Optimizing radiation exposure in screening of body packing: image quality and diagnostic acceptability of an 80 kVp protocol with automated tube current modulation

Abstract

The aim of this study was to evaluate the objective and subjective image quality of a novel computed tomography (CT) protocol with reduced radiation dose for body packing with 80 kVp and automated tube current modulation (ATCM) compared to a standard body packing CT protocol. 80 individuals who were examined between March 2012 and July 2015 in suspicion of ingested drug packets were retrospectively included in this study. Thirty-one CT examinations were performed using ATCM and a fixed tube voltage of 80 kVp (group A). Forty-nine CT examinations were performed using a standard protocol with a tube voltage of 120 kVp and a fixed tube current time product of 40 mAs (group B). Subjective and objective image quality and visibility of drug packets were assessed. Radiation exposure of both protocols was compared. Contrast-to-noise ratio (group A: 0.56 ± 0.36; group B: 1.13 ± 0.91) and Signal-to-noise ratio (group A: 3.69 ± 0.98; group B: 7.08 ± 2.67) were significantly lower for group A compared to group B (p < 0.001). Subjectively, image quality was decreased for group A compared to group B (2.5 ± 0.8 vs. 1.2 ± 0.4; p < 0.001). Attenuation of body packets was higher with the new protocol (group A: 362.2 ± 70.3 Hounsfield Units (HU); group B: 210.6 ± 60.2 HU; p = 0.005). Volumetric Computed Tomography Dose Index (CTDIvol) and Dose Length Product (DLP) were significantly lower in group A (CTDIvol 2.2 ± 0.9 mGy, DLP 105.7 ± 52.3 mGycm) as compared to group B (CTDIvol 2.7 ± 0.1 mGy, DLP 126.0 ± 9.7 mGycm, p = 0.002 and p = 0.01). The novel 80 kVp CT protocol with ATCM leads to a significant dose reduction compared to a standard CT body packing protocol. The novel protocol led to a diagnostic image quality and cocaine body packets were reliably detected due to the high attenuation.

Clinical, Diagnostic, and Treatment Features of Body Packing in Brazil: Drugs, Cell Phones, and Beyond

“…It is not known whether they were body packers or body stuffers. Our profile of young and male body packers matches that reported in other studies from several nations [13][14][15][16][17]. In addition, these patients ingested very different types of content.…”

Noise insertion in CT for cocaine body packing: where is the limit of extensive dose reduction?

“…We found an effective dose of 0.11 mSv to be sufficient for the detection of cocaine body packets. Prior studies evaluated body packing CT protocols with reduced radiation dose that are used in clinical routine and reported diagnostic image quality for CT protocols with an effective dose of 1.06–2.05 mSv [ 5 , 8 , 11 , 18 , 19 ] which is close to an abdominal radiography. However, due to the clinical setting of previous studies, a radiation-dose threshold could not be determined.…”

“…Rotation time was 0.5 s and collimation was 0.6 mm. Image quality of the CT protocol has been previously validated [ 11 ]. All scans were performed without oral or intra venous contrast media.…”