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Using barium as an internal radioprotective shield for pregnant patients undergoing CT pulmonary angiography: A retrospective study

Published:August 29, 2022DOI:https://doi.org/10.1016/j.ejmp.2022.08.014

      Highlights

      • Barium-based internal shielding during maternal CTPA limits PE assessment.
      • AEC increases tube current over the region of barium filled stomach.
      • Although restricting scan length to the top of left hemidiaphragm may overcome such limitations, it is not ideal for assessing the entire lungs.

      Abstract

      Purpose

      The purpose of our retrospective study was to assess the effect of barium sulfate contrast medium on radiation dose and diagnostic quality of CT Pulmonary Angiography (CTPA) in an in-vivo study of pregnant patients.

      Methods

      Our retrospective study included 33 pregnant patients who underwent CTPA to exclude pulmonary embolism. The patients received oral 40% w/v barium solution just prior to the acquisition of their planning radiograph. All CTPA were performed on 64-slice, single-source CT scanners with AEC with noise index = 28.62–31.64 and the allowed mA range of 100–450. However, only 5/33 patients had mA modulation (AEC 100–450 mA range), while 28/33 patients had mA maxed out at the set maximum mA of 450 over the entire scan range. We recorded CTDIvol (mGy), DLP (mGy.cm) and scan length. The same information was recorded in weight-and scanner-matched, non-pregnant patients. Statistical tests included descriptive data (median and interquartile range) and Mann-Whitney test.

      Results

      There were no significant differences in CTDIvol and DLP between the barium and control group patients (p > 0.1). The median mA below the diaphragm was significantly higher in each patient with barium compared to the weight and scanner-matched patient without barium. Evaluation of lung and subsegmental lower lobe pulmonary arteries was limited in 85% barium group. Due to thin prospective section thickness (1.25 mm), most patients were scanned at maximum allowed mA for AEC.

      Conclusion

      Use of AEC with thick barium in pregnant patients undergoing CTPA as an internal radioprotective shield produces counterproductive artifacts and tube current increments.

      Keywords

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