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CC BY-NC-ND 4.0 · Indian J Radiol Imaging
DOI: 10.1055/s-0044-1801835
Letter to the Editor

Unindicated Acquisition of Multiple Phases in CT/CT Part of PET CT at Scan Centers and Hospitals: Let Us Avoid It and Move toward Optimized Imaging

Anitha Sen 
1   Department of Radiodiagnosis, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
,
Jiji Valsalamony
1   Department of Radiodiagnosis, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Since we work in a tertiary care hospital, we get many computed tomography (CT) and positron emission tomography CT (PET-CT) scans done in other centers for review.

Recently, we have observed an increasing trend of acquisition of multiple phases for body CT scans, for all indications (including breast carcinoma): as triple phase (arterial, portal, and venous) studies in many centers and as arterial, venous, and delayed (for liver/abdomen) phases in some centers. In a few cases, noncontrast, arterial, portal, venous, and delayed images (five-phase/quintuple studies) have been acquired. Sometimes unindicated multiphase studies are also noted in the CT part of PET-CT studies.

Acquiring unnecessary phases, may be to avoid issues like recalling patients, in case an indeterminate lesion is detected on CT (this practice may be more in centers having teleradiology practice, since radiologists may not be available to do ultrasound correlation or to report continuation study done on another day).

However, performing a multiphase study in all patients is not desirable due to the following reasons:

  1. Increased radiation exposure to the patient.

  2. Increased amount of intravenous contrast needed for a multiphase study (at least 10 mL or more depending on institutional practices/machines), which may (1) increase the cost of the study and (2) push patients with borderline renal function to renal impairment.

  3. Decreased lifespan of CT tube due to more exposure time of tube.

  4. Time wastage for radiology technicians in printing more films/writing compact disk (CD)/uploading films/CDs to Picture Archiving and Communication System (PACS, if films/CDs are used for transferring images to the next level care like hospitals/referral centers). A CD is usually sufficient to record all phases of a study, but studies with multiple phases, may take more time for writing/opening/uploading CD.

  5. Time wastage for radiologists reporting/reviewing images and other clinicians viewing images (e.g., radiation oncologists seeing images for radiation therapy [RT] planning) while going through lots of unnecessary images.

  6. Storage space is unnecessarily used up on cloud/onsite server if such studies are uploaded on PACS. Maintaining server farms requires a lot of electricity, with generation of more electricity potentially causing global warming.

Usually, triple-phase (arterial, portal, and venous) CT studies are done for specific indications like characterization of liver lesions (if there is a confusion on ultrasound or CT or CT part of PET-CT) and identification of hepatocellular carcinoma (HCC) in a setting of cirrhotic liver. Presurgical evaluation of tumors (pancreas, kidney, liver, adrenals, mediastinum, lung, parathyroid) and vascular lesions (in any part of the body), and postoperative/traumatic bleeding or hematoma (to look for pseudoaneurysm/source of bleed) are other indications for multiphase studies. But most CT studies do not routinely require multiphase studies.

We find this trend of acquiring multiple phases in CT study for all patients in many scan centers and also in some hospitals. We would like to raise awareness about this issue so that, unindicated acquisition of multiple phases for CT studies/CT component of the PET-CT studies can be minimized. This would be in consonance with the practice of green and sustainable radiology.[1] [2] [3]

Meeting

The manuscript has not been presented as a part of at any meeting.




Publication History

Article published online:
17 February 2025

© 2025. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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