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Background <p>Pulmonary embolism (PE) is a potentially life-threatening condition that requires prompt and accurate diagnosis. Computed tomography pulmonary angiography (CTPA) is the reference standard for PE detection; however, it carries risks of radiation exposure and contrast-induced nephropathy, particularly in younger patients and those requiring repeated scans. This study aimed to evaluate whether a combined low-dose, low-contrast CTPA protocol could achieve diagnostic image quality comparable to the standard protocol.</p> Methods <p>In this prospective comparative study, 44 patients with clinically suspected PE were enrolled. The control group (<i>n</i> = 22) underwent standard CTPA (120&#xa0;kVp, 90&#xa0;mL contrast), while the experimental group (<i>n</i> = 22) received an optimized protocol (100&#xa0;kVp, 70&#xa0;mL contrast, automatic tube current modulation, and 50% ASiR-V iterative reconstruction). Radiation dose parameters and contrast usage were recorded. Subjective image quality was graded by two blinded radiologists using a 5-point Likert scale, and quantitative metrics Hounsfield units (HU), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were compared between groups.</p> Results <p>The optimized protocol achieved a 39.6% reduction in effective dose (2.65 ± 0.54&#xa0;mSv vs. 4.39 ± 0.62&#xa0;mSv; <i>p</i> ≤ 0.001) and a 22.2% reduction in contrast volume (70&#xa0;mL vs. 90&#xa0;mL). Subjective image quality was comparable between groups (<i>p</i> = 0.606). Quantitative analysis revealed no significant differences in SNR, CNR, or vascular attenuation (<i>p</i> &gt; 0.05). Interobserver agreement was excellent (ICC = 0.91).</p> Conclusions <p>A low-dose, low-contrast CTPA protocol can substantially reduce patient radiation and contrast exposure while maintaining diagnostic image quality. This approach supports the ALARA principle and may serve as a practical, cost-effective standard for routine PE imaging, especially in resource-limited or high-risk patient settings.</p>

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Optimizing CT pulmonary angiography: comparison of radiation dose, contrast volume, and image quality between standard and low-dose protocols

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月13日

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  • Prema H,
  • Mahesh M,
  • Sampritha U,
  • Kevin Aranha

摘要

Background

Pulmonary embolism (PE) is a potentially life-threatening condition that requires prompt and accurate diagnosis. Computed tomography pulmonary angiography (CTPA) is the reference standard for PE detection; however, it carries risks of radiation exposure and contrast-induced nephropathy, particularly in younger patients and those requiring repeated scans. This study aimed to evaluate whether a combined low-dose, low-contrast CTPA protocol could achieve diagnostic image quality comparable to the standard protocol.

Methods

In this prospective comparative study, 44 patients with clinically suspected PE were enrolled. The control group (n = 22) underwent standard CTPA (120 kVp, 90 mL contrast), while the experimental group (n = 22) received an optimized protocol (100 kVp, 70 mL contrast, automatic tube current modulation, and 50% ASiR-V iterative reconstruction). Radiation dose parameters and contrast usage were recorded. Subjective image quality was graded by two blinded radiologists using a 5-point Likert scale, and quantitative metrics Hounsfield units (HU), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were compared between groups.

Results

The optimized protocol achieved a 39.6% reduction in effective dose (2.65 ± 0.54 mSv vs. 4.39 ± 0.62 mSv; p ≤ 0.001) and a 22.2% reduction in contrast volume (70 mL vs. 90 mL). Subjective image quality was comparable between groups (p = 0.606). Quantitative analysis revealed no significant differences in SNR, CNR, or vascular attenuation (p > 0.05). Interobserver agreement was excellent (ICC = 0.91).

Conclusions

A low-dose, low-contrast CTPA protocol can substantially reduce patient radiation and contrast exposure while maintaining diagnostic image quality. This approach supports the ALARA principle and may serve as a practical, cost-effective standard for routine PE imaging, especially in resource-limited or high-risk patient settings.