CT pulmonary angiography: simultaneous low-pitch dual-source acquisition mode with 70 kVp and 40 ml of contrast medium and comparison with high-pitch spiral dual-source acquisition with automated tube potential selection

Boos, Johannes; Kröpil, Patric; Lanzman, Rotem S.; Aissa, Joel; Schleich, Christoph; Heusch, Philipp; Sawicki, L; Antoch, Gerald; Thomas, Christoph

doi:10.1259/bjr.20151059

Cited by 30 publications

(19 citation statements)

References 24 publications

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“…CTPA is currently the first line imaging technique in the diagnosis of suspected pulmonary embolism with high diagnostic yield and low radiation dose. [12][13][14][15][16] High-pitch CTPA is more attractive due to its associated very low radiation dose without affecting image quality and reduction of motion artefacts in cardiorespiratory imaging due to short scanning times and elimination of breathhold, and this is confirmed by some recent reports.…”

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confidence: 73%

Three-dimensional printing in medicine: Opportunities for development of optimal CT scanning protocols

Sun¹,

Aldosari²

2018

AMJ

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Three-dimensional (3D) printing has shown great promise with increased applications in the medical field. 3D printed models are reported to accurately replicate normal anatomy and pathology, assist pre-surgical planning and simulation, serve as a useful tool for medical education and improve patient-doctor communication. Another unique application of 3D printed realistic models is to develop optimal computed tomography (CT) scanning protocols for investigation of scanning parameters with low radiation dose while still achieving diagnostic images. This editorial highlights the application of using patient-specific 3D printed pulmonary artery model for investigation of optimal CT pulmonary angiography protocols for detection of pulmonary embolism.

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confidence: 73%

Three-dimensional printing in medicine: Opportunities for development of optimal CT scanning protocols

Sun¹,

Aldosari²

2018

AMJ

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“…The pitch of 0.9 as recommended by this study is consistent with Boos et al who also proposed the 70 kVp and pitch of 0.9 CTPA protocol. [36] We did not include 70 kVp in this study as 100 or 120 kVp is commonly used in CTPA. Further, due to 3D printed model being static instead of having hemodynamic flow features, we did not assess the effect of changing contrast medium volume on image quality.…”

Section: Discussionmentioning

confidence: 99%

Patient-specific three-dimensional printed pulmonary artery model: A preliminary study

2017

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Background and objectives: Three-dimensional (3D) printing has potential value in medical applications with increasing reports in the diagnostic assessment of cardiovascular diseases. The use of 3D printing in replicating pulmonary artery anatomy and diagnosing pulmonary embolism is very limited. The purpose of this study was to develop a 3D printed pulmonary artery model and test different computed tomography (CT) scanning protocols for determination of an optimal protocol with acceptable image quality, but low radiation dose. Materials and Methods: A patient-specific 3D printed pulmonary artery model was created based on contrast-enhanced CT images in a patient with suspected pulmonary embolism. Different CT pulmonary angiography protocols consisting of 80, 100 and 120 kVp, pitch 0.7, 0.9 and 1.2 with 1 mm slice thickness and 0.6 mm reconstruction interval were tested on the phantom. Quantitative assessment of image quality in terms of signal-to-noise ratio (SNR) was measured in the images acquired with different protocols. Measurements in pulmonary artery diameters were conducted and compared between pre-and post-3D printed images and 3D printed model. Results: The 3D printed model was found to replicate normal pulmonary artery with high accuracy. The mean difference in diameter measurements was less than 0.8 mm (<0.5% deviation in diameter). There was no significant difference in SNR measured between these CT protocols (p=0.96-0.99). Radiation dose was reduced by 55% and 75% when lowering kVp from 120 to 100 and 80 kVp, without affecting image quality. Conclusions: It is feasible to produce a 3D printed pulmonary artery model with high accuracy in replicating normal anatomy. Different CT scanning protocols are successfully tested on the model with 80 kVp and pitch 0.9 being the optimal one with resultant diagnostic images but at much lower radiation dose.

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“…However, the high radiation dose associated with the increased use of CTPA examinations has raised concerns leading to the paradigm shift of developing optimal CTPA protocols to lower radiation dose while still achieving diagnostic images. Low-dose CTPA protocols have been reported in some studies showing the feasibility of reducing tube voltage to 80 and 70 kVp with use of high pitch values with resultant effective dose of less than 2 mSv (6)(7)(8)(9)(10)(11)(12)(13). The main disadvantage of lowering tube voltage during CTPA is associated with increased image noise, with noise further increased when a high pitch protocol is used.…”

Section: Introductionmentioning

confidence: 99%

Patient-specific 3D printed pulmonary artery model with simulation of peripheral pulmonary embolism for developing optimal computed tomography pulmonary angiography protocols

Aldosari¹,

Jansen²,

Sun³

2019

Quant. Imaging Med. Surg

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Background: Computed tomography pulmonary angiography (CTPA) is the preferred imaging modality for diagnosis of patients with suspected pulmonary embolism (PE). Radiation dose associated with CTPA has been significantly reduced due to the use of dose-reduction strategies, however, investigation of low-dose CTPA with use of different kVp and pitch values has not been systematically studied. The aim of this study was to utilize a 3D printed pulmonary model with simulation of small thrombus in the pulmonary arteries for development of optimal CTPA protocols. Methods: Animal blood clots were inserted into the pulmonary arteries to simulate peripheral embolism based on a realistic 3D printed pulmonary artery model. The 3D printed model was scanned with 192-slice 3 rd generation dual-source CT with 1 mm slice thickness and 0.5 mm reconstruction interval. All images were reconstructed with advanced modelled iterative reconstruction (IR) at a strength level of 3. CTPA scanning parameters were as follows: 70, 80, 100 and 120 kVp, 0.9, 2.2 and 3.2 pitch values. Quantitative assessment of image quality was determined by measuring signal-to-noise ratio (SNR) in both main pulmonary arteries, while qualitative analysis of images was scored by two experienced radiologists (score of 1 indicates poor visualization of thrombus with no confidence, and score of 5 excellent visualization of thrombus with high confidence) to determine the image quality in relation to different scanning protocols for detection of thrombus in the pulmonary arteries. Results: No significant differences were found in SNR measurements among all CTPA protocols (P>0.05), regardless of kVp or pitch values used, although SNR was higher with 120 kVp and 0.9 and 2.2 pitch protocols than that in other protocols. The thrombi were detected in all images, with 70 kVp and 3.2 pitch protocol scored the lowest with a score of 3 by two observers, and images with other protocols were scored 4 or 5. Lowering kVp from 120 to 70 with use of high-pitch 2.2 or 3.2 protocol resulted in up to 80% dose reduction without significantly affecting image quality. Conclusions: Low-dose CT pulmonary angiography protocols comprising 70 kVp and high pitch 2.2 or 3.2 allow for detection of peripheral PE with significant reduction in radiation dose while images are still considered diagnostic.

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CT pulmonary angiography: simultaneous low-pitch dual-source acquisition mode with 70 kVp and 40 ml of contrast medium and comparison with high-pitch spiral dual-source acquisition with automated tube potential selection

Cited by 30 publications

References 24 publications

Three-dimensional printing in medicine: Opportunities for development of optimal CT scanning protocols

Three-dimensional printing in medicine: Opportunities for development of optimal CT scanning protocols

Patient-specific three-dimensional printed pulmonary artery model: A preliminary study

Patient-specific 3D printed pulmonary artery model with simulation of peripheral pulmonary embolism for developing optimal computed tomography pulmonary angiography protocols

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