TY - JOUR
T1 - Computed Tomography Pulmonary Angiography during Pregnancy
T2 - Radiation Dose of Commonly Used Protocols and the Effect of Scan Length Optimization
AU - Hendriks, Babs M. F.
AU - Schnerr, Roald S.
AU - Milanese, Gianluca
AU - Jeukens, Cecile R. L. P. N.
AU - Niesen, Sandra
AU - Eijsvoogel, Nienke G.
AU - Wildberger, Joachim E.
AU - Das, Marco
N1 - Funding Information:
JEW reports institutional research grants from Siemens, Philips, Bayer, AGFA and personal fees from Siemens, Bayer, outside the submitted work. MD reports institutional research grants (MUMC) from Siemens, Philips, Bayer, and personal fees from Siemens, Bayer, outside the submitted work.
Publisher Copyright:
© 2019 The Korean Society of Radiology.
PY - 2019/2
Y1 - 2019/2
N2 - Objective: To evaluate the radiation dose for pregnant women and fetuses undergoing commonly used computed tomography of the pulmonary arteries (CTPA) scan protocols and subsequently evaluate the simulated effect of an optimized scan length.Materials and Methods: A total of 120 CTPA datasets were acquired using four distinctive scan protocols, with 30 patients per protocol. These datasets were mapped to Cristy phantoms in order to simulate pregnancy and to assess the effect of an effective radiation dose (in mSv) in the first, second, or third trimester of pregnancy, including a simulation of fetal dose in second and third trimesters. The investigated scan protocols involved a 64-slice helical scan at 120 kVp, a high-pitch dual source acquisition at 100 kVp, a dual-energy acquisition at 80/140 kVp, and an automated-kV-selection, high pitch helical scan at a reference kV of 100 kV(ref). The effective dose for women and fetuses was simulated before and after scan length adaptation. The original images were interpreted before and after scan length adaptations to evaluate potentially missed diagnoses.Results: Large inter-scanner and inter-protocol variations were found; application of the latest technology decreased the dose for non-pregnant women by 69% (7.0-2.2 mSv). Individual scan length optimization proved safe and effective, decreasing the fetal dose by 76-83%. Nineteen (16%) cases of pulmonary embolism were diagnosed and, after scan length optimization, none were missed.Conclusion: Careful CTPA scan protocol selection and additional optimization of scan length may result in significant radiation dose reduction for a pregnant patient and her fetus, whilst maintaining diagnostic confidence.
AB - Objective: To evaluate the radiation dose for pregnant women and fetuses undergoing commonly used computed tomography of the pulmonary arteries (CTPA) scan protocols and subsequently evaluate the simulated effect of an optimized scan length.Materials and Methods: A total of 120 CTPA datasets were acquired using four distinctive scan protocols, with 30 patients per protocol. These datasets were mapped to Cristy phantoms in order to simulate pregnancy and to assess the effect of an effective radiation dose (in mSv) in the first, second, or third trimester of pregnancy, including a simulation of fetal dose in second and third trimesters. The investigated scan protocols involved a 64-slice helical scan at 120 kVp, a high-pitch dual source acquisition at 100 kVp, a dual-energy acquisition at 80/140 kVp, and an automated-kV-selection, high pitch helical scan at a reference kV of 100 kV(ref). The effective dose for women and fetuses was simulated before and after scan length adaptation. The original images were interpreted before and after scan length adaptations to evaluate potentially missed diagnoses.Results: Large inter-scanner and inter-protocol variations were found; application of the latest technology decreased the dose for non-pregnant women by 69% (7.0-2.2 mSv). Individual scan length optimization proved safe and effective, decreasing the fetal dose by 76-83%. Nineteen (16%) cases of pulmonary embolism were diagnosed and, after scan length optimization, none were missed.Conclusion: Careful CTPA scan protocol selection and additional optimization of scan length may result in significant radiation dose reduction for a pregnant patient and her fetus, whilst maintaining diagnostic confidence.
KW - Computed tomography
KW - Pulmonary angiography
KW - Radiation dose
KW - Pregnancy
KW - Fetus
KW - Pulmonary embolism
KW - CT ANGIOGRAPHY
KW - ITERATIVE RECONSTRUCTION
KW - VENOUS THROMBOEMBOLISM
KW - EMBOLISM
KW - POSTPARTUM
KW - MANAGEMENT
KW - DIAGNOSIS
KW - THROMBOSIS
KW - REDUCTION
KW - SOCIETY
U2 - 10.3348/kjr.2017.0779
DO - 10.3348/kjr.2017.0779
M3 - Article
C2 - 30672171
SN - 1229-6929
VL - 20
SP - 313
EP - 322
JO - Korean Journal of Radiology
JF - Korean Journal of Radiology
IS - 2
ER -