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Xie M, Wang H, Tang S, Chen M, Li T, He L. Application of dual-energy CT with prospective ECG-gating in cardiac CT angiography for children: Radiation and contrast agent dose. Eur J Radiol 2024; 170:111229. [PMID: 38056348 DOI: 10.1016/j.ejrad.2023.111229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE This research aimed to investigate the feasibility of utilizing dual-energy CT virtual monoenergetic images (VMI1) with prospective electrocardiogram (ECG2) gating for reducing radiation and contrast agent doses in pediatric patients with congenital heart disease (CHD3). METHODS There were 100 pediatric patients with CHD included in this study. Group A (n = 50) underwent dual-energy scanning with prospective ECG-gating, and group B (n = 50) underwent conventional scanning with retrospective ECG-gating. Comparative analysis of CT values of lumen, objective image quality assessment, subjective image quality evaluations, and diagnostic efficacy were performed. RESULTS CT values, image noise, signal-to-noise ratio (SNR4), and contrast-to-noise ratio (CNR5) were significantly affected by the VMI energy level, and they all increased with decreasing energy levels (P > 0.05). Combining subjective evaluation, the 45 keV VMI was considered the optimum image in group A. The 45 keV VMI exhibited higher CT values of lumen compared to conventional scanning images (P < 0.003 ∼ 0.836), but meanwhile, the image noise was also higher in the 45 keV VMI (P = 0.004). Differences between the two groups in SNR, CNR, and diagnostic accuracy were not statistically significant. Compared to group B, the 45 keV VMI showed fewer contrast-induced artifacts (P < 0.001) and higher image quality score (P = 0.037). Group A had a 64 % reduction in radiation dose and a 40 % decrease in iodine dose compared to group B. CONCLUSION The combination of dual-energy CT with prospective ECG-gating reduces radiation and iodine doses in pediatric patients with CHD. The 45 keV VMI can provide clinically acceptable image quality while declining contrast agent artifacts.
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Affiliation(s)
- Mingye Xie
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
| | - Haoru Wang
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
| | - Shilong Tang
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
| | - Mingjing Chen
- Department of Radiology, Jining No.1 People'S Hospital, Jining 272002, China.
| | - Ting Li
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
| | - Ling He
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
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Clinical Question Influence on Radiation Dose of Cardiac CT Scan in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081172. [PMID: 36010062 PMCID: PMC9406619 DOI: 10.3390/children9081172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/25/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022]
Abstract
Background: To assess the impact of different clinical questions on radiation doses acquired during cardiac computed tomography in children. Methods: A total of 116 children who underwent cardiac CT on a third-generation dual-source CT scanner were included. The clinical questions were divided into three main categories: the extent of scanning in the z-axis, coronary artery assessment and cardiac function assessment. Radiation dose values represented as a dose-length product (DLP) in mGy*cm were recorded from the CT scanner protocols. Results: There were significantly higher doses in cases with cardiac function assessment (median DLP 348 versus 59 mGy*cm, p < 0.01) and in cases with coronary artery assessment (median DLP 133 versus 71 mGy*cm, p < 0.01). Conclusion: The most important factor was the assessment of cardiac function, where the median radiation dose was 4.3× higher in patients with a request for cardiac function assessment. We strongly recommend that clinical requests for cardiac CT should be carefully considered in the paediatric population.
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Sun W, Tan H, Wang Y, Xie A, Tan X, Liu P, Xu D, Huang F. Pulmonary CT scans of white rabbits using the selective photon shield technique of the third-generation dual-source CT. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021527. [PMID: 35580575 DOI: 10.1088/1361-6498/ac7089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
This study aims to optimise the protocol for the low-dose pulmonary computed tomography (CT) scanning of infants by studying the effects of the selective photon shield (SPS) technique of the third-generation dual-source CT (DSCT) on the image quality and radiation dose of a chest CT in white rabbits under different tube currents. Twelve white rabbits of a similar weight to an infant were selected and randomly divided into an experimental group and a control group. The experimental groups (A1-A5) were scanned at low dose by the third-generation DSCT using SPS under different tube current × time (60, 50, 40, 30, and 20 mAs). The control group (B) was scanned under a conventional tube voltage (100 kV) and current × time (20 mAs). Advanced model iterative reconstruction at strength three was used for the objective and subjective evaluation of the image quality and radiation dose of the lung and mediastinal windows. With the standard deviation of the air in the trachea as image noise, the signal-to-noise ratio (SNR), contrast-to-noise ratio, and CT values of each site were evaluated. Radiation doses were compared using the volume CT dose index, dose length product, and effective dose. The differences in subjective image quality between groups A2 and B were not statistically significant (P= 0.34). The differences in the SNRs of the lung and mediastinal windows between groups A2 and B were not statistically significant (P> 0.05). The radiation dose of group A2 was 83.2% lower than that of group B. The SPS of the third-generation DSCT under 50 mAs might be applied in the pulmonary CT examination of infants.
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Affiliation(s)
- Wenjie Sun
- Department of Radiology, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), No. 61, West Jiefang Road, Changsha, Hunan 410005, People's Republic of China
| | - Hui Tan
- Department of Radiology, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), No. 61, West Jiefang Road, Changsha, Hunan 410005, People's Republic of China
| | - Yi Wang
- Department of Radiology, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), No. 61, West Jiefang Road, Changsha, Hunan 410005, People's Republic of China
| | - An Xie
- Department of Radiology, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), No. 61, West Jiefang Road, Changsha, Hunan 410005, People's Republic of China
| | - Xianzheng Tan
- Department of Radiology, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), No. 61, West Jiefang Road, Changsha, Hunan 410005, People's Republic of China
| | - Peng Liu
- Department of Radiology, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), No. 61, West Jiefang Road, Changsha, Hunan 410005, People's Republic of China
| | - Dan Xu
- Department of Radiology, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), No. 61, West Jiefang Road, Changsha, Hunan 410005, People's Republic of China
| | - Feng Huang
- Department of Radiology, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), No. 61, West Jiefang Road, Changsha, Hunan 410005, People's Republic of China
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Hustings N, Bosmans H, Dymarkowski S. PURSUING OPTIMAL RADIATION DOSE IN PEDIATRIC CARDIAC CT: A REPORT FROM UNIVERSITY HOSPITAL LEUVEN. RADIATION PROTECTION DOSIMETRY 2022; 198:139-146. [PMID: 35137188 DOI: 10.1093/rpd/ncac007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Computed tomography (CT) balances between high resolution and low radiation dose. Given the greater radiosensitivity of children, it is appropriate to use child-friendly CT-protocols that reduce radiation dose at acceptable image quality.This article states the radiation dose in pediatric cardiac CT-examinations at university hospital Leuven (Belgium) and compares with findings published by similar medical centers. The diagnostic accuracy was simultaneously compared, as it correlates with radiation dose. MATERIAL AND METHODS his retrospective observational study analyzed 58 CT-scans of 52 patients. The radiation dose was calculated in effective dose. The image quality was scored qualitatively with a 5-point scale. The diagnostic accuracy, a derivative representation of the image quality, was checked with findings from surgery or conventional angiography. RESULTS The mean effective dose in our study population was 1.3 ± 0.4 mSv. The qualitative image quality was on average 'good', elaborated with a score of 4.0 ± 0.2. The diagnostic accuracy was 92%. Comparative literature study provides a mean effective dose of 1.5 mSv and the reported diagnostic accuracy from other centers reaches ≥90%. CONCLUSIONS At our center pediatric cardiac CT-scans are obtained with good-to-excellent image quality and high diagnostic accuracy at low radiation doses. These results meet the radiation dose and diagnostic accuracy as published by comparable medical centers.
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Affiliation(s)
- Nico Hustings
- Radiology Resident in University Hospital of Leuven, University Hospital of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Hilde Bosmans
- Medical Physics and Quality Control in University Hospital of Leuven, University Hospital of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Steven Dymarkowski
- Radiologist in University Hospital of Leuven, University Hospital of Leuven, Herestraat 49, Leuven 3000, Belgium
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Optimize scan timing in abdominal multiphase CT: Bolus tracking with an individualized post-trigger delay. Eur J Radiol 2021; 148:110139. [PMID: 35021118 DOI: 10.1016/j.ejrad.2021.110139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE To conduct a head-to-head comparison in terms of image quality and diagnostic confidence between an individualized post-trigger delay and a conventional fixed post-trigger delay in bolus tracking abdominal multiphase CT. METHODS AND MATERIALS Abdominal multiphase CT was performed in 104 patients with either of the two bolus tracking strategies: an individualized post-trigger delay (group A) and fixed post-trigger delay of 11 s (group B). All CT scan parameters and contrast media protocol parameters were consistent between the two groups. Quantitative parameters (organs and blood vessels enhancement, image noise, signal-to-noise ratios [SNRs] and contrast-to-noise ratios [CNRs]) and qualitative visual parameters (overall image quality and diagnostic confidence) were compared. Quantitative and qualitative image quality for the two groups were compared using the Mann-Whitney U and independent sample t test. Degrees of agreement between two radiologists were evaluated using the Kappa analysis. RESULTS In the arterial phase (AP), images of group A provided higher attenuation (P ≤ 0.001). Although SNRs of liver, pancreas and aorta were similar in AP between the two groups, CNRs of liver, pancreas and portal vein in group A were significantly higher than those in group B (all P values ≤ 0.002). The overall subjective image quality and diagnostic confidence between the two groups were similar (P = 0.809; P = 0.768). CONCLUSION Compared to a fixed post-trigger delay using bolus tracking, application of an individualized post-trigger delay can optimize the objective image quality in arterial phase without compromising diagnostic quality in abdominal multiphase CT.
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Preoperative Morphological Prediction of Early Reoperation Risk After Primary Repair in Tetralogy of Fallot: A Contemporary Analysis of 83 Cases. Pediatr Cardiol 2021; 42:1512-1525. [PMID: 34075431 DOI: 10.1007/s00246-021-02635-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
This study was conducted to investigate the pulmonary artery (PA) variations in tetralogy of Fallot (TOF) and preoperative morphological predictors for early reoperation. Eighty-three TOF patients and 20 children with normal PA were included. The TOF group was divided into two subsets according to whether or not reoperation was performed within 3 years postoperatively. Clinical information was obtained, along with computed tomography (CT)-based three-dimensional geometry of the PA. Morphological measurements of the length of the main PA branches, the angles between them, and the cross-sectional area of each segment of the PAs were acquired using computer software. Logistic regression and receiver operating characteristic curves were applied to analysis. The TOF group showed a significantly smaller PA size and irregular PA shape, with lower Nakata and McGoon indices, than the control group. The median bifurcation angle (angle-γ) was greater than 100° in the TOF group, as compared to 66.70° in the control group (P < 0.000). Residual obstruction of the infundibulum or PAs was the main reason for early reoperation in this series. The development of the main PA and left PA was poorer in the reoperation subset than in the non-reoperation subset (P ≤ 0.01). The preoperative angle-γ in the reoperation subset was larger than that in the non-reoperation subset (median, 117.8° vs. 112.0°, P = 0.026). Higher weight (OR = 0.372) and McGoon index (OR = 0.122) were protective factors, while larger angle-γ (> 114.8°, OR = 5.040) and angle-γ normalized by body surface area (BSA) (γ/BSA > 297.9, OR = 18.860) were risk factors. This study provides an intuitive perspective of PA anatomical variations in TOF. Larger preoperative PA bifurcation angle and γ/BSA were morphological risk predictors of postoperative reoperation in patients with TOF.
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Chest CTA in children younger than two years - a retrospective comparison of three contrast injection protocols. Sci Rep 2019; 9:18109. [PMID: 31792291 PMCID: PMC6889233 DOI: 10.1038/s41598-019-54498-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/14/2019] [Indexed: 12/26/2022] Open
Abstract
To obtain the highest diagnostic information with least side effects when performing thoracic CT angiography (CTA) is challenging in young children. The current study aims to compare three contrast agent (CA) injection protocols regarding image quality and CA characteristic: a standard CTA, a fixed-bolus delay protocol, and the “microbolus technique (MBT)” developed in our institution. Seventy chest CTA scans of patients (<2 years) were divided into three groups. MBT was applied in group I, the standard protocol in group II and a fixed bolus delay in group III. Objective image quality was assessed by measuring peak enhancement, image noise, signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Two observers scored subjective image quality and artifacts. Significantly lower amounts of CA (mean ± SD) were used in the MBT group compared to Group II (9.0 ± 3.7 ml vs. 12.9 ± 4.5 ml). A lower, but still diagnostic (>400 HU) enhancement was registered in all major thoracic vessels in group I without significant differences regarding SNR and CNR in most regions (p < 0.05). The best scores for image quality and artifacts were reached in group I. All three chest CTA contrast injection protocols offered diagnostic vessel enhancement in young patients. MBT was associated with reduced image artifacts and less injected CA.
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Catheter, MRI and CT Imaging in Newborns with Pulmonary Atresia with Ventricular Septal Defect and Aortopulmonary Collaterals: Quantifying the Risks of Radiation Dose and Anaesthetic Time. Pediatr Cardiol 2018; 39:1308-1314. [PMID: 29744658 PMCID: PMC6153876 DOI: 10.1007/s00246-018-1895-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/02/2018] [Indexed: 12/01/2022]
Abstract
A comprehensive understanding of the native pulmonary blood supply is crucial in newborns with pulmonary atresia with ventricular septal defect and aortopulmonary collaterals (PA/VSD/MAPCA). We sought to describe the accuracy in terms of identifying native pulmonary arteries, radiation dose and anaesthetic time associated with multi-modality imaging in these patients, prior to their first therapeutic intervention. Furthermore, we wanted to evaluate the cumulative radiations dose and anaesthetic time over the study period. Patients with PA/VSD/MAPCA diagnosed at < 100 days between 2004 and 2014 were identified. Cumulative radiation dose and anaesthetic times were calculated, with imaging results compared with intraoperative findings. We then calculated the cumulative risks to date for all surviving children. Of 19 eligible patients, 2 had echocardiography only prior to first intervention. The remaining 17 patients underwent 13 MRIs, 4 CT scans and 13 cardiac catheterization procedures. The mean radiation dose was 169 mGy cm2 (47-461 mGy cm2), and mean anaesthetic time was 111 min (33-185 min). 3 children had MRI only with no radiation exposure, and one child had CT only with no anaesthetic. Early cross-sectional imaging allowed for delayed catheterisation, but without significantly reducing radiation burden or anaesthetic time. The maximum cumulative radiation dose was 8022 mGy cm2 in a 6-year-old patient and 1263 min of anaesthetic at 5 years. There is the potential to generate very high radiation doses and anaesthetic times from diagnostic imaging alone in these patients. As survival continues to improve in many congenital heart defects, the important risks of serial diagnostic imaging must be considered when planning long-term management.
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Hedgire SS, Baliyan V, Ghoshhajra BB, Kalra MK. Recent advances in cardiac computed tomography dose reduction strategies: a review of scientific evidence and technical developments. J Med Imaging (Bellingham) 2017; 4:031211. [PMID: 28894760 DOI: 10.1117/1.jmi.4.3.031211] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/28/2017] [Indexed: 12/24/2022] Open
Abstract
Cardiac imagers worldwide are bracing for increased utilization of cardiac computed tomography (CT) in clinical practice. This expanding opportunity brings along a responsibility to produce diagnostic quality images with optimized radiation dose. The following review aims to address the dose reduction strategies in cardiac CT in light of recent scientific evidence and technical developments.
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Affiliation(s)
- Sandeep S Hedgire
- Massachusetts General Hospital, Department of Imaging, Division of Cardiovascular Imaging, Boston, Massachusetts, United States
| | - Vinit Baliyan
- Massachusetts General Hospital, Department of Imaging, Division of Cardiovascular Imaging, Boston, Massachusetts, United States
| | - Brian B Ghoshhajra
- Massachusetts General Hospital, Department of Imaging, Division of Cardiovascular Imaging, Boston, Massachusetts, United States
| | - Mannudeep K Kalra
- Massachusetts General Hospital, Department of Imaging, Division of Cardiovascular Imaging, Boston, Massachusetts, United States
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