Dynamic computed tomography of the lungs with reduced radiation load
https://doi.org/10.24835/1607-0763-2020-1-48-58
Abstract
Aim. To evaluate the possibilities of dynamic lung CT using a low-dose scanning Protocol.
Materials and methods. The study is based on the experience of using two protocols of dynamic lung CT in 97 patients with single foci in the lungs. CT study was performed on a multispiral computed tomograph GE Optima CT660 with bolus administration of 100 ml of iodine-containing drug at a rate of 3.5 ml/sec. Native the study was conducted from the level of the jugular notch to the diaphragmatic sinuses. After that, the focus area was scanned for 30 seconds, 1, 2, 4, 6, 15 minutes after administration of contrast agent. Depending on the scanning Protocol used, the patients were divided into 2 groups. The Protocol of the first group of patients (n = 20) included the following parameters: radiation field (Nativ/contrast phase) – 270–340 mm/100-140 mm; voltage – 120 kV; the current 80–400 mA; rotation time of the tube – 0,6 sec; slice thickness 5 mm. the parameters of the scanning Protocol of the second group of patients (n = 50): radiation field (Nativ/contrast phase) – 270–340 mm/30–45 mm; voltage – 100 kV; the current 80–400 mA; rotation time of the tube – 0,6 sec; the slice thickness is 5 mm. Quantitative assessment included measurement of effective dose. Qualitative assessment of each study included the analysis of the CT scans obtained with an assessment of the degree of “noise” of the image and its impact on the interpretation of the obtained CT data.
Results. In the first group of patients, the tube voltage was 120 kV, the irradiation field in the native phase was within 270–340 mm, in contrast phases of the study-within 100–140 mm (124.5 ± 12.8 mm), while the effective dose ranged from 13.7 mSv to 21.5 mSv and averaged 18.1 ± 2.4 mSv. In the second group of patients radiation field in the native phase was in the range of 270–340 mm, the contrast phase of the study – in the range of 30–45 mm (36.0 ± 6.1 mm), the effective radiation dose was varied in the range of 5.1 mSv – 10.2 mSv and the average was 7.6 ± 1.7 mSv.
Conclusion. The use of the developed Protocol of CT-study in the dynamic CT of the chest provides a reduction in the dose of radiation by an average of 42% while maintaining an adequate assessment of the data on the accumulation and leaching of contrast agent formation.
About the Authors
A. P. PetrosianRussian Federation
MD, Research Associate of the Department of Computed Tomography
10 Marshala Zhukova str., Kaluga Region, Obninsk, 249036, Russian Federation
Phone: +7-953-316-24-64
N. K. Silanteva
Russian Federation
Doct. of Sci. (Med.), Head of the Department of Computed Tomography
10 Marshala Zhukova str., Kaluga Region, Obninsk, 249036, Russian Federation
D. B. Sanin
Russian Federation
Cand. of Sci. (Biol.), senior researcher of the Department of clinical dosimetry and topometry
10 Marshala Zhukova str., Kaluga Region, Obninsk, 249036, Russian Federation
A. D. Kaprin
Russian Federation
academician of the Academy of Science of Russian Federation, Doct. of Sci. (Med.), Professor, director of the National Research Radiological Center, Moscow
10 Marshala Zhukova str., Kaluga Region, Obninsk, 249036, Russian Federation
S. A. Ivanov
Russian Federation
Doct. of Sci. (Med.), Professor, director
10 Marshala Zhukova str., Kaluga Region, Obninsk, 249036, Russian Federation
A. Yu. Usacheva
Russian Federation
MD, Research Associate of the Department of Computed Tomography
10 Marshala Zhukova str., Kaluga Region, Obninsk, 249036, Russian Federation
M. F. Proskurina
Russian Federation
Cand. of Sci. (Med.), medical Advisor of Department of computer tomography
References
1. Barkhausen J., Stöblen F., Müller R.D., Streubühr U., Ewen K. Effect of collimation and pitch on radiation exposure and image quality in spiral CT of the thorax. Aktuelle Radiol. 1998; 8 (5): 220–224.
2. Chen M.Y., Chiles C., Choplin R.H., Aquino S.L. Bronchogenic carcinoma: a survey of CT protocols for staging disease. Acad. Radiol. 1997; 4 (10): 687–692. https://doi.org/10.1016/S1076-6332(97)80140-7
3. Funabashi N., Sato H., Asano M., Nakayama T. Utility of triple channel injection of contrast material with mixture of saline, with acquisition in the cephalic direction for arterial trees in the thorax using multislice computed tomography. Int. J. Cardiol. 2006; 113 (1): 97–103. https://doi.org/10.1016/j.ijcard.2005.07.079
4. Hein P.A., Romano V.C., Lembcke A., May J., Rogalla P. Initial experience with a chest pain protocol using 320-slice volume MDCT. Eur. Radiol. 2009; 19 (5): 1148–1155. https://doi.org/10.1007/s00330-008-1255-8
5. Livingstone R.S., Pradip J., Dinakran P.M., Srikanth B. Radiation doses during chest examinations using dose modulation techniques in multislice CT scanner. Indian J. Radiol. Imaging. 2010; 20 (2): 154–157. https://doi.org/10.4103/0971-3026.63036
6. Masatoshi M., Masatsugu I., Jun-Ichiro I., Shiro B. An optimal follow-up protocol for renal cell carcinoma based on the occurrence of recurrences after surgery. Nihon Hinyokika Gakkai Zasshi. 2000; 91 (12): 700–707. https://doi.org/10.5980/jpnjurol1989.91.700
7. Rehbock B., Hieckel H.G. Chest examination protocol with a reduced dose using a multi-slice spiral CT. Rofo. 2003; 175 (7): 963–966.
8. Salgado R.A., Spinhoven M., De Jongh K., Op de Beeck B., Corthouts B., Parizel P.M. Chest MSCT acquisition and injection protocols. JBR-BTR. 2007; 90 (2): 97–99.
9. Sigal-Cinqualbre A.B., Hennequin R., Abada H.T., Chen X., Paul J.F. Low-kilovoltage multi-detector row chest CT in adults: feasibility and effect on image quality and iodine dose. Radiology. 2004; 231 (1): 169–174. https://doi.org/10.1148/radiol.2311030191
10. Szucs-Farkas Z., Schaller C., Bensler S., Patak M.A., Vock P., Schindera S.T. Detection of pulmonary emboli with CT angiography at reduced radiation exposure and contrast material volume: comparison of 80 kVp and 120 kVp protocols in a matched cohort. Invest. Radiol. 2009; 44 (12): 793–799.
11. Wessling J., Fischbach R., Ludwig K.l. Multi-slice spiral CT of the abdomen in oncological patients: influence of table support and detector configuration on image quality and radiation exposure. Rofo. 2001; 173 (4): 373–378.
12. Zhu X., Yu J., Huang Z. Low-dose chest CT: optimizing radiation protection for patients. Am. J. Roentgenol. 2004; 183 (3): 809–816. https://doi.org/10.2214/ajr.183.3.1830809
13. Bai M., Chen J., Raupach R., Suess C., Tao Y., Peng M. Effect of nonlinear three-dimensional optimized reconstruction algorithm filter on image quality and radiation dose: validation on phantoms. Med. Phys. 2009; 36 (1): 95–97. https://doi.org/10.1118/1.3030953
14. Hu X.H., Ding X.F., Wu R.Z., Zhang M.M. Radiation dose of non-enhanced chest CT can be reduced 40% by using iterative reconstruction in image space. Clin. Radiol. 2011; 66 (11): 1023–1029. https://doi.org/10.1016/j.crad.2011.04.008
15. Inoue T., Ichikawa K., Hara T., Urikura A., Hoshino T., Miura Y., Terakawa S., Uto F. Investigation of vessel visibility of iterative reconstruction method in coronary computed tomography angiography using simulated vessel phantom. Nihon. Hoshasen Gijutsu Gakkai Zasshi. 2012; 68 (12): 1631–1636. https://doi.org/10.6009/jjrt.2012_jsrt_68.12.1631
16. Kang E.J., Lee K.N., Kim D.W., Kim B.S., Choi S., Park B.H., Oh J.Y. Triple rule-out acute chest pain evaluation using a 320-row detector volume CT: a comparison of the wide-volume and helical modes. Int. J. Cardiovasc. Imaging. 2012; 28 (1): 7–13. https://doi.org/10.1007/s10554-012-0072-y
17. Noël P.B., Fingerle A.A., Renger B., Münzel D., Rummeny E.J., Dobritz M. Initial performance characterization of a clinical noisesuppressing reconstruction algorithm for MDCT. Am. J. Roentgenol. 2011; 197 (6): 1404–1409. https://doi.org/10.2214/ajr.11.6907
18. Slovis T.L. Children, computed tomography radiation dose, and the As Low As Reasonably Achievable (ALARA) concept. Pediatrics. 2003; 112: 971–972. https://doi.org/10.1542/peds.112.4.971
19. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). 2000 Report to the General Assembly, Annex D: Medical Radiation Exposures. New York: United Nations, 2000.
20. McNitt-Gray M.F. AAPM/RSNA Physics Tutorial for Residents: Topics in CT Radiation Dose in CT. RadioGraphics. 2002; 22: 1541–1553. https://doi.org/10.1148/rg.226025128
21. Swensen S. Lung Nodule Enhancement at CT: Multicenter Study. Radiology. 2000; 214 (1): 73–80.
22. Yi C. Solitary Pulmonary Nodules: Dynamic Enhanced Multi–Detector Row CT Study and Comparison with Vascular Endothelial Growth Factor and Microvessel Density. Radiology. 2004; 233 (1): 191–199.
23. Jeong Y. Solitary Pulmonary Nodules: Detection, Characterization, and Guidance for Further Diagnostic Workup and Treatment. Am. J. Roentgenol. 2007; 188 (1): 57–68.
24. Lagkueva I.D., Sergeev N.I., Kotljarov P.M., Izmajlov T.R., PadalkoV.V., Solodkij V.A. Perfuzionnaja komp'juternaja tomografija v utochnenii prirody ochagovoj patologii legkih. Luchevaja diagnostika i terapija. 2019; 10 (1): 62–68. (In Russian)
25. Kotljarov P.M. Metodika magnitno-rezonansnoj tomografii s dinamicheskim kontrastnym usileniem pri dobrokachestvennyh ochagovyh obrazovanijah legkih. Luchevaja diagnostika i terapija. 2018; 3: 69–74. (In Russian)
26. Petrosjan A.P., Silant'eva N.K., Usacheva A.Ju., Zhavoronkov L.P. Dinamicheskaja komp'juternaja tomografija pri differencial'noj diagnostike novoobrazovanij legkih. Prakticheskaja pul'monologija. 2018; 1: 82–90. (In Russian)
27. Ye X. Characterization of solitary pulmonary nodules: Use of washout characteristics at contrast-enhanced computed tomography. Oncology Letters. 2011; 3 (3): 672–676.
28. Jeong Y., Yi C., Lee K. Solitary Pulmonary Nodules: Detection, Characterization, and Guidance for Further Diagnostic Workup and Treatment. Am. J. Roentgenol. 2007; 188 (1): 57–68. https://doi.org/10.2214/ajr.05.2131
29. The state of cancer care in Russia in 2016. Eds Kaprin A.D., Starinsky V.V., Petrova G.V. Moscow: P. Hertsen Moscow Oncology Research Institute – Branch of the National Medical Radiology Research Centre of the Ministry of Health of the Russian Federation, 2017. 236 р. (In Russian)
30. Kaprin A.D., Galkin V.N., Zhavoronkov L.P., Ivanov V.K., Ivanov S.A., Romanko Yu.S. Synthesis of basic and applied research is the basis of obtaining high-quality findings and translating them into clinical practice. Radiation and Risk. 2017; 26 (2): 26–40. https://doi.org/26-40.10.21870/0131-3878-2017-26-2-26-40 (In Russian)
31. Kaprin A.D., Mardinskiy Yu.S., Smirnov V.P., Ivanov S.A., Kostin A.A., Polikhov S.A., Reshetov I.V., Fatianova A.S., Denisenko M.V., Epatova T.V., Korenev S.V., Tereshchenko A.V., Filonenko E.V., Gafarov M.M., Romanko Yu.S. The history of radiation therapy (part I), Biomedical Photonics. 2019; 8 (1): 52–62. https://doi.org/10.24931/2413–9432–2019–8–1-52–62 (In Russian)
32. Tyurin I.E. Single pockets in the lungs: the possibility of radiation diagnosis. Practical Pulmonology. 2008; 2: 15–22. (In Russian)
33. Aznaurov V.G., Kondratiev E.V., Oganesyan N.K., Karmazanovsky G.G. Low-Dose Hepatopancreatic MDCT: Practical Experience of Applicability. Medical Visualization. 2017; 2: 28–35. (In Russian)
34. Tolkacheva G.S., Karmazanovskii G.G., Vishnevskii A.A. What does intravenous bolus contrast enhancement for CT (CT) differential diagnosis of small peripheral lung formations? Medical Visualization. 2000; (3): 36–40. (In Russian)
Review
For citations:
Petrosian A.P., Silanteva N.K., Sanin D.B., Kaprin A.D., Ivanov S.A., Usacheva A.Yu., Proskurina M.F. Dynamic computed tomography of the lungs with reduced radiation load. Medical Visualization. 2020;24(1):48-58. (In Russ.) https://doi.org/10.24835/1607-0763-2020-1-48-58