Chest computed tomography imaging practices of people with cystic fibrosis: insights from radiologists, radiographers, and pulmonologists

Objectives
The European Cystic Fibrosis Society - Clinical Trial Network (ECFS-CTN) is focused on optimising the use of chest CT, necessitating an understanding of current practices, dose reduction strategies, and variations across centres. These practices can differ significantly influenced by local expertise, available imaging modalities, and physician confidence. This study aimed to survey European centres to gain a detailed insight into chest CT practices and dose reduction techniques across the ECFS-CTN.

Methods
The survey, developed by ECFS-CTN experts, included 86 items tailored to CF specialist pulmonologist, radiologist and radiographer groups. It covered six domains including indications, protocols, optimisation practices, considerations for low-dose protocols, alternative imaging preferences, and perspectives on imaging scoring systems used for people with cystic fibrosis (PWCF).

Results
The survey attracted 54 respondents from various disciplines in CF centres across 11 European countries. Over 83% of radiologists and radiographers preferred using low-dose CT (LDCT) protocols for surveillance imaging of adult and paediatric PWCF, with 60% having a specific protocol for this purpose. There was no consensus on CT protocol optimisation, with varied approaches to designing low-dose protocols. Common strategies included iterative reconstruction (23/30), reducing mA (17/30), automated tube current modulation (15/30), and reducing kV (14/30). Both radiology (22/24) and pulmonology (22/29) professionals expressed concern about radiation exposure and believed patients shared these concerns (36/52). Most radiologists felt confident identifying CF imaging findings and tracking disease progression without scoring systems (17/22).

Conclusion
This study highlights the variability in imaging practices across disciplines and locations, emphasising the need for evidence-based guidelines to optimise and harmonise CT protocols for PWCF.