ct pulmonary angiography protocol
Calculations were performed on a standard PC using a statistical analysis program (Minitab, version 15, Minitab). Protocol Number: OCOG-2014-PEGeD . Transient interruption of the contrast bolus by unopacified blood from the IVC was a causative factor in one case and the second nondiagnostic study was caused by poor peak arterial enhancement. This study presents and evaluates a CT pulmonary angiography protocol dedicated to pregnant women. The causative mechanism of poor pulmonary arterial opacification during pulmonary CTA in pregnancy is multifactorial. A D-dimer assay might be a preferred alternative to test for pulmonary embolism, and that test and a low clinical prediction score on the Wells test or Geneva score can exclude pulmonary embolism as a possibility. Introduction: To prospectively evaluate the feasibility of single contrast bolus high-pitch CT pulmonary angiography (CTPA) subsequently followed by low-dose retrospectively ECG-gated cardiac CT (4D-cCT) in patients with suspected pulmonary embolism (PE) to accurately evaluate right ventricular (RV) function. One study that showed transient interruption of the contrast bolus in group B was considered diagnostic at the time of image acquisition and met both subjective and objective criteria of “good” and “adequate” at study reinterpretation. Studies analyzing pulmonary CTA of pregnant patients have confirmed that pulmonary arterial opacification is reduced during pregnancy [4, 7, 19, 20] and that transient interruption of the contrast bolus by unopacified blood from the IVC may occur more often in pregnant patients than in the general population [7]. When a portion of a pulmonary artery was noted to be lower in attenuation than adjacent areas of increased attenuation proximally and distally (Fig. In group A, final diagnoses included pneumonia (n = 2), pleural effusion (n = 1), pneumothorax (n = 1), and PE (n = 1). Protocol … Furthermore, specific variations between both patient groups that may affect vascular opacification including cardiac function, height, and weight were not recorded at the time of image reinterpretation. 18(7):882-7. ... Ct pulmonary angiogram muhammed Yasar. The contrast agent is injected into a vein (not an artery as in conventional angiography), usually in the arm. Readers were not blinded to the CTA protocol used. Two other patients underwent lung scintigraphy after an initial nondiagnostic CTA. In group B, two patients had nondiagnostic studies. When a portion of a pulmonary artery was noted to be lower in attenuation than adjacent areas of increased attenuation proximally and distally (Fig. Pulmonary arterial opacification was significantly higher in all locations in group B than group A and is detailed in Table 2. pmid:17940308 . The first patient’s pulmonary CTA study showed adequate MPA opacification excluding a central PE, but subsegmental arterial opacification was poor. Imaging of Pulmonary Embolism Gamal Agmy. The purpose of this study was to investigate the clinical application of computed tomography pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) based on a ... patient records, the positive rate of PE was 30.7%. The flow rate was kept constant at 4 mL/s throughout the procedure. For example, in a recent study of 43 pregnant patients, investigators reported a 19% rate of indeterminate CTA studies using 100–120 mL of contrast medium and held maximal inspiration, with slow breathing used as a trouble-shooting maneuver [20]. Radiology 2005; 237: 329-337. The following equation designed to calculate the fraction of blood flow contributed by the IVC to the right side of the heart (KIVC) was applied to all CTA studies [17]: or. Pulmonary embolism ppt resmigs. Patient age, week of gestation, vascular opacification in Hounsfield units, KIVC, effective dose, and image noise are expressed as mean values ± SD. Heyer CM, Mohr PS, Lemburg SP, Peters SA, Nicolas V (2007) Image quality and radiation exposure at pulmonary CT angiography with 100- or 120-kVp protocol: prospective randomized study. Vessel opacification was provided by IV injection of 95 mL of iopamidol (Niopam 370) via the antecubital vein. This artifact was confirmed in 11 of 28 CTA studies in group A (39%) and two of 20 CTA studies in group B (10%) (p = 0.05). Use of high pitch, 3.2 in 70 kVp protocol should be … This increase in blood volume is thought to contribute to hemodilution of contrast material administered to pregnant patients [5]. Ct angio ppt drksp. In all cases, the clinical and study reinterpretations agreed. The relative contribution of the IVC to the right heart was then evaluated. The mean effective dose per patient was also lower in group B (4.8 mSv) than in group A (5.6 mSv). When used in conjunction with validated clinical decision tools like modified Wells criteria, CT-angiography is highly sensitive (good at detecting PE when it's there and ruling it out when it's not) and specific (generating few false-positive results). TABLE 1: Pulmonary CT Angiography Contrast Medium Administration Parameters, Each study was then assessed for the presence or absence of a transient interruption of the contrast bolus by unopacified blood from the IVC. We thank the CT radiographers at St. Vincent’s University Hospital—in particular, Susan Collins and Sheena O’Keeffe—and chief physicist Michael Casey for their important contributions to image acquisition and dose calculation in this study. CT angiography of the chest (CTA chest) is a cross-sectional diagnostic examination that can be performed ECG-gated or non-ECG gated. Methods: To estimate vessel noise, the reviewers recorded the attenuation and SD of the MPA and the attenuation of air for each CT study. The causative mechanism of poor pulmonary arterial opacification during pulmonary CTA in pregnancy is multifactorial. CTA Chest (pulmonary angiogram) Reviewed By: Rachael Edwards, MD; Dan Verdini, MD; Brett Mollard, MD Last Reviewed: July 2019 Contact: (866) 761-4200, Option 1 In accordance with the ALARA principle, TRA policies and protocols promote the utilization of radiation dose reduction techniques for all CT examinations. to Reduce the use of CT Pulmonary Angiography in . In group A, objective image quality was classified as good (≥ 210 HU) in nine of 28 CTA studies (32.1%) compared with 16 of 20 CTA studies (80%) in group B (p = 0.0001), acceptable (170–209 HU) in eight of 28 CTA studies (29%) compared with three of 20 CTA studies (15%) in group B (p = 0.001), and poor (≤ 169 HU) in 11 of 28 CTA studies (39%) compared with one of 20 CTA studies (5%) in group B (p = 0.0001). Imaging Pulmonary Infection: Classic Signs and Patterns, Review. • An empiric timing protocol for CT pulmonary angiography had lower radiation exposure compared to a timing bolus protocol. Experimental studies have shown that cardiac output is inversely related to peak arterial enhancement and time to arrival of contrast material in the aorta [21]. exercise was to investigate if a change in CT pulmonary angiography (CTPA) scanning protocol resulted in improved opacification of the pulmonary arteries. In group A, eight patients had nondiagnostic pulmonary CTA studies. 2–4 CTPA is a standard procedure that obtains a CT volume while intravenously injected iodinated contrast media (CM) opacifies the pulmonary arteries. Three patients underwent repeat pulmonary CTA. AJR 2007; 188:1255–1261 • Jones SE, Wittram C. The indeterminate CT pulmonary angiogram: imaging characteristics and patient clinical outcome. Performing a traditional catheter angiogram carries a high risk of complications. Although this difference was not statistically significant, the slightly lower radiation dose in group B may have been due to shallow inspiration and resultant decreased z-axis coverage. The increase in cardiac output was also minimized by using a high concentration of contrast medium and by using bolus tracking, both of which are part of standard practice for CTA of pregnant patients in our institution. The patient was examined with the 70-kVp dual-source CT pulmonary angiography protocol (Group A). TABLE 2: Opacification of the Pulmonary Arteries on CT Angiography. TABLE 1: Pulmonary CT Angiography Contrast Medium Administration Parameters, Each study was then assessed for the presence or absence of a transient interruption of the contrast bolus by unopacified blood from the IVC. There was also a strong negative correlation between mean KIVC values in both the RA and RV and good subjective image quality (r = –0.51 and –0.5, p = 0.0001). Lung scintigraphy is not susceptible to the hemodynamic effects of pregnancy and remains a reliable tool for excluding PE in patients with normal findings on chest radiography while additionally conferring a lower maternal radiation dose than pulmonary CTA [12, 13]. In addition to these hemodynamic alterations during pregnancy, IVC pressure increases because of the gravid uterus. For scanner/protocol combinations In pregnant patients with suspected PE, a pulmonary CTA protocol optimized for use in pregnancy that includes a high flow rate, a high volume, and high concentration of contrast medium and shallow held inspiration significantly increases the rate of diagnostic adequacy and pulmonary arterial opacification and decreases the incidence of transient interruption of the contrast bolus by unopacified blood from the IVC. The pulmonary vasculature may be evaluated with various invasive and noninvasive methods. The pulmonary vasculature may be evaluated with various invasive and noninvasive methods. Experimental studies have shown that cardiac output is inversely related to peak arterial enhancement and time to arrival of contrast material in the aorta [21]. Vessel opacification was provided by IV injection of 75 mL of iopamidol (Niopam 370, Bracco) via the antecubital vein. Section: This study demonstrated the feasibility of 70-kVp CTPA using a dual-source CT protocol with low-pitch dual-source simultaneous acquisition mode and 40 ml of CM. This effect, known as the “thoracoabdominal pump,” is likely to be prominent in pregnancy because of inherently raised IVC pressures. Radiology 245: 577–583. Group B consisted of 20 patients, each of whom underwent one pulmonary CTA study. CTA studies were reinterpreted by consensus of two radiologists with 4 and 18 years of experience in chest CT using a standard workstation (Leonardo, Siemens Healthcare). PE was diagnosed in one patient. Protocol Number: OCOG-2014-PEGeD . Although this difference was not statistically significant, the slightly lower radiation dose in group B may have been due to shallow inspiration and resultant decreased z-axis coverage. CT pulmonary angiography in patients with acute or chronic renal insufficiency: Evaluation of a low dose contrast material protocol. Optimizing Protocols for the Individual Patient in CT Pulmonary Angiography. Introduction: Use of CT in the investigation of pulmonary embolism in radiosensitive patients such as pregnant and young female patients entails the need for protocol optimization. Our study was limited by its retrospective nature and small number of patients. 1), attenuation measurements were made in the area of decreased attenuation and in the proximal and distal areas of higher attenuation, as described in the literature [17, 18]. Both computed tomography pulmonary angiography (CTPA) and the ventilation/perfusion (V/Q) scan involve exposure to ionizing radiation. When used in conjunction with validated clinical decision tools like modified Wells criteria, CT-angiography is highly sensitive (good at detecting PE when it's there and ruling it out when it's not) and specific (generating few false-positive results). Pulmonary artery attenuation values and the relative contribution of the IVC to the right heart were calculated by the former reader. Two other patients underwent lung scintigraphy after an initial nondiagnostic CTA. In the CTA studies with the artifact, the mean attenuations (± SD) of the proximal high-attenuation region, intervening low-attenuation region, and distal high-attenuation region were 264 ± 64 HU, 134 ± 50 HU, and 229 ± 75 HU, respectively (Fig. Intrathoracic pressure decreases on deep inspiration and the thoracoabdominal gradient becomes more pronounced, resulting in increased venous return to the right heart. Pulmonary CT Angiography Protocol Adapted to the Hemodynamic Effects of Pregnancy, Transient Interruption of Contrast Material by Unopacified Blood From the Inferior Vena Cava, Original Research. Several study limitations are acknowledged. Same procedure; Clearly show the patho, compressed a. Tot of 4 scouts. This study tests the hypothesis that the empiric protocol more consistently produces diagnostic quality images of both the pulmonary arteries and the aorta with lower radiation exposure. The difference in mean gestation between groups A and B (31 vs 29 weeks) was not statistically significant (p = 0.4). In group A, final diagnoses included pneumonia (n = 2), pleural effusion (n = 1), pneumothorax (n = 1), and PE (n = 1). CTA studies were reinterpreted by consensus of two radiologists with 4 and 18 years of experience in chest CT using a standard workstation (Leonardo, Siemens Healthcare). Comparison was made between the smart prep protocol (SPP) and the test bolus protocol (TBP) for opacification in the pulmonary trunk. Statistical methods included the Shapiro-Wilk test to confirm normal distribution, Student t test, chi-square test, and Pearson correlation coefficient. Three patients did not undergo further imaging and PE was excluded clinically. [3] Images depicting clots in the pulmonary arterial system are provided below. However, the differences between the two groups in mean pulmonary arterial opacification and in the presence of transient interruption of the contrast bolus by unopacified blood from the IVC were statistically significant despite the fact that there were fewer patients in group B. A Combination of Normal-Dose Corticomedullary Phase With Low-Dose Unenhanced and Excretory Phases, Review. The reviewers were blinded to the clinical information or the initial radiologic interpretation. Other larger studies do not describe the breathing instructions used [6, 15] and report indeterminate rates of 17% and 5.6% using 100–125 mL and 80–95 mL of contrast material, respectively. [Dual-source CT scanners provide high-pitch dual source protocols … The inadequate group comprised CTA studies with poor pulmonary arterial enhancement, substantial noise, or substantial motion artifact. ; Clearly show the patho, compressed a. 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