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Demircioğlu A, Bos D, Demircioğlu E, Qaadan S, Glasmachers T, Bruder O, Umutlu L, Nassenstein K. Deep learning-based scan range optimization can reduce radiation exposure in coronary CT angiography. Eur Radiol 2024; 34:411-421. [PMID: 37552254 PMCID: PMC10791769 DOI: 10.1007/s00330-023-09971-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/24/2023] [Accepted: 05/28/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES Cardiac computed tomography (CT) is essential in diagnosing coronary heart disease. However, a disadvantage is the associated radiation exposure to the patient which depends in part on the scan range. This study aimed to develop a deep neural network to optimize the delimitation of scan ranges in CT localizers to reduce the radiation dose. METHODS On a retrospective training cohort of 1507 CT localizers randomly selected from calcium scoring and angiography scans and acquired between 2010 and 2017, optimized scan ranges were delimited by two radiologists in consensus. A neural network was trained to reproduce the scan ranges and was tested on two randomly selected and independent validation cohorts: an internal cohort of 233 CT localizers (January 2018-June 2020) and an external cohort from a nearby hospital of 298 CT localizers (July 2020-December 2020). Localizers where a bypass surgery was visible were excluded. The effective radiation dose to the patient was simulated using a Monte Carlo simulation. Scan ranges of radiographers, radiologists, and the network were compared using an equivalence test; likewise, the reduction in effective dose was tested using a superior test. RESULTS The network replicated the radiologists' scan ranges with a Dice score of 96.5 ± 0.02 (p < 0.001, indicating equivalence). The generated scan ranges resulted in an effective dose reduction of 10.0% (p = 0.002) in the internal cohort and 12.6% (p < 0.001) in the external cohort compared to the scan ranges delimited by radiographers in clinical routine. CONCLUSIONS Automatic delimitation of the scan range can result in a radiation dose reduction to the patient. CLINICAL RELEVANCE STATEMENT Fully automated delimitation of the scan range using a deep neural network enables a significant reduction in radiation exposure during CT coronary angiography compared to manual examination planning. It can also reduce the workload of the radiographers. KEY POINTS • Scan range delimitation for coronary computed tomography angiography could be performed with high accuracy by a deep neural network. • Automated scan ranges showed a high agreement of 96.5% with the scan ranges of radiologists. • Using a Monte Carlo simulation, automated scan ranges reduced the effective dose to the patient by up to 12.6% (0.9 mSv) compared to the scan ranges of radiographers in clinical routine.
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Affiliation(s)
- Aydin Demircioğlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ender Demircioğlu
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, 45147, Essen, Germany
| | - Sahar Qaadan
- Department of Mechatronics and Artificial Intelligence Engineering, German Jordanian University, Madaba, JO-11180, Jordan
| | - Tobias Glasmachers
- Faculty of Computer Science, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, 45138, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Kai Nassenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
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Antonopoulos AS, Simantiris S. Preventative Imaging with Coronary Computed Tomography Angiography. Curr Cardiol Rep 2023; 25:1623-1632. [PMID: 37897677 DOI: 10.1007/s11886-023-01982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE OF REVIEW Coronary computed tomography angiography (CCTA) is the diagnostic modality of choice for patients with stable chest pain. In this review, we scrutinize the evidence on the use of CCTA for the screening of asymptomatic patients. RECENT FINDINGS Clinical evidence suggests that CCTA imaging enhances cardiovascular risk stratification and prompts the timely initiation of preventive treatment leading to reduced risk of major adverse coronary events. Visualization of coronary plaques by CCTA also helps patients to comply with preventive medications. The presence of non-obstructive plaques and total plaque burden are prognostic for cardiovascular events. High-risk plaque features and pericoronary fat attenuation index, enrich the prognostic output of CCTA on top of anatomical information by capturing information on plaque vulnerability and coronary inflammatory burden. Timely detection of atherosclerotic disease or coronary inflammation by CCTA can assist in the deployment of targeted preventive strategies and novel therapeutics to prevent cardiovascular disease.
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Affiliation(s)
- Alexios S Antonopoulos
- Biomedical Research Foundation of the Academy of Athens (BRFAA), 4 Soranou Efesiou Street, Athens, Greece.
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Spyridon Simantiris
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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3
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Kędzierski B, Macek P, Dziadkowiec-Macek B, Truszkiewicz K, Poręba R, Gać P. Radiation Doses in Cardiovascular Computed Tomography. Life (Basel) 2023; 13:life13040990. [PMID: 37109519 PMCID: PMC10141413 DOI: 10.3390/life13040990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
We discussed the contemporary views on the effects of ionising radiation on living organisms and the process of estimating radiation doses in CT examinations and the definitions of the CTDI, CTDIvol, DLP, SSDE, ED. We reviewed the reports from large analyses on the radiation doses in CT examinations of the coronary arteries prior to TAVI procedures, including the CRESCENT, PROTECTION, German Cardiac CT Registry studies. These studies were carried out over the last 10 years and can help confront the daily practice of performing cardiovascular CT examinations in most centres. The reference dose levels for these examinations were also collected. The methods to optimise the radiation dose included tube voltage reduction, ECG-monitored tube current modulation, iterative and deep learning reconstruction techniques, a reduction in the scan range, prospective study protocols, automatic exposure control, heart rate control, rational use of the calcium score, multi-slices and dual-source and wide-field tomography. We also present the studies that indicated the need to raise the organ conversion factor for cardiovascular studies from the 0.014-0.017 mSv/mGy*cm used for chest studies to date to a value of 0.0264-0.03 mSv/mGy*cm.
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Affiliation(s)
- Bartłomiej Kędzierski
- Department of Radiology and Imaging Diagnostics, Emergency Medicine Center, Marciniak Lower Silesian Specialist Hospital, Fieldorfa 2, 54-049 Wrocław, Poland
| | - Piotr Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Barbara Dziadkowiec-Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Krystian Truszkiewicz
- Department of Radiology and Imaging Diagnostics, Emergency Medicine Center, Marciniak Lower Silesian Specialist Hospital, Fieldorfa 2, 54-049 Wrocław, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Paweł Gać
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368 Wrocław, Poland
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4
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Schnabel RB, Camen S, Knebel F, Hagendorff A, Bavendiek U, Böhm M, Doehner W, Endres M, Gröschel K, Goette A, Huttner HB, Jensen C, Kirchhof P, Korosoglou G, Laufs U, Liman J, Morbach C, Nabavi DG, Neumann-Haefelin T, Pfeilschifter W, Poli S, Rizos T, Rolf A, Röther J, Schäbitz WR, Steiner T, Thomalla G, Wachter R, Haeusler KG. Expert opinion paper on cardiac imaging after ischemic stroke. Clin Res Cardiol 2021; 110:938-958. [PMID: 34143285 PMCID: PMC8238761 DOI: 10.1007/s00392-021-01834-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/01/2021] [Indexed: 12/19/2022]
Abstract
This expert opinion paper on cardiac imaging after acute ischemic stroke or transient ischemic attack (TIA) includes a statement of the "Heart and Brain" consortium of the German Cardiac Society and the German Stroke Society. The Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork (AFNET) endorsed this paper. Cardiac imaging is a key component of etiological work-up after stroke. Enhanced echocardiographic tools, constantly improving cardiac computer tomography (CT) as well as cardiac magnetic resonance imaging (MRI) offer comprehensive non- or less-invasive cardiac evaluation at the expense of increased costs and/or radiation exposure. Certain imaging findings usually lead to a change in medical secondary stroke prevention or may influence medical treatment. However, there is no proof from a randomized controlled trial (RCT) that the choice of the imaging method influences the prognosis of stroke patients. Summarizing present knowledge, the German Heart and Brain consortium proposes an interdisciplinary, staged standard diagnostic scheme for the detection of risk factors of cardio-embolic stroke. This expert opinion paper aims to give practical advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on expert opinion, reported case series, and clinical experience.
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Affiliation(s)
- Renate B Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Atrial Fibrillation NETwork (AFNET) e.V., Münster, Germany
| | - Stephan Camen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology, University of Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig , Leipzig, Germany
| | - Udo Bavendiek
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Michael Böhm
- Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital of Saarland, Saarland University, Homburg (Saar) , Germany
| | - Wolfram Doehner
- Berlin Institute of Health, Center for Regenerative Therapies, and Department of Cardiology (Virchow Klinikum), Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
- Klinik Und Hochschulambulanz Für Neurologie Mit Abteilung Für Experimentelle Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
| | - Klaus Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andreas Goette
- Atrial Fibrillation NETwork (AFNET) e.V., Münster, Germany
- Department of Cardiology & Intensive Care Medicine, St. Vincenz Hospital Paderborn, Paderborn, Germany
| | - Hagen B Huttner
- Department of Neurology, University Hospital Gießen, Gießen, Germany
| | - Christoph Jensen
- B. Braun Ambulantes Herzzentrum Kassel MVZ GmbH, Kassel, Germany
- Ruhr University Bochum, Bochum, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Atrial Fibrillation NETwork (AFNET) e.V., Münster, Germany
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of Birmingham, Edgbaston, Birmingham, UK
| | - Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig , Leipzig, Germany
| | - Jan Liman
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center and Department for Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Tobias Neumann-Haefelin
- Department of Neurology, Klinikum Fulda, Universitätsmedizin Marburg - Campus Fulda, Fulda, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, Goethe-University Hospital Frankfurt, Frankfurt, Germany
- Department of Neurology and Clinical Neurophysiology, Klinikum Lüneburg, Lüneburg, Germany
| | - Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - Timolaos Rizos
- Department of Neurology, Heidelberg University, Heidelberg, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff-Heart-Center, Bad Nauheim, Germany and Campus Kerckhoff Justus-Liebig-University, Gießen, Germany
| | - Joachim Röther
- Department of Neurology, Asklepios Klinik Hamburg Altona, Hamburg, Germany
| | - Wolf Rüdiger Schäbitz
- Department of Neurology, Evangelisches Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Thorsten Steiner
- Department of Neurology, Heidelberg University, Heidelberg, Germany
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rolf Wachter
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig , Leipzig, Germany
- University Medical Center Goettingen, Göttingen, Germany
| | - Karl Georg Haeusler
- Atrial Fibrillation NETwork (AFNET) e.V., Münster, Germany.
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
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Verdoia M, Gioscia R, Marcolongo M, De Luca G. Noninvasive Imaging Risk Stratification with Computed Tomography Angiography for Coronary Artery Disease. Cardiol Clin 2020; 38:543-550. [PMID: 33036716 DOI: 10.1016/j.ccl.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The recent technological evolution of coronary computed tomography angiography (CTA) with improved sensitivity and high negative predictive value has extended its potential applications as a gatekeeper test before invasive coronary angiography. However, the definition of the most accurate diagnostic algorithms comprising CTA as a first-line strategy for ruling out coronary artery disease and the correct management of the patients according to the results of imaging tests still warrant better definition.
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Affiliation(s)
- Monica Verdoia
- Cardiologia e Unità Coronarica, Ospedale degli Infermi, ASL Biella, Via dei Ponderanesi, Biella 13900, Italy; Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Università del Piemonte Orientale, corso Mazzini, Novara 28100, Italy.
| | - Rocco Gioscia
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Università del Piemonte Orientale, corso Mazzini, Novara 28100, Italy
| | - Marco Marcolongo
- Cardiologia e Unità Coronarica, Ospedale degli Infermi, ASL Biella, Via dei Ponderanesi, Biella 13900, Italy
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Università del Piemonte Orientale, corso Mazzini, Novara 28100, Italy
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Podgorsak AR, Sommer KN, Reddy A, Iyer V, Wilson MF, Rybicki FJ, Mitsouras D, Sharma U, Fujimoto S, Kumamaru KK, Angel E, Ionita CN. Initial evaluation of a convolutional neural network used for noninvasive assessment of coronary artery disease severity from coronary computed tomography angiography data. Med Phys 2020; 47:3996-4004. [DOI: 10.1002/mp.14339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alexander R. Podgorsak
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Kelsey N. Sommer
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Abhinay Reddy
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Vijay Iyer
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Michael F. Wilson
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Frank J. Rybicki
- Department of Radiology University of Cincinnati 234 Goodman Street Cincinnati OH USA
| | - Dimitrios Mitsouras
- San Francisco Department of Radiology and Biomedical Imaging University of California 505 Parnassus Avenue San Francisco CA 94143USA
| | - Umesh Sharma
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Shinchiro Fujimoto
- Department of Cardiovascular Medicine Juntendo University 3‐1‐3 Hongo, Bunkyo‐ku Tokyo Japan
| | - Kanako K. Kumamaru
- Department of Radiology Juntendo University 3‐1‐3 Hongo, Bunkyo‐ku Tokyo Japan
| | - Erin Angel
- Canon Medical Systems USA, Inc. 2441 Michelle Drive Tustin CA 92780USA
| | - Ciprian N. Ionita
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
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7
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Gao Y, Mahmood U, Liu T, Quinn B, Gollub MJ, Xu XG, Dauer LT. Patient-Specific Organ and Effective Dose Estimates in Adult Oncologic CT. AJR Am J Roentgenol 2020; 214:738-746. [PMID: 31414882 PMCID: PMC7393764 DOI: 10.2214/ajr.19.21197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Patient-specific organ and effective dose provides essential information for CT protocol optimization. However, such information is not readily available in the scan records. The purpose of this study was to develop a method to obtain accurate examination- and patient-specific organ and effective dose estimates by use of available scan data and patient body size information for a large cohort of patients. MATERIALS AND METHODS. The data were randomly collected for 1200 patients who underwent CT in a 2-year period. Physical characteristics of the patients and CT technique were processed as inputs for the dose estimator. Organ and effective doses were estimated by use of the inputs and computational human phantoms matched to patients on the basis of sex and effective diameter. Size-based ratios were applied to correct for patient-phantom body size differences. RESULTS. Patients received a mean of 59.9 mGy to the lens of the eye per brain scan, 10.1 mGy to the thyroid per chest scan, 17.5 mGy to the liver per abdomen and pelvis scan, and 19.0 mGy to the liver per body scan. A factor of 2 difference in dose estimates was observed between patients of various habitus. CONCLUSION. Examination- and patient-specific organ and effective doses were estimated for 1200 adult oncology patients undergoing CT. The dose conversion factors calculated facilitate rapid organ and effective dose estimation in clinics. Compared with nonspecific dose estimation methods, patient dose estimations with data specific to the patient and examination can differ by a factor of 2.
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Affiliation(s)
- Yiming Gao
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Usman Mahmood
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Tianyu Liu
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Brian Quinn
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Marc J. Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - X. George Xu
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Lawrence T. Dauer
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Madaj P, Li D, Nakanishi R, Andreini D, Pontone G, Conte E, O’Rourke Franzcr R, Hamilton-Craig C, Nimmagadda M, Kim N, Fatima B, Dailing C, Budoff MJ. Lower Radiation Dosing in Cardiac CT Angiography: The CONVERGE Registry. J Nucl Med Technol 2020; 48:58-62. [DOI: 10.2967/jnmt.119.229500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022] Open
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Quantificação do fluxo sanguíneo miocárdico por tomografia por emissão de positrões – Atualização. Rev Port Cardiol 2020; 39:37-46. [DOI: 10.1016/j.repc.2019.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/03/2019] [Accepted: 05/05/2019] [Indexed: 10/24/2022] Open
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10
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Fernandes J, Ferreira MJ, Leite L. Update on myocardial blood flow quantification by positron emission tomography. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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11
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Affiliation(s)
| | - Christina Stewart
- Department of Medical Physics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicholas W Weir
- Department of Medical Physics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
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12
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Coronary CT angiography radiation dose trends: A 10-year analysis to develop institutional diagnostic reference levels. Eur J Radiol 2019; 113:140-147. [PMID: 30927938 DOI: 10.1016/j.ejrad.2019.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/31/2018] [Accepted: 02/12/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To develop institutional diagnostic reference levels (IDRL) for coronary CT angiography (CCTA) according to patient size by analyzing radiation dose changes over the past 10 years. MATERIALS AND METHODS This IRB approved retrospective investigation analyzed radiation dose data from CCTA between 2007 and 2016 at our institution. Annual trends in radiation dose were described for each scanner type and scanning mode. Radiation levels were analyzed for normorhythmic patients, patients with prior coronary artery bypass grafting (CABG), arrhythmia, and according to patient size and tube voltage. Median, and quartile values for volume CT dose index (CTDIvol), dose-length product (DLP), and size-specific dose estimate (SSDE) were calculated. Wilcoxon rank-sum test and Kruskal Wallis test were performed to assess the significance of quantitative data. RESULTS 35,375 examinations from 33,317 patients (median age, 58 [50-66] years; male patients, 21,087 [58.7%]) were analyzed. CTDIvol, DLP, and SSDE significantly decreased by 9.0%, 30.8%, and 40.1% (all P < 0.05) for all examinations, respectively. All radiation dose metrics progressively decreased across scanning modes (especially retrospectively ECG-gated spiral and prospectively ECG-triggered high-pitch spiral acquisition mode), but did not significantly change across scanners in the last 6 years. CTDIvol and DLP increased with patient size when water-equivalent diameters were >19 cm for normorhythmic and CABG patients. In arrhythmic patients, CTDIvol increased progressively with water-equivalent diameters across all groups. CONCLUSION CCTA radiation dose has progressively decreased in the past decade except in patients with prior CABG and arrhythmia. Size-specific IDRLs may optimize radiation utilization in these patients going forward.
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Eckert J, Renczes-Janetzko P, Schmidt M, Magedanz A, Voigtländer T, Schmermund A. Coronary CT angiography (CCTA) using third-generation dual-source CT for ruling out in-stent restenosis. Clin Res Cardiol 2018; 108:402-410. [DOI: 10.1007/s00392-018-1369-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/03/2018] [Indexed: 12/21/2022]
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Hirschberg K, Reinhart M, Mereles D, Uhlmann L, André F, Riffel J, Ochs M, Katus HA. Echocardiographic calcification score in patients with low/intermediate cardiovascular risk. Clin Res Cardiol 2018; 108:194-202. [PMID: 30083858 DOI: 10.1007/s00392-018-1343-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/19/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Calcification of aortic valve and mitral annulus is associated with cardiovascular risk factors, morbidity and mortality. Assessment of cardiac calcification with echocardiography is feasible, however, only few structured scoring systems have been established so far with limited prognostic data. This study aimed to evaluate an echocardiographic calcification score (echo-CCS) in patients with low/intermediate cardiovascular risk. METHODS Digitally stored echocardiography studies of 151 patients (median age 64, 49.7% male) from February 2008 to December 2009 were retrospectively reviewed for calcifications of the aortic valve, aortic root, mitral annulus, papillary muscles and ventricular septum. A calcification score ranging from 0 to 5 was assigned to every patient and its relation to computed tomography calcium score, coronary stenosis and ESC SCORE was assessed. Follow-up data were collected from 149 patients (98.7%) with a median of 6.2 years. Logistic regression and Kaplan-Meier analysis were performed to assess the association of the echo-CCS with significant coronary artery disease (≥ 50% stenosis) and risk for cardiac events and all-cause mortality. RESULTS An association of the echo-CCS with the ESC SCORE (ρ = 0.5; p < 0.001) and a good correlation of the echo-CCS with the Agatston score (ρ = 0.73; p < 0.001) can be observed. Univariate regressions revealed that echo-CCS is a significant predictor for cardiac events [OR = 5.1 (CI: 1.7-15.0); p = 0.003], coronary intervention [OR = 2.8 (CI: 1.3-5.7); p = 0.006], hospitalisation for cardiac symptoms [OR = 2.0 (CI: 1.2-3.4); p = 0.007], all-cause mortality [OR = 2.6 (CI: 1.3-5.5); p = 0.01] and significant CAD [OR = 3.2 (CI: 1.9-5.4); p < 0.001]. CONCLUSIONS We demonstrated the prevalence of an easily obtainable, radiation-free calcification score in patients with low/intermediate cardiovascular risk. The strong association with CT-calcium scoring may evoke its potential as an alternative method in CV risk assessment.
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Affiliation(s)
- Kristof Hirschberg
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Manuel Reinhart
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Derliz Mereles
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Florian André
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johannes Riffel
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Marco Ochs
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Coronary computed tomography angiography: a method coming of age. Clin Res Cardiol 2018; 107:40-48. [PMID: 29974195 DOI: 10.1007/s00392-018-1320-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 06/27/2018] [Indexed: 01/20/2023]
Abstract
In patients with stable symptoms suggestive of coronary artery disease (CAD), coronary CT angiography (CTA) allows for assessing several aspects of coronary atherosclerosis. Coronary artery stenoses are reliably detected, plaque formation can be quantified and characterized as calcified or non-calcified, and markers of potential instability such as expansive vascular remodeling, spotty calcification, and atheroma size can be described. As opposed to invasive coronary angiography, CTA visualizes the vessel lumen and wall. Being a purely anatomic test, even small plaques are detected with excellent sensitivity. At the other end of the spectrum, the hemodynamic significance of large plaque burden is sometimes overestimated. This may in part be corrected using mathematical modeling. Computational fluid dynamics of vascular anatomy and subtended myocardial mass provide for measures of CT-based fractional flow reserve (FFRCT). Large prospective trials have demonstrated the diagnostic utility of CTA in particular for ruling out obstructive CAD. The ability to detect non-obstructive plaque allows for improved risk prediction in comparison with functional testing, because even patients with sub-clinical atherosclerosis can be identified and selected for preventive medical treatment. This has led to incorporating CTA as one of several possible diagnostic tests for the evaluation of stable CAD in the actual European guidelines. Recently, it has even been forwarded as the first-line diagnostic test in the United Kingdom. The clinical implications of novel quantitative CTA-derived parameters such as FFRCT and non-calcified plaque volume are being examined in ongoing studies.
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First experience with zero-fluoroscopic ablation for supraventricular tachycardias using a novel impedance and magnetic-field-based mapping system. Clin Res Cardiol 2018; 107:578-585. [PMID: 29476203 PMCID: PMC6002461 DOI: 10.1007/s00392-018-1220-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/20/2018] [Indexed: 12/21/2022]
Abstract
AIMS Zero- and near-zero-fluoroscopic ablation techniques reduce the harmful effects of ionizing radiation during invasive electrophysiology procedures. We aimed to test the feasibility and safety of a zero-fluoroscopic strategy using a novel integrated magnetic and impedance-based electroanatomical mapping system for radiofrequency ablation (RFA) of supraventricular tachycardias (SVTs). METHODS We retrospectively studied 92 consecutive patients undergoing electrophysiology studies with/without RFA for supraventricular tachycardia (SVT) performed by a single operator at a single center. The first 42 (Group 1) underwent a conventional fluoroscopic-guided approach and the second 50 (Group 2) underwent a zero-fluoroscopic approach using the Ensite Precision™ 3-D magnetic and impedance-based mapping system (Abbott Inc). RESULTS Group 1 comprised 14 AV-nodal re-entrant tachycardia (AVNRT), 12 typical atrial flutter, 4 accessory pathway (AP), 2 atrial tachycardia (AT), and 9 diagnostic EP studies (EPS). Group 2 comprised 16 AVNRT, 17 atrial flutter, 6 AP, 3 AT, 2 AV-nodal ablations, and 7 EPS. A complete zero-fluoroscopic approach was achieved in 94% of Group 2 patients. All procedures were acutely successful, and no complications occurred. There was a significant reduction in fluoroscopy dose, dose area product, and time (p < 0.0001, for all), with no difference in procedure times. Ablation time for typical atrial flutter was shorter in Group 2 (p = 0.006). CONCLUSIONS A zero-fluoroscopic strategy for diagnosis and treatment of SVTs using this novel 3D-electroanatomical mapping system is feasible in majority of patients, is safe, reduces ionizing radiation exposure, and does not compromise procedural times, success rates, or complication rates.
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Patient-specific registration of 3D CT angiography (CTA) with X-ray fluoroscopy for image fusion during transcatheter aortic valve implantation (TAVI) increases performance of the procedure. Clin Res Cardiol 2018; 107:507-516. [DOI: 10.1007/s00392-018-1212-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/01/2018] [Indexed: 12/14/2022]
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