CT Colonography: Feasibility of Substantial Dose Reduction—Comparison of Medium to Very Low Doses in Identical Patients

Gelder, Rogier E. van; Venema, Henk W.; Florie, Jasper; Nio, C. Yung; Serlie, Iwo W. O.; Schutter, Michiel P.; Rijn, Jeroen C. van; Vos, Frans M.; Glas, Afina S.; Bossuyt, Patrick M.; Bartelsman, J. F. W. M.; Laméris, Johan S.; Stoker, Jaap

doi:10.1148/radiol.2322031069

Cited by 88 publications

(44 citation statements)

References 29 publications

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“…In view of the inherently high contrast between air and the soft tissue density of body organs, a low-dose protocol was employed for CT, without a loss of diagnostic accuracy. Low-dose protocols for CT have been used in many studies, such as the CT colonography and for detection of occult colonic perforation after colonoscopy [28][29][30] . Low-dose CT is considered to be a standard technique for the evaluation of ME and measurement of the residual gas in the GI tract.…”

Section: Discussionmentioning

confidence: 99%

Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

Maeda¹,

Hirasawa²,

Fujita³

et al. 2016

WJG

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AIMTo assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema (ME) immediately after endoscopic submucosal dissection (ESD). METHODSA total of 46 patients who were to undergo esophageal ESD were randomly assigned to receive either CO2 insufflation (CO2 group, n = 24) or air insufflation (Air group, n = 22). Computed tomography (CT) was carried out immediately after ESD and the next morning. Pain and abdominal distention were chronologically recorded using a 100-mm visual analogue scale (VAS). The volume of residual gas in the digestive tract was measured using CT imaging. RESULTSThe incidence of ME immediately after ESD in the CO2 group was significantly lower than that in the Air group (17% vs 55%, P = 0.012). The incidence of ME the next morning was 8.3% vs 32% respectively (P ORIGINAL ARTICLE Randomized Controlled TrialCarbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial after esophageal ESD with CO2 insufflation [8] . To further assess the efficacy of CO2 insufflation for reduction of post-ESD ME, we conducted a prospective, doubleblind, randomized controlled trial, the results of which are reported herein. MATERIALS AND METHODS Study designThis study was a single-center, randomized, doubleblind, controlled trial in Japan. This study was approved by the institutional review board of Sendai City Medical Center and met all criteria of the Declaration of Helsinki. The trial was registered with the UMIN Clinical Trials Registry (No. UMIN000006441). ParticipantsBetween February 2011 and May 2012, all consecutive patients undergoing esophageal ESD at the center were screened for recruitment. The inclusion criterion was all consecutive patients undergoing esophageal ESD. The following patients were excluded: those who had severe chronic obstructive pulmonary disease (COPD) resulting in less than 50% of the predicted values of the forced expiratory volume in 1 s (FEV1.0) or less than 70% of FEV1.0/FVC (forced vital capacity) [12] , those who had experienced CO2 retention, those who had multiple synchronous esophageal lesions treated at one time, those who were to undergo esophageal ESD under general anesthesia with positive pressure ventilation, and those who refused to participate. All participants provided written informed consent prior to enrollment in the study. Randomization and blindingParticipants were randomly assigned to either the CO2 insufflation group (CO2 group) or the air insufflation group (Air group). Randomization took place immediately before the ESD procedure. Individual randomization to the two treatment groups (1:1) was performed by using computer-generated random numbers. A sequentially numbered, opaque, sealed envelope containing a random number was opened sequentially by an endoscopy nurse after participant details were written on the envelope. When the number was even, the patient was allocated to the CO2 group and administration of CO2 was started. When the n...

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Section: Discussionmentioning

confidence: 99%

Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

Maeda¹,

Hirasawa²,

Fujita³

et al. 2016

WJG

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“…Other researchers have demonstrated reduction of CT colonography radiation dose, primarily by decreasing tube current and employing automatic tube current modulation (15,(30)(31)(32)(33). These studies have shown that cutting dose has an effect on the quality of 3D endoluminal renderings, although one study noted that this did not affect perception of polyps 6 mm or larger (30,32).…”

Section: Qualitative 3d Image Analysismentioning

confidence: 99%

“…These studies have shown that cutting dose has an effect on the quality of 3D endoluminal renderings, although one study noted that this did not affect perception of polyps 6 mm or larger (30,32). While prior studies used simulated low-dose data sets, we used true data from two separate acquisitions performed in the same patient on the same scanner at the same time, with the supine examination acting as a control.…”

Section: Qualitative 3d Image Analysismentioning

confidence: 99%

Reducing Radiation Dose at CT Colonography: Decreasing Tube Voltage to 100 kVp

Chang¹,

Caovan²,

Grand³

et al. 2013

Radiology

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Purpose:To assess the effect of a decrease in tube voltage from 120 kVp to 100 kVp on dose, contrast-to-noise ratio (CNR), and three-dimensional (3D) image quality in patients undergoing computed tomographic (CT) colonography as well as to determine how these changes are affected by patient size. Materials and Methods:This HIPAA-compliant and institutional review board-approved retrospective study included 63 consecutive patients who underwent CT colonography and who waived informed consent. Scanning was performed with patients in the supine (120 kVp) and prone (100 kVp) positions, with other parameters unchanged. Volume CT dose index (CTDI vol ), dose-length product (DLP), image noise, attenuation of selected materials, and CNR were compared with the Wilcoxon matched-pairs signed rank test. Two readers blinded to tube voltage independently assessed 3D endoluminal image quality. The k coefficients were calculated for interobserver agreement. Average image quality ratings were compared with the Wilcoxon signed rank test. All recorded data were stratified by patient anteroposterior diameter to determine effects of patient size. Results:Decreasing tube voltage from 120 to 100 kVp resulted in a 20% decrease in CTDI vol (P , .001) and a 16% decrease in DLP (P , .001). Image noise increased by 32% (P , .001). Mean attenuation of tagged fluid increased from 395 to 487 HU (P , .001). There was no change in mean CNR of tagged fluid (17.1 at 120 kVp, 16.8 at 100 kVp; P = .37), regardless of patient size. The 3D image quality decreased slightly from a median score of 5 out of 5 to 4 out of 5 (P , .001). There was substantial interobserver agreement. Conclusion:A decrease in tube voltage from 120 to 100 kVp results in a significant decrease in radiation dose but only a minimal decrease in 3D image quality at all patient sizes.q RSNA, 2012

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“…The medical literature indicates that the level of ionising radiation received by the patients during the CT examination varies from 5 to 20mSv [36][37][38][39][40][41] and this radiation level may induce cancer in 0.05% of the patients older than 50 years that were subjected to a CT abdominal examination [42]. Cohen [43] indicates in his paper that the risk of inducing cancer in patients is significantly lowered when they are subjected to low-level radiation exposure and an important number of studies were carried out in order to identify the minimal level of radiation dose that can be used in CTC but without a negative impact on the detection of colorectal polyps [41,[44][45][46]. The identification of the optimal scanning parameters (collimation, slice thickness, table speed, reconstruction interval) is a difficult problem and this procedure is applied on synthetic phantoms that are designed to accurately model the human body [47][48][49][50][51][52][53][54][55][56][57][58].…”

Section: Introductionmentioning

confidence: 99%

Development of a synthetic phantom for the selection of optimal scanning parameters in CAD–CT colonography

Chowdhury

Whelan

Ghita

et al. 2007

Medical Engineering & Physics

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The aim of this paper is to present the development of a synthetic phantom that can be used for the selection of optimal scanning parameters in Computed Tomography (CT) colonography. In this paper we attempt to evaluate the influence of the main scanning parameters including slice thickness, reconstruction interval, field of view, table speed and radiation dose on the overall performance of a Computer Aided Detection (CAD)-CTC system. From these parameters the radiation dose received a special attention, as the major problem associated with CTC is the patient exposure to significant levels of ionising radiation. To examine the influence of the scanning parameters we performed 51 CT scans where the spread of scanning parameters was divided into seven different protocols. A large number of experimental tests were performed and the results analysed. The results show that automatic polyp detection is feasible even in cases when the CAD-CTC system was applied to low dose CT data acquired with the following protocol: 13mAs/rotation with collimation of 1.5x16mm, slice thickness of 3.0mm, reconstruction interval of 1.5mm, table speed Preprint submitted to Elsevier Science 13 September 2006of 30mm per rotation. The CT phantom data acquired using this protocol was analysed by an automated CAD-CTC system and the experimental results indicate that our system identified all clinically significant polyps (i.e. larger than 5mm).

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CT Colonography: Feasibility of Substantial Dose Reduction—Comparison of Medium to Very Low Doses in Identical Patients

Cited by 88 publications

References 29 publications

Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

Reducing Radiation Dose at CT Colonography: Decreasing Tube Voltage to 100 kVp

Development of a synthetic phantom for the selection of optimal scanning parameters in CAD–CT colonography

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