Evaluation of a High Concentrated Contrast Media Injection Protocol in Combination with Low Tube Current for Dose Reduction in Coronary Computed Tomography Angiography

Sun, Yibo; Hua, Yanqing; Wang, Mingpeng; Mao, Dingbiao; Jin, Xisen; Cheng, Li; Shi, Kailei; Xu, Jianrong

doi:10.1016/j.acra.2017.07.001

Cited by 7 publications

(6 citation statements)

References 26 publications

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“…In the BMI approximation (24.7 § 2.2 vs. 24.8 § 2.9 kg/ m 2 ), the ED in the FLD group was significantly lower (2.6 § 0.8 mSv) when compared to the Ko study (19). For a total of 28 patients with a BMI 25 kg/m 2 (26.8 § 1.1 kg/m 2 ) in the FLD group, the ED (0.80 § 0.13 mSv) was significantly lower than that the study conducted by Rochitte et al (20) (BMI = 27 kg/m 2 and ED = 3.16 [2.82-3.63 mSv]) and similar with recent studies in which the BMIs of the patients were unknown (0.71-0.88 mSv) (12,21,22). Although decreases in radiation dose were associated with a concomitant increase in image noise and a possibility of reduction in overall image quality, we succeeded in maintaining a constant SNR and CNR on axial images or CPR reconstructions enabling adequate depiction of the coronary in the FLD group by increasing the iodine delivery rate (IDR).…”

Section: Discussionsupporting

confidence: 87%

“…Seen in this light, although increasing contrast media concentration cannot reduce radiation dose directly, it play an important role in image quality maintenance, complying with the principle "as low as diagnostically acceptable." The magnitude of radiation dose reduction in our study is same as the study conducted by Sun et al (12) despite the method to decrease tube current is different. Sun et al modified the tube current manually through multiplying the effective tube current by 0.6 based on automated tube current while we use noise index configuration.…”

Section: Discussionsupporting

confidence: 76%

“…Recently, investigators have explored the role of contrast media in radiation dose reduction (11) that high concentration of contrast media plays an important role in image quality maintenance. Sun et al evaluated a high concentrated contrast media injection protocol combined with manually modified low tube current for dose reduction in CCTA, revealing a mean effective dose reduction of 42% (12).…”

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confidence: 99%

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Higher Iodine Concentration Enables Radiation Dose Reduction in Coronary CT Angiography

Zhang

Shi

et al. 2021

Academic Radiology

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Rationale and Objectives: To test whether higher iodine concentration together with higher noise level could lead to a further dose reduction in an already low dose coronary CT angiography (CCTA) protocol without comprising image quality. Materials and Methods: One hundred eighty patients with suspected coronary artery disease (CAD) were randomly assigned into three groups: (a) conventional dose (CD) group, 100 kV with a noise index (NI) of 25 and iohexol (350 mg I/ml); (b) low dose (LD) group, 80 kV with a NI of 25 and iohexol (350 mg I/ml); (c) further low dose (FLD) group, 80 kV with a NI of 30 and iomeprol (400 mg I/ml). The volume and injection rate of contrast medium were fixed at 60 ml and 5 ml/s. The radiation dose (volume CT dose index [CTDIvol], dose length product [DLP], and effective dose [ED]) were recorded. For image quality, both quantitative (enhancement, noise, signal-to-noise ratio [SNR], and contrast-to-noise ratio [CNR]) and qualitative indices were assessed. Results: Compared to the CD group, ED was reduced by 16% and 42% in the LD and FLD groups, respectively (p < 0.05). Qualitative analysis showed no significant difference among the 3 groups (p > 0.05), while quantitative analysis revealed significantly higher attenuation in the LD and FLD groups. Signal-to-noise ratios and CNRs of the LD and FLD groups were significantly higher except for the CNR at the left circumflex branch of the FLD group (p < 0.05). Conclusion: Increasing iodine concentration and noise level may further reduce the radiation dose by 26% on top of a 16% reduction from 100 kV to 80 kV without image quality compromise.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 76%

mentioning

confidence: 99%

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Higher Iodine Concentration Enables Radiation Dose Reduction in Coronary CT Angiography

Zhang

Shi

et al. 2021

Academic Radiology

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“…Эффективность этого метода не вызывает сомнений. В различных исследованиях удавалось значительно снизить лучевую нагрузку при использовании АРСТ [10,11]. В частности, Lifeng Yu и соавт.…”

Section: Fig 6 Diagramunclassified

Low-Dose Liver and Pancreas Msct: Results of Practical Applicability

Aznaurov¹,

Kondratiev²,

Kаrmаzаnovsky³

2018

Rejr

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ель исследования. Определить возможности МСКТ с низким значением напряжения на рентгеновской трубке в визуализации очаговых образований печени и поджелудочной железы. Материалы и методы. В исследовании приняло участие 75 пациентов, разделенных на 3 группы. Все исследования были выполнены с внутривенным введением контрастного препарата. Применялось 3 протокола сканирования, различавшихся напряжением на рентгеновской трубке,-стандартный «120 кВ-90 мл контрастного вещества» (КВ), модифицированный «100 кВ-90 мл КВ», а также протокол с уменьшенным количеством контрастного препарата «100 кВ-65 мл КВ». Обрабатывались данные томограмм: шум, окружность брюшной полости, отношение «контраст-шум», данные контрастного усиления органов. Томограммы реконструировались с использованием стандартного и итеративного алгоритма реконструкции. Качественная оценка изображений проводилась по 2 параметрам с использованием 3-х балльной шкалы: оценка изображения в целом и визуализация образования. Результаты и обсуждение. Лучевая нагрузка снизилась на 32,2% при применении модифицированного протокола «100 кВ-90 мл КВ» и на 36,7% при применении модицифированного протокола «100 кВ-65 мл КВ». Уровень шума не различался при применении стандартной реконструкции, однако выраженно снижался при применении итеративной реконструкции. Отношение «контраст-шум» оказалось выше в группах «100 кВ-90 мл КВ» и «100 кВ-65 мл КВ» и последовательно возрастало с повышением уровней итеративной реконструкции. Оценки визуализации образований были значимо выше в группе «100кВ-90 мл КВ». При применении протокола сканирования с уменьшенным количеством контрастного препарата были достигнуты результаты, схожие с результатами в группе «120 кВ-90 мл КВ». Выводы. Применение протоколов сканирования с низкими значениями напряжения на рентгеновской трубке целесообразно, их использование способно улучшить визуализацию как гиперваскулярных, так и гиповаскулярных образований печени и поджелудочной железы, кроме этого, позволяет серьезно снизить дозу облучения пациента. Ключевые слова: МСКТ, контрастное усиление, лучевая нагрузка, низкое напряжение, протокол пониженной лучевой нагрузки, гиперваскулярное образование.

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“…For coronary CTA, contrast flow rates are generally no less than 5 mL/s, and an injection rate of 5 to 7 mL/s is recommended in most adults. [ 20 , 21 ] Only a few studies, however, have applied contrast flow rates <4 mL/s in some patients. [ 19 ] The present study aimed to assess the feasibility of a low-dose (no more than 40 mL), low-flow rate (no more than 3 mL/s), CM (370 mg I/mL) protocol to achieve appropriate individual contrast enhancement with a newly advocated, individualized test bolus-based CM protocol for second-generation dual-source computed tomography (DSCT).…”

Section: Introductionmentioning

confidence: 99%

Coronary angiography using second-generation dual source computed tomography

Zhu

et al. 2018

Medicine

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Improved contrast enhancement consistency can be achieved using an individualized contrast media (CM) protocol. This study aimed to assess the feasibility of a low-dose, low-flow rate CM protocol to achieve appropriate individual contrast enhancement using a newly advocated individualized test bolus-based protocol for second-generation dual-source computed tomography angiography.CM containing iodine (370 mg I/mL) was used in this study. A CM flow rate of 3.5 mL/s for patients with a body mass index (BMI) <25.0 kg/m2, and 4.5 mL/s for those with BMI ≥25.0 kg/m2 was used in group 1 (n = 189). An individualized test-bolus based contrast injection protocol was then derived from the information gained from the test bolus and coronary enhancements in group 1. The proposed individualized test-bolus based CM injection protocol was applied in group 2 (n = 219). Ascending aortic attenuations (AAo) were measured and compared with both groups.The contrast enhancement consistency of AAo in group 2 improved significantly (31.8 vs 56.3 Hounsfield units [HU]; P < .001). The number of patients in group 2 with a contrast flow rate ≤3 mL/s was 63 (28.8%), with 77 (35.2%) using a contrast dose ≤40 mL. In group 2, no significant differences in mean AAo were found among subgroups with contrast flow rates ≤3.0, 3.1 to 4.0, 4.1 to 5.0 and >5.0 mL/s (351, 344, 346, and 348 HU, respectively), nor among subgroups with contrast doses ≤40, 41 to 50, 51 to 60, and >60 mL (349, 345, 344, and 350 HU, respectively).Improved individual contrast enhancement uniformity can be achieved using an individualized CM protocol tailored to a test bolus. Approximately, one-third of patients received CM at a flow rate of no more than 3 mL/s and a total dose of no more than 40 mL.

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Evaluation of a High Concentrated Contrast Media Injection Protocol in Combination with Low Tube Current for Dose Reduction in Coronary Computed Tomography Angiography

Cited by 7 publications

References 26 publications

Higher Iodine Concentration Enables Radiation Dose Reduction in Coronary CT Angiography

Higher Iodine Concentration Enables Radiation Dose Reduction in Coronary CT Angiography

Low-Dose Liver and Pancreas Msct: Results of Practical Applicability

Coronary angiography using second-generation dual source computed tomography

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