Weight-Adjusted Contrast Administration in the Computed Tomography Evaluation of Pulmonary Embolism

Ratnakanthan, P.; Kavnoudias, Helen; Paul, Eldho; Clements, Warren

doi:10.1016/j.jmir.2020.06.002

Cited by 5 publications

(9 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are a number of arguments for using an individually tailored rather than a fixed CM strategy for CT examinations (13,30). Multiple weight-based regimens using several size indices have shown more robust enhancement and comparable image quality to fixed-volume strategies, despite less use of materials and lower cost (31)(32)(33). However, no single weightbased method has been conclusively shown to be superior to the others, and the assessment of body size and body composition has proven challenging (34).…”

Section: Discussionmentioning

confidence: 99%

Contrast medium protocols in routine chest CT: a survey study

2021

View full text Add to dashboard Cite

Background Administration of contrast medium (CM) is an important image quality factor in computed tomography (CT) of the chest. There is no clear evidence or guidelines on CM strategies for chest CT, thus a consensus approach is needed. Purpose To survey the potential impact on differences in chest CT protocols, with emphasis on strategies for the administration of CM. Material and Methods A total of 170 respondents were included in this survey, which used two different approaches: (i) an online survey was sent to the members of the European Society of Thoracic Imaging (ESTI); and (ii) an email requesting a copy of their CT protocol was sent to all hospitals in Norway, and university hospitals in Sweden and Denmark. The survey focused on factors affecting CM protocols and enhancement in chest CT. Results The overall response rate was 24% (n = 170): 76% of the respondents used a CM concentration of ≥350 mgI/mL; 52% of the respondents used a fixed CM volume strategy. Fixed strategies for injection rate and delay were also the most common approach, practiced by 73% and 57% of the respondents, respectively. The fixed delay was in the range of 20–90 s. Of the respondents, 56% used flexible tube potential strategies (kV). Conclusion The chest CT protocols and CM administration strategies employed by the respondents vary widely, affecting the image quality. The results of this study underline the need for further research and consensus guidelines related to chest CT.

show abstract

Section: Discussionmentioning

confidence: 99%

Contrast medium protocols in routine chest CT: a survey study

2021

View full text Add to dashboard Cite

show abstract

“…We replaced the reduced contrast volume in the experimental group with saline, keeping the injected volume, injection rate, CM concentration, and saline chaser unchanged, thus reducing the room for errors. Since we had no weight-based exclusion criteria, our results should be valid for the target population [30].…”

Section: Contrast Administration Techniquesmentioning

confidence: 99%

“…In this study, we used a weight-tailored CM dosage. Individually tailored CM dosage may reduce iodine load and variation in enhancement compared to fixed dosage [28][29][30], and total body weight is the most commonly used strategy [31].…”

Section: Contrast Administration Techniquesmentioning

confidence: 99%

Halved contrast medium dose in lower limb dual-energy computed tomography angiography—a randomized controlled trial

et al. 2023

View full text Add to dashboard Cite

Objectives To compare vascular attenuation (VA) of an experimental half iodine-load dual-layer spectral detector CT (SDCT) lower limb computed tomography angiography (CTA) with control (standard iodine-load conventional 120-kilovolt peak (kVp) CTA). Methods Ethical approval and consent were obtained. In this parallel RCT, CTA examinations were randomized into experimental or control. Patients received 0.7 vs 1.4 mL/kg of iohexol 350 mgI/mL in the experimental- vs the control group. Two experimental virtual monoenergetic image (VMI) series at 40 and 50 kiloelectron volts (keV) were reconstructed. Primary outcome: VA. Secondary outcomes: image noise (noise), contrast- and signal-to-noise ratio (CNR and SNR), and subjective examination quality (SEQ). Results A total of 106 vs 109 were randomized and 103 vs 108 were analyzed in the experimental vs, control groups, respectively. VA was higher on experimental 40 keV VMI than on control (p < 0.0001), but lower on 50 keV VMI (p < 0.022). Noise was higher on experimental 40 keV VMI than on control (p = 0.00022), but lower on 50 keV VMI (p = 0.0033). CNR and SNR were higher than the control on experimental 40 keV VMI (both p < 0.0001) and 50 keV (p = 0.0058 and p = 0.0023, respectively). SEQ was better on both VMIs in the experimental group than in the control (both p < 0.0001). Conclusions Half iodine-load SDCT lower limb CTA at 40 keV achieved higher VA than the control. CNR, SNR, noise, and SEQ were higher at 40 keV, while 50 keV showed lower noise. Clinical relevance statement Spectral detector CT with low-energy virtual monoenergetic imaging performed halved iodine contrast medium (CM) lower limb CT-angiography with sustained objective and subjective quality. This facilitates CM reduction, improvement of low CM-dosage examinations, and examination of patients with more severe kidney impairment. Trial registration Retrospectively registered 5 August 2022 at clinicaltrials.gov NCT05488899. Key Points • Contrast medium dosage may be halved in lower limb dual-energy CT angiography with virtual monoenergetic images at 40 keV, which may reduce contrast medium consumption in the face of a global shortage. • Experimental half-iodine-load dual-energy CT angiography at 40 keV showed higher vascular attenuation, contrast-to-noise ratio, signal-to-noise ratio, and subjective examination quality than standard iodine-load conventional. • Half-iodine dual-energy CT angiography protocols may allow us to reduce the risk of PC-AKI, examine patients with more severe kidney impairment, and provide higher quality examinations or salvage poor examinations when impaired kidney function limits the CM dose.

show abstract

“…However, the availability of faster scan times due to CT technology advancement has posed a challenge of precisely timing CT data acquisition to coincide with the transit of the contrast through the pulmonary vessels to achieve optimal enhancement. Approximately 5–26% of CTPA scans are non‐diagnostic, with causes including poor contrast enhancement 5,6 . Poorly enhanced CTPA studies often require repeat scanning with associated radiation exposure, repeat contrast doses and delayed treatment 7 .…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 5-26% of CTPA scans are non-diagnostic, with causes including poor contrast enhancement. 5,6 Poorly enhanced CTPA studies often require repeat scanning with associated radiation exposure, repeat contrast doses and delayed treatment. 7 The Royal College of Radiologists (RCR) suggest a level of 210 HU as providing acceptable contrast enhancement.…”

Section: Introductionmentioning

confidence: 99%

A comparison of bolus track and test bolus computed tomography pulmonary angiography and the implications on pulmonary and aortic vessel enhancement, effective dose and suboptimal scan rate

Murphy,

White

2023

J of Medical Radiation Sci

View full text Add to dashboard Cite

IntroductionBolus track and test bolus are the most commonly used contrast timing protocols to undertake computed tomography pulmonary angiography (CTPA). The aim of this study was to compare test bolus and bolus track contrast enhancement protocols in terms of enhancement of the pulmonary vessels and aorta, radiation dose and suboptimal scan rate to determine the optimal technique for CTPA.MethodsA total of 200 CTPA examinations (100 using each protocol) performed between January and February 2021 were assessed retrospectively. All scans were performed on a 2x128 Dual Source Siemens Drive Scanner. CT attenuation was measured in Hounsfield Units (HU), with measurements taken from the main pulmonary trunk, right pulmonary artery and left pulmonary artery, ascending and descending aorta. The mean effective dose was calculated from the dose‐length product (DLP). The suboptimal scan rate was calculated as the percentage of examinations below 210HU.ResultsThe average HU of the pulmonary arteries was 358 HU ± SD 129.2 in the test bolus group and increased to 394 HU ± SD 133.9 in the bolus track group with a P value of ≤0.05. The average HU of the aorta was 235 HU ± SD 82.8 in the test bolus group and increased to 319 HU ± SD 91.8 in the bolus track group with a P value of <0.001. Although not statistically significant, the mean effective dose was reduced by 4.2% for the bolus track protocol (2.4 mSv vs. 2.5 mSv, P > 0.05). Fewer suboptimal scans were performed with the bolus track protocol (5 scans <210HU Bolus Track vs. 9 scans <210HU Test Bolus).ConclusionThe bolus track protocol results in increased enhancement of the pulmonary arteries and aorta, with the added benefits of a lower suboptimal scan rate and lower effective dose.

show abstract

Weight-Adjusted Contrast Administration in the Computed Tomography Evaluation of Pulmonary Embolism

Cited by 5 publications

References 34 publications

Contrast medium protocols in routine chest CT: a survey study

Contrast medium protocols in routine chest CT: a survey study

Halved contrast medium dose in lower limb dual-energy computed tomography angiography—a randomized controlled trial

A comparison of bolus track and test bolus computed tomography pulmonary angiography and the implications on pulmonary and aortic vessel enhancement, effective dose and suboptimal scan rate

Contact Info

Product

Resources

About