Ultralow-Dose Chest Computed Tomography for Pulmonary Nodule Detection

“…Baumueller et al (22) investigated whether HPM for CT enables the diagnostic visualization of lung parenchyma under breathing and found that CT of the lung can be accomplished using HPM at low radiation dose, with maintaining diagnostic image quality even without suspended respiration. Other authors (10,18,19) evaluated HPM for the feasibility in coronary CT angiography and found that CT performed at HPM allows for coronary angiography with high pitch up to 70 bpm. In the above-listed studies, image acquisition was performed ECGgated and did not test HPM for the detection of PE protocols.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Comparison of High-pitch CT at 80 kVp Under Free Breathing with Standard-pitch CT at 100 kVp Under Breath-Hold for Detection of Pulmonary Embolism

et al. 2016

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RATIONALE AND OBJECTIVES To prospectively compare high-pitch computed tomography (HPCT) under free breathing (FB) with standard-pitch CT (SPCT) under breath-hold (BH) for detection of pulmonary embolism (PE). MATERIALS AND METHODS One hundred consecutive patients (47 females; mean age 58.7 ± 16.6) randomly underwent HPCT-FB (n = 50) or SPCT-BH (n = 50). Radiation doses were documented. One reader measured pulmonary artery attenuation and noise; mean signal-tonoise ratio (SNR) was calculated. Two readers assessed image quality, diagnostic confidence for detection of PE, motion artifacts, assessability of anatomical structures, and presence of transient interruption of contrast as sign of Valsalva maneuver. Inter-reader agreement was calculated. RESULTS Radiation dose was significantly lower in HPCT compared to SPCT (2.68 ± 0.60 mGy vs 6.01 ± 2.26 mGy; P < .001). Mean pulmonary artery attenuation and image noise were significantly higher in HPCT (attenuation: 479 Hounsfield unit (HU) vs 343HU; P < .001; noise: 16 HU vs 10 HU; P < .001) whereas SNR was similar between groups (34 HU vs 38 HU; P = .258). HPCT had significantly higher diagnostic confidence for PE detection (P = .048), less cardiac and breathing artifacts (P < .001), better assessability of anatomical structures, and fewer cases of transient interruption of contrast (P < .001) compared to the SPCT. CONCLUSIONS HPCT-FB allows for a significant reduction of breathing and motion artifacts compared to SPCT-BH. Diagnostic confidence, assessability of vascular and bronchial structures, as well as SNR are maintained. Materials and Methods:One hundred consecutive patients (47 females; mean age 58.7 ± 16.6) randomly underwent HPCT-FB (n = 50) or SPCT-BH (n = 50). Radiation doses were documented. One reader measured pulmonary artery attenuation and noise; mean signalto-noise ratio (SNR) was calculated. Two readers assessed image quality, diagnostic confidence for detection of PE, motion artifacts, assessability of anatomical structures, and presence of transient interruption of contrast as sign of Valsalva maneuver. Inter-reader agreement was calculated.Results: Radiation dose was significantly lower in HPCT compared to SPCT (2.68 ± 0.60 mGy vs 6.01 ± 2.26 mGy; P < .001). Mean pulmonary artery attenuation and image noise were significantly higher in HPCT (attenuation: 479 Hounsfield unit (HU) vs 343HU; P < .001; noise: 16 HU vs 10 HU; P < .001) whereas SNR was similar between groups (34 HU vs 38 HU; P = .258). HPCT had significantly higher diagnostic confidence for PE detection (P = .048), less cardiac and breathing artifacts (P < .001), better assessability of anatomical structures, and fewer cases of transient interruption of contrast (P < .001) compared to the SPCT.Conclusions: HPCT-FB allows for a significant reduction of breathing and motion artifacts compared to SPCT-BH. Diagnostic confidence, assessability of vascular and bronchial structures, as well as SNR are maintained.

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“…It has been pointed out that the diagnostic accuracy of CT could be maintained while reducing the radiation exposure; as a result, it has been claimed about the need of lowering the radiation dose "as low as reasonably achievable" (the ALARA principle) [1] .…”

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confidence: 99%

“…Nowadays, there are many scientific articles that refer to it, and the field of management of radiation dose has grown as well, significantly [1][2][3] .…”

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confidence: 99%

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Individually adapted kilovoltage for oncologic chest CT: Levels of radiation dose in clinical practice

Galiñanes

Pombar

Villamor

et al. 2015

IJDI

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Purpose: The main purpose of this study was to verify the adequacy of dose levels of irradiation in oncologic chest CT obtained in our daily practice with the recommendations of the existing referral guidelines. The secondary objective was to evaluate the effect on radiation dose of individual adjustment of kilovoltage in thoracic multidetector row computed tomography (MDCT) images acquired with single and dual-source technology. The impact of lowering the kilovoltage in the diagnostic quality of these studies was also evaluated. Methods:Ninety-seven patients were included in the study. CT examinations were performed using two different equipments: a conventional CT scanner (SOMATOM Emotion 6), and a dual-source computed tomography (DSCT) system (SOMATOM Force), (Siemens Medical System, Forchheim, Germany), with the following parameters. Emotion 6: collimation 6 × 1.0, slice thickness 1.25 mm, 110/130 kV, 48-107 mAs. FORCE: collimation 64 × 0.6, slice thickness 1 mm, 100-150 kV, 65-300 mAs. Dose levels of the CT scans were recorded digitally. The levels of DLP (Dose Length Product) obtained, as well as the existing noise in the acquired images, was evaluated. Results:The average DLP of the protocols was as follows. Emotion 6, 130 kV: 336.3 mGy (5.72 mSv). Emotion 6, 110 kV: 209 mGy (3.55 mSv). FORCE, 150 kV: 183.3 mGy (3.11 mSv). FORCE, 100 kV: 49.4 mGy (0.84 mSv). The values of effective dose were obtained using the conversion factor described by the European Guidelines for Computed Tomography for chest CT (0.017 mSv/mGy/cm). The levels of noise did not rise significantly in the lower kV group. Conclusions:The average values of DLP obtained in our daily practice meet the recommendations of the existing referral guidelines. Lower values can be achieved through individual adjustment of kilovoltage and using CT scanners with dual-source technology, maintaining the diagnostic quality of these studies.

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Ultralow-Dose Chest Computed Tomography for Pulmonary Nodule Detection

Cited by 213 publications

References 31 publications

Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging

Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging

Prospective Randomized Comparison of High-pitch CT at 80 kVp Under Free Breathing with Standard-pitch CT at 100 kVp Under Breath-Hold for Detection of Pulmonary Embolism

Individually adapted kilovoltage for oncologic chest CT: Levels of radiation dose in clinical practice

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