Intravenous contrast media in radiation therapy planning computed tomography scans – Current practice in Ireland

Minogue, Shane; Gillham, Charles; Kearney, Maeve; Mullaney, L.

doi:10.1016/j.tipsro.2019.11.002

Cited by 10 publications

(8 citation statements)

References 32 publications

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“…For example, Minogue et al found inconsistencies related to the time and method for assessment of renal function where some radiology departments followed the old guidelines and others the new guidelines. 24 In Sweden, the guidelines from SSUR, being spread through communication at national conferences, websites and publications, are not mandatory to follow. Even though their impact on radiological activities appears to be substantial, this study also showed a wide variation in practice.…”

Section: Discussionmentioning

confidence: 99%

Radiology departmental policy compliance with Swedish guidelines regarding post-contrast acute kidney injury for examinations with iodinated contrast media

Bjällmark

Bazzi

Karlsson³

et al. 2021

Radiography

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Introduction: Guidelines concerning intravenous iodinated contrast media (CM) during computed tomography (CT) examinations are important to follow to minimize the risk for post-contrast acute kidney injury (PC-AKI). The purpose of this study was to investigate the radiology departmental policy compliance with Swedish guidelines concerning PC-AKI. Methods: In February 2020, an electronic survey was distributed to the responsible radiographer at 41 radiology departments in all university hospitals and medium-sized hospitals in Sweden. The questions focused on routines around renal functional tests, individualized contrast administration and handling of patients with diabetes mellitus taking metformin. Results: The response rate was 83%. Seventy-six percent (n ¼ 26) of radiology departments calculated estimated glomerular filtration rate (eGFR) from serum creatinine prior to CM administration, but only 24% (n ¼ 8) followed the recommendation to calculate eGFR from both serum creatinine and cystatin C. For acute/inpatients, 55% (n ¼ 18) followed the recommendation that renal functional tests should be performed within 12 h before CM administration. For elective patients, 97% (n ¼ 33) followed the recommendation to have eGFR newer than three months which is acceptable for patients with no history of disease that may have affected renal function. Approximately 80% of the radiology departments followed the recommendation that CM dose always should be individually adjusted to patient eGFR. Seventy-six percent (n ¼ 26) followed the recommendation to continue with metformin at eGFR 45 ml/min. Conclusion: Compliance with the national guidelines was high regarding routines around renal functional tests, dose adjustment of CM and metformin discontinuation. Improvements can be made in using both cystatin C and serum creatinine for eGFR calculations as well as ensuring renal function tests within 12 h for acute/inpatients with acute disease that may affect renal function. Implications for practice: This study raises awareness of the importance of adhering to guidelines in healthcare. To have knowledge about the current level of compliance regarding PCI-AKI is important to maintain and develop effective clinical implementation of guidelines. The variation in practice seen in this study emphasizes the need of more effective implementation strategies to ensure adherence with best practice.

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Section: Discussionmentioning

confidence: 99%

Radiology departmental policy compliance with Swedish guidelines regarding post-contrast acute kidney injury for examinations with iodinated contrast media

Bjällmark

Bazzi

Karlsson³

et al. 2021

Radiography

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“…In addition to the investigation of differences in absolute mean HU values for critical structures and PTV between CCT and NCCT images sets, statistical evaluation included the mean dose, maximum dose, median dose, PTV volume covered by 98% of the prescribed dose (D 98% ), and PTV volume covered by 2% of the prescribed dose (D 2% ). For critical structures, the percentage difference (D % ) between relative doses in CCT (D CCT )-and NCCT (D NCCT )-based plans was calculated using Equation (1). A difference of 2% or less is considered acceptable, and relative doses less than 10% of the prescribed dose were omitted from evaluation to elude error overestimation.…”

Section: Treatment Planning and Evaluationmentioning

confidence: 99%

“…Non-contrast CT imaging (NCCT) has been the modality of choice for three-dimensional conformal radiotherapy (3DCRT) dose calculations since the introduction of algorithmsbased computerized treatment planning systems. However, visualization of anatomy in CT images generally could be improved by taking advantage of contrast agents [1] to differentiate organs, and enhance lesion detection and characterization, thus, improving the delineation accuracy of PTVs and OARs. International recommendations, such as the American Association of Physicists in Medicine (AAPM) Task Group 179 [2] and the Institute of Physicists and Engineers in Medicine (IPEM) Report No.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Contrast Agents on Dose Calculations of Volumetric Modulated Arc Radiotherapy Plans for Critical Structures

et al. 2021

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Radiotherapy dose calculation requires accurate Computed Tomography (CT) imaging while tissue delineation may necessitate the use of contrast agents (CA). Acquiring these two sets is a common practice in radiotherapy. This study aims to evaluate the effect of CA on the dose calculations. Two hundred and twenty-six volumetric modulated arc therapy (VMAT) patients that had planning CT with contrast (CCT) and non-contrast CT (NCCT) of different cancer sites (e.g., brain, head, and neck (H&N), chest, abdomen, and pelvis) were evaluated. Treatment plans were recalculated using CCT, then compared to NCCT. The variation in Hounsfield units (HU) and dose distributions for critical structures and target volumes were analyzed using mean HU, mean and maximum relative dose values, D2%, D98%, and 3D gamma analysis. HU variations were statistically significant for most structures. However, this was not clinically significant as the difference in mean HU values was within 30 HU for soft tissue and 50 HU for lungs. Variation in target volumes’ D2% and D98% were insignificant for all sites except brain and nasopharynx. Dose maximum differences were within 2% for the majority of critical structures and target volumes. 3D gamma analysis results revealed that majority of plans satisfied the 2% and 2 mm criteria. CCT may be acquired for VMAT radiotherapy planning purposes instead of NCCT, since there is no clinically significant difference in dose calculations based on either image set.

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“…Contrast-enhanced planning CT is used for the delineation of target volumes and OARs, and intravenous CT contrast can enhance normal tissue visualization and delineation [ 28 , 29 ]. Due to safety concerns associated with CT contrast, contrast-enhanced planning CT cannot be performed for all patients [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Denoising on Deep-Learning-Based Automatic Segmentation Framework for Breast Cancer Radiotherapy Planning

Lee

Choi

et al. 2022

Cancers

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Objective: This study aimed to investigate the segmentation accuracy of organs at risk (OARs) when denoised computed tomography (CT) images are used as input data for a deep-learning-based auto-segmentation framework. Methods: We used non-contrast enhanced planning CT scans from 40 patients with breast cancer. The heart, lungs, esophagus, spinal cord, and liver were manually delineated by two experienced radiation oncologists in a double-blind manner. The denoised CT images were used as input data for the AccuContourTM segmentation software to increase the signal difference between structures of interest and unwanted noise in non-contrast CT. The accuracy of the segmentation was assessed using the Dice similarity coefficient (DSC), and the results were compared with those of conventional deep-learning-based auto-segmentation without denoising. Results: The average DSC outcomes were higher than 0.80 for all OARs except for the esophagus. AccuContourTM-based and denoising-based auto-segmentation demonstrated comparable performance for the lungs and spinal cord but showed limited performance for the esophagus. Denoising-based auto-segmentation for the liver was minimal but had statistically significantly better DSC than AccuContourTM-based auto-segmentation (p < 0.05). Conclusions: Denoising-based auto-segmentation demonstrated satisfactory performance in automatic liver segmentation from non-contrast enhanced CT scans. Further external validation studies with larger cohorts are needed to verify the usefulness of denoising-based auto-segmentation.

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Intravenous contrast media in radiation therapy planning computed tomography scans – Current practice in Ireland

Cited by 10 publications

References 32 publications

Radiology departmental policy compliance with Swedish guidelines regarding post-contrast acute kidney injury for examinations with iodinated contrast media

Radiology departmental policy compliance with Swedish guidelines regarding post-contrast acute kidney injury for examinations with iodinated contrast media

The Effect of Contrast Agents on Dose Calculations of Volumetric Modulated Arc Radiotherapy Plans for Critical Structures

Impact of Denoising on Deep-Learning-Based Automatic Segmentation Framework for Breast Cancer Radiotherapy Planning

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