Survey of CT radiation doses and iodinated contrast medium administration: an international multicentric study

期刊论文
发表日期：

2024年8月24日

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Lina Karout,
Parisa Kaviani,
Giridhar Dasegowda,
Emiliano Garza-Frias,
Roshan Fahimi,
Mohammad Rawashdeh,
Charbel Saade,
Subba R. Digumarthy,
Alain S. Abi-Ghanem,
Seyedehelaheh Hosseini,
Luca Saba,
Shadi Ebrahimian,
Tanisha Pragnesh Vora,
Huda El Mais,
Yara Jabbour,
Antar Aly,
Lena Naffaa,
Mohamad B. Kassab,
Mahmoud Nassar,
Monica Bernardo,
Boluwatife Taiwo Oyetayo,
Abdel-Baset Bani Yaseen,
Zaina Mohammad Owda,
Jesus Alejandro Gabutti,
Keffi Mubarak Musa,
Ramesh Shrestha,
Heba Raid Hussein Al Qudah,
Mehran Ilaghi,
Mahsa Masjedi Esfahani,
Mohanad Ahmed Ghonim,
Mohammad Zeyad Hailat,
Mohamed K. Ibrahim,
Roshni Anand,
Sudhan Rackimuthu,
Aayush Shrivastava,
Arastou Shapouran,
Shamim Shafieyoon,
Linda Chamma,
Ali Ahmed Awas,
Viraj Shirish Panchal,
Vidhi Rajat Parikh,
Bernardo Corrêa de Almeida Teixeira,
Reza Saboori Amleshi,
Omar A. Safarini,
Ronaldo Albé Lucena,
Davi Fernandes de Castro,
Mooath Omar AL-Jarrah,
Ramin Shahidi,
Mehdi Khazaei,
Rahul Pratap Kotian,
Disha R. Kotian,
Nadeem Abdul Naser AlShunaigat,
Maryam A. Aziz Alkuwari,
Dana Alkhulaifat,
Abidin Kilinçer,
Abdalaziz Fahd Thawabah,
Anisa Chowdhary,
Gianne M. Goedert,
Leila Abs,
Francisco Edgardo Puente Gallegos,
Nabil Nassar,
Doris Segota,
Vincent Rizzo,
Mira Nabil Al Jabi,
Riccardo Cau,
Sravani Gampala,
Shreya Arvind,
Antônio Márcio Alves Pinheiro,
Hermin Mokrian,
Kareem Ahmed Abdelaziz Sabry,
Ala’a Abu Zaineh,
Ali Khaled Chaaban,
Anthony Maroun Nasr,
Larissa Marciano,
Felipe Moura Kiipper,
Jessica Villa Real,
Adrián Antonio Negreros-Osuna,
Monica Catalina Huerta-Sanchez,
Juan Alberto Garay Mora,
Susan Yohannan,
Omari Christie,
Mohamed Ahmed Ghonim,
Seyed Amir Ahmad Safavi-Naini,
Ashwin Deshmukh,
Shafeeque T. Maliyekkal,
Vibhor Agrawal,
Manoj Kumar,
Leen Tarawneh,
Kanan Panchal,
Anto J. Richie,
Vijay Narsidas Vaidya,
Adesina Mubarak Taiye,
Sohrab Koolivand,
Azin Shayganfar,
Hamidreza Talari,
Antonio Moscatelli,
Vesna Gershan,
Mannudeep K. Kalra

摘要

Objective

To assess the relationship between intravenous iodinated contrast media (ICM) administration usage and radiation doses for contrast-enhanced (CE) CT of head, chest, and abdomen–pelvis (AP) in international, multicenter settings.

Methods

Our international (n = 16 countries), multicenter (n = 43 sites), and cross-sectional (ConRad) study had two parts. Part 1: Redcap survey with questions on information related to CT and ICM manufacturer/brand and respective protocols. Part 2: Information on 3,258 patients (18–96 years; M:F 1654:1604) who underwent CECT for a routine head (n = 456), chest (n = 528), AP (n = 599), head CT angiography (n = 539), pulmonary embolism (n = 599), and liver CT examinations (n = 537) at 43 sites across five continents. The following information was recorded: hospital name, patient age, gender, body mass index [BMI], clinical indications, scan parameters (number of scan phases, kV), IV-contrast information (concentration, volume, flow rate, and delay), and dose indices (CTDIvol and DLP).

Results

Most routine chest (58.4%) and AP (68.7%) CECT exams were performed with 2–4 scan phases with fixed scan delay (chest 71.4%; AP 79.8%, liver CECT 50.7%) following ICM administration. Most sites did not change kV across different patients and scan phases; most CECT protocols were performed at 120–140 kV (83%, 1979/2685). There were no significant differences between radiation doses for non-contrast (CTDIvol 24 [16–30] mGy; DLP 633 [414–702] mGy·cm) and post-contrast phases (22 [19–27] mGy; 648 [392–694] mGy·cm) (p = 0.142). Sites that used bolus tracking for chest and AP CECT had lower CTDIvol than sites with fixed scan delays (p < 0.001). There was no correlation between BMI and CTDIvol (r² ≤ − 0.1 to 0.1, p = 0.931).

Conclusion

Our study demonstrates up to ten-fold variability in ICM injection protocols and radiation doses across different CT protocols. The study emphasizes the need for optimizing CT scanning and contrast protocols to reduce unnecessary contrast and radiation exposure to patients.

Clinical relevance statement

The wide variability and lack of standardization of ICM media and radiation doses in CT protocols suggest the need for education and optimization of contrast usage and scan factors for optimizing image quality in CECT.

Key Points

There is a lack of patient-centric CT protocol optimization taking into consideration mainly patients’ size.

There is a lack of correlation between ICM volume and CT radiation dose across CT protocol.

A ten-fold variation in iodine-load for the same CT protocol in sites suggests a lack of standardization.