Patient Dose in the Diagnosis of PE
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1 Patient Dose in the Diagnosis of PE IZAAZ BADSHAH 2018 CANM-CAMRT Joint Annual Meeting March 22-24, 2018
2 Disclosure I do not have a financial interest, arrangement or affiliation including receipt of honoraria or expenses with a commercial organization that may have a direct interest in the subject matter of my presentation
3 What is PE?
4 What is PE? A pulmonary embolism (PE) is a thrombus (clot) in the lungs Usually originates from the legs or pelvis It impairs blood flow and increases pressure on the heart It can be fatal 1 Multiple pulmonary emboli. Digital Image. Smart Servier Medical Art. Oct March 5, <
5 Diagnosing PE Ventilation-Perfusion Scan Computed Tomography Pulmonary Angiogram VQ Scan. Digital image. Some cases plus more. 20 Feb March < CTPA Scan. Digital Image. University of Virginia March <
6 Radiation Exposure Review Absorbed dose a measure of the energy deposited by ionizing radiation into the tissue (units are Gy) Effective dose Absorbed dose x RWF x TWF (units are Sv) Allows us to compare the health risks of radiation exposures to the whole body, between multiple exposures 2
7 VQ Scan 2 parts = ventilation and perfusion 3 Ventilation 99m Tc-DTPA or Technegas Historically 81m Kr and 133 Xe Perfusion 99m Tc-MAA
8 VQ Scan Dose Radiopharmaceutical Dose (MBq) Patient Dose (msv) DTPA Technegas MAA MBq Technegas MBq 99m Tc-MAA = 2.21 msv
9 VQ Scan Dose Radiopharmaceutical Dose (MBq) Patient Dose (msv) DTPA Technegas MAA MBq Technegas MBq 99m Tc-MAA = 2.21 msv
10 VQ Scan Dose Radiopharmaceutical Dose (MBq) Patient Dose (msv) DTPA Technegas MAA MBq Technegas MBq 99m Tc-MAA = 2.21 msv
11 VQ Scan Dose Radiopharmaceutical Dose (MBq) Patient Dose (msv) DTPA Technegas MAA MBq Technegas MBq 99m Tc-MAA = 2.21 msv
12 VQ Scan Dose Radiopharmaceutical Dose (MBq) Patient Dose (msv) DTPA Technegas MAA MBq Technegas MBq 99m Tc-MAA = 2.21 msv
13 CTPA Dose CTPA dose varies quite dramatically kvp, mas, slice thickness, pitch, etc. Exposure from 1.0 msv to 21.0 msv 6,7,8 Modern doses are on the lower end of the range 6,8
14 CTPA Scan kvp = beam of energy ( kvp = penetration of tissue + dose) 9 mas = product of tube current and time ( mas = image quality + dose) Ex. 120 kvp, 200 mas 7 = 21 msv
15 CTPA Scan kvp = beam of energy ( kvp = penetration of tissue + dose) 9 mas = product of tube current and time ( mas = image quality + dose) Ex. 120 kvp, 200 mas 7 = 21 msv
16 PE in Pregnancy PE is 5 times higher in pregnancy 7 Fetus and maternal breast tissue growing High radioactive exposures can: Lead to developmental abnormalities for the fetus ( > 50 mgy) 7 Lead to an increased risk of cancer for the mother, later in life 10
17 VQ Scan Pregnancy Exposure Perfusion only study with a lower dose 6 Reduced ventilation, reduced perfusion study Study Maternal Dose (msv) Breast Dose Fetus Dose Avg Perfusion Only Reduced Full VQ Normal VQ Study
18 VQ Scan Pregnancy Exposure Perfusion only study with a lower dose 6 Reduced ventilation, reduced perfusion study Study Maternal Dose (msv) Breast Dose Fetus Dose Avg Perfusion Only Reduced Full VQ Normal VQ Study
19 VQ Scan Pregnancy Exposure Perfusion only study with a lower dose 6 Reduced ventilation, reduced perfusion study Study Maternal Dose (msv) Breast Dose Fetus Dose Avg Perfusion Only Reduced Full VQ Normal VQ Study
20 VQ Scan Pregnancy Exposure Perfusion only study with a lower dose 6 Reduced ventilation, reduced perfusion study Study Maternal Dose (msv) Breast Dose Fetus Dose Avg Perfusion Only Reduced Full VQ Normal VQ Study
21 CTPA Pregnancy Exposure The settings (kvp, mas, etc.) are altered to reduce maternal and fetal doses 8 Weight (kg) kvp mas < * weight >
22 CTPA Pregnancy Exposure The settings (kvp, mas, etc.) are altered to reduce maternal and fetal doses 8 Weight (kg) kvp mas < * weight >
23 CTPA Pregnancy Exposure The settings (kvp, mas, etc.) are altered to reduce maternal and fetal doses 8 Weight (kg) kvp mas < * weight >
24 CTPA Pregnancy Exposure The settings (kvp, mas, etc.) are altered to reduce maternal and fetal doses 8 Weight (kg) kvp mas < * weight >
25 CTPA Pregnancy Exposure The settings (kvp, mas, etc.) are altered to reduce maternal and fetal doses 8 Weight (kg) kvp mas < * weight >
26 CTPA Pregnancy Exposure Patient BMI (kg/m 2 ) 8 Maternal Dose (msv) Breast Dose Fetal Dose >
27 CTPA Pregnancy Exposure Patient BMI (kg/m 2 ) 8 Maternal Dose (msv) Breast Dose Fetal Dose >
28 CTPA Pregnancy Exposure Patient BMI (kg/m 2 ) 8 Maternal Dose (msv) Breast Dose Fetal Dose >
29 CTPA Pregnancy Exposure Patient BMI (kg/m 2 ) 8 Maternal Dose (msv) Breast Dose Fetal Dose >
30 CTPA Pregnancy Exposure Patient BMI (kg/m 2 ) 8 Maternal Dose (msv) Breast Dose Fetal Dose >
31 CTPA Pregnancy Exposure Patient BMI (kg/m 2 ) Breast Dose Breast Dose Late Fetal Dose Fetal Dose Late >
32 CTPA Pregnancy Exposure Patient BMI (kg/m 2 ) Breast Dose Breast Dose Late Fetal Dose Fetal Dose Late >
33 CTPA Pregnancy Exposure Patient BMI (kg/m 2 ) Breast Dose Breast Dose Late Fetal Dose Fetal Dose Late >
34 Summary PE can be a fatal disease VQ and CTPA can be used to diagnose a PE Pregnant women are at a greater risk of having a PE VQ + CTPA parameters are reduced for pregnant women CTPA for pregnant women are very dependent on BMI
35 VQ vs CTPA Exposure Summary Maternal Effective Dose VQ CTPA Maternal Breast Absorbed Dose VQ < CTPA Fetal Absorbed Dose VQ = CTPA
36 VQ vs CTPA Exposure Summary Maternal Effective Dose VQ CTPA Maternal Breast Absorbed Dose VQ < CTPA Fetal Absorbed Dose VQ = CTPA
37 VQ vs CTPA Exposure Summary Maternal Effective Dose VQ CTPA Maternal Breast Absorbed Dose VQ < CTPA Fetal Absorbed Dose VQ = CTPA
38 VQ vs CTPA Exposure Summary Maternal Effective Dose VQ CTPA Maternal Breast Absorbed Dose VQ < CTPA Fetal Absorbed Dose VQ = CTPA
39 ACKNOWLEDGEMENTS
40 References 1. Lavorini, F., Di Bello, V., De Rimini, M., Lucignani, G., Marconi, L., & Palareti, G. et al. (2013). Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach. Multidisciplinary Respiratory Medicine, 8(1), Radiation doses - Canadian Nuclear Safety Commission. (2018). Nuclearsafety.gc.ca. Retrieved 5 March 2018, from 3. Roach, P., Schembri, G., & Bailey, D. (2013). V/Q Scanning Using SPECT and SPECT/CT. Journal Of Nuclear Medicine, 54(9), Parker, J., Coleman, R., Grady, E., Royal, H., Siegel, B., & Stabin, M. et al. (2012). SNM Practice Guideline for Lung Scintigraphy 4.0. Journal Of Nuclear Medicine Technology, 40(1),
41 References Continued 5. Mattsson, S., Johansson, L., Leide Svegborn, S., Liniecki, J., Noßke, D., & Riklund, K. et al. (2015). ICRP Publication 128: Radiation Dose to Patients from Radiopharmaceuticals: a Compendium of Current Information Related to Frequently Used Substances. Annals Of The ICRP, 44(2_suppl), Isidoro, J., Gil, P., Costa, G., Pedroso de Lima, J., Alves, C., & Ferreira, N. (2017). Radiation dose comparison between V/P-SPECT and CTangiography in the diagnosis of pulmonary embolism. Physica Medica, 41, Astani, S., Davis, L., Harkness, B., Supanich, M., & Dalal, I. (2014). Detection of pulmonary embolism during pregnancy. Nuclear Medicine Communications, 35(7),
42 References Continued 8. Perisinakis, K., Seimenis, I., Tzedakis, A., & Damilakis, J. (2014). Perfusion Scintigraphy Versus 256-Slice CT Angiography in Pregnant Patients Suspected of Pulmonary Embolism: Comparison of Radiation Risks. Journal Of Nuclear Medicine, 55(8), Raman, S., Mahesh, M., Blasko, R., & Fishman, E. (2013). CT Scan Parameters and Radiation Dose: Practical Advice for Radiologists. Journal Of The American College Of Radiology, 10(11), Freeman, L. (2007). Don't Bury the V/Q Scan: It's as Good as Multidetector CT Angiograms with a Lot Less Radiation Exposure. Journal Of Nuclear Medicine, 49(1), 5-8.
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