Split-bolus single-phase versus single-bolus split-phase CT acquisition protocols for staging in patients with testicular cancer: A retrospective study

• Published in: Radiography (London, England. 1995) Vol. 30; no. 2; pp. 628 - 633
• Main Authors: O'Regan, P.W., Dewhurst, C., O'Mahony, A.T., O'Regan, C., O'Leary, V., O'Connor, G., Ryan, D., Maher, M.M., Young, R.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.03.2024
• Subjects: Adult; Computed tomography methods; Contrast Media; Human; Humans; Male; Neoplasms, Germ Cell and Embryonal; Radiation dosage; Retrospective Studies; Testicular Neoplasms - diagnostic imaging; Tomography; Tomography, X-Ray Computed - methods; X-Ray; Computed tomography methods; Human; CED; PACS; CNR; DLP; kV; HU; ROI; Radiation dosage; CT TAP; CT; SD; mA; SNR; Tomography; X-Ray; Adult; ED
• ISSN: 1078-8174; 1532-2831; 1532-2831
• DOI: 10.1016/j.radi.2024.01.020

Computed tomography (CT) imaging has become indispensable in the management of medical oncology patients. Risks associated with high cumulative effective dose (CED) are relevant in testicular cancer patients. Split-bolus protocols, whereby the contrast medium injection is divided into two, followed by combining the required phase images in a single scan acquisition has been shown to provide images of comparable image quality and less radiation dose compared to single-bolus split-phase CT for various indications. We retrospectively evaluated the performance of split-bolus and single-bolus protocols in patients having follow-up CT imaging for testicular cancer surveillance. 45 patients with testicular cancer undergoing surveillance CT imaging of the thorax, abdomen, and pelvis who underwent split-bolus and single-bolus protocols were included. Quantitative image quality analysis was conducted by placing region of interests in pre-defined anatomical sub-structures within the abdominal cavity. The signal-to-noise ratio (SNR) and radiation dose in the form of dose length product (DLP) and effective dose (ED) were recorded. The DLP and ED for the single-bolus, split-phase acquisition was 506 ± 89 mGy cm and 7.59 ± 1.3 mSv, respectively. For the split-bolus, single-phase acquisition, 397 ± 94 mGy∗cm and 5.95 ± 1.4 mSv, respectively (p < 0.000). This represented a 21.5 % reduction in radiation dose exposure. The SNR for liver, muscle and fat for the single-bolus were 7.4, 4.7 and 8, respectively, compared to 5.5, 3.8 and 7.4 in the split-bolus protocol (p < 0.001). In a testicular cancer patient cohort undergoing surveillance CT imaging, utilization of a split-bolus single-phase acquisition CT protocol enabled a significant reduction in radiation dose whilst maintaining subjective diagnostic acceptability. Implications for Practice: Use of split-bolus, single-phase acquisition has the potential to reduce CED in surveillance of testicular cancer patients.