Computed tomography pulmonary angiography in around-the-clock clinical care with individualised scan protocols: a 5-year observational study on incidence and causes of repeat scanning - Report - MDSpire
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Computed tomography pulmonary angiography in around-the-clock clinical care with individualised scan protocols: a 5-year observational study on incidence and causes of repeat scanning
Five-Year Evaluation of Repeat CTPA Scans Using Individualized Protocols
Overview
This five-year observational study assessed repeat computed tomography pulmonary angiography (CTPA) scans at an academic hospital using individualized contrast media and scanning protocols. The study found that optimized protocols maintained diagnostic image quality while minimizing repeat scans, contrast media volume, and radiation exposure.
Background
CTPA is the preferred diagnostic tool for pulmonary embolism due to its high sensitivity and specificity. However, challenges such as precise contrast timing and patient-related factors often lead to non-diagnostic scans and repeat imaging, increasing radiation and contrast exposure. Advances in scanning technology and individualized contrast administration protocols aim to optimize image quality and reduce repeat rates. This study evaluates the real-world clinical performance of these protocols over a prolonged period.
Data Highlights
Parameter
Details
Study Period
January 1, 2017 – January 1, 2022
Setting
Maastricht University Medical Centre+
CT Scanners Used
Siemens SOMATOM Definition Flash (2nd gen DSCT), SOMATOM Force (3rd gen DSCT), AS 64 (64-slice MDCT)
Contrast Media
Iopromide 300 or 370 mg iodine/mL
Individualization
Contrast volume and flow rate adjusted by bodyweight and tube voltage (10-to-10 rule)
Scan Parameters
Automated tube current modulation, automated tube voltage selection (70–150 kV options), pitch 1.3–1.8, slice thickness 0.7–1 mm
Key Findings
Individualized contrast media injection protocols based on bodyweight and tube voltage effectively maintained diagnostic pulmonary artery attenuation.
Repeat CTPA scans due to non-diagnostic initial scans were minimized despite the narrow timing window required for optimal contrast enhancement.
Use of advanced CT scanners with automated tube voltage and current modulation contributed to optimized radiation dose without compromising image quality.
The 10-to-10 rule allowed for reduction of contrast media volume by approximately 10% per 10 kV decrease in tube voltage while preserving image quality.
Single-source acquisition on the SOMATOM Force scanner provided comparable volume coverage times to dual-source modes, facilitating uniform protocol implementation across centers.
Clinical Implications
Implementing individualized contrast media protocols and automated scanner settings can reduce contrast volume and radiation dose while maintaining diagnostic quality in CTPA. This approach may decrease the frequency of repeat scans, thereby reducing patient exposure and improving workflow efficiency. Centers should consider adopting such tailored protocols to optimize pulmonary embolism imaging.
Conclusion
Over five years, individualized scanning and contrast protocols in routine clinical practice effectively minimized repeat CTPA scans and maintained diagnostic image quality. These findings support the broader adoption of tailored protocols to enhance patient safety and imaging efficiency.
References
Various Authors/Multiple Years -- Diagnostic Performance and Optimization of CTPA Protocols
