Optimization of the Contrast Concentration for Low-Tube-Voltage Chest CT: A Randomized Controlled Trial with...

Area of Science:

• Radiology
• Medical Imaging
• Diagnostic Imaging

Background:

• Conventional chest CT protocols often utilize higher tube voltages and standard contrast media concentrations.
• Optimizing contrast media (CM) concentration and tube voltage is crucial for balancing image quality, radiation dose, and patient safety.

Purpose of the Study:

• To assess the non-inferiority of low-concentration contrast media (LCCMs) in 100 kVp chest CT compared to standard protocols.
• To evaluate the impact of varying CM concentrations on the quality of enhanced chest CT scans.

Main Methods:

• A prospective, multicenter, randomized controlled trial involving adult patients (BMI < 30).
• Participants were assigned to four groups: control (120 kVp, 320 mgI/mL CM) and three test groups (100 kVp with 320, 270, or 240 mgI/mL CM).
• Image quality was assessed by two independent readers, with non-inferiority based on the proportion of acceptable scans; adverse reactions were recorded.

Main Results:

• 100 kVp chest CT with LCCMs (270 and 240 mgI/mL) demonstrated non-inferior image quality compared to the standard protocol.
• While one reader noted a lower proportion of acceptable scans with 100 kVp and standard CM (320 mgI/mL), the other did not find significant inferiority.
• Adverse reactions like injection site pain and heat sensations were less frequent in LCCM groups, with systemic heat showing statistical significance (p = 0.003).

Conclusions:

• Low-tube-voltage (100 kVp) chest CT using LCCMs achieves non-inferior diagnostic image quality compared to standard protocols.
• Using conventional concentration CM with 100 kVp may decrease the proportion of diagnostically acceptable scans.
• LCCMs in conjunction with 100 kVp chest CT show potential for improved patient safety due to reduced adverse events.