Instituting a Low-dose CT-guided Lung Biopsy Protocol

Abstract

Rationale and Objectives We aimed to evaluate whether implementation of a low-dose CT-guided lung biopsy protocol, with the support of individual radiologists in the section, would lead to immediate and sustained decreases in radiation dose associated with CT-guided lung biopsies. Materials and Methods A low-dose CT-guided lung biopsy protocol was developed with modifications of kilovoltage peak (kVp), milliamperes (mA), and scan coverage. 413 CT guided lung biopsies were evaluated over a three-year period beginning in 2009, 175 performed with a standard protocol prior to development of a low dose protocol and 238 performed with a low dose protocol. The dose-length product (DLP) was recorded for each lung biopsy and retrospectively compared between the two protocols. Individual radiologist level DLPs were also compared before and after the protocol change. Results The mean biopsy dose decreased 64.4% with the low dose protocol (113.8 mGy-cm versus 319.7 mGy-cm; p <0.001). This decrease in radiation dose persisted throughout the entire 18 months evaluated following the protocol change. After the protocol change, each attending radiologist demonstrated a decrease in administered radiation dose. The diagnostic outcome rate and complication rate were unchanged over the interval. Conclusion Implementation of a low-dose CT-guided lung biopsy protocol resulted in an immediate reduction in patient radiation dose that was seen with all attending radiologists and persisted for at least 18 months. Such an intervention may be considered at other institutions wishing to reduce patient doses.

Low-dose versus standard-dose computed tomography-guided core needle biopsy for lung nodules: a randomized controlled trial

“…In our study, we adjusted the tube current to 10% of the normal current and achieved a more than 90% reduction in radiation exposure. This reduction extent was largely consistent with that (53%-95%) in past investigations regarding low-dose CT-guided lung biopsy [12,23,24]. Although major dose reductions exacerbated noise and decreased image quality, low-dose CT at 120 kV and 15 mA/s allowed for an image quality adequate for CNB procedure.…”

“…The low-dose CT protocol could be achieved by reducing the tube voltage and/or current [12,23,24]. In our study, we adjusted the tube current to 10% of the normal current and achieved a more than 90% reduction in radiation exposure.…”

Comparison of acquisition and iterative reconstruction parameters in abdominal computed tomography-guided procedures: a phantom study

“…Repetitive helical acquisitions remain mandatory to identify the anatomically safest path because they allow a retrospective analysis of the 3D volume that can identify vascular structures and organs to avoid (1). Considering the recent awareness of the cancer-inducing risks of radiation, dose optimization is currently an important issue (2)(3)(4)(5)(6)(7)(8)(9)(10). Regarding helical acquisitions, international practice guidelines for optimization recommend limiting their number and length (1,(11)(12)(13) and preferring sequential or fluoroscopic acquisitions when possible (3,7,10).…”

“…Considering the recent awareness of the cancer-inducing risks of radiation, dose optimization is currently an important issue (2)(3)(4)(5)(6)(7)(8)(9)(10). Regarding helical acquisitions, international practice guidelines for optimization recommend limiting their number and length (1,(11)(12)(13) and preferring sequential or fluoroscopic acquisitions when possible (3,7,10).…”

Computed tomography-guided cutting needle biopsy for lung nodules

“…[ 3 – 5 ] However, in most previous studies regarding of low-dose CT-guided lung biopsy, they included both lung masses and lung nodules. [ 3 , 4 ] The multiple disease types usually caused the potential bias. A study which focuses on unique disease type is required.…”