Abstract
Background: To promote standardisation of practice and sharing of knowledge, the European Cystic Fibrosis Society – Clinical Trial Network (ECFS-CTN) Imaging Standardisation Working Group was formed in 2022 (comprised of radiologists, medical physicists, pulmonologists - paediatric and adult, statisticians, CTN and Cystic Fibrosis Europe representatives from 13 different European countries). Building upon a pan-European survey of CF centres to assess practice of thoracic CT (2022), a sub-group was formed to focus on the development of guidance for the use of chest-CT in children and adults (2022-2024).
Methods: A 3-step process was followed to develop guidance for the use of chest-CT for regular monitoring of lung disease in CF and in special situations (such as haemoptysis, aspergillus-related lung disease, non-tuberculous mycobacterial infection and pneumothorax): (i) An pan-European online survey to identify key questions, (ii) a comprehensive literature search and (iii) a 3-round Delphi process to obtain collective opinion regarding key recommendations.
Results: The Delphi process informed guideline recommendations with consensus on the following statements: (i) the use of effective communication strategies using "de-medicalised" information for shared decision making between patients and physicians to develop a better understanding and improved decision-making process; (ii) performing ultra-low dose CT scans in every institution should be considered a priority in the management of people with CF; (iii) a typical ultra-low dose CT scan is defined as an effective radiation dose of approximately 0.08 mSv; as low as the equivalent of 2 to 4 chest X-rays; (iv) the use of a national tracking system (or radiation passport) integrated into the electronic patient record to monitor cumulative radiation dose; (v) chest CT should not be routinely used in very young infants if other parameters are satisfactory; (vi) the time interval between 2 consecutive CT scans adapted to the clinical picture; (vii) CT imaging follow up should be performed according to the clinical picture; and (viii) chest CT is justified in the presence of haemoptysis and multiple NTM-positive cultures. However, consensus could not be reached regarding systematic use of chest CT scans with lung volume monitoring in both children and adults, with the recommendation being use lung volume monitoring CT scanning only when necessary, and if used in cooperative children of school age and older, lung volume during HRCT should be optimised through coaching by staff trained in this technique. Likewise, no consensus could be reached on the use of CT prior to insertion of a chest tube in the case of pneumothorax.
Conclusions: The ultimate responsibility for justifying CT of a patient’s chest lies with the professionals directly involved in the treatment. The final decision may be influenced by indications, cost, expertise, available equipment and techniques, resources, the patient’s values, and possible changes in treatment modalities. The guidelines recommend the use of ultra-low-dose CT scans and a system for tracking cumulative radiation per patient. Further studies are needed to evaluate the long-term impact of systematic versus as-needed chest CT in PwCF, particularly in children.
Methods: A 3-step process was followed to develop guidance for the use of chest-CT for regular monitoring of lung disease in CF and in special situations (such as haemoptysis, aspergillus-related lung disease, non-tuberculous mycobacterial infection and pneumothorax): (i) An pan-European online survey to identify key questions, (ii) a comprehensive literature search and (iii) a 3-round Delphi process to obtain collective opinion regarding key recommendations.
Results: The Delphi process informed guideline recommendations with consensus on the following statements: (i) the use of effective communication strategies using "de-medicalised" information for shared decision making between patients and physicians to develop a better understanding and improved decision-making process; (ii) performing ultra-low dose CT scans in every institution should be considered a priority in the management of people with CF; (iii) a typical ultra-low dose CT scan is defined as an effective radiation dose of approximately 0.08 mSv; as low as the equivalent of 2 to 4 chest X-rays; (iv) the use of a national tracking system (or radiation passport) integrated into the electronic patient record to monitor cumulative radiation dose; (v) chest CT should not be routinely used in very young infants if other parameters are satisfactory; (vi) the time interval between 2 consecutive CT scans adapted to the clinical picture; (vii) CT imaging follow up should be performed according to the clinical picture; and (viii) chest CT is justified in the presence of haemoptysis and multiple NTM-positive cultures. However, consensus could not be reached regarding systematic use of chest CT scans with lung volume monitoring in both children and adults, with the recommendation being use lung volume monitoring CT scanning only when necessary, and if used in cooperative children of school age and older, lung volume during HRCT should be optimised through coaching by staff trained in this technique. Likewise, no consensus could be reached on the use of CT prior to insertion of a chest tube in the case of pneumothorax.
Conclusions: The ultimate responsibility for justifying CT of a patient’s chest lies with the professionals directly involved in the treatment. The final decision may be influenced by indications, cost, expertise, available equipment and techniques, resources, the patient’s values, and possible changes in treatment modalities. The guidelines recommend the use of ultra-low-dose CT scans and a system for tracking cumulative radiation per patient. Further studies are needed to evaluate the long-term impact of systematic versus as-needed chest CT in PwCF, particularly in children.
Original language | English |
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Article number | 168 |
Pages (from-to) | S94 |
Number of pages | 1 |
Journal | Journal of Cystic Fibrosis |
Volume | 23 |
Issue number | Supplement 2 |
DOIs | |
Publication status | Published - 26 Sept 2024 |
Event | North American Cystic Fibrosis Conference - NACFC Boston, Boston, United States Duration: 26 Sept 2024 → 28 Sept 2024 https://www.nacfconference.org/ |
Keywords
- cystic fibrosis
- guidance
- chest CT
- CT imaging
- children
- adults
ASJC Scopus subject areas
- Medicine(all)