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Publication

Impact of contrast media on image quality and radiation-induced DNA damage

Book - Dissertation

Iodine-based contrast media are used in CT imaging to increase image contrast in blood vessels and well perfused organs. The level of this CT image contrast is a complex interaction of numerous factors divided into patient-related, scanner-related, and contrast media-related factors. Considering the constant innovations in CT technology, the use of contrast media – particularly the injection protocol - has to evolve as well. In this work, I optimized the scan and injection protocol by evaluating their impact on the balance between image quality, radiation dose, and contrast media iodine dose.
In the first part of the thesis, I evaluated strategies to reduce contrast media iodine dose while maintaining the diagnostic quality of the CT scan. All these experiments were performed in a preclinical minipig model. Chapter I describes that a contrast media iodine dose reduction can be achieved by combining a low tube voltage scan protocol with iterative reconstruction techniques in a coronary CT angiography study. This was studied by comparing the image quality of a standard of care scan protocol with two low iodine dose study protocols. Even the CT images of the lowest iodine dose study protocol, with a 50% iodine dose reduction, were observed to be of diagnostic quality. In chapter II, I compared
time enhancement curves of injection protocols with different contrast media iodine concentrations, administered at constant iodine delivery rate and total iodine dose. We found that injection protocols with a reduced iodine concentration result in a diagnostically beneficial higher maximal enhancement and longer enhancement peak duration.
Another aspect concerning patient safety is the impact of contrast media on patient radiation dose. In the second part of this work, I evaluated the relationship between contrast media and radiation-induced DNA damage. In chapter III, we evaluated the amount of radiation-induced DNA damage of coronary CT angiography scans with three different contrast media iodine dose levels (0, 9.6, and 19.2 gI), scanned at a constant CTDIvol in a preclinical minipig model. The results showed that the presence of contrast media significantly increases radiation-induced DNA damage suggesting that a reduced contrast media iodine dose will result in a lower level of DNA damage. Subsequently, the contrast media iodine dose-dependency of radiation-induced DNA damage was evaluated in a clinical study on coronary CT angiography patients (chapter IV). This study confirmed that contrast media iodine dose increases the level of radiation-induced DNA damage in a linear dose-dependent manner, meaning that the level of DNA damage can be reduced by lowering the administered iodine dose.
Number of pages: 94
Publication year:2022
Keywords:Iodine-based contrast media, CT imaging, contrast, complex interaction
  • ORCID: /0000-0002-8937-9488/work/117747072
Accessibility:Closed