Low-dose CT with tin filter combined with iterative metal artefact reduction for guiding lung biopsy

Liu, Meiling; Liu, Dai‐Hong; Li, Xiaoqin; Lin, Meng-Ting; Tan, Yong; Luo, Yuesheng; Zeng, Xiangfei; Yu, Hong; Shen, Hesong; Wang, Xiaoxia; Liu, Leilei; Tan, Yuchuan; Zhang, Jiuquan

doi:10.21037/qims-21-555

Cited by 10 publications

(21 citation statements)

References 33 publications

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“…The dose reduction in the present study appears to be larger than previously reported 42,43 . In a diagnostic study, Mozaffary et al.…”

Section: Discussioncontrasting

confidence: 63%

“…The dose reduction in the present study appears to be larger than previously reported. 42,43 In a diagnostic study, Mozaffary et al evaluated the performance of a Sn filter-based CT (Sn150kV) compared with a routine low-dose CT (100 kV) and the standard protocol (120 kV) for the detection of urolithiasis, reporting a reduction of 28% and 66% in CTDIvol, respectively. 44 However, they elevated the applied kVp in the presence of the Sn filter compared with their routine protocol, whereas in the current study a reduced kVp compared with the routine protocol was employed.…”

Section: Discussionmentioning

confidence: 99%

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Ultra‐low dose CT scanning for PET/CT

Mostafapour,

Greuter,

van Snick

et al. 2023

Medical Physics

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BackgroundThe use of computed tomography (CT) for attenuation correction (AC) in whole‐body PET/CT can result in a significant contribution to radiation exposure. This can become a limiting factor for reducing considerably the overall radiation exposure of the patient when using the new long axial field of view (LAFOV) PET scanners. However, recent CT technology have introduced features such as the tin (Sn) filter, which can substantially reduce the CT radiation dose.PurposeThe purpose of this study was to investigate the ultra‐low dose CT for attenuation correction using the Sn filter together with other dose reduction options such as tube current (mAs) reduction. We explore the impact of dose reduction in the context of AC‐CT and how it affects PET image quality.MethodsThe study evaluated a range of ultra‐low dose CT protocols using five physical phantoms that represented a broad collection of tissue electron densities. A long axial field of view (LAFOV) PET/CT scanner was used to scan all phantoms, applying various CT dose reduction parameters such as reducing tube current (mAs), increasing the pitch value, and applying the Sn filter. The effective dose resulting from the CT scans was determined using the CTDIVol reported by the scanner. Several voxel‐based and volumes of interest (VOI)‐based comparisons were performed to compare the ultra‐low dose CT images, the generated attenuation maps, and corresponding PET images against those images acquired with the standard low dose CT protocol. Finally, two patient datasets were acquired using one of the suggested ultra‐low dose CT settings.ResultsBy incorporating the Sn filter and adjusting mAs to the lowest available value, the radiation dose in CT images of PBU‐60 phantom was significantly reduced; resulting in an effective dose of nearly 2% compared to the routine low dose CT protocols currently in clinical use. The assessment of PET images using VOI and voxel‐based comparisons indicated relative differences (RD%) of under 6% for mean activity concentration (AC) in the torso phantom and patient dataset and under 8% for a source point in the CIRS phantom. The maximum RD% value of AC was 14% for the point source in the CIRS phantom. Increasing the tube current from 6 mAs to 30 mAs in patients with high BMI, or with arms down, can suppress the photon starvation artifact, whilst still preserving a dose reduction of 90%.ConclusionsIntroducing a Sn filter in CT imaging lowers radiation dose by more than 90%. This reduction has minimal effect on PET image quantification at least for patients without Body Mass Index (BMI) higher than 30. Notably, this study results need validation using a larger clinical PET/CT dataset in the future, including patients with higher BMI.

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“…The dose reduction in the present study appears to be larger than previously reported 42,43 . In a diagnostic study, Mozaffary et al.…”

Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Ultra‐low dose CT scanning for PET/CT

Mostafapour,

Greuter,

van Snick

et al. 2023

Medical Physics

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“…Many recent studies have focused on the implementation of ULD protocols during percutaneous lung biopsies under CT guidance [21][22][23][24][25][26][27]. One of the most robust prospective randomised studies was published by Fu et al, demonstrating a ten-fold decrease of mean DLP (36.0 ± 14.1 mGy cm vs. 361.8 ± 108.0 mGy cm, p < 0.001) and effective dose (0.5 ± 0.2 mSv vs. 5.1 ± 1.5 mSv, p < 0.001) with comparable diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

An ultra-low-dose protocol for computed tomography-guided lung radiofrequency ablations

Golin¹,

Izaaryene²,

Dassa³

et al. 2022

J. Radiol. Prot.

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Purpose To evaluate safetey and efficacy of an ultra low dose (ULD) protocol implementation during lung radiofrequency ablations. Methods All patients who underwent a lung RFA were consecutively and retrospectively included between November 2017 and January 2021. 30 patiens were treated with a historical standard protocol (SP), 31 with an ULD protocol. Patient characteristics, dose indicators, technical efficacy (minimal margin MM, recurrence during the follow up) and complications (pneumothorax, alveolar hemorrhage, hemoptysis) were recorded. Results 61 patients were included (median age, 65 [54. 73], 33 women). There was no significant difference in the characteristics of the patients according to the type of protocol, except for the type of anesthesia. Even if the number of helical acquisitions had not significantly changed, all the dose indicators significantly decreased by 1.5-fold to 3-fold. The median dose-length-product and effective dose were respectively 465mGy.cm [315; 554] and 6.5mSv [4.4; 7.8] in the SP group versus 178 mGy.cm [154; 267] and 2.5mSv [2.2; 3.7] in the ULD group, (p<.001). The ULD group presented a lower intra-operator variability and a better inter-operator alignment. The MM were not significantly different in the 2 groups (4.6mm versus 5mm, p=.16). One local recurrence was observed in each group, at 8 months for the SP and at one year for the ULD group (p=1). No significant difference was found in the complications rates. Conclusion Implmenting an ultra-low dose protocol during lung RFA may allow with the same efficacy, a reduction of dose indicators, intra- and inter-operator alignments, without increasing complications rates.

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“…Following the application of inclusion and exclusion criteria, an additional six full-text articles were discarded. Consequently, six articles met the criteria of eligibility and were then included in this meta-analysis [11,12,[14][15][16][17]. A detailed flowchart outlining the search and selection process is presented in Fig.…”

Section: Literature Search Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…Several Randomized Controlled Trials (RCTs) have been conducted to evaluate the effectiveness of a LDCT protocol compared to a Standard-Dose CT (SDCT) protocol for guiding lung biopsy procedures [11][12][13][14][15][16][17]. The findings of these trials have been promising.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of randomized controlled trials comparing low-dose versus standard-dose computed tomography-guided lung biopsy

Li,

Xu,

et al. 2024

J Cardiothorac Surg

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Background Despite the existence of several Randomized Controlled Trials (RCTs) investigating Low-Dose Computed Tomography (LDCT) as a guide in lung biopsies, conclusive findings remain elusive. To address this contention, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of LDCT-guided lung biopsies. Methods A comprehensive search across major databases identified RCTs comparing the effectiveness of LDCT-guided with Standard-Dose Computed Tomography (SDCT)-guided lung biopsies. Subsequently, we utilized a random-effects model meta-analysis to assess diagnostic accuracy, radiation dose, operation duration, and clinical complications associated with these procedures. Results Out of 292 scrutinized studies, six RCTs representing 922 patients were included in the final analysis. Results indicated the differences between the LDCT and SDCT groups were not different with statistical significance in terms of diagnostic accuracy rates (Intent-to-Treat (ITT) populations: Relative Risk (RR) 1.01, 95% Confidence interval [CI] 0.97–1.06, p = 0.61; Per-Protocol (PP) populations: RR 1.01, 95% CI 0.98–1.04, p = 0.46), incidence of pneumothorax (RR 1.00, 95% CI 0.75–1.35, p = 0.98), incidence of hemoptysis (RR 0.95, 95% CI 0.63–1.43, p = 0.80), and operation duration (minutes) (Mean Differences [MD] -0.34, 95% CI -1.67-0.99, p = 0.61). Notably, LDCT group demonstrated a lower radiation dose (mGy·cm) with statistical significance (MD -188.62, 95% CI -273.90 to -103.34, p < 0.0001). Conclusions The use of LDCT in lung biopsy procedures demonstrated equivalent efficacy and safety to standard methods while notably reducing patient radiation exposure.

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Low-dose CT with tin filter combined with iterative metal artefact reduction for guiding lung biopsy

Cited by 10 publications

References 33 publications

Ultra‐low dose CT scanning for PET/CT

Ultra‐low dose CT scanning for PET/CT

An ultra-low-dose protocol for computed tomography-guided lung radiofrequency ablations

A systematic review and meta-analysis of randomized controlled trials comparing low-dose versus standard-dose computed tomography-guided lung biopsy

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