Perfusion CT Radiation Dose Reduction Efforts Finding Success

The latest developments in computed tomography (CT) scanner technology have made perfusion CT imaging a key diagnostic tool for patients with suspected stroke. Now, researchers are working to reduce radiation dosages used to acquire perfusion and other CT images.

Mayo Clinic (Rochester, MN, USA) medical physicist Cynthia McCollough, Ph.D., and her group of researchers presented their findings related to CT dose reduction at the 52nd annual meeting of the American Association of Physicists in Medicine on July 20, 2010, in Philadelphia, PA, USA. "We believe in the clinical value of perfusion CT, and though there is no documented risk of injury at the currently prescribed radiation levels, we are trying to lower the dose for the benefit of patients,” said Dr. McCollough, diagnostic radiologist, Mayo Clinic.

The "As Low As Reasonably Achievable” (ALARA) principle has always guided Mayo Clinic's approach to the dosages of radiation used to acquire CT images. Dr. McCollough's team has been studying a newly created image-processing algorithm that produces high-quality perfusion CT scans with up to 20 times less the radiation used under existing protocols. Depending on the diagnostic application, a perfusion CT exam takes about 30 seconds to scan the tissue multiple times after iodine has been injected. This technique detects alterations in blood volume and flow that reveal injuries to vessels or a tumor's response to treatment. Information from each consecutive scan is then digitally cross-referenced with other images taken during the exam to improve image quality and reduce distortions.

Up to now, the new perfusion CT algorithms have shown to be effective in animal models, and Dr. McCollough's team has begun looking at ways to introduce the methodologies into clinical practice. "When we use very low doses of radiation to acquire a CT, image graininess can significantly decrease the value of the exam,” said the study's first author, Dr. Juan Carlos Ramirez Giraldo, Mayo Clinic. "With this new algorithm, we are able to maintain the image quality by cross-referencing it with other images collected during the exam.”

In related work, using one of the latest CT scanners on the market, Mayo Clinic already has other advanced algorithms as part of its clinical practice. A team of radiologists and physicists has recently implemented a new routine head CT protocol that slashes radiation dose by nearly 50%. While the American College of Radiology (Reston, VA, USA) allows its accredited facilities to use head CT doses up to approximately 75 mGy, Mayo Clinic's newly introduced patient protocol uses a dose of only 38 mGy. This dose reduction is especially significant as head CT exams are one of the most typically performed CT procedures.

When asked how the new head CT protocol is changing clinical practice, neuroradiologist David DeLone, M.D., Mayo Clinic, stated, "Patients aren't aware that anything has changed, and as radiologists looking at a study, we don't know anything has changed. Yet, we are obtaining high-quality images, more consistently and in shorter times, while exposing patients to about half of the radiation dose. It's a win-win for everyone.”

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