Methods to Address Computed Tomography-Related Risk Factors in Oncology Patients: An Expert Opinion Based on Current Evidence

Abstract

Background: The present paper is intended to be a practical guide organized by statements describing methods to reduce risks related to CT examinations in cancer patients. Methods: A panel of radiologists, oncologists and nephrologists were selected based on their publication records in the field and expertise. Ten clinical questions, which were derived from clinical needs and an integration of all the committee members’ suggestions, were stated. The modified Delphi approach was used; it involved a detailed literature review and the collective judgement of experts, including electronic and face-to-face discussions. Results: Ten statements were derived from expert opinions based on the current literature, recently developed guidelines and technological advancements. Each statement is discussed in a short paragraph reporting the current key evidence. Conclusion: This paper addresses the clinical implications of performing numerous CT examinations in patients with cancer, providing clinicians with information regarding methods to reduce risk factors in this patient population.

The Establishment of an Optimal Protocol for Contrast‐Enhanced Micro‐Computed Tomography in the Cloudy Catshark Scyliorhinus torazame

“…2007; Del Mastro et al. 2018). The study of the optimal CM dose for Common Carp reported that 480 mgI/kg was sufficient for the coelomic organs, including the liver (Brust et al.…”

Incidence of contrast-induced acute kidney injury (CI-AKI) in high-risk oncology patients undergoing contrast-enhanced CT with a reduced dose of the iso-osmolar iodinated contrast medium iodixanol

“…To what extent our CT-protocol was responsible for the overall incidence of CI-AKI is difficult to attest due to the study design using a single contrast agent (iso-osmolar) at standardized concentration and volume. Our routine CT-examination protocol in cancer patients was developed in accordance with current expert opinions and guidelines for prevention of contrast-induced nephropathy recommending the use of IOCM along with a reduction in CM volume and/or concentration [9,41,42]. Combinations of low-kV and low-dose CM have been used successfully in the near past and demonstrated image quality comparable to high-dose protocols [43,44].…”

Acute kidney injury from contrast-enhanced CT procedures in patients with cancer: white paper to highlight its clinical relevance and discuss applicable preventive strategies

“…Furthermore, the increased survival achieved in the past decades, due to improvements in the treatment of a number of malignancies, is associated with a growing number of patients with cancer with an active disease, or in follow-up after treatment, or aged 70 years or more 1 ; these patients are therefore expected to present a number of comorbidities, 2 including acute and chronic kidney disease (CKD).…”

“…3 A consensus-based paper, established on a modified Delphi approach, on methods to reduce risks related to computed tomography (CT) examinations in patients with cancer has already been recently published. 2 In order to better focus on CM-induced renal damage, a multidisciplinary panel of experts from the specialties of radiology, oncology and nephrology assembled in 2018. Their specific aim was to comment on existing evidence and to provide their experience on the incidence and management of acute kidney injury (AKI) in patients with cancer who receive iodinated CM.…”