Quantifying Dual-energy computed tomography (DECT) in patients with renal calculi using a Toshiba Aquilion One Scanner.
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1 Quantifying Dual-energy computed tomography (DECT) in patients with renal calculi using a Toshiba Aquilion One Scanner. Poster No.: C-2613 Congress: ECR 2015 Type: Authors: Keywords: DOI: Scientific Exhibit I. S. Libra, C. Musowe; Swansea/UK Calcifications / Calculi, Outcomes analysis, Education, Diagnostic procedure, CT, Urinary Tract / Bladder, Radiation physics, Kidney /ecr2015/C-2613 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8
2 Aims and objectives Introduction Dual energy Computer tomography (DECT) involves the exposure of patients to two different energy doses, using two different x-ray tubes in a single CT scan. The attenuation is dependent upon different voltages (High: 140kvP and Low: 80kVP) applied across the tubes. Subsequently structures respond differently at different voltages which is why DECT allows better differentiation of certain substances from soft tissue. DECT recently as part of scientific research has been used to differentate between renal calculi composition. For example Wisenbaugh et al. [1], showed that single energy CT correctly differentiated non-uric vs uric acid stones in 40% of cases compared to DECT which accurately differentiated in 93% of cases. Similarly, Ascenti et al. [2] assessed low dose DECT in the detection and characterisation of renal calculi. The results assertained showed that DECT correctly identified renal stone composition in 100% of cases using a low dose protocol when compared with biochemical analysis. Aims and objectives 1. To quantify and analysis dual energy length products (mgycm) as absolute values and to compare them relative to the total body dose (mgycm) using a Toshiba Aquilion One Scanner. 2. To ascertain the percentage change in dose in dual energy CT scans of the urinary tract for the detection of the composition of renal calculi. 3. To discuss the benefits of using Dual energy CT as an investigation for the composition of renal calculi. Methods and materials Page 2 of 8
3 Retrospective collection of data over a period of 3 years from 69 patients who had undergone dual energy CT scans of the urinary tract for the detection of renal calculi using a Toshiba Aquilion One CT scanner. 5 patients were excluded from the study due to insufficient data leaving a total of 64 in the study (n=64). The types of stones included in the sample included uric acid, calcium oxalate, calcium phosphate and mixed composition renal calculi. Data was collected over a period of 2 years 9 months (October July 2014). Images for this section: Fig. 1: Toshiba Aquilion One Scanner. Reference: Department of Radiology, Singleton Hospital, Swansea, UK/2014. Page 3 of 8
4 Results 1. The mean total energy dose (mgycm): The mean relative value (total energy dose - dual energy dose/mgycm): On average there was a 19.68% increase in total body radiation dose over standard dose protocol in the detection of urate, calcium and mixed composition renal stones. 4. Two-paired T-test p > 0.18, therefore there was no signficant difference in radiation exposure between single CT dose protocol and Dual energy protocol. Images for this section: Page 4 of 8
5 Fig. 1: Toshiba Aquilion One Scanner. Reference: Department of Radiology, Singleton Hospital, Swansea, UK/2014. Fig. 2: By analyzing the data acquired in two different kv levels of the same anatomical region of a patient, the difference in the energy dependence of the attenuation coefficient of different materials provides information about the chemical composition of structures within the body. The blue line refers to calcium based calculi and the red denotes uric acid based calculi. Reference: Department of radiology, Singleton Hospital, Swansea, UK/2014. Page 5 of 8
6 Fig. 3: Shows the CaCO3/Uric acid analysis bar for the Toshiba Aquilion One Scanner. Reference: Department of Radiology, Singleton hospital, Swansea, UK/2014. Page 6 of 8
7 Conclusion In conclusion the increase radiation dose with DECT is not significantly different to that of a single dose CT scan. This is important due to the added risks that radiation exposure can pose to a patient. None of the currently available methods for stone composition analysis facilitates preoperative assessment; thus, individualizing optimal treatment according to stone composition in cases of recurrent calculi would be ideal [3,4]. An important advantage of dual-energy CT assessment of stone composition is that it enables preoperative analysis when the stone is first encountered. This is benefically from a patient centred view and also from a healthboard perspective. Research has shown that DECT has a high degree of accuracy on detecting stone composition. In combination with findings of this study showing that the dual energy radiation is not significantly different to that of single CT radiation protocols, it would be fair to conclude that DECT has a potential future in renal calculi management. Personal information References 1. Wisenbaugh ES, Paden RG, Silva AC, Humphreys MR. Dual-energy vs Conventional Computed Tomography in Determining Stone Composition. Urology. 2014;83(6): Ascenti G, Siragusa C, Racchiusa S, Ielo I, Privitera G, Midili, et al. Stone- Targeted Dual-Energy CT: A New Diagnostic Approach to Urinary Calculosis. dxdoiorg/102214/ajr Hidas,G., Eliahou, R., Duvdevani, M., Coulon, P., Lemaitre, L., Gofrit, O.N., Pode,D. & Sosna, J. Determination of renal stone composition with dual energy CT: In vivo analysis and comparison with X-ray diffraction. Radiology. 2010; 257: Page 7 of 8
8 4. Corbett J-H, Harmse WS. In vivo determination of renal stone composition with dualenergy computed tomography. S Afr J Rad. 2014;18: 1-5. Page 8 of 8
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