E3364. High-Pitch CT Protocol for Evaluation of Cardiothoracic Pathologies in Infants: Impact on Radiation, Image Quality and Patient Throughput
  1. Joshua Hunter; Case Western Reserve University School of Medicine
  2. Kaustav Bera; University Hospitals Cleveland Medical Center
  3. Leslie Ciancibello; University Hospitals Cleveland Medical Center
  4. Jennifer Sposato; University Hospitals Cleveland Medical Center
  5. Kianoush Ansari Gilani; University Hospitals Cleveland Medical Center
  6. Robert Gilkeson; University Hospitals Cleveland Medical Center
  7. Amit Gupta; University Hospitals Cleveland Medical Center
Unique challenges in imaging infants include an increased susceptibility to radiation’s harms and a relative inability to remain motionless during image acquisition, which hinders the utility of MRI without anesthesia. Dual-source CT (DSCT) scanners with high-pitch helical scanning (a.k.a. "Flash") capabilities offer a promising alternative, particularly in the pediatric population, to conventional CT protocols by reducing radiation exposure and accelerating image acquisition. In this study, we investigated the potential benefits, both clinical and operational, of Flash scanning in imaging infants with cardiothoracic abnormalities.

Materials and Methods:
Our retrospective single center study included 125 consecutive patients younger than 1 year who presented for CT assessment of complex cardiothoracic pathologies. 74 patients underwent ECG-gated scanning on a multidetector CT scanner (Control group) and 51 underwent ungated high-pitch scanning on a DSCT scanner (Flash group). These groups were compared in terms of: (i) radiation exposure, (ii) image quality, and (iii) patient throughput in the radiology department. Radiation exposure was assessed via radiation parameters extracted directly from the PACS. Image quality was evaluated qualitatively by two expert cardiothoracic radiologists and quantitatively with region of interest (ROI) analysis, each according to methods adapted from literature. Patient throughput was evaluated by extracting various examination timestamps, such as arrival time to Radiology department and examination end time, from PACS and calculating relevant time intervals.

Our study found that the Flash group achieved similar to better image quality with significantly less radiation exposure and superior patient throughout as compared to the control group. The Flash group experienced approximately 80% less radiation exposure across three primary measures: CTDI (mGy), DLP (mGy · cm), and effective dose (mSv). Image quality analyses, both qualitative and quantitative, demonstrated noninferiority of the Flash group across all measured metrics and superiority in several metrics. For example, qualitative analysis demonstrated a higher overall image quality rating in the Flash group (2.89 &#177; 0.60 vs. 2.69 &#177; 0.58, <em>p</em> = 0.006). Quantitative analysis revealed superior visualization of the left atrium and aorta, and noninferior visualization of the left ventricle and pulmonary artery. Lastly, the Flash group had 33% shorter examination times and 27% less time spent in the Radiology department, which both represent statistically significant decreases.

Our current study builds upon existing literature about the benefits of high-pitch CT protocols for cardiothoracic imaging in infants by showcasing its value across a relatively large study population with diverse pathologies. Additionally, our study demonstrates how high-pitch CT protocols can improve patient throughput. Thus, our study’s findings suggest that high-pitch CT for evaluation of cardiothoracic pathologies in infants offers both clinical and operational benefit.