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01-10-2013 | Chest

Clinical evaluation of automatic tube voltage selection in chest CT angiography

Authors: Tilo Niemann, Simon Henry, Jean-Baptiste Faivre, Kanna Yasunaga, Sofiane Bendaoud, Ariana Simeone, Jacques Remy, Alain Duhamel, Thomas Flohr, Martine Remy-Jardin

Published in: European Radiology | Issue 10/2013

Abstract

Objective

To evaluate the clinical impact of automatic tube voltage selection on chest CT angiography (CTA).

Methods

Ninety-three patients were prospectively evaluated with a CT protocol aimed at comparing two successive CTAs acquired under similar technical conditions except for the kV selection: (1) the initial CTA was systematically obtained at 120 kVp and 90 ref mAs; (2) the follow-up CTA was obtained with an automatic selection of the kilovoltage (Care KV; Siemens Healthcare) for optimised CTA.

Results

At follow-up, 90 patients (97 %) underwent CTA with reduced tube voltage, 100 kV (n = 26; 28 %) and 80 kV (n = 64; 69 %), resulting in a significant dose-length-product reduction (follow-up: 87.27; initial: 141.88 mGy.cm; P < 0.0001; mean dose reduction: 38.5 %) and a significant increase in the CNR at follow-up (follow-up: 11.5 ± 3.5 HU; initial: 10.9 ± 3.7 HU; P = 0.03). The increase in objective image noise at follow-up (follow-up: 23.2 ± 6.7 HU vs. 17.8 ± 5.1 HU; P < 0.0001) did not alter the diagnostic value of images.

Conclusion

Automatic tube voltage selection reduced the radiation dose delivered during chest CT angiograms by 38.5 % while improving the contrast-to-noise ratio of the examinations.

Key Points

• As low a dose as possible must be used for CT angiography.

• Automatic tube voltage selection permits reduced patient exposure.

• Lowering the kVp enables increased intravascular attenuation.

• Automatic tube voltage selection does not compromise the overall image quality.

Mayo JR, Aldrich J, Muller NL (2003) Radiation exposure at chest CT: a statement from the Fleischner Society. Radiology 228:15–21PubMedCrossRef

Kubo T, Lin PJP, Stiller W, Takahashi M, Kauczor HU, Ohno Y, Hatabu H (2008) Radiation dose reduction in chest CT: a review. AJR Am J Roentgenol 190:335–343PubMedCrossRef

Christner JA, Zavaletta VA, Eusemann CD, Walz-Flannigan AI, McCollough CH (2010) Dose reduction in helical CT: dynamically adjustable z-axis X-ray beam collimation. AJR Am J Roentgenol 194:W49–W55PubMedCrossRef

Sigal-Cinqualbre AB, Hennequin R, Abada HT, Chen X, Paul JF (2004) Low-kilovoltage multi-detector row chest CT in adults: feasibility and effect on image quality and iodine dose. Radiology 231:169–174PubMedCrossRef

Schueller-Weidekamm C, Schaefer-Prokop CM, Weber M, Herold CJ, Prokop M (2006) CT angiography of pulmonary arteries to detect pulmonary embolism: improvement of vascular enhancement with low kilovoltage settings. Radiology 241:899–907PubMedCrossRef

Heyer CM, Mohr PS, Lemburg SP, Peters SA, Nicolas V (2007) Image quality and radiation exposure at pulmonary CT angiography with 100- or 120-kVp protocol: prospective randomized study. Radiology 245:577–583PubMedCrossRef

Kim MJ, Park CH, Choi SJ, Hwang KH, Kim HS (2008) Multidetector computed tomography chest examinations with low-kilovoltage protocols in adults: effect on image quality and radiation dose. J Comput Assist Tomogr 3:416–421

Matsuoka S, Hunsaker AR, Gill RR, Oliva IB, Trotman-Dickenson B, Jacobson FL, Hatabu H (2009) Vascular enhancement and image quality of MDCT pulmonary angiography in 400 cases: comparison of standard and low kilovoltage settings. AJR Am J Roentgenol 192:1651–1656PubMedCrossRef

Szucs-Farkas Z, Kurmann L, Strautz T, Patak MA, Vock P, Schindera ST (2008) Patient exposure and image quality of low-dose pulmonary computed tomography angiography: comparison of 100- and 80-kVp protocols. Invest Radiol 43:871–876PubMedCrossRef

10.

Szucs-Farkas Z, Strautz T, Patak MA, Kurmann L, Vock P, Schindera ST (2009) Is body weight the most appropriate criterion to select patients eligible for low-dose pulmonary CT angiography? Analysis of objective and subjective image quality at 80 kVp in 100 patients. Eur Radiol 19:1914–1922PubMedCrossRef

11.

Gorgos A, Remy-Jardin M, Duhamel A, Faivre JB, Tacelli N, Delannoy V, Remy J (2009) Evaluation of peripheral pulmonary arteries at 80 kV and 140 kV: dual-energy computed tomography assessment in 51 patients. J Comput Assist Tomogr 33:981–986PubMedCrossRef

12.

Kalender WA, Deak P, Kellermeier M, van Straten M, Vollmar SV (2009) Application- and patient size-dependent optimization of x-ray spectra for CT. Med Phys 36:993–1007PubMedCrossRef

13.

Yu L, Li H, Fletcher JG, McCollough CH (2010) Automatic selection of tube potential for radiation dose reduction in CT: a general strategy. Med Phys 37:234–243PubMedCrossRef

14.

Winklehner A, Goetti R, Baumueller S, Karlo C, Schmidt B, Raupach R et al (2011) Automated attenuation-based tube potential selection for thoracoabdominal computed tomography angiography: improved dose effectiveness. Invest Radiol 46:767–773PubMedCrossRef

15.

Gnannt R, Winklehner A, Eberli D, Knuth A, Frauenfelder T, Alkhadi H (2012) Automated tube potential selection for standard chest and abdominal CT in follow-up patients with testicular cancer: comparison with fixed tube potential. Eur Radiol 22:1937–1945PubMedCrossRef

16.

Bongartz G, Golding SJ, Jurik AG, Leonardi M, van Meerten EP, Rodriguez R et al. (2004) European Guidelines for Multislice Computed Tomography. Funded by the European Commission. Contract number FIGM-CT2000-20078-CT-TIP. March 2004. Available from: www.msct.eu

17.

Pontana F, Duhamel A, Pagniez J, Flohr T, Faivre J-B, Hachulla A-L et al (2011) Chest computed tomography using iterative reconstruction vs. filtered back projection (Part 2): image quality of low-dose CT examinations in 80 patients. Eur Radiol 21:636–643PubMedCrossRef

18.

Committee for Proprietary Medicinal Products (CPMP) – European Agency for the Evaluation of Medicinal Products (EMEA) (2001) Points to consider on switching between superiority and non-inferiority. Br J Clin Pharmacol 52:223–228

19.

Fleiss JL (1986) Design and analysis of clinical experiments. Wiley, New York, pp 1–32

20.

Yuan R, Shuman WP, Earls JP, Hague CJ, Mumtaz HA, Scott-Moncrieff A, Ellis JD, Mayo JR, Leipsic JA (2012) Reduced iodine load at CT pulmonary angiography with dual-energy monochromatic imaging: comparison with standard CT pulmonary angiography – A prospective randomized trial. Radiology 262:290–297PubMedCrossRef

21.

Pontana F, Pagniez J, Flohr T, Faivre JB, Duhamel A, Remy J, Remy-Jardin M (2011) Chest computed tomography using iterative reconstruction vs filtered back projection (part 1): Evaluation of image noise reduction in 32 patients. Eur Radiol 21:627–635PubMedCrossRef

22.

Prakash P, Kalra MK, Digumarthy SR, Hsieh J, Pien H, Singh S, Gilman MD, Shepard JAO (2010) Radiation dose reduction with chest computed tomography using adaptive statistical iterative reconstruction technique: initial experience. J Comput Assist Tomogr 34:40–45PubMedCrossRef

Title: Clinical evaluation of automatic tube voltage selection in chest CT angiography
Authors: Tilo Niemann
Simon Henry
Jean-Baptiste Faivre
Kanna Yasunaga
Sofiane Bendaoud
Ariana Simeone
Jacques Remy
Alain Duhamel
Thomas Flohr
Martine Remy-Jardin
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 10/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-013-2887-x

At a glance: The STEP trials

Springer Medicine

Clinical evaluation of automatic tube voltage selection in chest CT angiography

Abstract

Objective

Methods

Results

Conclusion

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Key Points

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