Problems of Radiation Medicine and Radiobiology

A. A. Melnykova¹, S. V. Fedkiv²

¹Municipal Non"Profit Enterprise «Mykolaiv Regional Oncology Center» of the Mykolaiv Regional Council, 18 Mykolaivska St., Mykolaiv, 54018, Ukraine
² State Institution «Shupyk National Healthcare University of Ukraine», 9 Dorohozhytska St., Kyiv, 04112, Ukraine

TARGETED MULTISLICE COMPUTED TOMOGRAPHY FOR MONITORING LIKELY BENIGN PULMONARY INCIDENTALOMAS: TECHNIQUE AND CLINICAL CASES

Background. Incidental detection of pulmonary nodules remains a common diagnostic challenge in modern clinical practice. According to international guidelines, such findings often require repeated, long-term surveillance using follow-up imaging. Given the growing number of patients who need prolonged monitoring and the necessity to minimize cumulative radiation exposure, optimization of multislice computed tomography (MSCT) protocols has become paramount. The development and implementation of targeted, ultra-low-dose scanning approaches enable the acquisition of reproducible and highly informative diagnostic data while substantially reducing radiation dose. This is a key component in managing low-risk patients and forms the basis for personalized follow-up strategies that enhance safety in radiological imaging.
Objective: to scientifically validate, develop, and evaluate a targeted MSCT protocol for the monitoring of probably benign pulmonary nodules, and to evaluate its diagnostic performance and radiation exposure against a standard full-dose protocol to determine its clinical utility for routine application.
Materials and Methods. The study included 92 patients of the Mykolaiv Regional Oncology Center with incidentally detected solitary pulmonary nodules up to 15 mm requiring dynamic follow-up. Inclusion criteria were probably benign morphology and at least one previous follow-up imaging study. A known oncologic history or imaging suspicion of malignancy served as exclusion criteria.Scanning was performed on a 64-slice Revolution Maxima CT scanner (GE, USA) in the supine position during a breath-hold. A standard full-dose protocol (A) and a targeted protocol (B) were compared in terms of radiation exposure (CTDIvol, DLP) and diagnostic quality. Nodule dynamics were assessed using identical reconstruction parameters (slice thickness 1.25 mm, interval 1 mm, lung and mediastinal windows) with repeated measurements by two independent radiologists.
Results. The targeted protocol B reduced DLP by more than eight-fold (27.8 vs. 229.5 mGy·cm) and lowered CTDIvol by approximately 40 %, resulting in an 85 % reduction of effective dose, while maintaining high image quality. A total of 88 % of nodules remained stable, 7.6 % showed minor changes, and 4.3 % required surgical intervention, all demonstrating benign histology. Protocol B reliably differentiated stable incidentalomas from lesions requiring intervention, with minimal radiation exposure.
Conclusions. The developed targeted MSCT protocol is safe and effective for dynamic monitoring of probably benign pulmonary nodules. It significantly reduces cumulative radiation exposure without compromising diagnostic accuracy and should be integrated into routine radiological practice.
Key words: pulmonary nodules; lung masses; chest radiography; multislice computed tomography; targeted scanning; dynamic follow-up; radiation exposure.

Problems of Radiation Medicine and Radiobiology.
2025;30:501-512. doi: 10.33145/2304-8336-2025-30-501-512

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