Abdominal Imaging

, Volume 35, Issue 5, pp 596–601 | Cite as

CT colonography versus double-contrast barium enema for screening of colorectal cancer: comparison of radiation burden

  • Emanuele Neri
  • Lorenzo Faggioni
  • Francesca Cerri
  • Francesca Turini
  • Simone Angeli
  • Lorenzo Cini
  • Franco Perrone
  • Fabio Paolicchi
  • Carlo Bartolozzi
Article

Abstract

Our aim is to compare the radiation dose associated with a low-dose CT colonography (CTC) protocol for colorectal cancer screening with that delivered by double-contrast barium enema (DCBE). CTC of twenty asymptomatic individuals (M:F = 10:10) participating to a colorectal cancer screening program and DCBE of fifteen patients (M:F = 6:9) were evaluated. For CTC, absorbed dose was determined by calculating the dose-length product for each CTC examination from measurements on a CT dose phantom equipped with a CT ion chamber. For DCBE, the free-in-air Kerma at the patient’s X-ray entry surface and the Kerma-area product during fluoroscopy and fluorography were measured with a Barracuda system, with fluoroscopy times being recorded blinded to the performing operator. Effective dose at CTC was 2.17 ± 0.12 mSv, with good and excellent image quality in 14/20 (70%) and 6/20 cases (30%), respectively. With DCBE, effective patient dose was 4.12 ± 0.17 mSv, 1.9 times greater than CTC (P < 0.0001). Our results show that effective dose from screening CTC is substantially lower than that from DCBE, suggesting that CTC is the radiological imaging technique of the large bowel with the lowest risk of stochastic radiation effects.

Keywords

Computed tomographic colonography Multidetector computed tomography Double-contrast barium enema Radiation dose Colorectal cancer screening 

References

  1. 1.
    Jemal A, Murray T, Ward E, et al. (2005) Cancer statistics, 2005. CA Cancer J Clin 55(1):10–30CrossRefPubMedGoogle Scholar
  2. 2.
    Nelson NJ (2008) Virtual colonoscopy accepted as primary colon cancer screening test. J Natl Cancer Inst 100(21):1492–1499CrossRefPubMedGoogle Scholar
  3. 3.
    Brenner DJ, Georgsson MA (2005) Mass screening with CT colonography: should the radiation exposure be of concern? Gastroenterology 129(1):328–337CrossRefPubMedGoogle Scholar
  4. 4.
    International Commission on Radiological Protection (1991) 1990 recommendations of the international commission of radiological protection, publication no. 60. In: Smith H, (ed). Annals of the ICRP, vol 21. Oxford: Pergamon Press, pp 1–3Google Scholar
  5. 5.
    Hospital Physicists’ Association (Diagnostic Radiology Topic Group) (1977) The physics of radiodiagnostics: scientific report series, vol 6. LondonGoogle Scholar
  6. 6.
    Hirofuji Y, Aoyama T, Koyama S, Kawaura C, Fujii K (2009) Evaluation of patient dose for barium enemas and CT colonography in Japan. Br J Radiol 82:219–227CrossRefPubMedGoogle Scholar
  7. 7.
    Kemerink GJ, Borstlap ACW, Frantzen MJ, et al. (2001) Patient and occupational dosimetry in double contrast barium enema examinations. Br J Radiol 74:420–428PubMedGoogle Scholar
  8. 8.
    Graser A, Wintersperger BJ, Suess C, Reiser MF, Becker CR (2006) Dose reduction and image quality in MDCT colonography using tube current modulation. AJR Am J Roentgenol 187:695–701CrossRefPubMedGoogle Scholar
  9. 9.
    Macari M, Bini EJ, Xue X, et al. (2002) Colorectal neoplasms: prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy for detection. Radiology 224:383–392CrossRefPubMedGoogle Scholar
  10. 10.
    Schopphoven S, Faulkner K, Busch HP (2008) Assessment of patient organ dose in CT virtual colonoscopy for bowel cancer screening. Radiat Prot Dosimetry 129:179–183CrossRefPubMedGoogle Scholar
  11. 11.
    Sugiyama A, Ohashi Y, Gomi A, et al. (2007) Colorectal screening with single scan CT colonography in children. Pediatr Surg Int 23:987–990CrossRefPubMedGoogle Scholar
  12. 12.
    Wang J, Wang S, Li L, et al. (2008) Virtual colonoscopy screening with ultra low-dose CT and less-stressful bowel preparation: a computer simulation study. IEEE Trans Nucl Sci 55:2566–2675CrossRefPubMedGoogle Scholar
  13. 13.
    Branschofsky M, Vogt C, Aurich V, et al. (2006) Feasibility of ultra-low-dose multi-detector-row CT-colonography: detection of artificial endoluminal lesions in an in vitro-model with optimization of image quality using a noise reduction filter algorithm. Eur J Med Res 11:13–19PubMedGoogle Scholar
  14. 14.
    Taylor SA, Halligan S, Bartram CI, et al. (2003) Multi-detector row CT colonography: effect of collimation, pitch, and orientation on polyp detection in a human colectomy specimen. Radiology 229:109–118CrossRefPubMedGoogle Scholar
  15. 15.
    Laghi A, Iannaccone R, Mangiapane F, et al. (2003) Experimental colonic phantom for the evaluation of the optimal scanning technique for CT colonography using a multidetector spiral CT equipment. Eur Radiol 13:459–466PubMedGoogle Scholar
  16. 16.
    McCollough CH (2002) Optimization of multidetector array CT acquisition parameters for CT colonography. Abdom Imaging 27:253–259PubMedGoogle Scholar
  17. 17.
    Dalrymple NC, Prasad SR, El-Merhi FM, Chintapalli KN (2007) Price of isotropy in multidetector CT. Radiographics 27:49–62CrossRefPubMedGoogle Scholar
  18. 18.
    Luz O, Buchgeister M, Klabunde M, et al. (2007) Evaluation of dose exposure in 64-slice CT colonography. Eur Radiol 17:2616–2621CrossRefPubMedGoogle Scholar
  19. 19.
    Jensch S, van Gelder RE, Venema HW, et al. (2006) Effective radiation doses in CT colonography: results of an inventory among research institutions. Eur Radiol 16:981–987CrossRefPubMedGoogle Scholar
  20. 20.
    Liedenbaum MH, Venema HW, Stoker J (2008) Radiation dose in CT colonography—trends in time and differences between daily practice and screening protocols. Eur Radiol 18:2222–2230CrossRefPubMedGoogle Scholar
  21. 21.
    Geleijns J, Broerse JJ, Shaw MP, et al. (1997) Patient dose due to colon examination: dose assessment and results from a survey in the Netherlands. Radiology 204:553–559PubMedGoogle Scholar
  22. 22.
    Yanch JC, Behrman RH, Hendricks MJ, McCall JH. Increased radiation dose to overweight and obese patients from radiographic examinations. Radiology 2009. doi: 10.1148/radiol.2521080141

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Emanuele Neri
    • 1
  • Lorenzo Faggioni
    • 1
  • Francesca Cerri
    • 1
  • Francesca Turini
    • 1
  • Simone Angeli
    • 1
  • Lorenzo Cini
    • 1
  • Franco Perrone
    • 2
  • Fabio Paolicchi
    • 1
  • Carlo Bartolozzi
    • 1
  1. 1.Diagnostic and Interventional RadiologyUniversity of PisaPisaItaly
  2. 2.Department of PhysicsUniversity of PisaPisaItaly

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