Reinforcing the Importance and Feasibility of Implementing a Low-dose Protocol for CT-guided Biopsies

Eric J. Keller*, Robert J Lewandowski, Lee Goodwin, Vahid Yaghmai, Albert A Nemcek Jr, James Carr, Jeremy D Collins

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Rationale and Objectives: This study sought to more definitely illustrate the impact and feasibility of implementing a low-dose protocol for computed tomography (CT)-guided biopsies using size-specific dose estimates and multivariate analyses. Materials and Methods: Fifty consecutive CT-guided lung and extrapulmonary biopsies were reviewed before and after implementation of a low-dose protocol (200 patients total, mean age 61 ± 15 years, 128 women). Analyses of variance with Bonferroni correction were used to compare standard and low-dose protocols in terms of patient demographics, physician experience, target lesion size, total dose-length product, total acquisitions, size-specific dose estimate, signal-to-noise ratio, contrast-to-noise ratio, and lesion conspicuity ratings. All procedures were performed on the same 16-slice CT scanner. Results: Voluntary protocol adherence was 100% (lung) and 89% (extrapulmonary). The low-dose protocol achieved significantly lower total average dose-length product [(lung) 735.6 ± 599.4 mGy × cm to 252.1 ± 101.9 mGy × cm, P < .001; (extrapulmonary) 724.7 ± 545.0 mGy × cm to 392.9 ± 239.5 mGy × cm, P < .001] and size-specific dose estimate [(lung) 5.2 ± 0.8 mGy × cm to 4.3 ± 1.5 mGy, P < .001; (extrapulmonary) 10.1 ± 6.7 mGy to 6.5 ± 2.7 mGy, P < .001]. Only the change in protocol was independently associated with lower size-specific dose estimates when controlling for the other variables (P < .0001). This was achieved with no significant differences in signal-to-noise ratio, contrast-to-noise ratio, or lesion conspicuity. Conclusions: Implementation of a low-dose protocol for CT-guided biopsies resulted in 21% and 36% of size-specific dose estimate reduction for lung and extrapulmonary biopsies, respectively, with excellent adherence. Interventional and body radiologists should implement low dose CT-guidance protocols aiming to improve patient safety.

Original languageEnglish (US)
Pages (from-to)1146-1151
Number of pages6
JournalAcademic Radiology
Volume25
Issue number9
DOIs
StatePublished - Sep 1 2018

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Tomography
Biopsy
Lung
Signal-To-Noise Ratio
Noise
X-Ray Computed Tomography Scanners
Patient Safety
Analysis of Variance
Multivariate Analysis
Demography
Physicians

Keywords

  • CT-guided biopsies
  • Dose reduction
  • low dose protocol
  • size-specific dose estimate

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{c220aecff99643a7af86e1650b7ed1be,
title = "Reinforcing the Importance and Feasibility of Implementing a Low-dose Protocol for CT-guided Biopsies",
abstract = "Rationale and Objectives: This study sought to more definitely illustrate the impact and feasibility of implementing a low-dose protocol for computed tomography (CT)-guided biopsies using size-specific dose estimates and multivariate analyses. Materials and Methods: Fifty consecutive CT-guided lung and extrapulmonary biopsies were reviewed before and after implementation of a low-dose protocol (200 patients total, mean age 61 ± 15 years, 128 women). Analyses of variance with Bonferroni correction were used to compare standard and low-dose protocols in terms of patient demographics, physician experience, target lesion size, total dose-length product, total acquisitions, size-specific dose estimate, signal-to-noise ratio, contrast-to-noise ratio, and lesion conspicuity ratings. All procedures were performed on the same 16-slice CT scanner. Results: Voluntary protocol adherence was 100{\%} (lung) and 89{\%} (extrapulmonary). The low-dose protocol achieved significantly lower total average dose-length product [(lung) 735.6 ± 599.4 mGy × cm to 252.1 ± 101.9 mGy × cm, P < .001; (extrapulmonary) 724.7 ± 545.0 mGy × cm to 392.9 ± 239.5 mGy × cm, P < .001] and size-specific dose estimate [(lung) 5.2 ± 0.8 mGy × cm to 4.3 ± 1.5 mGy, P < .001; (extrapulmonary) 10.1 ± 6.7 mGy to 6.5 ± 2.7 mGy, P < .001]. Only the change in protocol was independently associated with lower size-specific dose estimates when controlling for the other variables (P < .0001). This was achieved with no significant differences in signal-to-noise ratio, contrast-to-noise ratio, or lesion conspicuity. Conclusions: Implementation of a low-dose protocol for CT-guided biopsies resulted in 21{\%} and 36{\%} of size-specific dose estimate reduction for lung and extrapulmonary biopsies, respectively, with excellent adherence. Interventional and body radiologists should implement low dose CT-guidance protocols aiming to improve patient safety.",
keywords = "CT-guided biopsies, Dose reduction, low dose protocol, size-specific dose estimate",
author = "Keller, {Eric J.} and Lewandowski, {Robert J} and Lee Goodwin and Vahid Yaghmai and {Nemcek Jr}, {Albert A} and James Carr and Collins, {Jeremy D}",
year = "2018",
month = "9",
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language = "English (US)",
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Reinforcing the Importance and Feasibility of Implementing a Low-dose Protocol for CT-guided Biopsies. / Keller, Eric J.; Lewandowski, Robert J; Goodwin, Lee; Yaghmai, Vahid; Nemcek Jr, Albert A; Carr, James; Collins, Jeremy D.

In: Academic Radiology, Vol. 25, No. 9, 01.09.2018, p. 1146-1151.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Reinforcing the Importance and Feasibility of Implementing a Low-dose Protocol for CT-guided Biopsies

AU - Keller, Eric J.

AU - Lewandowski, Robert J

AU - Goodwin, Lee

AU - Yaghmai, Vahid

AU - Nemcek Jr, Albert A

AU - Carr, James

AU - Collins, Jeremy D

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Rationale and Objectives: This study sought to more definitely illustrate the impact and feasibility of implementing a low-dose protocol for computed tomography (CT)-guided biopsies using size-specific dose estimates and multivariate analyses. Materials and Methods: Fifty consecutive CT-guided lung and extrapulmonary biopsies were reviewed before and after implementation of a low-dose protocol (200 patients total, mean age 61 ± 15 years, 128 women). Analyses of variance with Bonferroni correction were used to compare standard and low-dose protocols in terms of patient demographics, physician experience, target lesion size, total dose-length product, total acquisitions, size-specific dose estimate, signal-to-noise ratio, contrast-to-noise ratio, and lesion conspicuity ratings. All procedures were performed on the same 16-slice CT scanner. Results: Voluntary protocol adherence was 100% (lung) and 89% (extrapulmonary). The low-dose protocol achieved significantly lower total average dose-length product [(lung) 735.6 ± 599.4 mGy × cm to 252.1 ± 101.9 mGy × cm, P < .001; (extrapulmonary) 724.7 ± 545.0 mGy × cm to 392.9 ± 239.5 mGy × cm, P < .001] and size-specific dose estimate [(lung) 5.2 ± 0.8 mGy × cm to 4.3 ± 1.5 mGy, P < .001; (extrapulmonary) 10.1 ± 6.7 mGy to 6.5 ± 2.7 mGy, P < .001]. Only the change in protocol was independently associated with lower size-specific dose estimates when controlling for the other variables (P < .0001). This was achieved with no significant differences in signal-to-noise ratio, contrast-to-noise ratio, or lesion conspicuity. Conclusions: Implementation of a low-dose protocol for CT-guided biopsies resulted in 21% and 36% of size-specific dose estimate reduction for lung and extrapulmonary biopsies, respectively, with excellent adherence. Interventional and body radiologists should implement low dose CT-guidance protocols aiming to improve patient safety.

AB - Rationale and Objectives: This study sought to more definitely illustrate the impact and feasibility of implementing a low-dose protocol for computed tomography (CT)-guided biopsies using size-specific dose estimates and multivariate analyses. Materials and Methods: Fifty consecutive CT-guided lung and extrapulmonary biopsies were reviewed before and after implementation of a low-dose protocol (200 patients total, mean age 61 ± 15 years, 128 women). Analyses of variance with Bonferroni correction were used to compare standard and low-dose protocols in terms of patient demographics, physician experience, target lesion size, total dose-length product, total acquisitions, size-specific dose estimate, signal-to-noise ratio, contrast-to-noise ratio, and lesion conspicuity ratings. All procedures were performed on the same 16-slice CT scanner. Results: Voluntary protocol adherence was 100% (lung) and 89% (extrapulmonary). The low-dose protocol achieved significantly lower total average dose-length product [(lung) 735.6 ± 599.4 mGy × cm to 252.1 ± 101.9 mGy × cm, P < .001; (extrapulmonary) 724.7 ± 545.0 mGy × cm to 392.9 ± 239.5 mGy × cm, P < .001] and size-specific dose estimate [(lung) 5.2 ± 0.8 mGy × cm to 4.3 ± 1.5 mGy, P < .001; (extrapulmonary) 10.1 ± 6.7 mGy to 6.5 ± 2.7 mGy, P < .001]. Only the change in protocol was independently associated with lower size-specific dose estimates when controlling for the other variables (P < .0001). This was achieved with no significant differences in signal-to-noise ratio, contrast-to-noise ratio, or lesion conspicuity. Conclusions: Implementation of a low-dose protocol for CT-guided biopsies resulted in 21% and 36% of size-specific dose estimate reduction for lung and extrapulmonary biopsies, respectively, with excellent adherence. Interventional and body radiologists should implement low dose CT-guidance protocols aiming to improve patient safety.

KW - CT-guided biopsies

KW - Dose reduction

KW - low dose protocol

KW - size-specific dose estimate

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