Optimisation of the CT Pulmonary Angiogram (CTPA) Protocol Using a Low Kv Technique Combined with High Iterative Reconstruction (IR): A Phantom Study

Introduction: This study aims to optimise the current CTPA protocol at a public general hospital in Malta using lower kV combined with high Iterative Reconstruction (IR) (>50%).Methods: The research consisted of a 2-phase anthropomorphic phantom study. Phase 1: radiation dose evaluation of 6 experimental protocols consisting of the low kV technique and high IR values and comparison with the current protocol. Phase 2: image evaluation. Objective image quality was evaluated in terms of contrast to noise ratio (CNR) and signal to noise ratio (SNR). Subjective image quality evaluation was performed by 3 radiologists undertaking Absolute Visual Grading Analysis (VGA). Resultant image quality scores were analysed using Visual Grading Characteristics (VGC). Results: All experimental protocols achieved significant (p < 0.05) dose reductions. SNR and CNR improved in almost all protocols, however, differences were not significant (p > 0.05). In subjective image quality analysis, the current protocol provided significant superior image quality (AUC > 0.5; p < 0.05) when compared to the experimental protocols consisting of 80 kV with 70%, 80%, 90% and 100% IR. The only two experimental protocols yielding comparable image quality to the current protocol were 80 kV with 50% IR (AUC: 0.195; p: 0.137) and 80 kV with 60% IR (AUC: 0.554; p: 0.624). The protocol yielding the greatest decrease in radiation dose being 80 kV with 60% IR. Conclusions: The optimal IR value was 60%. When applying the optimal experimental protocol (80 kV combined with 60% IR), a significant dose reduction was achieved while maintaining diagnostic image quality. Implications for practice: The low kV technique combined with high IR parameter is easily implemented and involves no additional cost and equipment. (c) 2022 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.