Radiation dose comparison between V/P-SPECT and CT-angiography in the diagnosis of pulmonary embolism

Abstract

Purpose: The aim of this study is to compare two routine protocols at our institution, CTPA and V/P-SPECT, in terms of radiation dose to the most exposed organs (lungs and breast) and to the embryo/fetus in the case of pregnant patients.

Methods: At our institution, the CTPA protocol includes a contrast enhanced CT (scan parameters: 100kVp, 700mA, 0.5s/rot, pitch 0.984) and in some cases a non-contrast enhanced CT acquisition (120kVp, 400mA, 0.5s/rot, pitch 1.375). In the V/P-SPECT protocol, ventilation SPECT was performed after inhalation of 99mTc-Technegas, reaching 30MBq in the lungs; perfusion was performed after intravenous administration of 60-120MBq of 99mTc-MAA. The absorbed doses (mGy) to lungs and breast from CTPA were estimated using the "ImPACT CT Patient Dosimetry Calculator". The embryo/fetus dose was estimated for different gestational stages (0-7, 8-12, 13-25 and 26-40weeks) using the web based calculation tool "COnceptus Dose Estimation" (CODE). Doses to organs and embryo/fetus from V/P-SPECT were estimated based on published dose data normalized to administered activity (mGy/MBq).

Results: Embryo/fetus absorbed doses are similar for CTPA and V/P-SPECT and bellow 1mGy. The calculated dose to the lungs (breast) was 1.3-10.6 (27-136) times higher from CTPA when compared with V/P-SPECT.

Conclusion: For the diagnosis of PE in women, if both imaging modalities are available, it is recommended to proceed with V/P-SPECT rather than CTPA due to the considerably lower radiation dose to the breast.