Advantages of Application of Whole-Body Low-Dose Computed Tomography in Multiple Myeloma

Aim: This study was designed to investigate the application of whole-body low-dose computed tomography in the examination of multiple myeloma. Method: 40 patients with multiple myeloma admitted to our hospital were prospectively selected as the study subjects. All patients were pathologically confirmed and/or clinically diagnosed with multiple myeloma. Patients were randomly divided into two groups: Group A (n=20) received whole-body lowdose CT scan with SAFIR iterative reconstruction algorithm; Group B (n=20) underwent whole body conventional dose CT scan combined with conventional reconstruction algorithm. The image quality was scored subjectively, and the objective evaluation indexes (including CT value and noise of neck, chest, abdomen, pelvic cavity and lower extremities, signal-to-noise ratio and image quality index) were measured and recorded, and the radiation dose was recorded. Mann-Whitney U test (to evaluate the subjective score) and t test (to evaluate the objective evaluation index and radiation dose) were used to compare the differences of the above indexes between group A and group B. Result: All the images met the diagnostic requirements. There was no statistical significance in the scores between group A and group B (P>0.05). Significant differences in CT value, noise and SNR of neck, chest, abdomen, pelvis and lower extremities between group A and group B (P<0.05) were identified. For the image quality index (figure of merit, FOM), the FOM of chest, abdomen and pelvis was not statistically significantly changed (P<0.05). The radiation dose of group A decreased by 56.77% (3.06/5.39) compared to group B with a statistically significant difference (P<0.05). The Kappa values of subjective scores of the two groups showed no statistically significant difference (respectively, 0.68 and o.69, P>0.05). Conclusion: Compared to conventional CT examination, whole-body lowdose CT scan combined with SAFIR iterative reconstruction algorithm can effectively reduce noise, reduce X-ray radiation dose, and obtain ideal image quality in multiple myeloma examination, which has a certain application value.

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Ultra-low-dose CT-guided lung biopsy in clinic: radiation dose, accuracy, image quality, and complication rate

Acta Radiologica ◽

10.1177/0284185120917622 ◽

2020 ◽

pp. 028418512091762

Author(s):

Ting Liang ◽

Yonghao Du ◽

Chenguang Guo ◽

Yuan Wang ◽

Jin Shang ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Complication Rate ◽

Lung Biopsy ◽

Ct Guided ◽

Significant Difference ◽

Group A ◽

Mode Group ◽

Dose Accuracy ◽

Group B

Background Computed tomography (CT)-guided percutaneous lung biopsy is usually performed by helical scanning. However, there are no studies on radiation dose, diagnostic accuracy, image quality, and complications based on axial scan mode. Purpose To determine radiation dose, accuracy, image quality, and complication rate following an ultra-low-dose (ULD) protocol for CT-guided lung biopsy in clinic. Material and Methods A total of 105 patients were enrolled to receive CT-guided lung biopsy. The use of an ULD protocol (axial scan) for CT-guided biopsy was initiated. Patients were randomly assigned to axial mode (Group A) and conventional helical mode (Group B) CT groups. 64-slice CT was performed for CT-guided pulmonary biopsy with an 18-G coaxial cutting biopsy needle. The radiation dose, accuracy, image quality, and complication rate were measured. Results Ninety-seven patients were selected for the final phase of the study. There was no significant difference between the two groups for pulmonary nodule characteristics ( P > 0.05). The mean effective dose in group A (0.077 ± 0.010 mSv) was significantly reduced relative to group B (0.653 ± 0.177 mSv, P < 0.001). There was no significant difference in accuracy, image quality, and complication rate ( P > 0.050) between the two modes. Conclusion An ULD protocol for CT-guided lung nodule biopsy yields a reduction in the radiation dose without significant change in the accuracy, image quality, and complication rate relative to the conventional helical mode scan.

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Evaluation of Low-kVp Low-Volume Iodinated Contrast Protocol for Coronary CT Angiography Using Retrospective ECG Gating

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1741102 ◽

2022 ◽

Author(s):

Atul Kapoor ◽

Goldaa Mahajan ◽

Aprajita Kapoor

Keyword(s):

Radiation Dose ◽

Ct Angiography ◽

Ecg Gating ◽

Heart Rates ◽

Iodinated Contrast ◽

Significant Difference ◽

Group A ◽

Low Volume ◽

Group B ◽

Low Kvp

Abstract Objective The aim of this study was to evaluate the use of low peak kilovoltage (kVp) low-volume iodinated contrast protocol for performing coronary computed tomography (CT) angiography (CCTA) in patients using retrospective electrocardiogram (ECG) gating. Materials and Methods Hundred prospective patients undergoing CCTA were studied in two groups, A and B, using 70 kilovoltage (kV) and 120 kV protocols with half and standard intravenous volumes of injected iodinated contrast, respectively. All patients had heart rates less than 100 beats/min and body mass index (BMI) less than 31 kg/m2. Both the groups were evaluated for signal-to-noise (S/N) and contrast-to-noise (C/N) ratios along with radiation dose delivered in millisievert (mSv), and for image quality (IQ), on per patient and per segment basis. Results Patients with group A showed statistically reduced radiation dose of 1.86 mSv compared with 6.86 mSv in group B patients. Marked reduction in image noise with statistically improved S/N and C/N ratios in all coronary vessels was seen in group A. S/N ratios in group A were 20.25, 18.68, 19.04, 17.41, and 18.69 for aorta, left main, left anterior descending, right coronary, and left circumflex arteries while they were 13.34, 11.12, 10.96, 9.74, and 8.67 in group B patients. C/N ratios were also higher in all vessels in group A patients, that is, 19.48, 19.48, 19.04, 19.48, and 17.68, compared with group B patients, who had 12.43, 10.03, 9.23, 9.57, and 8.23 ratios (p < 0.0001). No significant difference in IQ per patient and per vessel was seen between both the groups. Discussion Retrospective ECG-gated low-kVp low-volume iodinated contrast protocol provides good diagnostic quality angiograms in patients with BMI up to 31 kg/m2 and with heart rates of less than 100 beats/min with three times reduced radiation dose. The reduced volume of contrast reduces the cost as well as the chance of contrast-induced nephropathy.

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Effect of different contrast administration protocols on contrast enhancement and image quality in CT scan

10.21203/rs.2.16817/v1 ◽

2019 ◽

Author(s):

Noor Ruhaya Ibrahim ◽

Noor Khairiah A. Karim ◽

Ibrahim Lutfi Shuaib ◽

Noor Diyana Osman ◽

Salwah Hashim ◽

...

Keyword(s):

Image Quality ◽

Contrast Enhancement ◽

Hounsfield Unit ◽

Fixed Time ◽

Qualitative Assessment ◽

Contrast Administration ◽

Contrast Volume ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Objective The aim of this study is to compare the effect of different contrast administration protocols practiced in Advanced Medical and Dental Institute, Universiti Sains Malaysia (Group A) and Hospital Pulau Pinang, Malaysia (Group B), on contrast enhancement and image quality in computed tomography scan. The two protocols were fixed time delay (FTD) with fixed volume (FV), and automatic bolus tracking (ABT) with weight based volume (WBV) contrast administration. Quantification of contrast enhancement’s magnitude in four different anatomical structures was measured in Hounsfield Unit (HU) and based on 5-point scale (1=poor, 5=excellent), the images were rated qualitatively.Results Mean enhancement values of all structures in Group B was higher compared to Group A (p = < 0.001). Mean of quality rating between the two groups was statistically not significant (p = 0.185). There was a weak correlation between HU values and administered contrast volume (r = 0.152). It can be concluded that FTD with FV protocol is non inferior to ABT with WBV protocol as it yielded higher degree of contrast enhancement. There was no significant difference between the two protocols in term of qualitative assessment although ABT with WBV protocol had higher mean grading in image quality.

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Image quality and radiation dose of CT venography with double dose reduction using model based iterative reconstruction: comparison with conventional CT venography using filtered back projection

Acta Radiologica ◽

10.1177/0284185117725780 ◽

2017 ◽

Vol 59 (5) ◽

pp. 546-552 ◽

Cited By ~ 2

Author(s):

Yeo-Jin Jeong ◽

Ki Seok Choo ◽

Kyung Jin Nam ◽

Ji Won Lee ◽

Jin You Kim ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Iterative Reconstruction ◽

Radiation Doses ◽

Back Projection ◽

Filtered Back Projection ◽

Ct Venography ◽

Group A ◽

Vascular Enhancement ◽

Group B

Background Computed tomography venography (CTV) at low kVp using model-based iterative reconstruction (MBIR) can enhance vascular enhancement with noise reduction. Purpose To evaluate image qualities and radiation doses of CTV at 80 kVp using MBIR and a small iodine contrast media (CM) dose and to compare these with those of CTV performed using a conventional protocol. Material and Methods Sixty-five patients (mean age = 58.1 ± 7.2 years) that underwent CTV for the evaluation of deep vein thrombosis (DVT) and varicose veins were enrolled in this study. Patients were divided into two groups: Group A (35 patients, 80 kVp, MBIR, automatic tube current modulation, CM = 270 mg/mL, 100 mL) and Group B (30 patients, 100 kVp, filtered back projection [FBP], 120 fixed mA, CM = 370 mg/mL, 120 mL). Objective and subjective image qualities of inferior vena cava (IVC), femoral vein (FV), and popliteal vein (PV) were assessed and radiation doses were recorded. Results Mean vascular enhancement in group A was significantly lower than in group B ( P < 0.01). Noise in group A was significantly lower than in group B except for PV and contrast-to-noise ratio were not significantly different in the two groups ( P > 0.05). In addition, radiation dose in group A was significantly lower than in group B ( P < 0.001). Subjective image quality comparison revealed group A was statistically inferior to group B except for subjective image noise. Conclusion CTV at 80 kVp using MBIR with small iodine contrast dose provided acceptable image quality at a lower radiation dose than conventional CTV using FBP.

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First experiences of a low-dose protocol for CT-guided musculoskeletal biopsies combining different radiation dose reduction techniques

Acta Radiologica ◽

10.1177/0284185119847676 ◽

2019 ◽

Vol 61 (1) ◽

pp. 28-36

Author(s):

Zlatan Alagic ◽

Haris Alagic ◽

Robert Bujila ◽

Subhash Srivastava ◽

Saif Jasim ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Success Rate ◽

Low Dose ◽

Quality Parameters ◽

Ct Guided ◽

Protocol Group ◽

Group A ◽

The Mean ◽

Group B

Background The use of computed tomography (CT) for image guidance during biopsies is a powerful approach. The method is, however, often associated with a significant level of radiation exposure to the patient and operator. Purpose To investigate if a low-dose protocol for CT-guided musculoskeletal (MSK) biopsies, including a combination of different radiation dose (RD) techniques, is feasible in a clinical setting. Material and Methods Fifty-seven patients underwent CT-guided fine-needle aspiration cytology (FNAC) utilizing the low-dose protocol (group A). A similar number of patients underwent CT-guided FNAC using the reference protocol (group B). Between-group comparisons comprised radiation dose, success rate, image quality parameters, and workflow. Results In group A, the mean total dose-length product (DLP) was 41.2 ± 2.9 mGy*cm, which was statistically significantly lower than of group B (257.4 ± 22.0 mGy*cm), corresponding to a mean dose reduction of 84% ( P<0.001). The mean CTDIvol for the control scans were 1.88 ± 0.09 mGy and 13.16 ± 0.40 mGy for groups A and B, respectively ( P < 0.001). The success rate in group A was 91.2% and 87.9% in group B ( P = 0.56). No negative effect on image-quality parameters, time of FNAC, and number of control scans were found. Conclusion We successfully developed a low-dose protocol for CT-guided MSK biopsies that maintains diagnostic accuracy and image quality at a fraction of the RD compared to the reference biopsy protocol at our clinic.

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The Value of Low-dose Prospective Dual-energy Computed Tomography with Iodine Mapping in the Diagnosis of Gastric Cancer

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666181023114051 ◽

2020 ◽

Vol 16 (4) ◽

pp. 433-437

Author(s):

Lifeng Wang ◽

Xingxing Jin ◽

Zhenguo Qiao ◽

Bin Xu ◽

Jiaqing Shen

Keyword(s):

Gastric Cancer ◽

Computed Tomography ◽

Image Quality ◽

Radiation Dose ◽

Low Dose ◽

Preoperative Staging ◽

Control Group ◽

Imaging Quality ◽

Group A ◽

Group B

Objectives: This study investigated the radiation dose and value of prospective dualenergy computed tomography (DECT) in the diagnosis of gastric cancer. Methods: Sixty patients scheduled for computed tomography (CT) for preoperative staging were divided into two groups. Thirty patients (Group A) underwent a single contrast-enhanced abdominal CT acquisition using a dual-source mode (100 kV/140 kV). Weighted average images of the two-kilovolt acquisitions and iodine maps were created. The remaining 30 patients underwent a standard CT scan (Group B). Two observers performed a blinded read of the images for gastric lesions, evaluating the image quality and recording effective dose. Results: During the blinded read, observers found 90% (27/30) of the cancers in both groups. The mean imaging quality scores were 2.1±0.9 for Group A, and 2.3±1.1 for Group B. The effective mean doses were 6.59±0.59 mSv and 25.86±0.44 mSv for Groups A and B, respectively. Compared with the control group (B), the imaging quality in the low-dose group decreased a little, but the radiation dose substantially decreased by 74.6%. Conclusion: The new DECT technique is valuable for examining gastric cancer patients. The dualkV scan mode can substantially reduce radiation dose while preserving good diagnostic image quality.

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Subjective and objective evaluation of image quality in biplane cerebral digital subtraction angiography following significant acquisition dose reduction in a clinical setting

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012296 ◽

2016 ◽

Vol 9 (3) ◽

pp. 297-301 ◽

Cited By ~ 11

Author(s):

Amir R Honarmand ◽

Ali Shaibani ◽

Tamila Pashaee ◽

Furqan H Syed ◽

Michael C Hurley ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Quality Assessment ◽

Image Quality Assessment ◽

Standard Dose ◽

Objective Assessment ◽

Objective Evaluation ◽

Side Branch ◽

Image Series ◽

Significant Difference

ObjectiveDifferent technical and procedural methods have been introduced to develop low radiation dose protocols in neurointerventional examinations. We investigated the feasibility of minimizing radiation exposure dose by simply decreasing the detector dose during cerebral DSA and evaluated the comparative level of image quality using both subjective and objective methods.MethodsIn a prospective study of patients undergoing diagnostic cerebral DSA, randomly selected vertebral arteries (VA) and/or internal carotid arteries and their contralateral equivalent arteries were injected. Detector dose of 3.6 and 1.2 μGy/frame were selected to acquire standard dose (SD) and low dose (LD) images, respectively. Subjective image quality assessment was performed by two neurointerventionalists using a 5 point scale. For objective image quality evaluation, circle of Willis vessels were categorized into conducting, primary, secondary, and side branch vessels. Two blinded observers performed arterial diameter measurements in each category. Only image series obtained from VA injections opacifying the identical posterior intracranial circulation were utilized for objective assessment.ResultsNo significant difference between SD and LD images was observed in subjective and objective image quality assessment in 22 image series obtained from 10 patients. Mean reference air kerma and kerma area product were significantly reduced by 61.28% and 61.24% in the LD protocol, respectively.ConclusionsOur study highlights the necessity for reconsidering radiation dose protocols in neurointerventional procedures, especially at the level of baseline factory settings.

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Comparison of two whole-body computer tomography protocols for polytrauma patients

British Journal of Surgery ◽

10.1093/bjs/znab202.049 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

N van Veelen ◽

S Studer ◽

B van de Wall ◽

R Babst ◽

B -C Link ◽

...

Keyword(s):

Radiation Dose ◽

Upper Extremities ◽

Whole Body ◽

Trauma Patients ◽

Two Phase ◽

Whole Body Ct ◽

Additional Imaging ◽

Group A ◽

Group B ◽

Extremity Injuries

Abstract Objective The use of whole-body computed tomography (CT) is an established standard primary diagnostic method in the work up of polytrauma patients. The protocols used for such CTs however vary between trauma centers. In our Level 1 trauma Centre the protocol was changed from a three phase to a two phase protocol with different positioning of the patient. The primary aim of this study was to compare the estimated radiation dose and scan duration of the two protocols. The secondary aim was to evaluate whether the revision of the CT protocol led to a reduction of required additional imaging of the upper extremities. Methods For this retrospective, cross-sectional study two groups of consecutive trauma patients, which were treated in a level 1 trauma center in Switzerland and received a whole-body CT were analyzed. Group A consisted of patients, who presented between January and August 2016. These patients received a three-phased CT in which a repositioning of the arms from the side of the torso to above the head between phases two and three was needed. Group B consisted of those, who presented between January and July 2017. These patients received a CT according to a revised protocol, which was performed in two phases with the arms positioned ventral on a pillow to the torso throughout the entire CT. Scan duration, estimated radiation dose, number of upper extremity injuries, number of addition imaging (xray and CT) of the upper extremities within 24 hours of initial CT. Results A total of 182 patients were included in group A and 218 in group B. Baseline characteristics didn't differ, except for there being more males in group B (p 0.006). The estimated radiation dose was lower (15.0 mSv vs 22.9 mSv, p < 0.001) and the scan duration shorter (4 vs 7 minutes, p < 0.001) in group B. No difference could be shown in the number of upper extremity injuries detected. Further, the number of additional images of the upper extremities needed within 24 hours of the initial CT did not differ between the groups. Conclusion Both the estimated radiation dose and the scan duration of a whole-body CT scan in trauma patients can be reduced when a two phase protocol in which the arms are positioned on a pillow ventral to the torso is used instead of a three phase protocol with repositioning of the arms. The amount of additional imaging of the upper limb could not be reduced by having the arms visible on the scan.

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Amifostine Can Reduce Oral Mucositis after High-Dose Melphalan Conditioning in Patients with Multiple Myeloma: A Retrospective Study.

Blood ◽

10.1182/blood.v104.11.5022.5022 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5022-5022

Author(s):

Antoine Italiano ◽

Emmanuel Chamorey ◽

Cyril Foa ◽

Frédéric Peyrade ◽

Josiane Otto ◽

...

Keyword(s):

Multiple Myeloma ◽

Oral Mucositis ◽

Anticancer Agents ◽

Systemic Infection ◽

Control Group ◽

High Dose ◽

Significant Difference ◽

Group A ◽

Group B ◽

High Dose Melphalan

Abstract Autologous peripheral blood stem cell (PBSC)- supported high-dose melphalan (HDM) is now considered standard therapy in the treatment of multiple myeloma, at least for patients under 65 years. Oral mucositis is a frequent non-hematological complication which causes severe pain, interferes with patient nutrition and can lead to systemic infection. Amifostine (WR-2721; Ethyol), a phosphoaminothiol, is a prodrug that protects a broad range of normal tissues from the cytotoxic damage induced by anticancer agents. We retrospectively compared two groups of patients with stage II/III previously untreated multiple myeloma who received between April 96 and May 2004 an induction chemotherapy with 3 or 4 cycles of VAD (vincristine, adriamycin, dexamethasone) followed by HDM (200 mg/m²) and autologous PBSC transplantation. These two groups either received (group A, n = 10 ) or did not receive (group B, n= 32) amifostine (740 mg/m²) before HDM. The occurrence of grade 3/4 oral mucositis was significantly decreased in group A in comparison to group B (10% versus 53%, p =0.023) with no difference for the time to mucosal recovery. Supportive care differed between the two groups: only 2 patients (20%) needed opioid treatment in group A versus 22 patients (69%) in group B ( p=0.005) and 1 patient (10%) required parenteral nutrition in group A compared to 16 patients (50%) in group B (p= 0.015). The occurrence of severe infectious complications did not differ between the two groups (0% versus 12,5%, p= 0.56). Amifostine did not affect haematological recovery, the median time to granulocyte recovery to > 500/μl was similar in the two groups (8,4 days versus 9,9 days, p=0.22). Moreover, there is no statistically significant difference between the amifostine and control group for the disease response. The tolerability of amifostine was excellent and no adverse effects were reported. This study suggest that amifostine can reduce mucosal damage associated with high dose melphalan-based therapy, reducing, as a consequence, the necessity of nutrition and analgesic support, without compromising therapeutic benefit. Obviously, these interesting results have to be confirmed by larger randomised trials.

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