Individualized protocol for radiation and contrast medium dose reduction in one-stop assessment for kidney transplantation patients.Jia, X., et al.
European Journal of Radiology 2021; 140: 109757.
This study aimed to compare image quality, radiation, and contrast medium (CM) doses between standard scan protocols versus individualised protocols in combined coronary CT angiography (CCTA) and iliac artery CTA for renal transplant recipients.
Participants were randomly split into the individualized group and conventional group on the basis of single or even numbers.
148 patients requiring assessment for coronary and iliac arteries prior to kidney transplantation.
Subjective image quality, objective image quality, CM dose and radiation dose.
This trial in the pre-operative work-up of kidney transplant recipients compared standard CT angiogram protocol to an individualised protocol based on BMI. Patients were assigned to the study arms on the basis of even or odd numbers, which is not truly random. Unfortunately, this removes the possibility of allocation concealment and also calls into question the effectiveness of blinding the two radiologists assessing images for quality. The individualised CT protocol used patient BMI to adjust the contrast dose rates for simultaneous CT coronaries and CT iliac arteries. The authors report that the individualised protocol increased the subjective scoring for images of the coronary arteries, but not the iliac arteries. The objective image quality was significantly better in the individualised protocol group, using signal-to-noise ratio and contrast-to noise ratio. The patients with the individualised protocol received significantly lower contrast medium doses. No power calculation is presented so the study may be underpowered for some outcomes presented. Unfortunately, there are a few questions to answer with regards to the methodology of this study, and also many transplant units will not be using CT angiogram to evaluate all kidney recipients pre-operatively.