Dose reduction in computed tomographic angiography of pregnant patients with suspected acute pulmonary embolism

The aim of this study was to quantify the effect of a reduced-dose pulmonary computed tomographic (CT) angiography protocol on radiation dose and image quality in pregnant patients as compared with a standard protocol.

Twenty-six pregnant women with suspected pulmonary embolism underwent reduced-dose CT angiography (200 mA and 100 kV, from the aortic arch to the diaphragm). The matched control group standard protocol was 400 mA, 120 kilovolt (peak), and the entire thorax. The CT dose index, dose-length product, effective dose, image quality, and signal-to-noise ratio were assessed and compared with the Wilcoxon rank sum test result.

The CT dose index, mean dose-length product, and calculated effective dose were lower in the pregnancy group than in the controls: mean (SD), 5.21 (1.54) mGy versus 20.86 (5.59) mGy; 105.65 (39.77) mGy cm versus 575.71 (154.86) mGy cm, and 1.79 (0.676) msv versus 9.787 (2.63) msv, respectively (P < 0.0001). Quality scores of segmental (P = 0.266) and subsegmental (P = 0.207) arteries and arterial attenuation (P = 0.443) were similar.

In pregnant patients with suspected pulmonary embolism, combined reduction of kilovoltage and milliampere-second settings and z-axis coverage results in a substantial reduction of radiation dose while maintaining diagnostic imaging quality.