Ultra–low-dose Protocol for CT-guided Lung Biopsies

Abstract

Purpose Computed tomography (CT) scans are a significant source of radiation to patients. It was hypothesized that technical success and complication rates would not be significantly changed by radically lowering the CT dose during lung biopsies with an ultra–low-dose (ULD) protocol. Materials and Methods A total of 100 consecutive patients aged 11–89 years who underwent biopsies of lung lesions were evaluated. Technical parameters were altered halfway through the study from the standard dose (140 kV localizing/100 kV subsequent guiding scans with auto-mA) to a ULD protocol (100 kV, 7.5 mAs) as part of a quality initiative. ULD studies were evaluated subjectively for image quality on a five-point scale. Patients' body mass indexes, total estimated radiation doses (dose–length product), technical success rates, and complications were compared between the standard-dose and the ULD groups. Results Average radiation dose was reduced from 677.5 mGy·cm for the standard-dose group to 18.3 mGy·cm for the ULD group ( P < .0001). In the ULD group, image quality was rated as adequate or better in 96% of cases. Pneumothoraces necessitating chest tube placements occurred in 10% and 6% of cases in the ULD and standard dose groups, respectively ( P = .715). Technical success rates of 92% and 98% were obtained in the ULD and standard dose groups, respectively ( P = .362). Conclusions Radiation dose to the chest during CT-guided percutaneous lung biopsies is reduced greater than 95% versus a standard protocol through the use of a ULD CT protocol without decreasing technical success or patient safety.