Advertisement

Customised weight-based volume contrast media protocol in CT of chest, abdomen and pelvis examination

  • Lilian Poh Poh Yap
    Affiliations
    Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia

    Department of Biomedical Imaging, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia

    Research Unit of Biomedical Imaging, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
    Search for articles by this author
  • Jeannie Hsiu Ding Wong
    Correspondence
    Corresponding author.
    Affiliations
    Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
    Search for articles by this author
  • Nadia Fareeda Muhammad Gowdh
    Affiliations
    Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia

    Department of Biomedical Imaging, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
    Search for articles by this author
  • Wei Lin Ng
    Affiliations
    Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia

    Department of Biomedical Imaging, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
    Search for articles by this author
  • Eric Chung
    Affiliations
    Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia

    Department of Biomedical Imaging, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
    Search for articles by this author
  • Ravi Chanthriga Eturajulu
    Affiliations
    Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia

    Department of Biomedical Imaging, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia

    Research Unit of Biomedical Imaging, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
    Search for articles by this author
  • Sue Anne Manushya Kaur Foo
    Affiliations
    Department of Biomedical Imaging, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia

    Research Unit of Biomedical Imaging, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
    Search for articles by this author
  • Anushya Vijayananthan
    Affiliations
    Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia

    Department of Biomedical Imaging, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
    Search for articles by this author
  • Fadhli Mohamed Sani
    Affiliations
    Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia

    Department of Biomedical Imaging, University of Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
    Search for articles by this author
Published:January 30, 2021DOI:https://doi.org/10.1016/j.jmir.2021.01.003

      Abstract

      Introduction

      Fixed volume (FV) contrast media administration during CT examination is the standard practice in most healthcare institutions. We aim to validate a customised weight-based volume (WBV) method and compare it to the conventional FV methods, introduced in a regional setting.

      Methods

      220 patients underwent CT of the chest, abdomen and pelvis (CAP) using a standard FV protocol, and subsequently, a customised 1.0 mL/kg WBV protocol within one year. Both image sets were assessed for contrast enhancement using CT attenuation at selected regions-of-interest (ROIs). The visual image quality was evaluated by three radiologists using a 4-point Likert scale. Quantitative CT attenuation was correlated with the visual quality assessment to determine the HU's enhancement indicative of the image quality grades. Contrast media usage was calculated to estimate cost-savings from both protocols.

      Results

      Mean patient age was 61 ± 14 years, and weight was 56.1 ± 8.7 kg. FV protocol produced higher contrast enhancement than WBV, p < 0.001. CT images' overall contrast enhancement was negatively correlated with body weight for FV protocol while the WBV protocol produced more consistent enhancement across different body weight. More than 90% of the images from both protocols were graded “Excellent”. WBV protocol also enabled a 28% cost reduction with cost savings of US$1238.

      Conclusion

      The customised WBV protocol produced CT images which were comparable to FV protocol for CT CAP examinations. A median CT value of 100 HU can be an indicator of good image quality for the WBV protocol.

      Résumé

      Introduction

      L'administration d'agents de contraste à volume fixe (VF) pendant un examen tomodensitométrique est la pratique courante dans la plupart des établissements de santé. Notre objectif est de valider une méthode personnalisée de volume basé sur le poids (VBP) et de la comparer aux méthodes conventionnelles de VF, introduites dans un cadre régional.

      Méthodologie

      220 patients ont subi un examen tomodensitométrique de l'abdomen et du bassin (CAP) selon le protocole standard de VF, puis un protocole personnalisé de 1,0 mL/kg de VBP dans un délai d'un an. Les deux séries d'images ont été évaluées pour l'amélioration du contraste en utilisant l'atténuation de la tomodensitométrie à des régions d'intérêt (RI) sélectionnées. La qualité visuelle de l'image a été évaluée par trois radiologues en utilisant une échelle de Likert à 4 points. Toutes les images classées dans chaque catégorie de qualité d'image ont été utilisées pour déterminer le rehaussement de HU indiquant les catégories de qualité d'image. L'utilisation des agents de contraste a été calculée pour estimer les économies réalisées grâce aux deux protocoles.

      Résultats

      L'âge moyen des patients était de 61 ± 14 ans, et leur poids de 56,1 ± 8,7 kg. Le protocole VF a produit une amélioration du contraste plus importante que le protocole VBP, p < 0,001. L'amélioration globale du contraste des images tomographiques était négativement corrélée au poids corporel pour le protocole VF, alors que le protocole VBP produit une amélioration plus cohérente pour différents poids corporels. Plus de 90% des images des deux protocoles ont été classées “excellentes”. Le protocole VBP a également permis une réduction des coûts de 28%, soit une économie de 1238 dollars US.

      Conclusion

      Le protocole VBP personnalisé produit des images CT comparables au protocole VF pour les examens CT CAP. Une valeur TDM médiane de 100 UH peut être une indication de la bonne qualité de l'image pour le protocole VBP.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Medical Imaging and Radiation Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Australian R.
        • Radiologists NZCo
        Iodinated Contrast Media Guideline.
        2018
        • Saini S.
        Multi-detector row CT: principles and practice for abdominal applications.
        Radiology. 2004; 233: 323-327
        • Davenport M.S.
        • Parikh K.R.
        • Mayo-Smith W.W.
        • Israel G.M.
        • Brown R.K.
        • Ellis J.H.
        Effect of fixed-volume and weight-based dosing regimens on the cost and volume of administered iodinated contrast material at abdominal CT.
        J Am Coll Radiol. 2017; 14: 359-370
        • George A.
        • Manghat N.
        • Hamilton M.
        Comparison between a fixed-dose contrast protocol and a weight-based contrast dosing protocol in abdominal CT.
        Clin Radiol. 2016; 71 (1314. e1311-1314. e1319)
        • Perrin E.
        • Jackson M.
        • Grant R.
        • Lloyd C.
        • Chinaka F.
        • Goh V.
        Weight-adapted iodinated contrast media administration in abdomino-pelvic CT: can image quality be maintained?.
        Radiography. 2018; 24: 22-27
        • Awai K.
        • Imuta M.
        • Utsunomiya D.
        • et al.
        Contrast enhancement for whole-body screening using multidetector row helical CT: comparison between uniphasic and biphasic injection protocols.
        Radiat Med. 2004; 22: 303-309
        • Yanaga Y.
        • Awai K.
        • Nakayama Y.
        • et al.
        Pancreas: patient body weight–tailored contrast material injection protocol versus fixed dose protocol at dynamic CT.
        Radiology. 2007; 245: 475-482
        • Haldar S.
        • Chia S.C.
        • Henry C.J.
        Body composition in Asians and Caucasians: comparative analyses and influences on cardiometabolic outcomes.
        in: Advances in Food and Nutrition Research. vol. 75. Elsevier, 2015: 97-154
        • Ibrahim N.
        • Karim N.A.
        • Shuaib I.
        • Osman N.
        • Hashim S.
        • Phuah H.
        Comparison study between different contrast administration protocols for routine CT thorax examination in two tertiary centres.
        in: Paper presented at: Journal of Physics: Conference Series. 2019
        • McLeod S.
        Likert Scale. 2008. Simply Psychology.
        2015
        • Jensen C.T.
        • Blair K.J.
        • Wagner-Bartak N.A.
        • et al.
        Comparison of abdominal computed tomographic enhancement and organ lesion depiction between weight-based scanner software contrast dosing and a fixed-dose protocol in a tertiary care oncologic center.
        J Comput Assist Tomogr. 2019; 43: 155-162
        • Dancey C.P.
        • Reidy J.
        Statistics without Maths for Psychology.
        Pearson Education, 2007
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        biometrics, 1977: 159-174
      1. Therapeutic Equivalent Brand and Generic Drugs. Ultravist 300 Uses. 2018
        • Benbow M.
        • Bull R.K.
        Simple weight-based contrast dosing for standardization of portal phase CT liver enhancement.
        Clin Radiol. 2011; 66: 940-944
        • Arana E.
        • Marti-Bonmati L.
        • Tobarra E.
        • Sierra C.
        Cost reduction in abdominal CT by weight-adjusted dose.
        Eur J Radiol. 2009; 70: 507-511
        • Rodrigues L.
        • Sampaio R.
        • Coimbra M.
        Contrast Medium Volume Optimization in Abdominal CT on Basis of Lean Body Weight.
        2013
        • Kanematsu M.
        • Watanabe H.
        • Kondo H.
        • Goshima S.
        • Kawada H.
        • Noda Y.
        Portal venous-phase CT of the liver in patients without chronic liver damage: does portal-inflow tracking improve enhancement and image quality?.
        Open J Radiol. 2013; 3: 112
        • Yamashita Y.
        • Komohara Y.
        • Takahashi M.
        • et al.
        Abdominal helical CT: evaluation of optimal doses of intravenous contrast material--a prospective randomized study.
        Radiology. 2000; 216: 718-723
        • Fujigai T.
        • Kumano S.
        • Okada M.
        • et al.
        Optimal dose of contrast medium for depiction of hypervascular HCC on dynamic MDCT.
        Eur J Radiol. 2012; 81: 2978-2983
        • Heiken J.P.
        • Brink J.A.
        • McClennan B.L.
        • Sagel S.S.
        • Crowe T.M.
        • Gaines M.V.
        Dynamic incremental CT: effect of volume and concentration of contrast material and patient weight on hepatic enhancement.
        Radiology. 1995; 195: 353-357
        • Goshima S.
        • Kanematsu M.
        • Kondo H.
        • et al.
        MDCT of the liver and hypervascular hepatocellular carcinomas: optimizing scan delays for bolus-tracking techniques of hepatic arterial and portal venous phases.
        Am J Roentgenol. 2006; 187: W25-W32
        • Koo T.K.
        • Li M.Y.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chirop Med. 2016; 15: 155-163
        • Nijssen E.C.
        • Rennenberg R.J.
        • Nelemans P.J.
        • et al.
        Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial.
        Lancet. 2017; 389: 1312-1322