A review of the benefits and rationale of viewing liver window settings for abdominal computed tomography scans

Abstract There have been many different opinions over the efficacy of routinely incorporating liver window settings in abdominal computed tomography (CT) scans. As a result, different clinical centres have varying protocols for incorporating liver‐windows for abdominal CT scans. This investigation aims to explore and determine whether various clinical centres throughout Victoria use liver‐window settings selectively or routinely and their justification for doing so. An additional purpose is also to assess the benefits and rationale of liver‐window settings in supplementing routine soft‐tissue‐windows for abdominal CT examinations by reviewing evidenced‐based studies. Surveys were sent out to CT supervisors at various clinical centres, including private and public institutions. This achieved an overall response rate of 74 per cent. Results indicate that the majority of clinical centres throughout Victoria routinely incorporate liver‐window settings for all abdominal CT examinations. Forty four per cent (11/25) of respondents stated that they utilise liver‐window settings selectively for abdominal CT examinations. Most of these respondents (7/11 = 63 per cent) believed that soft‐tissue‐window settings alone are adequate to demonstrate hepatic lesions; particularly if intravenous contrast media is used and the liver is captured in the arterial, venous and/or delayed phases. The benefits and rationale of incorporating liver‐window settings for all abdominal computed tomography scans has been questioned by two well noted studies in the United States. These evidence‐based studies suggest that such additional settings do not offer further advantages in detecting hepatic disease, when compared to soft‐tissue‐windows alone. Review of the available literature provides additional evidence suggesting that the routine use of liver‐window settings in conjunction with soft‐tissue‐windows offers no further advantages in the detection of hepatic diseases. This investigation found, however, that the majority of respondents are currently recording liver‐windows routinely for all abdominal CT scans. This is performed even though many of these respondents agreed with established literature that liver‐windows should be reserved for patients with high clinical suspicion of hepatic disease, or when a lesion is detected on the standard soft‐tissue‐window.