Biomedical Imaging, Universiti Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Wei Lin Ng
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Biomedical Imaging, Universiti Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Biomedical Imaging, Universiti Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia
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Mazloumi M, Van Gompel G, Tanaka K, Argacha JF, de Mey J, Buls N. The impact of iodine contrast agent on radiation dose of heart and blood: a comparison between coronary CT angiography and cardiac calcium scoring CT. Acta Radiol 2023; 64:2387-2392. [PMID: 37138465 DOI: 10.1177/02841851231170850] [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] [Indexed: 05/05/2023]
Abstract
BACKGROUND Iodine contrast agent (CA) is widely used in cardiac computed tomography (CT). The CA can increase the organ radiation doses due to the photoelectric effect. PURPOSE To investigate the impact of CA on radiation dose in cardiac CT by comparing the radiation dose between contrast coronary CT angiography (CCTA) and non-contrast calcium scoring CT (CSCT). MATERIAL AND METHODS Radiation doses were computationally calculated for 30 individual patients who received CSCT and CCTA in the same exam session. The geometry and acquisition parameters were modeled in the simulations based on individual patient CT images and acquisitions. Doses in the presence and absence of CA were obtained in the aorta, left ventricle (LV), right ventricle (RV), and myocardial tissue (MT). The dose values were normalized by size-specific dose estimate (SSDE). The dose enhancement factors (DEFSSDE) were calculated as the ratio of doses in CCTA over doses in CSCT. RESULTS Compared to the CSCT scans, doses increase in the CCTA scans in the aorta (DEFSSDE = 2.14 ± 0.20), LV (DEFSSDE = 1.78 ± 0.26), and RV (DEFSSDE = 1.31 ± 0.22). A linear relation is observed between the local CA concentrations and the dose increase in the heart; DEFSSDE = 0.07*I(mg/mL) + 0.80 (R2 = 0.8; p < 0.01). The DEFSSDE in the MT (DEFSSDE = 0.96 ± 0.08) showed no noticeable impact of CA on the dose in this tissue. In addition, patient variability in the dose distributions was observed. CONCLUSION A linear causal relation exists between local CA concentration and increase in radiation dose in cardiac CT. For the same CT exposure, dose to the heart is on average 55% higher in contrast cardiac CT.
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Affiliation(s)
- Mahta Mazloumi
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Gert Van Gompel
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jean-François Argacha
- Department of Cardiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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Van Gompel G, Delombaerde L, Zanca F, Tanaka K, Belsack D, de Mey J, Buls N. A patient- and acquisition-tailored injection approach for improving consistency of CT enhancement towards a target CT value in coronary CT angiography. J Appl Clin Med Phys 2022; 24:e13867. [PMID: 36537145 PMCID: PMC9860000 DOI: 10.1002/acm2.13867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Unoptimized coronary CT angiography (CTA) exams typically result in a highly variable arterial enhancement (HUa ) across patients. This study aimed at harmonizing arterial enhancement by implementing a patient-, contrast- and kV-tailored injection protocol. METHODS First, the optimal body size metric to predict HUa was identified by retrospectively analysing images of 76 patients, acquired with 70 ml contrast media (G1). Second, using phantom experiments, correction factors for the effect of kV and contrast concentration on HUa were determined. Third, a model was developed, prescribing the optimal contrast dose to be injected to obtain a diagnostically appropriate arterial target enhancement HUtarget . The model was then validated on 278 prospectively collected patients, in two groups with two different HUtarget : 525 HU (207 patients, G2A) and 425 HU (71 patients, G2B). The HUa histograms were compared among groups and to the target enhancement through their mean and standard deviation (SD) at 100 kVp reference level. Also, signal-to-noise ratio was obtained and compared among the groups. RESULTS Fat free mass (FFM) showed the highest correlation with HUa (r = 0.69). KVp correction factors ranged from 0.65 at 70 kVp to 1.22 at 140 kVp. The obtained model reduced the group heterogeneity (SD) from 101HU for reference G1 to 75HU (p < 0.001) for G2A and 68HU (p < 0.001) for G2B. The mean HUa of 506HU in G2A was slightly below HUtarget = 525HU (p = 0.01) whereas in G2B, the mean HUa of 414HU was not significantly different from HUtarget = 425HU (p = 0.54). The total iodine dose was lowered from 19.5 g-I to 17.6 g-I and 14.2 g-I from G1 to G2A and G2B, on average. CONCLUSION A contrast injection model, based on patient's fat free mass and accounting for the contrast agent concentration and the planned CT-scan tube voltage, harmonized arterial enhancement among patients towards a predefined target enhancement in coronary CTA scanning, without affecting the bolus timing.
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Affiliation(s)
- Gert Van Gompel
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of RadiologyBrusselsBelgium
| | | | | | - Kaoru Tanaka
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of RadiologyBrusselsBelgium
| | - Dries Belsack
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of RadiologyBrusselsBelgium
| | - Johan de Mey
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of RadiologyBrusselsBelgium
| | - Nico Buls
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of RadiologyBrusselsBelgium
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Revel MP, Beeker N, Porcher R, Jilet L, Fournier L, Rance B, Chassagnon G, Fontenay M, Sanchez O. What level of D-dimers can safely exclude pulmonary embolism in COVID-19 patients presenting to the emergency department? Eur Radiol 2022; 32:2704-2712. [PMID: 34994845 PMCID: PMC8739682 DOI: 10.1007/s00330-021-08377-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To identify which level of D-dimer would allow the safe exclusion of pulmonary embolism (PE) in COVID-19 patients presenting to the emergency department (ED). METHODS This retrospective study was conducted on the COVID database of Assistance Publique - Hôpitaux de Paris (AP-HP). COVID-19 patients who presented at the ED of AP-HP hospitals between March 1 and May 15, 2020, and had CTPA following D-dimer dosage within 48h of presentation were included. The D-dimer sensitivity, specificity, and positive and negative predictive values were calculated for different D-dimer thresholds, as well as the false-negative and failure rates, and the number of CTPAs potentially avoided. RESULTS A total of 781 patients (mean age 62.0 years, 53.8% men) with positive RT-PCR for SARS-Cov-2 were included and 60 of them (7.7%) had CTPA-confirmed PE. Their median D-dimer level was significantly higher than that of patients without PE (4,013 vs 1,198 ng·mL-1, p < 0.001). Using 500 ng·mL-1, or an age-adjusted cut-off for patients > 50 years, the sensitivity and the NPV were above 90%. With these thresholds, 17.1% and 31.5% of CTPAs could have been avoided, respectively. Four of the 178 patients who had a D-dimer below the age-adjusted cutoff had PE, leading to an acceptable failure rate of 2.2%. Using higher D-dimer cut-offs could have avoided more CTPAs, but would have lowered the sensitivity and increased the failure rate. CONCLUSION The same D-Dimer thresholds as those validated in non-COVID outpatients should be used to safely rule out PE. KEY POINTS • The median D-dimer level was significantly higher in COVID-19 patients with PE as compared to those without PE (4,013 ng·mL-1 vs 1,198 ng·mL-1 respectively, p < 0.001). • Using 500 ng·mL-1, or an age-adjusted D-dimer cut-off to exclude pulmonary embolism, the sensitivity and negative predictive value were above 90%. • Higher cut-offs would lead to a reduction in the sensitivity below 85% and an increase in the failure rate, especially for patients under 50 years.
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Affiliation(s)
- Marie-Pierre Revel
- Université de Paris, 75006, Paris, France. .,Radiology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Service de Radiologie27 rue du Faubourg Saint Jacques, 75014, Paris, France.
| | - Nathanael Beeker
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Unité de Recherche Clinique, Hôpital Cochin, Paris, France
| | - Raphael Porcher
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Centre d'épidémiologie clinique, Hôtel-Dieu, Paris, France
| | - Léa Jilet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Unité de Recherche Clinique, Hôpital Cochin, Paris, France
| | - Laure Fournier
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Radiologie, Hôpital Européen, Georges Pompidou, Paris, France
| | - Bastien Rance
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Département d'Informatique Médicale, Biostatistiques Et Santé Publique, Hôpital Européen Georges Pompidou, Paris, France
| | - Guillaume Chassagnon
- Université de Paris, 75006, Paris, France.,Radiology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Service de Radiologie27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Michaela Fontenay
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de d'hématologie biologique, Hôpital Cochin, Paris, France.,Institut Cochin INSERM U1016, CNRS UMR8104, Paris, France
| | - Olivier Sanchez
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Pneumologie Et Soins Intensifs, Hôpital Européen, Georges Pompidou, INSERM UMRS-1140 Innovative Therapies in Hemostasis and Biosurgical Research Lab (Carpentier Foundation), Paris, France.,F-CRIN INNOVTE, Saint-Etienne, France
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Morisaka H, Matsuura K, Yamaguchi H, Ichikawa T, Onishi H. Effect of decreased contrast injection flow rate on aortic enhancement in 80-KV peak CT with contrast dose reduction. Acta Radiol 2021; 64:353-359. [PMID: 34923851 DOI: 10.1177/02841851211067144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Effect of decreased injection flow rate of contrast agent at the same iodine dose and delivery rate on aortic enhancement has not been clearly elucidated. PURPOSE To evaluate the effect of decreased injection flow rate of contrast agent on aortic peak enhancement in a dynamic flow phantom and on aortic enhancement in clinical dynamic 80-kVp computed tomography (CT) with contrast dose reduction. MATERIAL AND METHODS In the dynamic flow phantom experiment, the effect of a decreased injection flow rate at the same total iodine dose and delivery rate on simulated aortic peak enhancement was evaluated. In the clinical retrospective study, we searched 312 patients with renal dysfunction who underwent an 80-kVp abdominal dynamic CT with 40% reduction of contrast agent from a standard 120-kVp protocol and measured the aortic enhancement at the level of the hepatic hilum. Independent predictors for aortic enhancement were determined by multiple linear regression analysis, and after adjustment of significant predictors, independent variables for acquiring optimal aortic enhancement, ≥300 HU, were determined by multiple logistic regression analysis. RESULTS In the phantom experiment, decreased flow rate showed a significant but small descent effect (6%-9%) on simulated aortic peak enhancement. In the multiple linear regression analysis, only age was an independent predictor of aortic enhancement; there was no independent predictor for optimal age-adjusted aortic enhancement of ≥300 HU. CONCLUSIONS Decreased injection flow rate had a small influence on aortic enhancement in vitro but had no significant effect on the aortic enhancement in clinical dynamic 80-kVp CT.
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Affiliation(s)
- Hiroyuki Morisaka
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
- Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Koichiro Matsuura
- Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Haruomi Yamaguchi
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tomoaki Ichikawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
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Van Cauteren T, Tanaka K, Belsack D, Van Gompel G, Kersemans V, Jochmans K, Droogmans S, de Mey J, Buls N. Potential increase in radiation-induced DNA double-strand breaks with higher doses of iodine contrast during coronary CT angiography. Med Phys 2021; 48:7526-7533. [PMID: 34564862 PMCID: PMC9293077 DOI: 10.1002/mp.15253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/25/2021] [Accepted: 09/14/2021] [Indexed: 11/09/2022] Open
Abstract
Purpose To investigate the contrast media iodine dose dependency of radiation‐induced DNA double‐strand breaks (DSBs) during a coronary computed tomography angiography (CCTA) scan. Methods This prospective patient study was approved by the ethical committee. Between November 2018 and July 2019, 50 patients (31 males and 19 females, mean age 64 years) were included in the study, 45 CCTA and five noncontrast‐enhanced (NCE) cardiac computed tomography (CT) patients. A single‐heartbeat scan protocol with a patient‐tailored contrast media injection protocol was used, administering a patient‐specific iodine dose. DNA double‐strand breaks were quantified using a γH2AX foci assay on peripheral blood lymphocytes. The net amount of γH2AX/cell was normalized to the individual patient CT dose by the size‐specific dose estimate (SSDE). Correlation between the administered and blood‐iodine dose and the SSDE normalized amount of DNA DSBs was investigated using a Pearson correlation test. Results CCTA patients were scanned with a mean CTDIvol of 10.6 ± 5.6 mGy, corresponding to a mean SSDE of 11.3 ± 5.3 mGy while the NCE cardiac CT patients were scanned with a mean CTDIvol of 6.00 ± 1.8 mGy, corresponding to a mean SSDE of 6.6 ± 2.7 mGy. The administered iodine dose ranged from 16.5 to 34.0 gI in the CCTA patients, resulting in a blood‐iodine dose range from 5.1 to 15.0 gI in the exposed blood volume. A significant linear relationship (r = 0.79, p‐value < 0.001) was observed between the blood iodine dose and SSDE normalized radiation‐induced DNA DSBs. A similar significant linear relationship (r = 0.62, p‐value < 0.001) was observed between the administered iodine dose and SSDE normalized radiation‐induced DNA DSBs. Conclusions This study shows that contrast media iodine dose increases the level of radiation‐induced DNA DSBs in peripheral blood lymphocytes in a linear dose‐dependent manner with CCTA. Importantly, the level of DNA DSBs can be reduced by lowering the administered iodine dose.
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Affiliation(s)
- Toon Van Cauteren
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussels (UZB), Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussels (UZB), Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussels (UZB), Brussels, Belgium
| | - Gert Van Gompel
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussels (UZB), Brussels, Belgium
| | - Veerle Kersemans
- Department of Oncology, CRUK/MRC Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Kristin Jochmans
- Department of Hematology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussels (UZB), Brussels, Belgium
| | - Steven Droogmans
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussels (UZB), Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussels (UZB), Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussels (UZB), Brussels, Belgium
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The presence of contrast agent increases organ radiation dose in contrast-enhanced CT. Eur Radiol 2021; 31:7540-7549. [PMID: 33783569 PMCID: PMC8452580 DOI: 10.1007/s00330-021-07763-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/08/2021] [Accepted: 02/05/2021] [Indexed: 01/09/2023]
Abstract
Objectives Routine dosimetry calculations do not account for the presence of iodine in organs and tissues during CT acquisition. This study aims to investigate the impact of contrast agent (CA) on radiation dose. Methods First, relation between absorbed radiation dose and iodine concentrations was investigated using a cylindrical water phantom with iodine-saline dilution insertions. Subsequently, a retrospective study on abdominal dual-energy CT (DECT) patient data was performed to assess the increase of the local absorbed radiation dose compared to a non-contrast scan. Absorbed doses were estimated with Monte Carlo simulations using the individual CT voxel data of phantom and patients. Further, organ segmentations were performed to obtain the dose in liver, liver parenchyma, left kidney, right kidney, aorta, and spleen. Results In the phantom study, a linear relation was observed between the radiation dose normalized by computed tomography dose index (CTDI) and CA concentrations Iconc (mg/ml) for three tube voltages; \documentclass[12pt]{minimal}
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\begin{document}$$ \frac{D_{80 kVp}}{CTDI_{vol}} $$\end{document}D80kVpCTDIvol = 0.14 × Iconc + 1.02, \documentclass[12pt]{minimal}
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\begin{document}$$ \frac{D_{120 kVp}}{CTDI_{vol}} $$\end{document}D120kVpCTDIvol = 0.16 × Iconc + 1.21, \documentclass[12pt]{minimal}
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\begin{document}$$ \frac{D_{140 kVp}}{CTDI_{vol}} $$\end{document}D140kVpCTDIvol = 0.16 × Iconc + 1.24, and for DECT acquisition; \documentclass[12pt]{minimal}
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\begin{document}$$ \frac{D_{DECT}}{CTDI_{vol}} $$\end{document}DDECTCTDIvol = 0.15 × Iconc + 1.09. Similarly, a linear relation was observed between the dose increase and the organ iodine contents (R2 = 0.86 and pvalue < 0.01) in the patient study. The relative doses increased in the liver (21 ± 5%), liver parenchyma (20 ± 5%), right kidney (37 ± 7%), left kidney (39 ± 7%), aorta (34 ± 6%) and spleen (26 ± 4%). In addition, the local dose distributions changed based on patient’s anatomy and physiology. Conclusions Compared to a non-contrast scan, the organ doses increase by 30% in contrast-enhanced abdominal CT. This study suggests considering CA in dosimetry calculations, epidemiological studies, and organ dose estimations while developing new CT protocols. Key Points • The presence of contrast media increases radiation absorption in CT, and this increase is related to the iodine content in the organs. • The increased radiation absorption due to contrast media can lead to an average 30% increase in absorbed organ dose. • Iodine should be considered in CT radiation safety studies.
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Ainsbury EA. The 2019 Bo Lindell Laureate Lecture: On the use of interdisciplinary, stakeholder-driven, radiation protection research in support of medical uses of ionising radiation. Ann ICRP 2020; 49:32-44. [PMID: 32907341 DOI: 10.1177/0146645320946629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Medical exposures form the largest manmade contributor to total ionising radiation exposure of the UK population. In recent years, new technologies have been developed to improve treatment and prognosis of individuals treated with radiation for diseases such as cancer. However, there is evidence of public, patient, and medical professional concern that radiation protection regulations and practices, as well as understanding of potential long-term adverse health effects of radiation exposure (in the context of other health risks), have not always 'kept pace' with technological developments in this field. This is a truly complex, multi-disciplinary problem for the modern world.The 'Radiation Theme' of the Public Health England and Newcastle University Health Protection Research Unit on 'Chemical and Radiation Threats and Hazards' is addressing this need, with a key focus on a genuinely interdisciplinary approach bringing together world-leading epidemiologists, radiation biologists, clinicians, statisticians, and artists. In addition, the project has a strong grounding in public, patient, and medical professional involvement in research. Similarly, the EU-CONCERT-funded LDLensRad project seeks to understand the mechanisms of action of low-dose ionising radiation in the lens of the eye, and the potential contribution to the development of cataract - in contemporary research, such projects will only be considered successful when they make use of expertise from a variety of fields and when they are able to demonstrate that the outputs are not only of benefit to society, but that society understands and welcomes the benefits. Finally, successful engagement, training, and retention of early career scientists within this field is crucial for sustainability of the research. Herein, the contribution of embedded interdisciplinary working, stakeholder involvement, and training of early career scientists to recent advancements in the field of medical (and wider) radiation protection research is discussed and considered.
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Affiliation(s)
- E A Ainsbury
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxford OX11 0RQ, UK; e-mail:
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10
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Söder S, Wällisch W, Dittrich S, Cesnjevar R, Pfammatter JP, Glöckler M. Three-Dimensional Rotational Angiography during Catheterization of Congenital Heart Disease - A ten Years' experience at a single center. Sci Rep 2020; 10:6973. [PMID: 32332807 PMCID: PMC7181762 DOI: 10.1038/s41598-020-63903-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/06/2020] [Indexed: 11/13/2022] Open
Abstract
This paper aims to assess the usability and advantages of three-dimensional rotational angiography (3DRA) in patients with congenital heart disease (CHD) and its application in the cath lab. Up to now, its use in CHD is not widespread or standardized. We analyzed all patients with CHD who underwent a 3DRA at our facility between January 2010 and May 2019. The 3DRAs were evaluated for radiation exposure, contrast dye consumption, diagnostic utility and image quality. We performed 872 3DRAs. 3DRA was used in 67.1% of the cases for interventional procedures and in 32.9% for diagnostic purposes. Two different acquisition programs were applied. The median dose-area product (DAP) for all 872 rotations was 54.1 µGym2 (21.7–147.5 µGym2) and 1.6 ml/kg (0.9–2.07 ml/kg) of contrast dye was used. Diagnostic utility of the generated 3D-model was rated superior to the native 3D angiography in 94% (819/872). 3DRA is an excellent and save diagnostic and interventional tool. However, 3DRA has not become a standard imaging procedure in pediatric cardiology up to now. Effort and advantage seems to be unbalanced, but new less invasive techniques may upgrade this method in future.
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Affiliation(s)
- Stefanie Söder
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Wolfgang Wällisch
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Robert Cesnjevar
- Department of Congenital Heart Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Jean-Pierre Pfammatter
- Department of Cardiology, Pediatric Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Glöckler
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany. .,Department of Cardiology, Pediatric Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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DNA Damage in Blood Leukocytes of Prostate Cancer Patients Undergoing PET/CT Examinations with [ 68Ga]Ga-PSMA I&T. Cancers (Basel) 2020; 12:cancers12020388. [PMID: 32046191 PMCID: PMC7072291 DOI: 10.3390/cancers12020388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 01/25/2023] Open
Abstract
The aim was to investigate the induction and repair of radiation-induced DNA double-strand breaks (DSBs) as a function of the absorbed dose to the blood of patients undergoing PET/CT examinations with [68Ga]Ga-PSMA. Blood samples were collected from 15 patients before and at four time points after [68Ga]Ga-PSMA administration, both before and after the PET/CT scan. Absorbed doses to the blood were calculated. In addition, blood samples with/without contrast agent from five volunteers were irradiated ex vivo by CT while measuring the absorbed dose. Leukocytes were isolated, fixed, and stained for co-localizing γ-H2AX+53BP1 DSB foci that were enumerated manually. In vivo, a significant increase in γ-H2AX+53BP1 foci compared to baseline was observed at all time points after administration, although the absorbed dose to the blood by 68Ga was below 4 mGy. Ex vivo, the increase in radiation-induced foci depended on the absorbed dose and the presence of contrast agent, which could have caused a dose enhancement. The CT-dose contribution for the patients was estimated at about 12 mGy using the ex vivo calibration. The additional number of DSB foci induced by CT, however, was comparable to the one induced by 68Ga. The significantly increased foci numbers after [68Ga]Ga-PSMA administration may suggest a possible low-dose hypersensitivity.
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Peristaltic Contrast Media Injection Improved Image Quality and Decreased Radiation and Contrast Dose When Compared With Direct Drive Injection During Liver Computed Tomography. J Comput Assist Tomogr 2020; 44:209-216. [DOI: 10.1097/rct.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Yang JS, Peng YR, Tsai SC, Tyan YS, Lu CC, Chiu HY, Chiu YJ, Kuo SC, Tsai YF, Lin PC, Tsai FJ. The molecular mechanism of contrast-induced nephropathy (CIN) and its link to in vitro studies on iodinated contrast media (CM). Biomedicine (Taipei) 2018; 8:1. [PMID: 29480796 PMCID: PMC5826038 DOI: 10.1051/bmdcn/2018080101] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 11/24/2022] Open
Abstract
Iodinated contrast media (iodinated CM) have increased ability to absorb x-rays and to visualize structures that normally are impossible to observe in a radiological examination. The use of iodinated CM may destory renal function, commonly known as contrast-induced nephropathy (CIN), which can result in acute renal failure (ARF). This review article mainly focuses on the following areas: (1) classifications of iodinated CM: ionic or non-ionic, high-osmolarity contrast media (HOCM), low-osmolarity contrast media (LOCM) and iso-osmolarity contrast media (IOCM); (2) an introduction to the physical and chemical properties of the non-ionic iodinated CM; (3) the management of anaphylactic reaction by iodinated CM; (4) a suggested single injection of adult doses and maximum dose for non-ionic iodinated CM; (5) the molecular mechanism of contrast-induced nephropathy (CIN); (6) In vitro studies on iodinated CM. Based on above information, this review article provide an insight for understanding the drug safety of iodinated CM.
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Affiliation(s)
- Jai-Sing Yang
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - Yan-Ru Peng
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Shih-Chang Tsai
- Department of Biological Science and Technology, China Medical University, Taichung 404, Taiwan
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung 402, Taiwan - School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung 402, Taiwan - School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Chi-Cheng Lu
- Department of Pharmacy, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan
| | - Hong-Yi Chiu
- Department of Pharmacy, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan
| | - Yu-Jen Chiu
- Division of Reconstructive and Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Sheng-Chu Kuo
- Chinese Medicinal Research and Development Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan - School of Pharmacy, China Medical University, Taichung 404, Taiwan
| | - Yuh-Feng Tsai
- Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan - School of Medicine, Fu-Jen Catholic University, Taipei 242, Taiwan
| | - Ping-Chin Lin
- Department of Medical Imaging, Chia-Yi Christian Hospital, Chiayi 600, Taiwan
| | - Fuu-Jen Tsai
- Genetics Center, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan - School of Chinese Medicine, China Medical University, Taichung 404, Taiwan - Department of Medical Genetics, China Medical University Hospital, Taichung 404, Taiwan
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Harbron RW, Ainsbury EA, Bouffler SD, Tanner RJ, Pearce MS, Eakins JS. The impact of iodinated contrast media on intravascular and extravascular absorbed doses in X-ray imaging: A microdosimetric analysis. Phys Med 2018; 46:140-147. [PMID: 29519400 DOI: 10.1016/j.ejmp.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/22/2017] [Accepted: 02/01/2018] [Indexed: 12/27/2022] Open
Abstract
Studies suggest iodinated contrast media (ICM) may increase organ dose and blood cell DNA damage for a given X-ray exposure. The impact of ICM on dose/damage to extravascular cells and cancer risks is unclear. METHODS We used Monte Carlo modelling to investigate the microscopic distribution of absorbed dose outside the lumen of arteries, capillaries and interstitial fluids containing blood and various concentrations of iodine. Models were irradiated with four X-ray spectra representing clinical procedures. RESULTS For the artery model, The average dose enhancement factors (DEF) to blood were 1.70, 2.38, 7.38, and 12.34 for mass concentrations of iodine in blood (ρiI) of 5, 10, 50 and 100 mg/ml, respectively, compared to 0 mg/ml. Average DEFs were reduced to 1.26, 1.51, 3.48 and 5.56, respectively, in the first micrometre of the vessel wall, falling to 1.01, 1.02, 1.06 and 1.09 at 40-50 μm from the lumen edge. For the capillary models, DEF for extravascular tissues was on average 48% lower than DEF for the whole model, including capillaries. A similar situation was observed for the interstitial model, with DEF to the cell nucleus being 35% lower than DEF for the whole model. CONCLUSIONS While ICM may modify the absorbed doses from diagnostic X-ray examinations, the effect is smaller than suggested by assays of circulating blood cells or blood dose enhancement. Conversely, the potentially large increase in dose to the endothelium of blood vessels means that macroscopic organ doses may underestimate the risk of radiation induced cardiovascular disease for ICM-enhanced exposures.
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Affiliation(s)
- Richard W Harbron
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, UK.
| | - Elizabeth A Ainsbury
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot OX11 0RQ, UK
| | - Simon D Bouffler
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot OX11 0RQ, UK
| | - Rick J Tanner
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot OX11 0RQ, UK
| | - Mark S Pearce
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, UK
| | - Jonathan S Eakins
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot OX11 0RQ, UK
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