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      Single-source chest-abdomen-pelvis cancer staging on a third generation dual-source CT system: comparison of automated tube potential selection to second generation dual-source CT

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          Abstract

          Background

          Evaluation of latest generation automated attenuation-based tube potential selection (ATPS) impact on image quality and radiation dose in contrast-enhanced chest-abdomen-pelvis computed tomography examinations for gynaecologic cancer staging.

          Methods

          This IRB approved single-centre, observer-blinded retrospective study with a waiver for informed consent included a total of 100 patients with contrast-enhanced chest-abdomen-pelvis CT for gynaecologic cancer staging. All patients were examined with activated ATPS for adaption of tube voltage to body habitus. 50 patients were scanned on a third-generation dual-source CT (DSCT), and another 50 patients on a second-generation DSCT. Predefined image quality setting remained stable between both groups at 120 kV and a current of 210 Reference mAs.

          Subjective image quality assessment was performed by two blinded readers independently. Attenuation and image noise were measured in several anatomic structures. Signal-to-noise ratio (SNR) was calculated. For the evaluation of radiation exposure, CT dose index (CTDI vol) values were compared.

          Results

          Diagnostic image quality was obtained in all patients. The median CTDI vol (6.1 mGy, range 3.9–22 mGy) was 40 % lower when using the algorithm compared with the previous ATCM protocol (median 10.2 mGy · cm, range 5.8–22.8 mGy). A reduction in potential to 90 kV occurred in 19 cases, a reduction to 100 kV in 23 patients and a reduction to 110 kV in 3 patients of our experimental cohort. These patients received significantly lower radiation exposure compared to the former used protocol.

          Conclusion

          Latest generation automated ATPS on third-generation DSCT provides good diagnostic image quality in chest-abdomen-pelvis CT while average radiation dose is reduced by 40 % compared to former ATPS protocol on second-generation DSCT.

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          Most cited references18

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          CT dose reduction and dose management tools: overview of available options.

          Cynthia McCollough, Michael Bruesewitz, James Kofler (2015)
          In the past decade, the tremendous advances in computed tomography (CT) technology and applications have increased the clinical utilization of CT, creating concerns about individual and population doses of ionizing radiation. Scanner manufacturers have subsequently implemented several options to appropriately manage or reduce the radiation dose from CT. Modulation of the x-ray tube current during scanning is one effective method of managing the dose. However, the distinctions between the various tube current modulation products are not clear from the product names or descriptions. Depending on the scanner model, the tube current may be modulated according to patient attenuation or a sinusoidal-type function. The modulation may be fully preprogrammed, implemented in near-real time by using a feedback mechanism, or achieved with both preprogramming and a feedback loop. The dose modulation may occur angularly around the patient, along the long axis of the patient, or both. Finally, the system may allow use of one of several algorithms to automatically adjust the current to achieve the desired image quality. Modulation both angularly around the patient and along the z-axis is optimal, but the tube current must be appropriately adapted to patient size for diagnostic image quality to be achieved. (c) RSNA, 2006.
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            Computed tomography--old ideas and new technology.

            F. Edward Boas, Dominik Fleischmann (2011)
            Several recently introduced 'new' techniques in computed tomography--iterative reconstruction, gated cardiac CT, multiple-source, and dual-energy CT--actually date back to the early days of CT. We review the historic origins and evolution of these techniques, which may provide some insight into the latest innovations in commercial CT systems.
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              Radiation risk from CT: implications for cancer screening.

              J. Albert (2013)
              The cancer risks associated with patient exposure to radiation from medical imaging have become a major topic of debate. The higher doses necessary for technologies such as CT and the increasing utilization of these technologies further increase medical radiation exposure to the population. Furthermore, the use of CT for population-based cancer screening continues to be explored for common malignancies such as lung cancer and colorectal cancer. Given the known carcinogenic effects of ionizing radiation, this warrants evaluation of the balance between the benefit of early cancer detection and the risk of screening-induced malignancy. This report provides a brief review of the process of radiation carcino-genesis and the literature evaluating the risk of malignancy from CT, with a focus on the risks and benefits of CT for cancer screening. The available data suggest a small but real risk of radiation-induced malignancy from CT that could become significant at the population level with widespread use of CT-based screening. However, a growing body of literature suggests that the benefits of CT screening for lung cancer in high-risk patients and CT colonography for colorectal cancer may significantly outweigh the radiation risk. Future studies evaluating the benefits of CT screening should continue to consider potential radiation risks.
              Article 0 comments Cited 37 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Clara Park: deeplee2@aol.com
                Tatjana Gruber-Rouh: tatjana.gruber-rouh@kgu.de
                Doris Leithner: doris.leithner@gmail.com
                Amelie Zierden: amelie_zierden@hotmail.de
                Mortiz H. Albrecht: moritzalbrecht@gmx.net
                Julian L. Wichmann: docwichmann@gmail.com
                Boris Bodelle: bbodelle@googlemail.com
                Mohamed Elsabaie: mohd802008@yahoo.com
                Jan-Erik Scholtz: janerikscholtz@gmail.com
                Moritz Kaup: kaupmoritz@gmail.com
                Thomas J. Vogl: T.Vogl@em.uni-frankfurt.de
                Martin Beeres:
                ORCID: http://orcid.org/0000-0001-5625-7196
                +49 (0)69-6301-7277 , beeres@gmx.net
                Journal
                Journal ID (nlm-ta): Cancer Imaging
                Journal ID (iso-abbrev): Cancer Imaging
                Title: Cancer Imaging
                Publisher: BioMed Central (London )
                ISSN (Print): 1740-5025
                ISSN (Electronic): 1470-7330
                Publication date (Electronic): 10 October 2016
                Publication date PMC-release: 10 October 2016
                Publication date Collection: 2016
                Volume: 16
                Electronic Location Identifier: 33
                Affiliations
                Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
                Author information
                http://orcid.org/0000-0001-5625-7196
                Article
                Publisher ID: 93
                DOI: 10.1186/s40644-016-0093-1
                PMC ID: 5057380
                PubMed ID: 27724954
                SO-VID: e531e4f5-8c32-429c-a177-d5cc84c95ae1
                Copyright © © The Author(s). 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 9 August 2016
                Date accepted : 3 October 2016
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2016

                Keywords: multidetector computed tomography,cancer,cancer staging,neoplasms,automated tube potential selection,dual-source ct
                Data availability:
                Keywords: multidetector computed tomography, cancer, cancer staging, neoplasms, automated tube potential selection, dual-source ct

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