The main issue within radiology today is how to reduce the radiation dose during CT examinations without compromising the image quality. Generally, a high radiation dose results in high quality images. A lower dose leads to increased image noise and results in unsharp images. Unfortunately, as the radiation dose increases, so does the associated risk of radiation induced cancer. However, there are several methods that can be used in order to lower the exposure to ionizing radiation during a CT scan.
New software technology can significantly reduce the radiation dose. The software works as a filter which reduces random noise and enhances structures. In that way, it is possible to get high quality images and at the same time lower the dose by as much as 30 to 70 percent.
Individualize the examination and adjust the radiation dose to the body type and body organ examined. Different body types and organs require different amounts of radiation.
Prior to every CT examination, evaluate the appropriateness of the exam whether it’s motivated or if another type of examination is more suitable.
Thursday, June 19, 2008
Adverse reactions to contrast agents
Because CT scans rely on intravenously administered contrast agents in order to provide superior image quality, there is a low but non-negligible level of risk associated with the contrast agents themselves. Certain patients may experience severe and potentially life-threatening allergic reactions to the contrast dye.
The contrast agent may also induce kidney damage. The risk of this is increased with patients who have preexisting renal insufficiency, preexisting diabetes, or reduced intravascular volume. In general, if a patient has normal kidney function, then the risks of contrast nephropathy are negligible. Patients with mild kidney impairment are usually advised to ensure full hydration for several hours before and after the injection. For moderate kidney failure, the use of iodinated contrast should be avoided; this may mean using an alternative technique instead of CT e.g. MRI. Perhaps paradoxically, patients with severe renal failure requiring dialysis do not require special precautions, as their kidneys have so little function remaining that any further damage would not be noticeable and the dialysis will remove the contrast agent.
The contrast agent may also induce kidney damage. The risk of this is increased with patients who have preexisting renal insufficiency, preexisting diabetes, or reduced intravascular volume. In general, if a patient has normal kidney function, then the risks of contrast nephropathy are negligible. Patients with mild kidney impairment are usually advised to ensure full hydration for several hours before and after the injection. For moderate kidney failure, the use of iodinated contrast should be avoided; this may mean using an alternative technique instead of CT e.g. MRI. Perhaps paradoxically, patients with severe renal failure requiring dialysis do not require special precautions, as their kidneys have so little function remaining that any further damage would not be noticeable and the dialysis will remove the contrast agent.
Radiation exposure
CT is regarded as a moderate to high radiation diagnostic technique. While technical advances have improved radiation efficiency, there has been simultaneous pressure to obtain higher-resolution imaging and use more complex scan techniques, both of which require higher doses of radiation. The improved resolution of CT has permitted the development of new investigations, which may have advantages; compared to conventional angiography for example, CT angiography avoids the invasive insertion of an arterial catheter and guidewire; CT colonography may be as useful as a barium enema for detection of tumors, but may use a lower radiation dose.
The greatly increased availability of CT, together with its value for an increasing number of conditions, has been responsible for a large rise in popularity. So large has been this rise that, in the most recent comprehensive survey in the United Kingdom, CT scans constituted 7% of all radiologic examinations, but contributed 47% of the total collective dose from medical X-ray examinations in 2000/2001. Increased CT usage has led to an overall rise in the total amount of medical radiation used, despite reductions in other areas. In the United States and Japan for example, there were 26 and 64 CT scanners per 1 million population in 1996. In the U.S., there were about 3 million CT scans performed in 1980, compared to an estimated 62 million scans in 2006.
The radiation dose for a particular study depends on multiple factors: volume scanned, patient build, number and type of scan sequences, and desired resolution and image quality. Additionally, two helical CT scanning parameters that can be adjusted easily and that have a profound effect on radiation dose are tube current and pitch.The radiation from current CT-scan use may cause as many as 1 in 50 future cases of cancer.
The greatly increased availability of CT, together with its value for an increasing number of conditions, has been responsible for a large rise in popularity. So large has been this rise that, in the most recent comprehensive survey in the United Kingdom, CT scans constituted 7% of all radiologic examinations, but contributed 47% of the total collective dose from medical X-ray examinations in 2000/2001. Increased CT usage has led to an overall rise in the total amount of medical radiation used, despite reductions in other areas. In the United States and Japan for example, there were 26 and 64 CT scanners per 1 million population in 1996. In the U.S., there were about 3 million CT scans performed in 1980, compared to an estimated 62 million scans in 2006.
The radiation dose for a particular study depends on multiple factors: volume scanned, patient build, number and type of scan sequences, and desired resolution and image quality. Additionally, two helical CT scanning parameters that can be adjusted easily and that have a profound effect on radiation dose are tube current and pitch.The radiation from current CT-scan use may cause as many as 1 in 50 future cases of cancer.
What are the Advantages and hazards of CT?
Advantages over projection radiography
First, CT completely eliminates the superimposition of images of structures outside the area of interest. Second, because of the inherent high-contrast resolution of CT, differences between tissues that differ in physical density by less than 1% can be distinguished. Third, data from a single CT imaging procedure consisting of either multiple contiguous or one helical scan can be viewed as images in the axial, coronal, or sagittal planes, depending on the diagnostic task. This is referred to as multiplanar reformatted imaging.
First, CT completely eliminates the superimposition of images of structures outside the area of interest. Second, because of the inherent high-contrast resolution of CT, differences between tissues that differ in physical density by less than 1% can be distinguished. Third, data from a single CT imaging procedure consisting of either multiple contiguous or one helical scan can be viewed as images in the axial, coronal, or sagittal planes, depending on the diagnostic task. This is referred to as multiplanar reformatted imaging.
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