Application of 80-kVp scan and raw data-based iterative reconstruction for reduced iodine load abdominal–pelvic CT in patients at risk of contrast-induced nephropathy referred for oncological assessment: effects on radiation dose, image quality and renal function

Nagayama, Yasunori; Tanoue, Shota; Tsuji, Akinori; Urata, Joji; Furusawa, Mitsuhiro; Oda, Shigeto; Nakaura, Takeshi; Utsunomiya, Daisuke; Yoshida, Eri; Yoshida, Morikatsu; Kidoh, Masafumi; Tateishi, Machiko; Yamashita, Yasuyuki

doi:10.1259/bjr.20170632

Cited by 12 publications

(6 citation statements)

References 45 publications

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“…By decreasing tube voltage, a substantial reduction in CM could be achieved without negatively influencing either objective or subjective image quality. 25,26 Reducing both parameters at the same time will decrease CNR and may lead to insufficient image quality. 13 However, in the current study, CNR was comparable between groups by adapting both radiation and CM dose, as intended in the study design.…”

Section: Discussionmentioning

confidence: 99%

“…Earlier studies focused on CM reduction in patients with reduced kidney function. By decreasing tube voltage, a substantial reduction in CM could be achieved without negatively influencing either objective or subjective image quality 25,26 . Reducing both parameters at the same time will decrease CNR and may lead to insufficient image quality 13 .…”

Section: Discussionmentioning

confidence: 99%

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Individualized Scan Protocols in Abdominal Computed Tomography

et al. 2022

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Background: In contrast-enhanced abdominal computed tomography (CT), radiation and contrast media (CM) injection protocols are closely linked to each other, and therefore a combination is the basis for achieving optimal image quality. However, most studies focus on optimizing one or the other parameter separately. Purpose: Reducing radiation dose may be most important for a young patient or a population in need of repetitive scanning, whereas CM reduction might be key in a population with insufficient renal function. The recently introduced technical solution, in the form of an automated tube voltage selection (ATVS) slider, might be helpful in this respect. The aim of the current study was to systematically evaluate feasibility of optimizing either radiation or CM dose in abdominal imaging compared with a combined approach. Methods: Six Göttingen minipigs (mean weight, 38.9 ± 4.8 kg) were scanned on a third-generation dual-source CT. Automated tube voltage selection and automated tube current modulation techniques were used, with quality reference values of 120 kV ref and 210 mAs ref . Automated tube voltage selection was set at 90 kV semimode. Three different abdominal scan and CM protocols were compared intraindividually: (1) the standard "combined" protocol, with the ATVS slider position set at 7 and a body weight-adapted CM injection protocol of 350 mg I/kg body weight, iodine delivery rate (IDR) of 1.1 g I/s; (2) the CM dose-saving protocol, with the ATVS slider set at 3 and CM dose lowered to 294 mg I/kg, resulting in a lower IDR of 0.9 g I/s; (3) the radiation dose-saving protocol, with the ATVS slider position set at 11 and a CM dose of 441 mg I/kg and an IDR 1.3 g I/s, respectively. Scans were performed with each protocol in arterial, portal venous, and delayed phase. Objective image quality was evaluated by measuring the attenuation in Hounsfield units, signal-to-noise ratio, and contrast-to-noise ratio of the liver parenchyma. The overall image quality, contrast quality, noise, and lesion detection capability were rated on a 5-point Likert scale (1 = excellent, 5 = very poor). Protocols were compared for objective image quality parameters using 1-way analysis of variance and for subjective image quality parameters using Friedman test. Results: The mean radiation doses were 5.2 ± 1.7 mGy for the standard protocol, 7.1 ± 2.0 mGy for the CM dose-saving protocol, and 3.8 ± 0.4 mGy for the radiation dose-saving protocol. The mean total iodine load in these groups was 13.7 ± 1.7, 11.4 ± 1.4, and 17.2 ± 2.1 g, respectively. No significant differences in subjective overall image or contrast quality were found. Signal-to-noise ratio and contrast-to-noise ratio were not significantly different between protocols in any scan phase. Significantly more noise was seen when using the radiation dose-saving protocol ( P < 0.01). In portal venous and delayed phases, the mean attenuation of the liver parenchyma significantly differed between protocols ( P < 0.001). Lesion detection was significantly better in portal veno...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Individualized Scan Protocols in Abdominal Computed Tomography

et al. 2022

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“…Minimizing the total volume of CM and using the least nephrotoxic CM should be applied in all cases. There have been efforts to reduce the contrast volume (iodine dose) as low as reasonably achievable during both CAG and CECT [ 50 , 105 ]. Clinicians should also consider the interval of CM administration when repeated procedures are needed because multiple doses of CM within a short period of time (24–72 h) increase the risk of CIN [ 10 , 106 ].…”

Section: Managementmentioning

confidence: 99%

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Cho

2022

Diagnostics

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Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.

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“…Finally, 30 patients for halfCM protocol and 30 patients for stdCM protocol were enrolled. 20,21 As shown in Table 1, there were no significant differences in terms of age, sex, or body weight between the groups.…”

Section: Study Populationmentioning

confidence: 85%

Decreasing the radiation dose for contrast-enhanced abdominal spectral CT with a half contrast dose: a matched-pair comparison with a 120 kVp protocol

et al. 2020

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Objectives: To compare the estimated radiation dose of 50% reduced iodine contrast medium (halfCM) for virtual monochromatic images (VMIs) with that of standard CM (stdCM) with a 120 kVp imaging protocol for contrast-enhanced CT (CECT). Methods: We enrolled 30 adults with renal dysfunction who underwent abdominal CT with halfCM for spectral CT. As controls, 30 matched patients without renal dysfunction using stdCM were also enrolled. CT images were reconstructed with the VMIs at 55 keV with halfCM and 120 kVp images with stdCM and halfCM. The Monte Carlo simulation tool was used to simulate the radiation dose. The organ doses were normalized to CTDIvol for the liver, pancreas, spleen, and kidneys and measured between halfCM and stdCM protocols. Results: For the arterial phase, the mean organ doses normalized to CTDIvol for stdCM and halfCM were 1.22 and 1.29 for the liver, 1.50 and 1.35 for the spleen, 1.75 and 1.51 for the pancreas, and 1.89 and 1.53 for the kidneys. As compared with non-enhanced CT, the average increase in the organ dose was significantly lower for halfCM (13.8% ± 14.3 and 26.7% ± 16.7) than for stdCM (31.0% ± 14.3 and 38.5% ± 14.8) during the hepatic arterial and portal venous phases (p < 0.01). Conclusion: As compared with stdCM with the 120 kVp imaging protocol, a 50% reduction in CM with VMIs with the 55 keV protocol allowed for a substantial reduction of the average organ dose of iodine CM while maintaining the iodine CT number for CECT. Advances in knowledge: This study provides that the half iodine contrast medium protocol for abdominal CT with a dual-layer-dual energy CT can significantly reduce the increase in the average organ dose for non-enhanced CT as compared with the standard contrast medium protocol.

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Application of 80-kVp scan and raw data-based iterative reconstruction for reduced iodine load abdominal–pelvic CT in patients at risk of contrast-induced nephropathy referred for oncological assessment: effects on radiation dose, image quality and renal function

Cited by 12 publications

References 45 publications

Individualized Scan Protocols in Abdominal Computed Tomography

Individualized Scan Protocols in Abdominal Computed Tomography

The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Decreasing the radiation dose for contrast-enhanced abdominal spectral CT with a half contrast dose: a matched-pair comparison with a 120 kVp protocol

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