Comparison of Diagnostic Quality and Radiation Dose between Test Bolus and Bolus Tracking protocols for Computed Tomography Pulmonary Angiography (CTPA) among Pregnant Women in Two Tertiary Centres
DOI:
https://doi.org/10.31674/mjmr.2023.v07i03.005Abstract
Introduction: Computed Tomography Pulmonary Angiography (CTPA) among pregnant women is often non-diagnostic and may need the repetition of CTPA. This study aims to compare the test bolus and the bolus tracking protocols for CTPA among pregnant women by analysing the mean contrast enhancement of the pulmonary artery, diagnostic quality and radiation dosage, as well as the outcome of repeated CTPA among pregnant women due to initial non-diagnostic CTPA. Methods: This retrospective study from two tertiary centres included pregnant women who underwent CTPA using test bolus and bolus tracking protocols. CTPA quality, mean pulmonary artery enhancement and dose length product (DLP) were collected and compared between both protocols. The frequency and outcome of CTPA repetition due to suboptimal quality were analysed. Results: Test bolus protocol yields a slightly higher number of diagnostic qualities CTPA than bolus tracking protocol; however not statistically significant. The bolus tracking protocol had significantly better acceptable CTPA quality than the test bolus protocol. Test bolus protocol had significantly lower mean DLP, 220 mGy.cm ± 69, than bolus tracking protocol, 323 mGy.cm ± 34, p-value <0.001. Half of the repeated CTPA did not show significantly better CTPA quality on repetition. Conclusion: No significant difference between test bolus and bolus tracking protocol in CTPA among pregnant women, but the bolus tracking protocol had better overall CTPA quality with higher radiation dose. Repetition of CTPA studies for poor CTPA quality may not always benefit. Hence, we advise weighing the risk and benefits of study repetition.
Keywords:
CTPA, Pregnant, Test Bolus, Bolus TrackingDownloads
References
Basson, D. J., & Moodley, H. (2022). An audit of the adequacy of contrast enhancement in CT pulmonary angiograms in a South African tertiary academic hospital setting. SA Journal of Radiology, 26(1), 2350. https://doi.org/10.4102/sajr
Cahill, A. G., Stout, M. J., Macones, G. A., & Bhalla, S. (2009). Diagnosing pulmonary embolism in pregnancy using computed-tomographic angiography or ventilation–perfusion. Obstetrics & Gynecology, 114(1), 124-129. https://doi.org/10.1097/AOG.0b013e3181a99def
Castañer, E., Gallardo, X., Ballesteros, E., Andreu, M., Pallardó, Y., Mata, J. M., & Riera, L. (2009). CT diagnosis of chronic pulmonary thromboembolism. Radiographics, 29(1), 31–50. https://doi.org/10.1148/rg.291085061
Chen, M., Mattar, G., & Abdulkarim, J. A. (2017). Computed tomography pulmonary angiography using a 20% reduction in contrast medium dose delivered in a multiphasic injection. World Journal of Radiology, 9(3), 143–147. https://doi.org/10.4329/wjr.v9.i3.143
Heit, J. A., Kobbervig, C. E., James, A. H., Petterson, T. M., Bailey, K. R., & Melton III, L. J. (2005). Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Annals of Internal Medicine, 143(10), 697–706. https://doi.org/10.7326/0003-4819-143-10-200511150-00006
James, A. H., Jamison, M. G., Brancazio, L. R., & Myers, E. R. (2006). Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. American Journal of Obstetrics and Gynecology, 194(5), 1311–1315. https://doi.org/10.1016/j.ajog.2005.11.008
Khalil, H., Woodfield, C., & Bourjeily, G. R. (2009). Pulmonary Artery Size in Pregnancy. Chest, 136(4), 60S. https://doi.org/10.1378/chest.136.4_meetingabstracts.60s
Leitman, E. M., & McDermott, S. (2019). Pulmonary arteries: imaging of pulmonary embolism and beyond. Cardiovascular Diagnosis and Therapy, 9(Suppl 1), S37. https://doi.org/10.21037/cdt.2018.08.05
Michelle Muller, Anna Beattie, A Chang, & J May. (2022, July 20). Adequate Contrast Enhancement of CT Pulmonary Angiograms. The Royal College of Radiologists (RCR). https://www.rcr.ac.uk/audit/adequate-contrast-enhancement-ct-pulmonary-angiograms
Ministry of Health Malaysia. (2016). Brief Info on Maternal Death in Malaysia 2016, Confidential Enquires into Maternal Deaths (CEMD).
Ministry of Health Malaysia. (2018). Brief Info on Maternal Death in Malaysia 2018, Confidential Enquires into Maternal Deaths (CEMD).
Moradi, M., & Khalili, B. (2016). Qualitative indices and enhancement rate of CT pulmonary angiography in patients with suspected pulmonary embolism: Comparison between test bolus and bolus-tracking methods. Advanced Biomedical Research, 5. https://doi.org/10.4103/2277-9175.184309
Mortimer, A. M., Singh, R. K., Hughes, J., Greenwood, R., & Hamilton, M. C. K. (2011). Use of expiratory CT pulmonary angiography to reduce inspiration and breath-hold associated artefact: Contrast dynamics and implications for scan protocol. Clinical Radiology, 66(12), 1159–1166. https://doi.org/10.1016/j.crad.2011.06.012
Nazaroĝlu, H., Özmen, C. A., Akay, H. Ö., Kilinç, I., & Bilici, A. (2009). 64-MDCT Pulmonary Angiography 64-MDCT pulmonary angiography and CT venography in the diagnosis of thromboembolic disease. American Journal of Roentgenology, 192(3), 654–661. https://doi.org/10.2214/AJR.07.3939
Nguyen, E. T., Hague, C., Manos, D., Memauri, B., Souza, C., Taylor, J., & Dennie, C. (2022). Canadian society of thoracic radiology/Canadian association of radiologists best practice guidance for investigation of acute pulmonary embolism, part 1: acquisition and safety considerations. Canadian Association of Radiologists Journal, 73(1), 203-213. https://doi.org/10.1177/08465371211000737
Pomp, E. R., Lenselink, A. M., Rosendaal, F. R., & Doggen, C. J. M. (2008). Pregnancy, the postpartum period and prothrombotic defects: Risk of venous thrombosis in the MEGA study. Journal of Thrombosis and Haemostasis, 6(4), 632–637. https://doi.org/10.1111/j.1538-7836.2008.02921.x
Revel, M.-P., Cohen, S., Sanchez, O., Collignon, M.-A., Thiam, R., Redheuil, A., Meyer, G., & Frija, G. (2011). Pulmonary Embolism during Pregnancy: Diagnosis with Lung Scintigraphy or CT Angiography? Radiology, 258(2), 590–598. https://doi.org/10.1148/radiol.10100986
Ridge, C. A., McDermott, S., Freyne, B. J., Brennan, D. J., Collins, C. D., & Skehan, S. J. (2009). Pulmonary Embolism in Pregnancy: Comparison of Pulmonary CT Angiography and Lung Scintigraphy. American Journal of Roentgenology, 193(5), 1223–1227. https://doi.org/10.2214/AJR.09.2360
Rodrigues, J. C. L., Mathias, H., Negus, I. S., Manghat, N. E., & Hamilton, M. C. K. (2012). Intravenous contrast medium administration at 128 multidetector row CT pulmonary angiography: bolus tracking versus test bolus and the implications for diagnostic quality and effective dose. Clinical Radiology, 67(11), 1053–1060. https://doi.org/10.1016/j.crad.2012.02.010
Schaefer-Prokop, C., & Prokop, M. (2008). CTPA for the diagnosis of acute pulmonary embolism during pregnancy. European Radiology, 18(12), 2705–2708. https://doi.org/10.1007/s00330-008-1158-8
Trainer, C., Schembri, N., & Taylor, T. (2013). Retrospective study analysing whether optimization of pulmonary vascular enhancement influences diagnostic outcome in the interpretation of CT pulmonary angiograms (CTPA). Thorax, 68(Suppl 3), A148–A148. https://doi.org/10.1136/thoraxjnl-2013-204457.311
Tromeur, C., van der Pol, L. M., Le Roux, P. Y., Ende-Verhaar, Y., Salaun, P. Y., Leroyer, C., Couturaud, F., Kroft, L. J. M., Huisman, M. V., & Klok, F. A. (2019). Computed tomography pulmonary angiography versus ventilation-perfusion lung scanning for diagnosing pulmonary embolism during pregnancy: A systematic review and meta-analysis. Haematologica, 104(1), 176–188. https://doi.org/10.3324/haematol.2018.196121
U-King-Im, J. M., Freeman, S. J., Boylan, T., & Cheow, H. K. (2008). Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy. European Radiology, 18(12), 2709. https://doi.org/10.1007/s00330-008-1100-0
Uysal Ramadan, S., Kosar, P., Sonmez, I., Karahan, S., & Kosar, U. (2010). Optimisation of contrast medium volume and injection-related factors in CT pulmonary angiography: 64-slice CT study. European Radiology, 20(9), 2100–2107. https://doi.org/10.1007/s00330-010-1782-y
Yamaguchi, T., & Takahashi, D. (2010, March). Development of novel injection method of contrast medium and the utility for coronary CT angiography (CCTA): Test bolus tracking (TBT) method. European Congress of Radiology-ECR 2010. https://doi.org/10.1594/ecr2010/C-1136
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Malaysian Journal of Medical Research (MJMR)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
